Eating Disorders And Substance Use Disorders: Exploring The Connection

Medically reviewed by April Justice, LICSW and Dr. Andrea Cziffer Paul, MD
Updated November 8, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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Eating disorders and substance use disorders are separate mental illnesses that can sometimes be linked. For example, recent research suggests that 50% of individuals living with an eating disorder have a history of substance misuse, and 35% of those who seek support for addiction meet criteria for an eating disorder. Here, we’ll take a closer look at the connection between these two types of disorders and examine integrated treatment options.

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What is substance misuse (formerly known as “substance abuse”)?

To understand the connection between eating disorders and substance misuse, it can be helpful to first examine the signs, symptoms, and impacts of these psychiatric disorders separately. It can also be important to note that the term “substance abuse” is no longer a recognized term in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the terms “substance misuse” and “substance use disorder” are now preferred. 

Substance misuse is the problematic and/or dangerous of a substance. Substance use disorder is when substance misuse qualifies as a mental health condition characterized by the uncontrolled use of one or more substances, such as alcohol, prescription medication, and/or illicit drugs. 

Symptoms of substance use disorder (formerly “substance abuse disorder”)

The signs of substance use disorder (SUD) may vary depending on the person, the substance, and the severity of their condition. However, some general symptoms of SUD may include: 

  • Craving and compulsive use. A person with SUD will typically have a strong desire or urge to use the substance, which may lead to compulsive behaviors. 
  • Loss of control. A person may feel like they are unable to stop using the substance, even if they want to. 
  • Tolerance and withdrawal. Over time, a person may require more of a substance to achieve the desired results. They may also experience psychological or physical withdrawal symptoms if they discontinue use. 
  • Neglect of responsibilities. Substance misuse may cause a person to fail to fulfill obligations and home or work. 
  • Continued use despite harm. Even after experiencing negative impacts, a person may continue to use or misuse substances. 

Potential impacts of substance misuse 

The symptoms of substance use disorder can have a significant impact on a person's daily functioning, relationships, and overall health and well-being. For example, physical impacts such as elevated blood pressure, heart disease, and a higher rate of injury are common. Substance use may cause mental health challenges such as stress, anxiety, and depression as well. Misusing alcohol or other substances can also make it challenging to meet the demands of school and work and may negatively impact interpersonal relationships. 

Eating disorders: Understanding anorexia nervosa, bulimia nervosa, and binge eating disorder

Eating disorders are mental health disorders that involve unhealthy eating patterns, which can impact a person physically, socially, and psychologically. These disorders may include key symptoms like binge eating, restrictive eating, low self-esteem, and concerns with weight and body image. Here’s a brief overview of some of the most common types of eating disorders.

Anorexia nervosa

Anorexia nervosa is a type of restrictive eating disorder in which a person eats less than their daily caloric needs in an attempt to lose weight or keep weight off, typically because they view themselves as overweight and/or fear gaining weight. Individuals who are anorexic may feel guilty or shameful after eating and may or may not engage in compensatory behaviors afterward, such as purging or excessive exercise. People who are living with anorexia may experience health effects like gastrointestinal issues, dangerous weight loss, anxiety, and depression. Over time, they may also be at risk of serious complications like organ failure and even death.

Bulimia nervosa

Individuals living with bulimia nervosa may experience a cycle of binge eating followed by an attempt to purge the food in order to avoid weight gain. This could take the form of vomiting, excessive exercising, or taking laxatives. Bulimia nervosa can be more challenging to diagnose because the individual may be less likely to show outward signs of weight loss, which is more common though not always present in those living with anorexia. 

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Binge eating disorder

Binge eating disorder is one of the most common eating disorders in the United States. It involves consuming large amounts of food over short periods, even when not hungry. This disorder may cause significant weight gain and associated health risks that come with obesity. A person living with a binge eating disorder may hide their binge eating due to feelings of anxiety and shame. Binge eating is often an attempt to cope with stress or other difficult emotions. 

The link between eating disorders and substance use disorders

Eating disorders and substance use disorders have similarities, and their symptoms can overlap. In both types of disorders, a person may struggle to control compulsive behaviors. What triggers disordered eating or substance misuse behaviors can also be similar, as both types of conditions may develop as an attempt to cope with underlying emotional pain, stress, or trauma.


