Effective Stress Management in Eating Disorder Recovery 

Stress & Eating Disorders

Everyone experiences stress. It is a natural human response to demands, pressure, challenges and threats. When individuals are stressed, they might engage in impulsive behaviors because they are overwhelmed. This can manifest in a lot of different of ways, but for those living with an eating disorder, stressors can cause individuals to engage in disordered eating behaviors. 

Individuals with anorexia nervosa may find themselves restricting because they’re too anxious to eat, while those with bulimia nervosa or binge eating disorder may start emotionally eating, leading to bingeing or purging.  

Chronic Stress

Short bursts of stress – acute stress – can be positive and productive in cases where you want to avoid danger or meet a deadline. They can also help you grow and be encouraging, like when you’re about to give a presentation in front of a large audience. Acute stress can also be negative, like when you have a fight with a loved one or get stuck in traffic. Acute stress typically subsides quickly and doesn’t have lasting effects. 

However, when stress lasts for a prolonged period, it can become chronic and have a negative impact on your health. Not only can high levels of stress hormones, like cortisol and adrenaline, lead to changes in eating behaviors, but those with eating disorders have a higher risk of experiencing chronic stress. Chronic stress can leave you stuck in a permanent stage of fight or flight, making it difficult for you to relax or stay focused. 

Impact of chronic stress

Chronic stress can cause a variety of health problems due to long-term activation of the stress response and excessive exposure to stress hormones, including: 

• Anxiety 
• Depression 
• Digestive problems 
• Headaches 
• Muscle tension and pain 
• Heart disease, heart attack, high blood pressure and stroke 
• Difficulty sleeping 
• Difficulty focusing or memory problems 

Since eating disorders, depression and anxiety are frequently co-occurring diagnoses, an increase in depression or anxiety symptoms may exacerbate disordered eating behaviors. 

Sources of Stress 

In today’s world, there are many possible sources of stress, but some of the largest contributors are related to big life changes or circumstances where you feel as though you have little control over your life, including: 

• Financial trouble or job loss 
• Death, injury or terminal illness of a loved one 
• Caretaking for an elderly or sick family member 
• Traumatic events, such as a natural disaster, theft or violence 
• Bullying, harassment or discrimination 
• Job dissatisfaction, heavy workload or working long hours 
• Poor academic performance, standardized testing or college enrollment 

While these are some of the biggest sources of stress, they’re far from the only ones. Even positive life events, like starting a new job or a new baby, can be sources of stress. Smaller things, like an upcoming test or going on a first date, can be stressors too.  

Eating Disorder Onset & Stressful Life Transitions

Research has shown that stressful life events, such as parental divorce or death of a family member or close friend, are associated with disordered eating behaviors, such as restriction and purging, as a way to cope or reduce negative emotions.

An early qualitative study identified two phases in life as the most common times an eating disorder emerges: during adolescence and launching into adulthood.¹

Individuals with eating disorders also noted events that may have contributed to the development of an eating disorder, including:¹

• School transitions
• Death of a family member
• Relationship changes
• Home and job transitions
• Illness or hospitalization

55% note that two or more events were connected to the development of an eating disorder.¹ Another contributor is a lack of support, as many patients also described that they either felt less supported or had a lack of support after these events.¹

Eating Disorders, Stress & Trauma

Traumatic events are major sources of stress and can develop into post-traumatic stress disorder or related disorders. Eating disorders may develop as a way for someone to cope with the unmanageable feelings associated with a traumatic events, such as:^2-4 

• Accidents (serious or life threatening)
• Assault (physical attack or robbery)
• Rape or other sexual assault
• Childhood physical abuse
• Emotional abuse
• Threats with weapon
• Witnessing violence
• Other events representing a threat to life, health or safety

Some studies have shown that traumatic events often predate an eating disorder, which suggests that trauma may be a significant risk factor in the development of eating disorders.⁵

Coping with Stress

Coping styles

The way you respond to stress can make a big difference to your overall wellbeing. Evaluating the source of your stress and utilizing active coping mechanisms rather than passive ones can help you manage your stress more effectively.

There are two major coping styles, active coping and passive (or avoidant) coping: 

• Active coping: An adaptive coping response when a person works to find productive, problem-focused solutions to stress and is aware of their stressor and problem-solves to reduce unwanted outcomes. 
• Passive (avoidant) coping: A coping response where individuals use maladaptive strategies when faced with stressful situations. This may include avoidance, denial or withdrawal. 

