PCOS NUTRITION CENTER BLOG

There is a strong link between PCOS and mood and eating disorders. So much so that the current International Evidence-Based Guidelines for PCOS recommends health care providers be screening all patients with PCOS for eating and mood disorders.

While the prevalence of eating disorders is particularly high among women of reproductive age, women suffering from PCOS tend to be at an even greater risk.

Women who suffer from PCOS tend to experience higher levels of androgens and insulin, which may stimulate binge eating behaviors due to an increased appetite and reduced impulse control around food.  Excess insulin may trigger women with PCOS to eat despite feelings of satiety, a behavior that may result in cycles of overeating or binge eating. Furthermore, when women with PCOS suffer from weight gain, they become more likely to develop negative body image and feelings of body dissatisfaction. In effect, these women are at risk for developing eating disorders. Let’s explore the findings present in scientific literature to understand why screening for eating and mood disorders is recommended for all women diagnosed with PCOS and what needs to be done to better treat it.

PCOS and Higher Rates of Eating Disorders

A study exploring the prevalence of eating disorders in women with PCOS found that in comparison to women unaffected by PCOS, women with PCOS had higher rates of clinical and subclinical bulimia nervosa. This study also discovered that eating disorders in women with PCOS may have a negative impact on the results of their PCOS treatment. Overall, the study concludes it is essential to consider eating disorder screening in women who suffer from PCOS; moreover, these women may need psychological treatment to manage the eating disorders they have developed as a result of their PCOS.

Substantiating these findings, another study reports a higher rate of eating disorders among women suffering from PCOS – 11% in these women compared to 7.6% in women without PCOS.  Additionally, a 2020 study found PCOS women to have higher scores of binge eating, restraint eating, body shape concerns and eating concerns than women without PCOS. Together, these studies confirm the relationship between PCOS and an increased risk for developing an eating disorder, and stress the importance screening and treatment.

Depression and Anxiety Among those with PCOS

Unfortunately, PCOS may affect more than just a person’s eating habits and relationship with food. Multiple studies have identified a correlation between PCOS and depression and anxiety. In addition to highlighting a correlation between PCOS and an increased chance of experiencing symptoms of anxiety and depression, a 2018 study also outlines a lower quality of life among women struggling with PCOS. Both infertility and worries surrounding weight influence the lower quality of life reported by these women.

A study exploring Racial differences in anxiety, depression, and quality of life in women with polycystic ovary syndrome found higher rates of anxiety in white women with PCOS in comparison to black women with PCOS; however, black women with PCOS were found to have lower quality-of-life scores than white women with PCOS. Keeping these findings in mind, it is important for all women struggling with PCOS to regularly check in with themselves and make note of any mood changes that could be due to their PCOS.

PCOS, Self-esteem and Psychological Distress

Delving deeper into the discussion of PCOS and a higher prevalence of mood disorders, various studies reveal that women with PCOS are at a greater risk for experiencing low self-esteem and psychological distress – two elements that may contribute to the development of an eating disorder.  One study published in 2019 found that 31.7% of women with PCOS had low self-confidence, compared to only 24.2% of women without PCOS. Moreover, this study notes a higher prevalence of psychological suffering in women with PCOS; while only 13.5% of women without PCOS experienced symptoms of psychological distress, 21% of women with PCOS were found to be struggling psychologically. Not only does this study affirm that women with PCOS are more likely to have lower self-esteem and experience psychological distress, but it also stresses that these two factors enhance the risk for women with PCOS to develop an eating disorder.

Why Screening is Necessary

Due to the correlation between PCOS and a greater prevalence of eating and mood disorders, multiple studies suggest women with PCOS undergo routine screening for these disorders.  In accordance with the International PCOS Guidelines, studies that identify a lower quality of life in women struggling with PCOS conclude the PCOS population should be screened for anxiety, depression and eating disorders. Furthermore, due to reports of a lower quality of life in PCOS women, routine evaluation of quality-of-life symptoms is also recommended.

The Need for Weight-Neutral Treatment

It is clear that dieting and attempts at weight loss increase one’s risk for an eating disorder. Given the unique challenges women with PCOS face: increased carbohydrate cravings, impaired appetite regulating hormones, lower basal metabolic rate, history of yo-yo dieting, etc. it would be more beneficial for this population to be treated with a weight neutral approach which does not focus on weight loss, but rather making sustainable lifestyle changes. These include self-care skill such as mindful or intuitive eating, supplements and medications, enjoyable exercise, improved sleep and stress management practices.

*Health Care providers can learn more about using a weight-neutral approach in the Online PCOS Training Course for RDNs.

**Patients with PCOS who struggle with mood or eating disorders may want to consider enrolling in the PCOS COMPLETE online course which takes a weight-neutral, non-diet approach to managing PCOS.

Conclusion

In summary, scientific literature emphasizes the relationship between PCOS and a greater risk for experiencing eating and mood disorders. PCOS weight gain may directly impact a person’s body image and self-confidence, which essentially increases the probability of developing an eating disorder, psychological distress, and symptoms of anxiety and depression. With these disorders being more common among people struggling with PCOS, routine screening for eating and mood disorders remains crucial. If you find yourself suffering from a mood or eating disorder, we encourage you to reach out for support from providers trained in mental health and eating disorders. As always, we at the PCOS Nutrition Center are here to help.

Sources:

https://doi.org/10.1016/j.xfre.2021.03.003

https://doi.org/10.1080/09513590.2020.1744554

https://doi.org/10.1016/j.fertnstert.2018.01.038

https://doi.org/10.1016/j.fertnstert.2019.03.027

Reviewed by PCOS Founder and Nutrition Expert Angela Grassi, MS, RDN

Hi! My name is Adriana Gildone, and I am a senior Comprehensive Science major at Villanova University. I plan to obtain a Master of Science in Nutrition after graduating from Villanova next spring. I am interested in studying women and children’s health, particularly in regard to disease prevention and eating disorder treatment. With a passion for nutrition and wellness, I love to cook, bake and be active. In my free time, I also enjoy babysitting and traveling.