A substantial number of women with eating disorders suffer from a depressive disorder as well. Through the years, clinicians and therapists have sought to determine whether eating disorders such as anorexia and bulimia are the cause of depression, or whether mood disturbances precede eating disorders. At the heart of our efforts to understand the psychological mechanisms of our patients, mental health professionals aim to focus our treatment on the underlying issues and facilitate recovery and restore emotional balance. However, as each individual’s condition is unique, there is no one, definitive answer when it comes to determining whether an eating disorder is the causative agent of depression or vice versa.
Historically, studies seem to point toward a conclusion that depression arises in women after they have developed an eating disorder. Indeed, in many cases this is true. It is not uncommon for a secondary emotional disorder to develop, especially when an individual’s eating disorder endures over a number of years. Yet, some research suggests that among those women with eating disorders who have attempted suicide or who have tried to inflict serious bodily injuries upon themselves the opposite may be true. Their depression appears to be the central psychological issue, often preceding the eating disorder by many years.
The apparent difference between suicidal and non-suicidal women with eating disorders is crucial for the therapist when developing the most effective treatment modality. Depression clearly affects a considerable number of eating disordered women, but among those who are suicidal, depression evidently develops at many years earlier than the eating disorder becomes manifest. Accompanying suicidal behavior, there is a rate of anxiety disorders that far exceeds that of the non-suicidal subset. Again, these co-occurring mood disorders develop years in advance of the eating disorder.
A course of treatment designed to pinpoint the underlying primary psychological is surely the goal of any program if a lasting recovery is to be gained. If a history of depression appears to precede the eating disorder, a program that focuses on attaining emotional regulation is important as there is an increased risk of suicide for these patients.