The connection between eating disorders and substance use disorders in women is more common than many people realize. At Anchored Tides Recovery, we frequently see women struggling with both conditions simultaneously—a pattern known as co-occurring disorders or dual diagnosis. Understanding this overlap is crucial for effective treatment and lasting recovery.
If you’re a woman dealing with both an eating disorder and substance use, you’re not alone, and you’re not broken. These conditions often develop together for complex biological, psychological, and social reasons. Let’s explore why this overlap occurs, how to recognize it, and most importantly, how specialized treatment can help you heal from both conditions simultaneously.
Understanding the Connection
Eating disorders and substance use disorders share remarkable similarities in their underlying causes, brain chemistry changes, and behavioral patterns. Both are serious mental health conditions that involve compulsive behaviors, loss of control, negative health consequences, and difficulty stopping despite wanting to. Both also serve as coping mechanisms for underlying emotional pain, trauma, or mental health conditions.
Research shows that up to 50% of individuals with eating disorders also struggle with substance abuse—a rate five times higher than in the general population. Women are particularly vulnerable to this overlap, experiencing co-occurring eating disorders and addiction at significantly higher rates than men.
This connection isn’t coincidental. The same factors that make women vulnerable to eating disorders—societal pressure around appearance, trauma history, perfectionism, and difficulty expressing emotions—also increase vulnerability to substance use disorders. Additionally, the brain changes caused by eating disorders can make women more susceptible to addiction, and vice versa.
Why Women Are Particularly Vulnerable
Societal Pressure and Body Image
From a young age, women receive intense cultural messages about the importance of physical appearance. The pressure to be thin, beautiful, and physically “perfect” creates a breeding ground for both eating disorders and substance use.
Many women begin restricting food or using substances as a way to control their weight or appearance. Diet pills, stimulants like cocaine or methamphetamine, and even alcohol (which some women use and then purge) become tools for achieving an “ideal” body that’s often unrealistic and unhealthy.
Social media has intensified these pressures, bombarding women with filtered images and impossible beauty standards. The constant comparison and never feeling “good enough” can drive both disordered eating and substance use as attempts to measure up or numb the pain of feeling inadequate.
Trauma and PTSD
Women experience trauma at higher rates than men, particularly interpersonal trauma such as sexual assault, domestic violence, and childhood abuse. According to the National Center for PTSD, trauma is one of the strongest predictors of both eating disorders and substance use disorders.
For many women, eating disorders and substance use develop as survival strategies—ways to cope with unbearable trauma symptoms. Restricting food can create a sense of control when trauma has left you feeling powerless. Bingeing and purging can serve as ways to punish yourself if you feel shame about the trauma. Substance use numbs the painful emotions and intrusive memories associated with PTSD.
The body dysregulation that results from trauma—difficulty recognizing hunger cues, disconnection from your body, hypervigilance—contributes to both eating disorders and addiction. Many women describe feeling “outside” their bodies, using both food restriction and substances to either reconnect with or further escape from physical sensations.
Perfectionism and Control
Women are often socialized to be “perfect”—to excel academically, maintain flawless appearance, meet everyone’s needs, and never show weakness. This perfectionism creates intense internal pressure and anxiety.
Eating disorders offer an illusion of control and achievement. If you can’t control other aspects of your life, you can control what you eat, how much you exercise, and what your body looks like. This same need for control can drive substance use, particularly stimulants that enhance productivity or alcohol that helps you “let go” of rigid control temporarily.
The perfectionism that fuels eating disorders also makes it difficult to ask for help or admit you’re struggling with addiction. Many women maintain successful external lives—excelling at work, caring for families—while secretly battling both conditions, believing they should be able to “handle it” on their own.
Emotional Suppression
Women are often taught to prioritize others’ feelings over their own and to suppress “difficult” emotions like anger, sadness, or fear. When you don’t have healthy ways to express and process emotions, they get channeled into destructive behaviors.
