The relationship between anorexia nervosa and anxiety disorders

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Anorexia nervosa (AN) is an eating disorder in which individuals are concerned about their body size and shape, often driven by an intense fear of gaining weight. In an attempt to not gain weight, an individual with AN does not correctly nourish themselves. Roughly 1.2% of Americans will experience AN at some point in their life. (1) AN can develop in any gender, regardless of size ; however, it is most common in women. 

In this article

Examining anxiety and anorexia nervosa

Anxiety is a symptom which is commonly seen in individuals with anorexia nervosa, and may include intense feelings of fear or uneasiness. It may also cause physical reactions, such as sweating, increased heartbeat, and muscle tension. Occasional anxiety is the body's natural response to stress, and it happens to nearly everyone. However, almost 40 million American adults have an anxiety disorder. (2) Anxiety is classified as a disorder when prolonged anxiety does not ease with time. Anxiety disorders are one of America's most common mental health concerns.

An important note about the relationship between anxiety disorders and anorexia nervosa is that while it's common for someone with anorexia to have anxiety or an anxiety disorder, the reverse is not true. Many people who have anxiety disorders do not have disordered eating.

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How does anxiety disorders interact with anorexia nervosa?

There are different anxiety disorders, many of which can co-exist with anorexia and affect how both conditions affect the body. 

Generalized anxiety disorder (GAD)

Generalized anxiety disorder occurs when a person feels constant worry over everyday things. GAD often comes with fatigue, trouble sleeping, muscle aches, sweating, nausea, and irritability. When a person has high anxiety levels, it can keep them from participating in daily activities and may interfere with their school, work, and personal life. (3) Someone with AN may experience generalized anxiety that manifests in worrying about their eating behaviors and physical appearance.

Obsessive-compulsive disorder (OCD)

OCD is a chronic disorder that causes a person to have uncontrollable thoughts or behaviors. When related to an eating disorder such as anorexia, those thoughts and behaviors are often about food, but can manifest incongruently. Many individuals living with anorexia constantly think about eating, if they should eat, and when to eat. They may also have rituals around cooking, preparing, and consuming food or have an obsessive nature only to eat certain foods. (4) It's common for people with an eating disorder to feel a lack of control over their bodies. Their obsessive compulsive tendencies may give them a feeling of control over something. 

Panic disorder

Panic disorder is when someone experiences a panic attack and has repeated fear of having another one. A panic attack's physical signs and symptoms include a rapid heartbeat, chest pains, trouble breathing, sweating, tingly, or dizziness. For someone with anorexia, a panic attack may spark while they're planning meals, after they eat, or if they're feeling uncomfortable in their body. Panic attacks can also occur from situations outside of eating and food, such as stress about school, work, or social obligations. 

Social anxiety disorder

Social anxiety is when a person avoids social situations for the fear of being judged or disliked by others. Signs and symptoms of social anxiety can vary, but it generally includes physical reactions blushing, nausea, sweating, trembling, shaking, dizziness, and a rapid heart rate. Someone with social anxiety and anorexia tends to avoid social gatherings where food is involved. People with anorexia may feel embarrassed about their eating behaviors, and being around others while eating can spike their discomfort. 

AN is a complex eating disorder, especially when it co-occurs with anxiety disorders. Despite these conditions, help is available from trusted resources such as Within Health. The Within Health team provides clinically superior evidence-based treatments. Each treatment plan is individualized to help clients cope with food challenges and explore interpersonal concerns underlying AN and anxiety. Contact the Within Health admissions team to get started today.

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Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Karg, R. S., Hedden, S. L., Colpe, L. J., Pemberton, M. R., Hirsch, E., Liao, D., Forman-Hoffman, V. L., Batts, K. R., & Bose, J. (2014, October). Past Year Mental Disorders among Adults in the United States: Results from the 2008–2012 Mental Health Surveillance Study. CBHSQ Data Review. Retrieved from 1. http://www.samhsa.gov/data/sites/default/files/NSDUH-DR-N2MentalDis-2014-1/Web/NSDUH-DR-N2MentalDis-2014.pdf
  2. NAMI. (n.d.). Anxiety disorders. NAMI. Retrieved from https://nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders
  3. Mayo Foundation for Medical Education and Research. (2017, October 13). Generalized anxiety disorder. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803
  4. Neziroglu, F., & Sandler, J. (n.d.). The relationship between eating disorders and OCD part of the spectrum. International OCD Foundation. Retrieved from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/

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