Q & A: Anxiety and Vulnerability to Anorexia Nervosa

Q: I know that childhood anxiety disorders predispose young girls to anorexia nervosa (AN). But, is anything more specific known about how this vulnerability works? (B.F., Montgomery, AL)

A: The association between childhood anxiety disorders and subsequent AN has been well described, but recent research may shed a bit more light on this association. In a study of 637 women with AN participating in a large multi-site genetics study, 39% reported histories of overanxious disorder of childhood, most commonly those with purging or binge-purging subtypes of AN. Those with childhood overanxious anxiety disorders had more extreme personality traits than did the others. One potential mechanism that might account for this association, suggested by Michael Strober, is that greater childhood anxiety may result in a heightened sensitivity to fear conditioning with resistance to extinction. Patients experiencing this heightened anxiety may be more likely to turn to purging for immediate relief of their extreme emotional distress (Int J Eat Disord 2008; 41:326ff). Although this hypothesis is consistent with clinical observations, proving whether it’s true or not will require much more additional research.

— J.Y.