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Disordered Eating, Anxiety 3
Disordered eating also accompanies risk factors—such as body dissatisfaction and
negative affect—that could later develop into a diagnosable and dangerous eating
disorder. For this reason, risk factors for eating disorders need to be identified and
managed in prevention programs in order to successfully prevent future eating pathology.
Risk Factors for Disordered Eating
Two predictive risk factors for the development of eating disorders are body
dissatisfaction and negative affect (Stice, 2002). Body dissatisfaction often results in
dieting in an attempt to control weight and also predicts the onset of bulimic symptoms
(Cooley & Toray, 2001). Similarly, negative affect causes people to ignore their feelings
of anxiety and to turn to other sources of comfort, such as food. Wertheim et al. (2001)
conducted a longitudinal study that revealed that negative affect led to increases in later
eating disorder behaviors.
Risk factors, such as body dissatisfaction and negative affect, often accompany
poor coping strategies to manage stress and anxiety. Avoidance coping often results in
emotional eating and emotional purging, and may be escalated by body dissatisfaction
and negative affect, which then creates a vicious cycle of low self-esteem. For example,
past research suggests that avoidance coping is positively correlated with disordered
eating behavior. In a study of 286 teenage girls, Fryer, Waller, and Kroese (1997)
observed that avoidance coping mechanisms led to low self-esteem which in turn led to
disturbed eating. More recently, Hasking (2006) observed a positive correlation between
non-productive coping strategies and disordered eating behavior, suggesting that nonproductive
coping strategies should be targeted in prevention programs as well.
Anxiety: An Overlooked Component of Bulimia
One explanation for why these risk factors—body dissatisfaction and negative
affect—have such a strong predictive power for future disordered eating is because of the
comorbidity between anxiety and eating disorders. The comorbity of Axis I and Axis II
disorders with eating disorders is high, with anxiety and depressive disorders being most
prevalent (Milos, Spindler, & Schnyder, 2003). More specifically, Godart et al. (2003)
found that 71% of people with bulimia suffered from at least one anxiety disorder, a
significant difference from the controls. Furthermore, the two most common anxiety
disorders comorbid with bulimia are social phobia (BN-P: 36.8%; BN-NP: 36%) and
generalized anxiety disorder (BN-P: 32.6%; BN-NP: 26.3%).
The direction of this relationship between eating disorders and anxiety remains
unclear, although there is evidence that a shared underlying diathesis exists. Keel et al.
(2005) looked at anxiety rates between mono-zygotic twins discordant for an eating
disorder. The twin without the eating disorder was still twice as likely to suffer from an
anxiety disorder than other non-eating disorder controls. This suggests that there is a
shared genetic transmission between eating disorders and anxiety disorders.
Interestingly, women recovered from bulimia were slightly more likely to have an anxiety
disorder than those women still suffering from an eating disorder, which further supports
the theory of a shared diathesis (Keel, Mitchell, Miller, Davis, & Crow, 2000). Even if a
diagnosable anxiety disorder is not found, women who were in recovery for an eating
disorder still reported higher levels of anxiety than women in the normal population
(Kaye, Bulik, Thornton, Barbarich, & Masters, 2004).