Bulimia Nervosa & Addiction | Symptoms, Risk Factors, & Dual Diagnosis Treatment

Dual diagnoses are cases involving both a substance use disorder (SUD) and some form of mental disorder. 

And while most people think of depression or post-traumatic stress disorder when they think of dual diagnosis, eating disorders are also commonly associated with both alcohol and drug addiction, especially bulimia nervosa.

Co-occurring Bulimia & Addiction

Bulimia nervosa, or bulimia, is a severe binge eating disorder that involves an unhealthy bodily self-image and an intense fixation on losing weight. 

Those who experience bulimia euphorically binge eat large amounts of food, experience depression or shame, and then induce vomiting. This is typically followed by periods of intensive exercise or fasting, and eventually another bout of extreme overeating and purging.

Eating disorders, and bulimia in particular, are heavily associated with substance use disorders and vice versa. 

How Common Is This Dual Diagnosis?

While figures vary between different studies using different methodologies, it’s thought that up to 50% of individuals with bulimia also experience a substance use disorder of one form or another. 

An SUD can form either before, during, or after the formation of bulimia nervosa. This heightened risk of dual diagnosis is known to be greater than other eating disorders alone, as well as the rate of substance use disorder in the general population.

What Substances Are Abused?

Eating disorders may involve a number of harmful substances ranging from alcohol to opioids, stimulant drugs, and laxatives.

Laxatives are used by bulimics as coping mechanisms to deal with mental or physical discomfort, or as tools to help curb appetite or  otherwise further weight loss.

Drunkorexia, Alcohol Abuse, & Eating Disorders

Drunkorexia is slang for using an eating disorder to self-enable alcohol use disorder. This practice involves individuals (typically women) who use bulimia or anorexia nervosa to control their food intake in order to make room for calories gained later from binge drinking. 

This practice can cause men or women with bulimia or anorexia to develop severe alcohol addiction or alcohol poisoning leading to hospitalization or death, especially when binging on an empty stomach.

Symptoms Of Bulimia & SUD Comorbidity

Both bulimia and substance use disorders can be hard for casual observers to recognize, whether they occur separately or together.

Common signs and symptoms of bulimia include:

• fixation on weight loss and body image 
• body dysphoria
• frequent weight loss and weight gain
• stomach cramps
• constipation
• acid reflux
• poor concentration
• dizziness/fainting
• feelings of coolness
• sleep difficulties
• cuts and calluses on top of finger joints (from inducing vomiting)
• dental issues and sensitivity from stomach acid exposure
• hair thinning and loss

Common signs and symptoms related to substance abuse include:

• drug or alcohol cravings
• obsessive thoughts related to substance use
• needing to use or drink more over time
• loss of control when using the substance
• spending money on substance use that you cannot afford
• loss of interest in family, friends, or hobbies
• poor performance at work or in school
• risky behavior (driving under the influence, theft, risky sex)
• physical or mental health issues related to substance use
• experiencing withdrawal symptoms when you don’t use
• failing to stop taking the substance when you try

Dual Diagnosis Risk Factors

SUD and bulimia have many known risk factors, some of which are shared between both conditions.

Risk factors for bulimia include:

• having close relatives with eating disorders or poor mental health
• past dieting
• body image dissatisfaction
• perfectionism and behavioral inflexibility
• anxiety disorders or a history of trauma
• limited social connections
• new exposure to western/American culture

Risk factors for substance use disorder include:

• family history of drug abuse
• psychiatric disorders
• lack of family involvement
• childhood trauma
• early exposure to substance use
• use of highly addictive or euphoric substances

Substance use and eating disorders can also act as risk factors for one another, as both can be characterized as forms of addictive behavior. 

Dual Diagnosis Treatment Programs For Bulimia & Addiction

As with all dual diagnoses, SUD and bulimia are best treated together as part of an integrated, cohesive, and highly personalized program. However, this combination of conditions presents unique challenges to care.

For instance, underfed or malnourished bodies often respond unpredictably to medications, making medication-assisted treatment risky. 

Individuals in treatment for one condition may also fall back on the remaining disorder, increasing substance use to deal with the stress of combating the eating disorder or increasing bulimic behavior in response to substance withdrawal and therapy.

Due to the increased risk and poor outlook, many addiction treatment centers are unable to treat individuals with active eating disorders. This makes finding a qualified and experienced inpatient dual diagnosis treatment program even more important.

Treatment options used in dual diagnosis cases include:

• cognitive behavioral therapy or other forms of psychotherapy
• individual and group counseling
• careful use of medications including selective serotonin reuptake inhibitors and drugs approved for the treatment of addiction
• medical nutrition therapy
• careful monitoring under the care of a physician
• education and supportive services
• participation in peer support groups

If you or a loved one is experiencing both addiction and an eating disorder, contact Ark Behavioral Health and inquire about our dual diagnosis treatment options today.