Can an Eating Disorder Cause Anxiety? (and other disorders?)
Can an eating disorder cause anxiety?
If you're googling this, there's a good chance anxiety is already with you. So let’s get straight to it: Yes, eating disorders can cause anxiety. But if you’ll stick with me through this blog, we can talk more about how that happens, why it happens, what other disorders are comorbid (occurring alongside something), and maybe we can even discover something out about compassion and how to heal. So, hang with me for awhile, and let’s get into it!
Using reality, language, and compassion to combat eating disorders.
First, It’s hard to talk about eating disorders without talking about all the ways that eating disorders can and will destroy our lives. I know this, because I see clients with eating disorders often; it’s one of my specialties in my therapy practice (if you want to jump straight to getting help, click here).
So much of living with an eating disorder is living in fear of the side effects of eating disorders. However, we need to be careful about the language we use when we talk about ourselves, and our disorders, or the disorders of our loved ones. Part of the therapeutic process of eating disorder recovery is around changing the language we use in describing eating disorders themselves.
Let’s do a check in. What words are you using to talk about yourself? Are they kind? Are they necessary? Are they true?
If you answered any of the above with the word “no”, then you aren’t alone. Millions of people around the world have low self-body image, or distorted self-image when it comes to their bodies. And for some of these people, the cognitive distortions are combined with a behavior (like undereating or overeating) in specific ways that become an eating disorder.
I’m now going to list the criteria for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and OSFED (Other Specified Feeding or Eating Disorder). Please, as you read through this criteria, do so without judgement. Try to just take in the information, rather than assign a moral label to the information. Ok. Ready?
CRITERIA FOR ANOREXIA NERVOSA
According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013), in order to qualify for Anorexia Nervosa, a person must:
Have a self-induced calorie restriction leading to significant weight loss, or a failure to gain weight in growing children—typically resulting in low body weight based on age, sex, height, and stage of growth.
Have an abnormal obsession with body weight and intense fear of gaining weight or becoming “fat.”
Experience a distorted self-image or an inability to acknowledge the seriousness of their condition.
Subtypes:
Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (e.g., self-induced vomiting or misuse of laxatives, diuretics, or enemas). Weight loss is primarily achieved through dieting, fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior.
Levels of Severity (Based on BMI):
Mild: BMI ≥ 17
Moderate: BMI 16–16.99
Severe: BMI 15–15.99
Extreme: BMI < 15
CRITERIA FOR BULIMIA NERVOSA
Recurrent episodes of binge eating, defined by both:
Eating, in a discrete period (e.g., within 2 hours), an amount of food significantly larger than most would eat under similar circumstances.
A sense of lack of control during the episode (e.g., feeling unable to stop eating).
Recurrent inappropriate compensatory behaviors to prevent weight gain (e.g., vomiting, laxative misuse, fasting, excessive exercise).
The behaviors occur, on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Severity of Bulimia Nervosa (Based on Frequency of Compensatory Behaviors):
Mild: 1–3 episodes per week
Moderate: 4–7 episodes per week
Severe: 8–13 episodes per week
Extreme: 14+ episodes per week
(American Psychiatric Association, 2013, pp. 338–345)
CRITERIA FOR OSFED
OSFED is characterized by “subgroups” of Anorexia Nervosa and Bulimia Nervosa that don’t quite meet the criteria for AN or BN. For example, there may be similar behaviors in OSFED, however the weight of the individual may be too high to qualify for AN, or binge eating episodes may not occur as often to qualify for BN, for example. (Fairburn & Bohn, 2004)
OSFED is currently the largest group of eating disorders found among individuals who receive diagnosis.
