When you have an eating disorder such as anorexia, bulimia, or binge-eating disorder, it’s not unusual for you to also have another mental health issue. These problems can include (but aren’t limited to) depression, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.

In fact, studies show that about two-thirds of people with eating disorders also suffer from an anxiety disorder. Of these, the most common is obsessive-compulsive disorder or OCD. In fact, some studies have shown that in women with anorexia nervosa, the rate of OCD is between 25% and 69%, and for women with bulimia nervosa, it’s between 25% and 36%.

Those who have both disorders often develop compulsive rituals connected to food, such as weighing every bit of food or cutting it into tiny pieces, using only certain silverware, cutting food symmetrically or even binge eating.

Other habits that can cause a great deal of harm are fasting or severely restricting calories, exercising for hours on end each day, and taking other actions that will prevent weight gain. Even though people who suffer from these disorders are typically underweight, they often still have an irrational fear of becoming fat.

People who have anxiety that leads to an eating disorder often end up in this situation because they feel as though they are able to control this aspect of their life. Rather than seeking help for eating disorders, taking control of food, weight, and exercise gives those with the disorder a false sense of control, which can help to temporarily relieve symptoms related to anxiety.

Disorders such as binge eating can temporarily reduce anxiety and increase positive emotions due to increases in serotonin and dopamine, therefore minimizing one’s awareness of the need for binge eating treatment and behavioral therapy. Anxiety levels tend to be very high just before a binge and decrease during a binge. Often, anxiety and depression return after the binge accompanied by guilt. Those suffering from a binge eating disorder may find that their anxiety often worsens after a binge, which can add fuel to the vicious cycle of the disorder.

Although these disorders are much more common among women and girls, men and boys make up about 5 to 15%of those with anorexia or bulimia and about 35% of those with a binge eating disorder. Learning to incorporate healthy eating habits with behavioral therapy is one of the best ways to avoid developing a binge eating disorder.

For those who have an eating disorder and a co-occurring anxiety disorder this may make their symptoms worse and recovery more difficult. Anxiety and eating disorders may be treated at the same time and in the same manner. Even so, recovery from one disorder does not ensure recovery from another, so it is necessary to seek help for both.