We All Know Somebody But Is There More To The Story?

by Staff of Timberline Knolls Residential Treatment Center


You are 17 years old … your best friend is a brilliant student, but due to financial difficulties in the family, must get a full scholarship to a good school or she won’t be able to attend college. You notice she is getting very thin, never eats lunch with you anymore, and always seems distracted and agitated. You ask her if she is okay; she says everything is fine.  She has changed.  

You are a sophomore in college …your roommate has taken health and fitness to a whole new level.  She gets up at 4 a.m. to run for two hours before her first class; she spends afternoons working out in the gym. Although she always wears a knee brace due to pain, she never stops running. You never talk or laugh together anymore. She has changed.

You married into a tight-knit family …you are very fond of your sister-in-law who has a bit of a rocky marriage and very stressful job. At family get-togethers, she always heads for the bathroom immediately after eating. Lately, she spends a lot of time alone; you see her less and less. She has changed. 

Whether it’s a case of disordered eating or full-blown anorexia, bulimia or binge eating, it’s likely that everybody does know somebody with an eating disorder.  But, here is what everybody is less likely to know about their “somebody”: this woman or girl probably has more than one addiction or disorder or is suffering from some type of trauma. The high school senior is taking diet pills to stay thin and help her study; the college student was raped the previous summer; the sister-in-law suffers from such crippling depression she is afraid one day she will not be able to get out of bed, she will lose her job and her husband will leave her.

Those in the behavioral health field know it is rare, indeed, for woman or girl to only struggle with an eating disorder; frequently, she will have a co-occurring disorder such as substance abuse, trauma, or a mood disorder.
  
What are Co-occurring Disorders?

Trauma

Unfortunately, trauma and traumatic experiences are nothing new to the human condition.  Whether a child is sexually violated early in life, or an adult experiences a horrific car accident, such trauma can and often does have profound and long-term consequences.  Ever increasingly, research indicates a connection between trauma and eating disorders.  Further, the type of trauma plays a role in whether the individual eventually presents with anorexia or bulimia.  Although variations certainly occur, trauma of a catastrophic nature such as severe physical abuse, rape or extreme injury is more likely to be associated with bulimia. Conversely, lesser trauma such as childhood neglect, being bullied or teased, or experiencing alcoholism in the family is often associated with anorexia.  In each instance, the eating disorder behavior allows the individual to suppress unpleasant emotions related to traumatic experience, to have a sense of control over her emotions and to disassociate from the trauma itself. 
 
Substance Abuse

Up to 35% of alcohol or illicit drug abusers have eating disorders compared to only 3% of the general population. Similarly, up to 50% of those with eating disorders have a simultaneous problem with drug or alcohol abuse. It is fairly easy to imagine why a woman or girl with an eating disorder would abuse drugs. If the goal is to be skinny, those with anorexia often become dependent on caffeine, nicotine, diet pills and stimulants such as Adderall to suppress  appetite or speed up metabolism. In time, women and girls may graduate to cocaine, meth and even crack. Similarly, those with bulimia often abuse diuretics, stimulants and laxatives for purging purposes.   
Yet, the connection between these two runs deeper.  At the very heart of the disease, eating disorders are about coping with stress, painful emotions or unpleasant thoughts; drugs and alcohol are often utilized to achieve the same effect. When a woman or girl is high or drunk, her emotional pain is numbed and she might not be as sad, lonely, anxious or depressed. In other words, the function of what both the eating disorder and substance abuse can do for these individuals is similar.
            
Mood Disorders

Mood disorders encompass a wide range of issues including major depression, severe anxiety, post-traumatic stress disorder, bipolar disorder, obsessive compulsive disorder and/or a personality disorder.  It is not uncommon for an individual with anorexia, bulimia or binge eating disorder to also have a mood disorder, particularly depression or anxiety.  In fact, studies indicate a significant connection between mood disorders and eating disorders in families.

Treatment

Once a diagnosis of an eating disorder is made, it is extremely important to identify additional co-occurring disorders. Knowing all that a woman or girl is struggling with is critical when it comes to treatment. Although outpatient therapy is frequently the first step, if significant strides are not apparent, treatment can progress to residential care.  Many programs focus exclusively on the eating disorder. At Timberline Knolls Residential Treatment Center, all disorders and addictions are addressed simultaneously through an integrated treatment approach. Utilizing dialectical behavior therapy (DBT) in combination with 12-step principles has proven highly effective in treating those with multiple diagnoses.     

Recovery

The most important thing for everyone to know is that recovery is entirely possible.  Moreover, the earlier treatment is sought for any disorder or addiction, the better the chance for a complete and lasting recovery.

Reference
National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2003).Food for Thought: Substance Abuse and Eating Disorders. New York, National Center on Addiction and Substance Abuse.

Last reviewed: By Jacquelyn Ekern, MS, LPC on 8 February, 2012
Published on EatingDisorderHope.com.