Study finds association between anxiety and eating disorders among adolescent girls
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Adolescent girls with anxiety disorder may be at an increased risk for eating disorders, according to results of a longitudinal cohort study published in European Eating Disorders Review.
“Findings suggest individuals with anxiety disorders are more likely to develop disordered forms of restrictive eating,” Caitlin Lloyd, BSc, MRes, a PhD student at the University of Bristol’s Centre for Exercise, Nutrition and Health Sciences in the United Kingdom, told Healio Psychiatry. “Greater awareness of this among clinicians treating childhood anxiety disorders may lead to improved early detection of eating disorders, and subsequently earlier intervention. This is important because earlier intervention is associated with improved eating disorder treatment outcomes.”
According to Lloyd and colleagues, etiological models have proposed that anxiety is a causal risk factor for the development of anorexia nervosa. Prior research has noted an association between dietary restriction and an alleviation of anxiety, with the behavior producing particularly favorable outcomes for those with high levels of anxiety. These individuals may then become increasingly dependent on dietary restriction to manage anxiety, the researchers wrote.
In the present study, Lloyd and colleagues analyzed data for 2,406 female adolescents included in the Avon Longitudinal Study of Parents and Children — a prospective population cohort study of families in the United Kingdom’s Bristol area. They assessed anxiety disorder among participants at ages 13 to 14 and 15 to 16 and measured fasting approximately 2 years after each anxiety assessment. Across the two longitudinal waves of data, they used generalized estimating equation models to examine whether anxiety disorders predicted later fasting.
The researchers found that across longitudinal waves, the presence of anxiety disorder predicted increased risk for later fasting (adjusted OR = 2.07; 95% CI, 1.03-4.17). Although evidence from wave-stratified analyses supported a positive association between anxiety disorder presence at wave 15 to 16 and fasting at wave 17 to 18 (aOR = 6.38; 95% CI, 2.81-14.49), it did not support an association between anxiety disorders at wave 13 to 14 and fasting at wave 15 to 16 (aOR = 0.23; 95% CI, 0.03-1.83), the researchers wrote.
“Although it remains unclear whether anxiety causes restrictive eating, the findings encourage further research to address this question, which would in turn inform whether reducing anxiety may be helpful in terms of eating disorder prevention,” Lloyd said. – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.
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Simon M. Wilksch, PhD
The findings highlight that young people presenting with anxiety symptoms need to be routinely assessed for eating disorder behaviors. Fasting can become a maladaptive coping strategy for distressing emotions. We know from other research that up to 20% of those presenting for treatment of anxiety or depression also meet criteria for an eating disorder. Parent-reported anxiety symptoms among the early adolescents in the study likely led to underreporting of such symptoms and this might explain the lack of association found in earlier adolescents. We also know that severe food restriction leads to physiological changes that can exacerbate anxiety. Thus, fasting does need to be addressed in young people for a range of reasons, including to assist with lowering anxiety.
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