The Vital Link Between Eating Disorders and Mental Health

*Trigger warning: The post below discussed eating disorders and mental illness, including depression, anxiety, borderline personality disorder, and OCD. If you are struggling, please contact a medical professional and/or the Eating Disorder Crisis Helpline.

I’m very passionate about the topics of eating disorders, eating disorder recovery, and mental health. In a previous post, I discussed my own experiences with eating disorder symptoms and compulsive exercise. I also discussed how those symptoms were related to my low self-esteem at the time and negative emotions towards my body. And I described my frustration with my primary care physicians. For example, they never recommended or prescribed mental health treatment of any kind. If you’d like to read that post, you can check it out here.

In today’s post I’ll be talking much more about the link between mental health and eating disorders. I’ll draw on research and doctor recommendations. I’ll also discuss recommended treatment options and provide a dose of inspirational quotes at the end.

The Most Common Eating Disorders

Eating disorders are far more common than many people realize. Indeed, researchers estimate that 9% of the U.S. population will have an eating disorder at some point in their lives. That’s likely an underestimate because many people with eating disorders never report them. Moreover, while eating disorders are commonly portrayed as a “White woman problem,” 25% of people with eating disorders are men and 20-26% are people of color.

The most common eating disorders are: anorexia nervosa, bulimia nervosa, orthorexia, binge eating disorder, and restrictive food intake disorder.

Anorexia Nervosa

Anorexia is characterized by severe calorie restriction and food avoidance. Symptoms of anorexia also include an outsize fear of weight gain and a distorted image of one’s body size (also called body dysmorphia). Individuals with anorexia frequently shift their eating habits. They may even take extreme measures to avoid eating in front of others.

Bulimia Nervosa

Those who have bulimia nervosa engage in self-induced vomiting (or purging) after meals. They may experience other disordered behaviors around eating (like avoiding eating with others), similar to those who have anorexia.

Restrictive Food Intake Disorder (RFID)

Like anorexia, those with RFID avoid food. However, individuals with RFID avoid food because of a fear or disgust with food or types of food. This is in contrast to individuals with anorexia who avoid food because of a fear of weight gain. While RFID is more common in children, doctors increasingly recognize that adults suffer from it as well.

Orthorexia

Orthorexia is also somewhat similar to anorexia. In fact, I identify somewhat more with having orthorexia as a teenager than anorexia. The difference between orthorexia and anorexia is that orthorexia is a compulsion to only eat healthy foods or to avoid particular foods because of the belief that they are harmful. Eating healthy sounds like a good thing. However, this compulsion can be taken to an extreme where the individual does not actually receive enough proper nutrition because they are not getting enough fats, carbs, and calories in their diet.

Binge Eating Disorder

Finally, binge-eating disorder is when an individual cannot stop themselves from over-eating, even though the over-eating episode often leads to shame, depression, and guilt. Moreover, those with binge-eating disorder eat when they are not hungry. They may also not be fully aware of how much they ate.

While these eating disorders are presented separately, they all have similar relationships with mental illness and other disordered behaviors like over-exercising. Additionally, regardless of the specific eating disorder, individuals who suffer from eating disorders often do not get proper nutrition. As a result, they may experience experience electrolyte imbalances, fatigue, heart problems, severe weight loss, and even death. In fact, being underweight has a higher risk of death than being overweight. 

The Link Between Depressive Disorders and Eating Disorders

Eating disorders have strong ties with depression. Indeed, it’s estimated that 50-75% of individuals with eating disorders experience depression symptoms. 42% of those with anorexia exhibit major depressive disorder. 

What do I mean by major depressive disorder? The National Institute of Mental Health defines major depressive disorder (or major depression) as a situation in which people experience a loss of interest or depressed mood, most of time time, for 2 weeks of more. These feelings often interfere with daily life. These depressive symptoms can include feelings of guilt, feelings of worthlessness, helplessness, frustration, hopelessness, pessimism, and more. For a complete list of common symptoms of depression, see the NIMH’s page on depression.

Does Depression Cause Eating Disorders Vice Versa?

Studies have shown that depression can be a risk factor for eating disorders and eating disorders can be a risk factor for depression. So, for some people, depression may cause anorexia or other eating disorders, while for others, eating disorders may cause depression. It’s important to note that there is rarely one cause of depression or eating disorders. For the vast majority of people, these will be one risk factor of many.

For example, having a family history of depression or genetic factors corresponds to a higher risk of depression and eating disorders. Experiences of trauma in childhood or adulthood play a big role in both. Additionally, life circumstances like conflict, the death of a loved one, job loss, or the diagnosis of an illness can play roles. Depression can even be brought on because of side effects from other health conditions (like eating disorders!) or medications. Again, often there are multiple causes that play a role in the onset of major depressive episodes and eating disorders.

