Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.
What is Postpartum Depression?
If you’ve just had a baby, you understand the mood swings that go along with your postpartum hormones. No matter how you love your child, how long you’ve wanted a baby, a new baby is stressful. Period. Lack of sleep, new important responsibilities, and a distinct lack of personal space and time to yourself, both parents can experience the baby blues. It’s extremely normal, but once symptoms of the baby blues last for a few weeks or worsen, you may be coping with postpartum depression.
Approximately 15% of new mothers and fathers will experience what is classified as postpartum depression (PPD). Symptoms may occur a few days after delivery or sometimes as late as a year later. People who experience postpartum depression will have alternating good days and bad days. Symptoms can be mild or severe, usually lasting for over 2 weeks.
There are lots of ways to help women suffering from postpartum depression, and remember that this is common, and you are never alone, no matter how you feel.
Is This Postpartum Depression or Is This The Baby Blues?
We know that you’ve just had a baby, and you’re expecting to be basking in the glory of a new life into this world. You thought you’d be celebrating with loved ones and enjoying every single second. But you’re not. In fact, you feel like crying or hiding away.
You thought you’d be joyous and excited, not weepy, exhausted, and anxiety-ridden. While you may not have intended this, you should know that mild depression, anxiety, and mood swings are totally normal. So normal that we can refer to them as the Baby Blues.
Approximately 50% to 75% of all new mothers will experience some negative feelings after giving birth. Normally these feelings occur suddenly four to five days after the birth of the baby.
Most women – to a greater or lesser extent – experience some symptoms of the baby blues after giving birth; the hormones that kept you pregnant are replaced by new hormones, lack of sleep, delivery, social isolation, major sleep loss, and stress, and it’s natural to notice them. Some women report that they feel emotionally fragile, sad, and overwhelmed. Generally the Baby Blues occur within a couple days of your delivery, last a week, and taper off by the second postpartum week.
What Are The Symptoms of Postpartum Depression?
In stark contrast from the baby blues, postpartum depression is a serious medical issue that should not be ignored. But how do you know the difference between postpartum depression and the Baby Blues?
PPD, as it’s often abbreviated, can look like the baby blues, so much so that they share many of the same symptoms, however the symptoms of postpartum depression last longer and are more severe. You may also feel hopeless and worthless, and lose interest in the baby. You may have thoughts of hurting yourself or the baby. Very rarely, new mothers develop something even more serious – postpartum psychosis – may have hallucinations or try to hurt themselves or the baby. They need to get treatment right away, often in the hospital.
The difference is that with postpartum depression, the symptoms are more severe (such as suicidal thoughts or an inability to care for your newborn) and longer lasting. Symptoms of postpartum depression begin either during pregnancy or within four weeks after having a baby.
The symptoms of postpartum mood disorders don’t differ from the non-postpartum mood disorders except that the feelings of guilt and inadequacy about being an incompetent mother feed a person’s worries about being less than an adequate parent.
You might find yourself withdrawing from your partner or being unable to bond well with your baby.
You might find your anxiety out of control, preventing you from sleeping—even when your baby is asleep—or eating appropriately.
You might find feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death or even wish you were not alive.
Feelings of profound sadness, emptiness, emotional numbness, irritability, or anger.
A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
Constant fatigue or tiredness, difficulty sleeping, overeating, or loss of appetite
A strong sense of failure or inadequacy
Intense concern and anxiety about the baby or a lack of interest in the baby
Thoughts about suicide or fears of harming the baby
People with postpartum depression feel guilty about being depressed at a time when they are supposed to be happiest and may be reluctant to discuss their feelings.
People with postpartum depression often experience a loss of appetite, leading to extreme weight loss.
People with postpartum depression often report an increased yearning for sleep, sleeping heavily, but awakening (and unable to get back to sleep) the moment their baby makes a noise.
The distinguishing feature in postpartum depression is irritability. Episodes of irritability may be unprovoked or provoked by the slightest infraction. These episodes of irritability are often directed at the significant other or baby and may escalate to violent outbursts or uncontrollable sobbing.
People with severe postpartum depression often have terrible panic attacks, severe anxiety, and spontaneous crying, long after the duration of the “baby blues.”
These people with PPD may feel jealous of their infant and have difficulties bonding with their babies.
These are all red flags for postpartum depression.
The Edinburgh Postnatal Depression Scale is a screening tool designed to detect postpartum depression. Follow the instructions carefully. A score greater than 13 suggests the need for a more thorough assessment because you could have postpartum depression.
If you’re a new mother or father, please don’t hesitate to bring up these feelings with your doctor. Don’t let your doctor brush it off. If s/he does, find another doctor.
Signs And Symptoms of Postpartum Psychosis:
Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth, characterized by loss of contact with reality. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.
Postpartum psychosis (PPP) is the most severe form of postpartum depression, but fortunately it is the rarest form. It occurs in 1 to 2 out of every 1,000 pregnancies. The onset is very sudden and severe, normally within 2 to 3 weeks after giving birth. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours.
Symptoms are characterized by a loss of touch with reality and can include:
Bizarre, erratic behavior
Thoughts of hurting the baby
Thoughts of hurting yourself
Rapid mood swings
Hyperactivity
Hallucinations (seeing things that aren’t real or hearing voices)
Delusions (paranoid and irrational beliefs)
Extreme agitation and anxiety
Suicidal thoughts or actions
Confusion and disorientation
Inability or refusal to eat or sleep
Thoughts of harming or killing your baby
Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.
What Causes Postpartum Depression?
Just as in all types of depression, there is no single reason to point to as the definitive cause of postpartum depression. A variable combination of lifestyle, physical, and emotional factors can all play a part.
There’s no single reason why some new mothers develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are believed to contribute to the problem.
Hormonal changes. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These rapid hormonal changes—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—may trigger postpartum depression.
Physical changes. Giving birth brings numerous physical and emotional changes. You may be dealing with physical pain from the delivery or the difficulty of losing the baby weight, leaving you insecure about your physical and sexual attractiveness.
Stress. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, you may feel overwhelmed and anxious about your ability to properly care for your baby. These adjustments can be particularly difficult if you’re a first-time mother who must get used to an entirely new identity.
Risk Factors For Postpartum Depression:
Several factors can predispose you to postpartum depression:
The most significant is a history of postpartum depression, as a prior episode can increase your chances of a repeat episode to 30-50%.
Mood Disorders: A history of non-pregnancy related depression or a family history of mood disturbances is also a risk factor.
Addiction: People with any history of depression, anxiety, alcohol or another substance use disorder prior to the pregnancy are at risk for developing depression during the pregnancy or within a few weeks after delivery.
Prenatal depression – Depression during pregnancy may be the strongest predictor for later suffering from PPD.
Prenatal anxiety
History of previous depression – Although not as strong a predictor as a depressive episode during the pregnancy, it appears that women with histories of depression previous to conception are also at a higher risk of PPD than those without
Examples of specific illnesses that have been associated with being associated with the potential to develop postpartum depression include any form of major depression, such as premenstrual dysphoric disorder, bipolar disorder, and generalized anxiety disorder.
Maternity blues – Especially when severe, the blues may herald the onset of PPD.
Recent stressful life events
Inadequate social supports
Poor marital relationship – One of the most consistent findings is that among women who report marital dissatisfaction and/or inadequate social supports, postpartum depressive illness is more common.
Low self-esteem
Childcare stress – Difficult infant temperament
In addition, three factors are less definitively predictive, but still arise consistently as factors that increase a woman’s risk of PPD, especially in combination with one or more of the factors listed above:
Single marital status
Unplanned or unwanted pregnancy
Lower socioeconomic status
What Is The Treatment For Postpartum Depression?
Postpartum depression (PPD) sometimes goes away on its own within three months of giving birth. But if it interferes with your normal functioning at any time, or if “the blues” lasts longer than two weeks, you should seek treatment. About 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. Participation in a support group may also be helpful. In cases of severe postpartum depression or postpartum psychosis, hospitalization may be necessary. Sometimes, if symptoms are especially severe, electroconvulsive (ECT) therapy may be used to treat severe depressions with hallucinations (false perceptions) or delusions (false beliefs) or overwhelming suicidal thoughts
Untreated postpartum depression can affect your ability to parent. You may:
Not have enough energy
Have trouble focusing on the baby’s needs and your own needs
Feel moody
Not be able to care for your baby
Have a higher risk of attempting suicide
Feeling like a bad mother can make depression worse. It is important to reach out for help if you feel depressed.
Researchers believe postpartum depression in a mother can affect her child throughout childhood, causing:
Delays in language development and problems learning
Problems with mother-child bonding
Behavior problems
More crying or agitation
Shorter height and higher risk of obesity in pre-schoolers
Problems dealing with stress and adjusting to school and other social situations
Postpartum depression, like other mental illnesses, presents along a continuum, and the type of treatment selected is based on the severity of the depression and type of symptoms present. However, before beginning psychiatric treatment, medical causes for mood disturbance (such as, thyroid dysfunction, anemia) must be excluded. Initial evaluation should include a thorough history, physical examination, and routine laboratory tests.
Non-pharmacological therapies are useful in the treatment of postpartum depression, including CBT, ITP, and couples counseling.
In a randomized study, it was shown that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine (Prozac) in women with postpartum depression.
Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild to moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT also benefit from significant improvements in the quality of their interpersonal relationships
These non-pharmacological interventions may be particularly attractive to those reluctant to use psychotropic medications (such as women who are breast-feeding) or for people with milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of, these non-pharmacological therapies.
Only a few studies have systematically assessed the pharmacological treatment of postpartum depression. Conventional antidepressant medications have shown efficacy in the treatment of postpartum depression at standard antidepressant doses were effective and well tolerated.
The choice of an antidepressant should be guided by the person’s prior response to antidepressant medication and a given medication’s side effects.
Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well tolerated (examples include: fluoxetine, sertraline, fluvoxamine, and venlafaxine)
For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs.
Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance.
Given the prevalence of anxiety symptoms in this population, adjunctive use of a benzodiazepine (e.g., clonazepam, lorazepam) may be very helpful.
Can I Breastfeed My Child If I’m On Medication?
The nutritional, immunologic, and psychological benefits of breastfeeding have been well documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk. Concentrations in the breast milk appear to vary widely. The amount of medication to which an infant is exposed depends on several factors, including dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings (Llewelyn and Stowe).
Over the past five years, data have accumulated regarding the use of various antidepressants during breastfeeding (reviewed in Newport et al 2002). Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to neonatal exposure to psychotropic drugs in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to exposure to these medications.
For women with bipolar disorder, breastfeeding may be more problematic.
First is the concern that on-demand breastfeeding may significantly disrupt the mother’s sleep and thus may increase her vulnerability to relapse during the acute postpartum period. Second, there have been reports of toxicity in nursing infants related to exposure to various mood stabilizers, including lithium and carbamazepine, in breast milk. Lithium is excreted at high levels in the mother’s milk, and infant serum levels are relatively high, about one-third to one-half of the mother’s serum levels, increasing the risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has been associated with liver damage in the nursing infant.
Can We Prevent PPD?
While it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women (i.e., women with a history of mood disorder) who are more vulnerable to postpartum affective illness. Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness.
Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.
For women with histories of postpartum depression, several studies have described a beneficial effect of prophylactic antidepressant (either TCAs or SSRIs) administered after delivery. Patients with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in this area:
Clinical evaluation for postpartum mood and anxiety disorders
Medication management
Consultation regarding breastfeeding and psychotropic medications
The most important task of infancy is the bonding process between the infant and parents, as the success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how the child will interact, communicate, and form relationships throughout life.
A secure attachment between parent and child is formed when the parent responds warmly and consistently to your baby’s physical and emotional needs. When your baby cries, you quickly soothe him or her. If your baby laughs or smiles, you respond in kind. You and your child are in synch. You recognize and respond to each other’s emotional signals.
Postpartum depression can interrupt this bonding. Depressed parents may be loving and attentive sometimes, but others may react negatively or not respond at all. Sadly, parents with postpartum depression tend to interact less with their babies, and are less likely to breastfeed, play with, and read to their children. They may also be inconsistent caregivers.
However, learning to bond with your baby not only benefits your child, it also benefits you by releasing endorphins that make you feel happier and more confident as a parent.
Make yourself and your baby the priority. Give yourself permission to concentrate on yourself and your baby – there is more work involved in this 24/7 job then in a full-time job.
Try to remember that we, as human beings are naturally social. Positive, happy, and supportive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically and from an evolutionary perspective, new parents received help from those around them when caring for themselves and their infants after childbirth. In today’s world, new mothers often find themselves alone, exhausted, and lonely for supportive adult contact.
When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friend – even if you’d rather be left alone. Isolating yourself will only make your situation feel even bleaker, so make your adult relationships a priority. Let your loved ones know what you need and how you’d like to be supported.
In addition to the practical help your friends and family can provide, they can also serve as a much-needed emotional outlet. Share what you’re experiencing – all of it – with at least one other person, preferably face to face. It doesn’t matter who you talk to, so long as that person is willing to listen without judgment and offer reassurance and support.
Even if you have supportive loved ones, you may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings. Good places to meet new moms include support groups for new parents or organizations such as Mommy and Me. Ask your pediatrician for other resources in your neighborhood.
One of the best things you can do to relieve or avoid postpartum depression is to take care of yourself. The more you care for your mental and physical well-being, the better you’ll feel. Simple lifestyle changes can go a long way towards helping you feel like yourself again.
Studies show that exercise, for some people, may be just as effective as medication. But don’t to overdo it: a 30-minute walk each day can work wonders. Stretching exercises such as those found in yoga have shown to be especially effective. Make certain that you’re cleared by your OB/GYN before you begin to exercise.
A full eight hours may seem like an unattainable luxury when you’re dealing with a newborn, but poor sleep makes postpartum depression worse. Do what you can to get plenty of rest – enlist the help of your partner or family members to catching naps when you can.
Make some time to relax and take a break from your parental duties. Find small ways to pamper yourself, like taking a bubble bath, savoring a hot cup of tea, or lighting scented candles. Get a massage. Splurge on a pedicure.
When you’re depressed, nutrition often suffers, because you may not have any appetite. As you know, what you eat has an impact on mood, as well as the quality of your breast milk, so do your best to eat well.
Sunlight lifts your mood – and prevents vitamin D deficiency – so try to get at least 10 to 15 minutes of sun per day.
More than half of all divorces take place after the birth of a child. For many people, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship unless couples put some time, energy, and thought into preserving their bond.
The stress of sleepless nights and responsibilities can leave you feeling overwhelmed and exhausted. And since you can’t take it out on the baby, it’s all too easy to turn your frustrations on your partner. Instead of finger pointing, remember that you’re in this together. If you tackle parenting challenges as a team, you’ll become an even stronger unit.
Many things change following the birth of a baby, including roles and expectations. For many couples, a key source of strain is the post-baby division of household and childcare responsibilities. It’s important to talk about these issues, rather than letting them fester. Don’t assume your partner knows how you feel or what you need.
It’s essential to make time for just the two of you when you can reconnect. But don’t put pressure on yourself to be romantic or adventurous (unless you’re both up for it). You don’t need to go out on a fancy date to enjoy each other’s company. Even spending 15 or 20 minutes together—undistracted and focused on each other— can make a big difference in your feelings of closeness and togetherness.
Help! My Loved One Has Postpartum Depression!
If your loved one is experiencing postpartum depression, the best thing you can do is to offer support. Give her a break from her childcare duties, provide a listening ear, and be patient, and understanding.
If your partner has PPD, remember that you also need to take care of yourself. Dealing with the needs of a new baby is hard for all involved. If your significant other is depressed, you are dealing with two major stressors.
Don’t wait, just offer help around the house. Chip in with the housework and childcare responsibilities. The person may not feel it is appropriate to ask for any help from anyone.
Encourage talking about feelings, which can be awkward, but is necessary for your loved one. Listen to your loved one without judging or offering solutions. Instead of trying to fix things, simply be there for your loved one to lean on.
Make sure your loved one takes time for themselves. Rest and relaxation are important. Encourage the parent to take breaks, hire a babysitter, or schedule some date nights.
Go for a walk together. Getting exercise can make a big dent in depression, but it’s hard to get motivated when you’re feeling low.
Additional Resources For Postpartum Depression:
Postpartum Health Alliance is a non-profit organization dedicated to raising awareness about perinatal mood and anxiety symptoms and disorders and providing support and treatment referrals to women and their families.
If you are struggling or have questions, please call our warmline at 619-254-0023. Our trained volunteers can provide you with support and referrals.
If you need immediate support please call the San Diego Access and Crisis Line at 1-888-724-7240. The toll-free call is available 24-hours a day, 7-days a week
Postpartum Depression International: source of great information about all types of Postpartum Mood Disorders and also offers women resources for where to go for local help. Call or Text our HelpLine
Available 24 hours a day, you will be asked to leave a confidential message and a trained and caring volunteer will return your call or text. They will listen, answer questions, offer encouragement and connect you with local resources as needed.
Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight.
There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder
Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35; however there is burgeoning research that indicates more and more men are developing eating disorders as well.
There are three main types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder.
People with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, patients often deny that they have a problem.
In many cases, eating disorders occur together with other psychiatric disorders like anxiety disorders, panic disorder, obsessive compulsive disorder, and alcohol and drug abuse problems. New evidence suggests that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history. Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems and other potentially fatal conditions can result. However, with proper medical care, those with eating disorders can resume suitable eating habits, and return to better emotional and psychological health.
While eating disorders may seem to be about beauty, weight, and image, they’re actually about control or avoidance of stress and emotional issues. Eating disorders may be a result of being unable to express strong feelings and emotions.
Those who suffer from eating disorders generally try to hide the problem, but there are signs of a problem if you know what to look for. Early detection and treatment of eating disorders makes for an easier recovery. It’s important to note that, while you may confront someone whom you suspect has an eating disorder, you cannot force someone with an eating disorder into treatment. Making an effort to be a caring, compassionate support system is often the best thing that can be done when a loved one suffers from an eating disorder.
Eating disorders involve extreme disturbances in eating behaviors, such as gorging, following rigid diets, throwing up after meals, and counting calories obsessively; they are more than just an unhealthy eating habit. The core of eating disorders involves self-critical, distorted attitudes about weight, body image, and food, all of which lead to the damaging eating behaviors.
