Nutrition & Mental Health

Amazingly, people often don’t seem to understand the connection between nutrition and mental health. Time and again people struggling with their mental health don’t eat breakfast, skip lunch, or don’t bother to eat until later in the day. Sometimes people simply forget to eat because they’re busy. Some people lose their appetite because of emotional distress, and others just can’t be bothered to eat properly. Whatever the reason, it’s imperative to understand the connection between poor eating habits and mood and anxiety, as this will underscore the importance of eating properly.

Everybody has heard the cliché you are what you eat, but for some reason many people don’t connect that adage with how they feel mentally and emotionally. What you eat doesn’t affect just physical health; it can also affect general mood on a day-to-day basis. In order for the brain to communicate with the rest of the body, it needs neurotransmitters, such as serotonin, which are made from the nutrients in the foods we eat. Not eating enough, or not eating a well-balanced, nutritious diet, prevents the body from being able to create enough of these chemicals, and depression and anxiety can result.

Skipping meals can make blood sugar levels fall too low, and that eating starchy, sugary foods or simple carbohydrates can cause blood sugar levels to increase too much. These fluctuations in blood sugar levels can make a person irritable, forgetful, or sad. In addition, not eating enough can lead to emotional reactivity, higher stress levels, and an overall sense of reduced well-being. Research in children has shown that skipping breakfast has negative consequences on problem solving, short-term memory, and concentration, and that eating breakfast increases positive mood, contentment, and alertness.

Of course, if a person has anorexia or bulimia, this must be addressed in therapy, either by your therapist or by someone who has experience with eating disorders—and sooner rather than later due to the health risks these disorders present. Besides treating the eating disorder, make sure to see a medical doctor and declared physically healthy enough to do this kind of work.

Sources: DBT Made Easy

Anorexia Nervosa: Symptoms

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn’t really about food. It’s an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia’s serious complications.


The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

• Extreme weight loss or not making expected developmental weight gains

• Thin appearance

• Abnormal blood counts

• Fatigue

• Insomnia

• Dizziness or fainting

• Bluish discoloration of the fingers

• Hair that thins, breaks or falls out

• Soft, downy hair covering the body

• Absence of menstruation

• Constipation and abdominal pain

• Dry or yellowish skin

• Intolerance of cold

• Irregular heart rhythms

• Low blood pressure

• Dehydration

• Swelling of arms or legs

• Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

• Severely restricting food intake through dieting or fasting

• Exercising excessively

• Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them

• Frequently skipping meals or refusing to eat

• Denial of hunger or making excuses for not eating

• Eating only a few certain “safe” foods, usually those low in fat and calories

• Adopting rigid meal or eating rituals, such as spitting food out after chewing

• Not wanting to eat in public

• Lying about how much food has been eaten

• Fear of gaining weight that may include repeated weighing or measuring the body

• Frequent checking in the mirror for perceived flaws

• Complaining about being fat or having parts of the body that are fat

• Covering up in layers of clothing

• Flat mood (lack of emotion)

• Social withdrawal

• Irritability

• Insomnia

• Reduced interest in sex


The exact cause of anorexia is unknown. As with many diseases, it’s probably a combination of biological, psychological and environmental factors.

Biological. Although it’s not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.

Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they’re never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.

Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it’s rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.

• Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

Transitions. Whether it’s a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.


Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

• Anemia

• Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure

• Bone loss (osteoporosis), increasing the risk of fractures

• Loss of muscle

• In females, absence of a period

• In males, decreased testosterone

• Gastrointestinal problems, such as constipation, bloating or nausea

• Electrolyte abnormalities, such as low blood potassium, sodium and chloride

• Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

• Depression, anxiety and other mood disorders

• Personality disorders

• Obsessive-compulsive disorders

• Alcohol and substance misuse

• Self-injury, suicidal thoughts or suicide attempts


There’s no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

Sleep Related Eating Disorder: Symptoms

Sleep-related eating disorder involves frequent episodes of out-of-control eating and drinking behaviors while in a state of sleep. You may be partially or fully unaware of your behavior while preparing and eating food, with little or no memory of these actions the next morning.

Sleep-related eating disorder can be dangerous because you could injure yourself during food preparation or eat inedible or toxic items. Sleep-related eating disorder can also have an impact on your health due to weight gain and obesity from eating high-carbohydrate and high-fat foods.

Sleep-related eating disorder can be associated with certain medications, eating disorders and other sleep disorders. Addressing these issues often resolves sleep-related eating disorder.


Sleep-related eating disorder is a parasomnia — abnormal activity or behavior that occurs while you’re falling asleep, sleeping or waking up.

Episodes of sleep-related eating disorder occur in the first half of the night after you’ve been sleeping and include:

• Frequent episodes, generally nightly, of eating and drinking in an out-of-control manner

• Impaired consciousness while preparing and eating food

• Little or no memory of these actions the next morning

• Eating high-carbohydrate and high-fat foods or odd combinations of food

• Possibly eating inedible or toxic substances, such as frozen foods, coffee grounds, cleaning solutions or cigarette butts

• Possibly experiencing injuries or engaging in dangerous food preparation activities

• Not being easily awakened or redirected during the episode

• Experiencing a negative impact on your health from the nighttime eating


Sleep-related eating disorder usually occurs during non-rapid eye movement sleep in the first half of the night and is associated with the transition from non-rapid eye movement to arousal during sleep.

The exact mechanism for why it occurs is not known, but sleep-related eating disorder often occurs in people who have a history of sleepwalking, so these conditions may be related.

Risk factors

Sleep-related eating disorder is more common in women and typically starts in the teenage years or the early 20s.

Increased risk of developing sleep-related eating disorder is associated with:

• Other sleep disorders, such as obstructive sleep apnea, sleepwalking, narcolepsy and restless legs syndrome

• Hypnotic sleep medications, such as zolpidem (Ambien, Edluar, Intermezzo, Zolpimist), and certain other medications, such as antidepressants or antipsychotics

• Having a daytime eating disorder, such as bulimia or anorexia

• Having a mental health disorder, such as stress, anxiety or depression

• Having a first-degree relative — a parent, child or sibling — with sleep-related eating disorder or sleepwalking

• Experiencing sleep deprivation


A sleep-related eating disorder can result in:

• Dangerous use of kitchen appliances, falls, cuts, burns, choking, injury from eating something inedible or toxic, or eating something you’re allergic to

• Health problems, such as weight gain, poor diabetes control or dental cavities

• Feelings of guilt and helplessness over the lack of control

• Daytime tiredness from disrupted sleep