Abstract
BackgroundEating disorders (EDs) and substance-related disorders pose a challenge when they co-occur and have implications for patient management. Clinical information on EDs and substance-related disorders as independent disorders is fairly well established in South Africa, but our understanding of the coexistence of these disorders is limited.AimTo determine the prevalence, the concurrent nature and the possible trends of substance use among patients diagnosed with EDs at a South African tertiary hospital over a 21-year period.SettingThe ED unit at Tygerberg Hospital, Cape Town, South Africa.MethodsWe performed a retrospective chart review of 162 patients who were treated for EDs between January 1993 and December 2014.ResultsThe prevalence of ED subtypes was 40.1% bulimia nervosa (BN), 33.3% EDs not otherwise specified (EDNOS) and 26.5% anorexia nervosa. Most participants (71.0%) used at least one substance. Alcohol was the most prevalent substance of choice (54.8%). Most patients had an additional psychiatric disorder (62.3%), of which major depressive disorder was the most prevalent (46.3%). Apart from the use of alcohol and cannabis, which remained consistent, the use of most other substances as well as the prevalence of BN declined during the study period.ConclusionUnderstanding the prevalence and trends of EDs and the corresponding patterns of substance misuse is essential to improve service provision. This study emphasises the need to better understand the ongoing and changing behavioural trends in EDs to improve patient management.
Highlights
The global burden of disease study 2013 has found the significant burden of eating disorders (EDs), in young women living in high-income countries
There were no significant differences in demographic characteristics, except for the highest level of education (p = 0.009), between patients with different ED subtypes
This study showed that bulimia nervosa (BN) was the most common ED subtype in our clinic in the 1990s but has declined proportionally, compared to EDs not otherwise specified (EDNOS) at the end of the study period
Summary
The global burden of disease study 2013 has found the significant burden of eating disorders (EDs), in young women living in high-income countries. A substance use disorder (SUD) can occur alongside any of the ED subtypes, which include AN, BN, binge eating disorder (BED) and EDs not otherwise specified (EDNOS),[3] the association seems to be highest among those with BN4,5,6 and binge/purge subtypes of AN.[7] there is a wide variability in the prevalence of SUD across ED subtypes from 2% to 6% for AN-restricting subtype, 12% to 27% for AN/binge–purge subtype and 2.9% to 48.6% for BN subtype.[6,8,9,10]. Eating disorders (EDs) and substance-related disorders pose a challenge when they co-occur and have implications for patient management. Clinical information on EDs and substance-related disorders as independent disorders is fairly well established in South Africa, but our understanding of the coexistence of these disorders is limited
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