Cited by 207Eating Disorders and BehaviorsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNutrition, Health and Food Behavior

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Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study

Godart, Nathalie T., Flament, Martine F., Curt, Florence, Perdereau, Fabienne, Lang, François, Venisse, Jean Luc, Halfon, Olivier, Bizouard, Paul, Loas, Gwenolé, Corcos, Maurice, Jeammet, Philippe, Fermanian, Jacques·2003·Psychiatry Research

DOI 10.1016/s0165-1781(03)00038-6

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Abstract

Women who were referred with an eating disorder (ED) were compared with a matched normal control group to answer the following questions: What are the frequencies of anxiety disorders in cases of anorexia and bulimia nervosa diagnosed according to DSM-IV criteria? Are anxiety disorders significantly more frequent among women with an eating disorder than among women from the community? We assessed the frequencies of six specific anxiety disorders among 271 women with a current diagnosis of anorexia or bulimia nervosa and 271 controls, using the Mini-International Neuropsychiatric Interview, French DSM-IV version. A lifetime comorbidity with at least one anxiety disorder was found in 71% of both the anorexic and the bulimic subjects, significantly higher than the percentage of controls with an anxiety disorder. The prevalence was significantly higher in the eating disorder groups than in controls for most types of anxiety disorder, and between 41.8 and 53.3% of comorbid cases had an anxiety disorder preceding the onset of the eating disorder. Anxiety disorders are significantly more frequent in subjects with eating disorders than in volunteers from the community, a finding that has important etiological and therapeutic implications.

