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Experiencing co-occurring disorders, such as having an eating disorder along with PTSD, happens more frequently than many people may realize. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there is a high correlation between eating disorders and other types of health and psychiatric disorders.

There is a particularly high correlation between eating disorders and substance abuse. When individuals experience eating disorders such as Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder along with other disorders including trauma, depression, or substance abuse this is also referred to as dual disorders.

It’s extremely important to diagnose correctly and then treat each disorder concurrently. The root cause of an eating disorder may be depression or anxiety while the primary cause of substance abuse may be the eating disorder. For treatment to be effective, it’s necessary to understand the root cause of the disorder in each individual and how each disorder influences and affects the other. There are several types of co-occurring disorders that a person might experience along with an eating disorder. It’s important to find a facility with experience treating different disorders simultaneously when seeking Portland eating disorder treatment.

Eating Disorders and Anxiety, Depression, and OCD

Anxiety can include general anxiety, social anxiety, a variety of phobias, and panic attacks. Anxiety will often precede an eating disorder. Repeated thoughts and behaviors are part of Obsessive-Compulsive Disorder or OCD. Individuals might develop an eating disorder as a way to control some aspects of life because anxiety has caused them to feel out of control. An eating disorder is often an unconscious way to deal with the anxiety a person is experiencing.

  • Symptoms – A person might experience irritability, feelings of dread, sweating, and shortness of breath when anxious. Depression is characterized by extreme sadness, feelings of worthlessness, or guilt. There is sometimes an overlap of symptoms seen in individuals with eating disorders and anxiety or depression. For example, symptoms of both depression and Anorexia Nervosa can include severe weight loss and fatigue.
  • Complications – Anxiety, depression, and OCD can contribute to an eating disorder and make symptoms worse. For example, people who are depressed may binge-eat to soothe their emotional state. This creates a vicious cycle of increased depression that can lead to more binge-eating. A person with OCD might be more likely to exercise compulsively to stay thin. This type of cycle can also contribute to an increase in the physical and medical complications associated with eating disorders.
  • Treatment Options – Cognitive-Behavioral Therapy (CBT) is often used to treat a variety of eating disorders. CBT can be effective when helping a person separate food from feelings. Individual therapy can help get to the root cause of an individual’s anxiety or depression. Nutritional counseling is also a form of counseling that a person experiencing these co-occurring conditions could benefit from. Medications can also be used to help control anxiety, depression, or OCD. Often a combination of these treatment methods is used either temporarily or on a long-term basis.

Eating Disorders and Substance Abuse

There is a high correlation between eating disorders and substance abuse. According to the National Institutes of Health, those diagnosed with Bulimia Nervosa were more than 4 times more likely to have a substance abuse disorder. Those with other types of eating disorders were up to 3 times more likely to abuse some type of substance. Substance abuse could include anything from alcohol and prescription drugs to illegal drugs. Substance abuse is generally defined as the uncontrollable use of a substance that leads to addiction. There are normally several factors involved that need to be explored when individuals have both an eating disorder and abuse alcohol or drugs.

  • Symptoms – Symptoms of eating disorders are often similar to those experienced by individuals abusing various substances. Extreme weight loss, insomnia, and irregular heart rhythms can all be experienced by those who are abusing drugs such as cocaine and amphetamines as well as an individual with Anorexia Nervosa. Other substances that are often abused by people with eating disorders include laxatives, diuretics, cocaine, heroin, and alcohol.
  • Complications – Complications from eating disorders or substance abuse can be life-threatening. The combination of the two may produce even more severe physical complications. Co-occurring eating disorders and substance abuse may prove more life-threatening than other co-occurring disorders because both types can directly damage vital organs in the body.
  • Treatment Options – An individual that is experiencing an eating disorder along with some type of substance abuse will need to specifically work through each disorder individually. Treatment may include some type of psychotherapy along with intensive medical care. Even though each disorder needs distinctive treatment, it must be treated simultaneously. Besides receiving treatment for the eating disorder the individual may want to attend meetings or therapy for substance abuse. When seeking treatment for eating disorders and substance abuse it’s important to find a treatment facility that is equipped to treat drug or alcohol detoxification as well as the eating disorder.

Eating Disorders and Trauma and PTSD

The American Psychological Association defines trauma as an emotional response to some sort of terrible event such as sexual assault, a car accident, or a natural disaster. PTSD (Post Traumatic Stress Disorder) is an extreme form of anxiety that results from a debilitating or traumatic incident in a person’s life. Many individuals with an eating disorder have experienced some sort of trauma in their life. While it is generally thought to be ideal to treat co-occurring disorders simultaneously, there may be exceptions. If an individual is medically unstable due to an eating disorder it will likely be necessary to focus on this part of the treatment first.

