Eating disorders are considered one of the leading causes of death of all mental health disorders. The three main eating disorders that are recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are anorexia nervosa, bulimia nervosa and binge eating disorder. Another type of eating disorder that is less common but is recognized by the DSM-5 is avoidant restrictive food intake disorder.
The prevalence of all these eating disorders combined is approximately 10 percent of people in the United States, according to the National Association of Anorexia and Associated Disorders. Eating disorders can occur by themselves, but many times the person also has a co-existing mental health disorder which makes treatment even more difficult, as treatment must aim at treating both the mental health disorder and the eating disorder.
Anorexia nervosa is diagnosed when severely underweight people go through extreme measures to prevent the intake of calories to either lose weight or to prevent themselves from gaining weight. These extreme measures may include restricting food intake, extreme exercise or purging. Anorexia nervosa leads to many physical complications, not to mention the mental disorders that co-occur. Patients with anorexia nervosa are more at risk for depression, anxiety and obsessive-compulsive disorder. These psychiatric conditions often go hand in hand with anorexia nervosa.
“A psychological profile for a patient with anorexia nervosa often demonstrates premorbid anxiety disorders, as well as more severe affective disorders, such as major depression and dysthymic disorder. Patients may also have symptoms of obsessive-compulsive disorder, with rigid and ritualistic eating behaviors. The study by Nicholls and colleagues found that of 208 individuals who met the criteria for an eating disorder, 41 percent had significant comorbidity (other psychiatric diagnoses) and 44 percent had a family history of psychiatric disorders,” according to an article released in Medscape.
Bulimia nervosa is diagnosed when a patient of normal weight binges and purges in order to maintain control. The main difference between anorexia and bulimia is that people with anorexia are underweight and people with bulimia are of normal weight. Binging consists of eating extreme amounts of food in a short amount of time followed by a purge. The purge can be in the form of self-induced vomiting as well as diuretic and laxative use. Patients with bulimia nervosa partake in these binge-purge episodes at least once a week.
As with anorexia nervosa, mental disorders also co-exist with bulimia nervosa. Depression, bipolar disorder, obsessive-compulsive disorder, generalized anxiety disorder and post-traumatic stress disorder are all types of psychiatric illnesses that co-occur with bulimia nervosa. The physical body serves as representation for the individual’s emotional state. People use the control brought by binging and purging to hide or heal their negative emotional feelings that are brought about by depression or anxiety. That is why the eating disorder as well as the underlying psychiatric condition must be treated, because treating one without the other will just perpetuate the cycle.
Co-occurring substance use disorders
Eating disorders are also deeply connected with substance use disorders. According to The National Center on Addiction and Substance Abuse (CASA) at Columbia University, up to one-half of individuals with eating disorders abuse alcohol or drugs, compared to 9 percent of the general population. Up to 35 percent of drug abusers have eating disorders, compared to 3 percent of the general population. Both eating disorders and substance abuse disorders have a similar underlying mechanism, the obsessive preoccupation with control and are often linked to psychiatric disorders such as depression.
According to the CASA report: “Bulimic women who are alcohol dependent report a higher rate of suicide attempts, anxiety, personality and conduct disorders and other drug dependence than bulimic women who are not alcohol dependent.” There is a strong link between eating disorders, substance abuse and other mental health disorders. Eating disorders and substance abuse disorders often develop as a means to cope with an underlying mental health issue such as depression and anxiety.
Unfortunately, treatment for eating disorders alone is difficult. Approximately 10 percent of patients with eating disorders will experience complications as severe as suicide. Meta-analysis by Arcelus and colleagues suggests that 1 in 5 people who died from anorexia nervosa had committed suicide. When you throw in a co-existing disorder such as depression or substance abuse, these statistics worsen.
The first step to treatment is seeking help for the eating disorder. Depending on the severity of the condition, inpatient or intensive outpatient treatment is necessary followed by years or even lifelong follow-up therapy sessions. Psychiatric conditions are similar to medical conditions in a sense that they do not disappear once treatment has started. A person with hypertension (aka high blood pressure) generally has to be on anti-hypertensive lifelong therapy and follow-up visits to monitor for complications. This is no different than treating a patient with an eating disorder or a mood disorder.