How do you know when it’s time to talk with your doctor about medication to treat anxiety and depression?
First things first. To treat something, it’s helpful to know what the “something” is and if it has a name.
So let’s first define anxiety and depression. After that we’ll address talking with your doctor about medication to treat anxiety and depression.
Occasional anxiety is normal. It’s natural, for example, to have anxiety preparing for an exam, meeting, or other important event. Generally, feeling anxious at times is not in and of itself problematic. In fact, anxiety can actually help you stay energized, motivated, and well prepared – depending on its intensity.
Anxiety is a problem when it happens a lot, regardless of what’s going on in life, and/or it causes distress. Especially when anxiety affects other areas of your life, including school, work, and family.
There are different types of anxiety. Often they include negative thinking and ‘what if’ scenarios.
What are common signs of anxiety that indicate it is time to seek help?
- Concentration difficulties
- Sleep problems
- Muscle tension and other physical symptoms such as a pounding heart or headaches.
Often the first place to seek help is with a psychotherapist. Together, you and the therapist can discuss when it is time to talk with your doctor about medication to treat anxiety (and depression). This especially makes sense if you know of a therapist you feel comfortable talking with.
Another resource is your primary care doctor (PCP). This option may make more sense than finding a therapist on your own, especially if you have a relationship with your PCP. Meeting with your PCP is also a good idea so you can have lab work done to rule out physical causes, such as hyperthyroidism.
All of us at times feel sad or discouraged. Depression is more than that, and it can last days, weeks, months, or years. Especially if left untreated.
To have clinical depression means you are either uninterested in things you used to enjoy, and/or have had a depressed mood – for at least two weeks.
Common symptoms in addition to lack of interest and/or feeling down include:
- Sleep or appetite changes
- Loss of energy
- Poor concentration
- Feeling worthless
It’s important to seek help for these symptoms since they can cause significant distress and affect your relationships at home, school, work, and in other important areas.
The treatment options discussed above for anxiety are the same for depression.
Whether or not medication is the best treatment for you depends on a lot of factors. Some considerations include the severity of depression and its history, your age, and personal preferences for treatment.
Most people do best with a combination of antidepressants and psychotherapy.
It is possible to have depression without anxiety, anxiety without depression, or both at the same time.
How Antidepressants Work
Most antidepressants slow down the removal of certain chemicals in the brain. The chemicals are called neurotransmitters. We need neurotransmitters for normal brain function. Serotonin is an example of a neurotransmitter. Selective serotonin reuptake inhibitors (SSRIs) is a common group of antidepressant medication. Another is serotonin-norepinephrine reuptake inhibitors (SNRIs).
Antidepressants are often used to treat anxiety, especially when depression and anxiety occur together.
How Anti-anxiety Medications Work
The symptoms of anxiety vary depending on the type of anxiety a person has. Proper diagnosis is useful so the medication with the best chance of being helpful is the first medication to try.
Many SSRIs and SNRIs are also used to treat anxiety. This is because these medications to treat depression can also help with anxiety. Both groups of medications target mood and stress.
Medication to Treat Anxiety and Depression
Anti-anxiety and anti-depressants are legitimate prescription drugs and not simply “happy pills.” The medications have risks and benefits, and are taken under a doctor’s supervision.
People of all ages vary in their comfort level with taking medication. Side effects are often a concern. So is the belief that taking medication indicates weakness or defeat.
Some people are uncomfortable talking candidly with their doctor about mental health. Acknowledging out loud the pain of depression or crippling effects of anxiety can be a lot more difficult than acknowledging the pain of a broken limb.
Here are the most common reasons people give for why they do not want to discuss medication:
- “I shouldn’t need medication. I should be able to manage without it.”
- “What if I take it and become numb, and lose touch with who I really am?”
- “Medication will cause me to gain weight.”
- “Medication causes suicide.”
- “I don’t want to become dependent on medication.”
There is no shame in taking medication for anxiety and/or depression.
