Understanding catastrophic worry in eating disorders: Process and content characteristics

Background and objectivesThe majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.MethodsTwenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.ResultsCompared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.LimitationsThe degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.ConclusionFindings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.

► Worry is a relevant but under-studied concept in Eating Disorders (ED).
► Catastrophic worry processes were examined using a standardized interview measure.
► Catastrophic worry content was explored with Thematic Analysis.
► Individuals with ED have elevated worry and engage in catastrophic worry.
► Worry content concerned both ED topics and much broader psychological difficulties.