Binge Eating And Substance Use Among Adolescents

Nutrition Research Newsletter, Nov, 1999

Bulimia nervosa affects approximately 1-3% of teenage girls and young women and 0.2% of adolescent males and young men. Dating back to the first clinical depictions of the disorder in 1979, bulimia has been associated with substance use. Since then, the available research on this topic did not focus on how bulimic symptoms, such as binge eating, purging, or using laxatives, affected the nature and extent of the substance use.

Because bulimia is most prevalent in the late adolescent period, student populations provide a good opportunity to examine the role of substance use in the early stages of this disorder. A study recently published in the International Journal of Eating Disorders researched the relationship between different patterns of binge eating and substance use in adolescent males and females via a survey of students. The study also explored gender differences and mental health connections in this population.

The data for the study was obtained from the 1997 Ontario Student Drug Use Survey of 3990 public and Catholic school students. The students were classified into four categories: non-bingers (NB), students who had a history of binging but not in the last 12 months (PB), students who reported binging but did not use any compensating behaviors (i.e., vomiting, over-exercising, using laxatives or enemas) (BNC), and students who reported binging and using these compensatory behaviors (BC). Different questionnaires were then used to measure binge eating, mental health status and substance misuse. Self esteem was gauged by the Rosenberg Self Esteem Scale and the CAGE (a fairly well-known questionnaire that asks patients about cutting down, being annoyed, feeling guilty, and using eye-openers) was used to screen for alcoholism and substance misuse.

Binge eating status was significantly related to past-year substance use in both males and females. Male non-bingers and past bingers reported using less tobacco, alcohol, cannabis, and other drugs than the other two categories of students. Between the four different female categories, there was an increasing prevalence of use for tobacco, alcohol, and cannabis across the four groups with NB students reporting the least use and BC students the most. Binge eating was correlated with a lower self-esteem, an increased rate of depression, and more problematic and heavier substance misuse. Binge eating status was not related to differences in attitudes of students with regard to the risk of harm posed by substance misuse.

Among all the students, females were more likely to engage in "inappropriate" compensatory behaviors for their eating binges than were their male counterparts. The authors speculate that this may be the result of a greater dissatisfaction the female students expressed concerning their body weight and image. Also, the increased stimulant and cigarette use (possible appetite suppressants) in the female population may be linked to their efforts to control their appetite and therefore their weight.

In summation, binges eaters were twice as likely to report some problematic drug use as compared to non-bingers. Also, compensatory behavior, such as purging, laxative, or enema abuse or over-exercising, was linked in both males and females to the use of drugs other than alcohol, tobacco, or cannabis. Therefore, the group of compensating binge eaters would benefit the most from some preventative programs targeting the relationship between bulimic and substance abuse symptoms.

Helen E. Ross and Frank Ivis, Binge Eating and Substance Use Among Male and Female Adolescents, International Journal of Eating Disorders 26(3): 245-260 (November 1999)