Depression and Eating Disorders: A Guide to Recovery
Which came first, the depression or the eating disorder?
Depression and Eating Disorders: Partners in crime
Depression and eating disorders often exist together, creating a complex web of emotional and psychological distress. Often, it’s hard to tease out which came first: did the depression increase vulnerability to disordered eating? Or did the physical and emotional drain of the eating disorder negatively impact mood? Understanding the connection between depression and eating disorders is central to carving out a path to recovery.
The relationship between depression and eating disorders can be cyclical. Depression can contribute to the development of eating disorders since eating related behaviors (like binge eating or purging as examples) can serve as methods to cope with overwhelming emotions or a poor self-image. Similarly, the restrictive behaviors and body image issues associated with eating disorders can exacerbate depressive symptoms. It’s not hard to imagine how the torment of an eating disorder can erode one’s mood; but taking the connection further, we know that when nourishment and weight are impacted by irregular, chaotic or restrictive eating, there are changes to both brain structure and function that profoundly impact mood and thinking.
Defining Depression and Eating Disorders
Many of us know what depression feels like but what is it exactly? The diagnostic criteria for Major Depressive Disorder (MDD), according to the DSM-5, require individuals to experience at least five specific symptoms over a two-week period, with one being either a depressed mood or a loss of interest in most activities. Other symptoms can include significant weight changes, sleep disturbances, fatigue, feelings of worthlessness, difficulty concentrating, and recurrent thoughts of death or suicide. These symptoms cause significant distress or impairment in daily functioning.
When we talk about eating disorders, we’re referring to conditions like anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder and a range of troublesome eating and body image concerns that may not fall neatly into one of the aforementioned diagnostic categories. All forms of eating disorders involve disturbances in food intake and attitudes about eating. With the exception of ARFID, most eating disorders also incorporate what we call “over-valuation of shape and weight.” Overvaluation of shape and weight refers to placing excessive importance on body shape and weight as a primary factor in determining self-worth and overall value as a person. For some, eating disorder behaviors can be driven by factors outside of weight/shape as well; there may be a reliance on food-related behaviors to calm or quell emotions or to distract from troubling thoughts or feelings.
There is a complex interplay between eating disorders and depression. Recognizing that these conditions often reinforce each other is an important step toward healing.
Weight Suppression and How It Impacts Depression
Set point theory refers to the concept that each person's body has a natural weight range it strives to maintain through physiological processes, including metabolism and appetite regulation. This set point can be influenced by genetics, environment, and lifestyle factors. When an individual drops weight below their set point, they are considered “weight suppressed.” People can be weight suppressed intentionally due to dieting or other weight control measures. They can also be weight suppressed accidentally after being sick or after any event (like prolonged stress) that can reduce appetite. Weight suppression impacts both the structure and function of the brain. As a result, we see some common complications.
Psychological Impact of Starvation
The Minnesota Starvation Study in the 1940’s revealed how weight loss and inadequate nutrition can profoundly impact mood and thinking. The subjects of the study were exposed to calorie restriction over a three-month period and consequently, dropped about 25% of body weight. The subjects experienced severe emotional disturbances, including depression, irritability, social isolation and obsessive thoughts about food. Several subjects had to drop out of the study because they became suicidal. Of note, prior to the start of the study, these subjects were described as being in good health, both physically and psychologically, which allowed researchers to observe the drastic changes that occurred during and after the starvation period. What we see with weight suppression often parallels the outcome of the starvation experiment; we see a significant increase in negative moods and mood states like anxiety, irritability, sadness, obsessiveness and compulsivity when weight is suppressed.
Erosion of Self Esteem and Well-Being
There are other ways that weight suppression – and eating disorders more generally - impact mood and can lead to depression. No doubt, the constant pressure to control weight can lead to burnout and feelings of inadequacy, failure, and hopelessness. This pressure can intensify the negative self-perception and self-criticism common in depression, creating a vicious cycle where emotional distress fuels further weight suppression and vice versa.
Social Consequences
Eating disorders can lead to significant social consequences, including isolation from friends and family due to shame or secrecy surrounding eating habits. Individuals may withdraw from social situations involving food, such as gatherings or meals, which can strain relationships and lead to feelings of loneliness. Additionally, the stigma associated with eating disorders can further marginalize affected individuals, making it difficult for them to seek support and engage in their communities. Isolation can lead to depression by creating a cycle of loneliness that diminishes emotional support and reinforces negative thoughts, making it harder for individuals to cope with their feelings.
Biological Factors
Chronic weight suppression disrupts the body’s normal stress response by altering hormonal balance, which can lead to heightened levels of cortisol and other stress hormones. These elevated stress hormones not only affect physiological processes but also exacerbate mood disturbances, increasing the risk of anxiety and depression in individuals experiencing prolonged starvation or restrictive eating patterns.
The Challenge of Diagnosis Depression and eating disorders
Diagnosing depression in someone with an eating disorder for several reasons. For one, we often see overlapping symptoms between depression and eating disorders including changes in appetite and sleep disturbances. We also see how weight suppression and erratic eating patterns can significantly contribute to feelings of depression, as the body and brain struggle to function optimally. Eating disorder behaviors by their very nature are isolating and breed feelings of shame and inadequacy. These complex feelings may present as “depression-like” but they are very much a consequence of the eating problem. In many cases, stabilizing eating behaviors may lead to an improvement in depressive symptoms, highlighting the importance of addressing both conditions concurrently.
Steps Toward Long-Term Recovery
Recovery from both depression and eating disorders requires a multifaceted approach. It involves addressing the emotional, psychological, and physical aspects of each condition while fostering a supportive environment for healing. By seeking professional help, building a strong support network, developing healthy coping strategies, addressing underlying issues, and understanding the impact of weight suppression, individuals can work toward achieving long-term recovery.
Depression is an understandable consequence of disordered eating and eating disorders often serve to quell depressed mood. Remember, recovery is possible; addressing both depression and eating disorders holistically and comprehensively is essential.
If you or someone you care about is experiencing an eating disorder and depression, Columbus Park can help. Contact us to learn more.
