Does Anxiety Contribute to Depression in Women With Anorexia?

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The presence of anxiety in a woman affected by anorexia nervosa can substantially heighten the chances that she will develop significant depression symptoms, according to recent findings from a group of British and Dutch researchers.

Anxiety is a common factor in women and men affected by the eating disorder known as anorexia nervosa. In fact, many people with the disorder have past or current histories of severe anxiety-related problems. In a study published in early 2015 in Advances in Eating Disorders: Theory, Research and Practice, researchers from one British institution and two Dutch institutions assessed the impact that anxiety has on the severity of depression-related symptoms in women with anorexia. The researchers concluded that certain aspects of anxiety lead to considerable increases in the depression risks associated with this eating disorder.

Anorexia and Anxiety

People with anorexia nervosa have an unrealistic view of their body weight and appearance that drives a damaging urge to severely restrict food intake and use other methods to lose or control weight. Common dysfunctional practices associated with the condition include heavily limiting overall food consumption, heavily limiting the types of food consumed, avoiding eating altogether whenever possible, frequently and compulsively assessing body weight or appearance and using secondary methods of weight control that may include food purging (i.e., intentional vomiting), laxative abuse and/or excessive exercise. A person with anorexia can develop serious or severe disruptions of normal organ function, including nerve damage or potentially fatal heart damage.

Roughly 66 percent of people affected by anorexia or other eating disorders have anxiety symptoms (e.g., fear, anxiousness, dread and physical changes associated with the “fight-or-flight” response) serious enough to merit a separate diagnosis of an anxiety disorder. Examples of such disorders include panic disorder, social anxiety disorder (social phobia) and generalized anxiety disorder. Statistics on this subject also commonly include two conditions—post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD)—once classified as anxiety disorders but now classified in their own separately defined categories of mental illness. In most cases, anxiety disorders, PTSD and OCD appear in the individual before anorexia or other eating disorders; however, an eating disorder may appear before an anxiety disorder takes effect.

Women, Anorexia and Depression

Depending on the source in use, women and girls account for 85 percent to 95 percent of all Americans affected by anorexia nervosa. All told, up to nearly 4 percent of all U.S. women will develop diagnosable symptoms of the disorder at some point in their adolescent or adult lives. For a number of reasons, women also develop symptoms of major depression and other depression-related mood disorders substantially more often than men. Up to half of all women affected by anorexia or another eating disorder have enough depression symptoms to qualify for a separate diagnosis of depressive illness.

Anxiety’s Contribution to Anorexia-Related Depression

In the study published in Advances in Eating Disorders: Theory, Research and Practice, researchers from the United Kingdom’s King’s College London and the Netherlands’ University of Utrecht and Altrecht Eating Disorders Centre Rintveld used a small-scale project involving 74 women to explore the connection between anxiety, anorexia severity and depression levels in women with anorexia nervosa. Thirty-six of the women enrolled in this project had an anorexia diagnosis, while the remaining 38 formed a comparison group of women unaffected by the disorder. The researchers looked at aspects of anxiety that included worry levels, the relative inability to cope with feelings of uncertainty, the relative ability to examine one’s thought processes, the relative tendency to avoid thinking about unpleasant subjects and the relative tendency to view problem-solving situations in a negative light.

After completing comparisons between the two groups, the researchers preliminarily concluded that the study participants with anorexia nervosa typically had anxiety levels high enough to merit a diagnosis of an anxiety disorder. They also concluded that two specific aspects of anxiety—a low tolerance for feelings of uncertainty and an impaired ability to examine one’s thought processes—significantly contribute to the level of depression present in a woman dealing with anorexia.

The study’s authors also found that two aspects of anxiety—a low tolerance for feelings of uncertainty and high worry levels—help increase the overall severity of anorexia nervosa, but do not change the typical weight of a woman affected by the disorder. They believe their general findings may contribute meaningfully to ongoing efforts to improve the treatment of anorexia-related anxiety.

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