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“A high comorbidity between AN and anxiety was previously established (Dellava et al., 2011; Godart et al., 2003; Raney et al., 2008; Thornton et al., 2011); it has been estimated that two-thirds of women with AN, BN, or both also suffer from an anxiety disorder (Kaye et al.”
Background
Social phobia in obsessive-compulsive disorder: Prevalence and correlates
Assunção, M. C., Costa, D. L. D. C., de Mathis, M. A., Shavitt, R. G., Ferrão, Y. A., do Rosário, M. C., Miguel, E. C., & Torres, A. R. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.05.044 · Cited by 34
The longitudinal relationship between worry and disordered eating: Is worry a precursor or consequence of disordered eating?
Sala, M., & Levinson, C. A. (2016) · Eating Behaviors · doi:10.1016/j.eatbeh.2016.07.012 · Cited by 32
Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking
Ranta, K., Väänänen, J., Fröjd, S. A., Isomaa, R., Kaltiala‐Heino, R., & MARTTUNEN, M. J. (2017) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2017.1366548 · Cited by 32
“or even a causal factor in the development of BN suggested by several earlier studies [6,14,15], and, on the other hand, the corresponding role of depression in increasing the risk for ED development—also observed in prior research”
BackgroundResultInfluential
Anxiety as a Mediator Between Perfectionism and Eating Disorders
Egan, S. J., Watson, H. J., Kane, R. T., McEvoy, P. M., Fursland, A., & Nathan, P. R. (2013) · Cognitive Therapy and Research · doi:10.1007/s10608-012-9516-x · Cited by 39
“The cross sectional design cannot answer this question however research has found that between 50 and 69 % of eating disorder samples report the onset of their anxiety disorder prior to the eating disorder (Godart et al. 2003; Swinbourne et al. 2012).”
BackgroundInfluential
Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders
Lapidus, R. C., Puhl, M., Kuplicki, R., Stewart, J. L., Paulus, M. P., Rhudy, J. L., Feinstein, J. S., Khalsa, S. S., & on behalf of the Tulsa 1000 Investigators (2020) · PLoS ONE · doi:10.1371/journal.pone.0235346 · Cited by 32
“Therefore, in the current study we planned on the inclusion of a MA control group (as recommended previously [30]), using a standardized set of interoceptive and nociceptive stimulation protocols.”
The impact of ongoing westernization on eating disorders and body image dissatisfaction in a sample of undergraduate Saudi women
AlShebali, M., AlHadi, A. N., & Waller, G. (2020) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-020-01028-w · Cited by 31
Exposure-Based Family Therapy (FBT-E): An Open Case Series of a New Treatment for Anorexia Nervosa
Hildebrandt, T., Bacow, T. L., Greif, R., & Flores, A. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2013.10.006 · Cited by 29
“AN is highly comorbid with anxiety disorders (Godart et al., 2003), and these disorders overlap in clinical phenomena such as perfectionism, rigidity, compulsivity, and harm avoidance (Collier & Treasure, 2004; Kaye, Bulik, Thornton, Barbarich, & Masters, 2004; Strober, 2004), which may reflect a…”
Background
Anxiety and Social-Emotional Processing in Eating Disorders: Examination of Family Trios
Goddard, E., & Treasure, J. L. (2013) · Cognitive Therapy and Research · doi:10.1007/s10608-013-9535-2 · Cited by 28
“These data support previous findings that social anxiety is associated with EDs (Godart et al. 2003; Hinrichsen et al. 2003).”
BackgroundResult
Memory Versus Perception of Body Size in Patients with Anorexia Nervosa and Healthy Controls
Øverås, M., Kapstad, H., Brunborg, C., Landrø, N. I., & Lask, B. D. (2014) · European Eating Disorders Review · doi:10.1002/erv.2276 · Cited by 27
“Anxiety is 109s Association. often reported to precede the onset of AN and persist after recovery (Godart et al., 2003; Huges, 2012).”
Nasogastric Tube Feeding for Individuals With Anorexia Nervosa
Kells, M. R., & Kelly‐Weeder, S. (2016) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390316657872 · Cited by 27
“In considering the high rates of comorbid anxiety and depression in this population (Godart et al., 2003), and the negative effects these diagnoses have on intake at meals (Klein et al.”
BackgroundInfluential
Comorbidity of Anxiety With Eating Disorders and OCD
Godart, N. T., Berthoz, S., Perdereau, F., & Jeammet, P. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.2.326 · Cited by 26
[Anxiety in eating disorders: a comparative study].
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Psychiatric comorbidity in eating disorders: a comparison of men and women
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Interspecies genetics of eating disorder traits
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“Several studies have shown that anxiety disorders are pre-morbid to the development of an eating disorder [Schwalberg et al., 1992; Brewerton, 1995; Deep et al., 1995; Bulik, 2002; Godart, 2003], indicating that studies unveiling mechanisms underlying anxiety disorders may provide further insight into susceptibility f…”
Background
The neurobiology of eating disorders—a clinical perspective
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Comparison of 35% carbon dioxide reactivity between panic disorder and eating disorder
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Presence of eating disorder symptoms in patients with obsessive-compulsive disorder
Bang, L., Kristensen, U. B., Wisting, L., Stedal, K., Garte, M., Minde, Å., & Rø, Ø. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-2457-0 · Cited by 22
The Contribution of BMI, Body Image Inflexibility, and Generalized Anxiety to Symptoms of Eating Disorders and Exercise Dependence in Exercisers
Zou, L., Yang, P., Herold, F., Liu, W., Szabó, A., Taylor, A., Sun, J., & Ji, L. (2022) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2022.024862 · Cited by 23
“Some studies indicated that anxiety disorders can precede the onset of ED [43,44].”
Background
The Relationship between Binge Drinking and Binge Eating in Adolescence and Youth: A Systematic Review and Meta-Analysis
Sampedro‐Piquero, P., Zancada-Menéndez, C., Brotóns, E. B., & Moreno‐Fernández, R. D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010232 · Cited by 22
Perceived need for treatment associated with orthorexia nervosa symptoms
Walker-Swanton, F. E., Hay, P., & Conti, J. (2020) · Eating Behaviors · doi:10.1016/j.eatbeh.2020.101415 · Cited by 21
Troubles du comportement alimentaire chez l'adulte
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The prospective relationship between anxiety symptoms and eating disorder symptoms among adolescents: a systematic review and meta-analysis of a bi-directional relationship
Trompeter, N., Dârvariu, Ş., Brieva‐Toloza, A. V., Opitz, M., Rabelo‐da‐Ponte, F. D., Sharpe, H., Desrivières, S., Schmidt, U. H., & Micali, N. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02601-9 · Cited by 24
“Most research to date has explored whether anxiety disorders predict the future onset of eating disorders [9–11], based on converging evidence within clinical samples that anxiety disorders tend to occur before eating disorder onset [4, 12].”
