Anxiety And Eating Disorders: What You Should Know

Anxiety disorders and eating disorders can occur simultaneously. Below are some facts you should know about both

More than 30 million people in the United States will be diagnosed with an eating disorder during their lifetime. Among those, a significant number will also be diagnosed with co-occurring mood disorders. Co-occurring disorders are mental health disorders that occur at the same time as the eating disorder. A large part of eating disorder recovery can include treatment for these co-occurring disorders.

Anxiety is one of the most common co-occurring disorders found with eating disorders. In fact, anxiety is more likely to occur with eating disorders than not. A recent study among people with eating disorders found 56 percent of participants were also diagnosed with an anxiety disorder.

Obsessive-compulsive disorder or OCD may have the strongest link with eating disorders. Of the 56 percent of people diagnosed with anxiety disorders in the study listed above, 20 percent had obsessive-compulsive disorder. Post-traumatic stress disorder (PTSD) and social anxiety are also commonly diagnosed with eating disorders. Common eating disorders include:

  • Bulimia nervosa: Bulimia nervosa is characterized by frequent episodes of binge eating followed by purging. During these binge episodes, an individual will consume large amounts of food in a short period of time. He or she will then often engage in purging behaviors, such as self-induced vomiting, laxative or diuretic use or excessive exercise in order to avoid gaining weight. Bulimia nervosa and anxiety disorders often go hand-in-hand.
  • Anorexia nervosa: Characterized by severe restrictive behavior; these behaviors typically lead to weight loss and an inability to gain weight. People with anorexia nervosa often have a distorted body image. Comorbid anxiety disorders are more common in people with anorexia nervosa than the general public.
  • Binge eating disorder: An individual with binge eating disorder will have repeated episodes of eating large amounts of food. People with binge eating disorder may feel a loss of control during the binge episodes and often feel shame or embarrassment about their behavior. People with binge eating disorder often have high rates of anxiety.

Anxiety and Eating Disorders: The Connection

Doctors and eating disorder specialists have had a difficult time identifying how anxiety and eating disorders are related. No one can say for sure why the connection between eating disorders and anxiety exists, but there are a few theories. One prominent study conducted in 2004 found that 42 percent of people with comorbid anxiety had developed the anxiety disorder during childhood long before the onset of their eating disorder.

How Does Anxiety Affect Eating Disorders?  

For those who have an eating disorder, an anxiety disorder may make their symptoms worse. It might also make recovery more difficult, which is why it is essential to be treated for both disorders.

Symptoms Of An Eating Disorder

The signs and symptoms of an eating disorder can vary across different types of disorders. Eating disorders are a group of behavioral disorders that involve a combination of emotional and behavioral symptoms. Eating disorders have a high rate of mortality compared with other mental disorders. In fact, anorexia nervosa has the highest mortality rate of any mental disorder.

Anorexia Nervosa

One of the main symptoms of anorexia nervosa is a below normal body weight and a distorted body image. A person with anorexia nervosa may believe they are overweight even when they are severely underweight. There is usually anxiety surrounding the disorder; for example, the individual may excessively worry about gaining weight. Other signs and symptoms include:

  • Extreme weight loss
  • Difficulty gaining weight
  • Fatigue and muscle weakness
  • The absence of menstruation in women
  • Low blood pressure
  • Preoccupation with body size or shape
  • Extreme fear of gaining weight
  • Irritability or agitation
  • Refusing to eat in public or lying about how much food one has eaten
  • Frequently skipping meals or refusing to eat
  • Severe restriction of food intake
  • Compulsive exercise
  • Frequent negative comments about weight or body size
  • Withdrawal from family or friends
  • Rituals around food, such as eating foods in a certain order
  • Dry skin and nails
  • Problems sleeping
  • Imbalances in sodium, potassium and other electrolytes

Bulimia Nervosa

The behaviors of bulimia nervosa include repeated episodes of binging or eating large amounts of food in a short time followed by purging behaviors, such as self-induced vomiting. Some other symptoms of bulimia nervosa include:

  • Noticeable fluctuations in weight
  • Eating beyond the point of feeling full
  • Preoccupation with body weight or size
  • Using laxatives to try to lose weight
  • Repeated episodes of fasting between binges
  • Engaging in extreme exercise or other compensatory behaviors after a binge
  • Feeling a loss of control during binges
  • Disappearingto the bathroom after eating
  • Muscle weakness or shakiness
  • Dizziness or syncope
  • Tooth decay and other dental problems
  • Social withdrawal
  • Bloating and stomach problems

Bulimia nervosa treatment can help address the underlying causes and behaviors of this eating disorder.

