Mental Health

Mental Health

Your mental health is just as important as your physical health when it comes to living a vital and fulfilling life. If you’re suffering from a mental health condition, get help understanding the facts, coping with symptoms and finding the right help.

Wednesday, Sep 23rd 2009

Getting Unstuck - How Do You Motivate Yourself?

authored by Sheryl Kraft

Yesterday was "one of those days." I spent a super restless night tossing and turning, alternately entertained and frightened by some pretty weird dreams. I mean, these were the kinds of dreams that really make me question my sanity. And the rest of the day was strange, too, because I just couldn't do anything right. I felt absolutely stuck.

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Your Mental Health at Midlife

middle-aged womanDo find yourself snapping at the people you love over small things that didn't used to bother you? Breaking into tears for no reason? Feeling fabulous and in love with life one day and as if you're stuck in the bleakest tunnel the next? No, you're not going crazy. You're going through middle age.

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Coping with Adult ADHD

by Pamela M. Peeke, MD, MPH

woman cooking and on the phoneEvery woman I know can probably relate to many of the symptoms of Attention Deficit Hypractivity Disorder (ADHD)-feeling overwhelmed and frazzled, disorganized, unable to focus. But take those symptoms and multiply them by 10, and you'll get some sense of what a woman with ADHD is dealing with.

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Reduce Stress with Diet and Exercise

by Pamela M. Peeke, MD, MPH

woman exercising outdoorsMore than one in 10 of those who responded to HealthyWomen's recent Web-based survey on stress said they coped with stress by doing unhealthy things such as overindulging in alcohol and food and other self-destructive behaviors.

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Passport to Good Health


Author: HealthyWomen and American Association of Nurse Practitioners
Published by: National Women's Health Resource Center, Inc., December 2010

Keep your health information organized with HealthyWomen and AANP's Passport to Good Health—a compact health record-keeping tool. Containing blood pressure and cholesterol screening ranges, preventive health screening details and schedule, vaccination schedule, personal record-keeping grids and more, it's the perfect place to keep track of personal health information and screening results.

All of our publications are available for free but we do charge shipping, handling and processing fees for orders of 3+ publications. Online orders are limited to a maximum quantity of 500. For requests exceeding 500 please email or call toll-free at 877-986-9472.

Didn't find what you were looking for? Visit our Health Topics A-Z area for more information.

Recovering from a Substance Abuse Problem

by Pamela M. Peeke, MD, MPH

woman sittting at a table with teaRecovering from a substance abuse problem doesn't occur just once; it's a lifelong challenge that takes place every day you make the choice not to have a drink, swallow a pill or pull out a needle.

That's why people with a history of substance abuse never say they're cured; they say they're "in recovery." In that way, they remind themselves every day of their challenge.

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I recently had a heart attack. The rehab I could handle, but I've been feeling really sad lately. Why is this? I should be happy to be alive!

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What is it?


What Is It?
Stressors are the external events, including pressures in people's lives, such as divorce, marriage, children, and work and money pressures. The experience of stress, however, is related to how you respond to these stressors.

Stress can be your friend or your foe. When stress fuels the spark of personal achievement, it can work to your benefit by making you more perceptive and productive, acting as a motivator and even making you more creative. But when stress flames out of control—as it often does for many of us—it can take a terrible toll on your physical and emotional health, as well as your relationships.

While stress is not considered an illness, it can cause specific medical symptoms, sometimes serious enough to send you to the emergency room or your health care professional's office. According to the American Psychological Association's 2010 Stress in America survey, the majority of Americans report living with moderate or high levels of stress. And on average, those who report their health as fair or poor have more stress (an average stress rating of 6.2 on a 10-point scale) compared with those who rate their health as excellent or very good (an average stress rating of 4.9 on a 10-point scale).

In today's fast-paced world, women are experiencing more stress at every stage of their lives than ever before. Juggling job pressures, family schedules, money issues, career and educational advancement and child and elder-care concerns are only a few of the common stressors confronting women.

Stressors are the external events, including pressures in people's lives, such as divorce, marriage, children, work and money. The experience of stress, however, is related to how you respond to these stressors. One person's stressor can be another person's motivator.

You can learn to manage how you respond to stressors through relaxation, meditation, some forms of psychotherapy and exercise, among other methods. However, you can also work to reduce the stressors in your life, such as learning to say no to some commitments, simplifying your life or leaving a bad job or relationship. Sometimes techniques that are originally designed to simply reduce your stress response and improve coping (for example, meditation and psychotherapy) can lead you to choose to reduce the stressors in your life because you begin to see more clearly what needs to change.

Working mothers, regardless of whether they are married or single, face higher stress levels—both in the workplace and at home. The National Institute for Occupational Safety and Health (NIOSH), the US agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury, provides these statistics regarding stress in the workplace:

  • 40 percent of workers reported their jobs were very or extremely stressful
  • 25 percent view their jobs as the number one stressor in their lives
  • 75 percent of employees believe that workers have more on-the-job stress than a generation ago
  • 29 percent of workers felt quite a bit or extremely stressed at work
  • 26 percent of workers said they were "often or very often burned out or stressed by their work."

Stress has been linked with a variety of physical ailments from headache to depression to symptoms that mimic a heart attack. The balance between stressors and your ability to cope with them, however, can determine your mental health. When the stressors in your life match your coping abilities, you feel stimulated, engaged and appropriately challenged. Too many stressors in your life that overwhelm your attempts to cope can result in depression or anxiety.

Depression can feel like a pervasive sense of hopelessness, a feeling of wanting to give up, tearfulness or a sadness that does not seem to go away after a couple weeks. Anxiety can feel like a chronic state of feeling "keyed up" or "on edge." Some people who are depressed or anxious have physical symptoms, such as changes in sleep or appetite (too much or too little).

