Eating Disorders Don’t Stand Alone

Whenever I meet with clients struggling with eating disorders, they tend to exhibit additional mental health struggles.  Research shows that there is a high prevalence of psychiatric comorbidity in both men and women presenting with eating disorders (Ulfvebrand et al., 2015).  This is an essential part of understanding eating disorders as symptoms that don’t just have to do with food, willpower, and vanity, but as maladaptive coping strategies that many use to deal with underlying mental health issues and attempt to address emotional dysregulation.  Moreover, sometimes an eating disorder can give rise to or worsen symptoms of already-existing mental health conditions. 

How Prevalent are These Co-occurring Conditions?

In 2007, Hudson and colleagues conducted a U.S. research study with approximately 3,000 adult participants who had eating disorders. Of these, 56.2% with anorexia , 94.5% with bulimia, and 78.9% with binge-eating disorder (BED) met symptom criteria for another mental health condition: anxiety, mood, impulse-control, and/or substance use disorders. In fact, at least 1/3 of these participants met criteria for three or more mental health disorders (Hudson et al., 2007). 

A more recent study in 2015 assessed 11,588 adult men and women at eating disorder clinics in Sweden. Results showed that 71% of these patients with eating disorders had at least one other mental health disorder. Those with the highest levels of comorbidity were women with BED and men with bulimia (Ulfvebrand et al., 2015).

What Are Some of These Co-Occurring Conditions?

Mood Disorders

Some prevalent mood disorders that individuals with eating disorders tend to exhibit include major depressive disorder, dysthymia, bipolar disorder, and various unspecified depressive or mood disorders. Around 40% of females and males with eating disorders each exhibit mood disorders, with the most prevalent being major depressive disorder (Ulfvebrand et al., 2015).

Anxiety Disorders

Further research shows that the most prevalent co-occurring conditions for both females and males with eating disorders are anxiety disorders (53%), with generalized anxiety disorder (GAD) being the most common of these diagnoses. Along with GAD, some other common co-occurring anxiety disorders include the following: obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), panic disorder, specific phobias, and social phobia (Ulfvebrand et al., 2015). Specifically, certain national studies have demonstrated that individuals with bulimia and binge-eating behaviors exhibit significantly higher rates of PTSD than individuals without an eating disorder (Mitchell et al., 2012).

Substance Use/Abuse

For individuals with eating disorders, some common co-occurring substance-related pathology includes both dependence and abuse of alcohol and/or illicit substances. Approximately 10% of females and males with eating disorders each present with co-occurring substance use and/or dependence, with the most prevalent being alcohol dependence (Ulfvebrand et al., 2015).

Personality Disorders

Personality traits and pathology can also affect eating disorder symptomology.  The most prevalent personality disorders associated with eating disorders are obsessive compulsive personality disorder and borderline personality disorder.  The former is related to anorexia nervosa, restricting type as the obsessive personality can lead the individual to enforce restrictive eating rules and patterns.  Meanwhile, the latter, which often forges impulsive eating behaviors, is associated with anorexia nervosa, binge/purge type and bulimia (Sansone & Sansone, 2011).

Other Disorders

According to Ulfvebrand and colleagues (2015), approximately 8% of females and males with eating disorders each exhibit co-occurring somatoform disorders (mental disorders that manifest as physical symptoms) and 0.5% of females and 1% of males demonstrate psychosis.

Comprehensive Treatment is Necessary

Having a co-occurring condition with an eating disorder adds another significant layer to the individual’s recovery – not only do they have to address the behaviors, feelings, and thoughts specifically related to their eating disorder, but they also have to deal with various components of any other mental disorders in order to enhance their treatment. A failure to recognize and address these comorbid conditions can impact the treatment and recovery outcome for the individual.  Without addressing these other mental health symptoms, the individual is prone to resorting to eating disorder behaviors or other maladaptive coping skills to regulate their distressing emotions.  This is why psychotherapy is such an integral part of the recovery process, in order to comprehensively address all distressing symptoms and provide tools for emotional regulation.