Men have eating disorders too: an analysis of online narratives posted by men with eating disorders on YouTube
Malova, E., & Dunleavy, V. O. (2021) · Eating Disorders · doi:10.1080/10640266.2021.1930338 · Cited by 24
“Overall, research shows that social appearance anxiety is much more common in people with ED than in healthy individuals (Godart et al., 2003; Koskina et al., 2011).”
Background
Study of Obsessive Compulsive Beliefs: Relationship with Eating Disorders
Roncero, M., Perpiñá, C., & García‐Soriano, G. (2011) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465811000099 · Cited by 22
“These data are coherent with general findings about the relationship between ED and OCD, with AN being closer to OCD than BN (Blinder, Cumella and Sanathara, 2006; Godart et al., 2003, 2006; Thornton and Russell, 1997).”
Result
Obsessive-compulsivity and working memory are associated with differential prefrontal cortex and insula activation in adolescents with a recent diagnosis of an eating disorder
Brooks, S. J., Dahlberg, L. S., Swenne, I., Aronsson, M., Zarei, S., Lundberg, L., Jacobsson, J. A., Rask‐Andersen, M., Salonen‐Ros, H., Rosling, A., et al. (2014) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2014.10.001 · Cited by 19
“…(OCD) (OCD is considered an anxiety disorder according to the DSM-IV) or social phobia in people with a main diagnosis of AN has been reported to be between 23% and 75% (Halmi et al., 1991; Deep et al., 1995; Godart et al., 2002; Godart et al., 2003; Swinbourne and Touyz, 2007; Raney et al., 2008).”
Background
The Role of Depression and Anxiety in Impulsive and Obsessive-Compulsive Behaviors Among Anorexic and Bulimic Patients
Finzi‐Dottan, R., & Zubery, E. (2009) · Eating Disorders · doi:10.1080/10640260802714654 · Cited by 19
“Incongruities can be found in the literature as to whether impulsivity and obsessive-compulsiveness ( Engel et al, 2005 ; Fessler, 2002 ; McElroy, Phillips & Keck, 1994 ; Nagata et al, 2000a ), or depression ( Braun, Dunday & Halmi, 1994 ; Polivy & Herman, 2002 ; Troop, Serpell & Treasure, 2001 ) and anxiety ( Godart…”
Background
Family history of anxiety and mood disorders in anorexia nervosa: Review of the literature
Perdereau, F., Faucher, S., Wallier, J., Vibert, S., & Godart, N. T. (2008) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/bf03327779 · Cited by 19
Treating Eating: A Dynamical Systems Model of Eating Disorders
Troscianko, E. T., & Leon, M. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01801 · Cited by 17
“Similarly, when considering social anxiety disorder (SAD), some retrospective studies suggest that SAD often starts before an eating disorder (e.g., Bulik et al., 1997; Godart et al., 2003; Swinbourne and Touyz, 2007), but neither of the prospective studies conducted on the question (Buckner et al.”
Background
Appearance concerns are uniquely associated with LPP amplitude to pictures of oneself
Jordan, C., Stewart, R. A., Brush, C. J., Cougle, J. R., & Hajcak, G. (2021) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsab115 · Cited by 18
“Previous work has shown that 36–42% of individuals with an eating disorder also have a co-occurring SAD diagnosis in their lifetime (Godart et al., 2003; Swinbourne et al., 2012).”
Background
Normative data for female adolescents with eating disorders on the Children's depression inventory
Watson, H. J., Egan, S. J., Limburg, K., & Hoiles, K. J. (2014) · International Journal of Eating Disorders · doi:10.1002/eat.22294 · Cited by 17
“The other study that examined the CDI in adolescents with EDs despite being a clinical sample referred for treatment was a relatively modest sample size (N 5 120).14 We aim to improve on these previous studies by examining a larger sample of adolescents with clinical EDs referred for specialist treatment of their ED.”
BackgroundInfluential
Psychiatric comorbidity including nicotine dependence among individuals with eating disorder criteria in an adult general population sample
John, U., Meyer, C., Rumpf, H., & Hapke, U. (2005) · Psychiatry Research · doi:10.1016/j.psychres.2005.07.011 · Cited by 17
Rational antidepressant selection: applying evidence-based medicine to complex real-world patients.
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Integrating “Lumpers” Versus “Splitters” Perspectives: Toward a Hierarchical Dimensional Taxonomy of Eating Disorders From Clinician Ratings
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“…EDs within Internalizing is consistent with research showing that approximately 80% of people with an ED have a co-occurring internalizing disorder (Godart et al., 2003; Hudson et al., 2007; Kaye et al., 2004; Keski-Rahkonen & Mustelin, 2016; Silberg & Bulik, 2005; Swinbourne et al., 2012);…”
Negative beliefs about the self prospectively predict eating disorder severity among undergraduate women
Williams, B. M., & Levinson, C. A. (2020) · Eating Behaviors · doi:10.1016/j.eatbeh.2020.101384 · Cited by 19
Is major depressive episode related to anxiety disorders in anorexics and bulimics?
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“We also showed in an earlier study that the prevalence of most of these disorders was significantly higher than that of a control group [27].”
BackgroundResult
Comorbidity Structure of Psychological Disorders in the Online e-PASS Data as Predictors of Psychosocial Adjustment Measures: Psychological Distress, Adequate Social Support, Self-Confidence, Quality of Life, and Suicidal Ideation
AL-Asadi, A. M., Klein, B., & Meyer, D. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3591 · Cited by 18
“The few studies that employed control groups found significant comorbidity between anxiety disorders and anorexia nervosa and bulimia nervosa populations in comparison to non-eating disordered controls [46,51-54].”
Animal Models of Eating Disorder Traits
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“Several studies have shown that anxiety disorders are premorbid to the development of an eating disorder (Schwalberg et al. 1992; Brewerton et al. 1995b; Deep et al. 1995; Bulik 2002; Godart et al. 2003; Brewerton et al. 1995a), indicating that studies unveiling mechanisms underlying anxiety disorders may provide insi…”
Background
Psychiatric Comorbidity Among Eating Disorders and Obsessive-Compulsive Disorder and Underlying Shared Mechanisms and Features: An Updated Review
Williams, B. M., Brown, M. L., Sandoval-Araujo, L. E., Russell, S., & Levinson, C. A. (2022) · Journal of Cognitive Psychotherapy · doi:10.1891/jcpsy-d-2021-0011 · Cited by 19
Oxytocin Receptor Polymorphism Decreases Midline Neural Activations to Social Stimuli in Anorexia Nervosa
Sala, M., Han, K., Acevedo, S. F., Krawczyk, D. C., & McAdams, C. J. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02183 · Cited by 15
Well-Being and Prejudice toward Obese People in Women at Risk to Develop Eating Disorders
Magallares, A. (2012) · The Spanish Journal of Psychology · doi:10.5209/rev_sjop.2012.v15.n3.39415 · Cited by 13
“In any case, to recognize the presence of low levels of well-being, as in the case of anxiety and depression, in non clinical settings in young women can help professionals to prevent the appearance of ED (Godart et al., 2003; Stice, Shaw, & Marti, 2007).”
Background

