The Connection Between Eating Disorders And Depression

Eating disorders often occur alongside other mental health conditions, most commonly mood disorders, anxiety disorders, and substance use disorders. Depression is a mood disorder that can also be connected to anxiety and substance use, which can make symptoms a factor in the diagnosis and treatment of eating disorders. Below, explore how depression and eating disorders are connected and how this connection can affect treatment.

Depression and eating disorders: Anorexia nervosa, bulimia nervosa, and binge eating disorder

Anorexia nervosa

Major depressive disorder is highly prevalent in people with anorexia, and it can affect symptom severity and recovery. Someone with anorexia and major depressive disorder is at higher risk for severe clinical symptoms, is more likely to have difficulty gaining weight in treatment, and has a higher risk of suicide. They are also more likely to die from their illness.

Bulimia nervosa

Some older data indicates that about 63% of people with bulimia have major depression; between 50% and 65% of people with bulimia experience major depression at some point in their lifetime. Depression and bulimia share many contributing factors, including low self-esteem, low self-worth, and problems with negative body image, and may be connected to childhood trauma.

Binge eating disorder

Reviews of studies on binge eating disorder have found that between 30% to 80% of people who binge have a comorbid anxiety or mood disorder. Research has shown that binge eating disorder and depression have a significant relationship and that depression is a potential cause of and a risk factor for binge eating.

The connection between eating disorders and depression

Depression and eating disorders affect everyone differently, but there are multiple ways they may be connected. For example, depression can have varying effects on appetite. Some people may overeat because it comforts them, while others may avoid food because nothing tastes as good as before or because they don’t have the desire or energy to prepare or order meals. 

Research has shown that both overeating and a lack of appetite in depression are tied to changes in the brain. This type of emotional response to eating is not the same as an eating disorder, but overeating or avoiding food as a result of depression can be considered disordered eating, which is a risk factor for developing one. 

Eating disorders may also be connected to how someone thinks. Someone with an eating disorder may find understanding how to deal with their emotions difficult and turn to disordered eating behaviors to help them cope. Not everyone with an eating disorder has depression, and not everyone with depression develops an eating disorder. However, when these conditions co-exist, studies have found that it can make both conditions more complicated and more difficult to treat.

Overlapping symptoms: Weight changes, behavior, and physical symptoms 

Some symptoms of depression and eating disorders can overlap, including in the following ways. 

Behavioral symptoms

Eating disorders and depression can both cause people to withdraw from friends and family and lose interest in hobbies and activities that they once enjoyed. They can cause sleep problems, fatigue, difficulty concentrating, and feelings of guilt or shame. Both eating disorders and depression can affect social and occupational functioning, significantly disrupting a person’s daily life.

Weight changes

Both depression and eating disorders can lead to weight loss or weight gain. Weight changes may not be as extreme as for those with anorexia or binge eating disorder. However, the person may still experience notable weight fluctuations that can be severe depending on how long the condition goes on. 

Other physical and mental health problems

Eating disorders and depression can both cause cramps or other non-specific gastrointestinal problems. People with these conditions may experience substance misuse, and both depression and eating disorders put people at higher risk of suicide. For this reason, seeking medical support from your doctor when you notice physical symptoms of any condition can be critical to ensuring early intervention. 

Is it depression, an eating disorder, or both?

Everyone experiences the symptoms of eating disorders and depression differently. Some people may experience both conditions simultaneously, but not everyone will. Only a mental health professional can diagnose mental health conditions, and some physical illnesses may mimic signs of mental illnesses and vice versa. Seeking professional intervention can help you ensure you receive the right treatments. 

People with eating disorders generally have symptoms that focus significantly on food, exercise, and their bodies. They may talk a lot about weight or food and exercise excessively. Depending on the type of eating disorder, people may take laxatives or diet pills, binge, purge, or refuse to eat in front of other people. In severe cases, people with eating disorders can become malnourished, which can lead to significant health issues, including weakness, dizziness, and dry and blotchy skin. Some of these health issues, like heart palpitations and other cardiac problems, can require hospitalization.

Symptoms of depression can also interfere with someone’s day-to-day functioning, but not necessarily in the same way. For example, someone with depression is more likely to experience a lack of energy or fatigue than to engage in excessive exercise.

Can depression cause an eating disorder?

While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) considers eating disorders and depression as two separate and distinct conditions, some research indicates that depression and eating disorders may have a bi-directional relationship and that eating disorders may incite the onset of depression and vice versa. Determining whether depression symptoms occurred before the onset of eating disorder symptoms can have implications for treatment.

Other mental health conditions that can occur with an eating disorder

Depression is not the only mental health condition that can co-occur with eating disorders. Considering comorbid mental health conditions can be part of ensuring effective treatment. In one study, 65% of women who sought treatment for an eating disorder also met the criteria for at least one anxiety disorder. Of those, 69% indicated that symptoms of the anxiety disorder predated the beginning of the eating disorder. 

Studies have also linked general anxiety disorder to eating disorders, concluding that “the presence of one significantly increases the likelihood of the other.” Social anxiety is also found at higher rates in people with eating disorders. Some statistics show that as much as 84.5% of people with bulimia also have social anxiety. The lifetime prevalence of comorbid substance use disorders is also high at 27.9%, with the lifetime prevalence of illicit drug use being 17.2% for anorexia and 18.6% for bulimia and alcohol use at 22.4% and 24.4%, respectively.

Types of treatment

Treatment for eating disorders varies from person to person and generally depends on the type and severity of the eating disorder and any co-occurring mental health conditions. People who experience significant medical complications may require hospitalization for monitoring, refeeding, and correcting electrolyte imbalances. Others may be admitted to residential treatment facilities or day programs until they can manage their symptoms on an outpatient basis. 

Psychotherapy is often a recommended intervention in treating eating disorders and the mental health conditions that can occur with them, including depression. Multiple types of approaches to therapy may be effective, including cognitive-behavioral therapy (CBT), interpersonal therapy, and dialectical behavior therapy (DBT).

Therapy options

Living with a mental illness can make getting to appointments with a therapist tricky. If you are experiencing symptoms of depression, an eating disorder, or both, online therapy can be a convenient and flexible way to get support throughout your recovery and to support your mental health in the long term. With an online therapy platform like BetterHelp, you can work with a qualified mental health professional from the comfort of your home or anywhere you have a reliable internet connection. Clients are often matched with a provider within 48 hours of signing up and can change therapists at any time, free of charge. 

Research has found that online therapy can be an effective way to manage the symptoms of eating disorders and comorbid mental health conditions. For example, one study found that online enhanced cognitive-behavioral therapy led to a significant reduction in eating disorder symptoms, depressive symptoms, and functional impairment and that these results were maintained at a three-month follow-up.