Differences in severity of eating disorder symptoms between adults with depression and adults with anxiety

Abstract

Objectives

Anxiety and depression are both considered maintaining factors for eating disorders (ED) but it is still unclear if one is more strongly associated with ED symptoms than the other. We examined differences in severity of ED symptoms among adults with either, both, or neither depression and anxiety.

Methods

Volunteers (N = 3,780) to the project implicit mental health website (https://implicit.harvard.edu/) self-reported their ED status (current ED: n = 374, past ED: n = 436; no ED: n = 2,970), their current depression/anxiety status, and their ED symptoms (using the Eating Attitudes Test). ANOVAs with post hoc comparisons were used to examine relationships between ED symptoms and comorbid depression/anxiety status among currently ill, recovered, and never ill individuals.

Results

Participants without comorbidities had the least and participants with both comorbidities had the most severe ED symptoms (p = .021). Participants with anxiety alone had more severe ED symptoms relative to those with depression alone across groups (current ED: p = .024; past ED: p = .019; no EDs: p = .021).

Discussion

These findings demonstrate, in contrast with an earlier study among youth with EDs (Hughes et al., 2013), that comorbid anxiety may be linked with more severe ED symptoms relative to comorbid depression. It is possible that anxiety serves as a maintaining factor for ED symptoms such that dieting and other ED-related behaviors may function to modulate symptoms of anxiety.

Level of evidence

Level III, case-control analytic study.

This is a preview of subscription content, log in to check access.

Data availability statement

Approval to use the data was obtained from Dr. Bethany A Teachman (PhD) from the University of Virginia (USA). Data available on request from the first author (REB).

References

  1. 1.

    Hoek HW (2016) Review of the worldwide epidemiology of eating disorders. Curr Opinion Psych 29(6):336–339

    Google Scholar 

  2. 2.

    Udo T, Grilo CM (2019) Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int J Eat Disord 52(1):42–50

    PubMed  Google Scholar 

  3. 3.

    Ulfvebrand S, Birgegård A, Norring C, Högdahl L, von Hausswolff-Juhlin Y (2015) Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Res 230(2):294–299

    PubMed  Google Scholar 

  4. 4.

    Bulik CYNTHIAM (2002) Anxiety, depression and eating disorders. Eating Disorders Obesity Handbook 2(1):193–198

    Google Scholar 

  5. 5.

    Blinder BJ, Cumella EJ, Sanathara VA (2006) Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med 68(3):454–462

    PubMed  Google Scholar 

  6. 6.

    Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR (2011) Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 68(7):714–723

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Hughes EK, Goldschmidt AB, Labuschagne Z, Loeb KL, Sawyer SM, Grange DL (2013) Eating disorders with and without comorbid depression and anxiety: similarities and differences in a clinical sample of children and adolescents. Eur Eating Disorders Rev 21(5):386–394

    Google Scholar 

  8. 8.

    Goel NJ, Sadeh-Sharvit S, Trockel M, Flatt RE, Fitzsimmons-Craft EE, Balantekin KN, Monterubio GE, Firebaugh M-L, Wilfley DE, Taylor CB (2020) Depression and anxiety mediate the relationship between insomnia and eating disorders in college women. J Am College Health 1:6

    Google Scholar 

  9. 9.

    Fassino S, Pierò A, Tomba E, Abbate-Daga G (2009) Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psych 9(1):67

    Google Scholar 

  10. 10.

    Godart NT, Perdereau F, Rein Z, Berthoz S, Wallier J, Jeammet P, Flament MF (2007) Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Aff Disorders 97(3):37–49

    CAS  Google Scholar 

  11. 11.

    Godart NT, Flament MF, Lecrubier Y, Jeammet P (2000) Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance. Euro Psych 15(1):38–45

    CAS  Google Scholar 

  12. 12.

    Brand-Gothelf A, Leor S, Apter A, Fennig S (2014) The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls. J Nerv Ment Dis 202(10):759–762

    PubMed  Google Scholar 

  13. 13.