Both eating disorders and substance use become ways to manage emotions you haven’t learned to tolerate. Food restriction numbs feelings, bingeing soothes anxiety temporarily, purging releases tension, and substances alter your emotional state. Over time, these become your primary coping mechanisms, creating a cycle where you can’t imagine managing emotions any other way.
Hormonal Influences
Women’s hormones fluctuate throughout the menstrual cycle, during pregnancy, postpartum, and during menopause. These hormonal changes affect mood, appetite, impulse control, and vulnerability to both eating disorders and substance use.
Many women report that eating disorder symptoms and substance cravings intensify during certain points in their cycle. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) can trigger both disordered eating and increased substance use as ways to cope with mood changes and discomfort.
Hormonal birth control, fertility treatments, and hormone replacement therapy can also affect eating disorder and addiction symptoms, though these relationships are complex and vary by individual.
Common Patterns of Co-Occurring Eating Disorders and Substance Use
Restricting and Stimulant Use
Many women combine food restriction with stimulant use—cocaine, methamphetamine, ADHD medications like Adderall, or excessive caffeine. Stimulants suppress appetite, making it easier to restrict food intake. They also provide energy despite inadequate nutrition and create a sense of focus and control.
This combination is particularly dangerous because both behaviors stress the heart, deplete nutrients, and can lead to serious medical complications including cardiac arrest, seizures, and organ damage. The malnutrition from restricting amplifies the dangerous effects of stimulants on the body.
Women who restrict and use stimulants often describe feeling “productive” and “in control,” which reinforces the behavior despite mounting negative consequences. The combination can also lead to rapid weight loss that’s praised by others, further reinforcing the dangerous pattern.
Binge Eating and Substance Use
Binge eating disorder—consuming large amounts of food in a short period while feeling out of control—frequently co-occurs with alcohol or marijuana use. Some women use substances before or during binges to “allow” themselves to eat, reducing inhibitions and quieting the critical inner voice.
Others use substances after binges to numb the shame, guilt, and physical discomfort that follow. This creates a cycle: restrict, binge, use substances to cope with the binge, experience a “hangover” that triggers more restriction, and repeat.
Alcohol in particular can trigger binges by lowering inhibitions, impairing judgment about food choices, and disrupting blood sugar regulation. Many women describe feeling unable to control their eating when drinking, then using this as “evidence” that they need to restrict more strictly, perpetuating the cycle.
Bulimia and Alcohol Use
Bulimia nervosa—characterized by bingeing and purging—has the highest rate of co-occurring substance use disorders among all eating disorders, with some studies showing rates as high as 65%.
Many women with bulimia use alcohol as part of the binge-purge cycle. Alcohol is easily purged and may be consumed during binges. Some women also use alcohol to induce vomiting or to numb themselves emotionally after purging.
The impulsivity that characterizes bulimia—the inability to resist urges to binge and purge—also increases vulnerability to substance use. Both behaviors involve similar brain pathways related to reward, impulse control, and compulsion.
The shame cycle is particularly intense with bulimia and alcohol use. Both behaviors are often done in secret, accompanied by intense guilt and self-hatred, which then drives more of the same behavior as a way to cope with these painful feelings.
Drunkorexia: Restricting to "Save" Calories for Alcohol
“Drunkorexia” is a non-clinical term describing the pattern of restricting food intake to compensate for alcohol calories or to intensify alcohol’s effects. This pattern is increasingly common, particularly among college-aged women and young adults.
Women engaging in drunkorexia severely restrict food during the day, skip meals before drinking, or purge after drinking to prevent weight gain. The motivations include wanting to get drunk faster on an empty stomach, “saving” calories to consume as alcohol, and maintaining weight despite alcohol consumption.
This pattern is extremely dangerous. Drinking on an empty stomach leads to rapid intoxication, increased risk of alcohol poisoning, blackouts, dangerous decision-making, and long-term damage to the liver, brain, and digestive system. The combination of malnutrition and alcohol creates severe health consequences that appear much faster than either condition alone.
