The term “co-occurring diagnoses” refers to someone having two or more mental health concerns at the same time. This can also be referred to as “dual diagnoses”. When an eating disorder is present with another diagnosis, it can prevent full recovery. Co-occurring disorders require proper assessment and therapy that is tailored to the individual’s experience.

Common Co-Occurring Diagnoses

1) Depression

50 - 75% of people with eating disorders will also experience major depression at some point in their lives. However, given that malnourishment can intensify depressive symptoms, it remains unclear what proportion of major depressive disorder diagnoses can be seen as a result of starvation as opposed to an independent disorder. 

2) Substance Abuse

About 50% of all individuals with eating disorders also struggle with a substance use disorder. Because it is important to address both disorders simultaneously, there are specialty treatment centers for people with substance abuse and eating disorders. (Check out ANAD for treatment facility options).

3) Anxiety

About 65% of people with eating disorders will struggle with one or more anxiety disorders in their lifetime. Anxiety disorders most commonly co-occurring with eating disorders are Obsessive Compulsive Disorder (OCD), Social Phobia and generalized anxiety disorder. Early-onset anxiety disorders may represent a risk factor for the development of anorexia nervosa and bulimia nervosa later in life.

3) Post-Traumatic Stress Disorder (PTSD)

There is a high co-occurrence of trauma and eating disorders. PTSD is a type of anxiety that can develop after experiencing a traumatic event. This can include physical or sexual abuse, military combat, or a natural disaster.

4) Borderline Personality Disorder (BPD)

BPD is associated with problems forming interpersonal relationships, self-image, emotion regulation, impulse behaviors, ad stress-related changes in thinking. Around 10% of people with eating disorders have BPD.

5) Self-Injury / Self-Harm

Self-injurious behavior is defined as the intentional, direct injuring of the body. The prevalence of self-injury among ED patients is approximately 25%. About 6% of people with eating disorders meet the criteria for BPD and engage in self-harm.

Stay Aware of the Risk Factors

Consider the following questions and critically assessing what is occurring:

• Is there avoidance of a particular emotion, circumstance, person or trauma?
• Is there engagement in an unhealthy behavior as means of distracting or avoiding?
• Are there relapses into behaviors associated with the diagnosis?
• Is there increased anxiety, depression, suicidal thoughts, difficulty concentrating, or anything abnormal from the baseline?

If the answer is yes to any of the above questions, there could be a occurring disorder. Whoever is experiencing this, should consider talking with a therapist about what they are currently experiencing. A professional can help identify if another mental health illness is present or developing.

References

1. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR.  (2004). Axis I Comorbidity in Patients with Borderline Personality Disorder: 6-Year Follow-Up and Prediction of Time to Remission.  American Journal of Psychiatry. 161:2108-2114.

2. Sansone, RA,  Levitt, JL, Sansone, LA. (2003). Eating Disorders and Self-Harm: A Chaotic Intersection. Reprinted from Eating Disorders Review. May/June. Volume 14, Number 3. 

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