Eating disorders can take many different forms including excessive eating, food avoidance, or obsessing about food throughout the day. There is also a close connection between eating disorders and substance abuse, as they frequently occur together and can worsen each others’ symptoms. Recently, due to the social distancing practices and isolation that have resulted from the outbreak of COVID-19, many people suffering from eating disorders have been in need of help that they may find inaccessible today. This guide is intended to provide connections to support and guidance for anyone who may be struggling with an eating disorder and substance abuse.
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About half of all people with an eating disorder also struggle with substance abuse.
While eating disorders are not well understood by the medical community, there are currently 6 major types of eating disorders.
Eating disorders are often misunderstood by family and friends who haven’t experienced them personally. Here are some resources to increase awareness and compassion.
Prevalence Of Eating Disorders
Eating disorders are much more common than one may think, as on average, 8.4% of women and 2.2% of men around the world are diagnosed with an eating disorder at some point in their life. It can be very difficult to accurately diagnose an eating disorder, and many studies that use a more broad definition of this condition indicate the prevalence of eating disorders to be around 19.4% for women and 13.8% for men.
North America sees the highest rates of eating disorders worldwide, followed by Asia, and then Europe. Additionally, the prevalence of eating disorders has been increasing over the last 20 years. In particular, from the year 2000 to 2018, the rates of diagnosed eating disorders more than doubled. Due to the increasing rates of these types of issues, it is more important than ever for those who may be suffering from an eating disorder to have the help and support that they need.
Co-Occurring Eating Disorder & Substance Abuse
There has been a well-documented co-occurrence of substance abuse alongside eating disorders. The reasons for this are not at all well understood, but people with an eating disorder report higher rates of substance use disorder than the general population. Additionally, certain eating disorders are linked to a higher incidence of co-occurring substance use disorder than others. For example, several studies have found that eating disorders that involve binging and purging are much more frequently co-occurring alongside substance use disorders compared to restrictive eating disorders.
According to the International Journal of Eating Disorders, around 50% of people with an eating disorder also suffer from drug or alcohol abuse. This is significantly higher than the rest of the population, in which around 9% of people suffer from drug or alcohol abuse. The opposite is also true, as over 35% of people with a substance use disorder also have a co-occurring eating disorder which, again, is significantly higher than the 1-3% rate among the general population.
According to one study, some of the most commonly abused drugs by people with a co-occurring eating disorder include cocaine, amphetamines, marijuana, and alcohol. Within this study, almost a quarter of those with anorexia, bulimia, or an unspecified eating disorder reported current cocaine use. Furthermore, almost half of those with bulimia and just over a third of those with binge eating disorder reported drug dependence at some point in their life.
In addition to the high rate of co-occurrence between substance use and eating disorders, there is also a documented trend that people who have these conditions together are more likely to suffer from an additional mood disorder or personality disorder. Furthermore, co-occurring conditions such as these often result in a much poorer long-term outcome than in either condition on its own. That being said, there are dual diagnosis treatment centers available that specialize in treating these co-occurring and synergistic mental health conditions. Getting help for both conditions at the same time will give someone the best possible chance for achieving long-term recovery from both substance use and an eating disorder.
Types of Eating Disorders
There are several major categories of eating disorders, and while they vary in their manifestation, they all involve controlling food intake and eating in some way or another. Some of the main eating disorders include:
- Anorexia Nervosa: Characterized by an intense fear of gaining weight, AN leads to food restriction, sometimes leading to potentially dangerous malnutrition. Someone with AN often has a false perception of being overweight, even if they are extremely skinny. There are also subtypes, such as anorexia nervosa binge/purge subtype which is characterized by intermittent bingeing and purging.
- Bulimia Nervosa: Bulimia nervosa is distinguished from the anorexia binge/purge subtype by the regularity of binge/purge episodes. To meet the diagnostic criteria for bulimia, these binge/purge episodes must occur at least once per week for 3 months to be considered bulimia. Binging episodes exhibit excessive food intake, distinguished by a lack of control over what, or how much, someone eats followed by a period of purging; either through induced vomiting, inappropriate use of laxatives, or other ways to avoid weight gain due to food intake.
