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Outlining Common Co-Occurring Disorders for People With Eating Disorders

Eating disorders don’t exist in a vacuum; people who have a disorder such as anorexia nervosa, bulimia nervosa, and binge eating disorder often experience another kind of mental health illness. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), studies show that these kinds of dual diagnoses are much more common in people with eating disorders than those without.

There is a particularly high correlation between eating disorders and substance abuse. In some advanced cases of anorexia nervosa, for example, a large portion of calories taken in may come from alcoholic drinks. Amphetamines and cocaine are also abused frequently for their appetite-suppressing qualities, leading to health problems and addiction.

When it comes to treating co-occurring eating and mental health disorders, it’s extremely important to diagnose them correctly and then treat each disorder at the same time. Co-occurring disorders are interrelated; the root cause of an eating disorder may be depression or anxiety while the primary cause of substance abuse may be the eating disorder.

The care teams at eating disorder treatment centers make sure to understand the root cause of the disorder in each individual – they’ve learned from experience that it’s futile to do otherwise.Each disorder influences and affects the other. For that reason, we’re going to outline some of the most common co-occurring disorders that can be found alongside eating disorders. If you notice some of these disorders, don’t wait – find a way to seek out help from an eating disorder treatment center that treats them.

Eating Disorders and Substance Abuse

There is a high correlation between eating disorders and substance abuse. According to the National Institutes of Health, when people are diagnosed with bulimia nervosa, they have a much higher chance of experiencing substance abuse disorder as well – as much as 4 times as much. Although bulimia was the highest one, other forms of eating disorders also made it 3 times more likely to abuse some type of substance. Substance abuse is generally defined as the uncontrollable use of a substance that leads to addiction. While alcohol is the most available and common substance that’s abused, various other drugs are popular among people with eating disorders. There are normally several factors involved that need to be explored when individuals have both an eating disorder and abuse alcohol or drugs.

  • Symptoms–Symptoms of substance abuse disorder are often behavioral, although dramatic physical and emotional complications are quite common.Extreme weight loss, lack of sleep, and heart irregularitiescommon reactions to drugs such as cocaine and amphetamines. Other substances that are often abused by people with eating disorders include laxatives, diuretics (the former are commonly abused by people with bulimia nervosa as a purging method), cocaine, heroin, and alcohol.
  • Complications – Complications from eating disorders or substance abuse can be life-threatening, and the combination of both ED and SAD may produce even more severe physical complications. Co-occurring eating disorders and substance abuse may prove more life-threatening than other co-occurring disorders because both types can directly damage vital organs in the body.
  • Treatment Methods–Stopping drug or alcohol use suddenly can cause withdrawal symptoms, which means that the beginning of eating disorder treatment may require medical care until the client is stabilized. After that, the normal course of treatment may include some type of psychotherapy in individual and group settings Even though each disorder needs distinctive treatment, it must be treated simultaneously. Besides receiving treatment for the eating disorder the individual may want to attend meetings or therapy for substance abuse. When seeking treatment for eating disorders and substance abuse it’s important to select a facility that can handle detox/withdrawal as well as the necessary tenets of eating disorder recovery.

Eating Disorders and Mood Disorders Like Anxiety, Depression, and OCD

Anxiety is a common form of mental illness that can include several different subtypes like general anxiety, social anxiety, a variety of phobias, and panic attacks. Anxiety can act as a trigger for disordered eating behaviors, since those behaviors may act as coping mechanisms for the negative feelings brought on by anxiety or depression. Individuals might develop an eating disorder as a way to control some aspects of life because anxiety has caused them to feel out of control. In fact, a feeling of loss of control is considered a large part of most eating disorders, and it can conflate with an anxiety disorder.

  • Symptoms – A person might experience irritability, feelings of dread, sweating, and shortness of breath when anxious. Depression is exemplified by a persistent sense of sadness, feelings of worthlessness, or guilt, and a lack of motivation. Some of the symptoms of and anxiety or depressive disorder can present similarly to those of an eating disorder. For example, symptoms of both depression and anorexia nervosa can include severe weight loss and fatigue.
  • Complications – Anxiety, depression, and OCD can contribute to an eating disorder and make symptoms worse. AS we mentioned the negative feelings and worries caused by a mood disorder might be temporarily by a binge eating episode, which then prompts a purging response for a person with bulimia nervosa. This creates a vicious cycle of increased depression that can lead to more binge-eating, and so on. A person with OCD might be more likely to exercise compulsively to avoid gaining any weight – perfectionism is a common symptom of both disorders.
  • Treatment Methods– Cognitive-Behavioral Therapy (CBT) is often used to treat eating disorders and was originally developed to be helpful across a wide spectrum of mental health ailments. CBT can be effective when helping a person separate food from feelings. Other forms of individual therapy can help get to the root cause of an individual’s anxiety or depression. Nutritional counseling is also useful as eating disorder clients usually need nutritional rehabilitation, but neurological science indicates that proper nutrition is important to rehabilitating depression and anxiety as well.

