Drug Abuse in Women with Eating Disorders

Dr. David Herzog, Emeritus Professor of Psychiatry at Harvard Medical School, founded and directed the Harvard Eating Disorders Center, which later became the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital.  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 to gain a better understanding of what happens to patients over time. They collected data by interviewing participants every 6-12 months about their eating behaviors, physical and emotional health, work and relationships. The study provided valuable information about the relationship between drug use disorder and eating disorders.

Forty-two (17.1%) of the 246 Longitudinal Study participants reported a lifetime history of drug use disorder. Of these 42 women, 22 (52.3%) had anorexia nervosa at intake and 20 (47.7%) had bulimia at intake. Of the 22 women with anorexia with a lifetime history of drug use disorder, 17 had a history of drug use disorder at entry into the study and of these, 4 had a prospective onset during the study. Five participants with anorexia developed a first episode of drug use disorder over the course of the study. Of the 20 participants with bulimia with a lifetime diagnosis of drug use disorder, 14 had a history of drug use disorder at intake into the study, and of these, 4 had a prospective onset during the course of the study, whereas 6 developed a new onset during the study. 

Dr. Herzog and his staff examined the degree to which participants who had a prospective onset of drug use disorder during the study also carried a diagnosis of affective disorder or alcohol use disorder during that same period. The data indicated that 12 of 19 participants (63.2%) had a co-occurring major depressive disorder episode and 6 of 19 participants (31.6%) had a diagnosis of hypomania during the drug use disorder episode. Seven of 19 participants (36.8%) had a co-occurring diagnosis of alcohol use disorder. 

The most commonly abused illicit drugs were amphetamines and cocaine (both of which have appetite suppressant effects) and marijuana.  Rates of drug use disorder did not differ between intake diagnoses of anorexia and bulimia. The finding that 5 of 22 participants with anorexia and 6 of 20 participants with bulimia were diagnosed with drug use disorder for the first time over the 9-year course of the study suggests that the risk for drug use disorder in women with eating disorders continues over time.

Dr. Herzog and his staff concluded from the study that drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process.