What Are Co-Occurring Disorders?

Co-occurring disorders, also known as dual diagnoses, refer to the presence of two or more mental health conditions in an individual at the same time. In the context of eating disorders, co-occurring disorders commonly involve other mental health conditions such as anxiety, depression, trauma, substance use disorders, and even bipolar disorder or autism spectrum disorder (ASD). These conditions are deeply interconnected and can complicate both diagnosis and treatment.

For example, someone with an eating disorder might also struggle with depression, which can intensify feelings of hopelessness or low self-worth, further fueling disordered eating behaviors. Similarly, anxiety disorders such as obsessive-compulsive disorder (OCD) may contribute to rigid eating rituals or fears about food and weight. Substance use or abuse is another common co-occurring issue, with individuals using substances as a way to cope with the emotional pain, anxiety, or control related to their eating disorder.

Co-occurring disorders are not simply two separate conditions; they interact and often amplify one another. Without addressing both the eating disorder and the underlying mental health issues, recovery can be difficult, as the symptoms of each condition can reinforce the other. Effective treatment requires an integrated approach that addresses both conditions simultaneously, helping individuals develop healthier coping strategies, improve emotional regulation, and heal from the root causes of their struggles.

At ‘Ai Pono Hawaii, we specialize in treating co-occurring disorders with a comprehensive, personalized treatment plan that ensures all aspects of a person’s health are addressed. By treating both the eating disorder and any co-occurring conditions, we help clients move toward a holistic recovery and a balanced, fulfilling life.

Common Co-Occurring Mental Health Disorders in Eating Disorder Treatment Settings

In the context of eating disorder treatment, it is common to encounter co-occurring mental health disorders that complicate the recovery process: 

• Anxiety disorders, such as generalized anxiety, social anxiety, and obsessive-compulsive disorder (OCD), frequently coexist with eating disorders, often contributing to rigid behaviors and intrusive thoughts about food or body image. 
• Depression is another prevalent condition, manifesting as low self-worth, hopelessness, or loss of interest in activities once enjoyed. 
• Bipolar disorder, characterized by extreme mood swings ranging from depressive lows to manic highs, can also coexist with eating disorders, intensifying emotional instability and the struggle for balance.
• Autism spectrum disorder (ASD) is also increasingly recognized in individuals with eating disorders, particularly in those who experience sensory sensitivities, difficulties with social communication, or a preference for routine and predictability, which can influence eating behaviors. 
• Trauma and post-traumatic stress disorder (PTSD) can also underpin disordered eating behaviors, as individuals may use food as a coping mechanism. 

Learn more about the relationship between trauma and eating disorders here.

• Additionally, substance use disorders are not uncommon, with some individuals turning to drugs or alcohol to manage emotional pain or stress. 

Effective eating disorder treatment requires addressing these co-occurring conditions through an integrated, individualized approach that treats the whole person, fostering resilience and sustainable recovery.

Symptoms of Co-Occurring Conditions for Eating Disorder Clients

Anxiety Disorders

• Excessive worry or fear
• Intrusive thoughts about food, weight, or body image
• Avoidance of social situations or triggering environments
• Ritualistic behaviors, such as strict food routines or exercise regimens

Depression

• Persistent feelings of sadness, hopelessness, or worthlessness
• Loss of interest in previously enjoyable activities
• Fatigue or lack of energy
• Changes in sleep patterns (insomnia or oversleeping)
• Difficulty concentrating or making decisions

Bipolar Disorder

• Mood swings ranging from depressive episodes to manic or hypomanic highs
• Impulsive behaviors, including risky eating habits
• Increased irritability or agitation during manic phases
• Periods of extreme lethargy during depressive episodes

Trauma and PTSD

• Flashbacks or intrusive memories related to past trauma
• Avoidance of certain places, people, or situations
• Hypervigilance or an exaggerated startle response
• Emotional numbness or detachment

Autism Spectrum Disorder (ASD)

• Sensory sensitivities to textures, tastes, or smells of food
• Preference for routine or sameness in eating habits
• Difficulty with social cues or communication about needs
• Increased focus on specific topics or interests, including food or body image

Obsessive-Compulsive Disorder (OCD)

• Intrusive, repetitive thoughts about weight, food, or appearance
• Compulsive behaviors like counting calories, body-checking, or excessive exercise
• Rigid adherence to food-related rituals or “rules”

Substance Use Disorders

• • Use of drugs or alcohol to cope with emotional pain or stress
  • Increased tolerance or dependence on substances
  • Risky behaviors associated with substance use
  • Withdrawal symptoms when substances are not used

This list highlights the importance of integrated care, as these symptoms often overlap with eating disorder behaviors and require tailored treatment approaches.

