Category: Youth Mental Health

Anorexia Nervosa: Symptoms

Eating Disorders, Mental Health, Youth Mental Health

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.

Symptoms

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

Causes

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.

Complications

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

Prevention

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.

McLean Psychiatric Hospital: Belmont, Massachusetts

Addiction, Mental Health, Psychiatric Hospitals, Youth Mental Health

Founded in 1811: McLean Hospital is a leader in psychiatric care, research, and education and is the largest psychiatric teaching hospital of Harvard Medical School.

Mission Statement

McLean Hospital is dedicated to improving the lives of people and families affected by psychiatric illness.

McLean pursues this mission by:

• Providing the highest quality compassionate, specialized and effective clinical care, in partnership with those whom we serve

• Conducting state-of-the-art scientific investigation to maximize discovery and accelerate translation of findings towards achieving prevention and cures

• Training the next generation of leaders in psychiatry, mental health and neuroscience

• Providing public education to facilitate enlightened policy and eliminate stigma

Core Values

We dedicate ourselves each and every day to McLean’s mission of clinical care, scientific discovery, professional training and public education in order to improve the lives of people with psychiatric illness and their families.

In all of our work, we strive to:

• Conduct ourselves with unwavering integrity

• Demonstrate compassion and respect for our patients, their families and our colleagues

• Foster an environment that embraces diversity and promotes teamwork

• Achieve excellence and ever-better effectiveness and efficiency through innovation

• McLean Hospital’s clinical and research activities are organized into seven Centers of Excellence and Innovation

These centers integrate the hospital’s three mission elements—clinical care, research, and education—with a focus on the rapid translation of science in order to establish, deliver, and disseminate ever-better, evidence-based approaches to care.

• Led by world-class clinicians and researchers, each of the seven centers have a primary diagnostic, research, or demographic focus and are laying the groundwork for further innovation as McLean continues to set a high bar in psychiatric care, research, and education.

Center of Excellence in Alcohol, Drugs, and Addiction

• McLean’s Center of Excellence in Alcohol, Drugs, and Addiction, led by Chief Roger D. Weiss, MD, is designed to foster integrated, evidence-based approaches to prevention, early detection, and treatment of substance use disorders.

• Addiction has become one of the most prevalent health issues of our time. From the current opioid crisis to the treatment of those dually diagnosed with addiction and other mental health illnesses, McLean offers a continuum of addiction care, including brief hospitalization for detoxification and stabilization, four residential programs, a partial hospital program, outpatient treatment, specialized programs, and a consultation service.

• The center also includes robust training and research initiatives through the Co-Occurring Disorders Institute, the Alcohol and Drug Addiction Clinical Research Program, and the Addiction Psychiatry Fellowship.

Nancy and Richard Simches Center of Excellence in Child and Adolescent Psychiatry

• Mental health issues are appearing ever-more widespread among young people. Joseph Gold, MD, is McLean’s chief medical officer and chief of the Simches Center of Excellence in Child and Adolescent Psychiatry. Children and teens are more prone than adults to depression, anxiety, obsessive compulsive disorder, attention-deficit/hyperactivity disorder, autism, bipolar disorder, addiction, and personality disorders.

• Led by Dr. Gold, McLean treats children ages 3 to 19 years who are struggling with these and other issues. Two fully accredited schools provide educational opportunities for children needing specialized academic programming. The center also reaches into the community to support children and adolescents in every possible setting, including public and private schools and pediatrician’s offices.

Center of Excellence in Depression and Anxiety Disorders

• Anxiety disorders are the most commonly diagnosed psychiatric disorders in the United States today, and individuals with anxiety also frequently suffer from clinical depression. Led by McLean’s Chief Scientific Officer Kerry J. Ressler, MD, PhD, along with its Director of Research Diego A. Pizzagalli, PhD, and Clinical Director Jane Eisen, MD, the Center of Excellence in Depression and Anxiety Disorders works to understand the biological underpinnings of these illnesses.

