Binge Eating/Bulimia and Anxiety

https://magnoliacreek.com/resources/blog/eating-disorder-statistics/

Most eating disorders do not exist alone, meaning there are often other types of psycho-disorders that unveil themselves when one begins to tackle and understand their own eating disorder. In fact, ANXIETY DISORDERS ARE THE SECOND MOST COMMON PSYCHOLOGICAL COMORBIDITY FOR INDIVIDUALS WITH BED (binge eating disorder) (1). In this particular section, I will discuss binge eating and its comorbid partner, anxiety. We will dive into how anxiety ties into binge eating (and purging for those with BN (bulimia nervosa), and how to tackle anxiety issues without turning to food. 

1. What is anxiety

2. BN/BED and anxiety - why we turn to food

3. Why does my eating disorder “help” my anxiety? 

4. Anxiety management 

5. If I treated my anxiety, would my binge eating go away? 

6. Medication

What is anxiety?

According to the American Psychological Association (2):

• Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.

• Anxiety is a long-acting response to an unexpected/unknown future-oriented threat. 

Before fully diving into anxiety disorders, one key note to remember: ANXIETY IS A NORMAL HUMAN EMOTION. We are supposed to be a little worried/anxious about things we are uncertain about. It keeps that adrenaline pumping and our senses heightened. It puts us on edge a bit so in case there’s danger, we are already ready for that fight or flight. Emotions often serve as a way to protect us, keep us on the alert, give us feedback, tell us of things we like and don’t like, so we know whether or not to do them again. 

However, when anxiety begins to impact our lives in negative ways, consistently, it is a problem. A constant feeling of that “fight or flight” is exhausting and can leave doing daily tasks near impossible. I will summarize below what the DSM-V states about General Anxiety Disorder (note that this isn’t the only anxiety disorder, just the most common one) (3).

DSM-V on General Anxiety Disorder

• Excessive anxiety and worry, occurring more than 6 months. 

• Person finds it difficult to control the worry

• Person shows 3+ symptoms  (with at least some symptoms present for more days than not)

• Restlessness or feeling keyed up or on edge

• Being easily fatigued

• Difficulty concentrating or mind going blank

• Irritability

• Muscle tension

• Sleep disturbance 

• Symptoms are not explained by another mental disorder (ex: anxiety about gaining weight for bulimia or anorexia nervosa) 

• The anxiety causes significant distress or impairment in social, occupational, or other important areas of functioning

• Symptoms are not caused by other substances (prescription medication, drugs, alcohol) 

BN, BED and Anxiety- why we turn to food 

How might BED/BN and anxiety tie into one another? Is one a trigger for the other? 

Most of the research I have done shows that binge eating actually seems to REDUCE ANXIETY, if only temporarily (4). This would suggest that maybe persons who have heightened anxiety, would have a greater tendency to binge eat. 

If you suspect that you might have anxiety, and think that it may contribute to your eating disorder, this isn’t all bad news. Learning how to tackle your anxiety with new solutions may be helpful in reducing your disordered eating tendencies as well. 

One notable point: anxiety is OFTEN (but not always) coupled with depression. This means that maybe your eating disorder is not SOLELY from anxiety, and it might be worth looking further into other proposed disorders so you can also properly tackle those. 

Why does my eating disorder “help” my anxiety?

First of all, it’s worth mentioning that although binge eating as a coping mechanism may “help” your anxiety (in the moment) it is not sustainable long term. Often after the food is consumed, anxiety is overall increased, as the subject feels they have failed at life.

So why does binge eating help reduce anxiety? During the moments when you are shoveling food in, research has shown that this specific act of binge eating may serve as a method of “cognitive avoidance” as well as a behavioral emotion regulation strategy (5). Basically, if you are feeling anxious most of the day, the only reprieve you may know is when you are eating food. The excess dopamine released when eating often is a distraction and has a somewhat calming effect. 

My simple understanding of this is, binge eating = brain turn off. Personally, binge eating is one of the few points in my week where there is some reprieve from my constant thoughts of how there’s not enough time in the day to do everything I need to in order to achieve the person that I want to become. How your anxiety presents itself is probably different than how mine does, but you are likely on this page because you may use the same coping mechanism as I do (binge eating food). Maybe you feel as though everyone hates you, maybe you are constantly worried about money or your health, maybe you ruminate, maybe you always believe the worst will happen, and the only part of the day when you aren’t thinking about that is when you’re eating food. 

Anxiety Management

I wanted to call this section “Anxiety solutions” but that would be an unfair lie. Anxiety doesn’t just magically go away, even if you do all the “right things”. The good news is, there are things you can do to manage your anxiety and change your life for the better. 

Things you can actually do to help:

1. GET ENOUGH SLEEP (actually prioritize your sleep people. This helps EVERYTHING.) 

   
   

2. EXERCISE! 

   1. Research suggests that individuals with high anxiety sensitivity who engage in negative affect reduction behaviors, such as physical activity, experience less binge eating (5).

      1. (This is a debated topic because some people might exercise off calories as part of their ED, but I am still putting this in here because getting movement of some kind is so incredibly important for mental health) 

         
         

3. Cognitive Behavioral Therapy 

   1. Cognitive-behavioral therapy examines thoughts, feelings, and behaviors and challenges cognitive avoidance. CBT has demonstrated success among individuals with binge eating (5).

