Addiction And Eating Disorders: Dual Diagnosis

Medically Reviewed by Johnelle Smith, M.D. on April 19, 2021

About half of people with eating disorders develop substance abuse issues at some point in their lifetime. Co-occurring eating disorders and substance abuse can be effectively treated with dual diagnosis treatment.

Co-Occurring Eating Disorders And Addiction

Eating disorders and substance use disorders (SUDs) affect millions of people in the United States each year, and both can be life-threatening without treatment.

According to the National Eating Disorders Association (NEDA), an estimated 50 percent of people with eating disorders develop substance abuse issues at some point in their lives.

Understanding the overlap between mental health disorders and substance abuse can help you identify these issues and find a treatment program that meets your or a loved one’s needs.

What Eating Disorders Co-Occur With Addiction?

Eating disorders are a type of mental health disorder that can affect a person’s physical health, mental health, and behavior. Without early treatment, they can become chronic illnesses.

There are various types of eating disorders. Each type of disorder generally centers around weight and food-related issues, although the causes and triggers of eating disorders can vary.

Common eating disorders include:

  • anorexia nervosa
  • bulimia nervosa
  • binge eating disorder
  • other specified feeding and eating disorders (OSFED, formerly EDNOS)

Less common eating disorders that can co-occur with substance abuse issues include avoidant restrictive food intake disorder (ARFID), pica, and orthorexia.

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Addiction And Anorexia Nervosa

Anorexia is an eating disorder characterized by the restriction of food, the avoidance of certain types of food, or the purging of foods without bingeing.

People with anorexia may misuse substances to influence their eating habits, or to self-medicate symptoms of their eating disorder, such as fatigue, insomnia, and anxiety.

Atypical Anorexia

Atypical anorexia is a subtype of anorexia used to describe people who show signs of anorexia but don’t have a body mass index (BMI) of 17.5 or less—a diagnostic requirement for anorexia.

This does not constitute its own diagnosis and is typically diagnosed as an other specified feeding and eating disorder (OSFED).


Drunkorexia is a term used to describe people with anorexia who abuse or have become addicted to alcohol. This is not an official diagnosis but is commonly used among college-aged students.

People who show signs of drunkorexia may replace food calories with those from alcohol, and can be at higher risk for dehydration, alcohol poisoning, and other serious health risks.

Addiction And Bulimia Nervosa

Bulimia nervosa is characterized by a pattern of bingeing on food and purging that food through self-induced vomiting, excessive exercise, or the use of laxatives or diuretics.

Bulimia nervosa commonly co-occurs with substance abuse. People with bulimia have higher levels of impulsivity, which can make them more likely to abuse drugs or alcohol.

Addiction And Binge Eating Disorder

Binge eating disorder is diagnosed in people who demonstrate patterns of eating excessive amounts of food within a short window, without purging afterward—as seen with bulimia.

People with binge-eating disorder are more prone to impulsivity, a known risk factor for substance abuse. They may also use substance misuse as a coping mechanism.

Addiction And Other Specified Feeding And Eating Disorders (OSFED)

People who have symptoms of an eating disorder but do not meet the criteria of anorexia, bulimia, or binge eating disorder may be diagnosed with OSFED, formerly known as EDNOS.

Like with other eating disorders, people with OSFED may abuse drugs or alcohol for a multitude of reasons, including to influence body shape, weight, or eating habits.

Addiction And Avoidant Restrictive Food Intake Disorder

Avoidant restrictive food intake disorder (ARFID) is characterized as a pattern of avoidant eating behaviors. Before 2013, this was previously diagnosed as a selective eating disorder.

People with ARFID may use alcohol or drugs to cope with the stress of their eating disorder or to manage the anxiety of eating certain foods.

Addiction And Orthorexia

Orthorexia refers to the aversion to certain types of foods or a hyperfocus on eating “healthy” or “clean”. This is not an official diagnosis but can be diagnosed as ARFID.

Orthorexia does not commonly co-occur with drug or alcohol abuse. Addiction is more likely to be experienced by people with anorexia, bulimia, or BED.

Addiction And Pica

Pica refers to a pattern of eating objects or substances with no nutritional value, such as dirt, hair, paper, or string. The prevalence of this type of eating disorder is unknown.

Although there’s little evidence that shows a direct link between pica and addiction, people with this disorder may misuse substances to cope with stigma or to self-medicate symptoms.

Common Substances Of Abuse Among People With Eating Disorders

Common substances of abuse among people with eating disorders can vary somewhat depending on the type of eating disorder.

Common substances of abuse include:

  • laxatives, diuretics, and emitives
  • amphetamines (appetite suppressants)
  • alcohol
  • cocaine
  • heroin
  • tobacco
  • caffeine

Can Drug Abuse Cause An Eating Disorder?