Using Substances to Facilitate Purging
Some women use substances specifically to aid eating disorder behaviors. This includes diet pills and laxatives (often taken in dangerous quantities), ipecac syrup to induce vomiting, diuretics to lose water weight, and stimulants to suppress appetite and increase metabolism.
These substances are often not recognized as “drug abuse” because they’re not recreational drugs, but their misuse is a form of substance use disorder. Many of these substances are extremely dangerous when used in the quantities and frequencies that eating disorders drive.
The secrecy around this pattern is particularly intense. Women often hide purchases, order from multiple pharmacies or online sources, and don’t disclose this use even when seeking treatment. This secrecy prevents them from getting help for the full picture of their struggles.
The Cycle: How Each Condition Fuels the Other
Understanding how eating disorders and substance use reinforce each other is crucial for breaking the cycle. These conditions create a vicious cycle where each behavior triggers and intensifies the other.
The Biological Cycle
Both eating disorders and substance use change brain chemistry, particularly affecting neurotransmitters like dopamine and serotonin that regulate mood, reward, and impulse control. Restricting food depletes these neurotransmitters, making you more vulnerable to depression and anxiety—which then increases the urge to use substances to feel better.
Substance use further disrupts brain chemistry, making it harder to regulate eating behaviors. Alcohol and many drugs affect blood sugar regulation, hunger cues, and inhibitions around food. This biological disruption makes it nearly impossible to address one condition while actively engaging in the other.
Malnutrition from eating disorders also affects how your body processes substances, often leading to faster intoxication, more severe hangovers, and increased risk of overdose. Your malnourished body can’t metabolize substances normally, making substance use more dangerous.
The Psychological Cycle
Psychologically, eating disorders and substance use serve similar functions—numbing difficult emotions, creating a sense of control, providing identity, and filling time. When you try to stop one behavior, the other often intensifies to fill the void.
Many women describe a “balloon effect”—squeezing one side (eating disorder or addiction) makes the other side bulge out. If you stop using substances but don’t address your eating disorder, the eating disorder symptoms worsen. If you focus only on normalizing eating without addressing substance use, your drinking or drug use escalates.
The shame and secrecy that surround both conditions also reinforce each other. Hiding your eating disorder makes it easier to hide your substance use, and vice versa. The isolation that results from keeping both conditions secret intensifies feelings of loneliness and worthlessness, which drive more disordered eating and substance use.
The Social Cycle
Both conditions damage relationships and social functioning, which then triggers more of the same behaviors. As your eating disorder and substance use progress, you withdraw from friends and family, miss important events, and lose connections that once brought joy and meaning.
This social isolation removes protective factors against both conditions. Without social connection, you have fewer reasons to recover and fewer people to notice when you’re struggling. The loneliness intensifies symptoms of both eating disorders and addiction.
Additionally, both conditions can lead to gravitating toward others who engage in similar behaviors—friends who drink heavily, communities that glorify thinness, or social situations centered around substance use. These relationships then reinforce rather than challenge your eating disorder and addiction.
