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Eating Disorder Or Overreacting?

Question:

I’m 22 years old and have been suffering from severe depression for about 15 months. I had episodes in the past but was able to get through them without treatment. I have made a lot of progress in the past 6 months and at the moment my depression is largely under control with the help of medication, Zoloft 100mg + Welbutrin 300 mg, and weekly therapy. But for the past few weeks I have been engaging in eating disordered behaviors pretty consistently, trying to restrict most days and purging a few times a week. I do want to lose weight, but not really for aesthetic reasons. It’s more because I feel like I don’t “deserve” to be well-nourished and it’s “wrong,” not necessarily unattractive, for me to weigh as much as I do at my healthy weight at 4’11” and ~102 lbs.

When I eat normally I usually feel guilty and as though my body has somehow expanded, though I know it’s impossible. I’ve had these thoughts on and off over the past year, but usually dealt with them by self-injuring, which I haven’t been doing lately. I know that restricting really impacts my quality of life but I still feel compelled to do it. I feel that I need to be given “permission” to eat.

I don’t want to let this unravel the strides I have made in improving my mental health, but I don’t know what to do. I feel like I would benefit from some aspects of treatment for eating disorders, in addition to my normal therapy, like being accountable to a dietician for a meal plan but at the same time I don’t want to be accused of overreacting when it hasn’t been that long and I haven’t lost much weight.

Do you think it would be appropriate for me to seek additional support?

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Answer:

You do not need to worry about overreacting to your symptoms. What you describe, including the depression you experience, are typical of an eating disorder, in this case, Bulimia Nervosa. In fact, I agree with you that you should get help now, before it gets worse.

In terms of psychotherapy, Cognitive Behavior Therapy are thought to be best for eating disorders and depression. Perhaps that is what you have right now. It seems to me that you have many automatic thoughts that cause you a lot of trouble. Automatic thoughts are those that are not completely true and need to be tested against what is really happening so they can be modified to reflect reality. That is what helps with depression as well as eating disorders. Nevertheless, it is good that you are in therapy and on medication.

Yes, a licensed nutrionist who has experience with eating disorders, is an excellent idea. The  nutritionist and therapist should work together as a team in helping you. Also, you talking to your psychiatrist who is prescribing your medications is a good idea. First of all, he should know about your eating disorder and might or might not adjust your medications because of the ED.

Yes, it is fully appropriate and necessary for you to seek additional support. This is a serious disorder and needs to be taken seriously.

Best of Luck

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