Which came first, the chicken or the egg? The same can be said for anxiety and eating disorders (ED). Numerous studies have shown that in most cases of ED, people developed an anxiety disorder in childhood before onset; additionally, the National Institutes of Health (NIH) reported that as many as 65% of ED cases also met criteria for an anxiety disorder. The most common anxiety disorder that co-exists with ED is obsessive compulsive disorder (OCD), which can create unhealthy and compulsive rituals around eating habits.
Anxiety may exist with most ED, but may manifest itself differently based on specific behaviors exhibited by different types of ED. Let’s explore this…
Anorexia nervosa (AN) can be described as a pattern of disordered eating that revolves around distorted body image that influences excessive restrictive behaviors that lead to excessive weight loss and inability to gain weight. Recent studies have shown that co-occurring anxiety disorders are highest among the AN population than the general population. Anxiety typically derives from the excessive need to count calories or being hyper-focused on only consuming a certain food or certain type of food. Additionally, AN is often the only known ED by the general population due to the visible signs of excessive weight loss, which can generate anxiety due to feeling more noticed and unable to hide the fact that they are struggling.
Bulimia nervosa (BN) can be described as a cycle of binge eating and purging that revolves around over-evaluation of body weight and shape that is fueled by shame and guilt and breeds in secrecy. Most experts believe that anxiety and BN “go hand-in-hand” due to the excessive need to correct their binges by participating in compensatory behaviors; which include self-induced vomiting, abusing laxatives, excessively exercising, or restricting for two weeks or more after the binge episode. Typically, anxiety is present before a binge episode when someone is hyper-focused on certain parts of their body; then, anxiety typically dissipates and positive emotions emerge during a binge episode (which can last anywhere from a few hours to a few days) due to increased serotonin and dopamine levels from consuming food; finally, anxiety typically returns after a binge episode when the guilt and shame from binging behaviors return, fueling compensatory behaviors, starting the cycle over.
Binge Eating Disorder (BED) can be described as frequent episodes of consuming large amounts of food past the point of satiation due to heightened anxiety being present and using food as a coping mechanism. It is common for people who frequently binge to have almost immediate relief from anxiety symptoms, like BN, due to increased serotonin and dopamine levels from food consumption. Unfortunately, shortly after a binge, people who struggle with BED may experience embarrassment from feeling out of control during their binge, which can fuel shame and guilt, creating increased anxiety, and starting the cycle of their ED all over again.
In general, anxiety disorders can exacerbate symptoms of ED, making treatment more difficult. Due to this fact, it is important to treat the co-occurring disorders at the same time. Persistent monitoring of symptoms for both disorders is important for each clinician to consider as well as keeping themselves informed on updated evidence-based treatment to address symptoms. Our therapists at Niyyah are equipped to address these symptoms and walk with you through managing your presenting symptoms with the ultimate goal of eliminating them. Recovery from your ED is possible, you are not your ED, it does not define you. Reach out today!