The Connection Between Eating Disorders & Mental Illness
- What are Eating Disorders?
- How Common Are Eating Disorders and Substance Use Disorders?
- How Are Substance Abuse and Eating Disorders Related?
- Substance Abuse and Eating Disorders Share a Common Etiology
- Substance Abuse and Eating Disorders Reinforce Each Other
How Are They Related?Eating disorders and substance abuse have a unique association with each other. Coping with one of these issues increases the chances that a person may have to cope with the other, at some point in time, and there are a number of factors that contribute to the interplay between both disorders.
What are Eating Disorders?
All of the various eating disorders are very serious conditions, associated with a number of grave health consequences and potential mortality. They are borne from complicated mental health processes, and each involves differing combinations of obsessive thoughts and compulsive behaviors concerning body image, food intake, and purging mechanisms:
Anorexia Nervosa – Can result in severe weight loss secondary to distorted body image, intense fear of gaining weight and resultant pathological dieting or food restriction.
- Anorexia has a lifetime prevalence of 0.9% in women and 0.3% in men.
Bulimia Nervosa – Frequent excessive eating (known as a food binge) followed by inappropriate purging (such as self-induced vomiting, abuse of laxatives and/or excessive exercising) to avoid weight gain.
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- Bulimia has a lifetime prevalence of 1.5% for women and 0.5% for men.
Binge Eating Disorder – Recurrent episodes of compulsively eating very large amounts of food with a sense of loss of control.
- Binge Eating Disorder has a lifetime prevalence of 3.5% among women and 2% among men.
How Common Are Eating Disorders and Substance Use Disorders?
It is not uncommon for a person with an eating disorder to also suffer from a substance abuse problem.
- In 2014, Substance Use Disorder affected 21.5 million people, or 8.1% of the U.S. population.
- Of these people, nearly 40% also struggled with a mental disorder.
- Research has found that up to 50% of people diagnosed with an eating disorder will struggle with substance abuse, whereas only 9% of the general population is diagnosed with a substance use disorder.
- Conversely, 35% of substance abusers have been found to also have an eating disorder, compared to the 3% of the general population diagnosed with an eating disorder.
How Are Substance Abuse and Eating Disorders Related?
The phenomenon is the topic of much ongoing study. To date, there may not be a definitive answer to the question of why eating disorders and substance abuse are related, but there are many research-supported theories.
Does substance abuse cause eating disorders?
Many drugs affect appetite – some, including marijuana and other cannabinoids, result in a subjective increase in appetite and subsequent eating behavior. Others, including stimulants such as cocaine and methamphetamine, reduce an individual’s drive to eat.
- Persistent changes in appetite and eating behavior – even when mediated by substance use – can prime an individual to develop chronically disordered eating patterns, and ultimately lead to an eating disorder diagnosis.
Stimulants and cannabis (marijuana) seem to be the substances most closely related to eating disorders.
- Marijuana increases appetite and thus may be implicated in some instances of binge eating.
- On the other end of the spectrum, those drugs that reduce appetite – including Ritalin (methylphenidate), Adderall (amphetamine), methamphetamine, cocaine and ecstasy – are all potentially related to disordered eating behaviors that involve restricted food intake, such as anorexia.
Alcohol is another drug that is related to eating disorders – specifically bulimia – though this association may mediated by the effects of other psychological disorders or personality traits.
- For example, impulsivity – specifically, reward sensitivity or drive – has been linked to both eating disorders and substance use.
- Both food and drugs stimulate the brain’s reward circuitry; the way this reward mechanism is influenced, either by aspects of personality (like impulsivity) or psychological disorders, is critical to the correlation between substance use and eating disorders.
All told, abusing any of these substances (or combination thereof) can cause a major change in diet and caloric intake, which may give rise to or hasten the development of an eating disorder.
Another theory regarding the association between eating disorders and substance abuse is that eating disorders may lead to substance abuse problems.
- Someone already struggling with an eating disorder may cause a person to begin using stimulants for their appetite-suppressing effects. When a person desperately wants to lose weight they may seek out appetite reducing substances that will further facilitate their caloric restricting behavior.
- Another way that an eating disorder may give rise to substance abuse is that food deprivation may affect the brain’s reward system pathways, making a person more likely to abuse substances that provide a rush of the brain’s reward chemicals.
Whether substance abuse initiates the development of an eating disorder or, conversely, eating disorders give rise to substance abuse behavior is still being debated—the directionality likely varies given differing individual circumstances.
Substance Abuse and Eating Disorders Share a Common Etiology
It has been suggested that particular personality traits may increase a person’s chances of developing both substance abuse and an eating disorder:
- Novelty-seeking – A person seeks out new experiences often.
- Impulsivity – A person makes spur-of-the-moment decisions and choices.
- High interpersonal sensitivity – A person is very good at perceiving others’ feelings and motivations.
- Neuroticism – A person has high levels of negative mood, such as depression, anxiety, and low self-esteem.
- Poor emotion regulation – A person may have maladaptive reactions to their emotional feelings.
Each of these personality traits has been associated with both eating disorders and substance abuse problems. Specific features of this personality profile may render a person more susceptible to emotional and societal pressures, potentially turning them towards the use of substances and strict food control to cope.
In addition to these personality traits, suffering from depression and experiencing life trauma have also been associated with both eating disorders and substance abuse.
Substance Abuse and Eating Disorders Reinforce Each Other
The effects of substance abuse and eating disorders may interact with each other in ways that reinforce or worsen each issue.
- Both substance abuse and eating disorders can cause feelings of guilt in a person—those suffering from an eating disorder may use substances as an attempt at self-medication to manage feelings of anxiety or depression.
In addition, bulimia has been found to have a stronger association with substance abuse than anorexia, perhaps due to the binging habits of people suffering from bulimia.
- Because people with anorexia use restrictive eating behavior, they may not be as willing to ingest other substances.
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