Authors: Godart, N. T., Flament, M. F., Curt, F., Perdereau, F., Lang, F., Venisse, J. L., Halfon, O., Bizouard, P., Loas, G., Corcos, M., Jeammet, P., & Fermanian, J.
Affiliations: Institute Mutualiste Montsouris (FR)
Centre National de la Recherche Scientifique (FR)
Centre Hospitalier Universitaire de Saint-Étienne (FR)
Hôpital Saint-Jacques (FR)
Centre Hospitalier Universitaire de Besançon (FR)
Centre Hospitalier Philippe Pinel (FR)
Hôpital Necker-Enfants Malades (FR)
Corresponding author: Godart, Nathalie T.
ORCID: Godart, Nathalie T.
Loas, Gwenolé
Corcos, Maurice
Fermanian, Jacques
Venue: Psychiatry Research
Publisher: Elsevier BV
Published: 2003-03
Volume: 117
Issue: 3
Pages: 245-258
ISSN: 0165-1781 (ISSN-L)
DOI: 10.1016/s0165-1781(03)00038-6
OpenAlex: W2129771883
Cited by: 207
References: 51
Citations by year: 2026: 1 · 2025: 5 · 2024: 8 · 2023: 8 · 2022: 8 · 2021: 12 · 2020: 13 · 2019: 2 · 2018: 8 · 2017: 9 · 2016: 10 · 2015: 18 · 2014: 14 · 2013: 17 · 2012: 13
FWCI: 5.71
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Psychiatry Research (publishedVersion)
PubMed (publishedVersion)
HAL (submittedVersion)
IRIS (submittedVersion)
SERVAL (Université de Lausanne) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords: anxiety disorders, eating disorders, anorexia nervosa, bulimia nervosa, comorbidities, prevalence, women, DSM-IV, Mini International Neuropsychiatric Interview, psychiatric comorbidity
MeSH terms: Adolescent, Adult, Anxiety Disorders, Feeding and Eating Disorders, Female, Humans, Patient Acceptance of Health Care, Severity of Illness Index, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders

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Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study

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