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When someone has an eating disorder, other mental health issues are more likely to be present as well. These issues are known as “co-occurring disorders.” People who have co-occurring disorders face unique obstacles that make treatment of their eating disorder more complicated. They may also be more likely to suffer a relapse after being discharged from eating disorder treatment. For this reason, the treatment team needs to be aware of these co-occurring mental health issues so they can be treated alongside the eating disorder.

What Is a Co-Occurring Disorder?

A co-occurring disorder is a secondary disorder that occurs alongside an existing diagnosis. In the case of someone who has an eating disorder, co-occurring disorders are usually related to mental health conditions, such as anxiety or obsessive-compulsive disorder. Researchers are not sure whether these co-occurring mental health conditions are the cause of eating disorders or whether the eating disorder makes these other conditions more likely to occur. However, most people who have both an eating disorder and a mental health condition will experience better outcomes if both disorders are treated simultaneously. Otherwise, the continued existence of the mental health condition will raise the chances of eating disorder relapse.

Common Co-Occurring Disorders

Any mental health condition can occur alongside an eating disorder. However, certain conditions are more likely to accompany eating disorders. Some of the most common mental health conditions that occur along with eating disorders include:

Substance Use Disorders

Substance use disorders are common among people with all types of eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder. In fact, according to the National Eating Disorders Association, the rate of substance abuse among people with eating disorders is approximately 50 percent, which is five times higher than the rate of substance abuse in the general population. People who have eating disorders are more likely to abuse alcohol, cocaine, and heroin. Some people with eating disorders also abuse non-intoxicating substances, such as laxatives or diuretics.


The rate of anxiety is high among people with eating disorders. The National Association of Eating Disorders reports that the rate of diagnosis of anxiety disorders among people with eating disorders is greater than 56 percent. An even higher proportion of these individuals likely experiences subclinical anxiety. Anxiety can exacerbate eating disorders, often leading people to spend more time concerned about their appearance and/or worrying about their eating habits. For example, in someone who has bulimia nervosa, the presence of anxiety may contribute to the desire to purge excess calories.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder is a type of anxiety disorder that commonly occurs with eating disorders. This disorder is characterized by specific, ongoing thoughts that are uncontrollable and invasive (“obsessions”). These thoughts typically lead the individual to engage in specific repetitive behaviors to alleviate distress (“compulsions”). For someone with an eating disorder, OCD may contribute to the development of rituals associated with eating, restricting food intake and/or purging excess calories. When an individual has an eating disorder complicated by OCD, addressing both conditions at the same time is essential to maximize the chances of treatment success.


The National Eating Disorders Association reports that more than 90 percent of people hospitalized for an eating disorder also suffer from depression. These individuals struggle with feelings of hopelessness and despair, as well as sleep disturbances and other related issues. All of these issues can contribute to eating disorder symptoms and complicate treatment. If someone who has a depressive disorder and an eating disorder does not receive treatment for depression, they may be more likely to return to disordered eating behaviors after being discharged from eating disorder treatment because of their ongoing depressive symptoms. 

Post-Traumatic Stress Disorder

Post-traumatic stress disorder, or PTSD, is another mental health condition that commonly appears alongside an eating disorder. In fact, trauma itself has found to be a significant risk factor for the development of any kind of eating disorder. Among people who have eating disorders, the rate of diagnosis of PTSD is substantially higher than in the general population. Likewise, even in people who have eating disorders but have not been formally diagnosed with PTSD, there is a high likelihood of past trauma. To effectively treat eating disorders, identifying the presence of PTSD or any past trauma is highly important. Addressing these issues will make it easier for the individual to overcome the eating disorder and deal with the triggers and stresses they will face after leaving treatment.

How Are Co-Occurring Disorders Treated Effectively?

Some treatment centers focus all of their time and attention on addressing disordered eating behaviors and/or the abnormal thought patterns that accompany disordered eating behaviors. However, focusing only on the basics of the eating disorder itself is not the best approach when there is a possibility that a co-occurring disorder is present. To effectively treat a co-occurring disorder, the care team must:

1. Identify which mental health conditions are present. 

In some cases, a person may have more than one co-occurring mental health condition. For this reason, it is important to make the exploration of co-occurring mental health disorders a central component of the assessment process for every patient who enters eating disorder treatment. During the assessment process, they should meet with a psychiatrist or similarly-trained medical professional who knows how to recognize the signs of a co-occurring mental health issue. Following an in-depth interview, this professional can provide their opinion of the individual’s mental health condition and indicate whether any co-occurring mental health issues are present. It may also be helpful for the care team to interview members of the their support system for additional information.

