Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls.

Abstract

To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, we tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology, but not substance abuse, bulimic symptoms predicted onset of depression, but not substance abuse, and substance abuse symptoms predicted onset of depression, but not bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances.

Experimental test of the affect‐regulation theory of bulimic symptoms and substance use: A randomized trial

“…These findings echo the evidence from double-blind randomized treatment trials that suggest that anti-depressant medications result in significant decreases in bulimic symptoms among adults meeting full diagnostic criteria for this eating disorder. 47 These findings also converge with the evidence that depressive symptoms predict onset of bulimic pathology 6,8,48 and may be cautiously interpreted as evidence that depression promotes bulimic symptoms.…”

“…Interestingly, the fact that bulimic symptoms also predict future increases in depressive pathology, 8,49 and that treatments for bulimic symptoms produce reductions in depressive symptoms, 50,51 suggests that depression and bulimic pathology are likely reciprocally related, as has been previously theorized. 52 It was noteworthy that a depression intervention that did not include content targeting eating or bulimic symptoms produced decreases in bulimic symptoms.…”

“…1,2 This theory also suggests that individuals might use radical compensatory behaviors, such as vomiting or laxative abuse, to reduce anxiety about impending weight gain consequent to overeating or because they believe that purging provides an emotional catharsis. In support of this theory, depressive symptoms and negative affect have been found to predict future increases in bulimic symptoms, 3,4 as well as onset of binge eating, 5 bulimic pathology, [6][7][8] and general eating pathology. 9 Although several prospective studies have reported null findings for these relations (e.g., 1, 10-11), these studies were more likely to have used smaller samples and focused on general eating pathology outcomes.…”

The Importance of Nutrition as the Best Medicine for Eating Disorders

“…B 12 and folic acid have significant mood-enhancing benefits when used alone and in combination with antidepressants. Both low B 12 and low folic acid have been noted in patients with depression.…”

“…11 Depression is a major risk factor for both substance use disorder and bulimia and explains to a great degree the association between substance use disorder and eating disorders. 12 A meta-analysis by Sullivan 13 found 178 deaths in 3,006 patients: 54% died from complications of their eating disorder, 27% from suicide, and 19% from other and/or unknown causes. The overall rate of .56% mortality per year in this study was 12 times greater than the expected mortality rate for women aged 15 to 24, and the suicide rate was 75 times higher.…”