Depression and Eating Disorders in Teens: Key Findings

Introduction

This paper examines the link between depression and eating disorders (EDs), with particular focus on young adults and teenagers. Limited information is available on the nutritional status and food consumption of ED-diagnosed individuals. The objectives of this study were: (1) to describe the nutritional intake of ED-diagnosed teenagers, and (2) to examine the relationship between depression and ED among teens both with and without an ED diagnosis.

Multiple data sources were drawn upon for the individual papers examined in this review. This examination supports several key inferences. The high stability of ED and its strong association with obesity and declining psychological health among adults highlight the necessity of timely identification and treatment during childhood and adolescence. Depressed young people must be monitored carefully to detect the development of restrictive EDs. Additionally, adult females with a lifetime ED diagnosis were found to be twice as likely to report migraines compared to unrelated members of the same cohort; comorbid major depressive disorder (MDD) accounts for this association. Further studies are needed to address the intermediary factors that may explain the mechanisms through which these linkages develop. Research findings underscore the need to prevent, treat, and detect ED in a timely manner — not only in obese or overweight teenagers, but in all patients exhibiting internalizing symptoms and abnormal eating behaviors.

Depressed young people must be monitored carefully to detect the development of restrictive EDs. Experts have frequently linked eating problems to poor metabolic control. Depression is becoming increasingly common among individuals with type 1 diabetes (T1D); notably, an alarming prediction for this century is that depression and diabetes will emerge together as highly prevalent health conditions. However, limited information exists on the occurrence of depression among T1D patients. While young people with T1D commonly exhibit both ED and depressive symptoms, the impact of these conditions on metabolic control and their interrelationship have not been adequately studied (Christina et al., 2015). Metabolic control may be weakened — directly or indirectly — by EDs through induced depression.

The complexity of ED symptoms has led to growing interest in understanding the mechanisms behind the full spectrum of eating psychopathology. Contemporary scholars largely acknowledge the existence of several risk pathways linked to the development and persistence of eating psychopathology (Costa, Maroco, Pinto Gouveia, & Ferreira, 2016). This review examines the link between depression and ED in teenagers, and briefly considers the role of migraine in depression and eating behaviors.

Literature Review

The literature consistently cites linkages between depression and ED. Prevalence studies report comorbidity rates as high as 80% between the two conditions.

Between Men and Women

Depression was found to be more prevalent in young female T1D patients than in males; however, a stronger link existed between metabolic control and depression alone among males (Lyoo et al., 2012). The coexistence of depression and diabetes increased diabetes-related complications and mortality among T1D females. Depression and ED symptoms are assumed to be more prevalent among T1D females than males (Christina et al., 2015).

Adolescence to Young Adulthood

Longitudinal research examining the course of eating disorders from adolescence into young adulthood is limited, with heterogeneous outcomes — likely because of relatively small sample sizes, patient selection differences, and variations in research design. While more recent studies have revealed stability in both ED behavior and ED diagnosis between early adolescence and young adulthood, earlier research failed to demonstrate such continuity in most participants. Most studies found that ongoing ED behavior was associated with the occurrence of obesity and a broad range of psychopathology (Herpertz-Dahlmann, Dempfle, Konrad, Klasen, & Ravens-Sieberer, 2015).

Women and Migraine

MDD, ED, and migraine all show predominance in female patients. Whether migraine is more prevalent in ED-diagnosed females compared to healthy females has not yet been definitively established. Mustelin and colleagues (2014) cite multiple literature sources that fail to provide conclusive evidence, owing to insufficient sample data. Researchers found that the reason for migraine's prevalence in ED-affected females is comorbid MDD, which is closely linked to migraine. High migraine prevalence in females with comorbid MDD and ED may occur due to an interaction between the two conditions; however, the researchers were not adequately equipped to conduct a formal examination of this possibility.

Methodology

This section evaluates the methodology adopted across the reviewed literature sources.

