アルコール乱用に続発して過食症を発症したBulimic alcoholics 2症例—過食症に対するアルコールの影響について

Effects of Alcohol on Bulimia: A case report of two female bulimic alcoholics

【抄録】　アルコール乱用が過食症発症の契機となったbulimic alcoholics自験2症例を報告した。この2症例はアルコール乱用，摂食障害の罹病期間や病態に差を認めたが，いずれも他の衝動行為はなく，肥満恐怖，体重コントロール欲求を背景としてアルコールを乱用し，酩酊下での食欲充進・嘔気増強を契機として，酩酊時の過食・嘔吐が出現した。長期罹病例では，非酩酊時の過食・嘔吐にまで発展した。2症例のアルコール乱用の治療方針は異なり，過食症も異なる経過を呈したが，最終的には断酒継続により改善した。アルコールは過食症を増悪させる可能性が示唆され，bulimic alcoholicsの治療では，アルコール乱用と過食症の双方への配慮が重要と思われた。

　We reported two cases of bulimia accompanying alcohol abuse (bulimic alcoholics;BA).

Case 1 was a 22-year-old woman with a shorter history of BA, whose DSM-IV diagnoses were alcohol dependence and eating disorders, not otherwise specified, and case 2 was a 30-year-old woman with a longer history of BA, whose DSM-IV diagnoses were alcohol dependence and anorexia nervosa, binge eating/purging type.

　Each BA patient began to show bulimic behavior only in the condition of drunkenness and had a tendency to fear obesity after the onset of alcohol abuse. However, later on, case 2 came to show bulimic behavior even in a non-drunk condition. During bouts of alcohol abuse, the bulimic behavior of these two cases was resistant to pharmacotherapy with fluvoxamine. Finally, the bulimic behavior of these two patients improved by abstinence. Nevertheless, case 2 came to show temporary escalation of bulimic behavior even during times of abstinence.

　Based on the study of these two cases, we discussed the association between alcohol abuse and bulimia in the BA course, and pointed out that alcohol might affect the induction and escalation of bulimic behavior.