Page last updated July 2021

The struggles of treating an eating disorder while having PCOS

Treating PCOS and eating disorders

Fiona has struggled with orthorexia, a fixation on “healthy” eating, and binge eating since being diagnosed with polycystic ovary syndrome (PCOS) when she was 13 years old. She’s not alone – studies have shown that people with PCOS, which is a complex and common condition that affects ovary function, are more likely to have binge-eating disorder, bulimia, and eating disorders in general, compared to those without it.1

It is not entirely clear why this is,2 but it may be partially explained by how PCOS can affect weight. People with PCOS may be insulin resistant, meaning that it is harder for the body to convert glucose from the blood into energy — this excess glucose is then stored as fat and can also increase the hunger drive. A predisposition to weight gain could then impact body image,3 including a sense of lost control over one’s body.

People with PCOS can struggle to get their eating disorder recognised or taken seriously, and when trying to access treatment often find themselves between a rock and a hard place: weight loss is recommended as a way to manage PCOS symptoms, yet this advice can be triggering or even dangerous.

When PCOS treatment is triggering

Due to higher insulin and blood glucose levels, people with PCOS are often advised to cut out carbohydrates and sugars, or to lose weight to manage their symptoms.

Harriet Eldridge, a nutritional therapist who specialises in eating disorders, says weight loss can be a “really challenging” treatment option for people with both PCOS and an eating disorder. “People feel extremely in conflict: they need to moderate [their] lifestyle and diet, and maybe reduce sugar and lose weight, and then in combination they’re trying to restore their relationship with food, by not restricting.”

While Marget feels her relationship with food is in a healthier place, she finds her body’s sensitivity to certain foods due to PCOS can trigger her disordered eating habits and thoughts

This resonates with Margret, who was diagnosed with PCOS when she was 15 and recalls restricting her food intake constantly as a young gymnast. “I was so worried about getting fat,” she says. “I didn’t realise that wasn’t normal until I came to university and saw people with healthy eating habits that weren’t anxious about food.”

While Marget feels her relationship with food is in a healthier place, she finds her body’s sensitivity to certain foods due to PCOS can trigger her disordered eating habits and thoughts. “I’m not supposed to have gluten or sugar. Gluten makes me feel so sick,” she says. “And obviously then you get afraid to eat because you don’t want to feel sick all the time. And the longer you don’t eat, the harder it is to start eating again.”

Treatment options that draw attention to how a person’s body is changing can also be triggering. Margret takes a contraceptive pill to regulate her period and has been prescribed painkillers to treat her symptoms in the past — both of which prompted her to restrict her eating. “There’s this myth that birth control is going to make you fat,” Margret says. “And the pain medication would make me so sick, so I wouldn’t want to eat when I took it. But then I’d be like, ‘I feel really good [about myself], I don’t want to eat for the rest of the day’.”

Looking beyond PCOS symptoms

There is no known cure for PCOS, so specialists tend to focus on treating symptoms as they arise. So, when a person with PCOS has gained weight, their treatment plan may be focused on losing it rather than considering how this fits in with their overall health and wellbeing.

However, Eldridge says that this “simplistic” treatment approach is counterproductive for people with a history of eating disorders. “The likelihood is that they can lose weight in the short term but if that hasn’t been addressed – the relationship with food – then you know it’s not going to be a long-term solution,” she says.

“People think, ‘PCOS is a lifestyle condition, therefore you need to lose weight and exercise more’. It’s a really simplistic view, and actually what we know is there’s so many complexities to it”

Instead, Eldridge focuses on working towards lasting nutrition goals for her clients. “When working with an eating disorder client, no matter what kind of size they are, it’s always about restoring their relationship with food first because that is what is going to be sustainable long-term,” she says. “If weight loss is a necessary goal, then that will be around three or four months after we have worked on their relationship with food.”

It is essential that clinicians recognise not only the psychological impacts of PCOS, but how these may impact other conditions such as Fiona’s — who believes that the lack of information doctors have given her about PCOS has contributed to her eating disorders developing. “I wish there was more known about it and they could tell me more about it,” she says. “I think the binge eating is all mainly about having anxiety — about my health, about being told that I wouldn’t have children. Because I don’t have control over my body, I then have controlled everything that I eat…which gives me a sense of control back.”

It is promising that guidelines for managing PCOS suggest mental wellbeing assessments,4 however there is still a lack of understanding about the link between PCOS, eating disorders, and body image issues. Further research and studies into this link will allow specialists to improve treatments for PCOS – treatments that address the psychological challenges that people with PCOS face, alongside the physical ones.

“People think, ‘PCOS is a lifestyle condition, therefore you need to lose weight and exercise more’,” says Eldridge. “It’s a really simplistic view, and actually what we know is there’s so many complexities to it.”
 
 
Featured image is an illustration of a person looking at themselves in the mirror. Their reflection is blurry and doesn’t give any sense of what they look like, it only indicates that they are looking at themselves. The person has their back to the viewer and has medium-length hair, tied up with a scrunchie
 
 
Page last updated July 2021

Fiona has struggled with orthorexia, a fixation on “healthy” eating, and binge eating since being diagnosed with polycystic ovary syndrome (PCOS) when she was 13 years old. She’s not alone – studies have shown that people with PCOS, which is a complex and common condition that affects ovary function, are more likely to have binge-eating disorder, bulimia, and eating disorders in general, compared to those without it.1

It is not entirely clear why this is,2 but it may be partially explained by how PCOS can affect weight. People with PCOS may be insulin resistant, meaning that it is harder for the body to convert glucose from the blood into energy — this excess glucose is then stored as fat and can also increase the hunger drive. A predisposition to weight gain could then impact body image,3 including a sense of lost control over one’s body.

