How to Best Treat Co-Occurring Eating Disorders and Mental Illness or Substance Abuse 

Eating disorders like anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are serious mental health conditions, but they rarely occur alone.

Treating eating disorders

It’s common for these conditions to co-occur with other mental disorders, including anxiety disorders, depression, and substance use disorder (SUD).

When someone is struggling with more than one mental health condition, regardless of what they are, it’s important to treat both disorders simultaneously. This can be particularly tricky when it comes to people with eating disorders and SUD, as there are many barriers to treatment for this combination of conditions.

But in all cases, there are several types of therapy and other treatments that may be able to help.

What Causes Eating Disorders?

Eating disorders are complex conditions that can be caused by any number of biological, psychological, and environmental factors. In most cases, it’s likely that a combination of these factors contributes to the development or maintenance of these psychiatric disorders.

Biological Causes of Eating Disorders

While eating disorders in general—and anorexia nervosa in particular—were once thought to be primarily caused by societal pressure to be thin, modern research is increasingly uncovering genetic influences on these conditions.

Anorexia nervosa and bulimia nervosa have both been found to run in families. Other research has uncovered heritable traits, such as the way a person responds to stress, which act as risk factors for developing disordered eating behaviors. [1]

And even some biological processes that are universal can bring an increased risk of eating disorder development. Puberty, in particular, is considered a “critical risk period,” thanks, in part, to the large number of biological changes taking place. [2]

Environmental Causes of Eating Disorders

It’s not just the biological aspect of puberty that makes it so dangerous. That age is also largely defined by increased social awareness and a changing perception of one’s place in the world. For many, this makes the approval of peers suddenly very important, and this can bring on concerns about fitting in, particularly when it comes to body weight and image. [2]

If differences in appearance lead to bullying, it can have long-lasting and damaging effects. In one survey, 65% of respondents with eating disorders said a history of bullying contributed to their condition. [3]

Still, bullying can contribute to the development of eating disorders for people at any age. And this is especially true when that kind of toxic messaging has become so prominent. The internet is overrun with damaging messages and ideas around body weight, shape, and size; appearance; dieting; and health in general.

Social media has been linked to increased rates of depression, anxiety, body dissatisfaction, and eating disorders.

Even when these messages are intended to help, they can ultimately be harmful. And while the internet is still relatively new in the eyes of human history, any number of studies have already linked its rise—and the rise of social media, in particular—to increasing rates of depression, anxiety, body dissatisfaction, and eating disorders. [4]

What Causes Substance Use Disorders?

Much like eating disorders, substance use disorders can be—and usually are—caused by a combination of biological, psychological, and social factors. 

Substance use disorder commonly occurs simultaneously with anxiety and depression.

In a large number of cases, SUD occurs simultaneously with anxiety disorders or depression. [5,6] It’s possible for these mood disorders to be caused by substance use, maintain substance use, contribute to the development of SUD, or a combination of these factors. A history of trauma, especially childhood trauma, also has a high rate of comorbidity, or co-occurrence, with substance use disorder. [7]

From a physiological perspective, addictive substances generally activate the brain’s reward center, releasing cascades of serotonin, dopamine, and other “feel-good” chemicals throughout the body. When the reward center is continuously triggered in such a way, the brain can “learn” to expect that pleasurable result, leading to cravings and other behaviors associated with addiction.

While it’s possible for anyone to become addicted to substances or even different types of behavior, there are a number of genetic factors that greatly increase someone’s chances of becoming physically dependent on these things. [8]

Common Treatments for Eating Disorders and Substance Use

In many cases, eating disorders and co-occurring mental health conditions share a number of common risk factors, driving factors, and symptoms. Because of these overlaps, it’s crucial to treat all of these conditions simultaneously, or else risk the chance of relapse for either or both disorders.

Thankfully, a number of different treatments have been developed to help someone recover from eating disorders, SUD, and other mental disorders at the same time.

