Secondary Diagnoses with Eating Disorders

Diagnoses in psychiatry are inherently confusing. There are categories with several criteria for each illness. If a patient fulfills enough of the symptoms, they receive the diagnosis. There are no definitive tests or diagnostic scans but only empirical data clinicians use to agree on definitions of illness.

This approach to mental illness was created to codify a language clinicians use to communicate with each other. However, it also leaves many people with a handful of diagnoses—a grab bag of symptoms which mean very little to patients when thrown together.

This experience is common for people with eating disorders. Most often, people with eating disorders develop a number of other symptoms secondary to the chronic eating symptoms such as depression, anxiety or OCD. The list of diagnoses following an eating disorder on a chart is often of little value. Normalizing eating almost always eliminates these issues as well. In other words, the eating disorder is usually the primary problem.

Some patients who have been ill for some time are excited or hopeful about the idea that another diagnosis may be the core issue. Their hope is that this new diagnosis opens the door for a clearer path to wellness.

Unfortunately, a new understanding by a clinician gives false hope. Some secondary diagnoses solidify over time and appear to be primary, but that only reflects the hardened nature of the eating disorder in a person’s life rather than the new realization which solves all their issues.

Bipolar disorder and Post-Traumatic stress disorder are the two most common illnesses which turn out to be primary and the eating disorder just a manifestation of those symptoms. Treating the primary issue in these cases can lead to a more swift recovery.

Panic disorder, Major depression and Obsessive Compulsive Disorder typically are secondary diagnoses. Focusing on these issues rarely leads to eating disorder recovery. OCD can sometimes appear to be the primary issue, but long-standing restriction typically leads to OCD symptoms that can be very strong but still secondary.

It is important to recognize and treat secondary diagnoses. No clinician should ignore these issues; however, treatment needs to stay focused primarily on eating disorder recovery. Prolonged periods of abnormal eating lead to symptoms that mimic other psychiatric illnesses, but eating disorder treatment needs to remain the number one issue.