   2. A link to page discussing CBT here: will link this after I finish that article

      
      

4. Figure out your anxiety triggers 

   1. “Knowing what triggers your anxiety can help you manage situations that might make such feelings worse. For example, if you know dieting books can exacerbate your anxiety, throw them out. Make your living area a safe and positive place that promotes a healthy body image” (6). 

Common anxiety triggers (7) (plus some of my own):

• Buildup of stress - upcoming tests, work projects, etc. 

• Conflict 

• Excess caffeine 

• Public events or performances

• Social events 

• Financial concern 

• Negative self-talk

• General health issues  

• Big changes, or even changes in routine

5. Mindfulness, Meditation, Relaxation techniques

   1. “We have to be willing to believe that changing our minds can change our lives,” says Melissa Groman, LCSW, a psychotherapist specializing in eating disorders and author of “Better Is Not So Far Away.” (6). 

A few simple mindfulness techniques: 

1. Box-breathing. Breathe in for 4 seconds, hold for 4, breath out for 4, repeat. 

   
   

2. Do a body scan. Start with your toes, notice how they feel, try and describe it to yourself in your head. Move on to your calves, legs, stomach, fingertips, arms, shoulders, neck, and head. Remember, you’re not in a rush (8). 

   
   

3. Go for a mindful walk. Try and notice the things around you. Even something as simple as thinking “that’s a tree” or “that’s a purple flower” can help ground and keep you in the present moment. 

So if I treat my anxiety, will my binge eating just go away? 

The short answer, yes and no. 

It has been suggested that to be truly effective, anxiety and BED/BN must be treated at the same time (6). One good thing is that cognitive behavioral therapy is often a good treatment for both and therefore may be a good step towards tackling both disorders. 

Similarly, since anxiety and binge eating are co-morbid, it may be easier to identify and treat both at once. For example, when tackling binge eating and anxiety it is crucial to identify what may trigger each disorder. Often something that may trigger anxiety (like going grocery shopping) is likely a trigger for binge eating as well. Thus by finding ways to reduce anxiety while grocery shopping, you are in turn finding ways to reduce your likelihood of binge eating as well. 

Things like mindfulness, meditation, and relaxation techniques have also proven useful for both. 

• Here is my favorite 5 minute guided meditation exercise. 

• You can also consider signing up for a yoga class

• Or just going outside to stretch

• Here is a website for relaxation techniques. It goes over deep breathing, progressive muscle relaxation, the body scan, and more. 

Medication 

Note: I am not a psychiatrist so I cannot suggest which medications to take

There is often a negative connotation around medication. I am simply here to say, get the help you need. I have been adamant about “solving” my eating disorder myself without the help of any medication. This is partly because of my own stubbornness, but also because I want to make sure that any advice I am giving is actually useful in helping conquer BED/BN, and that it’s not just medication that’s helping me. However, I want to share something that a psychiatrist who was working with me and my eating disorder said to me once, 

He said, “I believe you can get over this yourself, but I just want you to know that you are climbing the mountain using the slowest path. I believe medication could help you take a more direct route to the top. You don’t have to take medication forever, but it may help you get to the point you need to be at right now to conquer your eating disorder.” 

That stuck with me, and I wanted to share it with you all. As someone who was against any type of medication for a while I want to say, if you are putting in the work to try and combat your issues and need a boost of assistance, take it. You deserve a better way of living sooner rather than later.

Resources

1. van Hout, G.C.M., van Oudheusden, I. & van Heck, G.L. Psychological Profile of the Morbidly Obese. OBES SURG 14, 579–588 (2004). https://doi.org/10.1381/096089204323093336

   
   

2. “Anxiety.” American Psychological Association, American Psychological Association, 

   www.apa.org/topics/anxiety. Accessed 28 Oct. 2024.

   
   

3. Substance Abuse and Mental Health Services Administration. “Table 3.15, DSM-IV to DSM-5 Generalized Anxiety Disorder Comparison - Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health - NCBI Bookshelf.” Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]., U.S. National Library of Medicine, June 2016, 

   www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t15/.

   
   

4. Rosenbaum DL, White KS. The relation of anxiety, depression, and stress to binge eating behavior. Journal of Health Psychology. 2015;20(6):887-898. 

   doi:10.1177/1359105315580212

   
   

5. Rosenbaum, Diane L., and Kamila S. White. “The role of anxiety in binge eating behavior: A critical examination of theory and empirical literature.” Health Psychology Research, vol. 1, no. 2, 18 June 2013, p. 19, https://doi.org/10.4081/hpr.2013.e19.

   
   

6. Strickland, Katrine. “Is There a Connection between Binge Eating and Anxiety?” Walden Eating Disorders, 12 July 2023, 

   www.waldeneatingdisorders.com/blog/is-there-a-connection-between-binge-eating-and-anxiety/.

   
   

7. Holland, K. (2024, September 10). Anxiety triggers: 11 common causes of anxiety. Healthline. 

   https://www.healthline.com/health/anxiety/anxiety-triggers#triggers

   
   

8. Mindfulness for your health. (2024, June 18). NIH News in Health.

   https://newsinhealth.nih.gov/2021/06/mindfulness-your-health#:~:text=Wise%20Choices-,Being%20Mindful,programs%20and%20teacher%2Dguided%20practices .