Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder are known as the deadliest mental health disorders. Men and women are usually diagnosed in their teens or early adolescent years however eating disorders can affect men and women of all ages. Eating disorders often occur due to underlying causes such as low self-esteem, mental health disorders, substance abuse disorders, or a past history of trauma or neglect. When an eating disorder such as anorexia nervosa, binge eating or bulimia nervosa occurs with another mental health disorder such as depression or with a substance abuse disorder such as alcohol use disorder, it is coined co-occurring disorders. Co-occurring disorders are defined as having 2 or more mental health or substance abuse disorders at one time and was formerly known as dual diagnosis. The term dual diagnosis is no longer used as the word “dual” often refers to two where individuals may have more than two disorders occurring at the same time. More often than not individuals will only be treated for their specific eating disorder and their depression or anxiety goes untreated. This is problematic because their depression or anxiety could be the underlying problem driving the eating disorder. If the depression or anxiety remains untreated then the individual has a higher chance of relapsing and falling back into their binging and purging behavior. The following are co-occurring disorders that are commonly found with eating disorders:
Anxiety disorders are characterized by an excessive state of worry that does not resolve once the stressor is eliminated. This state of worry can interfere with the individual’s everyday life and can affect their occupation, their personal life and their relationships. Approximately 18% or 40 million adults are affected by an anxiety disorder each year in the United States and these disorders affect one in eight children in the U.S. Anxiety disorders are considered the most common type of psychiatric disorders in the general population. Anxiety disorder often co-occur with eating disorders and the binging and purging behavior can be an unhealthy coping mechanism to control the anxiety.
Depression is a common mood disorder characterized by an intense state of sadness, changes in sleep, changes in appetite, lack of interest, feelings of guilt, decreased energy, poor concentration, psychomotor agitation and suicidal ideations lasting for a minimum of two weeks duration. Eating disorders can lead to depression and depression is known is be a common trigger for eating disorders. Depression is the leading cause of disability in the United States for individuals 15-44 years of age. Lost wages, medications, psychotherapy treatment, suicide treatment, co-occurring mental health disorders and associated medical diseases all contribute to this disability cost. Living with untreated depression can be unbearable and lead to substance abuse, medical disorders and even suicide.
Substance abuse and alcohol are common co-occurring disorders associated with eating disorders and can lead to severe addiction, tolerance and dependence resulting in dangerous and compulsive behaviors. Commonly abused substances include alcohol, opioids, cocaine, marijuana, and benzodiazepines. Death can occur from overdose or in some cases withdrawal and serious medical complications can result from substance abuse and alcohol addiction. Depending on the specific substance, medications can be used to help prevent cravings and ease withdrawal effects. Additionally, psychotherapy is needed in order to teach individuals coping skills and uncover the underlying reason for their addiction.
Self-harm is the deliberate action of causing physical harm to oneself and is a very dangerous sign of emotional distress. According to the Statistical and Diagnostic Manual of Mental Disorders, Fifth Edition (DSM-5), self-harm is formally known as nonsuicidal self-injury disorder (NSSID) as these self-destructive behaviors are carried out without any intention of suicide. Cutting, skin carving, extreme scratching, or burning oneself as well punching or hitting walls to induce pain are examples of self injurious behavior. Other examples include ingesting toxic chemicals, extreme skin picking, hair pulling and deliberate interference with wound healing. Approximately 30% of individuals who engage in self-injury behavior also engage in binging and purging and therefore self-injury commonly co-occurs with eating disorders, especially in the teenage and adolescent populations.
Borderline personality disorder (BPD)
Borderline personality disorder is characterized by unstable and intense moods and interpersonal relationships resulting in impaired impulse control and unhealthy behaviors such as cutting and binging and purging. This personality disorder is classified under Cluster B, which is characterized, by dramatic and emotional. These individuals usually have chronic feelings of emptiness, unstable relationships, unstable self-image, intense anger and a deep fear of abandonment. This is the most over diagnosed personality disorder and is more prevalent in women than men. Personality disorders are often very difficult to treat because they are ingrained since childhood.
Obsessive-compulsive disorder (OCD)
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by intrusive unwanted thoughts known as obsessions that are relieved through repetitive acts known as compulsions. This relatively common disorder results in significant distress and impairment in one’s social, personal and professional life and is known as ego-dystonic meaning the individual realizes these thoughts are abnormal and unpleasant. Fear of contamination followed by ritualistic cleaning, need for symmetry and order followed by organizing, and concerns about losing something valuable followed by hoarding are common obsessive thoughts and compulsive actions that occur with OCD. Eating disorders are a manifestation of self-control and often co-occur with OCD.