Depression and eating disorders

Depression, other mental health issues such as anxiety, and eating disorders may all occur together*,*1. Eating more or less, a common symptom of depression, is also is a sign of eating disorders. Several young adults we interviewed described disordered eating as part of their depression experience. For some, managing what they ate provided a sense of control when other aspects of their life felt out of control. Julia says she ‘couldn’t control whether my mom was going to be home or not and I couldn’t controlfeeling like I had someone to go home to but I could control things like what I put in my mouth’. Elizabeth similarly says that her eating disorder allowed her to control the emotions that resulted from her anxiety. However, she also felt that eating less made her feel more depressed.

Elizabeth describes how her eating disorder both seemed to help and contribute to her mental health issues.

Age at interview 28

Gender Female

Age at diagnosis 17

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I think a lot of the eating issues came from anxiety and depression. I think that something chemically was not well that even produced those thoughts, I mean most people don’t look at a plate of food and say, Oh my gosh I can’t eat this and I can never eat again, And that’s a pretty serious thought. So I think the anxiety really played into that in a way too where I felt like it was a way for me to control my emotions in myself. Not in a way where I needed control but it was a way where I figured out how to kind of punish myself and control my behavior and my emotions and dictate my emotions and it worked for me for a while. And truthfully I think that a lot of the issues I had with food contributed to the depression in a lot of ways. When your brain and your body aren’t getting really any kind of nutrition, that’s not going to help your thinking at all it’s not going to help your health, your sleep, which I actually did sleep pretty well despite all that but yeah the anxiety, the depression, and the eating disorder really all went hand in hand.

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The beginnings of eating disorders

Many people we talked with described their eating disorder as beginning with a concern about their body image. Often, this happened when there was a change in their weight during puberty or in college. For Sara, she became anxious about judgment from her friends and boys.

Sara describes feeling judged about her body image.

Age at interview 26

Gender Female

Age at diagnosis 12

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Yeah, it’s I think it’s my body image, honestly.
Because it was, when I was so young and I was like, not worried about my weight at 12 years old or what I looked like, I was coming home with honor roll certificates and worried about school, what I wanted to do. And at 12 years old being slammed with that was like, I should be, I should be skinny. I shouldn’t be fat. The boys don’t like fat girls. And so throughout my whole childhood and even, especially teenage years I was like stressed out about what I looked like. I was like afraid of what people thought of me, like, even still like if somebody’s staring at me I have a problem with that because like, Are they judging me? That’s the biggest thing for me and then my mind starts to wonder from there. Like, What are they thinking? Do they think I’m this? Do they think I’m that? And no, they’re probably not thinking anything of me or even looking at me [laughter], but in my head that’s what it is and it’s, I think it’s males that bother me the most about it.

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Several people said their family members’ behaviors contributed to their eating disorder. Julia notes her mother also had an eating disorder. Her own behavior was both caused and normalized by her mother’s behavior. She says her mother would make comments such as, ‘Oh, you look so good.’ or ‘You’re so thin.’ and ‘compare herself to me, like ‘I’m a size 00.” Similarly, Frankie said her mother has ‘always been a dieter’ and she herself would often be subject to the diets as well. As a self-described ‘perfectionist’, Frankie liked the positive attention she received when she lost weight on restrictive diets. Gaining weight when she returned to a normal diet re-activated her eating disorder.

Frankie discusses how the comments she heard when she lost weight led to her eating disorder.

Age at interview 24

Gender Female

Age at diagnosis 13

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So I lost a bunch of weight and then we went back to normal, to eating, normal food with carbs and I just ballooned up. And it was the most embarrassing thing that I could think of, because everyone had told how great I looked and that just really fed into the perfectionist in me. Like, yes, give me more of that, tell me how beautiful I look, I look amazing, and all of a sudden that was gone and it was terrible. And so that’s when it started. And it just sort of continued.

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Men also suffer from eating disorders. In the United States, it is estimated that 10 million men will have a clinically significant eating disorder at some point in their life*2. Devin, in our study, attributes his eating disorder to feeling guilty about having his father pay for his food when he could not financially support himself.

Devin first limited how much he ate to lessen burden on family.

Age at interview 21

Gender Male

Age at diagnosis 16

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Working high school and then, yeah, yeah it took me, gosh a long time to find a job out there because after high school it is, it is really bad for jobs over there, it took me two years to find a job after high school.

Yeah and my dad was very upset over that, you know he. He was having to pay for my food and everything and you know the way, the best way for my brain to think about it was to lower the amount that you’re eating. And it just kept doing that and it’s odd to come from a guy saying this but I do have anorexia nervosa and it is because of that, that that happened. I just stopped eating,

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Signs of eating disorders: counting calories, excessive exercising, overeating

People we talked to described not eating, counting calories, or exercising excessively as a sign of their eating disorder. Often, these behaviors were a way to cope with certain emotions, but Julia describes how her counting calories led to her feeling more anxious, and that she would work out to try to burn any calories she ate. Leanna overate sugary foods to cope with her feelings.

A few people said their symptoms were a sign that they were being unhealthy and they were aware that these behaviors could have future consequences. Leanna in fact developed high blood pressure from overeating. Frankie realized her calorie restriction was unhealthy, but felt judged by others when she stopped and regained weight.

Frankie describes her feelings about gaining back the weight she lost.

Age at interview 24

Gender Female

Age at diagnosis 13

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But what actually happened was, when I was 20. So I was, I was in college. I decided that I was just going to lose a bunch of weight, which I guess sort of had been the goal throughout, but I wasn’t really making it a priority. So I decided to make it a priority. And I counted calories like crazy, ate barely anything, worked out for hours a day, and I lost 80 pounds I think. And then realized suddenly, whoa, I am super unhealthy. I, like, anytime I stood up I would just, like my eyes would just go black and I would fall down. Super healthy right. So I just decided that, that wasn’t working for me anymore, didn’t like it and yeah I decided to go back to normal which unfortunately has caused me to gain 90 pounds back. So in a, in a way I’m recovered but I’m, I’m, I’m feeling that like that 13 year old. Like, ugh, like everyone was so happy with me when I had lost 80 pounds and now like none of them understand that I’m actually probably healthier now. To them they just see, oh, she, you know, reverted back. That sucks for her, sort of thing and so yeah I, I have been struggling with it a lot.

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People also discussed their ongoing struggles with body image. Devin discussed how he still struggles with his body image and says that he ‘still [has] those times where I still don’t like myself, the way I look’. Frankie says her behavior was more ‘sporadic’ and ‘would go months without any symptoms’ or ‘would go three days in a row eating a ton of food and then like throwing it up or just deciding for the day that I wasn’t going to eat any food.’

Treatment for eating disorders

Getting help for depression or eating disorders helped some of the people we interviewed identify and address both issues. One participant said the symptoms of her eating disorder in combination with her depression symptoms resulted in her doctor offering her medication for depression.

For more information on treatment for depression, see ‘Therapy and counseling‘, ‘Depression, medication, and treatment choices‘, ‘Holistic and integrative approaches to depression‘, and ‘Depression and healing‘.

References
*Salbach-Andrae, Harriet, et al. “Psychiatric comorbidities among female adolescents with anorexia nervosa.” Child psychiatry and human development 39.3 (2008): 261-272.
*1 Wade, Tracey D., Anna Keski‚Äö√Ñ√™Rahkonen, and James I. Hudson. “Epidemiology of eating disorders.” Textbook of Psychiatric Epidemiology, Third Edition (2011): 343-360.
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