These friends, of course, are other mental illnesses. Eating disorders, of course, don't need any accompanying disorders to be miserable and deadly- they're quite capable of that on their own. And many sufferers can develop depression and anxiety while ill with their eating disorder, in part due to the malnutrition (yes, even if your weight is "normal" or you have a binge and/or purge pattern) and in part due to the sheer misery of the illness itself.

Sometimes, though, these disorders precede the eating disorder. Mine did. I've had OCD over half my life, as well as depression, both a full 4+ years before I started overexercising and restricting. I didn't think they were disorders, I just thought this was how life was going to be.

The OCD and depression play greatly into the eating disorder. Anxiety kills my appetite, flips off the switch between brain and stomach. Depression does as well, though it also makes me less motivated to fight off the ED thoughts when they arise.

Despite these other diagnoses, my first treatment priority was refeeding. Treatments for these disorders don't work when you're at a low weight and not eating properly. So I had to eat, and that did help with some of the symptoms. Not all of them, however, and so here I am, still in therapy (though admittedly, I'm also still in therapy for the eating disorder). I take meds for both OCD and depression, which helps, but not 100%. I couldn't function without them, however.

A recent essay from the Atlanta Journal-Constitution spoke to this need to treat the "underlying disorders" as well as the one that's the most obvious:

"My brain plays dominoes with these disorders. A bout of mania knocks over the depression domino, which knocks over the anorexia domino, which knocks over the exercise-drug-alcohol addiction domino, which goes on and on.

It took decades for me to figure this out. It took even longer to realize that the chain-reaction that effortlessly topples the dominoes does not work in reverse. They won’t automatically pop up if I manage to right just one.


Each disorder has its own treatment. Successfully treating one will not necessarily cure the other. A bipolar drug addict who gets clean is still going to have eye-popping mood swings, bursts of energy and paralyzing depression if the bipolar is not treated, too.

A food addict who smokes and gets treatment for her eating disorder but keeps smoking is still addicted to nicotine. Same with the alcoholic who cuts herself. She is not necessarily going to stop cutting just because she gets sober.


Like I said, it’s not fair. It is even worse because many doctors don’t understand this. They treat one illness but fail to diagnose the companion disorder(s). Then we blame the antidepressants or therapy for not working and we quit. Life becomes hell, all over again.

My solution: Surrender. Recognize the other disorders and treat them, too. I don’t think of it as being a loser. I just joined the winning side."