From a professional perspective, it has been my experience that when people come into treatment for an eating disorder they often bring with them concomitant issues with either depression and/or substance abuse. An educated guess with respect to the prevalence of these “dual diagnoses” would certainly amount to more than 80% of the eating disordered population fitting the “clinical criteria” for a mood disorder and more than 25% for a history of substance abuse.
There is a preponderance of thought to suggest people with an eating disorder suffer with depressive symptoms prior to developing their particular “flavor” of eating disorder. Likewise, beginning to plant the seeds of abusing substances like alcohol and drugs may be seen as an attempt to “self medicate” the emotional pain of feeling depressed. Given this phenomenon of presenting with an array of co-existing problems, it becomes apparent that any credible treatment for an eating disorder address not just a pathological relationship with food and body image but also focus on the underlying issues which perpetuate the problem, usually depression. Doing so involves the appropriate use of medication, therapy, support, and an altered lifestyle. What becomes an integral component of successful treatment is the continued recognition that co-existing issues must be continually addressed in order for someone to maintain their recovery from an eating disorder. For example, the bulimic who also is abusing alcohol must stop drinking (and stay stopped) if they are to have any hope of recovering from bulimia. Achieving this may necessitate attending and working a program of recovery in AA in while receiving treatment for their eating disorder. It may further involve taking an appropriate antidepressant medication for an extended period of time. All of these “pieces” of a treatment approach need to happen simultaneously. No matter the form of an eating disorder, there usually are other compulsive or self destructive patterns of behavior that warrant attention during the recovery process. Treatment can not be expected to have a successful outcome if someone is treated “cafeteria style” with the expectation that their “other problems” will be attended to after they gain control of their eating disorder.
Treatment programs, and therapists alike, need to offer the resources to treat a variety of issues in order to provide the proper care for their eating disordered patients. Those seeking treatment also need to acknowledge their issues beyond an eating disorder and be prepared to accept responsibility for their part in the recovery process. It’s not enough to suffer with bulimia and only commit to stop binge eating and purging with the agenda lurking in the wings of becoming a “better anorexic” - or to negotiate a treatment plan that does not include a commitment to stop using alcohol or to take a prescribed medication. In effect, both “doctor and patient” need to enter into a contract that does not contain “loopholes” that fall short of addressing all that accompanies the eating disorder. When successful, one can expect a better quality of life, one that offers far more than just an end to disordered eating.
Marty Lerner, Ph.D.