Chronic depression and anxiety have been linked to other physical problems, such as cardiovascular disease, chronic pain, hypertension and diabetes. If you notice symptoms of depression or anxiety, it is important to get them treated. Your health care professional or mental health professional can help.

Regardless of your physical or mental symptoms, talk about the stress in your life with your health care professional. A thorough assessment by your health care team will help determine the cause of these symptoms. You may find that stress has triggered an illness, such as high blood pressure.

Stress and Your Body

Research indicates that women's biological response to stress is to "tend and befriend"; this is, make sure the children are safe and then network with other women in stressful times. Men's biological reaction to stress is to go into the "flight-or-fight" mode. Studies indicate that the hormone oxytocin, which has a calming effect, is released during stressful times in both men and women.

Estrogen may enhance oxytocin release, while testosterone may diminish it; this may be one reason that women seem to seek social support more often then men when under stress. However, women have also been socialized from an early age to look to their social group, particularly their female friends, for support when under stress, whereas men tend to engage in activities, such as exercise or even using substances, when under stress.

During stress, hormones including adrenaline and cortisol flood the body, resulting in:

  • an increased need for oxygen
  • increased heart rate and blood pressure
  • constricted blood vessels in the skin
  • tensed muscles
  • increased blood sugar levels
  • increased clotting ability of blood
  • spilling of stored fat from cells into the bloodstream
  • constriction of bowel and intestinal muscles

All this can strain your heart and artery linings. In fact, if you already have coronary heart disease, stress might lead to chest pain, called angina. Plus, the increased tendency for blood to clot during stress may lead to a clot in your coronary arteries, causing a heart attack.

Other physical dangers of stress include stomach problems as your bowel and intestinal muscles constrict and depression and anxiety. While stress doesn't cause these mental illnesses, it can activate them in people who may already be prone to them.

Other physical dangers of stress include stomach problems, as your bowel and intestinal muscles constrict, as well as depression and anxiety. While stress doesn't cause these mental illnesses, it can activate them in people who may already be prone to them.

Stress can also cause what has been termed "toxic weight gain." Cortisol, a hormone released when you're under stress, is an appetite trigger. That's why so many women eat more—and less-than-healthy food—when under a lot of stress. Those extra calories are converted to fat deposits that gravitate to the waistline. These fat deposits, called visceral fat, are associated with life-threatening illnesses such as heart disease, diabetes, high blood pressure, stroke and cancer. Chronically high levels of cortisol may stimulate the fat cells inside the abdomen to fill with more fat. As you age, this expanding waistline can be life threatening.

Too much stress can also affect your immune system, weakening it and making you more susceptible to colds, coughs and infections.

Other symptoms of stress include muscular tension, headaches, gastrointestinal illnesses and sleeping more or less than normal.

Stress Triggers

It is important to distinguish between the acute stress response—when your heart beats faster and your breath comes faster as you get a rush of adrenalin—and the chronic stress response, in which you are continually under stress.

This chronic stress response is the one that causes the most problems as it literally wears out your body functions, leading to disease. That's because our physical stress response was designed for emergency situations, such as fleeing an attacking animal, not for the everyday stressors we experience in modern society.

You may feel stressed in response to external or internal triggers, such as stressors in your life or your own way of relating to yourself. These include:

  • trauma or crises
  • small daily hassles
  • conflicts or unpleasant people
  • barriers that prevent you from reaching your goals
  • feeling little control over your life
  • excessive or impossible demands from others
  • noise
  • boring or lonely work
  • irrational ideas about how things should or must be; perceiving that life is not unfolding as you think it should
  • believing you are helpless or can't handle a situation
  • drawing faulty conclusions like "they don't like me" or "I'm inferior to them," or having unreasonable fears of dire events such as "I'll be mugged"
  • pushing yourself to excel and/or failing to achieve a desired goal
  • assigning fault for bad events, for example, placing blame on yourself or on others
  • realizing you may have been wrong but wanting to be right
  • overreacting to current stress as a result of intense stress years earlier, especially in childhood

Stress is an individualized experience. What may be stressful to you may not affect someone else. Your past experience, other stressors in your life and even heredity can affect what you experience as stressful.



If you are suffering from stress, you may be experiencing a variety of symptoms that feel severe enough to prompt you to see a health care professional. These include:

  • headaches

  • frequent upset stomach, indigestion, gas pain, diarrhea or appetite changes

  • feeling as though you could cry

  • muscular tension

  • tightness in your chest and a feeling as though you can't catch your breath

  • feeling nervous or sad

  • irritability and anger

  • having problems at work or in your normal relationships

  • sleep disturbance: either insomnia or hypersomnia (inability to sleep or sleeping too much)

  • apathy-lack of interest, motivation or energy

  • mental or physical fatigue

  • frequent illness

  • hives or skin rashes

  • tooth grinding

  • feeling faint or dizzy

  • ringing in the ears

  • disruptions in your menstrual cycle or unusually severe PMS or menopausal symptoms

There is no specific test to diagnose stress. Typically, your health care professional conducts a variety of tests (which may include a personal and family health history, blood and urine tests and other assessments) to rule out various medical conditions.

Because your symptoms may be similar to those of depression, your health care professional should also evaluate your mental state to determine if you may be suffering from a depressive or anxiety disorder. Symptoms associated with stress, anxiety and sleeplessness, for example, typically subside when the stress triggering them subsides. When these same symptoms are caused by depression or another mood disorder, however, they may not go away without medication or therapy.

If stress is identified as the culprit for your symptoms, you may want to ask your health care professional for stress management strategies and consider ways to control the stressors in your life-before your health is affected.



Reducing or eliminating the things that cause stress and changing how you react to it are the safest and most effective ways to treat stress. No single method of stress management is always successful, so you might want to try a variety of approaches. It's also important that you treat any medical symptoms stress exacerbates. However, keep in mind that treating the stress may not cure the medical problem.

