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Bulimia & Addiction: Underlying Common Co-Occurring Disorders
Bulimia and addiction share common characteristics. Both are mental health disorders, and both affect brain function, physical body functions, and emotional health.
Research suggests that approximately 50% of people who have an eating disorder are also abusing substances [1]. Eating disorders and addictions affect men and women and have a detrimental impact on a person’s life.
Common Factors
Eating disorders and addictions have similar underlying factors. Genetics, environment, and biological factors all affect the development of both disorders.
More often, addictions commonly co-occur with eating disorders as a mechanism to numb a negative emotional or traumatic experience or medicate themselves for other underlying mental health disorders such as bipolar, major depression, or significant anxiety.
Past research has found that over 8,000 youths 12 years of age and older will engage in some substance use daily within the United States and that teens who first use alcohol by age 14 were five times more likely to become alcohol dependent or an addict by adulthood [1].
Co-Occurring Concerns
Co-occurring is a term that is used by clinical professionals to describe when a person struggles with two or more mental health disorders at the same time. It is also typically called a dual diagnosis.
Research indicates that almost 75% of individuals who have an eating disorder will also struggle with major depression [2].
Other co-occurring disorders can increase the risk of suicide and self-harm behaviors. Common depressive disorders are Major Depressive Disorder, Bipolar Disorder, and Dysthymia.
Anxiety disorders are another co-occurring disorder seen in those with bulimia and addiction. Anxiety disorders include Obsessive-Compulsive Disorders (OCD), Social Phobias, Generalized Anxiety Disorder (GAD), and Post-traumatic Stress Disorder (PTSD).
PTSD affects anyone who has been witness to or a part of a trauma.
It is a subtype of anxiety disorders and typically follows a chronic or acute traumatic event where a person feels their safety is threatened and feel helpless within the situation [2].
Borderline Personality Disorder (BPD) is another common co-occurring disorder affecting those who struggle with bulimia and addiction. It is a subtype of a personality disorder and interferes with a person’s daily functioning.
It can also affect a person’s’ professional or academic life, social functioning, and relationships. Low self-esteem and self-worth, emotional dysregulation, impulsive behaviors, and changes in healthy thinking are also common with BPD.
This disorder is seen in about 10% of the population of individuals who have both bulimia and addiction [2].
Self-harm is another common co-occurring disorder. Self-harm can be described as behaviors that are not meant as suicidal but are to relieve emotional pain through the use of cutting, burning, pulling of hair, hitting or cause other bodily harm to oneself.
25% of those with an eating disorder also struggle with self-harm behaviors [2].
Having both an addiction and bulimia coupled with commonly co-occurring mental disorders typically affects many aspects of the disorders, meaning, the severity, duration, and disability it causes to the person suffering [3].
Individuals who do struggle with co-occurring disorders seem to have more significant and severe medical, social, and emotional issues over those who struggle with either a mental health disorder or an addiction.
Often both disorders will trigger or enable the other, creating a cycle of behaviors that keep feeding on each other.
Relapse is another common co-occurring characteristic. If a person struggles with an addiction relapse, it can lead to emotional distress which can trigger worsening symptoms of the eating disorder.
Bulimia and Addiction Relationship
Bulimia can be described as a cycle of binge eating and directly followed with compensating behaviors, such as self-induced vomiting or over-exercise, to ‘rid’ the body of the food consumed. Often cycles include fasting periods before the binge and purge phases [4].
Studies have shown that there is a clinically significant relationship between bulimia and alcohol use, and these sufferers have a higher rate of alcohol use when compared to those without an eating disorder, up to 50% [4].
Individuals with bulimia and addiction share issues such as depression and anxiety disorders, menstrual cycle disturbances, stress-related concerns, which can affect the recovery rate when struggling with co-occurring disorders.
In conjunction with common causal factors to this dual diagnosis, fasting can also play a role in the use of alcohol and other substances.
When a person is restricting, or fasting, and then uses a substance, it alters the brain reward area which strengthens the desire to use of the substance again.
This changes the brain structure and neural pathways that are responsible for reward and pleasure, therefore increasing the symptoms of both disorders [4].
Personality factors can also play a role in this dual diagnosis. An addictive personality style or impulsive tendencies can steer a person to use alternate methods to manage the disorders.
Feelings of shame and guilt are common in those with bulimia and addiction. Often these emotions follow a binge-purge episode, and substances are frequently used to subdue these emotional states.
When a person is under the influence of a substance, it can lead to lack of hunger and increase food restriction. This can then lead to binging episodes later, which may strengthen the connection between bulimia and addictions.
Individuals who struggle with bulimia and addiction are also seen to have higher rates of depression, PTSD, anxiety, and personality disorders. Often they tend to relapse faster due to habitual addiction use, and these individuals tend to have higher rates of issues in professional, academic, and relationship struggles [4].
If you or a loved one is struggling with bulimia, addiction, and a co-occurring disorder, it is essential to get an assessment of both mental and medical illnesses.
Treatment needs to be multi-faceted and address both the eating disorder and addiction simultaneously.
Underlying co-occurring disorders are often addressed after medical stabilization is reached and overarching mental disorders are stabilized. Recovery is possible through support, treatment, and care of all medical and mental disorders.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References:
[1] Substance Abuse and Eating Disorders. (n.d.). Retrieved December 09, 2017, from https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders[2] Eating Disorders & Common Co-Occurring Disorders. (n.d.). Retrieved December 09, 2017, from https://eatingdisorder.org/eating-disorder-information/co-occurring-diagnosesdisorders/
[3] Co-Occurring Disorders. (2017, January 16). Retrieved December 09, 2017, from https://www.psychologytoday.com/conditions/co-occurring-disorders
[4] Bulimia And Alcoholism. (n.d.). Retrieved December 09, 2017, from https://www.mentalhelp.net/articles/bulimia-and-alcoholism/
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on January 27, 2018.
Published on EatingDisorderHope.com
