How anorexia nervosa affects your mental health

Is anorexia a mental condition?

Some people may wonder, "Does anorexia cause mental illness?" But the question actually looks at the situation backward. Anorexia nervosa is a type of mental health disorder, and the highly visible physical aspects of the condition are symptoms of those mental health effects.

All eating disorders—including bulimia nervosa (BN) and binge eating disorder (BED)—are classified as mental health concerns in the DSM-5, the record of all officially recognized mental health illnesses. The conditions affect all phases of a person’s health, and the person’s health will also affect their eating disorders.

In the case of AN, the disorder is defined by restricting energy (food) intake relative to what someone normally needs for their age, gender, health, and developmental stage. But that restriction is driven by the other criteria of the illness:¹

Without these underpinning anorexia nervosa mental effects, it's likely that someone would not be as motivated to restrict their food intake so severely.

Anorexia and mental health conditions

Aside from being a mental health disorder in and of itself, anorexia nervosa also frequently co-occurs with other types of mental health conditions.

According to a large national study in the United States, 83.7% of individuals with AN experience another psychiatric disorder at some point during their lives.² Some of the most common comorbid (co-occurring) conditions with AN include:²

• Major depressive disorder: 49.5%
• Persistent depressive disorder: 22.4%
• Generalized anxiety disorder: 21.9% 
• Panic disorder: 21.0%
• PTSD: 22.7%
• Any substance use disorder: 60.3%
• Borderline personality disorder: 30.3%

It's often difficult, if not impossible, to untangle which disorder impacted someone first. Someone may develop depression as a result of AN, for example, or develop AN as a maladaptive coping mechanism to help them deal with depression. In most cases, these mental disorders develop together and work to influence and drive each other, which is why comprehensive treatment for AN and other eating disorders is so important.

The relationship between anorexia and mental health 

Mental health and anorexia are tightly intertwined in a bidirectional relationship to the point where they often come to influence each other equally. When other mental health symptoms are high, they will negatively affect AN symptoms.

One study found that having anorexia nervosa increased the risk of later being diagnosed with another psychiatric disorder by almost four times. Similarly, being diagnosed with a psychiatric disorder made it over four times as likely that someone was later diagnosed with anorexia nervosa compared to those with no mental health conditions.³

One reason it can be so challenging to determine the primary diagnosis is that anorexia nervosa often develops as a maladaptive coping mechanism. This response can occur from the same trauma or stressful life events that may trigger or influence other mental health struggles. 

One study proposed that at least one mental health condition may consistently come before AN. In this case, chronic low self-esteem was suggested as a necessary prerequisite for developing anorexia nervosa or any type of eating disorder.⁴ But because it often manifests in such a visible way, AN is frequently diagnosed before any co-occurring disorders or medical complications, even if they predate AN, making it hard to tell which condition led to the other.⁶

Mental effects of anorexia

AN has a considerable impact on mental health, but how does anorexia affect mental health, specifically? The condition is often entangled with comorbid disorders, but it can also cause mental effects on its own.

The malnutrition that often results from anorexia nervosa can create more than outward physical changes. It can lead to changes in the structure of the brain, the activity of neurotransmitters, and hormone levels, among other factors, which can cause many anorexia mental health effects, including:^7,5

The fixation on food, eating, and body image can also lead to several other emotional and behavioral symptoms, including:⁵

Often, these behaviors develop specifically as anorexia nervosa mental effects, though some, such as social withdrawal, may also be related to other co-occurring conditions, like depression.

Finding help for the mental effects of anorexia nervosa

Whether someone starts struggling with anorexia nervosa or other mental health disorders first, it's essential to seek out comprehensive help to treat all conditions that may be negatively impacting someone's mental, physical, and emotional well-being. This help usually begins with a thorough evaluation by a team of medical and mental health experts.

Eating disorders and mood disorders often exist in a vicious cycle, in which mood disorders can trigger eating disorder behaviors like obsessing over body appearance and restricting calories, which can be quite isolating and lead to shame and self-loathing, which ultimately worsen mental health.

In these cases, a comprehensive treatment program that addresses both eating disorder symptoms and symptoms of co-occurring mental health disorders is a crucial part of recovery. With individualized treatment, patients can learn healthy coping strategies and develop the tools for managing stressors without turning to eating disorder behaviors.