The most common anxiety diagnoses observed in patients with eating disorders are obsessive compulsive disorder and social phobia.
It is well known that eating disorders are followed by fear of gaining weight, negative beliefs about oneself and nervousness while facing the prospect of eating food. So, people who suffer from eating disorders are often anxious about various things – food, weight, body image or other people. That’s why many researchers wanted to investigate the relationship between eating disturbances and anxiety disorders. Some of them are noticed more among people with eating disorder than others. Also, not every type of eating disorder is similarly connected with anxiety conditions.
Researchers from University of California and University of North Carolina (Kaye et al, 2004) conducted a study on a sample of more than 600 eating disorder patients. They found that rates of all anxiety disorders didn’t differ significantly among types of eating disorder (anorexia, bulimia and binge eating). In individuals with bulimia frequency of PTSD (posttraumatic stress disorder) was three times greater than in patients with anorexia. The most common anxiety diagnoses were OCD (obsessive compulsive disorder) and social phobia. Among these participants it was concluded that various anxiety disorders were present in their childhood, before eating disorder diagnosis was established. Some symptoms were more frequent, such as the need for symmetry, punctuality and order. These researchers believe that participants probably don’t recognize said symptoms as OCD symptoms.
Two thirds of participants reported lifetime presence of at least one anxiety disorder. However, patients who didn’t report a lifetime anxiety disorder and recovered at least 12 months ago, still experienced increased anxiety, harm avoidance and perfectionism. This level of anxiety was bigger than in sample of healthy women. Therefore, anxiety symptoms are more likely to be personality traits that describe most people with eating disorders, but not all of them meet the criteria for diagnosis of an anxiety disorder.
Researchers from London (Pallister and Waller, 2008) reviewed this research area. They concluded that eating and anxiety disorders could share some underlying factors when they both co-occur in patient. Their recommendations include treatment that targets these underlying factors. Some of them include beliefs about our own vulnerability, harm avoidance cognitions and safety behaviors. Safety behaviors represent the way a person gains control in order to prevent the occurrence of something fearful and therefore reduce anxiety, but only short-term. These mentioned factors should be treated thoughtfully, otherwise treatment could be less effective, with the risk of relapse as well. They believe that binge eating could occur because of trying to avoid negative affect. This leads to a conclusion that underlying emotions should be the target in treatments of binge eating disorder. Therefore, a patient’s capacity for distress tolerance could be increased. Also, treatment for binge eating should target the relationship between one’s beliefs, thoughts and emotions. A person can, due to anger or anxiety, create negative belief about oneself.
Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., & Price Foundation Collaborative Group. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12), 2215-2221.
Pallister, E., & Waller, G. (2008). Anxiety in the eating disorders: understanding the overlap. Clinical psychology review, 28(3), 366-386.