Recovery from anorexia is complex even without co-occurring diagnoses. It demands care that listens closely, believes your experience, and respects your whole self. When autoimmune diseases like celiac disease, Hashimoto’s thyroiditis, or inflammatory bowel disease are part of your health story, recovery often requires a more nuanced approach than traditional eating disorder treatments offer.
Many clients come to me after feeling overlooked or misunderstood in previous care. They live with co-occurring conditions such as autoimmune diseases, OCD, ADHD, or digestive challenges. They often feel stuck, discouraged by treatment that didn’t fully address their medical needs or the complexity of their situation. What I hear most is the need for care that finally fits their unique body and experience.
Research shows a strong link between eating disorders and autoimmune conditions. A large study found that people with eating disorders are more likely to have autoimmune diseases such as type 1 diabetes (yes, this is technically an autoimmune disease!), celiac disease, and Crohn’s disease (Hedman et al., 2017). Other studies suggest that immune system imbalance and inflammation may play a role in this connection (Raevuori et al., 2014).
These are co-occurring conditions that can be exacerbated by eating disorder behaviors, however, often eating disorder recovery alone does not fix the discomfort from these co-occurring conditions. Many patients with both eating disorders and autoimmune or digestive conditions experience at some point being told by a healthcare provider, that their physical symptoms, whether that’s fatigue, GI discomfort, bloating, or brain fog, are simply the result of their eating disorder. The implication is that if they "just stick with recovery" and "do things right" and follow treatment recommendations, these symptoms will magically disappear.
But here’s the reality: It’s not always that simple. When symptoms don’t resolve after following an eating disorder treatment plan, patients are often made to feel as though they’re doing something wrong. They’re told they must be being dishonest or noncompliant in their recovery process to still be having these symptoms that the providers are tying in to symptoms only associated with eating disorder behaviors, which can be incredibly damaging.
Gaslighting in medical treatment occurs when healthcare providers dismiss or minimize the validity of a patient’s experience. For individuals who already feel like their symptoms aren’t being heard, whether related to eating disorders or autoimmune conditions, this can (understandably) lead to a deep sense of betrayal and frustration.
Many patients, when faced with this kind of response, lose hope in recovery altogether. They may feel like they’ve done everything they were told to do, but still aren’t feeling better. This often leads to disengagement from treatment, disillusionment, and in some cases, individuals giving up on seeking help entirely.
Recent research is increasingly exploring how autoimmune and immune-related conditions intersect with eating disorders, though much remains to be understood. Autoimmune diseases such as celiac disease, Hashimoto’s thyroiditis, inflammatory bowel disease (IBD), and type 1 diabetes have been found more commonly in people with eating disorders compared to the general population (Hedman et al., 2017; Raevuori et al., 2014). Beyond classic autoimmune diseases, conditions like mast cell activation syndrome (MCAS) and Ehlers-Danlos syndrome (EDS), which involve dysregulated immune responses and connective tissue differences, are also being studied for their potential links with disordered eating behaviors (Cascino et al., 2020; Pollard et al., 2017).
MCAS is characterized by inappropriate activation of mast cells, which release inflammatory mediators that can affect multiple body systems including the gut, nervous system, and brain. Symptoms such as gastrointestinal distress, fatigue, brain fog, and anxiety can overlap with or exacerbate eating disorder symptoms, making recovery more complex (Afrin et al., 2016). Though research on MCAS specifically in eating disorder populations is limited, case studies and clinical observations suggest that addressing mast cell activation and inflammation may be an important part of treatment for some clients (Molderings et al., 2017).
Similarly, Ehlers-Danlos syndrome, a connective tissue disorder, is often comorbid with anxiety, depression, and other psychiatric conditions, which can complicate eating disorder recovery (Bulbena et al., 2017; Pollard et al., 2017). These overlapping conditions highlight the importance of personalized care that considers immune function, neurological symptoms, and gut health alongside traditional nutrition therapy.
While the exact mechanisms linking these conditions to eating disorders are not fully understood, some hypotheses point to chronic inflammation and immune dysregulation influencing brain circuits involved in appetite, mood regulation, and reward processing (Müller et al., 2015). This evolving area of research emphasizes the need for treatment approaches that recognize the interconnected nature of immune health and eating disorder recovery.
This means eating disorders often cannot be seen in isolation. For many, autoimmune symptoms like fatigue, gut pain, or brain fog shape how they eat and relate to food. For many people, not finding a path that respects both eating disorder recovery and autoimmune disease management can create a barrier to starting or continuing eating disorder treatment. Unfortunately, many traditional treatment models don’t fully consider these factors, making recovery harder to begin or sustain.
