We have updated our Privacy Policy. By using this website, you consent to our Terms and Conditions.


Anxiety disorders and eating disorders are known to occur at the same time. Here, we’ll look at the connection between them and examine what a co-occurring disorder diagnosis means for treatment. 

Eating disorders affect more than 30 million Americans. Within this demographic, a high percentage also experience emotional disorders such as anxiety or depression. Co-occurring disorders are defined as two forms of mental health disorder happening in the same person at the same time.Their high chance of co-occurrence means that eating disorder recovery center should include treatment for these co-occurring disorders.

Anxiety disorders are observed frequently in people with various kinds of eating disorders. In fact, anxiety is more likely to occur with eating disorders than not. According to NEDA, 56 percent of participants in a recent study were also diagnosed with one or more anxiety disorders.

Obsessive-compulsive disorder or OCD is perhaps the most dramatic of the anxiety disorders, and it’s not uncommon in people with repetitive eating disorders like bulimia nervosa. Of the 56 percent of people diagnosed with anxiety disorders in the study listed above, 20 percent also showed the signs of OCD disorder. Post-traumatic stress disorder (PTSD) and social anxiety are also commonly diagnosed with eating disorders. 

What Are the Common Forms of Eating Disorder?

Common eating disorders include:

  • Bulimia nervosa: Bulimia nervosa is defined in the DSM-V by repeated episodes of binge eating followed by attempts to purge the calories eaten in the binge. During these binge episodes, a person will eat large amounts of food very quickly, sometimes past the point of comfort or even pain. He or she will then employ purging behaviors, such as self-induced vomiting, laxative or diuretic use, or excessive exercise. Bulimia nervosa and anxiety disorders featuring compulsive behaviors are often linked.
  • Anorexia nervosa: Characterized by strict caloric intake restrictions; these behaviors typically lead to extreme weight loss and malnutrition. People with anorexia nervosa almost always have a distorted body image. Comorbid anxiety disorders are more common in people with anorexia nervosa than the general public.
  • Binge eating disorder: Similar to bulimia nervosa, people with binge eating disorder will have repeated binge eating episodes, with the difference being that BED sufferers don’t normally purge afterward. People with binge eating disorder may feel a loss of control during the binge episodes and often experience a feeling of guilt or shame about their behavior. 

Anxiety and Eating Disorders: The Connection

While many studies have been performed on the subject, no one can say for sure why the connection between eating disorders and anxiety exists. However many clinicians have put forth plausible theories backed by data. One major study conducted in 2004 found that 42 percent of people with co-existing anxiety and eating disorders had a diagnosed anxiety disorder before their eating disorder developed.

What Kind of Interplay Is There Between Anxiety and Eating Disorders?  

For those who have an eating disorder, an anxiety disorder may trigger or exacerbate disordered eating behaviors, which may be a form of coping mechanism. It might also make recovery more difficult, which is why it is essential to be treated for both disorders.

How to Tell If Someone Has an Eating Disorder

The signs and symptoms of an eating disorder can vary depending on the type of disorder.They normally involve a combination of emotional and behavioral symptoms. Eating disorders have the highest rate of fatality among all kinds of mental health disorders. That’s why it is essential to understand the symptoms and secure treatment as soon as possible.

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:

  • Sudden weight changes
  • Eating past the point satiety
  • Preoccupation with body weight or size
  • Abusing laxatives after meals
  • Repeated episodes of fasting between binges
  • Excessive exercise, especially after eating
  • Feeling a loss of control during binge eating episodes
  • Going to the bathroom after eating (to vomit)
  • Muscle weakness or shakiness
  • Dizziness and fatigue
  • Dental issues like decaying teeth
  • Social withdrawal
  • Bloating and constipation

Bulimia nervosa treatment should be able to comprehensively address the underlying causes and behaviors of this eating disorder.

Anorexia Nervosa

One of the main symptoms of anorexia nervosa is a distorted body image. A person with anorexia nervosa may believe they are overweight even when they are severely underweight. This leads to avoiding eating and caloric intake as much as possible. There is usually anxiety surrounding the disorder; for example, the individual may excessively worry about gaining weight. Other signs and symptoms include:

  • Weight loss, often extreme
  • Difficulty gaining weight
  • Tiredness and fatigue
  • The absence of menstruation 
  • Low blood pressure
  • Body dysmorphia, or dissatisfaction with one’s body
  • Extreme fear of gaining weight
  • Irritability and irrational behavior
  • Refusing to eat in public 
  • Lying about how much food one has eaten
  • Missing meals frequently
  • Severe restriction of food intake
  • Compulsive exercise, often past the point of injury
  • Frequent negative comments about weight or body size
  • Social withdrawal
  • Food rituals, such as eating foods in a certain order
  • Dry skin and nails
  • Insomnia 
  • Imbalances in sodium, potassium and other electrolytes

