Anxiety attacks and an eating disorder

Panic attacks and anxiety attacks are common during eating disorder recovery. A panic attack is described as more “bottom up” behavior, meaning it arrives suddenly and apparently without forethought, coming up through the body to the mind. An anxiety attack is a “top down” behavior,” meaning it typically arrives following a period of mental rumination and perseveration. 

Either way, they tend to have similar symptoms, all of which are associated with the nervous system’s response to fear: fight, flight, or freeze.

Symptoms of anxiety attacks

1. Chest pain: Your child may feel chest pain, heart palpitations, and an accelerated heart rate. Some people describe it as pressure on their chest, fluttering in their chest, stabbing pain in their chest, etc.

2. Sweating, trembling & shaking: Your child may sweat, tremble and shake during an anxiety attack. This may or may not be visible.

3. Nausea: Your child may feel nauseated as their blood rushes out of their digestive system to their limbs in preparation for running away or defending themselves against a predator.

4. A sense of choking, shortness of breath & smothering: Your child may feel their airways are constricted, which can increase anxiety because a lack of air is a panic-inducing experience. 

5. Dizziness and Fainting: Your child’s senses may become overwhelmed with fear, which can overwhelm their sense of balance and even lead to a complete freeze or shut down. 

6. Fear of dying: Your child’s symptoms will most likely feel like death is imminent, which adds to the panic. They may demand that you call 911. 

7. Racing thoughts: Your child’s mind will be trying to solve the situation by throwing up thousands of thoughts, which adds to the feeling of overwhelm.

What anxiety attacks feel like in eating disorder recovery

The experience of having an anxiety attack is extremely terrifying. Never hesitate to take your child to the ER or call 911 if you believe your child may be in danger. Paramedics and ER doctors see anxiety attacks regularly, and will be able to identify whether there is something life-threatening going on vs. anxiety symptoms.

Unfortunately, some professionals are not very thoughtful when presenting the diagnosis of an anxiety attack, which can lead to shame and increased anxiety. A doctor’s diagnosis that “it’s just anxiety” can make your child feel as if they have wasted everyone’s time and are pathetic and needy. This, of course, just increases anxiety. Reassure your child that there’s no shame in having a panic attack. Lots of people have them. And tell them that now that you know the symptoms, you’ll be able to respond differently in the future. 

Panic attacks are common. At some point in our lifetimes, nearly 30 percent of us will be hit by a wave of anxiety so intense that it includes some combination of nausea, dizziness, numbness, tingling, a feeling of detachment from reality, chills, sweating, and, as already noted, fear that one is losing control or dying.”

Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls

What to know about anxiety attacks

Here are some more things parents should know about anxiety attack symptoms:

1. Timing: Panic attacks typically build in severity over the course of about 10 minutes or less. Those 10 minutes can be incredibly scary, but symptoms will subside gradually after they reach a peak.

2. Acknowledge how your child feels, and accept how bad it feels. It’s all right to say to your child that they may be having a panic attack. Say this in a calm, confident, accepting tone, and your child may find relief in having a name for their experience. Allow the anxiety symptoms to arise under your care and acceptance. Help your child name the symptoms, and write them down if that seems to help your child recognize that their feelings are real and valid. 

3. Don’t ask questions about why the anxiety is happening – many times your child doesn’t actually know the cause until long after the event, and sometimes it’s never quite clear. Asking questions tends to create more anxiety. When your child is in a state of panic they are not capable of that level of evaluation. Keep it simple and soothing.

4. Calm them, but not by saying “calm down.” Telling someone who is having a panic attack to calm down can make the symptoms worse. Your child wants to calm down, but they need to sense that it is safe to calm down first. Regulate your own nervous system, which is always communicating with your child’s nervous system. Breathe calmly, keep your posture relaxed, and keep your eyes soft and gentle. If this is hard for you, start practicing mindfulness, which will help you achieve this level of calm faster. 

5. Reassure them that you are here for them. During panic attacks, your child may feel deeply ashamed of bringing anyone around us “down” with them. They may experience feelings of worthlessness, helplessness, and hopelessness. And, importantly, they may feel a deep fear of abandonment. Let your child know that you are in no rush and they can take all the time they need to recover. Say things like “this is exactly where I want to be,” and “I am here for you as long as you need me” to help them understand your unconditional positive regard in the face of a debilitating anxiety attack.

6. Tools may help your child recover from an anxiety attack. For example, some people find aromatherapy, a cold compress, a heavy blanket, a glass of cold water, or meditative music helpful. Some people find it helpful to listen to guided meditation, classical music, or yoga nidra podcasts during an anxiety attack.

Once you know your child has anxiety attacks in eating disorder recovery, keep these tools on hand so you can pull them out as needed. For example, if smelling something helps, carry a small bottle of essential oils at all times. If listening to yoga nidra helps, then download a favorite podcast on both your own and your child’s phone. Be aware that these tools may work sometimes and not others. Try not to get frustrated or take it personally if a tool doesn’t work – just try something else, or just stay calm, attentive, and present for a while.

7. Medication may help your child recover faster, and may be the route recommended by their care team. If your child’s doctor has prescribed medication to reduce the symptoms of anxiety, then keep them available in various places around your home and other locations so that you have medication ready to go when necessary.

After an anxiety attack

Once the anxiety attack seems to be coming to completion, your child may need to take a nap or at least rest for a while. Anxiety attacks are physically and emotionally exhausting, so don’t rush off to do something right away. If you have plans or are supposed to be somewhere, try to delay your arrival by at least an hour to provide time for recovery. 

When your child appears to be fully recovered, set an appointment with a care provider to talk about the anxiety attack. Anxiety attacks can seriously impact your child’s eating disorder behaviors, so take every attack seriously and talk to your child’s treatment team so they know about it and can recommend a course of action.

Finally, check in with your child periodically about their anxiety levels. Keep in mind that emotions and eating disorders are linked, so more panic attacks may mean more triggers for eating disorders. Especially in the days following an anxiety attack, your child may have residual symptoms. Make it safe for your child to talk to you about their symptoms of anxiety in a nonjudgmental manner.

See Our Guide to Emotions And Eating Disorders

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