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Binge Eating and Substance Abuse

Reprinted from Eating Disorders Review
November/December 1999 Volume 10, Number 6
©1999 Gürze Books

In the first attempt to systematically study gender differences in the relationship between binge eating and substance use among students, binge eating was linked with increased depressive symptoms in males and lowered self-esteem in females (Int J Eat Disord 1999; 26:245). Females were also more likely than males to attempt to compensate for their eating binges in inappropriate ways.

Study design
In 1997, 3,990 public and Catholic school students in Ontario, Canada, were surveyed on alcohol and other drug use with two questionnaires. Half the students were randomly assigned to a questionnaire that contained questions on dieting and bulimic behaviors, while the others completed a standard questionnaire that covered a broad range of areas related to substance abuse. A total of 2,016 students (1,084 females and 934 males) 10 to 20 years of age completed the survey containing questions on dieting and bulimic behavior. The questionnaire also included questions about frequency of alcohol and drug use in the past year, and problem drinking and drug use, as well as attitudes and beliefs about substance use, eating habits and depression and self-esteem.

Binge eating
Binge eating was significantly more common among females than males (46% versus 30%). The major difference occurred among females classified as the bingeing-compensating (BC) group. These students binged on food, then compensated with vomiting, laxatives, strict dieting or fasting, for example. Females outnumbered males by 3:1 in this group. Half of female BC students reported 3 or more bingeing episodes during the prior 12 months, and 14% reported 15 episodes or more. The compensating bingers were also significantly older.

Weight and dieting
Male students were more likely to report that they "were about the right weight." Those who were dieting were more likely to describe themselves as "too thin" rather than "too fat." The opposite was true of female students. Exercise was the most common method used by males and females to attempt to lose weight or to avoid gaining weight. Other methods included skipping meals, vomiting, and diet pills. Binge eaters, especially those in the BC group, were more likely to use all types of substances, particularly marijuana and drugs other than tobacco and alcohol.

Two screening questionnaires were used to report alcohol and other drug use. One in four males in the BC group scored 2 or more on the CAGE questionnaire and 1 in 2 reported problems as measured by the DAST (Drug Abuse Screening Test; Skinner, 1982) questionnaire. (CAGE is an anachronym that comes from 4 questions on the CAGE questionnaire: Have you felt a need to Cut down on your drinking? Have you ever felt Annoyed by criticism of your drinking? Have you ever had Guilty feelings about drinking? Do you ever take a morning Eye-opener? Mayfield, McLeod, and Hall, 1974).

Eating Disorders High Among Military Women

Article from Eating Disorders Review
March/April 2000 Volume 11, Number 2
©2000 Gürze Books

A combination of environmental and traditional factors place military women at greater-than-normal risk for developing an eating disorder, according to a recent study by Tamara D. Lauder, MD, and her colleagues.

The 1-year study showed a higher-than-normal prevalence of eating disorders among 423 women on active duty in the Army (Med Sci Sports Exer 31:1265, 1999). Thirty-three percent (142) of the women met the screening criteria (Eating Disorders Inventory, or EDI) for being at risk for abnormal eating behavior. Among 108 women interviewed, 33 were diagnosed with eating disorders: 3% had anorexia nervosa, 9% had bulimia nervosa, 15% had binge eating disorder, 33% had an eating disorder not otherwise specified (ED-NOS), and 39% had what the authors termed a "situational eating disorder." The authors developed this category to describe intermittent behaviors that were consistent with a DSM-IV diagnosis of ED-NOS. Situational eating behaviors occurred in connection with specific events during which the women felt significant pressure about weight and fitness.

The women with eating disorders exercised more, felt more dissatisfied with their weight, and felt more pressure about their weight than the other women in the study. Women with eating disorders also had a greater drive for thinness, used more bulimic behaviors, were more dissatisfied with their bodies, and had higher overall scores on the EDI Symptom Checklist. Army women face regular weigh-ins and army physical fitness testing (APFT) on a regular basis; the women reported that these were particularly high-stress times, and they engaged in abnormal dietary behaviors and exercise before the weigh-ins. Other studies have shown similar patterns (Mil Med 1999; 164:630; Mil Med 1997; 162:753).

Pressures similar to those in civilian athletes
Military women face many of the same pressures to be thin and fit as do civilian women athletes in organized sports. For example, women entering military academies are expected to perform at the same high physical and academic levels as their male counterparts. Women who become full-time active duty soldiers in the U.S. Army hold physically demanding jobs and also must participate in daily physical fitness programs. They also have to pass tests of fitness and meet weight standards every 6 months. In addition, they face the same societal pressures to acquire a "model-like physique."

The military lifestyle also challenges the soldiers' attempts to maintain weight and fitness standards For example, soldiers may only have access to high-calorie, high-fat foods. Frequent moves, field deployments, and field time may also make meal planning difficult.

The authors raise some interesting questions about whether eating disorders are being produced by the types of pressures put upon women and men in the military and whether this is the best approach to prepare soldiers for military duty. They suggest that women in the military could benefit from development of educational and preventive measures similar to those from the 1993 Eating Disorders Information and Education Act, which provided information and education about preventing and treating eating disorders.

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