PSYCHIATRIC-DISORDERS IN WOMEN WITH BULIMIA-NERVOSA AND THEIR FIRST-DEGREE RELATIVES - EFFECTS OF COMORBID SUBSTANCE DEPENDENCE

Objective: Women with bulimia nervosa (BN) and comorbid substance depe ndence often display impulsive behaviors. We assessed Axis I and II ps ychiatric diagnoses in their first-degree relatives in order to unders tand the etiological factors that may contribute to this subtype of BN . Method: We used contemporary family-epidemiological methodology to c ompare the lifetime prevalence of psychiatric disorders among 47 women with BN and 44 non-eating-disordered community control women, and the ir first-degree relatives (117 and 190, respectively). BN probands wer e stratified by the presence (n = 20) or absence (n = 27) of a lifetim e history of alcohol and/or drug dependence. Results: Social phobia, c onduct disorder, and clusters B and C personality disorders were signi ficantly more prevalent among BN probands with substance dependence th an among BN probands without substance dependence or control women pro bands. Substance use disorders, social phobia, panic disorder, and clu ster B personality disorders were significantly more prevalent among t he relatives of BN probands with substance dependence than the relativ es of the other two groups. Discussion: Women with BN and substance de pendence have problems with social anxiety, antisocial behavior, and a variety of personality disturbances, and come from families where the re are problems with substance use disorders, anxiety, impulsivity, an d affective instability. These data raise the possibility that a famil ial vulnerability for impulsivity and affective instability may contri bute to the development of substance dependence in a subgroup of women with BN. (C) 1997 by John Wiley & Sons, Inc.