A Dangerous Duo: Eating Disorders and Substance Abuse

September 28, 2023 by Riley Burns

According to a 2020 literature review (Eskander et al.): 

  • Women with eating disorders are more likely to abuse substances than those with no eating disorders.  
  • Approximately 12% to 18% of adults with anorexia nervosa (AN) and 30% to 70% of adults diagnosed with bulimia nervosa (BN) have substance use disorders. 
  • One-fourth of individuals with binge eating disorder (BED) reported substance use disorders. 

There are many shared risk factors between substance use disorders and eating disorders. Both are much more common in people with a history of traumatic experiences. They often occur in times of transition or stress. The biological underpinings and genetic profiles are very similar, with both sets of disorders highly correlated with low self-esteem, depression, anxiety, impulsivity, and compulsivity. 

The symptom profile of both substance use and eating disorders overlap as well, involving obsessive preoccupation, craving, compulsive behavior, and rituals. Both substance abuse and eating disorders are steeped in secrecy, shame, and social isolation. They are chronic, potentially fatal diseases with high relapse rates, which means they require intensive, specialized, and long-term therapy.  

While the statistics may seem daunting, the good news is there is hope for recovery! As with any blog for recovery month, I asked a brave and inspirational client to anonymously share their story. “Sandy” (not her real name) is approaching her six year sobriety date and is in full remission from severe binge eating disorder. Here is what she had to say: 

Good old Merriam Webster states a journey is travel or passage from one place to another”.  

I lived a vicious cycle of bingeing and drinking for comfort when I felt “less than” or someone made me angry. Unfortunately, this happened frequently – people’s actions really got on my nerves sometimes. Why couldn’t they act like they had some sense? Why were people so mean and unthinking? Why didn’t situations seem to go my way? 

 I frequently needed the sense of ease and comfort that came with eating those sugary bites or that first few drinks – I promised myself I could learn to only use my disordered behaviors for comfort when needed – that would be it. The problem was I stayed angry or hurt most of the time because life frequently did not go my way. 

It took therapy and another recovery program to teach me about ego, letting go, and prayer. I had to succumb to the fact that there was something in this universe that was more powerful than I was. My job was to accept what I could not control and treat others with love and respect. That’s it. Acceptance and Love.  

Letting go of what I could not control is a daily; sometimes hourly practice. But it can be done and you don’t have to do “this” alone. Reaching out for help was the most humiliating, frightening, empowering, self-saving, action I have ever taken. I was coached to give myself the gift of honoring my true needs and wants while learning to have real relationships with other humans.   

To those on their journey to recovery, please know that help and support is out there. Chrysalis Center has therapists who are trained in both eating disorders and co-occurring substance use who are here to help. 

Eskander, N., Chakrapani, S., & Ghani, M. R. (2020). The Risk of Substance Use Among Adolescents and Adults With Eating Disorders. Cureus, 12(9), e10309. https://doi.org/10.7759/cureus.10309 

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