addressLocality Complicated Relationship Between Substance Abuse and Eating Disorders
Complicated Relationship Between Substance Abuse and Eating Disorders

What are Eating Disorders?

It’s not just about food — and eating disorders are more than just a strict diet. Anorexia nervosa, bulimia nervosa, binge eating disorder and other types of eating disorders are serious and potentially life-threatening conditions that affect about 30 million men and women at some point during their lives.

The symptoms of eating disorders vary by condition (e.g., anorexia nervosa) and person, but all eating disorders are marked by severe disturbances in a person’s behaviors toward food and body weight. Eating disorder behaviors are often fueled by body dissatisfaction, low self-esteem and a preoccupation with food, body shape and weight.

Medical Complications of Eating Disorders

People with eating disorders will engage in extreme and unhealthy behaviors such as fasting, binge eating, excessive exercise, laxative or diuretic misuse and self-induced vomiting, in an effort to control body weight and shape. For example, common symptoms of anorexia nervosa include an intense fear of gaining weight and the severe restriction of calories to lose weight or prevent weight gain, while bulimia nervosa is characterized by episodes of binging and purging to compensate for consumed calories.

Due to the wide range of unhealthy behaviors that clients exhibit towards food and eating, eating disorders have the highest mortality rates of all mental disorders, with at least one person who dies every 62 minutes due to the direct effects of an eating disorder. That’s because clients who exhibit eating disorder behaviors often engage in unhealthy behaviors towards eating and food which can exacerbate or bring rise to certain mental health or medical conditions.

In many cases, eating disorders can occur at the same time as other medical and mental health conditions. For example, due to the compulsion to engage in extreme and unhealthy behaviors, men and women are at risk of serious medical conditions such as anemia, brain damage, multiorgan failure, osteoporosis (i.e., the thinning of the bones), kidney, stomach and liver problems, and even death. Seeking early treatment for an eating disorder is important because they can lead to serious health problems.

Challenges in Treating Comorbid Eating Disorders and Substance Abuse

In addition, about half of people who are diagnosed with an eating disorder also meet the diagnostic criteria for a concurrent addiction or mental illness (e.g., anxiety, depression, trauma and post-traumatic stress disorder, attention-deficit/hyperactivity disorder, self-harm, obsessive-compulsive disorder, etc.), according to the National Eating Disorders Association (NEDA). People who have eating disorders also commonly abuse over-the-counter (OTC) medications such as laxatives, diuretics, emetics and appetite suppressants to control their weight.

When an eating disorder occurs along with substance abuse or another mental health condition, it can make treatment and recovery more challenging. One reason is due to a phenomenon known as symptom substitution, which can become problematic because a client can replace one problematic behavior like binging and purging with another unhealthy behavior (e.g., self-harm, substance abuse).

In treatment settings that focus solely on addressing the symptoms of the eating disorder, but fail to address concurrent substance abuse, clients may turn to alcohol or drugs to find relief in an attempt to cope with distress and painful emotions that arise. Untreated substance abuse in clients with eating disorders can also compound health and psychological (e.g., low self-esteem, depression, anxiety, self-harm) issues that often occur at the same time as eating disorders.

Addressing Comorbid Substance Abuse and Eating Disorders

Despite the high comorbidity of eating disorders with other mental disorders and medical conditions, many clients do not receive treatment for both conditions at the same time. To combat this, eating disorder treatment needs to identify and target eating disorder behavior at the same time as substance abuse, depression and other co-occurring conditions.

At AKUA Mind & Body, our clinical team understands that focusing solely on eating disorder behaviors during treatment can make co-occurring conditions such as substance abuse or self-harm more prominent when eating disorder behavior stops. AKUA’s new Eating Disorder Track — MALANA — provides specialized care to women with a co-occurring substance use disorder and eating disorder in a safe and loving environment so they can focus on healing the body and mind. For more information about AKUA’s MALANA Eating Disorder Track, contact our 24/7 Admission Helpline.


  • Kristen, is a clinical content writer and enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine. She is a family medicine physician and author, who also teaches and contributes to medicine board education. Her passion lies within educating the public on preventable diseases including mental health disorders and the stigma associated with them. She is also an outdoor activist and dog enthusiast.

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