Eating Disorders and Addiction

By P. Casey Arrillaga, LCSW, LCDC

People usually don’t think of eating disorders and chemical addiction as being in the same category, but researchers and clinicians are increasingly aware that they may be different manifestations of the same problem. In this post, we’ll look at what is behind this change in thinking and what that can mean for getting people the help they need.

What We Know So Far

Historically, eating disorders and chemical addictions (professionally known as substance use disorders) have been thought of as completely separate problems. Chemical addictions, such as to alcohol or other drugs, have been known throughout history, and have typically been considered a failing of willpower or lack of proper morals. It’s not until relatively recently that these addictions have been understood to stem from a combination of genetic, environmental, and the resultant psychological patterns.

Eating disorders, on the other hand, were first documented in the Middle Ages, and they were associated with spiritual purity, since the fasting or food restriction was associated with penitence and perfectionism, which was often praised. The idea of it being a problem came later, with various psychological interpretations from the late 1800’s on, with eating disorders really coming into popular consciousness in the late 20^th century.

At that point, almost all the focus was on anorexia nervosa, the deliberate restriction of food in an attempt to achieve an impossible body ideal. This was blamed on media messages carrying a newer popular idea that being thin was the most attractive body type for women. Since then, there has been increasing awareness of bulimia nervosa, in which a person binges on food and tries to purge through vomiting, compulsive exercise, or food restriction, setting up a very dangerous cycle. Most recently, professionals have looked at binge eating disorder, which is eating unusually large and unhealthy amounts of food on a regular basis. Ironically, anorexia has been talked about the longest despite being the least common of the big three; bulimia was next at second most common, and binge eating has been formally diagnosed last even though it is around twice as prevalent as the others. This may say something about our common relationship with food, in that many people have turned to food for comfort, whereas few restrict it when they don’t have to.

As eating disorders have become better understood, researchers and clinicians have seen how many hallmarks of compulsive behavior these disorders have. The person with the eating disorder may be ashamed of their behavior, dislike its results, resolve to stop or at least moderate, and then go back to it while feeling helpless to change. Before they decide to even try changing, they may go through stages of denying it is a problem, engaging in dishonesty to keep it going, and/or actively defending it as not only okay but necessary for them. Most importantly, the compulsions can become deadly if left unchecked. As this has become more and more clear, it’s hard to not notice that all of these things have been well-known for thousands of years about chemical addictions.

This has led to a shift in thinking about whether these conditions are as separate as previously thought. In fact, surveys have shown that about 1 in 4 people with anorexia or binge eating disorder also identified as having a chemical addiction, and about 1 in 3 people with bulimia said they had a chemical addiction. Neurological research has shown that there are many brain mechanisms in common between eating disorders and chemical addiction, leading to an increasing belief that eating disorders are a type of behavioral addiction (sometimes called process addictions), similar to a gambling or sex addiction.

What Can Be Done?

First and foremost, when you or someone you love recognizes a problem like this, help needs to be sought. This can involve any combination of recovery fellowships, individual therapy, and outpatient or inpatient treatment centers. Let’s look at each of these options.

Recovery fellowships

These include 12 Step fellowships modeled after Alcoholics Anonymous. These all have in-person, online, and telephone meetings, along with written literature, websites, podcasts, social media presence, etc. The largest and best-known of these is Overeaters Anonymous at Home - Overeaters Anonymous (oa.org). Unfortunately, the name alone scares off some younger people and/or those with anorexia or bulimia.

A smaller but perhaps more targeted fellowship is Eating Disorders Anonymous at Eating Disorders Anonymous – The only requirement for membership is a desire to recover from an eating disorder.

SMART Recovery also addresses eating disorders by classing it with any other addictive or compulsive behavior and using the same set of tools. They have a page on this site speaking specifically about this here Eating Orders & Disordered Eating Help & Resources | Food Addiction - SMART Recovery

Individual therapy

While individual therapy can be very beneficial, it’s important to find someone who specializes in the problems you are bringing to the table. While there are therapists who advertise themselves as being good a just about every issue, take the time to interview a few to hear about their actual experience with eating disorders and addiction. Do they see them as completely separate issues or facets of the same problem? What approach do they take to the therapy? Make sure you are comfortable with them as how it feels to talk with them. The sense of rapport with a therapist is the most important factor in healing.

Outpatient/Inpatient treatment

While there are a lot of chemical addiction treatment centers out there, there are far fewer for eating disorders. What is most rare is a facility that treats both at the same time. This is partly because of the different histories of how the disorders were understood. It’s also partly because 12 Step recovery revolutionized care and treatment of chemical addictions, and has become the foundation for many treatment centers, but eating disorder treatment “grew up” completely separate from this, and recovery fellowships were a later addition. Thus, eating disorder treatment centers may take a very different approach, because many eating disorder specialists do not see eating disorders as s type of addiction at all.

If you or a loved one needs help with both issues and each type of treatment center sees themselves as having nothing to do with the other issue, what can you do? Luckily, some treatment centers for each issue have formed working partnerships with those who specialize in the other. For instance, at Windmill, we know the local facilities who can stabilize an eating disorder so that our client can then fully engage in our treatment for chemical addiction and/or other mental health issues. Just as with a therapist, the more important thing is to ask plenty of questions up front so that you or a loved one are not surprised to get somewhere only to have them tell you they can’t help you with your issues.

The Bottom Line

Eating disorders and other addictions are life-threatening conditions that have more in common than has been historically believed. As a result of better understanding, you or a loved one can get better help.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.