How We Treat Co-Occurring Disorders at ‘Ai Pono Hawaii

At ‘Ai Pono Hawaii, we understand that eating disorders are often intertwined with co-occurring mental health conditions, such as anxiety, depression, bipolar disorder, trauma, autism spectrum disorder (ASD), and substance use. To support our clients on their path to full recovery, we take an integrated, evidence-based approach to care that addresses both the eating disorder and any underlying or coexisting conditions.

Our treatment begins with a thorough assessment to identify each individual’s unique challenges and needs. This allows us to craft a personalized treatment plan that blends medical, psychological, and holistic interventions. Our team of experienced professionals—including therapists, dietitians, psychiatrists, and support staff—works collaboratively to provide comprehensive care in a safe and nurturing environment.

Key components of our treatment include:

• Evidence-Based Therapies: Techniques like cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and trauma-focused approaches are tailored to address the root causes of disordered eating and co-occurring conditions.
• Holistic Care: We incorporate mindfulness practices, yoga, art therapy, sound therapy, and other experiential therapies to help clients reconnect with their bodies and emotions.
• Nutritional Support: Our dietitians guide clients toward balanced, sustainable eating patterns, addressing sensory sensitivities, nutritional imbalances, and fears around food.
• Specialized Support for Autism Spectrum Disorder: We tailor care to accommodate sensory sensitivities and communication needs, fostering an environment of understanding and inclusion.
• Medication Management: When appropriate, our psychiatric team provides medication support to stabilize mood, manage anxiety, and enhance emotional well-being.

At ‘Ai Pono, we believe in treating the whole person, not just the symptoms. Our mission is to empower our clients to heal from the inside out, paving the way for a renewed sense of balance, purpose, and hope. Recovery isn’t just possible—it’s achievable with the right care and commitment.

Safely and Effectively Managing Co-Occurring Substance Use at ‘Ai Pono Hawaii

Approximately 50% of individuals with an eating disorder use alcohol or drugs, compared to approximately only 9% in the general population (1) and 1 out of 5 individuals with an eating disorder will develop a substance use disorder at some point in their lifetime (2).

At ‘Ai Pono Hawaii, we understand that eating disorders often coexist with substance use or abuse, creating an additional layer of complexity in the recovery process. Many individuals struggling with eating disorders may also turn to substances to cope with emotional distress, manage anxiety, or suppress appetite. Effectively treating both conditions is essential for sustainable recovery, which is why we take an integrated, compassionate approach.

While we do not provide detox services onsite at ‘Ai Pono, we do offer ongoing monitoring of physical and psychological withdrawal symptoms once a client is medically stable for our level of care. Our team works closely with detox or other substance abuse treatment programs to ensure a smooth and coordinated transfer when the client is ready to transition to our treatment center.

Our program features:

• Specialized Staff Expertise
  Our team includes professionals who specialize in both eating disorders and substance use disorders. This dual expertise ensures that each client receives comprehensive care tailored to their specific needs. By addressing both conditions simultaneously, we create a more effective treatment plan that helps clients heal from the inside out.
• Integrated Treatment Planning
  Our multidisciplinary team works together to develop an individualized treatment plan that addresses both the eating disorder and substance use. This approach helps uncover the emotional and psychological factors driving both conditions, ensuring a more holistic and effective recovery.
• Ongoing Monitoring of Withdrawal Symptoms
  Once clients are medically stable, we carefully monitor any withdrawal symptoms, providing ongoing physical and psychological support to ensure their comfort and safety as they move forward in treatment.
• Referral and Coordination with Detox Programs
  For clients requiring detox, we assist in connecting them with reputable detox programs. Our team works with these programs to ensure that clients receive the appropriate care and experience a smooth transfer to our facility once they are medically stable.
• Virtual Access to External Support Groups
  We offer virtual access to external support groups, including 12-step programs, so clients can continue engaging with supportive communities during their treatment. This provides an additional layer of support and accountability throughout the recovery process.
• Relapse Prevention
  Clients are equipped with the tools and strategies needed to manage triggers, create healthy routines, and maintain positive relationships. We also provide relapse prevention education to help clients sustain their recovery long after treatment ends.

At ‘Ai Pono Hawaii, we are committed to treating the whole person. With a team of specialists in both eating disorders and substance use, we offer an integrated, compassionate approach to help clients heal from both conditions. By combining expert care with virtual support groups, psychoeducation, and holistic therapies, we guide clients toward lasting recovery and improved well-being.

Book a call with us today to know how ‘Ai Pono Hawaii can be a helpful partner in your healing from your eating disorder and co-occurring mental health struggles.

Sources:

1. National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2003). Food for Thought: Substance Abuse and Eating Disorders. New York, National Center on Addiction and Substance Abuse.
2. Bahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis. Psychiatry Research, 273, 58–66. https://doi.org/10.1016/j.psychres.2019.01.007