Vulnerability to substance abuse in eating disorders.

Two types of eating disorders, bulimia nervosa in normal-weight bulimic (NWB) women and restricting-type anorexia nervosa (RAN), may provide insights into permissive or protective factors contributing to psychoactive substance use disorders (PSUD) in humans. These two eating disorders, while often grouped together, are at opposite extremes for rate of PSUD. Substance abuse is common in NWB patients and their family members, but rare in RAN patients. In addition, NWB and RAN are at opposite extremes in terms of pathologic feeding style and many behavioral traits (table 1). NWB individuals are impulsive, labile, may be overly sensitive to external cues, and have poor control of eating. In contrast, persons with RAN are rigid and perfectionistic, restrict eating, and are insensitive to internal and external cues.