Medication is definitely NOT a magic bullet to feeling better, but it can help. Especially when it is part of a comprehensive plan that includes psychotherapy.
Regarding the notion that you ‘should’ be able to manage without medication: Says whom? Where did you hear that? Is the same thing true for other people, or does it just apply to you?
Taking medication is not a sign of weakness. It is treating a disorder. Or helping to reduce symptoms.
The idea that you could lose touch with who you are is ironic. When depressed and anxious, people are prevented from being who they are. Their true selves are held hostage by depression and anxiety.
Concerns about weight gain are common. Some medications for depression and anxiety are associated with weight loss, some with weight gain, and some with weight neutrality (meaning no effect on weight).
Medication does not cause suicide.
The medications for depression are NOT from a family of medications that are associated with addiction/dependence. Certain anti anxiety medications are, however, which is why it is important to take these medications under the supervision of a prescriber, and to also meet regularly with a therapist.
When To Seek Treatment for Anxiety/or Depression
Overall, the sooner you recognize you have depression or anxiety and get treatment, the better the chances for recovery.
The first thing to do is to acknowledge how negatively depression and/or anxiety affect your life, and that you really could benefit from getting help.
Examples of signs that it is time to consider medication for treating depression and/or anxiety include:
- Length of time suffering
Has it been for two weeks or more? The longer you wait, the worse your symptoms can get, and the longer it will take to feel better.
- Effect on your work
If you start to miss work, or continue to arrive late it is time to get help. Another sign is if you fall behind and can’t catch up.
- Affecting physical health
The mind and body are connected. Changes in physical health are common and understandable. Depression or anxiety can cause changes in weight, problems sleeping, and lowered immune system.
- Self-medicating with drugs or alcohol
Using alcohol to ‘take the edge off’ depression and/or anxiety leads to more problems.
While treatment of any kind can be scary, people are usually relieved after starting on a treatment plan. They are typically happier and more hopeful. To treat anxiety and/or depression, many options are available. Medication can be one approach, utilized either alone or in combination with psychotherapy. There are many types of medication and of psychotherapy. What you try first may not be effective. Many people have to try several medications for example before they find the one that works well for them.
I am a clinical psychologist in MA who specializes in providing treatment for people with mood or anxiety disorders, body image concerns, and eating disorders. I have a particular interest in supporting people who are Highly Sensitive.
Healthy body image role models are hard to find, let alone meet. Especially in Diet Culture.
Diet culture is a system of beliefs we’re taught. The beliefs aren’t factually true, yet they’re nearly universally endorsed in Western culture. So much so that we often don’t even realize the beliefs aren’t actually true.
Diet Culture is dangerous. It harms people of all sizes.
Identifying Diet culture when we are immersed in it is difficult. It’s the lens we through which we see (and automatically judge) bodies, beauty, food, weight, and worth.
The belief system of Diet culture is based on the premise that weight and worth are connected. And that to be worthy, attractive, successful, likable, and “good”, you must be thin.
Thinness is idealized. It is the end all, be all. The pinnacle.
The beliefs of Diet culture are so embedded that we tend not to blink an eye when someone says she was “naughty” for eating dessert. Or that he was “bad” because he skipped the gym yesterday.
Dieting is put on a pedestal, and food is moralized. Worth as a human being is defined by body size and food choice in Diet culture.
The truth is though whether you order fries or a fruit cup your worth is the same. Whether or not you exercised yesterday, today, or anyday doesn’t determine your value as a human.
Fries and fruit have no moral value, even though Diet culture wants you to believe that fries are bad and fruit is good. And that you’re bad if you eat fries, and you’re good if you eat fruit.
(Bad fries would more accurately mean they were made from rotten potatoes. What if the fruit were also rotten? Would it still be “good”? Nutritional merit is not the same as the moral judgments of good or bad.)
Diet culture is so all-encompassing that we typically don’t even see it for what it is. Sort of like fish not knowing they’re wet.