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The root causes of these disorders may also be similar. For example, both types of disorders are thought to have a genetic component and may be passed down through families. Both disorders may develop as a result of environmental risk factors such as trauma, societal pressures, or the influence of peers. In addition, in some cases, a person may use substances as a way to try and manage weight, and alcohol, prescription medication, and illicit substances may exacerbate disordered eating habits as well. 

Potential impacts of these disorders on health and daily life

A person with comorbid eating disorders and substance use disorders may experience a variety of impacts on their health and daily life as a result. For instance, both disorders may impact a person’s physical health, potentially causing complications like heart problems, malnutrition, and damage to bodily systems. Long-term substance use combined with disordered eating may also impact brain function and cause liver damage. 

Psychologically, these disorders may lead to stress, anxiety, depression. A person may also feel shame or guilt related to their symptoms which, in addition to signs of depression, may result in social isolation and loneliness. These impacts may also affect a person’s daily functioning at home and work and may make it challenging to maintain or build relationships.  

The importance of early detection

When managing co-occurring SUD and eating disorders, an early diagnosis may be key to improving long-term outcomes. Identifying risk factors and learning to recognize the signs of these disorders can help a person seek help early. If you notice symptoms of an eating disorder or a substance use disorder in yourself, don’t hesitate to seek professional support.

Seeking treatment for these types of disorders

Treating co-occurring eating disorders and substance use disorders will often involve an integrated treatment program that addresses both illnesses. It may often be necessary to involve a team of professionals, which may include primary care providers, therapists, dieticians, and substance misuse counselors to provide support for both physical and mental health concerns.

Treatment options for co-occurring eating disorders and substance use disorders

Due to the nature of these disorders and how one can influence or exacerbate the other, it may be important to treat both simultaneously using an integrated approach. It’s important to speak with your doctor or psychiatrist for a personalized treatment plan. Some approaches they may recommend for treating co-occurring substance use and disordered eating include: 

  • Cognitive behavioral therapy (CBT). CBT is a talk therapy technique in which a therapist works with a client to help them identify distorted thought patterns and replace them with more realistic and productive thought patterns. This type of therapy has been suggested to be an effective way of reducing symptoms related to both of these types of disorders. 
  • Medication. In some cases, a doctor or psychiatrist may prescribe medication to a person living with an eating disorder and/or a substance use disorder—usually intended to be used in conjunction with other forms of treatment like therapy. Always consult with your doctor before starting, stopping, or changing any medication.
  • Nutritional therapy. In addition to treating the underlying causes of an eating disorder, it may also be necessary to treat the physical impacts on the body and build a healthier relationship with food. This process may involve working with a dietician and a physician to improve eating habits and support physical health.
  • Support groups. Connecting with other individuals who are also living with substance use disorders or disordered eating in a support group setting may be a beneficial way to build coping skills and gain social support for recovery. 

Long-term relapse prevention

With both disordered eating and substance use disorder, there is the potential for relapse. Reducing the risk of relapse may involve attending ongoing therapy sessions to remain connected to support and continue working on healthy coping mechanisms as new challenges arise. Additionally, reflective techniques such as journaling, meditation, and practicing mindfulness may be helpful. 

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Seeking professional support

Initial treatment for eating disorders and substance use disorders typically requires some form of in-person evaluation and care, since both types of illnesses can have significant physical effects. Therapy may also be recommended as an ongoing component of treatment over the longer term. For those who have trouble fitting in-person therapy appointments into their schedules, online therapy may be a more convenient option.

With a platform like BetterHelp, you can attend sessions with a licensed therapist from anywhere you have an internet connection—no commuting required. Research suggests that online therapy can offer similar benefits to in-person therapy for addressing symptoms of both eating disorders and substance use disorders as part of a broader treatment plan. 

Takeaway

Eating disorders and substance use disorders share some similar causes and symptoms and can co-occur in the same individual. Since both can significantly impact a person’s mental and physical health, seeking treatment as soon as possible is usually crucial. Treatment plans typically involve a team of support professionals, including primary care doctors, a substance misuse counselor, a dietitian, and a therapist.
Healing from eating disorders is possible
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