Food, for those with eating disorders, is used to deal with painful emotions. Restricting food (as is the case with anorexia nervosa) is used to feel in control. Overeating soothes sadness, anger, and loneliness. Purging combats feelings of self-loathing and helplessness. Over time, food and weight obsessions dominate the life of someone with an eating disorder.
What Are Some Common Warning Signs of Eating Disorders?
In the early stages of an eating disorder, it may be really hard to ascertain the difference between an eating disorder and normal weight concerns and dieting. As an eating disorder progresses, the red flags and warning signs become more apparent. Those who suffer eating disorders are particularly good at hiding their disorders, so knowing the common warning signs may help to spot an eating disorder.
Hoarding high-calorie food
Constant dieting – even when thin
Rapid unexplained weight gain or loss
Preoccupation with body or weight
Binging – usually performed in secret
Purging – disappearing after every meal or frequent trips to the bathroom
Obsession with food, calories or nutrition
Usage of laxatives, diuretics, or diet pills
Compulsive exercising
Making excuses to get out of eating
Eating tiny portions or refusing to eat
Intense fear of being fat
Distorted body image
Strenuous exercising (for more than an hour)
Hoarding and hiding food
Eating in secret
Disappearing after eating—often to the bathroom
Large changes in weight, both up and down
Social withdrawal
Depression
Irritability
Hiding weight loss by wearing bulky clothes
Little concern over extreme weight loss
Stomach cramps
Menstrual irregularities—missing periods
Dizziness
Feeling cold all the time\
Sleep problems
Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)
Dry skin
Puffy face
Fine hair on body
Thinning of hair on head, dry and brittle hair
Cavities, or discoloration of teeth, from vomiting
Muscle weakness
Yellow skin
Cold, mottled hands and feet or swelling of feet
What Are Some Common Myths About Eating Disorders?
There are many myths about the causes eating disorders, how serious they are, and who develops an eating disorder. Let’s dispel them now:
Are eating disorders a choice?
Eating disorders are not a choice. They are complex medical and psychiatric illnesses that people don’t opt to have. Eating disorders are bio-psycho-social diseases, which means that genetic, biological, environmental, and social elements all play a role.
Several decades of genetic research show that biological factors are an important influence in who develops an eating disorder. A societal factor (like the media-driven thin body ideal) is an example of an environmental trigger that has been linked to increased risk of developing an eating disorder.
Environmental factors also include physical illnesses, childhood teasing and bullying, and other life stressors.
Eating disorders commonly co-occur with other mental health conditions like major depression, anxiety, social phobia, and obsessive-compulsive disorder. Additionally, they may run in families, as there are biological predispositions that make people more vulnerable to developing an eating disorder.
Are eating disorders really that serious?
Eating disorders have the highest mortality rate of any psychiatric illness. Besides medical complications from binge eating, purging, starvation, and over-exercise, suicide is also common among individuals with eating disorders. Potential health consequences include heart attack, kidney failure, osteoporosis, and electrolyte imbalance. People who struggle with eating disorders also have intense emotional distress and a severely impacted quality of life.
The consequences of eating disorders can be life-threatening, and many individuals find that stigma against mental illness (and eating disorders in particular) can obstruct a timely diagnosis and adequate treatment.
Doesn’t everyone have an eating disorder?
Although our current culture is highly obsessed with food and weight, and disordered patterns of eating are very common, clinical eating disorders are less so.
About 20 million women and 10 million men will struggle with an eating disorder at some point during their lives. A study in 2007 found that:
0.9% of women and 0.3% of men had anorexia during their life
1.5% of women and 0.5% of men had bulimia during their life,
and 3.5% of women and 2.0% of men had binge eating disorder during their life
If eating disorders are linked to my genetic makeup, how do I recover?
Biology isn’t destiny. There is always hope for recovery.
While biological factors do play a large role in the onset of eating disorders, they are not the only factors.
The predisposition towards disordered eating may reappear during times of stress, but there are many good techniques people who have eating disorders can learn that will help manage their emotions and keep behaviors from returning.
Early intervention is a key part of eating disorder prevention, and helps reduce serious psychological and health consequences. Recovery from an eating disorder can be a long process and requires a qualified team of professionals and the love and support of family and friends.
Aren’t eating disorders a ‘girl thing’?
Eating disorders can affect anyone, regardless of their gender or sex.
While eating disorders are more common in females, researchers and clinicians are becoming aware of a growing number of males and non-binary individuals who now are seeking help for eating disorders. A 2007 study by the Centers for Disease Control and Prevention found that up to one-third of all eating disorder sufferers are male, and a 2015 study of US undergraduates found that transgender students were the group most likely to have been diagnosed with an eating disorder in the past year (Diemer, 2015).Eating disorders most often affect girls and women, but boys and men can also have an eating disorder.
One out of every four pre-teen kids with anorexia is a boy. Binge eating disorder affects females and males about equally.
It’s currently unclear whether eating disorders are actually increasing in males and transgender populations or if more of those people who are suffering are seeking treatment or being diagnosed. As some physicians may have preconceptions about who eating disorders affect, their disorders have generally become more severe and entrenched at the point of an actual diagnosis.
Don’t you have to be underweight to have an eating disorder?
People who have eating disorders come in all shapes and sizes – many of those people happen to be normal or overweight.The two best-known types of eating disorders are anorexia nervosa and bulimia nervosa and can occur separately or in the same person, additionally, binge-eating is another type of eating disorder.
Aren’t people with eating disorders super vain?
It’s not actually vanity that drives people with eating disorders to obsess about their food. Eating disorders are a product of feelings of shame, poor body image, anxiety, and powerlessness.
Do parents cause eating disorders?
Organizations from around the world, including the Academy for Eating Disorders, the American Psychiatric Association, and NEDA, have published materials that indicate that parents don’t cause eating disorders.
Parents, especially mothers, were frequently blamed for their child’s eating disorder, but recent research discovered that eating disorders have a firmer biological root. Eating disorders develop differently for each person, and there is no single set of rules that parents can follow to guarantee prevention of an eating disorder, however there are things everyone in the family system can do to play a role in creating a recovery-promoting environment. such as including parents and other family members in the treatment process.
Can someone be too young or too old to develop an eating disorder?
Eating disorders can develop or re-emerge at any age. Eating disorder specialists are reporting an increase in the diagnosis of children, some as young as five or six. Many eating disorder sufferers report that their thoughts and behaviors started much earlier than anyone realized, sometimes even in early childhood. Although most people report the onset of their eating disorder in their teens and young adulthood, there is some evidence emerging that people are being diagnosed at younger ages.
It’s not clear whether people are actually developing eating disorders at younger ages or if an increased awareness of eating disorders in young children has led to improved recognition and diagnosis.
Men and women at midlife and beyond are being treated for eating disorders, either due to a relapse, ongoing illness from adolescence or young adulthood, or due to the new onset of an eating disorder.
Doesn’t recovery from an eating disorder take a long time?
Recovery time from any mental illness varies from person to person. Some people get better relatively quickly, while others take longer to improve. While not everyone who has an eating disorder will recover fully, many people do improve with treatment. Even with full recovery, many people with eating disorders find that they have to take steps to make sure they stay well. This can include:
planning meals
regular check-ins with a therapist, dietitian, or doctor
medication
proper support
proper education
stress management
What Are The Types of Eating Disorders?
Currently, doctors have discovered that there are 6 types of eating disorders.
Anorexia Nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many people, a distorted body image.Avoidant Restrictive Food Intake Disorder (ARFID), once referred to as “selective eating disorder,” involves limitations in the amount and/or types of food consumed without any distress about body shape or size, or fears of being overweight.
Bulimia Nervosa is characterized by a cycle of binge eating and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
Binge eating disorder is the most common eating disorder in the United States and is characterized by episodes of eating large quantities of food; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures to counter the binge eating.
Orthorexia was coined in 1998 to describe an obsession with proper or ‘healthful’ eating.
Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and/or paint chips.
Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
Unspecified feeding or eating disorder (UFED) applies to presentations where symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.
What Is Anorexia?
Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many people, a distorted body image. People who have anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.
Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.
Most turn to this obsession as a sense of control in a reality where they feel they have none.
People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder.
Anorexia, with severity in relation to length of time, is a potentially life-threatening disorder marked by extreme fasting or restriction of food intake, often eating as little as 200 calories a day. Anorexics have an intense fear of weight-gain; even while underweight, they see themselves as fat. Females with anorexia develop amenorrhea, or the absence of menstruation.
While many people with this disorder die from complications associated with starvation, others die by suicide.
If you or someone you know is in crisis and needs immediate help, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week.
This eating disorder can affect males, females, and non-binary people, however, 90-95% of those diagnosed are girls and women and of these, it’s estimated that 5-20% of people affected by this eating disorder will die,
Do I Have Anorexia?
If you think you may have anorexia, please make an appoint to see your doctor as soon as possible. Delaying treatment can make recovery a bit more challenging. Your doctor will probably ask you if you have experienced any of the below questions:
Have you recently noticed a drastic decrease in weight?
Do you struggle with maintaining a healthy self-esteem?
Are you overly concerned about gaining weight?
Do you find yourself refusing or making excuses not to eat?
Are you self-conscious about your body image?
Do you exercise excessively?
Do you obsess over dieting?
Have you been distancing yourself from friends and family?
Are you often depressed?
Have you noticed dry or yellow tinted skin?
How Is Anorexia Diagnosed?
To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.
