1www.beyondblue.org.au 1300 22 4636 1www.beyondblue.org.au 1300 22 4636

Eating disorders, anxiety and depression

Having an eating disorder is neither a lifestyle choice, a ‘diet gone wrong’, nor an attempt to get attention. A person with an eating disorder has a mental health condition. Eating disorders are serious, potentially fatal conditions, and most people with eating disorders need psychological treatment and/or physical health treatment (e.g. nutritional advice) to promote recovery.

Anxietyanddepressionarecommoninpeoplewitheatingdisorders.Thegoodnewsisthatthereareeffectivetreatmentsbothforeatingdisordersandforanxietyanddepression.

Thisfactsheetlooksatthelinksbetweeneatingdisordersandothermentalhealthconditions,suchasanxietyanddepression.Italsolooksatwheretogethelp,treatmentoptionsandwhatfamilyandfriendscandotosupportpeoplewitheatingdisorders.

What are eating disorders?Eatingdisordersinvolveanunhealthypreoccupationwitheating,exerciseandbodyweight/shape.Distortedthoughtsandemotionsaboutbodyimageandself-worthcanleadtomarkedchangesineatingandexercisebehaviours–thesemayincludeexcessivedieting,fasting,overexercising,usingmedications(e.g.slimmingpills,diuretics,laxatives),vomitingorbingeeating.Anunhealthyrelationshipwithfoodisoftenanattempttodealwith

emotionalissuessuchasnegativefeelingsandlowself-esteem.

Eatingdisordersarecommonandincreasinglyprevalent.InAustralia,oneinfourpeopleknowssomeonewhohasexperiencedaneatingdisorder.Abouttwotothreeinevery100Australianfemaleshasanorexiaorbulimianervosa,andaroundfourin100Australianshavesymptomsofbingeeatingdisorder.1Itisnotuncommonforapersontoprogressfromoneeatingdisordertoanother.

Eatingdisorderscanaffectpeoplefromanyagegroup,genderorsocioeconomicandculturalbackground.

Features of eating disorders

Anorexia nervosa

• Distortedbodyimageandobsessivefearofgainingweight.

• Extremelylimitedfoodintakeand/orincreasedlevelsofexercise.

• Canleadtoadangerouslylowbodyweight,malnutritionandstarvation.

Bulimia nervosa

• Oftenstartswithdietingtoloseweight.

• Bingeeatingfollowedbyvomiting,fasting,overexercising,orusinglaxatives/diureticsasameansofpurging.

• Thebinge/purge/exercisecyclecanbecomeincreasinglycompulsiveanduncontrollableovertime.

Binge eating disorder

• Eatingexcessiveamountsoffood,oftenwhennothungry,asadistractionfromotherproblems.

• Nopurging,butfeelingsofintenseguilt,shameandself-hatredafterbinges.

• Mayinvolvesporadicfastsandrepetitivediets.

Other Specified Feeding and Eating Disorders (OSFED)

OSFEDisatermusedwhenapersonshowssignsofdisorderedeatingbutdoesnotmeetallthecriteriaforaspecificeatingdisorder.Forexample,apersonmayshowallofthepsychologicalsignsofanorexiabutnotyetbeconsideredunderweightfortheirheight.Thisdoesnotmeanthatthepersonhasalessseriouseatingdisorder;alldisordersinthiscategoryareseriousmentalhealthconditionsthatcausesignificantdistress.

Whilethegoalofdiagnosisistoaccuratelydescribesymptomsandseektherighttreatmentforthem,alargenumberofpeoplehaveothersignificanteatingconcernsanddistortedbodyimagewhicharenotcoveredbythesecategories.

Warning signs of an eating disorderIfyouareawareofsomeonedisplayingsomeofthefollowingwarningsigns,seekprofessionalhelp.

