National Eating Disorders Association

An eating disorder diagnosis can be challenging enough on its own, but many individuals also have other psychological issues that can accompany the eating disorder. Sometimes, the other disorder may be a result of eating disorder behaviors, as binging, purging, and restricting can all cause psychological distress. 

Sometimes, another psychological disorder can begin around the same time as an eating disorder, it can precede it, or it can crop up after the eating disorder has already begun. Mood and anxiety disorders most commonly occur alongside eating disorders, but post-traumatic stress disorder and personality disorders are also common.

Some mental disorders can be risk factors for eating disorders, indicating that a person may be more likely to later develop an eating disorder.

  • Two-thirds of people with anorexia also showed signs of an anxiety disorder several years before the start of their eating disorder.
  • Childhood obsessive-compulsive traits, such as perfectionism, having to follow the rules, and concern about mistakes, were much more common in women who developed eating disorders than women who didn’t.
  • A study of more than 2400 individuals hospitalized for an eating disorder found that 97% had one or more co-occurring conditions, including:
    • 94% had co-occurring mood disorders, mostly major depression
    • 56% were diagnosed with anxiety disorders
      • 20% had obsessive-compulsive disorder
      • 22% had post-traumatic stress disorder
    • 22% had an alcohol or substance use disorder
  • Approximately one in four people with an eating disorder has symptoms of post-traumatic stress disorder (PTSD).
  • In women hospitalized for an eating disorder, 36.8% regularly self-harmed
  • A 2009 study in the International Journal of Eating Disorders found that one in five women seeking treatment for an eating disorder had six or more signs of attention-deficit hyperactivity disorder (ADHD).

Personality disorders also commonly occur in individuals with eating disorders. 

Among those with anorexia,

  • Restricting type
    • 20% had obsessive-compulsive personality disorder
    • 10% had borderline personality disorder
  • Binge-purge type
    • 12% had obsessive-compulsive personality disorder
    • 25% had borderline personality disorder

Among those with bulimia,

  • 11% had obsessive-compulsive personality disorder
  • 28% had borderline personality disorder

A 2014 study found that combined and analyzed data from 20 previous studies found signs of personality disorders in 

  • 38% of people with EDNOS/OSFED
    • 11% had obsessive-compulsive personality disorder
    • 12% had borderline personality disorder
  • 30% of people with binge eating disorder
    • 10% had obsessive-compulsive personality disorder
    • 10% had borderline personality disorder

References:

Anderluh, M. B., Tchanturia, K., Rabe-Hesketh, S., & Treasure, J. (2003). Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. American Journal of Psychiatry, 160(2), 242-247.

Blinder, B. J., Cumella, E. J., & Sanathara, V. A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine, 68(3), 454-462.

Eddy, K. T., Dorer, D. J., Franko, D. L., Tahilani, K., Thompson-Brenner, H., & Herzog, D. B. (2008). Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. American Journal of Psychiatry, 165(2), 245-250.

Friborg, O., Martinussen, M., Kaiser, S., Øvergård, K. T., Martinsen, E. W., Schmierer, P., & Rosenvinge, J. H. (2014). Personality disorders in eating disorder not otherwise specified and binge eating disorder: a meta-analysis of comorbidity studies. The Journal of nervous and mental disease, 202(2), 119-125.

Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., & Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12), 2215-2221.

Kostro, K., Lerman, J. B., & Attia, E. (2014). The current status of suicide and self-injury in eating disorders: a narrative review. Journal of eating disorders, 2(1), 1.

Sansone, R. A., Levitt, J. L., & Sansone, L. A. (2004). The prevalence of personality disorders among those with eating disorders. Eating Disorders, 13(1), 7-21.

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating disorders, 22(1), 33-49.