Other diagnostic criteria can include:
A person 15% below their ideal weight
Person with an intense fear of being fat, even though they are underweight
He/She/They may have a distorted view of their body or deny that their low weight is a problem
(among women) missing at least 3 periods in a row
People who have anorexia may or may not also binge and purge, use laxatives, or other means of losing weight
If left untreated anorexia can have devastating effects.
When the body is starved of proper nourishment, the system slows down to conserve energy and can lead to injury of the organs, and even death.
What Are The Dangers Of Anorexia?
Systemic Symptoms:
Heart rates drop to an abnormally slow rate
Blood pressure drops
Blood count becomes abnormal
Risk of heart failure increases
Risk of osteoporosis and reduction in bone density
Muscles deteriorate
Body suffers from dehydration, leading to kidney failure
Physical Symptoms
Extreme thinness
Irregular periods in women
Lower testosterone in men
Feeling weak, fatigued, or dizzy, or experiencing fainting spells
Dry skin that may also take on yellowish tint
Bluish color on the tips of the fingers
Dry hair and hair loss
Downy hair that grows over the skin in order to keep warm
Anorexia affects all of the organs in the body. If left untreated, the body becomes severely malnourished. This can result in damage that is not treatable, even if the disease is taken under control.
Emotional Symptoms
Lying about whether or not you have eaten
Irritability
Withdrawing from social activities
Emotionally flat affect
Obsessing over weight gain
Feeling insecure about the way you look
Decreased interest in sex
Feeling depressed
Thoughts of suicide
If the above resonates with anything you’re experiencing, it’s time to see a doctor.
Medical attention doesn’t have to be scary. Think of it as a moment of clarity that’s bringing you closer to your desired result of being a healthy, happy human being.
Mortality and Binge Eating Disorders:
It is well known that anorexia nervosa is a deadly disorder, but death rate varies considerably between studies. This variation may be due to length of follow-up, or ability to find people years later, or other reasons. In addition, it has not been certain whether other subtypes of eating disorders also have high mortality. Several recent papers have shed new light on these questions by using large samples followed up over many years. Most importantly, they get around the problem of tracking people over time by using national registries which report when people die.Overall people with anorexia nervosa had a six fold increase in mortality compared to the general population. Reasons for death include starvation, substance abuse, and suicide.
In summary, these findings underscore the severity and public health significance of all types of eating disorders.
What Is Bulimia?
Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
How is Bulimia Diagnosed?
According to the DSM-5, the official diagnostic criteria for bulimia nervosa include:
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (such as within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
A feeling of lack of control over eating during the episode (such as a feeling that one cannot stop eating or control what or how much they are eating).
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa
It’s really important to remember that people with bulimia may be anywhere from underweight, to normal weight, to overweight.
Common Warning Signs That Of Bulimia:
Emotional and behavioral
Generally speaking, new behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
Evidence of binge eating, such as disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
Appears uncomfortable eating around others
Develops food rituals (including eating only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
Skips meals or takes small portions of food at regular meals
Fears of eating in public or with other people
Steals or hoards food in strange places
Drinks excessive amounts of water or non-caloric beverages
Uses excessive amounts of mouthwash, mints, and gum
Hides body with baggy clothes
Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories
Creates lifestyle schedules or rituals to make time for binge-and-purge sessions
Withdraws from friends and activities
Shows extreme concern with body weight and shape
Frequent checking the mirror for feared flaws in appearance
Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most people would eat under similar circumstances); feels lack of control over ability to stop eating
Purges after a binge (such as self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)
Extreme mood swings
Physical Symptoms of Bulimia:
Unusual swelling of the cheeks or jaw area
Calluses on the back of the hands and knuckles from self- induced vomiting
Teeth are discolored, stained from vomiting
Noticeable fluctuations in weight, both up and down
Body weight is typically within the normal weight range; may be overweight
Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux)
Cuts and calluses across the top of finger joints (a result of inducing vomiting)
Dry skin
Dry and brittle nails
Swelling around area of salivary glands
Fine hair on body
Thinning of hair on head, dry and brittle hair
Muscle weakness
Cold, mottled hands and feet or swelling of feet
Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
Poor wound healing
Increased infections due to poor immune response
Many people with bulimia nervosa also struggle with co-occurring conditions, such as:
Self-injury (cutting and other forms of self-harm without suicidal intention)
Substance use and abuse
Impulsivity (risky sexual behaviors, shoplifting, drugs)
Diabulimia (intentional misuse of insulin for type 1 diabetes)
What Is Binge Eating Disorder?
Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder that is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress, or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.
BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis.
What Are The Diagnostic Criteria for Binge Eating Disorder?
According to the DSM-5, the official diagnostic criteria for bulimia nervosa include:
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
The binge eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal.
Eating until feeling uncomfortably full.
Eating large amounts of food when not feeling physically hungry.
Eating alone because of feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least once a week for 3 months.
The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
What Are The Warning Signs for Binge Eating Disorder?
Emotional and Behavioral Signs and Symptoms
Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
Appears uncomfortable eating around others
Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
Fear of eating in public or with others
Steals or hoards food in strange places
Creates lifestyle schedules or rituals to make time for binge sessions
Withdraws from usual friends and activities
Frequently diets
Shows extreme concern with body weight and shape
Frequent checking in the mirror for perceived flaws in appearance
Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).
Eating alone out of embarrassment at the quantity of food being eaten
Feelings of disgust, depression, or guilt after overeating
Fluctuations in weight
Feelings of low self-esteem
Physical Symptoms of Binge Eating Disorder
Noticeable fluctuations in weight, both up and down
Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
Difficulties concentrating
What Are The Health Risks of Binge Eating Disorder?
The health risks of BED are most commonly those associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder. However, of individuals with BED, up to two-thirds are labelled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though BED can be diagnosed at any weight.
What Is Orthorexia?
While not formally recognized in the Diagnostic and Statistical Manual, awareness about orthorexia is on the rise. The term ‘orthorexia’ was coined in 1998 and means an obsession with proper or ‘healthful’ eating. Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being.
Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia. We still don’t know whether orthorexia if is a stand-alone eating disorder, a type of existing eating disorders like anorexia, or a form of obsessive-compulsive disorder. Studies have shown that many people with orthorexia also have been diagnosed with obsessive-compulsive disorder.
What Are Some Of The Symptoms of Orthorexia?
Compulsive checking of ingredient lists and nutritional labels
An increase in concern about the health of ingredients
Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
Unusual interest in the health of what others are eating
Spending hours per day thinking about what food might be served at upcoming events
Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
Obsessive following of food and ‘healthy lifestyle’ blogs on social media
Body image concerns may or may not be present
What Are The Health Consequences of Orthorexia?
Like anorexia, orthorexia involves restriction of the amount and variety of foods eaten, making malnutrition likely. Therefore, the two disorders share many of the same physical consequences.
How Is Orthorexia Treated?
There are currently no clinical treatments developed specifically for orthorexia, but many eating disorder experts treat orthorexia as a variety of anorexia and/or obsessive-compulsive disorder. Thus, treatment usually involves psychotherapy to increase the variety of foods eaten and exposure to anxiety-provoking or feared foods, as well as weight restoration as needed.
What is Avoidant Restrictive Food Intake Disorder?
Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously called “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of being overweight.
While many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.
How is ARFID Diagnosed?
According to the DSM-5, ARFID is diagnosed when:
An eating or feeding disturbance (such as, apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
Significant nutritional deficiency.
Dependence on enteral feeding or oral nutritional supplements.
Marked interference with psychosocial functioning.
The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
What Are The Risk Factors for Developing ARFID?
As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors will interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:
People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
Many children with ARFID also have a co-occurring anxiety disorder; these children are also at high risk for other psychiatric disorders.
What Are The Warning Signs of ARFID?
Behavioral and psychological
Dramatic weight loss
Dresses in layers to hide weight loss or stay warm
Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause
Dramatic restriction in types or amount of food eaten
Will only eat certain textures of food
Fears of choking or vomiting
Lack of appetite or interest in food
Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).
No body image disturbance or fear of weight gain
Physical
Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.
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)
In ARFID, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death.
Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body
What is Pica?
Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips.
It is unclear how many people are affected by pica. It most likely is more prevalent in developing countries.
Pica can affect children, adolescents, and adults of any genders.
Those who are pregnant and craving nonfood items should only be diagnosed with pica when their cravings lead to ingesting nonfood items, and the ingestion of those items poses a potential medical risk (either due to the quantity or type of item being ingested).
Pica can be associated with intellectual disability, trichotillomania (hair-pulling disorder), and excoriation (skin picking) disorder
There are no laboratory tests for pica. Instead, the diagnosis is made from a clinical history of the patient.
Diagnosing pica should be accompanied by tests for anemia, potential intestinal blockages, and toxic side effects of substances consumed (i.e., lead in paint, bacteria or parasites from dirt).
What Are The Warning Signs of Pica?
The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value.
The ingestion of the substance(s) is not a part of culturally supported or socially normative practice (e.g., some cultures promote eating clay as part of a medicinal practice).
Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice.
The eating of these substances must be developmentally inappropriate. In children under two years of age, mouthing objects—or putting small objects in their mouth—is a normal part of development, allowing the child to explore their senses. Mouthing may sometimes result in ingestion. In order to exclude developmentally normal mouthing, children under two years of age should not be diagnosed with pica.
