Common Co-Occurring Diagnoses in People With Eating Disorders and How Ezer Psychotherapy Treats Them
Eating disorders are complex mental health conditions that often occur alongside other psychological diagnoses. At Ezer Psychotherapy, PLLC, we understand that treating eating disorders effectively requires addressing co-occurring mental health conditions to support long-term recovery [1,2].
In this article, we’ll explore common co-occurring diagnoses seen in individuals with eating disorders and explain how evidence-based treatment can integrate care for both the eating disorder and additional mental health needs.
What Are Co-Occurring Diagnoses in Eating Disorders?
A co-occurring diagnosis, also known as a comorbidity, is when a person experiences one or more additional mental health conditions alongside an eating disorder. These diagnoses can significantly impact the course of recovery, making specialized and integrated treatment important [1,2].
Some of the most common co-occurring diagnoses include:
Anxiety disorders
Depression
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Attention-deficit/hyperactivity disorder (ADHD)
Substance use disorders
Addressing both the eating disorder and co-occurring conditions is critical to achieving lasting recovery.
Why Co-Occurring Diagnoses Are Common With Eating Disorders
Research indicates that eating disorders often occur alongside other psychiatric conditions, especially anxiety, mood disorders, trauma-related symptoms, and substance use concerns [1,2].
Mental health conditions can interact with eating disorder behaviors, creating a cycle that is difficult to break without comprehensive treatment.
Anxiety and eating disorders: Anxiety may contribute to restrictive eating, compulsive behaviors, fear of weight gain, food avoidance, or fear of eating in social settings [2,3].
Depression: Feelings of hopelessness, low motivation, and low self-esteem can worsen eating disorder symptoms and make recovery feel more difficult [1,4].
PTSD or trauma: Trauma history can contribute to emotional regulation challenges, avoidance, dissociation, and eating disorder behaviors used to manage distress [5,6].
At Ezer Psychotherapy, we screen for these conditions as part of an initial assessment to provide a holistic treatment approach.Most Common Co-Occurring Diagnoses With Eating Disorders
Most Common Co-Occurring Diagnoses With Eating Disorders
1. Anxiety Disorders
Anxiety disorders are among the most common co-occurring diagnoses in people with eating disorders [1,2].
How it presents:
Excessive worry about food, calories, body image, or health
Fear of eating in front of others
Panic or distress around meals
Avoidance of feared foods or situations
Perfectionism and fear of making mistakes
Treatment at Ezer Psychotherapy:
CBT-E to target anxious thoughts related to eating and body image
Exposure-based work for feared foods, social eating, or avoided situations
Mindfulness and stress reduction skills
Family support when anxiety affects meals or daily functioning
2. Depression
Depression commonly co-occurs with eating disorders and can affect motivation, energy, sleep, concentration, and hope for recovery [1,4].
How it presents:
Persistent sadness or emptiness
Loss of interest in activities
Low motivation
Sleep changes
Low self-worth
Increased isolation
Difficulty believing recovery is possible
Treatment at Ezer Psychotherapy:
Integrating CBT strategies for depression alongside eating disorder treatment
Behavioral activation and gradual re-engagement with meaningful activities
Reducing shame and self-criticism
Supporting nutrition, sleep, social connection, and daily structure
3. Obsessive-Compulsive Disorder
OCD and obsessive-compulsive symptoms are commonly seen in eating disorder populations, especially among individuals with restrictive eating disorders [7,8].
How it presents:
Rigid food rules
Excessive checking of calories, ingredients, weight, or body shape
Rituals around eating or exercise
Fear-driven avoidance
Intrusive thoughts about contamination, morality, health, or body image
Treatment at Ezer Psychotherapy:
Exposure and Response Prevention when OCD symptoms are present
CBT-E to address eating disorder thoughts and behaviors
Reducing rituals and compulsive reassurance-seeking
Addressing perfectionism, rigidity, and obsessive thinking
4. Post-Traumatic Stress Disorder
Trauma and PTSD are common in people with eating disorders and may complicate treatment if not addressed thoughtfully [5,6].
How it presents:
Emotional dysregulation
Avoidance of certain foods, body sensations, or situations
Dissociation or feeling disconnected from the body
Binge eating, restriction, or purging used to numb or manage distress
Hypervigilance, shame, or difficulty feeling safe
Treatment at Ezer Psychotherapy:
Trauma-informed therapy integrated with eating disorder care
Emotion regulation and distress tolerance skills
Careful pacing so nutrition, safety, and stabilization are supported
Faith-integrated therapy options for clients seeking spiritual support
5. ADHD
ADHD is increasingly recognized as associated with eating disorder symptoms, especially binge eating, loss-of-control eating, impulsivity, and difficulty maintaining structure [9,10].
How it presents:
Impulsivity around eating
Difficulty maintaining regular meals and snacks
Forgetting to eat, then overeating later
Executive functioning challenges
Emotional dysregulation
Difficulty with planning, transitions, and follow-through
Treatment at Ezer Psychotherapy:
Behavioral strategies to improve meal planning and structure
CBT techniques adapted for ADHD
Skills for impulsivity, emotional regulation, and self-monitoring
Practical systems for routines, reminders, and recovery goals
6. Substance Use Disorders
Substance use disorders can co-occur with eating disorders, especially binge-purge presentations, and may worsen medical and psychological risk [11,12].
