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Anxiety and Eating Disorders

Anxiety and eating disorders often manifest together, causing the person with both anxiety and an eating disorder to struggle with both when treatment is not provided. The obsession with food intake and exercise may start as a way to manage being “overweight,” but combined with an anxiety disorder, it can get out of control. In many cases of anorexia or bulimia nervosa, anxiety is a precursor to the development of an eating disorder. This may lead to more proactive treatment, as those with an anxiety disorder who receive treatment early on may not develop an eating disorder.

Anxiety and the Relationship with Eating Disorders

In an abstract published by Acta Psychiatrica Scandinavia, anxiety and the development of an eating disorder were studied. The goal was to determine the age of onset for an anxiety disorder and the prevalence of the development of anorexia nervosa or bulimia nervosa to figure out if those who are diagnosed with anxiety early on are at risk for developing an eating disorder. The study looked at 68 women with anorexia nervosa, 116 with bulimia nervosa, 56 with major depression and without a co-occurring eating disorder, and 98 randomly selected women to be the control group. The study concluded that in 90% of the women with anorexia nervosa, 94% of those with bulimia nervosa, and in 71% of those with major depression, anxiety was diagnosed first. As far as panic disorder, it was discovered that this is generally diagnosed after an eating disorder when both co-occur. The risk of developing obsessive-compulsive disorder was markedly higher for those with anorexia nervosa than with all other groups.

Understanding Obsessive-Compulsive Disorder and the Development of an Eating Disorder

Obsessive-compulsive disorder, or OCD, is an anxiety disorder that manifests in a wide variety of ways. For those who have developed anorexia nervosa, OCD can become out of control. Food restriction and a preoccupation with exercise can lead to obsessive thought patterns and behaviors.

As the obsession with food and exercise becomes more intense, OCD can develop. This may involve having rituals around food, such as cutting food into tiny bits and eating the food in a specific order. For some, the rituals provide control around food and limit the amount of food that is consumed. While OCD can occur without an eating disorder, those that develop anorexia nervosa are more susceptible to the development of OCD if the eating disorder is not treated properly.

How Anxiety and Eating Disorders are Treated at the Same Time

Learning new patterns of thought and engaging in healthier behaviors around food is vital to the success of any eating disorder treatment program. The use of cognitive behavioral therapy, or CBT, is effective at treating those with an eating disorder and an anxiety disorder at the same time. The treatment involves working closely with a counselor and recognizing the negative, unhealthy thought patterns that are driving the behaviors associated with the anxiety and eating disorder.

Cognitive behavioral therapy can be done in a group setting, or one-on-one with an individual therapist.  Once a negative thought or behavior is identified, the goal is to then understand how this thought is not healthy for the person who is suffering. For example, “I am so disgusting, if I just lose weight I’ll be happier”, can be a negative thought that pushes the need for control over food intake in order to lose weight. Taking a step back and looking at the thought from a neutral perspective, the negative thought can be identified and better understood.

Through CBT, the negative thought is then changed with the help of the therapist, and a more positive thought, “I am not disgusting, and I deserve happiness no matter what,” can lead to more positive thinking patterns. This type of therapy can be used in a wide variety of settings and circumstances. An effective CBT therapist will be able to work closely with an individual who has an eating disorder and anxiety to better identify problem thoughts and behaviors.

It’s important to remember that recovering from one disorder does not guarantee the other disappears, so treatment for both anxiety and an eating disorder at the same time will benefit the individual and offer the best chance at overall healing.