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Behavioural signs

• dietingorovereatingexcessively

• eatingveryquicklyorveryslowly

• eatingonlycertaintypesandamountsoffood

• avoidingsocialsituationsthatinvolvefood

• ‘playing’withfoodratherthaneatingit

• goingtothebathroomstraightaftermeals

• wearingloose-fittingclothestohideweightloss

• preparingandcookingmealsforothers,butnotactuallyeating

• engaginginrepetitiveorobsessivebehavioursrelatingtobodyshapeandweight(e.g.weighing)

• exercisingexcessively,feelingcompelledtoperformacertainnumberofrepetitionsofexercisesorexperiencingdistressifunabletoexercise.

Physical signs

• weightlossorweightfluctuations

• sensitivitytothecoldorfeelingcoldmostofthetime,eveninwarmtemperatures

• changesinorlossofmenstrualpatterns

• fainting

• swellingaroundthecheeksorjaw,callusesonknuckles,ordamagetoteethduetovomiting.

Emotional or psychological symptoms

• thinkingandtalkingalotaboutbodyimage,bodyweightandfood

• expressingextremedissatisfactionwithbodyorhavingadistortedbodyimage

• becomingirritableorwithdrawingfromfamilyandfriends

• beingsensitivetocommentsaboutfood,exercise,weightorbodyshape

• feelinganxiousordepressed

• havingdifficultyconcentrating

• havingproblemswithrelationships

• havingsuicidalthoughtsorbehaviour.

Eatingdisorderscanresultinawiderangeofphysicalhealthproblems,includingseveremalnutrition,orbrain,heartorkidneyproblems,whichmayleadtolossofconsciousnessordeath.Peoplewithuntreatedeatingdisorderscandieasaresultoftheseillnesses.

What is anxiety? Anxietyismorethanjustfeelingstressedorworried.Anxiousfeelingsareanormalreactiontoasituationwhereapersonfeelsunderpressureandusuallygoawayoncethestressfulsituationhaspassed,orthe‘stressor’isremoved.

However,forsomepeopletheseanxiousfeelingshappenfornoapparentreasonorcontinueafterthestressfuleventhaspassed.Forapersonexperiencinganxiety,anxiousfeelingscannotbebroughtundercontroleasily.Anxietycanbeaseriousconditionthatmakesithardforapersontocopewithdailylife.Therearemanytypesofanxietyandmanypeoplewithanxietyexperiencesymptomsofmorethanonetype.

Livingwithaneatingdisorderisoneofmanythings–suchasafamilyhistoryofmentalhealthconditions,stressfullifeeventsandpersonalityfactors–thatmaytriggeranxiety.

Anxietyiscommonandthesoonerapersongetshelp,thesoonertheycanrecover.

Signs of anxietyThesymptomsofanxietycanoftendevelopgraduallyovertime.Giventhatweallexperiencesomeanxiousfeelings,itcanbehardtoknowhowmuchistoomuch.Inordertobediagnosedwithananxietycondition,itmusthaveadisablingimpactontheperson’slife.Therearemanytypesofanxiety,andtherearearangeofsymptomsforeach.

Anxietycanbeexpressedindifferentwayssuchasuncontrollableworry,intensefear(phobiasorpanicattacks),upsettingdreamsorflashbacksofatraumaticevent.

Somecommonsymptomsofanxietyinclude:

• hotandcoldflushes

• racingheart

• tighteningofthechest

• snowballingworries

• obsessivethinkingandcompulsivebehaviour.

Thereareeffectivetreatmentsavailableforanxiety.FormoreinformationonanxietyandtreatmentsseethebeyondblueUnderstanding anxietyfactsheetorvisitwww.beyondblue.org.au/anxiety

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What is depression?Whileweallfeelsad,moodyorlowfromtimetotime,somepeopleexperiencethesefeelingsintensely,forlongperiodsoftime(weeks,monthsorevenyears)andsometimeswithoutanyapparentreason.Depressionismorethanjustalowmood–it’saseriousconditionthathasanimpactonbothphysicalandmentalhealth.

Depressionaffectshowapersonfeelsaboutthemselves.Apersonmayloseinterestinwork,hobbiesanddoingthingsheorshenormallyenjoys.Somepeoplemaylackenergy,havedifficultysleepingorsleepmorethanusual,whilesomepeoplefeelanxiousorirritableandfindithardtoconcentrate.

