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What’s the REAL Relationship Between Anxiety and Eating Disorders?

Anxiety and Eating Disorders often co-occur. Anxiety can begin before an Eating Disorder, around the same time, or after the onset of an Eating Disorder. This chronology has led many to wonder about the real relationship between anxiety and Eating Disorders.

So, let’s unpack this. First, anxiety.

Think of anxiety as on a continuum.

On one end is minimal anxiety. On the other end is severe anxiety. As anxiety approaches the ‘severe’ end of the continuum, it becomes an Anxiety Disorder. To be a disorder means symptoms interfere with daily life and impair functioning.

There are many different kinds of Anxiety Disorders.

They include: Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Simple Phobia, Panic Disorder, Social Anxiety Disorder, and Post-traumatic Stress Disorder.

To have an official disorder of any type means you meet specific criteria outlined by the Diagnostic and Statistical Manual (DSM). This is true for Anxiety Disorders and Eating Disorders. The DSM is THE official handbook that outlines and describes all psychiatric conditions.

In the DSM category of Eating Disorders, three main types include Anorexia nervosa, Bulimia nervosa, and Binge Eating Disorder.

Eating Disorder symptoms are challenging to treat. Plus, people with an Eating Disorder often have other psychological conditions too.

Guess which DSM diagnosis occurs most frequently among people with a DSM diagnosed Eating Disorder?

You guessed it: Anxiety!

Anxiety is the most common condition people with an eating disorder have.

In fact, 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with an Anxiety Disorder.

Far more people with an Eating Disorder have anxiety, but to a lesser degree than someone with a DSM Anxiety Disorder.

By the way, there is little research on the prevalence of Eating Disorders among people with an Anxiety Disorder.

One of the most common forms of anxiety that co-occurs with Eating Disorders is Obsessive Compulsive Disorder (OCD). In fact, OCD usually occurs first and is considered by some a risk factor for developing an Eating Disorder.

Anorexia nervosa is the Eating Disorder than most often overlaps with OCD.

The other two Anxiety Disorders most often associated with Anorexia are Social Anxiety Disorder and Generalized Anxiety Disorder. (Social anxiety disorder is also more common in people with bulimia than in people without an Eating Disorder.)

Actually, Social Anxiety Disorder is the anxiety disorder that occurs most often among people with any type of Eating Disorder (not only Anorexia.).

Think about the implications of co-occurring Social Anxiety Disorder and Eating Disorders.

When someone has Social Anxiety Disorder, they may be that much more reluctant to seek treatment. Having Social Anxiety makes getting help for an Eating Disorder (and the for Anxiety Disorder for that matter) that much harder. And less likely.

Delaying or avoiding treatment worsens the prognosis for someone with an Eating Disorder. Or with an Anxiety Disorder. Or with both.

Let’s put the pieces together: Anxiety Disorders seem to occur more often in people with an Eating Disorder than in the general population. We also have evidence that Anxiety Disorders likely emerge before an Eating Disorder.

What does this mean?

The sequence suggests that early onset anxiety may increase the risk of developing an Eating Disorder. This is especially true of Social Anxiety Disorder.

The research on the relationship between Eating Disorders and anxiety is difficult to interpret. One reason is because of all the combinations of different Eating Disorder and Anxiety Disorder diagnoses. (As outlined in the beginning of this article.) There are methodological problems in some of the research that also makes it tough to evaluate.

So the inconsistencies complicate the understanding of co-occurring anxiety and Eating Disorders.

Regardless, though, treatment for one often benefits the other.

For example, Cognitive Behavior Therapy (CBT) is one of the treatments of choice for Eating Disorders and Anxiety Disorders.

CBT is based on the idea that psychological problems are the result of distorted ways of thinking and unhelpful behavior. Through the use of specific techniques, CBT helps people learn to cope better with everyday kinds of things. Improved coping decreases their need to use Eating Disorder behaviors. The same sort of techniques are useful in treating Social Anxiety Disorder.

Another plus to mention is that certain medications called Selective Serotonin Reuptake Inhibitors (SSRIs) can be helpful. They are often part of an effective treatment plan for Anxiety and Eating Disorders. SSRI’s were originally developed to treat depression. (They help treat depression too!)

So what is the REAL relationship between Anxiety and Eating Disorders? It depends on which research findings you read.

My professional experience is that anxiety is practically always present before an Eating Disorder develops.

Anxiety can be one of the reasons why an Eating Disorder develops in the first place.

How so? Well, in an attempt not to feel anxious, a person turns to Eating Disorder symptoms. Usually this is not conscious.

Anxiety may then decrease, but only artificially. It is still there. An Eating Disorder masks it. But, the person no longer feels as anxious. The more she relies on Eating Disorder symptoms, the less anxiety she feels. An entrenched cycle has begun.

Anxiety also occurs during an Eating Disorder. Maybe because of sneaky behaviors that are involved. Or due to malnourishment.

Anxiety also occurs after an Eating Disorder and as part of recovery. Why? Well, change can be scary. Feelings are no longer numbed by an Eating Disorder. Instead, CBT and medication provide more skillful ways to be in the world. But learning and changing take time. There is no quick fix.

Both Anxiety and Eating Disorders are treatable. To be you, without symptoms of Anxiety or of an Eating Disorder is possible. Whichever type of Anxiety Disorder or Eating Disorder you have, seek treatment that addresses both. Doing so will be one of the best investments you will ever make.

Dr Elayne Daniels is a private practice psychologist in Massachusetts, specializing in the treatment of people with Eating Disorders and co-occurring conditions of all types.

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