Elizabeth, Mireia, Lisette, Chelsey, and many others believe there is a link between their hormones and eating disorders. With the chemical changes throughout the menstrual cycle and the weight gain that often accompanies puberty and other hormone-related conditions, there’s a lot to unpack when it comes to body image, disordered eating, eating disorders, and hormones. Keep reading to hear their stories of how their experiences with puberty, PMS, hypothyroidism, PCOS, endometriosis, and diabetes interact with eating disorders.
Do hormones affect eating disorders?
Eating disorders are both more common in females and often begin around puberty. Because of this, researchers suggest that hormones may be one of the biological causes of eating disorders. According to one study, “Given the abundance of research suggesting that reproductive hormones play a critical part in normal eating behaviors and food intake, it is reasonable to postulate that these hormones also have a functional role in the dysregulated eating behaviors associated with eating disorders, with estrogens being the most promising candidate.”
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Menstruation has a clear effect on women’s mental health. Psychiatric hospitalizations, suicidal behaviors, and depressed mood are more frequent during the premenstrual phase. Studies have shown that binge eating frequency and purging behaviors are significantly increased during the premenstrual phase compared with other phases of the menstrual cycle. One report showed a 60% increase in binge-eating frequency in the premenstrual phase. Meanwhile, body dissatisfaction and drive for thinness are highest during the premenstrual phase compared to other phases.
Since eating disorder symptoms are linked to menstrual phases, treatment should address female biology and the impacts of menstruation on mood and eating behaviors. For example, therapists can teach people cognitive techniques for responding to their increased chance of experiencing negative body image, “eating disorder thoughts” and eating disorder urges during the premenstrual phase. Unfortunately, hormonal fluctuations are rarely if ever a factor in eating disorder treatment.
How do hormones affect body image and disordered eating?
Beyond the biological fluctuations of menstruation, another trigger for eating disorders is the degree to which bodies change during puberty. Findings suggest that early puberty is associated with disordered eating and anxiety. Part of that may be due to the hormones themselves, but puberty also changes the way many girls look and therefore are treated by others.
Dramatic changes in appearance and the way people look at and respond to you can have a huge impact on a girl’s identity and sense of self, both of which are involved in eating disorder symptomatology. But it’s not just girls. Both males and females who undergo early puberty have higher rates of disordered eating. This suggests that there are both biological and psychosocial causes of eating disorders associated with puberty.
The research into the intersection of hormones and eating disorders is still in its early stages. However, there are many people with lived experience of their hormones influencing their eating disorder behaviors. Here are a few of their stories:
Elizabeth’s story of periods, anxiety, and eating
Elizabeth is 34 and actively in recovery from her eating disorder, which involves food restriction and food aversions. She has noticed a direct connection between her anxiety and her period. And since anxiety is a major factor in her eating disorder behaviors, identifying its source is essential to recovery. “When my anxiety gets worse, I have a harder time eating in general and a harder time with new or different foods or different textures.”
“I just recently noticed my anxiety gets worse right before I get my period, which directly affects my eating disorder,” says Elizabeth. “When I’m anxious, my OCD kicks in, I have a harder time working through things, and I have more issues with food. Now I’m able to realize where I am in my cycle and I can notice the voice of the eating disorder or the extra anxiety voice and know okay, well, it’s that time of the month. This is not just out of the blue, and it won’t last forever.”
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It’s been a relief for Elizabeth to track her period to her anxiety and eating disorder symptoms. “Right before my period, it shoots right up. I get super anxious and super hungry, but I also have more food aversions and more trouble eating. At first I asked myself ‘why is this happening? This is so annoying.’ And then I was like, ‘wait a minute, it’s the same time every month.”
“I was diagnosed last July with other specified feeding and eating disorders (OSFED), but I’ve been struggling since I was about 16, and I’m 34 now, so it’s been a long time,” says Elizabeth. “There are ARFID components to what I’m dealing with and a bit of anorexia as well.
Making the period-anxiety-eating disorder breakthrough is a milestone in Elizabeth’s recovery. “In the last month or so I’ve actually started feeling hopeful about the future,” she says. “Everything had always felt so out of my control and so uncomfortable that I never realized it all was so connected. I feel like now I’m in a different place with my thoughts, about my eating disorder.”
“Now I’m kind of like, all right, well, at least I know maybe the week before or even two to three days before my period the thoughts are going to most likely show up,” says Elizabeth. “I don’t have eating disorder thoughts every day now. So if it kicks in, I can say ‘oh, okay, no, get out of here, not now.’ And it’s easier to say knowing this is directly related to my period, and these are thoughts I do not want to engage in. I don’t have to listen to them.”
Mireia’s story of puberty, hypothyroidism, diabetes, and disordered eating
Mireia has struggled with disordered eating and body image issues since she was 12 years old. “I believe my body image issues started with puberty because it was a period of rapid changes. My period started and I started growing body hair well before my peers at age 11. I hated changing in front of girls my age, I was so ashamed of my body because it was different from theirs.” To this day, she says “My period always makes me hate my body, I perceive it bigger than it is when I’m on my period.”
“At 15 I started my first official intentional weight loss diet because I had a bigger body than my peers and it was pointed out to me by my pediatrician and family members and basically everyone in school, even teachers,” says Mireia. “I wanted to fit in and those changes in my body weren’t accepted by society. I felt rejected.”