So imagine meeting others who’ve discovered Diet culture alternatives to being in their body. Is it possible to be freed from Diet culture messages? Are there people whose relationship with their body is either neutral or positive?
Yes. Even in the world of social media. How ironic! Social media, has been a prime way Diet culture messages are spread. The very same platforms can be utilized to spread messages of body neutrality, and decoupling weight and worth, and food choice and virtue.
What is body image and why should you care?
Everyone with a body has a body image.
Body image fluctuates, based on lots of things. Factors like mood, hormones, age, health, cultural and family messages, media ideals, and personality traits such as perfectionism affect a person’s relationship with her body.
Historical roots are an important part of body image. Both in terms of your own personal family tree and systemically (sexism, classism, racism, and other ism’s).
There is only one place you’ll live your entire life, and that is in your body. So finding peace within the body you inhabit is important.
How you feel and think about your body is something to care about.
If you have a positive body image, you’re more likely to have physical and psychological well-being. You’re also more likely to have interests, purpose, and meaning in your life.
In contrast, negative body image is associated with depression, social anxiety and self-consciousness, as well as eating disorders. And not so much fulfillment.
Magic happens when you stop judging your body harshly and learn to appreciate your inner being, soul, and spirit.
You weren’t born hating your body. Diet culture taught you, starting at an early age.
Take back your birthright; live unapologetically in the body you were born in and with.
What are role models?
When you’re looking for guidance, who do you go to?
You probably go to people you know and who seem qualified. Maybe people you consider to be role models.
Role models are people you look up to and whom you might want to be like, now or in the future.
People you know but haven’t met personally could be role models, as is often the case when social media is involved. Or they may be people in authority. Parents can be role models. So can teachers, peers, and coaches.
In real life, people are just as likely, or more so, to spend equal time with social media influencers as with peers and parents.
Social media influencers have a lot of followers who consider them to be a role model.
Think about whom you have designated as role models.
Have you chosen role models whose values align with yours? Are the role models you have chosen celebrities or influencers who spread Diet culture messages (and who also may not even realize it)?
Consider that media influencers have lots of platforms to send their message. These include television., YouTube, video games, Twitter, and music. All of these platforms are available 24/7.
Not all celebrities, stars, or influencers have positive messages. Influencers’ messages can be powerful. And their messages affect all of us.
On some social media sites, the best body image role models have four legs.
Neither dog in the photo below is likely lamenting the shape of its ears or the way its stomach hangs down.
Social media influencers and celebrities get the most attention. They also have the most impact.
The way media works has naturally led to worsening body image country-wide (and in some cases internationally).
Instagram allows users to post images easily, and to view and follow other people. From the comfort of any room, you can easily access hundreds of images of women and men with “perfect” bodies. These images are “liked”, and praised for their appearance.
Many of the images are not even real! They’re filtered, airbrushed, or otherwise altered.
For teenage and young adult women, who may be consuming most of Diet culture’s media messages, unrealistic goals for weight and shape are reinforced.
Viral body image posts and even challenges are common. For example, there’s the trend of teenage girls balancing coins on their collarbones. How about all the ruckus about a thigh gap.
There may be no malicious intent. Regardless, the impact on body image is detrimental.
The increase in social media outlets has strengthened Diet culture. The system of beliefs spreads quickly, powerfully, and widely on the internet.
What then happens is we internalize what we consume and take them as ‘just the way things are’.
But there is good news here.
The intention and impact of social media influencers can be positive. Even with body image.
For example, Lorde posted two photos of herself on social media, one without makeup or Photoshop. “Remember, flaws are ok” she reminds followers.
There actually are positive body image role models who are human (not canine) and really do exist (and not just in social media).
We discussed that social media is a major transmitter of unhealthy body image messages.
An important step in a healthier body image is to think about the social media accounts you follow.
How do you feel about your body when you scroll through the posts on those accounts?
Why bombard your inbox with people who look a certain way and/or cause you to feel bad about yourself? How about if instead you include role models with a range of body sizes and shapes? While you are at it, include people of color, of different abilities, and gender identity.
