Anyone who has ever lived with an eating disorder likely understands the fact that illnesses like anorexia, bulimia, and binge eating disorder (BED) rarely exist in a vacuum. That means eating disorders are often accompanied by other psychiatric and medical conditions, including everything from anxiety to cardiac problems. While depression is one of the most common conditions to accompany any form of eating disorder, some research suggests that the symptoms of depression may be more severe in those with BED, specifically. So why do these two conditions tend to overlap—and what are the most effective ways to treat both?

How common is it to have binge eating disorder and depression?

In a national sample of over 36,000 adults in the United States, 66% of those with BED also had depression. It’s worth noting that even more people, 76%, had co-occurring depression and bulimia. “While depression is more prevalent in bulimia than BED, both diagnoses include binge eating behaviors, so they are very connected.” says Equip’s VP of Research, Dori Steinberg, PhD, RD. Depression is just one of the many mood disorders that are common in these populations; “The data shows that the prevalence of any mood disorder (e.g., depression, anxiety, bipolar disorder) is 70% in patients with BED and 80% for patients with bulimia,” says Steinberg.

Reggie Ash, LPCC-S, Therapy Director at Equip recognized these high rates in his own therapy practice, “I have treated a lot of people with BED and it was very common for them to have a diagnosis of depression as well,” says Reggie Ash, LPCC-S, Therapy Director at Equip. “I don't know that I've treated anyone that was only diagnosed with BED. They all had comorbid diagnoses of depression, anxiety, or trauma."

Why is BED associated with depression?

Comorbidities between eating disorders and other mental health conditions can develop for a variety of biological, psychological, and genetic reasons. “Binge eating is associated with increased feelings of shame and psychological distress, which may be the primary contributing factor to high rates of depression,” Steinberg says. “We also know that depression is statistically most likely to be a key factor in reducing quality of life for those with BED,” she adds.

Researchers continue to investigate the specific mechanisms underlying the depression and binge eating link, but some studies suggest that using food to cope with negative emotions may play a role in perpetuating the symptoms of both conditions. Other research indicates that some foods—particularly those high in fat and sugar—are often used to self-soothe because they trigger the release of dopamine, a neurotransmitter associated with feelings of satisfaction and pleasure. This self-soothing behavior (not to be confused with “food addiction” – which isn’t scientifically-backed) may eventually lead some individuals struggling with depression to rely on binge eating as a temporary solution to manage negative feelings.

While depression may be linked to BED, it isn’t exclusive to just one type of eating disorder. Depending on an individual’s specific genetic and environmental circumstances, depression can present in different ways. “Symptoms of depression can be overeating or undereating,” Ash says. “For example, if someone finds themselves eating more to cope with difficult feelings, that may be a trigger that leads to BED. The same can be said for someone who finds themselves eating less when navigating negative moods; they’re predisposed to restricting when having a change in mood.”

How to effectively treat binge eating disorder and depression

Treating both binge eating disorder and depression requires the introduction of regular eating patterns, establishing distress tolerance techniques, and working with a team of trained professionals who have clinical expertise in both. And according to Ash, there’s one piece of the treatment puzzle that can be particularly beneficial. “Therapy, therapy, therapy,” he says. “Therapeutic interventions help people learn coping skills and triggers, how to manage emotions, and how they’re impacted by their environment.”

It's also important that other co-occurring conditions are identified and addressed. For example, there's also a known link between ADHD and binge eating disorder.

While family-based treatment (FBT) is considered the gold standard treatment for young people with eating disorders, adults may benefit from a variety of modalities, including dialectical behavior therapy (DBT) and enhanced cognitive behavioral therapy (CBT-E). According to Ash, Medication can also be helpful, in particular antidepressants. Not all people with binge eating disorder and depression need them, but sometimes people do need medical assistance, and when combined with therapy, it can be successful.

Binge eating disorder and depression can often present as a tangled web of symptoms, leaving patients and loved ones confused about which developed first. In reality, identifying the order of events isn’t as important as receiving effective care.

When treating an eating disorder and a co-occurring condition, it’s vital you seek care with professionals trained in treating multiple conditions simultaneously. At Equip, patients are matched with a care team who treat the whole person, not just one diagnosis.

Get care for binge eating and depression, simultaneously Take the next step towards healing on all fronts.

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