Alcohol Use Disorder and Eating Disorders

Dr. David Herzog – Emeritus Professor of Psychiatry at Harvard Medical School – has devoted much of his career to improving the lives of individuals with eating disorders.  He founded and directed the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital and was the first Endowed Professor of Psychiatry in the Field of Eating Disorders at Harvard Medical School. 

Dr. Herzog’s Longitudinal Study of Anorexia and Bulimia Nervosa is internationally recognized as the largest and most extensive of its kind.  Beginning in 1987, he and his staff followed 246 women with anorexia and bulimia, trying to determine how patients fare over time.  Who gets better and how?  What factors lead to a better or worse outcome?  Data was collected by interviewing the women every 6-12 months about their eating behaviors, physical and emotional health, employment and relationships. The study has provided key knowledge about how eating disorders and alcohol use disorder influence each other. 

Over one fourth of the sample reported a lifetime history of alcohol use disorder. Ten percent of the study subjects developed alcohol use disorder over the course of the study. Alcohol use disorder did not influence recovery from eating disorder symptoms; however, a number of eating disorder symptoms predicted both the onset and recovery from an episode of alcohol use disorder. Poor psychosocial functioning and history of substance use predicted prospective onset of an episode of alcohol use disorder for both anorexia and bulimia. Unique predictors for alcohol use disorder for women with anorexia were depression, overconcern with body image, and vomiting.  For the women with anorexia nervosa, group therapy and hospitalization were useful for recovery from an alcohol use episode.  For the women with bulimia nervosa, individual therapy and exercise shortened recovery time from an alcohol use episode.

Dr. Herzog and his team concluded from their study that serious problems with alcohol are not uncommon in patients with anorexia or bulimia, and alcohol intake should be monitored in all patients with eating disorders, regardless of specific diagnosis.  A substantial number of patients who initially present with an eating disorder develop alcohol problems over the course of time, suggesting that the risk is an ongoing one. 

Future research is needed to determine the best combination of treatment modalities when eating disorders and alcohol use disorder co-exist and to address what works best for whom.