Eating disorders and substance use disorders are two very serious mental health conditions that can severely impact your physical and mental health. Eating disorders are potentially fatal illnesses associated with dysfunctional behaviors, thoughts, and emotions involving food, and include anorexia nervosa, bulimia nervosa, and binge-eating disorder.1
Eating disorders affect a wide range of demographic groups, and over 30 million people in the U.S. suffer from one. While all eating disorders have elevated mortality risks, anorexia nervosa has among the highest mortality rates of any mental illness.2
Keep reading to learn more about eating disorders, how eating disorders and substance abuse affect each other, and what treatment may be affective for your recovery.
What is an Eating Disorder?
Eating disorders are characterized by persistently disturbed patterns of eating behaviors, thoughts, and feelings associated with food and weight issues.1, 3, 4 Eating disorders are extremely serious illnesses that can have significantly harmful health effects or even be fatal.3 Eating disorders affect all genders, racial groups, and ethnicities. 1, 3
While there is no one specific cause of an eating disorder, certain risk factors may make a person more likely to develop one. These can include: 1, 3, 4
- Age. Eating disorders often develop during adolescence and early adulthood.
- Drastic changes. Stressful changes, like moving or divorce, can be a trigger.
- Environmental factors. Cultures that value thinness can push people to aim for unrealistic goals. Certain sports or careers that focus on weight or physique, like dancing, gymnastics, modeling, or wrestling can also contribute to an eating disorder.
- Gender. Eating disorders are more likely to affect females, but eating disorders in males are less likely to be noticed.
- Genetic or biological factors. There may also be a biological predisposition to developing disordered patterns of eating. A person may be more likely to develop an eating disorder if a close relative has one.
- Trauma. Physical or sexual abuse or bullying can factor into an eating disorder.
- Emotional Health. Certain characteristics, such as perfectionism and impulsivity, as well as having turbulent relationships can affect a person’s self-worth and make them more prone to eating disorders.
Anorexia nervosa (AN) is a condition in which a person restricts what they eat to lose weight.1, 3 People with AN sometimes view themselves as overweight or believe they are fat despite being underweight.1, 3, 4 There are different types of AN, including a restricting type (restricting food and/or extreme amounts of exercise) and a bingeing/purging type (binge eating and vomiting or using laxatives, diuretics, or enemas to purge).4
Signs and symptoms of anorexia nervosa may include: 1, 3, 4, 5
- Always feeling cold.
- Eating small amounts.
- Emaciated appearance.
- Fear of being fat.
- Fine hair on arms, legs, and stomach.
- Obsession with food, exercise, or weight.
- Pulling away from family and friends.
- Unwillingness to eat in front of others.
- Wearing loose clothing to cover weight loss.
Bulimia nervosa (BN) commonly involves a person regularly eating excessive amounts of food in a short time (binges).1, 3, 4 After binges, the person attempts to compensate for the calories they have consumed by purging.1, 3 People with BN may range from underweight to overweight.1, 3
Potential signs and symptoms of bulimia nervosa include: 1, 3, 4, 5, 6
- Damaged or eroded teeth.
- Eating excessive amounts of food, often in secret.
- Fear of gaining weight.
- Finding wrappers from food, laxatives, water pills, or diet pills.
- Going to the bathroom right after eating.
- Hoarse voice.
- Lots of food disappearing.
- A puffy appearance to the neck or jaw, from swollen salivary glands.
- Purging (by vomiting, laxatives, enemas, extreme exercise, or restricting) after bingeing.
- Signs of vomiting (calluses on knuckles, bloodshot eyes, or slight bruising underneath eyes).
Binge-eating disorder (BED) involves episodes of binge eating in a short period of time similar to BN, however such episodes aren’t followed by compensating behaviors.1, 3, 4 People with BED may experience feelings of embarrassment, guilt, shame, depression, or disgust over their binges.3, 4 People who have BED can range from a normal weight to obese.3 Signs of binge-eating disorder can include: 1, 3, 5, 6
- Eating excessive amounts of food, usually in secret.
- Eating small amounts in front of others.
- Finding food wrappers.
- Hiding food or evidence of binges.
- Not eating around others.
- Noticing significant amounts of food going missing.
- Often going on a diet without seeing results.
