The Relationship Between Eating Disorders and Depression

Eating disorders are a common illness that affects over 9% of the world population. [1] Eating disorders can be debilitating and even fatal if left untreated, and symptoms range from severely limiting food intake to not being able to control how much you’re eating.

As painful as it is to live with an eating disorder, it may become even more difficult when you’re also dealing with depression. This is a situation many people face. Eating disorders and depression often appear together, leaving people to battle two serious mental health conditions at the same time.

But what is the exact connection between eating disorders and depression? Does one cause the other, and if so, which comes first?

The answer to this question isn’t as simple as you may think. Here’s what we know so far.

What Is Depression?

Major depressive disorder, often just called depression, is a serious and common mental health condition. Over 8% of U.S. adults go through at least one major depressive episode in any given year.^[2]

The symptoms of a major depressive episode include:

• Low or irritable mood
• Inability to concentrate
• Changes in sleep patterns (sleeping too little or too much)
• Changes in eating patterns (eating too little or too much), which may result in weight loss/gain
• Loss of interest in activities you used to enjoy
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Feelings of hopelessness
• Increased thoughts about death or suicide

You must have experienced these symptoms almost all the time for two weeks or more to meet the criteria for depression. Other types of mood disorders that can cause depression include persistent depressive disorder and bipolar disorder.

The Relationship Between Eating Disorders and Depression

There’s still a lot we need to learn about the exact relationship between eating disorders and depression. But one thing is clear: the link between these disorders is strong.

Experts estimate that over 40% of people with eating disorders also have depression. ^[3] One study found that over 90% of patients who were hospitalized for an eating disorder met the criteria for a mood disorder. ^[4]

Depression is the most common psychiatric condition that co-occurs with eating disorders. And this is sometimes a deadly combination: People with eating disorders and depression have a higher rate of suicide death than people without co-occurring depression.

Anorexia and Depression

Anorexia nervosa is a life-threatening eating disorder that causes people to severely restrict their food intake in order to lose weight and achieve their “ideal” body. Anorexia very commonly comes along with depression. The National Institute of Mental Health reports that around 40% of people with anorexia also experience a mood disorder like depression.

Anorexia is unique in that it tends to cause the most severe weight loss and malnourishment. The physical changes in the brain that are caused by this weight loss can worsen depression symptoms.

Some depression symptoms may actually be a direct result of anorexia, rather than depression itself. For example, changes in eating habits, weight loss, and low energy are all symptoms of depression. However, if the person also has anorexia, these symptoms may be due to their eating disorder, and not depression.

One study found that people with both anorexia and depression have more severe anorexia symptoms than people without depression — including lower BMI and more hospitalizations. ^[5]

The Relationship Between Binge Eating Disorder and Depression

Binge-eating disorder is an eating disorder that causes people to go through binge-eating episodes. These episodes usually last for 2 or 3 hours. During this time, they eat more food than is considered normal, and don’t have control over how much or how rapidly they eat.

People who have binge eating disorder can get caught in a vicious cycle. They may have low self-esteem or negative thoughts about their body, which leads them to go on restrictive diets or deny themselves of food they enjoy. After some time dieting, they give in to the urge to binge eat, which may temporarily bring them some emotional relief.

If the person also has depression, this cycle may become even more severe. They may binge-eat as a coping mechanism, which may actually make their depression symptoms even stronger.

One review found that the research so far studying the exact link between binge-eating disorder and depression is inconclusive. But several studies found that people with binge-eating disorder had higher rates of depression and a lower quality of life than people without binge-eating disorder. ^[6]

Binge-eating disorder also often causes weight gain. People with obesity statistically have higher rates of depression than people who aren’t overweight. One study found, however, that overweight people with binge-eating disorder had even higher rates of depression than overweight people without it. ^[7]

The Relationship Between Bulimia and Depression

Bulimia nervosa is an eating disorder in which people go through cycles of binge-eating and purging. A person with bulimia will go through a binge-eating period, much like people with binge-eating disorder. Then, they try to “purge” the excess calories consumed through unhealthy habits like self-induced vomiting.

