Eating disorders are complex, potentially life threatening conditions that negatively impact a person’s physical and emotional health. According to the National Eating Disorders Association, 20 million women and 10 million men will suffer from a clinically significant eating disorder at some point, including anorexia nervosa, bulimia nervosa, binge eating disorder, or other or unspecified feeding or eating disorder.1

Bulimia nervosa commonly begins in adolescence or young adulthood and is characterized by recurrent episodes of binge eating and compensatory behaviors (often referred to as “purging”.2 Comorbidity with other mental disorders is common with individuals with bulimia nervosa, with studies indicating that nearly half of bulimia nervosa patients also have a co-existing mood disorder. 3

Individuals with bulimia nervosa show an increased frequency of both depressive symptoms (ex: low self-esteem) and depressive disorders. For many patients, the mood disturbance begins at the same time as or following the eating disorder, but for some the mood disturbance precedes the development of bulimia nervosa. 4

Given the overlapping relationship between bulimia nervosa and depressive disorders, it helps to understand both and find effective treatment.

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Symptoms of bulimia nervosa

Individuals with bulimia nervosa typically are within normal weight or overweight range, and the binge eating frequently begins during or after an episode of dieting to lose weight. The essential features of bulimia nervosa are as follows:

  1. Recurrent episodes of binge eating characterized by eating (in a discrete amount of time) an amount of food that is larger than most individuals would eat given the circumstances and a sense of lack of control during the eating episode.
  2. Recurrent compensatory behaviors (“purging”) to prevent weight gain, including: self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  3. The binge eating and purging both occur at least once a week for 3 months.
  4. Self-evaluation is influenced by weight and body shape
  5. The disturbance does not occur during anorexia. 5

Individuals with bulimia nervosa place an excessive emphasis on weight and body shape, and these evaluations of their bodies negatively impact their self-esteem.

Binge eating often occurs in secret and can be triggered by stress, negative feelings related to weight or body shape, boredom, or dietary restraint. Binge eating can result in feelings of shame.

The 12-month prevalence of bulimia nervosa among young females is 1%-1.5%. The disorder peaks in adolescence and young adulthood and has a 10:1 female-to-male ratio. 6

Suicide risk

Suicide risk is elevated for individuals with bulimia nervosa, particularly with a co-occurring mood disorder.

Symptoms of major depressive disorder increases the risk of suicide. 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 plan. 7

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, as a more than one treatment approach might be necessary.

Treatment of bulimia nervosa and depression

Treatment of bulimia can be complicated. Effective treatment addresses the underlying emotional issues that contribute to low self-esteem and negative self-perception.

Treatment of bulimia nervosa and depression is most effective with a team approach. Your treatment team includes you, your family, your primary care doctor or health practitioner, your mental health practitioner, and a dietitian experienced in treating eating disorders. Treatment can include:

  • Cognitive Behavioral Therapy (CBT) to help you identify unhealthy, negative thought patterns that contribute to disordered eating and replace them with positive ones
  • Family therapy (this is particularly important with adolescents)
  • Interpersonal therapy to help work through issues related to self-esteem, communication, and problem solving
  • Medication management – some antidepressants can be effective for treatment of bulimia nervosa when combined with psychotherapy. 8
  • Nutrition education to design a healthy eating plan
  • Hospitalization – if you have significant health complications from bulimia nervosa, hospitalization might be necessary

Finding help for bulimia nervosa and depression

There is no simple answer for treating bulimia nervosa and depression. The best first step to take is to ask your primary care physician for a referral to an eating disorders specialist. From there, your specialist can lead your team to help you find the treatment plan that works best for you.

 

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Last Updated: Jul 10, 2017