Co-Occurring Disorders: Eating Disorders and Substance Abuse
Eating disorders and substance use disorders commonly co-occur. For instance, women who have either disorder are over 4 times more likely to develop the other disorder than women who didn’t have either. A review conducted in 2010 determined that in women with a substance use disorder, 14% each had AN and BN.5
Up to half of all people with an eating disorder abuse substances, while the average for people without an eating disorder is 9%. Among people with a substance use disorder, 35% have an eating disorder; among the general population, only 3% have some type of eating disorder.7
The strongest association between eating disorders and substance abuse is seen with BN, followed by BED. The lifetime prevalence of substance use among people with BN is roughly 30%.4, 7 As an eating disorder becomes more severe, a person may begin to use an increasing number of different substances.5
People with eating disorders may be more likely to abuse certain substances. Prevalent types of co-occurring substance use in people with eating disorders appear to be marijuana and stimulants, including amphetamines, cocaine, and ecstasy.8
- AN: Alcohol use is more likely, especially with binge-eating/purging type.4, 7 Stimulant use is common in efforts to lose weight by reducing appetite.4, 5, 7 Sedatives or marijuana may be used to manage symptoms of insomnia or the effects of stimulants.5, 7
- BN: Stimulants are often used as appetite suppressants, along with sedatives or marijuana to overcome the effects of the stimulants and associated insomnia.4, 5, 7
- BED: Most commonly associated with alcohol use, especially with severe forms.5 Marijuana may also play a role in binge eating, as it has appetite-stimulating properties.8
Treating Eating Disorders and Substance Abuse Concurrently
In some instances, problematic eating and substance use behavior may serve as coping mechanisms, so attempting to manage just one could conceivably result in a compensatory increase in activity of the other.5 It may be helpful to treat both simultaneously to ensure that symptoms of one disorder don’t worsen or affect treatment outcomes for the other disorder.7, 8
Continuum of Care for Dual Diagnosis
For substance use disorders, there is a continuum of care that helps meet people’s needs at all levels of treatment. Some terms you may hear include:
- Detox: A professional detoxification program can help a person safely withdraw from substances under medical care. Depending on withdrawal severity and the risk of complications, medications and supportive care may be provided to ease symptoms and to manage any health issues that can arise as a consequence of the substance use, withdrawal, or the eating disorder.9
- Inpatient: Inpatient or residential facilities provide a place for the person to stay while they start the recovery process.9 Treatment is provided in both individual and group sessions, and in the case of dual diagnosis patients, will often involve psychiatric care, eating disorder treatment, nutritional management, and family sessions as well.5, 9
- Outpatient: Relatively less restrictive than an inpatient or residential treatment setting, outpatient programs provide a similar range of therapeutic options on a less time-intensive basis while the patient lives in their own home and readjusts to daily life in recovery.9
- Aftercare: This refers to ongoing recovery efforts, such as private therapy sessions, medical follow-ups, and nutritionist sessions. There are many self-help groups available for substance use and/or eating disorder recovery, including Alcoholics Anonymous, Narcotics Anonymous, or Overeaters Anonymous.
Facilities like Oxford Treatment Center offer all of the above services so as to best maintain a continuum of care across many points in the recovery process.
Therapies for Substance Use Disorder and An Eating Disorder Diagnosis
A comprehensive treatment plan will include some sort of behavioral therapy to help a person work through an eating disorder and substance disorder. Some types of behavioral include:
- Acceptance and commitment therapy (ACT). This aims to change behaviors by examining what is important to you, setting goals based on those values, behaving rationally rather than emotionally, and accepting that difficult emotions are a part of life.10
- Cognitive-behavioral therapy (CBT). This focuses on noticing unhealthy or maladaptive thinking patterns and coming up with and using more realistic thoughts to change your feelings and behaviors.1, 5, 10, 11
- Dialectical behavior therapy (DBT). This method changes behaviors by developing healthy skills to healthy skills to replace disordered eating behavior and learning how to regulate emotions, manage stressors, and communicate more effectively. 7, 10, 11
- Interpersonal therapy (IPT). Works to improve social skills and coping skills to reduce negative emotions that feed into unhealthy eating disorder behaviors.5, 7, 10
If your loved one is struggling with an eating disorder and substance use, it’s important to help them get into treatment that is tailored to meet their unique needs. Programs at facilities like Oxford Treatment Center can help provide that care with effective behavioral therapies and medical support.
Successful treatment looks different for everyone. It can mean not engaging in certain behaviors and maintaining a healthy weight. Recovery from eating and substance use disorders isn’t an easy process—it’s an ongoing process. But recovery is possible if you work hard and don’t give up hope.
- National Institute of Mental Health. (2016). Eating disorders.
- Smirk, F.R., van Hoeken, D., & Hoek, H.W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports 14(4), 406-414.
- National Alliance on Mental Illness. (2019). Eating disorders.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
- Substance Abuse and Mental Health Services Administration. (2011). Clients with substance use and eating disorders. Advisory, 10(1), 1–12.
- S. Department of Health and Human Services. (2017). Bulimia.
- Gregorowski, C., Seedat, S., & Jordaan, G.P. (2013). A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders. BMC Psychiatry, 13 (289), 1–12.
- Nøkleby, H. (2012). Comorbid drug use disorders and eating disorders — a review of prevalence studies. Nordic Studies on Alcohol and Drugs, 29(3), 303–314.
- National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide (3rd edition).
- National Eating Disorder Association. (2018). Types of treatment.
- Waller, G. (2016). Recent advances in psychological therapies for eating disorders. F1000 Research Faculty Rev, 702, 1–6.