• The center conducts both clinical and basic science research into the relationship between stress, fear, trauma, and the prevalence of depression and anxiety disorders. Because these disorders occur in all demographics and often appear in conjunction with other psychiatric diagnoses, the center works collaboratively with McLean’s six other centers of excellence to speed the translation of science from bench to bedside to develop ever-better clinical and medication treatments.

• The center incorporates all levels of care, from outpatient to residential to multiple specialty inpatient programs and outpatient services like ECT, TMS, and ketamine.

Center of Excellence in Geriatric Psychiatry

• Providing psychiatric care for older adults can include managing the normal effects of mental and physical changes of aging while also concentrating on the psychological and neurological changes that can worsen as the body and brain get older.

• Led by Chief Brent P. Forester, MD, MSc, McLean’s Center of Excellence in Geriatric Psychiatry works to make the later stages of life healthy, fulfilling, and joyful. Clinical care and research at the center focus on older adults with depression, bipolar disorder, and behavioral complications of Alzheimer’s disease and related dementias.

Center of Excellence in Psychotic Disorders

• Led by Chief Dost Öngür, MD, PhD, the Center of Excellence in Psychotic Disorders includes inpatient programs, a residential facility, specialty outpatient clinics, and community-based services for individuals diagnosed with psychotic disorders, primarily schizophrenia or bipolar disorder.

• Dr. Öngür and his team have built clinical and research collaborations to advance our understanding of the neurobiology of psychosis and develop new insights into treatment and prevention. Researchers and clinicians in the center are changing the landscape of recovery and helping to restore lives and offer hope to those diagnosed with these debilitating disorders.

Center of Excellence in Women’s Mental Health

• The mission of McLean’s Center of Excellence in Women’s Mental Health is to innovate and improve mental health care for all women and girls throughout their life span. Led by center Chief Shelly F. Greenfield, MD, MPH, and Clinical Director Amy Gagliardi, MD, the center provides a uniting infrastructure to advance clinical care, training, and education.

• The center is a national leader in this emerging field and is conducting and sharing research across McLean and around the globe.

Center of Excellence in Basic Neuroscience

• One of McLean’s primary mission elements is to conduct state-of-the-art scientific investigation to maximize discovery and speed translation of findings toward prevention and cures for major psychiatric disorders.

• Chief Bill Carlezon, PhD, leads McLean’s Center of Excellence in Basic Neuroscience which is dedicated to studying the role of biological factors in mental illness. Under his direction, more than 130 principal investigators in more than 40 research labs conduct research into the “why” and “how” of mental illness.

• Scientists study the brain at the cellular and molecular levels to push the frontiers of knowledge and move their findings from “benchtop to bedside.”

McLean Values are at the core of everything we do. As clinicians, researchers, educators, administrators, and support staff, we conduct ourselves in ways that reflect our deep commitment to integrity, compassion and respect, diversity and teamwork, excellence, and innovation. These Values are the essence of McLean; they are at once emblematic of who we are and what we aspire to be.

~ McLean Hospital President and Psychiatrist in Chief Scott L. Rauch, MD

Mental Illness: Symptoms

Diagnosis Symptoms, Mental Health, Stigma, Youth Mental Health

Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.

A mental illness can make you miserable and can cause problems in your daily life, such as at school or work or in relationships. In most cases, symptoms can be managed with a combination of medications and talk therapy (psychotherapy).

Symptoms

Signs and symptoms of mental illness can vary, depending on the disorder, circumstances and other factors. Mental illness symptoms can affect emotions, thoughts and behaviors.

