The number of divergent purging behaviors is associated with histories of trauma, PTSD, and comorbidity in a national sample of women.

The number of different types of purging behaviors (NPB) of subjects with bulimia nervosa (BN) has been associated with greater severity of illness and psychiatric comorbidity. No studies have examined the association between the NPB used (vomiting, laxative abuse, diuretic abuse), histories of trauma, and post-traumatic stress disorder (PTSD). A national, representative sample of 3,006 adult women (≥18 years) completed a structured telephone interview including screenings for victimization experiences, PTSD, BN, major depression (MD), alcohol abuse (AA), and alcohol dependence (AD).

A comparison of women with child-adolescent versus adult onset binge eating: results from the National Women's Study.

Objective: Studies of age of first binge have been conducted in clinical samples of patients with bulimia nervosa (BN) and binge eating disorder (BED), but few studies have examined age of first binge using nationally representative samples.

Method: We examined age of first binge and its clinical correlates using data generated from the National Women's Study (n = 3,006). Participants who endorsed ever binge eating (n = 707) were divided into two groups: (1) child-adolescent onset (CO)--age of first binge <18 years, and (2) adult onset (AO)--age of first binge ≥18 years.

Seasonal patterns of birth for subjects with bulimia nervosa, binge eating, and purging: results from the National Women's Study.

Objective: Studies of birth patterns in anorexia nervosa have shown relative increases between March and August, while studies in Bulimia Nervosa (BN) have been negative. Since there are no studies using representative, nonclinical samples, we looked for seasonal birth patterns in women with BN and in those who ever endorsed bingeing or purging.

Method: A national, representative sample of 3,006 adult women completed structured telephone interviews including screenings for bulimia nervosa (BN) and questions about month, date, and year of birth.

Use of an Electronic Medical Record to Facilitate Screening for Depression in Primary Care.

BACKGROUND: Screening programs for depression often fail to improve care because of lack of adequate communication and follow-up. The purpose of this study was to examine a primary care depression screening program that utilized an electronic medical record (EMR) to improve communication and follow-up. METHOD: All adult patients in a family practice office were screened for depression using the Center for Epidemiological Studies Depression Scale (CES-D) during the period March 2000 through March 2001.

PTSD symptom severity as a predictor of cue-elicited drug craving in victims of violent crime.

This study examined posttraumatic stress disorder (PTSD) symptom severity as a predictor of cue-elicited craving among alcohol- and cocaine-dependent individuals with a history of at least one physical and/or sexual assault. Approximately half of the sample had current PTSD. Severity of PTSD symptoms was measured via the Impact of Events Scale-Revised (IES-R) total severity score.

Perpetration of partner violence: effects of cocaine and alcohol dependence and posttraumatic stress disorder.

The present study examined the effects of substance dependence and posttraumatic stress disorder (PTSD) on perpetration of partner violence. Participants were 72 men and 124 women diagnosed with and/or without PTSD and cocaine or alcohol dependence. Participants were interviewed with the Structured Clinical Interview for the DSM-IV (SCID-IV) and completed the Conflict Tactics Scale-2 (CTS-2).

Comparative profiles of women with PTSD and comorbid cocaine or alcohol dependence.

This study examined differences in substance abuse severity, trauma history, posttraumatic stress disorder (PTSD) symptomatology and psychiatric comorbidity among treatment-seeking women (N= 74) with PTSD and either comorbid cocaine or alcohol dependence. Women in the cocaine/PTSD group, compared with the alcohol/PTSD group, demonstrated greater occupational impairment (e.g.

Clinical characteristics of under-reporters on urine drug screens in a cocaine treatment study.

To explore the concordance between urine drug screen (UDS) results and self-report of cocaine use, results in a pharmacologic treatment trial for cocaine dependence were evaluated. Subjects with at least two occurrences of a positive UDS for cocaine were characterized as either an under-reporter (UR, n = 43) or a truthful reporter (TR, n = 32). Interestingly, URs attended more study sessions and were more likely to complete the study.

Carbamazepine in the treatment of cocaine dependence: subtyping by affective disorder.

Studies investigating carbamazepine (CBZ) in the treatment of cocaine dependence have been inconsistent. In this study, cocaine-dependent individuals with (n = 57) and without (n = 82) affective disorder were compared in a 12-week, double-blind, placebo-controlled trial. Urine drug screens (UDS) and self-report of drug use were collected weekly.

Trauma and substance cue reactivity in individuals with comorbid posttraumatic stress disorder and cocaine or alcohol dependence.

Although the high comorbidity of posttraumatic stress disorder (PTSD) and substance use disorders has been firmly established, no laboratory-based studies have been conducted to examine relationships between the two disorders. Using cue reactivity methodology, this study examined the impact of personalized trauma-image cues and in vivo drug cues on drug-related responding (e.g.

Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: preliminary findings.

Individuals (n = 39) participated in an outpatient, 16-session individual, manual-guided psychotherapy designed to treat concurrent PTSD and cocaine dependence. Therapy consisted of a combination of imaginal and in-vivo exposure therapy techniques to treat PTSD symptoms and cognitive-behavioral techniques to treat cocaine dependence. Although the dropout rate was high, treatment completers (i.

Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: description of procedures.

