It may surprise you that more boys and men are diagnosed with Eating Disorders than girls and women? Part of the reason for not reaching out is the stigma around Mental Health support and the lack of education about the disorder.

Eating Disorders are complex and treatment directed toward males can be limited. Helping someone overcome an Eating Disorder requires patience, therapy, or a stay at an in-house treatment center. I’ve only read a couple of books on Eating Disorders and will say it’s a very long road of relapses to reach recovery.

Due to their own stigma parents and family often overlook the early warning signs and do not reach out for help until it’s a crisis.

EATING DISORDERS IN MEN & BOYS

In the United States alone, eating disorders will affect 10 million males at some point in their lives. But due in large part to cultural bias, they are much less likely to seek treatment for their eating disorder. The good news is that once a man finds help, they show similar responses to treatment as women. Several factors lead to men and boys being under- and undiagnosed for an eating disorder. Men can face a double stigma, for having a disorder characterized as feminine or gay and for seeking psychological help. Additionally, assessment tests with language geared to women and girls have led to misconceptions about the nature of disordered eating in men according to the National Eating Disorder Association.

COMMON SYMPTOMS OF AN EATING DISORDER

Emotional and Behavioral Symptoms

• In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns
• Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
• Appears uncomfortable eating around others
• Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
• Skipping meals or taking small portions of food at regular meals
• Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Withdrawal from usual friends and activities
• Frequent dieting
• Extreme concern with body size and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Extreme mood swings

Physical Symptoms

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
• Dizziness, especially upon standing
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin and hair, and brittle nails
• Swelling around area of salivary glands
• Fine hair on body (lanugo)
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin (in context of eating large amounts of carrots)
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

The list of symptoms is long because it’s all-encompassing.

I encourage you to visit National Eating Disorder Association for a breakdown of the seven types of Eating Disorders and other behavioral and food concerns. Finding the underlying causes requires a trained professional in the right setting, an individual plan, and most importantly support from family and friends.

When looking for the right professional, talk with them about their approach and experience before introducing them to the patient. Finding the right approach may require research and time. It’s important to do this on the front end if possible. An approved method and training will make all the difference on the road to recovery. Disruptions during treatment can interfere with the recovery process making the patient resistant to continued treatment.

Melinda

References

National Eating Disorder Org.

It’s surprising how physical grief can be. Your heart literally aches. A memory comes up that causes your stomach to clench or a chill to run down your spine. Some nights, your mind races, and your heart races along with it, your body so electrified with energy that you can barely sleep. Other nights, you’re so tired that you fall asleep right away. You wake up the next morning still feeling exhausted and spend most of the day in bed.

Amy Davis, a 32-year-old from Bristol, TN, became sick with grief after losing Molly, a close 38-year-old family member, to cancer. “Early grief was intensely physical for me,” Davis says. “After the shock and adrenaline of the first weeks wore off, I went through a couple of months of extreme fatigue, with nausea, headaches, food aversion, mixed-up sleep cycles, dizziness, and sun sensitivity. It was extremely difficult to do anything. … If there’s one thing I want people to know about grief, it’s how awful it can make your body feel.”

What causes these physical symptoms? A range of studies reveal the powerful effects grief can have on the body. Grief increases inflammation, which can worsen health problems you already have and cause new ones. It batters the immune system, leaving you depleted and vulnerable to infection. The heartbreak of grief can increase blood pressure and the risk of blood clots. Intense grief can alter the heart muscle so much that it causes “broken heart syndrome,” a form of heart disease with the same symptoms as a heart attack.

Stress links the emotional and physical aspects of grief. The systems in the body that process physical and emotional stress overlap, and emotional stress can activate the nervous system as easily as physical threats can. When stress becomes chronic, increased adrenaline and blood pressure can contribute to chronic medical conditions.

Research shows that emotional pain activates the same regions of the brain as physical pain. This may be why painkilling drugs ranging from opioids to Tylenolhave been shown to ease emotional pain.

