Generalized Anxiety Disorder and Eating Disorders

Understanding the overlap and distinction between these conditions.

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Most people get anxious from time to time. And most people complain about appearance, attempt to eat more healthfully, or get into an exercise routine at some point.

To be diagnosed with a disorder, however – be it an anxiety disorder or an eating disorder – the symptoms must be significant, persistent and impairing.

The hallmark feature of generalized anxiety disorder (GAD) is uncontrollable, chronic worry.

People with GAD worry excessively – when there is nothing wrong or in a way that is disproportionate with actual risk – and experience physical symptoms as a result of the anxiety.

There is certainly overlap between the kinds of symptoms described by an individual with an eating disorder and an individual with GAD – worry, gastrointestinal distress, irritability, fatigue, and impaired concentration to name just a few.

In light of the similarities, it may not be all that surprising that among all anxiety disorders, GAD not infrequently co-occurs in people with eating disorders.  In fact, some research suggests the disorders may share specific vulnerability factors, including a thinking style marked by difficulty tolerating uncertainty.

Yet, GAD is a quite distinct diagnosis from eating disorders such as anorexia nervosa, bulimia nervosa, or binge eating disorder.

What are the key differences between GAD and eating disorders?

A main difference between GAD and eating disorders is the scope and source of worry. Individuals with GAD worry about a variety of topics the represent typical life circumstances or dilemmas including job performance, finances, or the health of loved ones. In the case of eating disorders, the worry is typically more circumscribed.

Body shape, size, and weight of primary importance and worries related to this include concerns (and distortions) about adequate calorie intake and exercise, as well as adhering to lots of food rules. For those with eating disorders, worry manifests in a number of psychologically and physically damaging behaviors:  strict dieting, binge eating, self-induced vomiting or other compensatory strategies.

While avoidance plays a part in both types of conditions, what is being avoided is likely to differ. For example, someone with GAD may avoid making career decisions or having a conversation with a boss about a raise due to worry about competence or finances.  Someone with an eating disorder may avoid interactions with a boss because of a tendency to make negative comparisons about appearance; work lunches might also be avoided, or attended with great anxiety, due to fears of eating too much or of being noticed for eating too little.

The reason for irritability, fatigue, and poor concentration also varies by diagnosis.

Feeling ‘keyed up’ for an extended period of time can lead someone with an anxiety disorder to become exhausted. Persistent multi-faceted worry and difficulty dealing with life’s uncertainties can lead to a short temper or be very distracting.

For an individual with anorexia nervosa, irritability, fatigue and difficulty focusing are likely a result of low weight or inadequate nourishment. Someone with bulimia nervosa may feel emotionally and physically depleted as a result of a cycle of severely restrictive eating, binge eating (feeling out of control and eating a lot of food in one sitting), and purging. In addition, metabolic and electrolyte disturbances resulting from purging behaviors can cause a variety of physical symptoms. Distress about binge eating (and time spent doing it) can also lead to irritability and fatigue in a person with binge eating disorder.

What if you have both GAD and an eating disorder?

Approximately two-thirds of people with either an eating disorder suffer from some type of anxiety disorder in their lifetime. And nearly half of those developed the anxiety disorder first, often during childhood and clearly prior to the onset of the eating disorder.

The presence of an eating disorder often worsens pre-existing anxiety symptoms. Depending on the nature of the eating disorder, it will either be treated first or simultaneously with GAD.

For example, an individual who is underweight and/or frequently binge eating and purging, may experience an improvement in anxiety if weight is restored and if eating is normalized. After starting to regulate weight and eating, residual GAD symptoms (or other anxiety symptoms) will be assessed and treated.  

On the other hand, there may be circumstances that benefit from targeting the conditions simultaneously.

Finally, although having multiple problems can complicate the treatment process, there is a high degree of overlap in treatment approaches shown to be effective for both GAD and eating disorders. Cognitive behavioral therapy, for example, is commonly and effectively used to treat both problems, as are a number of medications including antidepressants.  Mindfulness-based approaches are also used to treat both types of disorders.


American Psychiatric Association. Diagnostic and statistical manual of mental disorders (Fifth edition). Washington, D.C.: American Psychiatric Association; 2013.

Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia. Am J Psych. 2004;161: 2215-2221.

Konstantellou, A, Campbell M, Eisler I, Simic M, Treasure J. Testing a cognitive model of generalized anxiety disorder in the eating disorders. J Anxiety Disord. 2011;25:864-869.

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