How Are Eating Disorders and PCOS Connected?

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PCOS stands for polycystic ovary syndrome. It is the most common endocrine disorder found in people with ovaries during their reproductive years. In addition to causing reproductive, metabolic, and psychological problems, there appears to be a strong link between PCOS and eating disorders or disordered eating.

This article discusses the symptoms of PCOS and how the condition is connected to eating disorders. It also explores how common treatments for PCOS can contribute to the onset or worsening of eating disorders.

Woman struggling with PCOS and an eating disorder
Verywell / Jessica Olah

Common Symptoms and Assessment

Despite its relatively high prevalence, PCOS is one of the most poorly funded and researched health conditions. Originally known as Stein-Leventhal Syndrome, it was first recognized in 1935. Once thought to be a gynecologic and dermatologic problem, it is now recognized as a multisystem disorder that has no cure (although its symptoms can be treated).

PCOS is most often diagnosed by a medical doctor. The doctor will usually assess menstrual patterns and weight, insulin resistance, hair patterns, and acne. Blood tests are conducted to measure hormone levels, glucose tolerance, fasting insulin levels, and related markers.

Many people with PCOS don’t realize they have it. Both physical and psychological symptoms are common.

Physical Symptoms of PCOS

  • Abdominal bloating
  • Acne and skin tags
  • Back pain
  • Elevated male sex hormones and thyroid irregularities
  • Fatigue
  • High blood pressure, high cholesterol, and increased risk of heart disease
  • Higher weight accompanied by abdominal fat
  • Increased appetite
  • Infertility and increased rates of miscarriage
  • Male-pattern hair loss on the head and excess hair growth on the face and body
  • Menstrual symptoms, including irregularity, cramps, and heavy bleeding
  • Ovarian cysts and endometriosis
  • Pre-diabetes and insulin resistance

It is important to note that women with smaller body sizes sometimes assume their symptoms are unrelated to PCOS. As a result, they may not seek diagnosis or treatment.

Psychological Symptoms of PCOS

Recap

Symptoms of PCOS are both physical and psychological in nature. This includes menstrual problems, reproductive issues, body image problems, and symptoms of depression and anxiety. 

Prevalence of PCOS and Eating Disorders

PCOS is believed to affect up to 20% of reproductive-aged people with ovaries. While research on eating disorders among those with PCOS is scant, the prevalence of eating disorders appears to be higher in this group than among the general population.

One study of individuals with PCOS reported a high prevalence of overall eating disorders (21%). The prevalence among those without PCOS is 4%.

In another study, the prevalence of disordered eating in people with PCOS was over four times the rate of disordered eating behaviors among individuals without PCOS. People with PCOS exhibited significantly higher rates of concern about their weight and the shape of their body.

This study also found a high prevalence of the following conditions among people with PCOS:

Individuals with PCOS reported significantly more binge episodes and more frequent episodes of compulsive exercise in the prior month than did the controls.

Psychologist Gretchen Kubacky, PsyD, specializes in treating women with PCOS. In her book, The PCOS Mood Cure, she estimates the prevalence of eating disorders and disordered eating among those with PCOS in her practice to be close to 100%.

The Link Between PCOS and Eating Disorders

PCOS is often associated with higher weights and a predisposition to weight gain. As a result, people who have PCOS are often advised to diet to lose weight.

The symptoms of depression and negative body image associated with several aspects of PCOS, such as excessive facial hair or higher weight, can also contribute to the urge to diet. It is important to note, however, that dieting is a well-established risk factor for developing an eating disorder.

Studies suggest that people with PCOS often use a range of weight loss and weight management strategies. Healthy eating approaches and following low glycemic index diets are two common approaches.

Unfortunately, some people may also try alternative approaches to weight loss that rely on unhealthy practices such as smoking, diet pills, and laxatives.  

“Most women with PCOS have insulin resistance. Of important note, insulin levels are tremendously higher in PCOS compared to folks with type 2 diabetes...Insulin is a growth hormone, so when it is high a person’s weight will not go down unless something drastic is done," explains Julie Duffy Dillon, RD, a registered dietitian.

"I do witness women with PCOS losing weight from [extreme dieting] methods, yet the weight always comes back," Duffy notes. "It starts a diet-binge cycle and an eating disorder is born.”

Recap

PCOS can contribute to a higher body-mass index (BMI), which people often respond to with a range of methods. Some of these methods are healthy, but some are disordered or extreme. For individuals with higher weight and higher percent body fat, dieting and losing weight are sometimes recommended for managing PCOS symptoms. In some cases, this further increases the risk of developing an eating disorder.

Treatment for PCOS

PCOS treatment is often uncoordinated, with different specialists working to address each aspect of the disorder. Unfortunately, this disjointed approach is far from ideal.

Treatment is typically led by an endocrinologist, a doctor who specializes in treating the endocrine system. Gynecologists are commonly involved in PCOS treatment, especially when fertility is a concern. People with PCOS may also have an internist for general non-PCOS-related medical care.

