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Eating Disorders & Common Co-Occurring Disorders


The term “co-occurring disorders” refers to an individual being affected by two or more psychiatric disorders at the same time. This can also be referred to as “dual diagnoses”. When an eating disorder occurs concurrently with another diagnosis and it is not identified or addressed, it can significantly interfere with the recovery process and contribute to relapses.   

Co-occurring disorders require proper assessment and evidence-based treatment that is tailored to the unique individual’s experience. This can be particularly complicated when eating disorders are involved because malnourishment and low body weight can induce or amplify psychiatric symptoms that may mimic other disorders such as anxiety and depression.  

At the Center for Eating Disorders we provide thorough assessment, including formal psychological testing when necessary, to properly identify and rule out any co-occurring disorders. This is a necessary step to ensure that an individual’s treatment plan can appropriately address any intersection of co-occurring disorders and promote holistic healing. Some of the most common co-occurring disorders in individuals with eating disorders include:

Depression

Most of the research indicates that 50- 75% of patients with eating disorders will also experience major depression at some point in their lives. However, given that malnourishment can intensify depressive symptoms, it remains unclear what proportion of major depressive disorder diagnoses can be seen as a result of starvation as opposed to an independent disorder. It’s important to note that individuals with eating disorders and a history of depression may also be at increased risk for suicide.

Anxiety Disorders

About 2/3 of the individuals with eating disorders will struggle with one or more anxiety disorders in their lifetime.  Anxiety disorders most commonly co-occurring with eating disorders are Obsessive Compulsive Disorder (OCD) and Social Phobia. Others include Generalized Anxiety Disorder, specific phobias, and PTSD (see below).  Studies suggest that early-onset anxiety disorders may represent a risk factor for the development of anorexia nervosa and bulimia nervosa later in life.

Post-Traumatic Stress Disorder (PTSD)

There is a high co-occurrence of trauma and eating disorders. PTSD is a type of anxiety disorder that can develop following exposure to a traumatic event that threatens your safety or makes you feel helpless.  Such events can include physical or sexual abuse, military combat or a natural disaster. Click here to read more about trauma symptoms and our specialty treatment track for patients with co-occurring eating and trauma disorders.

Alcoholism / Substance Abuse

About half of all individuals with eating disorders also struggle with a substance use disorder. Because it’s important to address both disorders simultaneously, the Center for Eating Disorders provides a specialty treatment track for patients with substance abuse and eating disorders. Click here to read more about the intersection between these two diagnoses.

Borderline Personality Disorder (BPD)

BPD is one of several different types of personality disorders that can impact and interfere with a person’s daily life. It is associated with problems in interpersonal relationships, self-image, emotion regulation, impulsive behaviors, and stress-related changes in thinking. The prevalence of rate of BPD in people with eating disorders is about 6-11% which is slightly elevated when compared to 2-4% in the general population. Conversely, people with BPD have a greater prevalence of eating disorders, with one study reporting that 53.8% of patients with BPD also met criteria for an eating disorder.1

Self-Injury / Self-Harm

Self-injurious behavior is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions. The prevalence of non-lethal self-injury among ED patients is approximately 25%.  Self-harm is most common in adolescence and young adulthood, usually first appearing between the ages of 12 and 24. About 25% of self-harming individuals with eating disorders also meet the criteria for borderline personality disorder.2

Management and blockade of eating disorder behaviors is usually a necessary step in effectively addressing the co-occurring disorders. Seeking treatment for depression or anxiety alone, while still continuing to act on an eating disorder is not effective. Furthermore, in some cases adequate nutritional intake and balanced eating can go a long way in helping to alleviate other behavioral symptoms such as depression.

You may also be interested in the following links:

References:

1.    Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR.  (2004). Axis I Comorbidity in Patients with Borderline Personality Disorder: 6-Year Follow-Up and Prediction of Time to Remission.  American Journal of Psychiatry. 161:2108-2114.

2.    Sansone, RA,  Levitt, JL, Sansone, LA. (2003). Eating Disorders and Self-Harm: A Chaotic Intersection. Reprinted from Eating Disorders Review. May/June. Volume 14, Number 3.  Available:  http://www.bulimia.com/client/client_pages/newsletter17.cfm
 

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