Depression and Eating Disorders: When Sadness Never Fades
Depression always goes hand-in-hand with an eating disorder. Together the two rob a person of their happiness and self-worth, and easily wreak havoc on innocent lives. Unfortunately, we are living in a "pill society" and, more often than not, therapists tend to treat depression alone with drugs instead of with a more psychological basis and along with the eating disorder. It's amazing to look at the statistics and discover the multitudes of people who suffer from depression while this, just as with eating disorders, still appears to be an enigma to understanding. Hopefully the information contained here will help clear some of the fogginess of sadness away...
Depression is not biased - it affects anyone at any race and age and economical standing. It can strike at any moment; it doesn't need a tragic incident to trigger onset. Over 19 million over age 18 are considered to be clinically depressed, or 1 out of 5 people in general society. Depression is so common that it is second only to heart disease in causing lost work days. More frighteningly so, untreated, depression is the number ONE cause of suicide (appx. 13,000 people died from suicide in '96 alone).
There are indeed three different kinds of depression - normal, mild, and then severe. I have found personally that those with eating disorders tend to range between having mild and severe depression.
normal.depression - This is a natural reaction to the loss of a loved one, one which has caused sadness, lethargy, and in serious cases, grief to the point of loss of appetite, insomnia, anger, obsessive thoughts about the lost person, and never ending guilt. What is different about normal depression from mild and severe cases is that most people eventually recover and return to their typical moods after encountering normal depression. When the moods of a person do not lift and instead continue, then mild depression is setting in.
mild.depression - When a person is chronically depressed, possesses low self-esteem, and has some symptoms of severe depression, then they are considered to have mild depression. With mild depression the person can still function through their daily life, but it is very hard for them and they are known as having "the blues." Many times the mildly depressed person has nothing to hold accountable for their change of moods. Doctors and therapists should carefully watch over a person with mild depression because often times the mild depression will start out this way, but eventually progress into severe depression.
I am the voice inside your head and I control you
I am the hate you try to hide and I control you
I am denial guilt and fear and I control you
I am the lie that you believe and I control you
I am the high you can't sustain and I control you
I am the truth from which you run and I control you
I take you where you want to go
I give you all you need to know
I drag you down, I use you up
Mr. Self Destruct-NIN
severe.depression - The person with this feels utterly hopeless and feels such great despair that they lose all interest in life, causing the person to be incapable of feeling pleasure. Sometimes the person will be unable to eat for days or be incapable to get out of bed. Trying to do these activities when severely depressed, the person feels anxious, irritable, agitated, and chronic indecisiveness. Sleep disturbances such as insomnia are not uncommon. Just as with mild depression, severe depression often does not set in after a traumatic incident or the loss of a loved one. However, the intense feelings of grief, guilt, and unworthiness are experienced just the same. Untreated, an estimated 25% of sufferers try to kill themselves after suffering for 5 years with this horrible mood disorder.
Often trying to figure out which triggered what (Did the eating disorder trigger the depression, or the other way around?) ends up being a game of whether the chicken or the egg came first, so I don't even bother. What's more important to me is finding the main trigger to the depression currently. Obviously the helplessness and hopelessness that comes from anorexia and bulimia is plenty enough to aggravate someone's moods. The person with the eating disorder feels helpless - they feel out of control, while desperately searching for control by starvation and/or purging. At the same time, they feel like failures for not losing enough weight and not doing it fast enough (making a twisted accomplishment). The current state of the medical community also doesn't host many rays of light, as it isn't uncommon for a severe case to be called "hopeless" and "incurable," or for a mis-understanding and mis-educated doctor to call someone with an eating disorder "selfish" and "manipulative." It's extremely hard to "think positively" and to "just read a few self-help books" and then magically, POOF, be ok. Depression doesn't work that way, and inevitably it is aggravated and made worse. The person may occasionally able to have a once in a blue moon GENUINE happy moment, but for the majority, they are down in the dumps (often believing they deserve to be there).