- Binge Eating Disorder: This may be similar to bulimia nervosa, but is distinct in that there are no compensation measures taken, such as induced vomiting. Binge eating disorder is characterized by excessive food intake and may include eating to the point of physical discomfort, eating more rapidly than normal, hiding excessive eating, and being disgusted or feeling guilty with oneself due to these episodes of binge eating.
- Avoidant/Restrictive Food Intake Disorder (ARFID): An obsession with avoiding food, or reducing caloric intake to an unhealthy or potentially dangerous degree. The outward signs can include drastic weight loss, significant nutritional deficiency, interference with social interactions, a reliance on nutritional supplements, or a combination of these issues.
- Other Specified Feeding or Eating Disorder (OSFED): This can include components of other disorders, but does not necessarily meet the inclusion criteria for any other specific eating disorder. This may include the symptoms of anorexia nervosa except that the person’s weight is within normal bounds. It may also include symptoms of bulimia nervosa and binge eating disorder except that the binging, and purging in the case of bulimia, occurs less than 1 time per week, or occurs for less than 3 months total.
- Unspecified Feeding or Eating Disorder (UFED): This can include any type of feeding or eating disorder that causes psychological distress or impairs social or work interactions, but may not necessarily fit the exact criteria of other specific disorders.
Another similar and often co-occurring disorder, although distinct from a proper eating disorder, is body dysmorphic disorder (BDD). This is a condition where someone will perceive flaws or defects in their physical appearance that may not be apparent, or appear extremely minor, to others. This can involve weight or body fat, but this is where things get tricky to diagnose. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) has this to say on the matter:
“In an individual with an eating disorder, concerns about being fat are considered a symptom of the eating disorder rather than body dysmorphic disorder. However, weight concerns may occur in body dysmorphic disorder. Eating disorders and body dysmorphic disorder can be comorbid, in which case both should be diagnosed.”
DSM-V (PDF Version), page 246
Eating disorders seem to be more common in women than in men, and among women, the most common eating disorder today is binge eating disorder. This is the case in every socioeconomic population studied including those from Africa, Asia, and the Americas. That being said, many mental health issues go unreported or are consistently under-reported in male populations. While the numbers point to a female-dominant demographic of eating disorder sufferers, the lack of reporting by men could lead to this misconception. There may also be many people who are struggling with a UFED-type disorder, and a lack of a proper diagnosis may keep someone from getting the help they need.
Educational & Support Resources for Loved Ones
Eating disorders are often misunderstood by those who have not struggled with these difficult issues themselves. Due to this, we have listed educational resources so that someone can become more informed on these issues, and hopefully be better able to offer care and support in someone’s time of need.
- National Alliance on Mental Illness: A non-profit organization dedicated to increasing awareness of mental health issues, including eating disorders. They provide educational guides and links to further support resources so that you or a loved one who may be struggling with an eating disorder can be informed about the condition.
- Families Empowered And Supporting Treatment for Eating Disorders (FEAST): This organization is for the parents and families of those who may be struggling with an eating disorder. They provide a wealth of support resources for the loved ones of those in recovery from an eating disorder, as well as resources for the families of those who have not yet found recovery from an eating disorder.
- Academy for Eating Disorders – The Purple Book: A comprehensive guide to help those with eating disorders or their loved ones identify an eating disorder and take the appropriate steps to find treatment. It provides a wealth of information about the dangers, signs, risk-reduction strategies during treatment, and the most effective recovery practices.
- National Association of Anorexia Nervosa and Associated Disorders (ANAD): A non-profit group that provides informational materials for someone suffering from an eating disorder and their loved ones. Their article “How To Help A Loved One” is a fantastic place to start if you are trying to help someone you know that is struggling with an eating disorder.
- National Institute of Mental Health – Eating Disorder Statistics: A look at the prevalence of eating disorders in America today across all age and gender groups. This page helps to paint a clear picture of just how common eating disorders are in today’s world. They also provide informational guides for loved ones, including About More Than Food, Let’s Talk About Eating Disorders, and a full page of shareable resources on eating disorders.
