The Intersection Between Eating Disorders and Mental Health
It’s that time of year again: Feb 26- March 4, 2017 is National Eating Disorders Awareness week (#NEDAwareness). This year’s theme is: It’s time to talk about it! The goal is to increase the conversations about eating disorders to decrease their stigma. Previous eating disorders blogs I wrote have discussed prevalence, warning signs, focusing on healthy habits instead of weight, males with body image issues, and even a first-person account of living with an eating disorder. This year I’m going to focus on the intersection of eating disorders and other common mental health conditions.
Depression is a mood disorder characterized by feelings of intense sadness, helplessness, worthlessness, anxiety, and/or guilt. Depression is one of the most common of all mental health problems. Appetite changes and weight changes, including weight loss or weight gain, are common symptoms of depression. Depression and eating disorders have an interesting relationship. The American Psychiatric Association has reported that lifetime rates of major depression in individuals with eating disorders range between 50% and 75%. Interestingly, some behaviors related to eating disorders can lead to worsening of depression. For example, being severely underweight and malnourished, which is common in Anorexia Nervosa, can cause changes to the body’s physiology and chemistry that are known to negatively affect moods. To complicate matters even more, many medications used to treat depression do not work as effectively during these periods of extreme nutrition restriction and malnourishment (they are more effective once the patient is at a healthy weight). People with eating disorders are more likely than the general population to attempt (and complete) suicide; people with a combination of an eating disorder plus depression are at even higher risk.
Nearly one in five people in the US suffer from anxiety. Eating disorders commonly co-occur with anxiety disorders. One study showed about 60% of people with an eating disorder (Anorexia Nervosa or Bulimia Nervosa) also had a diagnosis of anxiety; the vast majority of the anxiety diagnoses occurred prior to diagnosis of the eating disorder. Specific anxiety disorders, like obsessive-compulsive disorder, are also more prevalent in people with eating disorders than in the general population. The treatment of eating disorders, namely increasing amount of calories consumed, forced decrease in physical activities, and possibility of gaining weight, can cause feelings of anxiety in patients with eating disorders. Like mentioned above, some medications to treat anxiety may not be as effective during periods of extreme nutritional restriction.
Multiple studies have demonstrated that many people who struggle with eating disorders have also struggled with substance abuse. According to a report from the National Center on Addiction and Substance Abuse, 50% of individuals with an eating disorder abused alcohol or other drugs, a rate five times higher than the general population. Interestingly, 35% of individuals who abuse alcohol or other drugs have suffered from an eating disorder, a rate eleven times higher than that of the general population. When looking at specific eating disorders, people with Bulimia Nervosa have the highest prevalence of substance use, followed by Binge Eating Disorder and Anorexia Nervosa. The most commonly abused drugs include alcohol, tobacco, and amphetamines/stimulants. Research has shown that eating disorder patients who abuse substances are worse off than those with an eating disorder alone, including increased general medical complications, longer recovery times, poorer functional outcomes, and higher relapse rates.
Eating disorders and other mental health disorders like depression, anxiety, or substance abuse are a very dangerous combination. It is important to get professional help, which will likely include a medical professional, a nutritionist, and a mental health professional. If you have concerns that you or someone you know has any of these conditions, contact your health care provider.