Thegoodnewsisthatjustlikeaphysicalcondition,depressionistreatableandeffectivetreatmentsareavailable.

Signs of depressionApersonmaybedepressedifheorshehasfeltsad,downormiserablemostofthetimefor more than two weeksand/orhaslostinterestorpleasureinusualactivities,andhasalsoexperiencedsomeofthesignsandsymptomsonthelistbelow.

It’simportanttonotethateveryoneexperiencessomeofthesesymptomsfromtimetotimeanditmaynotnecessarilymeanapersonisdepressed.Equally,noteverypersonwhoisexperiencingdepressionwillhaveallofthesesymptoms.Thesymptomswillnotprovideadiagnosis–forthatyouneedtoseeahealthprofessional–buttheycanbeusedasaguide.

Somecommonsymptomsofdepressioninclude:

• notgoingoutanymore,lossofinterestinenjoyableactivities

• withdrawingfromclosefamilyandfriends

• beingunabletoconcentrateandnotgettingthingsdoneatworkorschool

• feelingoverwhelmed,indecisiveandlackinginconfidence

• increasedalcoholanddruguse

• lossorchangeofappetiteandsignificantweightlossorgain

• troublegettingtosleep,stayingasleepandbeingtiredduringtheday

• feelingworthless,helplessandguilty

• increasedirritability,frustrationandmoodiness

• feelingunhappy,sadormiserablemostofthetime

• thoughtssuchas,“I’mafailure”,“Life’snotworthliving”,“Peoplewouldbebetteroffwithoutme”.

Aswithanxiety,thereareeffectivetreatmentsavailablefordepression.Formoreinformationondepressionandtreatmentsseebeyondblue’s Anxiety and depression: An information bookletorvisitwww.beyondblue.org.au/depression

What are the links between eating disorders, anxiety and depression?Researchindicatesthereisalinkbetweenanxiety,depressionandeatingdisorders.Eatingdisordersarethoughttoaffectabout9percentofthepopulation2,andalmost3millionAustraliansarelivingwithdepressionoranxiety.3Oneinfivewomenandoneineightmenwillexperiencedepressionatsometimeintheirlife.Onaverage,oneinfourpeoplewillexperienceanxiety.3Peoplewitheatingdisordersaretwiceaslikelytoexperienceanxietyanddepressionwhencomparedtopeopleinthewidercommunity.Onestudyfoundthatcloseto50percentofadolescentswitheatingdisordershadhighlevelsofanxietyanddepression,especiallythosewithbulimia.4

However,itisunclearwhetherdepressionisariskfactorforaneatingdisorder,oroccursasaresultofaneatingdisorder.Depressioncanmakepeoplemorelikelytofeelnegativelyabouttheirbodiesandthemselves–thismayputthematriskofdevelopinganeatingdisorder.Eatingdisordersmayalsomakepeoplemoreatriskofdevelopingdepression,particularlyiftheyexperiencerapidweightlossorstarvation.

Researchhasdemonstratedthatpeoplewithanorexianervosatendtohavechildhoodandpersonalitycharacteristicssuchasobsessionsandperfectionism,suggestingthattheyhaveanunderlyinganxioustraitthatprecedestheeatingdisorder.

Theconditionsalsosharemanyriskfactors:

• biologicalfactors

• geneticfactorse.g.afamilyhistoryofmentalhealthproblems

• socialfactorse.g.mediaemphasisona‘thinideal’ofbeauty

• psychologicalfactorse.g.lowself-esteem,ineffectivecopingstrategiesandpoorrelationships.

Managinganxietyanddepressioncangreatlyimprovepeople’swellbeingandqualityoflifeaswellastheireatingdisorderandtheirattitudetowardsit.Peoplewithanxietyand/ordepressioncanfinditdifficulttotakethefirststepinseekinghelp.Theymayneedthesupportoffamily,friendsand/orahealthprofessional.

