Those living with PCOS often struggle with eating disorders and eating disorder behaviours. As eating disorders can affect PCOS treatment it’s important to raise awareness of this link. In both research and clinical practice, the link between eating disorders and PCOS has been verified. Iif you find yourself struggling with both PCOS and a tough relationship with food: You are not alone.
This article will dive into this link and explore how living with PCOS can impact mental health. We will also bring clarity on what to do if you have PCOS and need support with your relationship with food.
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a very common condition that impacts, and is impacted by, hormones. It is a syndrome which means there isn’t one checklist of symptoms everyone will experience. This means that although the NHS reports 1 in 10 people experience PCOS some articles and researchers have even claimed 1 in 5 but with many undiagnosed.
Common PCOS symptoms include menstrual cycle and ovulation irregularities, unwanted hair growth, and insulin resistance. PCOS sufferers may also suffer with body image disturbances and find weight management difficult, developing a difficult relationship with food. Eating disorders and eating disorder behaviours are also prevalent in those with PCOS.
What are eating disorders and eating disorder behaviours?
An eating disorder is a clinical diagnosis based on the criteria outlined in the Diagnostic and Statistical Manual for Mental Health (DSM). Approximately 1.25 million people in the UK are reported to have an eating disorder, but due to a lack of diagnosis, this has been reported to actually be up to 3.4 million.
Eating disorder behaviours, also known as disordered eating, are much more common. Current statistics suggest that disordered eating rates are 30% to 75% in the UK. This is not to say that disordered eating is inherently “less severe” than an eating disorder. But that diagnosis and treatment of an eating disorder can take a long time.
Eating disorders and disordered eating are prevalent in our society for a number of reasons, including:
- Disordered eating behaviours are upheld and encouraged in our society. We often see thin or muscular bodies promoted as desirable. We may have experiences in our childhood that cultivate this including how our parents approach food, teasing about body weight, images in media, or comments about bodies.
- The stereotypes of what an eating disorder looks like and how it impacts people is very binary. This means many people experience an eating disorder before being formally diagnosed or believe they are not sick enough to receive support.
- Many medical conditions treatments – such as PCOS – are prescribed disordered eating behaviours to manage their symptoms. Weight loss is promoted as a quick and easy fix, to the point that someone may see it as their only option.
- We’re in a 24/7 society meaning we’re overworked with a focus on perfection and achievement while lacking in areas such as sleep, mindfulness, and general wellbeing.
Eating disorders and disordered eating are life-impacting conditions. But you are deserving of support. Especially support that also takes your PCOS into account. We will come back to what you can do if you’re struggling with your relationship with food towards the end of this article.
Does PCOS cause eating disorders?
Eating disorders may be more common in those living with PCOS. But we cannot say that any one thing causes eating disorders – they are down to genetic, social and environmental influences all coming together.
A blanket statement often made is that those with PCOS are living with Binge Eating Disorder (BED). While research does suggest this could be the case, in clinical experience with real-life people, PCOS can live with all eating disorders.
Some reasons PCOS and eating disorders may co-occur include:
- You may be trying to treat PCOS by cutting out foods. Restriction fuels a lot of disordered eating. We have a whole article on eating for PCOS which explains why cutting out foods, especially carbs might not be the answer.
- The effects of living with PCOS. Being diagnosed may make you extremely stressed and prone to binging. PCOS may also come with some fertility struggles that can affect you emotionally and your relationship with your body. You may also experience negative treatment by healthcare professionals which will have an effect.
- You may be experiencing insulin resistance – sometimes insulin resistance is associated with carb cravings which may cause binging, especially if you are trying to eat a particular diet.
Which eating disorders are common in PCOS?
PCOS and many eating disorders share common features such as body image disturbances and increased depression and anxiety risk. The research in this area is lacking. Unsurprising, as PCOS has only recently started being researched. Prevalence rates have been reported anywhere from 12 to 25%.
- Binge Eating Disorder (BED) – an eating disorder determined by binge eating, feeling guilt over binging, and feeling out of control with eating. Often binges occur during times of restriction, stress and for those with PCOS during a flare up of symptoms. Rates of BED in those with PCOS are unknown. However, there are similarities between impacts of BED and PCOS.
- Anorexia Nervosa (AN) – restricting energy intake, often coupled with an increased fear of gaining weight. This can be restricting AN or binge/purging type.
- Bulimia Nervosa (BN) – episodes of binging coupled with methods of compensation including exercise, laxatives, self-induced vomiting, or dieting.
- Orthorexia Nervosa (ON) – an obsessive focus on eating ‘healthy’. This often leads to self-imposed rules around food. If you live with PCOS, you may experience a worry of eating “PCOS non-compliant foods.”
As we mentioned above, Binge Eating Disorder is most linked to PCOS in research. The research interest comes from the similarities between the impact of binge eating and unmanaged PCOS. Including insulin resistance, type 2 diabetes, high cholesterol, and hypertension.
Why PCOS treatment can worsen binge eating
Many are told to lose weight, or to never gain weight, when they’re diagnosed with PCOS. They are made to feel like it’s the only way to keep their PCOS in check.
For most people, this leads to a binge/restrict cycle. This is when restriction leads to binge eating;, causing shame and guilt. You then become determined to double down and be tighter than ever with your diet, and restriction starts again.
Research suggests that intentionally trying to lose weight is a big predictor of a future eating disorder.
Does PCOS affect mental health?
PCOS has been linked with anxiety, depression, low self-esteem, and negative body image. But it’s very much a chicken or egg situation. Some people with PCOS may have already experienced mental health challenges but being diagnosed with a lifelong medical condition will take its toll. Especially if you’re not supported enough with PCOS management.
PCOS sufferers are three times more likely than those without, to experience depression and anxiety. This is just where the research has been focused; there’s upcoming research looking at the link between PCOS and OCD and bipolar disorder.
How can PCOS affect mental health?
Anxiety around PCOS symptoms, such as possible infertility, excess body hair, and the long-term impacts of PCOS.
Irregular periods may affect mood. Many people comment on feeling significant changes in their mood with their cycle.
If you are being treated with medication it may be affecting your mental health.
Why is there such a strong link between PCOS and eating disorders?
In terms of the science, we don’t 100% know as PCOS is an area of emerging research. But from anecdotes and lived experiences we know that being diagnosed with PCOS is in itself a hard pill to swallow and may affect your mental health. This is then coupled with health practitioners advising you to lose weight to treat your condition.
Eating disorders are often a form of control. Controlling what you eat, how much and when, as well as restoring control post-binge eating. Receiving a diagnosis of PCOS can make you feel out of control in your body, and with your life which an eating disorder might make you feel you can solve.
What should you do if you have PCOS and think you have an eating disorder?
Remind yourself that you’re not alone. People with PCOS are at a higher risk of eating disorders and disordered eating.
Find a professional who works in the field of eating disorders. They will be best suited to help you, and check if they work with PCOS clients.
If private support isn’t accessible, speak with your GP about referral to NHS counselling services and/or an eating disorders clinic.
Talk to a loved one who can help support you. If you don’t have someone that comes to mind, try and find a support group that can best help you.
Focus on other ways to help improve your health that aren’t weight based, this may aid with your PCOS and act as a distraction from your eating disorder.
Healing your relationship to food while managing your PCOS can be a tricky balance. That’s why we recommend 1:1 support with a professional who can help you. As a general guide, we recommend focusing on eating regularly, stress management, and offering yourself compassion.
