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Eating Disorders and Depression

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Eating disorders often begin with the best of intentions -- a desire to lose weight and control eating. But in some people, those good intentions go badly wrong, resulting in anorexia nervosa, bulimia, binge eating, or other disorders.

Why some people are at risk for eating disorders isn’t clear. But surveys show that depression is often a factor. In a 2008 study by researchers at the University of Pittsburgh Medical Center, for example, 24% of bipolar patients met the criteria for eating disorders. An estimated 44% had trouble controlling their eating.

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As many as half of all patients diagnosed with binge eating disorder have a history of depression, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Binge eating afflicts 3% of adults in the U.S., making it the most common eating disorder.

Depression also plagues many people with anorexia, another common eating disorder. People with anorexia fail to eat enough food to maintain a healthy weight. The results can be tragic. Studies show that anorexics are 50 times more likely than the general population to die as a result of suicide.

The Link Between Depression and Eating Disorders

Depression may lead to eating disorders, but there’s also evidence that eating disorders can result in depression. “Being severely underweight and malnourished, which is common in anorexia, can cause physiological changes that are known to negatively affect mood states,” says Lisa Lilenfeld, PhD, an associate professor of clinical psychology at Argosy University in Arlington, Va., who specializes in eating disorders.

Depression in people with eating disorders typically has its own unique features, according to Ira M. Sacker, MD, an eating disorders specialist at Langone Medical Center at New York University and author of Regaining Your Self: Understanding and Conquering the Eating Disorder Identity.

“People who develop eating disorders feel as people that they’re not good enough,” Sacker says. “They become obsessed with perfectionism. That perfectionism begins to focus on what they eat. But underlying it is depression and anxiety. Often, these patients have suffered a lot of emotional trauma.”

People with binge eating disorder are frequently overweight or obese, for instance. This can lead them to feel chronically depressed about the way they look. After succumbing to an episode of binge eating, they may feel disgusted with themselves, worsening their depression. 

To determine if depression is part of an eating disorder, doctors use a well-tested battery of questions that tease out the most common symptoms of depression. These include:

  • Feelings of sadness or unhappiness
  • Loss of interest in activities that once were pleasurable
  • Loss of libido
  • Irritability or anger
  • Sleep problems
  • Loss of appetite

Diagnosing serious depression is relatively easy, experts say. But finding an effective treatment for combined depression and eating disorders can be a challenge.

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