Bulimia, depression, and anxiety frequently occur together. Their symptoms can overlap and reinforce each other.
Without support, these three conditions can create a cycle of fear, shame, guilt, and hopelessness that can be difficult to manage.
Fortunately, mental health professionals can help people manage these conditions. Treatment typically includes therapy, medication, medical care, and nutritional oversight.
Eating disorders (EDs) like bulimia nervosa, which involves cycles of binge eating followed by behaviors meant to prevent weight gain, are often accompanied by other mental health conditions [1]. Depression and anxiety disorders are especially common. They affect approximately 60% of people living with bulimia [2].
The connection between these conditions is complex, and experts are still working to understand it. However, learning more about how eating disorders and other mental health conditions interact can help you know when to reach out for help and advocate for the integrated care you deserve.
Where bulimia, depression, and anxiety overlap
As we explore how bulimia, depression, and anxiety overlap, it’s important to remember that these are different conditions.They frequently co-occur, but having one doesn’t automatically mean that you’ll develop the others.
At the same time, left untreated, co-occurring conditions can worsen your symptoms. For example, living with an eating disorder may bring on feelings of shame similar to depression. It may also increase your risk of anxiety — especially in social settings [3]. However, it doesn’t mean that eating disorders are stand-alone causes of depression and anxiety (or vice versa). In reality, the relationship between these three conditions is more complex.
Researchers have proposed various biological, psychological, genetic, and social factors to help explain the connection [4]. Many mental health conditions can stem from similar underlying risk factors, even though they may show up in very different ways.
However, in addition to these shared risk factors, it appears that bulimia may reinforce anxiety and depressive symptoms in some unique ways. Here’s how it works [5]:
Anxiety is a fear of something bad happening in the future. Many people with bulimia live in constant fear of gaining weight. The binge-purge cycle may be a response to this anxiety, and, in turn, these behaviors may impact mood. People may feel guilty or ashamed after binging and purging. These feelings are strongly associated with depression.
Physical sensations are another key bridge between bulimia and anxiety and depression. Research shows that feeling wobbly or physically unsteady (which can occur with EDs), can increase anxiety. Similarly, appetite changes and libido loss (also common with EDs) can increase depression.
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Signs of co-occurring bulimia, depression, and anxiety
When a person has coexisting bulimia, depression, and anxiety, their symptoms often intertwine. It’s not as though one day they experience anxiety, the next depression, and so on.
Living with all three conditions often means navigating symptoms of bulimia, depression, and anxiety at the same time. Without support, these challenges can feed off of one another, making a person’s symptoms worse.
Here’s a simplified example of how this might show up in real life:
“I’m constantly dieting because I’m scared of gaining weight. It’s downright terrifying to me and sometimes is all I can think about. But when I restrict my food intake, it backfires. My eating gets out of control, and I end up binging. For a little while, I get some relief from my anxiety. But it doesn’t last long, and I end up purging because I feel so guilty.
Afterwards, I’m ashamed. I always tell myself I’ll stop and that this is the last time. So I restart the cycle, promising myself I’ll stay on track and not veer away from my diet. But when I can’t, I feel so hopeless and depressed. My anxiety about my weight begins to swell again, and the pattern continues.”
The effects of living with all three conditions
Without support, living with bulimia, depression, and anxiety together can impact your mental, emotional, and physical health. It can make it harder to care for yourself, maintain relationships, and function at home, work, or school. You may start withdrawing from social activities and spending more time alone, especially if you’re experiencing shame.
Untreated bulimia can also lead to medical complications (like dental, heart, or stomach problems) that can be harder to manage if you’re also living with anxiety or depression. In some cases, severe bulimia can be life-threatening [6]. This is due to a heightened risk of suicide* and accompanying health complications. That risk may increase with the presence of co-occurring conditions, like depression and anxiety disorders. However, please know that recovery is possible with the right support.
