What Are the Treatment Options for an Eating Disorder with a Dual Diagnosis?

Eating disorder treatment can be a rewarding yet complex process. There are programs available for virtually every eating disorder known to science. However, when an individual receives a co-occurring diagnosis (also known as a dual diagnosis), chances are they will need access to additional eating disorder treatment options that take care of both conditions. The occurrence of popularly known disorders such as anorexia nervosa and bulimia nervosa are often accompanied by mental health disorders such as anxiety and depression, and sometimes medical disorders like diabetes type II and anemia.

Eating disorders in women and men both require specialized treatment that accounts for biological, emotional and gender-specific programs which offer a wide array of treatment options for eating disorders. Offering a combination of medical, therapeutic and psychiatric care services, both residential and outpatient eating disorder treatment services can be effective in promoting a healthy, recovered life. While co-occurring disorders can be more complex, early intervention and access to supportive eating disorder counseling have been proven to be effective.

What Is a Dual Diagnosis?

As far as eating disorder counseling goes, a dual diagnosis is when an eating disorder is co-occurring with another medical or psychiatric disorder. In particular, co-occurring disorders of a psychological nature are quite common in cases of anorexia nervosa, bulimia nervosa and binge eating disorder. Whenever an eating disorder such as anorexia nervosa or binge eating disorder occurs in conjunction with another mental health diagnosis, simultaneous care is required. If both conditions are not addressed at the same time, the individual runs a much higher risk of relapse of one or both disorders after completing eating disorder treatment.

Whether the program is residential, partial hospitalization or outpatient eating disorder treatment, any program design must take into consideration dual treatment for dual diagnosis. For this reason, any facility that only treats eating disorders, without taking into account the reciprocating nature of a co-occurring disorder, should be avoided.

Loved ones must work to understand the symptoms of each co-occurring disorder and how they work together. Co-occurring eating disorder counseling should begin at the initial point of assessment – that means the first call or appointment with the counselor. Open and honest communication about any conditions in addition to the eating disorder should take place from day one of treatment.

What Kind of Disorders Are We Talking About?

While eating disorders in women is a concept most people are familiar with, many do not understand men can develop eating disorders as well, although at a lower rate. Study after study by medical and psychiatric institutions have noted that male, female, or non-binary gender, people with eating disorders have a much higher rate of co-occurring mental health disorders than the general population. Among the most common co-occurring disorders include:

Addiction and Substance Abuse

In addition to the abuse of non-psychoactive drugs such as laxatives (which can be common in bulimia nervosa cases), drug and alcohol abuse is statistically much higher in people with eating disorders. In some cases, diet pills containing amphetamines can lead to dependency, and similar appetite suppressants such as cocaine are also commonly abused. Alcohol addiction is also higher among people with eating disorders and can exacerbate the various liver, blood and heart diseases that may result.

As with most eating disorders, many different factors may contribute to substance abuse or addiction, including genetics, social and biological factors, family environment and more. Many of the factors that contribute to the development of alcoholism and substance abuse are very similar to those that increase the chances of developing an eating disorder as well.


Depression is at the top of the list for most frequently co-occurring conditions related to the major eating disorders. Depression is a common factor in the development of eating disorders in women and men and is also a frequent trigger for relapse. Depression can result in low energy levels, self-harming, feelings of self-hatred, and a sense of worthlessness or inertia. Depression is widespread; it affects about 16 percent of Americans every year.


Anxiety is another mental health disorder which has received more publicity in recent years, with good reason – over 18 percent of Americans suffer one form or another of anxiety disorder. With anxiety, people may have several different mental health disorders that result in fear, nervousness and general apprehension. Social anxiety disorder, panic disorder (inducing panic attacks), general anxiety disorder, and many more are included among the list of anxiety disorders.

Anxiety disorders can be a key component to the development of eating disorders because they play on individuals’ fears and worries, at times about their appearance or weight. They also often induce disordered actions as coping mechanisms for those fears, which can manifest in binging, purging and food avoidance.

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder or PTSD is among the most common triggering factors for eating disorders in women and men alike. PTSD is a response to traumatic events in someone’s life. It is much more than “combat fatigue,” as it is commonly presented in the media. Any traumatic experience can cause PTSD; cases have been seen resulting from auto accidents, divorces, losing a job, witnessing a crime, or even experiencing a natural disaster.

Common signs of PTSD include emotional detachment, flashback episodes, the avoidance of certain places or people related to a past traumatic event and more. People with PTSD are much more likely to develop an eating disorder than their peers, often suing their compulsive eating disordered behaviors as a coping mechanism.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder or OCD is a well-known but misunderstood disorder. Too often, people who are extremely neat and clean are called “OCD,” with little to no justification. OCD is a pattern of repeated actions that the OCD sufferer finds compulsive. If they don’t perform these actions, they get a sense of dread or a misguided certainty that something terrible will happen.

