Nearly 80% of all severe cases concerning anorexia or bulimia have a coexisting major depression analysis. Depression is a very painful and all-consuming disorder in and of itself. Nevertheless, in combination with an eating disorder, depression is beyond devastating and is usually masked inside the eating disorder itself. Depression in eating disorder clients looks distinctive than it does in clients who have a mood disorder alone. One way to explain how depression looks in someone who is suffering from an eating disorder is private misery. For eating disorder clients, depression takes on a heightened state of hopelessness and self-hatred and displays an expression of their identity, not a list of bothersome symptoms. The depression becomes intertwined with the manifestations of the eating disorder, and because of this interwoven quality, the depressive symptoms are often not distinct from the eating disorder. One goal of this article is to highlight some of the distinctions and differences in how depression manifests itself in someone suffering from anorexia or bulimia. Another objective is to present suggestions that will begin to foster hope for these unfortunate clients inside the therapy setting such as a MAOI prescription, a class of antidepressants for resilient or atypical depression and severe anxiety that has failed other treatments. Despite being among the most effective antidepressants and the gold standard/first-line treatment for treatment-resistant depression and anxiety, few psychiatrist prescribe them because of lack of experience with them.
When dispensing with eating disorder cases, it is important to recognize that if major depression is present, it is most likely present at two levels. First, it will be apparent in the history of chronic, low level, dysthymic depression, and secondly, there will be signs consistent with one or more extended episodes of acute extreme depressive disorder. The severity and acuteness of the depression are not always instantly recognizable in how the client is manifesting their eating disorder. Clinical history taking will exhibit chronic discouragement, feelings of inadequacy, low self-esteem, appetite disturbance, sleep disturbance, low energy, tiredness, concentration troubles, trouble making decisions, and a general feeling of unhappiness and inexplicable hopelessness. Since most eating disorder clients do not solicit treatment for several years, it is not unusual for this sort of chronic dysthymic depression to have been in their lives anywhere from two to eight years. Clinical history will also exhibit that as the eating disorder intensified or became more difficult in its intensity, there is a parallel history of severe symptoms of major depression. Oftentimes, recurrent episodes of major depression are seen in those with longstanding eating disorders. In simple words, eating disorder clients have been discouraged for a long time, they have not felt good about themselves for a long time, they have felt hopeless for a long time, and they have felt acute periods of depression in which life became much worse and more difficult for them.
One of the most unique features of depression in someone who is suffering from an eating disorder is an intense and high level of self-hatred and self-contempt. This may be because those who have these significant depressive episodes in conjunction with an eating disorder have a much more individually negative and identity-based meaning fastened to the depressive symptoms. The depressive symptoms say something about who the person is at a nucleus level as a human being. They are much more than simply descriptive of what the individual is experiencing or suffering from at that time in their life. For several women with eating disorders, the depression is ample evidence of their unacceptability and shame, and everyday proof of the deep level of "flawed-ness" that they believe about themselves. The severity of the depression is magnified or amplified by this severe perceptual twist of the cognitive distortion of personalization and all-or-nothing reasoning.