National Eating Disorders Association

Mental Health Conditions

An eating disorder diagnosis can be challenging enough on its own, and many individuals have other issues that can accompany the eating disorder. Anxiety, depression, and obsessive-compulsive disorder (OCD) are just a few additional mental health diagnoses that frequently co-occur with eating disorders. Sometimes, these other disorders may be a result of eating disorder behaviors, as binging, purging, and restricting can all cause psychological distress. 

A co-occurring mental health diagnosis can begin around the same time as an eating disorder, can precede it, or can emerge after the eating disorder has already begun. Mood and anxiety disorders most commonly occur alongside eating disorders, and post-traumatic stress disorder is also common. 

Some mental disorders can be risk factors for eating disorders, indicating that a person may be more likely to later develop an eating disorder. A study of more than 2,400 individuals hospitalized for an eating disorder found that 94% of the participants had a co-occurring mood disorder, with 92% of those in the sample struggling with a depressive disorder. Of the 56% of individuals who were diagnosed with anxiety disorders, 20% had OCD.

Recent research finds that 32-39% of people with anorexia nervosa, 36-50% of people with bulimia nervosa, and 33% of people with binge eating disorder are also diagnosed with major depressive disorder. 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with an anxiety disorder.

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Major Depressive Disorder is the most commonly diagnosed form of depression. Approximately 16.1 million adults aged 18 years or older in the U.S. had experienced at least one major depressive episode in the last year, which represented 6.7% of all American adults. Depression is the leading cause of disability in the United States among people ages 15-44.

Anxiety Disorders are the most common and pervasive mental disorders in the United States and can affect anyone at any age. Anxiety and stress are natural responses to every day stressors--if the feelings of anxiety are extreme and begin to interfere with one's daily life, then it may be a sign of an anxiety disorder.

Obsessive Compulsive Disorder (OCD) is the most common anxiety disorder to co-occur with an eating disorder. Those who have both disorders often develop compulsive rituals connected to food.

Depression 

Warning Signs & Symptoms

  • Feelings of emptiness and hopelessness
  • Irritability, anxiousness, and guilt
  • Feelings of exhaustion, severe tiredness
  • Feelings of tension
  • Loss of interest and energy
  • Inability to concentrate or remember details
  • Suicidal thoughts or attempts of suicide
  • Changes in appetite – eating too much or too little
  • Physical symptoms – aches and pains, cramps, headaches, digestive issues, breast tenderness, bloating
  • Mood swings 
  • Panic attacks
  • Sleep disturbances; sleeping too much or too little, insomnia

If you or someone you know express one or more of the following symptoms, please seek professional help. 

Risk Factors

Key findings show that more than 8% of adults older than 20 years old reported having depression during a given two-week period. Most of us may feel anxious or depressed when dealing with a death in the family, losing a job or home, separation and divorce, financial instability; and other difficult situations can lead a person to feel sad, lonely and scared which are normal feelings and usually pass with time. If these intense feelings interfere with daily activities, cause a high level of distress, or occupy your mind endlessly, you may have an anxiety disorder or depression — or both.

Depression can happen at any age and can co-occur with other chronic illnesses such as cancer, diabetes and heart disease. Risk factors include: personal or family history of depression, major life changes, trauma, or stress or certain serious illnesses and medications.

Health Consequences

The relationship between eating disorders and depression is a complex problem to understand, treat, and research. ADAA member Karen Cassiday authored a NEDA blog Learning to Live Well with Depression and Eating Disorders and explained that “the patient’s concern is their body and eating.” The other problem is that depressed patients can lack motivation and energy to complete any treatment because their depression symptoms of apathy fatigue, flat affect, and disturbed appetite are difficult to manage without also having the overlay of an eating disorder.

Anxiety Disorders

Warning Signs & Symptoms

  • Feeling nervous, irritable or on edge
  • Having a sense of impending danger, panic or doom
  • Having an increased heart rate
  • Breathing rapidly (hyperventilation), sweating, and/or trembling
  • Feeling weak or tired
  • Difficulty concentrating 
  • Having trouble sleeping
  • Experiencing gastrointestinal (GI) problems

If you or someone you know express one or more symptoms, please seek professional help.

Treatment

Anxiety/depression disorders and eating disorders may be treated at the same time and in the same manner. It is important to note that, recovery from one disorder does not ensure recovery from another, so it is necessary to seek help for both issues. 

Cognitive-Behavioral Therapy 

A well-established, highly effective, and lasting treatment called cognitive-behavioral therapy (CBT) focuses on identifying, understanding, and changing thinking and behavior patterns. Benefits are usually seen in 12-16 weeks, depending on the individual. In this type of therapy, the patient is actively involved in his or her own recovery, has a sense of control, and learns skills that are useful throughout life. CBT typically involves reading about the problem, keeping records between appointments, and completing homework assignments that practice and reinforce treatment procedures. Patients learn skills during therapy sessions, and they must practice repeatedly to see improvement. 

Taking medications under a doctor’s supervision and joining a support group are also sound treatment options.

Medication

Medication treatment is generally safe and effective, and is often used in conjunction with therapy. Medication may be a short-term or long-term treatment option, depending on severity of symptoms, other medical conditions, and other individual circumstances. However, it often takes time and patience to find the drug that works best for you.

Medications are commonly prescribed by physicians (e.g., family practice, pediatricians, OB-GYNs, and psychiatrists), as well as nurse practitioners in many states.

Four major classes of medications are used in the treatment of depression and anxiety disorders:

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs relieve symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which improves mood. SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, and sertraline) generally produced fewer side effects when compared with tricyclic antidepressants. However, common side effects include insomnia or sleepiness, sexual dysfunction, and weight gain. They are considered an effective treatment for all anxiety disorders, although the treatment of obsessive-compulsive disorder, or OCD, typically requires higher doses.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

The serotonin-norepinephrine reuptake inhibitor, or SNRI, class (venlafaxine and duloxetine) is notable for a dual mechanism of action: increasing the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain. As with other medications, side effects may occur, including stomach upset, insomnia, headache, sexual dysfunction, and minor increase in blood pressure. Since these medications are deemed as effective as SSRIs, they are also considered a first-line treatment, particularly for the treatment of generalized anxiety disorder.

Benzodiazepines

This class of drugs is frequently used for short-term management of anxiety. Benzodiazepines (e.g., alprazolam, clonazepam, diazepam, and lorazepam) are highly effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence.

Tricyclic Antidepressants

Concerns about long-term use of the benzodiazepines led many doctors to favor tricyclic antidepressants (e.g., amitriptyline, imipramine, and nortriptyline). Although effective in the treatment of anxiety, they can cause significant side effects, including orthostatic hypotension (drop in blood pressure on standing), constipation, urinary retention, dry mouth, and blurry vision.

Contact your physician if you experience side effects, even if you are not sure a symptom is caused by a medication. Do not stop taking a medication without consulting with the prescribing physician; abrupt discontinuation may cause other health risks.

Medications will work only if they are taken according the explicit instructions of your physician, but they may not resolve all symptoms of an anxiety disorder.

Treatment for eating disorders also includes nutritional management and nutritional counseling. Those who experience severe symptoms may require hospitalization to help stabilize their health.

 

Special thanks to ADAA and Dr. Richa Bhatia, MD, FAPA

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