As the behaviors centering on food are brought under control, the individual must learn to be comfortable with the underlying issues which have been driving the eating disorder. Depression in some degree is nearly universal in eating disorders. In some cases this becomes as serious as a diagnosable major depressive disorder and in other cases a condition labeled dysthymia. Major depression is a disturbance of the biological rhythms of the body in which sleep, appetite, weight, energy levels, the speed of body movements and mood are affected. Early morning awakening, loss of body weight, loss of appetite, lack of interest in formerly pleasurable activities and suicidal feelings are common.
Major depression responds to antidepressant medications.
Psychotherapy for depression is often required. An individual who has been the victim of rape or abuse may experience a profound sense of loss of control. For some, altering the body shape in such a way that others would not find sexually appealing can be part of misinterpretation and at times distortion.