Eating Disorders and PTSD

This might be the most common and important dual diagnosis when it comes to eating disorders. The American Psychological Association defines trauma as an emotional response to some sort of terrible event such as sexual assault, a car accident, or a natural disaster, although it can be a result of less violent experience such as a divorce or losing a job. PTSD (Post Traumatic Stress Disorder) is an emotional response to these kinds of events and can be present for years after the experience. Many that develop a disorder like anorexia nervosa, bulimia nervosa, or binge eating disorder have experienced some sort of trauma in their life. While it is generally thought to be ideal to treat co-occurring disorders simultaneously if the individual is experiencingacute and intense PTSD symptoms, psychiatric care may be necessary at first.

  • Symptoms – A person with PTSD often has flashbacks to the event or to the emotional distress they experienced.They may try to avoid places or situations that they correlate with the traumatic experiences. Physical symptoms may also occur that can include nausea and headaches. PTSD attacks are also potent triggers for disordered eating behaviors. It is an attempt to distance themselves from the trauma or relieve the pain associated with a traumatic event or situation.
  • Complications – Eating disorders can cause health and medical complications while Trauma and PTSD will likely cause problems in an individual’s relationships. PTSD can be debilitating if left untreated; it can interfere with a person’s social life, relationships, and even careers.
  • Treatment Methods – A combination of psychotherapy and medication is often used to treat PTSD, although medication is typically not part of an eating disorder treatment program.Cognitive Behavioral Therapy (CBT) is used since it allows people to identify disordered thoughts related to PTSD and replace them. Trauma-focused CBT has specifically been designed for treating people struggling with their response to trauma. This particular type of therapy teaches young people how to understand, then process, and finally cope with the trauma they’ve experienced.

Eating Disorders and Borderline Personality Disorder

Borderline Personality Disorder is a disorder defined by extreme behaviors, varying mood changes, low self-esteem, fear of abandonment, and difficulty providing acceptable social behaviors. There are features of other mental health issues present, including bouts of anxiety, depression, or anger that may last a few hours or several days at a time. Some research from the Mayo Clinic has found that borderline personality disorder and eating disorders share a prominent risk factor, namely past trauma, especially childhood abuse.

  • Symptoms – A person with borderline personality disorder normally experiences mood swings and an inability to read social cues and respond in a socially appropriate way. Impulsive behavior is common and can lead to risky behaviors like drug abuse or risky sexual behaviors. This impulsivity may be a contributing factor to the eating behaviors seen in many eating disorders.
  • Complications – An individual may find it difficult to maintain healthy relationships, and the inability to maintain socially acceptable behaviors can cause trouble at work. The Mayo Clinic states that those with borderline personality may be experiencing self-image problems, which is a common causative factor in virtually every eating disorder. Whether it’s anorexia nervosa, binge eating disorder, or another type of eating disorder, those with a borderline personality could more easily exhibit extreme behaviors related to the eating disorder.
  • Treatment Options – Borderline personality disorder often occurs with other disorders. However, its treatment is still being explored by psychiatric professionals – it can be difficult to treat using a single method. A few options include Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT). When creating a treatment plan for each individual it’s important to keep in mind that a study following individuals with borderline personality and eating disorders discovered that migration to different eating disorders was prevalent.

Seeking Help for CoOccurring Disorders

Even though a high number of individuals with eating disorders also have co-occurring disorders, not every facility is equipped to treat them.Every psychiatric condition is complex – people spend their careers focusing on one particular type of disorder. That’s why it’s important to find a facility that has experience recognizing and treating co-occurring disorders. An individualized treatment plan can be designed that includes the client’s individual needs for both their eating disorder and any other co-occurring disorders.

Treating co-occurring disorders requires a very personal and customized approach. Make sure you or your loved one can talk to the admissions specialists before headed into treatment – they can help identify unique treatment needs and let the treatment staff get a head start. It can lead to long-term, complete recovery.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.