How Anxiety Fuels Eating Disorders

eating disorder

Most people diagnosed with an eating disorder also experience anxiety severe enough to be diagnosed with an anxiety disorder.  It is common for an anxiety disorder to precede or develop before an eating disorder. Eating disorders can often be a destructive reach for control, or a means of managing fear.  In this article, you will learn what types of anxiety disorders are most commonly diagnosed with an eating disorder as well as how the anxiety drives the eating disorder.

Anxiety Disorders

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.

If you or someone you know is struggling with an eating disorder, please contact us. The Relationship Center has therapists who specialize in eating disorder treatment. We are here to help and would be happy to answer any questions you may have.


eating disorder treatmentOver 1,400 families in southwest Missouri trust the counselors of The Relationship Center to serve their counseling needs. With more than 14,000 hours of therapy in the last 5 years alone TRC counselors have the experience that can make the difference. We specialize in Biblically Christian and Clinically Proven Counseling provided by Licensed Professionals. Session fees range from $75-$125 and we have payment plans & scholarships to meet every budget. Have more questions? Click Here to Learn More About Eating Disorder  Counseling at The Relationship Center


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

Koenig, K. R. (2007). The food and feelings workbook: A full course meal on emotional health. Carlsbad, CA: Gürze Books.

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How to help a loved one struggling with Bulimia.

Bulimia (bulimia nervosa) is a serious eating disorder that may require extensive treatment and recovery time.  Family and friends often find it very difficult to know how to support their loved one struggling with this disorder.  Family members can be helpful. The best way to help sufferers of bulimia is by learning the symptoms, being familiar with stages of change, how these stages play into deciding when to seek treatment, and understanding what kind of support is helpful. This is Sarah’s story.

Sarah is a 35 year old real estate agent who has struggled with her weight for as long as she can remember.  As a child, she remembers being slightly overweight and very shy. Sarah hates the sharp pain she feels when someone mentions her size, and she doesn’t deal with stress very well. She started following a very strict calorie count in order to control her weight, but before long, she would binge on sugary foods. Sarah feels so guilty about these binges that she throws up or uses laxatives to get rid of the food. This relieves the stress and helps her feel back in control for a while. Just when she thinks she’s in control of her eating, she binges again. Throwing up multiple times per day has a way of bringing back that out-of-control feeling around both her eating and her emotions. She’s at her breaking point.

Symptoms of Bulimia Nervosa

Let’s take a look at the diagnostic symptoms Sarah experiences:

  • She frequently engages in binge eating. Binge eating is defined as:
    • Discretely eating an amount of food that is larger than what the average person would eat at that time under the same circumstances
    • Feeling a lack of control while eating
  • She frequently engages in extreme behavior in order to prevent weight gain including using laxatives and self-induced vomiting.
  • She binge eats and engages in the extreme behavior to prevent weight gain multiple times per week.
  • She bases her self-worth on body shape and weight.

These symptoms are confusing and difficult to understand. And, they look different in each individual. For example, while Sarah uses self-induced vomiting (throwing up) to compensate for her binges, another girl with bulimia may refuse to leave her house due to feeling depressed because the bathroom scale reads that she gained a pound or two.  She might compensate for these feelings by exercising for hours at a time to compensate for that pound or two, because she believes this will make her feel less depressed.  These behaviors make those who experience them feel crazy and those who love them feel powerless to help.

Do you feel like you know someone suffering from bulimia? How can you help?

Understanding Stages of Change

Your loved one may realize that she has bulimia, but that does not necessarily mean she’s ready for professional help. Why? Girls with disordered eating often believe that having bulimia provides more benefits than not having bulimia. For many eating disorder sufferers, the disorder serves as a coping mechanism to deal with other stressful issues in their life.  Therefore, they may or may not be ready to consciously let go of this coping mechanism. It’s helpful for family and friends to understand the five stages of change.

  • Precontemplation: She does not see her eating disorder as a problem, and therefore, does not believe she needs to change.
  • Contemplation: At this stage, she is weighing the pros and cons of her eating disorder.
  • Preparation: Now she’s gathering resources for the change process. She is trying to prepare herself. It is important that she finds a change strategy that works for her.
  • Action: Now she’s ready and is actually implementing strategies for change and actively resisting urges to binge and use inappropriate coping behaviors.
  • Maintenance: At this point, she has returned to normal eating and is practicing coping strategies to cope with eating disorder symptoms.

It is important to identify which stage of change your loved one is currently in before trying to discuss the eating disorder. For example, discussing treatment options with someone in the precontemplation stage would not be beneficial. It would be most beneficial to voice personal concerns to the individual struggling with an eating disorder during the contemplation stage and to discuss treatment during the preparation stage.

In Sarah’s case, it sounds like she is moving from the precontemplation stage to the contemplation stage. Due to Sarah’s binge eating and throwing up multiple times per day, she is realizing that she does have a problem. Sarah will begin weighing the pros and cons of her eating disorder. A family member who is concerned about Sarah would find it beneficial to ask Sarah if they could discuss a few concerns the family member has about Sarah’s eating habits. If Sarah agrees, the family member would be most helpful in identifying a few specific behaviors that they are worried about (example: throwing up multiple times per day). The family member’s statement may sound something like: “Sarah I appreciate you letting me talk with you about a few concerns I have about your eating behaviors. I have noticed that after each meal you go to the bathroom for 10 minutes. I am concerned that you may be throwing up the food you ate. I am very worried about your well-being.” After making this statement, it is most helpful to let Sarah respond and listen carefully to her response. Next, the family member should summarize Sarah’s response. This will help Sarah feel heard and understood.