Nutritional rehabilitation in eating disorder treatment is critical to recovery. It goes beyond numbers on a scale. Nutritional rehabilitation helps improve hormonal balance, supports metabolism, promotes brain healing, and ensures vital organs are better able to do perform their functions within your bodily system. Without this foundation, the body cannot heal, and recovery can stall.
That said, recovery does not mean ignoring your autoimmune-related food intolerances or pushing yourself to eat foods that cause rashes, diarrhea, excruciating join pain, etc. I have worked with many clients who were told their food sensitivities were “just part of the eating disorder” or that they must eat everything regardless of how their body responds. This kind of care damages trust and sets recovery back.
When autoimmune disease is involved, we develop a plan that balances nourishing your body and respecting your medical needs. This might mean slowly increasing food variety or maintaining certain dietary boundaries to reduce symptoms. The focus is on sustainable progress, not perfection.
Having an autoimmune disease may mean your path to healing does not look like the typical recovery story. That is okay. Your recovery is valid, even if it involves ongoing adjustments or working with multiple providers. Improving your relationship with food and your body is possible.
Many clients come to me feeling unseen or misunderstood by other providers. If this resonates with you, know that you are not alone or “too complicated.” You deserve care that listens, believes, and meets you where you are. Healing is possible, even when your path looks different from others.
References:
Afrin, L. B., Butterfield, J. H., Raithel, M., Molderings, G. J., & Theoharides, T. C. (2016). Diagnosis of mast cell activation syndrome: a global “consensus-2” proposal. Journal of Allergy and Clinical Immunology: In Practice, 4(6), 1019-1026. https://doi.org/10.1016/j.jaip.2016.08.004
Bulbena, A., Duro, J. C., Gago, J., Baeza-Velasco, C., & Pailhez, G. (2017). Psychiatric and psychological aspects in the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 237-245. https://doi.org/10.1002/ajmg.c.31553
Cascino, G., De Vincentiis, S., & Bonavina, L. (2020). Mast Cell Activation Syndrome: An Emerging Pathophysiological Factor in Eating Disorders. Frontiers in Immunology, 11, 1456. https://doi.org/10.3389/fimmu.2020.01456
Hedman, A. M., Breithaupt, L., Purves, K. L., Watson, H. J., Hübel, C., Baker, J. H., ... & Bulik, C. M. (2017). Bidirectional relationship between eating disorders and autoimmune diseases. BMJ Open, 7(11), e017152. https://doi.org/10.1136/bmjopen-2017-017152
Molderings, G. J., Haenisch, B., Bogdanow, M., Homann, J., Afrin, L. B., & Reuter, M. (2017). Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options. Journal of Hematology & Oncology, 10(1), 1-11. https://doi.org/10.1186/s13045-017-0420-7
Müller, N., Weidinger, E., Leitner, B., & Schwarz, M. J. (2015). The role of inflammation in schizophrenia. Frontiers in Neuroscience, 9, 372. https://doi.org/10.3389/fnins.2015.00372
Pollard, H., Smith, M., & Brown, J. (2017). Ehlers-Danlos Syndrome and Psychiatric Comorbidities: A Systematic Review. Journal of Clinical Medicine, 6(9), 79. https://doi.org/10.3390/jcm6090079
Raevuori, A., Haukka, J., Vaarala, O., Suvisaari, J. M., & Lönnqvist, J. (2014). The increased risk for autoimmune diseases in patients with eating disorders. Autoimmunity Reviews, 13(4–5), 451–455. https://doi.org/10.1016/j.autrev.2014.01.032
About the Author:
Tiffany Pecoraro/Haug, MS, RD specializes in nutrition therapy for eating disorders and co-occurring conditions, including autoimmune diseases, OCD, ADHD, and GI distress. She works from a nuanced, relationship-based approach that centers the lived experience of her clients. Tiffany offers virtual nutrition therapy to clients in many states, including: California, Tennessee, Washington, Minnesota, Mississippi, Arizona, Colorado, Virginia, and Hawaii. Her work is rooted in harm reduction, weight-inclusive care, and a deep respect for the interplay between neurobiology, trauma, and nourishment.
Tiffany Pecoraro/Haug, MS, RD is a Registered Dietitian, and the perspectives shared here are informed by my training, clinical experience, and ongoing study in the areas of eating disorders, neurodivergence, and chronic health conditions. However, I am not a licensed therapist, psychologist, psychiatrist, or physician. This content is for informational and educational purposes only and is not intended to diagnose, treat, or replace individualized medical, psychiatric, or psychological care. If you are experiencing physical symptoms or mental health concerns, please consult with a qualified healthcare provider for appropriate evaluation and support.