An estimated 30% to 50% of cocaine-dependent individuals meet criteria for lifetime PTSD. This comorbidity has detrimental effects on clinical presentation, and treatment course and outcome. Cocaine dependence is associated with increased rates of exposure to trauma, more severe symptoms, higher rates of treatment attrition and retraumatization, and greater vulnerability to PTSD when compared to other substance use disorders.

Which comes first in the pathogenesis of bulimia nervosa: dieting or bingeing?

Objective: Clinical experience has indicated that dieting usually precedes the onset of binge eating in the development of bulimia nervosa (BN). However, data confirming this in nonclinical, representative samples are lacking.

Method: Using results obtained from the National Women's Study (NWS), we were able to determine the chronological relationship between age of onset of significant dieting (attempting to lose 15 lbs) and onset of bingeing in 85 respondents who met DSM-III-R criteria for BN.

Cocaine dependence with and without post-traumatic stress disorder: a comparison of substance use, trauma history and psychiatric comorbidity.

This study examined the relationship between substance use, trauma history, post-traumatic stress disorder (PTSD), and psychiatric comorbidity in a treatment seeking sample of cocaine dependent individuals (N = 91). Structured clinical interviews revealed that 42.9% of the sample met DSM-III-R criteria for lifetime PTSD.

Acute and protracted cocaine abstinence in an outpatient population: a prospective study of mood, sleep and withdrawal symptoms.

This study addresses unresolved questions about cocaine withdrawal by prospectively assessing monitored cocaine abstinence over 28 days in a sample of 24 male and female cocaine-dependent outpatients. Based on results from urine drug screens and self-reported substance use, it is likely that these patients were abstinent from cocaine during the assessment period. Abstinence-related symptoms were monitored at 2, 5, 10, 14, 21, and 28 days following last cocaine use.

Comorbidity of bulimia nervosa and alcohol use disorders: results from the National Women's Study.

Objective: The nature of the relationship between bulimia nervosa (BN) and alcohol abuse/alcohol dependence (AA/AD) and the extent to which women with BN+AA differ from women with BN-AA were examined in a national sample of women (N = 3,006).

Method: The sample of was generated by multistage geographic sampling and interviews were conducted by telephone.

Results: AA was higher in women with BN compared to women without BN or binge eating disorder, only when the influence of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) was controlled.

Differential urge and salivary responsivity to alcohol cues in alcohol-dependent patients: a comparison of traditional and stringent classification approaches.

Seventy alcohol-dependent individuals were presented with alcohol and water cues on separate trials while salivary responding and self-reported urge for alcohol were measured. Researchers used 2 distinct classification approaches to classify participants as either responders or nonresponders on urge and salivation. Through a traditional classification approach, both urge and salivary responder groups reported higher pleasantness ratings in response to the alcohol cues than nonresponders, yet did not differ on measures of alcohol dependence or withdrawal.

Intimate violence and post-traumatic stress disorder among individuals with cocaine dependence.

Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview.

Untreated symptoms of PTSD among cocaine-dependent individuals. Changes over time.

Changes over time in posttraumatic stress disorder (PTSD) symptoms during periods when individuals with substance use disorders remain abstinent has not received much attention. PTSD symptomatology over a 36-month period was studied in cocaine-dependent individuals (N = 34) who entered a pharmacologic trial targeting cocaine use and depression, but did not include any treatment for PTSD. All participants reported at least one PTSD Criterion A event, and 17.

Posttraumatic stress disorder and cocaine dependence. Order of onset.

To investigate differences between patients whose posttraumatic stress disorder (PTSD) preceded their cocaine dependence and vice versa, 33 patients with comorbid PTSD and cocaine dependence were divided into two groups: one in which the traum and PTSD occurred before onset of cocaine dependence (primary PTSD) and one in which the PTSD occurred after cocaine dependence was established (primary cocaine). In the primary-PTSD group, the trauma was generally childhood abuse. In the primary-cocaine group, the trauma was generally associated with the procurement and use of cocaine.

Screening for PTSD in a substance abuse sample: psychometric properties of a modified version of the PTSD Symptom Scale Self-Report. Posttraumatic stress disorder.

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSS-SR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology.

Use of self-report measures of crime-related posttraumatic stress disorder with substance use disordered patients.

Researchers have documented that approximately three-quarters of all patients in treatment for a substance use disorder (SUD) report a history of sexual or physical assault and that at least 25% of treatment-seeking SUD patients suffer from crime-related posttraumatic stress disorder (CR-PTSD). To address the pressing need to accurately evaluate symptoms associated with victimization, a battery of self-report instruments and a semi-structured interview were administered to 114 SUD patients. More than 90% of the SUD patients reported some type of victimization and approximately 38% met criteria for current CR-PTSD.

Relationship of childhood sexual abuse and eating disorders.

Objective: To review the literature that has examined the relationship between childhood sexual abuse and the eating disorders.

Method: Each of the five authors reviewed all identified empirical studies to be certain that inclusion/exclusion criteria were met. Two teams of raters then independently reviewed each study to determine whether it supported any of a series of six hypotheses that had been tested in this literature.

The National Women's Study: relationship of victimization and posttraumatic stress disorder to bulimia nervosa.

Objective: In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa.

Method: To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews.

Results: Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.