To widen definitions of beauty and body size, diversify your accounts. Move away from unhealthy body image messages social media presents as healthy and normal. Those are the ones that keep you stuck in Diet culture and self-criticism.
So what to do?
The first step is a social media cleanout.
The second step is to follow healthier body image role models,
To find healthier body image role models, check out these accounts, many of which are borrowed from Alissa Rumsey’s list. Let me know if you have any accounts to add.
Body image accounts – Role models
Websites and Quotes from Body Image Role Models:
1. Virgie Tovar (https://www.virgietovar.com/): She’s an author and expert on weight discrimination and body image. She’s also relatable and fun.
“When we reconnect with our body, it doesn’t just mean we may have more confidence or a better relationship to the mirror. It means we reconnect to the information superhighway that is our body. It means we reconnect to what our bodies are telling us – not just about food or hunger – about everything.”
2. Christy Harrison (https://christyharrison.com) is an anti-diet, Health At Every Size informed, Registered Dietician, podcaster, and author.
In her own words, “My mission is to help you recognize Diet culture for the life thief that it is, and tune back into your body’s inner wisdom about how to truly nourish yourself—so that you can free up space in your life for bigger and better things.”
3. Alissa Rumsey, RD (https://alissarumsey.com/) helps people “free themselves of the shame and pain of chronic dieting so they can live their most unapologetic, liberated lives.”
As she says, “the more you trust your body with food, the more you start to trust yourself in other areas of your life.”
4. The Body Positive (https://thebodypositive.org)
They “help people develop balanced, joyful self-care and a relationship with their bodies that is guided by love, forgiveness, and humor.”
5. Sonya Renee Taylor (https://sonyareneetaylor.com)
She’s the founder of “The Body is Not An Apology, a digital media and education company promoting radical self-love and body empowerment as the foundational tool for social justice and global transformation.”
6. Lindo Bacon, PhD (https://lindobacon.com)
Lindo is an author, professor, speaker, social activist, and outspoken proponent for global body positivity.
Read their Body Manifesto.
Registered Dietician Body Image Role Models:
These body image role models provide anti diet, Health at Every Size/Intuitive Eating informed nutrition.
- @Evelyntribole Evelyn Tribole (Co-creator of Intuitive Eating_
- @ElyseResch Elyse Resch (co-creator of Intuitive Eating)
- @haes_studentdoctor Jess Campbell
- @thethicknutritionist Tash (Non-diet nutritionisht)
- @kristamurias Krista Murias (“Your worth doesn’t change with the shape of your belly…”)
- @mollybcounseling Molly Bahr
- @haescoach Kerry Beake (Coach who specializes in social justice, weight stigma, body image)
- @thewellful Brenna O’Malley (“Friends don’t let friends talk sh*t about their bodies”)
- @body_peace_liberation Kathleen Bishop
- @bodypositiveyoga Sarah Harry
- @fionawiller Fiona Willer Author, podcaster, speaker from Australia
- @kaley_rd Kaley Sechman (“Hunger is a normal body sensation.”)
- @rachaelhartleyrdRachael Hartley
- @thereallife_rd Robyn Nohling (She is a non-diet nutritionist and Nurse Practitioner, specializing in women’s health.)
- @laurathomasphd Laura Thomas
- @themindfuldietitian Fiona Sutherland
- @hgoodrichrd Haley Goodrich
- @immaeatthat Kylie Mitchell
- @jessihaggertyrd Jessi Haggerty (Registered Dietician, Personal Trainer)
- @intuitiveeatingrd Sumner Brooks (“My body is not for your viewing pleasure, or displeasure…”)
- @lindsaystenovec_rd Lindsay Stenovec (“How do I unlearn diet culture?”)
- @emilyfonnesbeck_rd Emily Fonnesbeck (“My body is my home and I won’t burn it down.”)
