A Complex Connection

There’s a complicated connection between depression and eating disorders.
The primary reasons for the complexity are the multiple layers of depression, how to address co-occurring disorders such as grief or trauma, and getting to the source of both the depression as well as the eating disorder.

Types of Depression

According to WebMD, clinical depression has numerous distinctions:

• Major depressive disorder, a form of clinical depression that may happen once, or be reoccurring.
• Persistent depressive disorder, which is clinical depression that lasts for two years or longer.
• Bipolar disorder, a combination of extreme low, depressive moods and high, excitable periods.
• Seasonal affective disorder, which many people experience during the fall and winter months when there’s less sunshine to help the body produce mood-enhancing vitamin D.
• Psychotic depression, a type of clinical depression combined with delusions, hallucinations, and paranoia.
• Postpartum depression, a condition some women experience after giving birth, often related to hormonal and brain chemistry changes.
• Premenstrual dysphoric disorder, which is often related to the hormonal shifts women experience prior to their cycles starting.
• Situational depression, a form of depression often triggered by a stressful event. Also referred to as stress response syndrome.
• Atypical depression, which differs from melancholic conditions in that someone’s mood will improve if something positive happens, and they can sustain that feeling for some time.

Risk Factors

Risk factors for depression include abuse, anxiety, chronic pain, conflict, grief or loss, genetics, medical complications, prescription medication, sleep difficulties, substance abuse, sudden life changes, and traumatic events. These risks are also frequently warning signs of the disease.

Symptoms

Various depressive conditions often share similar symptoms:

• Agitation and irritability
• Excessive sleep or, conversely, insomnia and difficulty falling or staying asleep
• Fatigue
• General discontent and sadness
• Guilt
• Hopelessness
• Inability to let go of negative thoughts
• Inability to focus on daily tasks or personal self-care
• Increased or decreased appetite, binge eating, or refusal to eat
• Lack of concentration
• Lack of socialization
• No pleasure or interest in activities
• Substance abuse
• Suicidal thoughts or attempts
• Weight loss or gain

A 2015 medical study determined that “mood disorders were more frequent among eating disorder (ED) patients than the control group, with a global prevalence of the order of 80 percent for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders…mood disorders in some cases preceded and in others followed the onset of eating disorders.”

Most Common Eating Disorders

There are three primary categories of eating disorders:

• Anorexia Nervosa: people believe they’re overweight when in reality they’re starving themselves thin. They may avoid meals altogether, get rid of food through extreme exercise, laxative use, or vomiting (also known as purging), or repeatedly eat the same foods in small quantities.
• Binge Eating Disorder: a person has frequent compulsive episodes of overeating, but doesn’t purge additional calories. This condition often leads someone being overweight or obese.
• Bulimia Nervosa: an individual compulsively engages in binge eating, followed by some form of purging. As a result, he or she may have a normal weight, but live with a fear of gaining weight and have a distorted body image.

A sub-category, “eating disorders not otherwise specified,” or EDNOS, includes disorders combined with other factors, including specific compulsive eating behaviors that lead to a process addiction.

Risks and Symptoms

Risks and symptoms for eating disorders range considerably, but the Anxiety and Depression Association of America (ADAA) indicates “two-thirds of people with eating disorders suffer from anxiety…and the odds of developing bulimia are greater for women with PTSD and social anxiety disorder.” WebMD points to research indicating “as many as half of all patients with binge eating disorder have a history of depression…and depression also plagues many people with anorexia, who are 50 times more likely than the general population to die as a result of suicide.”

Depression and Eating Disorders Pose a Real Health Threat

This WebMD article references the work of physician Ira Sacker, author of Regaining Your Self: Understanding and Conquering the Eating Disorder Identity. He says that most people with eating disorders also have emotional trauma. “They feel that they’re not good enough and become obsessed with perfectionism.” But at the core, he says, is depression and anxiety. The same article quotes researcher Lisa Lilenfeld of Argosy University, who says, “being underweight and malnourished, which is common in anorexia, can cause physiological changes known to negatively affect mood states.”

In a post for the National Eating Disorders Association, Karen Lynn Cassidy says depressed individuals often “lack the motivation and energy to complete any treatment because their depression symptoms of apathy, fatigue, flat affect, and disturbed appetite are difficult to manage without also having the overlay of an eating disorder.” Cassidy is a former board president of the ADAA. She notes that when a patient presents with an eating disorder, some clinicians treat that intensely, but if depression is also a factor, they simply medicate it “without the benefit of offering other therapies that are powerful anecdotes to depression.”

Statistics

The National Association of Anorexia Nervosa and Associated Disorders offers some startling statistics:

• About 30 million people “of all ages and genders suffer from an eating disorder in the U.S.”
• Out of all mental illnesses, people with eating disorders have the greatest mortality rate.
• One in five people with anorexia commits suicide.
• Between 33–50 percent of patients with anorexia have some type of mood disorder, and nearly 50 percent of people who have bulimia have a mood disorder, usually depression.
• One in 10 people who struggle with binge eating also abuse drugs and alcohol.

Healing Mood Disorders at Cottonwood Tucson

Depression, anorexia nervosa, bulimia nervosa, binge eating, and EDNOS are disorders that respond well to focused treatment. Getting to the heart of trauma, grief, and other psychological conditions help an individual regain a healthy self-image and learn more effective ways to handle depression.

Take this self-assessment quiz. If you or a loved one has more than two “yes” answers, contact our expert staff at Cottonwood Tucson to schedule a more thorough medical assessment.