Eating disorders may not be as common as other mental illnesses when it comes to dual diagnoses, but there are many people suffering from eating disorders and substance abuse issues at the same time. Eating disorders typically affect the eating habits of a person, as well as their associated thoughts and emotions. Patients are often obsessed with controlling their body’s shape, weight, and the amount of food they eat.
In the United States, as many as 20 million women and 10 million men struggle with eating disorders. When a person with an eating disorder turns to drugs, this is usually because they want to numb their physical pain as well as their emotional pain that causes them anxiety and depression. If you are curious as to how substance abuse and eating disorders co-occur, then this article will shed light on that.
What Are the Types of Eating Disorders
There are a variety of eating disorders that one can suffer from. Each of them has its own causes, symptoms, and even the right treatment approaches to use. While these are different types, they all cause patients to have an incessant preoccupation of their physical appearance. Here’s what you need to know about the different types of eating disorders:
- Anorexia nervosa – is an eating disorder that causes a patient to view or see themselves as someone who is overweight, even if they are severely underweight in reality. They restrict their diets and constantly check on their weight loss “progress”. People suffering from this mental illness are usually afflicted with osteoporosis, brittle hair and fingernails, as well as low blood pressure.
- Bulimia nervosa – is a disorder that causes a person to constantly binge on food in large amounts, and then force themselves to vomit. These people may also exercise excessively, avoid eating for long periods, and use laxatives to get rid of what they have eaten. They usually suffer from gastrointestinal problems, tooth decay, and severe dehydration because of forced regurgitation and laxative abuse.
- Binge-eating disorder – is a disorder that is most common among people in the US. This is characterized by inability to cease eating. This causes people to rapidly consume excessive food over a short amount of time, and are usually linked with feelings of depression and shame.
- Body dysmorphic disorder – is a disorder that causes a person to constantly think about the flaws in their body. They are fixed on their body image and usually spend hours criticizing their appearance in the mirror. Experts reported that body dysmorphia is not an eating disorder, but because the patient mainly points out flaws in their body constantly, it can eventually lead to an eating disorder in the long run.
- Pica – this usually involves a person eating things instead of food. This could be anything. Most of the time, patients can be found eating dirt, cloth, hair, buttons, nails, etc at least once a month. Most of the time, patients with pica are diagnosed with intestinal blockage, poisoning, and infections from consuming dangerous, non-food items.
- Avoidant or restrictive food intake disorder – this condition is seen in a patient’s refusal, avoidance or lack of interest in food as based on its texture, color or irrational thinking like concerns about choking on it. Because of this illness, patients fail to meet the daily nutritional requirements needed to gain weight or experience weight loss.
- Rumination disorder – this is a condition where a patient constantly regurgitates their food after each meal. In comparison to bulimia where patients force themselves to throw up their food, patients with rumination disorder throw up or expel their food involuntarily. This condition is common among infants as well as people with cognitive disorders.
- Other specified feeding disorder or eating disorder – disorders may be labelled with this if they meet the conditions of disordered eating but may not be enough to warrant any of the labels above. This way, the person can still receive treatment for their harmful habits, while not necessarily meeting the criteria of any of the other diagnoses.
Which eating disorder is mostly associated with substance abuse?
According to reports, bulimia nervosa and substance abuse is more prevalent than anorexia nervosa or any other disorders listed above. Bulimic and anorexic patients are known for eating/purging, and are most likely to use drugs as part of their condition. It has been found that patients who suffer from bulimia have the highest rates of alcohol consumption, while those with anorexia are the least to use alcohol or drugs compared to other types of eating disorders.
People with eating disorders were found to use and abuse various types of substances namely sedatives, caffeine pills and marijuana. There are also those who take stimulants, opiates, hallucinogens, inhalants, cocaine/crack and phencyclidine. In some cases, individuals with eating disorders may also abuse legal or prescribed substances like:
- Diet pills
- Artificial sweeteners
- Diuretics
- Laxatives
- Nicotine
- Thyroid hormones
The Role of Substance Abuse
Those who are suffering from eating disorders may see drugs or alcohol as an appealing way to get relief from their conditions. Since some drugs come with benefits to those who are dealing with eating disorders, patients believe that it can help suppress their appetites or feel just a little bit better about not eating or craving food. This is also true to those who are desperately hungry but want to keep away from eating, because if these drugs can help their hunger or cravings disappear, they will see this as a useful tool.
However, the association between eating disorders and substance abuse are not fully understood. Drug abuse could begin before or after the onset of the eating disorder, or if it is used as a cover for another disorder.
There are several theories as to why eating disorders and drug/alcohol abuse co-occur. One is that eating disorders mirror a lot of habits of addiction, such as compulsion, secrecy, self-harm, etc. It could also be a shared biological factor or genetics and environmental risk factor like trauma. In recent studies, it suggested that substance use disorders and eating disorders share the same genetic risk factors that led them to the condition.
They also share the same risk factors like impact on the brain chemicals dopamine and serotonin, family history, depression, anxiety, low-self esteem, and even an onset of stress. Not only that, in terms of peer pressure, vulnerability to social media and ads, and childhood history also play a big role in developing these disorders.
People with SUD and eating disorders are also more prone to relapse, and at higher rates. They also have more severe medical complications than those who ONLY have eating disorders alone. Both conditions can lead to death and even a greater mortality rate than for each alone.
Treatments: SUD vs. Eating Disorders
Since both eating disorders and SUDs have high comorbidity, anyone who is being treated for one must be assessed for another condition. However, professionals who treat one disorder may not always detect the other. That being said, it is crucial that the health care professionals must understand bother disorders and treat them separately.
Treatment for substance use disorder should help patients increase their abstinence and restraint from substances. They are also encouraged to join and participate in self-help programs like AA in order to reduce the risk of relapse.
Meanwhile, treatment for eating disorders requires aggressive psychological intervention, medical management, and nutrition. The primary goal for this is to reduce overcontrol and eliminate food restriction in order to normalize eating patterns. Self-help programs are not really recommended to treat eating disorders, nor are they effective in preventing relapse. Because of this, both disorders must be treated together. However, unfortunately they are rarely able to be treated together since not a lot of patients willingly admit that they have other underlying disorders that may need to be addressed.
As a result, the treatments provided are in a sequential manner without integrated, holistic treatment programs. Because of this, patients who are treated for SUD may experience an increase in eating disorder symptoms while in recovery for addiction, and vice versa. That is why when it comes to treating both disorders, it is best for patients to learn and understand that they must abstain from substances, and that food is good for the body and meant to nourish it in a healthy way. It is also a must for them to increase their control over substance use and decrease their control over eating. This type of treatment approach can help address both disorders in the best way possible.