    Milos G, Spindler A, Ruggiero G, Klaghofer R, Schnyder U (2002) Comorbidity of obsessive-compulsive disorders and duration of eating disorders. Int J Eat Disord 31(3):284–289

    PubMed  Google Scholar 

  14. 14.

    Sidor A, Baba CO, Marton-Vasarhelyi E, Chereches RM (2015) Gender differences in the magnitude of the associations between eating disorders symptoms and depression and anxiety symptoms. Results from a community sample of adolescents. J Mental Health 24(5):294–298

    Google Scholar 

  15. 15.

    Bulik CM, Sullivan PF, Carter FA, Joyce PR (1996) Lifetime anxiety disorders in women with bulimia nervosa. Compr Psychiatry 37(5):368–374

    CAS  PubMed  Google Scholar 

  16. 16.

    Ivarsson T, Råstam M, Wentz E, Gillberg IC, Gillberg C (2000) Depressive disorders in teenage-onset anorexia nervosa: a controlled longitudinal, partly community-based study. Compr Psychiatry 41(5):398–403

    CAS  PubMed  Google Scholar 

  17. 17.

    Holtkamp K, Müller B, Heussen N, Remschmidt H, Herpertz-Dahlmann B (2005) Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. Eur Child Adolesc Psychiatry 14(2):106–110

    CAS  PubMed  Google Scholar 

  18. 18.

    Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, Edkins K, Krishna M, Herzog DB, Keel PK (2017) Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. J Clini Psych 78(2):184–189

    Google Scholar 

  19. 19.

    Bardone-Cone AM, Harney MB, Maldonado CR, Lawson MA, Robinson DP, Smith R, Tosh A (2010) Defining recovery from an eating disorder: conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behav Res Ther 48(3):194–202

    PubMed  Google Scholar 

  20. 20.

    Wagner A, Barbarich-Marsteller NC, Frank GK, Bailer UF, Wonderlich SA, Crosby RD, Henry SE, Vogel V, Plotnicov K, McConaha C (2006) Personality traits after recovery from eating disorders: do subtypes differ? Int J Eat Disord 39(4):276–284

    PubMed  Google Scholar 

  21. 21.

    Yackobovitch-Gavan M, Golan M, Valevski A, Kreitler S, Bachar E, Lieblich A, Mitrani E, Weizman A, Stein D (2009) An integrative quantitative model of factors influencing the course of anorexia nervosa over time. Int J Eat Disord 42(4):306–317

    PubMed  Google Scholar 

  22. 22.

    Koskina A, Campbell IC, Schmidt U (2013) Exposure therapy in eating disorders revisited. Neurosci Biobehav Rev 37(2):193–208

    PubMed  Google Scholar 

  23. 23.

    Forrest LN, Smith AR, Swanson SA (2017) Characteristics of seeking treatment among US adolescents with eating disorders. Int J Eat Disord 50(7):826–833

    PubMed  Google Scholar 

  24. 24.

    Swanson SA, Field AE (2016) Commentary: considerations for the use of registry data to study adolescent eating disorders. Int J Epidemiol 45(2):488–490

    PubMed  Google Scholar 

  25. 25.

    Berkson J (1946) Limitations of the application of fourfold table analysis to hospital data. Biometrics Bulletin 2(3):47–53

    CAS  PubMed  Google Scholar 

  26. 26.

    Marzola E, Porliod A, Panero M, De-Bacco C, Abbate-Daga G (2020) Affective temperaments and eating psychopathology in anorexia nervosa: Which role for anxious and depressive traits? J Affect Disord 266:374–380

    PubMed  Google Scholar 

  27. 27.

    Glenn JJ, Werntz AJ, Slama SJ, Steinman SA, Teachman BA, Nock MK (2017) Suicide and self-injury-related implicit cognition: a large-scale examination and replication. J Abnorm Psychol 126(2):199

    PubMed  Google Scholar 

  28. 28.