Reducing stress can be difficult. Often, people succeed in relieving stress in the short term but return to old stress-producing habits. Plus, personal responsibilities don't alwayslend themselves to stress-reducing tactics. The process of learning to control or redirect stress is lifelong, but working to master it will improve your lifelong health.

Cognitive-behavioral therapy, which helps you substitute desirable responses and behavior patterns for undesirable ones, is one proven way to reduce stress. It is very important that you learn cognitive-behavioral coping skills from a professional. They include:

  • Identifying sources of stress. You may want to keep a stress diary in which you record stressful occasions, incidents that triggered anger or anxiety or that caused a physical response like a sour stomach or headache. Jot down the time of day and the circumstances that led to these feelings, then try to identify the types of events or activities that caused them. See if you can alter or avoid these circumstances.

  • Restructuring priorities. Examine your priorities and goals to determine which stressful activities or situations you can get rid of. For instance, replace time-consuming chores that aren't really necessary (like ironing) with more pleasurable or interesting activities.

  • Find ways to balance the stress inducers you can't eliminate—like unpleasant working conditions, an unhappy family situation or a significant loss—by including stress-reducing activities in your day. Studies have shown that such activities can positively affect your immune system. Making time for recreation and stress reduction is as essential as paying bills or shopping for groceries.

  • Adjusting your responses to stress. Because you can't simply wish some stresses away-you can't just quit your job or walk out on your family, for example-you have to learn how to respond to stress to reduce its effects. These include:

    • Discussing your feelings. If you don't discuss your feelings of anger or frustration, you may feel hopeless and depressed. Becoming aware of your feelings can help you assert yourself when it's important. You can do this in a positive way, by writing a letter or calmly discussing your feelings with the other person. Asserting yourself in a negative way (yelling and behaving aggressively, for example) is only counterproductive. It's also important that you learn to listen, empathize and respond to others with understanding. If you can't talk to a trusted friend, try writing in a journal or composing a letter.

    • Keeping your perspective and looking for the positive. Think of the worst possible outcome to a situation that is stressing you and assess the likelihood of it occurring (usually small). Then, envision a positive outcome and develop a plan to achieve that outcome. It's also helpful to remember past situations that initially seemed negative but ended well.

    • Using humor. Stress management experts often recommend that people keep a sense of humor during difficult situations. Laughing releases the tension of pent-up feelings and helps maintain your perspective on the situation.

In addition to cognitive-behavioral methods to approaching stress, learning a relaxation technique-the natural unwinding of the stress response-can also help. A stress management specialist can teach you some relaxation techniques, including:

  • Deep breathing. When you're under stress, your breathing becomes shallow and rapid. Taking a deep breath is an effective technique for winding down. Inhale through your nose slowly and deeply to the count of 10, making sure your stomach and abdomen expand but your chest does not rise. Exhale through your nose, also to the count of 10. Concentrate fully on the breathing and counting. Repeat five to 10 times. The goal is to take three inhales and three exhales per minute, for a total of three deep breaths.

  • Relax your muscles. Sitting anywhere, even at your desk, relax your shoulders, let your arms drop to your side, rest your hands on top of your thighs, relax your legs, and don't forget your jaw muscles, which often tense with stress. Close your eyes and breathe deeply. You can also do this lying in bed. Beginning with the top of your head and progressing downward, tense and then relax the muscles in your body one by one while maintaining a slow, deep breathing pattern.

  • Passive stretches. Allow gravity to help you relax and stretch your muscles. Relax your neck and let your head fall forward to the right. Then let it drop even more as you breathe slowly. Do the same with your shoulders, arms and back.

  • Visualization. Remember a relaxing time or place like a lakeside picnic or a beautiful beach scene. Close your eyes for a few minutes and picture it in your mind.

  • Meditation. The goal of meditation is to quiet your mind, to relax your thoughts and increase your awareness. Meditation can also reduce your heart rate, blood pressure, adrenaline levels and skin temperature. It involves concentrating on a simple image or sound while sitting in a comfortable position away from distractions. It can involve cultivating an open awareness or a more loving attitude toward yourself and others. Meditation can also help you become more aware of your priorities so you can make more productive choices in your life.

  • Electromyographic Biofeedback (EMG). During this totally painless process conducted in a health care professional's office, you learn to reinforce your relaxation skills using methods such as those described earlier. Electromyograph biofeedback measures the electrical activation that signals muscles to contract. Electromyographic biofeedback training helps you relax overly contracted muscle groups to help reduce tension. As training continues, you learn to use the information from the instruments to discriminate between tension and relaxation. By repeating this process, you learn to associate the sound with the relaxed state and to achieve this state of relaxation by yourself without the machine.

  • Massage therapy. This approach slows the heart and relaxes the body. Rather than causing drowsiness, however, massage actually increases alertness

Your health care professional will probably discuss other issues with you, such as the necessity of:

  • Maintaining healthy habits. People who are coping with chronic stress often resort to unhealthy habits including high-fat and high-salt diets, tobacco use, alcohol abuse and a sedentary lifestyle.

  • Avoiding stimulants like tobacco (which contains nicotine) that make you feel calm in the short run, but actually rev up your nervous system. The addictive characteristics of some stimulants like nicotine can leave you anxious until your next fix.

  • Getting regular aerobic exercise. Even a brisk walk can reduce levels of stress hormones in your blood. At least 30 minutes a day (or two 15-minute sessions) most days of the week is best, but even three times a week offers benefits. In addition, as you get fitter, your body is better able to withstand stress and your mind to cope with stress and stay on an even, happier keel. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous. You should first discuss any exercise program with your health care professional.

  • Strengthening or establishing a support network. Even a pet can help reduce medical problems aggravated by stress. Studies of people who remain happy and healthy despite many life stresses conclude that most have very good social support networks.

