Eating disorders are treatable with the help of mental health professionals and nutritionists, but if co-occurring disorders are present, they can complicate the treatment plan. Although many physical illnesses may result from eating disorders and issues like substance abuse are common co-occurring disorders, the instance of mental health disorders is present in most cases of an eating disorder. For this reason, any long-term eating disorder recovery should begin with a careful evaluation that not only identifies the type and severity of the eating disorder an individual has but also any co-occurring mental health disorders they might have.
As we’ll see, it’s quite rare for an eating disorder to exist in isolation. Most people with an eating disorder have also received a diagnosis of a mental health or personality disorder, which can be both a trigger for the eating disorder behaviors as well as being caused by them. The cycle of eating disorders and their co-occurring conditions can be difficult to break; many people who have completed an eating disorder treatment program find themselves facing a relapse when their mental health condition rears its head. This can complicate the methods of treatment used for eating disorder recovery because the two different disorders influence each other and require specialized treatment.
In this article, we’ll outline some of the more common co-occurring mental health disorders that arise in conjunction with eating disorders like binge eating disorder, anorexia nervosa, and bulimia nervosa, as well as the kinds of treatment methods that can be used to address them.
What Mental Health Disorders Are Common With Eating Disorders?
Borderline Personality Disorder
Over 25 percent of people that have been diagnosed with bulimia nervosa, anorexia nervosa, or binge eating disorder also have some form of borderline personality disorder. Borderline personality disorder is a mental illness in which the individual experiences low self-esteem, extreme emotional instability, and, usually, a strong fear of abandonment. The disorder can kickstart eating disorders like anorexia nervosa or make them worse by playing on a person’s low self-image and negative emotions which cause disordered behaviors.
Borderline personality disorder is considered to be one of the hardest mental health illnesses to diagnose and treat. Unlike other psychiatric disorders, borderline personality doesn’t have a clear neurochemical cause that can be addressed with medications (similar to eating disorders). Therefore, even though some medications such as antidepressants can help slightly, talk therapy and cognitive therapy are the most common methods used to treat BPD.
Obsessive-compulsive personality disorder, commonly shortened to OCD, affects over 22 percent of men and women with anorexia nervosa – in contrast, only 6 percent of the general population is thought to suffer from this acute disorder. Researchers think this implies a strong connection between the two types of disorder, which is also evidenced by the similar symptoms shared between OCD and many eating disorders.
As with eating disorders like binge eating disorder and bulimia nervosa, OCD sufferers have “perfectionist” tendencies and engage in repetitive actions as a way to cope with stress and anxiety. In most cases of OCD, the person fears something bad will happen to them or a loved one if a specific action isn’t taken. These compulsive behaviors can severely interfere with a person’s psychosocial health; everything from employment to personal relationships can be affected. The staff at most eating disorder recovery centers will address OCD while simultaneously developing an individualized eating recovery treatment plan. Psychiatric treatments for OCD include a combination of CBT, talk therapy, and medications such as serotonin reuptake inhibitors, or SSRIs.
Post-Traumatic Stress Disorder is perhaps the most prominent trigger for disordered eating behaviors. As many as 25 percent of people with anorexia nervosa or bulimia nervosa are estimated to experience trauma and have symptoms of PTSD at some point in their lives. One of the reasons for the potency of PTSD as a trigger for eating disorders is that the strongly negative emotions caused by PTSD episodes can be alleviated by serotonin, which is released by disordered eating behaviors like binge eating or purging.
PTSD is also concurrently treated at eating disorder treatment centers. Like BPD, it’s not usually treated with medication in an ongoing sense, although anti-anxiety medications can be used to deal with acute episodes and panic attacks. CPT is currently considered the most effective form of talk therapy for PTSD since it specifically focuses on addressing past events rather than a more general sense of self-awareness that comes from mindfulness exercises.
What Kinds of Treatment Work for Both Mental Illnesses and Eating Disorders?
