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Dual Diagnosis Eating Disorders and Substance Abuse Treatment

What do eating disorders and substance abuse have in common? Both can be classified as psychological disorders that can have deadly physical effects on the body. Regardless of this understanding, a good majority of people don’t associate one with another. Evidence supports that both eating disorders and substance use disorders can go hand in hand. Since two separate psychological illnesses can overlap and enable the other, a person with co-occurring disorders will benefit from quality eating disorder and substance abuse treatment. At Phoenix Rising, our dual diagnosis eating disorders and substance abuse treatment treats the entire person, not just the symptoms.

Eating Disorder and Substance Abuse Treatment

Many of the emotional effects of both eating disorders and addiction are similar. Addiction tends to develop around feelings of stress, dissatisfaction, obsession and depression. If these sound eerily similar to the emotions associated with eating disorders, then you’d be correct.

Woman needing dual diagnosis eating disorder and substance abuse treatment

About 50% of people seeking treatment for eating disorders also have a substance use disorder. Additionally, around 30-40% of the substance-abusing community receives treatment for an illness classified as an eating disorder. When a person is suffering from more than one psychological illness at a time, it’s referred to as dual diagnosis.

Eating disorders and substance use disorders tend to reinforce each other, making unhealthy habits particularly hard to break. Aside from the back and forth driving each illness further, this type of dual diagnosis can be very time-consuming, costing extra time and money to sustain.

Getting treatment for eating disorders and substance abuse together includes considerable therapy and trigger response. However, it also proves tedious when developing proper coping skills. This is because, previously, one illness may have been implemented to cope with the other during active addictions. Treatment will include working on the development of healthy and sober new habits. It will also require redefining the nature of coping skills altogether.

How Common are Eating Disorders?

Even in today’s health-aware society, eating disorders can often go unnoticed or misunderstood. Intensive dieting routines like intermittent fasting may have those around you less concerned about typical mealtime preferences. The standards and customs that were once observed as norm are being changed to accept certain eating disorders and health-conscious efforts. In fact, addiction and restraint can even be considered dedication to one’s wellness goals, instead of cause for concern.

Gender, Eating Disorders, and Substance Abuse

Tens of millions of individuals suffer from an eating disorder at some point in their lives. On average, women double the amount of men who suffer, yet gender is not necessarily a determining factor.

More than 10 million men have had an eating disorder. When visiting the issue of both eating disorders and substance abuse, addiction is observed slightly higher with men. Determining the occasion where one illness can lead to the other, may play a part in evening that gender-likely playing field.

Unfortunately, stereotypes and stigmas can deter people from getting the proper care they need. In general, eating disorders are often associated with women, while men are more likely stereotyped for substance abuse. This sets up many needing treatment for difficult emotions revolving around being open about the care that they need. If you’re in addiction treatment but don’t receive help for an eating disorder, your risk of relapse will increase by over 43%.

If you are suffering from an eating disorder and a substance abuse problem, you’re not alone. The best thing you can do is enroll in an eating disorder and substance abuse treatment center. If these illnesses are left untreated and able to advance, they can lead to serious injury or even death. Society is increasingly seeing eating disorders and substance abuse as treatable illnesses. Know that help is available, and that you don’t have to do it alone.

What Are Eating Disorders?

An eating disorder is an illness that is classified by a disturbance in adequate consumption. People with eating disorders are unable to properly manage eating to maintain health.

These illnesses can span through behaviors, emotions, patterns, and thoughts revolving around nutrition and void of knowledge and necessity. Eating disorders affect a person on both a mental and physical level. They’re similar to addiction in terms of the lack of control the person has over the illness. In fact, it can be considered an addictive habit.

A person with an eating disorder consistently performs tasks necessary to maintain the illness, despite realistic health. Those suffering with the illness tend to place an enormous amount of stress on food and the act of eating it. It also includes having intense feelings toward weight, shape and physical appearance.

Eating disorders are especially common in young adults. Anyone who finds themselves going through physical changes can develop this life-threatening malady. Complications arise in their bones, teeth, mouth and gastrointestinal functions and lead to more deadly outcomes.

An eating disorder is a serious and chronic health concern and shouldn’t be taken lightly. If left untreated, it will continue to develop and have long-lasting, devastating effects. If you or someone you know is suffering from an eating disorder, it’s important to get appropriate treatment.

Signs and Symptoms of Eating Disorders

Just like many illnesses that affect both the body and mind, eating disorders can begin with vague symptoms. Becoming aware of the potential mental and physical symptoms can help determine the need for intervention. Each person may have their own individual and specific tells. Keep in mind that these can vary, intensify or recede with time.

