Eating disorders are complex mental health conditions characterized by unhealthy eating habits and severe physical and mental consequences. Common eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder and others such as orthorexia and avoidant/restrictive food intake disorder (ARFID).
A question that often arises in discussions about these disorders is whether an individual can have more than one eating disorder simultaneously or throughout different periods of their life.
How do eating disorders work?
Before going into the topic of multiple eating disorders, it is essential to understand what constitutes an eating disorder, as each disorder has its own set of diagnostic criteria and behaviors.
Anorexia nervosa is characterized by extreme food restriction, an intense fear of gaining weight and a distorted body image. Bulimia nervosa involves cycles of binge eating followed by compensatory behaviors such as vomiting, fasting or excessive exercise. Binge eating disorder is marked by recurrent episodes of eating large quantities of food, often rapidly and to the point of discomfort, accompanied by feelings of loss of control and shame.
Other disorders, like orthorexia, focus on an obsession with healthy eating, while ARFID involves avoiding specific foods or entire food groups.
Can eating disorders co-occur?
Research does show that it is indeed possible for an individual to experience more than one eating disorder. This phenomenon is known as “comorbidity,” where multiple disorders co-occur or in succession. For example, a person with anorexia nervosa may develop bulimic behaviors over time, leading to a diagnosis of bulimia nervosa. Similarly, someone with a binge eating disorder may later struggle with restrictive eating patterns, indicative of anorexia or ARFID.
Several factors contribute to the co-occurrence of eating disorders. Firstly, the underlying psychological issues, such as low self-esteem, perfectionism and trauma, can predispose individuals to multiple disorders. Additionally, societal and cultural pressures regarding body image and diet can further trigger these tendencies.
Biological factors, such as specific genes, family history and chemical imbalances, may also play a role in the development of multiple eating disorders.
What eating disorders are more likely to co-occur?
Certain eating disorders are more likely to co-occur due to overlapping symptoms, shared psychological and environmental factors, and similar underlying issues. More frequent combinations include the following.
1. Anorexia nervosa and bulimia nervosa
It’s not uncommon for individuals to transition between anorexia nervosa and bulimia nervosa. A person may begin with restrictive eating patterns typical of anorexia and later develop bulimic behaviors, such as binge eating followed by purging.
This transition may occur as the body responds to extreme starvation by triggering binge episodes, which are then followed by purging to maintain a low body weight.
2. Bulimia nervosa and binge eating disorder
Both disorders involve episodes of binge eating, but bulimia nervosa includes behaviors like purging, fasting or excessive exercise to compensate for the extreme intake of calories.
Some individuals may fluctuate between periods where they engage in purging behaviors and periods where they only binge eat without the purging, thus meeting the criteria for a binge eating disorder.
3. Anorexia nervosa and Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is characterized by avoiding certain foods or entire food groups, which can lead to significant nutritional deficiencies similar to those seen in anorexia nervosa. While ARFID does not typically involve a fear of gaining weight or a distorted body image, some individuals may present with symptoms of both disorders, particularly if their restrictive eating patterns evolve.
4. Orthorexia and anorexia nervosa or bulimia nervosa
Orthorexia, an obsession with healthy or “clean” eating, can sometimes coexist with anorexia or bulimia. The rigid dietary rules of orthorexia can overlap with the restrictive behaviors of anorexia, and the intense focus on food quality can lead to binge-purge cycles seen in bulimia.
The co-occurrence of any of these disorders highlights the need for comprehensive treatment plans that address the full spectrum of symptoms and underlying psychological issues. Understanding these overlaps can provide room for more effective interventions and support for those struggling with multiple eating disorders.
What does treatment for co-occurring eating disorders look like?
The presence of more than one eating disorder complicates the treatment process, as each disorder requires a specific approach to address its unique symptoms and underlying causes. A comprehensive treatment plan should incorporate medical care, nutrition and psychological therapy personalized to each client.
Cognitive-behavioral therapy (CBT) is often employed to help individuals challenge and change negative thoughts and behaviors related to food and body image. Dialectical behavior therapy (DBT) can be beneficial for those who struggle with emotional regulation, a common issue among individuals with eating disorders. Family-based therapy is another practical approach, particularly for younger individuals, as it involves family members in the recovery process, offering support and understanding.
Addressing underlying psychological issues, such as anxiety, depression or trauma, is equally important. This may involve individual therapy sessions focusing on building self-esteem, improving coping mechanisms and fostering a healthier relationship with food and body image.
Are you ready to begin treatment?
To get started treating co-occurring eating disorders, contact Seeds of Hope by calling 610-644-6464 or filling out an online contact form today.
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