Obsessive Compulsive Disorder (OCD)– This disorder is the most common anxiety disorder diagnosed in conjunction with an eating disorder. Someone who has OCD in addition to an eating disorder would experience recurring and persistent thoughts about things other than food and their body image. For example, the person may obsess about cleanliness or checking on specific things around the house. The second part of OCD consists of compulsions which silence the obsessive thoughts. Going along with our example, someone may clean a specific part of their body numerous times per day which would dry out their skin and interrupt other responsibilities. Someone who checks things may check to make sure the stove is off 20 times before they leave the house. The thoughts are obsessions while the actions are compulsions. Most importantly, the thinking and actions interrupt daily functioning.
Social Phobia– This disorder is characterized by an intense fear of social situations where one comes into contact with unfamiliar people or scrutiny of others. This fear is not limited to food consumption and body image. Due to this fear, a person with social anxiety will avoid these situations in order to reduce the anxiety. Someone with social anxiety will fear that they will act in a certain way that makes others have a poor opinion of them. For example, someone with social anxiety would avoid her husband’s work party because she is fearful of being around those she does not know and acting in a way that may make others laugh or question her actions.
Generalized Anxiety Disorder (GAD)– With this disorder, a person has difficulty controlling excessive anxiety over a number of events or activities, not limited to food and body image. The worry leads to physical symptoms including restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. The key to this disorder is an excessive amount of anxiety. Someone with GAD would worry excessively about finances, losing their job, the car breaking down, whether they are being a good parent, and coping with difficulties that arise.
How Anxiety Drives An Eating Disorder
Using the words “fuel” or “drive” to describe anxiety’s role in eating disorders is very fitting. Anxiety gives the eating disorder life. It gives the eating disorder a superficial purpose. Many of the eating disorder behaviors continue because they are helpful in reducing anxiety. While anxiety is rarely the underlying issue of an eating disorder, it helps harmful eating patterns develop into an eating disorder. Anxious attachment is very central to these disorders. So, how does this happen?
- The anxiety is excessive.
Someone suffering from an eating disorder experiences overwhelming anxiety. They feel that it will never go away. The only relief they may feel is when they focus their attention on food: eating or not eating. Therefore, they focus more attention on calories, food preparation, exercising, purging, how little calories they can eat, or when they will eat next in order to feel relief. The issue of control almost always points to attempts to stop fear, which is central to anxiety issues.
- The anxiety makes one feel out of control.
Even with all the focus on food, eating or not eating, the anxiety still returns. It is like the eating disorder sufferer is in a vicious cycle. The cycle occurs because the ritual with food allows a temporary break from anxiety, at the cost of long term increase in anxiety. It is like borrowing money now to spend, while at the same time developing an unmanageable debt. At the same time, the rituals with food are becoming less effective. A larger dose is needed. As much as one tries to get off this cycle, they keep spinning and spinning. They feel no sense of control over their anxiety. The only area they may feel a slight level of control is over what they do or don’t eat.
- The anxiety shames.
Shame feels like something is wrong within you. Often, you feel that failure defines you. The secrecy and feeling the need to hide your eating disorder can produce shame. Due to this shame, anxiety creeps in to help you hide your disordered eating behaviors. You may eat late at night or when no one is looking because you are fearful of binging. You may lie and say you already ate when you are starving. You become anxious after these behaviors wondering if anyone knows the truth. You think something must be wrong with you to act on this anxiety. The shame is huge, as are the unrealistic expectations you may have of yourself, others, relationships, and success.
- The anxiety isolates.
Due to feeling shame about disordered eating patterns, those suffering from an eating disorder often become anxious about eating around others. They worry what others will think of them or that they will find out the sufferer’s secret. In order to continue to hide the eating problems, an eating disorder sufferer will avoid social situations, family gatherings, and even spending time with a few good friends. The shame and isolation felt by the eating disorder sufferer also makes them feel alone in their struggles. They begin to believe that no one understands or suffers like they do.
- The anxiety helps you believe lies.
People believe something when they feel it is true, not necessarily because it factually is or isn’t. Many people who suffer from eating disorders believe lies such as:
My life would be better if I could just lose weight or look a certain way or the pain I feel will never go away.
Anxiety perpetuates these lies. Due to the worry and physical symptoms of anxiety, these lies or irrational thinking continue because it calms the anxiety. For example, it is easier to focus on food than to focus on anxiety, hurt, pain, sadness, and fear. While the eating habits may calm the anxiety for a short period, it does more harm than good in the long run. It can become part of a fantasy of what could be, which is not based in reality.
Kaye, W. H., Bulik, C. M., Thornthon, L., Barbarich, N., & Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161, 2215-2221. Retrieved from http://journal.psychiatryonline.org/article.aspx?articleid=177216
Koenig, K. R. (2007). The food and feelings workbook: A full course meal on emotional health. Carlsbad, CA: Gürze Books.
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