Bulimia & Co-Occurring Depression 

Eating disorders, such as bulimia nervosa (BN), are complex mental health conditions, which are developed and driven by a number of factors. But some influences are more closely associated with these disordered thoughts and behaviors than others.

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Depression of all types, including major depressive disorder, is very frequently connected to BN, anorexia nervosa (AN), binge eating disorder (BED), and many other eating disorders.

The types of attitudes and thoughts brought on by depression can be particularly influential on someone struggling with body image issues, leading to or worsening eating disorder behaviors. Likewise, eating disorder symptoms can alter body chemistry in a way that leaves someone more susceptible to depressive thoughts and tendencies.

Still, treatment for both of these conditions is possible. Though, if someone is struggling with a comorbid or co-occurring case of depression and bulimia nervosa, it’s important to have both of these conditions treated simultaneously.

The Connection Between Bulimia & Depression

Eating disorders like BN are closely tied to mood disorders, including depression and anxiety. One study estimated that as many as 75% of people with bulimia nervosa have a mood disorder of some type, with nearly 63% specifically struggling with a co-occurring depressive disorder. [1]

More than 60% of those with bulimia nervosa struggle with co-occurring depression.

There are many overlapping factors of these two conditions, which likely lead to their high rate of comorbidity. Depression and eating disorders also can influence each other to the point where it can be difficult to determine whether someone’s depressive symptoms led to their disordered eating behaviors or vice versa.

One major connection between depression and bulimia nervosa is the neurotransmitter serotonin. This chemical interacts with many areas of the brain and is responsible, in part, for creating the conditions that lead to feelings of hunger and happiness, among others.

Imbalances in serotonin levels have been connected to both depression symptoms and aspects of BN, including a tendency to binge eat. [2] Though, it’s hard to say whether an imbalance would lead to both of these conditions arising in the same person or if it would manifest as one condition, which would then influence the development of the second disorder.

Depression has also been tied to malnutrition, with studies finding that the presence of either condition can influence the development of the other, almost in equal measure. [3] This means someone with chronic disordered eating behaviors may be more susceptible to developing a depressive disorder, and vice versa.

Depression and bulimia nervosa also share a number of psychological effects that can be difficult to untangle from one another.

Both conditions are marked by a low sense of self-worth and low self-esteem. These can represent symptoms of depression, which feed into the negative body image frequently associated with BN. Or, they can be developed or made worse by the negative body image present as part of an eating disorder.

Depression itself can also directly contribute to a reduced appetite or loss of pleasure in activities like eating, which can exasperate disordered eating behaviors. Likewise, it can bring about feelings of guilt or self-blame, which are then dealt with through maladaptive coping mechanisms, such as binging episodes or self-induced vomiting.

Both BN and depression have been closely connected to trauma, particularly in the instance of childhood trauma.

Sadly, sexual trauma experienced in childhood has been found to be one of the biggest predictors of both depression and bulimia nervosa. [6, 7] In the case of BN, the connection is likely through the use of disordered behaviors as a maladaptive coping mechanism. And feelings of shame or self-blame associated with childhood trauma can be formative in developing depression.

Similarly, bullying has been connected to the development of both bulimia and depression. [8, 9] Bullying directed specifically at someone’s appearance can further work to contribute to negative body image, which can bring about disordered eating behaviors.

The Signs of Co-occurring Depression & Bulimia

While BN and depressive disorder are two distinctive mental health conditions, a comorbid case of these disorders can generally be identified through a number of common symptoms.

Some frequent signs of depression include: [4]

  • A persistent feeling of sadness, emptiness, tearfulness, or hopelessness
  • A general loss of interest in things a person once liked
  • Chronic fatigue, insomnia, or oversleeping
  • Anxiety, agitation, and restlessness

Bulimia nervosa can also be identified by a number of common symptoms, including: [5]

  • A preoccupation with body weight, size, or shape
  • A significant fear of gaining weight
  • A distorted, negative body image
  • Evidence of purging behaviors, including:
  • Evidence of binging episodes, such as hoarding food or only eating alone

Those with bulimia and depression are more likely to self-isolate.

