Anxiety and eating disorders often co-occur with one another. Anxiety is a painful experience, and it can feel overwhelming and suffocating. Although anxiety attempts to make you feel safe by bringing potential threats to your awareness, it can become like a warning light that does not turn off.
And, there is hope. Although both anxiety and eating disorders can feel overpowering, many people are healing every day. Because the path to healing means addressing both the symptoms and the cause of suffering, eating disorder recovery can become an incredible gift that benefits the entirety of your life.
Types of Anxiety Disorders
Anxiety is fear that has lost its ability to discern true threats. Beneficial fear is powerful, wise, and needed in your day-to-day life. Beneficial fear can save your life. It is perceptive, and it can lead you to feel empowered to take necessary action.
However, beneficial fear morphs into non-beneficial anxiety for several reasons:
- You’ve experienced trauma.
- You do not have clarity about why you feel fear, so you do not know how to address it.
- You do not believe we have the skills or power to address the stressor at hand.
- A stressor is repeated, and despite your best efforts, you cannot stop it.
When you’ve experienced these types of stressful situations, you may develop an anxiety disorder. Several types of anxiety disorders co-occur with eating disorders (Swinbourne & Touyz, 2007).
Generalized Anxiety Disorder
With Generalized Anxiety Disorder, you feel worried more often than not. This worry has negatively impacted your relationships, work, and enjoyment in life. It feels difficult to control this worry; you feel tense, on edge, easily irritable, and restless. You may have trouble sleeping as a result. This worry and its symptoms have occurred for at least 6 months (5th ed.; DSM-5; American Psychiatric Association, 2013).
Social Anxiety Disorder and Social Phobia
With social anxiety disorder or social phobia, the anxiety that you feel is specifically linked to the fear of being judged, evaluated, or criticized. With social anxiety, you may fear doing something embarrassing, being rejected by a peer group, and feeling as though people are watching you. This may be accompanied by physical symptoms such as blushing, sweating, and rapid heart rate (5th ed.; DSM-5; American Psychiatric Association, 2013).
Post-Traumatic Stress Disorder
With post-traumatic stress disorder, you’ve experienced a trauma in which you survived a significantly harmful situation. The protective fight-flight-or-freeze mechanism in your nervous system became stuck “on.” Rest became nearly impossible. With post-traumatic stress disorder, you may have nightmares, flashbacks, avoidance of things that remind you of the trauma, unwanted reminders of the trauma, and dissociative symptoms (5th ed.; DSM-5; American Psychiatric Association, 2013).
Obsessive Compulsive Disorder
An Obsessive-compulsive disorder is characterized by repetitive and unwanted thoughts and behaviors. You experience obsession and feel compelled to take action to alleviate the obsession (5th ed.; DSM-5; American Psychiatric Association, 2013). When you have an obsession, you feel intense fear that something undesirable will happen if you do not take specific and immediate action.
With panic disorder, your anxiety becomes so intense that you experience physical symptoms such as rapid heart rate, heart palpitations, shortness of breath, chest pain, dizziness, and abdominal distress (5th ed.; DSM-5; American Psychiatric Association, 2013). During a panic attack, you may believe yourself to be in physical danger, and you may believe yourself to be dying. These symptoms can come out of the blue. With panic disorder, you may develop anxiety about having a panic attack.
Types of Eating Disorders
The Diagnostic and Statistical Manual has identified multiple types of eating disorders. The three most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder.
Anorexia nervosa is characterized by self-starvation (NIMA, 2023). As a result, you may experience malnutrition and low body weight. Anorexia nervosa has the highest mortality rate of any psychological diagnosis. If you struggle with anorexia nervosa, you may restrict food by dieting and fasting, you may engage in excessive exercising, and you may have cycles of binge eating and purging.
The complications associated with anorexia nervosa include:
- Brain fog
- Inability to concentrate
- Extreme fatigue
- Bone fractures
- Bone thinning
- Muscle weakness
- Muscle loss
- Intolerance to cold
- Brittle hair and nails
- Hair loss
- Cessation of menstruation
- Life-threatening abnormal heath rhythms
- Life-threatening heart abnormalities
If you struggle with bulimia nervosa, you cycle between periods of eating large amounts of self-prohibited foods (binging), followed by a period of compensation for the binge (purging) (NIMA, 2023).
