PCOS & Eating Disorders
Guest blog by Catherine Leckie.
PCOS is the most prevalent endocrine disorder dysfunction in women of reproductive age, with it estimated that around 69% of cases are currently undiagnosed (Ormsby, 2016). Symptoms associated with the condition include weight gain, menstrual irregularity, acne, hair growth and balding, each of which are likely to impact on the self-esteem of those with PCOS. From these symptoms, one which seems to receive a great deal of attention from health professionals is weight gain. It has been reported that one of the most common reactions from GPs is to prompt those diagnosed with PCOS to lose weight to lessen the impact of their symptoms (Ormsby, 2016), however very little guidance is given on how to do this safely or whether dieting or exercise actually are the solution to this problem.
As expected, women who have experienced weight gain without any obvious changes to their diet or lifestyle may panic and feel an urgent need to adjust their diet regime and increase exercise in an attempt to control these weight fluctuations. To those who may be predisposed and susceptible to developing disordered eating behaviours, this focus on dieting and exercise can be very triggering and dangerous. The feeling of deprivation could potentially lead to behaviours associated with binge-eating disorder and bulimia nervosa. This misguided singular focus on weight loss could lead to weight cycling and restricting, both of which are associated with depression and eating pathology, already apparent in PCOS.
As mentioned, weight gain is a symptom of PCOS, not a cause so targeting this and focusing on weight loss within treatment is misguided. Instead, a focus should be placed on insulin resistance as this has been reported to be one of the main causes of weight gain and, in turn, one of the main causes of the increase in risk of diabetes in those with PCOS (Marshall & Dunaif, 2012). Marshall and Dunaif (2012) observed that insulin resistance affects 65-70% of those with PCOS and, when this isn’t well-managed, the body is much more likely to store fat particularly around the mid-section. This is also likely to exacerbate other symptoms of PCOS including that of menstrual irregularity and acne. Glucose and insulin levels should therefore be targeted with appropriate medication and guided nutrition and exercise, to improve symptoms and overall condition. It therefore seems that weight can be controlled in many cases by focusing on insulin resistance, with recommendations of dieting and increased exercise increasing the likelihood of those with a predisposition to eating disorders, to develop unhealthy habits.
Further research into eating disorders has observed that there is a high comorbidity between various categories of eating disorder and PCOS. A positive association between PCOS and bulimia has been observed due to the commonality of symptoms in both, including that of menstrual irregularity, acne and weight gain (Fairburn & Beglin, 1990). Research has also shown that those with binge-eating disorder with underlying PCOS, may actually go for a long period of time without PCOS being diagnosed (Teede et al., 2011). This is because, again, there are many commonalities between the conditions including irregular periods, poor skin and impaired impulse control due to intense feelings of deprivation. For women with PCOS, binge-eating disorder and bulimia can also co-exist due to this impaired impulse control leading to both binging and purging. Increased psychological distress has been found to lead to increased craving for unhealthy food (Yau & Potenza, 2014). When this frustration and despair then leads to overeating, the guilt of this can potentially trigger the want to purge, leading to behaviours associated with bulimia.
Research by Morgan, Scholtz, Lacey and Conway (2008) observed that there was a relatively high prevalence of eating disorders (36.3%) in those with PCOS who experienced increased facial hair growth. Negative mood, including that of anxiety and depression which are already common symptoms of both conditions, were also more apparent in those with PCOS and an eating disorder. While research by Michelmore, Balen and Dunger (2001) found that there were no significant differences in eating disorder symptoms and dieting scores between those with PCOS and a control group, indicating that PCOS did not predispose women to developing an eating disorder, it does appear that those with a predisposition to eating disorders may be triggered by the focus on weight loss within treatment for PCOS and by their unexplained weight gain. It may not be that PCOS makes anyone more likely to develop an eating disorder, but that the unhealthy focus of diet and exercise may trigger those who are more susceptible to such conditions. Where eating disorders and PCOS do co-exist, it is important that this is well-managed by health professionals with successful treatment of PCOS and its symptoms lessening the likelihood of unhealthy eating behaviours, with less emphasis on controlling weight and improving negative affect through diet and exercise, and more information provided on the causes and management of this specific weight gain.
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Fairburn, C. G. & Beglin, S. J. (1990). Studies of the epidemiology of bulimia nervosa. The American Journal of Psychiatry, 147, 401-08.
Marshall, J. C. & Dunaif, A. (2012). All women with PCOS should be treated for insulin resistance. Fertility and Sterility, 97, 18-22.
Michelmore, K. F., Balen, A. H. & Dunger, D. B. (2001). Polycystic ovaries and eating disorders: Are they related? Human Reproduction, 16, 765-69.
Morgan, J., Scholtz, S., Lacey, H. & Conway, G. (2008). The prevalence of eating disorders in women with facial hirsutism: An epidemiological cohort study. International Journal of Eating Disorders, 41, 427-31.
Ormsby, M. (2016). Retrieved from: https://www.mirror-mirror.org/pcos-and-eating-disorders.htm
Teede, H. J., Misso, M L., Deeks, A. A., Moran, L. J., Stuckey, B. G. A., Wong, J. L. A., Norman, R. J. & Costello, M. F. (2011). Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline. Medical Journal of Australia, 195, 65-112.
Yau, Y. H. C. & Potenza, M. N. (2014). Stress and eating behaviours. Minerva Endocrinology, 38, 255-67.