Psychiatric Illness Can Co-Occur with Eating Disorders

September 29, 2022

Although it can happen, most mental health disorders don’t happen by themselves. There are usually one or more other disorders occurring at the same time, in a phenomenon known as a dual diagnosis. Eating disorders are no different; they are listed in the DSM-V with other forms of psychiatric illnesses, and they tend to appear in conjunction with disorders like depression, OCD, and PTSD.

Here’s we’ll explore some of the types of psychiatric illness that co-occur in a dual diagnosis with eating disorders, such as Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder. Common psychiatric treatments and recovery options are also going to be covered here.

Common Psychiatric Disorders That Co-Occur with Eating Disorders

Below are some examples of psychiatric disorders that may co-occur with an eating disorder. In most cases, the diagnostic team of doctors and psychiatrists will develop a simultaneous treatment program that addresses both. Some of the common psychiatric disorders include:

Depressive Disorders

The DSM-V (Diagnostic and Statistical Manual for Mental Disorders-V) supports a diagnosis of clinical depression if five or more of the following symptoms are reported by a patient:

  • Insomnia or hypersomnia (oversleeping and sleeping more than 12 hours a day)
  • Anhedonia, or a loss of interest in previously enjoyed activities
  • Self-isolation/avoiding social situations
  • Cognition difficulties such as memory loss, difficulty concentrating, and trouble making decisions
  • Suicidal ideation (contemplating or planning suicide)
  • Sadness, lack of motivation, and/or a feeling of emptiness
Anxiety Disorders

Generalized Anxiety Disorder
Characterized by irrational worries, a constant sense of apprehension, and a negative outlook on the future, generalized anxiety disorder (GAD) is commonly co-diagnosed in individuals with eating disorders. Anxiety disorders often engender a sense that the person is losing control over their circumstances, which can trigger eating disorders as a way to “regain” control over something. This can become a cycle that exacerbates both the anxiety disorder and the eating disorder. Thankfully, many therapeutic methods effectively treat both kinds of disorders.

Phobias and Panic Disorder
Also, on the spectrum of anxiety disorders are phobias and recurring panic attacks. Many people with eating disorders, especially Anorexia Nervosa and ARFID, have fears about food and eating, resulting in food avoidance or extensive food rituals. Individuals with Anorexia Nervosa may suffer panic attacks if they have to eat even a small amount of a fear food. Treating psychiatric disorders such as phobias and panic is an essential precursor to successfully addressing a person’s eating disorder.

Post-Traumatic Stress Disorder (PTSD)

Experiencing traumatic events such as abuse, violence, a divorce, loss of a loved one, or even an auto accident can cause a debilitating disorder known as PTSD. Symptoms of PTSD can include extreme anxiety, nightmares, flashbacks to the traumatic event, and difficulty coping with normal life stressors. As with GAD, PTSD can trigger disordered eating behaviors as a coping mechanism and means to take back control.

Personality Disorders

Personality disorders can be much more difficult to treat than other forms of mental illness because they form a central aspect of the person’s self-identity. Borderline, Obsessive-Compulsive, and Avoidant Personality Disorders are some of the most common types of personality disorders diagnosed in people with Anorexia Nervosa, Bulimia Nervosa, or Binge-Eating Disorder. Evidence-based talk therapies, such as CBT and DBT, may help individuals cope with personality disorders, as well as certain medications, which may continue long after residential eating disorder treatment has been completed.

The Basics of a Psychiatric Evaluation

A comprehensive psychiatric evaluation allows the eating disorder treatment team to assess a person’s complete treatment needs. This information is critical to developing an individualized recovery program that can capably treat any and all disorders, giving the individual the best chance at a full recovery.

Basic Questionnaires

Certain standard questionnaires can get the ball rolling. Because many psychiatric illnesses and eating disorders can both impair cognitive ability, various cognitive questionnaires can be administered to assess their cognitive abilities. For example, tests containing questions that measure a client’s complex attention processes can determine how well they can observe stimuli without being distracted.

Medical History

Although psychiatric illnesses are generally mental health disorders, the individual’s medical history must also be assessed. This is especially true when there is a comorbid eating disorder and the individual may have severe medical complications that need attention. Does the patient have a history of seizures? Migraine headaches? Recurring infections? Heart disease? Dental issues?

Any prescribed medications and medical allergies should be discussed as well. If the individual has a history of substance abuse, their last usage, and type of drug should be mentioned. While much of this may be something the individual wants to keep secret, it’s essential to their health that all avenues are explored.

Psychosocial and Developmental History

The final component of psychiatric evaluations involves the individual’s developmental and psychosocial history. Developmental history involves a discussion of the individual’s childhood and adolescence, and examining important past experiences that may have influenced a person’s development. Some things of particular concern to psychiatrists include a history of chronic diseases, physical abuse, or sexual abuse, which may have had a profound effect on the patient’s psychological maturation.

Family relationships and those with close friends are explored to get an idea of the individual’s psychosocial baselines. Every effort should be made to include cultural sensitivity as part of this evaluation, as it will play a central role in the eventual individualized treatment plan.

Treatments for Dual Diagnosis of Eating and Psychiatric Disorders

After the initial psychiatric evaluation, the medial, therapeutic, and psychiatric team at an eating disorder center will design an individual treatment plan. This includes several different types of therapy, each of which is designed to help the individual overcome both the eating disorder and the co-occurring mental health disorder(s).


The basic building block of any recovery program, psychotherapy is a type of “talk” therapy that reinforces how to process their emotions and maintain control over them. Psychotherapists talk with the individual about their thoughts and feelings even if they experience anxiety and fear over acknowledging them.

Cognitive Behavioral Therapy (CBT)
Decades of evidence-based studies of psychotherapy utilized by eating disorder therapists and psychologists has led to the development of Cognitive Behavioral Therapy (CBT). CBT helps people recognize distorted thoughts and behaviors as being unhealthy via an objective one-on-one dialogue between client and therapist. This has proven to be especially helpful for individuals diagnosed with Borderline Personality Disorder, depression, eating disorders, and anxiety/phobias.

Central to CBT is helping individuals see the way they think objectively and not through the filter of their subjective emotions. For example, a person with an anxiety disorder who reports they are unable to focus on anything because they feel something bad is going to happen to them will be guided by a CBT therapist to examine these thoughts see if there is any objective reason to think so. Eventually, after several sessions, the individual might come to realize their fears are not based on solid evidence, but are instead irrational.

How Treatment Programs Can Keep an Individual Motivated

Many teens and adolescents who need eating disorder treatment may feel guilty about their disordered eating behaviors, but treatment centers’ programs for family and friends can increase their motivation to get better. Family members and support groups can be of great help to those who may need extra motivation and support when the urge to start engaging in eating disorder behaviors is persistent and overwhelming.

No matter the program eventually chosen, securing a psychiatric evaluation and a specialized treatment plan based on that evaluation is the essential first step to a full recovery.

At Clementine, a Monte Nido Affiliate, we support adolescents and their families on the path to full recovery by preparing each adolescent to navigate the challenges of life free of the eating disorder. We believe that quality eating disorder treatment for adolescents, which maximizes the opportunity to be fully recovered. For more information, please visit: