This is another case of examining which comes first — did depression cause the eating disorder or did the eating disorder cause the development of depression? Singularly, these are two separate mental states that need exclusive treatment. However, if these are present in one person, then the treatment plan is more complex and will require the intervention of psychiatrist, nutritionist and primary care physician.
Eating Disorder and Depression
Persons with an eating disorder are obsessed with perfectionism. This is the nature of anorexia nervosa. The battle to stay thin is a constant reminder that they need to stay thin. This is different from staying fit and fab as what health buffs promote to maintain a healthy body. This means they will do everything to stop from gaining weight up to the point of starving or food deprivation measures and activities that will help them lose weight. The perfectionism can be seen on the obsessive ways on how they count the calories on the food they eat, matching it to a number of calories that they will lose if they exercise. When they fail to lose a pound despite the efforts, frustration and depression sets in. According to Mindia Gabichvadze, PsyD, “Symptoms may include persistent feelings of hopelessness, sadness, or emptiness.” And if they feel that way, the more that they don’t want to eat or to do the binge-purge cycle.
In bulimia nervosa, the person may feel already depressed due to stringent demands resulting in the binge and purge episodes. Persons with binge eating disorders are normally overweight and this is the cause of their depression. As they continue to eat more, the more depressed they become and will feel guilty after the episode of binge eating.
In general, persons with eating disorders have a problem with body-image disturbance and self-esteem issues. They are not able to accept their own body and will feel depressed and anxious about it. This now develops into an insidious cycle of emotional conflicts and problematic eating patterns.
Statistics reported that eating disorders are more common in women. However, men are also affected with 10% of them in the total population. In people with anorexia nervosa, almost 33-50% are found to be struggling with depression. This is also true for binge eating disorders.
“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 and an expert in eating disorders.
Managing The Conditions
The treatment approach is addressed on the urgency of the problem. If complications of eating disorders are highly evident like electrolyte imbalance, internal hemorrhage, cardiac arrest, or any physical manifestations, these are managed first until the person becomes stable. Hospitalization is necessary to follow the medical management and monitor clinical progress until discharge. “Psychotherapy can be very helpful in addressing not only your disordered eating, but also your overall emotional health and happiness. Indeed, the focus of psychotherapy treatment will be to address the underlying emotional and cognitive issues that result in the disordered eating,” says John M. Grohol, Psy.D.
Psychotherapy will follow, whether in-patient or out-patient basis, to address the problem of depression and eating disorders. The person undergoes cognitive-behavioral therapy to change how the mind thinks about oneself thereby changing the attitudes and behaviors afterward. Medications are prescribed to manage and control depressive states. These will include antidepressants and anxiolytics. The person is also taught how to select and prepare nutritional meals in order to help in the weight management program.
Both mental health states need immediate treatment. It will also need a lot of patience and understanding from family members and significant others. It will be hard for the person and the family all throughout the process, and there will even be relapse along the way. Constant support and guidance are very important to achieve the goals of the treatment.