What is stress-induced anorexia?

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People with anorexia nervosa (AN) often experience high anxiety and stress levels. Stress is often a key trigger in the development of an eating disorder. It can sometimes be challenging to determine which condition came first, but stress-induced anorexia usually refers to an individual who experiences chronic stress or post-traumatic stress disorder (PTSD) before developing anorexia nervosa. (2)

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The relationship between stress and disordered eating

Everyone experiences stress. It is the body's natural reaction to change. In small doses, anxiety alerts the body to danger. In most cases, stress relieves itself quickly, and the individual can proceed through life without any significant physical, emotional, or psychological changes. However, some individuals experience chronic stress behavioral and mental health disorders, including disordered eating. (1)

Not only can high levels of stress lead to changes in eating behaviors, but those with an eating disorder like anorexia nervosa have a higher risk of experiencing chronic stress. This can even lead to stress induced anorexia. (2) Part of the relationship between stress and disordered eating is related to how an individual copes. 

People can have an active or avoidance coping style:

  • Active Coping: This is a healthy coping response when a person works to find productive or active solutions to reduce stress. In active coping, the individual is aware of their stressor and problem solves to reduce unwanted outcomes. 
  • Avoidance Coping: This coping is maladaptive; the individual partakes in harmful or destructive behaviors in order to avoid directly dealing with the cause of their stress. (3) An eating disorder is an example of “avoidance coping” (4)

The risks of stress induced food restriction

Stress-induced food restriction can lead to the same complications as anorexia nervosa. A few complications associated with anorexia and restricting food include:

  • Anemia: is a condition that develops when someone doesn't have enough iron in their blood. It can happen when a person does not consume enough iron-rich foods. Anemia can cause fatigue, dizziness, headaches, increased heartbeat, cold hands and feet, shortness of breath, and brittle nails. (5)
  • Heart complications: The heart needs nutrients to function. Food restriction keeps essential nutrients from the heart and slows the heart down to conserve energy. If the heart weakens, it makes it more difficult to circulate blood, which can cause mitral valve prolapse, abnormal heart rhythms, or heart failure. (6)
  • Osteoporosis: One of the most common causes of osteoporosis is calcium deficiency which can happen when someone doesn't consume enough calcium-rich foods. Osteoporosis is a condition that causes the bones to weaken. People with osteoporosis have a greater risk of bone fractures. (7)
  • Gastrointestinal complications: Restricting food can lead to gastrointestinal problems such as diarrhea because of the body's lack of protein and amino acids. (8) Restricted eating can also weaken the muscles in the digestive system, making it difficult for the stomach to empty and causing constipation and bloating.

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Finding other outlets for stress

Part of treatment for stress-induced AN is finding outlets to relieve stress aside from restrictive eating. Everyone's approach to stress management is different, but some common methods are: (9)

  • Meditation: The objective of meditation is to instill calm and balance to help counteract stress. Meditation is flexible and can be a few minutes of deep breathing or an hour of intentional quiet. It comes in a number of different techniques some of which work better for certain individuals. 
  • Sleep: Sleep is the opportunity for the body and mind to recharge. Quality sleep reduces stress and a person's mood, concentration, and energy levels.
  • Journaling: Writing down thoughts and feelings during high-anxiety moments helps express oneself. Journaling is also a valuable tool in reflection to understand stressors and triggers. 
  • Art: Channeling stress into a creative art project is a great way to express and manage emotions. Music writing, drawing, sewing, and painting are great creative options to explore.
  • Counseling: Coping with stress is not always something a person can do independently. Sometimes it's helpful to seek stress management guidance from a trained counselor or therapist. 

At Within Health, we understand the complexities of eating disorders and stress. Our expert team approaches each client with empathy and humanity to develop a personalized care program to address their needs. Each individualized plan strikes a balance between helping clients cope with food and body challenges and exploring the interpersonal concerns underlying their anorexia, including techniques for how to cope with stress. Contact our admissions team to get started on the recovery journey.

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. Yale Medicine. (2019, November 15). Chronic stress. Yale Medicine. Retrieved March 23, 2022, from https://www.yalemedicine.org/conditions/stress-disorder
  2. Brewerton, T. D. (2018, February 21). Trauma, posttraumatic stress disorder, and eating disorders. National Eating Disorders Association. Retrieved March 23, 2022, from https://www.nationaleatingdisorders.org/blog/trauma-ptsd-and-eating-disorders
  3. Holahan, C. J., Moos, R. H., Holahan, C. K., Brennan, P. L., & Schutte, K. K. (2011). Stress generation, avoidance coping, and depressive symptoms: A 10-year model. Journal of Consulting and Clinical Psychology, 73(4), 658–666. https://doi.org/10.1037/0022-006x.73.4.658
  4. Cleveland Clinic. (2021, December 27). How stress can make you eat more -- or not at all. Cleveland Clinic. Retrieved March 23, 2022, from https://health.clevelandclinic.org/how-stress-can-make-you-eat-more-or-not-at-all/ 
  5. Cafasso, J. (2017, December 24). Iron deficiency anemia secondary to inadequate dietary iron intake. Healthline. Retrieved March 23, 2022, from https://www.healthline.com/health/iron-deficiency-inadequate-dietary-iron
  6. Northwestern Medicine. (n.d.). How anorexia impacts your heart. Northwestern Medicine. Retrieved March 23, 2022, from https://www.nm.org/healthbeat/healthy-tips/anorexia-and-your-heart
  7. U.S. National Library of Medicine. (2022, January 26). Osteoporosis. MedlinePlus. Retrieved March 23, 2022, from https://medlineplus.gov/osteoporosis.html
  8. Rattue, P. (2012, July 26). Malnutrition and starvation cause inflamed intestines. Medical News Today. Retrieved March 23, 2022, from https://www.medicalnewstoday.com/articles/248330#1
  9. Mayo Foundation for Medical Education and Research. (2021, March 18). Stress relievers: Tips to tame stress. Mayo Clinic. Retrieved March 23, 2022, from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-relievers/art-20047257

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