*A note on safety: If you’re having thoughts of harming yourself, don’t hesitate to ask for help. You can contact the National Suicide and Crisis Lifeline by dialing 988 from any phone. The counselors will provide confidential support and resources to help keep you safe.
Managing bulimia when you also have depression and anxiety
Co-occurring bulimia, depression, and anxiety require integrated care that encourages physical and emotional healing at the same time. Here are some examples of what that may look like:
Medical oversight: Depending on the circumstances and the severity of your symptoms, you may need to access medical care and/or nutritional support before you can successfully engage with other forms of treatment. Medical and nutritional oversight can help you achieve stability and maintain your well-being throughout recovery.
Therapy: Cognitive behavioral therapy (CBT) is considered a first-choice treatment for bulimia, and it can also help with symptoms of depression and anxiety. CBT can help you reduce and reframe fears related to weight gain, challenge and replace unhelpful thought and behavior patterns, and introduce healthy coping strategies.
Medication: There are no medications specifically developed for treating bulimia. But there are many medications approved for treating depression and anxiety disorders. Research shows that some of these medications may be helpful for people living with bulimia [7]. You can talk to your psychiatric provider about whether this option is right for you.
Self-care: Most people with co-occurring mental health conditions require professional help. But there are also things you can do outside of treatment to support yourself. For example, creating consistent routines (especially around mealtimes), making time for stress-management activities (like deep breathing or mindfulness meditation), and doing something social each day (even if it's just sending a text) can help you maintain your well-being.
Anxiety can blur the body’s signals, making it hard to tell the difference between hunger and physical anxiety symptoms, like nausea, tightness, or loss of appetite. Over time, this can make someone distrust their body and rely more on behaviors than internal cues.
Ashley Ayala, LMFT
Clinical reviewer
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More than half of people living with bulimia also experience depression and anxiety. We don’t yet fully understand all the reasons for this overlap, but it’s likely due to some shared risk factors and symptoms feeding into each other over time.
Without treatment, these intertwining experiences can worsen symptoms. But fortunately, co-occurring conditions can be managed with the right support. With therapy, psychiatric care, self-care, and medical/nutritional oversight (if needed), you can learn to effectively manage your symptoms.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
Rula patients pay about $15 per session with insurance, and 93% say they feel better after getting care through Rula. We have 21,000+ providers, and appointments are available as soon as tomorrow. We’re here to help you take the next step — wherever you are in your mental health journey.
References
- Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature https://pmc.ncbi.nlm.nih.gov/articles/PMC9442924/#Abs1
- Hospitalization Outcomes and Comorbidities of Bulimia Nervosa: A Nationwide Inpatient Study https://pmc.ncbi.nlm.nih.gov/articles/PMC6034764/
- Clarifying the prospective relationships between social anxiety and eating disorder symptoms and underlying vulnerabilities https://pmc.ncbi.nlm.nih.gov/articles/PMC5112114/#:~:text=Social%20anxiety%20disorder%20%28SAD%29%20has,et%20al.%2C%202000%29.
- What are Eating Disorders? https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders#section_0
- The Core Symptoms of Bulimia Nervosa, Anxiety, and Depression: A Network Analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC5378619/#abstract1
- Increased Mortality in Bulimia Nervosa and Other Eating Disorders https://psychiatryonline.org/doi/10.1176/appi.ajp.2009.09020247
- Medical complications of bulimia nervosa https://www.ccjm.org/content/88/6/333
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Ashley Ayala, LMFT
Ashley is a Licensed Marriage and Family Therapist who specializes in generational healing and family dynamics. Ashley has worked in schools, clinics, and in private practice. She believes that people’s relationships, including our relationship with ourselves, greatly shape our experiences in life.
Ashley is committed to empowering others to show up authentically and deepen their self understanding. This passion stems from taking a critical lens on her own life story and doing inner healing. One of her favorite quotes is “Be yourself and the right people will love the real you.”
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