By: Susan Bennett, PhD
Monday, July 18, 2016
At the ACUTE Center for Eating Disorders, it is not uncommon to hear our patients express that they feel anxious and panicky. In many cases, individuals tell us that they did not feel anxious prior to the development of the eating disorder, but they became increasingly so as the disorder progressed. Others have reported that they have experienced anxiety many years before the development of the eating disorder and as it progressed the symptoms became more difficult to manage, eventually turning into panic attacks. These symptoms – anxiety, fear and panic attacks – are responses that frequently co-occur during the active phase of an eating disorder.
First, it is important to know that there is a difference between anxiety and fear even though they often occur together. Anxiety is a response to an unknown or vague threat while fear is a response to a known, external, definite threat. Many of our patients note that they have panic attacks during times of heightened anxiety when their eating disorder has become exceptionally threatening. Interestingly, patients with eating disorders may experience panic attacks even without a history of anxiety disorder. Regardless, our patients tell us that anxiety and/or panic attacks either developed or worsened as they lost more weight.
A panic attack is best described as an abrupt surge of intense physical and emotional discomfort that occurs for a brief period of time. The body is wise, and in severe cases of restricting or binge-purge anorexia, it knows that something is wrong as organs, hormones, and brain function become compromised during starvation—simply put, the alarms begin to sound. The individual may not even be aware that there are any underlying medical concerns, yet he or she reports experiencing feelings of fear or panic. This is an autonomic response to a stressful condition occurring within the body. Because there is no conscious interpretation of a physiological symptom, the panic feeling may seem to come completely out of the blue.
In cases of severe malnutrition, there are multiple stimuli and opportunities for conscious thoughts and evaluations that can contribute to a fear response. Conscious thought such as “I was afraid that I wouldn’t wake up in the morning,” is one example frequently reported by our patients. Other times, facing a meal or changes in one’s body can prompt a fear response that when heightened, can cause a panic attack. Whether the stimulus is conscious or unconscious, something is occurring that is interpreted as a threat, resulting in chemical changes within the body that end with what is known as a fight-or-flight response.
The fight-or flight response often felt during periods of anxiety or panic is produced by the brain – the hypothalamus to be precise. This part of the brain activates our sympathetic nervous system (nerve pathways), which prepares the body for action by releasing hormones into the bloodstream. This release of these hormones causes an increase in heart rate, blood pressure and blood-glucose levels, to name only a few. In response, the body becomes more alert, tense and sped up so a person can quickly respond to his or her situation—a helpful state if you are facing a tangible threat such as being chased by a vicious animal.
This primitive system has perpetuated our existence by helping us to avoid life threatening situations; however, being in a state of frequent or constant anxiety can be met with maladaptive responses. Such is the case for eating disorders. For instance, the presentation of certain foods and/or perceptions of weight gain become feared due to the deceptive nature of an eating disorder. Anxiety and panic increase in response to that fear, and in order to feel more comfortable, one avoids the situation in order to return to a calmer state.
When the body is starving, this avoidance reaction is dangerous because both nutrition and weight gain are essential to survival. Therefore, the path of restricting or purging as a means to control an uncomfortable response is not the path of life-preservation as intended by our primitive system; rather, an individual is guided away from it. At the same time, there are autonomic responses occurring as the body is alarmed by its starved and compromised state, so the alarms continue to sound. The stress of this can become physically harmful and emotionally taxing.
Good treatment programs appreciate this paradox and work with individuals to confront anxiety and fear in order to help condition new responses to previously feared situations. At ACUTE Center for Eating Disorders, these patient responses to treatment are familiar and understood. Having a compassionate therapist provides an opportunity for individuals to talk about anxiety and fears, learn skills to manage fear responses, and find alternative ways to think about challenges while continuing the work of recovery.
We are here to help and wish you only the best on your road to recovery.
Susan Bennett, PhD