  • Reducing stress at work. Try establishing a network of friends there, seeking out a sympathetic manager, or schedule daily pleasant activities and physical exercise during free time. For additional support, schedule an appointment with an Employee Assistance Program clinician, if your company offers that benefit. These programs provide professional counselors who can give you and your family confidential assessment and counseling.



You can't simply wish away stressful events from your life. The key is to handle the stress appropriately. The following may enhance your ability to manage stressful events in your life:

  • Eat a balanced, nutritious diet. General health and stress resistance can be enhanced by eating well and by avoiding alcohol, caffeine, tobacco and junk food.

  • Exercise regularly. Exercise promotes emotional well-being as well as physical fitness.

  • Schedule your time more effectively using a calendar and to-do lists, prioritizing activities and realizing you can't do everything.

  • Learn how to say no to requests that add extra burdens and can wreak havoc on your day.

  • Insist on help with regular chores.

  • Balance work and play by planning time for hobbies and recreation—activities that relax your mind and temporarily take you away from your stresses. Even diversions like taking a warm shower, going to a movie or taking a walk can help.

  • Practice relaxation exercises every day, including visualization, deep muscle relaxation, meditation and deep breathing.

  • Rehearse for stressful events. Imagine yourself feeling calm and confident in an anticipated stressful situation. You will be able to relax more easily when the situation arises.

  • Let yourself laugh and cry. Laughter makes your muscles go limp and releases tension, so try to keep a sense of humor. Tears can help cleanse the body of substances that accumulate under stress.

  • Talk out troubles. It sometimes helps to talk with a friend, relative or spiritual leader. Another person can help you see a problem from a different point of view.

  • Help others. Because we concentrate on ourselves when we're distressed, sometimes helping others is the perfect remedy for whatever is troubling us.

  • Learn acceptance when a difficult problem is out of your control, which is better than worrying and getting nowhere.

  • Develop and maintain a positive attitude. View changes as positive challenges, opportunities or blessings.

You don't need to do all of these. Some may work for some people and others for other people. The key is to use the ones that work for you. Some of these become more effective with practice. If you are feeling especially overwhelmed, seek help. There is no need to suffer and there are trained people out there to help.

Facts to Know

Facts to Know

  1. According to the American Psychological Association's 2010 Stress in America survey, the majority of Americans report living with moderate or high levels of stress. And on average, those who report their health as fair or poor have more stress in their lives (an average stress rating of 6.2 on a 10-point scale) compared with those who rate their health as excellent or very good (an average stress rating of 4.9 on a 10-point scale).

  2. Working mothers, in particular, are among the people most likely to experience stress, particularly when they do not have a lot of support from others.

  3. Stress takes a toll on your body. Stress can cause stress hormones such as adrenaline and cortisol to flood your system. These hormones cause your heart rate and blood pressure to rise, your muscles to tense, your blood sugar levels to increase and other physical symptoms.

  4. The effects of stress may lead to actual medical illnesses, including heart problems, stomach problems and headaches.

  5. While stress doesn't cause mental illnesses like depressive disorders or anxiety disorders, it can lead to feelings of depression and anxiety. It can precipitate mental illnesses in people predisposed to them, particularly if left untreated.

  6. Symptoms of stress include irritability, sleep disturbances, appetite changes, muscular tension, apathy, fatigue, headache and frequent illness.

  7. Stress can be brought about by external factors such as conflicts in your relationships, job pressures and even traffic. In addition, internal factors-such as a desire for perfection, a feeling of helplessness, blaming yourself for things that are out of your control or intense worry-also cause stress.

  8. The ways you react to stressful situations can be relearned. You can use cognitive-behavioral approaches in which you identify sources of stress and work to minimize them and adjust your responses to the stresses you can't eliminate.

  9. Relaxation techniques help dispel stress and can cause adrenaline and cortisol levels in your blood to decrease. These techniques include deep breathing, muscle relaxation, stretching, visualization, meditation and biofeedback.

  10. A nutritious diet and regular exercise not only prepare your body to withstand the physical effects of stress, but strengthen your mind to cope with stress and stay on an even keel.

  11. According to the National Institute for Occupational Safety and Health, the U.S. agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury, 40 percent of workers reported their job was very or extremely stressful.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about stress so you're prepared to discuss this important health issue with your health care professional.

  1. Could I have an underlying medical condition that could be causing my feelings of stress and anxiety?

  2. Could some medication I'm taking be causing my feelings of stress and anxiety?

  3. Has my stress caused or exacerbated physical or mental illness that needs to be dealt with medically, separately from the stress itself?

  4. If the stress is left untreated, what will happen to my mental and physical health?

  5. Can you refer me to a mental health professional who can teach me how to best manage and control my stress?

  6. Can you teach me relaxation techniques or refer me to someone who can?

  7. Can you refer me to an effective stress management class or workshop?

  8. How can exercise and adequate sleep help me manage my stress?

  9. How can meditation help? Can you teach me this technique or refer me to someone who can?

  10. I have an upset stomach/diarrhea/headaches/stiff neck nearly every day. Could this be stress? And if so, what are some of the other signs of stress?

  11. What substances should I stay away from if I'm having problems with stress? If alcohol relaxes me, why shouldn't I drink when I feel stressed?

  12. What should I do if my stress becomes too overwhelming for me to cope with?

Key Q&A

Key Q&A

  1. I feel so distressed that I have recurrent thoughts of suicide or death. Is this stress? What should I do?

    You should seek care or crisis intervention immediately. These types of thoughts are more indicative of a depressive disorder than stress, but your health care professional can assess your situation, give you a diagnosis and recommend treatment.

