Eating Disorders and Substance Use Disorders Comorbidity

Many individuals with eating disorders also struggle with alcohol and drugs. In fact, about half of all individuals diagnosed with an eating disorder also have a substance use disorder. Let’s take a look at the nature of both eating disorders and substance use disorders so we can examine their relationship and how to best treat these disorders when they co-occur.

Eating Disorders

Eating disorders are real, complex illnesses that are affected by biological, psychological, social, and environmental factors in an individual’s life. Eating disorders are characterized by a disturbance in eating or food behaviors and are often accompanied by negative body image. Eating disorders often co-occur with other mental health disorders such as substance use, anxiety, or depression. Eating disorders are categorized in the DSM-5 as follows:

Anorexia Nervosa. Anorexia revolves around the restriction of food intake and an obsession with body weight, size, or shape. It is the most fatal of all mental illnesses. Warning signs in preteens and teens may include a refusal to maintain an age-appropriate weight, body dysmorphia, over-exercising, and restrictive behavior around food.

Bulimia Nervosa. Bulimia is an illness that causes an individual to overeat and then to purge. Warning signs typically include uncontrollable eating followed by compensatory behavior such as vomiting, using laxatives or diuretics, and/or extreme exercise.

Binge Eating Disorder. Binge eating is characterized by repetitive moments of extreme and uncontrollable eating. Warning signs may include eating to self-soothe, hiding wrappers and food, weight gain, or shame around eating.

Avoidant/Restrictive Food Intake Disorder. ARFID is most commonly found in children and teens. It is an eating disorder that results in weight loss, nutrient deficiency, and difficulty in day-to-day life. Warning signs can be weight loss, a refusal to eat due to feeling ill or due to a fear of choking, a lack of interest in food, a disdain for certain food textures or consistencies, and a lack of body image concerns. ARFID is most commonly found in children and teens.

Other Specified Feeding or Eating Disorder. OSFED consists of atypical anorexia (anorexia without weight loss), infrequent bulimia, binge eating with fewer occurrences that usual, and purging disorder. Signs and symptoms generally correlate to the major eating disorder (anorexia, bulimia, or binge eating) that they most closely resemble.  

Substance Use Disorder

Substance use disorder is an illness that affects an individual’s brain and behavior and leads to an inability to control their use of drugs or medications. Substances that are abused can include illegal drugs such as methamphetamines and steroids or legal substances such as alcohol, nicotine, and prescription medications.

Individuals who become addicted to a certain substance may find it challenging to control or stop their use despite the harm it causes. As time goes on, an individual may need larger doses of the substance to reach the desired high and it may become increasingly difficult to live without using the drug. In addition, if an individual attempts to stop using substances, they may experience intense cravings and withdrawal.  

Symptoms of substance use disorder may include:

• Using or feeling like you have to use a substance daily or multiple times a day
• Having intense urges to use the substance that overpower other thoughts
• Needing more of the drug as time goes on
• Continuing substance use despite negative effects and problems it may be causing
• Spending excess money and time on the substance
• Having a hard time stopping use
• Experience withdrawal symptoms when stopping the substance

Eating Disorders and Substance Use Disorders

Why do eating disorders so commonly co-occur with substance use disorders? This relationship may exist because of the intertwined effects of the substance and the eating disorder behaviors. Substance abuse often aids in eating disorder behaviors.

Common substances that are abused by those with eating disorders include nicotine, caffeine, laxatives, and amphetamines. These substances may be used to suppress appetite or to encourage purging. For example, a nicotine addiction may also act as an eating disorder behavior because it masks appetite, making it easier to restrict food intake. Due to this relationship, it is clear why substance abuse disorders can develop after an eating disorder as they can help facilitate eating disorder symptom use. While substance use may start initially as a way to lose weight, it may turn into a severe substance use disorder as time progresses.

Another reason these co-occurring conditions may exist is because eating disorders and substance use disorders have a similar relationship with the “reward center” of the brain. In eating disorders, the brain reward center is stimulated by food-related acts such as bingeing or restricting. In the case of bingeing, the reward center becomes dampened, resulting in an individual consuming more and more food in an attempt to feel satisfied. The link is similar for those with substance use disorders—the brain becomes stimulated by a substance but eventually, that substance loses its pleasurable effect, causing an increase in usage.

Because of the complex and intertwined nature of eating disorders and substance use disorders, it is essential that individuals receive proper treatment. If left untreated, these comorbid disorders can cause significant problems and may have severe consequences. The longer an individual experiences an eating disorder or substance abuse, the longer it may take to recover and heal.

Co-occurring eating disorder/substance use disorder can cause significant, ongoing problems that can make it more difficult for an individual to achieve lasting recovery. The unique challenges that eating disorders and substance use disorders present necessitate specialized care that addresses both concerns concurrently. At The Emily Program, we treat eating disorders as well as conditions that often co-occur with eating disorders.

By treating both the substance use disorder and the eating disorder, The Emily Program believes individuals can achieve lasting recovery from both illnesses. By understanding the intricacies and overlaps of the two disorders, individuals can begin to unravel the relationship and find new, healthy ways of living.

 If you are interested in learning more about The Emily Program or starting treatment, you can complete our online form or call 1-888-364-5977.