Binge Eating Disorder

People with binge eating disorder engage in repeated binge eating episodes, often punctuated by dieting and a poor body image. The person may feel a loss of control and be unable to control how much they eat during one of these episodes. Other symptoms of binge eating disorder include:

  • Eating past the point of comfort
  • Eating sparingly at meals but in large amounts in private
  • Hiding food for late binge eating episodes
  • Periods of eating more rapidly than normal
  • Preoccupation with food and dieting
  • Feeling guilty, ashamed or embarrassed following a binge eating episode
  • Low self-esteem and poor body image
  • Fluctuations in weight or size
  • Frequent stomach cramps or other gastrointestinal issues

Symptoms Of An Anxiety Disorder

Everyone feels anxious from time to time; an anxiety disorder is a more constant a debilitating situation. Anxiety disorders are serious mental illnesses that can take over a person’s life. Eating disorders often have similar symptoms as anxiety disorders, necessitating specialized treatment that deals with both kinds of disorders. Anxiety disorders can range in severity. Some symptoms of an anxiety disorder may include:

Fear and worry about the future: Anxiety often causes people to worry about the future, to the point where it affects their ability to make decisions. They may find the worry difficult to control.

Restlessness: The person with an acute anxiety disorder may feel restless or skittish. If the person also has an eating disorder, they may feel especially stressed at mealtimes or other food-related situations.

Agitation or irritability: Irritability and agitation are signs of an anxiety disorder, especially in teens.

Rapid heartbeat: Anxiety disorders may cause a faster heart rate during acute anxiety or panic attacks. 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: Anxiety often causes difficulty in relaxing and tensing of muscles.

Social withdrawal: A person with an anxiety disorder, especially social anxiety, may avoid parties or crowded restaurants, to name a few examples. If the person also has an eating disorder, they may avoid eating in public, at family gatherings where food is present, etc.

Insomnia and difficulty sleeping: Anxiety can negatively affect people’s ability to fall asleep and stay asleep. 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. Irrational fears may also extend to other areas of their lives.

Intense, overwhelming panic: Panic attacks, in which overwhelming fear takes hold of an individual, can also occur with 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 disordered eating behaviors as a form of coping mechanism.

How Is an Eating Disorder/Anxiety Disorder Dual Diagnosis Treated?

Most treatment models demand that anxiety disorders and eating disorders are treated simultaneously. If a person has both an eating disorder and anxiety disorder, they must seek help for both disorders. Co-occurring treatment for eating disorders is based on an individual’s needs and personal history, meaning that no treatment plan should be “one-size-fits-all.” Common treatments for dual diagnosis include:

Evidence-based therapy: Cognitive behavioral therapy (CBT) is a highly effective type of psychotherapy between an individual therapist and client. It involves logical back-and-forth to identify disordered thoughts and gradually teaches the client to avoid them.

Trauma-focused psychotherapy: This type of therapy helps address any past trauma that may have influenced the dual diagnosis. PTSD is a common contributing factor to eating disorder development.

Exposure therapy: Exposure therapy is an extremely useful method for preparing clients to return to the “real world.” 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.

Every client with an eating disorder should also receive nutritional education and the advice of a dietitian. This will help restore nutritional balance, which is often disturbed after months or years of disordered eating.

Co-occurring Anxiety And Eating Disorder Treatment Levels Of Care

Depending on the diagnosis and severity of the disorder being treated, there are various levels of care available at eating disorder treatment centers. The level of care depends on the individual’s needs. Supervised 24-hour care in the residential setting may be necessary in extreme cases of OSFED, ARFID, anorexia nervosa, bulimia nervosa, and binge eating disorder. As the client progresses in treatment, they may be able to step down from residential to an outpatient or supervised living setting.

Residential treatment: A residential treatment program normally includes 24-hour medical and psychiatric care and supervision as well as therapy and movement classes. The individual lives on-site and receives treatment for both the eating disorder and any co-occurring disorders.

Day treatment (outpatient treatment): A day treatment program is ideal for individuals stepping down from a residential level of care or who need more support than a single therapist can provide. This level of care allows the individual to have greater independence while working toward becoming fully recovered. Day treatment programs, as with residential programs,begin with a thorough assessment, they follow with a personalized program of daily group and individual therapy, exposure work, and more. 

Treatment of co-occurring disorders may be an essential step in achieving a 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.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.