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Mental Health

There is a Significant Connection between EDs and Substance Use

— November 7, 2022

Data reveals a strong correlation between eating disorders and substance use disorders.

The National Eating Disorders Association indicates as much as half of all people who struggle with eating disorders (EDs) also misuse alcohol or drugs. Furthermore, as much as 36% of those battling substance use disorders (SUDs) also have an eating disorder. These numbers reveal the troubling connection between substance misuse and problematic eating. They also suggest that clinicians who have patients presenting with one or the other should be asking questions to uncover whether a patient is struggling with both. When an individual has both an SUD and ED, tackling both in treatment is vital in order for the person to heal sustainability. If only one condition is addressed, the presence of the other unaddressed problem could lead to relapse and make full recovery impossible.

Let’s take a look at each of these conditions in turn in order to better understand the connection between them…

EDs involve unhealthy eating patterns that can be detrimental to one’s mental, emotional and physical health and well-being. There are three main types of EDs. These include:

Anorexia nervosa: This involves greatly restricting caloric intake in order to maintain control of one’s weight. 

Bulimia nervosa: Individuals with this disorder intake a far greater amount of food than is required to remain healthy and vomit after meals in order to maintain a low body weight.

Binge eating disorder: This includes eating very large amounts of food in a short amount of time. Individuals with this disorder tend to hide food and binge in secrecy. 

There is a Significant Connection between EDs and Substance Use
Photo by Andres Ayrton from Pexels

There are also lesser known EDs including pica, which involves eating inedible and often dangerous objects such as chalk, dirt, and paint chips, Avoidant Restrictive Food Intake Disorder (ARFID), which involves steering clear of certain foods to the point that it impacts a person’s health because the individual has a phobia of choking or vomiting if they do eat those foods, and rumination disorder, which includes excessive chewing or chewing and swallowing of food only to regurgitate it in order to maintain a low body weight.  There are also other EDs recognized in the latest Diagnostic and Statistical Manual of Mental Health Disorders (DSM V-TR). Many include excessive laxative use, self harming behaviors (i.e., cutting) and other maladaptive behaviors all linked to poor self-image and low self-esteem.

If one takes a look at the addictive properties behind problematic eating, it may not be all that surprising that an individual with an ED would also be living with an SUD. Moreover, SUDs tend to keep a person from eating. Instead of intaking food, an individual engages in substance use. Thus, an individual who is obsessively trying to maintain a certain body weight with an ED might also turn to substances to achieve this goal.

Here are some troubling statistics demonstrating the overlap between the two:

When anorexia nervosa is present, 27% of sufferers will develop a substance use disorder. Of those living with bulimia nervosa, 36.8% will develop a substance use disorder. When a person has binge eating disorder, 23.3% will also develop a substance use disorder.

In addition to poor body image (and body dysmorphic disorder), other shared traits between EDs and SUDs that tend to link the two include trauma, poor coping mechanisms for stressful situations, genetics, and modeling of these problematic behaviors in childhood. Certain personality types may also contribute to the development of EDs and SUDs, especially if an individual has a diagnosable Cluster A or Cluster B personality disorder, an anxiety disorder, or a mood condition.

The medical community and mental health professionals can tackle the presence of EDs and SUDs with a combination of medication and psychotherapy. Antidepressants, mood stabilizers, and medications to reduce anxiety can help along with (depending on the patient’s presenting concerns) cognitive-behavioral therapy, dialectical-behavior therapy, acceptance and commitment therapy or psychodynamic work. When both conditions are adequately addressed, the prognosis for remission is relatively high. The first step, though, is accepting that a problem exists and seeking help.


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