Normal vs. Pathological Grief

Depression is not a normal part of grief, but a complication of it. Depression raises the risk of grief-related health complications and often requires treatment to resolve, so it’s important to know how to recognize its symptoms. Sidney Zisook, MD, a grief researcher and professor of psychiatry at the University of California, San Diego, says people can distinguish normal grief from depression by looking for specific emotional patterns.

“In normal grief, the sad thoughts and feelings typically occur in waves or bursts followed by periods of respite, as opposed to the more persistent low mood and agony of major depressive disorder,” Zisook says.

He says people usually retain “self-esteem, a sense of humor, and the capacity to be consoled or distracted from the pain” in normal grief, while people who are depressed struggle with feelings of guilt and worthlessness and a limited ability “to experience or anticipate any pleasure or joy.”

Complicated grief differs from both depression and normal grief. M. Katherine Shear, MD, a professor of psychiatry at Columbia University’s School of Social Work and director of its Center for Complicated Grief, defines complicated grief as “a form of persistent, pervasive grief” that does not get better naturally. It happens when “some of the natural thoughts, feelings, or behaviors that occur during acute grief gain a foothold and interfere with the ability to accept the reality of the loss.”

Symptoms of complicated grief include persistent efforts to ignore the grief and deny or “rewrite” what happened. Complicated grief increases the risk of physical and mental health problems like depression, anxiety, sleep issues, suicidal thoughts and behaviors, and physical illness.

How Does Avoidance Harm Your Health?

Margaret Stroebe, PhD, a bereavement researcher and professor of clinical psychology at Utrecht University, says that recent research has shed light on many of “the cognitive and emotional processes underlying complications in grieving, particularly rumination.”

Research shows that rumination, or repetitive, negative, self-focused thought, is actually a way to avoid problems. People who ruminate shift attention away from painful truths by focusing on negative material that is less threatening than the truths they want to avoid. This pattern of thinking is strongly associated with depression.

Rumination and other forms of avoidance demand energy and block the natural abilities of the body and mind to integrate new realities and heal. Research by Stroebe, and others shows that avoidance behavior makes depression, complicated grief, and the physical health problems that go with them more likely. Efforts to avoid the reality of loss can cause fatigue, weaken your immune system, increase inflammation, and prolong other ailments.

How Do Role Adjustments Affect Your Health?

When someone close to you dies, your social role changes, too. This can affect your sense of meaning and sense of self.

Before losing Molly, Davis says she found a personal sense of value in “being good at helping other people and taking care of them.” But after Molly died, she felt like she “couldn’t help anyone for a while.” Losing this role “dumped the bucket” of her identity “upside down.” Davis says, “I felt like I had nothing to offer. So I had to learn my value from other angles.”

Caregivers face especially complicated role adjustments. The physical and emotional demands of caregiving can leave them feeling depleted even before a loved one dies, and losing the person they took care of can leave them with a lost sense of purpose.

“Research shows that during intense caregiving periods, caregivers not only experience high levels of stress, they also cannot find the time and energy to look after their own health,” says Kathrin Boerner, PhD, a bereavement researcher and professor of gerontology at the University of Massachusetts in Boston.

“This can result in the emergence of new or the reemergence of existing ‘dormant’ health problems after the death of the care recipient. These health issues may or may not be directly related to the caregiver’s grief experience, but they are likely related to the life situation that was created through the demands of caregiving,” Boerner says.

It can be hard to make life work again after a close family member dies. Losing a partner can mean having to move out of a shared home or having to reach out to other loved ones for help, which can further increase emotional stress and worry. Strobe says the stress of adjusting to changes in life and health during and after a loss can “increase vulnerability and reduce adaptive reserves for coping with bereavement.”

What Can You Do to Cope With Grief?

Emotional and physical self-care are essential ways to ease complications of grief and boost recovery. Exercising, spending time in nature, getting enough sleep, and talking to loved ones can help with physical and mental health.

“Most often, normal grief does not require professional intervention,” says Zisook. “Grief is a natural, instinctive response to loss, adaptation occurs naturally, and healing is the natural outcome,” especially with “time and the support of loved ones and friends.”

