Key Takeaways
A related response to that toll is dissociation in eating disorders.
Chronic pain and eating disorders often occur together, and each can intensify the other. Persistent pain can shape how a person eats, while the physical effects of disordered eating can worsen pain. Addressing both conditions together, with a coordinated care team, supports more durable recovery.
- Chronic pain and eating disorders share biological pathways, including how the nervous system processes stress and pain signals.
- Pain-avoidance eating can begin as a practical response to discomfort and gradually develop into a restrictive eating disorder.
- Fibromyalgia and other chronic pain conditions are linked with a higher likelihood of disordered eating.
- Children and adolescents with chronic pain are an at-risk group whose eating disorder symptoms are easily missed.
- Integrated treatment combines medical care, nutrition support, therapy, and non-medication approaches to pain.
How Does Chronic Pain Trigger Disordered Eating?
The relationship between chronic pain and eating disorders is bidirectional, each condition can trigger and worsen the other. Chronic pain and eating disorder diagnoses frequently appear together, and clinicians who treat one condition must be alert to the presence of the other. There are several mechanisms through which chronic pain can trigger or worsen disordered eating behaviors.
Pain-avoidance eating is one of the most common ways chronic pain influences food intake. Individuals with chronic pain may begin to associate certain foods with increased pain, leading to a progressively restrictive diet. Over time, this restriction can take on the psychological characteristics of anorexia nervosa, with the original pain-avoidance rationale giving way to more entrenched disordered thinking about food and body weight. The comorbid nature of eating disorder and chronic pain makes diagnosis and treatment more complex, requiring a multidisciplinary approach.
Emotional regulation is another key mechanism. The constant suffering of chronic pain creates significant emotional distress, and disordered eating can become a way to distract from or numb this pain. Binge eating, in particular, can provide temporary relief from the emotional burden of chronic pain, while restriction can create a sense of control when the body feels unpredictable and unmanageable. For adolescent patients especially, the development of comorbid chronic pain and eating disorders can have long-lasting consequences for physical and mental health.
What Is the Connection Between Fibromyalgia and Eating Disorders?
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and sleep disturbances. Research has shown a significant overlap between fibromyalgia and eating disorders, particularly bulimia nervosa. The emotional distress and body image issues that are common in individuals with fibromyalgia can contribute to the development of an eating disorder. A systematic review of adults with fibromyalgia found that disordered eating and related eating difficulties are notably common in this population (Gilheaney et al., 2023), and eating disorders have also been documented in juvenile fibromyalgia (Miyamae et al., 2016).
The relationship between fibromyalgia and eating disorders may be mediated by shared neurobiological mechanisms, including dysregulation of the serotonin and dopamine systems, as well as central sensitization, a process by which the nervous system becomes hypersensitive to pain signals. These same neurobiological factors are implicated in the development and maintenance of eating disorders, suggesting a common underlying vulnerability. At Eating Disorder Solutions, we recognize the unique challenges faced by individuals with both fibromyalgia and an eating disorder, and our treatment approach is tailored to address both conditions simultaneously.
How Does Somatic Therapy Help with Chronic Pain and Eating Disorders?
Somatic therapy is a body-centered approach that helps individuals release trauma and emotional distress that is stored in the body. For individuals with chronic pain and an eating disorder, somatic therapy can be a powerful tool for healing. By focusing on the physical sensations in the body, clients can learn to process and release the emotional pain that is contributing to both their chronic pain and their disordered eating.
Somatic Experiencing, developed by Dr. Peter Levine, is one somatic modality that has shown promise in treating both chronic pain and eating disorders. By helping clients complete the body’s natural stress response cycle, Somatic Experiencing can reduce the chronic activation of the nervous system that underlies both conditions. EMDR (Eye Movement Desensitization and Reprocessing) is another evidence-based approach that addresses the traumatic memories and beliefs that often drive both chronic pain and disordered eating. Our therapists at Eating Disorder Solutions are trained in a variety of somatic modalities to help clients reconnect with their bodies in a safe and supportive way.
Who Is Most at Risk for Co-Occurring Chronic Pain and Eating Disorders?
Research shows that children and adolescents with chronic pain are at elevated risk for developing eating disorders (Pianucci et al., 2021). Eating disorders in adolescents with chronic pain often go undetected because the restrictive eating is attributed to the pain rather than recognized as an eating disorder. Pediatric chronic pain programs are increasingly recognizing the need to screen for eating disorder symptoms as part of routine assessment, including among youth with functional abdominal pain (Sim et al., 2024). Teens with eating disorders who also experience chronic pain face compounded challenges in recovery, as the physical symptoms of both conditions can reinforce each other.
Adults with chronic conditions such as fibromyalgia, chronic low back pain, functional abdominal pain, and irritable bowel syndrome are also at elevated risk. People with chronic pain who develop eating disorder behaviors often describe using food restriction or binge eating as a way to manage pain intensity and regain a sense of control. Eating disorders share several features with chronic pain conditions, including central sensitization, heightened interoceptive awareness, and dysregulation of the stress response system.
