Depression and Anxiety in Eating Disorders

Depression is very common in people who suffer from eating disorders. For many, the depression is merely secondary to the eating problem. It is unsurprising that the sorrow and suffering of anorexia nervosa or muscle dysmorphia may result in a deep and profound melancholia.

Likewise, nutrition plays an integral part in mood, and symptoms of depression are prevalent in all causes of starvation. However, it is also the case that a significant minority of patients with eating disorders have developed depression before their eating disorders. In this instance, the pattern of disordered eating can be a response to the low mood.

Just as some alcoholics will drink to deal with their depression, so some men with eating disorders will be trying to resolve a primary problem of melancholia. Several years ago we decided to quantify all of this in a research study. We examined levels of depression in patients admitted for the treatment of anorexia nervosa.

We found that weight gain was accompanied by a lowering of mood, such that most patients in early recovery from anorexia nervosa passed through a clinically significant episode of existential despair.

This is of more than academic interest. If the eating disorder or muscle dysmorphia is being used to dampen down feelings of despair and depression, then treating that eating disorder seems to increase those negative feelings. In more basic terms, if you engage in treatment for your eating disorder you may well feel worse before you feel better. Knowing that these periods of depression are temporary is quite essential if you are to tolerate them.

Indeed, one of the features common to the many and various psychotherapies used in the treatment of eating disorders is merely a process of becoming ‘sadder and wiser.’ Another is learning the ability to put your feelings into words rather than behaviors. It is therefore unsurprising that there is an active link between depression and disordered eating.

Of course, depression is not the only mood disorder that has been linked to eating disorders. A significant minority of patients with eating disorders suffer from a range of anxiety problems, including obsessional-compulsive symptoms as well as an array of phobias. The overlap between eating disorders and obsessive-compulsive disorders is so high that some people have suggested that eating disorders are merely a manifestation of obsessional behavior.

This remains speculative, simplistic and most probably untrue. Nonetheless, very many men with eating disorders develop rituals and fears which need to be tackled in addition to the disordered eating.

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