Co-Occurring Issues: Treating the Whole Person

Depression and Mood Disorders

What It Is

Depression (Major Depressive Disorder) involves persistent feelings of sadness, hopelessness, and loss of interest in activities. When co-occurring with eating disorders, depression can be both a cause and consequence of disordered eating.

How It Connects to Eating Disorders

• •Before the eating disorder: Depression may predate the eating disorder, with food restriction or binge eating emerging as coping mechanisms for depressive feelings
• •During the eating disorder: Malnutrition from restriction directly causes depression symptoms (fatigue, hopelessness, difficulty concentrating)
• •Maintaining both conditions: Depression reduces motivation to recover; the eating disorder provides (temporary) relief from depressive feelings

Signs You May Have Co-Occurring Depression

• •Persistent sadness, emptiness, or hopelessness
• •Loss of interest in activities you once enjoyed
• •Fatigue and low energy, even with adequate sleep
• •Difficulty concentrating or making decisions
• •Sleep disturbances (insomnia or oversleeping)
• •Feelings of worthlessness or excessive guilt
• •Thoughts of death or suicide
• •Physical symptoms (aches, pains, digestive issues)

Treatment Approach

We address depression through Cognitive Behavioral Therapy (CBT) to challenge negative thought patterns, behavioral activation to reengage with meaningful activities, nutritional rehabilitation (malnutrition directly causes depression), medication evaluation when appropriate, and processing underlying grief, loss, or trauma contributing to depression.

Anxiety Disorders

What They Are

Anxiety disorders include generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, specific phobias, and obsessive-compulsive disorder (OCD). These conditions involve excessive worry, fear, or ritualistic behaviors that interfere with daily life.

How They Connect to Eating Disorders

• •Anxiety often precedes eating disorders: Anxiety about weight, appearance, or social acceptance can trigger disordered eating
• •Eating disorder behaviors temporarily reduce anxiety: Restriction, purging, or exercise provide (short-term) relief from anxious feelings
• •Both conditions share traits: Perfectionism, rigidity, need for control, fear of uncertainty
• •OCD overlap: Many eating disorder behaviors are ritualistic and compulsive (food rules, calorie counting, body checking)

Common Anxiety Presentations

Treatment Approach

We address anxiety through exposure therapy for feared situations and foods, cognitive restructuring to challenge anxious thoughts, mindfulness and grounding techniques, distress tolerance skills (DBT), addressing perfectionistic standards, and medication evaluation when appropriate.

Trauma and PTSD

What It Is

Post-Traumatic Stress Disorder (PTSD) develops after experiencing or witnessing traumatic events such as abuse, assault, violence, accidents, or loss. Complex PTSD (C-PTSD) results from prolonged or repeated trauma, particularly in childhood.

How Trauma Connects to Eating Disorders

Trauma is one of the strongest predictors of eating disorder development:

• •Sexual trauma: 30-65% of individuals with eating disorders have experienced sexual abuse or assault
• •Childhood trauma: Physical abuse, emotional abuse, neglect, or witnessing violence
• •Attachment trauma: Inconsistent caregiving, abandonment, or ruptures in early relationships
• •Medical trauma: Invasive procedures, hospitalizations, or chronic illness
• •Identity-based trauma: Discrimination, bullying, or violence related to race, sexual orientation, gender identity, disability, or body size

Why Eating Disorders Develop After Trauma

• •Body disconnection: Trauma teaches that bodies are unsafe; eating disorders create further disconnection as a protective mechanism
• •Control: After trauma involving powerlessness, eating disorder behaviors provide a sense of control
• •Numbing: Restriction, binge eating, or purging numb painful emotions and memories
• •Self-punishment: Some survivors internalize blame and punish themselves through eating disorder behaviors
• •Making the body "disappear": Restriction may be an attempt to become smaller, less noticeable, or less sexualized
• •Soothing: Binge eating may provide temporary comfort or filling of emotional emptiness

Signs You May Have Co-Occurring PTSD

• •Intrusive memories, flashbacks, or nightmares
• •Avoidance of people, places, or situations that trigger memories
• •Hypervigilance (always on alert, easily startled)
• •Negative changes in mood and thinking
• •Dissociation (feeling detached from your body or surroundings)
• •Difficulty trusting others or forming close relationships
• •Strong emotional reactions to seemingly minor triggers

Treatment Approach

We use trauma-informed care that includes creating safety and stabilization first, EMDR (Eye Movement Desensitization and Reprocessing), trauma-focused CBT, somatic therapy to reconnect with the body safely, processing traumatic memories when you're ready, building resources and coping skills, and never forcing you to discuss trauma before you're prepared.

Substance Use Disorders

What It Is

Substance use disorders involve problematic use of alcohol, drugs (prescription or illicit), or other substances that interfere with daily functioning and wellbeing.

How Substance Use Connects to Eating Disorders

• •Shared risk factors: Impulsivity, difficulty regulating emotions, trauma history, genetics
• •Appetite suppression: Stimulants may be used to suppress appetite or lose weight
• •Numbing: Both eating disorder behaviors and substances serve to numb emotional pain
• •Disinhibition: Alcohol or drugs may trigger binge eating by reducing inhibitions
• •Cross-addiction: Sometimes called "trading addictions," individuals may shift from one compulsive behavior to another

Treatment Approach

We provide integrated treatment for both conditions through assessment of substance use patterns, simultaneous treatment, understanding the function both behaviors serve, developing healthier coping mechanisms, addressing underlying trauma, depression, or anxiety driving both, coordination with addiction specialists when needed, and harm reduction approaches when appropriate.

Other Common Co-Occurring Conditions