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Summary
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A young adult whose depression has improved in treatment describes recent restriction, purging, and guilt about eating. They worry that seeking specialist eating-disorder support may be dismissed because little weight has changed.
The response takes the eating behaviors seriously and supports obtaining additional help before the pattern worsens, rather than using weight change or duration as reasons to wait.
It discusses coordinated support from a therapist, an eating-disorder-experienced nutrition professional, and the prescribing psychiatrist, with attention to automatic thoughts and the reader’s existing treatment.
Question
Reader · Identity withheldI’m 22 years old and have been struggling with severe depression for about 15 months. While I’ve experienced depressive episodes before, I was able to manage them without treatment until now. Over the past six months, I’ve made significant progress, and currently, my depression is mostly under control thanks to medication (Zoloft 100 mg and Wellbutrin 300 mg) and weekly therapy.
\nIn the last few weeks I’ve been consistently engaging in disordered eating behaviors. I’ve been trying to restrict my food intake on most days and purging a few times a week. Yes I do want to lose weight, but this is not the reason I am doing it. I feel like I don’t deserve to be well-nourished and that it’s somehow wrong for me to weigh what I do at my healthy weight (4’11” and about 102 lbs).
\nWhen I eat normally, I often feel guilty and have the sensation that my body has expanded, even though I logically know it hasn’t. These thoughts have come and gone over the past year, but in the past, I coped with them by self-injuring, something I haven’t done recently. I’m aware that restricting my eating harms my quality of life, yet I still feel a strong urge to continue. I also feel like I need permission to eat.
\nI don’t want this to undo the progress I’ve made with my mental health, but I’m unsure what to do next. I believe I might benefit from additional treatment focused on eating disorders, like working with a dietitian and having accountability around a meal plan, alongside my current therapy.
\nAt the same time, I worry about being dismissed or told I’m overreacting because it hasn’t been very long and I haven’t lost much weight.
\nDo you think it would be appropriate for me to seek extra support?
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Answer
Allan Schwartz, Ph.D.You do not need to worry about overreacting to your symptoms. What you describe, including the depression you experience, are typical of an eating disorder, in this case, Bulimia Nervosa. In fact, I agree with you that you should get help now, before it gets worse.
\nIn terms of psychotherapy, Cognitive Behavior Therapy are thought to be best for eating disorders and depression. Perhaps that is what you have right now. It seems to me that you have many automatic thoughts that cause you a lot of trouble.
\nAutomatic thoughts are those that are not completely true and need to be tested against what is really happening so they can be modified to reflect reality. That is what helps with depression as well as eating disorders. Nevertheless, it is good that you are in therapy and on medication.
\nYes, a licensed nutritonist who has experience with eating disorders, is an excellent idea. The nutritionist and therapist should work together as a team in helping you.
\nAlso, you talking to your psychiatrist who is prescribing your medications is a good idea. First of all, he should know about your eating disorder and might or might not adjust your medications because of the ED.
\nYes, it is fully appropriate and necessary for you to seek additional support. This is a serious disorder and needs to be taken seriously.
\nBest of Luck
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