Anxiety and eating disorders often go hand-in-hand, and it’s common for people to experience both mental health issues together. Anxiety is a common risk factor for disordered eating, and ongoing anxiety about weight, size, appearance, and perception of control can maintain problematic symptoms. Subsequently, eating disorder recovery often entails learning how to identify and manage anxiety-related issues.
How Are Anxiety & Eating Disorders Related?
Eating disorders inherently entail a strong current of anxiety. People with eating disorders often fear gaining weight; they may also worry about calories and exercise, and how their bodies look in particular garments. They dread losing control or not doing things “perfectly.” In severe conditions, anxiety can dictate nearly every food-related decision they make. Some people develop OCD-like rituals, or appear to develop phobic reactions to eating situations.
Research backs this relationship between eating disorders and anxiety. At least 65% of people with an eating disorder also meet the criteria for an anxiety disorder. In addition, the anxiety symptoms appear to predate and persist even beyond eating disorder remission.1
How Can One Cause the Other?
While eating and anxiety disorders can often co-occur simultaneously, there is no concrete evidence that one issue causes the other. Instead, it’s important to examine risk factors and potential variables that overlap. For example, someone who experiences high levels of anxiety may find that they can “channel” some of this anxiety into a specific focus (food or weight). This starts as an avoidance strategy–until the eating disorder becomes more consuming.
Perfectionism, sexual abuse, trauma, and a history of early dieting are strong risk factors for the development of an eating disorder.2 Likewise, perfectionism, stress, trauma, and other mental health disorders represent strong risk factors for anxiety.3
What Is Anxiety?
Anxiety is an overarching, broad term for excessive worry and preoccupied thinking. Anxiety symptoms can manifest both physically and emotionally, and they can have varying impacts on one’s level of functioning. Anxiety can be highly specific (such as having a certain phobia) or more generalized.
Common symptoms of anxiety include:
- Excessive worry
- Panic attacks
- Racing thoughts
- Dizziness or feeling lightheaded
- Chest tightness
- Rapid heartbeat
- Sweating or feeling hot
- Nightmares or other sleep disturbances
- Appetite fluctuations
- Persistent sense of dread
- Difficulty concentrating
- Feeling unable to control, manage, or stop the worry
What Are Eating Disorders?
Eating disorders refer to a cluster of mental health conditions characterized by problematic eating patterns. People with eating disorders such as anorexia, bulimia, or binge eating disorder experience significant distress over food and how their consumption may impact their weight, body size, or overall mood.
The most common eating disorders include:
- Anorexia nervosa: Anorexia is a restrictive eating disorder associated with dangerously low body weight, coupled with an excessive preoccupation with thinness. People with anorexia may also engage in compensatory behaviors to manage food intake, but restriction is the most characteristic feature. This condition is most common among girls and younger women.4
- Bulimia nervosa: Bulimia is characterized by binge/purge cycles, and those with this disorder also tend to be preoccupied with weight and thinness but usually average weight or overweight, which is a defining feature from anorexia nervosa. They binge on large quantities of food and attempt to compensate for this behavior by purging. Purging can include excessive exercise, laxative misuse or self-induced vomiting.They may restrict food between binge/purge episodes, but may also consume more normal-sized portions. This condition is also most common in young women.
- Avoidant restrictive food intake disorder (ARFID): ARFID refers to one’s 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 in relation to food. AFRID is most commonly diagnosed in children and adolescents, but it can also persist into adulthood.5
- Binge eating disorder: Binge eating disorder is an eating disorder characterized by frequent food binges. People with binge eating disorder overeat and binge without taking compensatory measures afterward. This condition is most common in adult women, although many adult men also meet the criteria.
- Other specified feeding and eating disorder (OSFED): OSFED refers to disordered eating behaviors that do not meet the full diagnostic criteria for other types of eating disorders. It may include atypical anorexia (all anorexia criteria are met except for significant weight loss); low-frequency binge eating or bulimia; atypical purging (purging without any bingeing); and night eating syndrome.
How Do Anxiety & Eating Disorders Overlap?
Many people find that anxiety exacerbates eating disorder symptoms. Stress, in many ways, represents a significant trigger. If the stress feels unmanageable (which can be a common theme in anxiety disorders), people may turn to restricting, overeating, or purging food as a way to cope.
