There are many types of mental health disorders that can co-occur with addiction. In some cases, the mental health disorder comes first, resulting in the person self-medicating with drugs or alcohol. In other cases, the addiction comes first, which can affect the individual’s body and brain to a degree that it can result in another mental health disorder.
To varying degrees, both of these options can be true of eating disorders. People who have issues with body image or challenging relationships with food often also have issues with drug or alcohol abuse. However, with the right treatment, people who are struggling with co-occurring substance abuse and eating disorders can learn to manage their conditions.
About Eating Disorders
An eating disorder occurs when a person exhibits abnormal eating patterns and attitudes about food that can have a detrimental effect on health. According to the National Eating Disorders Association, these disorders result in the individual having extreme emotions and attitudes that can result in extreme behaviors around food and body image.
As a result, the person may lose control over eating patterns, either eating or not eating to excess. Other behaviors might be involved as well, including bingeing, purging through vomiting or laxatives, excessive exercise, and hiding eating habits or hoarding food to be eaten in secret. These behaviors depend greatly on the type of eating disorder and the person’s perceptions and mental challenges around food.
Types of Eating Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which outlines criteria for diagnosis, defines specific types of eating disorders. These include:
- Binge eating disorder: This disorder involves recurring episodes of eating to the point of fullness or beyond, with a perceived lack of control over eating. Shame and guilt about eating may result in hiding binges.
- Anorexia nervosa (anorexia): This disorder involves distorted body image based in a fear of becoming fat that results in excessive dieting and extreme weight loss. Sometimes, there is a bingeing and purging cycle in those with anorexia.
- Bulimia nervosa (bulimia): This disorder involves frequent binge eating followed by purging through use of laxatives or through forcing vomiting to avoid gaining weight from the bingeing. Episodes may occur once per week or more.
- Other eating disorders, not defined: This is a small category of eating disorder types. This used to include binge eating disorder until recently, when it was given its own category. This category includes atypical forms of other eating disorders, as well as purging-only disorders and night eating syndrome.
As described by the National Institute of Mental Health, people who have eating disorders are often unable to exert control over eating behaviors, which is a defining aspect of the disorders. This can leave them feeling helpless and overwhelmed in a way that is similar to addiction, and it can sometimes result in self-medication either to ease negative feelings or, in some cases, to aid in their extreme eating behaviors.
Statistics about Eating Disorders
The organization ANRED states that about 1 percent of adolescents are struggling with anorexia, while 4 percent of college students struggle with bulimia. About 50 percent of those who have anorexia will also develop bulimia at some point. Only about 10 percent of those with anorexia or bulimia are male.
As for binge eating disorder, about 1 percent of women also struggle with this problem; however, the number jumps to 30 percent among women who are seeking weight loss solutions. Overall, 2 percent of people in the US are dealing with binge eating disorder.
When looking at the numbers of women with combined substance abuse and eating disorders, about 72 percent of alcoholic women younger than age 30 have some type of eating disorder. An article from Social Work Today quotes research that shows up to 50 percent of people with eating disorders abuse some type of drugs or alcohol.
Addiction with Co-occurring Eating Disorders
There are many forms that addiction takes in people who have eating disorders. While each individual has different experiences, there are some generalizations that have been found through research. For example, a study in the Journal of Substance Abuse shows a correlation between girls who diet in the sixth grade and girls who begin using alcohol in the ninth grade. On the other hand, a research article from European Eating Disorders Review shows that women who engage in binging and purging – and particularly those with bulimia – are more likely than those with other eating disorders to engage in alcohol or drug abuse.
A study in the Psychiatric Clinics of North America shows that up to 40 percent of women alone who have eating disorders have a co-occurring substance use disorder; this does not include men with eating disorders. Whatever other connections can be made, the figure shows how deeply intertwined these disorders are. This is often because the individual tries to soothe the feelings of guilt, anxiety, or fear from the eating disorder by using drugs or alcohol – a concept referred to as self-medication.
In other cases, however, the individual may use drugs to further the eating disorder, such as women with anorexia who use stimulants to curb appetite and avoid eating. Some women who use crystal meth – a potent stimulant – may even develop anorexia from using the drug due to its extreme effects on appetite and energy.
Regardless of the relationship between eating disorders and substance abuse, treating them when they occur is essential to the health and wellbeing of the individual. Eating disorders are the most deadliest mental illnesses, and their severity and health effects can be compounded by co-occurring substance abuse.
Treating Eating Disorders and Addiction
In order to help people who are struggling with co-occurring eating disorders and substance abuse, it is important to find a program that provides integrated treatment for both disorders. If a program addresses one issue without addressing the other, there is a possibility that the untreated disorder can serve as a trigger for the other, resulting in a higher likelihood of relapse after treatment.
One of the Treatment Improvement Protocols from the Substance Abuse and Mental Health Services Administration discusses the importance of integrating treatment for co-occurring disorders, stating that if the disorders are treated separately, any conflicts between treatments may result in problems with recovery, and subsequent higher potential for relapse. When treatments are instead integrated, the individual benefits from:
- Implementing a psychiatric treatment plan that takes into account all individual factors
- Avoiding treatment medications that may worsen the substance abuse
- Finding commonalities between treatments for each disorder that may support one another
- Learning how to manage the co-occurring disorder so it does not become a trigger for substance abuse, and vice versa
Finding a Treatment Program
In order to get the type of treatment that is most likely to help those with substance abuse and eating disorders, the individual, or family members, seeking help can ask the following questions of any potential treatment center:
- Do you provide personalized treatment programs based on the individual’s needs?
- Do you have experience treating co-occurring eating disorders?
- Do you provide integrated treatment for co-occurring disorders?
- Do you include behavioral therapy treatment for your clients?
- Are your treatment programs research-based?
Programs that answer “yes” to these questions, and provide details about the plans, are more likely to be able to support a positive treatment outcome, making it possible for people who are struggling with co-occurring substance abuse and eating disorders to achieve and maintain long-term recovery.