Along with an eating disorder triggering and aggravating depression, biological problems also affect mood disorders such as this. Studies on seratonin, also known as the "feel good" neurotransmitter, have caused some interesting findings to come up - some showing that you can be born with messed up levels and that alone can cause a 4 year old to be diagnosed as clinically depressed. The basics of seratonin are if it falls too low, depression and other complications occur, and starving and/or purging always messes up this chemical. Usually when someone with anorexia is in what is known as "starvation mode" (occurs generally when the weight has fallen below 98 pounds and the body just goes completely bonkers and manic), depression is almost solely biological. Some therapists even require that a patient's weight be raised up past 98 pounds before they will treat them for the eating disorder and/or depression because it is too hard to have the person think clearly at such a weight and condition that the body is in.
Just as with any additional disorder, depression MUST be treated along with the eating disorder. Often depression treatment includes Cognitive Behavioral Therapy (CBT) which identifies the ten forms of distorted thinking found in depression (see below). Besides CBT, there are many anti-depressants that are used. These include the famous Prozac, Zoloft, and Paxil. It is true that generally after a person is taken away cold turkey from their anti-depressant that they relapse back into old thinking patterns and the depression re-surfaces, however, when treated along with Cognitive Behavioral Therapy, most are able to be "weened" off of the anti-depressants without many problems. The key is to learn better rationalization techniques along with using the drug as just a little "booster," so that in the end you have learned how to rationalize and use logic for your problems well enough that you no longer need anti-depressants.
- All-or-Nothing Thinking :
This is the black or white thinking pattern. If the person is not perfect they are nothing and a total failure. If the victim gets an A- on a test it's the end of the world
- Labeling :
The person makes a mistake and instead of thinking that hey they made a mistake no big deal they label themselves names such as a failure or pathetic. Another example of this is having a parent yell at you for forgetting to do a chore. Instead of thinking that you'll remember next time you may label yourself totally worthless and because of that your parents don't love you now.
- Over-generalization :
This is when a person makes a slight blunder and believes they will never get it right. ("I relapsed again; I wont ever be able to recover.")
- Mental Filtering :
ED victims tend to do this quite a lot. Say a friend commented on a piece of art work but then added that one of the colors was a little off. Instead of remembering that 99% of the art work is great looking the person dwells on the negative part of what the friend said and filters out any positive remarks. Many times the ED victim will say that they are good for nothing and that no one gives them any positive remarks but they do not realize that any positive remarks that they have been given they have immediately dismissed.
- Discounting the Positive :
This thinking is when you do something well such as cooking a good meal and then when given positive remarks on it you immediately think things like "Well, anyone could have done it," or, "It wasn't that great..."
- Jumping to Conclusions :
You assume the worst based on no evidence. You decide that another person is reacting negatively to you. ("I know she didn't really mean it when she said I wasn't fat; she's lying just to be nice.")
This is the exaggeration of importance of problems and minor annoyances. An example of this would be an eating disorder victim not exercising for a full hour and thinking that what he did before was worth nothing.
- Emotional Reasoning :
Ever confuse your emotions for reality? This is when the thoughts of 'I feel fat so therefore I am fat' come up. The self-demanding tip-off's include 'must', 'ought to', and 'have to'.
- Personalizing the Blame :
These thoughts are another very common trait among eating disorder victims. The person believes that things beyond his or her control are the victim's fault. ("I ate yesterday and that's why the plane crashed," or, "If I had gotten an A+ instead of an A then my mom wouldn't have a migraine today.")
Personally, I have found that a major key in helping rid depression is realizing that we all have limits and faults, but that that is OK, and that there are better ways of dealing with things than self-destruction. One particular quote has been especially helpful, and it goes a lil' something like this: Most depression or anxiety-producing events are not inherently awful. What makes them feel distressing is the way we react to them.
Last Updated: 18 April 2016
Reviewed by Harry Croft, MD