Both obsessive-compulsive and borderline personality disorders tend to worsen the distinctive symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. The negative emotions and anxieties caused by PTSD, OCPD, and borderline personality disorder can trigger coping mechanisms like a binge eating episode, or an urge to exercise well beyond the point of pain or injury. This becomes a repeated pattern of behavior as can be observed in cases of OCPD.
In both cases of PTSD and borderline personality disorder intensifies the urge for patients to want to “control” their food intake and body appearance. Feelings of loss of control are frequent symptoms of virtually all eating disorders, and they can be addressed in both individual and group therapy.Therapists at eating disorder treatment centers elsewhere have taken to treating both the eating disorder and any other mental health disorders together, as a part of a comprehensive treatment plan.
In addition to the specific treatment modalities we’ll mention below, one form of talk therapy that’s useful in virtually any mental health therapy setting is group therapy. The experience of discussing one’s mental health and past experiences in the presence of other people who are in the same boat often encourages people to open up in ways they couldn’t before. Breakthroughs are very common during group therapy sessions, and many graduates of eating disorder treatment programs express that the bonding experience with other clients to be the most powerful part of their experience.
Cognitive Behavioral Therapy (CBT)
Commonly used for decades to treat a variety of mental illnesses, CBT emphasizes the importance of how unhealthy thought patterns directly influence self-destructive behaviors. When used correctly, CBT can lift the wool from a person’s eyes about their disordered thought patterns stemming from a disorder. CBT therapists will demonstrate to the patient that the negative thoughts and fears aren’t reality – they also challenge the patient’s dysfunctional feelings and beliefs they may have learned in childhood. “Schemas” (life and thought patterns) are examined dispassionately by therapist and client alike, and when they are self-destructive, they can be slowly eliminated.
Dialectical Behavioral Therapy
Dialectic behavioral therapy (DBT) is a therapeutic technique based on CBT but with a few different wrinkles. DBT focuses on developing mindfulness and interpersonal skills to help people deal more effectively with extreme emotions and how they influence behaviors. DBT was originally developed to treat borderline personality disorder and helps to rebuild low self-esteem and fears of abandonment. An evidence-based treatment originally based on one-on-one sessions, DBT is also an effective type of group therapy modality used frequently to improve communication skills at eating disorder treatment centers.
Cognitive Processing Therapy (CPT)
Originally developed as an offshoot of CBT, cognitive processing therapy is designed specifically to help individuals process traumatic experiences and their reactions to them. It’s normally administered over 12 sessions, each staking a specified step toward the eventual goal of modifying how they feel about the traumatic event. The steps include writing about their feelings, then discussing them with the therapist, and eventually challenging those beliefs together. CPT is primarily used to treat PTSD, but it can be applied in almost as many ways as CBT. It’s become a prominent treatment for eating disorders since trauma is so common a trigger for them.
Simultaneous Treatment Is Essential for Recovery
Treating mental health problems like OCD, BPD, and PTSD (as well as more generalized disorders such as depression and social anxiety)at the same time as addressing an eating disorder is essential for completing a successful eating disorder recovery program. If the co-occurring disorder isn’t treated, there is a very high risk of relapse of the eating disorder, since the negative thoughts and emotions they create act as triggers for disordered eating.
For this reason, Eating disorder treatment centers include therapy programs for a variety of psychological and psychiatric illnesses as part of their eating disorder treatment program. Just like nutritionists and dietitians can teach clients to meal plan and balance a weight restoration plan after the client goes home, therapists can teach coping exercises and set up therapy referrals to encourage long-lasting recovery. Additionally, graduates leaving a residential eating disorder recovery center can take advantage of eating disorder support services provided by recovery centers. These can include newsletters, online alumni meetings, and even step-down therapy services.
If you or a loved one is dealing with an untreated eating disorder, you should seek help as soon as you can. Make sure you bring up any co-occurring diagnoses you’ve had to your admission specialists and the care team – they’ll be able to make sure your treatment plan is prepared to treat all co-occurring disorders.