  2. What causes stress?

    What causes a person to experience stress is different for different people; what may be one person's stressor can be an exciting motivator to another person. However, this doesn't mean one person is weak and the other is strong. That being said, some common causes of stress are changes in your life like marriage, divorce, a new job or the birth of a child; trauma or crises, like illnesses, death of a loved one, or a traumatic event like a burglary; excessive demands on you and your time; conflicts or unpleasant people; small daily hassles; barriers that prevent you from reaching your goals; feeling little control over your life; and boring or lonely work.

  3. Sometimes when I feel stressed out, I feel a pain or tightness in my chest. What is this and what should I do?

    You need to seek care immediately to rule out heart disease or to begin treatment for any heart-related illness you might have. While you might not have a physical illness, you do need to have this symptom diagnosed. If you don't have a serious illness-rather the stress in your life is causing this symptom-you need to address this issue so your health doesn't deteriorate further.

  4. Is stress an illness?

    While stress is not itself considered an illness, it is a common cause of specific medical symptoms from high blood pressure to muscle aches and stomach ulcers. According to the American Psychological Association (APA), in 2010, 51 percent of people surveyed reported fatigue, 40 percent reported headaches, 49 percent reported lack of motivation or energy, and 56 percent reported irritability or anger as a result of stress.

  5. Who's most likely to suffer from stress?

    According to the APA, women report higher levels of stress than men, and women are less likely to think they are doing enough to manage the stress in their lives. On a 10-point scale, 28 percent of women report an average stress level of eight, nine or 10, versus 20 percent of men. In addition, those most likely to report frequent mental stress include younger adults, working mothers, divorced or widowed individuals, the unemployed and those with low incomes.

  6. What are the effects of stress?

    Stress can cause symptoms of a variety of physical and mental illnesses and make you more susceptible to other illness. Some specific symptoms of stress include feeling anxious, depressed or irritable; stomach upset, diarrhea or appetite changes; muscular tension; headaches; mental or physical fatigue and apathy; sleep disturbances and frequent minor illnesses.

  7. Can I avoid stress?

    You probably can't completely avoid stressful situations, but you can alter your reaction to those situations, resulting in far fewer physical symptoms of stress and negative results. With enough "tools," some stress may actually feel motivating.

  8. Are there treatments for stress?

    While you can't necessarily control the events that cause you stress, you can control how you manage the stress. Cognitive-behavioral methods, a form of psychological treatment that is used to help you substitute desirable responses and behavior patterns for undesirable ones, are the most effective ways to reduce stress. These methods include identifying sources of stress and then altering or avoiding these circumstances; restructuring your priorities and goals; and adjusting your responses to stress by discussing your feelings, keeping your perspective, looking for the positive and using humor. In addition, learning relaxation techniques-the natural unwinding of the stress response-can be helpful. Finally, working with someone to change your life in ways that reduce the external stressors is also helpful. Improving how you cope with stress as well as reducing stressors in your life go hand in hand. Mental health professionals can help you do both of these things.

Lifestyle Tips

Lifestyle Tips

  1. Eat your way to calm

    In general it's a good idea, but particularly during times of stress, to skip the simple sugars and starches, such as potato chips, cakes and ice cream. According to the APA 2010 Stress in America poll, more than half of Americans (51 percent) reported overeating or eating unhealthy foods in response to stress, and one-third (33 percent) said they eat to manage stress. Seek healthier comfort foods as alternatives, such as nonfat or low-fat yogurt instead of ice cream and carrot sticks or nuts instead of potato chips. And avoid coffee and other caffeinated food and drinks. They not only increase levels of certain stress hormones, they also mimic their effects in the body such as increasing heart rate. Load up on vegetables and other high-fiber foods. Not only do they keep your gastrointestinal tract working during high-stress periods (and help you avoid constipation), but the nutrients they provide lend an extra dollop of protection against chronic stress. Choose complex carbohydrates—oatmeal, whole grains, nuts and beans. Their steady release of sugar keeps your blood sugar levels steady and induces the brain to release more of the mood-enhancing chemical serotonin.

  2. Coping with fear and anxiety about war, terrorism and other public threats

    If you're worried about unknown danger, turn it into something known. Educate yourself on the current situation and recommendations from the federal government and public health authorities. Make reasonable plans to take safety precautions, and then think about something else. Leave the television and radio off if they're increasing your anxiety. Get involved in activities that are familiar and rewarding, such as hobbies, yard work, cleaning something, playing a sport or going to the movies. Talk to your friends and family. Plan a weekend getaway. Don't drink or smoke to compensate for anxiety because these activities ultimately do not make stress go away and can damage your health.

  3. Try writing out your stress

    If you are under stress or recovering from a traumatic event, could keeping a daily journal help? Studies of college students suggest that it may. Students were told to write of their experiences at college for 20 minutes a total of three times over a two-week period, but half were instructed to write about their deepest feelings and tie them together at the end of the journal entry. The other half simply wrote of their day and what they could do better. After testing, the students who wrote about their deepest feelings had better memory and higher GPAs, both immediately after the experiment and in the subsequent semester, than those who didn't. In addition, the students in the deep feelings writing group who chose to write about a negative event had fewer problems with intrusive, negative thoughts.

  4. When both partners are stressed

    Learn to recognize the signs of stress in each other. Don't take everything that either of you say or do too seriously if you're both stressed. Use good-natured humor to relieve the tension. Avoid criticism or negativity. Be flexible. Gentle touching, a mutual foot rub, backrubs or baths are all likely to help. Do stretches that involve two people. Take turns with chores. Plan a strategy for the week, with both of you sharing the load. Be realistic about what you can accomplish, and set priorities. Give each other opportunities to talk and for quiet time. Get enough sleep.

  5. Reduce stress at work

    Get enough sleep, exercise regularly and eat nutritional meals to best prepare for coping with work-related stress. Avoid or cut back on alcohol, smoking, caffeine and sugar. Drink water to stay hydrated. Come in a little early and use planning techniques and prioritizing to manage your time. Anticipate that not everything will happen on schedule, and build in buffer time. Delegate if you can. Look for creative ways to solve problems or work around them rather than simply getting angry. Get to know your coworkers a little better. Get up and walk around periodically if you have a desk job. If your job is really not a good match, consider looking for a new one. Sometimes changing the situation is the answer. But consider this as a last resort.