According to the National Institute of Mental Health (NIMH), bulimia has a higher rate of co-occurring depression than other eating disorders. Over 70% of people with bulimia also have a mood disorder (like depression), compared with 40% of people with anorexia.

Differences Between Eating Disorder and Depression Symptoms

We mentioned earlier that sometimes eating disorder symptoms and depression symptoms overlap. A classic example is a change in eating patterns and weight loss. This is recognized as a symptom of both depression and eating disorders. So how can you tell the difference between these two disorders?

Be honest with your mental health provider about everything you’re experiencing. Your provider can help you untangle which of your symptoms are due to depression, and which are due to an eating disorder — you don’t have to figure it out on your own.

Although only a licensed mental health provider can give you an accurate diagnosis, here are some key differences between depression and eating disorders:

• People with depression may lose their appetite due to their mood. People with eating disorders (with a few exceptions, like people with orthorexia) change their eating habits to lose weight.
• Both people with depression and people with eating disorders often struggle with feelings of worthlessness. But for people with eating disorders, these feelings usually tie in with their body image.
• Both depression and eating disorders can lead people to isolate from their loved ones. For people with depression, this may be because they no longer find pleasure in activities and social interactions they used to enjoy. They may not necessarily be trying to hide their depression symptoms. People with eating disorders often go to great lengths to hide their eating disorder from loved ones.

The main difference between these two disorders is that depression is primarily a mood disorder that may or may not affect someone’s appetite and eating habits. Eating disorders primarily affect someone’s eating habits and body image, and may or may not affect their mood.

Do Eating Disorders Cause Depression (or Vice Versa)?

The research makes clear there is definitely a strong relationship between depression and eating disorders. Which leaves us with the question: Which of these disorders comes first?

Third factors

Both depression and eating disorders are complex mental health conditions. There are multiple causes for each of these conditions — in other words, we can’t definitively say that either is the cause of the other. There may be a third factor that leads to both. Some risk factors for both eating disorders and depression include:

• Genetics
• Family history
• Life circumstances
• Low self-esteem
• Brain chemistry

With that being said, each of these disorders can cause or worsen the symptoms of the other, especially if you’re already at risk for both.

How depression can lead to an eating disorder

If you already live with depression, you may be at higher risk of developing other mental health conditions, including an eating disorder. One of the symptoms of depression is feelings of worthlessness and low self-esteem. Especially if you place a high value on body shape or size, then having low self-esteem could make you feel bad about your body — leading you to develop an eating disorder.

Living with depression can also interfere with eating disorder recovery. Depression often causes a lack of motivation and apathy. This makes it hard for people with depression to make and work toward personal goals. This lack of motivation can also make it difficult for people to find the drive to continue working toward eating disorder recovery.

How an eating disorder can lead to depression

But the reverse is also true: Having an eating disorder could also make you more depressed. Many people with eating disorders get locked in a cycle. They feel depressed, and may overeat to try to find emotional comfort. Although a binge might bring temporary relief, it usually quickly leads to feelings of guilt and shame. These painful feelings can trigger a depressive episode, especially for people who are already at risk.

Research shows having an eating disorder, especially one that makes you malnourished, can also lead to biological changes in your body, which may cause low mood. In one study, malnutrition was found to be a significant risk factor for depression in an elderly population. ^[8] Anorexia, in particular, causes hormonal changes and endocrine dysregulation that have been associated with depression.

Lastly, people with eating disorders often become isolated from their friends and family. This may be self-inflicted — the person with the eating disorder might feel ashamed of their eating habits, causing them to stop sharing meals with their loved ones. The stress of mealtimes can also cause strain in relationships.

One of the factors that protects us against depression is a strong social support system. When someone with an eating disorder becomes socially isolated, this may leave them vulnerable to developing depression.

Treatment for Co-Occurring Eating Disorders and Depression

If you live with both an eating disorder and depression, then treatment can become complex. It’s important that both of these disorders are correctly diagnosed and addressed.