- @chr1styharrison Christy Harrison
- @rebeccascritchfield Rebecca Scritchfield (“Never diet again.”)
- @bodyimagewithbri Brianna M. Campos (Body image educator)
- @heytiffanyroe Tiffany Roe (“Body bashing is not bonding.”)
- @bravespacenutrition Katherine Metzelaar (“You don’t need to love your body to improve your body image.”)
- @livedexperiencecounsellor Sonny Jane
- @alissarumseyrd Alissa Rumsey
Fitness Body Image Role Models
- meisjessamyn Jessamyn Stanley
- @bodypositiveyoga Sarah Harry
- @bodypositivefitnes trainers (“Removing barriers to fitness with a safe, inclusive space for all.”)
- @bodypositivehf Shelley Lask
- @curvyyoga Anna Guest Jolley also includes free yoga and meditation for people in bodies of all sizes.
- @deadlifts_and_redlipss Karen Preene (Non diet personal trainer)
- @positiveforcemovement coaches
- @amberkarnesofficial Amber Karnes
- @the.intuitive.trainer Julie Newbry (non diet, Intuitive Eating oriented personal trainer)
- @fatgirlshiking community
- @louisegreen_bigfitgirl Louise Green (Author of Big Fat Girl; “size inclusive fitness expert”.)
- @bloomfittraining trainers (“I was not put on this earth to count almonds.”)
- @practicewithdana Dana Falsetti
- @thephitcoach Jake Gifford
- @emmafitnessphd Emma Green (“Why you don’t need to do 10,000 steps/day.”)
- @letsjoyn – Free body neutral classes for all bodies
- @themirnavator Mirna Valerio
- @sarahsapora sarah sapora
- @bloomfittraining coaches
- @iamlshauntay Latoya Shauntay Snell (“Chef, journalist, speaker, advocate.”)
- @fitragamuffin Jamie (“We’re prioritizing the wrong things when it comes to fitness.”)
- @tallyrye Tally Rye (“Your body is not your art. It is your paintbrush.”)
- @dearbodybymeg Meg Boggs (“Be your body’s protector, not its predator.”)
Activist & Educator Body Image Role Models
- @Madeonagenerousplan Meredith Noble (Fat liberation coach)
- @Sundaymorningview (“celebrating the beauty in women”; Self Love magazine)
- @Historicalfatpeople (“Vintage photos featuring nice to not-so-nice fat people of yore. Occasional diet ephemera.”)
- @Ownitbabe Rini Frey
- @Bodyimagemovementt Taryn Brumfitt
- @yrfatfriend Aubrey Gordon (“What we don’t talk about when we talk about fat.’)
- @iamivyfelicia Ivy Felicia( “Body peace is your birthright. You just have to claim it.”)
- @fierce.fatty Victoria Welsby (Author, speaker who “helps fat people ditch shame and unlearn fatphobia.”)
- @themilitantbaker Jes Baker (“Pay attention to who you are with when you feel your best.”)
- @sonyareneetaylor Sonya Renee Taylor
- @meghantonje MeghanTonjes is a singer/songwriter. (“Fat, blessed, and thriving.”)
- @betteringbecca Becca Ferry (Postpartum body image; “Your weight might fluctuate but your worth does not.”)
- @shesallfatpod (“The podcast for FAT POSITIVITY, radical self love, and chill vibes ONLY.”)
- @shanboody Shan Boodram (“Dr Ruth meets Rhianna”)
- @fyeahmfabello Melissa Fabello is a digital media educator with a PhD in Human Sexuality studies.
- @iamchrissyking Chrissy King (Writer, speaker who talks about equity for wellness community)
- @beauty_redefined (Lexie & Lindsay Kite) (“To improve your body image, prioritize the way you experience the world, not the way the world experiences you.”)
- @DanaSuchow Dana Suchow
- @bodypositivememes Michelle Elman (“You are a walking miracle. Struct accordingly.”)
