It should come as no surprise that mood and eating are highly related.
Our mood states affect what and how much we eat, which in turn affects how we feel afterwards.
This is very true of binge eating.
There’s been a lot of research attention devoted to understanding the link between depression and binge eating. While there are many different viewpoints on this topic, I’m aiming to clarify this here.
Before diving into the link between binge eating and depression, it’s first necessary to define these terms.
What is binge eating?
As I’ve mentioned previously, binge eating refers to eating a lot of food in a short period while at the same time feeling like you’ve lost complete control.
It’s usually associated with 1 or more of the following features:
- Eating at a rapid rate
- Consuming foods that are high in fat or carbohydrates
- Feeling a profound sense of shame or guilt
- Continued eating in the absence of hunger
If you’re wanting to learn more about binge eating, I’d recommend visiting one of my earlier articles here.
What is depression?
Depression is a type of mood disturbance that is characterized by persistent feelings of sadness and loss of interest in activities that were once previously enjoyable.
Importantly, and contrary to what people think, depression is more than just feeling “down”.
There are heaps of other key symptoms that underpin the depression construct, some of which include apathy, loss of appetite, insomnia, concentration difficulties, psychomotor agitation, suicidal ideation, self-blame, and energy loss.
It is also worth noting that depressive symptoms are not the same as depressive syndromes.
Depressive symptoms are on a continuum, where almost everyone experiences one or more symptom from time to time. For instance, on one week you might feel really sad, have no appetite, and may even have fleeting suicidal thoughts, but on the next week these symptoms might have decreased in intensity.
In contrast, a depressive syndrome is something that persists over a prolonged period of time, where the person must meet a set of stringent criteria in order to receive a depressive disorder diagnosis.
Binge eating and depression are bi-directionally related
The question many of us want to know is what comes first – depression or binge eating?
While the answer is complex, there’s good quality evidence showing that it goes both ways. That is, depressive symptoms can trigger a binge episode, and a binge episode can exacerbate depressive symptoms.
However, the relationship is stronger for the depression-binge eating relationship than for the binge eating-depression relationship.
For example, a recent meta-analysis of 42 studies found that depressive symptoms was more strongly predictive of binge eating pathology than was the case for when binge eating pathology predicted depressive symptoms 1 Puccio, F., Fuller‐Tyszkiewicz, M., Ong, D., & Krug, I. (2016). A systematic review and meta‐analysis on the longitudinal relationship between eating pathology and depression. International Journal of Eating Disorders, 49, 439–454 .
This goes to show that we need to be on the lookout for any co-occurring depressive symptoms among people who binge eat, and vice versa.
Underlying mechanisms for these relationships?
Let’s start off by addressing the question of why depressive symptoms might trigger binge eating.
While the answer is complex, let me try to break it down by drawing from the affect regulation model 2 Haedt-Matt, A. A., & Keel, P. K. (2011). Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychological Bulletin, 137, 660-681 .
This model conceptualizes binge eating as a maladaptive coping method by which an individual attempts to escape and alleviate affective distress by focusing on external food cues. Over time, this behaviour becomes a conditioned response that is negatively reinforced.
This can explain why many binge eaters turn to food whenever they feel down in the dumps.
In contrast, why binge eating can lead to further depression is a much more complex question with multiple mechanisms. Let’s take a biopsychosocial approach to understand this:
- Biologically, periods of restrictive and binge eating may disrupt normative developmental processes across puberty. Puberty is a critical period that is known to influence later mental health problems, especially when it’s delayed.
- Psychologically, an episode of binge eating brings about profound feelings of shame, guilt, or self-loathing, all of which could trigger a future depressive episode.
- Socially, binge eating is thought to disrupt social maturation or relationships. Think about it: people who binge eat typically avoid or withdraw from social situations that involve food or that expose one’s body image. This interpersonal avoidance could then fuel a range of different depressive symptoms.
In sum, there is likely a complex interaction of factors that can explain why binge eating can lead to depression, and why depression can lead to binge eating.
Clearly, we need more rigorous research investigating this, but I think we’ve got a great set of hypotheses to work off.
Just how common do the two co-occur?
Understanding the overlap requires one to look into the comorbidity rates between these problems.
A useful study in 2009 provides useful estimates of comorbidity between binge-eating disorder and mood disorders 3 Grilo, C. M., White, M. A., & Masheb, R. M. (2009). DSM‐IV psychiatric disorder comorbidity and its correlates in binge eating disorder. International Journal of Eating Disorders, 42(3), 228-234 . Of those with binge-eating disorder:
- 54% presented with a lifetime mood disorder
- 47% presented with a lifetime major depressive disorder
- 7% presented with lifetime dysthymic disorder
- 3% presented with lifetime depressive disorder not otherwise specified.
What’s the impact on treatment?
One important thing to note is that depressive symptoms usually improve after binge-eating disorder treatment 4 Hilbert, A., Petroff, D., Herpertz, S., Pietrowsky, R., Tuschen-Caffier, B., Vocks, S., & Schmidt, R. (2019). Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. Journal of consulting and clinical psychology, 87(1), 91 .
While it’s not well-understood why this is the case, a possible reason is that treatment usually helps the person develop healthy coping strategies. Therefore, they’re better able to combat any co-occurring depressive symptoms through the implementation of these learned coping strategies.
There is also some evidence to show that depression can negatively impact the outcome of binge-eating disorder treatment.
For example, one study showed that those with higher depression levels before entering treatment for binge-eating disorder were less likely to recover than those without high depression levels 5 Vall, E., & Wade, T. D. (2015). Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 48, 946–971 .
It is possible that depression interferes with motivation levels, makes people prone to skipping therapy sessions, and creates that sense of hopelessness in the quest for recovery, potentially explaining why it can negatively affect treatment outcomes.
If you’re struggling with binge eating, it’s important to consider whether you’re also dealing with depression – either the symptoms or the syndrome.
Being aware of this and letting people know could help with efforts to try to stop binge eating.
One of the main reasons why people find it hard to stop binge eating is because they’re not acutely aware of those things that are maintaining it.
Since there’s good evidence showing that depression can fuel binge eating, it’s necessary to try to reflect on this and see whether this is true for you.
After all, it might really help you towards overcoming these problems.
|↑1||Puccio, F., Fuller‐Tyszkiewicz, M., Ong, D., & Krug, I. (2016). A systematic review and meta‐analysis on the longitudinal relationship between eating pathology and depression. International Journal of Eating Disorders, 49, 439–454|
|↑2||Haedt-Matt, A. A., & Keel, P. K. (2011). Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychological Bulletin, 137, 660-681|
|↑3||Grilo, C. M., White, M. A., & Masheb, R. M. (2009). DSM‐IV psychiatric disorder comorbidity and its correlates in binge eating disorder. International Journal of Eating Disorders, 42(3), 228-234|
|↑4||Hilbert, A., Petroff, D., Herpertz, S., Pietrowsky, R., Tuschen-Caffier, B., Vocks, S., & Schmidt, R. (2019). Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. Journal of consulting and clinical psychology, 87(1), 91|
|↑5||Vall, E., & Wade, T. D. (2015). Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 48, 946–971|