Warning Signs of Co-Occurring Eating Disorders and Substance Use
Recognizing that you’re struggling with both conditions is the first step toward getting appropriate help. Warning signs include:
Related to Eating and Body Image
- Severe calorie restriction or skipping meals regularly
- Binge eating episodes (consuming large amounts in a short time)
- Purging behaviors (vomiting, laxative use, excessive exercise)
- Obsessive calorie counting, food weighing, or tracking
- Rituals around food preparation and eating
- Avoiding social situations involving food
- Preoccupation with weight, body shape, and appearance
- Wearing baggy clothes to hide body changes
- Frequent trips to the bathroom after eating
- Evidence of vomiting (smell, marks on hands, dental problems)
Related to Substance Use
- Drinking or using drugs alone or in secret
- Needing increasing amounts to achieve the same effect
- Using substances to cope with emotions or stress
- Drinking or using more than intended
- Unsuccessful attempts to cut back or quit
- Spending significant time obtaining, using, or recovering from substances
- Continuing use despite negative consequences
- Neglecting responsibilities due to substance use
- Changes in friend groups toward others who use heavily
- Secretive behavior or lying about substance use
Related to the Overlap
- Restricting food to “save calories” for alcohol
- Using stimulants to suppress appetite or increase weight loss
- Bingeing while intoxicated or using substances
- Purging after drinking alcohol
- Using alcohol or drugs to cope with eating disorder behaviors
- Worsening of eating disorder symptoms when using substances
- Worsening of substance use when eating disorder symptoms intensify
- Feeling unable to stop either behavior
- Medical complications related to both conditions
- Intense shame about both eating and substance use
Emotional and Behavioral Signs
- Severe mood swings or emotional instability
- Anxiety or panic attacks
- Depression or suicidal thoughts
- Irritability, especially when unable to engage in behaviors
- Perfectionism and rigid thinking
- Difficulty expressing emotions
- Low self-esteem and intense self-criticism
- Secretive behavior and social withdrawal
- Lying to loved ones about food intake or substance use
- Defensive when confronted about either issue
If you recognize multiple warning signs, it’s time to reach out for professional help. Don’t wait until the consequences become severe—early intervention leads to better outcomes.
The Dangers of Treating Only One Condition
One of the biggest mistakes in treating co-occurring eating disorders and substance use is addressing only one condition while ignoring the other. This approach almost never works and can actually be dangerous.
Why Single-Focus Treatment Fails
When treatment focuses only on your eating disorder without addressing substance use, the addiction continues undermining your recovery. Substances impair your judgment, making it difficult to follow meal plans or resist urges to restrict or purge. Intoxication or withdrawal interferes with therapy and prevents you from fully engaging in treatment.
Similarly, treating only the addiction while ignoring the eating disorder leads to the eating disorder intensifying as you attempt sobriety. Many women in substance abuse treatment who don’t receive eating disorder support end up substituting one compulsive behavior for another—they stop drinking but their eating disorder spirals out of control.
The Risk of Symptom Substitution
Without integrated treatment, many women experience symptom substitution or “cross-addiction”—when you stop one behavior, another takes its place. You might stop using drugs but develop severe food restriction. You might recover from bulimia but begin drinking heavily.
This substitution occurs because the underlying issues—trauma, difficulty managing emotions, perfectionism, low self-worth—haven’t been addressed. You’ve only changed the symptom, not healed the root cause.
Medical Complications
The combination of eating disorders and substance use creates serious medical complications that require specialized medical monitoring. Malnutrition combined with substance use dramatically increases risks including cardiac arrest and heart problems, liver and kidney damage, electrolyte imbalances that can cause seizures, gastrointestinal damage, weakened immune system, and bone density loss.
Treatment that addresses only one condition may miss dangerous medical complications related to the other, putting your health and life at risk.
Integrated Treatment: Addressing Both Conditions Simultaneously
Effective treatment for co-occurring eating disorders and substance use must be integrated—addressing both conditions at the same time with a coordinated treatment approach.
What Integrated Treatment Looks Like
Integrated treatment means your entire treatment team understands both conditions and how they interact in your specific situation. This includes:
Comprehensive assessment that evaluates both eating disorder and substance use history, severity, and how they influence each other.
Coordinated treatment planning where eating disorder interventions and addiction treatment strategies are designed to complement rather than conflict with each other.
Specialized staff trained in both eating disorders and addiction who understand the unique challenges of treating co-occurring conditions.
Medical monitoring that addresses health complications from both conditions simultaneously.
Nutritional rehabilitation that accounts for how substance use affects nutritional needs and how malnutrition impacts substance use recovery.
Therapy approaches that address underlying issues driving both conditions—trauma, emotion regulation difficulties, perfectionism, and self-worth.
Evidence-Based Therapies for Co-Occurring Conditions
Several therapeutic approaches have proven effective for treating co-occurring eating disorders and substance use:
Dialectical Behavior Therapy (DBT) teaches skills for managing intense emotions, tolerating distress, and reducing impulsive behaviors—all crucial for recovery from both eating disorders and addiction.
