How Often do Eating Disorders & Addiction Co-Occur in Teens?

teenager relapsing into Bulimia and standing on a hill

Eating disorders and addictions tend to be commonly associated. In addition to addictive behaviors, compulsive eating patterns have been associated with high-risk substance abuse [1].

Some sufferers turn to alcohol and substances to manage and cope with overwhelming thoughts and emotions. According to the Eating Disorders Coalition, over 90% of those suffering from an eating disorder are teens [1].

Common Characteristics

Often co-occurring mood and anxiety disorders are connected to eating disorders. From research on this topic, substance abuse and misuse are associated with mood and anxiety disorders.

Changes in neurotransmitters, like serotonin, are connected to both eating disorders and depression. Other chemical changes from self-starvation and purging can cause imbalances in the brain that can also affect mood and emotions [1].

Eating disorders, which has causal factors such as genetic, family, and environmental influences, addiction has been found to have similar beginnings.

The National Center on Addiction and Substance Abuse reported that addiction and eating disorders are connected from causal sources, and share common characteristics [1]. Both share risk factors such as imbalances in the brain, family history, and trauma or abuse.

Both addiction and eating disorders tend to emerge and increase in symptoms during stressful periods in life or transition. Low self-esteem, depression, and anxiety can also trigger symptoms to develop and develop a pattern of compulsive behaviors.

Eating disorders often begin in tween and teen years when body changes are occurring and an awareness of self-begins to develop [2]. Frequently, both eating disorders and addictions develop out of maladaptive coping skills to manage unrealistic beliefs about self, academic pressures, or sport.

Of those using drugs or alcohol, regardless of gender, a higher rate of those individuals also struggle with an eating disorder.

Teens that have co-occurring eating disorders and addiction are independently correlated with higher than expected rates of death from both medical complications and suicide [3].

It is not entirely sure which comes first the eating disorder or addiction, but substance abuse can cause appetite suppression, which can lead to significant weight loss and can trigger the onset of an eating disorder.


Approximately over 8,000 teens age 12 and over will use illicit drugs for the first time on a daily basis. Studies show that teens who do use for the first time did so by the age of 14 and were five times more likely to be diagnosed with alcohol dependence or abuse as adults than those who waited until after the age of 21 [3].

Woman by the lakeMany teens who struggle with an eating disorder also struggle with a substance addiction. Almost 50% of those with Binge Eating Disorder (BED) also abuse substances [4].

Often the eating disorder precedes the substance abuse, and adolescents will start using drugs or alcohol to diminish the symptoms or results of the eating disorder.

When a person is engaging in both eating disorders and substance abuse, the cycle of both can be relentless.

Both are emotional and physical stressors and negatively impact each other.

Being able to seek treatment that can focus on both the eating disorder and substance abuse is essential in the recovery process.

Treatment for Co-Occurring Disorders

Addressing eating disorders and addictions can be difficult to manage and treatment plan for. Often one disorder is treated before the first depending on the medical needs and severity of each disorder.

Sometimes individuals struggling with co-morbid issues will initially be hospitalized due to detoxification and medical stabilization [5]. Once an assessment is conducted, a treatment plan can be developed, which is individualized and structured to both disorders.

Dual treatment typically includes disease-specific psychoeducation and therapy; group therapy; medication treatment and management; nutritional needs and meal planning; and family therapy if appropriate.

Including treatments such as group therapy, nutritional meal planning, and management as well as coping skill building are all essential in programs that address both eating disorders and addictions.

Often, for teens who do not struggle with co-occurring disorders, they battle to maintain healthy eating patterns. Repeat use of substances with an eating disorder can further curb appetite and result in weight loss.

Teaching healthy eating patterns and meal plan structure can help with symptom management. Group therapy allows individuals to connect with peers who struggle with similar circumstances and have others to talk with and learn from in the recovery process.

When receiving therapy for comorbid issues, it is important to remember that all behaviors are ceased and working on managing urges, learning healthy coping skills, and building positive supports are part of the process.

Often after hospitalization, individuals will go into residential, partial hospitalization or intensive outpatient programming for continued care and recovery focus.

Woman standing by the trainOften therapy can include Cognitive-behavioral therapy (CBT), Dialectical Behavioral Therapy (DBT), and Interpersonal Therapy (IPT), as well as group therapy to engage in the recovery process.

These therapies work on various aspects of a person’s thinking, emotions, distress tolerance, skill building, and interpersonal relationships and patterns to address the issues that lead to the disorders [5].

In conclusion, addictions and eating disorders often occur within the teenage population. Being able to identify the symptoms as well as obtain proper treatment is essential in treating a teen who is struggling with co-occurring disorders.

Image of Libby Lyons and familyAbout 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.


[1] Eating Disorders. (n.d.). Retrieved August 13, 2017, from
[2] Eating Disorders and Teenagers: Programs, Treatments, & Help. (n.d.). Retrieved August 13, 2017, from
[3] Substance Abuse and Eating Disorders. (n.d.). Retrieved August 13, 2017, from
[4] A. (2017, June 15). Binge Eating & Drug Abuse In Teens: Facts & Statistics. Retrieved August 19, 2017, from
[5] Eating Disorders and Addictions. (n.d.). Retrieved August 19, 2017, from

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 November 9, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on November 9, 2017.
Published on