The Intertwining Effect of Eating Disorders and Co-Occurring Mental Illnesses

Thrive • October 8, 2021
By Thrive Sacramento’s Program Director, Gillie Francis, LCSW

Many people who struggle with eating disorders also suffer from co-occurring mental illnesses . According to the National Institute of Mental Health , 56 percent of people with anorexia nervosa, 94 percent of people with bulimia nervosa, and 78 percent of people with binge eating disorder (BED) struggle with at least one other mental health diagnosis. Eating disorders and co-occurring mental illnesses can dangerously exacerbate one another, requiring integrated treatment that targets all conditions. 

MENTAL HEALTH CONDITIONS THAT COMMONLY CO-OCCUR WITH EATING DISORDERS 

In addition to mental illnesses, eating disorders are frequently expressed alongside certain temperaments and thinking patterns. Find out which mental health conditions co-occur most frequently with eating disorders below. 

Mental illnesses: 

  • Anxiety disorders
  • Depression
  • Obsessive-compulsive disorder (OCD)
  • Substance use disorders
  • Trauma and post-traumatic stress disorder (PTSD)

Temperaments and thinking patterns: 

  • Rigid thinking patterns
  • Obsessional thinking
  • Perfectionism
  • Harm avoidance
  • High threat sensitivity
  • Reduced reward sensitivity

FACTS ABOUT THE BRAIN, EATING DISORDERS, AND CO-OCCURRING MENTAL ILLNESSES

Trauma and genetics contribute to the development of co-occurring mental health conditions. 

Co-occurring mental health conditions may develop as a result of previous traumatic experiences in a person’s life. Additionally, individuals may have genetic predispositions to certain mental health conditions.

Eating disorders may serve as coping strategies for co-occurring mental illnesses. 

While the exact relationship between eating disorders and co-occurring mental illnesses is still being explored, it’s believed that eating disorders and mental illnesses are influenced by shared dimensions in the brain. Maladaptive coping strategies, which are unhealthy or destructive ways to process emotions, originate within these parts of the brain. Individuals may use maladaptive coping strategies such as disordered eating behaviors to navigate the symptoms of a mental illness.

Everyone expresses mental health conditions and recovers differently.

No individuals experience eating disorders and co-occurring mental health conditions in the same way, so afflicted individuals should receive a comprehensive assessment and treatment plan from their clinical team to determine their exact diagnosis and unique path to recovery.

TREATMENT FOR EATING DISORDERS AND CO-OCCURRING MENTAL ILLNESSES

Effective treatment requires untangling psychological struggles.

Before beginning eating disorder treatment, clinicians assess a client’s current and underlying symptoms to provide them with a comprehensive understanding of their mental health. From their findings, clinicians create a treatment plan that includes specific evidence-based interventions to address the variety of the client’s symptoms.  

Integrated treatment is the answer.

Integrated treatment can address a person’s eating disorder and associated mental illnesses. Integrated treatment involves multidisciplinary teams to ensure that the client’s medical and mental health are being nurtured. An integrated approach allows treatment teams to draw on each clinician’s specialties and collaborate on an individual’s care. 

DEEPLY ROOTED EATING DISORDER RECOVERY

Clients receive integrated, multidisciplinary treatment at Thrive.

At Thrive, clients are met by a team of therapists, psychiatrists, dietitians, body-positive specialists, and mindful movement specialists who carefully collaborate to provide them with well-rounded eating disorder treatment. Using the latest research and integrating the most advanced evidence into our programming, we help clients holistically heal from eating disorders and co-occurring mental health conditions. You can learn more about our eating disorder treatment programs by getting in touch with us .  

About the Author

Gillie Francis, LCSW — Thrive Sacramento’s Program Director

Gillie Francis received her master’s degree in Social Work at the University of Nevada and is a fully licensed LCSW in both Nevada and California. Her experience spans a variety of settings and levels of care including inpatient, residential, and outpatient and crisis services. Gillie has experience working with adults and adolescents with severe mental illness, eating disorders, mood and anxiety disorders, suicidal ideation, personality disorders and other co-occurring disorders. Gillian is passionate about honoring each individual’s journey and utilizes approaches that emphasize empowerment with clients. Approaching her work with integrated modalities, she works with individuals to find their voice and engage in pivoting towards their values. She believes that each individual has the capacity for meaningful change in their lives. When she is not working with clients, she enjoys time outdoors with her spouse and dog, Charlie.

