Tag Archives: Etiology

Eating Disorders (EDs) and Substance Use Disorders (SUDs): Shared and Causal Etiology


The etiologies of both Eating Disorders (EDs) and Substance Use Disorders (SUDs) are perceived to be complex and multidimensional in nature.  No simple etiological path is indicated in either category.  Many contemporary theories “implicate a ‘collision’ among biological factors (e.g., genetic influences on neurotransmitter and hormonal function), psychological tendencies (problems with mood, temperament, and impulse controls), and social pressures (promoting body consciousness or generalized self-definition problems, and developmental processes (conducive to self-image or adjustment problems).”  (Blaney & Millon, 2009, p. 436)  The current model of SUD risk factors would not be complete without all of the above, perhaps with a few minor modifications.  This essay will attempt to address and discuss the common etiological factors between EDs and SUDs, as well an explore concepts of causal etiology that suggest that having one disorder predispositions an individual to succumb to another.

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Causal etiology has suggested that having one disorder (an eating disorder, for example) may put an individual at risk for developing another disorder (like substance abuse, or vice versa).  The statistics surrounding the comorbidity of substance abuse and eating disorders is considerable.  “Substance abuse and eating disorders have the highest mortality risks of all mental disorders and half of all clients with eating disorders abuse alcohol or illicit drugs.”  (Carbaugh & Sias, 2010, p. 125)  Shared or causal etiological factors between the substance abuse and eating disorders include psychological, environmental, and biological antecedents.  Both disorders are influenced by specific personality type (lack of control, craving, denial, impulsiveness), similar developmental issues (societal and familial pressures), as well as common family history (genetic predisposition) and specific biological vulnerability.  (Carbaugh & Sias, 2010)  Whether causal or shared, it is increasingly evident that SUDs and EDs share common etiological pathways, even to the extent that they may be causal in their relationship.

Common personality factors play a significant role in the onset and maintenance of both eating disorders and their comorbid conditions.  However, the personality of people whom suffer from AN tend to qualitatively different from the personalities of people whom suffer from BN.  Individuals whom suffer from AN have been found to be approval seeking, self-doubting, conflict-avoidant, excessively dependent, socially anxious, and have a tendency to be described as “perfectionists.”  Individuals whom suffer from bulimia often experience significant affective instability including highly variable mood states, impulsive behavior, low frustration tolerance, and high anxiety.  (Netherton, Holmes, & Walker, 1999, p. 401)  Differences in the underlying personality deficiencies can account for differences in comorbidity when comparing EDs among themselves, although EDs and SUDs generally continue to demonstrate remarkable comorbidity regardless of the type of ED we examine.

The news media frames obesity as a “moral problem.”  Obese populations are condemned by the media as engaging in gluttony and sloth while society overwhelmingly blames “bad individual choices” (despite increasing discussion of social-structural factors over time).  (Saguy & Gruys, 2010, p. 247)  The above statements easily could have been rewritten to drive home a different message.  The news media frames drug abuse as a “moral problem.”  Drug abusers are condemned by the media as engaging in greed and apathy (synonyms for gluttony and sloth) while society overwhelming blames “bad individual choices” (despite increasing discussing of social structural factors over time).  Obesity and drug abuse are 21st Century witches.  Will you join the hunt?

The contribution of the family only begins with biological disturbances in the serotonin, dopamine, gamma-aminobutyric acid and endogenous opioid peptide systems that may underlie both disorders.  (Pearlstein, 2002, p. 70)  Despite the fact that The Academy for Eating Disorders (AED) has specifically condemned statements that implicate family influences “as the primary cause of AN or BN,” they have acknowledged that particular styles of family behavior and biological vulnerability may increase risk for psychopathology in general, including eating disorders.  (“Role of Family in EDs”, 2009)  Dieting is one example of a behavior that is frequently encouraged by well intentioned families.  Research supports the positive association between the dieting behaviors (not just eating disorders themselves) and increased risk for alcohol use problems.  (Heidelberg & Correia, 2009)  Families who promote dieting in their children may inadvertently be promoting substance abuse.  Add latent genetic influence (like a parent with an eating disorder or who abuses substances) to that encouragement we may have a ‘perfect storm’ of predispositions that could potentially result in a full blown eating disorder comorbid with a substance abuse problem.  Be it through the environmental impact of familial behavior, or by latent genetic influence, family plays a significant role in the development of both disorders.

EDs and SUDs can be viewed through the same lens.  Shared etiology, including familial contributions, media influences, and personality factors; all play a role in the perpetuation of the stereotype.  If we perpetuated the image of common people drinking wate,r instead of hard bodies drinking alcohol, perhaps the association between substance abuse and eating disorders could be severed.

