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Eating Disorders and Co-Occurring Mental Health Disorders

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT

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Anorexia nervosa, bulimia nervosa, binge eating, and other eating disorders are quite a serious problem – in fact, for many patients, they can be deadly. Estimated mortality rates hover in the four to five percent range, and that number climbs higher when including co-occurring disorders. A person with an eating disorder has an elevated risk of suicide, complicated by corresponding or underlying mental health issues. They also lead to significant,  negative physical health consequences.

When considering these factors in combination, a sobering picture emerges. Some experts estimate that the real mortality rate is closer to ten percent, making anorexia nervosa arguably the deadliest mental disorder. Other eating disorders, such as bulimia nervosa, orthorexia, and binge eating disorder, also have high mortality rates.

Yet, every single day, people do recover from eating disorders and go on to live full, healthy, and happy lives. There is hope that, with proper intervention and treatment, patients can and will regain a sense of balance and healthy esteem for their bodies.

How do we get there?

One thing is certain: mental health and wellness are a big part of the picture. In any successful intervention, the mental and emotional needs of the patient must be given careful consideration.

That care begins with a careful evaluation. If you’re the parent of a teenager you think may have an eating disorder, you need to ask yourself the following questions:

What’s typical for a teen?

What’s cause for concern?

Typical Teen Behavior or Mental Health Concern?

For parents, it’s easy to forget that high school can be a pressure-cooker for teens. While that pressure can drive young people to excel, it can also breed competitiveness, stress, and pressure to succeed at a level that unrealistic – or at least can lead to mental and physical health issues. Experts connect these external forces to traits found in adolescents with eating disorders.

Mental health conditions that commonly co-occur with eating disorders include:

These issues are part of a complex picture. For example, anorexia may begin in adolescence as a typical teen preoccupation with personal appearance. Teens may become preoccupied with exercise, as well as clean eating or fad diets. These new interests may not seem problematic at first, but can quickly escalate and cause problems. Alcohol, tobacco, and drug use also correlate with many eating disorders. Studies show that depression, while it can often be difficult to recognize in a moody teenager, also often goes hand-in-hand with eating disorders.

Finding the Root of the Problem

When mental health struggles manifest in disordered eating, they’re not always easy to identify. Disordered eating habits often look like typical choosy eating. Like anorexia, orthorexia – or an obsession with eliminating certain foods, to the point where it becomes detrimental to health – can lead to severe malnutrition, even organ failure. Yet studies find that orthorexia often begins with an obsession with athletics, dieting, or thinness. Even the most concerned parent might perceive these enthusiastic pursuits as healthy or at least harmless.

Until they aren’t.

A recent study clarified that associated mental health conditions for orthorexia range from anxiety, competitiveness, and poor self-esteem, to obsessive-compulsive disorder (OCD).

“When taken to the extreme,” one researcher noted, “an obsession with clean eating can be a sign that the person is struggling to manage their mental health.”

Bulimia and binge-eating disorders can develop in a similar manner.

Since these behaviors are frequently misidentified as typical teen behavior, it’s difficult for parents to correctly understand when their teen begins to cross the line into dangerous, pathological, or disordered habits.

A professional psychiatric evaluation is a crucial step. Assessing their habits and understanding whether their behavior meets the criteria that indicate a clinical problem requiring intervention is essential in preventing an escalation of physical, psychological, and emotional dysfunction.

A Complete Picture

So what’s the bottom line?

Can mental health issues be understood as the underlying cause of eating disorders?

It would be more accurate to say that, in many patients, eating disorders and mental health issues are co-occurring disorders. One reason eating disorders were seen for years as intractable and difficult to treat is that they are part of a complicated picture. Anorexia, orthorexia, bulimia, or binge-eating: these conditions are all part of a complex and interrelated landscape of mental and physical health and well-being. To ensure that you make the best treatment decisions for your teen or loved one, it’s critical to step back and consider the entire landscape.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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