According to the National Association of Anorexia Nervosa and Associated Disorders, 1 in 10 of those suffering with bulimia or binge eating disorder have a comorbid substance abuse disorder. This makes sense if you view eating disorders as a maladaptive coping mechanism like chemical dependency.
The Ace Study gives a strong sense of how body image is often symbolic. The ACE Study was developed by a man named Dr. Vincent Felitti and asserted that there was a correlation between adverse childhood experiences and health problems later in life. His inspiration for the ACE Study began in the mid-1980s when he worked at Kaiser Permanente’s Department of Preventive Medicine in San Diego. While he was there, he noted that patients in the Weight Program who were successfully losing weight were the most likely to drop out. Due to Western conceptions about body image this stuck him as strange and he decided to give the situation a closer look. What he found was that for the individuals “fleeing,” the study obesity frequently seemed sexually, physically, or emotionally protective. When he asked participants who left the study after losing weight questions about their backgrounds what he found was that many of them had a shared history of childhood sexual abuse.
One way of viewing any type of eating disorder is that food, restriction, and body image are just a means of compacting more complex problems into something that seems manageable. The more someone focuses on food, restriction, and body image, the less attention they have left to devote to deeper issues. Like drinking or doings drugs, eating disorders can create distance. There is a physiological component to how eating disorders work as well. Both starvation and compulsive overeating activate the pleasure centers in the brain. The more someone uses eating disordered behaviors the more ingrained they become. Soon enough, “behaviors” are what someone knows and may become their first response to even ordinary stressors. From inside the disorder this can be harder to untangle however.
Chemical dependency can work similarly and it is no coincidence that many people with eating disorders struggle with drug addiction as well. In relation to chemical dependency specifically, Dr. Feletti wrote:
“The sequence in the ACE Pyramid supports psychoanalytic observations that addiction is primarily a consequence of adverse childhood experiences. Moreover, it does so by a population-based study, thereby escaping the potential selection bias of individual case reports. Addiction is not a brain disease, nor is it caused by chemical imbalance or genetics. Addiction is best viewed as an understandable, unconscious, compulsive use of psychoactive materials in response to abnormal prior life experiences, most of which are concealed by shame, secrecy, and social taboo.”
Addictions involve complexities that are specific to the individual and being able pinpoint the underlying issues might prove helpful in terms of finding alternative methods of coping. For instance, if the person came from an emotionally abusive background, they might have a particular need for positive reinforcement and confidence building activities. The phrase “fake it till you make it,” is popular among people recovering from addictions and that person might need more support until exposure to better experiences eventually imbued them with more self-esteem.
This is part of the reason twelve-step groups can help even for people with eating disorders. While individual therapy can be helpful and even vital, the relationship between therapist and patient is necessarily unequal. Twelve-step groups can relieve feelings of shame, allow patients to learn from each other, and provide a sense of community and purpose to people who may feel alone in their disorder. Some programs, like Insight, in Chicago, IL, rely on group therapy as a core component of treatment. For those without health insurance or the means to access treatment, there are also free twelve-step groups in most cities.