Some people with eating disorders (EDs) experience all types of disordered behaviours, while others stay on one part of the spectrum. The different ED shapes and sizes play out in various ways, according to the individual. Similarly, the disorders can occur on their own or in the presence of other mental illnesses and/or additions. When more than one issue is at play, a person is said to have a dual diagnosis.

What kind of mental illnesses co-occur with eating disorders?

The most common co-morbid issues for people with EDs are:

• Post-Traumatic Stress Disorder (PTSD)
• Depression
• Anxiety
• Obsessive-Compulsive Disorder (OCD)
• Borderline Personality Disorder (BPD)
• Bipolar Disorder (BD)

The addiction link

People with EDs frequently also suffer from various forms of addiction. When this is to drugs or alcohol (a substance of some kind) this is quite easy to identify. Certain behaviours like self-harm or excessive gambling or shopping – process addictions – can be much harder to recognise. All addictions work in the same way; the only thing that’s different is what, exactly, a person is dependent on.

When a person ingests a substance or acts out on a behaviour, neurochemicals are released. These activate the same pleasure centres in the brain. Addicts become dependent on those neurochemicals, whether they are triggered by other substances or by some action. Add to that the control issues, guilt and shame that co-occur with eating disorders, and the combination is potent.

So what comes first?

With so many layers and contributing factors, there’s seldom a single cause for an individual’s ED. In terms of a dual diagnosis, the disordered eating behaviour can flick the switch and activate the mental illness. Or the reverse can happen. Low body weight and electrolyte imbalances may be due to an ED and trigger depression, or maybe due to depression and trigger an ED. Everybody (and everybody) is unique.

Similarly, another addiction may be masking an ED, or clients may uncover other dependencies when they enter ED recovery. As you work on yourself and receive treatment, various layers are uncovered. For some people, it can feel like as soon as they deal with one issue, another raises its head. But individuals also say that with time and effort, their different conditions become easier to manage.

What does dual diagnosis treatment involve?

The idea behind dual diagnosis treatment is that for true recovery, all aspects of a person need to heal. Imani has received wide recognition in this kind of rehabilitation, and we pride ourselves on offering a multidisciplinary approach. By offering a team of experts including dieticians, counsellors, psychiatrists and psychologists, we can deal with any arising issues.

Depending on your other medical or psychiatric illnesses, you may require medication to maintain physical and mental wellbeing. By introducing various therapies along with prescribed medication, we help you deal with past trauma and learn healthy coping mechanisms. Our comfortable, home-like treatment facility offers the ideal environment for you to do this work. Your addictions and illnesses don’t disappear, but you’ll be able to cope with them and lead a full life.

Identifying each condition, and understanding how they interact with each other and affect you, takes time. Often, this is only possible through intensive therapy and through connecting with others who have a dual diagnosis. That’s one of the reasons we stress connecting with recovery fellowships so much. In Cape Town, we’re fortunate enough to have a vibrant, strong community to lean on for support.

Healing is possible

There’s really no point in sugar-coating this truth; dealing with a dual diagnosis is incredibly challenging. Friends and family members often also feel overwhelmed and don’t know what to do. However, as many of our treatment alums can attest, with hard work it is possible. And the gifts of recovery make the journey infinitely worthwhile. We are here to walk the path with you, every step of the way.