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What Kinds of Co-Occurring Disorders Come With Eating Disorders?

co-occurring disorders with eating disorders

Co-occurring disorders, a situation where a person has two or more different mental health disorders, are quite common with eating disorders. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there is a strong link between eating disorders and other types of psychiatric disorders.

There is a particularly high correlation between eating disorders and substance abuse, but psychiatric disorders like depression and OCD are also very common. Here, we’ll outline some of the commonly co-occurring disorders (also known as dual diagnoses) that may come with eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder.

Anxiety, Depression, and OCD

Anxiety is a series of disorders that range from phobias to OCD, and are often closely linked to an eating disorder. Aside from the general worry and nervousness of general anxiety, repeated thoughts and behaviors are part of Obsessive-Compulsive Disorder or OCD. Very often, anxiety has caused people to feel out of control, which leads to disordered eating behaviors as a coping mechanism.

Cognitive-Behavioral Therapy (CBT) is often used to treat a variety of eating disorders. CBT can be effective in retraining a person’s cognitive patterns This helps them identify which behaviors are disordered and replace them with healthier ones. Individual therapy can help get to the root cause of an individual’s anxiety or depression. Although they are not generally prescribed for eating disorders, medications can also be used to help control anxiety, depression, or OCD. Often a combination of these treatment methods is used either temporarily or on a long-term basis.

Eating Disorders and Substance Abuse

There is a high correlation between eating disorders and substance abuse. In a study performed by the National Institutes of Health, people with bulimia nervosa were more than four times more likely to struggle with substance abuse and addiction. Those with other types of eating disorders were up to 3 times more likely to abuse some type of substance. Substance abuse could include anything from alcohol and prescription drugs to a variety of illegal drugs. Stimulants such as cocaine and amphetamines are often abused by people with anorexia nervosa and other eating disorders related to disordered body image. There are normally several factors involved that need to be explored when individuals have both an eating disorder and abuse alcohol or drugs.

An individual that is experiencing an eating disorder along with some type of substance abuse normally needs to first address any medical needs, such as detox, and then work on both disorders at the same time when they enter a residential eating disorder treatment center. Besides receiving treatment for the eating disorder the individual may want to attend meetings or therapy for substance abuse or locate a facility that can treat both. When seeking treatment for eating disorders and substance abuse it’s important to find a treatment facility that is equipped to treat drug or alcohol detoxification as well as the eating disorder.

Eating Disorders and PTSD

The American Psychological Association defines trauma as an emotional response to some sort of troubling event like a robbery or assault, or a non-violent one like a divorce or losing a job. PTSD (Post Traumatic Stress Disorder) is a type of anxiety resulting from a traumatic incident in a person’s life. PTSD is present in the majority of eating disorder diagnoses. Although PTSD must be treated in therapy if an individual is medically unstable due to an eating disorder the chances are high that the treatment team will focus on this part of the treatment first.

Cognitive Behavioral Therapy (CBT) is used in PTSD treatment since it focuses on exploring the relationship between feelings, thoughts, and specific behaviors, which is also why it’s so effective in treating eating disorders. Trauma-focused CBT has specifically been designed for treating both adults and teenagers. 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 Self-Harm

The rate of self-harm is much higher in people with eating disorders than in people without them. Self-harm actions could include cutting, scratching, or otherwise taking painful action. Like disordered eating behaviors, it’s often a disordered way to control or alleviate anger, frustration, and emotional pain. Although it’s not necessarily associated with suicide as a general rule, there is a chance suicidal ideation will be present, and suicide rates are higher among people with an eating disorder.

Treatment would focus on finding ways to cope with difficult emotions and feelings that don’t involve self-harm or dangerous eating habits. Specific therapies might include forms of psychotherapy. Cognitive-Behavioral Therapy (CBT) can help a person manage and rethink difficult emotions that have led to irregular eating patterns and self-harm. Group or family therapy may also be used to treat self-harm that is co-occurring with an eating disorder.

Co-Occurring Treatment Is a Must for a Full Recovery

A truly effective eating disorder treatment program has to be equipped to treat a wide spectrum of other mental health disorders; in some ways, it’s just as important as being able to treat medical complications associated with eating disorders. A full continuum of care for treatment includes a team of therapists and psychiatrists who can address co-occurring disorders such as OCD, depression and anxiety, and PTSD. Many f the treatment methods are similar for these disorders and eating disorders. Some may include medication such as SSRIs or antidepressants, although there are no medications designed exclusively for an eating disorder.

When you are searching for a recovery program, for yourself or a loved one, you should always take co-occurring disorders into account. Take the time to speak with the admissions staff at the facility o learn about their capabilities for treating mental health and/or related conditions. They will be willing to go through in detail in most cases, as well as let you know about the facility’s living arrangements, grounds, daily schedules, and nutrition plans. Don’t forget to ask about the food being served and whether there are life-enhancing activities such as outings or art therapy programs. All these factors, combined together, give the best chance for a complete recovery.

Melissa Spann, PhD, LMHC, CEDS-S

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.
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