Examples of signs and symptoms include:

• Feeling sad or down

• Confused thinking or reduced ability to concentrate

• Excessive fears or worries, or extreme feelings of guilt

• Extreme mood changes of highs and lows

• Withdrawal from friends and activities

• Significant tiredness, low energy or problems sleeping

• Detachment from reality (delusions), paranoia or hallucinations

• Inability to cope with daily problems or stress

• Trouble understanding and relating to situations and to people

• Problems with alcohol or drug use

• Major changes in eating habits

• Sex drive changes

• Excessive anger, hostility or violence

• Suicidal thinking

Sometimes symptoms of a mental health disorder appear as physical problems, such as stomach pain, back pain, headaches, or other unexplained aches and pains.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with some mental illnesses. If you think you may hurt yourself or attempt suicide, get help right away:

• Call 911 or your local emergency number immediately.

• Call your mental health specialist.

• Call a suicide hotline number. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use its webchat on suicidepreventionlifeline.org/chat.

• Seek help from your primary care provider.

• Reach out to a close friend or loved one.

• Contact a minister, spiritual leader or someone else in your faith community.

Suicidal thinking doesn’t get better on its own — so get help.

Helping a loved one

If your loved one shows signs of mental illness, have an open and honest discussion with him or her about your concerns. You may not be able to force someone to get professional care, but you can offer encouragement and support. You can also help your loved one find a qualified mental health professional and make an appointment. You may even be able to go along to the appointment.

If your loved one has done self-harm or is considering doing so, take the person to the hospital or call for emergency help.

Causes

Mental illnesses, in general, are thought to be caused by a variety of genetic and environmental factors:

• Inherited traits. Mental illness is more common in people whose blood relatives also have a mental illness. Certain genes may increase your risk of developing a mental illness, and your life situation may trigger it.

• Environmental exposures before birth. Exposure to environmental stressors, inflammatory conditions, toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness.

• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When the neural networks involving these chemicals are impaired, the function of nerve receptors and nerve systems change, leading to depression and other emotional disorders.

Risk factors

Certain factors may increase your risk of developing a mental illness, including:

• A history of mental illness in a blood relative, such as a parent or sibling

• Stressful life situations, such as financial problems, a loved one’s death or a divorce

• An ongoing (chronic) medical condition, such as diabetes

• Brain damage as a result of a serious injury (traumatic brain injury), such as a violent blow to the head

• Traumatic experiences, such as military combat or assault

• Use of alcohol or recreational drugs

• A childhood history of abuse or neglect

• Few friends or few healthy relationships

• A previous mental illness

Mental illness is common. About 1 in 5 adults has a mental illness in any given year. Mental illness can begin at any age, from childhood through later adult years, but most cases begin earlier in life.

The effects of mental illness can be temporary or long lasting. You also can have more than one mental health disorder at the same time. For example, you may have depression and a substance use disorder.

Complications

Mental illness is a leading cause of disability. Untreated mental illness can cause severe emotional, behavioral and physical health problems. Complications sometimes linked to mental illness include:

• Unhappiness and decreased enjoyment of life

• Family conflicts

• Relationship difficulties

• Social isolation

• Problems with tobacco, alcohol and other drugs

• Missed work or school, or other problems related to work or school

• Legal and financial problems

• Poverty and homelessness

• Self-harm and harm to others, including suicide or homicide

• Weakened immune system, so your body has a hard time resisting infections

• Heart disease and other medical conditions

Prevention

There’s no sure way to prevent mental illness. However, if you have a mental illness, taking steps to control stress, to increase your resilience and to boost low self-esteem may help keep your symptoms under control. Follow these steps:

• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.

• Get routine medical care. Don’t neglect checkups or skip visits to your primary care provider, especially if you aren’t feeling well. You may have a new health problem that needs to be treated, or you may be experiencing side effects of medication.

• Get help when you need it. Mental health conditions can be harder to treat if you wait until symptoms get bad. Long-term maintenance treatment also may help prevent a relapse of symptoms.

• Take good care of yourself. Sufficient sleep, healthy eating and regular physical activity are important. Try to maintain a regular schedule. Talk to your primary care provider if you have trouble sleeping or if you have questions about diet and physical activity.

Sources: The Mayo Clinic, NAMI, NIH