Real facts about eating disorders & co-occurring conditions

By Professor Cynthia Bulik, PhD, EDGI Lead Principal Investigator

When I started in this field several decades ago, it was commonplace to encounter someone who had anorexia nervosa only or bulimia only. Binge-eating disorder didn’t even officially exist yet, although we definitely saw it in the clinic. As time has passed and we have become more informed about how eating disorders live in the community, it has become increasingly clear that they often co-occur with other mental health problems.

The reality is that eating disorders rarely travel alone. Estimates tell us that upwards of 80% of people with anorexia nervosa, bulimia nervosa, or binge-eating disorder also report having an anxiety disorder or depression at some point in their lives. Often, the anxiety starts before the eating disorder sets in. Some of our recent genetic work on anorexia nervosa revealed that there are actually shared genetic factors among anorexia nervosa, depression, and anxiety which partly explains why they so commonly co-occur. What this means clinically is that treatment of the eating disorder also has to take depression and anxiety into account and clinicians have to ensure that all aspects of the person’s condition are being appropriately addressed.

Another common co-occurring problem is alcohol and substance use. Although we have known this for decades, we have done a particularly poor job at developing treatments that address both at the same time. Far too often people with these co-occurring conditions bounce between eating disorders and substance abuse treatment facilities, never receiving concentrated treatment that focuses on both issues concurrently. Some recent research by our colleagues is showing how genetic factors influence risk for both types of illness, hopefully allowing us to begin to identify shared pathways that may inform future more effective treatments.

Importantly, genes are only part of the story. For many individuals with eating disorders, trauma history also plays a role in the development of their eating disorder or challenges in reaching recovery. Our colleague at the University of North Carolina at Chapel Hill, Dr. Mary Hill, has written three excellent blog posts about trauma and eating disorders which you can read here, here and here.

As an important reminder, eating disorders really don’t care how old you are, what gender you are, how much money you make, or what your cultural background is. Sometimes it seems like the media only focus on a narrow cross-section of people with the illnesses—a cross-section that reinforces stereotypes. The EDGI team know that that is not the case and respect the stories of individuals from all backgrounds who are living with or have lived with these illnesses. We see you and hear your stories and will do our best to let the rest of the world know that these illnesses strike across the board.