Binge
Eating and Substance Abuse
Article
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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