Several classes of antidepressants have been tested for people recovering from alcohol addiction, nicotine addiction, and other types of SUD, as well as BN, BED, and AN. Results were generally good, with the medications found to help cut down on cravings in people with SUD, reduce binging and purging in people with BN and BED, and overall, improve mood and help with comorbid depression and anxiety disorders. [9, 10]

Still, medication can be a tricky subject, especially when concerning a history of substance use. It’s important to consult with a doctor before starting any new medications.

Cognitive behavioral therapy (CBT) is considered a first-line treatment for both addiction and eating disorders. The therapeutic approach centers around the idea that unhelpful behaviors are caused by unhelpful thoughts, and the overall goal is helping someone identify these thoughts and proactively change them.

CBT follows a pre-set course of treatment, with the hope that by the end of a full session, someone will be so adept at redirecting unhelpful thoughts that they’ll no longer be having unhelpful thoughts at all. But the technique also gives patients tools to track their own mental health, look out for triggers, and get back on track should a relapse occur.

It’s relatively common for eating disorder patients and very common for those struggling with addiction to participate in group therapy. In this type of treatment, a group of individuals with similar issues will discuss related topics together, generally under the guidance of a trained professional who helps to keep the conversation on topic and productive. 

This type of therapy can help a patient feel less isolated, showing that there are others in similar situations who are also working to heal. Sharing experiences, especially such difficult ones that may be hard to explain to others, can help form a sense of community and help someone build a stable support system, stay accountable to their own progress, and practice new coping skills and strategies. 

Finding Help for Eating Disorders with Co-Occurring Mental Health Conditions

Mental health disorders like eating disorders and substance use disorders are dangerous and can be deadly if left untreated. That danger only increases when these conditions occur together or in tandem with other issues, like depression or anxiety.

If you or a loved one are struggling with one of these conditions, it’s important to seek help.

Your primary care physician, therapist, or another trusted medical professional can be a great place to start. These experts can help you obtain an official diagnosis, which may open up avenues to treatment. They may also be able to refer you to successful treatment programs or otherwise determine your next best steps.

If you’d rather not talk about these sensitive issues in person, there are a number of eating disorder and mental health hotlines you can utilize. These services allow callers to remain anonymous while giving out information and other resources about where to find help for substance use issues or eating disorders.

Regardless of where you start your search, the most important step of all is deciding to start. Recovery happens one step at a time, and the decision to seek help is the first major milestone on the journey toward healing.


  1. Berrettini W. (2004). The genetics of eating disorders. Psychiatry; 1(3):18–25.
  2. Klump KL. (2013). Puberty as a critical risk period for eating disorders: a review of human and animal studies. Hormones and Behavior; 64(2):399–410.
  3. Bullying and Eating Disorders. (n.d.). National Eating Disorders Association. Accessed July 2023. 
  4. Marks R, De Foe A, Collet J. (2020).  The pursuit of wellness: Social media, body image and eating disorders. Children and Youth Services Review; 119:105659. 
  5. Swendsen J, Merikanga  K. (2000). The comorbidity of depression and substance use disorders. Clinical Psychology Review; 20(2):173-189.
  6. Smith JP, & Book SW. (2008). Anxiety and Substance Use Disorders: A Review. The Psychiatric Times; 25(10):19–23.
  7. Khoury L, Tang YL, Bradley B, Cubells JF, & Ressler KJ. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and Anxiety; 27(12):1077–1086.
  8. Ducci F, & Goldman D. (2012). The genetic basis of addictive disorders. The Psychiatric clinics of North America; 35(2):495–519.
  9. Davis H, & Attia E. (2017). Pharmacotherapy of eating disorders. Current Opinion in Psychiatry; 30(6):452–457.
  10. Torrens M, Fonseca F, Mateu G, Farre M. (2005). Efficacy of antidepressants in substance use disorders with and without comorbid depression: A systematic review and meta-analysis. Drug and Alcohol Dependence; 78(1):1-22.

Last Update | 09 - 28 - 2023

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