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Features Associated With Laxative Abuse in Individuals With Eating Disorders

From the Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina (F.T., L.R., C.M.B.); Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania (L.M.T., W.H.K.); Neuropsychiatric Research Institute, Fargo, North Dakota (J.M.); Roseneck Hospital for Behavioral Medicine, affiliated with the University of Munich (LMU), Prien, Germany (M.M.F.); Department of Psychology, Michigan State University, East Lansing, Michigan (K.L.K.); Department of Psychology, Georgia State University, Atlanta, Georgia (L.R.L.); Neuropsychiatric Institute and Hospital, School of Medicine, University of California at Los Angeles, Los Angeles, California (M.S.).

Address correspondence and reprint requests to Cynthia M. Bulik, PhD, Department of Psychiatry, University of North Carolina at Chapel Hill, 1st floor Neurosciences Hospital, CB #7160, Chapel Hill, NC, 27599-7160. E-mail: cynthia_bulik{at}med.unc.edu

Objective: Laxative abuse is common in patients with anorexia and bulimia nervosa and has been associated with longer duration of illness, suicide attempts, impulsivity, and greater eating and general psychopathology. We explored the extent to which laxative abuse was associated with specific psychopathological features across eating disorder subtypes.

Methods: Participants were 1021 individuals from the multisite, International Price Foundation Genetic Studies. Axis I disorders, personality disorders and traits, and obsessive compulsive features were assessed.

Results: Laxative abuse was associated with worse eating disorder and general psychopathology and higher prevalence of borderline personality disorder (BPD). Symptom level analyses revealed that specific features of BPD, including suicidality and self-harm, feelings of emptiness, and anger, were most strongly associated with laxative abuse.

Conclusions: The function of laxative abuse may differ across individuals with eating disorders, alternatively serving as a method of purging and a form of self-harm.

Key Words: eating disorders • laxatives • borderline personality • self-harm

Abbreviations: ED = eating disorder; AN = anorexia nervosa; BN = bulimia nervosa; PAN = purging anorexia nervosa; BAN = binge-purge anorexia nervosa; PBN = purging bulimia nervosa; EDNOS = eating disorders not otherwise specified; ANBN = individuals with both a history of anorexia and bulimia nervosa; BPD = borderline personality disorder; PTSD = posttraumatic stress disorder; BMI = body mass index; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; SCID-I and -II = Structured Clinical Interview for DSM-IV for Axis I and Axis II disorders; SIAB = Structured Inventory of Anorexia Nervosa and Bulimic Syndromes; TCI = Temperament and Character Inventory; MPS = Multidimensional Perfectionism Scale; YBOCS = Yale-Brown Obsessive Compulsive Scale; YBC-EDS = Yale-Brown-Cornell Eating Disorder Scale; GEE = generalized estimating equations.