  6. Help your child cope with stress

    Manage your own stress, because your child is sensitive to your anxiety. Make time to spend with your child one-on-one, in a quiet environment without distractions. Ask your child to talk to you, and even if the conversation doesn't focus on your child's worries or concerns, listen carefully. Spend time in outdoor or indoor activities with your child. Encourage a regular schedule with enough time for sleep and balanced meals. Teach your child assertiveness and problem-solving techniques to replace too-passive or too-aggressive behavior. Encourage your child to build a network of friends. Make your home a welcoming place.

Organizations and Support

Organizations and Support

For information and support on coping with Stress, please see the recommended organizations, books and Spanish-language resources listed below.

American Institute of Stress
Address: 124 Park Ave.
Yonkers, NY 10703
Phone: 914-963-1200

American Psychological Association
Address: 750 First St., NE
Washington, DC 20002
Hotline: 1-800-374-2721
Phone: 202-336-5500

American Self-Help Group Clearinghouse
Address: 375 E. McFarlan St.
Dover, NJ 07801
Phone: 973-989-1122

Emotions Anonymous
Address: EA International Service Center
P.O. Box 4245
St. Paul, MN 55104
Phone: 651-647-9712

Heal Within, an element of InnerSite, Inc.
Address: 208 S. Louise
Glendale, CA 91205
Phone: 818-551-1501

Pulmonary Hypertension Association
Address: 801 Roeder Road, Suite 400
Silver Spring, MD 20910
Hotline: 1-800-748-7274
Phone: 301-565-3004

Women's Health Initiative (WHI)
Address: 2 Rockledge Centre
Suite 10018, MS 7936 6701 Rockledge Drive
Bethesda, MD 20892
Phone: 301-402-2900

10 Steps to Take Charge of Your Emotional Life: Overcoming Anxiety, Distress, and Depression Through Whole-Person Healing
by Eve A. Wood, M.D.

Calm at Work: Breeze Through Your Day Feeling Calm, Relaxed and in Control
by Paul Wilson

The Food and Feelings Workbook: A Full Course Meal on Emotional Health
by Karen R. Koenig

MindWalks: 100 Easy Ways to Relieve Stress, Stay Motivated, & Nourish Your Soul
by Mary H. Frakes

RealAge Makeover: Take Years Off Your Looks and Add Them to Your Life
by Michael F. Roizen

Relaxation and Stress Reduction Workbook
by Martha Davis, Elizabeth Robbins Eshelman, Matthew McKay and Patrick Fanning

Relax: You May Only Have a Few Minutes Left: Using the Power of Humor to Overcome Stress in Your Life and Work
by Loretta LaRoche

The 6 Stress Points in a Woman's Life
by Kevin Leman

Stress: Living and Working in a Changing World
by George Manning, Kent Curtis, and Steve McMillen

Stress Management Sourcebook: Everything You Need to Know
by J. Barton, Phd Cunningham

Take Back Your Life: Smart Ways to Simplify Daily Living
by Odette Pollar

The Women's Concise Guide to Emotional Well-Being
by Karen J. Carlson M.D., Stephanie A. Eisenstat M.D., and Terra Ziporyn Ph.D.

The Worry Cure: Seven Steps to Stop Worry from Stopping You
by Robert L. Leahy

Your Body Speaks Your Mind: Decoding the Emotional, Psychological, and Spiritual Messages That Underlie Illness
by Deb Shapiro

Medline Plus: Stress
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894

American Academy of Family Physicians

Last date updated: 
Mon, 2011-06-27

What is it?


What Is It?
Schizophrenia is a brain disorder, with many abnormalities of the brain structure, function and chemistry.

Schizophrenia is a chronic brain disorder that is usually progressively debilitating without medical treatment. According to the National Institute of Mental Health, about 1 percent of the population currently suffers from schizophrenia. While there is no known cure for this severe mental illness, new medications can help alleviate many of the disease's severe symptoms with fewer motor side effects than older medications.

The number of reported cases is split evenly between men and women, although schizophrenia tends to appear earlier for men—usually in the late teens or early 20s—compared to women, who generally begin to display symptoms in their 20s or early 30s. Onset of schizophrenia is rare before puberty and uncommon after age 45.

Early Symptoms

Schizophrenia presents differently in different people. Symptoms tend to appear gradually and can easily go unnoticed by friends and family in the beginning. However, in some cases, symptoms of schizophrenia occur suddenly and can be quite dramatic. As the illness advances, the symptoms can become more bizarre and severe.

People with schizophrenia tend to have psychotic symptoms, such as hearing voices when no one is speaking or insisting that other people are listening to their thoughts or attempting to control them. Many people with schizophrenia have active psychotic episodes, a state where hallucinations and/or delusions occur and they lose touch with reality. Most people with schizophrenia experience at least one relapse after their first such episode.

Other early signs of the disease include increasing social withdrawal and loss of interest in normal pursuits, unusual behavior or a decrease in overall functioning, often before the delusions and hallucinations begin. These are often the first warning signs that alert friends and family to a problem.

As the illness progresses, a person's speech and behavior tend to become progressively disorganized and confused, and their work performance usually deteriorates. Eventually, the symptoms become more extreme, appearing as if the person has undergone a dramatic personality change. If these and other symptoms persist for six months or longer and no external cause such as the effects of illicit drug use or a medical illness is detected, the person is usually diagnosed with schizophrenia.

People who have schizophrenia are more likely to commit suicide than people in the general population, with an estimated 10 percent of all people diagnosed with schizophrenia ending their life this way. Young adult males are most likely to commit suicide.

