Binge Eating and Depression: A Guide for Support

Binge Eating Disorder or Depression

Hello, Doctor: My girlfriend (23 years old) has always had high self-expectations.
Recently, she often engages in self-denial, feeling useless, lacking ability, unable to find a sense of achievement in life, believing that life lacks purpose, and feeling unmotivated.
Everyone thinks she is doing well, but she does not share that sentiment.
In the past, she was brave in accepting challenges, but now she struggles.
To others, she appears to be a cheerful, optimistic, and intelligent girl, and her former colleagues regarded her as capable.
However, when she is alone, she constantly experiences the aforementioned emotions.
About five months ago, she began to show signs of binge eating disorder; she often eats junk food excessively even when she is full.
According to her, she does not find the food enjoyable but feels compelled to eat mechanically.
After overeating to the point of discomfort, she induces vomiting, which leads to feelings of regret and sadness.
This behavior fluctuates; during bad periods, it may happen 2-3 times a week, while during better times, it may not occur for two to three weeks.
This behavior is more likely to happen when she is feeling down.
She is trying hard to avoid this but often finds it difficult to control herself.
(Many online sources suggest that the causes of binge eating disorder are often related to body image; she is 158 cm tall and weighs in the 40s, which is not considered overweight, yet she constantly criticizes her body.) About three months ago, we noticed this situation and sought help from a therapist a few times, but we stopped afterward.
In December and early January, she seemed to improve slightly, and recently she appeared to be making an effort to bounce back, but she seems to have started feeling down again.
I would like to ask: 1.
Does this situation qualify as binge eating disorder or depression? 2.
Does she need to see a doctor, or would it be better for her to try to adjust on her own if the situation is not severe? (I am concerned about affecting her self-esteem.) 3.
Should she see a psychiatrist, a psychosomatic specialist, or a therapist? What are the differences between these three? 4.
If she sees a psychiatrist, will she almost certainly be prescribed medication? Once she starts taking medication, will it be difficult to stop? (For example, my mother has been on medication for several years and finds it hard to discontinue.) 5.
She usually shares most of her feelings with me, but sometimes she tries to hide them.
My approach is to encourage her to face things positively and to express herself.
Is this the right approach? Additionally, how can I help her? 6.
Do you have any suggestions regarding this situation? Thank you!

Mr. X, 20~29 year old female. Ask Date: 2014/01/28

Dr. Ding Shuyan reply Psychiatry

Hello, what you described does resemble symptoms of depression and binge eating disorder.
However, I must emphasize that online diagnoses are not appropriate; it's acceptable to inquire about medical knowledge, but actual diagnoses must be made in person.
If you feel the issue is serious, consulting one or two experts is beneficial.
Doctors are, of course, specialists in treating illnesses, and in Taiwan, medical care is affordable and convenient, so I can't think of a reason not to see a doctor.
Doctors may primarily focus on prescribing medication, and if the outpatient clinic is busy, there may be limited time for discussion, unless the doctor has designated time slots for psychotherapy, which would be even better.

Psychological counselors cannot prescribe medication, but their training in psychotherapy is generally more rigorous.
They may approach cases from a different perspective; physicians tend to think in terms of disease, while counselors consider psychological aspects and interpersonal issues more comprehensively.
However, it's important to recognize that for some conditions, medication may provide quicker relief than psychotherapy, and this cost-benefit analysis should be carefully considered.

The issue of being unable to stop taking medication is complex.
Some individuals prefer medication as it seems less effortful and may avoid exploring the psychological or adjustment issues that contribute to their depression or mental illness.
Others may have conditions that are difficult to treat, leading to prolonged treatment, while some may require ongoing long-term therapy.
These reasons vary widely.

It seems you possess strong analytical skills, so the possibility of being unable to stop medication should not be a concern for you.
Each person's willingness to share their thoughts with others differs.
Even in close relationships, such as marriage, there can still be secrets.
This may stem from embarrassment, fear of burdening others, or a desire for autonomy.
Encouraging words can sometimes become a source of pressure for patients.
Support and listening are valuable, but we can also experience emotions, especially when it appears that patients are not receptive to guidance.
A bit of impatience or frustration may cause them to withdraw and become less willing to communicate.

You are very considerate, and I wish her a swift recovery under your care and support.

Sincerely,
Dr.
Ding Shuo-Yan

Reply Date: 2014/01/28

More Info

Understanding binge eating disorder (BED) and its connection to depression is crucial for both the individual experiencing these issues and their loved ones. Your girlfriend's situation reflects a complex interplay of mental health challenges, and it's commendable that you are seeking guidance on how to support her effectively.

1. Diagnosis of Binge Eating Disorder and Depression: Based on your description, your girlfriend exhibits symptoms consistent with both binge eating disorder and depression. BED is characterized by recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort, followed by feelings of shame or guilt. The self-critical thoughts and feelings of worthlessness she experiences are also common in depression. It's important to note that these conditions often coexist, with one exacerbating the other.

2. Seeking Professional Help: Given the severity of her symptoms, it is advisable for her to seek professional help. While some individuals may manage mild symptoms through self-help strategies, your girlfriend's situation appears to be more complex and may require intervention from a mental health professional. Encouraging her to see a therapist or counselor can provide her with the tools to cope with her feelings and behaviors.

3. Types of Professionals: The distinction between a psychiatrist, psychologist, and psychotherapist is important. A psychiatrist is a medical doctor who can prescribe medication and may focus on the biological aspects of mental health. A psychologist typically provides therapy and conducts psychological assessments but does not prescribe medication. A psychotherapist can be a psychologist, counselor, or social worker who provides talk therapy. For your girlfriend, starting with a psychologist or psychotherapist who specializes in eating disorders and depression may be beneficial.

4. Medication Concerns: If she sees a psychiatrist, medication may be prescribed, especially if her symptoms are significantly impacting her daily life. It’s a common misconception that once you start medication, you cannot stop. While some individuals may need long-term medication, many can eventually taper off under a doctor’s guidance. The key is to have open communication with the prescribing physician about concerns regarding medication.

5. Encouragement and Support: Your approach of encouraging her to express her feelings is positive. Open communication can help her feel supported and understood. However, it’s essential to balance encouragement with sensitivity. Sometimes, individuals may need space to process their emotions. Let her know you are there for her without pressuring her to share more than she is comfortable with.

6. Practical Suggestions: Here are some additional ways you can support her:
- Encourage Healthy Coping Mechanisms: Suggest activities that promote well-being, such as exercise, mindfulness, or creative outlets. These can help reduce stress and improve mood.

- Promote Balanced Nutrition: While it’s important not to focus solely on food, encouraging a balanced diet can help stabilize mood and energy levels. Consider discussing this with a nutritionist who specializes in eating disorders.

- Be Patient and Understanding: Recovery from BED and depression is often non-linear, with ups and downs. Your patience and understanding can be a significant source of comfort for her.

- Educate Yourself: Learning more about binge eating disorder and depression can help you understand what she is going through and how best to support her.

In conclusion, your girlfriend's situation is serious and warrants professional attention. Encouraging her to seek help, while providing emotional support, can make a significant difference in her recovery journey. Remember, you are not alone in this; many resources and professionals are available to assist both of you.

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