EDs are characterised by disturbances in eating behaviours and food intake that impair psychosocial functioning and/or physical health. These disturbances may involve:
- Food restriction (e.g., limiting the amount of food eaten each day by reducing portion size, going long periods of time without food [>4 hours at a time], eliminating food types such as fats or carbohydrates, or not eating at all).
- Compensatory behaviours in reaction to consuming food (e.g., overexercising, vomiting and/or purging, laxative use).
- Binge eating (i.e., consuming an objectively large amount of food in a short period of time, accompanied by a sense of feeling out of control).
The majority of physical symptoms associated with ED are related to the effects of starvation, bingeing, purging, and/or overexercising [1408–1410]. People with ED, particularly bulimia nervosa, may show few outward signs of their disorder [1411, 1412], and may also hide symptoms of their ED (e.g., by wearing loose fitting clothing) [428]. Any visible physical signs of the ED may be complicated by AOD use. For example, AOD use can influence features that are usually associated with the assessment of ED, such as weight, appetite and food restriction [1412]. Furthermore, people with an ED may experience eating-related symptoms which are similar to those associated with AOD use, such as cravings and patterns of compulsive use [10]. Further, for some with ED and AOD conditions, alcohol may serve as the main source of nutrition. AOD workers should therefore endeavour to maintain a direct, non-judgemental approach during assessment, and seek to obtain as much additional information as possible (e.g., from family and/or friends with the client’s consent) [1413]. The level of care required will depend on illness severity, the presence of any medical complications, dangerousness of behaviours, and any other psychiatric comorbidities (e.g., depression, anxiety) [1408, 1414]. In more complex presentations of ED, consultation with additional interdisciplinary professionals may be required, including dieticians, exercise therapists, social workers, family therapists, and psychiatrists [1408].
AOD workers should also be aware of the potential interactions between co-occurring ED and AOD use and consider this interplay when conducting assessments. There may be AOD use related to the ED; for example, the use of tobacco, stimulants, diet pills, laxatives, diuretics, or caffeine to control weight or suppress appetite [1400]. As such, assessment should include a focus on the use of AOD as a weight loss mechanism, as well as the role it may have in emotion regulation [1415].