Eating disorders and anxiety often occur together. Approximately 65% of people with an eating disorder also meet the criteria for an anxiety disorder. A built-in aspect of eating disorders is experiencing anxiety surrounding food and body image. Additionally, individuals with anxiety may develop an eating disorder as an unhealthy way to distract from and numb their anxiety.
Anxiety and eating disorders are also connected because they develop from the same risk factors. Perfectionism, stress, sexual abuse, and trauma are strong risk factors for both disorders.2 Because of this overlap, it is important to treat both disorders simultaneously to ensure one disorder doesn’t keep triggering the other. When treated together, individuals with anxiety and eating disorders can heal completely.
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Can Anxiety Cause an Eating Disorder?
Chronic anxiety increases the risk of a person developing an eating disorder because controlling food can be a way for them to find relief from anxiety symptoms. At first, disordered eating may be used as an unhealthy coping mechanism and allow the person to feel calmer and less anxious. However, disordered eating easily spirals out of control, leading to the development of an eating disorder that makes anxiety worse than before.
Additionally, anxiety can initially cause a person to lose weight. If a person has struggled with an eating disorder in the past, this weight loss can trigger disordered thoughts that re-spiral them into their eating disorder.
Can Social Anxiety Cause an Eating Disorder?
Social anxiety, in particular, can increase a person’s risk of developing an eating disorder because individuals with social anxiety are more likely to worry about other people’s judgment of their physical appearance and how that impacts them socially. This can cause a person to try to perfect their physical appearance, which can quickly develop into an eating disorder.4
Can OCD Cause an Eating Disorder?
Although research does not indicate that obsessive-compulsive disorder can cause an eating disorder, individuals with obsessive-compulsive disorder (OCD) are at a higher risk for developing eating disorders.5 OCD is characterized by unwanted, intrusive thoughts followed by compulsive rituals. Similarly, people with eating disorders experience obsessive thinking about food, weight, and control. If an individual with OCD experiences obsessions regarding their weight, shape, or appearance, they may develop compulsive eating disorder behavior. This is especially common for individuals with just right OCD.
Why Do Eating Disorders Cause Anxiety?
Eating disorders cause anxiety because of the stress and physical damage they create. People with eating disorders often have anxiety about gaining weight and excessively worry about calories, exercise, and how their bodies look. They also may have a fear of losing control over their body or ruminate about not eating the “perfect” diet. In severe conditions, anxiety can dictate nearly every food-related decision they make.
Physically, eating disorders harm the body, which can cause the person to worry about the permanent damage that may be occurring. Additionally, eating disorders can create imbalances in the brain, which can make managing anxiety even more difficult.
Here is how the different types of eating disorders can cause anxiety:
Anorexia & Anxiety
Anorexia nervosa is a restrictive eating disorder associated with dangerously low body weight and an obsession with thinness. Individuals with anorexia will experience anxiety before meal times in anticipation of needing to eat. They can experience anxiety during the meal, wondering if others are noticing they are not eating. Finally, they will experience anxiety after eating if they feel like they ate too much.
Physically, anorexia causes severe malnutrition, which can lead to osteoporosis, heart problems, and fertility issues. Individuals with anorexia may have anxiety about the damage they are doing to their body.
Bulimia & Anxiety
Bulimia nervosa is characterized by binging and then purging repeatedly, along with an obsession with thinness. Anxiety can trigger bulimic behaviors like binging and purging as a way to try to cope with distressing emotions. However, any relief that these behaviors bring is short-lived and ultimately leads to more anxiety.
Individuals suffering from bulimia often worry about possibly binging when they are around food. After eating, they may experience anxiety about how/where they can purge privately and how soon after eating they need to purge to ensure the food isn’t digested. Additionally, they may worry about the physical damage bulimia can cause, including gastrointestinal issues and damage to the teeth and esophagus.
Binge Eating & Anxiety
Binge eating disorder is characterized by frequent food binges. A person may develop a binge eating disorder as a way to manage stress and anxiety. While binging, they may experience temporary relief, but before and after the binge, the person’s anxiety will spike.
Before a binge, a person may have anxiety about whether they can avoid binging. While binging, they may have anxiety that others will notice their binging. After binging, they may be anxious about replenishing the food they ate so no one notices. They also may worry about the physical consequences of binging, including possibly developing heart disease, type 2 diabetes, and high blood pressure.
ARFID & Anxiety
Avoidant restrictive food intake disorder (ARFID) is characterized by little to no interest in eating food. People with ARFID are not concerned about losing weight or their body image, but they do experience ongoing distress and anxiety while eating food because of the taste or texture.3
Orthorexia & Anxiety
Orthorexia is characterized by an obsessive focus on eating “clean” or “pure” foods to the extent that it harms the person’s emotional and physical well-being. Individuals struggling with orthorexia may experience anxiety when shopping for groceries, obsessively checking and rechecking ingredients. They also may feel anxious when eating food that they did not cook because they cannot know whether the ingredients are “pure.” Finally, they may feel anxious after eating food that they do not consider to be “clean” enough.
