CAN EATING DISORDERS CAUSE DEPRESSION? Yes, But It's Not That Simple

Self, Health And Wellness

You’re Caught In A Vicious Cycle

You’ve been wondering, can eating disorders cause depression? You’re feeling pretty down. Food is all you have on your mind and it’s really hard. Whether your eating disorder is anorexia, restrictive eating, binging and purging, or just plain binging, you’re trying desperately to control what you put into your body.

Maybe you feel successful at it, or maybe you don’t. But, you do have your rules. And, the worst part is that those rules run your life. There are allowable foods; how much you can eat; how little you’re “supposed to;” when and where you eat; and definitely how you look.

You probably mostly think: you don’t look good enough. Maybe never good enough.  

Your eating rules are meant to control that painful feeling. So, if you fail to live up to them that’s when a harsh voice in your head starts to go after you, right? It probably calls you all kinds of names: Failure. Fat. Ugly. Idiot. And, you feel downright awful about yourself for not being in control. You don’t have to live this way.

When you feel so terrible about yourself, there’s no choice but starting your eating cycle again. Telling yourself this time you’ll do “better.” In fact, maybe that even means “perfect.” No more slip-ups … that voice tells you. But, who can be perfect? Thinking you’re supposed to be perfect is part of the problem.

You’re struggling. And, this very “down” feeling lately, every time you think you fail? You want to know: is this what depression feels like? And, is your eating disorder causing it? Or is it possible you were depressed before and didn’t know it?

Let’s talk about that. And let’s start with some typical symptoms of depression.

What Are Symptoms Of Depression?

  1. Feelings of sadness, tearfulness, emptiness or hopelessness
  2. Angry outbursts, irritability or frustration, even over small matters
  3. Loss of interest or pleasure in most or all normal activities
  4. Sleep disturbances, including insomnia or sleeping too much
  5. Tiredness and lack of energy, so even small tasks take extra effort
  6. Reduced appetite and weight loss or weight gain
  7. Anxiety, agitation or restlessness
  8. Slowed thinking, speaking or body movement
  9. Feelings of worthlessness or guilt, fixating on past failures or self-blame
  10. Trouble thinking, concentrating, making decisions and remembering things
  11. Frequent or recurrent thoughts of death, suicidal thoughts
  12. Unexplained physical problems, such as back pain or headaches

So, what is it? Is your eating disorder causing your depression? Or is your depression (the one maybe you didn’t really know you had) causing the problems in eating to begin with? Of course, you’re confused.

Sorting this question out is not so simple. You’re quite sure you haven’t felt this depressed in the past. But, sometimes depression is masked by other preoccupations; like eating or not eating. So, then, it’s hard to know that depression is there.  

Really, this whole matter isn’t simply a chicken or egg question. It could go either way. It could even be a bit of both. So let’s sort out each side of the equation.

Can Eating Problems Cause Depression?

Yes, eating disorders can cause depression. Because it is very depressing to be caught in that vicious cycle you can’t stop. To be so preoccupied with eating or not eating that you fall behind in everything else. It interferes with your social life, your work success, and your relationships.

That doesn’t make anyone happy. Plus, to feel like you are constantly failing, out of control, and not good enough is very depressing to be sure. So, again; yes. It is entirely possible that your eating disorder is making you depressed.

Yet, before we go farther into the fact that the chicken or egg question doesn’t really matter, let’s think about the other side of the coin.

Are Eating Disorders A Symptom Of Depression?

Eating disorders can definitely be a symptom of depression. Often, an eating disorder is a way of managing a poor body image. Feelings of not being good enough. And worries about whether you take too much (or need too much) from your loved ones.

All of these worries can be a red flag that depression is (and was) already there. And, especially if these worries mean you either isolate yourself or you can’t ask for very much. Then, you never have what you really need. You live on empty. Always feeling there aren’t ample supplies, and convincing yourself you don’t need anything anyway.

It might make sense, then, that the eating disorder (feeding yourself or starving yourself) was trying to fight off a depression in the first place.

Chicken Or Egg? It Doesn’t Really Matter.

It’s very possible that your eating disorder is actually trying to “solve” or evade or control a depression from taking over. But does any of this really matter at this point? It’s a chicken or egg issue. And, the reality is you’re depressed. And, even if you can point to your eating disorder as the “cause,” that doesn’t answer the deeper question.

What exactly is it that’s depressing you? And, once you find a conscious answer or two, there really is another step that needs to happen. Finding out what is going on underneath. Because eating disorders are really a symptom of something else.

