Anxiety and Anorexia

It's hard to understand what anxiety feels like if you've never personally experienced it. It's like someone who's blind understanding the beauty of a sunset. Even so, I want to try to describe it, to make it tangible. Because for those who do experience it, they know that it can cause the most vivid and intense physiological experiences they have ever had. For some of you, it may be that you have unexplained physical pain or physical discomfort and you have no idea what could be causing it. Maybe it's with you all the time, or mayber it's only occasionally present. It could range from something minute to something unimaginably consuming.

Anxiety, for some, is a tiny nuisance. It's like that squeaky door that you barely even notice. Maybe it's been there so long that a part of you doesn't even notice it anymore. And maybe it doesn't drastically impair your life or you've accepted it as a part of who you are. If you have managed to find a way to cope with it, and you don't mind that it's there, that's great. Anxiety isn't always a bad thing, in fact, it can be quite adaptive. Someone with no anxiety is likely oblivious to danger in their surroundings. It's good to have some anxiety because anxiety helps to keep you safe.

But what about when you're anxious All.The.Time? The kind of anxiety that takes over everything. You second guess every task you complete, even as you're completing it. You worry that you forgot to lock your house or you double and triple check that your kids were properly buckled. Maybe you can't bring yourself to be engaged at social gatherings because you are consumed with comparison, wondering if anyone will like you. Or perhaps you self-sabotage because you're anxious about what could happen if you were actually noticed for the things you do well. Maybe you never take the steps to improve your life the way you'd like because change is terrifying, and even though your goals don't go away, familiarity brings comfort.

Then we have panic attacks. If you've experienced this, you know exactly what I'm talking about. It feels almost like your body isn't your own. You lose control. You feel white hot fire rising through your neck, and your face begins to burn, even though AC is set to a nice cool 70 degrees. The world around you begins to blur, your thoughts are both cloudy and racing. You lose all ability to focus, yet you know you have to complete your tasks, which of course only makes it worse. So you just keep your head down and pretend everything is fine, for as long as you can. And finally, you break down. You can't breath, you can't calm down or strop the stream of tears that's now pouring from your eyes. And you crumple into a ball, gasping, screaming. It may last several seconds, or several minutes. You don't know and you can't control it.

The possibly boring part

If you have an eating disorder, you may be familiar with the discomfort of anxiety. We know from research that serotonin is heavily involved in both anxiety and appetite. Based on multiple studies, there is a strong theory that those who suffer from anorexia may have excessive serotonin, (particularly higher 5-HT). Studies of those with bulimia have had mixed findings, with various abnormalities in serotonin. Some of these abnormalities are similarly linked to impulsivity, which is a common factor in both biging and purging behaviors.

The not so boring part (again)

Anxiety is such a common ailment. And I see it show up in eating disorders all.the.time. I see it in the way a client criticizes their body, in the way they're crippled at meals. I see it in how they interact with peers and the way they show up in session. I see it with every decision about clothing, hairstyles, makeup. They worry what their relatives will say at the next family gathering. They pull away from friends because the thought of someone questioning them for not eating lunch is overwhelming. Someone who has anorexia is typically not only trying to make themselves literally smaller, but also metaphorically. Somewhere along the lines, they learned that they don't deserve to take up space, so do their best to not.

Imagine living with the anxiety I described above, the kind that controls your every waking moment. The kind that causes panic attakcs and makes life feel like a nightmare. It's not hard to understand why someone would want to do anything to stop it. And the sad reality is that many don't know healthy ways to do this. So whether they've learned it from media or family or through a search engine, they came up with the idea that controlling what they eat can stop the overwhelm. The absurdity of it is that the eating disorder never actually gets rid of the anxiety. It simply gives the anxiety a direction, an area of focus. It tells the anxiety to worry about numbers. And the anxiety in turn drives this insatiable need to be smaller, to eat less, to hids from the world.

Giving credit where it's due, and in case you'd like to learn more about the research on anxiety, serotonin, and eating disorders, visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC305267/