More than food: The overlooked mental health struggles behind eating disorders

It’s Mental Health Awareness Month, and this year, we want to recognize some of the commonly overlooked mental health issues that those with eating disorders struggle with every day. Eating disorders can be misleading, with many taking them for face value and not considering any psychological triggers responsible for them, such as trauma, depression, anxiety, and low self-esteem.

The mental health connection: Beyond the plate

As eating disorder professionals and specialists, it’s important to remember that eating disorders are not just about food—they are often coping mechanisms to help deal with other mental struggles and co-occurring conditions. 

Treating an eating disorder isn’t just about restoring someone’s ideal body weight or helping them have a better relationship with food or movement. While these goals are important, they aren’t the only things necessary to help someone recover from their eating disorder. 

A crucial part of treatment is to address the underlying cause of the disorder, commonly things like depression, anxiety, trauma, and even obsessive compulsive disorder (OCD). Only once these comorbid mental health conditions are addressed can we start to see the possibility of long-term recovery.

Anxiety and the desire for control

Anxiety is a common precursor to eating disorders and can manifest as perfectionism, a fear of failure, or a strong need to control one’s body. Controlling one’s food intake or physical activity can be a way to gain control over one’s life—in some cases, this is not a bad thing. However, it’s a slippery slope to being obsessive over control, leading to eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder. 

When anxiety leads to an eating disorder, it can also lead to compulsive or excessive exercise, which has its own set of complications. 

Controlling food intake can offer those with anxiety a sense of psychological relief in several ways, including:

• Perceived control
• Structure and routine
• Distraction
• Sense of accomplishment
• Emotional regulation
• Temporary physical comfort

It’s worth noting that while controlling food intake may provide someone with temporary relief from anxiety symptoms, in addition to leading to disordered eating patterns, it can further anxiety and even worsen body image issues.

Trauma and its impact on eating behaviors

Trauma—whether physical, emotional, or psychological—can significantly impact someone’s relationship with food, their body, and their sense of control. Regardless of whether the trauma was related to self-esteem, body image, or food, it can significantly affect someone’s emotional and psychological well-being. 

Common feelings and symptoms of those with past trauma include:

• Powerlessness or a lack of control
• Distorted body image or a negative view of their body
• Shame or disgust of themselves
• Difficulty processing emotions
• Disassociation (feeling disconnected from their body)
• Low self-esteem

One may engage in disordered eating habits as a way to temporarily:

• Numb emotional pain (e.g., by binge eating)
• Feel a sense of control (e.g., by restricting food intake)
• Re-establish a connection to their physical body and sensations
• “Improve” or control their body (or attempt to)
• Distract themselves from stressful situations or environments

When trauma results in body image issues, severe restriction of food intake or purging behaviors are common as a way to lose weight or manipulate their body shape. This often doesn’t help curb the feelings of worthlessness or shame—it can actually worsen the stress related to body image. 

Trauma can also disrupt the body’s natural ability to regulate hunger and satiety, which can lead to starvation or even overeating. 

Depression and low self-esteem: Feeling invisible

Depression and low self-esteem are extremely common in those with eating disorders since these are both often tied to one’s physical appearance. 

Depression can lead to disordered eating behaviors in several ways. When one’s depression is related to body image, it can very quickly spiral into extreme restriction of food, starvation, purging cycles, and even binge eating. This connection is more obvious as someone strives to be “skinny” or fit into what they believe is the “ideal” body type. 

Another way that depression can lead to the onset of an eating disorder is by affecting one’s desire to eat at all. Those who are depressed often feel fatigued and have a loss of interest in things that were once pleasurable. Depression can also greatly affect one’s appetite. These symptoms naturally result in someone eating less. 

On the flip side, someone may turn to binge eating as a way to deal with their depression or to distract themselves from negative feelings. Not only does this result in health risks associated with overeating, but it can also result in purging behavior, which has its own set of physical risks. 

Obsessive thoughts and compulsive behaviors

Obsessive-compulsive disorder (OCD) and eating disorders are closely connected in several ways, with the main commonality being that both involve patterns of intrusive thoughts and compulsive behaviors. Other ways the two are related include: 

• Rigid rituals around eating: Things like strict meal plans, extreme rules around portion sizes, and repetitive routines around food can be seen in OCD and disordered eating behaviors. 
• Repetition: Both share a central theme of repetitiveness, whether it’s repeatedly washing hands before eating or repeatedly weighing yourself. 
• Perfectionism and control: With both disorders, there is a strong need for control and perfection. Those with these conditions may have excessively high standards of themselves and need to feel more in control of their bodies and surroundings. 
• Anxiety: Someone with OCD and or an eating disorder is very likely to also have some kind of anxiety. It may stem from obsessions, fear, doubts, body image, or self-esteem. 
• Distorted thinking: Cognitive distortions are common in both OCD and eating disorders, which lead to excessive worry or an unhealthy relationship with food. For example, with eating disorders specifically, they may have an exaggerated fear of gaining weight.

Our responsibility to reduce the stigma around mental health struggles

As experts in the eating disorder field, it’s important to remember that friends and families of loved ones struggling with an eating disorder are likely unaware of the nuances around eating disorders and the lesser-known mental health struggles associated with them. They may not be aware that their loved one has been dealing with anxiety or depression or even suffered trauma early in life that led to the onset of their eating disorder. 

As professionals, we must be understanding of our patients’ support systems and stay vigilant in educating them and helping them understand the complex issues behind eating disorders. We also need to help them understand that mental health issues are real and serious. It’s not a “choice” and isn’t something that can be fixed easily—it takes time, patience, professional help, and a strong support system to overcome.

Accessible, compassionate care is Within Reach.

Learn more about our intentionally-virtual eating disorder treatment program.