Teasing out the functional relationship between wider
anxiety phenomena and/or the presence of a primary anxiety
disorder can be challenging, and even after weightrestoration
anxiety symptoms tend to persist [93]. Detailed
functional analysis of behavioural and cognitive rituals, the
scope of intrusive thoughts, the scope of avoidance, and
any other symptoms of fear may help clarify how these
features are directly part of AN or more correctly attributed
to another primary anxiety disorder. Importantly,
anxiety symptoms may not be reported due to the success
of avoidance or engaging in subtle “safety behaviours” that
keep symptoms at bay. In such cases, anxiety symptoms
may only emerge once there are treatment demands for
change. As a result, the absence of anxiety symptoms on
initial assessment should not be taken as evidence of the
absence of anxiety.
Obsessions and compulsions particularly increase with
starvation, and sometimes to an intensity that is comparable
to people with OCD. Conclusions about the presence
of a primary anxiety disorder should wait until the effects
of starvation have abated