- @chubstr (“Style for big men”)
- @lizzobeeating Lizzo
- @jameelajamilofficial Jameela Jamil (“The only diet advice you should take from celebrities is ‘don’t take diet advice from celebrities”)
- @i_weigh Jameela Jamil
- @iamivyfelicia Ivy Felicia
Body Image Role Models
- @Ellanabryan Ellana Bryan (“Self love and Body Positive Advocate”)
- @sassyredlipstick Sarah Tripp (“Curvy, confident body positive mama”)
- @lolo_russell Logan Russell (“Empowering you to embrace your body”)
- @tessholiday Tess Holiday
- @ashleygraham Ashley Graham
- @Madeonagenerousplan Meredith Noble (“Fat liberation coach”)
Consider all the options available for choosing body image role models. There are 88 examples provided here, and this is not an exhaustive list.
Check out these accounts. However many of them you want to. . Then, decide in a more deliberate way whose accounts to follow and whose not to follow.
And whose to delete.
Together, we can ditch Diet Culture and create radical changes to improve body image.
YOU have agency. You can choose.
Once you recognize Diet culture’s impact, you’re in a stronger position to choose body image role models who aren’t drinking the (diet) Kool-aid.
One reason stress gets a bad rap is because it can trigger physical and mental health problems, including eating disorders and depression. Knowing how stress can “cause” eating disorders and depression may help prevent you or someone you love from suffering.
To be clear, stress is not always a bad thing. Especially in the short term, when it may help you feel energized to meet challenges.
In and of itself, then, stress doesn’t mean you’re destined to develop an eating disorder or depression.
But, when demands in life are greater than your coping skills, mind and body are impacted. And usually in a negative way. As in possibly leading to eating disorders and/or depression.
Stress can trigger psychological or physical problems, or both. Makes sense. After all, the mind and body are connected.
Many factors are involved in how stress impacts mind and body. Some of these factors are family history, genetics, emotional support, race, peer relations, education, social constructs, trauma history, temperament, coping skills, finances, among others.
Some factors are a buffer, and others worsen stress’ impact.
Can stress cause eating disorders ?
National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. That’s a lot of people. We don’t need a national survey to tell us that 100% of people experience stress in their life.
If stress caused eating disorders, the rate of eating disorders would be 100%, or somewhere close to it.
So the next time you hear people wonder if stress causes eating disorders (and depression), you’ll know what to say: “Not exactly.”
But stress can be and often is the straw that breaks the camel’s back.
Stress does not CAUSE eating disorders (or depression) but is a variable in the equation.
There’s a handful of ways stress and eating disorders are linked.
1. Stress can trigger — and seem to cause — eating disorders (and depression).
Worrying about food and weight is central to all eating disorders, regardless of the type of eating disorder. The clear message from social media, peers, and diet culture is that thinner is better, and that what you eat defines your worth as a human. Being a part of diet culture and adopting its belief system create stress (and a $70 billion/year industry).
So, in people with other risk factors, stress can easily lead to problematic coping. Coping by dieting is socially suggested, approved, and even sanctioned.
Staying on a calorically restricted diet is stressful. Even, or especially, when the diet is camouflaged as wellness, clean eating, or a lifestyle change.
Weight loss compliments and admiration from others is a source of stress as well. In 95% of cases, weight loss will be replaced by weight gain. And no more compliments or admiration.
Dieting is one of the main risk factors for eating disorders.
Stated in another way, eating disorders begin with an “innocent” diet.
Stress is part of the perfect storm.
2. Eating disorders create (more) stress.
Having a poor relationship with your body and an unhealthy relationship with food is stressful. (Thank you, diet culture, said no one ever.) Worrying constantly about food and weight causes anxiety. It’s like a 24/7 internal battle that affects everything – your relationships, mental health, physical well being, and self worth. Your fundamental sense of who are you is at stake.
Another way eating disorders create more stress is physically. Put simply: Having an eating disorder is exhausting.
Eating disorders involve harmful behaviors in the name of achieving a cultural aesthetic. Restriction, poor nutrition, purging methods, and other eating disorder behaviors place stress on your body, including your organs. (That includes your heart.)
