There’s a high incidence of overlap between eating disorders and substance use problems, and it can be hard at times to differentiate between—or integrate treatment for—the two. The eating disorders (EDs) that co-occur most often with substance use disorders (SUDs) are anorexia nervosa, bulimia, and binge eating disorder. Anorexia is characterized by food restriction, body image distress, and fear of weight gain. There are two subtypes within this diagnosis: the restriction subtype and the binge/purge subtype. Bulimia involves regular instances of bingeing and purging as well as body image distress. Binge eating disorder consists of frequent episodes of binge eating.
Substance use disorders, formerly called substance abuse or dependence, are a group of (typically) chronic conditions where a person continues to use substances despite negative consequences of that substance use.
The Overlap: How common is co-occurrence?
Although the specifics of the relationship between these disorders varies depending on the type of ED/subtype, the specific substance, and other factors like demographics, gender, etc., the overlap is nonetheless well established in both clinical and community studies. Some quick stats:
- Up to 35% of people who abuse alcohol and/or drugs also have EDs, a rate 11 times greater than the general population.
- Approximately 1 in 4 people with an ED will develop SUD at some point in their life.
- About half of women who suffer from EDs also struggle with SUDs.
Individuals with binge eating disorder or bulimia are more likely to have a co-occurring SUD compared to anorexia—which is not as strongly associated with SUDs.
Physical Impact
Both conditions are mental health disorders with major physical components, as maladaptive consumption of either food or drugs/alcohol can have a profound impact on one’s physical well-being. In fact, they are among the two most lethal mental health diagnoses for those (and related) reasons.
Risk Factors
EDs and SUDs share biological, psychological, and social risk factors, too—such as genetic predisposition, family history, trauma history, emotional dysregulation, low self-esteem, and other co-occurring mental health disorders like depression or anxiety.
Secrecy and Shame
Secrecy and cycles of shame tend to be present in both disorders, and similarly, both thrive in isolation—unfortunately, also a typical feature of each.
Compulsive Behavior
Both disorders consist of compulsive behaviors that are usually driven by cravings and the use of food or substances as a way to temporarily escape difficult emotions (and satisfy those cravings). The behavior can often feel obsessive and out of control.
Differences
EDs, of course, involve food, body, and control around various facets of eating, while SUDs involve drugs and alcohol. Despite the prevalence of their co-occurrence, EDs and SUDs have different diagnostic criteria and physical health impacts, as well as unique treatment approaches, interventions, and considerations.
“Drunkorexia”
“Drunkorexia” is not a medical diagnosis but rather a colloquial term used to describe the restriction or compensation of food to compensate for alcohol consumption. Generally, these behaviors are associated with the fear of weight gain. The associated behavior can lead to negative, and at times dangerous, health outcomes. Unfortunately, this overlap of disordered eating behaviors and problematic substance use may be more common than you think: some studies suggest that up to 80% of college students have engaged in this behavior.
Treatment Challenges and Considerations
The relationship between the conditions is symbiotic, meaning the development of one disorder is both sustained and exacerbated by the other. The combination of these disorders is also associated with earlier medical problems, higher rates of suicide, more severe co-occurring disorders, and treatment needs tend to be greater and more complicated.
Treating only one of these disorders when they are both present runs a high risk of switching between the problematic behaviors of either disorder—also known as symptom substitution. This can happen any time, but is especially likely in recovery when someone uses substances to cope with feelings or situations that trigger ED behaviors or vice versa.
Therefore, treatment of co-occurring EDs and SUDs needs to be integrated, since treating one disorder in isolation can miss important needs and often fails. Despite that reality, it can be difficult in practice to find a provider—especially treatment centers— that has a thorough understanding of both EDs and SUDs, and is equipped to treat both simultaneously. In addition, these disorders require comprehensive and collaborative care such as the involvement of a medical provider, psychiatrist, dietitian, and therapist.
Reach Out
If you or someone you know is struggling with an eating disorder and/or substance use, you don’t have to suffer alone. Reach out to Courage to Nourish and Monarch Wellness & Psychotherapy and get support today for integrated, comprehensive care.
About the Author
Taylor Rapuano, LCPC, LPC is a therapist at Monarch Wellness & Psychotherapy who sees clients in-person in Maryland and virtually in DC and Virginia. Taylor specializes in addiction/substance use, eating disorders and PTSD.