Eating disorders are characterized by extreme thoughts and behaviors toward food and body image, and they can co-occur with drug or alcohol addictions.

Eating disorders (ED) are a group of mental health conditions that can cause serious and even deadly health problems. It is estimated that 30 million people throughout the United States struggle with some type of eating disorder. Eating disorders affect people of all ages, genders, races, religions and socioeconomic statuses. 

People with eating disorders also have a higher risk of developing co-occurring substance use disorders. A substance use disorder (SUD) — also known as addiction — is a mental disorder that affects a person’s brain and behavior, making the person unable to control their use of drugs, alcohol or medications. Those who struggle with an eating disorder are five times more likely to abuse alcohol or illicit drugs. Additionally, those who have a history of drug and alcohol abuse are 11 times more likely to have disordered eating habits. 

The effects of an eating disorder and a co-occurring substance use disorder can range from mild to life-threatening. Health problems can include:

• Hair loss
• Constipation
• Low blood pressure
• Tooth decay
• Osteoporosis
• Electrolyte imbalance
• Heart failure 
• Infertility
• Multi-organ failure

The Connection Between Eating Disorders and Substance Use

Certain symptoms can occur in someone who has an eating disorder and a substance use disorder, including:

• Anxiety
• Depression
• Isolation
• Impulsivity
• Emotional irregularity

A study from BMC Psychiatry found that people with binging and purging behaviors are more likely to be dependent on alcohol, and patients who also have depression have the highest rate of alcohol abuse. The study also shows that people who excessively restrict either alcohol or food often over-consume the other one.

Overuse of stimulants like caffeine and tobacco is frequently seen in patients with eating disorders. These stimulants are used as appetite suppressants that aid in restrictive eating behaviors. For example, people with restrictive eating behaviors may use cigarettes because they provide an oral distraction that can reduce food intake.

Treating Co-Occurring Substance Use and an Eating Disorder

It can be difficult to find a treatment center that addresses both an eating disorder and a substance use disorder. An analysis done by SAMHSA found that only 16% of 351 substance use disorder treatment centers offered programs for co-occurring SUD and ED. 

The most commonly abused substances among people with eating disorders include:

• Caffeine
• Tobacco
• Alcohol
• Laxatives and/or diuretics 
• Amphetamines 
• Heroin
• Cocaine

People who struggle with both ED and SUD often have a higher rate of relapse, increased medical complications and longer recovery times. Fortunately, there are several treatment options for EDs, and multiple approaches may be used simultaneously. The most common treatments for an eating disorder are:

Psychotherapy: Psychotherapy for ED may use cognitive-behavioral therapy (CBT), which helps identify negative thoughts, feelings and behaviors and replaces them with healthy coping mechanisms. Using different therapy approaches can help provide someone with ED the coping skills necessary for recovery. 

Nutritional Rehabilitation: Those with severe restrictive behaviors or repeated binging are at higher risk for health complications, such as electrolyte imbalance, cardiac issues and even death. Those who require nutritional support are put on a high-calorie meal plan that helps them gain weight at a medically and emotionally steady pace of up to one pound per week. 

Pharmacotherapy: Stimulants, anticonvulsants and antidepressants can be effective medications for ED treatment, depending on the type of eating disorder. For example, selective serotonin reuptake inhibitors (SSRIs) like Fluoxetine help people with binge eating disorder, as it reduces binging episodes and improves mood.

However, not all treatments are capable of treating both disorders. It’s important for the treatment team to consider their patient’s physical and psychological needs before recommending a treatment program.

What Is an Eating Disorder?

An eating disorder is a mental disorder characterized by severe changes and disturbances to a person’s eating behaviors and their thoughts and emotions surrounding food. Eating disorder behaviors include:

• Overeating
• Restricting food
• Obsessive exercising
• Laxative use
• Obsessive thoughts of food
• Hiding food or food wrappers
• Eating in secret 
• Isolation
• Obsessive body image

EDs are caused by social, biological and psychological factors. Societal factors, such as the culture of “thinness,” are linked to increased dissatisfaction in personal appearance and can lead to eating disorders. Being exposed to disordered thoughts and behaviors, like associating food with guilt, during childhood can also have an impact. Disordered eating may also be used as a coping mechanism to deal with stressors in daily life. 

Psychological factors like depression or anxiety disorder, poor body image or self-oriented perfectionism can contribute to an eating disorder. According to the ADA, two-thirds of people who have an eating disorder also suffer from anxiety. Further, OCD is the most common co-occurring mental health disorder in people with EDs.