Many of the treatments recommended for PCOS can increase the risk of developing an eating disorder.

Lifestyle Changes

Lifestyle changes are often the primary treatment recommendation for PCOS. Since many of the symptoms of the condition are related to insulin resistance, this is the target of most of the suggested treatments.

Weight loss is often advised. Unfortunately, this guidance can merely aggravate problems and contribute to disordered eating or the development of an eating disorder.

Weight loss often also leads to weight regain. Weight cycling can lead to increased insulin, which only exacerbates the problem the weight loss was attempting to solve.

Because of this, people with PCOS are often instructed to restrict carbohydrates (also referred to as starches) to lower glucose and insulin. The problem is that these restrictions are usually not sustainable. They can lead to increased preoccupation with food and contribute to binge eating.

A better recommendation is to eat regular balanced meals, including adequate starches, throughout the day. Eating starches as part of a balanced meal that includes protein and fat causes glucose to be released more slowly into the bloodstream than when consuming starches alone. Ensuring that carbohydrates are accompanied by protein and fats helps create satiety and a lower likelihood of bingeing.

Health at Every Size

Experts recognize that most diets don’t work in the long term. People with PCOS also have a harder time losing weight in the first place.

A better approach when treating PCOS is to focus not on weight loss but instead on healthy behaviors, including eating regularly from a range of enjoyable foods, planning meals, and engaging in moderate physical activity for the sake of health rather than weight loss.

Health at Every Size (HAES) offers an alternative to the diet worldview. This approach focuses on eating enough to feel satisfied and prevent binge eating, not on the number on the scale. It advocates for finding some type of movement that is enjoyable and something you will want to sustain, not on punishing intense exercise.

Medication for PCOS

Medications are commonly used for the treatment of PCOS. These often include:

  • Birth control pills to help regulate periods
  • Metformin (an insulin sensitizer) to decrease insulin resistance and prevent early-onset type 2 diabetes
  • Spironolactone for excessive facial hair and acne

Recap

The approaches used to treat PCOS are often inconsistent but typically involve changes in diet and medications. Lifestyle recommendations that focus on dietary and exercise changes for health rather than weight loss are often the most beneficial and can reduce the risk for problems with disordered eating and eating disorders. 

Treatment for PCOS and Eating Disorders

There are no established researched treatment protocols specifically for a combined diagnosis of PCOS and eating disorders. Ideally, eating disorder treatment involves a multidisciplinary team including dietitians, psychotherapists, and physicians.

Given the risk that traditional weight management practices for PCOS will exacerbate an eating disorder when PCOS co-occurs with an eating disorder, an anti-diet approach is even more critical.

People who have both conditions benefit when a team of medical professionals well-versed in PCOS works closely with a dietitian and therapist experienced with both eating disorders and a HAES approach.

Challenges of PCOS and Eating Disorders

Dealing with these two conditions can create a great deal of strain for the individual experiencing them. Recovery is not a straightforward process, and learning to cope with symptoms of PCOS along with an eating disorder often involves developing new perspectives on weight, body image, and nutrition.

In addition to coping with co-occurring PCOS and eating disorders, research also indicates that people with polycystic ovary syndrome are at a much higher risk of experiencing other psychiatric conditions. 

The concerns that people experience related to weight and body image, along with the stress created by the symptoms of PCOS, may play a role in this increased risk for other mental health issues.

In one study examining the increased risk of disordered eating among people with PCOS, those with the condition were more likely to be concerned about body shape and weight. They also displayed elevated scores on measures of anxiety and depression. 

Another study reported that among people with PCOS, 33% also experienced major depression, 13.6% had generalized anxiety disorder, and 6.8% had binge-eating disorder. 

Coping With PCOS and Eating Disorders

Caring for both your physical and emotional health can help you cope with the symptoms you are experiencing. In addition to getting professional treatment:

  • Get social support from friends and loved ones who can help you on your path toward recovery
  • Find activities that you enjoy that can provide a distraction, such as exploring a new or old hobby
  • Focus on activities that help improve your health instead of those designed to manage weight

Each person's experience with PCOS is different, so it is essential to work with a healthcare professional or treatment team to find an approach that works for you. This treatment should be geared toward improving your health and not worsening concerns about body image or contributing to disordered eating.

Getting treatment is imperative if you have co-occurring symptoms of an eating disorder or other mental health conditions such as anxiety or depression. Psychotherapy, medication, or a combination of the two may help address co-occurring psychiatric conditions.

Recap

Coping with having both PCOS and an eating disorder is challenging. Anxiety and depression are also common among individuals with these conditions, so getting appropriate treatment is essential.

A Word from Verywell

If you have PCOS and are experiencing symptoms of an eating disorder, it’s important to let your medical professionals know and seek appropriate help. With the proper support, your eating disorder can be fully resolved and your PCOS symptoms adequately managed.

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7 Sources
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