chapter  5
10 Pages


As we have worked with women with bulimia and studied the literature on the subject, we have found that depression is a frequent complaint. The question, which has perplexed us, is "Which comes first, the depression followed by eating problems or eating problems followed by depression?" While we feel that the preponderance of evidence that

we are about to present supports the conclusion that depression is a reaction to the state of semi-starvation which develops after a long period on a restrictive diet. Considerable evidence exists that diagnosed depressive reactions tend to run in the families of individuals with bulimia (e.g., Hudson, Pope, Jonas, & Yurgelun-Todd, 1983; Strober, Salkin, Burroughs, & Morrell, 1982). This means that a predisposition toward depression may exist in these patients which is brought out or exacerbated by the restrictive diet.