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When a person receives a diagnosis of anorexia nervosa, it’s natural to be worried about taking the steps to get better and focus on those challenges. This can be very useful if anorexia nervosa is the only mental health disorder present.Unfortunately, anorexia nervosa usually comes hand-in-hand with one or more other mental health disorders and when someone receives an anorexia nervosa diagnosis along with co-occurring disorders or they receive a dual diagnosis, they will need specialized treatment at a facility that can handle their cases.

While many families are familiar with common eating disorders like anorexia nervosa and bulimia nervosa or binge eating disorder, it’s less commonly known that very often people with eating disorders also have one or more co-occurring mental health disorders. At dedicated eating disorder recovery centers like Clementine, individuals have access to the full continuum of care in a home-like setting.

What Are Co-Occurring Disorders?

As defined by mental health professionals like psychiatrists and eating disorder counselors,a co-occurring disorder means when a person is diagnosed with at least two kinds of mental health disorders, such as OCD and binge eating disorder, or anorexia nervosa and alcohol addiction disorder. Co-occurring disorders can cause or be caused by the simultaneous eating disorder and can make treatment more challenging. For example, a person with both anorexia nervosa and depression will need more complicated treatment plans and require specialized treatment methodologies. When both conditions are not addressed at the same time, the recovery process might be held up since the person going into treatment is more likely to experience a relapse or require longer treatment times for the same outcome.

Before choosing an eating disorder treatment program, parents or other family members should get all the facts about their loved one’s need for treatment. A consultation with a therapist or psychiatrist can help identify any co-occurring disorders are present and help to design the complete treatment plan.

This is essential since if the client’s primary therapist and the eating disorder treatment center aren’t communicating, either disorder might not be treated as part of a complete, holistic plan. Co-occurring counseling for someone with the symptoms of anorexia nervosa often requires an additional assessment of the individual before designing a unique treatment program to fit their individual experience. The family and referring doctors and therapists should let the treatment center know what they know in regards to the client’s mental health.

Common Forms Mental Health That Come With Anorexia Nervosa

Eating disorders rarely appear in a vacuum; although people are usually aware of disordered eating behaviors like calorie restriction or excessive exercise, they may not know this. Eating disorders are often complicated by other mental disorders like depression as well. It’s estimated that as many as 50 percent of people with anorexia nervosa have a co-occurring dual diagnosis, and that figure is almost certainly lower than the true number, as people don’t always report their mental health status accurately.

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder, normally shortened to PTSD, is a primary trigger for most disordered eating behaviors and a powerful anxiety disorder in its own right. With PTSD, past traumatic experiences like being in a car accident or suffering domestic abuse can cause recurring feelings of anxiety, fear, hopelessness, or tension that can last for years after the event. This means that a PTSD episode can happen any time, especially in times of stress o when a similar event or emotion happens.


Anxiety is shorthand for several mental health disorders that are commonly associated with eating disorders like anorexia nervosa. Some of the most common types of anxiety disorders include social anxiety disorder, panic disorders, phobias, and generalized anxiety disorder. Anxiety about socializing, body image, and food are common warning signs of a developing eating disorder, and anxious emotions may be triggers for disordered eating behaviors.


Depression is the most common mental health disorder in America and is intimately associated with eating disorders like anorexia nervosa. Defined by feelings of worthlessness and sadness, as well as decreased motivation and ability to enjoy things,depression affects over 50 million people in the United States. People with depression tend to lose motivation and lack energy over time, which can affect body image and lower self-esteem, further triggering disordered eating behaviors.

Obsessive-Compulsive Disorder

Another severe psychiatric disorder that is related in many ways to eating disorders like anorexia nervosa is obsessive-compulsive disorder. This is because the disordered behaviors found in cases of obsessive-compulsive disorder, such as repeated actions and strong anxiety if those behaviors aren’t completed, are very similar. Obsessive-compulsive disorder is a type of anxiety disorder that is characterized by repetitive thoughts and actions, with a sense if certain actions are not taken, negative consequences will result. This relates to anorexia nervosa in that if the person with anorexia nervosa doesn’t perform their disordered eating behaviors, they fear they will gain weight, which is to them a negative outcome.

