Depression and your child’s eating disorder

Your child’s eating disorder and depression are likely linked. Depression is both a risk factor and maintaining factor of an eating disorder. This is important, because both eating disorders and depression are common and increasing among all populations, particularly children and teens.

As with anxiety, your child’s treatment for depression first and foremost needs to focus on eating regular meals containing enough nutrition. If your child is weight suppressed, restricting, purging, and/or skipping meals, then the lack of nourishing food is likely contributing to and maintaining their depression symptoms. Even with treatment, it is unlikely that your child’s depression will decrease if they lack nutrition.

Additionally, depressive symptoms are strongly associated with both stress and a lack of sleep. Evaluate your child’s lifestyle right now and determine whether you need to take things off their plate to reduce stress and ensure they are able to get the hours of sleep recommended for their age. Few people get enough sleep, but impaired sleep is both a risk factor and a symptom of depression, and it must be addressed for any other attempts to treat depression to work.

Psychological symptoms of depression

Depression is both physical and psychological. Most people are familiar with and look for the psychological symptoms of depression, which include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities
• Anxiety, agitation or restlessness
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

Physical symptoms of depression

Parents should be aware that physical symptoms of depression are common. In fact, physical symptoms may be your child’s only symptoms of depression. There is a strong link between increased sensations of pain and depression based on a shared neurologic pathway. Physical symptoms of depression include: 

• Headache
• Joint pain
• Limb pain
• Back pain
• Fatigue
• Sleep disturbances
• Slowed thinking, speaking or body movements

Importantly, other physical symptoms of depression include gastrointestinal distress (stomachaches, nausea, etc.) and a change in appetite (either high or low), which makes it a major risk factor and maintaining factor for eating disorders.

Depression affects the way your child perceives food. Some kids with depression find that food looks and tastes “gray” and dull. This can exacerbate restrictive eating issues. Other kids will seek comfort and solace in food when they are depressed. It may be the one way they can “feel” something, which may lead to increased binge eating. In other words, your child’s depression is very likely interacting with their eating disorder behaviors.

What causes depression?

Many different factors cause depression. Like eating disorders, depression is a biopsychosocial disorder that combines biological, psychological and social risk factors, including:

Biological risk factors: Reduced production of the neurotransmitters in the brain including serotonin, norepinephrine, dopamine, gamma – aminobutyric acid (GABA), cerebral nerve growth factor and more.

Psychological risk factors: Other mental disorders including anxiety, eating disorders, and depression (people who have one depressive episode are more likely to have another). Low self-esteem, emotional repression, cognitive distortions, a lack of emotional regulation, and low self-efficacy or agency.

Social risk factors: Adverse childhood events, childhood trauma, early adversity including food insecurity, stress, parental depression and substance use, non-supportive school or family environments, and social forces of oppression like sexism, racism, weight stigma, etc.

How depression works

Like anxiety, depression occurs along a spectrum. Most people feel sadness and even despair regularly – even daily. Sadness is a natural human emotion that is ideally noticed and processed when it arises. However, if a person avoids feelings of sadness and represses their experiences of sadness, leaving those feelings unprocessed, they may experience a depressive episode.

“I often think of depression as “stuck sadness.” In fact, when clients come in for therapy and tell me that they are depressed, my first thought is, “What is the sadness they are not allowing themselves to experience?”

Elaine Carney Gibson / Your Family Revealed

In a depressive episode, clinically called “major depression,” a person has persistent symptoms for at least two weeks. However, if the episode extends to two years, it is called persistent depressive disorder. Depression is the most common psychiatric disorder in people who die by suicide, making it an important condition to treat, especially when combined with an eating disorder.  

Treating depression and your child’s eating disorder

If your child is in a depressive episode, they should receive therapy to treat it. The most common treatment for depression is cognitive behavioral therapy (CBT). Another evidence-based treatment for depression is interpersonal psychotherapy (IPT), which focuses on improving interpersonal functioning.

I have seen success in treating depression with Internal Family Systems (IFS) therapy as well as somatic therapies. Your child’s doctor may recommend psychiatric medications. These medications are short-term interventions and should be used in conjunction with psychotherapy and emotional development. If your child does not learn emotional processing skills they remain at risk for future depressive episodes.

Keep in mind that feeling sad sometimes – even every day – is not the same as being depressed. Sad is a core human emotion and is both normal and natural. Support your child in feeling their feelings and emotions during eating disorder recovery. Most feelings, even the hard ones like anger, jealousy, and sadness, pass in about 30-90 seconds. The danger is not feeling sadness, but rather repressing or getting lost in it. If your child’s sadness is persistent and feels hopeless for two weeks, seek professional support for depression. 

See Our Parent’s Guide To Mental Health And Eating Disorders