Many teenagers with eating disorders also experience other mental health concerns. They may have lived through trauma or experience distressing feelings that cause and maintain eating disorders. They might develop harmful behaviours and emotions as a result of their eating disorder and the way it impacts their mental, physical, and social well-being.
Teenagers with eating disorders may also experience mental health concerns rooted in the same vulnerabilities that contributed to their eating disorder, such as interpersonal difficulties, perfectionism, and low self-esteem.
One form of harm that can develop alongside eating disorders is alcohol use and alcohol abuse. Alcohol use is most common in eating disorders that involve bingeing or purging, like bulimia nervosa or binge eating disorder. But teenagers with anorexia nervosa may also use alcohol in harmful ways, especially if they engage in purging behaviours.
This blog offers some information on alcohol use among young people with eating disorders, including anorexia. It also outlines the kind of treatment available for teenagers living with anorexia nervosa and alcohol use disorder.
How Common Is Substance Abuse Among People with Eating Disorders?
Most of the research about substance abuse, alcohol abuse, and eating disorders has taken place among adults. Studies have found that:
- Up to half of individuals with eating disorders may engage in alcohol or illicit drug abuse, compared to around 9% percent in the general population (2003)
- Up to 35% of individuals who abuse alcohol or illicit drugs may have an eating disorder, compared to 3% in the general population (2003)
- 10% of individuals with anorexia nervosa may abuse or be dependent on alcohol, and 16% may have a substance use disorder, while 29% may drink alcohol (2021)
- Females who had a diagnosis of anorexia nervosa, bulimia nervosa, or both disorders in their lifetime were at an increased risk of alcohol abuse and dependence (2011)
- Alcohol and illicit substance use were more common among individuals with a lifetime diagnosis of bulimia nervosa or bulimia and anorexia nervosa than anorexia nervosa alone
What Explains the Link Between Eating Disorders and Alcohol Abuse?
People who misuse alcohol often drink as a way to escape from distressing thoughts, feelings, or experiences. Alcohol abuse is also associated with impulsivity: individuals who are more impulsive may be more likely to drink when they feel distressed, rather than looking for other coping mechanisms.
These same pathologies are linked to bingeing (and purging) behaviours, too. People who engage in binge eating typically describe a sense of loss of control during binge eating episodes, which are often triggered by intense emotions. And like those who misuse alcohol, they’re more likely to be impulsive.
This means that people who engage in binging and purging behaviours are more likely to use alcohol as a way to deal with difficult emotions, including those caused by their eating disorder.
Eating disorders and alcohol use disorders also share a number of other common risk factors that make the development of both conditions more likely. These include:
- Low self-esteem
- Depressive symptoms
- Childhood trauma
Alcohol Use and the Purging Subtype of Anorexia
Alcohol use is typically lower among people with anorexia nervosa than among those with other types of eating disorders. Anorexia nervosa usually involves restrictive behaviours, when someone tries to limit the amount of energy they take into their body. This can make them less likely to drink alcohol.
However, many people with anorexia nervosa also experience episodes of binging and purging. This is known as binge-purge anorexia nervosa (as opposed to the restrictive subtype). Research suggests that a majority of people with an anorexia nervosa diagnosis binge or purge at least once a month.
Research exploring the link between alcohol abuse or dependence and different types of anorexia found that:
- A history of alcohol abuse or dependence was most common among individuals who had had both a diagnosis of anorexia and bulimia in their lifetime
- A history of alcohol abuse or dependence was least common in individuals with a lifetime diagnosis of restrictive anorexia nervosa
- A history of alcohol abuse or dependence was greater among individuals with a lifetime diagnosis of bingeing or purging anorexia nervosa, compared to those with restrictive anorexia
Alcohol Use Among Teenagers with Anorexia Nervosa
As with adults, research suggests that teenagers with binge-purge anorexia nervosa are more likely to drink alcohol than those who only engage in restrictive behaviours. They may use alcohol as a way to cope with the emotional distress and interpersonal issues that underpin disordered eating behaviours. Some of this distress may be caused or exacerbated by their eating disorder, such as that caused by body dissatisfaction or social isolation. A qualitative study found that adolescents with eating disorders typically use substances to relieve anger, avoid eating, “get away,” and relax.
Another study among adolescents with an alcohol or other substance use disorder found that 26.4% of young people had at least one eating disorder symptom. Among females, this figure rose to 49.1%. Teenagers with more eating disorder symptoms were also more likely to experience alcohol-related social problems.
What Are the Dangers of Alcohol Use for Young People with Anorexia Nervosa?
Research now suggests that drinking any quantity of alcohol is harmful to our health, and excessive drinking can seriously damage our bodies. But for young people with anorexia nervosa, the risks are even greater.