Eating Disorders Are A Deeper Symptom 

Ok, you’re probably thinking, but what? That’s a good question. I can’t really answer specifically without knowing you and the particulars of your life. But, I can give you some examples you might relate to:

The need for control (to be “perfect”)

On the surface, you’re trying to control food. But, actually isn’t your perfectionism more about a need to look good? And, I’m not just talking about your physical appearance. Looking good may seem that way on the surface — when it comes to body image and food. But, it’s much more than that.

Really, aren’t you afraid of being judged on all levels? With anything that “shows;” (even your feelings or your needs). Anything somebody might not like. And, the root of that goes quite far back; to childhood. Perhaps your physical appearance was criticized. Or you were made to think your feelings were “silly” or unwanted.

That you were too sensitive. That you should be quiet and not ask for much. That you’d be yelled at; or ignored; if you did. Or even that someone else’s problems and needs were more pressing than yours. Maybe, even, there were intrusive demands about how you were “supposed to” be; and weren’t.  

Any of this; and any other form of hurt and neglect that early childhood trauma takes can make you feel not good enough. It can lead to trying to have control over what you couldn’t control in the past. One thing you certainly want to control now is hunger. The hunger for something you don’t think you can have.

Hunger:  “I’m too fat”

Sometimes you’re successful in controlling your physical hunger and sometimes you’re not. But, what is it about hunger that you hate? I’m sure that voice keeps playing in your head: “You’re going to get fat.” “You’re getting fat.” “You are fat!” Is that the constant refrain? It’s terribly hard to live that way.

So, the important question is: what exactly is “fat”? Maybe you need to lose weight, but this self-criticism is more than that. Or maybe you are a normal weight and feel fat anyway. Or maybe you are skinny and all you see is “fat” in the mirror. So, again: what is this feeling “fat?”

Or, to put it another way: what is “feeling fat” all about? Feeling fat is most often about emotional need. You can’t want too much. Think you need too much. You’re going to be too much. Or, you certainly felt you were too much for someone in the past (probably first as a child.)  

So, you try to go on very little; you take care of yourself; you’re tough. You ask for almost nothing. Go it alone. You might even be preoccupied with feeding or giving to others. And, you likely tell yourself: “I’m fine. I don’t need anyone at all.”  

This all plays out with food. And, you try very hard not to break any of these “rules.” So, of course, your eating disorder is making you depressed.

A bullying voice in your head

Because, when you “fail,” you get hit with that bullying voice in your head: “Look at you. You’re stupid.” “What did you do that for?” “Now you really have to starve yourself.” “You’ve done it again.” “You should know better.” “What’s wrong with you??”

Let’s go back to our list of the symptoms of depression. Remember #9? Feelings of worthlessness or guilt, fixating on past failures or self-blame? Depression largely boils down to self-hate. Of the needs (or things) you can’t control.

The Most Depressing Part Of An Eating Disorder  

The most depressing part of an eating disorder is self-hate. Are you obsessed with mirrors? Avoiding them. Looking constantly. Or not looking; out of fear of what you’ll see. If you look, you want confirmation of a reflection back of someone you might like and feel good enough about. Mostly, though, you don’t like what you see.   

And, then it’s back to making yourself “better.” The eating disorder takes over. You starve because skinny looks better. Or, if you binge and gain more weight; it’s because you’re hungry for a feeling that you’re starving for. Love. The lack of self-love. Needing something you’ve never had.

So, yes, an eating disorder can cause depression when the self-hating voice is particularly unrelenting and loud. But, since that self-hating voice existed before the eating disorder; very likely, so did your depression.

And, now, you feel stuck.

What To Do If Your Eating Disorder Is Depressing?

If you feel stuck, it’s time to get help from an expert in treating eating disorders. That expert should be a mental health professional that understands and knows about what is going on underneath the more obvious surface symptoms.

Trust is likely a sensitive and difficult issue. You probably worry about judgment. And, exposure to your emotional need is a scary thing. But, is your eating disorder out of hand? And is depression getting the best of you? Life doesn’t have to be this way.

So, getting help from someone who not only understands but has years of experience in depression and eating disorders - is a really good idea.

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I’m Dr. Sandra Cohen, a Los Angeles based psychologist and psychoanalyst. I work with people of all ages struggling with eating disorders and the related symptoms of depression and anxiety. Whether you have anorexia, bulimia, restrictive, or overeating you don’t have to live this way. Psychotherapy can help.

This article was originally published at Sandra E. Cohen, Ph.D's Moving Forward Blog. Reprinted with permission from the author.