The Link Between Eating Disorders and Addiction

Eating disorders include a complex and often life-threatening set of mental health conditions, which involve unhealthy eating habits due to disturbances in an individual's thoughts, behaviors and attitudes toward food and body image. Statistics indicate about 20 million women and 10 million men in the United States have suffered from an eating disorder at some point in their lives, with most eating disorders affecting young women.

The National Eating Disorders Association (NEDA) reports up to half the people with eating disorders also abuse alcohol or illicit drugs—a figure five times higher than the rate of substance use found in the general population. On the flip side, up to 35 percent of those who abused alcohol or were dependent on it also reported having had eating disorders—a rate 11 times higher than that of the broader population.

Carolyn Comas, a licensed clinical social worker and certified eating disorder specialist and supervisor at Eating Disorder Therapy L.A., noted that people with eating disorders sometimes abuse substances as a coping mechanism.

"What happens so often is sometimes with an eating disorder, people feel like they are feeling too much or they don't feel at all and substances can be something that can really numb them out when they're feeling like there are too many feelings," Comas said. "Food gets played into that too. Like maybe you're stuffing down your feelings by physically eating a lot or you're not eating at all so you can numb out and just not feel anything.

"The fact that certain substances can play a big role in a person's appetite or weight may explain why the correlation between substance abuse and eating disorders exists," Comas added.

Alcohol, laxatives, emetics (medications that cause vomiting), diuretics, amphetamines, heroin and cocaine are the substances most frequently abused by people who suffer from eating disorders, according to NEDA.

It's worth noting that some of the most common factors responsible for higher risks of developing a substance use or eating disorder overlap, such as brain chemistry, family history, depression, anxiety, self-esteem issues and compulsive behavior, as well as environmental and cultural factors.

Anna Brown, a licensed clinical psychologist who serves as the clinical director at the Eating Recovery Center in the Woodlands, Texas, noted that there's never any single cause of an eating disorder. Rather, it's the result of a combination of the aforementioned biological, psychological, environmental and social factors, which come together to create a perfect storm.

"For people struggling with an eating disorder, restricting food intake or self-soothing by eating lots of food or purging can help to dull emotions that are otherwise difficult for them to manage," Brown said. "They can kind of feel like they're getting rid of feelings that way. It becomes like a perceived solution to something they're struggling with. And that's kind of where the control piece comes into it: 'I feel like I'm masterful at this and I've got control over it.'"

Researchers have found that eating disorders, as with substance use, often begin during adolescence, when individuals are particularly vulnerable to developing addictive and maladaptive behaviors.

According to a 2011 study published in Current Drug Abuse Reviews, individuals with anorexia nervosa behave in a similar way to individuals with a substance use disorder. For example, individuals with anorexia nervosa narrow their behavior so severely that their focus on weight loss, excessive exercise and food restrictions may interfere with their day-to-day activities. They also may use restrictive eating as a way to cope with anxiety or dysphoric mood, and they may feel increased anxiety when they have to eat.

These parallel with the behaviors of those with substance use disorders in that they continue to abuse substances despite the harmful effects it has on their life, relationships and health. Additionally, they may often use substances to cope with their moods or anxiety and feel withdrawal and emotional distress during periods of abstinence.

However, despite similarities between eating disorders and substance use, experts have also found critical differences. While individuals with substance use issues typically pursue the immediate effects of drugs on mood or behavior, individuals with eating disorders are more likely to pursue the short-term goal of a perceived sense of control over their body—and by proxy, their life—as well as the long-term goal of sustained weight loss and thinness. Importantly, while the dieting culture of Western society usually rewards thinness and weight loss, misbehavior as a result of substance use is not as socially acceptable.

"I would say that the behaviors that come along with eating disorders are more like an obsession rather than addiction," Comas said. "I know sometimes my clients might say that it feels like an addiction, but I think it kind of gets rolled into more of a desire to have a lot of control. And a lot of times eating disorders come out of trying to be in control as much as possible, and you see that in behaviors like calorie counting or checking your body after eating and weighing yourself constantly."

So, she noted, though there are similarities, eating disorders can't be fully lumped in with addiction because of what each disorder focuses on.

"When we talk about addiction to drugs or alcohol, I think it's very easy to take on a mentality of, 'Okay, we're gonna have a complete abstinence from this,'" Comas explained. "And I hear so often people say, 'I'm addicted to food.' And it may not be that you're addicted to it, but maybe you just have a really bad relationship with it. Because we can't get rid of the foods that make you uncomfortable. You have to face eating every day, multiple times a day. So there's a major difference in that way."

People with eating disorders often obsess over how much or how little food they eat as well as the shape, size and weight of their bodies. That being said, the rising popularity of calorie-counting apps aimed at fitness and weight loss can present a challenge for people who already struggle to control their obsession with their eating habits.

"I definitely believe that these apps are fairly harmful," Comas said. "You just plug in your information and they give you a calorie count to hit each day, and oftentimes the calorie count can be actually extremely low. That can make someone even more obsessive about what they're eating and they might become more likely to restrict on certain foods because it doesn't fit into their calorie count for the day. They can also lead to disorder behaviors generally, which can lead to an eating disorder."

Comas noted that while some people can use calorie-counting apps on and off and be just fine, she often hears from clients that these types of programs are major contributors to their eating disorders.

Brown agreed that some people are more vulnerable to the possibility of these apps becoming a preoccupation for them.

"For some people, that much focus on calories can become a slippery slope and can quickly sort of spiral into an obsession, and then their behaviors might become modified or follow suit to help them meet whatever the goal is," Brown explained. "For some folks, they find themselves just consumed with the numbers."

Brianna Donahue, a clinician and clinical intake coordinator at the Multi-Service Eating Disorders Association (MEDA), noted that one of the major dangers of calorie-counting apps is that they're often inaccurate or advise for an inadequate daily caloric intake depending on the goal and the timeline the user enters in.

"It's always important to go to a medical professional or a dietitian that specializes in nutrition and nutrition evaluation so that you can be accurately evaluated," Donahue said. "And I do think that apps and the media generally are definitely having a huge impact on the higher prevalence of eating disorders we're seeing amongst teens and young adults."

Because eating disorders are often borne out of a desire to feel in control of your life or emotions, it's easy to fall into the trap of thinking that if you haven't yet had any severe health problems due to your eating disorder that you have it under control and can continue with the disordered eating behaviors.

However, Brown noted, it's crucial to seek treatment as early as possible if you're suffering from an eating disorder.

"Eating disorders, unlike other mental illnesses, affect every physical system within the body," Brown said. "And so you may not see immediate signs of impact, but they can certainly be there."

Disordered eating can affect your blood counts, circulation, immune system and more—all things you may not be aware of or immediately attribute to your eating habits.

"You're basically well until you're not," Brown explained. "It's kind of a fragile thing, right? I mean, one day, you can have normal labs and the next day, you can have abnormal labs. That's how quickly these things tend to go. And every type of presentation of an eating disorder has a dramatic effect on our physical well-being. No one is protected from that. That's why eating disorders have one of the highest mortality rates of any mental illness because of how they affect all the systems in the body."

If you're struggling with an eating disorder, you should seek help right away. You can find an eating disorder screening survey on NEDA's website, a national database of eating disorder treatment providers, along with a hotline where you can get immediate support and information from a professional. A list of free eating disorder recovery support groups can also be found on MEDA's website, along with groups for parents and family members of those suffering from an eating disorder.