Alcohol & Eating Disorders

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Eating disorders (EDs) are mental health conditions in which an individual becomes preoccupied with body weight, body shape, and food or eating habits. Worldwide, 9% of people will be diagnosed with an eating disorder at some point in their lives. Second only to opioid use, eating disorders are the deadliest mental health concern globally, claiming one life every 52 minutes. They are eleven times more common among patients with substance use disorders (SUD), as 35% are diagnosed with an ED at some point in their lives. Alcohol is one of the more frequently used substances for people with eating disorders due to its effects on the body and mind.

If you or someone you love is dealing with an eating disorder and alcohol use, Guardian Recovery can help. Our dual-diagnosis treatment programs focus on your substance use and mental health concerns. From initial medical detox to nutrition therapy, our team of knowledgeable, experienced clinicians will navigate you through each step of your recovery. Contact us today to speak with a treatment advisor 24/7 who can give you more information about our comprehensive, individualized services. Read on to find out more about the relationship between alcohol and eating disorders.

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Why Do Alcohol & Eating Disorders Often Occur Together?

Substance use and mental health disorders regularly co-occur. In the case of alcohol misuse, research suggests that eating disorders have a more significant influence on the development of alcohol use disorder (AUD) than the inverse. In fact, 50% of individuals with an eating disorder report using alcohol or drugs, five times more than the general population.

People with an ED and a prior history of substance use, depression, self-induced vomiting, body image concerns, or poor psychosocial functioning are more apt to develop AUD. Similarly, anxious and dramatic tendencies, such as impulsivity and perfectionism, are found in alcohol users with an ED. This connection suggests drinking is a means of managing anxiety and the perceived lack of control related to the eating disorder.

On the other hand, AUD can lead to maladaptive eating patterns. Alcohol users often adapt their eating habits to their drinking plans. Before consuming alcohol, for example, they may have a large meal to blunt the effects of drinking or find themselves overindulging on snacks while intoxicated. Likewise, they may restrict certain foods after a heavy drinking session to alleviate hangover symptoms.

Are Alcohol & Eating Disorders Related?

While it is hard to say if alcohol use definitively causes eating disorders or vice versa, it is clear that certain personality traits and biological and environmental risk factors are common in both conditions. Eating disorder traits typically develop from ages 12 – 25, most often in females. Many EDs are driven by an individual’s desire to have control over their life, which is often lacking in teens and young adults due to parental rules and influence. 

Problematic alcohol use may begin in adolescence but usually starts in the 20s when rates of risk-taking and impulsivity are high. Teens and young adults may drink as a means of rebelling against caretakers or because others compel them to try new substances. Although eating disorders are a way to control one’s life via food intake, and alcohol is a means of disregarding parental control, both serve to lessen the anxiety surrounding body image issues and social pressure.

Some Other Shared Characteristics of Alcohol Use & Eating Disorders Include:

  • Altered reward system in the brain.
  • Family history of AUD or ED.
  • Low self-esteem.
  • Depression.
  • Social phobia.
  • Social isolation.
  • Compulsive behavior.
  • Personality disorders.
  • Higher risk for suicide.

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Alcohol & Anorexia

Anorexia nervosa is an eating disorder characterized by restrictive food intake or binge-purge cycles. People with this ED often develop an extreme fear of weight gain and have body dysmorphia (distorted body image). They may engage in excessive dieting, fasting, or vomiting and refuse to eat in public places where they cannot control caloric intake. Social withdrawal is driven by a desire to hide the eating disorder for fear of judgment.

Signs & Symptoms of Anorexia Include:

  • Extreme weight loss or very low body weight (emaciation).
  • Dry, brittle hair and skin.
  • Blue nailbed discoloration.
  • Swollen arms and legs.
  • Fine, soft hair covering the body.
  • Fatigue.
  • Insomnia.
  • Feeling dizzy.
  • Constipation.
  • Loss of monthly period.
  • Irregular heartbeat.
  • Dehydration.
  • Low blood pressure.
  • Anemia.

People with anorexia tend to display perfectionism, hypersensitivity, and obsessive-compulsive behaviors rooted in anxiety and poor self-image. Drinking either alleviates this anxiety to cope with the eating disorder or acts as a substitute for food. Among those with AUD and anorexia, greater eating disorder severity is linked to higher levels of intoxication and adverse physical effects from alcohol.

