On their own, eating disorders can affect almost every aspect of an individual’s life. Unfortunately, for many patients, these disorders co-occur with other mental health disorders, making the impact even more severe. Some mental health disorders are more likely to co-occur with eating disorders than others. In this article, we discuss the mental health disorders that appear most commonly alongside eating disorders, as well as how they complicate treatment and recovery.
Facts on Comorbidity
According to the National Eating Disorders Collaboration, the incidence of mental health diagnoses among people with eating disorders ranges from 55 to 97 percent. The most common mental health disorders diagnosed alongside eating disorders include substance use disorders, post-traumatic stress disorder, social anxiety disorder, obsessive-compulsive disorder, and mood disorders. People who suffer from eating disorders are also more likely to engage in self-harm, struggle with sexual dysfunction and experience suicidal ideation. In fact, research has shown that someone who has anorexia nervosa is 31 times more likely to commit suicide than someone who does not have an eating disorder. For individuals who have bulimia nervosa, the suicide rate is 7.5 times higher than the rate for people without an eating disorder.
Risks of Comorbidity
Treating an eating disorder on its own is already difficult, and relapse is always a risk. However, when an individual also has a comorbid mental health disorder, the risk of relapse and other complications grows even more. For example, someone who struggles with both an anxiety disorder and anorexia nervosa may be at a higher risk of relapse if they go through a treatment program that addresses only the eating disorder and not the anxiety.
After leaving treatment, symptoms of the anxiety disorder may make it more difficult for the individual to avoid disordered eating behaviors. To give this individual the best chance of avoiding relapse, treatment professionals must address both disorders so the patient will have the coping skills necessary to deal with triggers and refrain from disordered eating even after treatment is complete.
Common Comorbid Disorders
Some of the disorders that are most likely to develop with an eating disorder include:
Substance Use Disorder
Substance use disorders develop when someone abuses a specific substance, such as alcohol, heroin or another drug. These disorders typically involve a noticeable impact on school, work or life at home. Substance use disorders may also lead to physical symptoms and complications. In some cases, a substance use disorder can even be fatal if an individual overdoses or develops a serious complication from using drugs for an extended period.
Some people with eating disorders may develop a substance use disorder after using a specific drug to lose or maintain weight. Other people who develop substance use disorders alongside an eating disorder may simply be self-medicating for the same negative moods or feelings that led them to begin engaging in disordered eating behaviors. When someone who has both a substance use disorder and an eating disorder enters treatment, part of the process will involve defining the relationship between the two disorders so that they can both be addressed effectively.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder, or PTSD, is a disorder that develops in an individual who has experienced a frightening or shocking event. Some of the symptoms of PTSD include:
- Frightening thoughts
- Nightmares
- Flashbacks
- Outbursts of anger
- Trouble sleeping
- Feeling tense
- Being startled easily
- Avoiding places or situations associated with the traumatic event
- Avoiding thoughts of the traumatic event
Although research has shown that the rate of eating disorders among PTSD patients is higher than in the general population, the nature of the link isn’t clear. Someone who has both an eating disorder and PTSD needs specialized treatment to overcome both conditions.
Social Anxiety Disorder
Social anxiety disorder stems from a deep fear of being rejected, judged or ridiculed in a social situation. People who suffer from this disorder often experience substantial anxiety and distress when they are forced into social situations and may even avoid some or all forms of socializing. Symptoms of a social anxiety disorder include sweating, nausea and rapid heart rate in social situations, as well as avoidance behaviors.
Someone who has both an eating disorder and social anxiety disorder will often experience overlapping symptoms. Both disorders can stem from a fear of negative judgment. Likewise, someone who has social anxiety disorder may be more prone to withdraw from friends and family, which can exacerbate the symptoms of an eating disorder. For this reason, any individual who has these comorbid conditions will need treatment designed specifically to meet their unique needs.
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder, or OCD, involves irrational fears and thinking patterns that usually lead to repetitive behaviors. In most cases, repetitive behaviors, or “compulsions,” temporarily alleviate the distress associated with irrational fears or thoughts. The obsessions and compulsions that come with OCD can be powerful enough to disrupt every aspect of the individual’s life.
For most people, OCD centers around a specific theme. For example, the individual may have a fear of germs, danger or doing something wrong. People who have OCD may develop obsessions related to their weight, eating behaviors or exercise, which will complicate the treatment of the eating disorder. To improve outcomes among patients, it is important to find a treatment program that can address both the eating disorder and OCD concurrently.
