The prevalence of co-occurring diagnoses of eating disorders and substance use disorders is on the rise. According to the National Center on Addictions and Substance Abuse, up to 50% of individuals with eating disorders also abuse alcohol or illicit drugs, a rate 11 times greater than the general population. It’s worth noting, however, that this statistic is from 2003. The prevalence rate may be much higher 20 years later, especially after the increased stress and isolation of the COVID-19 pandemic.
Why are those who struggle with eating disorders more likely to experience problems with addiction and vice versa? There may not be a simple answer to this, but to better understand, it’s important to consider some similarities between ED and SUD.
First, there are many risk factors for developing an ED, and many of these are shared with developing SUD. Some of these common risk factors include alteration in brain chemistry, family history of the disorder, low self-esteem, depression, anxiety, trauma, undiagnosed mental health issues, and social pressures.
These risk factors often lead to the individual searching for a coping mechanism, a way to “control” their situation, or a temporary distraction. Substance use and engaging in ED behaviors can serve their purpose here. While both are dangerous and can be life-threatening, they are coping strategies that vulnerable populations often utilize.
Second, there are some behavioral and personality-trait overlaps between those with ED and SUD. Sufferers of both disorders often may have an obsessive preoccupation, compulsive behaviors, a tendency to be secretive about their behaviors, and may isolate to continue the behaviors. People who suffer from eating disorders often describe their ED behaviors as feeling addictive, similar to how an addict feels towards drugs or alcohol – like it has become less of a choice and more of a compulsion.
The concept of transferring addictions is one that comes up a lot in the world of substance use. When a person discontinues using their substance of choice, often their first instinct is to replace that addiction with another. Even if a person is not experiencing an eating disorder in active addiction, it’s quite common for eating disorder behaviors to emerge or re-emerge when that person gets sober. It’s important to be on the lookout for eating disorder behaviors when a person is newly sober, even if they haven’t exhibited signs of having an eating disorder previously.
Although eating disorder recovery and addiction recovery can look different, what is similar between the two is that it can be very difficult, if not impossible, to stop without help. Fortunately, recovery from addiction and/or an eating disorder is possible, and getting help with one can often improve the likelihood of recovery from the other.
The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003.