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  • Nada Tasra

The Complexity of Eating Disorders and The Dual Diagnosis Conundrum

By: Nada Tasra, Dietetic Intern

Reviewed by Dina Skaff, Registered Dietitian

Certified Intuitive Eating Counselor


*Content Warning : Eating disorders symptoms discussed


Introduction


"Eating disorders are only about food, so if you eat, you will get better."

" It’s just a phase, a fleeting trend, it will probably go away with time."

"It’s not that serious anyways…".


You have probably heard at least one of these assumptions when discussing eating disorders with others. Unfortunately, so many myths and stereotypes made about eating disorders prevent people from understanding the reality of these serious mental health illnesses. These misunderstandings can make it difficult for individuals with an eating disorder to get the help they need. They can lead to delays in diagnosis and treatment and hurt those who are suffering… That is why it’s important to dispel the myths and learn the truth about eating disorders.


Eating Disorders and the Brain


Eating disorders are complex mental health illnesses that impact both the body and mind. People with eating disorders are often concerned with food, weight, size and body image. Many of their thoughts and behaviors are actually controlled by the disorder that is active in their brain, and as such, they may not act like themselves. This means that behaviors, like restriction of food, binging, and purging, are not a choice. They are symptoms of the eating disorder illness.


Factors Behind Eating Disorders


Eating disorders are complex and difficult to understand. This includes understanding the way they affect the brain, as well as what really causes an eating disorder to develop. So far, research has shown that many factors can be involved, such as:

  • Genetics: e.g. A family history of eating disorders.

  • Biology: e.g. Having health conditions like diabetes.

  • Psychology: e.g. Dealing with self-esteem issues or other psychological factors.

  • Environment: e.g. Dealing with the social pressure to have an unrealistic body shape and size.


Having one or more of these factors puts an individual at higher risk of developing an eating disorder. These factors can vary and may not be the same for everyone. Many people with eating disorders have a combination of these risk factors, which makes these illnesses even more complex.


Dual Diagnosis


The struggle is real for those who battle eating disorders. It is very common for individuals with an eating disorder to also be affected by other mental health issues. In fact, 94% of people hospitalized for eating disorders also had at least one other mental health condition (1). It is not clear which one of these conditions comes first, and it can be different for each person. One thing is clear – understanding the complexity of this dual diagnosis puzzle is key to effectively diagnose and treat affected individuals.


Double Trouble


Co-occurring mental health conditions can be associated with eating disorders in many ways:

  • Eating disorders may develop as a coping mechanism for other mental health issues. For example, someone struggling with depression may turn to restrictive eating as a way to cope with low moods or negative thoughts. This could snowball into a preoccupation with food and weight and eventually an eating disorder.

  • Eating disorder behaviors can lead to other mental health illnesses. For instance, someone with anorexia nervosa may develop depression as a result of the physical and psychological effects of their restrictive eating.


Connected at the Roots


Eating disorders and other mental health illnesses are often closely linked because both may be connected at the same roots. Take the example of Obsessive-Compulsive Disorder, (OCD) and eating disorders. Research has shown that 69% of people with eating disorders also have OCD, while 17% of people with OCD also struggle with an eating disorder (2). So, what does this mean?


This means that these disorders can share the same root factors. Here is an example:


  • Obsessions: Individuals with OCD have obsessions and recurrent thoughts that disrupt their normal daily routine. Similarly, individuals with eating disorders may also have obsessions about food, weight, body shape and size.

  • Compulsions: The obsessions of individuals with OCD often lead an individual to do repetitive behaviors (compulsions). Individuals who have an eating disorder may also experience compulsions and repetitive behaviors such as restriction or over-exercise.


Eating disorders and other mental health illnesses can often be traced back to the same set of common causes.


Nutrition Challenges


Nutrition is an important part of eating disorder recovery. Managing nutrition can be more complicated when there are other physical and mental health conditions. Take the example of someone with diabetes who has an eating disorder. They may have a more difficult time managing their nutrition. They may feel guilt and anxiety when eating foods that are needed for managing diabetes. This can lead to further struggles with food. This is why it’s important to build a team of health care experts who specialize in eating disorders. This team can include doctors, therapists and dietitians. They work together to take into account all health and mental health factors. Having this type of team can help to support people struggling on the road to recovery.


Conclusion


Eating disorders are complex illnesses that can be difficult to understand. When you add in the complexity of co-occurring mental health diseases, the picture becomes even more blurred. These co-occurring illnesses can both fuel and be fueled by eating disorders. This makes it hard to know where one ends and where the other begins. But here is the thing, it doesn’t matter which disorder came first. They all need to be treated for the best outcome.


A Message to those struggling…


If you are struggling with an eating disorder or co-occurring mental health illnesses, remember that you are worthy of care. Don’t be afraid to speak up to get the care you need. Your voice matters and you deserve to be heard.


References


1- Dual Diagnosis & Co-Occuring Disorders. Eating Disorder Hope. Retrieved January 22, 2023, from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occuring-dual-diagnosis.

2- The Relationship Between Eating Disorders and OCD Part of the Spectrum. International OCD Foundation. Retrieved January 22, 2023 from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/.

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