Dual Diagnosis & Co-Occurring Disorders

Men and women with anorexia, bulimia, binge eating, or other forms of disordered eating often exhibit co-morbid diseases or disorders. These additional disorders are called “co-occurring disorders” or together “dual diagnosis”.

It is important to understand the symptoms of each co-occurring disorder and the relationship between them to facilitate a successful treatment strategy.

Too often we see someone with a serious condition such as depression treated only for their eating disorder, while the depression (due for instance from a death in the family) goes untreated but is actually the root disorder that triggered the disordered eating. This leads to a higher chance of lapsing into bad eating behaviors again once treatment stops or tapers off. To help understand these dual diagnosis relationships, we have written a number of articles on the topic:

Co-Occurring Disorders with Alcoholism / Substance Abuse

Alcoholism or Substance Abuse is the uncontrollable and compulsive consumption of alcoholic beverages or drugs that leads to a dependency.  These disorders have severe consequences, causing men or women to suffer severe mental and physical consequences.

Many factors can contribute to the addiction of drugs or alcohol, including genetics, familial circumstances, and social factors.  It is common for drug or alcohol addictions to co-exist with other disorders, such as an eating disorder, especially with the commonality of an addictive nature.

Seeking the help of a comprehensive treatment team can help address the underlying issues connected with addictive disorders. Learn more about co-occurring substance abuse and eating disorders.

Co-Occurring Disorders with Anxiety

Anxiety is a term used to encompass the several disorders that affect nervousness, apprehension, and fear.  Types of anxiety disorders are panic disorders, phobias, generalized anxiety disorder, and social anxiety disorder.  An anxiety disorder can have physical, emotional, behavioral, and cognitive effects.

Woman dealing with Self-harm in treatment

Factors that can lead to the development of an anxiety disorder include traumatic events, relational stresses, or a family history of anxiety disorders.  Frequently, anxiety disorders co-exist with other illnesses, such as an eating disorder, especially as an eating disorder can become a method of coping with intense anxiety.

Comprehensive treatment addressing both disorders is important to address the root causes of the illnesses. Learn more about co-occurring anxiety and eating disorders.


Mood disorders that are characterized by intense feelings of sadness, worthlessness, and/or guilt are known as depression.  Depression can affect the various facets of a man or woman’s life, including thoughts, feelings, and overall well-being.  Symptoms can include but are not limited to low energy levels, feelings of self-hate or insignificance, and alteration in appetite with weight fluctuations.

Factors that can contribute to depression include traumatic life events, substance abuse, or hormonal imbalances.  Depression can also lead to the development of eating disorders.

If a man or woman is suffering with both an eating disorder and depression, it is important to treat both conditions simultaneously.

Treatment would involve a comprehensive medical team that would include physicians, therapists, and nutritionists. Learn more about co-occurring depression and eating disorders.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder in which a man or woman experiences repeated thoughts, feelings, sensations, behaviors, or ideas that lead them to the engagement of a repeated habit or compulsion.  Most individuals who suffer from OCD often experience symptoms related to obsessive thoughts and compulsive behaviors, such as irrational fears.

Factors that may contribute to the development of OCD include but are not limited to psychological and biological components, and this disorder can debilitate day-to-day function.

OCD is often connected with eating disorders, especially since many behaviors may overlap, such as obsessive thoughts about food and food rituals.  Because these two disorders have strong connections, it is critical to address both conditions with a comprehensive treatment plan. Learn more about co-occurring OCD and eating disorders.


The deliberate and direct injury or damage of body tissue is known as self-injury.  The most common forms of self-injury are cutting of the skin but can also include other behaviors, such as scratching, hair-pulling, burning, or the consumption of toxic substances.

Signs that a man or woman is struggling with self-injurious behaviors include but are not limited to fresh scratches, cuts, bruises or other observable wounds, several scars resulting from cuts or burns, or frequent isolation.  Factors that can contribute to the risk of self-harming behaviors include psychological, genetic, medical history, substance abuse, and familial components.

There is also a connection between individuals who have eating disorders and self harm behaviors, and it is important that both these issues are addressed with appropriate treatment. Learn more about co-occurring self-harm and eating disorders.

Post-Traumatic Stress Disorder Creating Co-Occurring Issues

Post-Traumatic Stress Disorder (PTSD) is a severe anxiety disorder that may develop as a result exposure to an event that results in psychological trauma.  Such events may include anything that might overwhelm an individual’s ability to cope, such as the unexpected death of a loved one or physical or emotional abuse.

Signs of PTSD might include flashback episodes or emotional detachment or avoidance of places or people that might be correlated with the traumatic experience.  Men or women who suffer with PTSD have an increased likelihood of developing an eating disorder, as eating disorder behaviors often become a means of coping with experiences related to PTSD.

Addressing both conditions simultaneously in treatment will help address the underlying issues and promote healing. Learn more about co-occurring trauma and eating disorders.


The compulsive urge to pull out one’s own hair is an impulse control disorder known as Trichotillomania.  This disorder is self-induced and is often utilized to release tension or obtain a sense of relief.  If a man or woman is struggling with trichotillomania, signs or symptoms that may be observed include but are not limited to patchy or balding regions on the scalp or other areas of body and strong urges to pull hair out followed by feelings of release once hair is pulled.

Woman in Eating disorder treatment with co-occurring issuesTrichotillomania is thought to be caused by a combination of factors, such as genetic, biological, or environmental.  The physical and emotional consequences resulting from this disorder can be debilitating, and it is common that this exists alongside another illness, such as an eating disorder.

Since trichotillomania shares many clinical features of an eating disorder, it is critical that these co-occurring conditions be treated simultaneously to promote healing. Learn more about co-occurring trichotillomania and eating disorders.

Last Reviewed By: Jacquelyn Ekern, MS, LPC on October 15, 2020

Page last updated: October 15, 2020
Published on EatingDisorderHope.com, Resources for Eating Disorder Information and Treatment