Mood Disorders
Mood disorders are a group of disorders characterized by abnormal emotions and feelings. The most common examples of mood disorders include major depression and bipolar disorder. While major depression involves extreme feelings of depression lasting more than two weeks, bipolar disorder is characterized by periods of depression alternating with periods of mania.
All types of mood disorders can influence and complicate eating disorders. For example, someone who suffers from both major depression and an eating disorder may notice a vicious cycle in which one disorder continuously exacerbates the other. Treating both disorders at the same time is essential to ensure that the individual can recover fully and live a better life.
How Comorbid Disorders Affect the Treatment Process
If an eating disorder patient has a co-occurring disorder, this fact must be taken into consideration throughout the treatment process. In most cases, comorbid disorders are intricately related to the eating disorder and may have even contributed to its development. Because the eating disorder and the co-occurring disorder are so intertwined, they must be treated concurrently to ensure a lasting recovery for the patient.
To appropriately treat a patient who has both an eating disorder and a mental health disorder, the treatment team will typically begin by interviewing the patient to fully understand all of the underlying issues and diagnoses. Once the team has an accurate and detailed profile of the patient, they can create a treatment plan designed specifically to meet that patient’s needs. Treatment plans may include services designed to treat the mental health disorder alone, services designed to address the eating disorder alone and services designed to address the connections between the two issues.
Some of the services that may be included in a treatment plan for a patient with a co-occurring mental health disorder and eating disorder include:
- Medical care
- Nutritional programming
- Cognitive processing therapy (CPT)
- Dialectical behavioral therapy
- Cognitive-behavioral therapy
- Experiential therapies
- Psychodynamic therapy
- Support group meetings
- Interpersonal therapy
- Family therapy
- Exercise
Many treatment facilities will also incorporate other activities intended to improve the overall well-being of patients, such as yoga, meditation, and life-enhancing activities.
Seeking Treatment
If you or someone you love is dealing with an eating disorder in combination with a mental health disorder, professional treatment is the best way forward. With the right treatment program, both of these disorders can be addressed. However, it is important to note that not every treatment program will be equally effective in treating a patient who has a dual diagnosis. For this reason, it is important to compare available programs and make an informed, thoughtful decision. Some of the issues to consider as you compare various programs include:
- The background of the professionals working in the program – If possible, look for a program that employs professionals who have a background in the treatment of both eating disorders and mental health disorders. Professionals who understand and can address both of these issues will be able to provide more effective services to patients with co-occurring mental health conditions and eating disorders.
- The services available from the program – Different eating disorder treatment centers will offer different services. It is essential to ensure that you are selecting a program that not only provides a variety of services but also provides services designed specifically for patients with a dual diagnosis.
- The cost of the program – Although the cost of the treatment program should not be your sole concern, it is important to ensure that you will be able to afford the program you choose. Many programs accept payments from health insurance companies, so be sure to inquire about these possibilities before you select a treatment facility.
- The reputation of the program – Learning about the treatment facility’s reputation will give you an idea of what to expect during treatment. If possible, try to find testimonials or reviews written by patients who have both a mental health disorder and an eating disorder.
As you compare different programs, you may consider other factors as well, such as the location. However, the factors above are most important when selecting a program for a patient with a dual diagnosis.
Treatment for Co-Occurring Disorders at Monte Nido
Monte Nido is a full-service treatment facility that provides both residential and day treatment options for people who struggle with any type of eating disorder. Our treatment facility is designed to provide patients with a structured, positive experience in which they can develop insight into their eating disorders as they work toward a better relationship with food. Our facility utilizes a wide variety of therapeutic approaches to ensure that every patient receives the services they need to have the best chance of achieving a full recovery. Our programs are designed to treat the whole person, leading to a healthier body, mind, and spirit. Monte Nido offers treatment facilities all across the United States, with locations in California, Illinois, Massachusetts, New York, Maryland, Oregon, and Pennsylvania.
At Monte Nido, we treat binge eating disorder, anorexia nervosa, and bulimia nervosa, as well as all other eating disorders. We are also happy to offer customized treatment services to patients who have co-occurring mental health disorders, including PTSD, mood disorders, anxiety disorders, and others. If you or someone you love is exhibiting signs of an eating disorder with or without a co-occurring mental health disorder, we are here to help. Please contact us today to learn more about our programs or to begin the enrollment process.
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.