Understanding depression and eating disorders

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When someone enters treatment for an eating disorder, it is important they receive a comprehensive assessment to determine any underlying or co-occurring problems that may have contributed to the development of the eating disorder. In some cases, depression may occur alongside an eating disorder, like anorexia or bulimia. In fact, depression and eating disorders often overlap.

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Depression and eating disorders: an overview

Depression is a common mental health disorder, with an estimated 8.4 percent of U.S. adults experiencing an episode of depression within the previous year, as of 2020, according to one study. (1) Eating disorders are less common, with recent reports indicating 1.2 percent of adults have binge eating disorder within a given year, and 0.3 percent have bulimia. Furthermore, 0.6 percent of adults will experience anorexia at some point during their lives. (2)

While eating disorders may not be as prevalent as depression, it is common for individuals with eating disorders to have other psychiatric diagnoses. In fact, a study of over 2,000 women receiving treatment for an eating disorder found 94 percent of them had a co-occurring mood disorder, with depression being the most common co-occurring diagnosis. (3) Eating disorders are relatively rare in the population as a whole, but many individuals with these conditions also live with depression.

How do depression and eating disorders interact?

Research shows depression is extremely common among individuals who live with an eating disorder. There are several explanations for this overlap. For instance, genetic risk factors can make a person vulnerable to both depression and eating disorders. Furthermore, depression may increase a person’s risk of later developing an eating disorder, which can explain the interaction between these two conditions. (4) 

In addition, there are some overlapping psychological and social factors that can contribute to both eating disorders and depression: (4)

  • Perfectionistic personality
  • History of being bullied
  • Poor body image 
  • Rigid thinking patterns
  • Lack of social support

While there is no single cause of co-occurring depression and eating disorders, there are risk factors that can contribute to the development of both conditions.

Depression and eating disorders by eating disorder diagnosis 

There is an interaction between depression and eating disorders on the whole, but depression rates can vary among individual eating disorder diagnoses. Below is the breakdown of how depression can overlap with the three most common eating disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Depression and anorexia nervosa

National data shows significant overlap between depression and anorexia nervosa (AN). Within their lifetimes, 42.1 percent of people with anorexia will experience a mood disorder, which is the category that encompasses depression. (2) 

Depression and bulimia nervosa

Depression may be even more common among individuals with bulimia nervosa (BN), as 70.7 percent of those with this eating disorder will be diagnosed with a mood disorder at some point during their lives. (2)

Depression and binge eating disorder

Depression is also common among those with binge eating disorder (BED). The lifetime prevalence of a co-occurring mood disorder in people who live with binge eating is 46.4 percent. (2)

Treating co-occurring depression and eating disorders 

Treatment for eating disorders and depression can vary based upon each individual’s unique needs and eating disorder diagnosis. Most important is receiving a comprehensive treatment plan that addresses both the eating disorder and the depression. If depression is left untreated, eating disorder symptoms may return, and vice versa. 

Treatment begins with a thorough assessment, in which a team of professionals evaluates eating disorder symptoms, as well as physical and mental health and functioning in various areas of life, such as in relationships and at work or school. The treatment plan will then address any areas of need.

Oftentimes, individuals will work with a dietician throughout the recovery process to ensure they receive adequate nutrition. A doctor may be part of the treatment team to address any underlying medical conditions that have arisen as a result of the eating disorder. Finally, a therapist will address the underlying issues that led to depression and an eating disorder. 

A specific type of counseling called cognitive behavioral therapy (CBT) is often used to treat depression, and the research shows that it can also be effective for treating eating disorders. (5) In cognitive behavioral therapy, patients can learn to overcome negative thoughts about themselves and replace them with more balanced ways of thinking, which can alleviate both depression symptoms and distorted thoughts about food and body image.

There are other types of psychotherapy that have also been found to be effective. They include: 

  • Acceptance and commitment therapy (ACT)
  • Cognitive behavioral therapy (CBT)
  • Cognitive remediation therapy (CRT)
  • Dialectical behavioral therapy (DBT)
  • Emotionally focused therapy (EFT)
  • Exposure therapy
  • Internal family systems (IFS)
  • Interpersonal therapy (IPT)

In addition, there are many other therapies, practices, and activities that can be helpful as part of a comprehensive treatment plan for eating disorders, such as:

  • Art therapy
  • Dance therapy
  • Meditation and mindfulness
  • Movement therapy
  • Music therapy
  • Outdoor activities
  • Sports
  • Yoga 

Ultimately, the best course of treatment for depression and eating disorders depends upon each individual’s needs. Contact our team at Within to begin the treatment process.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. U.S. Department of Health and Human Services. (n.d.). Major depression. National Institute of Mental Health. Retrieved February 28, 2022, from https://www.nimh.nih.gov/health/statistics/major-depression 
  2. U.S. Department of Health and Human Services. (n.d.). Eating disorders. National Institute of Mental Health. Retrieved February 28, 2022, from https://www.nimh.nih.gov/health/statistics/eating-disorders 
  3. Blinder, B.J., Cumella, E.J., & Sanathara, V.A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine, 68(3), 454-462. https://doi.org/10.1097/01.psy.0000221254.77675.f5.
  4. Risk factors. National Eating Disorders Association. (2018, August 3). Retrieved February 28, 2022, from https://www.nationaleatingdisorders.org/risk-factors 
  5. Linardon, J., Wade, T. D., de la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85(11), 1080–1094. https://doi.org/10.1037/ccp0000245
  6. Manlick, C.F., Cochran, S.V. & Koon, J. Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review. Journal of Contemporary Psychotherapy 43, 115–122 (2013). https://doi.org/10.1007/s10879-012-9223-7
  7. Huurne, E.D.T., de Haan, H.A., Postel, M.G., et al. Long-term effectiveness of web-based cognitive behavioral therapy for patients with eating disorders. Eating & Weight Disorders. 2021 Apr;26(3):911-919. https://pubmed.ncbi.nlm.nih.gov/32449152/ 
  8. Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013). Psychological treatments for eating disorders. Current Opinion in Psychiatry, 26(6), 549–555. https://doi.org/10.1097/YCO.0b013e328365a30e
  9. Iryna Ivanova & Jeanne Watson (2014) Emotion-focused therapy for eating disorders: enhancing emotional processing. Person-Centered & Experiential Psychotherapies, 13:4, 278-293, DOI: 10.1080/14779757.2014.910132
  10. Butler, R.M., Heimberg, R.G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, Volume 78. https://doi.org/10.1016/j.cpr.2020.101851. (https://www.sciencedirect.com/science/article/pii/S0272735820300398)
  11. Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple Self in a US eating-disorders treatment center. American Ethnologist, 44(1) 23-35.
  12. Miniati, M., Callari, A., Maglio, A., & Calugi, S. (2018). Interpersonal psychotherapy for eating disorders: Current perspectives. Psychology Research and Behavior Management, 11, 353-369.

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