Generally, those with pica are not averse to ingesting food.
What Are The Risk Factors for Pica?
Pica often occurs with other mental health disorders associated with impaired functioning (e.g., intellectual disability, autism spectrum disorder, schizophrenia).
Iron-deficiency anemia and malnutrition are two of the most common causes of pica, followed by pregnancy. In these individuals, pica is a sign that the body is trying to correct a significant nutrient deficiency. Treating this deficiency with medication or vitamins often resolves the problems.
A medical professional should assess if the behavior is sufficiently severe to warrant independent clinical attention (e.g., some people may eat nonfood items during pregnancy, but their doctor may determine that their actions do not indicate the need for separate clinical care).
How is Pica Treated?
The first-line treatment for pica involves testing for mineral or nutrient deficiencies and correcting those. In many cases, problematic eating behaviors disappear as deficiencies are corrected. If the behaviors aren’t caused by malnutrition or don’t stop after nutritional treatment, a variety of behavioral interventions are available.
Scientists in the autism community have developed several different effective interventions, including redirecting the person’s attention away from the desired object and rewarding them for discarding or setting down the non-food item.
What Is Rumination Disorder?
Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. Typically, when someone regurgitates their food, they do not appear to be making an effort, nor do they appear to be stressed, upset, or disgusted.
How is Rumination Disorder Diagnosed?
The DSM-5 criteria for rumination disorder are:
Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition).
The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, BED, or avoidant/restrictive food intake disorder.
If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention.
What Is The Treatment for Rumination Disorder?
Once a physical cause for rumination disorder has been ruled out, the most common way rumination disorder is treated involves a combination of breathing exercises and habit reversal. A child with rumination disorder is taught to recognize the signs and situations when rumination is likely, and then they learn diaphragmatic breathing techniques to use after eating that prevent them from regurgitating their food. They eventually learn to prevent the rumination habit by replacing it with deep breathing techniques.
Seeking Treatment for Eating Disorders:
Recovery from an eating disorder can be a long process that requires not only a qualified team of professionals, but also the love and support of family and friends. It is not uncommon for someone who suffers with an eating disorder to feel uncertain about their progress or for their loved-ones to feel disengaged from the treatment process. These potential roadblocks may lead to feelings of ambivalence, limited progress, and treatment drop out. Therefore, knowing about the Stages of Change Model, as defined by Prochaska and DiClemente, will help everyone involved better negotiate the road to recovery.
The Stages of Change in the process of recovery from an eating disorder are a cycle rather than a linear progression. The person may go through this cycle more than one time or may need to revisit a particular stage before moving on to the next. They may also go through the stages for each individual eating disorder symptom. In other words, if they are recovering from anorexia, they could be in the Action Stage for restrictive eating (e.g., eating three meals a day along with snacks, engaging in social eating, and utilizing support system) while, at the same time, they could be going through the Contemplation Stage for body image and weight concerns (e.g., becoming aware of how body image is tied to self-esteem and self-worth, defining oneself as a body or number, and identifying the negatives of striving for the “perfect body”). This is precisely why recovery from an eating disorder is complex and individualized.
If you are a parent or friend of someone struggling, you no doubt suffer right along with them, so it is crucial for you to pay attention to your own needs as well as be present for your child or friend during her recovery process.
What Are The Stages of Change?
There are five Stages of Change that occur in the recovery process: Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance. Let’s examine them further.
1) The Pre-Contemplation Stage is evident when a person does not believe they have a problem. Close family and friends are bound to pick up on symptoms such as restrictive eating, the binge/purge cycle, or a preoccupation with weight, shape, and appearance even before the person admits to it. They may refuse to discuss the topic and deny they need help. At this stage, it is necessary to gently educate the person about the devastating effects the disorder will have on their health and life, and the positive aspects of change.
Do not be in denial of your child or friend’s eating disorder.
Be aware of the signs and symptoms.
Avoid rationalizing their eating disordered behaviors.
Openly share your thoughts and concerns with your child or loved one.
2) The Contemplation Stage occurs when an person is willing to admit that they have a problem and are now open to receiving help. The fear of change may be very strong, and it is during this phase that a psychotherapist should assist the person in discovering the reason they have an eating disorder so they can understand why it is in their life and how it no longer serves them. This, in turn, helps the person move closer toward the next stage of change.
If your child is under the age of 18, insist that they receive professional help from a qualified eating disorder specialist.
Educate yourself about the disorder.
Be a good listener.
Do not try to “fix” the problem yourself.
Seek your own encouragement from a local eating disorder support group for family and friends.
3)The Preparation Stage the person transitions into the Preparation Stage when they are ready to change, but aren’t sure how to do it. Time is spent establishing specific coping skills such as appropriate boundary setting and assertiveness, effective ways of dealing with negative eating disorder thoughts and emotions, and ways to tend to their personal needs. Potential barriers to change are identified. This is usually when a plan of action is developed by the treatment team, (i.e. psychotherapist, nutritionist, and physician) as well as the person and designated family members. This generally includes a list of people to call during times of crisis.
If supporting a loved one in their recovery, identify what your role is in the recovery process.
Explore your own thoughts and beliefs about food, weight, shape, and appearance.
Ask your child/loved one and the treatment team how you can be best involved in the recovery process and what you can do to be supportive.
ACTION STAGE
4) The Action Stage begins when the person is ready to start their strategy and confront the eating disorder behavior head on. By now, they are open to trying new ideas, behaviors, and are willing to face fears in order for change to occur. Trusting the treatment team and their support network is essential to making the Action Stage successful.
Follow the treatment team’s recommendations.
Remove triggers from your environment: no diet foods, no scales, and no stress.
Be warm and caring, yet appropriate and determined with boundaries, rules, and guidelines.
Reinforce positive changes without focusing on weight, shape, or appearance.
5) The Maintenance Stage evolves when the person has sustained the Action Stage for approximately six months or longer. During this period, they actively practice new behaviors and new ways of thinking as well as consistently use both healthy self-care and coping skills. Part of this stage also includes revisiting potential triggers in order to prevent relapse, establishing new areas of interests, and beginning to live their life in a meaningful way.
Applaud your loved one’s efforts and successes.
Continue to adjust to new developments.
Redefine the boundaries at home as necessary.
Maintain positive communications.
Be aware of the possibility of recovery backsliding and relapse to prior distorted eating.
6) The Termination Stage & Relapse Prevention. Relapse is sometimes grouped with the maintenance stage since recovery doesn’t occur all at once, and it’s normal for some relapsing behaviors.
So, how do you know when it is time to discontinue treatment? With the understanding that this decision is best made in consultation with your treatment team, ask yourself the following questions:
Have I mastered the Stages of Change in the major areas of my eating disorder?
Do I have the coping skills necessary to maintain these changes?
Do I have a relapse prevention plan in place?
Am I willing to resume treatment in the future if necessary?
To prevent relapsing ask for help, communicate your thoughts and feelings, address and resolve problems as they arise, live a healthful and balanced life, and remember that you would not have made it this far if it were not for your strong determination and dedication toward recovery.
How Do I Help a Loved One With An Eating Disorder?
If you’ve spotted the warning signs of an eating disorder in someone you care about, it’s hard to know what you should do about it. You don’t want to hurt their feelings, falsely accuse them, or say the wrong thing.
Do it anyway.
People who suffer eating disorders can be very afraid to ask for help, and eating disorders get worse over time. Say something to them when you first suspect there is a problem.
How to Talk to Someone About an Eating Disorder:
Avoid accusatory, critical or harsh statements as it may make your loved one defensive. Instead, talk about what worries you.
Focus upon feelings and relationships rather than weight or food. Use specific examples of times that you noticed a particular behavior.
Don’t mention their looks – the person with the eating disorder is already too aware of their body. Comments about weight and/or appearance will reinforce their obsession.
Avoid power struggles over food.
Don’t demand that they change.
Don’t criticize their eating habits.
Respect their privacy but tell them you’re concerned about their health. Knowing that you’re concerned will help the person with the eating disorder feel more comfortable.
Avoid casting blame, shame, or guilt-trips. Don’t accuse them. Instead of saying, “You just need to eat,” say, “I’m concerned because you didn’t eat breakfast.”
Avoid simple solutions. They’re notoriously unhelpful and may minimize the problem.
Help! My Child Has An Eating Disorder!
Having a child with an eating disorder is one of the hardest things a parent may have to handle. Alongside professional treatment, here are some tips:
Avoid threats, scare-tactics, angry outbursts, and insults. Negative communication will only make it worse.
Look at your OWN attitudes about food, weight, body image, and body size. Discuss the way you’re affected by body image pressures with your child.
Set caring, consistent limits.
Stay firm. Eating disorders are very serious and require constant supervision.
Promote their self-esteem in any way possible.
Encourage your child to find better, healthier ways to manage unpleasant feelings like stress, depression, loneliness and self-hatred.
Remember, above all else, IT IS NOT YOUR FAULT.
My Best Friend Is Starving Herself. What Do I Do?
If you know that your friend is not eating or is eating and purging, tell someone.
Tell his or her parents, a teacher, or even your parents. Your friend may listen to an adult before she listens to you.
If you are an adult, gently express your concern to them. Perhaps you can talk to their spouse or partner. Be supportive, especially if inpatient treatment or long-term outpatient treatment is needed. Recovery isn’t instantaneous.
