title: Psychiatric disorders in women with bulimia nervosa and their first-degree relatives: effects of comorbid substance dependence.
abstract: OBJECTIVE
  Women with bulimia nervosa (BN) and comorbid substance dependence often display impulsive behaviors. We assessed Axis I and II psychiatric diagnoses in their first-degree relatives in order to understand the etiological factors that may contribute to this subtype of BN.
  
  
  METHODS
  We used contemporary family-epidemiological methodology to compare the lifetime prevalence of psychiatric disorders among 47 women with BN and 44 non-eating-disordered community control women, and their first-degree relatives (177 and 190, respectively). BN probands were stratified by the presence (n = 20) or absence (n = 27) of a lifetime history of alcohol and/or drug dependence.
  
  
  RESULTS
  Social phobia, conduct disorder, and clusters B and C personality disorders were significantly more prevalent among BN probands with substance dependence than among BN probands without substance dependence or control women probands. Substance use disorders, social phobia, panic disorder, and cluster B personality disorders were significantly more prevalent among the relatives of BN probands with substance dependence than the relatives of the other two groups.
  
  
  CONCLUSIONS
  Women with BN and substance dependence have problems with social anxiety, antisocial behavior, and a variety of personality disturbances, and come from families where there are problems with substance use disorders, anxiety, impulsivity, and affective instability. These data raise the possibility that a familial vulnerability for impulsivity and affective instability may contribute to the development of substance dependence in a subgroup of women with BN.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Lilenfeld
authors.forename: W H
authors.initials: WH
authors.lastname: Kaye
authors.forename: C G
authors.initials: CG
authors.lastname: Greeno
authors.forename: K R
authors.initials: KR
authors.lastname: Merikangas
authors.forename: K
authors.initials: K
authors.lastname: Plotnicov
authors.forename: C
authors.initials: C
authors.lastname: Pollice
authors.forename: R
authors.initials: R
authors.lastname: Rao
authors.forename: M
authors.initials: M
authors.lastname: Strober
authors.forename: C M
authors.initials: CM
authors.lastname: Bulik
authors.forename: L
authors.initials: L
authors.lastname: Nagy
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D002032:Bulimia / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D005192:Family Health; D005260:Female; D006801:Humans; D019964:Mood Disorders / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D010554:Personality Disorders / Q000453:epidemiology; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*