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

Carbaugh, R. J., & Sias, S. M. (2010, Apr). Comorbidity of bulimia nervosa and substance abuse: Etiologies, treatment issues, and treatment approaches. Journal of Mental Health Counseling, 32(2), 125-138. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=2026599321&sid=1&Fmt=3&clientId=4683&RQT=309&VName=PQD

Heidelberg, N. F., & Correia, C. J. (2009, Dec). Dieting behavior and alcohol use behaviors among national eating disorders screening program participants. Journal of Alcohol and Drug Education, 53(3), 53-64. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1959547071&sid=9&Fmt=3&clientId=4683&RQT=309&VName=PQD

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Paper stresses important role of family in eating disorders. (2009, Nov). Journal of Psychosocial Nursing & Mental Health Services, 47(11), 11. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1908060671&sid=9&Fmt=3&clientId=4683&RQT=309&VName=PQD

Pearlstein, T. (2002, Mar). Eating disorders and comorbidity. Archives of Women’s Mental Health, 4(3), 67-78. Retrieved from http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?index=24&did=687270031&SrchMode=2&sid=11&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1274809726&clientId=4683

Saguy, A. C., & Gruys, K. (2010, May). Morality and health: News media constructions of overweight and eating disorders. Social Problems, 57(2), 231-250. doi: 10.1525/sp.2010.57.2.231

Substance Abuse: Etiological Considerations


Over the course of the last few decades prevalence of substance abuse has increased on a global scale.  The lifetime prevalence of a substance use disorder in the general population is approximately 24%.  The lifetime prevalence of any mental disorder (excluding substance abuse/dependence) is approximately 22.5%.  (McDowell & Clodfelter Jr., 2001)  Despite the increase, no single etiological path has been identified as a precipitating cause.  “Many interrelated factors influence a person’s decision to use substances.  These include psychological (intrapersonal and interpersonal), biological, environmental, and cultural factors.”  (Netherton, Holmes, & Walker, 1999, p. 245)  This essay will attempt to address some of the more predominant etiologies as related to substance abuse, with the express understanding that no single explanation is solely plausible due to the interactional and interdependent natures of the etiologies themselves.

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Individualized personality traits have been inexorably linked to problem drug behavior.  The “addictive personality” has come to represent individuals whom demonstrate significant levels of neuroticism; disinhibitory tendencies; anti-sociality; novelty seeking; negative affect; low self-esteem; anxiety sensitivity; hopelessness; sensation seeking; and impulsivity.  All of these individualized variables and personality traits can be employed to predict both nature and course of substance use.  (Blaney & Millon, 2009, p. 271, p. 260)  “Drug abusers show deficits in impulsive choice and inhibition, although it is impossible to know whether difference in impulsivity caused or were caused by drug abuse.”  (Perry & Carroll, 2008, p. 19)  Reyno and associates (2006) found that anxiety sensitivity was strongly related to alcohol consumption in certain high risk situations.

Genetically speaking, “having a biological parent who was or is alcoholic increases one’s risk for alcoholism about 2.5 times, regardless of whether one was raised by that parent.”  (Blaney & Millon, 2009, p. 261)  Drug availability, when coupled with permission parental attitudes (up to and including parental drug use), has been shown to facilitate adolescent initiation and use of substances.  (Blaney & Millon, 2009, p. 258)  Parental smoking has been shown to increase risk for substance use in adolescent offspring.  (Keyes, Legrand, Iacono, & McGue, 2008)  As severity of substance abuse in the family increases, the negative consequences on adolescent development increase and are manifested in physical symptoms and negative mood.  (Gance-Cleveland, Mays, & Steffen, 2008)  It has been suggested that removal of the child from the substance abusing household can result in significant gains in child cognitive functioning.  McNichol & Tash (2001) found that children placed in forster care presented with low to average cognitive skills, but that they made disproportionate and significant improvement during placement.  Furthermore, they found that children with prenatal exposure to drugs scored significantly lower at the beginning of the placement, but made significantly more progress than the other children during placement.  This research seems to suggest that prenatal exposure to drugs, while regrettable, is not a “life sentence” for children.

