title: Bulimic Behaviors and Early Substance Use: Findings from a Cotwin-Control Study.
abstract: BACKGROUND
  Bulimic behaviors (i.e., binge eating and compensatory behaviors) and substance use frequently co-occur. However, the etiology underlying this association is poorly understood. This study evaluated the association between bulimic behaviors and early substance use, controlling for genetic and shared environmental factors.
  
  
  METHODS
  Participants were 3,540 young adult women from the Missouri Adolescent Female Twin Study. A telephone adaptation of the Semi-Structured Assessment for the Genetics of Alcoholism interview assessed DSM-IV bulimic behaviors, substance use, and other psychological characteristics. Lifetime bulimic behaviors were examined in twin pairs concordant and discordant for early substance use. Logistic regressions were adjusted for the nonindependence of twin data, zygosity, age, body mass index, early menarche (onset before age 12), and early sex (first consensual sexual intercourse before age 15).
  
  
  RESULTS
  In the entire study population, women who reported early use of alcohol or nicotine were more likely to engage in bulimic behaviors after adjusting for covariates. In 53 pairs of monozygotic twins discordant for alcohol experimentation before age 15, the twin who reported early alcohol experimentation had 3.21 (95% confidence interval = 1.54 to 6.67) times higher odds of reporting bulimic behaviors than the cotwin who did not report early alcohol experimentation, even after adjustment for covariates.
  
  
  CONCLUSIONS
  Findings suggest that early alcohol experimentation may contribute to the development of bulimic behaviors via mechanisms extending beyond shared vulnerability, including individual-specific environmental experiences or causal pathways.
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Munn-Chernoff
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Julia D
authors.initials: JD
authors.lastname: Grant
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Bucholz
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Arpana
authors.initials: A
authors.lastname: Agrawal
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lynskey
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Pamela A F
authors.initials: PA
authors.lastname: Madden
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Heath
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.|George Warren Brown School of Social Work, Washington University, St. Louis, Missouri.
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Duncan
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002032:Bulimia / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic; D055815:Young Adult
keywords: Bulimia; Cotwin-Control Design; Early Substance Use; Eating Disorders; Sexual Intercourse