Addressing Underlying Anxiety and Depression in Eating Disorders

Woman working through Anxiety and Depression in Eating Disorders and Binge Eating Disorder and Diabetes

Contributed by Canopy Cove

The comorbidity rate of eating disorders with other mental illness diagnoses is incredibly high. One study determined that 97% of female inpatients were diagnosed with at least one other mental illness [1]. So what is the best way to approach Anxiety and Depression in Eating Disorders?

Two of the most common comorbidities are Major Depressive Disorder (depression) and Generalized Anxiety Disorder (anxiety).

Each of these varies in their presentation and impact on the eating disorder itself and should not be ignored in the treatment of these disorders.


75% of individuals diagnosed with an anxiety disorder are also diagnosed with either Anorexia Nervosa (AN) or Bulimia Nervosa (BN) [2]. There have been long withstanding “chick-or-the-egg” debates regarding which comes first – the eating disorder or the anxiety disorder.

It seems research is beginning to clearly point to the understanding that “the anxiety disorder often precedes the onset of the eating disorder [2],” meaning, the anxiety disorder “comes first.”

Despite this clear research, nothing is set-in-stone. Therefore, there are numerous theories regarding the relationship between eating disorders and anxiety.

One theory posits that anxiety disorders may be a risk factor that makes individuals with this diagnosis more susceptible to eating disordered behaviors. However, Eating Disorder symptomatology does not always come after anxiety.

This leads to the second theory, which posits that eating disorders may lead to or exacerbate symptoms of anxiety disorder [2].

A third theory focuses less on which comes first and more on which comes before both, looking at the vulnerability factors that lead to both and how they overlap.


Major Depressive Disorder is the most common comorbid diagnosis in individuals with eating disorders, with lifetime rates ranging from between 50% to 75% [3].

A diagnosis of depression also results in higher mortality rates, not only from the eating disorder itself but also through increased rates of suicide [3].

The debate regarding depression and eating disorders focuses less on which leads to which but more on how the treatment of one can assist recovery from another.

Depression has proven to be alleviated significantly through the use of psychiatric medications. Therefore, much research has been done focusing on whether or not medicating depression helps to alleviate eating disorder symptomatology.

So far, results have indicated that medication-assisted depression treatment does not impact the likelihood of eating disorder recovery or protect against relapse [3].

These results make it clear that medication is not the only answer to recovery from any mental illness and that it is not enough to merely focus on one disorder in treatment.

Addressing Comorbidity in Treatment

Mother and daughter hugging after discussing eating disordersIt is clear that both depression and anxiety can interact with eating disorders and create catastrophic results.

One study indicated that the mortality rate in individuals with Anorexia Nervosa is 18 times higher when another psychiatric diagnosis exists [4].

Ignoring them in treatment would be akin to seeing multiple holes in a dam but plugging only one – the problem is not solved.

As such, clinicians and healthcare professionals need to be aware of these comorbidities and address them as they tackle the eating disorder.


[1] Blinder, B.J., Cumella, E.J., Sanathara, V.A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine. 68:3, 454-62.

[2] Swinbourne, J., et al. (2012). The comorbidity between eating disorders and anxiety disorders: Prevalence in an eating disorder sample and an anxiety disorder sample. Australian and New Zealand Journal of Psychiatry, 46:3, 118-131.

[3] Mischoulon, D. et al. (2011). Depression and eating disorders: treatment and course. Journal of Affective Eating Disorders, 130:3, 470-477.

[4] Unknown (2018). Psychiatric comorbidities present in nearly all eating disorder patients. Rivermend Health. Retrieved on 10 November 2018 from

About Our Sponsor:

Canopy Cove Eating Disorder Treatment Center is a leading residential Eating Disorder Treatment Center with 25 years’ experience treating adults and teens who are seeking lasting recovery from Anorexia, Bulimia, Binge Eating Disorder and other related eating disorders.

We are a licensed rehabilitative provider accredited by the Commission on Accreditation of Rehabilitation Facilities. Trusted and recommended by doctors and therapists throughout the country, our program provides clients with clinical excellence and compassionate care.

As one of the most experienced Eating Disorder Centers in the nation, we’ve developed a highly effective program that incorporates solid evidence-based therapies which have been shown to increase recovery rates.

  • Each person we treat receives a customized treatment plan tailored to their specific needs.
  • We increase recovery rates by simultaneously treating co-existing conditions such as anxiety, depression. (We also accept clients with an Eating Disorder and co-existing Diabetes).
  • We provide family education and family therapy throughout the recovery process. (Offered by phone for out of town families).
    Our Christian-based eating disorder treatment program warmly accepts all clients from various belief systems.

Get help now. Call 855-338-8620.
[email protected]

Image of Margot Rittenhouse.About the Author: 

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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 a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on November 16, 2018.
Reviewed & Approved on November 16, 2018, by Jacquelyn Ekern MS, LPC

Published on

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.