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How to Cope With an Eating Disorder & Anxiety
Learning both coping skills for eating disorders and coping skills for anxiety is important to stop the cycle of one disorder making the other worse. Every person will find different skills that work for them, and no one skill is healthier than another. The key is consistency. It can also be helpful to keep a list of coping skills that have worked because when in crisis, it can be difficult to remember the coping skills one has developed.
Here are ten ways to cope with anxiety and eating disorders:
1. Challenge Your Negative Thoughts
Challenging negative thoughts can help with anxiety and eating disorders by allowing a person to replace harsh self-criticisms and unrealistic expectations with healthier thoughts. It can specifically help with overcoming thoughts related to perfectionism or body image. One example is to replace “I am a failure if I eat this” with “I need food to give my body the fuel it needs to function.”
2. Expand Your Support System
Expanding your support system can be a helpful part of healing, as it provides a safety net. This can help difficult tasks like meal planning or dealing with anxiety triggers feel more manageable. A strong support system can help a person feel accomplished when they take on challenges and also reduce the loneliness that an eating disorder causes and makes anxiety worse.
Here are some tips for how to expand your support system:
- Open up to friends and family about your struggles
- Join a support group for eating disorders
- Find hobbies or activities that connect you with others who share similar interests
- Write a list of things you need support for and ask for help from people you trust
- Seek out activities that can calm anxiety, like yoga, meditation, or other wellness classes
3. Engage in Healthy Distractions
Healthy distractions can help anxiety and an eating disorder by providing a person with a break from the cycle of negative thoughts and behaviors. For example, engaging in hobbies like painting, gardening, or playing a musical instrument can take attention away from obsessive, anxious thoughts about food and body image.
4. Practice Mindfulness Throughout Your Day
Mindfulness can ease anxiety and help with eating disorders. By focusing on the present moment, mindfulness can help to stop rumination and worry. For instance, mindful eating can help individuals struggling with an eating disorder reconnect with the taste, texture, and sensations of food rather than with anxious thoughts about how the food will impact their body.
5. Journal for 5-10 Minutes
Journaling for just 5-10 minutes a day can offer a powerful outlet for coping with anxiety and eating disorders. It provides a way to express feelings, track patterns, and reflect on goals, which can help reduce symptoms like intrusive thoughts and feelings of isolation by externalizing them. For instance, journal prompts for anxiety can help a person to identify what is making them anxious and what coping skills can help them instead of turning to their eating disorder to cope.
6. Use Positive Affirmations
Repeating body positive affirmations like “I am worthy of respect and care, regardless of my size” or “I choose to treat my body with kindness” can help a person begin to overcome self-criticism, low self-esteem, and body dissatisfaction. This can shift the focus from feeling guilty about what they are eating to a more compassionate mindset of nourishing one’s body.
7. Establish a Routine
A predictable schedule can reduce the uncertainty and decision-making that can increase anxiety for people with eating disorders. This can include regular meal times, exercise, or relaxing activities that are built into the daily routine.
8. Focus on Self-Compassion
Self-compassion and learning to love oneself are key for healing from anxiety and eating disorders, as they can reduce feelings of shame and self-doubt that feed into both conditions. Replacing self-critical thoughts with positive messages can reduce perfectionism and build a healthier relationship with oneself.
9. Engage in Physical Activity
Physical activity can reduce anxiety and increase endorphins, improving mood and outlook. Gentle, non-competitive activities like walking or yoga for anxiety can be especially helpful for people with eating disorders. It’s important to think of movement as self-care rather than as a tool for weight loss.
10. Stay Away From Triggers
Identifying and staying away from triggers whenever possible is an important part of managing anxiety and eating disorders. Triggers may include certain people, specific foods, or social media showing unrealistic body standards or thinspo. Setting boundaries around these triggers can help individuals reduce anxiety and the risk of disordered eating.
How Are Eating & Anxiety Disorders Treated?
Recovery from any mental illness is complex, but it’s important to treat both conditions together. Treating anxiety without addressing an eating disorder may cause someone to spiral deeper into their eating disorder. It’s common for people to feel worse once they gain awareness of their anxiety triggers. They may attempt to cope with these challenging feelings using the self-destructive behaviors of their eating disorder.
At the same time, it’s unhelpful to only treat an eating disorder without treating the anxiety. Stopping eating disorder behaviors usually causes someone to feel more anxious or out of control. The person needs to know how to cope with their anxiety to avoid relapsing into disordered behavior.
Treatment for anxiety and eating disorders may involve:
Therapy
Comprehensive therapy should focus on managing anxiety and increasing healthy coping skills for eating disorders. When people can reduce stress–and consistently practice better self-care–they will be less likely to use their eating disorder to cope.
Research shows that cognitive therapies, such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), tend to be effective for both anxiety and eating disorders. CBT for anxiety focuses on changing negative thought patterns and developing healthier coping strategies. DBT for anxiety and DBT for eating disorders help people regulate their emotions, practice distress tolerance, and implement healthier social skills. CBT for eating disorders (CBT-E) blends psychoeducation and self-monitoring to reduce eating disorder habits.
