Eating disorders are complex and often begin with good intentions: The desire to lose excess weight and change eating habits. For some people, the desire to lose weight can result in anorexia nervosa. Why some people are at risk of developing eating disorders while others are not isn’t entirely clear, but there is evidence that heredity and depressive disorders can elevate the risk.

One study found that anorexia nervosa is estimated to have a heritability rate of 58% (heritability is the variation between individuals in a given population due to their genetic variation) and that the comorbidity of anorexia nervosa and major depression is likely due to genetic factors that influence the risk for both disorders.1 Another study of over 2,400 females in inpatient treatment for eating disorders found that 94% of patients evidenced comorbid mood disorders, largely unipolar depression (depression without manic states).2

Given that anorexia nervosa and major depression commonly co-exist1, it helps to understand the symptomology and treatment options for both.

Symptoms of Anorexia

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-5), there are three primary features of anorexia nervosa: persistent food restriction, intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain.2

The physical signs and symptoms of anorexia nervosa can include the following:

  • Extreme weight loss
  • Abnormal blood counts
  • Fatigue
  • Dizziness
  • Fainting
  • Discoloration of the fingers
  • Thinning or brittle hair
  • Absence of menstruation
  • Insomnia
  • Thin appearance
  • Dry or yellowish skin
  • Dehydration
  • Irregular heartbeat
  • Osteoporosis
  • Low blood pressure

Symptoms of Major Depressive Disorder

The essential feature of major depressive disorder is a period of two weeks during which there is either depressed mood most of the day nearly every day or loss of interest or pleasure in nearly all activities. Other potential symptoms include:

  • Significant weight loss when not dieting or weight gain and changes in appetite
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive guilt
  • Impaired ability to think or concentrate, and/or indecisiveness
  • Recurrent thoughts of death, recurrent suicidal ideation without a plan, or a suicide attempt or suicide plan3

The symptoms of major depressive disorder cause significant distress or impairment in social, occupational, or other areas of functioning. Suicide is always a risk when an individual experiences a major depressive episode. It is very important that individuals discuss their depressive symptoms with their health care providers when seeking help for bulimia nervosa, (self-induced vomiting to rid the body of food) as a more than one treatment approach might be necessary.

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Symptom Overlap

Though both illnesses can include fatigue, severe weight loss is the symptom that most often overlaps between the two. The big difference between the two, however, is that most individuals with major depressive disorder do not have either a desire for excessive weight loss or a fear of gaining weight.4

Suicide Risk

According to the DSM-5, the risk of suicidal behavior is elevated for both major depressive disorder and anorexia nervosa. The possibility of suicidal behavior exists at all times during a major depressive episode, particularly when there is a history of suicide attempts or threats,5 and rates of suicide for patients with anorexia nervosa are reported to be 12 per 100,000 per year.

Treatment of Anorexia Nervosa and Major Depressive Disorder

Due to the complex nature of anorexia nervosa and major depressive disorder, treatment for both conditions includes a comprehensive medical team that encompasses a physician, a therapist, and a nutritionist. Individual treatment plans will vary depending on symptoms and severity but can include the following:

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Last Updated: Feb 13, 2018