Hormone-related conditions
Mireia has hypothyroidism, which is a hormonal condition associated with weight gain. When she was 21 years old she was diagnosed with Type 2 Diabetes, another hormone-related condition. “It triggered a lot of body image issues because again I thought it was my fault for eating badly,” she says. “The year prior to being diagnosed with diabetes I was eating a lot and I even told my therapist I was concerned I had binge eating disorder/bulimia but she gaslighted me and told me to eat healthy and exercise more. Later I learned that insatiable hunger is a symptom of uncontrolled diabetes.” Mireia’s hunger was a symptom of diabetes, not a personal weakness. Her therapist’s weight stigma led to delayed medical diagnosis and a missed opportunity to address her eating behaviors.
Mireia is now 26 years old and recently gave birth. Pregnancy with diabetes is more challenging, but she is grateful that her body was able to grow a baby. “I’m fat, but I try to remain at least neutral about it. I got so much better in the past months, pregnancy helped me realize I need to eat for nutrition and not to lose weight.”
Lisette’s story of PCOS, hormones, and body image
Lisette is 49 and is in her seventh year of eating disorder recovery. She traces her eating disorder back to when she was 17 years old and diagnosed with PCOS. She was prescribed two hormones and her body rapidly changed in response.
“My body changed a lot in about 3-6 months because it went through puberty very suddenly,” Lisette says. “It was alarming to me. It was scary. And that’s really when all of my disordered eating started. Looking back, I realize my body changing was normal and natural. But at the time, that’s really when I started messing around with eating disorder behaviors, and it just got worse as I got older. Maybe if I had understood that it was supposed to change my body and that these things were necessary in order to menstruate, it would have been different. But I got very strong messages that thin was good and dieting was what women did and all of the things most of us were exposed to.”
Lisette got positive feedback as her body changed, but she could not line up her new body with the identity she’d held for seventeen years of her life. “My mom said, ‘you look so beautiful,’ but in my head, it was way bigger than it had ever been. I was used to being smaller and all of a sudden, I wasn’t. I remember being at a pool party and comparing my body to my friends and really realizing that it had changed. My brain was thinking, ‘this change is not okay.”
Vivid memories
“I have this vivid memory of trying on clothes and there was some size that I always was and all of a sudden, none of it fit,” says Lisette. “And I had to go get bigger sizes and I remember looking at myself and thinking this is not okay.”
Lisette went into eating disorder treatment twice before getting married and having three kids. “I gained up to the target that they gave me and would not do certain behaviors. And in my mind, that was recovery, but I was not where my body wanted to be; I was still restricted.”
Lisette entered what she calls true recovery after her youngest son was one year old. “Throughout my pregnancies, I was working on it but I wasn’t free all the way,” she says. “But then I learned about Health At Every Size® (HAES®) and learned about how this is a social justice issue. I learned that some of the treatment I had received was harmful. And I did what I consider true recovery. My body changed and found its set point in a size much larger than any target weight they ever gave me in treatment.”
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Chelsey’s story of puberty, endometriosis, and an eating disorder
Chelsey developed an eating disorder at age 14. She’s now 31 years old and has been working on recovery for three years. “When I first got my period, at 13 years old, I immediately struggled with severe pain,” says Chelsey. “I was told that I needed to lose weight, change my eating habits, or work out more. They even said that I probably have a low pain tolerance and just simply cannot handle the pain of menstrual cramps. I quickly became unhappy with my body for having pain. It felt like it was my fault. I would often become depressed, anxious, and irritable before my period and noticed increased fear and unhappiness with my body.”
After almost ten years of trying to get doctors to listen to her, Chelsey was finally diagnosed with endometriosis at age 22. It wasn’t easy. “The doctor that ended up diagnosing me did NOT believe me but I advocated for myself, demanded a laparoscopic surgery, and he then apologized for not listening to me,” she says.
Hormonal fluctuations
“Hormonal fluctuations have continued to contribute to my disordered eating,” says Chelsey. “I notice that I experience significant depression when I am PMSing, and it is all centered around how I feel about my body. Sometimes I’ll be feeling so low that I don’t want to get dressed, socialize or be intimate with my husband. I cry every day, thinking about how terrible my body is and questioning how my husband can be attracted to me. I experience deep, deep sadness and feel as though I will not escape it. Then, after having my period, I feel the opposite: content, proud of what my body has done, not afraid to eat certain things, and confident. It’s a struggle because it’s very up and down for me.”
“I think people need to realize that hormones and eating disorders go hand-in-hand,” says Chelsey. “For me, hormonal fluctuations heighten anxiety, depression, and OCD which then plays a huge role in your thoughts and emotions around negative body image, disordered eating, and/or over-exercise. I know that for me when my anxiety and depression are heightened, I obsess around “needing” to work out over what I ate, I pull and tug at my clothes, I am physically uncomfortable with how my body looks and feels, and the negative self-talk spirals.”
Ginny Jones is on a mission to empower parents to help their kids recover from eating disorders, body image issues, and other mental health conditions. She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents who have kids with mental health issues.
Ginny has been researching and writing about eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.