Very few, if any, medical or mental health conditions, such as anorexia nervosa, exist as stand-alone illnesses. For instance, somebody diagnosed with major depression is also likely to have a co-existing sleep disorder given that among the symptoms of depression is insomnia or hyposomnia. Many times, it is challenging for a mental health professional to ascertain which the primary disorders are and which are the secondary disorders that are caused by the primary disorder. It is frequently a chicken or the egg dilemma. In any event, all conditions are generally treated at the same time. Mental health disorders that happen at the same time as another primary disorder are known as co-morbid conditions or disorders with morbid meaning sick or ill.
It is fairly common, for instance, to diagnose a patient with Alcohol Dependence (primary diagnosis) and a co-morbid disorder of Dysthymia, a milder form of chronic depression. Both conditions are dealt with as one with improvement in one condition leading to improvement in the other.
Looking specifically at Anorexia Nervosa as a primary condition, let us consider co-morbid mental health conditions which frequently accompany this eating disorder:
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Major Depressive Disorder
Major Depressive Disorder is demonstrated by depressed mood, social withdrawal, irritability, insomnia and disinterest in sexual activity.
Obsessive Compulsive Disorder
Anorexics are preoccupied by obsessive thoughts of food. They may obsessively hoard non-nutritional foods, such as plain lettuce or saltine crackers to keep their starvation eating behaviors secret from family members. Anorexics continuously count food items that they allow themselves to eat, and obsessively check to ensure the non-nutritional food is still in its hiding place.
Body Dysmorphic Disorder
With this disorder, the patient has an unfaltering belief that his/her body is horrifically repulsive in spite of hearing the truth about their appearance from others. Anorexics are convinced that their abdomen, buttocks and thighs are fat and unattractive, even though these body parts may in reality be agonizingly skeletal in appearance. The term flat buttocks used by mental health professionals who treat eating disorders indicate a patient’s completely flat buttocks, a sign of severe malnutrition.
Alcohol and Drug Abuse
Anorexics tend to abuse illegal stimulant drugs to avoid feeling hungry and to maintain a false level of energy. Alcohol is abused for similar reasons; anorexics that drink excessively develop alcohol gastritis, an acute stomach pain that prevents them from eating.
Borderline Personality Disorder
A personality disorder is a mental health condition that stems from the underlying character, or personality, of the patient. They reflect the patient’s view of the world and their place in it. Personality disorders are permanent conditions although their symptoms can be effectively managed. The Borderline Personality Disorder’s primary characteristics are a life constantly in chaos and turmoil, history of suicide attempts, unpredictable and impulsive mood, lack of genuine personal relationships, and a constant need for “drama” in their lives. Anorexics with BPD make frequent suicide attempts, have very unstable personal relationships, and their chaotic behavior may try the patience of everyone who knows them. A combined primary disorder like Anorexia Nervosa and a co-morbid personality disorder are referred to as “double trouble” among mental health professionals.
Anorexia Nervosa is an extremely complicated mental disorder. Combine Anorexia with the wide variety of co-morbid disorders, and you can see how difficult the disorder can be to treat. This is why only an experienced mental health provider should be the one to administer therapy. Anorexia is not for the novice therapist by any means.