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Abstract: Eating disorders (ED) and substance use disorders (SUD) commonly co-occur, especially in conjunction with posttraumatic stress disorder (PTSD), yet little is known about ED and ED symptoms in women presenting to addiction treatment programs. This study examined the association between ED symptoms and substance use frequency and severity in a sample of women with a DSM IV diagnosis of current SUD and PTSD enrolled in SUD treatment. Participants were 122 women from four substance abuse treatment sites who participated in a multi-site clinical trial through NIDA’s Clinical Trials Network (CTN). The Eating Disorder Examination-Questionnaire (EDE-Q), the Clinician Administered PTSD Scale (CAPS), and the Addiction Severity Index (ASI) were administered at baseline and correlational analyses were performed. Variables that significantly correlated with EDE-Q total and subscale scores were entered into a linear regression analysis. Results found that scores on the EDE-Q Global scale, as well as the Eating Concern, Weight Concern, and Shape Concern subscales of the EDE-Q were significantly associated with Caucasian race/ethnicity, past 30 day opiate use, higher ASI Psychiatric Subscale score, and lower ASI Employment Subscale score. Conclusions: Women in recovery from SUD and PTSD reported concerns about weight, shape, and eating at a higher rate than in the general US population of women. The finding that past 30 day opiate use was associated with EDE scores may indicate that opiates also play a substantial role in disordered eating symptoms. Though exploratory, these findings suggest that there may be a relationship between addiction severity, use of certain drugs of abuse, and eating disorder symptoms, particularly those involving weight and shape concerns in women with comorbid PTSD and SUD. Comprehensive and integrated treatment approaches need to be developed to address this complex but common comorbidity. Related protocols: CTN-0015, CTN-0015-A-1

Abstract:

A strong association between substance use disorders (SUD) and eating disorders (ED) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. This ancillary investigation assessed the prevalence of ED symptoms and their affect on treatment outcomes in a sample of substance abusing women with co-occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women from four of the CTPs participating in a multi-site clinical trial comparing two behavioral treatments for co-occurring SUD and PTSD (protocol CTN-0015, “Women’s Treatment for Trauma and Substance Use Disorders”). The Eating Disorder Examination self-report (EDE-Q) and measures of PTSD and SUD symptoms were administered at baseline, during treatment, and at four follow-up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n=35) and those who reported no binge eating episodes (No Binge group; n=87). Women in the Binge group endorsed significantly higher ED, PTSD, and depression symptoms at baseline than those in the No Binge group. Though all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower.

These findings suggest that a sub-group of women with co-occurring PTSD and SUDs who endorsed binge ED symptoms responded differently to SUD/PTSD group treatment. Identification of eating disorder symptoms among treatment-seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes.

Related protocols: CTN-0015-A-1