Are Eating Disorders Related To Anxiety?

Research indicates that the prevalence of eating disorders has more than doubled over the last two decades, increasing from approximately 3.5% to 7.8%. Eating disorders often co-occur with other mental health conditions, including anxiety. With the lifetime prevalence of anxiety also rising, understanding how these conditions can be related may help with early identification and treatment. In many cases, both disordered eating and anxiety symptoms can be addressed through therapy.

Eating disorders and comorbid conditions

The most common mental health disorders that occur alongside eating disorders usually include mood disorders, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, substance use disorder, and personality disorders. Understanding the onset of these conditions and how they can impact eating disorder symptoms can be crucial to a person’s diagnosis, treatment, and prognosis.

Types of anxiety disorders that can co-occur with eating disorders

Some research has determined that anxiety tends to be the most prevalent comorbid mental health condition with eating disorders. Risk factors for anxiety disorders and eating disorders can overlap, and these conditions may share symptoms in some cases.

Both anxiety and eating disorders often involve a desire for perfection, sometimes leading to intense worry and a fear that one will not be able to meet the high standards they’ve set for themselves. The following anxiety-related disorders may arise alongside eating disorders:

Obsessive-compulsive disorder

Although this disorder is no longer classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), obsessive-compulsive disorder (OCD) frequently involves anxiety and can be especially common in people with eating disorders. 

Research has found that between 20% and 60% of people with eating disorders may have a lifetime history of OCD. Symptoms of OCD and eating disorders can interact at times. A person with OCD can develop compulsive rituals connected to food, with the symptoms of one disorder potentially worsening the other. Some researchers believe that OCD and eating disorders may lie on the same spectrum, although a causal relationship between the two has not yet been identified.

Social anxiety disorder

Social anxiety disorder can also co-occur with eating disorders. Research has found that the two conditions tend to share some risk factors, particularly maladaptive perfectionism, which can occur when people make unrealistic attempts to meet impossibly high standards for themselves.

Post-traumatic stress disorder (PTSD)

PTSD is not considered an anxiety disorder, but the two conditions can share some features. Eating disorders and PTSD tend to be highly comorbid, with a comorbidity estimated to be as high as 62%. 

Traumatic experiences tend to be more often associated with binging and purging. However, some types of abuse can lead to body dissatisfaction or difficulties with impulsivity and emotional regulation, which can contribute to other eating disorder symptoms.

How anxiety and eating disorders overlap

Anxiety and eating disorders can affect one another in various ways. One study found that generalized anxiety disorder was typically associated with longer eating disorder illness duration, more frequent hospitalizations, and a poorer lifetime nutritional state. Other research has determined that anxiety can be associated with binge eating, vomiting, and calorie restriction.

Worry can be a common anxiety disorder symptom, and it is something that people with eating disorders typically experience in relation to food, body weight, and related behaviors, like excessive exercise and vomiting. 

In around 60% to 90% of cases, people with eating disorders who have comorbid anxiety report that the symptoms of anxiety appeared first, but anxiety does not always precede eating disorders.

Eating disorders can also worsen anxiety. According to the Anxiety and Depression Society of America, co-occurring eating disorders can exacerbate anxiety symptoms and make recovery more difficult.

How co-occurring anxiety disorders can affect eating disorder treatment

Because the symptoms of these two conditions can overlap and interact, treatment for people who experience eating disorders with comorbid anxiety disorders usually have better outcomes when treatment addresses both disorders simultaneously. 

It may also be worth noting that inadequate nutrition can lead to the development of anxiety disorders. Nutritional imbalances due to disordered eating may contribute to the development of anxiety symptoms. As individuals recover and correct these imbalances, anxiety symptoms may improve.

Treatment for eating disorders

Treatment for eating disorders and any co-occurring mental health conditions can involve multiple facets, depending on the type of eating disorder, its severity, and the other conditions that need to be addressed. Here are some of the components that may be part of a comprehensive treatment plan. 

Hospitalization or close monitoring

Depending on the severity of the eating disorder or co-occurring mental health condition, hospitalization or other types of intensive treatment may be necessary. People who cannot eat or who are experiencing severe, life-threatening medical problems due to eating disorder symptoms may be admitted to a hospital for treatment. 

For people who need long-term monitoring and care, or who are not improving with outpatient treatment, residential treatment may be necessary. Day treatment programs may be an option, too. People in these facilities usually attend group, individual, and family therapy sessions a few days a week for multiple hours each day, and they may also receive some medical care.

Nutritional counseling

Treatment for eating disorders typically involves working with a registered dietitian to learn more about disordered eating and how to maintain healthy eating habits. Goals of this aspect of treatment may be to learn about how nutrition affects the body, understand meal planning, and establish regular eating patterns and routines. Nutritional therapy may also focus on correcting nutritional imbalances that may have developed in response to disordered eating habits.

Psychotherapy 

Talk therapy tends to be a crucial part of treatment. Psychotherapy can help people with eating disorders and co-occurring conditions learn how to replace unhealthy habits with more constructive ones, find healthy ways to cope with stress, learn problem-solving skills, and improve their relationships with food and their bodies. Prescription medications may be helpful for some people, but they generally work best when combined with talk therapy.

Getting online support

If you’re living with an eating disorder and anxiety symptoms, or if you’re seeking support for long-term recovery, online therapy may be a helpful component of treatment. Online therapy with a platform like BetterHelp can be a convenient and flexible way to receive professional support. You can work with a licensed therapist from the comfort of your own home or anywhere you have an internet connection. Most people who sign up are matched with a therapist within 48 hours, and you can change providers at any time for no additional fee. 

Research suggests that online therapy can be an effective option for treating eating disorders and co-occurring mental health conditions like anxiety. For example, a 2021 study found that online therapist-delivered cognitive behavioral therapy (CBT) typically reduced eating disorder psychopathology and body dissatisfaction with results that were sustained one year post-treatment.

In addition, a 2018 review of 14 studies found that online CBT led to an approximate 50% improvement in symptoms of social anxiety disorder, obsessive-compulsive disorder, panic disorder, and generalized anxiety disorder.