Written by: Holly Willis, PMHNP-BC
Nurse Practitioner, The Renfrew Center
Research shows that people with polycystic ovary syndrome (PCOS) are at higher risk for developing an eating disorder. In this post, we explore theories about the relationship between the two and where to go next if you’re struggling.
What is POCS?
Polycystic ovarian syndrome, or PCOS, is a common hormonal disorder that affects up to 15% of people assigned female at birth during their reproductive years. In people with PCOS, the ovaries produce increased amounts of male sex hormones, known as androgens. While the cause of PCOS is not fully understood, it is known to run in families.
People with PCOS also often have insulin resistance, meaning their body does not use insulin well, which may cause higher levels of androgens. Symptoms of PCOS can include irregular periods, excess body hair, weight gain around the abdomen, acne, fertility issues, skin tags, patches of dark or thick skin, and cysts on the ovaries. The medical specialty that manages PCOS is endocrinology.
Why are people with PCOS more likely to develop eating disorders?
Research shows that people with PCOS have about three times the likelihood of having an eating disorder than those without PCOS. While the reason behind this relationship is unclear, several theories have been proposed.
Most explanations have to do with the role of insulin, especially in terms of PCOS and its relationship to binge eating symptoms. Additionally, due to insulin resistance, many people with PCOS experience weight gain and often report shape and weight concerns. Unfortunately, many medical providers often focus on weight and prescribe weight loss as a form of treatment. Some patients may intentionally pursue it by turning to disordered eating behaviors, such as severe food restriction or compensatory behaviors, such as purging or over-exercise.
What are the risk factors for someone with PCOS to develop an eating disorder?
The literature reports that factors such as body dissatisfaction, weight concerns, eating concerns, depressive symptoms, and higher body weight are risk factors for eating disorders amongst those with PCOS.
If someone with PCOS engages in dieting in response to these risk factors, they appear to be at higher risk for developing an eating disorder. Dieting can also be a gateway to other weight loss strategies, such as purging by self-induced vomiting or laxative abuse.
In fact, one study found at five-year follow-up that dieters were more likely to engage in purging. The authors of that study proposed that dietary restriction recommended to those with PCOS, often from an early age, increases the risk of developing an eating disorder during their lifetimes.1
Why are those with PCOS at higher risk of bingeing behaviors?
Many theories attempting to explain increased bingeing behaviors in PCOS revolve around the role of insulin.
The hormone insulin signals our cells to use glucose found in the bloodstream for energy. Because of insulin resistance, most people with PCOS have high levels of insulin as their bodies try to overcome that resistance. These high levels of insulin can lead to hypoglycemia, or low blood sugar, that can stimulate appetite and lead to cravings for carbohydrates. These cravings can lead to binge eating episodes.
Alteration in insulin function can lead to weight gain which triggers the desire to lose weight. When an individual attempts weight loss through restriction, it can set off a restrict-binge cycle in which the person is biologically hungrier following a period or dieting, which may lead to bingeing symptoms.
Can PCOS contribute to the development of eating disorder behaviors other than bingeing?
While much of the research related to PCOS and eating disorders focuses on binge eating episodes, those with PCOS are susceptible to other eating disorder symptoms.
The pursuit of weight loss through dieting, often recommended by medical practitioners as treatment for PCOS, can set into motion the futile weight loss cycle. The futile weight loss cycle occurs when a person attempts to lose weight through dieting, frequently in the form of calorie restriction. In most cases, the diet is either not sustainable or fails to deliver the desired weight loss, so the individual ceases weight loss efforts. Through various metabolic and dietary processes, the individual usually lands at a higher weight than when they started the dieting process.
When weight increases, the individual will often redouble their weight loss efforts and the cycle of restriction repeats. This cycle can occur repeatedly throughout an individual’s lifetime, as they continually pursue weight loss goals that are likely unachievable or unsustainable. If they repeatedly engage in compensatory behaviors to lose weight, such as self-induced vomiting, over-exercise, laxative use, diet pill use, or fasting in response to bingeing, they may meet criteria for bulimia nervosa diagnosis.
A diagnosis of anorexia nervosa is met when an individual reaches a significantly low body weight using eating disorder behaviors, however symptoms of anorexia can occur at any weight.
If you have PCOS and are struggling with your relationship with food or your body, consider working with a therapist, a dietician and a medical provider that take a weight-inclusive treatment approach, such as Health at Every Size. These providers are less likely to focus on weight or prescribe restrictive diets that can lead to bingeing or other disordered eating behaviors.
Seek specialized eating disorder treatment if you are experiencing eating disorder symptoms, such as restricting, bingeing, or purging. It is important to attend to your mental health; if possible, seek support for any symptoms of depression, anxiety, or other mental health disorders, as well. You deserve compassionate and weight inclusive support for both your physical and mental wellbeing.
- Pagoto S, Bodenlos JS, Kantor L, Gitkind M, Curtin C, & Ma Y (2007). Association of major depression and binge eating disorder with weight loss in a clinical setting. Obesity, 15, 2557–9. doi: 10.1038/oby.2007.307