How it presents:
Using alcohol or drugs to cope with emotions
Using substances to suppress appetite
Using substances to manage anxiety, sleep, or shame
Increased impulsivity or risk-taking
Difficulty maintaining recovery routines
Treatment at Ezer Psychotherapy:
Integrated care addressing both eating disorder behaviors and substance use
Coping skills training
Relapse prevention planning
Coordination with additional providers or higher levels of care when needed
How Ezer Psychotherapy Treats Eating Disorders With Co-Occurring Diagnoses
At Ezer Psychotherapy, PLLC, we offer a comprehensive and individualized approach that addresses both the eating disorder and co-occurring mental health conditions.
1. Comprehensive Assessment
Every client begins with a detailed evaluation to identify eating disorder behaviors, co-occurring conditions, medical concerns, safety needs, and unique treatment goals.
2. Evidence-Based Treatment
Treatment may include:
Family-Based Treatment: For adolescents and young adults when family involvement is clinically appropriate [13].
CBT-E: For older adolescents and adults, addressing disordered eating and maintaining factors such as perfectionism, low self-esteem, and body image distress [14].
Trauma-informed care: For clients with PTSD, trauma histories, or nervous system dysregulation [5,6].
Faith-integrated counseling: For clients seeking spiritual support alongside therapy.
3. Integrated Care for Co-Occurring Conditions
Our therapists address anxiety, depression, PTSD, OCD, ADHD, substance use concerns, and other diagnoses alongside eating disorder treatment, because untreated co-occurring symptoms can contribute to relapse risk and ongoing distress [15].
4. Virtual Therapy Access
Our secure online sessions make it easier for clients across Minnesota, Wisconsin, Florida, and North Dakota to access specialized treatment from the comfort of home.
Learn more about our eating disorder therapy services.
FAQs About Eating Disorders and Co-Occurring Diagnoses
Q1: Can someone have multiple co-occurring diagnoses with an eating disorder?
A: Yes. Many clients experience two or more mental health conditions alongside an eating disorder. Integrated care is critical.
Q2: How do co-occurring diagnoses affect recovery?
A: Co-occurring conditions can complicate recovery, but addressing both disorders simultaneously improves long-term outcomes.
Q3: Is family support important?
A: Absolutely. Family involvement, especially through FBT, is a key predictor of successful recovery for adolescents.
Q4: Are online therapy sessions effective?
A: Yes. Our virtual therapy sessions maintain the same level of care, confidentiality, and evidence-based treatment as in-person sessions.
Q5: Can spiritual guidance be included in treatment?
A: Yes. We offer faith-integrated therapy for clients who want spiritual support as part of their recovery journey.
Take the First Step Toward Recovery
Eating disorders rarely occur in isolation. At Ezer Psychotherapy, we provide comprehensive, evidence-based treatment that addresses both the eating disorder and co-occurring mental health conditions.
Recovery is possible with:
Early intervention
Integrated, individualized care
Family involvement and support
Compassionate, expert guidance
If you or a loved one is struggling with an eating disorder and a co-occurring diagnosis, reach out today to schedule a confidential consultation.
Contact Ezer Psychotherapy now and start your journey toward healing and lasting recovery.
References
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Jewell T, et al. Mental health problems associated with eating disorders and disordered eating: an umbrella review. Journal of Eating Disorders. 2023.
Morris R, Keeler J, Treasure J, Himmerich H. The pharmacological treatment of anxiety in people with eating disorders: a systematic review. Pharmacological Research. 2025.
Lydecker JA, Grilo CM. Psychiatric comorbidity as predictor and moderator of binge-eating disorder treatment outcomes: an analysis of aggregated randomized controlled trials. Psychological Medicine. 2021.
Day S, Hay P, Tannous WK, et al. A systematic review of the effect of PTSD and trauma on treatment outcomes for eating disorders. Trauma, Violence, & Abuse. 2023.
Moroshko I, Raspovic A, Liu J, Brennan L. Trauma and eating disorders: an integrated umbrella and scoping review. Clinical Psychology Review. 2025.
Mandelli L, Draghetti S, Albert U, De Ronchi D, Atti AR. Rates of comorbid obsessive-compulsive disorder in eating disorders: a meta-analysis of the literature. Journal of Affective Disorders. 2020.
Drakes DH, et al. Comorbid obsessive-compulsive disorder in individuals with eating disorders: an epidemiological meta-analysis. Journal of Psychiatric Research. 2021.
Levin RL, Rawana JS. Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: a systematic review of the literature. Clinical Psychology Review. 2016;50:22-36.
El Archi S, Cortese S, Ballon N, et al. Negative affectivity and emotion dysregulation as mediators between ADHD and disordered eating: a systematic review. Nutrients. 2020;12(11):3292.
Bahji A, Mazhar MN, Hudson CC, Nadkarni P, MacNeil BA, Hawken E. Prevalence of substance use disorder comorbidity among individuals with eating disorders: a systematic review and meta-analysis. Psychiatry Research. 2019;273:58-66.
Alves TPV, Nunes P, Timóteo S. Substance use in patients with eating disorders: a review of the current evidence. European Psychiatry. 2023;66(Suppl 1).
Lock J, La Via MC. Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2015;54(5):412-425.
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Sala M, et al. Predictors of relapse in eating disorders: a meta-analysis. Journal of Psychiatric Research. 2023.
