About half of all people with eating disorders also have depression. The best treatment approach involves addressing both problems at the same time. Counseling techniques that help people control both persistent sadness and the urge to restrict food can give people very real tools they can use to gain control and then stay in control for the rest of life.
According to the National Association of Anorexia and Eating Disorders, nearly 50 percent of individuals with eating disorders satisfy the diagnostic criteria for depression. The starting place of treatment for co-occurring eating disorder and depression is to receive a medical diagnosis. The Diagnostic and Statistical Manuel of Mental Disorders-5 (DSM-5) sets forth the criteria for a doctor or mental health professional to diagnosis, and gauge the severity of, anorexia nervosa and depression. Although these are separate disorders, depression and anorexia are often linked.
From a psychiatric standpoint, the form of depression involved in anorexia can have distinct features, whether the two conditions co-occur or one causes the other. For instance, a person with anorexia often has a desire for perfectionism. This desire may be a symptom of underlying depression (i.e., the individual is chronically depressed due, in part, to a perceived inability to meet a desired standard of beauty). As anorexia and depression occur with some frequency, when individuals receive a diagnosis of anorexia, it may be a good medical practice for them to also be screened for depression.
Symptoms associated with depression include but are not limited to:
It is established in the mental health services community that when two disorders co-occur, such as anorexia and depression, treatment for each must be provided simultaneously. A failure to treat one condition can trigger a relapse of the other condition. Further, a lack of treatment for a mental health disorder can exacerbate its symptoms.
Whenever possible, an effective treatment approach is to receive care for both issues within the same program. If such treatment is unavailable, treatment may occur in separate facilities, but it is critical that treatment teams coordinate to provide an integrated recovery plan for both anorexia and depression.
As Mayo Clinic discusses, research-based treatments are available to treat anorexia and depression. When both disorders are being treated, the traditional treatment approaches for each disorder are provided simultaneously. In other words, there is not typically a combined approach (i.e., there usually is not a separate treatment practice for co-occurring anorexia and depression in particular). Attending treatment professionals will work to ensure that medications (if any) taken for each disorder are complementary (hence the need for integrated care). When beneficial, treatment services, such as therapy (psychological counseling), can address both disorders in individual or group sessions. A therapist who has training and experience in both anorexia and depression is typically the optimal treatment provider.
Treatment for anorexia generally includes therapy, medical monitoring, nutrition education, and, in some instances, prescription medications. Medical monitoring helps to ensure the recovering person is working toward a healthy weight and stable physical condition without undermining recovery by re-engaging in anorexic practices.
A residential treatment program can provide 24/7 support and supervision. However, an outpatient program can also be effective as the staff may have ways to discern if the recovering person is following the treatment curriculum, such as via weigh-ins, medical checkups, and during individual counseling sessions.
The length of therapy depends on an individual’s receptivity to treatment. Although some individuals benefit from short-term therapy, others may have treatment-resistant depression (only detectable after a course of treatment is provided). These individuals are advised to seek maintenance therapy, a longer-term therapy program.
There are over 200 schools of therapy, and recovery centers employ those that best complement their overall treatment philosophy. While various therapeutic approaches may be employed, CBT has been shown to be effective as a research-based approach to treating eating disorders. Many centers implement this approach in both individual and group sessions.
Nutritional education is a key component of care. Depression treatment alone will typically not include this service, but it is essential to the treatment of eating disorders.
Traditional treatment for depression includes medications, therapy, and supplemental activities such as exercise. Depression medications span five categories:
Exercise may be included in the recovering person’s treatment curriculum and can also be engaged in after program graduation. It is critical for the recovering person to develop a healthy relationship with exercise, as excessive exercise is a symptom of anorexia. Balance is essential.
Disclaimer: AAC facilities do not treat anorexia. Care can be found at specialty facilities throughout the country.