Role of Genetics

Genetics appear to play a role in schizophrenia. However, genetics alone do not explain the disease. An identical twin of someone with schizophrenia has a 40 percent to 65 percent chance of developing the illness, while children who have a first-degree relative with the disease have about 10 times the risk of developing it than that of someone who does not have a family member with the illness. People with a second-degree relative, such as an aunt, grandparent or cousin with schizophrenia, also have an increased risk.

Researchers believe multiple genes are involved in the risk for schizophrenia but that no single gene causes the disease by itself. Recent research shows certain gene mutations occur among families in which several members have the illness, but that these abnormalities are not found in other families. This suggests that mutations may occur in any of a number of genes that might result in schizophrenia. Affected genes have been linked to various aspects of brain functioning that could account for the symptoms of schizophrenia and could affect a patient's ability to function. Future research may be able to identify who is at risk for developing the disease based on genetic profiles.

Other factors, such as prenatal difficulties (including viral infections and complications around the time of birth), also appear to influence the development of the disease. In addition, some illicit drugs, such as marijuana and stimulants like cocaine and amphetamines, may make schizophrenia symptoms worse. Research has found increasing evidence of a link between marijuana use at a young age and a greater risk of developing schizophrenia.

Role of Brain Abnormalities

Schizophrenia is a brain disorder, with many abnormalities of the brain structure, function and chemistry. For example, several studies find people with schizophrenia have enlarged ventricles, cavities in the brain filled with cerebrospinal fluid. In addition, some studies find that people with schizophrenia tend to have specific areas of the brain that are smaller compared to people without schizophrenia, and that some of these areas have lower metabolic activity. However, scientists are careful to note that these and other abnormalities are subtle, are not found in all cases and could be present in people who never develop schizophrenia.

In addition, studies of brain tissue following death have revealed changes in the distribution or characteristics of brain cells in people with schizophrenia that may have taken place before birth as well as during other times of change in brain development. Considerable brain restructuring occurs during adolescence and may be further altered in schizophrenia, resulting in the characteristic onset of symptoms during this crucial developmental stage in life. Scientists are working to better determine exactly how schizophrenia develops.



A challenging part of diagnosing schizophrenia is that there is no way to confirm it with laboratory studies, so clinicians rely on a pattern of psychotic symptoms and functional deterioration. Many of the symptoms can be found in other mental disorders, which can present further challenges. For example, some individuals with schizophrenia have prolonged periods of elation or depression, which can be confused with bipolar disorder (also called manic depression) or major depressive disorder. People with bipolar disorder and major depression can also experience psychotic symptoms. These conditions need to be ruled out before diagnosing schizophrenia.

A mental health professional such as a psychologist or psychiatrist typically diagnoses schizophrenia. The clinician begins with a complete medical history and physical examination followed by blood and urine tests to rule out other medical causes for the symptoms. For instance, commonly abused drugs such as cocaine, methamphetamines or LSD can cause symptoms that mimic schizophrenia (including hallucinations or paranoia).

Interestingly, people who have schizophrenia tend to abuse drugs and alcohol at a higher rate than the general population. So just because someone is abusing drugs doesn't mean the person doesn't also have schizophrenia.

Psychiatrists often diagnose schizophrenia when someone has had at least two active symptoms of the disorder, such as a psychotic episode that includes delusions and hallucinations, for at least a month, with other symptoms, such as a decline in functioning and disturbed thoughts lasting six months or longer.

Schizophrenia appears to improve and worsen over the course of the illness. When it improves, the person suffering from the disease may appear perfectly normal. Unfortunately, this is when many people decide to stop taking their medication and relapse. During an acute psychotic episode, patients often lose their ability to think logically or may lose their perception of who they are or of others around them.

Most people with schizophrenia also have social and occupational problems, including problems in the workplace, with interpersonal relationships and in the way they care for themselves.

Symptoms of schizophrenia are usually split into positive, negative and neurocognitive categories.

Positive symptoms are unusual thoughts, perceptions or distortion of normal functions. They include:

  • Delusions. These are firmly held erroneous beliefs that result from distortions or exaggerations of reasoning or misinterpretations of a person's perceptions or experiences. Common delusions include unrealistic beliefs that the person is being watched or followed (e.g. paranoia).

  • Hallucinations. These are abnormalities of perception that can occur in any of the senses, although auditory hallucinations (hearing voices even though no one is speaking) are most common. These voices often insult the person, comment on his or her behavior or give commands. Visual hallucinations are the second most common type.

  • Thought disorders. These are dysfunctional or unusual ways of thinking. "Disorganized thinking" is when a person can't organize or connect his or her thoughts. Speech may be garbled and hard to understand. "Thought blocking" is when a person stops talking in the middle of a thought. Another form of thought disorders may cause a person to make up meaningless words.

Negative symptoms relate to disruptions of normal emotions, motivation and drive. Symptoms to look for include:

  • "Flat affect," when a person's emotional expressions go "flat," and there is little change in their facial expressions, voice or body language. The person may avoid eye contact.

  • Lack of pleasure in everyday life and/or needing help with everyday activities. May include a neglect of basic personal hygiene.

  • Speaking little, even when spoken to, or giving only disinterested replies.

  • Disinterest in social interaction and retreat into an "inner world."

Neurocognitive symptoms of schizophrenia are symptoms that have to do with the person's ability to think and reason. They include:

  • Problems with attention
  • Trouble with certain types of memory
  • Problems with functions that allow one to plan and organize

Some patients with schizophrenia also experience abnormal movements, such as twitching, repetitive gestures or catatonia (for example, maintaining unusual positions or not moving or responding at all). For reasons that are not understood, more severe forms of catatonia were more common before the availability of antipsychotic medications. On the other hand, certain motor movements, such as tremor, rigidity and restlessness, commonly occur as side effects to antipsychotic medications.

