Co-occurring Concerns

Eating disorders are highly co-morbid

While estimations of comorbidity vary greatly, it is widely accepted that a large portion of individuals presenting with an eating disorder will also meet the diagnostic criteria for another diagnosable condition. While lots of psychological conditions increase an individual’s vulnerability to eating disorder onset, eating disorders can affect the brains of individuals in such a way that mimics other psychological conditions that didn’t previously exist.


Depression is one of the most common comorbidities seen in individuals with eating disorders. It is estimated that approximately 50-75% of individuals with eating disorders also experience depression. Depression can affect someone’s appetite and ability to care for themselves adequately, increasing the risk of eating disorder onset. Depression also frequently follows eating disorder onset as the neurotransmitters in the brain that are responsible for mood are severely affected by the malnutrition that accompanies eating disorders. The good news is that the treatments of both depression and eating disorders have a lot in common and so, it is highly likely that treating your eating disorder will also resolve symptoms of depression.

Anxiety disorders (including OCD):

Anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), frequently co-occur with eating disorders. The rates of comorbidity between eating disorders and anxiety disorders range from 30-75%. As is the case with depression, anxiety may have existed prior to the onset of the eating disorder or it may have followed it. For those whom were affected by anxiety prior to developing an eating disorder, they may have found initial relief from their anxiety through the eating disorder due to their rigidity as well as their effect on brain activity however, once the effects of malnutrition have set in, many report a worsening of their anxiety. While the thought of eating disorder treatment and what it entails often increases individual’s anxiety to begin with, most report significant improvements after 10 or less treatment sessions.

Attention-deficit/hyperactivity disorder (ADHD):

ADHD is characterized by symptoms such as inattention, hyperactivity, and impulsivity. ADHD is also associated with executive functioning difficulties, which involve skills such as planning, organization, and self-regulation. Impaired executive functioning can affect an individual’s ability to participate in the activities required to maintain a pattern of regular eating, often leading to inadequate intake and/or chaotic eating patterns. Impulsivity is thought to increase an individual’s risk of binge eating whereas difficulties with self-regulation are suspected to increase an individual’s vulnerability to purging and other compensatory behaviours. Given the first-line treatments for ADHD often involve stimulant medications, it is imperative that the eating disorder is treated before ADHD treatment is commenced.


Autistic people (as well as those with autistic traits) often have unique sensory sensitivities, which can impact their eating behaviors. Certain textures, smells, tastes, or even the social aspects of eating can be overwhelming and aversive for autistic individuals. These sensory challenges may lead to selective eating, restricted food choices, or even avoidance of food altogether, increasing the vulnerability of eating disorder onset. Autistic people often exhibit rigid thinking patterns and engage in ritualistic behaviors which can manifest in their relationship with food, leading to rigid dietary rules, obsessions with specific foods, or repetitive eating habits which also increase vulnerability to eating disorder onset. Full recovery from an eating disorder is possible for autistic people however, treatment approaches may require some considered and appropriate adaptations.


The terms “big T” and “little t” trauma are often used by researchers and clinicians in the trauma field to distinguish between different types and levels of traumatic experiences. Big T trauma refers to major traumatic events that are objectively considered to be highly distressing and involve significant threat to a person’s life or physical integrity. These can include experiences such as natural disasters, war, physical or sexual assault, severe accidents, or witnessing violence. Little t trauma, on the other hand, refers to the accumulation of smaller, objectively less severe (yet subjectively distressing) experiences that have a cumulative impact on an individual’s well-being. These events are often more chronic in nature and may not involve immediate physical harm. Examples of little t traumas can include ongoing emotional abuse, neglect, bullying, parental divorce, frequent relocations, or other adverse experiences that affect an individual’s sense of safety, trust, and stability. While big T traumas tend to be more obvious and recognizable due to their dramatic nature, little t traumas can accumulate over time and still have significant consequences for an individual’s mental health. It is important to note that the distinction between big T and little t trauma is not meant to diminish the significance of any traumatic experience, as each person’s response to trauma is unique and can be influenced by various factors. Both “big T” and “little T” trauma are highly cormorbid with eating disorders as such, a trauma-informed approach to treatment is central to our approach at Centre for Integrative Health, irrespective of whether or not trauma is a recognised part of an individual’s eating disorder experience.

Treatment priorities

Given the mortality and morbidity associated with eating disorders, it is appropriate that management and/or treatment of the eating disorder is prioritised however, effective eating disorder treatment requires the accurate identifying and understanding of the many co-occurring concerns that may accompany an eating disorder. The eating disorder specialist team at Centre for Integrative Health are well equipped to support with this.