  • Symptoms – A person with PTSD will likely experience flashbacks of the traumatic event. An individual may also avoid certain places or exhibit signs of emotional detachment. Physical symptoms may also occur that can include nausea and headaches. An eating disorder or substance abuse often accompanies trauma and PTSD. It is an attempt to distance themselves from the trauma or relieve the pain associated with a traumatic event or situation.
  • Complications – Eating disorders can cause health and medical complications while Trauma and PTSD will likely cause problems in an individual’s personal relationships. PTSD may also hinder a person’s ability to hold a job or function normally in a variety of social situations. Left untreated the combination of these disorders could lead to the loss of jobs and relationships and life-threatening health and medical problems.
  • Treatment Options – A combination of psychotherapy and medication is often used to treat PTSD. Cognitive Behavioral Therapy (CBT) is used since it focuses on exploring the relationship between feelings, thoughts, and specific behaviors. Trauma-focused CBT has specifically been designed for treating adolescents. This particular type of therapy teaches young people how to understand, then process, and finally cope with the trauma they’ve experienced. Prolonged Exposure Therapy is another type of therapy often used that focuses on facing feelings and talking about the trauma.

Eating Disorders and Borderline Personality Disorder

BPD is a disorder marked by extreme behavior swings, varying mood changes, and a poor self-image. Episodes of anxiety, depression, or anger may last a few hours or several days at a time. Some research has found that borderline personality disorder and eating disorders share a prominent risk factor. This factor is a history of childhood abuse.

  • Symptoms – A person with borderline personality disorder may exhibit extreme moods and inappropriate reactions to a variety of events or situations. Individuals might have an intense fear of being abandoned, engage in impulsive behavior, express intense anger, or have suicidal thoughts. This impulsivity and extreme moods may be a contributing factor to the eating behaviors seen in disorders such as Bulimia Nervosa and Binge Eating Disorder.
  • Complications – An individual may find it difficult to maintain healthy relationships and a stable job. The Mayo Clinic states that those with borderline personality may be experiencing self-image problems. This can be directly connected to an eating disorder. Whether it’s Anorexia Nervosa, Binge Eating Disorder or another type of eating disorder, those with a borderline personality could more easily exhibit extreme behaviors related to the eating disorder.
  • Treatment Options – Borderline personality disorder often occurs with other disorders and has been historically difficult to treat. After a diagnosis has been made, there are several treatment options a medical professional may use to treat this condition in conjunction with an eating disorder. A few options include Dialectical Behavior Therapy (DBT) and Mentalization Based Therapy (MBT). When creating a treatment plan for each individual it’s important to keep in mind that a study following individuals with borderline personality and eating disorders discovered that migration to different eating disorders was prevalent.

Eating Disorders and Self-Harm

Individuals who are engaging in self-harm are deliberately injuring their own bodies. These actions could include cutting, scratching, or burning different areas of the skin. Those who engage in self-harm often use it as a way to release anger, frustration, and emotional pain. It’s also used as a way to gain control over some aspect of their lives. It is important to note that self-harm is usually not associated with a suicide attempt. Self-harm is more prevalent in females, with nearly half of women and girls who self-harm also having a history of some type of sexual abuse.

  • Symptoms – Symptoms include bruises, cuts, and other wounds on the skin. Mental Health America states that those experiencing a self-injury disorder will engage in skin cutting 70% to 90% of the time. While cutting is the most obvious form of self-harm, an individual may engage in dozens of other types of self-injury. These might involve burning, poisoning, or piercing the skin with sharp objects. There may also be broken bones. An individual may wear long sleeves or pants even during warm weather to cover self-inflicted injuries. Individuals with Anorexia Nervosa may also wear heavy clothing to hide how dramatically their body has changed.
  • Complications – The most obvious complications of self-injury are scarring and damage to the external parts of the body. Even though suicide is usually not intended, sometimes a person may hurt themselves more than intended. This could result in a variety of serious health complications. When coupled with an eating disorder the injuries may be more severe or take longer to heal because a person is not getting adequate nutrition.
  • Treatment Options – Treatment would focus on finding ways to cope with difficult emotions and feelings that don’t involve self-harm or dangerous eating habits. Specific therapies might include forms of psychotherapy. Cognitive-Behavioral Therapy (CBT) can help a person manage and rethink difficult emotions that have led to irregular eating patterns and self-harm. Group or family therapy may also be used to treat self-harm that is co-occurring with an eating disorder.

Even though a high number of individuals with eating disorders also have co-occurring disorders many facilities only diagnose and treat the eating disorder. It’s important to find a facility that has experience recognizing and treating co-occurring disorders when looking for an eating disorder treatment center in Portland. Treating co-occurring disorders requires a very personal and customized approach.

“Every adolescent that comes to Clementine must be seen as a person first, unique in their gifts and in what they need in order to recover.”

Clementine specializes in the treatment of adolescents and young women. They feature a holistic approach that includes a variety of therapies, programs, and even a personalized education plan. Clementine provides high-quality eating disorder treatment that is customized to meet each individual’s specific needs. They offer the most extensive levels of psychiatric and medical care that an individual can receive outside of a hospital. The luxurious surroundings in a homelike setting will enable individuals to realize their full potential. Those who are seeking treatment for themselves or a loved one should contact Clementine for more information.

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Houston, TX | South Miami, FL | Malibu Lake, CA | Naperville, IL | Portland, OR | Briarcliff Manor, NY | Twin Lakes, VA


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.