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What are the treatments for eating disorders, anxiety and depression?Thereisnooneprovenwaythatpeoplerecoverfromaneatingdisorder,anxietyordepressionandit’sdifferentforeverybody.However,thereisarangeofeffectivetreatmentsandhealthprofessionalswhocanhelppeopleontheroadtorecovery.Therearealsomanythingsthatpeoplewithanxiety,depressionandaneatingdisordercandotohelpthemselvestorecoverandstaywell.Theimportantthingisfindingtherighttreatmentandtherighthealthprofessionalthatworksforyou.

Differenttypesofanxietyordepressionrequiredifferenttypesoftreatment.Thismayincludephysicalexerciseforpreventingandtreatingmildanxietyanddepression,throughtopsychologicalandmedicaltreatmentformoresevereepisodes.Thetreatmentforanxietyanddepressioninsomeonewithaneatingdisorderinvolvesacoordinatedapproachthatmonitorsandtreatsthesymptomsofanxiety,depressionandtheeatingdisorder.

Professionaltreatmentforeatingdisordersinvolvesmanagingphysicalhealth(includingnutritionaladvice)andpromotingmentalhealth.Inaddition,medication,supportgroupsandsomealternativetherapiesmaybehelpful.

Physical health managementPhysicalhealthmanagementaimstomonitor,restoreandmaintainaperson’snutritionalbalance(avoidingstarvingorovereating)andalsotreatthelonger-termphysicalproblemsthatresultfromunhealthyeatingpatterns.Thetreatmentusuallyinvolvesseeingadoctorand/oradietitian,developingaplanforhealthyeatingandhavingregularcheck-ups.

Somepeopleneedmoreintenseandstructuredcareinhospital.Beingadmittedtohospitalfortreatmentofweightlossoccursonlyiftheindividualisverymalnourished.

Psychological treatmentsPsychologicaltreatmentforeatingdisordersbeginstoaddresseatingpatternsandrelatedthoughts,feelingsandbehavioursbyhelpingpeoplefindnewwaysofthinkingaboutandhandlingissuessuchasself-esteem,control,perfectionismandfamilyproblems.Thiscanincludeindividualandfamilytherapyandpsycho-education(informationonpsychologicalissues).Psychologicaltherapiesarealsousedtotreatanxietyanddepression.

• Cognitive behaviour therapy (CBT)isaneffectivetreatmentforpeoplewithanxietyanddepression.Itteachespeopletoevaluatetheirthinkingaboutcommondifficulties,helpingthemtochangetheirthoughtpatternsandthewaytheyreacttocertainsituations.

• Interpersonal therapy (IPT)isalsoeffectivefortreatingdepressionandsometypesofanxiety.Ithelpspeoplefindnewwaystogetalongwithothersandtoresolvelosses,changesandconflictinrelationships.

Psychologicaltherapiesmaynotonlyhelpwithrecovery,butcanalsohelppreventarecurrenceofanxietyordepression.Thesetherapieshelpbuildskillsincopingwithstressfullifecircumstancesandcanbeprovidedbyapsychologist,psychiatristorothertrainedhealthprofessional.

MedicationAntidepressantmedication,alongsidepsychologicaltherapies,canalsoplayaroleinthetreatmentofmoderatetoseveredepressionandsomeanxietyconditions.

Makingadecisionaboutwhichantidepressantisbestforapersoncanbecomplex.Thedecisionwillbemadeinconsultationwithadoctor,aftercarefulassessmentandconsideration.Thedoctorshoulddiscussdifferencesineffectsandpossibleside-effectsofmedications.Stoppingmedicationshouldonlybedonegradually,withadoctor’srecommendationandundersupervision.

Adoctorortreatinghealthprofessionalwilltakeintoaccountseveralfactorswhensuggestingthemostsuitabletreatment.Regularcontactwithandongoingassessmentbyadoctortocheckthattreatmentsareworkingeffectivelyisanimportantpartofbecomingandstayingwell.Mostpeopletakingmedicationwillalsobenefitfrompsychologicaltherapies,whichwillreducethelikelihoodofrelapseafterthepersonhasstoppedtakingthemedication.