Allen and colleagues (2012) sent questionnaire packages to teenage participants to complete at home prior to attending a direct assessment, aiming to:

1. Examine the nutritional intake of ED-affected teenagers relative to a control group — a comparison of micro- and macro-nutrient consumption was carried out across non-ED and ED groups.
2. Compare fatty acid consumption across ED-affected teenagers with and without depression — the ED group was divided into low and high depression clusters based on Beck Depression Inventory for Youth (BDI-Y) scores, using fixed cut-off values.
3. Explore links between depression, ED, and fatty acid consumption — correlations were examined between BDI-Y scores, fat consumption, and global ED symptom scores.
4. Test a mediational hypothesis in which fat consumption acts as a partial mediating factor in the depression–ED relationship — regression analyses were conducted to determine whether fat consumption mediated this relationship.

Herpertz-Dahlmann and colleagues (2015) used specially trained interviewers to conduct a computer-assisted child/teenager and parent interview. Respondents were also mailed questionnaires to be returned by post. The SCOFF questionnaire evaluated both baseline and follow-up ED behavior. SCOFF is an acronym derived from the first letter of the focus word in each of the following five questions, which assess various ED dimensions:

1. Do you make yourself Sick because you feel uncomfortably full? (purposeful vomiting)
2. Do you worry that you have lost Control over how much you eat? (lack of intake control)
3. Have you recently lost more than One stone (approximately 6 kg) in a three-month period? (weight loss)
4. Do you believe yourself to be Fat when others say you are too thin? (distortion of body image)
5. Would you say that Food dominates your life? (food's disproportionate effect on life)

Conclusion

This research reveals that female ED patients demonstrate experiences consistent with the phenomenology of shame. In other words, such individuals believe that others view them negatively — as ugly, worthless, or imperfect. The understanding of perceived exposure to failure and imperfection therefore acts as an external driver fueling fear of negative judgment (Costa et al., 2016). The studies reviewed establish a link between loss of eating control, body image distortion, intentional vomiting, and other distinct behaviors at a young age with subsequent depression, irrespective of baseline depression and prior body weight. ED behavior potentially indicates profound dissatisfaction with oneself and the undue influence of body shape and weight on self-image, which can precipitate depression (Herpertz-Dahlmann et al., 2015).

Allen and colleagues (2012) found that depressed and ED-diagnosed teenagers reported significantly lower polyunsaturated fat consumption compared to ED-diagnosed teenagers without evident depression. This pattern of results has implications for the assessment and management of depression in ED-affected individuals. For example, fat supplementation might improve mood even during early ED treatment phases, when individuals may be reluctant to make drastic changes to their eating habits. Additional research is needed to assess this possibility and to determine whether changes in fat consumption predict changes in depression. Educational initiatives targeting young people with T1D can help them assume full independent disease management responsibility, thereby avoiding unsatisfactory metabolic outcomes and improving diabetes self-management. To prevent the persistence of mental health problems, premature complication onset, and poor outcomes for diabetic patients, ongoing diabetes care is recommended, including routine screening for psychological issues during the transition to adult diabetes care (Christina et al., 2015).

References

Allen, K., Mori, T., Beilin, L., Byrne, S., Hickling, S., & Oddy, W. (2012). Dietary intake in population-based adolescents: support for a relationship between eating disorder symptoms, low fatty acid intake and depressive symptoms. Journal of Human Nutrition and Dietetics, 459–469.

Christina, B., Lange, K., Stahl-Pehe, A., Castillo, K., Scheuing, N., Holl, R., . . . Rosenbauer, J. (2015). Symptoms of eating disorders and depression in emerging adults with early-onset, long-duration type 1 diabetes and their association with metabolic control. PLoS ONE.

Costa, J., Maroco, J., Pinto Gouveia, J., & Ferreira, C. (2016). Shame, self-criticism, perfectionistic self-presentation and depression in eating disorders. International Journal of Psychology and Psychological Therapy, 315–328.

Herpertz-Dahlmann, B., Dempfle, A., Konrad, K., Klasen, F., & Ravens-Sieberer, U. (2015). Eating disorder symptoms do not just disappear: the implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood. European Child & Adolescent Psychiatry, 675–684.

Lyoo, I., Yoon, S., Jacobson, A., Hwang, J., Musen, G., & Neil, H. (2012). Prefrontal cortical deficits in type 1 diabetes mellitus: brain correlates of comorbid depression. Archives of General Psychiatry, 1267–1276.

Mustelin, L., Raevuori, A., Kaprio, J., & Keski-Rahkonen, A. (2014). Association between eating disorders and migraine may be explained by major depression. International Journal of Eating Disorders, 884–887.