Eating Disorders Treatment with Co-Occurring Diagnoses

Despite some disparity estimating the number of people who seek treatment for an eating disorder, there is an ever increasing body of evidence to suggest an eating disorder diagnosis rarely is unaccompanied by at least one other bona fide illness. Those most often identified as “primary suspects” include one or more of the following: recurrent or single episodes of depression, anxiety disorders, bi-polar disorder, attention deficit disorders, post traumatic stress disorder, current or past histories of alcohol and/or drug dependencies, and obsessive compulsive disorders.
By far, the most common are co-occurring mood disorders [e.g. depression, anxiety] and chemical dependencies [e.g. alcohol, drugs].

Suffice it to say, it is important to understand in some instances the mood disorder resolves by virtue of the eating disorder behavior[s] no longer being actively pursued. In yet a few other instances, the primary issue with abusing a drug was more related to controlling someone’s appetite- as may be the case with abusing cocaine or similar stimulants and appetite depressants [e.g. ADD medications]. However, it is more than likely the co-occurring problem traveling along side the eating disorder is a “stand alone” issue that would and will exist independent of resolving the eating disorder alone. Hence, no longer suffering with bulimia, anorexia, or binge eating, a person may still be left with significant symptoms of depression, anxiety, or remain abusing alcohol or drugs. Likewise, treating someone’s depression will not likely, by itself, resolve the eating disorder.

Chicken or Egg

In those instances where someone’s symptoms of marked variations in mood, depression, anxiety, or experiencing a traumatic event with ensuing symptoms of post traumatic stress [e.g. panic attacks, nightmares] pre-date the onset of an eating disorder, it is more than, likely these issues will persist unless addressed along with the eating disorder. In other words, the key phrase here is pre-dated. Depression, as an example, pre-dating the onset of anorexia, might suggest the eating disorder developed as an attempt [albeit misguided] to resolve depressed feelings. “When I see I’ve lost weight, I feel better or, at least, less depressed.” “When I restrict I feel numb.” These are fairly typical experiences most eating disorder professionals hear from their clients or patients. The problem becomes more chronic as someone then learns to rely on the eating disorder as a means of avoiding emotional pain. From my experience, I would suggest the problem here is the eating disorder becomes “addictive” as the sole means of dealing with the painful feelings. Like most addictions, with time, the need to engage in the addictive behavior is no longer to feel good or better, but in fact, to avoid feeling worse. Ask anyone with anorexia what it feels like to eat after a period of relying on restricting to manage emotions. I would further the theory to extend to the other forms of eating disorders with the same intention – namely to manage both physical and emotional feelings.

Chicken Soup

Given the nature of these co-occurring issues, successful treatment involves an approach that pays respect to the entire package that comes with an eating disorder. Doing otherwise it to offer a temporary respite from a complex array of problems that need to be addressed together.

Most people with an eating disorder who “fit the bill” with co-occurring diagnoses are in need of a treatment team rather than a “once size fits all” therapist or physician. It would seem successful treatment involves the availability, expertise and guidance of an experienced therapist, nutritionist [registered dietitian], internist, and psychiatrist at a minimum. In fact, providing a therapeutic setting [preferably residential] in combination with a multidisciplinary treatment team is ideal for devising and implementing a comprehensive treatment plan. In the end, successful outcomes are usually a product of three essential ingredients in the recovery process: a therapeutic alliance between individual and the treatment team, an experienced group of multidisciplinary professionals, and a safe and structured setting from which to begin the recovery process.

For more information about treatment for eating disorders or references, feel free to contact me at mlerner@MilestonesProgram.Org or call 800-347-2364.