Treatment for Eating Disorders:
There are many different treatment options for eating disorders, but an individualized care plan will be developed for the individual suffering an eating disorder. Effective treatment must address both psychological and physical aspects of the disorder, with the end goal of treating medical and nutritional needs, promoting a positive relationship with food, and teaching constructive ways to deal with food.
Eating disorder treatment can be delivered in a variety of settings. Understanding the different levels of care and methodologies can be helpful when selecting a provider. It’s also good to understand types of treatment as insurance benefits are tied both to diagnosis and the type of treatment setting.
Levels of Care:
Inpatient Hospitalization
Patient is medically unstable as determined by:
Unstable or weak vital signs
Laboratory findings presenting acute health risk
Complications due to coexisting medical problems such as diabetes
Patient is psychiatrically unstable as determined by:
Rapidly worsening symptoms
Suicidal and unable to contract for safety
Residential Treatment Program:
Person is medically stable and requires no major medical intervention
Person is psychiatrically impaired and unable to respond to partial hospital or outpatient treatment
Partial Hospitalization Program (PHP)
Person is medically stable but:
Eating disorder does impair functioning without immediate risk
Needs daily assessment of physiologic and mental status
Person is psychiatrically stable but:
Unable to function in normal social, educational, or vocational situations
Engages in daily binge eating, purging, fasting or very limited food intake, or other pathogenic weight control techniques
Intensive Outpatient Program (IOP)
Person is medically stable and does not need daily medical monitoring
Person is psychiatrically stable and has symptoms under enough control to be able to function in normal social, educational, or vocational situations while continuing to make progress in recovery
Types of Psychological Therapy:
One of the most important considerations when selecting a psychotherapist is the type of therapy they provide. Different therapies work differently for different people, and some may be more helpful than others, depending on the person and their stage of recovery, while others may not be as helpful. It’s important to remember that if you don’t click with one therapist, there are many others available. Reducing eating disorder behaviors is generally considered the first goal of treatment, and the following therapies currently have the most evidence for effectiveness.
Psychodynamic Psychotherapy
The psychodynamic approach to treatment of eating disorders focuses upon trying to understand the root cause of the disorder. Psychodynamic psychotherapists see eating disorder behaviors as the result of internal conflicts, motives, and unconscious forces; if these behaviors are discontinued without addressing the underlying motives that are driving them, then relapse will occur. Symptoms are viewed as expressions of the person’s underlying needs and issues, and are believed to be resolved by working through these issues.
Cognitive Behavioral Therapy (CBT)
A relatively short-term, symptom-oriented therapy focusing on the beliefs, values, and cognitive processes that maintain the eating disorder behavior. CHT modifies distorted beliefs and attitudes about weight, shape, and appearance; these are heavily related to the development and maintenance of an eating disorder(s).
Acceptance and Commitment Therapy (ACT)
The goal of ACT is focusing on changing your behavior instead of focusing upon your thoughts and feelings. People in ACT are taught to identify core values and commit to creating goals to fulfill these values. ACT also encourages patients to detach themselves from emotions and learn that pain and anxiety are a normal part of life. The goal isn’t to feel good, but to live an authentic, good life. After people begin to live a good life, they often find they do start to feel better.
Dialectical Behavioral Therapy
DBT is behavioral treatment that has been proven to be effective for treatment of binge eating disorder, bulimia nervosa, and anorexia nervosa. DBT operates under the notion that the first course of treatment should focus upon changing one’s behaviors. DBT treatment focuses on learning skills to replace maladaptive eating disorder behaviors. These skills focus upon building mindfulness, learning how to better build interpersonal relationships, how to regulate emotions, and the tolerance for distress. While DBT was first developed to treat borderline personality disorder, it is currently being used to treat eating disorders as well as substance abuse.
Evidence-Based Treatment
While all of these therapies are frequently used to treat people with eating disorders, they have varying levels of efficacy and research supporting their use. Many therapists now recommend the use of evidence-based treatment, which is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual people.” In eating disorder therapies, evidence-based treatment usually means that the therapy has been used in a research study and found to be effective in reducing eating disorder symptoms, encouraging weight restoration in underweight patients, and decreasing eating disorder thoughts.
Calling a therapy “evidence-based” doesn’t mean that it works for everyone; just that it works for many people. Research and evaluate which types of treatments would best target your symptoms and psychological concerns. Also, not all therapists who say they utilize a type of treatment actually use it in all of their sessions. Some CBT therapists might have a primarily psychodynamic approach and only occasionally use CBT principles. Ask about how strictly the therapist adheres to treatment guidelines, what a typical session might consist of, how much training the therapist has received in this particular treatment modality, the rough percentage of patients who they treat using this form of psychotherapy, and how current their ED knowledge base is.
Interpersonal Psychotherapy Therapy
Interpersonal psychotherapy (IPT) is an evidence-based treatment for people who have bulimia nervosa and/or binge eating disorder. IPT contextualizes eating disorder symptoms as occurring and being maintained in a social and interpersonal context. IPT is associated with specific tasks and strategies linked to the resolution of a specified interpersonal problem area.
The four problem areas include grief, interpersonal role disputes, role transitions, and interpersonal issues. IPT helps clients improve relationships, communication, and resolve interpersonal issues in the identified problem area(s), which leads to a reduction of eating disorder symptoms. Just as interpersonal dysfunction is linked to the onset and maintenance of eating disorder behaviors, healthy relationships and improvements in interpersonal functioning are linked with symptom reduction.
Cognitive Remediation Therapy (CRT)
CRT works to develop the person’s ability to focus on more than one thing. CRT works to target rigid thinking processes that make up a core component of anorexia nervosa through simple exercises, reflection, and guided supervision. As of 2017, CRT is being studied to test effectiveness in improving treatment adherence in adults with anorexia. However, CRT has not been tested in other eating disorders.
Family-Based Treatment
Family-Based Treatment, also known as the Maudsley Method, is a home-based treatment approach that has been shown to be effective for some teens with anorexia and bulimia. FBT doesn’t focus on the cause of the eating disorder but does place focus upon eating and full weight restoration to promote recovery. All family members are considered an essential part of treatment, which consists of re-establishing healthy eating, restoring weight and interrupting compensatory behaviors; returning control of eating back to the adolescent; and focusing on remaining issues.
Eating Disorder Hotlines:
The ANAD (National Association of Anorexia Nervosa and Associated Disorders) Helpline – 630-577-1330
National Eating Disorders Association’s Toll-Free Information and Referral HelpLine at 1-800-931-2237
Additional Eating Disorders Resources:.
The National Association of Anorexia Nervosa and Associated Disorders (ANAD) has an international network of support groups, offers referrals to health care professionals, publishes a newsletter, and will mail information packets customized to individual needs upon request. They work to educate the public, promote research projects, and fight insurance discrimination and dangerous advertising. Their national hotline (847-831-3438) can give you a listing of support groups and referrals in your area.
Maudsley Parents is a site for parents of eating disordered children. The site offers information on eating disorders and family-based treatment, family stories of recovery, supportive parent-to-parent advice, and treatment information for families that opt for family-based Maudsley treatment.
The Something Fishy Website on Eating Disorders has lots of resources of all kinds, including information and online support. (Scales are for Fish!)
The Academy for Eating Disorders is a global organization for professionals from all fields who are committed to leadership in eating disorders research, education, treatment and prevention. Phone (US) 703-556-9222.
Overeaters Anonymous is a twelve-step program offering support for recovering from compulsive overeating. Phone (US) 505-891-2664.
About-Face focuses on the impact mass media have on the physical, mental and emotional well being of women and girls. They challenge our culture’s overemphasis on physical appearance and encourage critical thinking about the media. Phone (US) 1-415-436-0212.
The Weight-control Information Network provides the general public, health professionals, the media, and Congress with up-to-date, science-based information on weight control, obesity, physical activity, and related nutritional issues. Phone (US): (202) 828-1025 or 1-877-946-4627.
The Council on Size and Weight Discrimination, Inc. provides information on eating disorders, “sizism,” the non-dieting movement, and size discrimination. Phone (US): (914) 679-1209.
It’s one in the morning on New Year’s Day. I’m alone in my room savoring the last taste of mini-chocolate donuts before my medicine kicks in. Once it does, I get so nauseous that all I can do is lay still and hope that I can sleep.
When the clock hit midnight, I was lying in bed watching a documentary about obese people on my computer.
I was alone.
The only “Happy New Year” wishes I got were two texts. One was from a wrong number. The other was from one of my friends that I’m in the process of losing touch with; I suspect it was a mass message to everyone in her phone.
My mom and sister were downstairs, but they made no effort to come see me. I’d snapped at them earlier, so they left me alone. My boyfriend didn’t say anything either. I haven’t heard from him since seven, when he said he was sorry for not coming over because he was tired and in a meh mood. I’m guessing he fell asleep.
I’ve spent most of that time crying on and off.
You see, the problem is that I’ve spent the last three days with a pain in my left side, and while it fades in and out, it’s been getting worse. Normally this wouldn’t bother me too much, but in the last three weeks I’ve been in and out of doctors’ offices. I started off with a Urinary Tract Infection (my third since May), and after being off of those antibiotics for a day, I developed an ear infection. While I had my ear infection, my allergies ran amok, and I had to get a special nose spray to allow some sinus tube to open back up. I just finished the antibiotics for the ear infection yesterday morning.
