Research has shown that up to half of people with eating disorders may also suffer from a substance use disorder—and those numbers tend to ring true among patients at Penn Medicine Princeton Center for Eating Disorders, according to Jose Vazquez, MD, Medical Director of Psychiatric Services at Princeton Medical Center. In the Q&A below, Dr. Vazquez shares his insights on eating disorders and addiction.
PCED: Why is there a link between eating disorders and substance abuse?
JV: Both are very complex, chronic disorders that have common risk factors. Each can stem from low self-esteem, emotional issues like anxiety or depression, or past trauma. In fact, an eating disorder and an addiction can develop as a self-soothing, maladaptive coping mechanism for an array of underlying issues. Brain chemistry, family history, social factors, and media messages also play a role in both.
PCED: Which comes first, an eating disorder or substance use?
JV: This depends on many factors, including genetics, the individual’s environment, and stressors in life. With so many commonalities between the two, it’s easy to see why someone with an eating disorder may turn to substance use to mask pain, provide emotional relief, or help them manage their disorder. Likewise, an eating disorder can arise subsequent to an addiction. For example, bulimia can develop after frequent purging due to excessive alcohol intake, or substance abuse may lead to physical abuse by others, making an eating disorder appealing as a means of regaining perceived control.
PCED: What addictions are you seeing most often?
JV: Among our patient population, we commonly see addictions to alcohol, cocaine, opiates, marijuana, and nicotine. Some patients also enter our program with addictions to laxatives or diuretics, which they may be using very excessively. Patients with a history of binge eating disorder or bulimia nervosa present with addiction more often than those with other types of eating disorders.
PCED: Should an eating disorder and an addiction be treated simultaneously?
JV It’s critical to conduct a comprehensive screening and assessment, and if a co-occurring disorder exists, to address both conditions during treatment. If only one disorder is treated, patients will shift more easily from remission to relapse. Because Princeton Center for Eating Disorders is hospital based as part of Princeton Medical Center, we have a continuum of easily accessible experts and resources to provide specialized treatment for those with a dual diagnosis.
PCED: How are co-occurring conditions clinically treated?
JV: We can treat many withdrawal symptoms on the eating disorders unit. Medically compromised patients with co-occurring conditions—particularly those with respiratory, cardiac, or liver problems—first receive inpatient treatment on a medical unit of the hospital until they are medically stable, at which point they are transferred to the eating disorders unit. We have a team of specialists that ensures streamlined care across all levels of treatment, which is a unique benefit for patients. Our psychiatrists follow patients during their medical stabilization, and our medical specialists continue to see patients as needed once they are transferred to the eating disorders unit.
PCED: What other resources are provided for those with a dual diagnosis?
JV: We offer a unique, comprehensive blend of medical and psychological support, robust therapy groups to instill healthier coping skills, family involvement, and education. Long before discharge, we also assess what support systems are in place in the home environment. Treating an eating disorder and restoring weight often will position patients to effectively continue the recovery journey from an addiction, and we connect patients to community programs and resources that will facilitate that process after discharge.
When to Refer for More Intensive Care
- According to Dr. Vazquez, it’s important for clinicians to be vigilant for signs of an addiction among their patients with eating disorders. Candidates for intensive treatment include those who:
- Are not making outpatient treatment progress
- Are noncompliant or are missing appointments
- Continue to lose weight
- Especially in the case of a co-occurring disorder, early detection and treatment will lead to more positive outcomes.