Eating Disorders are complex mental health conditions that rarely exist on their own. An eating disorder will often co-exist with one or more mental illnesses, such as depression, anxiety and OCD (Bhatia, 2018). This can be referred to as comorbidity or co-occurring disorder. Co-occurring disorder refers to an individual presenting with two or more mental health diagnoses at the same time. Diagnosis of this co-occurring condition could start around the same time as an eating disorder, could precede it, or could even emerge after the eating disorder has begun (Bhatia, 2018). Regardless of the order, it is important to understand and address the relationship between these comorbidities to achieve an accurate diagnosis and provide effective care (Rittenhouse, 2021).
The 3 major mental health conditions we will touch on below are anxiety, depression and OCD.
Anxiety is characterized by excessive fear and an overwhelming feeling of distress that can prevent you from doing everyday activities. It is the most common mental health concern in the US and can occur in a variety of forms, but is always a persistent, excessive fear or worry in situations that are not threatening (NAMI, n.d.). Research consistently shows that a significant number of patients with eating disorders (anorexia or bulimia) will suffer from one or more anxiety disorders. In many cases, the onset of anxiety will precede the eating disorder meaning it may be a significant risk factor for ED development. There are some exceptions to this rule, such as panic disorders, which are more likely to follow an eating disorder than proceed it. These two conditions can feed into each other making it imperative to treat both, often simultaneously (Swinbourne & Touyz, 2007).
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave, leading to a variety of emotional and physical problems (Mayo Clinic, 2018). Research shows that people suffering from an eating disorder are at an increased risk of facing a comorbidity of depression. This comorbidity is particularly noticeable for those suffering from bulimia nervosa. There are significant consequences of the comorbidity between eating disorders and depression, including suicide, economic burden and severe role impairment (Puccio et al, 2016). There is evidence supporting a bi-directional relationship, meaning that disordered eating can significantly predict depression and depression can significantly predict development of an eating disorder. Individuals with depression may develop disordered eating patterns to reduce negative moods. Whereas those with eating disorders may develop depression due to a feeling of failure when controlling eating behaviors such as restriction and/or binge eating. They can feel a since of failure by not achieving their physical ideal which can also lead to depression (Puccio et al, 2016).
Obsessive-compulsive disorder or OCD is characterized by repetitive, unwanted and intrusive thoughts (referred to as obsessions) coupled with irrational, excessive urges to do certain actions (referred to as compulsions), hence the name of this condition (NAMI, n.d.). OCD is the most common anxiety disorder to co-occur with eating disorders. Several studies report that a significant comorbidity exists between those with eating disorders such as anorexia or bulimia and OCD (Swinbourne & Touyz, 2007). This can be accounted for by a variety of traits associated with OCD, including attachment to rigidity, meticulousness or perfectionism as well as difficulty coping with distress related to daily life changes, big or small. Furthermore, eating disorders often involve both obsessive beliefs and thought patterns as well as compulsive behaviors which could be associated with OCD or lead to its development (Rittenhouse, 2021). Anorexia nervous overlaps with OCD behavior and thought processes due to similar neurobiological, genetic or psychological elements. However, this does not mean OCD cannot still occur with bulimia. OCD and bulimia can be linked to severe mood and core eating disorder psychopathology exasperating the condition further, thereby strengthening its hold (Swinbourne & Touyz, 2007).
In conclusion, the complexity of eating disorders and their treatment can be complicated by co-occurring mental health conditions such as anxiety, depression or OCD. Eating disorders can develop because of, lead to the incident of and even occur simultaneously with another mental illness. It is important to understand common mental health diagnoses associated with eating disorders and how they may be connected to provide comprehensive care. This understanding can help secure the proper diagnosis and treatment for individuals. It is vital to be aware of the risk if you already suffer from anxiety or mood disorders. If you currently have an eating disorder, talk with a mental health professional about potential underlying comorbidities such as other mental illnesses and how this may affect treatment going forward.
Resources
- Bhatia, R. (2018, August 7). Anxiety, depression, & obsessive-compulsive disorder. Nationaleatingdisorders.org. Retrieved November 9, 2021, from https://www.nationaleatingdisorders.org/anxiety-depression-obsessive-compulsive-disorder
- Mayo Foundation for Medical Education and Research. (2018, February 3). Depression (major depressive disorder). Mayo Clinic. Retrieved November 9, 2021, from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007.
- National Alliance on Mental Illness . (n.d.). Mental health conditions. NAMI. Retrieved November 9, 2021, from https://nami.org/About-Mental-Illness/Mental-Health-Conditions.
- Puccio, F., Fuller-Tyszkiewicz, M., Ong, D., & Krug, I. (2016). A systematic review and meta-analysis on the longitudinal relationship between eating pathology and depression. The International journal of eating disorders, 49(5), 439–454. https://doi-org.wvu.idm.oclc.org/10.1002/eat.22506.
- Rittenhouse, M. (2021, October 20). Dual diagnosis & co-occurring disorders. Eating Disorder Hope. Retrieved November 9, 2021, from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis.
- Swinbourne, J. M., & Touyz, S. W. (2007). The co-morbidity of eating disorders and anxiety disorders: a review. European eating disorders review: the journal of the Eating Disorders Association, 15(4), 253–274. https://doi-org.wvu.idm.oclc.org/10.1002/erv.784