A binge involves a sense that you’ve lost control over the amount of food you consume. Binges usually involve eating large volumes of food in isolation over a short amount of time. Both during and after a binge, you may feel ashamed. Binges can bring about severe physical discomfort in the forms of nausea, bloating, and brain fog.
Purging attempts to prevent weight gain and reverse the effects of the binge. Purging may involve vomiting, the use of laxatives, and compulsive exercise. If you struggle with bulimia nervosa, you may experience the following:
- Gastroesophageal reflux
- Dental decay (due to persistent stomach acid exposure)
- Chronic sore throats
- Esophageal tears
- Gastric ruptures
- Lethal cardiac arrhythmias
Binge Eating Disorder
If you struggle with binge eating disorder, you may eat more rapidly than normal, eat large amounts of food (even if you are not hungry), eat until you are uncomfortably full, eat in isolation, feel embarrassed about how much you eat, and feel regret, disgust, depressed, and guilty after a binge (NIMA, 2023).
Binge eating disorder differs from bulimia nervosa as there are no compensatory behaviors to attempt to reverse the effects of the binge. Health complications associated with binge eating include:
- Heart disease
- Increased risk of stroke
Anxiety and Eating Disorders: How They Are Connected
Eating disorders are linked to anxiety in several ways:
- Anxiety occurs when you do not believe you have control over the stressors in your life, and eating disorders may be displaced efforts of control. For example, you may not be able to control the people bullying you at school or the intimidation of your boss at work. However, you may feel indirectly empowered when you exert control in unrelated areas of your life, such as controlling your food intake and hunger impulses (Tiggemann & Raven, 1998).
- Eating disorders, specifically anorexia nervosa, may arise (initially) as an effort to practice self-mastery and self-discipline. However, through the disorder, you have lost the control you sought when the eating disorder became more powerful than your ability to stop it (Fürtjes, et al, 2022).
- Perfectionism is a part of obsessive-compulsive disorder. Striving for perfection can lead to deprivation and harmful standards around body image and “perfect” food intake.
- Eating disorders may arise as a result of seeking social acceptance. Social anxiety or social phobias can fuel eating disorders. For example, if you hold a belief that a particular body type will make you more desirable, you may engage in dangerous eating or purging behaviors.
- Binge eating disorder may develop as an indirect means to cope with post-traumatic stress disorder. For example, if you’ve experienced a trauma related to sexual assault or objectification, the physical effects of binge eating can bring about a sense of safety by generating a body we believe is undesirable.
- Binge eating disorder and bulimia nervosa may arise as a means to self-soothe and seek comfort when the anxiety you experience leads to burnout. When you feel anxiety, your sympathetic nervous system is activated. The sympathetic nervous system is involved with adrenaline, increased heart rate, irritability, and restlessness. When you eat, you activate your parasympathetic nervous system, which is involved with relaxation, rest, restoration, and comfort. If you struggle to relax (as is the case when you have an anxiety disorder), excessive food becomes a way to bring about a needed state of relaxation.
There Is Support
If you struggle with an eating disorder, you are not alone. Support is available. Both eating disorders and anxiety are painful to bear and potentially life-threatening. However, through recovery, you experience freedom from the grips of the eating disorder, as well as a means to heal your anxiety.
At Virtue Recovery Eating Disorders, we have a team of compassionate and evidence-based clinicians to support you on your recovery journey. To speak with a specialist to help you find the support you need, contact us today.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Fürtjes, S., Seidel, M., Diestel, S., Wolff, M., King, J., Hellerhoff, I., . . . Ehrlich, S. (2022). Real-life self-control conflicts in anorexia nervosa: An ecological momentary assessment investigation. European Psychiatry, 65(1), E39. DOI:10.1192/j.eurpsy.2022.29
National Institute of Mental Health (2023). Eating Disorders. DOI: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders
Swinbourne, Jessica, M. & Touyz, Stephen W (2007) The co-morbidity of eating disorders and anxiety disorders: a review. European Eating Disorder Review. Volume15, Issue4. July/August 2007. Pages 253-274 DOI: https://onlinelibrary.wiley.com/doi/abs/10.1002/erv.784
Tiggemann, Marika & Raven, Melissa. (1998). Dimensions of control in bulimia and anorexia nervosa: Internal control, desire for control, or fear of losing self-control?, Eating Disorders, 6:1, 65-71, DOI: 10.1080/10640269808249248