All of this would be overwhelming enough by itself, but this happened after almost an entire year when I didn’t go one week without something happening to make me stop what I’m doing and curl up on the couch and wait for it to go away.
All of this has happened because I have fibromyalgia.
I’d explain what fibromyalgia is to you, but I don’t even know myself – my doctors don’t either. They THINK it’s nerves over-reacting and sending out false pain signals. But if that were all there was, it wouldn’t be associated with so many other things. If you stop by any fibromyalgia website, you can click on a page and find a long list of associated diseases and ailments. All of them aren’t even listed.
As if the pain and stiffness weren’t enough, now I have Irritable Bowel Syndrome, chronic fatigue and insomnia, sensitivity to temperature and certain chemical smells, loss of concentration, and worse, anxiety. I hope that my reproductive organs function properly, because I want children one day (Even though I already know this might not be true. I’ve had one cyst and irregular periods so my doctor threw me on birth control a few years ago and that was that.)
So I have my pill cocktails for this thing and that thing, and I have patterns I need to follow or else something will flare up. There’s an even bigger problem with all of these things: I’m nineteen.
I was diagnosed with fibromyalgia at sixteen, and for a while it looked like it was being managed by medication. I was able to function and go to school and go out with friends. It would flare up every now again around my periods and during the winter, but it was still manageable…until January of this past year.
My doctor decided to switch me to a new drug for fibromyalgia. This drug was hardcore. It came in a trial in this little book container. I had to ease into it because it carried some potentially harsh side effects. It was hell from the beginning. I was nauseous from the second pill, but my mom and I decided to give it a chance.
By the middle of the trial, I was so nauseous and weak that it put my new part-time job into jeopardy. I sat through the orientation trying not to throw up. When I started having heart palpitations to the point where my heart stopped beating long enough for me to panic, we decided to take me off of the drug, but of course, I had to taper down because there was a chance of seizures from suddenly stopping.
Ever since, the problems haven’t stopped. I’m more than a semester behind in college because I’ve had to drop classes. This next semester, I will try for the third time to finish Composition 2 and Intro. to Sociology, and at this point, I’m not sure if I will be able to do it on this try.
I did online classes last semester, and this semester was supposed to be my attempt at real classes again. My anxiety has been right below the surface for weeks. I keep thinking, “If I can’t even make it more than a few days without something happening, how can I make it through classes? How can I live a normal life and have a job when I can barely function for more than a few days?”
I’m very aware of how much my parents spend on my doctor’s appointments and medications – it isn’t a small sum. My mom’s stack of doctor’s bills and reports is easily over six inches. I know my insurance runs out when I hit twenty-five, so I know I have a time limit to finish school and find a job, but I’m going to school to be a high-school English teacher. My starting salary will be somewhere in the mid thirty thousand dollar range.
I don’t want to have to admit that I will have to rely on someone to help take care of me, but honestly, on a teacher’s salary, I will be stuck at home until I pay off all of my student debts or I move in with a boyfriend. I refuse to live with friends because I don’t want them to have to take care of me when I get bad. I don’t want them to have to bring me things when I can’t get up. I don’t want them to have to sit with me when I’m curled up in bed sobbing because I don’t want to be sick anymore.
All I can do is hope that it will go back into remission or I can find a way to manage it because I don’t know how I can ever have a normal life with it as it is. I always have the fear that people are going to leave me because I’m such a mess. I tell my boyfriend that I’m a mess; that I’m falling apart, and he tries to reassure me that the rest of me makes up for it.
It angers me when people don’t take my illness seriously. My sister laughs at me if I tell her why I’m feeling bad. I’ve had people tell me it was all in my head or look suspiciously at me when I can’t give them an adequate explanation of fibromyalgia.
I know I don’t look sick, but I like it that way. If I looked sick every time I felt bad, I’d always look awful. I get mad when I see all this research money being thrown at all these other manageable diseases or anti-ageing products when fibromyalgia has the potential to systematically destroy people’s lives. It doesn’t matter that it’s not deadly: if a disease has a potential to confine you to bed, it deserves funding.
My plans for my future are very tentative. Even if I’m only planning a week in advance, I have to add “I think” to the end of it because I have no idea if I’ll be up to it. I’m sick of having to add “I think” to all of my plans.
I want to have a job. I want to go to school full-time. I to live on my own. I want all of the things people my age complain about. I want these things because they’re normal. I want to know that I can be normal. It hurts to hear people complain about this stuff – I want so badly to do it all.
My political views are becoming more liberal. I’m okay with universal healthcare when we can afford it. I need it. I’d gladly pay extra taxes if it means I don’t have to pay for outrageous doctor bills or ridiculously expensive mediation because I react badly to certain generics.
I support abortion because if I were to accidentally get pregnant, I’d have to choose whether to put my body through excruciating hell and lose all functionality for nine months, or abort. I’m not even fond of the idea of abortion, but I still want that option.
I recently started supporting medical marijuana because my body is being worn down by pain medications. I get upset when people try to oppose me on that one. My favorite argument is that America doesn’t need more high people because people with chronic pain are already high all the time. People in chronic pain take pain pills to function, not to relax. (Also, the people who actually would need medical marijuana hate the people who want to abuse it just as much as you do.) I’d gladly eat a pot brownie instead of taking a pain pill that’ll leave me nauseous and weak for six hours and for half a day afterward because my body is already worn down.
Do I need to repeat that I’m only nineteen?
And all I can do is just sit, wait, swallow some pills, try to exercise when my body lets me, try to eat healthy when my stomach lets me, and hope that I can get everything into a manageable state.
I’m starting to feel it’s too much to hope for it to just go away.
I feel kind of dumb typing this out, but I need to talk to somebody – out of respect for my husband and his feelings, I can’t tell the people I’d normally go to for support. I’m not even sure where to start, so forgive me if this is disjointed.
I’ll start here: I have an incredibly complicated situation with my in-laws.
Some background: my in-laws are lovely people, and I genuinely love and care for them, BUT they drive me a bit crazy. Sometimes, my in-laws act in a less than socially appropriate manner – they want to be as close as possible to my family and me.
Before my husband was born they had a stillborn daughter, followed by my husband (who is healthy), followed by 10 miscarriages. Then, my in-laws adopted my brother-in-law, who has had mental health and behavioural problems from the get-go.
I don’t think they’ve ever really dealt with the death of their daughter. Back in those days, baby losses weren’t really acknowledged, you know? So when we got married, I was embraced as the daughter they’d never had, and frankly, I felt smothered by their desire to know everything – to be a part of everything in my life. I’m a private person and feel uncomfortable answering questions about my sex life (why in the world would you want to know what your son and I do in private?!) or other personal stuff from my husband’s parents.
Anyway, the smothering got worse when my daughters were born. I totally understand how precious it is for them to have granddaughters, particularly after the pain they’ve experienced, so we tried to be understanding. Although there have been issues over the years with boundaries being crossed, we’ve worked hard on getting along, and my girls have a good relationship with them (I’m super careful not to say negative things about them).
Fast-forward to a few months ago.
My father-in-law came over, and as we had some errands to run, he offered to look after the girls. No big deal; that’s happened plenty of times before. This time, though, while we were out, my oldest daughter called, upset, and begged us to come home NOW. We did. She was settled; everything seemed normal, but after my father-in-law had left, I asked her about it. She said she had felt really uncomfortable around him and didn’t want us to leave them with him again.
I felt sick.
She assured me several times (and has when we’ve discussed it since) that he didn’t say or do anything wrong, didn’t touch her or anything like that, just that she felt really uncomfortable. She’s very open with me, and I am confident she’s not lying; she seems really confused about why she felt that way, but is adamant that she did feel that way. Thinking back, I wonder if it was a culmination of my in-laws’ more “natural” approach to things (e.g. they had a naked photo of themselves kissing on their fridge for a while (just a Polaroid, not an artsy one) and on one occasion my toddler had gone into the toilet with him and he didn’t send her out (I called her to come out and he was cranky about that).
I wonder if it was something like that.
I genuinely don’t believe that he would molest a child. One of the things I really respect about my in-laws is that they supported a childhood friend of my husband who had been molested by their minister and went to court to testify, despite enormous community and family pressure not to. They lost “friends” through that process, but did the right thing.
I really don’t think he has done anything to my daughter. HOWEVER, obviously, I will never leave her in a situation where she isn’t comfortable, so my in-laws won’t be babysitting any more. That’s really awkward, though, because they’ve babysat before.
My husband and I have talked and talked about it and just can’t find a good way forward. My in-laws want as much contact with our kids as possible and now want sleepovers, too. We won’t let that happen, but how can we possibly explain it? They would be SO hurt, and I think their good relationship with our eldest daughter would be very damaged. It would be impossible to explain in a way that doesn’t hurt their feelings, and honestly, there is NOTHING they could do that would make it okay to look after the kids again. My father-in-law will forever have this question mark lingering around him – since I don’t know why my daughter was upset and uncomfortable with him. My mother-in-law has MS and can’t cope with them on her own. It’s just a nightmare.
My husband is so sad that we’re in this situation. He loves his parents and wants them to be happy, but what they want isn’t a possibility. My littlest daughter is only 2, so I see years and years ahead of conflict about access to our girls. It’s meant that we never leave the kids at the moment because if they hear that we’ve used other babysitters they’ll be even more hurt – no more dates or possible weekends away. I don’t see a good way forward.