Patients with eating disorders who also experience physical pain present unique challenges for treatment teams. Pain specialists and eating disorder clinicians must collaborate closely to develop an integrated treatment plan. Pain rehabilitation programs that incorporate Acceptance and Commitment Therapy (ACT) have shown promise in treating both chronic pain and eating disorders simultaneously, helping patients develop psychological flexibility and reduce the impact of both pain and eating disorder symptoms on daily functioning.
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What Does Integrated Treatment for Chronic Pain and Eating Disorders Look Like?
Eating disorder treatment for individuals with comorbid chronic pain must address both conditions simultaneously. A comprehensive treatment program at Eating Disorder Solutions includes medical stabilization, nutritional rehabilitation, individual therapy, group therapy, and somatic therapies. Pain management is integrated into the treatment plan, with a focus on non-pharmacological approaches that do not risk exacerbating disordered eating behaviors.
Early intervention is critical for patients with eating disorders and chronic pain. The onset of eating disorder behaviors in the context of chronic pain can be insidious, with restrictive eating initially appearing as a reasonable response to pain. Health outcomes are significantly better when eating disorder treatment begins early, before the behaviors become entrenched. Our eating disorders program at Eating Disorder Solutions is designed to provide comprehensive, integrated care for individuals with complex presentations, including those with comorbid eating disorder and chronic pain symptoms.
Eating disorders often co-occur with other mental health conditions, including depression, anxiety, and PTSD. For patients with chronic pain, these mental disorders can compound the challenges of recovery. Our treatment team addresses the full spectrum of mental health conditions that may be present alongside the eating disorder, providing a truly holistic approach to healing.
| Feature | Pain-Avoidance Restriction | Anorexia Nervosa |
| Primary motivation | Avoiding foods perceived to cause pain | Fear of weight gain / body image disturbance |
| Body image disturbance | May be absent initially | Core diagnostic criterion |
| Awareness of restriction | Often justified as ‘medical necessity’ | May be denied or minimized |
| Overlap risk | Can evolve into full AN over time | May develop pain-avoidance as secondary feature |
| Treatment approach | Somatic therapy + nutritional rehabilitation | CBT + FBT + medical stabilization |
| Prognosis | Improved with integrated pain + ED treatment | Improved with early, specialized intervention |
Frequently Asked Questions
Can an eating disorder cause chronic pain?
Yes, the physical complications of an eating disorder, such as malnutrition, electrolyte imbalances, and osteoporosis, can cause or worsen chronic pain. Anorexia nervosa is associated with bone loss and joint pain. Bulimia nervosa can cause gastrointestinal pain and esophageal damage. Treating the eating disorder is an essential component of managing eating disorder-related chronic pain.
What is pain-avoidance eating and how is it treated?
Pain-avoidance eating is a pattern of restrictive eating driven by the belief that certain foods will cause or worsen pain. While it may begin as a rational response to a diagnosed condition, it can evolve into a more serious eating disorder over time. Treatment involves working with a registered dietitian to develop a safe and balanced eating plan, as well as therapy to address the underlying fear and anxiety around food.
Is fibromyalgia linked to eating disorders?
Research suggests a significant overlap between fibromyalgia and eating disorders, particularly bulimia nervosa. Shared neurobiological mechanisms, including dysregulation of the serotonin system and central sensitization, may explain this connection. Integrated treatment that addresses both conditions simultaneously is recommended for individuals with comorbid fibromyalgia and an eating disorder.
How can I support a loved one with chronic pain and an eating disorder?
Be a compassionate and non-judgmental listener. Encourage them to seek professional help from a treatment center that specializes in co-occurring conditions. Offer practical support, such as helping with meals or transportation to appointments, and be patient with them as they navigate their recovery journey. You can reach Eating Disorder Solutions for guidance, and the crisis resources listed below are available any time.
References
- Gilheaney Ó, et al. The prevalence and nature of eating and swallowing problems in adults with fibromyalgia: a systematic review. Dysphagia. 2023;39(1):92-108. doi:10.1007/s00455-023-10597-8
- Miyamae T, et al. Eating disorder in juvenile fibromyalgia. J Child Adolesc Psychopharmacol. 2016;26(7):653-655. doi:10.1089/cap.2014.0136
- Pianucci L, et al. Disordered eating among adolescents with chronic pain: the experience of a pediatric rheumatology subspecialty pain clinic. Pediatr Rheumatol Online J. 2021;19(1):16. doi:10.1186/s12969-021-00506-4
- Sim L, et al. Eating concerns in youth with functional abdominal pain disorders. J Pediatr Gastroenterol Nutr. 2024;79(5):1040-1046. doi:10.1002/jpn3.12377
Support and Crisis Resources
If you or someone you love is struggling, support is available. If you are in crisis or need immediate help, call or text 988 to reach the 988 Suicide and Crisis Lifeline, a free, confidential service available 24/7.
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