Anxiety is the most common mental health disorder in the United States, with as many as 18% of the country’s population reporting acute symptoms each year. That translates to more than 50 million people who struggle with anxiety in the US alone. Anxiety can range from a relatively minor hindrance to being a debilitating mental illness requiring hospitalization. Anxiety can also trigger other forms of disordered behavior and is a common underlying factor in many eating disorders. It’s so common in people with eating disorders that virtually every eating disorder professional and treatment facility makes dual diagnosis anxiety therapy a central tenet of their treatment programs.
According to the National Eating Disorder Association (NEDA), 56 percent of individuals in a study of 2,400 individuals involved in an eating disorder treatment program were also diagnosed with an anxiety disorder. To break down those numbers even further, 54 to 81 percent of people with bulimia nervosa and 48 to 51 percent of people with anorexia nervosa also have an anxiety disorder. Therefore, people who enter an inpatient anorexia treatment program or even those following a bulimia treatment plan as outpatients often need help with anxiety.
Even though anxiety is oftentimes considered a monolithic mental disorder that is only one issue, anxiety disorders can be broken down into subtypes. Understanding the specific subtype of anxiety disorder that a person in an eating disorder treatment program is experiencing helps the care providers better aim their recovery efforts and therapy plans. Here is a look at four different types of anxiety that are often associated with eating disorders.
Social anxiety is defined as having a fear of social interactions or social settings. Virtually everyone experiences nervousness from time to time in social settings – you might feel anxiety before giving a big presentation at work or before asking someone out on a date. With social anxiety, however, even everyday interactions can cause a powerful sense of anxiety. Something as simple as interacting with a supermarket cashier or answering a question in class can bring on a powerful worry that they will do something incorrectly or the people around them will make judgments. The stress caused by this sense of anxiety can have a significant effect on a person’s psychosocial life. It can cause problems in relationships, education, and even employment.
Social anxiety is one of the more prevalent forms of anxiety for people who have an eating disorder because the anxiety is often driven by a fear of being evaluated or negatively assessed by others. When combined with a poor body image and/or a sense that people are judging them for their weight, social anxiety can lead to disordered eating behaviors like calorie restriction and purging behaviors. Many people with eating disorders also feel uncomfortable at mealtimes with other people, which can be exacerbated if they also have social anxiety disorder. These kinds of issues are often addressed during residential and day treatment for eating disorders. Someone in a residential anorexia treatment program may have a fear of social interactions, for example,but a gradual introduction to a group therapy setting can help them work on being more comfortable in social situations as well as bonding with other people who have the same eating disorder. Social anxiety can be treated with medication, but talk therapy is usually the preferred treatment methodology.
Phobias are a subtype of anxiety driven by strong or irrational fear. Phobic anxiety involves having an excessive fear of something like an object or situation. For those in eating disorder treatment programs, phobias are often associated with consuming specific foods or even the entire act of eating itself. A good example of another form of phobia often relative to eating disorders is how someone in a bulimia treatment plan may have specific phobias relative to certain foods they’ve had binge eating experiences with.
Food phobias are central to Avoidant/Restrictive Food Intake Disorder (ARFID), a specific form of eating disorder that was finally recognized in the most recent Diagnostic and Statistical Manual, the DSM-5. This disorder causes people to avoid certain foods and even entire food groups out of fear of certain textures and flavors. ARFID can also trigger fear of certain foods that might cause choking or food poisoning. When presented with these “fear foods,” many people with ARFID experience heightened anxiety. It’s more than simply being a picky eater; ARFID can cause severe weight loss and nutritional imbalances that dramatically affect a person’s health.
Panic disorder is a form of anxiety in which an individual will have sudden onset panic attacks because of their anxiety. A panic attack is a major episode in which an individual will have such anxiety that it generates physical symptoms, such as heart palpitations, sweating, shaking, or even nausea. These episodes can be extremely dangerous; if a person is driving or operating heavy machinery when they have a panic attack, for example, they can easily be involved in an accident. Even with less severe panic episodes, panic disorder can interfere with a person’s job or schoolwork, which can cause further anxiety. A panic episode can be treated with sedatives, but for long-lasting recovery, extensive talk therapy will also be required, which is normally part of an eating disorder recovery program.
Panic disorder can be deeply entwined with eating disorders, often causing individuals with an eating disorder to react in a certain way to try to soothe the symptoms of an attack, as a coping mechanism. For instance, someone who is trying to follow a bulimia nervosa treatment plan will have to learn how not to purge because of the food they have consumed, which can bring on a sense of panic and loss of control. Dialectic talk therapy like Cognitive Behavioral Therapy (CBT) is a central part of dual diagnosis treatment with panic disorders; it can help people identify which thoughts and emotions are triggers for panic and/or disordered eating behaviors, and replace them with more positive reactions.
Obsessive-compulsive disorder (OCD) is a form of anxiety disorder that causes people to suffer from recurring ideas and obsessions. These recurring obsessive ideas or thoughts can drive an individual to act compulsively. This is often represented as a compulsion to turn a light switch on and off a certain number of times, as an example, or repeating washing of the hands. Many people with OCD experience both obsessive thoughts and compulsions to repeat these actions. In some cases, the individual feels that something bad will happen if they do not perform these actions. In any case, OCD can have a serious effect on a person’s wellbeing; the compulsive actions are not enjoyable and take up a considerable portion of their time.
OCD shares many qualities with eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, and orthorexia. For instance, an individual may have recurring thoughts about burning off calories after consuming a meal so they will exercise compulsively to a degree that would be outside of typical behavior. Or they may refuse to eat a food that has touched another food on the plate. People with OCD are also at a much higher risk of developing an eating disorder than others. OCD is treated with a combination of medication and behavioral therapy. Normally, an individual with OCD who is also in treatment for an eating disorder will have a specialized treatment program that can address both issues. If they are not treated concurrently, the chances of successful recovery are much lower.
Mental Health Treatment Must Address Every Disorder
By examining the underlying anxiety disorder an individual is dealing with during an eating disorder treatment program, it is easier to understand where some of the attention needs to be focused during therapy. A complete recovery is an arduous journey even if there is only one disorder; in a dual diagnosis situation, the complexity of treatment increases greatly. Thankfully, most professionals that work in eating disorder recovery centers are trained to treat co-occurring disorders. Psychiatrists, especially, have to study anxiety disorders extensively as they earn their degrees.
Complexity aside, both anxiety disorders and eating disorders have a great impact on quality of life. Treatment is a necessity to maintain a happy, healthy lifestyle. SO don’t hesitate – if you or a family member struggle with an anxiety disorder and an eating disorder, reach out to us at Oliver-Pyatt Centers for assistance.