One type of therapy isn’t inherently better than another. Instead, it’s about finding a type of therapy that feels right for you. Furthermore, it’s most important that you feel safe and supported by your therapist during this process.
Medications
Anti-anxiety medications may be useful for people experiencing anxiety and eating disorders by reducing anxiety, which can help the person cope with their eating disorder more easily. There are no FDA-recommended medications for anorexia. However, several studies have demonstrated the efficacy of Topamax, Prozac, Norpramin, and Buspar as medications for binge eating disorder and bulimia nervosa.6
Group Therapy & Support Groups
Group therapy and support groups for co-occurring disorders are intended for people who experience multiple mental health issues, such as anxiety and eating disorders. These groups can be helpful in providing support, validation, and a sense of personal accountability. These groups take place in numerous settings, including hospitals, schools, nonprofit facilities, and private practices. Group therapy and support groups are also available online.
How to Find Professional Support
Finding professional support for anxiety and an eating disorder is easier if you know where to start. An online therapist directory is a great way to search for providers in your area who specialize in treating a co-occurring eating disorder and anxiety. You can also filter for therapists who take your insurance. Reading profiles and reviews can give you a sense of a clinician’s personality and approach. Alternatively, an online therapy platform for anxiety may be an option worth exploring if you would find therapy online in your own home to be more comfortable or accessible.
In My Experience
Frequently Asked Questions
What Percent of People With Eating Disorders Have Anxiety?
The correlation between anxiety and eating disorders is high. 47.9% of adults with anorexia nervosa, 80.6% of adults with bulimia nervosa, and 65.1% of adults with binge-eating disorder also have an anxiety disorder.7
Is Food Anxiety an Eating Disorder?
Food anxiety is not classified as an eating disorder and is not an official diagnosis in the DSM-5. However, it can occur alongside eating disorders like anorexia and bulimia. Food anxiety can be related to personality traits like perfectionism, concerns about body image, or a fixation on healthy eating. Food anxiety is more than just picky eating and can cause significant fear related to food.
Is Anorexia an Anxiety Disorder?
Anorexia is an eating disorder, not an anxiety disorder. While anorexia can cause feelings of anxiety when it comes to food, weight, or eating, eating disorders are in a different category than anxiety disorders. Anxiety and anorexia or other eating disorders often co-occur. In anorexia, anxiety is often higher before, during, or after a meal, making this an important time for support.
Can Overeating Cause Anxiety?
Like any other unhealthy coping skill or compulsive behavior, overeating can lead to an increase in anxiety. Overeating can lead to stress, guilt, or regret, which contributes to anxiety. It can also cause psychological changes such as discomfort or blood sugar shifts, which impact mood and increase anxiety. If overeating is used as a coping tool for stress, any relief it provides will be short-lived.
Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Hilbert, A., Pike, K. M., Goldschmidt, A. B., Wilfley, D. E., Fairburn, C. G., Dohm, F. A., Walsh, B. T., & Striegel Weissman, R. (2014). Risk factors across the eating disorders. Psychiatry research, 220(1-2), 500–506. https://doi.org/10.1016/j.psychres.2014.05.054
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Mayo Clinic. (n.d.). Anxiety: Symptoms & causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
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Diamantis, D. V., Emmett, P. M., & Taylor, C. M. (2023). Effect of being a persistent picky eater on feeding difficulties in school-aged children. Appetite, 183, 106483. https://doi.org/10.1016/j.appet.2023.106483
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Levinson, C. A., & Rodebaugh, T. L. (2012). Social anxiety and eating disorder comorbidity: the role of negative social evaluation fears. Eating behaviors, 13(1), 27–35. https://doi.org/10.1016/j.eatbeh.2011.11.006
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International OCD Foundation. (n.d.). Expert opinion: Eating disorders and OCD. Retrieved from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
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Gorla, K., & Mathews, M. (2005). Pharmacological treatment of eating disorders. Psychiatry (Edgmont (Pa. : Township)), 2(6), 43–48.
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National Institute of Mental Health. (n.d.). Eating Disorders. NIMH. Retrieved from https://www.nimh.nih.gov/health/statistics/eating-disorders
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: Nicole Arzt, LMFT (No Change)
Medical Reviewer: Kristen Fuller, MD (No Change)
Primary Changes: Added sections titled “Can Anxiety Cause an Eating Disorder?”, “Can OCD Cause an Eating Disorder?”, “Why Do Eating Disorders Cause Anxiety?”, “How to Cope With an Eating Disorder & Anxiety”, “How to Find Professional Support”, and “FAQs”. New content written by Michelle Risser, LISW-S, and medically reviewed by Kristen Fuller, MD. Fact-checked and edited for improved readability and clarity.
Author: Nicole Arzt, LMFT
Reviewer: Kristen Fuller, MD
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