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The Connection between Eating Disorders, Substance Use

Updated: Oct 4, 2023

The National Eating Disorders Association has revealed that as many as half of all individuals living with an eating disorder (ED) also misuse alcohol or drugs. Moreover, as much as 36% of those who have a substance use disorder (SUDs) also have an eating disorder. The connection between substance misuse and problematic eating is due to many factors which can be uncovered by a skilled clinician so a person struggling can heal sustainably.


EDs involve maladaptive patterns of eating which can significantly impact one’s health. The three most common EDs include:


Anorexia nervosa: Restricting caloric intake in order to maintain control of one’s weight.


Bulimia nervosa: Eating a large amount of food, then purging after meals.


Binge eating disorder: Consuming an excessive amount of food in a short period of time. (Individuals with this disorder tend to hide food and eat in secrecy.)


There are also lesser known EDs, including …


Avoidant Restrictive Food Intake Disorder (ARFID): Avoiding certain types of food to the point that it’s detrimental to one’s health because of a phobia of choking or vomiting.


Pica: Craving and eating inedible and often dangerous objects.


Rumination disorder: Excessive chewing or chewing and swallowing of food only to regurgitate it.


There are also other EDs recognized in the latest Diagnostic and Statistical Manual of Mental Health Disorders (DSM V-TR). In addition to substance misuse, many of these include excessive laxative use and self harming (i.e., cutting) behaviors.



Why is there such a strong connection?


Eating disorders and substance use disorders both involve impulsive-compulsive, addictive behaviors. Individuals living with EDs and SUDs both tend to have a need for control, poor body image, low self-esteem and be lacking proper coping mechanisms for stress. Also, specific drugs can help individuals maintain a low body weight. For example, those with anorexia nervosa may turn to caffeine, weight loss drugs, amphetamines or cocaine because these all decrease appetite. Individuals with anxiety-induced EDs may also use benzodiazepines or alcohol to calm the nervous system.


Here are some troubling statistics demonstrating the overlap between EDs and SUDs:

As many as 27% of those living with anorexia will develop a substance use disorder. Of those living with bulimia nervosa, 36.8% will develop a substance use disorder. And, among binge eaters, 23.3% will also develop a substance use disorder.


What causes EDs and SUDs?


Many factors can lead to the development of an eating disorder and/or substance use disorder, and it is up to a skilled clinician to identify underlying factors that may be contributing to these issues. Childhood trauma, sometimes referred to as adverse childhood experiences (ACES), is commonly linked to the development of maladaptive eating and substance use patterns. Children who have been abused, neglected, or abandoned are not only at high risk of developing a subsequent addiction but they may also develop a personality disorder that ultimately causes these addictive behaviors.


For example, a person who felt abandoned in childhood may never heal from their abandonment wounds and could go on to develop borderline personality disorder (BDP), especially if they are predisposed genetically. BPD involves lack of stability in relationships, mood, and in almost all other areas of a person’s life. They may then turn to EDs and SUDs to try to maintain control when everything else is so chaotic.


In general, individuals with Cluster A or Cluster B personality disorders, an anxiety disorder, or a mood condition often develop addictions that serve as unhealthy coping mechanisms. Drugs and alcohol are also commonly used in order to numb the pain of a toxic living environment. A person living in an abusive home may turn to substances to cope. They may also develop an ED in an attempt to maintain control over an otherwise uncontrollable situation.


Extreme stress (which, when prolonged, could lead to Acute Stress DIsorder) might also cause EDs and/or SUDs. Again, using substances and engaging in problematic eating are fleeting attempts to maintain control and reduce stress.


Treatment Options for Tackling Comorbid Disorders: EDs and SUDs


An individual struggling with co-existing disorders, and who recognizes the need for help, should talk with both their physician and a mental health professional. A psychiatrist or a family doctor can prescribe medication that can help reduce symptoms and allow an individual to deal with past trauma and/or current stressors in a healthier way. Some commonly prescribed medications for this purpose include antidepressants, mood stabilizers and anti-anxiety drugs. Prescription medications can replace illicit drugs, more effectively managing symptoms.


A mental health practitioner can address psychological distress contributing to an individual’s need for substances and disordered eating. Some treatment methods that have proven to be effective include:


Cognitive-behavioral therapy (CBT). CBT helps an individual reframe negative thought patterns in order to develop a healthier self-concept. The patient and the therapist examine together the thoughts that enter a person’s mind right before they engage in destructive habits. Once these are recognized, the patient can develop strategies to change these thoughts and behaviors.


Dialectical-behavior therapy (DBT). Originally developed for treating BPD, DBT has since expanded into the addictions area and has even been used to treat other mental health issues. This form of therapy involves using mindfulness, working on emotional regulation and interpersonal effectiveness, coping ahead, and building distress tolerance skills. All of these skills can be used to address EDs and SUDs by helping a person develop long-term strategies to build self-awareness and better relationships while decreasing the desire to engage in unhealthy behaviors.


Psychodynamic work. This approach to therapy allows a person to address past traumas, and in doing so, recognize relational and behavioral patterns that are conducive to EDs and SUDs. Psychodynamic therapists may work with individuals to heal their inner child wounds that ultimately led to the development of personality disorders, EDs, and/or SUDs. The purpose is to address these issues at their core in order to build self-awareness and break unhealthy patterns once and for all.


It is very difficult to break maladaptive behaviors without help. However, it is possible to recover from both EDs and SUDs with proper treatment. The first step is to recognize that a problem exists and become determined to tackle it head on. From there, a person can ask for help and begin their recovery journey.


For more information, please check out The Recovery Village's comprehensive guide titled 'What is The Connection between Eating Disorders and Addiction?'

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