Eating Disorders and Anxiety

Depressed Young Woman, Image Courtesy of David Castillo Dominici, FreeDigitalPhotos.net

According to the Anxiety and Depression Association of America (2012), anxiety disorders and eating disorders often occur together, and they can create a vicious circle with the symptoms of one disorder worsening the symptoms of the other and vice versa.

Eating disorders include anorexia, bulimia, and binge eating. A recent study conducted by Swinbourne et al. (2012) found that 65% of women who were being treated for eating disorders also had one or more anxiety disorders, and of these, just over two-thirds said that their anxiety disorders developed before their eating disorders. Some studies have found even higher rates of anxiety disorders associated with eating disorders (Bulik et al., 1997).

The most common anxiety disorder associated with eating disorders is social phobia. Other disorders that occur in conjunction with eating disorders include post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder/agoraphobia, and specific phobias (Swinbourne et al., 2012).

Anorexia

Anorexics believe they’re obese even if they’re actually very thin. They avoid many foods, skip meals, and consume very small quantities of food when they do eat. Some anorexics exercise excessively or purge using diuretics, laxatives, or enemas.

Anorexics can suffer a variety of unpleasant consequences, including lethargy, constipation, thinning bones, brittle fingernails and hair (which can lead to hair loss), yellowish dry skin, anemia, weakness, and muscle loss. Bulik et al.’s (1997) study of eating disorders and anxiety found that 90% of all anorexic women suffered from an anxiety disorder prior to developing anorexia.

Bulimia

Bulimics binge (eat a large quantity of food) and then purge by vomiting or using diuretics or laxatives. They may also fast or exercise excessively in between binges. Weight is often within the normal range, but the bulimic will usually feel that his eating is out of control and that his body is unattractive.

Potential complications associated with bulimia include chronically sore throat, accelerated tooth decay, gastroesophageal reflux disorder, dehydration, and kidney problems.  One survey found that just over 80% of bulimics have suffered from an anxiety disorder (Herrin & Matsumoto, 2011). Bulik et al. (1997) found an even higher rate among bulimic women at 94%.

Binge Eating Disorder

Binge eating disorder is characterized by regular consumption of enormous portions of food but no subsequent purging. Those with the disorder tend to be overweight or obese, and suffer from intense distress, guilt, and shame about their inability to control their eating.

Treatment of Eating Disorders

Although a desire to be thinner may seem to be the key feature in some eating disorders (particularly anorexia), such disorders indicate deeper, more profound issues that need to be addressed. Many people with eating disorders are trying to achieve more control over their lives (or at least the things they can control). Perfectionism, low self-esteem, anxiety, depression, and reactions to various societal and personal pressures may all play a role. Focusing solely on the thinness imperative can obscure these larger issues. Although many people with eating disorders appear to fixate on thinness or overall body image, this fixation has deeper roots in a variety of other problems.

Cognitive-behavioural therapy (CBT) is an effective treatment for all types of eating disorders, as well as the anxiety disorders that often accompany them. The advantage of CBT is that it can get to the root of the problem, challenging faulty beliefs and maladaptive behaviours in all realms of life, rather than just interactions with food. Benefits are typically achieved between 12 and 16 weeks of therapy, though there are exceptions to the rule.

Support groups can be beneficial for some people with eating disorders, and medication may be prescribed in certain cases. Nutritional counseling is also helpful. When eating disorders become sufficiently extreme that they’re life-threatening, hospitalization may be required.

When treating eating disorders, it’s often necessary to treat anxiety as well. In addition to effective clinical treatments for anxiety such as CBT, there are a number of complementary therapies that can be beneficial. See the Natural Anxiety and Panic Disorder Treatments page for more information.

If you suffer from depression, see the Depression page for information on types of depression and treatment options.

This article is provided for informational purposes only and is not intended as a substitute for medical or psychiatric advice. Medical concerns should be referred to a qualified doctor.

References:

• Anxiety and Depression Association of America. (2012). “Eating Disorders.” ADAA.org.
• Bulik, C.M.; Sullivan, P.F., Fear, J.L.; & Joyce, P.R. (1997). “Eating Disorders and Antecedent Anxiety Disorders:  A Controlled Study.” Acta Psychiatrica Scandinavica, 96, 101-107.
• Herrin, M., Dr., & Matsumoto, N. (2011, April 6). “Treating Eating Disorders and the Depression or Anxiety That Often Accompany Them.” Psychology Today, PsychologyToday.com.
• Swinbourne, J.; Hunt, C.; Abbott, M.; Russell, J.; St. Clare, T.; & Touyz, S. (2012). “The Comorbidity Between Eating Disorders and Anxiety Disorders: Prevalence in an Eating Disorder Sample and Anxiety Disorder Sample.” Australian and New Zealand Journal of Psychiatry, 46(2), 118-131.