When a young person drinks alcohol without having eaten, their blood alcohol concentration reaches a higher level than if they had eaten first. As their blood alcohol concentration rises, they’re more likely to experience harm to their bodies, such as vomiting, passing out, and alcohol poisoning. This means that drinking alcohol, especially in larger quantities, can be very dangerous for young people who are restricting their diet or engaging in purging behaviours.
Teenagers who engage in binge-purging behaviours often experience dehydration. Purging behaviours, like vomiting or using laxatives, dehydrate our bodies and destabilise water and electrolyte balances. Alcohol is a diuretic, meaning that it causes the body to remove fluids from the blood. If a teenager’s body is already dehydrated, they’re at a greater risk of reaching dangerous levels of dehydration.
Dehydration also exacerbates some of the existing consequences of malnutrition caused by eating disorders, including:
- Fatigue
- Weakness
- Dizziness
- Absorption of nutrients
- Electrolyte imbalances
Alcohol Consumption and Compensatory Behaviours
Sometimes, alcohol consumption can cause compensatory, disordered eating behaviours among young people. Teenagers may try to compensate for the energy intake of alcohol by not eating beforehand or afterwards. They may also exercise or use purging behaviours before or while drinking. One study found that 29.7% of female undergraduate students limited their food intake before or after drinking alcohol.
Compensatory behaviours for alcohol consumption are common among young people, whether or not they meet the criteria for an eating disorder. But those with higher disordered eating attitudes and behaviours may be more likely to engage in these behaviours. Research suggests that compensatory behaviours for alcohol consumption are associated with body dissatisfaction, drive for thinness, and bulimia symptoms.
Treating Alcohol Use Disorders and Anorexia Nervosa in Teens
If a young person has an alcohol use disorder alongside anorexia nervosa, it’s important to treat both conditions simultaneously. Co-occurring symptoms can complicate the treatment process for both disorders, making recovery more difficult. Moreover, if left unaddressed, one co-occurring disorder can cause the other to resurface after the end of treatment, making relapse more likely.
Treatment for co-occurring alcohol use disorder and anorexia nervosa may involve a combination of modalities that address each condition. But since both disorders are often rooted in the same underlying causes, some transdiagnostic treatment approaches may be effective for both conditions. These might include treatment approaches that address emotional regulation, impulsivity, or interpersonal difficulties.
Some psychosocial approaches that have evidence for both conditions include:
- mindfulness-based cognitive behavioural therapy
- dialectical behavioural therapy
- family therapy
Dialectical Behavioural Therapy for Co-Occurring AUDs and Anorexia Nervosa
Both alcohol use disorders and anorexia nervosa are connected to emotional regulation: the understanding, awareness, and modulation of emotions. Young people who face difficulties with emotional regulation (known as emotional dysregulation) tend to experience intense, ongoing emotions. They lack effective strategies to soothe or cope with these feelings, often using harmful coping mechanisms instead. These coping mechanisms may include using alcohol, restricting eating, or bingeing behaviours.
These patterns are also linked to impulsivity. Impulsive traits may cause young people to engage in these behaviours, despite the knowledge that they are harmful and without searching for a more considered response.
Research has found that people with SUDs and eating disorders reported greater difficulty with emotion regulation, including higher impulsivity, and less access to emotion regulation techniques.
The connection of emotional dysregulation to both alcohol use disorders and eating disorders highlights the importance of addressing emotional dysregulation in treatment. One of the most established treatment approaches for emotional dysregulation is dialectical behavioural therapy for adolescents. Through four skills modules (mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness), DBT-a supports young people in accepting their emotions and experiences, while developing strategies to reduce and cope with emotional distress in healthy ways.
The Wave Clinic: Specialist Mental Health Support for Young People and Families
The Wave Clinic offers specialist mental health treatment spaces for children, adolescents, young adults, and families. We take a whole-person approach to mental health care, supporting young people to grow in self-confidence, develop life skills, and reconnect with their passions as they recover from mental health challenges. Our programs are trauma-focused, emphasising the impact of past experiences on shaping the way young people think, feel, and behave.
We understand that young people don’t exist in isolation. Their well-being – and their recovery – are influenced by the people and environment around them. One of the most important social systems is the family system. Parents and other family members can play an invaluable role in supporting a young person’s recovery.
That’s why we offer family intensives and parenting intensives for family members of young people experiencing emotional dysregulation, eating disorders, borderline personality disorder, and self-harm. We aim to bring parents back into the role of the parent, developing strategies to respond to distressing and different circumstances with effective parenting, warmth, and security.
If you’d like to enquire about our programs, get in touch today.
