Eating disorders are one of the easiest mental illnesses to miss because people confuse them with discipline. In South Africa you still hear it, she’s so good, she never eats junk, he’s so committed, look how much weight he lost, they’re just health focused. Meanwhile the person is living in a private war with food, their body, and their own mind, and the “healthy” persona is often a mask that keeps everyone else calm while the disorder tightens its grip.
Addiction slips into this space for a simple reason, eating disorders create unbearable feelings. Shame, fear, disgust, anxiety, emptiness, perfectionism, and the need to control something when everything else feels out of control. Substances can numb those feelings fast. Alcohol can soften the rules for an hour. Stimulants can kill appetite and create a fake sense of power. Sedatives can knock you out when guilt is loud. Cannabis can dull hunger panic or emotional spikes. The person then starts using food control and substance use as a single coping system, not two separate problems, and that combination can wreck health, relationships, and judgement quickly.
They are about fear and identity
Food is the visible part, but the engine is psychological. Eating disorders are often driven by fear of losing control, fear of being seen, fear of being rejected, fear of being ordinary, fear of being wrong. The person learns that controlling food gives them a sense of safety. They count, restrict, binge, purge, overexercise, fast, obsess, and they build a life around numbers and rules because rules feel safer than feelings.
Families often miss this because the behaviour can look like self control. The person may be praised for dieting, praised for gym consistency, praised for willpower. In some homes, thinness is treated like a moral achievement. In others, being “strong” is a survival requirement. The eating disorder then becomes a respected coping style, until it becomes medically dangerous, emotionally explosive, or both.
Where addiction enters
A lot of people assume addiction means partying or chasing pleasure. In eating disorders, substance use is often functional. It is used to control appetite, to blunt anxiety around eating, to push through exercise, to cope with guilt, or to punish the body. That makes it harder to spot, because the person can claim, I’m just trying to cope, I’m just stressed, I’m just tired.
Alcohol often enters as permission. The person who restricts all week drinks on the weekend, eats more while drinking, then feels shame and “fixes it” with restriction, vomiting, laxatives, or excessive exercise. Alcohol then becomes part of the binge purge cycle, and the hangover becomes another reason to hate the body. This is not casual drinking. This is a ritual that feeds self disgust.
Stimulants are another common trap. Some people use high doses of caffeine, energy drinks, or illicit stimulants to suppress appetite and stay in control. Others misuse prescription medication. The short term result is appetite suppression and a sense of drive. The long term result is anxiety, insomnia, paranoia, mood instability, and a crash that can trigger binge eating and deeper shame. The person then takes more stimulant to “correct” the binge, and the cycle becomes predictable.
Sedatives and sleeping tablets often appear when the person cannot handle the internal noise. Restriction makes the mind obsessive. Bingeing creates guilt. Purging creates shame. The person lies awake replaying it all. A pill becomes the off switch. Then dependence builds, because sleep becomes tied to chemical sedation rather than natural rest.
Shame keeps both disorders alive
Eating disorders and addiction thrive in secrecy. The person hides wrappers, hides bottles, hides vomiting, hides missing money, hides missed meals, hides exercise routines, hides pill use, hides the truth. They become skilled at looking fine. They might still work. They might still smile. They might still show up. Many families only realise the severity when a crisis hits, fainting, heart palpitations, panic attacks, medical complications, or a sudden collapse in mood.
Shame is the fuel. The person often believes they are disgusting, weak, and broken. They may also be perfectionistic and terrified of being exposed. That shame makes them defensive when questioned. Families then back off because they do not want to cause conflict. That silence feels kind, but it is also permission for the disorder to continue.
Why this combination is medically risky
Eating disorders already strain the heart, hormones, digestion, and brain. Add alcohol, stimulants, vomiting, dehydration, and you increase the risk of heart rhythm problems, electrolyte imbalance, fainting, seizures, and severe mood instability. The person may still look “normal” because appearance is not a reliable indicator of medical risk. That is why waiting for someone to look sick is a dangerous mistake. Many people are in serious danger long before their body shows it clearly.
The mental risk is also high. Eating disorders are linked to self harm and suicidal thinking, especially when shame is intense and the person feels trapped. Add substances and you add impulsivity. Impulsivity is what turns thoughts into actions. Families often think the person would never do something drastic because they seem in control. The truth is that control can snap when the system collapses.
You cannot treat the substance and ignore the control disorder
If you treat addiction without addressing the eating disorder, the person often clings harder to food control to replace the substance. If you treat the eating disorder without addressing substance use, the person keeps using chemicals to manage anxiety and discomfort, and the therapy cannot fully land. Treatment needs to be integrated, medically informed, and structured.
The first step is assessment, medical and psychological. You need to know risk levels, malnutrition, heart risk, withdrawal risk, and mental health risk. Then you need stabilisation, routine meals, sleep routine, reduced secrecy, reduced access to substances, and accountability. Therapy must address perfectionism, body image distortions, shame, trauma where relevant, and the person’s relationship with control. Family work matters because family patterns can either support recovery or keep the disorder comfortable.
One of the most important shifts is teaching families to stop negotiating with the disorder. If the person is using substances and restrictive eating to control their world, gentle hints rarely work. Clear boundaries work better. That does not mean cruelty. It means clarity. We will support treatment. We will not fund substances. We will not participate in secrecy. We will not tiptoe around obvious danger signs. We will not pretend this is just a phase.
Control is a coping strategy that can turn fatal
Eating disorders and addiction are not fixed by willpower. They are systems built around fear, shame, and the illusion of control. The person does not need more judgement. They need real intervention, structured treatment, and a household that stops rewarding secrecy. If you are the person struggling, the hardest truth is this, the thing you are using to feel safe is making you less safe. If you are the family, the hardest truth is this, silence is not kindness. Kindness is action.