Alcohol & Bulimia

Unlike anorexia, characterized by extreme thinness and low body weight, people with bulimia nervosa tend to be normal or overweight. This eating disorder usually involves over-consuming food (binging), followed by either self-induced vomiting (purging), laxative or supplement use, or excessive exercise to undo the effects of binging. Whereas anorexia is strict control of eating, people with bulimia tend to feel they lack control over what, when, and how much they consume. 

Other Features of Bulimia Include:

  • Eating unusually large portions in one sitting.
  • Perseverance on body image and weight.
  • Compulsive urge to find a bathroom after eating to purge.
  • Social isolation during a binge-purge cycle.
  • Mouth sores, gum irritation, and dental corrosion due to constant vomiting.
  • Scabs or scratch marks on knuckles from self-induced vomiting.
  • Swollen legs, arms, face, or neck.
  • Fluctuating weight.

Alcohol can be used after a binge to help induce vomiting or to quell the guilt and shame associated with overeating. People with bulimia or binge eating disorder are more likely to use alcohol as a coping mechanism than those with anorexia. As a result, individuals with bulimia have a greater likelihood of developing AUD.

Alcohol & Binge Eating Disorder

Binge eating disorder (BED) involves a lack of control over eating, leading to the consumption of unnecessarily large meals in a short period, followed by extreme shame. The guilt many times leads to further binging in an attempt to alleviate low mood, further perpetuating the cycle. Most people with BED are clinically overweight or obese. They may continue to gain weight if untreated because there is no compensatory behavior like the purging or exercising seen with anorexia and bulimia. 

BED Can Result in the Following:

  • Abdominal pain after binging.
  • Continuing to eat when full.
  • Social isolation during binging.
  • Feeling helpless over the urge to binge.
  • Nausea.
  • Heart disease.
  • Diabetes.
  • Gastrointestinal complications (e.g., reflux, gallbladder disease).
  • Sleep apnea.
  • Joint problems and mobility issues.
  • Depression.

BED is the most common eating disorder, and people with this condition often had anxiety or depressive disorders that led to emotional or “stress eating” before their BED diagnosis. The same factors contributing to BED also give rise to alcohol misuse and self-medicating with other substances. Alcohol misuse is frequent during binging periods, though it also mitigates the sensations of guilt and shame after the fact. 

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Alcohol & Eating Disorder Treatment

Alcohol misuse and eating disorders are two distinct yet interconnected conditions. Both diagnoses must be addressed in treatment concurrently. A combination of therapy, medication, and social support is required.

Eating disorders are treated predominantly with cognitive behavioral therapy (CBT) to address and correct the underlying thought distortions related to food and weight. A psychiatric provider may prescribe antidepressants for associated depression and anxiety or to stimulate appetite and encourage weight gain, if appropriate. A consult with a nutritionist or dietician will address nutritional deficiencies and identify the components of a well-rounded diet.

Patients with anorexia may require refeeding in an inpatient facility to correct excessive weight loss, electrolyte abnormalities, and cardiovascular complications caused by malnutrition. Elsewhere on inpatient units, bulimia is treated with close monitoring during and after eating to prevent purging. BED can be treated with medications to control feeding impulses and suppress appetite. 

AUD treatment involves a similar combination of therapy and medication management in all levels of care, from detox to outpatient. Therapy focuses on identifying triggers for drinking, resolving past trauma, and making a plan for a sober lifestyle. Antidepressants and mood stabilizers may be offered to regulate anxious or depressive symptoms, while agents such as acamprosate or naltrexone can be prescribed to control alcohol cravings.

Overcoming the combination of alcohol use and an eating disorder can seem intimidating. Treatment for one condition requires treatment for both. At Guardian Recovery, our goal in dual-diagnosis therapy is to address your mental health and substance use. Our evidence-based programs utilize 12-Step Immersion and Relapse Prevention Training to guide you toward sobriety and whole-body wellness.

Our admission process is simple: Once you reach out to us, we will provide a free, no-obligation health insurance benefit check and complimentary assessment. The entire process takes just 15 minutes at one of our local facilities. Contact Guardian Recovery today for more information about how we can help you heal.


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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.


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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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