There is a strong link between being depressed, having an eating disorder, and being female in a western industrialized country. Here are some facts about these conditions:
1. Females are twice as likely as males to be depressed, and the vast majority of eating disorder patients are female.
2. The depression sex difference emerges at puberty, and eating disorders emerge at puberty.
3. The depression sex difference is only found in western countries, and eating disorders are present in western countries and far less common/virtually absent in non-western countries.
4. There is more depression today, and there are more eating disorders today.
5. The average age of onset for depression is younger now than in the past, and the average age of onset for eating disorders is younger now than in the past.
Because of these correlations, it has been proposed that there is a relationship between the thin ideal that permeates western cultures, eating disorders and depression. Some studies report that episodes of depression precede the onset of the eating disorder and even that eating disorder behaviors are an attempt to combat depression.
In such a case, a person who is depressed subconsciously attempts to modify their mood state by utilizing eating disorder behaviors such as restriction, binge eating, purging, and over-exercising. By engaging in these behaviors, a person may feel a sense of taking corrective action to improve their life circumstances.
The thin ideal
The cultural ideal of hard-to-achieve thinness (the “thin ideal”) for women could be a driver of both depression and eating disorders. There are two ways this can happen.
First, if a girl perceives her body as not meeting the thin ideal, body dissatisfaction can arise. Since a very small proportion(~5%) of female bodies can meet the thin ideal without extreme control and modification, body dissatisfaction can occur at any body size, shape, and weight.
Second, there is a powerful belief that a thin body is the only way a woman can be attractive to others. The need to be seen as attractive to others is an element of self-esteem, and thus a pervasive sense of being unattractive (due to higher weight than is deemed “attractive”) may lead to eating disorder behaviors. This may also explain the observed trend of depression and eating disorder onset during puberty, a time when the body is changing at the exact same time as a desire to be attractive to others increases.
It has been shown that people who have eating disorders have high levels of body dissatisfaction coupled with low self-esteem and feelings of ineffectiveness and inadequacy. It has also been shown that people who are depressed tend to have higher levels of body dissatisfaction and feelings of ineffectiveness and inadequacy.
This is where diet culture comes into the picture since dieting is strongly associated with body dissatisfaction and feelings of ineffectiveness and inadequacy. First, dieting causes extreme psychic and physical stress, which can drastically impact mood states, leading to depression.
Second, dieting fails 95% of the time. A person may lose weight but will regain it all plus more almost every time. This failure is almost always attributed to personal behaviors rather than the fact that diets are proven to lead to weight gain. Feelings of ineffectiveness and inadequacy based on weight regain after weight loss almost always occur.
It has also been observed that one in four people who diet will develop an eating disorder. This may be a natural response to the proven weight cycling inherent in dieting. A person can quickly notice that unless they take extreme measures, they cannot control their weight. Those extreme measures are the primary eating disorder behaviors of restriction, purging, and over-exercising. Binge eating is a natural and primal response to all of these behaviors.
Lack of control
Western cultures believe that weight is something that can be controlled, and yet the evidence points in the exact opposite direction. Research has shown for more than 50 years that intentional weight loss almost always leads to weight gain. This disconnect between a cultural belief and the reality of weight control leads to feelings of failure.
Attempting to control weight, which is a fruitless effort, leads women to feel more dissatisfied with their bodies. Repeat dieters report lower self-esteem than do non-dieters, which can lead to both depression and eating disorders. In a cruel twist of fate, the more a person diets, the higher their weight climbs. Additionally, many people who are depressed turn to food to soothe their depression. This can create an endless and lifelong cycle of body dissatisfaction, dieting, and depression.
Puberty changes everything
Body dissatisfaction is a symptom of both depression and eating disorders, and both are more common in females and typically arise during puberty.
During puberty, the female body changes, often dramatically. The thin ideal resembles a pre-pubescent girl (flat stomach, long legs, slender hips, flat chest). The process of puberty includes weight gain and the addition of new curves and rolls, which can be destabilizing for many females. Puberty takes girls further from the thin ideal while it typically brings boys closer to the masculine ideal.
Several studies have noted that girls become increasingly less satisfied with their bodies as they progress through puberty. At every age, girls are less satisfied with their bodies than boys. Girls also have higher rates of body dysmorphia and the belief that their bodies are larger than they actually are.
The trends linking our societal beliefs, being female, depression and eating disorders need to be openly addressed in order to reverse worrying trends of increasing rates of both depression and eating disorders. Both depression and eating disorders are increasing, and beginning at younger ages. There are many societal factors to be considered in these conditions in western females, but one known factor is the thin ideal.
Some actions we should take to protect females from higher risk of depression and eating disorders include:
1. Talk to girls about the thin ideal and its dangers.
2. Talk about the devastating impact of dieting on the body and mental health.
3. Seek ways to show girls the diversity of body size, shape and weight in the real world compared to what we see on television, social media, advertising, etc.
4. Don’t ever diet, or allow dieting in your home.
5. Speak up against companies that use Photoshopping, editing, and other techniques to take an already unrealistic body ideal to new extremes.
6. Demand that companies feature diverse body types in advertising and in entertainment programs.
7. Support companies that promote body size diversity in their advertising, social media, etc.
8. Learn about Health at Every Size
Also, monitor for signs of depression and eating disorders, especially during puberty. We have two quizzes available. The first is Does My Child Have an Eating Disorder? and can be taken by a parent. The second is an adaptation of Burn’s Depression Checklist, which should be taken by the person who is being evaluated for depression.
Reference: McCarthy, M., The Thin Ideal, Depression and Eating Disorders in Women, Journal of Behavior Research and Therapy, 1990