Eating Disorder Co-morbid (co-existing) Conditions
Individuals with each of the three eating disorders described above often suffer from other mental health disorders and disturbances as well. An occurrence of two or more disorders at the same time is called a co-morbid condition. For example, people suffering from the symptoms of anorexia, bulimia, and binge eating often harbor significant sadness and depression. Their lives feel out of control and they are chronically unhappy with their weight and bodies. Their self-esteem suffers and they may feel they are unsuccessful and ugly. A sense of loneliness and isolation may also contribute to feelings of sadness. In addition, insomnia, a common side effect of malnutrition, may be also be a factor in developing depression.
Symptoms of anxiety are also typical for those suffering from an eating disorder. Certainly, many of these individuals are nervous about gaining weight, being fat, and not losing enough pounds. They worry about what other people think and how their body compares to others. They are determined to be successful and control their eating, and may think about this a great deal as well. Individuals with eating disorders may also have intense fears (phobias), powerful social anxiety (around others), and/or experience panic attacks. Obsessive-compulsive behavior is also common among those with eating disorders, which is a form of anxiety that involves recurrent, unwelcome thoughts (obsessions) and/or repetitive behaviors (compulsions) that significantly interfere with daily functioning.
People with eating disorders can sometimes suffer from personality disorders as well. A personality disorder often develops in adolescence or early adulthood, and involves consistent patterns of perceiving and relating to others, as well as thinking about oneself that are inflexible and maladaptive. Three common personality disorders that may accompany anorexia and bulimia include Histrionic Personality Disorder, Borderline Personality Disorder, and Obsessive-Compulsive Personality Disorder. Those with Histrionic Personality Disorder generally express emotions in either an exaggerated or superficial manner, and are very dramatic, needing excessive attention or approval, and overly conscious and focused on their appearance. Borderline Personality Disorder is characterized by a pervasive pattern of unstable relationships, thinking, emotions, and self-image that interferes with normal functioning. Many individuals with Borderline Personality or an eating disorder engage in self-destructive behaviors such as self-mutilation and suicide attempts. A person with Obsessive Compulsive Personality Disorder suffers from perfectionism, rigid conformity to rules, inflexibility, and excessive orderliness that interferes with their relationships and their daily functioning.
Because living with an eating disorder is painful and agonizing, many individuals turn to unhealthy coping mechanisms to manage their problems. Thus, many bulimics, anorexics and binge eaters develop addictions to gambling, shoplifting, alcohol, and drugs. Research suggests that 30-50% of individuals with eating disorders use alcohol or drugs compared to only 9% of the general population. Conversely, up to 35% of alcohol or illicit drug abusers have eating disorders, compared to one to three percent of the general population.
In addition to caffeine, laxatives, and diuretics, the drugs of choice for those with eating disorders include amphetamines, barbiturates, tranquilizers, cocaine, and heroin. These drugs are often initially used to suppress appetite, increase metabolism, purge unwanted calories, and self-medicate negative emotions, but quickly turn into physical addictions. Selection of a particular drug may be linked to the type of eating disorder a particular individual is experiencing. Compared to other eating disorders, rates of drug use for anorexics tend to be lower because they do not easily tolerate the lack of control associated with intoxication. If anorexics use drugs, they tend to fall in the amphetamine (stimulant) classes because of their tendency to increase rates of metabolism and decrease appetite. Food restrictors tend to avoid the high calorie content of alcohol and the appetite-stimulating effects of marijuana; while purging types tend to use alcohol, cocaine, and cigarettes. Bingers are often drawn to the sedative effects of alcohol and tranquilizers. Regardless of the substance selected, drug and alcohol use exacerbates feelings of being powerless and out of control, further impairs physical health, and further complicates recovery for those with eating disorders.