The behaviors found in OCD are similar in many ways to those found in anorexia nervosa, bulimia nervosa and binge eating disorder. In all these disorders, the actions taken tend to be compulsive in nature may also serve as a coping mechanism for a sense of anxiety. Many of the people who have obsessive-compulsive disorder experience symptoms that are related to both obsessive thoughts and compulsive behaviors.

What Treatment Options Are There for Eating Disorders With a Dual Diagnosis?

Today, the treatment options for eating disorders and other co-occurring disorders are more comprehensive than in the past, due to an increased knowledge that these disorders are interconnected. This means people seeking eating disorder treatment can reasonably expect to have a full psychiatric analysis and assessment performed from the beginning of treatment. However, it remains important to stay vigilant when seeking out co-occurring disorder treatment. It is recommended that a doctor and psychiatrist should be consulted as part of the intake process.

At Oliver-Pyatt Centers’ eating disorder treatment programs, we provide a full assessment at the onset of treatment for medical and psychiatric issues before engaging a weekly re-assessment of these disorders. This is the highest level of care possible outside of a hospital setting and is absolutely vital when treating those who have a dual diagnosis.

Integrated Care Options for Dual Diagnosis

Quality eating disorder treatment centers, on both an inpatient or outpatient basis, that provide integrated care for their clients combine strategies from both psychiatric and eating disorder-specialized fields of study. By treating both disorders simultaneously, the immediate effectiveness of the program is increased, and the relapse rate among their recovery program graduates are lowered. Since co-occurring disorders tend to influence each other (i.e. symptoms of anxiety cause disordered behaviors and the guilt resulting from disordered behaviors causes anxiety), treating them both is essential to the resolution of both.

Some of the other main reasons it is so important to treat co-occurring disorders at the same time include:

  • Similar therapeutic methodologies in group therapy for different kinds of mental health disorders can provide a strong peer support network.
  • Treating co-occurring disorders such as anorexia nervosa or bulimia nervosa concurrently with disorders like anxiety and PTSD can help identify and combat triggers for disordered behaviors.
  • In cases where medication is required for a psychiatric disorder, integrated treatment can help avoid conflicting side effects in the treatment of eating disorders.
  • Integrated recovery programs are designed to help patients overcome the negative side effects of their co-occurring mental health disorders such as low levels of motivation, the fear of socializing with others and reduced attention spans.

When the treatment options for eating disorders are based around an integrated treatment program, a truly comprehensive continuum of care is possible. It is essential to remember that eating disorders such as anorexia nervosa and bulimia nervosa are only rarely standalone disorders – they more often than not come with another mental health disorder or addiction. While mental health and eating disorders in women and men can be very complex, with proper treatment, a full recovery is possible.

What Options Are There for Levels of Care?

As families explore treatment options for eating disorders, they should remember each treatment program must be individually designed. One-size-fits-all programs won’t address the unique needs of each client.

  • Residential treatment programs provide structured care in a supervised and safe rehabilitation setting. This is generally the best option for severe cases because 24/7 care is available.
  • Outpatient eating disorder treatment is an excellent option for less severe cases and for those where the client cannot avoid work or school responsibilities. It also tends to be more affordable, although the first priority should always be a complete recovery.
  • In most cases, medication is not the best option for eating disorders. However, co-occurring psychiatric care can ensure that both the behavioral and talk therapies are supported by proper psychiatric medication in those cases in which it is necessary.
  • Access to peer support groups can be extremely important to the recovery process for individuals with a dual diagnosis. This is mainly since social withdrawal is often the result of living with one or more mental health conditions. Peer counseling can help bring patients out of isolation and create a lasting support system.
  • Partial hospitalization programs can be a blessing for those people whose eating disorder has resulted in serious medical issues coinciding with the eating disorder and psychiatric disorders. It is a vital option for people struggling with malnutrition or other life-threatening symptoms.

Contact Oliver-Pyatt Centers For a Compassionate Assessment

Eating disorders in women and men can put individuals at risk for a number of different long-term health consequences, and their treatment can be extraordinarily complex when other medical or mental health disorders are present. At Oliver-Pyatt Centers and our affiliates, we offer our clients the highest level of treatment in a compassionate, comfortable and home-like setting. We offer highly customized treatment designed to help patients through the recovery process with access to both medical and psychiatric care. Call 866-511-4325 or contact our friendly admissions team online today to learn more about the variety of treatment options we offer.