Anxiety disorders are a group of psychological disorders characterized by debilitating anxiety that interferes with a person’s functioning. The following explores the connection between starvation eating disorders, core anxiety, weight obsessions, and compulsions. Beyond the relationship between starving oneself and anxiety, there is a risk for a person with a starvation eating disorder of having a true anxiety disorder that is separate from an eating disorder.

Not surprisingly, the anxiety disorder most associated with starvation eating disorders is obsessive-compulsive disorder. In addition, panic disorder and social phobia are also seen in people who have starvation eating disorders. Because this association goes beyond the effects of starvation, it’s important to include a short discussion about each of these anxiety disorders.


Despite the similarity in names, obsessive-compulsive disorder (OCD) and the obsessive-compulsive personality traits discussed thus far are distinct from each other. OCD is a true anxiety disorder involving behaviors such as compulsive hand washing or checking. People with OCD may engage in these behaviors so often that there is little time for anything else.

OCD with contamination fear is a good example of such interference. Imagine being as afraid of germs as you are of gaining weight. The fear of germs leads to compulsive hand washing and hours of cleaning.

Hand washing fifty or more times a day, scrubbing the body in the shower for more than an hour, even using bleach to clean the skin are not uncommon activities for someone with OCD. In addition, people who suffer with contamination OCD often spend hours cleaning their homes, frequently cleaning and recleaning the same area of the house over and over. Similarly people who suffer with the checking types of OCD spend hours checking doors, windows, stoves, and even drive back and forth over the same part of a road to make sure they haven’t run over something.
Symptoms of OCD are seen in people with very low weight but also in people who have recovered from their starvation eating disorder and are completely weight restored. OCD is also seen more often in people with starvation eating disorders than in people with other types of eating disorders, indicating a relationship between OCD and starvation eating disorders (Godart et al. 2006).

Even though the obsessive and compulsive personality traits common in people with starvation eating disorders are not the same as symptoms of OCD, the combination of these personality traits and low weight can make it look like someone has true OCD. Further, obsessive or compulsive personality traits (like harm avoidance) may make someone more susceptible to developing OCD. For these reasons, it is very hard to know if someone who is starving has OCD in addition to a starvation eating disorder, so if you have symptoms of OCD, you will probably have to wait until you gain weight to determine if you really have true OCD.


The defining feature of panic disorder is fear of anxiety, specifically, fear of the strong physical manifestation of anxiety, called a panic attack. Panic attacks are characterized by symptoms like racing or pounding heart, difficulty breathing, and feeling dizzy. People with panic disorder become so concerned that they might have a panic attack that they start avoiding any situation that might trigger panic. This avoidance can result in being afraid even to leave the house. Panic disorder is seen in people with starvation eating disorders and also in people with bulimia. Interestingly, the risk for panic disorder is not increased for people who have a binge-eating disorder (Godart et al. 2006).


Social phobia involves feeling so embarrassed in social situations that the social phobic person avoids all or most social situations. This avoidance causes an isolation that can result in significant impairment.
Like OCD, social phobia is associated with starvation eating disorders and is seen less often in people with other types of eating disorders. Like OCD and panic disorder, social phobia can persist after weight gain (Godart et al. 2006).


Because the symptoms of OCD, panic disorder, and social phobia can be associated with low weight, it can be hard to determine if you have an anxiety disorder separate from your starvation eating disorder.
The bottom line is this: as with depression, you have to gain weight before it can be determined if you have an anxiety disorder. If the symptoms persist after you have gained weight, you may need treatment for one of these anxiety disorders. As with treatment for depression, weight gain should come first.


Starvation eating disorders are powered by anxiety. Understanding what being thin means for you can help you understand your core anxiety. Core anxiety is the innermost layer of anxiety. Core anxiety can be so powerful that it leads to obsessive thinking. Obsessive thinking leads to compulsive behaviors, which are an attempt to escape the anxiety. The obsessions with weight and shape take over, and compulsive starvation eating disorder behaviors (like overexercising) consume large amounts of time. In this way, time that might have been spent with family or friends or doing other important things is spent maintaining the starvation eating disorder.
You should now have a basic understanding of starvation eating disorders and be ready to move to stage II. The chapters in stage II will prepare you for weight restoration by giving you the opportunity to strengthen your commitment, pull together a support team to help you get well, and explore what is involved in successful treatment by looking at treatment components.

Author's Bio: 

DOREEN A. SAMELSON, ED.D., MSCP, is a licensed clinical psychologist and eating disorder specialist. She practices at Kaiser Health Care Department of Psychiatry in Tracy, CA, where at least half of her clinical work consists of treating patients with anorexia. She presents continuing education workshops several times a year on the topic of eating disorders, and recently presented a four-hour training on the treatment of anorexia at the California Psychological Association annual conference.