Both eating disorders and substance abuse disorders – typically called addiction – are behavioral disorders involving compulsive actions. Some eating disorders, like binge eating, share behavioral patterns with addictions while others involve restricting intake of calories, which may involve abusing substances like stimulants.
More women than men are diagnosed with eating disorders, although the Diagnostic and Statistical Manual and Mental Disorders, Fifth Edition (DSM-5) has broadened the definition of some disorders, like anorexia nervosa, so men can receive an appropriate diagnosis. Conversely, more men than women receive a substance use disorder diagnosis, but this, too, is changing as addictions are better understood and treated.
What Are the Most Common Eating Disorders?
While there are several kinds of eating disorders, there are three that are most frequently diagnosed.
1. Anorexia nervosa: Anorexia is a condition in which a person restricts their caloric intake to the point that they rapidly lose weight and may become dangerously underweight; however, they typically see themselves as overweight. The crash dieting associated with anorexia can seriously harm internal organs, making this condition the most lethal of all the eating disorders. The associated poor self-image typically leads to either death or hospitalization due to starvation or suicide attempts. Symptoms associated with anorexia include:
- Extremely restricted food intake
- Emaciation (a body mass index of 17.5 or less, below normal)
- Relentless pursuit of thinness
- Unwillingness to maintain a normal, healthy body weight
- Intense fear of gaining weight
- Distorted body image
- Self-esteem influenced by perceived body weight and shape
- Denial of how dangerous low body weight can be
Physical problems associated with anorexia include:
- Osteoporosis or osteopenia (thinning bones)
- Physical weakness
- Muscle wasting
- Brittle hair and nails
- Dry, yellowing skin
- Lanugo (growing fine hair all over the body)
- Severe constipation
- Low blood pressure
- Slowed breathing and pulse
- Cardiovascular damage
- Brain damage
- Hypothermia, or a drop in internal body temperature
- Lethargy, sluggishness, or feeling tired all the time
2. Bulimia nervosa: People who struggle with bulimia go through periods of binge eating, consuming unusually large amounts of food, and they feel unable to control these episodes. In response to their loss of control over how much food they consume, they purge to get rid of the calories. This behavior may be forced vomiting, excessive use of diuretics or laxatives, fasting, or exercising too much, or a combination of purging behaviors.People with bulimia may maintain a healthy weight, or be slightly underweight or overweight, but will not show blatant signs of an eating disorder. Instead, they will develop behavioral changes, like not eating in front of others. Symptoms associated with bulimia include:
- Chronically inflamed esophagus
- Sore throat and raspy voice
- Worn tooth enamel
- Sensitive and decaying teeth due to exposure to stomach acids
- Swollen salivary glands in the neck and jaw area
- Acid reflux disorders
- Gastrointestinal problems and damage
- Intestinal distress or irritation from laxative abuse
- Severe dehydration
- Electrolyte imbalance, leading to stroke or heart attack
3. Binge eating disorder: When a person struggles with binge eating, they have periods of compulsive overeating; however, unlike bulimia, these periods are not followed by purging behaviors. People who struggle with binge eating disorder are typically overweight or obese, but not always. This is the most common eating disorder in the United States. Symptoms of binge eating disorder include:
- Eating unusually large amounts of food in a specific period of time
- Continuing to eat even when full or not hungry
- Eating rapidly during periods of bingeing
- Eating until one is uncomfortably full
- Eating alone or in secret
- Feeling distressed, guilty, or ashamed of eating
- Frequent dieting, potentially with no weight loss
People who struggle with binge eating disorder may develop chronic health problems associated with being overweight, including diabetes, cardiovascular damage, and gastrointestinal problems.
How Often Do Eating Disorders and Substance Abuse Co-Occur?
Eating disorders and substance abuse disorders do, unfortunately, frequently co-occur. Mental health problems often trigger both of these conditions, so a person who struggles with an eating disorder, a substance use disorder, or both, is more likely to struggle with a mental illness, too. However, a person who struggles with an eating disorder may abuse substances to decrease their appetite or as part of a binge.
According to information gathered by the Substance Abuse and Mental Health Services Administration (SAMHSA), women who struggle with either an eating disorder or substance use disorder are four times more likely to develop the other condition, and struggle with both co-occurring addiction and disordered eating. About 14 percent of women struggle with both an addiction and anorexia; similarly, about 14 percent struggled with substance abuse and bulimia.
- About 24.5 percent of people who struggle with anorexia also develop alcohol use disorder; 17.7 percent develop an addiction to illicit drugs; and 27 percent develop any substance use disorder.
- Marijuana was the second most frequently reported drug of abuse among those struggling with anorexia after alcohol.
- About 33.7 percent of people struggling with bulimia develop an alcohol use disorder; 26 percent develop an addiction to illicit substances; and 36.8 percent develop any substance use disorder.
- About 21.4 percent of those struggling with binge eating disorder develop an alcohol use disorder; 19.4 percent develop an addiction to illicit drugs; and 23.3 percent develop any problem with substance abuse.
People who are working to recover from an eating disorder are at risk for developing an addiction as a method of self-medicating intense emotions. At the same time, people recovering from substance abuse are at risk for developing an eating disorder as a way to manage their psychological experience. Medical researchers believe these risks are due to using a substance, like food or an intoxicating drug, to balance neurotransmitters in the brain. About half of those who struggle with any eating disorder are also abusing substances compared to 9 percent of the general population; additionally, 35 percent of those struggling with a substance use disorder report struggling with a co-occurring eating disorder compared to 1-3 percent of the general population.
Eating disorders are more closely associated with mental illnesses, which also put the person at greater risk for developing substance abuse. Anorexia is closely associated with major depressive disorder and narcissistic personality disorder; people who struggle with bipolar II disorder are at risk for both bulimia and anorexia; and bulimia is especially associated with those struggling with borderline personality disorder.
Getting Treatment for Co-Occurring Disorders
When a person enters treatment – either for an eating disorder or addiction – it is important to screen for both mental illnesses and other behavioral conditions. Because eating disorders, addictions, and mental illnesses are closely associated, screening those entering treatment for these co-occurring conditions will help them get the type of therapy they need to get healthy.
People who struggle with eating disorders may benefit from antidepressants, which have shown specific effectiveness for bulimia. These medications may also help to manage underlying depression or anxiety, and they can help treat associated depression or anxiety related to detox and rehabilitation for addiction.
Knowing the risks of co-occurring disorders during treatment is also important. Clinicians can watch their patients for symptoms associated with eating disorders or substance abuse, as they progress through treatment. For example, a person in treatment to overcome alcohol use disorder can be monitored for binge eating and purging behaviors because these conditions have commonality.
SAMHSA states that few substance abuse treatment centers currently screen for eating disorders, but as both eating disorders and addiction are better understood, the co-occurrence of these disorders can be better treated, using therapy and medications.