Eating Disorders and Addiction: A Look at the Similarities and Co-occurrences

Eating disorders exist as a result of cultural, biological, environmental and societal factors. The same can be said for substance use disorders, and it is no wonder that there is a lot of overlap in similarities and co-occurrences between the two. 

This can be shown by both the high rate of the two disorders co-occurring, as well as how the compulsive aspect of eating disorders and addiction function through similar neurotransmitter systems and regions of the brain. Motivational and reward dopamine mechanisms in the brain respond similarly to things like food and drugs. However, the brain’s motivation and reward processing when it comes to food is more complex.

Let’s dig a little deeper. 

Similarities Between Addiction and Eating Disorders

According to the National Eating Disorders Association, “eating disorders and substance use share a number of common risk factors, including brain chemistry, family history, low self-esteem, depression, anxiety, and social pressures. Other shared characteristics include compulsive behavior, social isolation, and risk for suicide.”

Childhood trauma plays a significant role in the risk of developing an eating disorder and substance use disorder. Common features in comorbid substance use disorder and eating disorders are impulsivity, emotional dysregulation, and novelty-seeking traits. 

Alcohol and Eating Disorders

In the case of alcohol use, disordered eating and addiction have a complicated relationship. Several recent studies have shown that nearly 50% of people who engage in alcohol misuse report disordered eating behaviors, with participants often reporting that they find food to be less important to them than alcohol.

This is demonstrated in a number of ways and is different for different people. While people may not set out to avoid food at first, the habit of prioritizing alcohol consumption over food develops. People who struggle with alcohol use disorder may eventually forgo spending money on food so that they can keep it to buy alcohol. Their interest in food can decline to the point that they do not feel the need to eat.

On the contrary, people with an eating disorder use alcohol for various purposes. Whether that be to suppress their appetite, promote binging/purging episodes, or manage their compulsions and preoccupation with food.

Substance use disorder, especially alcohol use disorder, is commonly associated with eating disorders. Alcohol use disorder is more associated with binge eating behavior than food restriction behavior as seen in patients with anorexia nervosa.

Substance Use and Binge Eating

People living with either substance use or binge eating disorders have several parallel signs and symptoms. Both disorders show signs such as:

• Cravings and urges to engage in the behavior

• Feeling a loss of control over the behavior

• Multiple unsuccessful attempts to stop the behavior on your own

• Using the behavior as a maladaptive coping mechanism to manage stress or negative mood

• Denial about the severity of the problem

• Continuing the behavior despite harmful consequences

In some cases, people who have a binge eating disorder can even experience sudden physical and psychological withdrawal symptoms if they suddenly stop binging. In a broad sense, disordered eating patterns can be seen as a form of addictive behavior.

Substance Use and Anorexia Nervosa

Substances such as alcohol, opioids, and amphetamines can be used as a tool to control appetite, which often leads to addiction. However, substance use disorder and anorexia nervosa co-occur less frequently than other eating disorders.

In a literature review released in 2020, women with eating disorders are more likely to abuse substances than those without an eating disorder. Approximately 12% to 18% of adults with anorexia nervosa and 30% to 70% of adults with bulimia nervosa have a substance use disorder. Approximately 1 in 4 individuals with binge eating disorder report a co-occuring substance use disorder.

Studies have also found that amphetamine, cannabis, and opiate use is higher among women with anorexia nervosa than those with bulimia nervosa and binge eating disorder.

Anorexia is often associated with an individual's desire for control which doesn’t track with substance use disorder. Addiction is often associated with a relinquishing or loss of control so the association between the two disorders is nuanced.

Neurocircuitry of Eating Disorders and Addiction

Similarly, many parallel patterns emerge in neurobiological systems. Dopaminergic D2 receptors appear to be decreased both in people with substance use disorder and in individuals with binge eating disorder. 

The D2 receptor is responsible for the synthesis, release, and uptake of dopamine. Dopamine is a neurotransmitter, a chemical messenger within the brain that carries the signal of “reward” or “motivation”. Dopamine is released during activities that feel good, and this release can drive people to return to behaviors over and over again.

Engaging in either a binge episode or substance use causes the brain to release a large amount of dopamine. When repeated over time, the brain becomes accustomed to these high levels of dopamine, which results in a reduction or modification of D2 receptors.

Because the dopamine receptors are damaged, finding pleasure in normal everyday things can be difficult.

These brain changes result in a key pattern of behavioral symptoms, including:

• Lack of motivation

• Persistent exhaustion

• Lack of concentration

• Mood swings & anxiety

• Depression & hopelessness

• Lack of pleasure in previously enjoyable experiences

• Low libido 

This leads to a psychological dependence on substances, whether that be drugs or food, to provide a sense of motivation and reward that they can’t get otherwise.

One huge difference between binge eating disorder and other addictions is that unlike drugs, abstaining from food is not an option. Those with addictive behaviors pertaining to food must interact with their drug of choice every day during recovery.

The science behind addiction and eating disorders can be shocking and devastating. If you or  loved one struggles with either or have more questions about red flag behaviors for eating disorders or addiction - reach out to us at Nurtured Nutrition today!