You may feel tempted to start treating your depression rather than your eating disorder. This is normal, but it’s important that you treat both disorders at the same time. Living with an eating disorder can have life-threatening consequences. Although you might feel like you want to address your depression first, it can be dangerous to leave your eating disorder untreated.

Your treatment team should have expertise in both eating disorders and depression, not just one or the other. These disorders are usually treated separately, but simultaneously. Unlike other co-occurring disorders (for example, substance use disorder and post-traumatic stress disorder), there is no treatment model that addresses both eating disorders and depression at the same time.

You might also feel your depression symptoms get worse before they get better. This is normal, and it’s important that you don’t give up on your recovery. As unhealthy as eating disorder behaviors are, many people use them as coping mechanisms. A therapist can help you replace these coping mechanisms with healthier ones, but the difficulty of leaving your eating disorder in the past may trigger some depression symptoms at first.

Therapy

Individual, group, and family therapy can all be effective for people with eating disorders and depression. Specific forms of psychotherapy that are helpful for eating disorders and depression include:

• Cognitive-behavioral therapy (CBT). CBT helps people to notice, and challenge, the way their thoughts affect their emotions and behaviors. For example, both eating disorders and depression may cause someone to have negative thoughts about themselves. They may have untrue thoughts like, “I’m not good enough,” or “I need to lose weight to be worthy of love.” A CBT therapist can help someone notice when they’re having these thoughts and work to change them.
• Dialectical behavior therapy (DBT). DBT was originally designed for people with self-harming and suicidal behaviors. DBT focuses on teaching people coping skills they need to be able to manage strong waves of emotion. DBT may be especially helpful for people with co-occurring eating disorders and depression who struggle with suicidal thoughts.
• Interpersonal psychotherapy (IPT). IPT focuses on your interpersonal relationships, and the ways these relationships interact with your mental health. This may be helpful because both eating disorders and depression can severely and negatively affect relationships. Poor relationships can then, in turn, make it harder to recover from these disorders. By strengthening your relationships, you can help yourself move toward recovery.
• Family therapy. Family-based therapy can also be helpful when you’re going through an eating disorder and depression, especially for young people. Recovery can be easier when your family is on your side. In family therapy, you can explore, together, the way that the people in your life can support you. For example, your family members can learn how to not enable your eating disorder behaviors. Family therapy can also give you an opportunity to explore family dynamics.

Hospitalization and nutritional counseling

Although depression and eating disorders should be treated simultaneously, there are occasions when the eating disorder causes such severe and life-threatening physical consequences that you must be medically stabilized first.

In some cases, hospitalization might be necessary as a first treatment step. In the hospital, your medical team can provide you with supervision to make sure that issues like malnutrition are being properly addressed. You might also receive nutritional counseling so you can start to change your eating habits and start consuming enough healthy foods.

Psychiatric hospitalization might be necessary if you are having thoughts about hurting yourself or ending your life.

Residential treatment

After you are medically stable, you may choose to enter into a residential treatment center for eating disorders and depression. Residential treatment is a great option for people who need extra supervision and support when they’re in the early stages of recovery. Typically, you will live in the same facility where you receive treatment. Residential treatment stays can last between several weeks to several months.

Eating Disorder and Depression Treatment in Washington

The good news is that full recovery is possible.

If you live with both an eating disorder and depression, you need a treatment team who is able to help you with both. Our team at The Center • A Place of HOPE has over three decades of experience helping people like you recover from disordered eating and co-occurring mental health issues. Our team truly cares about helping you heal your relationship with food. Our residential treatment program for eating disorders accepts many different insurance plans, and financing is also available.

We have specialized programs for women, men, and adolescents. All of our programs are whole-person based, which means we see you as a complete human being, not just an eating disorder or depression patient.

To learn more about our admissions process and how you can start your treatment journey with us, get in touch with us today.

[1] https://anad.org/eating-disorders-statistics/
[2] https://www.nimh.nih.gov/health/statistics/major-depression
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085695/
[4] https://pubmed.ncbi.nlm.nih.gov/16738079/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280337/
[6] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.654.5492&rep=rep1&type=pdf#page=42
[7] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.654.5492&rep=rep1&type=pdf#page=42
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743311/