Eating
Disorders
Bulimic Teens Also Likely to Suffer From Depression
(December 7, 2004) -- Teen-agers suffering from
bulimia may in fact be fighting a two-front war, coping with the effects of
a devastating
eating disorder while struggling with a
chronic form of
depression, reveals research by Texas A&M University psychologist Marisol
Perez, who says the finding has critical implications for the way the disorder
is treated.
Often masked by the bulimia itself,
dysthymia -
a lower-level, chronic form of
depression - is often present in bulimics and may even predispose them to
the eating disorder, shows the research by Perez and her colleagues Thomas E.
Joiner Jr. of Florida State University and Peter M. Lewinsohn of the Oregon
Research Institute.
Dysthymia, Perez explains, is different from the more familiar major
depression in terms of its duration, severity and persistence of mood
disturbance, all factors that can impact the course and treatment of eating
disorders.
"As pernicious as major depression can be, it tends to remit, even if
untreated," she notes. "By contrast, dysthymia is unrelenting, often lasting
decades, with the average episode length lasting more than 10 years."
It's this long-lasting nature, Perez says, that makes dysthymia, rather than
major depression, more likely to be associated with bulimia, which is
characterized by unrelenting negative feelings about one's self.
Bulimics, she says, tend to have chronic low self-esteem. Previous models,
she notes, have proposed that high perfectionism when dashed by low self-worth
is predictive of bulimia. Because of this, the chronic and
pervasive self-esteem problems associated with dysthymia may make dysthymic
people vulnerable to bulimia, she says.
The relationship between bulimia and dysthymia might be the struggle to
regulate unrelenting negative moods stemming from the depression and the
feelings of low self-esteem associated with the eating disorder, Perez
speculates.
Individuals who suffer from simultaneously existing disorders, such as
bulimia and dysthymia, usually have a worse course and prognosis in treatment
than those who only suffer from one disorder, Perez says. She believes that her
findings can provide additional information to create more focused and effective
treatments for teens with bulimia. Knowledge of the co-existence of bulimia and
dysthymia in teens can help therapists assess specifically for dysthymia in
bulimic patients and choose a treatment that will combat both disorders, she
says.
Perez says that it is possible for adults to suffer from both disorders, but
she notes that the patterns between bulimia and dysthymia may change from
adolescence to adulthood, making major depression more likely to co-exist in
adults than dysthymia.
She reasons that as the course of bulimia progresses, the social support
network and resources of a bulimic person may start to diminish, making negative
life events harder to overcome. The binges and purges that serve as a type of
coping mechanism in the beginning of the disorder may, over time, lose their
comforting aspects while their harmful ones continue to be amplified. This, in
turn, may cause the intensity of the depression to increase, making the
occurrence of major depression and bulimia more common in adults, she says.
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