Eating Disorders and Substance Use

The connection between eating disorders and substance use is complex and often overlooked, yet critical to understanding the full scope of these co-occurring conditions.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), 24 million Americans are affected by eating disorders. Some health experts consider eating disorders to be a silent epidemic. They have the highest mortality rate of any mental illness. Sadly, only 1 in 10 people with an eating disorder receive treatment.

Various biological and environmental variables contribute to the emergence of an eating disorder and aren’t often treated alone. This is because they commonly co-occur with conditions such as depression, PTSD, trauma, anxiety, and substance use. In this regard, there is no one-size-fits-all treatment for eating disorders.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), 24 million Americans are affected by eating disorders. Some health experts consider eating disorders to be a silent epidemic. They have the highest mortality rate of any mental illness. Sadly, only 1 in 10 people with an eating disorder receive treatment.

Various biological and environmental variables contribute to the emergence of an eating disorder and aren’t often treated alone. This is because they commonly co-occur with conditions such as depression, PTSD, trauma, anxiety, and substance use. In this regard, there is no one-size-fits-all treatment for eating disorders.

Eating Disorders and Substance Use

Up to 50% of individuals who are living with an eating disorder abuse alcohol or illicit drugs. This is a rate 5 times higher than the general population. Similarly, up to 35% of individuals who abused alcohol or other drugs have had an eating disorder. This is 11 times higher than the general population. This could be due to shared risk factors for both conditions. These can include brain chemistry, family history, low self-esteem, depression, anxiety, social pressures, and compulsive behavior.

“There’s a lot of symptom substitution. We find that individuals who are going through eating disorder treatment, once their eating symptoms subside, we often see the resurgence or the beginning of a substance abuse problem.” – Amy Baker Dennis, PhD

According to NEDA, alcohol, laxatives, emetics, diuretics, amphetamines, heroin, and cocaine are the most common substances individuals with eating disorders use.

It therefore becomes essential that a clinician be able to diagnose and treat both substance use disorders and eating disorders.

Eating Disorders, Trauma, and PTSD

Similar to how people turn to substance use to self-medicate, excessive eating and/or purging are behaviors that reduce anxiety associated with trauma and help numb/avoid the traumatic experience. Because trauma, PTSD, and eating disorders can be intertwined, an integrated approach that addresses the underlying issues should be used. If trauma is not addressed in the treatment for an eating disorder, a successful recovery will likely be thwarted.

Both PTSD and eating disorders have high rates of dissociation, where behaviors can distance themselves from disturbing memories associated with PTSD. While food cannot fill an emotional void, purging can be seen as eliminating something unwanted, like memory or emotion. Excessive eating can be seen as a way to feel full. Both conditions serve as a coping mechanism and temporarily relieve unresolved trauma.

The DSM-5 does not diagnose partial PTSD, so patients who suffer from an eating disorder and PTSD often go undiagnosed with PTSD. Additionally, since all criteria of symptoms must be met, professionals cannot correctly diagnose patients experiencing both conditions.

How PIMSY Can Help

Treating complex, co-occurring conditions like eating disorders, substance use, and trauma requires an integrated and flexible system of care. PIMSY EHR empowers clinicians with tools designed specifically for behavioral health:

• Customizable treatment planning that supports dual diagnoses

• Secure internal messaging and patient engagement tools for consistent communication

• eMAR & medication management to reduce risk and support recovery

• Robust reporting and outcomes tracking to inform and improve care

Whether you’re part of a specialized treatment center or a small private practice, PIMSY’s fully integrated platform gives you the clinical insight and operational support needed to effectively treat clients with layered and interconnected challenges.

👉 Ready to see how PIMSY can support your team? Schedule a demo today.

Sources Include: 

The Alliance for Eating Disorders

National Eating Disorder Association