Anxiety and panic disorders encompass a wide range of psychiatric subtypes including generalized anxiety, obsessive-compulsive disorder, post-traumatic stress disorder and panic disorder/panic attacks. Development of clinical anxiety disorders generally begins in childhood or adolescence, but adults can be diagnosed with an anxiety disorder when they previously suffered minimal anxiety. Feeling constantly anxious and panic-stricken is both physically and mentally debilitating. Unless they seek professional treatment, people trying to cope with overwhelming anxiety often adopt harmful and ineffective behaviors to alleviate anxiety.
Anxiety Disorders Often Precede Eating Disorders
Experiencing anxiety without relief makes people feel like they have no control over their lives. Racing thoughts, worrying about things that may not happen and enduring repeated panic attacks dramatically impact an anxious person’s ability to live a normal life. At some point, that person actively searches for something they can control, something that gives them a false sense of respite and power. In some cases, that sense of control focuses on weight management and food intake.
A study published in the American Journal of Psychiatry involved subjects diagnosed with anorexia nervosa or bulimia nervosa. Rates of anxiety/panic disorders were similar among these groups. Nearly two-thirds of this study’s subjects had at least one anxiety disorder. The most common anxiety disorders were social phobia and obsessive-compulsive disorder. Most participants reported symptoms of generalized anxiety disorder, object phobia, social phobia and OCD began in childhood. Because they never received treatment, these participants eventually developed an eating disorder as a way to deal with their anxiety.
Treating Eating Disorders and Anxiety Together
Eating and anxiety/panic disorders should be treated simultaneously since they are correlated and exacerbate symptoms of either disorder. Getting help for just one disorder does not guarantee recovery from the other. One of the most effective psychotherapies used to treat anxiety and eating disorders is cognitive behavioral therapy.
CBT focuses on modifying self-sabotaging, negative thought patterns that produce physiological and psychological signs of anxiety, panic, and depression. CBT counselors teach patients to recognize and stop false beliefs about themselves, about others and about events happening in their lives before these thoughts initiate emotions detrimental to their well-being. People with eating disorders and anxiety frequently engage in the following:
- Mentally concentrating on the bad things in life instead of the positive things
- Minimization and magnification–exaggerating negative events while downplaying favorable ones
- Using emotional reasoning instead of objective reasoning–letting emotions get the best of you
- Personalization–feeling like everything is your fault even though it is probably out of your control
- Should, could, would statements–obsessing over past mistakes when it does no good to do so
- Jumping to conclusions–assuming the worst when no evidence exists for such an assumption
When used in combination with medication, cognitive behavioral therapy can greatly improve the ability of a patient to manage feelings of anxiety, panic and the compulsion to use food to alleviate strongly unpleasant emotions. CBT counselors assist individuals with eating disorders understand why they eat too much or too little by educating them about the trap of self-critical and defeating thinking patterns that distort the way they perceive themselves and the world around them. Antidepressants, nutritional counseling/management, and experiential therapy are also beneficial to treating co-occurring anxiety and eating disorders.
The development and progression of an eating disorder are complex and multi-faceted. Clinical anxiety may be just one of several psychological issues underlying bulimia nervosa, anorexia nervosa or binge eating. In addition to receiving psychotherapeutic counseling, some patients may also require medical attention prior to beginning counseling sessions to correct nutritional deficiencies potentially contributing to anxiety and panic disorders.