The Relationship Between Bulimia & Anxiety 

Bulimia nervosa (BN) is an eating disorder and mental health condition that commonly co-occurs with other mental health conditions, including depression and anxiety. 

When it comes to anxiety in particular, the condition can be complexly intertwined with BN, and either condition can lead to the development of the other. In fact, studies have shown that as many as 65% of people with an eating disorder also have an anxiety disorder. [1]

Anxiety and bulimia

Still, some treatments have been developed to help people struggling with concurrent mental health conditions, including those who simultaneously struggle with bulimia nervosa and anxiety.

How Does Anxiety Impact Bulimia Nervosa?

While the development of any comorbid—or co-occurring—mental health diagnosis represents a complex chain of causes and effects, patterns do sometimes emerge in these cases.

It’s entirely possible for someone to showcase signs of BN before developing an anxiety disorder, but more often than not, the anxiety comes first. 

70% say their anxiety disorder came before their eating disorder.

One survey found that nearly 70% of respondents said their anxiety disorder was diagnosed before their eating disorder. [1] In fact, anxiety is often thought of as a potential risk factor for developing an eating disorder. [2] 

Why Does Anxiety Come First?

There are a number of reasons why people may experience anxiety disorders before developing the thoughts and behaviors that lead to an eating disorder. But one of the biggest may be the fact that, for many people, bulimia nervosa develops as a maladaptive coping mechanism. 

In these cases, disordered eating behavior may manifest as an outlet for dealing with undue stress and anxiety. Sometimes, exerting control over what, when, and how much they eat helps people feel they have more control over their lives.

Eating also activates the parasympathetic nervous system. While this mechanism is at work, the body directs much of its active energy toward the tasks of digestion and nutrient absorption, leaving other functions in ‘energy conservation’ mode. 

The result often feels like a sense of relaxation, which many people may rely on, subconsciously or not, to alleviate feelings of stress.

Types of Anxiety Disorders

There are many different types of anxiety disorder, all of which have their own dynamic with and relationship to bulimia nervosa. 

Some of the most common anxiety disorders include:

  • Generalized anxiety disorder (GAD): This involves persistent feelings of fear, dread, or worry to the point that they interfere with daily life.
  • Social anxiety disorder: Also known as SAD, this disorder involves persistent and intense fear of being judged and watched by others.
  • Panic disorder: Symptoms include recurring, frequent, and/or unexpected panic attacks.
  • Phobia-related disorders: This involves aversion to or intense fear of specific situations or objects, which is disproportionate to their actual potential for danger.
  • Post-traumatic stress disorder (PTSD): This disorder is signified by recurring and intrusive thoughts after witnessing or being involved in a traumatic event or experience.
  • Obsessive-compulsive disorder (OCD): Symptoms include uncontrollable obsessions (recurring thoughts) and compulsions (behaviors) that are repeated over and over.

Co-Occurrence of Bulimia and Anxiety

It’s possible for bulimia nervosa to co-occur with any type of anxiety disorder. But some of the most common comorbid anxiety conditions include:

  • Social phobias
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder (GAD)
  • Obsessive-compulsive disorder (OCD)
  • Panic and agoraphobia disorders

Overall, OCD is one of the most common anxiety disorders to co-occur with any type of eating disorder, most likely due to the fixation and compulsive actions involved in the condition. [3] And women who struggle with PTSD are also at a particularly high risk of developing BN.

Treating Anxiety and Bulimia Nervosa Together

Typically, when someone experiences co-occurring mental health disorders, the conditions are best treated simultaneously, in a comprehensive manner. This can include courses of counseling, medical treatment, or medication when needed. 

Still, some therapeutic approaches lend themselves better than others to treating BN and anxiety at once.

Cognitive behavioral therapy (CBT) operates on the philosophy that unhelpful behaviors stem from unhelpful thoughts. Its purpose is to change those undesirable behaviors by helping someone understand and, eventually, change their negative thought patterns.

Change is often realized by addressing the root causes behind these thoughts and identifying potential triggers. Patients are also taught healthier coping strategies and emotional regulation techniques to help them overcome their unhelpful thoughts and actions.

Dialectical behavior therapy (DBT) operates off a similar theory as CBT. Patients are still encouraged to change their unhelpful behaviors by recognizing and changing unhelpful thoughts, and therapists teach their patients similar coping strategies.

But with DBT, the idea of dealing with two truths at once is also introduced. In these cases, patients are shown how they can come to a place of self-acceptance while simultaneously working to change the thoughts and behaviors driving their conditions.

Acceptance and commitment therapy (ACT) goes one step further than DBT when it comes to teaching acceptance.

With ACT, achieving that perspective is the primary goal. Patients are encouraged to find fulfillment by pursuing activities that align with their morals, and therapists also teach them the tenets of mindfulness to help encourage a healthier mindset.

When patients are treated for bulimia nervosa along with an anxiety disorder, additional counseling or therapy around the ideas of food, nutrition, and body image may be included. 

Sometimes, pharmaceutical options can also help alleviate one or both conditions. Certain types of medication have been found to help with some symptoms of both anxiety and BN.

Finding Help for Bulimia Nervosa

Recovery from bulimia nervosa necessitates a comprehensive treatment program that also accounts for the treatment of any co-occurring disorders, including anxiety disorders. 

If you or a loved one is struggling with signs of either of these conditions, you should reach out for help. When comorbid mental health conditions are treated together, they can be optimally managed for a long and sustained recovery.

Speaking with your primary care physician or therapist can be a great first step toward finding the kind of treatment that can help you build a healthier and happier future.


  1. Swinbourne, J., Hunt, C., Abbott, M., Russell, J., St Clare, T., & Touyz, S. (2012). The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. The Australian and New Zealand journal of psychiatry; 46(2):118–131.
  2. Deboer, L. B., & Smits, J. A. (2013). Anxiety and Disordered Eating. Cognitive therapy and research; 37(5):887–889.
  3. Eating Disorders. (2021, September 28). Anxiety Depression Association of America (ADAA). Retrieved September 21, 2022.

Last Update | 01 - 12 - 2023

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