My daughter suffered with bulimia in high school and college. During that time she abused alcohol. When she found out she was pregnant she stopped doing both. She has continued to need antidepressants and in the last six months she has been prescribed anti-anxiety meds. Are these all linked? Do people who have had bulimia often have anxiety?

– Nancy, Indiana

You are definitely on to something, Nancy. Anxiety disorders (especially obsessive-compulsive disorder) are much more common in people with all kinds of eating disorders, including bulimia. It is more often the case that anxiety disorders begin in childhood before the onset of an eating disorder, supporting the idea that anxiety may create vulnerability for the eating disorder to develop.

Given your daughter's history, the most likely connection between her bulimia, alcohol abuse, anti-depressants and anti-anxiety medications is that all of these are attempts to cope with intense negative thoughts and emotions that are extremely painful. The bingeing and purging behaviors as well as the alcohol abuse all create significant physical sensations that temporarily distract from emotional pain. Her more recent attempts to cope by taking prescription medications are a much more useful approach; rather than injuring the body like the previous approaches did, the medications provide chemicals that are temporarily helpful to the body.

Ultimately, though, it will be most helpful for your daughter to learn additional ways to cope with painful emotions and thoughts, a skill that is unfortunately not taught in school. Two avenues to consider include a skills-training group called Dialectical Behavior Therapy (DBT) and a class in Mindfulness-Based Stress Reduction (MBSR). DBT was initially developed for people with borderline personality disorders, but has been used more recently to help people effectively cope with intense emotional pain of any kind. MBSR trains people to develop a nonjudgmental awareness of thoughts, feelings, and body sensations in the present moment, which is much more difficult than it sounds. Both are well-studied and quite helpful programs; you can learn more about DBT from Psych Central and about MBSR from the Center for Mindfulness in Medicine, Health Care, and Society.