Eating Disorders and Addiction

Eating disorders and addiction often occur together, and both require treatment. Here’s what you need to know about eating disorders, addiction, and mental health.

What is an Eating Disorder?

According to the American Psychiatric Association, “eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.”¹ Eating disorders can impact almost every facet of life, including work, school, social life, and physical health. They often co-occur with other mental health disorders, including depression, anxiety, obsessive-compulsive disorder (OCD), and substance abuse.

Statistics on Eating Disorders

Eating disorders are more common than most individuals realize. According to research,² eating disorders affect at least 9% of the worldwide population. Approximately 28.8 million Americans will suffer from an eating disorder in their lifetime.³ In addition, eating disorders are one of the deadliest types of mental illnesses and are second in danger only behind opioid overdoses.

Who Is Most Likely to Experience Eating Disorders?

There is a genetic component to eating disorders. Adoption studies, where twins are separated at birth, show that when one twin develops an eating disorder, the other has a 50% chance of developing one as well.⁴ However, society also contributes to the disorder. The pressure for both men and women to stay thin and fit fuels the development of this disease. In other cultures that do not hold the same Western ideal of thinness, eating disorders are virtually non-existent.⁵ Differences in brain structure are also a potential contributing factor to this issue. Researchers found that serotonin and dopamine differences may be a contributing factor behind eating disorders.⁶

Risk Factors for Eating Disorders

Because of these various components, there are several different risk factors for developing this type of disorder: A close relative that has either an eating disorder or mental health condition

History of dieting
Those with Type 1 diabetes
History or tendency towards perfectionism or anxiety
Significant body image dissatisfaction
Those on the autism spectrum, ADHD, or an intellectual disability
History of teasing or bullying
Those from a racial or ethnic minority group
Those who are isolated or have a limited social network
Presence of intergenerational trauma

However, people without these risk factors can still be in danger of developing an eating disorder.

Common Types of Eating Disorders

There are several eating disorder types, including:

Anorexia Nervosa

As one of the most well-known eating disorders, anorexia nervosa usually develops during the teen years and young adulthood. It also typically affects women more than men. Those with anorexia tend to see themselves as overweight, even if they are severely underweight. As a result, they often monitor their weight constantly, avoid specific foods and food groups, and severely restrict their calories. OCD and BDD are often co-occurring with anorexia. Symptoms for this disorder include:

Very restrictive eating patterns
Fear of weight gain
The endless pursuit of thinness and refusal to keep a healthy weight
Distorted body image

Bulimia Nervosa

People with bulimia binge eat abnormally large amounts of food in a short amount of time, followed by purges to compensate for calories consumed during a binge. Typical forms of purging include forced vomiting, over-exercise, fasting, laxatives, and enema. While symptoms are similar to the binge eating subtype of anorexia, those with bulimia nervosa are more likely to be average weight. Symptoms include:

Episodes of binge eating that the individual feels they cannot control themselves
Episodes of purging to prevent weight gain
Self-esteem based on body shape and weight
Fear of weight gain, even if they are at a healthy weight

Binge Eating Disorder

Binge eating is one of the most common eating disorders in the United States. Like anorexia and bulimia, it often begins in adolescence and early adulthood. However, it can start at any age. Like bulimia, individuals feel that they lose control and eat large amounts of food in a short amount of time. However, they do not engage in purging behaviors or restrict calories after binging. Those who have a binge eating disorder tend to be overweight or obese in most cases. Symptoms of a binge eating disorder include:

Eating large amounts of food rapidly in secret until painfully full, even if they are not hungry
Feeling out of control during periods of bingeing.
Shame, disgust, and guilt over binge eating behaviors
No purging

Body Dysmorphic Disorder

Although not an eating disorder itself, Body Dysmorphic Disorder (or BDD) often accompanies eating disorders. BDD, which used to go by the name dysmorphophobia, is an obsessive fixation on a body part or an individual’s belief that their body is severely flawed. While dislike of one’s appearance is common, BDD is extreme and results in unhealthy behavior in an attempt to appear normal. A person with BDD is abnormally concerned about a minor or non-existent body flaw to the point that it interferes with their everyday life. Symptoms include:

Constantly looking in the mirror or avoiding the mirror altogether
Hiding body parts under a hat, scarf, or makeup
Constant exercising or grooming
Continual comparison with others
Not going out, especially during the day
Unnecessary plastic surgeries
Avoiding social events
Picking at skin
Mood issues, especially anxiety or depression
Intense shame
Thoughts of suicide

Avoidant Restrictive Food Intake Disorder

Avoidant Restrictive Food Intake Disorder (ARFID) is a new term for what was previously referred to as “Feeding Disorder of Infancy and Early Childhood.” The disorder was a diagnosis for children under the age of seven. However, it can persist into adulthood, which prompted the name change. ARFID is a disorder where there is a lack of interest in eating and distaste for certain food temperatures, textures, colors, tastes, or smells. It goes beyond picky eating to have a real impact on physical health. The diagnosis does not include avoidance or restriction due to religious or cultural practices. Symptoms of ARFID include:

Avoidance or restriction of food intake to the point of malnourishment
Eating habits that interfere with social functioning and eating with others
Weight loss and poor development
Dependence on supplements or tube feeding due to nutrient deficiencies

The Connection Between Eating Disorders and Addiction

While there is a clear correlation between eating disorders and substance abuse disorders, the connection is not completely understood. However, in a study of more than 2400 individuals who were hospitalized for an eating disorder:⁷

97% had at least one co-occurring disorder
94% had a mood disorder, typically major depression
54% had an anxiety disorder
20% had an obsessive-compulsive disorder
22% had an alcohol or substance use disorder

Substances Abused During An Eating Disorders

There is no uniform substance abuse amongst those who have an eating disorder. Substances include sedatives, marijuana, hallucinogens, opioids, cocaine, inhalants, and caffeine pills. Those with an eating disorder can also misuse legal substances, such as laxatives, diuretics, diet pills, thyroid hormones, and artificial sweeteners. Substance abuse is not equal across all eating disorders. For example, those with anorexia nervosa are least likely also have a substance use disorder. However, those with bulimia and eating/purging anorexia are more likely to have a substance use disorder and have the highest alcohol consumption.

Treatment for Co-Occurring Addiction and Eating Disorders

Diagnosis is an important first step in recovery. How a treatment program proceeds is based on the type of eating disorder, any co-occurring mental disorders, the substance use disorder.

Detox

A critical step in recovery is getting all abused substances out of the body. Without a sober mind, it is difficult to treat an eating disorder. Depending on the substance and duration of use, detox can take anywhere from a few days to a month. In addition, there may need to be inpatient care for an eating disorder, depending on the severity. Unstable or depressed vital signs, or acute health risk, for example, may require inpatient care.

Therapies

Therapy is an essential part of recovery and continued sobriety. There are some options to choose from for therapy. Acceptance and commitment therapy (ACT) focuses on changing actions as opposed to feelings or thoughts. Patients commit to creating goals that will fulfill their core values and learn to live with pain and anxiety as a normal part of life. Cognitive-behavioral therapy (CBT) is a short-term, symptom-oriented form of therapy. It seeks to change distorted beliefs and attitudes towards weight and appearance. Dialectical behavioral therapy (DBT) is an evidence-based practice to replace maladaptive eating behaviors with healthy skills to handle daily pressures.

Eating Recovery Center

Those who require a higher level of care but not hospitalization may choose to stay at an eating recovery center. There they can get more intensive care under the watch of professionals.

Resources

https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107207
https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/
https://pubmed.ncbi.nlm.nih.gov/26095891/
https://pubmed.ncbi.nlm.nih.gov/12956542/
https://www.biologicalpsychiatryjournal.com/article/S0006-3223(13)00647-1/fulltext
https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

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Eating Disorders and Addiction