How to Communicate and Provide Support

Finding out a loved one is struggling with an eating disorder is very troubling, and it can be difficult to know how to be supportive.  Let’s discuss this issue by using three animals to help you visualize the best way to provide support to your loved one suffering with an eating disorder.  In these examples you are the concerned person.

  • Kangaroo Care: The concerned person wants to protect their loved one from the eating disorder just like a Kangaroo protects its young in its pouch. You try to keep the sufferer safe by treating them like a child and giving in to demands.  This type of response is not helpful because the sufferer does not learn how to cope with eating disorder symptoms.
  • Rhinoceros Response:  The concerned person becomes stressed and exhausted with the eating disorder symptoms. The loved one feels that there is an easily solution that the sufferer is not trying. The problem with this type of response is there is too much control and direction. The sufferer may not feel that she can recover on her own.
  • Dolphin: This is the recommended style of support for individuals suffering from an eating disorder.
    • Be flexible with consistent encouragement
    • Discuss why the sufferer wants to change and reasons why they may not want to change.
    • Discuss steps that the sufferer feels they can take toward change, even little steps can be helpful.
    • The focus should be on the anxieties of the sufferer about change than on the logical reasons to change.
    • Most importantly, listen to her and reflect back on what she tells you. This helps her feel heard and understood.

As Sarah weighs the pros and cons of her eating disorder, she discovers that there are more harmful consequences to her disordered eating than benefits.  For example, even though throwing up after binging makes her feel in control, Sarah knows that this response is harmful to her physically and only relieves anxiety for a short period of time. She appreciates the concern that her family member discussed with her. As a result of feeling heard by her family member, Sarah was able to discuss reasons she wants to change and fears about treatment. By gathering information about treatment options and facilities for bulimia, Sarah has the resources to start the change process. With the support of her family, Sarah called a counselor in order to be assessed for bulimia and start the therapy process.

If you have a loved one struggling with an eating disorder, the most helpful thing you can do is to be there to listen to her feelings and fears.  Often those struggling with bulimia feel unloved, unwanted, and not good enough in some area of their lives. Being there to listen to your loved one share feelings and fears about her eating disorder and struggles communicates the love that you have for her. It is also helpful to reflect back to your loved one the things that she shares with you. This helps her know that you were listening and understood her feelings.  In the example with Sarah, her family member shared concerns about the specific behaviors that caused worry. When talking with a loved one struggling with bulimia, it is important to share concerns about specific behaviors and be willing to thoroughly listen to her response to your concerns.  In most cases, the only way to recover from an eating disorder is to seek professional help. If you are concerned that a loved one may have an eating disorder, research treatment options in your area and schedule an appointment to discuss symptoms and concerns.


Recommended Reading:

Restoring our Bodies, Reclaiming our Lives: Guidance and Reflections on Recovery from Eating disorders edited by Aimee Liu

Skills Based Learning for Caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith, and Anna Crane

The Overcoming Bulimia Workbook. Your Comprehensive, Step-By-Step Guide to Recovery by Randi E. McCabe, Traci L.  McFarlane, and Marion P. Olmsted



American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association.

McCabe, R., McFarlane, T., & Olmsted, M. (2003). The overcoming bulimia workbook: Your comprehensive, step-by-step guide to recovery. United States: New Harbinger Publications.

Treasure, J., & Macdonald, P. (2011). What to suggest and how to suggest it: Talking tips to parents with open communication. In Liu, A.  (Ed.), Restoring our bodies, reclaiming our lives: Guidance and reflections on recovery from eating disorders (pp. 50-52). Boston: Trumpeter Books.

Treasure, J., Smith, G., & Crane, A. (2007). Skills-based learning for caring for a loved one with an eating disorder.  New York: Routledge.


eating disorder treatmentOver 1,400 families in southwest Missouri trust the counselors of The Relationship Center to serve their counseling needs. With more than 14,000 hours of therapy in the last 5 years alone TRC counselors have the experience that can make the difference. We specialize in Biblically Christian and Clinically Proven Counseling provided by Licensed Professionals. Session fees range from $75-$125 and we have payment plans & scholarships to meet every budget. Have more questions? Click Here to Learn More About Eating Disorder Counseling at The Relationship Center

The post How to help a loved one struggling with Bulimia. appeared first on September Trent.

What Is Bulimia?

bulimia help springfield moBulimia nervosa, not unlike anorexia nervosa, is a psychiatric disorder that revolves around food. Those with bulimia consume tremendous amounts of food, often thousands of calories, in a short period of time, then purge it from their bodies. Self-induced vomiting is the standard method of purging, though laxative abuse is also extremely common.

These behaviors are incredibly hard on the human body. A person with this disorder may binge, and subsequently purge, between 20 and 30 times a day. The truth is, the body was not designed to take in such a huge volume of food at one time. The medical complications of bulimia include extreme injury to the esophagus, stomach, teeth and intestines as well as damage to the kidneys and heart.

The emotional impact of prolonged bulimia is also severe. Unlike an individual with anorexia who is often proud of her strength and appearance, a girl or woman with bulimia suffers a tremendous amount of shame and guilt over her behavior. Even she knows that the act of consuming thousands upon thousands of calories, then purging, doesn’t make sense. This guilt is intensified by the cost involved with aquiring so much food. It is not unusual for the person to begin stealing the necessary food.

Professional care is usually required to break the highly addictive binge/purge cycle. Bulimia treatment typically begins with outpatient therapy from a counselor experienced in treating eating disorders. Although this can be effective, it is not unusual for patients to require a higher level of care, where their behavior can be monitored.

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