Understanding the Intersection of Eating Disorders and Depression
Written by Emily Costa
Eating disorders and depression are two significant health challenges that often intersect, creating a complex web of mental health issues. This article aims to delve deeper into this intricate relationship, shedding light on the ways these two conditions influence and exacerbate each other.
What co-occurring illnesses are
The importance of treating co-occurring illnesses in eating disorder treatment
Eating disorder symptoms
Depression symptoms
How eating disorders and depression are diagnosed
The statistical connection between eating disorders and depression
The importance of treating depression and eating disorders together
Reaching out for help
What is a co-occurring illness?
A co-occurring illness, also known as a comorbid condition, refers to when two or more disorders or illnesses occur in the same person, simultaneously or sequentially.
In the context of eating disorders, a co-occurring illness is often a mental health disorder that exists alongside the eating disorder. This is common due to the psychological elements involved in eating disorders.
Depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder are examples of mental health conditions that are often co-occurring illnesses with eating disorders.
What is the importance of treating co-occurring illnesses in eating disorder treatment?
It is essential to treat co-occurring illnesses in the context of eating disorder treatment for several reasons.
Firstly, untreated mental health conditions can often exacerbate the symptoms of an eating disorder, creating a vicious cycle that makes recovery more challenging. For instance, if someone with anorexia nervosa also suffers from depression, their low mood might further decrease their appetite and reinforce their eating disorder behaviors.
Secondly, these coexisting mental health disorders might have contributed to the development of the eating disorder in the first place.
Lastly, having a co-occurring illness can significantly impact an individual's quality of life and overall health prognosis. Therefore, addressing both the eating disorder and the co-occurring illness simultaneously offers the best opportunity for full recovery and improved quality of life.
Let's talk eating disorders and disordered eating symptoms
Eating disorders manifest themselves through numerous physical, emotional, and behavioral signs, which can often be indicative of unhealthy weight control behaviors or an unhealthy relationship with food.
These symptoms can range from severe restriction of food intake, extreme concern with body size and shape, frequent checking in the mirror for perceived flaws, to recurring episodes of binge eating followed by compensatory behaviors such as forced vomiting, excessive use of laxatives, or extreme fasting.
Disordered eating symptoms, while not meeting the strict diagnostic criteria of specific eating disorders, involve a range of irregular eating behaviors that might not be healthy or appropriate. These can include chronic yo-yo dieting, frequent weight fluctuations, rigid rituals and schedules around food, and feelings of guilt or shame associated with eating.
Below are a few common symptoms:
Rapid weight loss or frequent weight changes
Obsession with calories and fat contents of food
Avoidance of social functions, family, and friends
Development of food rituals (e.g., eating foods in certain orders or rearranging food on a plate)
Consistent dieting even when thin
Frequent checking in the mirror for perceived flaws in appearance
Continual complaints about being fat despite being underweight
Compulsive or excessive exercising
Noticeable discomfort around food
Use of bathroom directly after meals
Mood swings, depression, fatigue
Understanding depression and its common symptoms
Depression, also known as major depressive disorder or clinical depression, is a common and serious mood disorder. It's more than just feeling down or experiencing a temporary bout of sadness—it is a persistent problem that can cause significant distress and impact every aspect of a person's life.
Depression encompasses a range of emotional, cognitive, physical, and behavioral symptoms.
Here are some of the most common signs and symptoms of depression:
Persistent sad, anxious, or "empty" mood
Loss of interest or pleasure in activities once enjoyed, including sex
Feelings of hopelessness, pessimism, or a sense of impending doom
Irritability or restlessness
Decreased energy, fatigue, or a feeling of being "slowed down"
Difficulty concentrating, remembering, or making decisions
Insomnia, waking up too early, or oversleeping
Appetite or weight changes—significant weight loss when not dieting, or weight gain
Thoughts of death or suicide, suicide attempts
Physical symptoms that do not subside with treatment, such as headaches, digestive disorders, and chronic pain
It's crucial to remember that symptoms for both eating disorders and depression vary in severity and frequency from one person to another.
Diagnosis of depression and eating disorders
Diagnosing depression or an eating disorder involves a comprehensive evaluation conducted by a healthcare professional. For depression, this typically entails a psychiatric assessment and physical examination. The professional might use specific diagnostic criteria based on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria evaluate the intensity, duration, and type of symptoms, and rule out other potential causes of these symptoms.