Eating disorders create a stress fest. But festive it is not.
3. People who develop eating disorders are often prone to stress.
The impact of stress on eating disorders is likely mediated by temperament (e.g. overly controlled; perfectionistic in the case of anorexia; impulsive, outgoing in the case of bulimia).
And certainly mediated by diet culture. Social media has intensified diet culture’s harmful impact. Even Instagram acknowledges the harmful effects of filtered selfies on body image. (“Compare and despair”)
For an eating disorder and depression to develop takes more than stress alone. When other risk factors are in place, and a stressful event occurs, an eating disorder can become activated. Without the stressful event, the eating disorder may not be triggered.
The ‘why now’ question of the timing of an eating disorder usually involves a triggering event. Examples of the kinds of triggering events include a loss of a pet or other loved one, a divorce, an injury or other medical event, or teasing. In other words, some form of stress.
4. The relationship between stress and eating disorders is a vicious cycle.
Stress does not cause eating disorders, but the two combine to create a vicious cycle.
Here is how that happens.
In general, two main eating disorder symptoms are negative body image and a problematic relationship with food.
Having a poor body image and relationship with food is stressful! And that stress in and of itself worsens body image and triggers eating disorder thinking and behaviors.
Hello, vicious cycle.
Stress occurs, and you feel overwhelmed. To cope, you turn to eating disorder behaviors. Then, ongoing negative body image and self talk associated with eating disorders increase stress.
It is a hard trap to get out of. Once you see it, though, you are in a position to make some changes to stop the cycle from continuing.
Stress and Binge Eating Disorder
The most common eating disorder is called Binge Eating Disorder (BED).
BED is characterized by eating large quantities of food (binges) and feeling a loss of control during the binge episodes. Eating is often rapid, and to the point of discomfort. Often the person feels a sense of shame or guilt afterwards. The person does not have compensatory behavior, such as purging, to offset the binge eating. The person will often deliberately restrict intake between binges.
In their lifetime, 3.5% of women and 2.0% of men will have BED.
To put this in perspective: BED is more than three times more common than anorexia and bulimia combined. BED is also more common than breast cancer or HIV.
The good news is that BED is treatable. (And preventable.)
The stress of following diets or other rules contributes to the stress that fuels BED. (Hello again, diet culture.) People with BED in larger bodies face additional stress from weight stigma and discrimination.
To cope with stress, binge eating becomes the relied upon method to manage feelings that would otherwise be overwhelming. Bingeing can provide immediate comfort. The bingeing itself, though, then causes more stress and overwhelm and causes you to feel bad about yourself.
Then, there is the stress associated with fearing weight gain. And of actual weight gain. There is also the stress associated with replacing the food you’ve binged on so no one knows about the binge.
Even physicians are guilty of shaming people with diagnosed or undiagnosed BED. Especially when people are in larger bodies. If that isn’t stressful, what is?
Stress and Bulimia nervosa
Bulimia nervosa is a serious, potentially life-threatening eating disorder. It is characterized by cycles of bingeing, and self-induced purging to undo the effects of bingeing.
Three in 100 American women suffers from bulimia.
It’s common for people with bulimia nervosa to use food and purging to manage feelings they’d rather not feel — including sadness, shame, anger, stress and boredom.
So the person with bulimia feels stressed, binges (for comfort) and purges (for relief) to alleviate the stress. What then replaces the original stress is the stress of being secretive, of cleaning up the ‘evidence’ of the binge or the purge, and of shame.
The physical impact of bingeing and of purging is another form of stress caused by the eating disorder. The list of short term and long term physical effects of bulimia is extensive.
Stress and Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by weight loss, refusal to maintain a medically appropriate body weight, and distorted body image.
People with anorexia tend to restrict calories and good tasting food. Some people with anorexia also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. One in 200 American women suffers from anorexia.