BINGE EATING DISORDER
Binge Eating Disorder (BED) is a serious and distinct eating disorder characterized by recurrent episodes of consuming large quantities of food accompanied by a loss of control. According to the DSM-5, to meet the diagnostic criteria for BED, a person must experience the following:
Recurrent episodes of binge eating, defined by:
Eating, within a discrete period of time (e.g., within 2 hours), an amount of food significantly larger than most people would eat under similar circumstances
A sense of loss of control over eating during the episode
Binge eating episodes are associated with at least three of the following behaviors:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not physically hungry
Eating alone due to embarrassment
Feeling disgusted with oneself, depressed, or guilty afterward
Marked distress regarding binge eating is present
The behavior occurs:
At least once a week for 3 months (DSM-5 criteria)
(Previously DSM-IV required at least twice per week for 6 months)
The binge eating is not associated with regular compensatory behaviors (such as purging, fasting, or excessive exercise), and it does not occur exclusively during episodes of anorexia nervosa or bulimia nervosa (Hudson et al., 2016).
There is no severity listed for Binge Eating Disorder.
Now that we’ve gotten through the criteria, do you or a loved one meet the criteria for any of these disorders?
Because so much of these disorders has to do with distortions and fear around gaining weight, we need to first address the language we are using through cognitive behavioral therapy. In my practice, trust and compassion come first. I have endless empathy for what you are going through, and through encouragement and trust we can begin to address the language you are using and the behaviors that are holding you back from being who you want to be in your life. With compassion and understanding, we can tackle the anxiety that you are feeling. We can begin the journey toward self-love and a healthy self-image. Because so many with AN, BN, and NOS have a hard time even seeking help due to the fear of their bodies changing in ways they don’t like, it’s important to work with a practitioner that you can trust not to rush or strong-arm you into change. You deserve safety and compassion at all times.
Comorbidity with BN, AN, Binge Eating Disorder, and OSFED.
Comorbidity refers to other disorders or health concerns occurring along side of eating disorders. There are many, many comorbidities of eating disorders, which is why eating disorders are considered a serious health concern. In my last blog, you’ll find a great table listing some of the comorbidities of eating disorders, however, I will list more here. As we already mentioned, anxiety is one. Please note: I am not a doctor. Please consult with your doctor for a full list of health concerns, and talk to them if you are concerned about yourself or a loved one.
HEALTH CONCERNS OF ANOREXIA NERVOSA
Cleveland Clinic (2023) explains that the following health concerns may occur with Anorexia Nervosa:
Loss of bone mass (osteoporosis) and erosion of tooth enamel
Rapid breakdown of skeletal muscle (rhabdomyolysis)
Kidney and liver damage
Heart failure or cardiac arrest
Delayed puberty and growth in children
Infertility in adults
Johns Hopkins Medicine (n.d.) adds that the following could occur as well:
Low red blood cell count (anemia)
Heart problems (arrhythmias, slow heart rate, heart failure, and mitral valve prolapse)
Low blood pressure
Kidney problems
Electrolyte imbalance
Lack of menstrual periods in women
Low testosterone in men
Bone loss
Brain damage
Multi-organ failure
Death
HEALTH CONCERNS OF BULIMIA NERVOSA
Better Health Channel (2023) explains that the following health concerns could occur with BN:
weight change or fluctuations in weight
dental erosion
bad breath
swelling around the cheeks and jaw
indigestion
frequent constipation
diarrhoea, or new food intolerances
heart-related conditions, irregular heart beat, low blood pressure
fainting or dizziness that is not due to another illness or health condition
fatigue or sleep difficulties
loss of periods or altered menstrual cycles
muscle fatigue, cramps.
In addition to the above health concerns, we have psychological comorbidities and concerns to consider. These are the consideration that we would work with in our time together in therapy (if you are experiencing any of these psychological concerns). It’s highly likely that if you have an eating disorder, that you are experiencing one or more of these psychological comorbidities, as the rate of people who experience at least one of them alongside AN, BN, Binge Eating Disorder, or OSFED is high. In therapy, we would work toward reducing and eliminating these maladaptive psychological behaviors. To book a session with me, please click here to fill out the contact form and let’s get started.
PSYCHOLOGICAL COMORBIDITIES OF AN, BN, BINGE EATING DISORDER, & OSFED:
Research demonstrates that 55–97% of people diagnosed with an eating disorder also receive a diagnosis for at least one more psychiatric disorder. The most common psychiatric disorders which co-occur with eating disorders include:
mood disorders (e.g., major depressive disorder)
anxiety disorders (e.g., obsessive compulsive disorder, social anxiety disorder)
post-traumatic stress disorder (PTSD) and trauma
substance use disorders
personality disorders (e.g., borderline personality disorder, OCPD)
sexual dysfunction
non-suicidal self-injury, and suicide ideation (National Eating Disorders Collaboration, n.d.).