Studies of college students have shown that individuals with an avoidant coping style are at a higher risk of disordered eating.⁶ Rather than avoiding, denying or withdrawing from your sources of stress, facing stress head-on is the first step to effectively managing it.  

Stress Management Techniques

Progressive muscle relaxation

Progressive muscle relaxation (PMR) is a technique that involves alternating between tensing and releasing different muscle groups to reduce physical tension and help calm the mind. Progressive muscle relaxation applies the principles of neuronal “top-down” and “bottom-up” processing:^E

• Top-down processing: using areas higher in the nervous system like the cerebral cortex and the cerebellum to contract muscles and gradually release the tension
• Bottom-up processing: holding and releasing of bodily tension produce proprioceptive stimulation from peripheral muscles to the spinal cord, brain stem and eventually the brain

Together, these form a feedback loop between the brain and the rest of the body that encourages relaxation.⁷

PMR has been shown to help reduce stress. 30-minute sessions of progressive muscle relaxation reduce test anxiety, while other studies have shown that PMR is useful for reducing feelings of general anxiety and depression.⁷

Diaphragmatic breathing

Diaphragmatic breathing, which is also known as deep breathing, is a breathing technique involving slow, deep breaths where one contracts the diaphragm to inhale and exhale.

Deep breathing is a mind-body integration practice which emphasizes the interconnectedness between a person's thoughts, emotions and physical wellbeing. Deep breathing doesn’t just help the mind, but can help the body by increasing blood oxygen levels and massaging the inner organs near the abdomen.⁷

Diaphragmatic breathing has been shown to be beneficial for stress reduction by decreasing cortisol levels.⁷ One study suggests that when combined with other therapies, like aromatherapy, 40% of the patients demonstrated a decrease in anxiety.⁷

Aerobic exercise

Exercise may help lower feelings of stress. Despite it being a popular belief, there is relatively little research covering the stress-reduction benefits of exercise.

Reducing stress with exercise when you have a history of overexercising

For those with a history of compulsive exercise, reintegrating exercise into their routine needs to be thoughtful and intentional. While exercise offers a range of physical and emotional benefits, it can become dangerous when used as a method of weight control.

Overexercising itself is an unhealthy coping mechanism in response to stress; for those with eating disorders, it can include overwhelming thoughts or feelings about weight, shape or diet.

It may be helpful to work with your treatment team as you reintroduce activity. Remember to:

• Start gradually
• Focus on low-intensity, non-competitive activities like walking, gentle yoga or stretching
• Refrain from setting strict fitness goals
• Focus on mind-body connection over calorie burn
• Limit how often or how long you do an activity
• Monitor physical and emotional responses
• Make sure to take rest days

Building supportive relationships

Fostering supportive relationships can help reduce stress. Studies have consistently shown that social support significantly lowers physiological markers of stress, such as cardiovascular and cortisol reactivity to acute stressors, and those who report higher levels of support also report lower stress levels.

Conversely, negative interactions and low-quality relationships can increase stress responses, leading to:  

• Higher daily stress ratings
• Higher cortisol levels
• Higher perceived stress
• Poorer stress recovery

Lack of supportive relationships diminishes the ability to cope, leading to amplified perceived demands and emotional load. On top of that, social isolation – frequently exhibited in those with eating disorders – disrupts stress-regulating behaviors (sleep, exercise and nutrition).

S.S.T.A: Stop, Slow Down, Think, Act

SSTA stands for stop, slow down, think and act. SSTA is a group of skills that allows one to be aware of their feelings while also minimizing the negative impact of overwhelming emotions, like stress or anxiety.

Instead of ruminating on a stressful situation or problem, SSTA empowers individuals to make informed decisions based on their emotions by:

• Stopping and becoming more aware – what are you feeling and why?
• Slowing down and giving your brain and body a chance to feel your emotions until the initial intensity fades
• Thinking and using your problem-solving skills to cope with the problem
• Act and put your problem-solving ideas into action

Psychotherapy for Stress Management

Mindfulness-based cognitive therapy

Mindfulness-based cognitive therapy (MBCT) trains individuals to cultivate mindfulness, an active and open attention to the present moment and helps develop a different relationship with one’s thoughts and emotions, reducing the tendency to ruminate and increasing emotional regulation.

