Binge Eating Disorder and Anxiety

Binge eating disorder (BED) and anxiety are deeply intertwined and often co-occur.

In fact, approximately 37% of those who are diagnosed with BED are also diagnosed with a full-fledged anxiety disorder. Rather than a linear relationship model (i.e., that anxiety leads to binge eating behaviors or binge eating behaviors lead to anxiety), binge eating disorder and anxiety are much more transactional and are comprised of biological, psychological, and social factors.

Biological Factors

From a biological point of view, researchers are especially interested in the role of the neurochemical dopamine in the co-occurrence of BED and anxiety. Dopamine plays a critical role in feelings of reward and pleasure, including those feelings related to eating.

Dopamine

According to research, binge eating releases dopamine, which produces relief from anxiety and depression. This, in turn, reinforces the binge eating behaviors. Some researchers liken this to a substance abuse model of psychological reinforcement. Like individuals who are dependent on substances to help relieve negative emotions or mood states, so do binge eaters.

Withdrawal Symptoms

Also similar to those who abuse substances, binge eaters experience withdrawal symptoms in between binge episodes, continue to binge eat even thought they know it is harmful, and feel deprived when they cannot binge. These experiences are what fuel BED symptoms, including:

  • Feeling out-of-control over eating behaviors (i.e., the overeating feels unpreventable or unstoppable)
  • Binging that involves at least three of the following:
    • Eating very quickly
    • Eating to uncomfortable fullness
    • Eating when not hungry
    • Eating alone due to shame
    • Feeling very upset after overeating
  • The binge eating causes worry and concern

Psychological Factors

Individuals who suffer with BED experience anxiety, worry, or distress after a binge occurs and negative emotions such as anxiety and depression often lead to binge behaviors as a way to cope with these negative behaviors. Binge eating and anxiety can often become a vicious and out-of-control cycle.

Trading A Bad Emotion for a Less-Bad One

From a psychological point of view, researchers believe that individuals who suffer from BED distract themselves from negative emotions by trading off more aversive emotions they are experiencing before they binge-eat (e.g., depression, anxiety) with less aversive emotions that follow binge-eating (e.g., shame, guilt).

Other researchers suggest that individuals who suffer from BED tend to subject themselves to high standards and when they fail to meet these standards, an aversive emotional state follows. Thus, to escape these negative emotions, they pay more attention to their environment, which leads to a disinhibition of eating.

Social Factors

In regard to social and cultural factors, traumatic situations, such as a history of physical, sexual, or emotional abuse, life stressors and interpersonal difficulties can increase the risk of BED and anxiety. Social pressures to be thin, which are typically influenced through media, can also trigger emotional eating.

Persons subject to critical comments about their bodies or weight (e.g., bullying, weight stigma) may be especially vulnerable to co-occurring BED and anxiety.

Treating Co-occurring Bed and Anxiety

In regard to treatment, it is important to address both the binge eating behaviors and negative mood states. Cognitive-behavioral and interpersonal therapies appear to be the most effective types of therapy when attempting to treat co-occurring BED and anxiety.

In cognitive behavioral therapy, the mental-health professional works to help the person with binge eating disorder identify, challenge, and decrease negative emotions and thinking and otherwise dysfunctional belief systems that trigger unwanted behaviors.

The goal of interpersonal therapy tends to be identifying and managing problems the sufferer of binge eating disorder may have in his or her relationships with others.

In regard to effective medications, selective serotonin reuptake inhibitors (SSRIs) appear to be the most effective treatment for co-occurring BED and anxiety. Moreover, other pharmacological treatments for BED include tricyclic antidepressants, monoamine oxidase inhibitors, and opioid receptor antagonists, which have all been reported to exhibit some therapeutic effects in patients with BED.

In seeking treatment, it is helpful to have a team of treatment professionals that can work together to help address the biological, psychological, and social components of co-occurring BED and anxiety.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Arlington, VA: American Psychiatric Publishing.

2. Brewerton, T.D. (1999). Binge Eating Disorder. CNS Drugs, 11(5), 351-361.

3. Broft, A.I., Berner, L.A., Martinezy, D., & Walsh, B.T. (2011). Bulimia nervosa and evidence for striatal dopamine dysregulation: A conceptual review. Physiology and Behavior, 104(1). 122-127.

4. Grilo, C.M., White, M.A., & Masheb, R.M. (2009). DSM-IV Psychiatric disorder comorbidity and its correlates in binge-eating disorder. International Journal of Eating Disorders, 42, 228-234.

5. Guerdjikova, A.I., McElroy, S.L., Kotwal, R., Welge, J.A., Nelson, E., Lake, K., Alessio, D.D., Keck P.E., & Hudson, J.I. (2008). High-dose escitalopram in the treatment of binge-eating disorder with obesity: a placebo-controlled monotherapy trial. Human Psychopharmacology Clinical Experiments, 23, 1-11.

6. Heatherton, T.F. & Baumeister, R.F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86-110.

7. Williamson, D.A., Zucker, N.L., Martin, C.K., & Smeets, M.A.M. (2004). Etiology and management of eating disorders. In H.E. Adams, & P.B. Sutker (Eds.), Comprehensive handbook of psychopathology (3rd ed.) (pp. 641-670). New York: Springer Science + Business Media, LLC.

Article Contributed By: Chelsea Fielder-Jenks, M.A.

Chelsea Fielder-JenksChelsea Fielder-Jenks is a designated Expert Writer on Eating Disorder Hope.  Her well researched and thoughtful pieces have been helpful to many of our visitors.  We hope you will read through some of her other interesting pieces: Binge Eating Disorder & Anxiety, Bulimia in Athletes,  The Pressure to Compete.

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