Why am I experiencing anxiety with my eating disorder?
Now that we understand the comorbidities of the most common eating disorders, let’s dive into why a person might experience anxiety with an eating disorder.
Did you know that most commonly, eating disorders START with anxiety? It’s true. Eating disorders commonly occur as a response to high anxiety. In this, they have a lot in common with obsessive compulsive disorder, in that the anxiety causes the eating disorder to occur as a behavioral response to the anxiety or mental anguish. Simply put, the individual cannot tolerate the anxiety, and as a result comes up with a behavior in which they regain control over the anxiety and their lives.
For others, sometimes the eating disorder will start first, and then the behavior will cause the anxiety. For example, the behavior of the eating disorder, like restrictive eating, can lead to anxiety about what the individual eats and when. (Eating Disorders Victoria, 2020)
Because of this, there’s really very little separation between anxiety and eating disorders. They go hand-in hand.
What’s next for me?
As you can see, there are many concerns about comorbid psychological and medical side-effects of eating disorders, as well as solid reasons that individuals with eating disorders have high anxiety. Unfortunately, for many people struggling with eating disorders, there is more to worry about than anxiety. Fear and anxiety, however, are at the base of the issue as core emotions people feel when having an eating disorder. Most individuals with eating disorders are already experiencing one or more of the health and psychological concerns listed above.
The first step, and often the hardest step, is to get help. Both psychological and medical help is best when recovering from an eating disorder. My psychological approach to helping an individual recover from an eating disorder is to use cognitive-behavioral therapy (CBT) with a focus on compassion. CBT is the gold standard of psychological therapeutic interventions for eating disorders. Because so much of eating disorders occurs alongside fearful thoughts and obsessive behaviors, we must first address the cognitions, or thoughts, occurring in the brain, and make the direct link to how they are affecting the individual’s behavior through restrictive or binge eating. The link is there from the body to the brain, and it’s our work together that will lesson the hold those thoughts have on you. As the hold lessons, we can move forward into recovery. But first, comes the willingness, the desire, to change.
Especially for AN, desire to change is a hard first step. I recognize this and I take the time to gain trust with my clients before asking them to change. Because of the necessity of establishing trust, this recovery takes time. The sooner you start, the sooner you will be in recovery. To book a session with me today, please fill out my contact form here. And remember, you are not alone. This is a lonely disorder, and I know you’ve suffered greatly, but I am here, for you, with you. Together we will tackle this and help you succeed.
Please feel free to download and use the resources I created below!
Make it stand out
That’s a high number! It’s important to work with a therapist to help you move through the comorbidities of an eating disorder as well. To start working with me, click here.
There are many other other specified feeding or eating disorders, like Pica, AFRID, and more. I’m also available to help with these. To book a session and get help for you or your loved one today, click here and fill out the contact form.
APA Citations:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Better Health Channel. (2023). Bulimia nervosa. Victorian State Government. https://www.betterhealth.vic.gov.au/health/healthyliving/bulimia-nervosa
Cleveland Clinic. (2023, August 16). Anorexia nervosa. https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa
Eating Disorders Victoria. (2020). Eating disorders and anxiety: Exploring the connection. https://eatingdisorders.org.au/wp-content/uploads/2020/12/Eating-disorders-and-anxiety.pdf
Fairburn, C. G., & Bohn, K. (2004). Eating disorder NOS (EDNOS): An example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behaviour Research and Therapy, 42(6), 691–701. https://doi.org/10.1016/S0005-7967(03)00161-2
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2016). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. In W. T. Reeves & R. A. Rachal (Eds.), StatPearls. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK338301/table/introduction.t1/
Johns Hopkins Medicine. (n.d.). Anorexia nervosa. https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/anorexia-nervosa
National Eating Disorders Collaboration. (n.d.). Co-occurring conditions. https://nedc.com.au/eating-disorders/types/co-occurring-conditions