Many clients suffering from eating disorders present with concomitant addictive disorders as well, and the reverse is also true. As these are both disorders of impulse control, mood dysfunction and self-esteem, there are obvious benefits to working on both simultaneously, but this is typically not the approach taken. And there are advantages to treating both disorders in a controlled environment. Here, Amelia Davis, MD, describes a case in which a young woman with a significant history of problems in both realms received care for both, highlighting the benefits of an integrated and comprehensive approach to the treatment of the dually-diagnosed…Richard Juman, PsyD
My experience evaluating and treating the psychiatric conditions of patients with eating disorders has taught me that people suffering from anorexia, bulimia and binge eating disorder often suffer from more than one clinical disorder, whether anxiety, depression, PTSD or, commonly, substance use disorders.
Unfortunately, many treatment facilities—those that treat eating disorders and those focused on addiction treatment—are ill-equipped to handle the co-occurring eating disorder/substance use disorder patient, as that person’s treatment often requires a highly specialized, multidisciplinary team, trained in the treatment of both disorders.
Recognizing the overlap of a patient’s eating disorder and substance use disorder is critical to developing an individualized recovery model that addresses both conditions simultaneously, which may include weight restoration and detox occurring in tandem.
As the following case study illustrates, treating patients with co-occurring eating disorders and substance use disorders is challenging and requires multiple modalities, but addressing them together gives the patient a better chance at preventing relapse of either disorder.
Jennifer: At Presentation
“Jennifer” was a 30-year-old Caucasian female I initially met when she was transferred to the Rosewood Centers for Eating Disorders’ inpatient eating disorder treatment program from another facility where she was receiving treatment for an eating disorder and other mental health conditions.
When she initially presented to treatment, she was exhibiting signs and symptoms of mania, which included hyperverbal speech, flight of ideas, mood lability, psychomotor agitation and room pacing. Additionally, she made threatening remarks to staff when she was told she would not receive Adderall. Since she was difficult to redirect, her initial psychiatric evaluation was challenging.
During the first 48 hours of admission at Rosewood, Jennifer repeatedly asked to receive Adderall, stating that doctors at the previous facility had diagnosed her with bipolar disorder. However, she didn’t believe she had bipolar disorder, but insisted the Adderall was needed to treat her ADHD.
Records from the previous treatment facility noted a history of manic symptoms and demanding stimulant medications. The facility had initially discontinued stimulants, but later she was given Adderall, as she was taking the medication prior to admission.
A History of Dieting and Drug Abuse
As Jennifer worked through treatment, her parallel histories of addiction—to prescription, illicit and over-the-counter drugs—and dieting, which ultimately lead to bulimia nervosa, became clear.
At age 18, she reported being obese (weighing 220 pounds, height 5’4″ and a BMI of 37.8) and began dieting. At this time she took Ephedra, a diet pill that is chemically similar to amphetamines and methamphetamines that was banned from the U.S. in 2004.
When she could no longer obtain Ephedra, Jennifer began purging by self-induced vomiting at around age 19, and continued purging daily for six years. During this time period, she reported losing 80 pounds and continued to lose weight, dipping as low as 105 pounds two years prior to admission. Through interviews, she denied binge eating, but said she was addicted to sugar and was vegetarian.
In terms of her substance use history, Jennifer reported her cocaine use started at age 20, and she smoked crack cocaine daily starting at age 27. She also reported using marijuana, LSD and mushrooms in the past. She had also been taking benzodiazepines for many years as treatment for anxiety, and took multiple different psychotropic medications, including Depakote, Seroquel, Ambien, Remeron, Effexor and Clonazepam. All told, she had been hospitalized seven times in the past six years for psychiatric reasons.
The patient initially told staff she was diagnosed with ADHD at age 15, but collateral information revealed she was not diagnosed with ADHD until after age 22. Additionally, family members said she had not shown symptoms of ADHD growing up and that she had previously done well in school, receiving straight As.
On the day of discharge, she voiced appreciation for her treatment and appeared motivated in her recovery.
While at first challenging, Jennifer did very well in treatment. By addressing both the eating disorder and the substance use disorder at the same time as well as applying motivational interviewing techniques in addition to a variety of other therapies, she made significant improvements.
Treatment was delivered by a multidisciplinary team with specialized treatment experience in eating disorders. In addition, family therapy was also very beneficial for the patient as she learned to develop healthy boundaries with her family as well as provided education to the family about the eating disorder. This is one example of how a comprehensive program can successfully treat co-occurring substance use and eating disorders.
Amelia Davis, MD, is the medical director of Rosewood Centers for Eating Disorders in Wickenburg, Ariz. Board certified in psychiatry by the American Board of Psychiatry and Neurology, she is licensed to practice medicine in the state of Arizona, California, and Florida, where she was formerly chief of the eating disorders program at the University of Florida School of Medicine. In addition to her role as medical director, Dr. Davis is a program director for Rosewood’s clinical eating disorders fellowship.
Interdisciplinary care for a young woman dually-diagnosed with addictive and eating disorders. Many treatment facilities can’t treat both eating disorders and addiction. Many clients suffering from eating disorders present with concomitant addictive disorders as well, and the reverse is also true. As these are both disorders of impulse control, […]