Eating Disorders and Anxiety

Eating disorders often go hand in hand with one or more other mental illnesses, such as anxiety, due to the associated negative feelings and low self esteem which are present with both conditions.

The topic of co-morbidity of eating disorders and anxiety disorders such as obsessive compulsive disorder (OCD) has attracted a high level of interest, with recent research presenting varying opinions on the topic.

The debate as to whether a mental illness such as anxiety precedes the onset of an eating disorder, and  thus is a determining factor, or occurs as a result of the eating disorder, and thus is a symptom, is ongoing.

Because of the complicated nature of eating disorders, and the fact no two eating disorders are the same, both arguments may present an element of truth in different cases. As with many other aspects of eating disorders (such as risk factors, causes and even the most effective treatment), there is no conclusive evidence one way or another. The reality is that most people who experience an eating disorder will also encounter a level of  anxiety at some point.

Treating the Underlying Causes

Eating disorders are sometimes diagnosed in the same people who receive anxiety treatment and research shows that eating disorders and anxiety co-occur at an alarming rate.

The two main types of eating disorders are anorexia nervosa and bulimia nervosa. People with anorexia nervosa have an intense fear of becoming overweight. As a result, they severely restrict food intake, often bringing themselves to the brink of starvation. People with bulimia nervosa engage in a binge-purge cycle. They will eat large amounts of food and then take measures to get it out of their system such as vomiting, taking laxatives, abusing diuretics, or exercising excessively.

Social Phobia, Anxiety and Eating Disorders

Some of the symptoms of social phobia appear very similar to the symptoms of eating disorders. Fear of eating in public is a symptom common of both social phobia and eating disorders, but the specific types of behavior and the motivation underlying the behavior are quite different.

People with anorexia are concerned about being judged for overeating or being overweight, and may develop unusual patterns or rituals such as shifting food around on their plate or cutting food into tiny pieces.

People with social phobia are not concerned with eating behavior directly. They are intensely worried that others will notice the symptoms of their anxiety while eating, such as trembling hands or spilled food. People with social phobia usually have a range of social fears in addition to the fear of eating in front of others, while those with eating disorders tend to report few other social anxieties.

When Anxiety and Eating Disorders Co-occur

A 2004 study on eating disorders and anxiety in the American Journal of Psychiatry examined the relationship between anxiety and eating disorders in 672 people with anorexia, bulimia, or both disorders. The study participants were evaluated in terms of anxiety, perfectionism, and obsessive behavior using a diagnostic interview based on the DSM-IV criteria. The results of the study showed that approximately two-thirds of those who had an eating disorder also suffered from an anxiety disorder.

Forty percent of the study participants were diagnosed as having obsessive-compulsive disorder (OCD) in addition to an eating disorder, and 20% were diagnosed with social anxiety disorder. The majority of those with both an anxiety disorder and an eating disorder reported that their anxiety symptoms came first.

Eating disorders frequently co-occur with anxiety disorders and both have a strong genetic component. The same foods that can aggravate anxiety disorders may be problematic for someone with an eating disorder.

Research on Anxiety and Eating Disorders

A 2008 study on eating disorders and anxiety at Princeton University discovered that bingeing on sugar may activate neural pathways in a manner similar to taking drugs of abuse, resulting in related signs of dependence. The researchers concluded that sugar increased anxiety, binging behavior, and dependence, reinforcing the idea that sugar and other foods can be addictive.

Treatment of Anxiety Eating Disorders

Although the eating disorders and anxiety research shows that anxiety disorders tend to precede eating disorders, specific anxiety disorders seem to be more likely to occur with either anorexia nervosa or bulimia nervosa. More research should be done with control groups and with comparison groups with other psychiatric disorders to determine how risk-specific the anxiety disorders are for later development of eating disorders. It is important to understand the nature of the interaction between these two sets of disorders because of the implications for disease management and treatment.