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Conditions that Often Exist with Eating Disorders

Bridget Engel, Psy.D., edited by Kathryn Patricelli, MA

Individuals with eating disorders often suffer from other mental health disorders and disturbances as well. When a person has two or more conditions at the same time, it's known as a co-morbid or co-existing condition. For example, people suffering from the symptoms of anorexia, bulimia, and binge-eating disorder often have significant sadness and depression. Their lives feel out of control and they are chronically unhappy with their weight and bodies. They have low self-esteem and may feel they are unsuccessful and ugly. A sense of loneliness and isolation may also add to feelings of sadness. In addition, having trouble falling asleep or staying asleep (insomnia) can happen because of not getting enough nutrients in the diet. Insomnia may be also be a factor in developing depression.

Feeling anxious is also typical for those suffering from an eating disorder. They are nervous about gaining weight, being fat, and not losing enough weight. They worry about what other people think and how their body compares to others. They are determined to be successful and control their eating. They may think about this a great deal. People with eating disorders may also have intense fears (phobias), anxiety about being around others (known as social anxiety), and/or experience panic attacks. Obsessive-compulsive behavior is also common among those with eating disorders. That is a form of anxiety that involves ongoing, unwelcome thoughts (obsessions) and/or repetitive behaviors (compulsions) that significantly interfere with daily activities.

People with eating disorders can sometimes suffer from personality disorders as well. A personality disorder often starts in the teen years or early adulthood. It involves steady patterns of observing and relating to others. It also involves patterns of thinking that are inflexible and unhealthy.

Three common personality disorders that may be found in those with an eating disorder include:

  • Histrionic Personality Disorder - emotions are expressed in either an exaggerated or superficial manner. People with this condition are very dramatic, need lots of attention or approval from others, and focus a great deal on their appearance.
  • Borderline Personality Disorder- characterized by an ongoing pattern of unstable relationships, thinking, emotions, and self-image that interferes with normal daily activities. Many individuals with Borderline Personality or an eating disorder engage in self-destructive behaviors such as cutting and suicide attempts.
  • Obsessive-Compulsive Personality Disorder - A person with this condition is very perfectionistic. They stick tightly to rules, are inflexible and are excessively orderly. These behaviors interfere with their relationships and their daily activities.

Because living with an eating disorder is painful and agonizing, many people cope in unhealthy ways. This may lead them to develop addictions to gambling, shoplifting, alcohol, and drugs. Research suggests that 30-50% of individuals with eating disorders use alcohol or drugs compared to only 9% of the general population. Up to 35% of alcohol or illicit drug abusers have eating disorders, compared to 1-3% of the general population.

Those with an eating disorder often use caffeine, laxatives, and diuretics. They may also use illegal drugs including amphetamines, barbiturates, tranquilizers, cocaine, and heroin. These drugs are often used in the beginning to reduce their appetite, increase their metabolism (how fast they burn calories), purge unwanted calories, and deal with negative emotions. However, they can quickly turn into physical addictions. Which drug someone takes may be linked to the type of eating disorder that they have.

Compared to other eating disorders, rates of drug use for those with anorexia tend to be lower. This is because they do not easily tolerate the lack of control associated with being drunk or high. If people with anorexia use drugs, they tend to use stimulants because of the ability to increase their rates of metabolism and decrease their appetite. Those who are restricting the food they eat tend to avoid the high calorie content of alcohol and the appetite-stimulating effects of marijuana. Those who purge tend to use alcohol, cocaine, and cigarettes. Those with binge-eating disorder are often drawn to the calming effects of alcohol and tranquilizers. Regardless of the substance selected, drug and alcohol use makes the feelings of being powerless and out of control worse. The substances also further affect physical health, and make recovery more complicated for those with eating disorders.

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