Anorexia and Anxiety

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Contributor: Neathery Thurmond, LMSW, Staff Therapist, Hill Country Recovery Center (Austin, TX)

When attempting to understand the maladaptive coping skills of an individual struggling with anorexia nervosa (AN), the biosocial theory posits there is a biological component that sets these coping mechanisms into action.

According to the biosocial theory, individuals suffering from AN are biologically predisposed to a highly sensitive nervous system.

In time, an individual with AN who lives in an aggressively invalidating environment develops maladaptive coping skills in order to “fit in” (Crowell, Beauchaine, & Linehan, 2009).

Common temperament traits of AN are seen in individuals as:

  • Perfectionism
  • Harm avoidance
  • Persistence
  • Increased need for order
  • Reward dependence
  • Self-critical and obsessive thinking (Klump et al., 2000)

Combine these traits with a society obsessed with the “thin ideal,” or any invalidating experience in an individual’s life and we have the perfect storm for the development of AN.

Which Came First?

Anxiety and AN are similar to the “chicken or the egg?” question. In some cases it is apparent anxiety came first, yet AN certainly maintains and even elevates anxiety in an individual. The very nature of AN by deprivation of food and nutrients creates a starved and stressed brain which elevates anxiety levels.

Paradoxically, when dopamine is released in an individual with AN it creates anxiety rather than pleasure (Bailer et al., 2012). It is crucial to know how AN is used as a coping skill for anxiety and how anxiety is still elevated when using AN behaviors. If this sounds confusing, it’s because eating disorders are paradoxical by nature.

Co-Occurring Disorders

Nearly two-thirds of individuals with eating disorders present with a co-occurring anxiety disorder and, it is imperative to understand the function of an eating disorder as a way to manage anxiety.

The most common co-occurring anxiety disorders are:

  • Obsessive Compulsive Disorder
  • Generalized Anxiety Disorder
  • Social Anxiety (Tetyana, 2013)

With AN, we can see how OCD presents itself in rigidity with food rules and obsession with numbers. Social Anxiety accounts for the preoccupation of how an individual is perceived by others.

Holistic Approaches to Treatment

man-395870_640As we conceptualize the role anxiety plays in the development and maintenance of AN, it is critical to continue to take a holistic approach to treatment. Eating disorders have historically been complex to treat and AN is no exception.

Aside from continued medical and nutrition support, psychotherapy needs to address both the anxiety and AN concurrently. An individual with AN and increased anxiety will find it difficult to learn new behaviors and maintain motivation for change in traditional talk therapy alone.

Addressing both disorders requires psychoeducation, particularly on the individual’s temperament traits and the influence of neurotransmitters and neurocircuits.

Learning Coping Skills

Additionally, learning skills to help tolerate uncomfortable sensations and situations can help an individual cope throughout the process of treatment and provide a way to learn new coping skills instead of resorting to eating disorder behaviors

With a specialized treatment team, there is hope for an individual struggling with both AN and anxiety to find peace, freedom, and new ways to manage anxiety and create a life worth living.

Community Discussion – Share your thoughts here!

What tools have you found to find peace and freedom when struggling with AN and anxiety?


  1. Bailer, U.F. et al. (2012). Amphetamine induced dopamine release increases anxiety in individuals recovered from anorexia nervosa. International Journal of Eating Disorders 45(2), 263-271.
  2. Crowell, S.E., Beauchaine, T.P., and Linehan, M.M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending linehan’s theory. Accessed at:
  3. Klump K.L. et al. (2000) Temperament and character in women with anorexia nervosa. The Journal of Nervous and Mental Disease. 188(9), 559-67.
  4. Tetyana, (2013). Is anorexia nervosa an anxiety disorder? Accessed at:

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on December 18th, 2014
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About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.