Anxiety and Eating Disorders
Eating disorders often present with other diagnoses. One of the more common co-occurring disorders is anxiety. Researchers and providers recognize that the relationship between these disorders is intertwined and complex.
What is anxiety?
Anxious feelings like stress and worry are normal reactions while under pressure and usually go away once the situation or "stressor" has passed. For some people, however, these feelings occur for no reason or continue long after the stressor is gone. This, simply put, is anxiety. There are many types of anxiety disorders including Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, Panic Disorder, phobias, and generalized anxiety disorders and each has its own diverse set of symptoms. Some of the most common across the group include:
- Hot and/or cold flashes
- Racing pulse
- Tightening of the chest
- "Snowballing" worries
- Obsessive thinking
- Compulsive behavior
These symptoms often develop gradually over time and, given that we all experience anxious feelings throughout our lives, it can be difficult to recognize how much is too much. To be diagnosed with an anxiety condition, the condition and its symptoms must have a debilitating impact on a patient's life.
The relationship between anxiety and eating disorders
Though their influence on one another is still becoming clear, it is evident that anxiety and eating disorders like anorexia or bulimia nervosa are in some capacity related. A commonly cited study published by the American Journal of Psychiatry, "Comorbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa," found that roughly two thirds (64%) of the 672 disordered eating patients they studied had one or more anxiety disorders at some point in their life. By comparison, the authors noted that the percentage of people in the community (i.e.: those without an eating disorder) that had at some point suffered from an anxiety disorder ranged 12.7% - 30.5%, depending on the study referenced. Independent of this study, it is estimated that 37% of those with Binge Eating Disorder are also diagnosed with an anxiety disorder. (As a newly classified diagnosis, it is important to note that there is less research on the link between BED and anxiety disorders.)
Why patients with disordered eating habits display such significantly higher rates of anxiety is still a mystery of sorts. While it is known that the two conditions share many risk factors including biological, genetic, social, and psychological conditions, the question if one causes the other is still debated. Anxiety can make people feel negative about their bodies or lead to compulsive rituals involving food - putting patients at risk for an eating disorder. On the other hand, eating disorders, especially those involving rapid weight loss or starvation, put the patient under extreme stress, increasing the chances of developing an anxiety disorder. The study referenced above found instances of both scenarios, though participants were more likely to have had anxiety before developing an eating disorder.
Other interesting findings have emerged in the research dealing with these two conditions, including:
- The most common anxiety disorder among eating disorder patients is obsessive compulsive disorder, followed by social phobia
- The rates of specific anxiety disorders are similar across the eating disorder subtypes anorexia nervosa, bulimia nervosa, and anorexia nervosa/bulimia
- People with a history of an eating disorder who were not currently ill and never had an anxiety disorder diagnosis still tend to be anxious, perfectionistic, and harm avoidant
Anxiety and eating disorders can be treated at the same time and even share several methods of treatment. However, it is imperative for care providers and patients alike to remember that recovery from one does not guarantee recovery from the other - they need to be treated as separates with a coordinated treatment plan.
Treatments for anxiety range from physical exercise to prevent mild anxiety to psychological medications for more serious cases. Among some of the most common techniques to helping patients with anxiety are:
- Help change thinking and action patterns that are exposing them to anxiety
- Teach coping and problem-solving skills to successfully manage stressful circumstances
- Build confidence to face anxiety-inducing situations
- Differentiate between productive and unproductive worries
- Develop the ability to "let go" when necessary
- Work through relaxation and breathing exercise to control anxiety and physical tension
- Encourage a healthy diet and physical activity (as appropriate for an eating disorder patient)
- Discuss medication options such as antidepressants
At The Emily Program, our providers specialize in working with individuals struggling with co-occurring disorders including eating disorders and anxiety. We are committed to working with other community professionals to provide the best care possible and help people manage symptoms, but even more so, lead full, healthy lives.