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Identifying Co-Occurring Depression in Teens with EDs
Adolescents experiencing an eating disorder (ED) are often diagnosed with co-occurring mood disorders, particularly depression. In fact, research estimates that 23-48% of adolescents with an ED have comorbid depression .
Additionally, approximately 11% of adolescents with anorexia nervosa (AN), and 50% with bulimia nervosa (BN) will experience depressive symptoms in conjunction with their ED symptoms.
The simultaneous occurrence of both disorders can worsen the symptomology of each as well as complicate the diagnosis, treatment, and recovery processes. Depression often exacerbates ED symptoms and studies show that “depression is a moderator of the outcome, reducing the likelihood of remission for adolescents .”
With all this research, co-occurring disorders still go undiagnosed. One study surveyed 520 nurses that work with adolescents and found that more than a quarter identified gaps in their knowledge of common teen health issues such as depression and eating disorders .
It is essential that any person with teens in their care have a basic understanding of what may indicate co-occurring ED and depression.
Age of Onset
In general, it is safest to persistently be vigilant about the mental health status of teens in your care. The transition from childhood to adolescence is overwhelming and makes pre-teens and teens vulnerable to numerous psychological health concerns.
In fact, both depression and eating disorders begin to emerge in pre-adolescence, with the average onset of both depression and EDs beginning as early around the age of 12  .
As such, it is not enough to be watchful as your children experience their teen years, pay attention to their mental, emotional, and physical state before and during this transitionary period.
Which Comes First?
For co-occurring disorders, the “chicken-and-the-egg” question always arises: which comes first? As with most dual diagnoses, the answer to this question remains unclear with depression and EDs. One study “found a unidirectional association between depressive symptoms…indicating that depressive symptoms predict the development of disordered eating in teens .” Yet, other studies indicate that ED symptomology can give way to depressive symptoms.
The varying research on this makes it clear that one cannot predict whether an ED will result in depression or vice-versa. As such, it is crucial that mental health and health care providers that work with adolescents are consistently screening for both disorders.
Depression and EDs are marked by their relationship to maladaptive behaviors. Teens may develop maladaptive behaviors to cope with their depression, and an ED may be one of those unhealthy mechanisms. Be aware of how the teen in your life is coping with any “growing pains” that occur during adolescence.
Additionally, make sure the lines of communication are open between you and your teen and truly listen to what may be troubling them, distinguishing between what may be typical teenage troubles and anything that may indicate a more significant problem.
Adolescents with depression and EDs are also found to have significantly higher suicidality. 3-20% of teens with Anorexia and 25-30% of those with BN have attempted suicide .
Keep an eye out for your teen showing behaviors indicating suicidality such as talking about being a burden or having no reason to live, increasing alcohol or drug use, withdrawing or isolating themselves, saying goodbye to people or giving away prized possessions, and expressing feelings of depression, anxiety, worthlessness, or hopelessness.
Research makes it clear that early intervention is key to fighting both EDs and depression. This can only be possible if parents, teachers, coaches, and those in the healthcare and mental health field are aware of what may indicate either disorder co-occurring and are vigilant for these signs.
About the Author: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
References: Watson, H, et al. (2014). Normative data for female adolescents with eating disorders on the children’s depression inventory. International Journal of Eating Disorders, 47, 666-670.
 Maher, M. (2009). It’s not easy being teen. American Journal of Nursing, 109:3, 20.
 Rawana et al. (2010). The relation between eating – and weight-related disturbances and depression in adolescence: a review. Clinical Child and Family Psychology Review, 13:3, 213-230.
 National Eating Disorders Association (2016). Prevalence and correlates of eating disorders in adolescents. Retrieved on 09 October from https://www.nationaleatingdisorders.org/prevalence-and-correlates-eating-disorders-adolescents.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on November 7, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on November 7, 2017.
Published on EatingDisorderHope.com