I should start off by being absolutely clearÐthis is not the article that I originally intended to write. I had meant to say something pithy and incisive about the seven deadly sins and their role in the eating disorders. Well, can you name them? My colleagues could not even agree on the names of the seven dwarves in Snow White. Thereafter, I went into a bit of a decline. And that, for some reason, is when the topic of alcohol sprang to mind.
A lot of my clients appear to have relatively extreme attitudes to alcoholÐ they either do not touch it or use it with gusto. Surely, it could not just be me driving them to drink? An obvious starting point is a paper by Kaye et al. (1996) which clearly shows that bulimics are much more likely to have comorbid alcohol or drug dependency if they grew up in a family where alcohol and other substances were abused. In a related vein, Meyer (1997) shows that a family history of alcohol abuse is not a crucial determinant of eating disturbance. Rather, these non-clinical women had unhealthier eating attitudes if their partner was an alcohol abuser. Your nearest and dearest get you one way or another, it seems.
But should we really be all that worried about comorbidity of eating problems and alcohol abuse? A couple of recent papers answer that question with an emphatic `yes'. Bulik et al. (1997) andLilenfeld et al. (1997) ®nd that bulimics who abuse alcohol are more likely to experience a variety of additional problems, including impulsivity, suicidal behaviour and some of the more intractable personality characteristics and disorders. By way of consolation, it seems that their eating itself does not appear to be much worse if they abuse alcohol. Not much of a silver lining, I admit, but it is the best I can do.
Our normal concern is with the number of alcohol abusers who appear in our eating disorders clinics. Just in case of any complacency, it is worth noting that there have been some papers that suggest that a lot of eating disordered women do not come directly (if ever) to our services. A good starting point is Zweben's (1996) review, which con®rms that a lot of people in alcohol and