Diagnosis of an eating disorder also involves a thorough evaluation, which may include a physical exam, lab tests, psychological evaluation, and discussion of eating habits. A diagnosis of eating disorders is typically based on the presence of specific symptoms that meet the criteria outlined in the DSM-5.
Both depression and eating disorders are complex conditions that require a nuanced understanding of the individual's experiences, behaviors, and symptoms. Therefore, seeking help from a professional who specializes in diagnosing and treating eating disorders and co-occurring illnesses is extremely important. These professionals are adept at identifying the nuances of these conditions and can provide the most accurate diagnoses.
Related: How are eating disorders diagnosed?
Statistical connection between eating disorders and depression
Up to 50% of individuals with eating disorders also meet the criteria for depression. Moreover, individuals with eating disorders are four times more likely to have a lifetime diagnosis of major depressive disorder compared to those without eating disorders.
Additionally, another study discovered that 94.5% of women with Bulimia Nervosa also had a lifetime diagnosis of another psychiatric disorder, including major depressive disorder.
These statistics highlight the profound link between eating disorders and depression, emphasizing the importance of comprehensive diagnosis and treatment strategies that address both conditions simultaneously.
Does one cause the other? How do you determine which came first?
Establishing the causality between depression and eating disorders can be a complex task due to their bidirectional relationship. It's much like the chicken-and-egg conundrum, where it's challenging to ascertain which came first.
On one hand, the stress and anxiety caused by an eating disorder, such as anorexia nervosa or bulimia nervosa, can lead to depressive symptoms. The constant pressure to maintain a certain body image, coupled with the physical exhaustion of constant dieting, binging, or purging, can trigger feelings of sadness, hopelessness, and a lack of interest in everyday activities, which are hallmarks of depression.
Conversely, individuals with depression may resort to disordered eating behaviors as a way to cope with their depressive symptoms. The act of controlling one's diet and body size might provide a temporary relief from the feelings of despondency and lack of control associated with depression.
However, this relief is short-lived and can ultimately intensify the symptoms of depression, leading to a vicious and potentially harmful cycle. Therefore, while it can be difficult to determine definitively whether depression leads to eating disorders or vice versa, it is clear that the two are intimately interconnected and often fuel one another.
The importance of simultaneous treatment for depression and eating disorders
In light of the significant interplay between depression and eating disorders, it becomes essential to address both conditions concurrently during treatment. A comprehensive, multi-faceted approach that tackles both conditions simultaneously is typically the most effective.
Psychotherapy, particularly cognitive-behavioral therapy (CBT), has demonstrated efficacy in treating both depression and eating disorders. CBT helps individuals identify and alter problematic thought patterns and behaviors, thereby reducing depressive symptoms and disordered eating tendencies.
In addition to CBT, medication is another common modality used in treatment. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), can be effective for managing symptoms of both depression and certain eating disorders.
Moreover, nutritional counseling is integral to the treatment of eating disorders. A dietician can guide individuals toward healthier eating habits while also addressing body image issues and fears about weight and food.
It should be emphasized that the treatment plan should be personalized to the client’s needs and should also consider any other co-occurring conditions. In addition, the recovery process should involve a multidisciplinary team of healthcare professionals, possibly including a psychiatrist, therapist, and dietician.
Related: 6 Common Cognitive Distortions Behind Eating Disorders
Reaching out for help
It's critical to remember that you are not alone if you or someone you know is struggling with depression, an eating disorder, or both. It may seem overwhelming, but help is available, and recovery is attainable.
Central Coast Treatment Center specializes in treating co-occurring conditions and is always ready to answer your questions and guide you through the process of understanding and treating both conditions. Our team of dedicated professionals are committed to providing comprehensive, personalized care.
Reach out to us today to learn more about treatment options.
Emily Costa
Having struggled with an eating disorder herself, Emily is passionate about spreading awareness, education and the possibility of recovery with others. Emily previously volunteered as a Crisis Text Line counselor and with the eating disorder non-profit Project HEAL where she served as their blog manager, their NYC Chapter Leader & a recovery mentor in their Communities of HEALing pilot program completing training by the Carolyn Costin Institute. Emily now enjoys working with various treatment centers, clinicians and non-profits in the eating disorder community providing marketing and design services. In her free time she enjoys spending time with friends, hanging with her dogs, and reading a book at the beach.