*sigh*
I don’t actually know if I even want this published, but I just needed to get it out. I don’t want to go on and on to my husband because it’s so hard for him but it bothers me everyday, and I just want to bounce it off of somebody, you know?
Anyway, if you’ve read this far, thank you for your time.
What would you do? Am I making a big deal out of nothing? Or am I not reacting enough? I’m going nuts just thinking this out!
My views regarding my mother have changed in recent years.
Presently, she is someone who exists as part of a story in my life, catalyzing a significant examination of myself and those who surround me.
I often contemplate whether that was her purpose, but intertwined in those thoughts; there is guilt.
Parents make sacrifices for their children, and perhaps hers was the loss of our relationship, forcing me to embark on a new path. However, I don’t think she’ll ever be cognizant of that.
I have fond memories of her, times when she was a picturesque, doting mother, ferrying my friends and me to practice, taking us to the mall, and covering for me when I exceeded my curfew.
Those untainted recollections haunt me because I’ve realized that for every good deed, there was a price tag. The cost was never evident, as though you had found a one of a kind item at the store. You stand alone in the aisle, puzzled while turning the object over and back again in an attempt to locate that small, sticky, square sliver of paper that gives something its value.
You approach the register, convincing yourself it isn’t a lavish novelty—until the cashier regrettably informs you that the item exceeds your price range. After an internal battle, you purchase it anyway because you falsely believe that you need it.
That’s how it was with her.
She’d give, I’d take, and I would later have buyer’s remorse. I felt liable during those exchanges on many occasions, but they’ve taught me that I shouldn’t give more than I’m willing to lose–whether that be time, money, or respect. I did and said things throughout our strained relationship that weren’t fair, correct, or appropriate. There were times my behavior was unquestionably harsh.
In other moments, I yelled too much, was self-absorbed, and at times manipulative. Even as a child, I innately sensed that she was not capable of truly loving anyone. Her affections were an unmarked, dead-end road; I never knew where the pavement faded into the dirt until I found myself in the mud. She tirelessly helped people (and probably still does), but would then complain when her efforts didn’t garner adequate appreciation or her deeds weren’t reciprocated.
Through watching her perform this soliloquy of martyrdom and innumerable encore performances, I uncovered another meaningful piece of knowledge: If you’re giving to fill a void within yourself, stop giving and fix yourself because no one else will. To me, that is her downfall—she never fixed herself. Perhaps she didn’t know how—or was unable to recognize that she needed mending. It was always easier for her to blame her short-comings on others.
Usually, it was my dad, the man who worked seven days every week to provide for his family and allow her to do as she pleased. He was flawed, but not any more than the rest of us tend to be. My dad had a temper, was overly strict, and could be perceived as controlling at times, but he expressed an abundant amount of love and dedication to his family.
Yet somehow, my mother always found a reason to make him not good enough for her, or for us. She would shout from the proverbial rooftops to whatever audience was present: family, church people, or her friends—it didn’t matter. If they had ears and minute of time, she would begin Act I of her tragic play.
Her behavior reminded me of the game “Telephone” in elementary school.
The story at the end was never the story at the beginning, but no one was able to decipher what that was because true to her victim mentality, “She would never say that!” And so it went throughout my teenage years, her speaking half-truths, my dad getting mad, and her tear-soaked, half-hearted apologies.
Lather. Rinse. Repeat.
I’ve surmised that’s where my lesson on people began—with those years of trusting, then not, and the gray area twisted between the confusion. It’s strange to look back on it now, coldly removed from it, emotionless. Or perhaps it’s still anger; I’m not sure. I vividly recall frequent conversations with my dad and his constant reminders to, “Not be like your mom.”
At that point in time, I always thought he meant weak because that’s how I perceived her: sad, depressed, and angry. She attended a private masquerade, a façade tuned so finely that she is still unaware that she’s wandering through a false reality. During those times, I didn’t know that life was preparing me for something I would never see approaching—the Trojan horse of life’s fuckery right in front of me. I was oblivious to the depth of her wounds and subsequent actions, until one day I could no longer deny the existence of her illness.
For many people, the term “mother” is synonymous with love, compassion, and devotion. An upstanding matriarch fiercely defends her children from harm and zealously supports their endeavors. I have spent countless nights awake thinking about the perfect incarnation of a mom, and I’ve concluded that my mother will never embody those characteristics. The greatest, albeit most difficult thing about life, is that it gives everything you need to know if you pause momentarily, pay attention, and don’t allow your ego to get the best of you.
If you’re repeatedly finding yourself in the same situation, it’s because you haven’t mastered the lesson those particular circumstances are supposed to teach you, or maybe you have, and you’re too stubborn or stupid to recognize them. I fell into the latter category because that’s just who I was then, optimistic and dumb enough to believe I could right any wrong. Writing that now is ridiculous, but that’s how it started—the relationship with a price tag so high, it almost destroyed my credit, and me.
He was charismatic.
Funny.
Handsome.
He said all of the right things at exactly the right time. Looking back, I guess he had to, or someone would peel back the thin layers around his dysfunction and see a hollow vessel, devoid of empathy or compassion unless it was for selfish gain.
My mother, however, adored him. She thought he was fantastic. The words of praise for him gushed from her mouth like a broken faucet. She insisted he was perfect for me.
I initially agreed until I saw through the shroud to what was underneath. It was like my internal GPS had lost signal on life’s journey and now it was too late to turn back. The scenery was beautiful at times. There were days filled with sunshine, laughter, and hope. Those times were my favorite because most days were dark and tumultuous. It seemed as though I was trying to outrun the rain, but I never knew when lightning would strike. The storm always seemed to clear at the exact moment that I was ready to relocate to a better climate.
And of course, there was my mother, clearing wreckage, and negotiating an insurance policy—or so I thought.
What I failed to realize is that insurance agents love disasters. Disasters wreak havoc and chaos while convincing policyholders that they require more insurance so that they are better prepared for the next catastrophe. I purchased an abundance of insurance from my mother. I talked and confided in her, while she manipulated the weather to her liking. In return, the weather repaid the debt by providing her with a temperate climate.
From my mother’s perspective, it was a fair exchange. She was never one to forgo a “diamond of a deal.” She received the attention and adoration she was so desperately seeking, and he received another layer of protection. Together, they were a perfect storm and were moving toward the coast at an alarming rate.
He and I found ourselves at the beach on that road trip from hell. By that point, I was preparing to change routes and terminate my insurance because I could no longer afford the premium; however, the best-laid plans always go awry when the atmosphere becomes unstable.
That day began calmly and seemingly beautiful, but the bright sunlight obscured the horizon as it beamed through the car windows that morning. We were exploring on that trip. Laughter and conversation filled the air like particles of pollen—invisible and damaging. I thought that maybe, just maybe, the sky was going to remain clear. If I only I hoped enough, had enough insurance, I falsely believed everything would be ok.
I was absolutely wrong.
He—the weather, became erratic and violent; I was stranded in the current, drowning while trapped in a car until I suddenly saw the eye of the hurricane approaching. Those few moments of relief granted me the clarity to see daylight. I suddenly became aware that I couldn’t regulate the weather, but I could control my reaction to it. There was an open road, but it had been hidden by the debris from the frequent storms.
That day I began driving.
I drove away from the downpours, evaded the lightning strikes, and put miles between the constant uncertainty of whether I had purchased enough insurance. When I called my mother, the insurance agent to discontinue my policy, she didn’t answer. She wasn’t available that night or the next day. She was too busy attempting to manage the self-made disaster that she didn’t care about me—her daughter. She turned away the child she had known for 32 years. She abandoned me, the daughter that she was supposed to unfailingly love and support.
I don’t know what he promised her exactly, but whatever it was, it was enough for them both to attempt to pursue me down that new, secret road I had discovered. They attempted to detour my journey through phone calls, texts, and at times, unnerving threats. I kept driving farther and farther away. She revived the soliloquy that had served her well and performed it for a multitude of audiences. The new version had added a few additional scenes, and they served to convey how terrible I was. She was heartbroken that her child could just walk away from her. It was then, that my dad’s words from over a decade ago reverberated in my mind, “Don’t be like your mom.” The statement had been a clear warning that I was unable to comprehend at the time because I didn’t understand that she was mentally ill. I was too naïve to fully perceive the environment that tarnished my childhood and too self-centered to evaluate my contribution.
She and I were and always will remain different people. She will forever be the insurance agent feeding and creating disasters for her own personal gain. I hope that someday her catastrophic business will close and she will have placed a vacant sign in the window. Although, I think the absence of orchestrating calamities would force introspection, and the disasters we harbor on the inside are usually far worse than those we create. My lessons in this life are far from over, and I hope that they’re never complete because if I stop learning, I cease to evolve into a better person. The chapter about my mother has been painful and dangerous, yet exceedingly valuable.
I’m grateful for the destruction and nearly being swept away because I changed routes. I began a migration to a new destination that I plotted and chose on my own. My mother and I will forever be traveling in opposite directions, but we were at the same starting point for a brief time. She may never fully grasp the reason or the outcome of our sudden departure in life, but I hope that one day her course becomes calm and clear instead of winding and uncertain.
Despite the pain she has caused, she unknowingly and unwillingly sacrificed her happiness for her child’s—and that’s the worst punishment of all.
