My daughter has an eating disorder and an opioid use disorder. What do I do?

A: Dr. Nicole Avena

It is actually more common for those with eating disorders (EDs) to misuse substances than those without an ED. According to the National Center on Addiction and Substance Abuse, around 50% of women with eating disorders struggle with some kind of substance use disorder. The relationship between these disorders is multifaceted. Studies have shown that both EDs and substance use disorders can arise from the same set of personality traits or past experiences. Both kinds of disorders can be ways of coping with trauma in the past. Substance use can also be an enabler for the ED. Drugs can speed up metabolism or suppress appetite, which is desirable specifically for those suffering from anorexia.[1]

It is important, while seeking treatment, that individuals acknowledge that the same underlying issues for their disorders can be expressed in multiple ways. Post-traumatic Stress Disorder (PTSD) is seen as a common underlying factor in women suffering from both EDs and substance use disorder.[2]

Certain personality traits have also been cited as indicators for the propensity to develop multiple disorders. However, it is important to note that these personality traits, including self-destructive and erratic behavior, are much more consistent and obvious when comparing subsets of ED sufferers with and without the comorbidity of substance use disorder. Conversely, comparing ED sufferers with substance use sufferers leads to a much less significant correlation. This indicates that there is a very specific set of traits that intersect in individuals with both substance use disorders and EDs.

The exact type of eating disorder and substance use disorder is also important to consider, as it can help make a more specific diagnosis and a more highly-tailored treatment plan. For example, according to Clinical Psychology Review, a substance use comorbidity is more often seen with bulimia nervosa and binge/purge anorexia than with restrictive anorexia.[3] This occurs because of the similar physiological effects of using drugs and purging.