Anxiety, Temperament, and Eating Disorders

Well. I finally got the time to read this great NY Times Article, Understanding the Anxious Mind. It’s long, but totally worth a read – thanks to edbites and Laura Collins for bringing this article to my attention!

What I really appreciate about this article is the way that it complicates both the biological model and the behavioral/environmental model of anxiety and brings them into dialogue with each other. It’s a desperately needed approach! The article demonstrates that biology/temperament may very well predispose a person to anxiety, but this biology is not destiny and these things are also difficult to quantify in a lab setting that is “artificial.” That’s a *very* rough and reductive summary of the nine page article, so I’d suggest you read it! 🙂

Anyway, some lingering questions that I have:

– The article clearly shows that while we may be able to see clearly neurological, structural, and tempermental paredispositions in people with anxiety, it also shows that many learn to manage this anxiety. For many, though anxiety might be present, it does not negatively impact their daily lives as they mature. So, one may have the biological predisposition, but she/he may not outwardly display anxiety, and she/he may not even necessarily feel heightened anxiety. I wonder, does this work the other way around? Can someone *without* the biological and tempermental predictors for anxiety learn anxiety – from their environment, caretakers, mentors, experiences, etc.? Can anxiety develop via experience/environment, without the biological predisposition?

– What are the implications for this as far as child psychology, parenting, family, etc.? The article shows that the jury is still out in regard to what are the most effective ways to nurture a child with anxiety so that the anxiety becomes manageable (I was a bit miffed at how quickly they feel into the individualist mindset with this). But, I assume that more theories and studies about this will follow. So, if a child shows these predisposition to anxiety, do parents have a responsibility to “deal” with it? Do doctors? Psychologists? How do we stress the important role of parents/caretakers/families in helping anxious children, without playing the blame game? (i.e. “Your child has specific needs that can be best met in this way.” v. “You didn’t raise your child ‘correctly’ so now she/he is an anxious adult!”) Obviously, though, a lot more work needs to be done on the behavioral/environmental side of this before they can draw any conclusions about what is helpful/necessary.

– How does this research impact eating disorders specifically? Research as shown that – at the very least in anorexia nervosa, which tends to be the most researched e.d. (though it’s the least prevalent statistically) – there are certain biological/genetic markers that may predispose someone to develop AN. So, my first question works for e.d.’s as well. Not *everyone* who holds these genetic/biological markers develops full-blown AN. So, there must be other factors involved. If someone can have biological markers, but not develop the full-blown disorder, can this too work the other way around?  Can someone develop the disorder without the biological predispositions? How? Why?

– How does an e.d. exacerbate anxiety? It is clear that when an e.d. is active, many other psychological implications follow – depression and anxiety, for example. This happens for a number of reasons having do to w/ (mal)nutrition & the effects on the brain, added stress in social situations, an increasingly rigid need for routine and order, etc., etc. How do clinicians and treatment providers acknowledge the anxiety and depression without falling into the trap of assuming it underlies the e.d.? For example, for some patients, the e.d. may be a way to cope with anxiety and depression that are already (and perhaps biologically) present, yet for others, the anxiety and depression are a symptom of the e.d. (and perhaps they do not have the biology for it). I have seen, more than once, people medically treated for anxiety and/or depression because it is assumed to be a chemical imbalance, yet in the long run, the medication has proven unnecessary b/c the anxiety and/or depression was a symptom of the e.d. and “cleared up” as the e.d. was treated. Yet, for others, an inherent biological predisposition to anxiety and/or depression may mean that medication is the most effective treatment. How can treatment providers best navigate this delicate balance?

– Are there temperamental signifiers that we should be looking at for people with eating disorders? Certainly many “personality traits” have been outlined for people w/ anorexia  and a bit for people with other e.d.’s (though, again, I wish there were more research for the other eating disorders!). For example, we often hear of people with AN as being ambitious/driven, type A, perfectionist, obsessive, etc., etc. Using myself as an example, I have always been on the “stoic” side of normal. Even as a baby, according to my parents, I was not as expressive as some (I did not laugh or cry as easily as many babies). I remember very clearly that as a young child (we’re talking preschool age) I expected myself to individually manage my emotions and keep them internal, so as to avoid burdening or worrying people. I was often asked if I was “sad” as a child, but I wasn’t sad. I was just stoic! I have no doubt that this internalizing of emotions and perhaps this inherent “stoic” temperament was influential in my development of an e.d. If we do find temperamental markers for the array of eating disorders, again, what implicaitons does this have for parents, caretakers, (mental) health care workers, etc.? If we find temperamental markers, can potential e.d. behaviors be rerouted before they start? Can a certain kind of environment based on tempermanet cut e.d.’s off at the pass, so to speak?

– The article stated that anxious people with high intelligence tended to be better at managing their anxiety. If there’s one thing we often hear about eating disordered people, it is that we are “highly intelligent.” I can’t even count the number of times I’ve heard something to the effect of, “But you’re so smart! How could you do this?!” Given that many people with eating disorders ARE highly intelligent AND highly anxious, what is the disconnect here? Why are these two characteristics so disproportionatly and concurrently present in people with eating disorders when intelligence seems to beneficially mediate anxiety in the more general population?

As always, the more “empirical” research there is, the more questions I have! And wow. This was much longer than I anticipated!