Studies show that individuals with eating disorders and depression tend to share core depression symptoms: sadness, indecisiveness, and loss of pleasure, interest, and energy. However, those with eating disorders have a much more negative sense of self than those who “just” have depression.

Consequently, those with eating disorders and co-morbid depression may benefit from receiving therapy that helps address the root causes of depression and eating disorders. Often this will involve addressing body image, as well as any triggering events for depression.

The Link Between Anxiety Disorders and Eating Disorders

Similar to depression, anxiety is prevalent among those with eating disorders. It’s estimated that about 60% of those with eating disorders have anxiety disorder at some point in their lives. According to the Statistical Manual of Mental Disorders, common symptoms of anxiety including feelings of nervousness, panic, or impending doom; difficulty sleeping, and a racing heart. For a full list of symptoms, visit the Mayo Clinic’s website on anxiety.

One of the most common anxiety disorders associated with eating disorders is obsessive-compulsive disorder (OCD). OCD involves repeated, unwanted negative thoughts, feelings, or sensations that cause people to engage in repetitive behaviors to get rid of those thoughts/feelings/sensations. For example, someone who turns the light off and on 3 times because of a fear that not doing so would lead to the death of a loved one could have OCD. These repeated thoughts and behaviors frequently interfere with people’s daily lives. These disorder behaviors can also be directed towards food, potentially leading to disordered eating.

Does Anxiety Cause Eating Disorders or Vice Versa?

It’s unclear whether anxiety causes eating disorders, eating disorders cause anxiety, or a different factor causes both. Most likely it’s the same as with depression. For some people, anxiety will come first and for others eating disorders will come first. Some studies have found that individuals with eating disorders are much more likely to have anxiety in childhood, suggesting anxiety may come first. Another study found that maladaptive perfectionism (basically perfectionism that is taken to an extreme that negatively impacts quality of life) causes both anxiety and eating disorders.

The reality is that it’s less important to know which came first, and more important to acknowledge that both disorders have significantly overlapping symptoms and risk factors. So many people should seek treatment that addresses both simultaneously. 

Borderline Personality Disorder and Eating Disorders

Borderline Personality Disorder (BPD) is less well known than many other mental illnesses, but it is associated with a substantially increased risk of experiencing an eating disorder. BPD is associated with the following symptoms:

• Intense fear of abandonment
• Unstable and intense personal relationships
• Low or unreliable sense of self
• Suicidal thoughts or behaviors
• Drastic mood shifts
• And more, for the full list and additional information see Eating Disorder Hope

It’s estimated that about 1/4 of those with anorexia or bulimia also have BPD and 54% of those with BPD have a history of an eating disorder. There are a number of theories as to why BPD and eating disorders are so tied. For one thing, eating disorders may stem from an attempt to control one’s life when BPD can leave individuals feeling very much not in control. The low sense of self associated with BPD also has a strong link with eating disorders.

There are therapies specifically designed for those with BPD and eating disorders (I’ll discuss those below). Consequently, if you think you have BPD, consult with a doctor and consider therapies tailored to your situation.

Can You Recover From an Eating Disorder?

Eating disorders are very, very treatable. I am certainly an example of that. And I’m someone who didn’t even have proper treatment for an eating disorder. Basically I winged my recovery, which I wouldn’t recommend to anyone. With the right treatment and a supportive team, you can definitely make a full recovery from an eating disorder. 

Additionally, many of the symptoms of an eating disorder quickly reverse with treatment and return to a healthy diet. Addressing the nutritional deficiencies associated with eating disorders leads to an improvement in body weight, regulation of heart rhythms and hormones, improvement in skin, hair, and nails, and more. Beyond this, therapy and/or medication help many people address their unhealthy relationship with food, negative body image, and other mood disorder symptoms.

How Long Does Eating Disorder Recovery Take?

The length of eating disorder recovery is very individual and depends on the treatment received. It took me about two years to fully recover. For many people, that recovery time will be less, and for some it will be more. For some of the therapies recommended below, practitioners note that it can take about 12-16 weeks until patients notice a substantial difference.

Why does eating disorder recovery take so long? Most importantly, eating disorders are generally a symptom of a larger problem. Hopefully this post has helped illustrate that the development of an eating disorder frequently happens after or in tandem with mental health disorders and other co-occurring disorders. As a result, it’s not enough to tell people to eat more or stop purging or over-eating. Anyone with an eating disorder knows that would help. But that recommendation doesn’t get to the root of the problem.

Consequently, for eating disorder recovery to be sustainable, it must be accompanied by a holistic treatment plan that addresses root causes, including any mental health conditions. Often these treatments address body image issues. Treatments may also address the possibility that individuals control their eating behaviors as a coping mechanism for feeling a lack of control in other areas of their life.

