You might be wondering: Why is anxiety so often a part of an eating disorder? What’s the anxiety in eating disorders really all about?

Are eating disorders anxiety disorders?

These are good questions. The simple answer is this: No. Eating disorders aren’t specifically anxiety disorders, but anxiety often co-exists with problems in eating.

The more complicated questions are “why” and “what’s that anxiety all about.” The answers are very individual and best explored in therapy with an expert.

But, there are some general categories you might relate to and find helpful.

Those include:

1. reasons for developing an eating disorder; 2. hating your emotional needs; 3. body image worries & distortions; and 4. eating disorder preoccupations.

Reasons For Developing An Eating Disorder

Eating disorders have unconscious psychological roots.

They develop because of unmanageable feelings, fears, anxieties, and early experiences that you’ve pushed aside.

Most often, eating problems come out of a traumatic childhood. A childhood that at least involved neglect and emotional deprivation, if not overt physical or sexual abuse.

Is this you?

If so, you had parents who were unreachable, neglectful, hurtful, abusive, and unable to give you the basics of what every child needs.  That more than hurts.

Your feelings felt overwhelming and out of control. Especially if they were rejected, and no one listened or wanted to hear.

You felt no control as a child over getting what you needed. Or over the feelings that are inevitably stirred up when you don’t. And, this creates anxiety.

You needed to feel control. Eating rituals are one way to do that.

The obvious is: you control what, when, or how much you put into your body.

The not so obvious is: you’re the one controlling how you satisfy your hungers. You aren’t waiting endlessly for someone else to give something to you.

Yes, those hungers seem to be physical. But, really, the roots are emotional. 

As a child, you had no control over being loved, held, valued, or given the affection and warmth you needed.  Emotional food.

Every child needs emotional food to grow and feel safe and good.

When you don’t get it or can’t count on it, your self-esteem suffers. You feel anxious and overwhelmed. There is nowhere to turn.

You learned early that you had to take care of yourself. So, either, you unconsciously decided not to need much at all.  Or felt you needed too much.

And, you grew to hate yourself for your very normal emotional needs.

Hating Emotional Need

When you’ve been traumatized as a child, and unable to get what you need, you feel there’s something wrong with you.

That it must be your fault that you aren’t provided for or loved. What did you do wrong, you asked yourself?  You were certain it had to be you.

You  – needing too much. Not being good. Certain that your needs were annoying. Feeling you were better off quiet or disappearing into the woodwork.

And, when you couldn’t do that (no child can), a voice in your mind mercilessly beat you up.

One of the worst things every traumatized child lives with is self-hate. Feeling it’s all your fault. You just must not be lovable enough.

You’ve tried very hard to make your needs and wants go away and not exist.

Anorexia

If you have anorexia, you imagine you’ve been successful at that (sort of).

You’ve gained some kind of ultimate control. At least, that’s what you think. You don’t need anything, you tell yourself. See? Your starvation is proof. A victory. 

But, a victory over what? Over your hunger for love. Over needing anyone or anything. Starvation is to make any need (and your feelings) disappear. Starving gives you a high.

If you slip up (and how could you not?), you hate yourself. You’re not supposed to be hungry. Hunger is bad. But, really, you need food. Mostly, you need love.

Bulimia

Bulimia means you’re on a see-saw of extreme hunger and attempts to control it. Through purging or episodic starvation.

You hate yourself when you can’t.

You get rid of that seemingly terrible (emotional) need and hunger with whatever type of purging you do. Vomiting or exercising or laxatives.

But, your hunger doesn’t go away.

Hunger

The reality is, when you have anorexia or bulimia, you are hungry. Always have been. You were starved as a child of love, attention, respect, and emotional care.

Now you try to starve yourself. 

If you can’t, or aren’t skinny enough, your self-hate rears its terrible head. And, that self-hate is focused on how you see your body.

Too often, fat or ugly.  This is what your mirror seems to say.

But, your mirror image is distorted. Because, really, it’s reflecting back the ways you hate how much you need.

Body Image Worries (& Distortions)

You don’t see yourself clearly even though you’re convinced you do.

What you don’t realize is that the way you see yourself in the mirror is the way you thought you were seen as a child. It’s your hungry child self that you hate.

A child self you thought was too hungry for love and attention, wanted too much. That hunger has turned into “fat” in your mind.

To you, your child self is ugly. Hunger makes you ugly. Needing anything from anyone makes you ugly. You feel ugly if your hunger is “out of control.” Ugly = your self-hate.

That’s what you see in the mirror. Or when your stomach isn’t flat (empty) enough. You want to get rid of the too-muchness of it all.

Of who you think you are, of your emotional hunger for love and attention, of all the feelings you have no idea what to do with. Feelings that overwhelm you and are too much to handle.

So, you’re caught in a vicious cycle of eating preoccupations and behaviors. Trying to have some kind of control.

And, this creates a lot of anxiety.

Eating Preoccupations & Behaviors (Anxieties)

Over the years, beginning as a teenager or in college, you developed certain eating behaviors to feel some control.  The roots go back much further.

We’ve talked about your need to control your emotional hungers and your feelings. Both have given you a lot of anxiety for a long time.

If you feel your needs are “wrong” or “bad” and you shouldn’t show them, that creates anxiety. Now, having to be so careful to control your eating, that makes you anxious too.

You’re preoccupied with doing this perfectly, and not slipping up. Not letting any need show. And, you keep your eating behaviors just as hidden as your feelings and needs.

At least as secret as you can. Having to be so careful makes you more anxious.

Eating disorders aren’t first and foremost anxiety disorders. Your anxiety is about your needs, about overwhelming feelings coming out. About how bad you feel.

And, the fact that all of this is now bundled into your eating, your self-image, and self-hate, makes your anxiety sometimes unbearable.

It’s hard to live this way. Eating disorders take up too much time and energy, all to try to manage how much you hate feelings and your needs.

And, you believe everyone else hates them too.

Sometimes you ask yourself: What can I do? Is there any help at all?

There Is Help

Yes, there is help. You can get free of the vicious cycle of eating behaviors, preoccupations, and anxiety about how you look and how you feel. 

And you can find what the anxiety in your eating disorder is all about. Here’s what you need:

Find an expert in eating disorders for psychotherapy. 

But, not just any expert. A lot of eating disorders therapists work in a cognitive-behavioral way to deal with your eating behaviors and controlling the symptoms.

This kind of therapy doesn’t help you get to the unconscious roots of your feelings, anxieties, and the childhood trauma that caused your eating disorder in the first place.

Look for an expert trained in psychoanalysis or psychodynamic psychotherapy. A good therapy for your eating disorder will:

• Work with a dietician or medical doctor to oversee your physical condition
• Understand the childhood trauma that led to your eating disorder
• Create a safe space for you to bring in the feelings you’ve had to shut off
• Know that you’re fighting off your emotional hungers
• Help work out your self-hate towards the traumatized child inside that needs
• Build up your self-esteem
• Help you work out all the effects of your childhood trauma

When you have this kind of help, the eating problems, behaviors, need for control, and hatred of your emotional needs will gradually subside. 

And, you can grow to like yourself, even to love yourself.  You’ll learn to have empathy for the child in you who was deprived and didn’t feel safe needing anyone or anything.

Life can be much happier.

I’m Dr. Sandra Cohen, a Los Angeles based psychoanalyst. I specialize in the treatment of childhood trauma and eating disorders. Your life can change.