2. Consider subclinical mental health issues. 

In some cases, a person may not meet the requirements to be formally diagnosed with a specific mental health condition, but they may still suffer from certain symptoms or have a unique history that should be incorporated into the care plan. For example, many people who have eating disorders may struggle with anxiety but not have enough symptoms to qualify for an anxiety disorder diagnosis. Likewise, many people who do not meet the requirements for a diagnosis of PTSD may still have eating disorders that are complicated or exacerbated by past traumas. Psychiatrists and other members of the care team should look for these issues and consider them when developing a treatment plan for any eating disorder patient. 

3. Create a care plan that incorporates mental health treatment. 

After identifying any mental health diagnoses or subclinical issues, the care team should develop a customized treatment plan that takes these issues into consideration. The specific treatment recommended will depend on the specific diagnosis, as well as the patient’s unique characteristics. Depending on the situation, people may benefit from psychotherapy, behavioral therapy, medication and/or other services aimed at addressing the symptoms of mental health disorders. Some people may benefit from alternative therapies as well. All dual diagnosis patients should also be educated about the role their mental health issues plays in the development and presentation of their eating disorder. When people understand how these two disorders interact, it will be easier for them to make lasting changes and overcome both issues. 

4. Proactively plan for aftercare. 

Following discharge from an eating disorder treatment program, many people will continue to experience some of the symptoms of their mental health disorder. In fact, for some, these disorders will be a life-long problem. Unfortunately, if people who have a dual diagnosis don’t continue to receive the support they need after leaving an inpatient program, they are more likely to relapse. To reduce the chances of relapse, people need to continue treatment for their mental health issues even after completing an inpatient program. Many people will benefit from continuing to receive care on an outpatient basis. For example, people may attend a weekly appointment with a psychiatrist or behavioral therapist. People who have a co-occurring mental health diagnosis may also benefit from other aftercare activities, such as support group meetings.

Seeking Treatment for Dual Diagnosis

If you or someone you love is struggling with an eating disorder complicated by mental health issues, getting the proper treatment is essential. If the treatment plan does not address both of these disorders, a full recovery is not as likely. The best treatment programs will be individualized based on the individual’s situation and will include services specifically designed to address mental health conditions and symptoms that contribute to the eating disorder. When looking for a treatment facility, it is important to research the programs the facility offers carefully. For the best results, look for a program that explicitly addresses mental health issues among eating disorder patients. 

To determine whether a given program is right for an eating disorder patient who has a co-occurring mental health disorder, ask the following questions:

  • Does your program screen people for mental health disorders before admission?
  • Can your program handle people who have a dual diagnosis?
  • What services are available for people who have co-occurring mental health disorders?
  • Does your program customize treatment plans for each patient?
  • What is your program’s success rate for treating people who have a dual diagnosis?
  • How does your program handle discharge planning for people who have co-occurring mental health disorders?
  • Will I pay more for dual diagnosis services or is mental health treatment included in the program?

Treatment for Co-Occurring Disorders at Clementine

At Clementine, we understand that psychiatric conditions complicate eating disorders themselves and the eating disorder treatment process. For this reason, we make psychiatric care an integral component of the services we provide. We are proud to offer individualized treatment to people with any co-occurring mental health disorder, including mood disorders, substance use disorders, PTSD and more. We also offer specialized treatment to people who have a history of trauma. 

All people at our facility undergo a thorough psychiatric assessment before enrolling. Every patient at our facility will also participate in individualized psychotherapy sessions twice each week. When appropriate, our psychiatrists prescribe medications to help people with mental health conditions. We know that people can experience distress or other psychiatric concerns at any time during treatment. For this reason, we provide all of our residential clients with access to psychiatric care 24 hours a day, 7 days a week as well as medical and nursing care at all times. 

People who have an eating disorder and a co-occurring mental health disorder require specialized treatment that has been tailored to their unique situation. Clementine is dedicated to providing this high level of care to every patient we treat. To learn more about the services we provide to people who have a dual diagnosis, or to begin the enrollment process, please contact us today. 


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.