Although anorexia nervosa most often begins during adolescence, an increasing number of children and older adults are being diagnosed.
You cannot tell if a person is struggling with anorexia by looking at her. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity (yep, diet culture’s effects again).
Anorexia nervosa numbs emotion and creates preoccupation with food, weight, calories, and exercise. The preoccupation is the body’s response to restriction and starvation (both of which are stressful to mind and body).
Simply put, the preoccupation is stressful. It is all the person with anorexia can think of. It is the last thing she thinks of before bed, and the first thing that comes to mind upon awakening. Even dreams are often about food and body size.
Sleep is usually poor, which creates stress in and of itself.
Anorexia is an attempt to feel more of a sense of control in life, and therefore less stress.
However, a ton of stress is created by the symptoms of anorexia. The stress anorexia creates affects both the mind and body. In fact, anorexia has a higher mortality rate of any psych illness. That is stressful.
Can stress cause depression?
Does stress cause depression? Yes and no.
Depression is a mood disorder. Its symptoms include sadness, and/or a lack of interest or motivation in things you used to enjoy. Additional symptoms include lethargy, fatigue, low motivation, poor concentration, sleep problems, or changes in appetite. Depression may include physical symptoms that don’t respond to treatment, such as headaches or gastrointestinal problems. Having any of these symptoms is stressful.
Depression affects about one in 15 adults (6.7%) per year. One in six adults (16.6%) experience depression at some time in their life. Depression can occur at any time. Typically it first appears during the late teens to mid-20s.
Stress affects 100% of adults, yet 100% of adults do not develop depression.
1. Stress can trigger depression
Stress can (seem to) cause depression in a few different ways.
When people don’t cope effectively with stress, they may become depressed. They may feel defeated, ill-equipped, or overwhelmed by the stress. A “why bother” attitude could develop, which is a depression response to stress called learned helplessness.
What happens in learned helplessness is people eventually stop trying to manage the stress because nothing has worked in the past. Not trying leads apathy. All-or-nothing thinking comes next. The person’s self talk is based in distorted thinking. It may be something like, “Nothing I do matters. I suck”.
Chronic stress is especially problematic. It can derail your natural physiological stress response, which means you are not able to manage stress as well. Depression sets in.
Generally, when people feel stressed, their problem solving skills aren’t optimal. Without the stress, the person’s coping and problem solving skills may be effective enough.
Stress can also lead to people neglecting self-care. Or to engaging in behaviors that harm their health, such as smoking or drinking alcohol.
2. Depression creates more stress
The effects of depression can create or intensify stress.
Being depressed is stressful for a bunch of reasons..
Depression disrupts life. It’s often associated with withdrawing from people and instead isolating yourself. And not doing things you usually enjoy doing.
Depression and stress can lead to a vicious cycle
The relationship between depression and stress is bidirectional. Depression can cause stress, and stress can cause depression. Stress makes depression worse, and depression makes stress worse.
3. So how does stress cause eating disorders and depression?
Stress in and of itself does not CAUSE eating disorders or depression.
Rather, stress triggers or intensifies eating disorders or depression. Stress is bidirectional in the case of eating disorders and depression.
At their core, eating disorders and depression are disorders of disconnection.
Feeling disconnected from others or from yourself is stressful.
One way to address disconnection and social isolation is to connect with someone you trust. Let that person (or those people) support you.
Often it’s better for a supportive person to ask an open ended question rather than to tell you what to do or not to do.
The disconnection at the core of eating disorders and depression can be from yourself. And that stress has the biggest potential impact of all.
If talking to friends or family is not helpful or comfortable, please speak with a trained professional.
Learning effective methods to cope with stress decreases risk for eating disorders and depression. And makes for a more meaningful life.
There will always be stress. But it need not be harmful to your well being or quality of life.
Dr Elayne Daniels is a Massachusetts based clinical psychologist specializing in the treatment of eating disorders, body image and associated concerns. She also works with people who identify as Highly Sensitive.. Contact her here to get in touch.