Eating Disorders and Addiction

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What are Eating Disorders?

An eating disorder is any mental illness that shows itself in patterns of abnormal eating that endangers the individual’s physical or mental health. There are many different kinds of eating disorders, but the most common are bulimia nervosa, anorexia nervosa, binge eating disorder and pica. Although it is not fully understood what causes these disorders, it is known that a variety of genetic and environmental factors can play a role. Eating disorders are seen in both genders, but they are much more common in females than in males.

What are the Signs and Symptoms of Eating Disorders?

Anorexia Nervosa:

Individuals with anorexia will starve themselves to lose weight. They typically exhibit rapid and continuous weight loss leading to an extremely low body mass index (BMI). Anorexia often leads to ritualistic eating behaviors such as cutting food into tiny pieces or chewing each bite a specific number of times.

Starvation and low BMI often leads to amenorrhea (the abnormal cessation of menstruation), dry skin, bad breath, abdominal distention, chronic tiredness, low blood pressure, and in later stages, lanugo—a fine, soft hair that grows over the face and body. Unhealthy behaviors such as vomiting, excessive laxative use, and obsessive exercising are common, including “micro-exercising,” in which the individual attempts to maintain constant movement so that additional calories are always being burned.

Individuals with anorexia usually suffer a distorted self-perception that causes them to feel overweight even when they are extremely thin. They also frequently exhibit isolating and secretive behavior, mood swings, self-harming, and obsessive admiration of thin people.

Bulimia Nervosa:

Individuals with bulimia typically consume excessive amounts of food followed by purging what they ate by forcing themselves to vomit or by using laxatives. They also often use diuretics and stimulant drugs and engage in over-exercising and intermittent fasting. Most people with bulimia maintain a BMI in the normal range but often suffer the same kind of distorted body image seen in people with anorexia.

Individuals with bulimia may have thickened skin on the knuckles from frequently induced vomiting, as well as dental damage from exposure to stomach acids. Anxiety and depression are commonly associated with bulimia, as well as an elevated risk of self-harm and suicide.

Binge Eating Disorder:

Individuals with binge eating disorder typically consume excessive amounts of food in a short time. This behavior is recurring and compulsive, as it is with bulimia, but the binging is not followed by purging. Sufferers feel intense guilt and shame after binging, and considerable distress with these episodes, which average at least once per week for three months.


Pica is a psychological disorder characterized by the craving to eat non-nutritive substances such as hair, ice, paper, stones, or chalk. To be diagnosed with pica, an individual must engage in these behaviors for more than one month and be of an age when the behavior is considered developmentally inappropriate.

How Do Eating Disorders Interact with Addiction?

Eating disorders are frequently co-occurring with substance use disorders. Over half of individuals suffering from eating disorders also report an addiction to one or more substances. There are many similarities between eating disorders and substance use disorders, such as the level of obsession and uncontrolled, compulsive behaviors associated with both.

Individuals with eating disorders often suffer from intense anxiety and are drawn to drugs and alcohol because these chemicals can relieve anxiety symptoms and stimulate the reward center of the brain through the same neurological network that rewards survival activities such as eating.

Eating disorders are also often accompanied by the abuse of drugs used to cause or accelerate weight loss or the feeling of weight loss, such as diuretics, purgatives, and laxatives, as well as amphetamines, which both contribute to weight loss and counteract the fatigue that results from improper or insufficient nutrition.

Many people with eating disorders binge or purge to take some control over their lives, just as many people with substance use disorders do with substances. Whether the unhealthy behaviors are a way to forget past abuses, low self-esteem, or to escape the present, the root psychological causes of the two disorders can be similar.

Shared Brain Connection

Individuals suffering from eating disorders are five times more likely to have a substance use disorder than the general population. While it’s impossible at this point to say that one of these disorders causes the other, it is important to note that both addiction and eating disorders are impacted by the same neurotransmitters in the same area of the brain. Binging and purging, as well as purging alone, work in the brain’s VTA, an area commonly referred to as the limbic or reward system. This complex system releases feel-good chemicals into the body and is where addiction occurs. Since both eating disorders and addiction increase the neurotransmitter dopamine in the VTA, it may indicate the two are related. Or perhaps if someone is more susceptible to addiction, they may be more susceptible to an eating disorder, or vice versa.

It’s also hypothesized that the correlation between the two disorders is associated with problems related to impulse control. Those who binge and purge, or just purge, are driven by compulsions, even though they understand the negative consequences of the behaviors. When they’re especially stressed or anxious, they may feel as though they have to engage in disordered eating behaviors, and lack any control to stop it. The same occurs for many individuals with substance use disorders. 

How are Eating Disorders and Substance Use Disorders Treated?

Eating disorders require specific, targeted treatment. In cases of extreme weight loss, treatment must begin in a medical hospital so that a gradual and carefully monitored re-feeding process can bring the patient up to a healthier BMI. Many people recovering from eating disorders will have electrolyte imbalances and vitamin and mineral deficiencies that must also be remedied.

Mental health treatment for eating disorders usually involves long-term cognitive behavioral therapy to rewrite negative thought patterns and to work on positive eating habits. Eating disorders, and in particular anorexia nervosa, have a high mortality and suicide rate, which makes it even more imperative for sufferers to receive targeted inpatient treatment from specialists who are experienced in eating disorder recovery. Even though there is a very strong correlation between addiction and eating disorders, and the two are often co-occurring, not every rehab facility will be suitable for this dual diagnosis.

Integrated Approach

For a person with both an eating disorder and an addiction, an integrated treatment approach is necessary. When this doesn’t occur, the disorders tend to work against each other. When there’s no drug use, the eating disorder flares out of control, or once the eating disorder is stabilized, a drug or alcohol binge occurs and the addiction spirals downward. To stop this dangerous cycle, the co-occurring disorders must be addressed together at a facility with the resources and experience to handle this unique dual diagnosis.