Eating Disorders and Substance Use Disorders Comorbidity

Contributed by The Emily Program, a national leader in eating disorder treatment

In recognition of Eating Disorders Awareness Week (February 25th - March 3rd) we wanted to take the opportunity to highlight the relationship between eating disorders and substance use disorders. Eating disorders commonly occur alongside substance use disorders. In fact, about half of all individuals who have an eating disorder also have a substance use disorder.

One 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’s 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 effects, causing an increase in usage.

Substance use disorder also often occurs in the context of 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 repress appetite or to encourage purging. Due to this relationship, it’s clear why substance use disorders can develop after an eating disorder as an “aid” in eating disorder symptom use. While substance use may start initially as a way to lose weight, it often becomes a severe substance use disorder as time progresses.

Because of the closely intertwined relationship, it is important to be aware that having one disorder increases the likelihood of being diagnosed with the other. Not exactly sure what an eating disorder is? Like substance use disorders, they are serious illnesses that are affected by biological, psychological, social, and environmental factors. Eating disorders are defined by a disturbance in eating habits and they often co-occur with other struggles such as substance use, anxiety, or depression. The DSM-5 recognizes five types of eating disorders:

Anorexia Nervosa. Anorexia presents with extreme food restriction, weight loss, body dysmorphia, and a fear of food. There is typically significant weight loss with anorexia.

Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID includes feeding or eating disorders that involve a lack of interest in or an avoidance of certain foods that results in a failure to meet nutritional needs.

Binge Eating Disorders (BED). BED is characterized by repeated episodes of excessive and uncontrollable food consumption without compensatory behaviors like purging.

Bulimia Nervosa. Bulimia is noted by purging following food consumption. Like anorexia, those with bulimia often fear weight gain and have body dysmorphia.

Other Specified Feeding or Eating Disorder (OSFED). OSFED catches all other eating disorders that cause significant distress but do not meet the criteria for the other four eating disorders.

Common signs and symptoms of an eating disorder include:

  • A change in food intake

  • Weight loss or weight gain

  • Purging (diet pills, laxatives, vomiting, exercise, or diuretic use)

  • A preoccupation with food, weight, or body image

  • Medical complications such as dental problems, heart problems, hair loss, fainting

Because of the complex relationship between eating disorders and substance use disorders, it’s 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 find healing. For those experience both disorders at the same time, specialized care is recommended. The Emily Program offers individualized treatment for those with an eating disorder and substance use disorder diagnosis. This treatment includes a chemical dependency assessment, medical management, individual therapy, nutrition planning, and access to various support groups. With proper intervention and quality care, those suffering from comorbid disorders can find lifelong recovery.

To learn more about The Emily Program, please visit their website here.

To show your support of National Eating Disorder Awareness Week, take the Body Acceptance Challenge or Eating Disorder Screening quiz to see if you are at risk.