Binge Eating Disorder

People with binge eating disorder typically consume large amounts of food at one time. The person may feel a loss of control and be unable to control how much they eat during a binge. Other symptoms of binge eating disorder include:

  • Eating until feeling uncomfortably full
  • Eating a greater amount of food than what most people would eat during the same time
  • Hiding food and engaging in other secretive behaviors to hide binges
  • Periods of eating more rapidly than normal
  • Preoccupation with food
  • Feeling guilty, ashamed or embarrassed after a binge
  • Low self-esteem and self-confidence
  • Fluctuations in weight or size
  • Frequent stomach cramps or other gastrointestinal issues

Symptoms Of An Anxiety Disorder

Everyone feels anxious from time to time; however, anxiety disorders are different. Anxiety disorders are serious mental illnesses that can take over a person’s life. People with eating disorders often have some anxiety as part of the eating disorder; however, when the anxiety becomes debilitating, it could be an anxiety disorder. Anxiety disorders can range in severity. Some symptoms of anxiety disorder may include:

  • Excessive worry: A person with an anxiety disorder will often worry excessively about a variety of things. They may find the worry difficult to control. In eating disorders, the worry may center around eating certain types of foods or eating in social situations.
  • Restlessness: The person may feel restless or frequently on-edge. If the person also has an eating disorder, they may feel especially stressed around situations that involve food.
  • Agitation or irritability: Irritability and agitation are signs of an anxiety disorder, especially in teens.
  • Rapid heartbeat: Anxiety disorders may cause the person to experience a fast heartbeat. It can sometimes be difficult to tell if this symptom is from the anxiety disorder or the eating disorder as eating disorders often cause heart complications.
  • Tense muscles: The person may experience tense or tight muscles and may have difficulty relaxing.
  • Avoidance of social situations: A person with an anxiety disorder may avoid social situations. If the person also has an eating disorder, they may avoid eating in public, at family gatherings where food is present, etc.
  • Sleep problems: Worry may interfere with a person’s sleep. They may find it difficult to go to sleep or get a good night’s rest.
  • Irrational fears: A person with an anxiety disorder may feel irrational fears. They may fear weight gain or body changes. The irrational fears may also extend to other areas of their lives.
  • Intense, overwhelming fear: Panic or intense fear can also occur in some anxiety disorders. When an individual also has an eating disorder, they may experience panic at the thought of eating in public, for instance. These types of situations can trigger intense fear.

How Are Comorbid Eating Disorders And Anxiety Disorders Treated?

It is important that comorbid anxiety disorders and eating disorders be treated simultaneously. If a person has both an eating disorder and anxiety disorder, they must seek help for both disorders. Co-occurring treatment programs offered by eating disorder treatment centers address and treat both.  Co-occurring treatment for eating disorders is based on an individual’s needs and personal history. Common treatments for both disorders include:

  • Psychotherapy: Cognitive behavioral therapy is a highly effective type of psychotherapy typically used to treat both types of disorders. This therapy helps the person change maladaptive thinking patterns and develop more adaptive behaviors.
  • Psychoeducation: Psychoeducation helps the person learn to manage symptoms of the anxiety disorder and the eating disorder.
  • Trauma-focused psychotherapy: This type of therapy helps address any past trauma that may contribute to anxiety symptoms.
  • Exposure therapy: Exposure therapy is a cornerstone of anxiety treatment. It helps the person gradually learn to cope with greater challenges that may have previously triggered anxiety.
  • Medication management: Psychiatric care and medication management can be used to treat anxiety disorders and eating disorders.
  • Co-occurring disorder groups: These groups are based on peer support and are led by a treatment professional.

A person with an eating disorder should also receive nutritional education and therapy. This will help develop more mindful approaches to eating and restore nutritional balance.

Co-occurring Anxiety And Eating Disorder Treatment Levels Of Care

Co-occurring disorders treatment can take place in a variety of settings including inpatient, residential, outpatient and supervised living. The level of care depends on the individual’s needs. Supervised 24-hour care in the residential setting may be necessary to treat both the anxiety and the eating disorder. As the person progresses in treatment, they may be able to receive treatment in an outpatient or supervised living setting.

  • Residential treatment: A residential treatment program providing 24-hour medical and nursing care and supervision. The individual lives on-site and receives treatment for both the eating disorder and any co-occurring disorders.
  • Outpatient eating disorder treatment/Day treatment program: A day treatment program is ideal for individuals stepping down from a residential level of care or who need more support than an individual therapy schedule is providing. This level of care allows the individual to have greater Independence while working toward becoming fully  Day treatment programs may include a thorough assessment to determine appropriateness of this level of care, daily group and individual therapy, exposure work and more.
  • Supervised living: Supervised living is typically provided as a step-down program that can be combined with day treatment, after an individual completes residential treatment. This type of program provides support in the evenings and can be beneficial on the path to recovery.

Treatment of co-occurring disorders may be an essential step in achieving full recovery from an eating disorder. If you or a loved one is showing signs of a co-occurring anxiety disorder or eating disorder, please reach out to an eating disorder treatment center today. Eating disorder recovery is possible.


With 20 years of behavioral health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioral health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at large.