Are Women With Eating Disorder Depressed More

In a published scientific paper titled Psychopathology in Anorexia by Christine Pollice, B.A., Research Specialist at Center for Overcoming Problem Eating, University of Pittsburgh Medical Centre , Walter H. Kaye, M.D. Professor of Psychiatry and Director, Eating Disorders Module at Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Catherine G. Greeno, Ph.D., Research Principal, Department of Psychiatry at  Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center and Theodore E. Weltzin, M.D., at the University of Wisconsin Medical School , USA touched upon an important topic linking depression with eating disorder. The purpose of this study was to determine whether associated symptoms of anxiety and obsessionality changed with state of eating disorder known as anorexia nervosa. Thus, patients were studied who were underweight and at several stages of weight restoration and recovery. This strategy permitted an examination of which symptoms are related to starvation, and which symptoms persist after weight restoration. In addition, this study sought to determine whether the two subtypes of anorexia nervosa, restricting type and binge eating/purging type, differ on these associated symptoms. The purging type is commonly found and Princess Diana was its well-known case.

Depression, anxiety, and obsessionality are commonly seen in underweight, malnourished patients with loss of appetite. All these types of patients were compared with healthy women in this study.

The results from this study suggested that malnutrition is the main cause of depression, anxiety and obsessionality in patients suffering from loss of appetite. However, this issue continued for a long term, suggesting that there could be a cause for this disease. The cause of Anorexia Nervosa is unknown, but occurs in teenage girls who have the following issues: -
1. Refused to maintain normal body weight.
2. Fear of becoming fat,
3. Feeling uncomfortable with their present body weight.
Most of these patients consume less food and do excessive exercise, although they may be underweight.
Many patients of loss of anorexia nervosa also have a high incidence of comorbid psychiatric illness, which has also been highlighted in other studies as well. In fact, almost 91 percent of underweight patients also suffer from depression, as was highlighted in another study. On the other hand, around 15 to 58 percent of such patients continue to suffer from depression, even after restoring their weight loss.
All these studies suggest that malnutrition increases depression in patients suffering from anorexia nervosa. But not much is known about diseases related to anorexia nervosa with anxiety or obsessionality symptoms. It was also found that in patients suffering from OCD (Obsessive Compulsive Disorder) such as fussing over cleaniness by repeated hand washing, in upto 31 percent in patients with less appetite symptoms, which continued even after weight restoration.
In the following study, we wish to find out whether symptoms of anxiety and obsessiveness changed with improvement of anorexia nervosa.

Three groups of women with anorexia nervosa were studied.
1. 22 women were evaluated.
2. Same 22 patients were again checked up on weight restoration.
3. Separate group of 26 women studied after long term weight restoration.
These women were then compared with 18 healthy control women with comparable age groups. All subjects in this study were free from any medicine’s intake.
All parameters, like depression, anxiety, and Obsessionality were measure with standardized scales

When the symptoms of depression, anxiety, and obsessionality were compared, it was evident that the above symptoms were most severe during the underweight period.
As compared to normal women, depression remained elevated in underweight patients; which reduced after weight recovery, but did not go completely. As compared to normal women, anxiety also remained elevated in the underweight group as well. Same was true with obsessionality as well.

The findings show that depression increases due to weight loss and malnutrition, but level of depression is reduced after recovery. Anxiety and obsessionality also showed the same pattern. Hence, it’s a vicious circle where symptoms make malnutrition worse and vice versa

Almost similar trend was seen in most patients, ie, increased depression scores in underweight patients, which slightly improved upon proper feeding, but continued to remain increased as compared to normal women. 


Compiled from various international research journals available at google scholar by D. Mukherjee having 38 years of pharmaceutical (Cardiac, Diabetic, Neurology, Pain & Inflammation products) experience with a Swiss Multinational Company NOVARTIS and edited by Dr Sandeep Ahlawat, MBBS