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Eating Disorders are conditions in which a person’s concerns about gaining weight leads to inappropriate behavior related to weight control, food and eating. Those affected by these disorders typically are preoccupied with significant body-image dissatisfaction. A distorted perception of how one appears causes distress about one’s body size and there is confusion about what is a healthy weight or normal body shape. Currently, there are two conditions categorized as Eating Disorders by the American Psychiatric Association. These are Anorexia Nervosa and Bulimia. Both have subtypes which describe specific behaviors unique to each.

Anorexia Nervosa

Anorexia Nervosa, commonly known simply as Anorexia, is an Eating Disorder in which body weight of less than 85% of that appropriate for height and age is maintained. People with Anorexia refuse to maintain an appropriate body weight and use behaviors designed to cause weight loss or to maintain an inappropriate weight. Anorexic behaviors are used to restrict food and/or overcompensate for food that has been eaten. They are unhealthy behaviors that can lead to detrimental physical consequences. Sometimes the consequences of prolonged anorexic behaviors can be life-endangering.

As in both Eating Disorders, in Anorexia Nervosa there is a significant and persistent fear of gaining weight that motivates food and eating related behavior as well as the intensity and frequency of exercise. The fear-based behaviors in this Eating Disorder, however, are motivated by a distorted perception of body size and body shape. Individuals with Anorexia Nervosa perceive themselves as overweight when they are not. Conversely, people with this disorder may perceive themselves to be at an appropriate and satisfactory body weight when malnourished and severely underweight.

Bulimia

Bulimia is an Eating Disorder in which there is a cycle of binge eating followed by behaviors intended to compensate for binging. These behaviors are used to prevent weight gain and typically include purging. Purging behaviors are used to empty the body of food consumed during binges and may include self-induced vomiting, compulsive exercise, fasting or the use of laxatives, enemas and diuretics. As in Anorexia, there is a significant and persistent fear of gaining weight and of being overweight.

Co-Occurring Issues

Both Anorexia Nervosa and Bulimia commonly co-occur with other mental health conditions. Some of these include depression, anxiety, substance abuse and personality disorders. Additionally, many with Eating Disorders have experienced traumatic events. Some who have histories of trauma will have an Eating Disorder along with co-occurring Posttraumatic Stress Disorder. It is not unusual for an individual with an Eating Disorder to have symptoms of all the conditions mentioned here.

Other Forms of Problematic Eating and Common Co-Occurring Disorders

Other forms of problematic eating include overeating or compulsive eating, secretive eating and the fear of eating in front of others. Many with such eating behaviors do not qualify for the full diagnosis of an Eating Disorder such as Anorexia Nervosa or Bulimia. These other eating issues can, however, can cause significant distress, health problems and difficulty in social situations. It is common for such eating problems to arise out of co-existing Depressive Disorders and Anxiety Disorders. Particularly those with depression, social anxiety and generalized anxiety may use an inappropriate eating behavior to cope with symptoms of these other conditions.

Depression and Eating Disorders

Clinical depression and an Eating Disorder are common co-occurring mental health problems. For some, a clinical depression leads to problematic eating and symptoms of problematic eating continue over a period of time an Eating Disorder may develop. On the other hand, an already existing Eating Disorder may precipitate a clinical depression. In either event, a coordinated and simultaneous treatment of the two problems is typically recommended and can be highly successful in resolving both. In fact, there is research evidence that the simultaneous treatment of all co-existing mental health disorders is a best clinical practice.

Anxiety and Eating Disorders

Like serious depression, clinically significant anxiety requires dual diagnosis treatment when it occurs along with an Eating Disorder. Typically, a characteristic of all Eating Disorders, anxiety may, however, be significant enough to warrant the separate diagnosis of an Anxiety Disorder. As with all co-existing disorders, an Anxiety Disorder may have proceeded or given rise to the development of an Eating Disorder or it may have developed after an Eating Disorder was already active.

Problematic Substance Use and Eating Disorders

Substance Abuse and Substance Dependence often co-occur with an Eating Disorder. Similar in their characteristics and dynamics, Substance Disorders and Eating Disorders share what are commonly considered to be symptoms of addiction. Some of these symptoms involve obsession, compulsion and continued practice despite negative consequences. Additionally, many individuals with Eating Disorders will have a problematic use of substances as well. For example, along with other common substances of abuse and addiction such as alcohol, cannabis and amphetamines, some with Eating Disorders will also abuse and/or become dependent upon over-the-counter drugs. These are used primarily for controlling weight and include such substances as diet aids and laxatives.

Borderline Personality Disorder

People with Eating Disorders may have co-existing Personality Disorders that include significant anxiety and self-image problems. Characterized by poor coping skills and chaotic relationships, personality problems can involve impulsive behaviors and efforts to control image such as those found in Anorexia Nervosa, Bulimia, compulsive eating, secretive eating and the fear of eating in front of others. The co-occurrence of an Eating Disorder and Borderline Personality Disorder in particular is common.

Recovery

Recovery from co-occurring Eating Disorders and other mental health conditions requires treatment and support from providers who understand the treatment of dual disorders. Simultaneously coordinated care can address symptoms of both disorders so that a comprehensive plan can be developed. Typically, individual and group counseling are used to enhance insight and facilitate an understanding of the dynamics involved in both conditions. Additionally, education is provided about the nature of co-occurring problems and techniques for coping with each. Treatment may also involve the use of psychiatric services and medications when indicated as well as the use of community resources such as 12 Step self-help groups. Such a thorough and multi-faceted treatment plan is individualized for each person seeking treatment in order to facilitate a complete and lasting recovery.