Alcoholism, Addiction, and Substance Abuse

People with anorexia nervosa experience addiction to alcohol or drugs as much as 5 times higher than that of the general population, according to some experts. Alcoholism and substance abuse are characterized by an uncontrollable and compulsive psychological need to consume alcohol or other drugs. In some cases and some kinds of drugs, a physical need is also present after the person has become addicted.Abuse of stimulants like amphetamines and cocaine common in people with anorexia nervosa, since they tend to lower the appetite and promote weight loss.

Many different factors may contribute to an addiction to alcohol or drugs including genetics, social and biological factors, familial circumstances, and more.  These are among the same factors that commonly influence developing eating disorders, which can make dual diagnosis treatment for eating disorders even more necessary.

Why Do Co-Occurring Disorders Happen?

As with eating disorders, the psychological illnesses listed above are more common in people whose family has a history of the disorder – that is a parent who has depression is more likely to have a child with depression.According to the experts at eating disorder treatment centers, eating disorders in adolescents very often are coping mechanisms for feelings of low self-esteem, depression, and anxiety. For example, when someone with depression might be having pangs of negative emotion, they may retreat to excessive exercise or purging, which comes with serotonin releases. The disordered eating behaviors become almost like an addiction, repeated to get the rush of pleasant feelings that serotonin and dopamine releases provide.

What Type of Treatment Is Available for Co-Occurring Disorders?

Today, there are more options for anorexia nervosa treatment centers than ever before, with an array of treatment programs covering outpatient and residential options. However, not all eating disorder recovery facilities are created equal; some are not as well prepared to address co-occurring disorders as well as the eating disorder. Clementine, which also adds decades’ worth of combined expertise in treating adolescents in this setting, is prepared to do just that.

The Importance of Integrated Care

Simply treating an eating disorder while the presence of another disorder may find some success at recovery, but the chances for relapse or a partial recovery are higher. It’s essential to design treatment plans for both disorders simultaneously while the individual is still actively in treatment, whether in a residential or day treatment basis.Integrated care can provide more consistently positive outcomes and lower the relapse rate among their recovery program graduates.

Some of the other main reasons why it is so important to treat co-occurring mental health and eating disorders at the same time include:

  • Both prolonged malnutrition and prolonged substance abuse cloud cognitive abilities, meaning an individual can’t concentrate or think clearly. Simultaneous treatment can make sure that both disordered are treated and cognition is restored.
  • Integrated programs bring in the perspectives of experts in treating different types of mental health disorders. For example, an anorexia nervosa specialist may focus on increased eating, while a depression expert might focus on improving motivation to get better.
  • Medication therapy is often more effective when addressing both mental health conditions and substance abuse disorders simultaneously, and while it’s not always the best course of action to provide medication, it’s best to coordinate those treatments.

Co-Occurring Disorder Treatment Centers Offer Different Levels of Care

Each of the different levels of care should include provisions for treating co-occurring disorders, and for people seeking out eating disorder treatment for their child, it’s important to find a center that treats its clients as individuals.The best level of care for one case may not be appropriate for the next. However, different severities and different costs can mean that there is a proper level of care for each case. Parents and other loved ones should consider these factors when choosing the right program for a successful recovery:

  • Residential treatment programs provide the highest level of care, in which the client lived at the eating disorder treatment facility for 30 or more days. This includes 24-hours-a-day supervision and a complete focus on recovery. It’s best suited for severe cases and those which require medical or psychiatric care.
  • Outpatient eating disorder treatment, also known as day treatment, is a great alternative for clients who don’t need all-day supervision, and also for people stepping down from residential care that still need regular sessions. This can be ideal for students, parents, and anyone who can’t put aside their responsibilities to go into residential treatment.
  • Access to peer support groups and alumni groups, is a key part of aftercare, especially for those with a co-occurring disorder.This can be through group therapy sessions, online events, or even a quick Zoom session. These groups reduce isolation and allow for open honest communication about life in recovery.
  • Education and counseling for families may also be a necessary part of a successful recovery program. Having a strong support system in place is vital for anyone who has an eating disorder and another co-occurring mental health condition.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.