Emotional Signs of an Eating Disorder

  • Stress or worry around mealtime
  • Agitation associated with hunger
  • Anxious thoughts about people watching what you eat
  • Obsessive or depressive feelings about weight or physical appearance
  • Depression, anxiety, obsessive-compulsive behaviors, or unreasonable feelings of distress that are unreasonable about one’s own appearance or eating habits

Behavioral Signs of an Eating Disorder

  • Being distracted about how weight or size affects the quality of life
  • Extreme fluctuations of mood
  • Withdrawing from social events that were previously enjoyable
  • Avoid eating with others
  • Displaying patterns and rituals with food, such as refusal to eat when separate foods touch
  • Obsessiveness with appearance or frequent urges to look in the mirror
  • Frequently discussing personal flaws

Physical Signs of an Eating Disorder

  • Extreme or noticeable weight change
  • Having difficulty with coordination, focus or concentration
  • Irregular menstrual cycles or sexual dysfunction
  • Dizzy spells or fainting
  • Frequent digestive upset such as cramps, gas, acid reflux, constipation or gag reflex
  • Excessive fatigue or weakness of the muscles

While it’s rare for someone with an eating disorder to have all of these signs, some will be noticeable. You must remember that seeking professional care is the best course of action. Don’t attempt to force feed or pressure a person into dietary changes. When there is a psychological illness present, it can do more harm than good, both emotionally and physically.

Types of Eating Disorders

Like a drug or alcohol addiction, eating disorders are not one-size-fits-all types of illnesses. Each person has a different experience with them. When you identify the feelings and behaviors associated with each illness, you can determine the best course of treatment.

However, there are four distinct eating disorders that can coincide with substance abuse. Each eating disorder may present vastly different; however, they usually stem from very similar psychological standpoints. The four most commonly identified eating disorders diagnosed while participating in rehab are:

  • Anorexia
  • Bulimia
  • Binge-eating disorder
  • Pica

For those in more flexible programs like outpatient drug rehab, symptoms may be more difficult to identify. This is likely due to the fact that mealtimes can occur away from our facility. That’s not to say that outpatient rehab and proficient care are unavailable options for eating disorders and substance abuse. However, this type of dual diagnosis may require a more intensive option like residential treatment.


Individuals with anorexia nervosa are extremely thin yet perceive themselves as obese or overweight. While anorexia is more commonly diagnosed in women than in men, either gender can have it.

Symptoms of anorexia nervosa include:

  • Inaccurate or distorted body perception
  • Anxiety or fear of weight gain or “getting fat”
  • Obsession with the idea and action of losing weight
  • Typically below average body weight (especially if left untreated for an extended duration)
  • Restrictive eating patterns that exceed acceptable restraint
  • Refusal to eat on a regular basis

Even though not everyone with anorexia is obviously thin, the determining factor is whether the person has a skewed perception of themselves. This often makes it difficult or extremely uncomfortable for them to socialize or be in public. Anorexia can be especially dangerous when drinking to assist with comfortability at group events. The lack of additional nutrients in your body that help metabolize alcohol can lead someone to get drunk quickly.

People with anorexia will often feel compelled to have control. Feelings associated with being dominated or inadequate disappear when they stop eating food. By restricting what they eat, they may find themselves constantly obsessing over food. Anorexia sufferers often compliment any food intake with laxatives to flush their bodies as quickly as possible.

Anorexia can cause chronic fatigue and weakness. Additionally, their illness can get worse over time if untreated. As a result, side effects can stretch from brittle nails and hair, to poor bone development and infertility.


Bulimia nervosa is classified by two distinct compulsive behaviors: binging and purging. Binging refers to the massive intake of food, and purging is the immediate excretion of said food. Purging often happens through vomiting or abusing laxatives.

eating disorders and substance abuse

People with bulimia will often find themselves exceedingly full after a meal. Meals will usually consist of unhealthy foods. After sufferers purge, they’ll react by subjecting themselves to extreme exercise. These behaviors are done with the intention of lessening the guilt associated with eating, overeating or eating poorly nutritionally.

Signs of bulimia include:

  • Chronic behaviors of purging after eating
  • Consuming meals in excessively large amounts on a regular basis
  • Spending (reoccurring) time purging
  • Associating nourishment with weight gain
  • Fear of putting on additional weight despite healthy body measurement
  • Obsessive exercise
  • Making the determination of self-worthiness based on body shape and weight
  • Overindulgence and extreme use of laxatives

The lack of nutrients brought on by binging and purging is just the beginning of the danger. However, when coupled with a substance use disorder, bulimia can be devastating. Since drugs or alcohol won’t be as effective when they’re purged, people with bulimia and substance abuse might opt for drugs that can be injected, like heroin. Injection, smoking, or snorting will ensure a high without interfering with binging and purging.

Force-vomiting repeatedly also takes a major toll on the body. Damaging the throat, esophagus, mouth and teeth can lead to infection and irreparable deterioration. Due to the extreme behaviors associated with bulimia, it can progress quickly.


Although similar to bulimia, binge-eating disorder differs in that there is no purging involved. Binge-eating disorder is typically associated with finding comfort and relief in food.

This eating disorder falls along the lines of an obsessive condition, if there aren’t any underlying factors that contribute. This can be particularly dangerous when addiction is present, substituting food for addictive and commonly abused substances. The impulse control often leads to shame after a binge-eating episode has occurred. This shame is only a further driving force that can often lead to development of an addiction.


