Symptom Swapping & Comorbidity

As some of you may have guessed, based on my last couple of posts, my emotions have been all over the place recently. One of my best friends from treatment was readmitted to a different facility this week, but not for what you'd expect. After being out of treatment for nearly a year, this individual's eating habits have returned to normal, but unfortunately there are still several underlying issues that need to be dealt with. 

As a result, different self-destructive behaviors have surfaced that do not involve eating, also known as symptom swapping. Symptom swapping is going from one addictive behavior to another. For example, some of us with eating disorders might begin to get our eating related symptoms under control, but begin drinking or smoking instead. Many of these behaviors, such as OCD tendencies, self harm, or shop lifting, are often present during the eating disorder; however, they become much more prevalent during recovery. Without the eating disordered symptoms to numb out and/or avoid, many individuals resort to these other self-medicating tactics.

Another aspect of eating disorder recovery that is often overlooked is comorbidity. Comorbidity, in contrast, is when two disorders are present at the same time. Many of us who suffer from eating disorders also deal with other mental health disorders such as anxiety, depression, bipolar, borderline personality, PTSD, obsessive compulsive, ext.; which makes treating the eating disorder even more difficult. In one study, it was found that 94% of patients diagnosed with eating disorders also struggled with comorbid mood disorders and 22% deal with substance abuse. 

I found this list of comorbid disorders, but please keep in mind there are several other disorders that may coincide with eating disorders.

 "Depression and anxiety. Disordered eating behaviors like restricting intake, purging or food rituals can serve as powerful stress relievers for those suffering with anxiety and depression.

 Obsessive-compulsive disorder (OCD). Eating disorders symptoms can often mirror OCD symptoms. Rigidity, compulsivity and the creation of elaborate rituals around food and exercise often display in both diagnoses.

 Bipolar disorder. Seen most commonly alongside bulimia, bipolar disorder shares several key symptoms with bulimia, including weight issues and impulsivity.

 Substance abuse. Abuse of drugs and alcohol offers a mechanism for those suffering from eating disorders to numb their pain and anxiety. The use of substances that decrease or suppress appetite in an effort to manage weight tends to be an anorexia comorbidity, while the abuse of substances with no effect on appetite or weight tends to be a bulimia comorbidity."

In my personal experience, I honestly cannot think of one individual I know in recovery who has not gone through a period of symptom swapping or suffered from comorbid symptoms, myself included. It's frustrating to say the least. We go into treatment, develop a new relationship with food, and gain weight only to have these other issues surface. I oftentimes question why I can't just have one disorder to deal with, as if that isn't enough.

My heart breaks for my friend who is back in treatment this week, but I am also incredibly proud of her for taking care of these co-occurring issues. Symptom swapping and comorbidity are much more common than I realized. It is also beginning to make sense to me why recovery is never a straight line. We are dealing with more than just eating related issues and if we choose to ignore these things, a full recovery is not possible.

My friend has taught me there is no shame in dealing with other mental health illnesses along side the eating disorder. In fact, it is perfectly normal. Let's all follow her lead and do our best to get the help we need beyond the ED symptoms.

Progress.