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August 21, 2025
When Emma was 8, her parents noticed her food choices shrinking. At first, they assumed it was just picky eating — “She’ll outgrow it,” friends said. But by 10, Emma would only eat crackers, cheese, and chicken nuggets. Family dinners became nightly struggles, her growth slowed, and she skipped birthday parties to avoid “strange food.” Her parents felt powerless, her brother grew frustrated, and outings dwindled. What began as food avoidance soon reshaped the rhythm of the entire household. When children avoid food, most parents expect it’s a passing stage. But when restriction deepens, shrinks to only a few “safe foods,” and begins affecting growth or health, families suddenly find themselves in unfamiliar territory. This is often where Avoidant/Restrictive Food Intake Disorder (ARFID) emerges — with effects that extend far beyond the plate. As providers, we need to be attuned to these patterns. It’s tempting to dismiss them as “no big deal,” yet for many families, they are life-altering. Sadly, Emma’s story is not unusual. Mealtimes as Battlegrounds Families living with ARFID often describe mealtimes as emotionally charged, exhausting, and unpredictable. What should be a chance to connect around the table can feel more like a negotiation or even a standoff. Parents wrestle with whether to push their child to try a new food or give in to the same “safe foods” again and again to avoid tears, gagging, or complete meltdowns. This ongoing tension can make mealtimes dreaded rather than cherished. Siblings, too, are affected. Some may feel resentful when family meals are limited to what only one child will tolerate. Others may act out in response to the constant attention the child with ARFID receives. Over time, the dinner table shifts from a place of nourishment and bonding into a stage for conflict, anxiety, and guilt — a pattern that can erode family cohesion and resilience. Social Isolation and Missed Experiences ARFID impacts more than what happens at home; it influences how families engage with the world around them. Everyday events — birthday parties, school lunches, vacations, even extended family dinners — become sources of stress. Parents may pack special foods to avoid confrontation or, in many cases, decline invitations altogether to protect their child from embarrassment or overwhelm. This avoidance can lead to an unintended consequence: isolation. Families miss out on milestones, friendships, and traditions because of the unpredictability surrounding food. The child may feel left out or ashamed, while parents grieve the loss of “normal” family experiences. This social withdrawal can compound the anxiety already present in ARFID and deepen its impact across generations. Emotional Toll on Parents The emotional strain on parents navigating ARFID is significant. Many describe living in a constant state of worry — Will my child get enough nutrients? Will they ever grow out of this? Am I doing something wrong? This worry often spirals into guilt and self-blame, particularly when outside voices dismiss the disorder as mere “picky eating.” In addition, the pressure to “fix” mealtimes can strain marital relationships, creating disagreements over discipline, feeding strategies, or medical decisions. Parents may also feel emotionally depleted, pouring all their energy into managing one child’s needs while inadvertently neglecting themselves or their other children. Without support, this chronic stress can lead to burnout, depression, and disconnection within the family system. The Role of Providers For clinicians, ARFID must be viewed not only as an individual diagnosis but as a family-wide challenge. Effective care requires attention to both the clinical symptoms and the family dynamics that shape recovery. Parent Support: Educating caregivers that ARFID is not their fault, offering psychoeducation, and helping them reframe mealtime struggles as part of the disorder — not a parenting failure. Family-Based Interventions: Coaching families in structured meal support, communication strategies, and gradual exposure work so parents don’t feel powerless. Holistic Care: Involving therapists, dietitians, occupational therapists, and medical providers ensures that the family does not shoulder the weight of treatment alone. When families are validated, supported, and given practical tools, the entire household can begin to heal. Treatment is not only about expanding a child’s food repertoire but also about restoring peace, resilience, and connection at home. Moving Forward ARFID may begin with one individual, but its ripple effects are felt across the entire family system. By addressing both the psychological and relational dimensions, providers can help transform mealtimes from a source of conflict into an opportunity for healing and connection. For those who want to go deeper, we invite you to join our upcoming training on ARFID , where we will explore practical strategies for supporting both clients and their families.
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As a parent, noticing alarming behaviors around food or routines in your child can raise some important questions. You might be asking yourself, “Is this an eating disorder, obsessive-compulsive disorder (OCD), or something else entirely?” Understanding the signs and differences between these disorders is key to getting your child effective, timely treatment. In this blog, we’ll break down the overlap between OCD and eating disorders, what signs to watch for, and how to get professional help. If you're a parent wondering “Is my child’s eating disorder actually OCD?” or “OCD vs eating disorder in teens,” know that you’re not alone and you’re in the right place to find specialized care for your child. What Is OCD? Obsessive-Compulsive Disorder (OCD) is a mental health condition where unwanted thoughts (obsessions) cause anxiety, leading to repetitive behaviors (compulsions) intended to ease that anxiety. OCD can be focused on any subject. Common obsessions include contamination, perfectionism, scrupulosity, and harm, but sometimes, the content of obsessions can be focused on food, body image, or weight. What Is an Eating Disorder? Eating disorders , like anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID) involve disturbed eating behaviors and intense concerns about body weight or shape. These conditions go beyond dieting or “picky eating” and can become life-threatening without professional intervention. The Overlap: Why It Can Be Confusing OCD and eating disorders often share similar symptoms : Ritualistic eating (e.g., needing to eat foods in a certain order or at a certain time) Rigid rules about food (like only eating certain food groups or certain amounts of food) Excessive checking (like weighing food or body or repeated checking of expiration dates or thorough cooking) Avoidance behaviors ( like avoiding carbs, fats, or other food groups or avoiding places or objects that can trigger obsessions) Distress when routines are disrupted (either around mealtimes or exercise routines) So, How Can You Tell the Difference? Use the following chart to compare and contrast symptoms of OCD and eating disorders.
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