Biological factors, such as a family history of EDs, can also cause EDs to develop. Currently, scientists are researching the brain chemistry of people with ED to discover future treatment options.

Eating disorders can affect anyone, regardless of age, gender, race, religion or socioeconomic status. Women are more likely to develop an eating disorder, but men still account for up to 15% of all reported eating disorder cases. 

Types of Eating Disorders

Anorexia nervosa

Anorexia nervosa (AN) is characterized by restrictive eating behaviors that result in low caloric intake. The condition causes a distortion of body image with an extreme fear of weight gain. A patient does not have to be underweight to be diagnosed with AN.

Bulimia

Bulimia nervosa (BN) is a cycle of binging and purging. Binging is characterized by the consumption of an extreme amount of calories in a short amount of time with the intent of purging. Purging includes self-induced vomited, laxative use or over-exercising.

Binge Eating Disorder

Binge eating disorder (BED) involves frequently binging large amounts of food in a short amount of time. There are not always methods of purging associated with BED. BED is the most common type of eating disorder.

Avoidant

Avoidant restrictive food intake disorder (ARFID) is characterized by a very selective consumption of food, and it does not involve body image issues or concern of weight gain. ARFID was previously known as selective eating disorder (SED).

Other

Other eating disorders include:

Pica: Consuming things that are not considered food and have no nutritional value (paint, paper, dirt)

Rumination Disorder: Food is chewed, spit out and re-chewed; found mostly in younger children

Laxative use: Using laxatives to “rid” the body of food and to feel empty

Excessive Exercise: Over-exercising as a way to regulate body size

FAQs

Is an eating disorder an addiction?

Eating disorders are not considered an addiction. However, someone with an eating disorder may display behavior that can seem addictive, such as consistent over-exercise and obsession with body size.

Can medications cause eating disorders?

Medications cannot cause an eating disorder, but certain side effects of medications can stimulate or suppress appetite and affect eating habits as a result. A change in appetite can be an intentional or unintentional result of a medication, depending on the prescribed use.

How does substance abuse affect eating?

Substance abuse can affect eating by stimulating or suppressing appetite. For example, marijuana is frequently associated with an increase in appetite, while stimulants are known to reduce appetite.

Do I have an eating disorder?

You may have an eating disorder if you exhibit these behaviors:

Extreme rituals around food

Calorie restriction for weight loss that is not for health reasons

Obsessive thoughts surrounding your body image

Intense fear of weight gain

Fear of eating in front of others

Guilt while eating foods that you deem unhealthy (sugar, carbs, fats)

Binging or purging

Who can diagnose co-occurring substance use and an eating disorder?

Healthcare providers can diagnose co-occurring substance use and eating disorders. Providers include physicians and licensed mental health professionals.

Are medications for treating an eating disorder addictive?

SSRIs, a common medication used to treat eating disorders, are not addictive. However, if SSRIs are discontinued too quickly, a patient can experience withdrawal-like symptoms.

Eating Disorder Symptoms 

Symptoms can vary depending on the type of eating disorder. Common eating disorder symptoms include:

• Food and weight loss are a primary concern
• Calorie counting
• Dieting
• Mood swings
• Preoccupation with body size/image
• Isolation from family and friends
• Fatigue
• Noticeable weight loss
• Dehydration 
• Concentration issues 
• Cardiac issues
• Dizziness or frequent headaches
• Muscle weakness

Someone who is diagnosed with an eating disorder can experience a variety of these symptoms at any time.

Effects of Substance Use on Eating Disorders

A 2013 study explained that alcohol was used as a way to self-soothe and regulate emotions related to ED behaviors. There was a link between alcohol abuse and binge eating, with eating disorder symptoms increasing as alcohol use increased. 

Stimulants, thyroid medications and insulin are also commonly used for weight loss and appetite suppression. Withdrawal from substances like alcohol and stimulants can be dangerous for people with ED, as it can worsen ED-related health concerns like cardiac issues, dehydration and other physical symptoms. Withdrawal symptoms like nausea, vomiting or loss of appetite can also affect eating disorder symptoms. 

What Resources Are Available to Me?

If you think you may have substance use disorder or a co-occurring mental health condition, The Recovery Village Cherry Hill at Cooper can help. Our rehab facility is a dual diagnosis treatment center that offers services for substance use and a variety of mental health disorders. Contact us today to learn more about treatment programs that can work well for your needs.