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J Stud Alcohol Drugs. 2009 Jan;70(1):106-16.

A cross-lagged evaluation of eating disorder symptomatology and substance-use problems.

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  • 1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.



The purpose of this study was to conduct a temporal examination of the associations among disordered eating behaviors, substance use, and use-related negative consequences in female college students-a population at high risk for developing eating and substance-use disorders.


Participants completed assessments of disordered eating behaviors, alcohol and drug use, and use-related negative consequences.


Results support previous research suggesting that disordered eating behaviors are more strongly associated with alcohol- and substance-related problems rather than use per se. With respect to temporal precedence, results indicated that binge eating preceded alcohol-use problems, but a bidirectional relationship was found for vomiting. With regard to drug problems, laxatives use preceded drug problems, whereas drug problems preceded fasting. These associations were not better accounted for by pre-existing eating or substance-use problems or psychiatric distress (e.g., depression, anxiety).


This study further supports the importance of assessing consequences, in addition to use patterns, when examining substance use in individuals demonstrating threshold and subthreshold eating-disordered behaviors.

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