Although eating disorders are themselves complex, in many cases, the eating disorder is not the only problem. Related conditions, termed by the medical field as “co-morbid conditions” are frequently found in people suffering from eating disorders.

Obsessive Compulsive Disorder (OCD) is found in some individuals suffering from eating disorders. OCD is a condition in which repetitive thoughts (obsessions) or ritualistic behaviors (compulsions) occur which are beyond the ability of the individual to control. These patterns center on the items that an individual feels driven to control. Such patterns may include fears of being unable to achieve safety (by locking doors, turning off appliances), fears about cleanliness (excessive hand washing, pulling out hair), fears of lack of order (counting rituals) and other such items. The presence of OCD in addition to an eating disorder greatly complicates the picture of starvation or ritualistic eating. OCD can in many cases be treated successfully with medication.

Drug addiction, including excessive use of alcohol or street drugs, is also found in some individuals with eating disorders, particularly those with bulimia and binge eating. Feelings of shame and guilt are frequently present in any eating disorder but are denied by the individual who suffers these feelings. Denial of powerful feelings can lead to the use of chemicals to achieve a sense of relief, more so when the individual finds the experience of having feelings too uncomfortable. Frequent use of chemicals as a coping mechanism can then lead to a pattern of drug abuse or even addiction. In some cases, chemical addiction or other impulsive repetitive behaviors such as gambling and/or frequent impulsive sexual behaviors can emerge. As the behaviors centering on food are brought under control, the individual must learn to be comfortable with the underlying issues which have been driving the eating disorder.

Shoplifting and other thrill-seeking behaviors are in some cases co-morbid with an eating disorder. Shoplifting has common psychodynamic features with eating disorders including secretiveness and obtaining something in an incomplete manner (the purchase of the item or the swallowing of the food).

Depression in some degree is nearly universal in eating disorders. In some cases this becomes as serious as a diagnosable major depressive disorder and in other cases a condition labeled dysthymia. Major depression is a disturbance of the biological rhythms of the body in which sleep, appetite, weight, energy levels, the speed of body movements and mood are affected. Early morning awakening, loss of body weight, loss of appetite, lack of interest in formerly pleasurable activities and suicidal feelings are common. Major depression responds to antidepressant medications. Psychotherapy for depression is often required.

Post Traumatic Stress Disorder (PTSD) may be part of the origin of some cases of eating disorders, particularly when an individual has been subjected to the trauma of sexual abuse in childhood or other forms of rape. An individual who has been the victim of rape or abuse may experience a profound sense of loss of control. For some, altering the body shape in such a way that others would not find sexually appealing can be part of misinterpretation and at times distortion. It is important that any feelings concerning sexual abuse and PTSD be explored carefully with a competent and experienced psychotherapist.