It is commonly accepted that eating disorders often co-exist or co-present alongside mental illness or addiction. Associated problems include depression, anxiety disorder and suicidal behaviour.(1) In addition, sufferers are highly vulnerable to developing substance misuse problems or alcohol dependency(2). The national Eating Disorder Association actually identify self harming behaviour, drug addiction, alcohol abuse and tranquilliser addiction as being consequences of an eating disorder.
So how do we “take due account of ordinarily confounding issues including contemporary patterns of co-morbidity and co-occurrence of problems and disorders…” (3)
The Graham Menzies Foundation and Cyswllt Contact Ceredigion have compiled a proposal for a dual diagnosis pilot service in Ceredigion, with both local and national reach. If you are developing similar plans or placing funding bids in this area then the following evidence and reading may be of use. Please contact me if you need more information or support.
The prevalence of non-lethal self-injury among ED patients is approximately 25%, regardless of the type of eating disorder or the treatment setting(4)
About 25% of self-harming individuals with ED (eating disorders) appear to meet the criteria for borderline personality disorder (BPD). (4)
Co-morbid major depression or dysthymia has been reported in 50%–75% of patients with anorexia nervosa and bulimia nervosa.(3)
Estimates of the prevalence of bipolar disorder among patients with anorexia nervosa or bulimia nervosa are usually around 4%–6% but have been reported to be as high as 13%).(3)
The lifetime prevalence of obsessive-compulsive (OCD) among anorexia nervosa cases has been as high as 25%, and obsessive-compulsive symptoms have been found in a large majority of weight-restored patients with anorexia nervosa treated in tertiary care centres.(3)
OCD is also common among patients with bulimia nervosa.(3)
Co-morbid anxiety disorders, particularly social phobia, are common among patients with anorexia nervosa and patients with bulimia nervosa.(3)
Substance abuse has been found in as many as 30%–37% of patients with bulimia nervosa; among patients with anorexia nervosa, estimates of those with substance abuse have ranged from 12% to 18%, with this problem occurring primarily among those with the binge/purge subtype).(3)
Co-morbid personality disorders are frequently found among patients with eating disorders, with estimates ranging from 42% to 75%.(3)
Eating disordered patients with personality disorders are more likely than those without personality disorders to also have concurrent mood or substance abuse disorders.(3)
(1) KCL Anorexia Nervosa, The physical Consequences
(2) Eating disorders and psychiatry, Kings College London. By professor Janet Treasure and Dt Anna Crane, 2008.
(3) All Wales Eating Disorder Special Interest Group, report comissioned for Health Commission Wales.
(4) The Prevalence of SHB (self harming behaviour) Among Eating Disorders Patients
Eating Disorders and Self-Harm: A Chaotic Intersection Eating Disorders Review
Randy A. Sansone, MD is a Professor at Wright State University School of Medicine, Dayton, OH.
John L. Levitt, PhD is Clinical Director of the Eating Disorders Program at Alexian Brothers Behavioral Health Hospital, Rolling Meadows, IL.
Lori A. Sansone, MD is in private practice with Alliance Physicians, Dayton, OH
Interested in this subject? Suggested further reading:
‘Self Harm and Eating Disorders’ (edited by John L. Levitt, Randy A. Sansone and Leigh Cohn).
This book explores the prevalent but largely uncharted relationship between self-injury behaviours and eating disorders symptoms. (available from Amazon).
And check out… a related construct; “multi-impulsive bulimia”, which also involves impulsive self harm behaviour (e.g. suicide attempts), in addition to other forms of impulsivity such as substance abuse and sexual promiscuity. Compared with BPD, considerably less is known about multi-impulsive bulimia in terms of etiology. It may be that this syndrome is actually made up of a subset of individuals with BPD. (4)