For many people going through a hard time, reaching out is impossible. If your friend is in grief, reach out to them.Amy Davis

Grief researchers emphasize that social support, self-acceptance, and good self-care usually help people get through normal grief. (Shear encourages people to “plan small rewarding activities and try to enjoy them as much as possible.”) But the researchers say people need professional help to heal from complicated grief and depression.

Davis says therapy and physical activities like going for walks helped her cope. Social support helped most when friends tried to reach out instead of waiting or asking her to reach out to them.

“The thing about grief and depression and sorrow and being suicidal is that you can’t reach out. For many people going through a hard time, reaching out is impossible. If your friend is in grief, reach out to them. Do the legwork. They’re too exhausted!”

Davis’ advice to most people who are grieving is to “Lean into it. You only get to grieve your loved one once. Don’t spend the whole time trying to distract yourself or push it down. It does go away eventually, and you will miss feeling that connected to that person again. And if you feel like your whole life has fallen apart, that’s fine! It totally has. Now you get to decide how to put yourself back together. Be creative. There’s new life to be lived all around you.

Melinda

Reference:

“WebMD News Special Report Reviewed by Neha Pathak, MD on July 11, 2019

Many people react to changes in light with shifts in energy level and mood, and for some, the fall is a difficult time.

One of the characteristics of depression in bipolar disorder is the variable patterns of the course. “Patterns” and “course” generally refer to recurrent themes: something predictable over time. Experiencing depression at specific times of the year is referred to as having a “seasonal pattern,” while daily fluctuations are termed “diurnal variation.”

Why Do I feel Depressed in the Fall?

The change in seasons affects everyone. The intensity and duration of light are what determine patterns for all living entities: new green leaves appear in the spring, and bears hibernate in the winter. The privilege of being alive is dependent on sunlight. 

Many people react to changes in light with shifts in energy level and mood, and for some, the fall is a difficult time. Days become shorter; we see the migrations of birds and reflect that the leaves fall, and winter is on its way. Joni Mitchell captures a doleful fall mood in the lyrics for her song “Urge for Going”: “And all that stays is dying and all that lives is getting out.”

For those experiencing depression at any time of the year, it is wise to keep a diary, even if you only write down a single word on your calendar that captures your mood on a given day. Over time, you can look back and, in discussion with healthcare providers, explore whether there is a seasonal pattern. This is important, as everyone is different. The seasonal behaviors of some mammals are highly predictable, but less so for humanity. 

If a seasonal pattern is identified, you can anticipate and prepare more easily. For those who experience depression in the fall, it is wise to plan how you will mitigate the impact. Schedule an appointment with your care provider well in advance of the anticipated challenging time. 

Recall what the symptoms were in previous depressions and put contingency plans in place. For example, if sleep is typically a problem, discuss this with your doctor or therapist. Cover all options, including light therapy, medications, and talk therapies. If time away — somewhere warm and sunny — is available to you, consider it.

Can You Explain ‘Diurnal Variation,’ as Opposed to ‘Seasonal Patterns’?

Many people experience daily patterns in which they wake up in a lousy mood with limited energy and the ability to engage with the world. As the morning passes, mood may gradually begin to pick up, and often things feel better by lunchtime or so. This is what clinicians refer to as diurnal variation. 

While it is frequently incapacitating, it can be useful in monitoring mood changes. Individuals who are beginning to enter a depressed phase often note that mornings are getting increasingly worse; during the improvement phase, they may notice that the time to feeling better shortens. 

The basis for diurnal variation is not known; it is likely related to your internal body clock, the driver of the sleep/wake cycle. While it is often a measure of depressed mood, many of my patients tell me they are just not “a morning person,” and they choose to start their day mid- or late morning. If your lifestyle aligns with this pattern, that’s totally fine. 

However, obligations often require a fixed schedule, and therefore, adaptations are necessary. Again, work with your support team to develop a plan, which may involve a combination of medical and/or environmental strategies. Allocate weekend time to “sleep in” and catch up. Coordinate with your family around schedules. Keep a mood diary and share it with your care providers. 

Unstable moods are a part of bipolar disorder and come in many variations. Learning your own mood patterns and developing a strategy with your healthcare team and family is an essential part of successful management. 

Melinda

Reference:

Melvin G. McInnis, MD, FRCPsych