Cognitive Behavioral Therapy (CBT) helps identify and change thought patterns that drive both disordered eating and substance use, teaching healthier ways of thinking and behaving.
Trauma-Focused Therapy addresses the underlying trauma that often drives both conditions, using approaches like EMDR (Eye Movement Desensitization and Reprocessing) or trauma-focused CBT.
Acceptance and Commitment Therapy (ACT) teaches psychological flexibility and helps you build a life based on your values rather than avoiding uncomfortable thoughts and feelings through eating disorder behaviors or substance use.
Family Therapy involves loved ones in your treatment, helping them understand both conditions and how to support your recovery effectively.
The Role of Nutritional Rehabilitation
Nutritional rehabilitation is essential for treating co-occurring eating disorders and substance use. Malnutrition affects brain function, making it nearly impossible to resist cravings, manage emotions, or engage effectively in therapy.
Comprehensive nutritional treatment includes:
- Medical stabilization if you’re severely malnourished
- Structured meal planning that normalizes eating patterns
- Nutritional education about how both conditions affect your body
- Support during meals if you’re in a residential or PHP program
- Addressing the fear and anxiety around weight restoration
- Working with a dietitian who specializes in both eating disorders and addiction
As your body receives adequate nutrition, your brain chemistry begins to normalize, making recovery from both conditions more achievable.
The Importance of Medical Monitoring
Both eating disorders and substance use can cause serious medical complications that require ongoing monitoring. Integrated treatment includes:
- Regular medical check-ups and lab work
- Monitoring of vital signs (heart rate, blood pressure, temperature)
- Assessment of electrolyte levels and organ function
- Evaluation of bone density if you’ve had prolonged malnutrition
- Management of any medical complications
- Safe detoxification from substances if needed
- Medication management for co-occurring mental health conditions
Medical safety must be the foundation of any treatment program for co-occurring conditions.
Frequently Asked Questions
Yes, not only can you recover from both simultaneously, but integrated treatment addressing both conditions at once leads to better outcomes than treating them sequentially. While recovery from co-occurring conditions is challenging, many women successfully achieve lasting recovery from both. The key is finding a treatment program that specializes in dual diagnosis treatment and addresses both conditions comprehensively rather than focusing on just one.
You don’t have to choose. Effective treatment addresses both conditions simultaneously because they’re interconnected. Trying to treat one while ignoring the other usually leads to the untreated condition undermining your recovery. However, if you’re in medical danger from either condition, medical stabilization must come first—for example, if you need supervised detoxification or you’re severely malnourished requiring medical intervention.
It’s common to feel overwhelmed by the idea of addressing both conditions simultaneously. Remember that you’re not expected to be “perfect” at recovery immediately. Treatment provides structure, support, and graduated steps toward recovery. You’ll have a team helping you manage both conditions, and the process happens gradually with lots of support. Many women are surprised to find that as they address the underlying issues driving both conditions, managing both becomes more possible than they expected.
Weight changes in recovery are possible and depend on multiple factors including your current nutritional state, the substances you’ve been using, and your eating disorder behaviors. Some women gain weight, some lose weight, and some maintain their current weight. What’s important is that integrated treatment helps you develop a healthy relationship with your body and food regardless of weight changes. Your treatment team will help you navigate these changes with medical monitoring and therapeutic support. Remember that weight is just one measure of health, and true recovery means finding physical and emotional wellbeing, not achieving a specific number on the scale.
If substances are negatively impacting your life—affecting relationships, causing health problems, interfering with responsibilities, or causing distress—that’s a problem worth addressing regardless of whether it’s “part of” your eating disorder. The distinction matters less than getting help for both issues. A comprehensive assessment by professionals experienced in co-occurring disorders can help you understand the relationship between your substance use and eating disorder and develop an appropriate treatment plan. Read about signs of alcohol addiction to better understand substance use concerns.
