Eating disorders and antecedent anxiety disorders: a controlled study

Abstract

We compared the prevalence and age of onset of adult and childhood anxiety disorders relative to the primary diagnosis in 68 women with anorexia nervosa (AN), 116 women with bulimia nervosa (BN), 56 women with major depression with no eating disorder (MD) and 98 randomly selected controls (RC) in order to determine whether antecedent anxiety disorders are plausible risk factors for AN and BN. Comorbid anxiety disorders were common in all three clinical groups (AN, 60%; BN, 57%; MD, 48%). In 90% of AN women, 94% of BN women and 71% of MD women, anxiety disorders preceded the current primary condition (P = 0.01), although panic disorder tended to develop after the onset of AN, BN or MD. In multivariate logistic regressions, the odds ratios (ORs) for overanxious disorder (OR = 13.4) and obsessive-compulsive disorder (OR = 11.8) were significantly elevated for AN. The ORs for overanxious disorder and social phobia were significantly elevated for BN (OROAD = 4.9; ORSP = 15.5) and MD (OROAD = 6.1; ORSP = 6.4). These data suggest that certain anxiety disorders are non-specific risk factors for later affective and eating disorders, and others may represent more specific antecedent risk factors.

Associations Between Fear of Negative Evaluation and Eating Pathology During Intervention and 12-Month Follow-up

“…These findings, along with evidence that social anxiety develops prior eating pathology (Brewerton, Lydiard, Herzog, & Brotman, 1995; Bulik et al, 1997), provide support for directly targeting FNE in prevention programs. Incorporating cognitive restructuring and exposure exercises, commonly used in cognitive behavioral interventions for social anxiety, is one way to do this.…”

“…Social anxiety disorder and EDs are highly comorbid, with social anxiety disorder diagnosed in 41% of those with bulimia nervosa, 32% of those with binge eating disorder, and 25% of those with anorexia nervosa (Hudson, Hiripi, Pope, & Kessler, 2007). Furthermore, onset of social anxiety disorder appears to pre-date the onset of EDs, suggesting that social anxiety psychopathology may serve as a predisposing risk factors for the later development of EDs (Brewerton et al, 1995; Bulik, Sullivan, Fear, & Joyce, 1997; Swinbourne, Hunt, Abbott, Russell, St. Clare, & Touyz, 2012). It is possible that the disorders are linked as a result of an overlapping risk factor such as fear of negative evaluation (FNE).…”

The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: Evidence from a family study with discussion of nosological and neurodevelopmental implications

“…First, the association has face validity inasmuch as fear-laden cognitions, heightened vigilance, and defensive avoidance are central to the phenomenology of eating disorders, in particular, anorexia nervosa (AN). Second, anxiety disorders among individuals with AN usually begin before signs of dietary preoccupation and weight loss, 2 and heritable traits linked to anxiety proneness (e.g., neuroticism, harm avoidance, and low novelty seeking) 3,4 are characteristic of the premorbid state in persons who develop AN. 5,6 Third, subthreshold features of anxiety often persist long after recovery of normal body weight.…”

Neurobiology of anorexia and bulimia nervosa

“…Recent studies have shown that the majority of people with AN and BN exhibit childhood perfectionism, obsessivecompulsive personality patterns, and anxiety that predate the onset of AN and BN (16,23,24). Moreover, studies done on 3 continents ( Table 2) have shown that in AN and BN individuals with a lifetime history of an anxiety disorder diagnosis, the anxiety disorder most often began in childhood before the onset of the ED (25)(26)(27)(28). The most common (15) premorbid childhood disorders were OCD and social phobia.…”

“…Silberg and Bulik (184), using twins, found a unique genetic effect that influences liability to early anxiety and eating disorder symptoms. When a lifetime anxiety disorder is present, the anxiety most commonly occurs first in childhood, preceding the onset of AN or BN (25,26,28). Anxiety and harm avoidance remain elevated after recovery from AN, AN-BN, and BN (185), even if individuals never had a lifetime anxiety disorder diagnosis (15).…”