Since adolescents place great value on peer opinions and struggle to fit in, peers contribute to the onset of drug use first by providing access to the substance by contributing to developing attitudes regarding expectancy.  (Blaney & Millon, 2009, p. 258; Netherton et al., 1999, p. 247)  Early expectancies of personal response to drug use have been shown to predict later use.  (Blaney & Millon, 2009, p. 268)  Research suggests that doing things in order to be popular with others is strongly related to feeling pressured by others, and that peer pressure is a far stronger predictor of risk behaviors and potential psychosocial difficulties than popularity.  (Santor, Messervey, & Kusumakar, 2000)

There is considerable evidence that severe trauma (e.g., disaster, assault, combat) greatly increase the risk for drug use and abuse.  (Blaney & Millon, 2009, p. 260)  In an exemplary study, Brave Heart (2003) leveraged the Lacota population to demonstrate that historical trauma (HT) has substance abuse ramifications, deemed to be a historical trauma response (HTR).  HT represents the cumulative emotional and psychological wounding over the lifespan and across generations.  HTR manifests in traumatized populations as depression, self-destructive behavior, suicidal thoughts and gestures, anxiety, low self-esteem, anger, difficulty recognizing and expressing emotions, and substance abuse.  (Brave Heart, 2003)  There is also evidence to the contrary, with research that suggests that among homeless men, trauma experiences are strong indicators of mental health problems, but are not indicators of either physical health or substance abuse problems.  (Kim, Ford, Howard, & Bradford, 2010)

The weight of cultural influences is colossal, as demonstrated by relative conformity of subcultures within a specific society, and by the wide comparative variability between and among cultures and subcultures.  (Blaney & Millon, 2009, p. 255)  For example, “the holocaust experienced by American Indian and Alaska Native (AI/AN) peoples during the past five centuries includes ravaged communities, destroyed families, the brutal murder of hundreds of thousands of AI/AN people, organized attempts to erase rich cultures and beautiful languages, and trans-generational scars that affect AI/ANs to this day.”  The subsequent introduction of alcohol and other substances have resulted in high rates of sexual and physical trauma, high death rates from physical complications of substance abuse, suicide, homicide, depression, grief, poor school performance, and low employment rates.  (Gray & Nye, 2001)

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References

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

Brave Heart, M. Y. (2003, Jan-Mar). The historical trauma response among natives and its relationship with substance abuse: A Lakota illustration. Journal of Psychoactive Drugs, 35(1), 7-13. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=338232111&sid=18&Fmt=3&clientId=4683&RQT=309&VName=PQD

Gance-Cleveland, B., Mays, M. Z., & Steffen, A. (2008, Jan). Association of adolescent physical and emotional health with perceived severity of parental substance abuse. Journal for Specialists in Pediatric Nursing, 13(1), 15-25. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1418986821&sid=20&Fmt=3&clientId=4683&RQT=309&VName=PQD

Gray, N., & Nye, P. S. (2001). American indian and alaska native substance abuse: Co-morbidity and cultural issues. American Indian and Alaska Native Mental Health Research (Online), 10(2), 67-84. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1077011111&sid=19&Fmt=3&clientId=4683&RQT=309&VName=PQD

Keyes, M., Legrand, L. N., Iacono, W. G., & McGue, M. (2008, Oct). Parental smoking and adolescent problem behavior: An adoption study of general and specific effects. The American Journal of Psychiatry, 165(10), 1338-1344. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1567487491&sid=7&Fmt=4&clientId=4683&RQT=309&VName=PQD

Kim, M. M., Ford, J. D., Howard, D. L., & Bradford, D. W. (2010, Feb). Assessing trauma, substance abuse, and mental health in a sample of homeless men. Health & Social Work, 35(1), 39-48. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1969768361&sid=18&Fmt=3&clientId=4683&RQT=309&VName=PQD

McDowell, D. M., & Clodfelter Jr., R. C. (2001, Apr). Depression and substance abuse: Considerations of etiology, comorbidity, evaluation, and treatment. Psychiatric Annals, 31(4), 244-251. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=71687723&sid=22&Fmt=4&clientId=4683&RQT=309&VName=PQD

McNichol, T., & Tash, C. (2001, Mar/Apr). Parental substance abuse and the development of children in family foster care. Child Welfare, 80(2), 239-256. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=70552258&sid=20&Fmt=4&clientId=4683&RQT=309&VName=PQD

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Perry, J. L., & Carroll, M. E. (2008, Sep). The role of impulsive behavior in drug abuse. Psychopharmacology, 200(1), 1-26. doi: 10.1007/s00213-008-1173-0

Reyno, S. M., Stewart, S. H., Brown, C. G., Horvath, P., & Wiens, J. (2006, Aug). Anxiety sensitivity and situation-specific drinking in women with alcohol problems. Brief Treatment and Crisis Intervention, 6(3), 268-282. doi: 10.1093/brief-treatment/mhl007

Santor, D. A., Messervey, D., & Kusumakar, V. (2000, Apr). Measuring peer pressure, popularity, and conformity in adolescent boys and girls: Predicting school performance, sexual attitudes, and substance abuse. Journal of Youth and Adolescence, 29(2), 163-182. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=53959633&sid=17&Fmt=4&clientId=4683&RQT=309&VName=PQD