Who can assist?A General Practitioner (GP)isagoodfirststeptodiscussyourconcerns.AgoodGPcan:

• makeadiagnosis

• checkforanyphysicalhealthproblemormedicationthatmaybecontributingtothecondition

• discussavailabletreatments

• ifappropriate,workwiththepersontodrawupaMentalHealthTreatmentPlansoheorshecangetaMedicarerebateforpsychologicaltreatment

• providebriefcounsellingor,insomecases,psychologicaltherapies

• prescribemedication

• referapersontoamentalhealthspecialistsuchasapsychologist,socialworkerorpsychiatrist.

Makesurethatthedoctormanagingyoureatingdisorderknowsifyouhaveanxietyordepression.ItisrecommendedthatpeopleconsulttheirregularGPoranotherGPinthesameclinic,asmedicalinformationissharedwithinapractice.

Psychologistsarehealthprofessionalswhoprovidepsychologicaltherapiessuchascognitivebehaviourtherapy(CBT)andinterpersonaltherapy(IPT).PsychologistsarenotdoctorsandcannotprescribemedicationinAustralia.

Psychiatristsaredoctorswhospecialiseinmentalhealth.Theycanmakemedicalandpsychiatricassessments,conductmedicaltests,providetherapyandprescribemedication.PsychiatristsoftenusepsychologicaltreatmentssuchasCBT,IPTand/ormedication.Iftheconditionrequireshospitaladmission,apsychiatristwillbeinchargeoftheperson’streatment.

Mental health nursesarespeciallytrainedtocareforpeoplewithmentalhealthconditions.TheyworkwithpsychiatristsandGPstoreviewaperson’smentalhealth,monitormedicationandprovideinformationaboutmentalhealthconditionsandtreatment.Somehavetraininginpsychologicaltherapies.

Social workers in mental healtharespeciallytrainedtoworkwithpeoplewhoareexperiencingdifficultiesinlife.Socialworkerscanhelppeoplefindwaystomanagemoreeffectivelysomeofthesituationsthattriggertheseconditionssuchasfamilyissues,financialproblems,workstressandlivingarrangements.Mentalhealthsocialworkerscanalsoprovidefocusedpsychologicalself-helpstrategies.

Occupational therapists in mental healthhelppeoplewho,becauseofamentalhealthcondition,havedifficultyparticipatinginnormal,everydayactivities.Mentalhealthoccupationaltherapistsalsoprovidefocusedpsychologicalself-helpstrategies.

Aboriginal and Torres Strait Islander mental health workersunderstandthementalhealthissuesofIndigenouspeopleandwhatisneededtoprovideculturallysafeandaccessibleservices.Somemayhaveundertakentraininginmentalhealthandpsychologicaltherapies.SupportprovidedbyAboriginalandTorresStraitIslandermentalhealthworkersmightinclude,butisnotlimitedto,casemanagement,screening,assessment,referrals,transporttoandattendanceatspecialistappointments,education,improvingaccesstomainstreamservices,advocacy,counselling,supportforfamilyandacutedistressresponse.

Thecostoftreatmentfromamentalhealthprofessionalvaries.However,inthesamewaythatpeoplecangetaMedicarerebatewhentheyseeadoctor,theycanalsogetpartoralloftheconsultationfeesubsidisedwhentheyseeamentalhealthprofessionalfortreatmentofanxietyordepression.Seebeyondblue’sGetting help – How much does it cost? factsheetat www.beyondblue.org.au/resources

Tofindamentalhealthpractitionerinyourarea,visitwww.beyondblue.org.au/find-a-professionalorcallthebeyondblueSupportServiceon1300 22 4636.

Helpful strategies and tips• Learnaboutanxiety,depression

andeatingdisordersandhowtheseconditionsinteract.

• Developamentalhealthplanwithyourdoctor.

• Visityourdoctorregularlytoreviewyoureatingdisorderandmentalhealthmanagement.

• Talktoyourdoctoraboutpossiblebarrierstotreatment,suchascost,organisationorplanning,aswellaswhattodoifyourconditionworsens.

• Gethelp,supportandencouragementfromfamilyandfriendsandhavethemhelpyoutofollowyourmentalhealthplan.

• Learnrelaxationtechniques.

• Getinvolvedinsocialactivities.

• Stayactiveandexerciseunderthesupervisionofadoctor.

