Anxiety has been known for some time to be common in people with an eating
disorder. But a new study suggests that anxiety often precedes—in fact,
may even be a predisposition to—eating disorders.
This finding "may be surprising to people," Walter Kaye, M.D.,
a professor of psychiatry at the University of Pittsburgh, told
Kaye was the chief author of the study, which appears to be the largest to
date on the co-occurrence of anxiety disorders and eating disorders. Results
appeared in the December American Journal of Psychiatry.
Kaye and his coworkers gave the Structured Clinical Interview for
DSM-IV Axis I Disorders, as well as standardized tests for anxiety,
perfectionism, and obsessionality, to 672 subjects with an eating disorder (97
individuals with anorexia nervosa, 282 with bulimia nervosa, and 293 with both
anorexia and bulimia).
Some two-thirds of the subjects, it turned out, had had one or more anxiety
disorders at some point in their lifetimes, a much higher rate than that found
in mentally healthy women in the community by other researchers (between 13
percent and 31 percent).
The most common anxiety disorders experienced by these subjects were
obsessive-compulsive disorder (41 percent) and social phobia (20 percent).
Even more striking, most of the subjects who reported an anxiety disorder
said that they had developed it in childhood, before they had acquired an
Thus, childhood anxiety may not just herald the later onset of eating
illnesses but may actually predispose to them, Kaye and his coworkers
concluded in their study report.
Nonetheless, it is probably not anxiety per se, but the inheritance of
anxiety traits that makes a person vulnerable to the development of eating
ailments, Kaye pointed out. "While many people diet and are concerned
about weight in our culture, relatively few develop an eating disorder. Thus
there may be certain traits that make some people particularly
Also, since there is growing evidence that eating disorders have a genetic
input (Psychiatric News, June 4, 2004), and since anxiety disorders
appear to often precede eating disorders, the same genes that predispose to
anxiety illnesses may also set the stage for eating disorders, Kay suspects.
In fact, he and his colleagues have some preliminary evidence that certain
genetic regions implicated in anxiety are also implicated in eating
Moreover, because of the purportedly close link between anxiety illness
genes and eating disorder genes, Kay conjectured, eating disorders "may
be a strategy that some people use to reduce anxiety. That is, extreme eating
may blunt anxious feelings."
"The finding that anxiety disorder commonly precedes the diagnosis of
the eating disorder should [also] generate additional investigations on
prevention/early intervention strategies addressing anxiety disorders,"
David Herzog, M.D., said in an interview. Herzog is head of the Harvard Eating
Disorders Center at Massachusetts General Hospital.
Kaye concurred. "Teaching children with these traits better coping
strategies for anxiety might reduce the incidence of eating
The investigation was funded by the Price Foundation, a private foundation
based in Europe.
The study, "Comorbidity of Anxiety Disorders With Anorexia and
Bulimia Nervosa," is posted online at<http://ajp.psychiatryonline.org/cgi/content/full/161/12/2215?>.▪
Am J Psychiatry20041612215