Generally, people who struggle with both conditions are motivated by deep-seated feelings of shame, guilt, sadness, or self-criticism. They may express feelings of inadequacy, worthlessness, or otherwise feeling like a failure. They may also be much more likely to self-isolate, which can make it difficult to reach them or understand the true extent of what they’re going through.

Treating Co-occurring Bulimia and Depression

Depression and bulimia nervosa play on each other in ways that make a comorbid diagnosis not only more dangerous but often more difficult to treat.

The deep entanglements of the conditions make it imperative for someone to work through both issues at once or else risk retaining some symptoms of one, which can more easily lead to the resurgence of the other.

Failing to properly address depression in someone with BN can also, unfortunately, have deadly consequences. Suicidal thoughts and attempts are particularly high among people with bulimia nervosa, with as many as one-third of people with the condition attempting suicide at some point, by some estimates. [10] And lingering symptoms of depression can potentially play a role in perpetuating these thoughts.

There are a number of therapies that have proven effective at simultaneously addressing bulimia nervosa and depression. And additional treatments, such as medication and nutritional counseling, can also help someone achieve and maintain lasting recovery.

Finding Help for Depression and Bulimia

If you or a loved one are struggling with bulimia nervosa and depression, it’s imperative to find help. The longer these conditions go on, the more likely they are to become entrenched in someone’s way of thinking or even become part of their sense of personal identity.

A primary care physician, therapist, psychiatrist, or other trusted medical professional is a good person to reach out to for information. These experts are generally versed in eating disorders and mood disorders, and they may be able to point you in the direction of a suitable program or help you determine your next best steps.


A number of mental health and eating disorder hotlines can also help. These services offer additional information and resources for eating disorder and mental health treatment while allowing callers to remain anonymous.

Bulimia nervosa and depression are deceptive and dangerous. Both conditions may do their best to convince you that you’re not worthy of help. But nothing can be farther from the truth. And help is always possible.

Finding the proper treatment for bulimia nervosa and depression can help you adopt more positive outlooks and behaviors that will have you feeling better about your body and yourself and help you begin on the path toward a happier and healthier future.


  1. Comorbidities in eating disorders. (2011). Psychiatry and Clinical Psychopharmacology; 21(2).
  2. Steiger H. (2004). Eating disorders and the serotonin connection: state, trait and developmental effects. Journal of Psychiatry & Neuroscience; 29(1):20–29.
  3. Keshavarzi S, Ahmadi SM, & Lankarani KB. (2014). The impact of depression and malnutrition on health-related quality of life among the elderly Iranians. Global Journal of Health Science; 7(3):161–170.
  4. Depression (Major Depressive Disorder). (2022). Mayo Clinic. Accessed April 2023. 
  5. Bulimia Nervosa. (2022). Mayo Clinic. Accessed April 2023. 
  6. Hill, J. (2003). Childhood trauma and depression. Current Opinions in Psychiatry; 16(1):3-6. 
  7. Wonderlich S, Rosenfeldt S, Crosby R, et al. (2007). The effects of childhood trauma on daily mood lability and comorbid psychopathology in bulimia nervosa. Journal of Traumatic Stress; 20(1):77-87. 
  8. Overland Lie S, Ro O, Bang L. (2019). Is bullying and teasing associated with eating disorders? A systematic review and meta-analysis. International Journal of Eating Disorders; 52(5):497-514.
  9. Kaltiala-Heino R, Frojd S. (2022). Correlation between bullying and clinical depression in adolescent patients. Adolescent Health, Medicine and Therapeutics; 2:37-44. 
  10. Smith AR, Zuromski KL, & Dodd DR. (2018). Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Current Opinion in Psychology; 22:63–67.

Last Update | 05 - 16 - 2023

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