“You’re okay, just breathe,” I thought to myself, but louder voices overpowered mine, reprimanding me for eating a sandwich and feeling full while in a bathing suit. Feeling full has always set me off. If I'm not empty, I'm anxious. I felt so much and nothing all at once. Surrounded by friends, I felt completely alone.
Later that night, I was so zonked out on anti-anxiety medications that I couldn’t make it to a birthday party. This was only the beginning of leaving early and missing out because of my eating disorder and its intimate relationship with anxiety.
I’m not alone, though, two-thirds of people suffering from an eating disorder also suffer from an anxiety disorder, according to the Anxiety and Depression Association of America, which isn’t surprising considering that an eating disorder thrives on the need to control.
“The experience of anxiety within the context of an eating disorder can be hard to tolerate and can lead to avoidance,” says Deborah R. Glasofer, Ph.D., Clinical Psychologist, Columbia Center for Eating Disorders, New York State Psychiatric Institute. “For someone with an eating disorder, that might mean not eating certain foods or being in certain social situations or not looking in the mirror.”
The two disorders have a well-established psychological link, but there still is not a clear understanding of the systematic interplay between the two, says Glasofer.
Recent research suggests that a predisposition to anxiety may be related to abnormal activity of serotonin, a chemical in the brain responsible for regulating mood, and that people who develop eating disorders tend to have this abnormal serotonin activity, too, according to Ashley Solomon, Psy.D., a clinical psychologist and executive clinical director of Eating Recovery Center, Ohio.
While recovery is possible through various kinds of therapy and medications, it’s a big obstacle. Some women use food restriction as a way to cope with anxiety, and if their coping mechanism is no longer available, intense anxiety may come rushing back.
“One thing we find is that people who recover from eating disorders may still have the high anxiety and driven mentality and start channeling that into new ‘obsessions,’ such as school or work,” Solomon says. “At the end of the day, true recovery means that my behavior isn’t compulsive or driven by an attempt to avoid feeling anxious.”
Sara, 24, says her anorexia developed as a way to cope with her anxiety. Apprehensive thoughts prevented her from performing simple tasks like calling someone on the phone or going into the store, and at times her professional reputation at work was damaged.
“I would get so anxious about going into work for my shift that I could not handle it, and I would make up excuses, usually lies, as to why I could not come in,” she says. “In the depths of my eating disorder, I could not hold a job for long not only because my poor health or lack of strength, but I would be so self conscious about how I looked and felt in my body that I was a liability when I couldn’t perform at my best.”
Liz, 30, who has EDNOS—eating disorder not otherwise specified, which means she exhibits disordered eating that doesn't fall under a label like “anorexia” or “bulimia”—experienced similar circumstances.
“The idea of starting to eat more or different foods feels just as threatening as jumping out of an airplane of watching spiders crawl all over one’s body,” Solomon says. “In this way, the anxiety both predisposes someone to develop eating disorder symptoms, and helps to keep the symptoms going. It becomes a cycle that the person often feels they just can’t escape.”
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The cycle can worsen when individuals isolate because anxiety and eating disorders tend to thrive in isolation.
“I have lost friends, and even a boyfriend,” Liz says. “At times I would cancel plans again and again to the point that they think I don’t want to be friends with them or don’t want to see them—when the reality is that my anxiety makes it hard to leave the house.”
Sara says it was her relationship with herself that was most damaged, though.
“I like to think of myself as a very easygoing, fun-loving woman who loves to get outdoors and laugh, but my eating disorder removed all emotions from the surface,” she says.
Social media has only made the struggles between eating disorders and anxiety worse.
This yoga pose can help you breathe easier:
Glasofer says that, though the hyper-connectivity of our society is of little help to those with anxiety and eating disorders, we can begin to think creatively about using these technologies to our advantage.
“Research into these avenues—allowing virtual connectivity to help someone with social anxiety, for example, creating recovery forums for people who have had eating disorders, or using apps to get well or stay well from these kinds of disorders—is very exciting, but still in its relative infancy,” says Glasofer.
For Liz, the hardest thing about recovery has been feeling her emotions after 12 years of using disordered eating to mask them.
“I know I’m not in a place where I’m using my behaviors as much, and it’s scary to figure out what to do with my feelings without using behaviors,” she says.
She recalls a journal entry she recently wrote and how she couldn’t bring herself to use the word “happy.”
“I was afraid to let myself be happy or even admit it because it’s been so long that I don’t remember what it feels like,” she says. “But I’ve begun to realize it’s okay to say it, and to admit it, and it’s okay that it has taken a long time to get there.”
As for me, I still struggle. I’ve missed a birthday dinner here and there. Like Liz though, I remember that it’s okay to be happy, and then I let myself feel it. On those days, I succeed.