Types of Anxiety and Their Relation to Eating Disorders

It is commonly known that anxiety disorders and eating disorders (EDs) are often co-occurring. What is less known is that there are various forms of anxiety disorders, and each one interacts with eating disorders differently.

The DSM-V emphasizes that anxiety shares characteristics of fear but is quick to differentiate that “fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of a future threat [1].” Fear often initiates more visceral fight, flight, or freeze responses, whereas anxiety precipitates muscle tension and avoidant behaviors. The DSM-V specifies that each disorder varies in relation to the fear, anxiety that precipitates it and the behaviors this leads to.

Types of Anxiety

Generalized Anxiety Disorder (GAD):
GAD is marked by excessive worry and anxiety over various things when there is no reason for these worries [2]. GAD is often characterized by “four components: Intolerance of uncertainty, positive beliefs about worry, poor problem orientation, and cognitive avoidance [3].”

These characteristics have also been found to be elevated in those with EDs, particularly intolerance of uncertainty [3].

Social Anxiety Disorder (SAD):
This disorder involves “fear or anxiety over social situations in which the individual is exposed to possible scrutiny by others [1].”

These fears can particularly manifest those with a predisposition to EDs, as research finds that “stress from negative social evaluation may play a pivotal role as a cause of eating disorder symptoms [4].” In fact, social anxiety has been found to be prevalent in 20% of individuals with EDs [4].

Obsessive Compulsive Disorder (OCD)
While many who have perfectionist tendencies conversationally remark that they have OCD, the real disorder involves someone having repeated, unwanted thoughts that lead them to engage in repetitive behaviors [5]. EDs share this symptomatology, including excessive thoughts about food and calories.

Those with co-occuring ED and OCD often focus on the shape, color, and weight of the food they’re eating. It has been found that around 41% of patients with EDs also experience OCD [6].

Panic Disorder
Those with Panic Disorder experience “sudden and repeated attacks of fear that last for several minutes or longer [7].” These “panic attacks” can often make someone feel as if they’re dying. It is theorized that EDs and panic attacks have a strong relationship because they become part of a vicious binge-panic-purge cycle. In this cycle, “stress results…to which the patient responds by bingeing as a coping mechanism. The binge…evokes renewed panic followed by purging [8].”

Similar to panic disorder, eating disorders are commonly found to be a coping mechanism for anxiety disorders, or other co-occurring mental health disorders. Strengthening healthy coping mechanisms can often be the key to ensuring one recovers from their eating disorder and regains the power their anxiety stole from them.

Community Discussion – Share Your Voice!

What coping mechanisms have helped you overcome your co-occurring eating disorder and anxiety disorder?  Connect with others to discuss further on Eating Disorder Hope’s online forum today!

About the Author: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

References:

[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental health disorders (5th ed.). American Psychiatric Publishing.
[2] Generalized anxiety disorder: when worry gets out of control (2016). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml
[3] Konstantellou, A. et al. (2011). Testing a cognitive model of generalized anxiety disorder in the eating disorders. Journal of Anxiety Disorders, 25, 864-869.
[4] Levinson, C. A., Rodebaugh, T. L. (2012). Social anxiety and eating disorder comorbidity: the role of negative social evaluation fears. Eating Behaviors, 13, 27-35
[5] Obsessive compulsive disorder (2016). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml?utm_content=buffer69236&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer.  
[6] Kaye, W. H. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161, 2215-2221.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published May 29, 2017.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on May 25, 2017.
Published on EatingDisorderHope.com

Eating Disorder Hope Staff

The EatingDisorderHope.com editorial team comprises experienced writers, editors, and medical reviewers specializing in eating disorders, treatment, and mental and behavioral health.