Anorexia nervosa and co-occurring disorders are seen together in most, if not all, individuals with this eating disorder. While it is possible to separate them into different diagnoses, treating them separately can mean someone won’t reach a healthy state of recovery, that things just keep going wrong. There is a good reason for this, and why Alsana never approaches any client from a single stance.
Frequent co-occurring disorders (problems often seen with anorexia) are depression, anxiety, obsessive-compulsive disorder (OCD), and substance abuse. During evaluations clinicians are often able to identify symptoms of these emotional issues just by observing clients and talking with them. What can be more subtle are any drug and alcohol abuse issues that are used to numb emotional pain.
As clients become better during eating disorder treatment, often the symptoms of co-occurring conditions worsen. Clients and family may worry, thinking that treatment isn’t working, or that they are beyond treatment. But when eating disorders have been used to help control or cover underlying issues or painful emotions, something else is just going to naturally take its place, as a kind of self-protection.
As hard as it is, clients (and family members who are asked to share perspectives) can actually help recovery greatly by talking about emotions, and any use of drugs and alcohol to help control their emotions, insecurities and unease. People entering treatment expect to talk about the eating disorder, but sharing drug or alcohol history isn’t as easy to bring out into the open. This can be particularly true when someone is also using drugs or drinking to control depression or anxiety. But opening up and being honest is critical.
By treating anorexia and co-occurring disorders at the same time, overall improvement is more even and sustained. When the ability to use eating behaviors to feel better and to cope isn’t there, strategies can also being addressed to help the depression without using alcohol or drugs to take the place of the eating behaviors. Sometimes the eating disorder symptoms will be worse, or the emotions, and then at other times during treatment these improve, without falling back on substitutions of other sorts to feel better. Slow steps forward, and all factors treated together—that’s the necessary double whammy of effective treatment.
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