In the field of eating disorders, psychiatric comorbidities, such as mood disorders, are commonly presented with eating disorders or symptoms of eating disorders. Studies have shown that eating disorder patients with comorbid depression are at higher risk of ongoing eating disorder symptoms, poorer health and higher rates of mortality than those without comorbidity (at the 14-year follow up) (Hughes et al., 2013).
In comorbid patients, it can often be difficult for clinicians to determine whether the eating disorder preceded the depression or whether the psychological issues occurred first.
A significant study of females with a history eating disorders has demonstrated that massive depressive disorder and eating disorders occur in the first instance in close proximity, that is, within a 3 year window. In addition, just over 43% of both illnesses occurred together, within 1 year of each other (Fernandez et al., 2007).
Comorbidity and Complexity
Comorbid conditions like depression can make treatment and recovery more challenging, and they can increase illness severity and complexity; they can also increase the risk of relapse. While depression can be an expected consequence of disturbed eating patterns, it can occur at any time during the illness (including during and after the recovery process), hence complicating diagnosis, treatment and recovery.
In a recent 2013 study of children and adolescents, it was discovered that patients who were diagnosed with comorbid depression presented with more complex and severe forms of the illness than those without comorbidity or comorbid anxiety. This was indicated by more frequent binge eating and purging, greater dietary restraint, eating, weight and shape-related concerns, higher levels of depressive symptoms and lowest levels of self-esteem.
Children and adolescents who came from non-intact families were also more likely to present with depression comorbidity than those without or with only comorbid anxiety disorder. However, the correlation between comorbid depression and family stability, and how to treat this, is something that requires further investigation (Hughes et al., 2013).
A Shared Risk Factors Approach
By focusing on shared, modifiable risk factors, an effective public health approach may be possible. Common risk factors of eating disorders and depression include body dissatisfaction, weight/shape concerns, low self-esteem, and bullying and weight-related teasing, the last of which also contributes to heightened suicide ideation and functional impairment in youth sufferers (Becker et al., 2014).
At present, there are no public health programs or universal prevention interventions that seek to simultaneously address eating disorders and depression. Where programs do exist that target commonalities they do not necessarily effectively impact the targeted risk factor/s and there is little evidence that proves the success of these approaches. It is also uncertain whether altering the risk factors will also alter the course of the approach and the end point/outcome for eating disorder and depression patients (Becker et al., 2014).
In a clinical setting, many gaps also exist in treating eating disorder patients with comorbidity. For example, certain third-wave strategies, such as mindfulness-based cognitive therapy, have shown some efficacy in depression treatment and are only starting to be adopted in eating disorders literature (Bailey et al., 2014).
Read more about risk factors.
Recognising that many commonalities exist between eating orders and depression is vital in developing effective diagnoses, interventions and treatment approaches. While the relationship between depression and eating disorders requires further research, targeting variable shared risk factors in health initiatives and clinical treatment may be one viable approach in addressing the heightened complexity and severity of the comorbidity and achieving successful treatment outcomes.
Bailey, A. P., Parker, A. G., Colautti, L.A., Hart, L. M., Lieu, P., Hetrick, S. E. Mapping the evidence for the prevention and treatment of eating disorders in young people (2014). Journal of Eating Disorders, 2:5 doi:10.1186/2050-2974-2-5.
Becker, C.B., Plasencia, M., Smith Kilpela, L., Briggs, M., Stewart, T. Changing the course of comorbid eating disorders and depression: what is the role of public health interventions in targeting shared risk factors? (2014). Journal of Eating Disorders, 2:15 doi:10.1186/2050-2974-2-15.
Fernandez-Aranda, F., Poyastro Pinheiro, A., Tozzi, F., Thornton, L. M., Fichter, M. M., Halmi, K. A., Kaplan, A. S., Klump, K. L., Strober, M., Woodside, D.B., Crow, S., Mitchell, J., Rotondo, A., Keel, P., Plotnicov, K. H., Berrettini, W.H., Kaye, W. H., Crawford, S. F., Johnson, C., Brandt, H., La Via, M., Bulik, C. M. Symptom profile of major depressive disorder in women with eating disorders. Australian & New Zealand Journal of Psychiatry (2007) Jan;41(1):24-31.
Hughes, E. K., Goldschmidt, A. B., Labuschagne, Z., Loeb, K. L., Sawyer, S. M., & Le Grange, D. (2013). Eating Disorders with and without Comorbid Depression and Anxiety: Similarities and Differences in a Clinical Sample of Children and Adolescents. European Eating Disorders Review, 21(5), 386-394.
Pan, J. (2009). Eating Disorders and Comorbidity in Childhood and Adolescence: A Comparison between Children and Adolescents Diagnosed exclusively with an Eating Disorder and those Diagnosed with another Comorbid Condition in addition to the Eating Disorder: Final Outcomes Report. McMaster University, June 20 2009.
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