by Claire Mysko

Claire Mysko is the Chief Executive Officer of the National Eating Disorders Association and an internationally recognized leader in eating disorders advocacy and education. Mysko has appeared as an expert on 20/20, Good Morning America, CNN, and in The New York Times, The Wall Street Journal, Glamour, and Teen Vogue among others.

Depression is not simply feeling sad, anxiety doesn’t just mean worrying a lot, and eating disorders are not as simple as eating too much or too little. And living with two or more of these disorders simultaneously can be a lonely, underrepresented experience.

While there is still work to be done, dedicated advocates and organizations have made progress in normalizing conversations and visibility around mental health and illness. Oftentimes, however, discussions about the complexity, range, and severity of mental illness do not address the reality of living with these illnesses, and the high incidence of comorbid diagnoses among those who struggle with mental health.

The child struggling with bipolar disorder may also be struggling with an anxiety disorder. Someone struggling with post-traumatic stress disorder could also be battling depression. The person struggling with one or more eating disorders has an elevated risk of struggling with depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder, among other conditions.

Eating disorders are pervasive bio-psycho-social illnesses that impact every system in the body, affecting 30 million people in the United States during their lifetimes—and they are strongly correlated with other mental health conditions:

* In a nationally representative study, 56.2% of those with anorexia nervosa, 78.9% of those with binge eating disorder, and 94.5% of those with bulimia nervosa had a co-occurring anxiety, mood, impulse-control, or substance use disorder. (Hudson 2007)

* More than half of people with an eating disorder have a co-occurring mood disorder. (Hudson 2007)

* Two-thirds of people with anorexia also showed signs of an anxiety disorder several years before the start of their eating disorder. (Kaye 2004)

* In a study of more than 2,400 people hospitalized for an eating disorder, 94% had co-occurring mood disorders, mostly major depression, 20% had obsessive-compulsive disorder, and 22% had post-traumatic stress disorder. (Blinder 2006)

Eating disorders have been widely-represented as conditions that primarily affect affluent young white women, obscuring the diversity, complexity, and severity of these conditions. The misrepresentation of eating disorders has a real effect, marginalizing the lived experiences of those who have struggled without recognition, and often, treatment. June Alexander, who was diagnosed with an eating disorder in her 30s, described the pain and stress of living with undiagnosed comorbid conditions: “By age 28, I feared I was going crazy and if I shared my feelings with a doctor I would be locked up, separated from my husband and beautiful children. Death seemed the only way out, but luckily love for my family gave me strength to confide in a doctor. Another four years would pass before a psychiatrist provided a correct diagnosis of bulimia, chronic anxiety, and depression.”

These struggles are not unique, but they are underrepresented in mental health discussions. Greater recognition of the interconnectivity of mental health conditions is vital, enhancing both intervention and activism efforts—we can improve attunement to signs of an undiagnosed

struggle in an individual, and strengthen the mental health field as a whole through collaborative approaches that recognize the spectrum of mental health struggles.

Contact the NEDA Helpline for support, resources, and treatment options for yourself or a loved one: (800) 931-2237

References

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

Hudson JI, Hiripi E, Pope HG, Kessler RC. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological psychiatry. 2007;61(3):348-358. doi:10.1016/j.biopsych.2006.03.040.

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.