It’s dangerous enough to have an eating disorder, but many people struggling with anorexia, bulimia, binge eating and related issues also face other mental health conditions. In fact, in most cases, multiple diagnoses are the expectation rather than the exception. Not only do these so-called co-occurring disorders make daily life incredibly difficult, but they also complicate treatment and recovery.
Where there are eating disorders, these other mental health issues may also be lurking:
Studies show that one-quarter of patients entering treatment for eating disorders will meet the criteria for substance use disorders. Eating disorders and substance abuse go hand in hand so frequently, there are a number of treatment centers that specialize in addressing both conditions simultaneously. Through drugs and alcohol, people with eating disorders escape their anxiety and emotional pain.
Depression and Anxiety
Some people engage in disordered eating behaviors to cope with depression and anxiety. Overlapping symptoms can include fatigue, feelings of hopelessness or despair, and changes in appetite. Studies show that about two-thirds of eating disorder patients also meet the diagnostic criteria for depression and/or anxiety. Roughly half the time, these mood disorders existed long before the eating disorder developed. In other cases, people develop depression or anxiety as a result of the shame and emotional pain of disordered eating.
A type of anxiety disorder, the symptoms of obsessive compulsive disorder (OCD) often overlap with eating disorder symptoms. In both conditions, patients struggle with compulsions, black-or-white thinking, and rituals surrounding food and exercise. An estimated 40 percent of patients in eating disorder treatment will also meet the criteria for OCD.
Post-Traumatic Stress Disorder
A significant number of individuals with eating disorders have a history of abuse, neglect or other trauma. As a result of a traumatic experience, they may turn to disordered eating behaviors as a way to cope with painful memories or to feel in control of their lives.
This mood disorder often affects people with eating disorders, particularly bulimia. Shared symptoms include impulsivity and a preoccupation with weight.
Individuals with eating disorders may be at increased risk of self-harm (deliberately cutting, burning or otherwise injuring oneself). In addition to bingeing, purging or starvation, some individuals feel that the only way they can cope with their emotional pain is through inflicting physical pain on themselves.
Treatment for Eating Disorders and Co-Occurring Conditions
By themselves, eating disorders are difficult to treat. Patients are often resistant to change and dependent on their eating disorder as their primary coping mechanism. When eating disorders are complicated by other mental health issues, treatment requires:
- Comprehensive assessments and regular psychiatric and medical screenings
- Individualized treatment plans tailored to the patient’s specific diagnoses
- A multidisciplinary treatment team made up of medical and mental health professionals that is experienced in treating the full range of psychiatric illnesses and works closely to provide coordinated care
- Simultaneous treatment for all co-occurring disorders
- Medication management
- Case management
- Long-term aftercare and relapse prevention
Particularly in the case of eating disorders and co-occurring mental health disorders, treatment must be built around the specific patient. The complexities simply cannot be managed with a one-size-fits-all approach. The best path to eating disorder recovery is the one that is tailored to the individual and provides concurrent care for all disorders.