July 30, 2010 Jeanne Rust

Increase in Eating Disorders with Dual Diagnoses

At Mirasol we have been admitting many more patients recently who are considered to be dual-diagnosis patients, meaning that they have more than one serious diagnosis. It is not uncommon for a patients to admit with not only an eating disorder, but substance abuse, post-traumatic stress disorder, depression, and accompanying anxiety.

The conventional way of thinking is to treat the substance abuse first, then address the eating disorder. At Mirasol, we have long believed that co-occurring conditions need to be treated simultaneously. If all the conditions are not treated at the same time, treatment outcomes are usually poor, and what would ordinarily be considered a small slip can turn into a cascading event, almost like a house of cards, with one slip triggering another one rapidly.

A strong connection between eating disorders and substance abuse has been long evident with a majority of women reporting binge eating and/or bulimia nervosa along with the substance abuse. Some 40-50% of all women who have an eating disorder will have a problem with alcohol and drugs either currently or at some time in their lives. The eating disorder and substance abuse are frequently accompanied with PTSD.

In a recent survey of eating disorder symptoms among women in treatment for substance abuse, researchers found that among women with co-occurring substance abuse disorders and PTSD, a little more than one-third of the women were binge eaters as well. The women who were binge eaters had higher eating disorder, PTSD, and depressive symptomology than those women in the non- eating disordered group. Researchers also found that progress in the binge-eating group was much slower. It stands to reason that the relapse rate would also be higher with the binge eaters.

Substantial new research in eating disorders, substance abuse, and PTSD, indicates that the greater the severity of childhood trauma and PTSD or Disorder of Extreme Stress Not Otherwise Specified (DESNOS), the earlier the onset of alcoholism and related problems. Consequently, Mirasol is now evaluating all new patients with dual-or multiple diagnoses for PTSD and trauma, and we have developed specific protocols for treating these patients.