Eating Disorders and the Dual Diagnosis as it Relates to Addiction

When many individuals come into treatment for substance abuse, it’s common for a secondary diagnosis (or dual diagnosis) to present after detox. For some individuals dual diagnosis, they may face eating disorders. Up to 35% of individuals who abuse drugs and alcohol also have a clinical or sub-clinical eating disorder, according to the National Eating Disorder Association (NEDA). The reason for this high correlation is due to the fact that eating disorders are not a choice. Just like the disease of addiction. Both are linked to genetic predisposition, environmental factors, and a history of low self-esteem. Both also have been shown to result from altered brain chemistry and neurocircuitry in the brain. This affects perception of the severity and intensity of their condition as well as their physiological reaction to specific behaviors (such as drinking alcohol and restricting food intake, respectively).

There are 3 main types of clinical eating disorders:

1. Anorexia Nervosa
2. Bulimia Nervosa
3. Binge Eating Disorder

Each eating disorder presents with different signs and symptoms:

Anorexia Nervosa is characterized by a restriction of energy intake resulting in a significantly low body weight. It can also be characerized by an intense fear of gaining weight or becoming fat despite being underweight and undue influence of body weight or shape on self-esteem and self-image. Physical signs include: significant weight loss, emaciated appearance, cold extremities, and white, downy hair growth on the skin. Other signs to look for include:

1. avoidance of social occasions which include food
2. continuous activity and movement (constant foot or finger tapping, inability to sit for long periods)
3. reduced spontaneity and flexibility of food intake.

Bulimia Nervosa is characterized by recurrent episodes of binge eating. Binge eating refers to eating within a two hour window large amounts of food and a sense of lack of control over eating. This is followed by inappropriate behavior to prevent weight gain (purging). Purging behaviors may include: vomiting, laxative or diuretic abuse, or excessive exercise. Physical signs include: swollen cheeks or parotid glands, dental enamel erosions, and persistent redness in the eyes. Other signs to look for include: frequent trips to the bathroom after a meal, hoarding of food (especially sweets) for the end of the day, and a tendency to exercise more in relation to eating more food than normal.

Binge Eating Disorder is characterized by recurrent episodes of bingeing WITHOUT compensatory purging behavior. This disorder is typically associated with at least 3 of the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not physically hungry; eating alone due to feeling embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after a binge episode. It’s important to note that all of these disorders are associated with feelings of low self-esteem.  Treatment must focus on increasing self-acceptance and developing a positive self-image in addition to helping clients to understand the harmful impacts of their behaviors and how to adopt healthier eating behaviors. If the only focus of treatment is on healthy eating and attaining a healthy weight, treatment will not be successful long-term.

The best outcome is associated with early intervention and a team-based approach, which should include a physician, registered dietitian, and psychologist or licensed counselor trained in working with clients with eating disorders. If an eating disorder is diagnosed before or after substance abuse treatment is initiated, it is important to determine what the primary diagnosis is and address that diagnosis before addressing the secondary diagnosis. Some clients may come to substance abuse treatment when they really need to be treated for their eating disorder first. Considering a client’s overall signs, symptoms, and past behaviors will allow for this determination to be made.

For more information, please consult the resources below:https://www.nationaleatingdisorders.org/https://www.mirror-mirror.org/resources.htmIf you have further questions, please contact Bridging the Gaps registered dietitian Nikky Hindle at (540)535-1111