Link Between Anorexia and Other Mental Health Conditions
By Dhia Azhani
What Is Anorexia?
Anorexia Nervosa, also commonly referred to as Anorexia, is a treatable eating disorder1 affecting 4% of females in their lifetime, and about 0.3% of men in their lifetimes2. It is characterized of low body weight, a strong fear of gaining weight, and limiting the amount or type of food that is being consumed1.
Although many individuals with Anorexia appear thin, not all individuals are thin and some may be overweight, but they have actually lost weight. However, you cannot tell by a person’s appearance if they have Anorexia3.
What Causes Anorexia?
Early identification and treatment are crucial for a lasting recovery2. With that being said, healthcare providers believe there is no single cause for Anorexia4. There are many factors that contribute to it, including:
1. Brain differences
Scientists notice brain differences in people with anorexia. For example, you may have different levels of serotonin and dopamine. This can affect appetite, mood and impulse control4.
2. Genetics
If a family member (parent, sibling, etc) has an eating disorder, you are more likely to have one too5.
3. Environment
Parental over-emphasis on child’s weight and shape can affect the way you may become later in life. Maternal control of children’s eating interferes with the development of dietary self-regulation6.
4. Psychology
Having low self-esteem or feeling that your self-worth depends on your body weight can lead to developing an eating disorder. Factors like trauma, abuse and bullying can also contribute4.
Anorexia Nervosa also frequently co-occurs with other types of mental health conditions7. Mental health and Anorexia tend to be in a bidirectional relationship. This means that when problems arise in Anorexia, it will also affect your mental health, and vice versa.
A study found that having anorexia nervosa increased the risk of later being diagnosed with another psychiatric disorder by almost four times. Similarly, being diagnosed with a psychiatric disorder made it over four times as likely that someone was later diagnosed with anorexia nervosa compared to those with no mental health conditions8.
Anorexia may be challenging to diagnose, primarily because it sprouts as a coping mechanism7. It is a response to stressful life events and trauma that may also trigger other mental health struggles7.
One study proposed that at least one mental health condition may consistently come before Anorexia. In this case, chronic low self-esteem was suggested as a necessary factor for developing anorexia nervosa or any type of eating disorder9. However, it was also suggested that this is due to the fact that eating disorders generally manifest in a more visible way, making it easier to be spotted1.
Research demonstrates that 55-97% of people diagnosed with an eating disorder also receive a diagnosis for at least one more psychiatric disorder10. The most common psychiatric disorders which co-occur with eating disorders include mood disorders (e.g., major depressive disorder), anxiety disorders (e.g., obsessive compulsive disorder, social anxiety disorder), post-traumatic stress disorder (PTSD) and trauma, substance use disorders, personality disorders (e.g. Borderline Personality Disorder, OCPD), sexual dysfunction, non-suicidal self-injury, and suicide ideation10.
Death from suicide is much more prevalent in individuals with eating disorders. Research has found that individuals with anorexia are 31 times more likely to suicide than individuals from the general population10.
Comorbidities
Comorbidities are medical conditions that coexist alongside a primary diagnosis and affect your health, including your treatment11. Physical comorbidity examples can include hypertension, chronic lung disease, and diabetes, while mental comorbidities can include PTSD, Depression, OCD, etc12.
Physical Comorbidities
Comorbid conditions experienced by people experiencing an eating disorder may be connected to their eating disorder symptoms and behaviours, like Polycystic Ovarian Syndrome (PCOS). For other comorbidities, the connections are unclear and are a focus of future research10.
The following complications tend to have a higher prevalence in those with Anorexia compared to the general population10:
· Type 1 and 2 diabetes.
· Polycystic ovarian syndrome (PCOS).
· Osteopenia and osteoporosis.
· Hypotension Gastrointestinal problems.
· Joint pains.
· Headache and migraine.
· Menstrual problems.
Mental Comorbidities
In addition to physical complications, you also may have other mental health symptoms and conditions, including:
· Depression and other mood disorders.
· Anxiety.
· Personality disorders.
· Obsessive-compulsive disorders.
· Alcohol and substance misuse.
· Self-injury, suicidal thoughts, suicide attempts or suicide.1
Prevention
Anorexia is a complex eating disorder, developing from a mixture of factors rooted in someone’s physical and mental health as well as their environment and medical history. It’s the reason why Anorexia can be challenging to treat and, likewise, unfortunately, why there’s no known way to prevent Anorexia13. However, there are a few ways to prevent Anorexia symptoms from worsening.
· Focus on a balanced diet.
Many people who struggle with anorexia nervosa have a very low body weight and need to work on healthy eating habits when healing from the disorder. Regardless of where you are on your recovery journey, focusing on creating diets that work for you can be helpful14.
· Pursue social activities you enjoy.
The general idea is that eating disorders are driven by, in part, by a focus on food, eating, and body image, which can have a negative effect on self-esteem. Instead, focusing on things that feel good and instilling a sense of personal accomplishment can help rebuild that self-esteem and utilize that energy more appropriately15.
· Make appointments with mental health professionals.
No matter what point you're at in, it's always helpful to check in with a mental health professional. Whether it's a therapist, psychiatrist, or nutritional counselor, these experts are all generally well-educated in eating disorders. They may be able to offer helpful advice on how to prevent anorexia symptoms from spiralling, how to recover from a relapse, or how to generally maintain a positive body image and stay in a positive mindset16.
· Get your loved ones involved.
Working on building a home environment that supports healing and positivity can have a positive effect on Anorexia. This can be done in several ways, including helping parents, siblings, and other household members learn about new attitudes around food, weight, exercise, and appearance13.
· Practice self-care and self-love.
Learning how to love and accept yourself is the goal of many types of eating disorder treatment. This will always take time and practice, but building a more loving and healthy relationship with yourself and the food that nourishes you is certainly possible.
Conclusion
Anorexia is a very nuanced mental health condition, and while prevention does not have one singular answer, there are many ways to support and thrive mentally. Anorexia can also be linked to other mental health conditions, such as Depression, Anxiety disorders, etc. However, recovery is always, very much possible.
If you are worried about a loved one, kindly tell them to seek professional help. Professionals will be able to safely guide your loved one to recovery.
If you think you have an eating disorder, please seek help. If you are thinking about suicide, contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
SOURCES:
van Eeden AE, van Hoeken D, Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2021 Nov 1;34(6):515-524. doi: 10.1097/YCO.0000000000000739. PMID: 34419970; PMCID: PMC8500372 (2)
https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/anorexia-nervosa (13)