Additionally, eating disorder recovery can take a long time because calorie restriction, purging, or binging all lead to appetite changes. If you have a loss of appetite from calorie restriction/purging or an increase in appetite because of binging, it takes a long time for your body to adapt to having more/less food. In the meantime, we all know how uncomfortable it is to eat well beyond feeling full or to deprive ourselves when we’re hungry.

Treatment Recommendations

For those suffering from eating disorders, the first step is to talk with a doctor. It’s important to find a physician who is understanding and compassionate. A doctor can help you develop the right treatment plan for your symptoms and situation. An important part of most treatment plans is mental health counseling and potentially nutritional counseling. 

There are a number of different kinds of therapeutic practices eating disorder sufferers have benefitted from. These include:

Psychotherapy (or talk therapy)

Psychotherapy involves identifying problematic thoughts and behaviors, and developing strategies with your therapist to help resolve them. The American Psychiatric Association recommends receiving psychotherapy that is eating-disorder focused. For example, psychotherapy to treat anorexia might address anxieties around body shape and weight gain.

You can seek a recommendation for a therapist from a trusted doctor or find eating disorder therapists on Psychology Today’s website.

Cognitive Behavioral Therapy (CBT)

CBT is a goal-oriented form of talk therapy. The goal is specifically to help individuals identify and change negative thought processes or behaviors. CBT helps individuals develop better coping and problem-solving behaviors, understand the behaviors of other people, and face fears rather than avoiding them. Studies have found CBT to be an especially effective form of therapy for many health conditions, including eating disorders.

Dialectical Behavior Therapy (DBT)

DBT is a type of Cognitive Behavior Therapy that is designed for those who experience severe emotions, such as those who have Borderline Personality Disorder or panic disorder. With DBT, individuals develops skills like mindfulness, distress tolerance, and emotional regulation that can help them sit with and move past difficult emotions. Many studies have shown its usefulness for adults. A recent study illustrated that DBT showed promise for treating eating disorders in young adults as well.

Family Therapy

Family-based therapy is specifically for children and teens experiencing eating disorders. In this kind of therapy, parents or other family members are the main coaches helping their children get through eating disorders. Caregivers and children receive weekly counseling. However, caregivers also offer emotional support, prepare food, and enforce strict rules around eating. It can be a very time-consuming process for caregivers, though studies show it is also quite effective for anorexia and bulimia.

Other Kinds of Support

There are a number of activities you can try yourself, including journaling and meditation that can improve mental health. You can check out this great list of self love journal prompts to help you get started. And I love the Calm app for their meditations for anxiety.

Nutritional Counseling: With nutritional counseling, patients work with licensed nutritionists to discuss their eating habits and lifestyle and come up with a strategy for healthier eating.

Some individuals also benefit from attending an online or in-person support group.

And, for particularly severe cases or cases in which individuals have continuously relapsed, individuals may consider residential treatment sites that allow patients to be immersed in a supportive and healthy environment. 

In all cases, treatment should be individualized and address the emotional aspects of a person’s experience. For guidance on choosing the right therapist for you, check out this great guide for finding the right mental health professional near me from Sunny Days Counseling.

Inspirational Quotes for Eating Disorders

“It doesn’t have anything to do with how the world perceives you. What matters is what you see.” — Gabourey Sidibe

“You have been criticizing yourself for years and it hasn’t worked. Try approving of yourself and see what happens.” — Louise Hay

“With all the sharpness and harshness and violence and fear that has been around, perhaps the softness of my body is a blessing. It has been able to nurture me in a way that my mind could not.” — Tracee Ellis Ross

“I can’t think of any better representation of beauty than someone who is unafraid to be herself.” — Emma Stone

“Weight loss does not make people happy. Or peaceful. Being thin does not address the emptiness that has no shape or weight or name. Even a wildly successful diet is a colossal failure because inside the new body is the same sinking heart.” — Geneen Roth

“[Y]esterday I decided to fight the f**k back. Reclaim my body and stop trying to change this chest and these hips and these curves that my mum and dad made and love so unconditionally.” — Sam Smith

“Don’t waste so much time thinking about how much you weigh. There is no more mind-numbing, boring, idiotic, self-destructive diversion from the fun of living.” — Meryl Streep

Summary

It is vital to remember that you are not alone and not at fault for an eating disorder or mood disorder. There are many causes behind both. The most important thing is to seek treatment from compassionate individuals who understand the complex link between eating disorders and mood disorders, and who can recommend a holistic treatment plan that addresses both. Beware of anyone who merely tries to treat you with medication or a recommendation to eat more/less with no additional support. There is rarely a single exact cause of eating disorders. Disorder treatment should be just as multifaceted.

If you enjoyed this post, please consider liking, subscribing, or sharing with others. It’s always a big help and I really appreciate it! For related content, check out my posts on my eating disorder experience, the role of sizeism for unhealthy body images, and how to set boundaries.

Remember that I am not a medical professional. Before making any changes to your health, speak to a medical professional.