Support Resources for Eating Disorder Recovery
If you or someone you know struggles with food, their weight, body image, or self-worth related to their appearance, there is help available. Below we have listed many helpful resources so that anyone struggling with these issues can better understand their condition, and hopefully take some steps to find help.
- National Eating Disorders Association: Previously 2 separate organizations, the original NEDA and the National Association for Males with Eating Disorders, this new combined organization is dedicated to eating disorder awareness and recovery. They provide an expansive website that includes helpful resources, recovery support, and helpful articles such as Substance Abuse and Eating Disorders.
- Kirsten Haglund Foundation: A non-profit organization whose goal is to raise awareness about eating disorders and to help those struggling with eating disorders find recovery.
- Recovery Warriors: A website, blog, podcast, and also an app that aims to provide support and helpful resources to those struggling with an eating disorder and mental health issues.
- Eating Disorder Hope: A site devoted to promoting eating disorder awareness, support, and recovery that provides multiple educational guides and links to recovery resources.
- National Centre for Eating Disorders: A treatment provider based in the UK, this organization aims to increase awareness and visibility of eating disorders, aid recovery, and provides support to professional eating disorder counselors and therapists.
- Centre for Clinical Intervention – Disordered Eating: A series of informational packages provided by the Australian government that can help someone recognize an eating disorder. This is not treatment, but a means of identifying whether or not someone is suffering from an eating disorder that may require treatment and support.
- Project HEAL: An organization that aims to help people suffering from an eating disorder find and enter treatment. They will offer guidance and support and help people find treatment, offer insurance navigation, and may even provide cash assistance for eating disorder treatment.
Eating Disorder Recovery Programs
Just as there are several different types of eating disorders, there are also several different eating disorder recovery programs and fellowships. While some eating disorder recovery programs may be specific to certain types of eating disorders, the ones listed here are all-inclusive. For the most part, anyone with an addiction or obsession with food, weight, or body image may find help, support, and recovery in these programs.
- Eating Disorders Anonymous: A 12 step program that currently has meetings in over 10 countries as well as online meetings at any time of day. The purpose of EDA, as quoted from their website, is “…living without obsessing on food, weight and body image.” This is a very inclusive fellowship that helps someone address and recover from any type of eating disorder.
- Food Addicts In Recovery Anonymous: This fellowship currently has meetings in at least 10 countries all over the world. Food Addicts may sound specific, but as the 3rd tradition of FA states “The only requirement for membership is a desire to stop eating addictively.” This could include overeating, undereating, compulsively exercising, or a mental obsession and fixation on food, weight, and exercise in general.
- Overeaters Anonymous: Currently hosting meetings in dozens of countries around the world, this program is for those who may have issues with regularly eating too much. This could include someone hiding their eating from others, eating until feeling sick, and the use of food as an emotional crutch or coping mechanism. The impetus of OA, as quoted from the OA Preamble goes “Our primary purpose is to abstain from compulsive eating and compulsive food behaviors and to carry the message of recovery through the Twelve Steps of OA to those who still suffer.”
Crisis and Support Hotlines
Mental health and addictive behaviors frequently go hand-in-hand. If you or someone you know is undergoing a crisis due to an eating disorder or other mental health issues, these crisis lines may be able to offer help.
- ANAD Eating Disorder Helpline: Call 630-577-1330 (Monday through Thursday 9:00am-9:00pm / Friday 9:00am-5:00pm / Sunday 5:00pm-9:00pm Central Standard Time).
- FEAST Around the Dinner Table Forum: Call 1-855-50-FEAST in the US (numbers to 5 other countries are available on their site) to be connected with other parents and families of those who are in recovery from eating disorders. They also provide connections to further resources and support and a community forum for those in recovery, or their loved ones.
- NEDA Helpline: Call 1-800-931-2237 (Monday through Thursday 11:00am-9:00pm / Friday 11:00am-5:00pm Eastern Standard Time)
- Crisis Text Line: Text NEDA to 741741 in the US & Canada / 85258 in the UK / 50808 in Ireland to chat with an eating disorder crisis counselor.
- National Suicide Prevention Lifeline: Call 1-800-273-8255 for 24/7 crisis intervention and support services.