• Eathealthilyandincludeawidevarietyofnutritiousfoods.

• Limityouruseofalcohol,tobaccoandcaffeine.

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www.beyondblue.org.au 1300 22 4636 ©BeyondBlueLtd. BL/070003/14

Where to find more information

beyondbluewww.beyondblue.org.auLearnmoreaboutanxietyanddepression,ortalkitthroughwithoursupportservice.

1300 22 4636 Email or chat to us online at www.beyondblue.org.au/getsupport

mindhealthconnectwww.mindhealthconnect.org.au Accesstotrusted,relevantmentalhealthcareservices,onlineprogramsandresources.

The Butterfly Foundationwww.thebutterflyfoundation.org.au 1800 33 4673Education,supportandservicesforpeoplewitheatingdisordersandtheirfamilies.

National Eating Disorder Collaborationwww.nedc.com.auEvidence-basedinformationoneatingdisorders;theirprevention,identificationandtreatment.

Eating Disorders Foundation of Victoria www.eatingdisorders.org.au 1300 550 236SupportandinformationforpeoplewitheatingdisordersandtheirfamiliesinVictoria.

Eating Disorders Foundation of ACT (EDFACT)(02) 6166 1679 info@edfact.org.auInformationandreferralforpeoplewitheatingdisordersandtheirfamiliesintheACT.

Eating Disorders Association Inc (QLD)www.eda.org.au (07) 3394 3661SupportandreferralforpeoplewitheatingdisordersandtheirfamiliesinQLD.

Anxiety, Compulsive and Eating Disorders Association (ACEDA) SAwww.aceda.org.au (08) 8237 4011Informationandsupportforpeoplewitheatingdisorders,theirfriendsandfamiliesinSA.

Bridges Association Inc (WA)www.bridges.net.auInformationandsupportforallpeopleaffectedbyeatingdisordersinWA.

The Centre for Eating and Dieting Disorders (NSW)www.cedd.org.auInformationforpeoplewitheatingdisorders,theirfamilyandfriendsinNSW.

facebook.com/beyondblue twitter.com/beyondblue

Donate online www.beyondblue.org.au/donations

beyondbluewouldliketoacknowledgetheassistanceoftheNationalEatingDisorderCollaborationintheproductionofthisfactsheet.

References1 VictorianCentreofExcellenceinEating

Disorders&EatingDisordersFoundationofVictoria(2004).An Eating Disorders Resource for Schools. A Manual to Promote Early Intervention and Prevention of Eating Disorders in Schools.Melbourne:beyondblue.

2 WeltzinTE,WeisenselN,FranczykD,BurnettK,KlitzC,andBeanP.(2005).Eatingdisordersinmen:Update.Journal of Men’s Health & Gender,2(2),186-193.

3 AustralianBureauofStatistics(2008).National Survey of Mental Health and Wellbeing: Summary of Results 2007(4326.0).Canberra:ABS.

4 PattonGC,CoffeyC&SawyerSM(2003).Theoutcomeofadolescenteatingdisorders:findingsfromtheVictorianAdolescentHealthCohortStudy.European Child & Adolescent Psychiatry12:I/25-9.

How family and friends can help • Whenapersonhasaneating

disorderandanxietyordepression,itcanaffectfamilyandfriends.It’simportantforfamilyandfriendstolookaftertheirownhealthaswellaslookingafterthepersonwhohasaneatingdisorder.

• Learnabouteatingdisorders,anxietyanddepressionandtheirsymptomstohelpyourecognisewarningsigns.

• Encouragethepersontogotothedoctoriftheireatingdisorder,anxietyordepressiongetsworse.Makesureyouseekhelpifyouthinkyouneedit,too.

• Supportthepersonbyhelpingthemtofollowtheirmentalhealthplans.Gentlyremindthepersontotaketheiranxietyanddepressionmedicationregularlyandtoattendalltheirmedicalappointments.

• Encouragethepersontodothingsthattheywouldnormallyenjoy.

• Lookafteryourownhealthbyeatingwell,exercisingregularly,gettingenoughsleepanddoingthingsthatyouenjoy,too.