Eating Disorders (EDs) and Substance Use Disorders (SUDs): Shared and Causal Etiology

The etiologies of both Eating Disorders (EDs) and Substance Use Disorders (SUDs) are perceived to be complex and multidimensional in nature.  No simple etiological path is indicated in either category.  Many contemporary theories “implicate a ‘collision’ among biological factors (e.g., genetic influences on neurotransmitter and hormonal function), psychological tendencies (problems with mood, temperament, and impulse controls), and social pressures (promoting body consciousness or generalized self-definition problems, and developmental processes (conducive to self-image or adjustment problems).”  (Blaney & Millon, 2009, p. 436)  The current model of SUD risk factors would not be complete without all of the above, perhaps with a few minor modifications.  This essay will attempt to address and discuss the common etiological factors between EDs and SUDs, as well an explore concepts of causal etiology that suggest that having one disorder predispositions an individual to succumb to another.

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Causal etiology has suggested that having one disorder (an eating disorder, for example) may put an individual at risk for developing another disorder (like substance abuse, or vice versa).  The statistics surrounding the comorbidity of substance abuse and eating disorders is considerable.  “Substance abuse and eating disorders have the highest mortality risks of all mental disorders and half of all clients with eating disorders abuse alcohol or illicit drugs.”  (Carbaugh & Sias, 2010, p. 125)  Shared or causal etiological factors between the substance abuse and eating disorders include psychological, environmental, and biological antecedents.  Both disorders are influenced by specific personality type (lack of control, craving, denial, impulsiveness), similar developmental issues (societal and familial pressures), as well as common family history (genetic predisposition) and specific biological vulnerability.  (Carbaugh & Sias, 2010)  Whether causal or shared, it is increasingly evident that SUDs and EDs share common etiological pathways, even to the extent that they may be causal in their relationship.

Common personality factors play a significant role in the onset and maintenance of both eating disorders and their comorbid conditions.  However, the personality of people whom suffer from AN tend to qualitatively different from the personalities of people whom suffer from BN.  Individuals whom suffer from AN have been found to be approval seeking, self-doubting, conflict-avoidant, excessively dependent, socially anxious, and have a tendency to be described as “perfectionists.”  Individuals whom suffer from bulimia often experience significant affective instability including highly variable mood states, impulsive behavior, low frustration tolerance, and high anxiety.  (Netherton, Holmes, & Walker, 1999, p. 401)  Differences in the underlying personality deficiencies can account for differences in comorbidity when comparing EDs among themselves, although EDs and SUDs generally continue to demonstrate remarkable comorbidity regardless of the type of ED we examine.

The news media frames obesity as a “moral problem.”  Obese populations are condemned by the media as engaging in gluttony and sloth while society overwhelmingly blames “bad individual choices” (despite increasing discussion of social-structural factors over time).  (Saguy & Gruys, 2010, p. 247)  The above statements easily could have been rewritten to drive home a different message.  The news media frames drug abuse as a “moral problem.”  Drug abusers are condemned by the media as engaging in greed and apathy (synonyms for gluttony and sloth) while society overwhelming blames “bad individual choices” (despite increasing discussing of social structural factors over time).  Obesity and drug abuse are 21st Century witches.  Will you join the hunt?

The contribution of the family only begins with biological disturbances in the serotonin, dopamine, gamma-aminobutyric acid and endogenous opioid peptide systems that may underlie both disorders.  (Pearlstein, 2002, p. 70)  Despite the fact that The Academy for Eating Disorders (AED) has specifically condemned statements that implicate family influences “as the primary cause of AN or BN,” they have acknowledged that particular styles of family behavior and biological vulnerability may increase risk for psychopathology in general, including eating disorders.  (“Role of Family in EDs”, 2009)  Dieting is one example of a behavior that is frequently encouraged by well intentioned families.  Research supports the positive association between the dieting behaviors (not just eating disorders themselves) and increased risk for alcohol use problems.  (Heidelberg & Correia, 2009)  Families who promote dieting in their children may inadvertently be promoting substance abuse.  Add latent genetic influence (like a parent with an eating disorder or who abuses substances) to that encouragement we may have a ‘perfect storm’ of predispositions that could potentially result in a full blown eating disorder comorbid with a substance abuse problem.  Be it through the environmental impact of familial behavior, or by latent genetic influence, family plays a significant role in the development of both disorders.

EDs and SUDs can be viewed through the same lens.  Shared etiology, including familial contributions, media influences, and personality factors; all play a role in the perpetuation of the stereotype.  If we perpetuated the image of common people drinking wate,r instead of hard bodies drinking alcohol, perhaps the association between substance abuse and eating disorders could be severed.

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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

Carbaugh, R. J., & Sias, S. M. (2010, Apr). Comorbidity of bulimia nervosa and substance abuse: Etiologies, treatment issues, and treatment approaches. Journal of Mental Health Counseling, 32(2), 125-138. Retrieved from

Heidelberg, N. F., & Correia, C. J. (2009, Dec). Dieting behavior and alcohol use behaviors among national eating disorders screening program participants. Journal of Alcohol and Drug Education, 53(3), 53-64. Retrieved from

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Paper stresses important role of family in eating disorders. (2009, Nov). Journal of Psychosocial Nursing & Mental Health Services, 47(11), 11. Retrieved from

Pearlstein, T. (2002, Mar). Eating disorders and comorbidity. Archives of Women’s Mental Health, 4(3), 67-78. Retrieved from

Saguy, A. C., & Gruys, K. (2010, May). Morality and health: News media constructions of overweight and eating disorders. Social Problems, 57(2), 231-250. doi: 10.1525/sp.2010.57.2.231

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