Anxiety and Anorexia: What’s the Connection?

It may be tempting to simplify anorexia nervosa into a condition that is just about food, weight or body image. But underneath the eating behaviors often lies a lot of anxiety.

For those struggling with an eating disorder, it is probably no surprise to learn that anorexia and anxiety are deeply connected. In fact, anxiety is the most common mental health problem associated with all eating disorders.

What is Anorexia Nervosa?

Anorexia nervosa is a severe psychiatric disorder. It is the most deadly of all mental disorders, and has a high rate of medical complications. It is commonly thought to happen in young women, but really can occur in people of any age, gender, or ethnicity.

Anorexia nervosa is characterized by body image distortion and an extreme fear of weight gain. These inaccurate perceptions of the body lead to severe food restriction and potentially an unhealthy body weight. If not treated, anorexia can cause severe malnutrition and eventually death.

It is unclear what exactly triggers anorexia nervosa. There is a strong genetic predisposition, but that alone doesn’t cause anorexia nervosa. Environment, such as the messages we received about our bodies and food, contributes to the development of an eating disorder. And often there is a triggering event, like an attempt to lose a few pounds. This then triggers an alteration in brain chemistry, leading to more  extreme restriction.

Often people will feel like things in their life or the world are out of control, and that makes them anxious. Controlling food gives them a sense of control over something, somewhat easing that anxiety. The sense of control is false though and creates more problems than it solves.

Anorexia nervosa is not a lifestyle choice or a diet gone wrong. And sufferers can’t “just get over it.” The toll eating disorders take on people is vast and the difficulty recovering from them shouldn’t be minimized.

Recovery from anorexia nervosa can be a long process. Ideally, treatment involves a team of dietitians, medical doctors, and therapists who specialize in treating eating disorders. It often includes cognitive behavioral therapy to address underlying psychological disorders, such as anxiety.

Full recovery from an eating disorder is possible, particularly if it is caught and treated early. Recovery is often not a linear process. On-going work with a registered dietitian, medical doctor, or therapist may be required for many years.

What is Anxiety?

The feeling of anxiety or nervousness is a normal stress reaction, particularly to situations that are dangerous or unknown. Anxiety may even be beneficial in some circumstances, helping keep us safe from harmful situations. For example, it is normal to feel anxious before giving a presentation and to some degree anxiety actually improves performance.

But anxiety becomes disordered when it is excessive, constant, and begins to impact your day to day life. Anxiety disorders impact up to 31% of adults at some point in their lives. 

 People experience anxiety in different ways, but symptoms may include:

• Headaches
• Sweating
• Shortness of breath
• Heart palpitations
• Restlessness
• Tension
• Sleep disturbances
• Withdrawal from social situations
• Nervous ticks or habits
• Obsessive and persistent thoughts

There are many different types of anxiety disorders, from phobias to obsessive compulsive disorder. Although anorexia nervosa is not technically classified as an anxiety disorder, there is a significant connection between the two.

Is Anorexia Nervosa an Anxiety Disorder?

I would argue that yes, anorexia nervosa is a type of anxiety disorder, although it is not formally classified that way. Many patients with anorexia nervosa also have severe anxiety, one study found that up to ¾ may struggle with anxiety. There is also a genetic connection between anxiety and anorexia.

Frequently, the anxiety in anorexia nervosa is focused around food, eating habits, or weight gain. For those with anorexia nervosa, eating is associated with high levels of stress that may also involve ritualized behaviors.

For example, many people with anorexia nervosa may take very small bites of food or tear up food into pieces during meals. These rituals are similar to people with certain phobias or compulsions. If rituals are not allowed, people with anorexia may feel severe anxiety.

But it is not uncommon for those with eating disorders to be anxious about other aspects of life as well. Those with anorexia nervosa may also have obsessive compulsive disorder (OCD) or social phobia. They may display certain anxious personality traits such as perfectionism, harm avoidance, and neuroticism.

Additionally, stress caused by prolonged starvation can alter brain chemicals and hormones, such as cortisol, that make anxiety worse. So, although a characteristic of anorexia is anxiety at the onset, the progression of the eating disorder can make it worse.

Can Anxiety Cause an Eating Disorder?

No, anxiety doesn’t cause eating disorders. There are many different types of anxiety that have nothing to do with eating behaviors and many underlying causes of eating disorders. Therefore, we can’t say anxiety is the only underlying cause of anorexia.

But it is common that those with anorexia nervosa have a history of anxiety disorders. Also, eating disorders may develop as a way of coping with severe anxiety or extreme stress.

Even once someone has recovered from anorexia nervosa, they may still report struggling with obsessions and anxiety. The eating behaviors may have improved, but they need on-going support and mental health treatment.

Anorexia nervosa is a complex disorder with many triggers, so it is difficult to determine the exact cause for an individual. What is important is that each patient receives the treatment they need to help them overcome eating disorder thoughts and behaviors.

 Treating Anxiety and Eating Disorders

Successful treatment for anorexia nervosa involves many things, including addressing underlying anxiety. Clinicians will help people challenge and reframe the anxious, negative thoughts they experience around food and life in general.

Treatment may also include exposure therapy, which helps people see that they can do anxiety-provoking things without the negative consequences they expect occurring.

Depending on the needs of the patient, nutrition and behavioral therapy may be provided on an outpatient basis. If the situation is more severe, day programs or inpatient treatment are also options. Medications may be part of the treatment plan.

A registered dietitian can help educate and support patients to improve their eating behaviors. RDs specialize in helping patients use nutrition to heal their relationship with food. If you are struggling with anxiety around your eating habits, reach out! I am happy to help guide you on your journey towards better physical and mental health.