How Anorexia Feeds Depression

Content Note: This article describes eating disorder thoughts, behaviors, and symptoms. It also mentions sexual abuse. If you or a loved one are struggling, consider reading our mental health resources page.

I suffered from anorexia for 25 years, from the time I was 26 until I was 51. I was hospitalized on eating disorder units 9 times and I was admitted to a couple of outpatient eating disorder partial hospitalization programs.

The connection between anorexia and depression

Each time I restricted and became malnourished, I also drove myself straight into a depression. I sat on my nutritionist's couch, sobbing. I wanted desperately to eat, but I was also terrified to eat. I felt ripped in 2, then ripped in 2 again.

The depression weighed me down, but I felt compelled to move my body somehow to burn off the few calories I was consuming. I also abused laxatives and diuretics in the hopes they would reduce the number of calories my body held onto.

My anorexia rituals

Upon awakening in the morning, I followed a strict ritual, caressing my skeletal body while still lying in bed. I savored my body's sharp edges as I ran my fingertips over my protruding collarbones, palms stroking my concave belly, and dancing over jutting hipbones. Then I'd weigh myself, wearing only a pair of cotton underwear, and record the number in a notebook I kept squirreled away.

If I lost weight, my mood would lift, if only for an hour, and if I gained weight seeing that number on the scale added significantly to my depression.

Physical and mental depletion

I became a shell of myself, skeletal, weak, depleted, and depressed. Barely able to function, during the week, I dragged myself to whatever job I was managing to hang on to. On the weekends, I predictably ended up in the emergency room to rehydrate. Sometimes I’d get admitted because my electrolytes were so screwed up.

Despite anorexia being a psychiatric illness, I was left with permanent physical deficits. From the laxative abuse, I have GI issues, including chronic constipation and motility issues. I'm osteoporotic and have suffered 4 stress fractures just from walking my dog.

Losing my teeth

The one I regret the most is losing all my teeth. I never purged by vomiting, so the damage is not from enamel loss. Teeth are bone and the severe and prolonged malnutrition simply caused them to crumble. When I was 55, the remaining ones had to be pulled and I now wear a full set of dentures.

Acceptance of that situation was difficult. Losing all my teeth that young felt unnatural and being thrust into a universe where Poligrip and Polident were suddenly part of my everyday vernacular felt unreal.

Looking for new ways to cope with depression

In 2007, amid a particularly prolonged episode of depression and anorexia, I signed up for a writing class at a local center, having no idea what to expect. My first piece of writing was about my anorexia and the instructor suggested I submit it to an anthology with the theme of illness and healing.

I was ecstatic when it was accepted. Seeing my name in print was the only feeling that matched the high I got when I stepped on the scale and saw I lost weight.

Finding strength in my passion

I persisted in writing and participating in classes and workshops. I learned to weather rejections and build a thicker skin. Slowly, I replaced my identity as an anorexic with that of a writer. I found I didn't need to starve myself any longer to feel whole. Writing, and seeing my name on the published page fed my psyche and my soul.

I attended a week-long intensive writing workshop at a local college and asked one of the panelists, an established author, “How do you know when you can call yourself a writer?”

She answered, “If you write, you're a writer.” So, I was.

Eating disorder relapses happen

I can't say I didn't relapse. The emotional symptoms of an eating disorder are much more difficult to recover from than simply weight restoration. Emotional symptoms include depression, body distortion, eating only "safe" foods, wanting to keep my weight at a specific number, exercise compulsion (feeling guilty if I don't), and feeling fat even if I'm not.

These thoughts tend to linger, and the root cause needs to be addressed in therapy.

A history of eating disorders in my family

I come from a family of women who struggled with their weight. My mother was overweight most of her life, and one shelf of our refrigerator was well-stocked with Tab, the first diet cola that was sweetened with saccharin. My aunt and her 3 daughters were also weight- and body-conscious.

I went on my first diet at age 10, vowing to cut out bread and desserts. That lasted about a week, as did the many diets that followed. I was always self-conscious of my stomach. I refused to wear bikinis or tuck shirts into my jeans. I envied the slim girls with flat bellies, who seemed to eat whatever they wanted and stay thin without effort.

Generational trauma

Several years after my mother passed away from pancreatic cancer in 2002, I had a conversation with my aunt, my mother's sister. I learned that her oldest brother had molested her when he came home on leave from the Navy. He was 25 and she was 15. She coped by becoming bulimic, but it was 1950 and no one knew what bulimia was, let alone how to treat it.

She never sought treatment and suffered from it her entire life. She also lost all her teeth, but she was 35 when it happened.

Return of anorexia behaviors in menopause

The last time I restricted was when I hit menopause. Like many women, with no change in diet or exercise, extra pounds appeared. I was unable to tolerate the weight gain and began to severely restrict my calories.

I lost the weight, but with the price of depression symptoms and the other physical symptoms.

Choosing my mental and physical health

I was writing, and publishing, and I'd returned to work. My psychiatrist and I had a discussion. I had to make a choice. The weight I'd earmarked as my ideal weight was not sustainable for the goals I wanted to achieve. This weight was not optimal for physical, emotional, and cognitive functioning.

I chose 10 more pounds. I chose to thrive.