Yes, appropriate medications prescribed and monitored by a psychiatrist who understands addiction can be important parts of recovery. Many women benefit from medications for depression, anxiety, or other mental health conditions that co-occur with eating disorders and addiction. The key is working with a physician who specializes in addiction medicine or is part of your integrated treatment team. Be honest with your prescriber about your substance use history so they can choose medications with lower abuse potential when possible and monitor you appropriately.
Education is key. Many families don’t initially understand co-occurring disorders or how eating disorders and addiction are related. Most treatment programs offer family education sessions or family therapy that can help your loved ones understand both conditions and how to support your recovery. You might also direct family members to resources like the National Eating Disorders Association or SAMHSA’s National Helpline. Remember that you can’t control whether your family understands, but you can set boundaries to protect your recovery and seek support from others who do understand. Learn more about how to approach a loved one about addiction.
Treatment length varies significantly based on severity, how long you’ve been struggling, previous treatment history, co-occurring mental health conditions, and your support system. Residential treatment typically lasts 30-90 days, PHP usually runs 2-4 weeks, IOP generally continues for 6-12 weeks, and outpatient treatment may continue for months or years. Many women benefit from a step-down approach—starting with intensive treatment and gradually decreasing intensity while maintaining support. Long-term recovery support through therapy, support groups, and alumni programming often continues indefinitely. Understanding PHP vs IOP can help you determine the right level of care for your needs.
Relapse with either condition is a warning sign that needs immediate attention. Even if you haven’t relapsed with the other condition yet, the risk is high because they’re interconnected. Contact your treatment team immediately, increase your support (more meetings, additional therapy sessions), assess what triggered the relapse, and potentially consider increasing your level of care temporarily. Understanding the relapse definition can help you recognize warning signs. Relapse doesn’t mean failure—it means you need more support. Many women experience relapse during recovery and go on to achieve long-term sobriety and eating disorder recovery.
Yes, it’s very common to feel worse initially in treatment for co-occurring conditions. When you stop using substances and eating disorder behaviors as coping mechanisms, you feel the emotions you’ve been avoiding—often for years. This can be uncomfortable and scary. Additionally, your body is adjusting to adequate nutrition and absence of substances, which can cause temporary physical and emotional discomfort. This difficult period is temporary, and with support from your treatment team, you’ll develop healthier coping skills and begin to feel genuinely better rather than just numbing your pain.
You Deserve Comprehensive, Compassionate Care
If you’re struggling with both an eating disorder and substance use, you deserve treatment that addresses both conditions with expertise, compassion, and understanding. At Anchored Tides Recovery, we specialize in treating co-occurring disorders in women, providing integrated care that addresses the full complexity of your experience.
Our women-only treatment programs offer a safe, supportive environment where you can heal from both conditions simultaneously. Our team understands the unique ways eating disorders and addiction overlap in women’s lives, and we’re equipped to help you address both conditions while treating the underlying issues—trauma, perfectionism, emotional difficulties—that drive them.
We offer multiple levels of care including PHP and IOP, allowing us to provide the right intensity of treatment for your needs. Our trauma-informed approach recognizes that healing from co-occurring conditions requires addressing the root causes, not just the symptoms.
Recovery from both an eating disorder and substance use disorder is possible. You don’t have to struggle alone, and you don’t have to choose which condition to address first. Integrated treatment can help you heal from both conditions and build a life of genuine freedom, peace, and wellbeing.
Take the first step toward recovery today. Call Anchored Tides Recovery at (866) 329-6639 for a confidential assessment. We’re here to help you navigate the path to healing from both eating disorders and addiction.
Anchored Tides Recovery is a women-only addiction and mental health treatment center located in Huntington Beach, California. We specialize in integrated treatment for co-occurring disorders, including eating disorders and substance use disorders. Our comprehensive programs include PHP, IOP, eating disorder treatment, and trauma-informed care designed specifically for women’s unique needs.