MBCT has been shown to consistently decrease symptoms related to stress, as well as depression and anxiety, while also enhancing cognitive functions and emotional regulation.⁸

Mindfulness-based stress reduction

Mindfulness-based stress reduction (MBSR) is a form of meditation therapy. It was originally designed for stress management, but has been used to treat a variety of psychiatric illnesses, including anxiety and depression.

MSBR trains individuals to focus on the present moment with compassionate self-awareness, which decreases rumination and emotional reactivity. This mindful attention helps regulate the body’s stress response.

MSBR is effective for both clinical and nonclinical populations.^A MBSR has been consistently shown not only to help reduce perceived stress, but also:^9-12

• Lower physiological stress indicators (cortisol, blood pressure)
• Reduce habitual patterns of stress
• Reduce mood disturbances
• Improve quality of life

Problem-solving therapy

Problem-solving therapy (PST) is a shorter-term intervention that provides people with the tools they need to identify and solve problems that arise from stress. Problem-solving therapy is oriented around positive problem-solving, involving:

• Optimism
• Self-efficacy
• Acceptance that problems are a normal part of life

PST aims to improve quality of life and empower patients to manage stress across all areas of life.

References

1. Berge, J. M., Loth, K., Hanson, C., Croll‐Lampert, J., & Neumark‐Sztainer, D. (2011). Family life cycle transitions and the onset of eating disorders: a retrospective grounded theory approach. Journal of Clinical Nursing, 21(9–10), 1355–1363. https://doi.org/10.1111/j.1365-2702.2011.03762.x
2. Lie, S. Ø., Wisting, L., Stedal, K., Rø, Ø., & Friborg, O. (2023). Stressful life events and resilience in individuals with and without a history of eating disorders: a latent class analysis. Journal of Eating Disorders, 11(1), 184. https://doi.org/10.1186/s40337-023-00907-8
3. Trottier, K., & MacDonald, D. E. (2017). Update on Psychological Trauma, Other Severe Adverse Experiences and Eating Disorders: State of the Research and Future Research Directions. Current psychiatry reports, 19(8), 45. https://doi.org/10.1007/s11920-017-0806-6
4. Brewerton T. D. (2007). Eating disorders, trauma, and comorbidity: focus on PTSD. Eating disorders, 15(4), 285–304. https://doi.org/10.1080/10640260701454311
5. J Jenzer, T., Meisel, S. N., Blayney, J. A., Colder, C. R., & Read, J. P. (2020). Reciprocal processes in trauma and coping: Bidirectional effects over a four-year period. Psychological trauma: theory, research, practice and policy, 12(2), 207–218. https://doi.org/10.1037/tra0000500
6. MacNeil, L., Esposito-Smythers, C., Mehlenbeck, R., & Weismoore, J. (2012). The effects of avoidance coping and coping self-efficacy on eating disorder attitudes and behaviors: A stress-diathesis model. Eating Behaviors, 13(4), 293–296. https://doi.org/10.1016/j.eatbeh.2012.06.005
7. Toussaint, L., Nguyen, Q. A., Roettger, C., Dixon, K., Offenbächer, M., Kohls, N., Hirsch, J., & Sirois, F. (2021). Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation. Evidence-based Complementary and Alternative Medicine, 2021, 1–8. https://doi.org/10.1155/2021/5924040
8. Gkintoni, E., Vassilopoulos, S. P., & Nikolaou, G. (2025). Mindfulness-Based Cognitive Therapy in Clinical Practice: A Systematic Review of Neurocognitive Outcomes and Applications for Mental Health and Well-Being. Journal of Clinical Medicine, 14(5), 1703. https://doi.org/10.3390/jcm14051703
9. Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519–528. https://doi.org/10.1016/j.jpsychores.2015.03.009
10. Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). A randomized, Wait-List controlled clinical trial: The effect of a Mindfulness Meditation-Based Stress Reduction Program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62(5), 613–622. https://doi.org/10.1097/00006842-200009000-00004
11. Hoge, E. A., Bui, E., Palitz, S. A., Schwarz, N. R., Owens, M. E., Johnston, J. M., Pollack, M. H., & Simon, N. M. (2017). The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Research, 262, 328–332. https://doi.org/10.1016/j.psychres.2017.01.006
12. Nyklíček, I., & Kuijpers, K. F. (2008). Effects of Mindfulness-Based Stress Reduction intervention on psychological well-being and quality of life: Is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35(3), 331–340. https://doi.org/10.1007/s12160-008-9030-2