The short answer is: No. Several common drugs of abuse can have effects on appetite, eating habits, and weight. However, these effects do not cause an eating disorder.

Substance abuse treatment can help normalize a person’s weight and appetite. But for people with eating disorders, this isn’t so simple. This can cause significant distress.

Recovering from an eating disorder requires more than restoring normal eating habits or weight.

This will require treatment that can address the disordered thoughts and behaviors that accompany the eating disorder, as well as physical and medical concerns.

Eating Disorder And Addiction Statistics

Substance abuse can become worse over time as an eating disorder becomes more severe. Eating disorders can become life-threatening and chronic without specialized treatment.

Additional eating disorder and addiction statistics include:

  • Thirty-seven percent of people with bulimia are estimated to abuse drugs or alcohol—an estimate that’s higher than with anorexia (27 percent) or binge eating disorder (23 percent).
  • About 1 in 10 people with OSFED have a co-occurring substance use disorder.
  • Orthorexia and pica have a weaker link to substance abuse and addiction.
  • Up to 35 percent of people with substance use disorders meet the criteria for an eating disorder.
  • Women with an eating disorder or SUD are more than four times as likely to develop the other disorder compared to women with neither disorder.

Who Is Affected By Eating Disorders And Addiction?

Contrary to popular belief, eating disorders don’t occur solely in young, white women. Eating disorders can affect people of all genders, ages, and racial and ethnic backgrounds.

High-risk populations for eating disorders include:

  • LGBTQ populations
  • active military and military dependents
  • teenagers and young adults
  • people with diabetes (i.e. diabulimia)
  • male and female athletes

Risk factors for eating disorders can vary by the type of disorder. A history of trauma, bullying about size, and having a family history of eating disorders are also considered risk factors.

Many of the risk factors of eating disorders overlap with those of substance abuse, including a history of trauma, depression, low self-esteem, and genetic factors.

Symptoms Of Eating Disorders And Addiction

Eating disorders are generally characterized by food and weight issues, although this can vary depending on the type of eating disorder. Symptoms can be physical, emotional, and behavioral.

Behavioral Signs Of An Eating Disorder

The following are behavioral signs of eating disorders:

  • avoiding certain food groups
  • eating very slowly or rapidly
  • eating excessive amounts or eating very little
  • unusual eating behaviors (i.e. food rituals)
  • discomfort eating around others
  • lying about food intake or hiding food
  • going to the bathroom directly after eating
  • refusal to eat certain foods
  • cycling between diets, including fat diets (e.g. keto, intermittent fasting)

Mental And Emotional Signs Of Eating Disorder

The following are some mental and emotional signs of an eating disorder:

  • irrational beliefs about foods or eating
  • difficulty concentrating
  • difficulty sleeping
  • increased anxiety or agitation
  • less interest in activities previously enjoyed
  • distorted perception of one’s body
  • fixation around body image

Physical Signs Of An Eating Disorder

Physical signs and symptoms of eating disorders include:

  • changes in weight (i.e. weight gain or loss)
  • stomach cramps
  • constipation
  • feeling cold very often
  • fine hair on the body (lanugo)
  • cuts or calluses on the knuckles (from vomiting)
  • dry skin and hair
  • abnormal lab results (e.g. anemia, low thyroid and hormone levels)
  • menstrual irregularities or sexual dysfunction
  • dizziness upon standing
  • fainting
  • excessive fatigue

Treating Eating Disorders And Substance Abuse

Recovering from an eating disorder can be difficult without specialized eating disorder treatment. Severe cases can require higher levels of care, including inpatient treatment.

Eating disorder treatment programs include:

  • inpatient and residential treatment
  • partial hospitalization programs (PHPs)
  • intensive outpatient programs (IOPs)
  • outpatient counseling and nutritional services

If someone with an eating disorder is actively abusing drugs or alcohol, looking for a dual diagnosis treatment program that treats eating disorders may be recommended.

Dual Diagnosis For Eating Disorders

Dual diagnosis is a type of treatment that integrates mental health and substance abuse treatment in order to treat all co-occurring disorders at once. This is the most effective treatment approach.

Dual diagnosis for eating disorders may involve:

  • medically supervised detox
  • inpatient rehab
  • nutritional rehabilitation
  • cognitive behavioral therapy (CBT)
  • dual diagnosis group therapy
  • medication
  • psychiatric services
  • medical care

Find A Dual Diagnosis Treatment Program Today

If you or a loved one is struggling with an eating disorder and substance abuse, we may be able to help.

By calling us today, we can:

  • explain the process of seeking treatment
  • discuss your treatment options
  • help you find a dual diagnosis treatment program that’s right for you

Recovering from substance abuse and an eating disorder is possible. Call our helpline today to find a dual diagnosis treatment program that’s right for you.

This page does not provide medical advice. See more

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Medically Reviewed by
Johnelle Smith, M.D. on April 19, 2021
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