Mental Health Blogs

Co-Morbid Substance Abuse and Eating Disorders Statistics

This week is National Eating Disorder Awareness week, and I think it is important to highlight the link between eating disorders and substance abuse. As a person who struggled with both, I feel it is important to bring awareness of statistics and research in this area.

Binge Eating Disorder and Substance Abuse

We hear a lot about binge eating disorder in the media, and its high rates in society, however we do not often hear about the high percentage of those who struggle with substance use disorders as well.

In a small study of 404 patients with binge eating disorder (BED), 73.8% had at least one additional lifetime psychiatric disorder, and 24.8% of those were a struggle with substance use disorders. Men had higher lifetime rates of substance use disorders who struggled with binge eating disorder.

This is an important study, because it shows that when people are being screened and treated for an eating disorder, they also need to be screened for other psychiatric disorders, especially substance abuse.

High Incident Rates between Substance Abuse and Eating Disorders

Research shows a significant association between substance use disorders (SUD) and eating disorders (ED). It is estimated by many treatment centers and research studies, that nearly 50% of the patients entering treatment for eating disorders also have a substance use/abuse struggle. When comparing incidence rates between anorexia (AN) and bulimia (AN) in a twin study, there was little incident difference. However in other studies, substance use disorders in patients with bulimia are a higher percentage than those with anorexia.

I personally struggled with a mix of bulimic and anorexic symptoms, and it is important to explain that there are a lot of people who do not neatly fit within the boxes of DSM labels, and each person has a range of eating disorder behaviors, and has different reasons for turning to substances.

Why Do Substance Use Disorders and Eating Disorders Frequently Coexist?

There is no one cause, one explanation, or one pathway to easily explain the co-morbidity between these two struggles. If there is one thing to remember when we are talking about addiction and eating disorders, it is how complex these issues are, and be mindful of any study that claims to have the single “cause” to simplify these issues. The associations are complex, and include biological and psychosocial influences.

Shared Genetic Influences

Research has shown a great amount of evidence for shared genetic influences between substance abuse and dependence and eating disorders. 83% of the phenotype correlation between BN and illicit drug abuse/dependence was accounted for by genetic influences. There are also genetic factors that help explain the association between binge eating and alcohol use, as well as weight preoccupation. To me this says that it is important to look more at the behaviors of the person, than get tied up in the diagnosis of a person when trying to treat them. People, who are susceptible to one struggle, may be more susceptible to another, based on genetic influences, as well as temperament, and personality.

In general, the more severe the behaviors are with people who struggle with an eating disorder, the greater number of substances used. When I mention substances, I mean both legal and illicit drugs and alcohol. There are different reasons for which substance a person chooses to use, and the substances can include alcohol, cocaine, cigarettes, stimulants, prescription drugs, amphetamines, etc. I talk to a lot of people who struggle with eating disorders, disordered eating, substance abuse, dependence, and there is a lot crossover and acceleration of behaviors. I know I escalated mine from drinking, restriction, purging, to a full blown substance dependence and eating disorder struggle, while adding prescription pills. I also saw my self-harm incidences increased.

Recovery, Sobriety, and Being Mindful of Co-Morbid Conditions

It is important to make note that once one gets sober, or enters eating disorder recovery; there lies a likelihood they may seek other ways to “cope”. A lot of people get sober, and then discover they are struggling with body image, food behaviors, self-harm, etc. People in eating disorder recovery, also feel they have no way to cope without their eating disorder behavior and may turn to drugs or alcohol to numb the pain. It is crucial for long term recovery of both to be mindful and address these issues with treatment teams.

Recovery Is Possible

I absolutely believe in full recovery from eating disorders, and freedom from the struggle of addictions. I know there are a lot of differences between the two struggles not only in symptomology, but in identification and labeling. I try not to get tripped up over the differences, and focus on the similarities with the struggles, because I feel when we struggle, there are so many common issues we can relate to, regardless of the specific behaviors, or substances we use. I find this connects us into a community of compassion, understanding, support, and inspiration.

We are not defined by our struggles, we are intelligent, unique people who have struggled with issues, but are capable of fighting for recovery, while healing and pursuing a full life free from the torment that may have existed in our past. We are more than our past or struggles.

If you are currently struggling with an eating disorder, a substance abuse issue, or a mood disorder, please know there is nothing to be ashamed of, and it is important to seek out professional treatment and support. You are not alone, and recovery is absolutely possible and happening every day. As a person who struggled with a mood disorder, a mix of eating disorders and substance abuse and dependence, I feel really grateful because I have connected with so many wonderful people from a variety of fields, and the more I talk about my issues, and these co-morbid issues, the more people feel comfortable coming forward and not only talking about their own struggle, but seeking professional help. In honor of National Eating Disorder Awareness Week I am honored to help give a voice to these issues.

If you have any questions about my struggle, treatment, or research on these issues, please feel free to ask!

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References:

Baker JH, Mazzeo SE, Kendler KS. Association between broadly defined bulimia nervosa and drug use disorders: Common genetic and environmental influences. Int J Eat Disord 2007; 40: 673–678.)

Bulik CM. Drug and alcohol abuse by bulimic females and their families. Am J Psychiatry 1987; 144: 1604–1606.

Franko DL, Dorer DJ, Keel PK, Jackson S, Manzo MP, Herzog DB. How do eating disorders and alcohol use disorder influence each other? Int J Eat Disord 2005; 38: 200–207.

Holderness CC, Brooks-Gunn J, Warren MP. Co-morbidity of eating disorders and substance abuse review of the literature. Int J Eat Disord 1994; 16: 1–34.

Kaye WH, Lilenfeld LR, Plotnicov K, Merikangas KR, Nagy L, Strober M, et al. Bulimia nervosa and substance dependence: Association and family transmission. Alcohol: Clin Exp Res 1996; 20: 878–881.

Slane JD, Burt SA, Klump KL. Genetic relationship between disordered eating, internalizing symptoms, and externalizing behaviors in adult male and female twins. In Behavior Genetics Association Annual Conference, Louisville, KY, 2008.

Young SE, Rhee SH, Stallings MC,Corley RP,Hewitt JK. Genetic and environmental vulnerabilities underlying adolescent substance use and problem use: General or specific? Behav Genet 2006; 36: 603–615.

Walfish S, Stenmark DE,Sarco D,Shealy JS,Krone AM. Incidence of bulimia in substance misusing women in residential treatment. Int J Addict 1992; 32: 425–433.

Welch SL, Fairburn CG. Impulsivity or comorbidity in bulimia nervosa: A controlled study of deliberate self-harm and alcohol and drug misuse in a community sample. Br J Psychiatry 1996; 169: 451–458.

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