Research shows that social anxiety and eating disorders often coincide with one another. For instance, people with eating disorders may worry about negative evaluation, and experience more worry about their social appearance. Subsequently, perceptions of negative social evaluations also appear to play a significant role in eating disorder symptoms.6
Likewise, there are also parallels between OCD and eating disorders. People with eating disorders experience obsessive thinking about food, weight, and control. As a result, they engage in ritualistic compulsions to manage these obsessions. Like OCD, even if someone “knows” they might be acting irrationally, they often find it extremely difficult to stop the behavior.
Some common overlapping features of anxiety and eating disorders include:
- Need for control
- Fear/worry about weight gain
- Wanting approval from others
- Low self-esteem
- Difficulties coping with stress
- Poor emotional regulation
- Family history of mental illness
How Are Comorbid 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 same self-destructive behaviors.
At the same time, it’s unhelpful to solely treat an eating disorder without examining potential anxieties. The ceasing of eating disorder symptoms usually causes someone to feel more anxious or out of control. They need to know how to understand and cope with this anxiety to avoid relapsing into disordered behavior.
Comprehensive therapy should include treatment that focuses on managing anxiety and increasing healthy coping skills. When people can reduce stress–and consistently practice better self-care–they may be less likely to engage in their eating disorder.
Research shows that cognitive models 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 helps people regulate their emotions, practice distress tolerance, and implement healthier social skills. CBT-E blends psychoeducation and self-monitoring to reduce eating disordered habits.
One model isn’t inherently better than another. Instead, it’s about finding a style that resonates with you. Furthermore, it’s most important that you feel safe and supported by your therapist during this process.
Psychiatric medications may be helpful for people experiencing anxiety and eating disorders. Antidepressants, for instance, may reduce anxiety symptoms. Along with therapy and/or other lifestyle changes, this reduction may have a beneficial impact on eating disorder recovery.
There are no FDA-recommended medications for anorexia. However, several studies have demonstrated the efficacy of anticonvulsants (Topamax), antidepressants (Prozac), tricyclic antidepressants (Norpramin), and buspirone (Buspar) for bulimia and binge eating disorder.7
Co-Occurring Disorder Groups
Co-occurring groups are intended for people who experience multiple mental health issues. For example, many eating disorder groups are open to people who have anxiety or depression, as well. These groups can be helpful in providing peer support, validation, and a sense of personal accountability. These groups take place in numerous settings, including hospitals, schools, nonprofit facilities, and private practices.
9 Healthy Ways to Cope With Anxiety & Eating Disorders
All successful recovery requires using different coping skills to manage potential triggers. It’s important to build an active list of skills you can refer to when you’re struggling. No one skill is healthier than another. Instead, it’s more important for you to commit to doing them consistently.
Here are nine ways to deal with anxiety and eating disorders:
- Practice cognitive restructuring/reframing: It’s important to identify and challenge distorted thinking. For example, instead of giving into all-or-nothing thoughts, it’s helpful to ask yourself, what’s another alternative to this situation?
- Building a support system: Having support is paramount during your recovery process. Ideally, when you feel stressed, you can lean on loved ones who believe in you.
- Engaging in healthy distractions: At times, it can be helpful to simply distract yourself when you feel triggered. Clean a room, take a nap, do the laundry, or take your dog for a walk.
- Meditating: Meditating can help you feel more present and grounded with your body. Focusing on your breath reduces anxiety and may help you feel calmer.
- Practicing mindfulness: Mindfulness can help you maintain perspective when you feel overwhelmed. Try to focus on the current moment as often as you can.
- Journaling: If you struggle to talk about your feelings, writing them down may help. Commit to journaling for a set amount of time each day.
- Positive affirmations: Have a mantra that you can refer to when you’re struggling. Write it down and remind yourself of it often.
- Acting “as if” you are recovering: The next time you aren’t sure what to do, imagine ‘acting as if’ you are someone who’s recovering well. Think about how they might respond to the particular stressor you’re facing.
- Sticking to a routine: It can be helpful to maintain structure, particularly in the early days of recovery. Write down a routine (or make one with your therapist) and try to adhere to it as much as possible.
Living with comorbid eating disorders and anxiety can be challenging. But the proper treatment can help you feel better and get your life back on track. Choosing the right therapist may be the first (and most important) step in beginning your healing journey.