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Eating Disorders And Depression
Depression and Bulimia
Article by: Katie Hurley. LCSW
Eating disorders are complex, potentially life threatening
conditions that negatively impact a person’s physical and emotional health.
According to the National Eating Disorders Association, 20
million women and 10 million men will suffer from a clinically significant
eating disorder at some point, including anorexia nervosa, bulimia nervosa,
binge eating disorder, or other or unspecified feeding or eating disorder.
Bulimia
nervosa commonly begins in adolescence or young adulthood and is characterized
by recurrent episodes of binge eating and compensatory behaviors (often
referred to as “purging.”
Comorbidity with other mental disorders is common with
individuals with bulimia nervosa, with studies indicating that nearly half of
bulimia nervosa patients also have a co-existing mood disorder.
Individuals
with bulimia nervosa show an increased frequency of both depressive symptoms
(ex: low self-esteem) and depressive disorders.
For many patients, the mood disturbance begins at the same
time as or following the eating disorder, but for some the mood disturbance
precedes the development of bulimia nervosa.
Given
the overlapping relationship between bulimia nervosa and depressive disorders,
it helps to understand both and find effective treatment.
Symptoms of bulimia nervosa
Individuals with bulimia nervosa
typically are within normal weight or overweight range, and the binge eating
frequently begins during or after an episode of dieting to lose weight.
The essential features of bulimia nervosa are as follows:
1. Recurrent episodes of binge eating
characterized by eating (in a discrete amount of time) an amount of food that
is larger than most individuals would eat given the circumstances and a sense
of lack of control during the eating episode.
2. Recurrent compensatory behaviors
(“purging”) to prevent weight gain, including: self-induced vomiting, misuse of
laxatives, diuretics, or other medications, fasting, or excessive exercise.
3. The binge eating and purging both
occur at least once a week for 3 months.
4.
Self-evaluation is influenced by
weight and body shape
5.
The disturbance does not occur during
anorexia. Individuals with bulimia nervosa place an excessive emphasis on
weight and body shape, and these evaluations of their bodies negatively impact their
self-esteem.
Binge
eating often occurs in secret and can be triggered by stress, negative feelings
related to weight or body shape, boredom, or dietary restraint. Binge eating
can result in feelings of shame.
The
12-month prevalence of bulimia nervosa among young females is 1%-1.5%. The
disorder peaks in adolescence and young adulthood and has a 10:1 female-to-male
ratio. 6
Suicide risk
Suicide risk is elevated for
individuals with bulimia nervosa, particularly with a co-occurring mood
disorder.
Symptoms
of major depressive disorder increases the risk of suicide.
The essential feature of major depressive disorder is a
period of two weeks during which there is either depressed mood most of the day
nearly every day or loss of interest or pleasure in nearly all activities.
Other potential symptoms include:
· Significant weight loss when not
dieting or weight gain and changes in appetite
· Insomnia or hypersomnia nearly every
day
· Psychomotor agitation or retardation
nearly every day
· Fatigue or loss of energy nearly
every day
· Feelings of worthlessness or
excessive guilt
· Impaired ability to think or
concentrate, and/or indecisiveness
· Recurrent thoughts of death,
recurrent suicidal ideation without a plan, or a suicide attempt or suicide
plan.
The
symptoms of major depressive disorder cause significant distress or impairment
in social, occupational, or other areas of functioning.
Suicide is always a risk when an individual experiences a
major depressive episode.
It is very important that individuals discuss their
depressive symptoms with their health care providers when seeking help for
bulimia nervosa, as a more than one treatment approach might be necessary.
Treatment of bulimia nervosa
and depression
Treatment of bulimia can be complicated.
Effective treatment addresses the underlying emotional
issues that contribute to low self-esteem and negative self-perception.
Treatment
of bulimia nervosa and depression is most effective with a team approach.
Your treatment team includes you, your family, your
primary care doctor or health practitioner, your mental health practitioner,
and a dietitian experienced in treating eating disorders.
Treatment can include:
· Cognitive Behavioral Therapy (CBT) to
help you identify unhealthy, negative thought patterns that contribute to
disordered eating and replace them with positive ones
· Family therapy (this is particularly
important with adolescents)
· Interpersonal therapy to help work
through issues related to self-esteem, communication, and problem solving
· Medication management – some
antidepressants can be effective for treatment of bulimia nervosa when combined
with psychotherapy.
· Nutrition education to design a
healthy eating plan
· Hospitalization – if you have
significant health complications from bulimia nervosa, hospitalization might be
necessary
Finding help for bulimia
nervosa and depression
There is no simple answer for
treating bulimia nervosa and depression.
The best first step to take is to ask your primary care
physician for a referral to an eating disorders specialist.
From there, your specialist can lead your team to help you
find the treatment plan that works best for you.
Katie Hurley, LCSW
Katie
Hurley, LCSW is the author of No
More Mean Girls and The
Happy Kid Handbook. Katie provides child and adolescent psychotherapy,
family therapy, and parent education in her private practice. She is the
founder of Girls Can! empowerment workshops for elementary and middle school
girls, and has extensive experience working with children and adolescents with
learning disabilities, anxiety and low self-esteem.
