Eating Disorders And Substance Use Disorders: Exploring The Connection
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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.
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.
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
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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.
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
Can eating disorders lead to substance abuse?
Eating disorders are highly correlated with substance use disorders. Around 50% of individuals with eating disorders use alcohol or illicit drugs, a rate five times higher than the general population. However, evidence suggests that substance use concerns can develop before, during, or after an eating disorder. Sometimes, individuals begin using substances after achieving full recovery from an eating disorder. Eating disorders and substance use disorders likely share underlying factors that contribute to an increased likelihood of receiving one or both diagnoses. Some evidence suggests that eating disorders appear before substance use disorders more commonly than after them, but more research is required to confirm.
What is the connection between substance abuse and food?
Substance abuse and food are related to eating disorders. Many people experience substance use disorder comorbidity with eating disorders. Comorbidity refers to two disorders that appear at the same time. Substance use and comorbid eating disorders may be related to impulse control disorders, executive function deficits, or other psychiatric and neurological conditions that promote addictive behaviors.
Researchers theorize that the release of “feel good” chemicals like dopamine contributes to the behaviors seen in both eating disorders and substance use disorders. For example, those with bulimia nervosa experience binge eating episodes followed by compensatory behaviors like purging to account for the excessive calories consumed during the binge. When a binging episode occurs, many with bulimia report feeling out of control of their actions and often experience shame after the episode concludes. Those with substance use disorders report a similar loss of control and shame following substance use. It is possible that the maladaptive function of the brain’s reward system could reinforce bulimic behaviors (and other eating disorders) as well as substance use.
What mental health conditions are related to substance abuse?
Evidence suggests that substance use disorders often appear alongside co-occurring disorders that affect mental health. Anxiety disorders, including generalized anxiety disorder, attention-deficit hyperactivity disorder, bipolar disorder, personality disorders, and schizophrenia, are all associated with comorbid substance use. Alcohol use disorders are most commonly associated, but mental health concerns can contribute to the development of any type of substance use disorder.
What four underlying factors are thought to be associated with eating disorders?
The risk factors associated with eating disorders are diverse and may vary widely. However, four broad categories of common risk factors are thought to contribute to eating disorders:
- Biological factors. Eating disorders likely have a biological component. A systematic review revealed that genetics, problems with brain development, and brain damage likely play significant roles.
- Behavioral factors. Many people develop disordered eating as a behavioral response to stress or adverse life circumstances.
- Psychological factors. Mental health concerns like anxiety disorders, mood disorders, and personality disorders are all associated with an increased risk of developing an eating disorder. Addictive disorders, like alcohol use disorder, can also increase the risk of developing an eating disorder.
- Social factors. The ideal body image is often distorted or misrepresented in the media, which may reduce a person’s confidence in their body type. In addition, those who have experienced bullying related to their appearance are more likely to develop an eating disorder.
What causes binge eating disorder?
Like all eating disorders, binge eating disorder is thought to be caused by a combination of several factors. Genetics, mental health, and social issues are all thought to contribute. Although binge eating disorder is most commonly associated with weight gain, evidence suggests that a preoccupation with body weight and shape is a common driver of disorder symptoms. Mental health disorder comorbidity may also play a role. Research indicates that binge eating disorder is correlated with major depressive disorder, alcohol misuse, and other mental health conditions.
A family history of increased food intake or unhealthy eating behaviors may also contribute to the development of binge eating disorder. Those who were raised with an unhealthy relationship with food, such as being encouraged to eat excessively or eating to cope with strong feelings, are significantly more likely to develop binge eating disorder.
What triggers an eating disorder?
The cause of eating disorder symptoms is nuanced and complex. Researchers believe that a combination of biological, psychological, and social factors contribute to the development of eating disorders, as well as co-occurring disorders, such as comorbid substance use disorders. Because the underpinnings of eating disorders are so complex, it is unlikely that there is one specific factor that triggers them. The American Psychiatric Association indicates effective treatment addresses as many underlying factors as possible. Generally, a multi-disciplinary approach to treatment is preferred, which may include medical professionals, therapists, registered dieticians, and eating disorder support groups.
What condition is most associated with eating disorders?
Drug use disorders are commonly associated with eating disorders. Comorbid drug and alcohol use concerns are frequently identified in patients who have entered eating disorder treatment programs or obtained clinical services to help address disordered eating. In some cases, patients develop an eating disorder as a way to avoid withdrawal symptoms from drug or alcohol misuse. The actual treatment of an eating disorder often involves addressing underlying causes that drive both eating and substance use concerns, which often requires a multi-disciplinary approach.
What most likely causes eating disorders?
Eating disorders can have many causes that typically consist of biological, psychological, and social factors. Poor body image and a preoccupation with body shape or weight are usually seen in the most common eating disorders, such as anorexia nervosa, which is typically characterized by extreme food restriction, although atypical anorexia nervosa is becoming more common.
Bullying, a family history of disordered eating, traumatic exposure, and a previous history of mental disorders have all been identified as risk factors that promote the development of an eating disorder. Comorbid conditions, such as drug abuse or binge drinking, might also play a role. Still, disorder comorbidity might also mean that underlying factors drive the development of both eating disorders and comorbid disorders.
How does trauma contribute to eating disorders?
Evidence suggests that those who have experienced traumatic events, especially in childhood, are twice as likely to report disordered eating than those without traumatic exposure. Trauma is also linked to comorbid mental health concerns, such as increased alcohol consumption or other substance use disorders. A professional seeking to treat eating disorders typically needs to consider underlying factors and comorbid conditions, including trauma. In many cases, trauma-informed structured psychotherapies such as cognitive behavioral therapy and dialectical behavior therapy are required to address both underlying trauma and the eating disorder itself.
What factor is most responsible for causing eating disorders?
There is no single factor that is most responsible for eating disorders. Childhood trauma, bullying, poor body image, and preoccupation with body shape and weight have all been implicated as risk factors. Still, there is not one single profile that indicates a person will develop an eating disorder.
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