PCOS and eating disorders: what’s the link?

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. If 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, specifically surrounding eating disorders. We will also bring clarity on what to do if you have PCOS and need support with your relationship with food. Curious to know more? Keep reading!

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a 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. 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 from body image disturbances and struggle with their weight, developing a difficult relationship with food. Unfortunately, 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 societal expectations, eating disorder stereotypes, weight loss prescriptions and our busy lifestyles.

Societal expectations

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.

Eating disorder stereotypes

The stereotypes of what an eating disorder looks like and how it impacts people are very binary. This means many people experience an eating disorder before being formally diagnosed or believe they are not sick enough to receive support.

Weight loss prescriptions

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.

Busy lifestyles

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 – eating disorders are multifactorial. This means that they have many factors that influence their prevalence including genetic, social and environmental influences all coming together.

It is often thought that those with PCOS can only be diagnosed with Binge Eating Disorder (BED) as an eating disorder. While research does suggest that BED is the most common eating disorder affecting people with PCOS, people with PCOS can be affected by other eating disorders.

There are several reasons why PCOS and eating disorders may co-occur including restriction, the effect of living with PCOS and the link to insulin resistance.

Treating PCOS with restriction

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 effect 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 on your quality of life and mental wellbeing.

PCOS and insulin resistance

You may be experiencing insulin resistance as up to 80% of people with PCOS have insulin resistance, regardless of body weight or shape. Insulin resistance is associated with carb cravings which may cause binging, especially if you are trying to restrict.

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 that is 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 the impacts of BED and PCOS.

>> Read more | How to stop binge eating with PCOS

Anorexia Nervosa (AN)

An eating disorder characterised by 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 about eating “PCOS non-compliant foods.”

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 predictor of a future eating disorder.

Why is there such a strong link between PCOS and eating disorders?

In terms of the science, we don’t 100% know where there is such a strong link between PCOS and eating disorders, as PCOS is an area of emerging research. But from anecdotes and lived experiences, we know that being diagnosed with PCOS may affect your mental health.

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.

PCOS sufferers are three times more likely than those without, to experience depression and anxiety and have increased prevalence of 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.

What should you do if you have PCOS and think you have an eating disorder?

If you have PCOS and believe you have an eating disorder, first remind yourself that you’re not alone. Then, it is important to seek out medical and therapeutic help and support.

Seek professional help

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 a referral to NHS counselling services and/or an eating disorders clinic.

Help is available via Beat Eating Disorders in the UK or NEDA in the US.

Find personal support

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. We recommend the PCOS Health at Every Size Facebook group which you can access here.

Embrace non-diet ways to manage PCOS

Despite what you may have heard, PCOS does not need to be managed by losing weight. There are many non-diet approaches to PCOS management that you can take. We reocmmend trying Intuitive Eating once you’re recovered from an eating disorder.

Key takeaways: PCOS and eating disorders

People with PCOS do tend to have an increased likelihood of developing eating disorders because of a variety of factors. Remembering you’re not alone, seeking professional and personal support as well as embracing non-diet ways to manage your PCOS are essential.

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Shannon Western ANutr Author at The PCOS Collective

Guest Author | Registered Associate Nutritionist

Shannon is a Registered Associate Nutritionist and Nutrition Counsellor. She is the founder of Ease Nutrition Therapy - a nutrition counselling clinic that specialises in weight-inclusive care. She has a huge passion for helping people recover from disordered eating. Shannon offers 1:1 PCOS support in our virtual PCOS clinic.

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