The Intersection of Anxiety, Eating Disorders, and IBS

By: Jessica Long

Guest Post Writer

Trigger Warning: Mention of eating disorder behaviors.

If you’re a medical professional in the eating disorder field or you yourself have struggled with an eating disorder, the following statement might not surprise you: 

There is a significant overlap between anxiety, eating disorders, and gastrointestinal disorders (namely, IBS). 

Let’s dig into the research

To illuminate this, let’s dig into the research for a bit. 

DeJong et al.¹ found that over 68% of patients with bulimia enrolled in an outpatient facility had IBS. Likewise, Boyd et al.² discovered that 98% of patients admitted to an eating disorder unit had at least one functional gastrointestinal disorder (FGID), with IBS being the most prevalent (in 52% of patients). Interestingly, anxiety was a strong predictor of IBS status.² Patients with IBS have higher levels of both anxiety and depression,³ and research suggests this connection might have a genetic component.⁴

Although the current research cannot definitively tell us which comes first (the anxiety, the eating disorder, or the IBS), in 89 patients with both an eating disorder and IBS, the eating disorder came prior to the IBS in 78 cases.⁵ Most gastrointestinal symptoms significantly decrease following termination of the eating disorder behaviors (i.e. restoring normal eating habits and patterns).⁶ 

However, you don’t have to have an eating disorder to experience adverse gastrointestinal symptoms; disordered eating behaviors (like laxative abuse, skipping meals, or restricting certain food groups) can dramatically impact our digestion, for the worse. Those with IBS are more likely to engage in unhealthy food behaviors, like not eating despite being hungry.⁷

So, how do we move towards a healthy relationship with food, one that might impact our digestion, for the better?

Here are 3 tips!

1. Decrease stress around food. Since we know there’s a connection between anxiety and IBS, it’s important to make our mealtimes as stress-free as possible. One way we can do this is by viewing food as neutral, rather than as “bad” or “good”. Unfortunately, for those with IBS, many well-intentioned medical providers, family members, and even friends have recommended different diets, supplements, or lifestyle changes, all of which are steeped in diet culture and actually increase food preoccupation, anxiety over food choices, and increased stress before and after meals. 

2. Eat regularly. Our digestive systems work at their best when we give them regular meals and snacks. Skipping meals, which often leads to a restrict-binge-restrict cycle, is quite stressful for our digestion, and for those with IBS, we don’t want to cause any additional distress.

3. Use gentle nutrition strategies. Are there certain behaviors that can decrease IBS symptoms? Absolutely! Adding soluble fiber (like seeds, peas, beans, lentils, and some fruits and vegetables like apples and strawberries) can help alleviate diarrhea, while insoluble fiber (like wheat bran, whole grains, and certain vegetables like potatoes and carrots) can help with constipation. Some find that incorporating a probiotic into their daily routine can ease their IBS symptoms. Avoiding foods like diet sodas, sugar free gum, and other sugar substitutes, which are known to aggravate symptoms, might also help.

Need more support? Connect to a HAES-informed dietitian in your area, who can help you navigate your symptoms in a way that’s both empowering and sustainable!

Jessica Long is a graduate student at Meredith College in Raleigh, NC. She is an avid reader of research, and her interests include eating disorders, intuitive eating, and approaching medical nutrition therapy (MNT) from a weight-neutral lens. She is especially intrigued by the intersection of diabetes and weight neutral care, having experience working with patients with diabetes in a primary care setting. She is currently spearheading a research project investigating intuitive eating in minority undergraduate populations. Jessica can be reached via email at jlong@email.meredith.edu or on Instagram at @jessicalongrd.  

References:

1. DeJong H, Perkins S, Grover M, Schmidt U. The prevalence of irritable bowel syndrome in outpatients with bulimia nervosa. Int J Eat Disord. 2011;44:661-664.

2. Boyd C, Abraham S, Kellow J. Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders. Scand J Gastroenterol 2005;40:929–935

3. Fond G, Loundou A, Hamdani N, et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2014;264:651-660.

4. Bengtson M, Aamodt G, Vatn MH, Harris JR. Co-occurrence of IBS and symptoms of anxiety or depression, among Norwegian twins, is influenced by both heredity and intrauterine growth. BMC gastroenterol. 2015;15:9.

5. Perkins SJ, Keville S, Schmidt U, Chalder T. Eating disorders and irritable bowel syndrome: is there a link? J Psychosom Res. 2005 Aug;59(2):57-64.

6. Norris ML, Harrison ME, Isserlin L, Robinson A, Feder S, Sampson M. Gastrointestinal complications associated with anorexia nervosa: A systematic review. Int J Eat Disord. 2016;49:216-237.

7. Reed‐Knight B, Squires M, Chitkara DK, Tilburg MAL. Adolescents with irritable bowel syndrome report increased eating‐associated symptoms, changes in dietary composition, and altered eating behaviors: a pilot comparison study to healthy adolescents. Neurogastroenterol Motil. 2016;28:1915-1920.