    Werntz AJ, Steinman SA, Glenn JJ, Nock MK, Teachman BA (2016) Characterizing implicit mental health associations across clinical domains. J Behav Ther Exp Psychiatry 52:17–28. https://doi.org/10.1016/j.jbtep.2016.02.004

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Nosek BA (2005) Moderators of the relationship between implicit and explicit evaluation. J Exp Psychol Gen 134(4):565

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Vigne P, Simões BFT, de Menezes GB, Fortes PP, Dias RV, Laurito LD, Loureiro CP, Moreira-de-Oliveira ME, Albertella L, Lee RSC (2019) The relationship between obsessive-compulsive disorder and anxiety disorders: a question of diagnostic boundaries or simply severity of symptoms? Compr Psychiatry 94:152116

    PubMed  Google Scholar 

  31. 31.

    Garner Al (1982) Eating attitudes test (EAT-26). Psychol Med 12:871–878. https://doi.org/10.1037/t06908-000

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Garner DM, Garfinkel PE (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med 9(2):273–279

    CAS  PubMed  Google Scholar 

  33. 33.

    Lavender JM, De Young KP, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, Peterson CB, Le Grange D (2013) Daily patterns of anxiety in anorexia nervosa: associations with eating disorder behaviors in the natural environment. J Abnorm Psychol 122(3):672

    PubMed  PubMed Central  Google Scholar 

  34. 34.

    Bodell LP, Brown TA, Keel PK (2012) The impact of bulimic syndromes, mood and anxiety disorders and their comorbidity on psychosocial impairment: what drives impairment in comorbidity? Eur Eating Disorders Rev 20(1):74–79

    Google Scholar 

  35. 35.

    Cooper Z, Fairburn C (1987) The eating disorder examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 6(1):1–8

    Google Scholar 

  36. 36.

    Spindler A, Milos G (2007) Links between eating disorder symptom severity and psychiatric comorbidity. Eat Behav 8(3):364–373

    PubMed  Google Scholar 

  37. 37.

    Matthies S, Schiele MA, Koentges C, Pini S, Schmahl C, Domschke K (2018) Please do not leave me—separation anxiety and related traits in borderline personality disorder. Curr Psychiatry Rep 20(10):83

    PubMed  Google Scholar 

  38. 38.

    Hildebrandt T, Bacow T, Markella M, Loeb KL (2012) Anxiety in anorexia nervosa and its management using family-based treatment. Eur Eating Disorders Rev 20(1):e1–e16

    Google Scholar 

  39. 39.

    Pallister E, Waller G (2008) Anxiety in the eating disorders: understanding the overlap. Clini Psychol Rev 28(3):366–386

    Google Scholar 

  40. 40.

    Klein R, Ratliff K, Vianello M, Adams R Jr, Bahník S, Bernstein M, Bocian K, Brandt M, Brooks B, Brumbaugh C (2014) Data from investigating variation in replicability: a “many labs” replication project. J Open Psychol Data 2:1

    Google Scholar 

  41. 41.

    Nosek BA, Banaji MR, Greenwald AG (2002) Harvesting implicit group attitudes and beliefs from a demonstration web site. Res Pract 6(1):101

    Google Scholar 

  42. 42.

    Kraut R, Olson J, Banaji M, Bruckman A, Cohen J, Couper M (2004) Psychological research online: report of board of scientific affairs’ advisory group on the conduct of research on the internet. Am Psychol 59(2):105

    PubMed  Google Scholar 

  43. 43.

    Slof-Landt MCT, Dingemans AE (2019) Self-assessment of eating disorder recovery: absence of eating disorder psychopathology is not essential. Intern J Eating Disorders 12:2–4

    Google Scholar 

Download references

Funding

This research received no specific grant from any funding agency.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Roni Elran-Barak.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

Dr. Bethany A Teachman (PhD) from the University of Virginia (USA) was responsible for data collection. This study was approved by the University of Virginia Institutional Review Board for the Social and Behavioral Sciences.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Elran-Barak, R., Goldschmidt, A.B. Differences in severity of eating disorder symptoms between adults with depression and adults with anxiety. Eat Weight Disord (2020). https://doi.org/10.1007/s40519-020-00947-y

Download citation

Keywords

  • Eating disorders
  • Depression
  • Anxiety
  • Comorbidity