People with PCOS can struggle to get their eating disorder recognised or taken seriously, and when trying to access treatment often find themselves between a rock and a hard place: weight loss is recommended as a way to manage PCOS symptoms, yet this advice can be triggering or even dangerous.

When PCOS treatment is triggering

Due to higher insulin and blood glucose levels, people with PCOS are often advised to cut out carbohydrates and sugars, or to lose weight to manage their symptoms.

Harriet Eldridge, a nutritional therapist who specialises in eating disorders, says weight loss can be a “really challenging” treatment option for people with both PCOS and an eating disorder. “People feel extremely in conflict: they need to moderate [their] lifestyle and diet, and maybe reduce sugar and lose weight, and then in combination they’re trying to restore their relationship with food, by not restricting.”

While Marget feels her relationship with food is in a healthier place, she finds her body’s sensitivity to certain foods due to PCOS can trigger her disordered eating habits and thoughts

This resonates with Margret, who was diagnosed with PCOS when she was 15 and recalls restricting her food intake constantly as a young gymnast. “I was so worried about getting fat,” she says. “I didn’t realise that wasn’t normal until I came to university and saw people with healthy eating habits that weren’t anxious about food.”

While Marget feels her relationship with food is in a healthier place, she finds her body’s sensitivity to certain foods due to PCOS can trigger her disordered eating habits and thoughts. “I’m not supposed to have gluten or sugar. Gluten makes me feel so sick,” she says. “And obviously then you get afraid to eat because you don’t want to feel sick all the time. And the longer you don’t eat, the harder it is to start eating again.”

Treatment options that draw attention to how a person’s body is changing can also be triggering. Margret takes a contraceptive pill to regulate her period and has been prescribed painkillers to treat her symptoms in the past — both of which prompted her to restrict her eating. “There’s this myth that birth control is going to make you fat,” Margret says. “And the pain medication would make me so sick, so I wouldn’t want to eat when I took it. But then I’d be like, ‘I feel really good [about myself], I don’t want to eat for the rest of the day’.”

Looking beyond PCOS symptoms

There is no known cure for PCOS, so specialists tend to focus on treating symptoms as they arise. So, when a person with PCOS has gained weight, their treatment plan may be focused on losing it rather than considering how this fits in with their overall health and wellbeing.

However, Eldridge says that this “simplistic” treatment approach is counterproductive for people with a history of eating disorders. “The likelihood is that they can lose weight in the short term but if that hasn’t been addressed – the relationship with food – then you know it’s not going to be a long-term solution,” she says.

“People think, ‘PCOS is a lifestyle condition, therefore you need to lose weight and exercise more’. It’s a really simplistic view, and actually what we know is there’s so many complexities to it”

Instead, Eldridge focuses on working towards lasting nutrition goals for her clients. “When working with an eating disorder client, no matter what kind of size they are, it’s always about restoring their relationship with food first because that is what is going to be sustainable long-term,” she says. “If weight loss is a necessary goal, then that will be around three or four months after we have worked on their relationship with food.”

It is essential that clinicians recognise not only the psychological impacts of PCOS, but how these may impact other conditions such as Fiona’s — who believes that the lack of information doctors have given her about PCOS has contributed to her eating disorders developing. “I wish there was more known about it and they could tell me more about it,” she says. “I think the binge eating is all mainly about having anxiety — about my health, about being told that I wouldn’t have children. Because I don’t have control over my body, I then have controlled everything that I eat…which gives me a sense of control back.”

It is promising that guidelines for managing PCOS suggest mental wellbeing assessments,4 however there is still a lack of understanding about the link between PCOS, eating disorders, and body image issues. Further research and studies into this link will allow specialists to improve treatments for PCOS – treatments that address the psychological challenges that people with PCOS face, alongside the physical ones.

“People think, ‘PCOS is a lifestyle condition, therefore you need to lose weight and exercise more’,” says Eldridge. “It’s a really simplistic view, and actually what we know is there’s so many complexities to it.”
 
 
Featured image is an illustration of a person looking at themselves in the mirror. Their reflection is blurry and doesn’t give any sense of what they look like, it only indicates that they are looking at themselves. The person has their back to the viewer and has medium-length hair, tied up with a scrunchie
 
 
Page last updated July 2021

Nicola Blackburn

Nicola is a London-based freelance journalist from Sydney. She likes to write about issues affecting all women, whether they be medical, social, international, political, or a nasty combination of the above! While completing her masters in journalism she’s worked as a community news reporter, written reviews, and interviewed foodies, but it’s writing about women that she keeps coming back to.

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References

  1. Thannickal, A., et. al, Eating Sleeping and Sexual Function Disorders in Women with Polycystic Ovary Syndrome (PCOS): A systematic review and meta-analysis, Clinical Endocrinology, 2020, vol. 92, no. 4,  pp. 338-349
  2. Dokras, A., Lee, I., Mental Health and Body Image in polycystic ovary syndrome, Current Opinion in Endocrine and Metabolic Research, June 2020, vol. 12, pp. 85-90
  3. Ibid
  4. NICE, Polycystic Ovary Syndrome, Clinical Knowledge Summary, National Institute for Health and Care Excellence, September 2018 [online] [accessed 8 July 2021]