This eating disorder is recognized as one of the most impulsive. People with pica consume things that typically aren’t considered food, including:

  • Dirt
  • Soap
  • Chalk
  • Hair
  • Clay
  • Paint
  • Cigarette butts
  • Toilet paper

In reality, almost any non-food item can be on this list.

Pica is a serious mental health condition. Although it can coincide with substance use disorder, it doesn’t necessarily cause pica. The body simply cannot break down or tolerate an excessive amount of these foreign materials. This illness typically develops within a month’s time before additional health issues happen to be noticed.

The Development of Eating Disorders

Eating disorders don’t develop through any specific cause. However, they are all associated with low self-esteem or self-worth. As a result, doctors and rehab specialists conclude that the psychological connections between eating disorders and substance abuse are similar. Both may also have a genetic origin and may be inspired by self-consciousness or trauma.

Common risk factors of an eating disorder and substance abuse include:

  • Exposure, where they have observed these behaviors from a close family member or close friend growing up.
  • During the trial and error of ritual dieting.
  • Poor self-image or value of oneself.
  • As a result of bullying, especially at a young age or on social media.
  • Having unrealistic expectations of fitting into pop-culture.
  • Being encouraged by peers to invest in the experience.

It’s not unusual for a person to find some flaws within themselves, whether in appearance or personality. This is what makes each of us beautiful and unique. However, when that dissatisfaction leads to taking dangerous and unhealthy action, it can be problematic.

The Connection Between Eating Disorders and Substance Abuse

About half of those that suffer from either addiction or an eating disorder have the other as well. This may contribute to abusing substances for assistance in maintaining unhealthy eating desires.

People with eating disorders commonly turn to stimulants and depressants for comfort, as well as over-the-counter dietary or digestive aids. To be specific, many develop addictions to substances such as:

  • Alcohol
  • Cocaine
  • Heroin
  • Opioids
  • Amphetamines

Substance abuse can also be accompanied by abusing drugs unintended for their purpose, such as:

  • Diuretics
  • Laxatives
  • Extreme fiber consumption using psyllium derived products
  • Emetics, which are used to induce vomiting

Over-the-counter medications can be just as hazardous as illegal drugs. Used to quickly remove sustenance from the body, they come with a list of dangers associated with misuse. Unfortunately, due to their effectiveness, they are often solicited when an eating disorder is suspected.

When consumed together, the results can be catastrophic. The lack of nutrients that are derived from eating disorders can lead to insufficient processing of these addictive chemicals. Suffering with an eating disorder can make drugs more potent, or even create higher tolerance levels overtime. In the case of dual diagnosis, when an addiction and an eating disorder are both present, early intervention is essential.

Risk Factors of Eating Disorders

Common environmental risk factors that can be associated with developing dual diagnosis include:

  • Pressure from peers and society
  • Feelings of stress and anxiety
  • Brain function abnormalities
  • Low self-worth
  • Depressed or helplessness mood

Derived from similar emotional and psychological reasonings, dual diagnosis is shockingly common. Getting professional treatment for eating disorders and addiction should be discussed with a rehab specialist. In many cases, getting a sick person the help they need can’t wait another day.

Dual Diagnosis Eating Disorder and Substance Abuse Treatment

While there are similarities between factors that contribute to developing eating disorders and substance abuse, treatment options are different. Rehab for addiction requires that you begin with detox and then move into treatment, while treatment for eating disorders doesn’t.

However, after the 30-day detox is complete, treating dual diagnosis with therapy will begin. Depending on each unique case requirements, the following therapies may be implemented to treat both simultaneously:

  • Cognitive behavioral therapy: The program is designed to develop new proactive behaviors. This may include addressing dietary changes and habits as well as substance abuse triggers.
  • Family therapy: Beneficial for both the addict/patient and their families to gain a better understanding of the dual diagnosis. Promotes healing and bonding.
  • Group therapy: A safe place to discuss and learn about the struggles of your peers, while sharing your own. Open discussion encourages accountability and insight into your own illnesses and goals for recovery.

When a person is working through treatment for an eating disorder, a licensed dietitian may help with their recovery. For those participating in a residential treatment program, meals will be provided that will aid in maintaining proper nourishment.

Residential treatment is considered the most proactive treatment for those suffering from a dual diagnosis. By remaining within the facility after detox, residents will have access to around the clock care. This includes therapy being as readily available as possible for those having a particularly hard time.

Find Eating Disorder and Substance Abuse Treatment in California

Suffering from eating disorders and substance abuse may leave you feeling ashamed and afflicted. However, many have been where you are right now. By getting help, you’re taking real control of your life. It’s time to discuss the opportunities available at a rehab facility designed to help.

At Phoenix Rising, our eating disorder and substance abuse treatment programs can give you back the part of your life that has been consumed by addiction and illness. Don’t miss another experience to enjoy life and all it has to offer while achieving health and sobriety along the way.