Almost 30 million Americans will experience an eating disorder in their lifetime. This is often not talked about in the media likely due to stigma and the many misconceptions about eating disorders. Substance use disorder (SUD), which impacts approximately 20 million Americans, is also often stigmatized and misunderstood. Over the past several years, substance use disorder has gained more attention and understanding, but much more needs to be done for both of these treatable mental illnesses. In order to provide effective care, it is important that we understand the nature of both disorders and the complexities that occur when these disorders intertwine. 

Clearing up Misconceptions Around Eating Disorders

Eating disorders are complex, biopsychosocial illnesses that manifest as a significant disturbance in one’s food intake. Eating disorders impact individuals of all shapes, sizes, genders, race, socioeconomic status, abilities or disabilities, and sexual orientations. There are several misconceptions about eating disorders, including the idea that someone would choose to have an eating disorder and that individuals with eating disorders are just focused on vanity and appearance. The truth is that eating disorders are NOT a choice, and the symptoms of eating disorders are maladaptive ways of coping with distress, trauma, anxiety, depression, or other mental health issues. These facts are also true for substance use disorder. 

Individuals with eating disorders can experience obsessive thoughts about their shape, weight, and food intake, which leads to harmful behaviors and emotional distress. Some of these behaviors include food restriction, binge eating, and purging. These behaviors lead to malnutrition and significant physical, medical, and psychological complications. 

Addiction and anorexia nervosa have the highest and second highest mortality rates amongst all psychiatric illnesses.

When an eating disorder and substance use disorder co-occur, the impact on one’s body and mind is even greater than either disorder alone. The rate of medical complications, mortality, and suicidality increases. Research indicates that 12-18% of adults with anorexia nervosa, 30-70% of adults with bulimia nervosa, and 25% of individuals with binge eating disorder also have a coexisting substance use disorder.

In both eating disorders and substance use disorders, we have learned that genetics and environment play an important role in their development. The variation in different genes contributes to traits that either increase or decrease the risk for these disorders. Some shared environmental risk factors include PTSD, interpersonal traumas, racism, discrimination, modeling of behaviors by peers or family members, and messages from the media and social media. According to research, the best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness. 

Why do Eating Disorders and SUD co-occur at such high rates? 

A substance use disorder can either occur before, during, or even after developing an eating disorder. When someone has an eating disorder, substance use amplifies innate personality traits, such as impulsivity and mood instability, which can make recovery more difficult. Someone with an eating disorder may turn to substances in order to reduce psychological distress and quiet the intrusive thoughts and feelings around food or their body. Other individuals may abuse substances in order to change their appetite or manipulate their weight. Someone with substance use disorder may develop an eating disorder once their appetite has been suppressed by the drug use. They may experience withdrawal from substances and engage in eating disorder behaviors to increase stimulation to the pleasure center of their brain.

Recovering from Eating Disorders and Substance Use Disorder 

Eating disorder and substance use symptoms are typically what causes concern and what leads to one getting help. We call these behaviors “the tip of the iceberg.” The bottom of the iceberg, hidden beneath the surface, contains the underlying emotions and issues that drive the behaviors. In the short term, the symptoms of EDs and SUDs can temporarily allow one to distract, numb, and disconnect from the underlying issues. In the long term, the symptoms of these disorders become out of one’s control and cause more physical and emotional distress.

Recovery involves courageously facing feelings and processing the stressors at the bottom of the iceberg. Recovery may come with feeling difficult emotions at times, but it also comes with feeling joyful emotions and experiences that make life worth living. There is so much life beyond one’s eating disorder and/or substance use disorder. With proper support and treatment, recovery from eating disorders and substance use is possible.

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Dr. Allie Weiser (She/Her) is the Resources Manager at The Alliance and a licensed Clinical Psychologist. She earned her Masters and Doctoral degree in Clinical Psychology from Nova Southeastern University. Dr. Weiser completed two years of post-doctoral residency at The Alliance’s Psychological Services. During time, she gained experience in providing evidence-based psychotherapies and administering psychological evaluations to a wide-range of diverse individuals and families across the lifespan. Dr. Weiser’s passion for the prevention and treatment of eating disorders was solidified during her time at Psychological Services and at a South Florida hospital, where she worked as a member of the multidisciplinary eating disorders treatment team. Dr. Weiser also has a special interest and specialized training in the treatment of obsessive-compulsive and related disorders. Dr. Weiser looks forward to  continuing to advocate for all individuals experiencing eating disorders, providing education to community members and providers, and connecting individuals/families to treatment. In addition, she maintains a private practice in West Palm Beach, Florida. When not working, you can find Dr. Weiser at the beach. For more information about the National Alliance for Eating Disorders, please visit allianceforeatingdisorders.com.