Several subtypes of schizophrenia have been suggested, based on a person's range and intensity of symptoms. There several recognized types of schizophrenia, including the following:

  • Paranoid schizophrenia. A person experiences predominantly positive symptoms (delusions and hallucinations), without a lot of disorganization or negative symptoms. The person may feel suspicious, persecuted and/or grandiose.

  • Disorganized schizophrenia (also called hebephrenic schizophrenia). People with disorganized schizophrenia have difficulty with logical, coherent thinking and speech. They also sometimes lack motivation, emotion and the ability to feel pleasure.

  • Catatonic schizophrenia. People with catatonic schizophrenia exhibit extreme inactivity or activity that's disconnected from his or her environment or encounters with other people. These episodes can last for minutes to hours.

  • Undifferentiated schizophrenia. People with undifferentiated schizophrenia meet diagnostic criteria for schizophrenia, but not the paranoid, disorganized or catatonic subtypes.

  • Residual schizophrenia. People with residual schizophrenia have a history of schizophrenic episodes characterized by negative symptoms or mild positive symptoms. People with this form of schizophrenia differ from those with other forms in that they lack prominent psychotic symptoms.

Although schizophrenia is usually a lifelong illness, some people develop all the symptoms of schizophrenia that resolve spontaneously. When the symptoms last less than one month, a diagnosis of brief psychotic disorder is given. When symptoms last less than six months, the diagnosis schizophreniform disorder is used. Unfortunately, schizophreniform disorder is rare, and most people progress to chronic schizophrenia.



The best treatment for any individual suffering from schizophrenia blends a combination of antipsychotic medications with psychosocial interventions. Psychosocial interventions include supportive psychotherapy, illness management skills, integrated treatment for any coexisting substance abuse, family participation in therapy and psychosocial and vocational rehabilitation.

People with schizophrenia who need a high degree of social services should receive assistance from an interdisciplinary treatment team.

Antipsychotic medications for schizophrenia can eliminate or reduce the hallucinations and delusions of the disorder. These drugs, which help restore biochemical imbalances, may also help people regain their coherent thinking abilities. The older "conventional" or "typical" antipsychotic drugs were introduced in the 1950s. Over the years, studies have found that these drugs are very effective in treating acute episodes of delusions or hallucinations and can provide long-term maintenance and prevention of future schizophrenic relapses. However, these drugs can cause unpleasant side effects such as dry mouth, constipation, blurred vision and difficulty urinating. These types of side effects are called "anticholinergic."

These medications can also cause extrapyramidal side effects (EPS), which affect how the body moves. For example, restlessness, tremors and slowing of normal gestures and movements can occur after days to weeks of treatment. Some patients report muscle spasms and cramps in the head and neck area, as well as stiff muscles throughout their body.

Tardive dyskinesia (TD) is a type of EPS that can occur after months or years of treatment with antipsychotic medications. The risk of TD increases the longer antipsychotic medications are taken. This condition is more common among older patients. It involves small involuntary movements of the fingers, tongue, lips, face or jaw. The symptoms tend to get worse and turn into thrusting and rolling motions of the tongue, lip smacking, grimacing or uncontrollable sucking motions. Involuntary movements of the hands, feet, neck and shoulders can also occur. Tardive dyskinesia can be a permanent, irreversible side effect.

These medications can also interfere with reproductive hormones, affecting a woman's menstrual cycles and fertility or causing breast enlargement, milk secretion or sexual side effects in both men and women. Sedation and dizziness are also relatively common side effects.

Because of the potential side effects associated with these medications, it is important that any medication regimen is tailored to the individual. You should work closely with your doctor to achieve the most benefit with the fewest problems from the medication. Sometimes adding another drug can help reduce certain antipsychotic-related side effects and possibly improve their effectiveness.

Examples of older "typical" antipsychotic medications include chlorpromazine (Thorazine), haloperidol (Haldol), perphenazine (Trilafon) and fluphenazine (Prolixin).

Over the past 20 years, pharmaceutical manufacturers have introduced a newer generation of antipsychotic drugs known as novel or "atypical" antipsychotics. The major advantage of these medications is a decreased risk of some side effects, such as EPS. These medications include clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon), paliperidone (Invega) and aripiprazole (Abilify).

Clozapine is unique in that it is the most effective antipsychotic medication and is not typically associated with EPS or TD. However, patients taking clozapine must be monitored closely with regular blood tests because the medicine can cause a blood disorder called agranulocytosis, a disorder in which there are an insufficient number of white blood cells. Although it only occurs in a very small percentage of those taking clozapine, it can prove fatal if not caught and treated immediately.

Studies find the atypical antipsychotics are about as effective as the older conventional medications but have fewer extrapyramidal side effects. It has also been suggested that the atypical antipsychotics may improve anxiety, depression and cognitive symptoms. As a result, these newer drugs have replaced older drugs as "first line" therapy in the United States.

However, this new generation of medications has its own potential side effects, including sedation, significant weight gain and sexual dysfunction. Some are associated with a higher incidence of diabetes or high cholesterol, particularly in those who gain weight. While they don't typically interfere with menstruation as much as the typical antipsychotics, there is little information about the safety or impact of antipsychotic treatment during pregnancy and breastfeeding. If you are taking these medications and considering getting pregnant, talk to your health care professional first.

Perhaps the biggest challenge facing people with schizophrenia and their families is the high rate at which many stop taking their medication. Some stop treatment because they don't really believe they are ill. Others have such extreme disorganized thinking they can't remember to take their regular medication doses. Injectable medications that last for several weeks can sometimes help in these situations.

Patients also stop taking their medication because of difficulties with side effects. Substance abuse can also interfere with the efficacy of the medication, influencing patients' compliance. Finally, uninformed family members may suggest patients stop taking their medication because the symptoms seem to have disappeared. That's why it's important for a health care professional to stay involved in the treatment of someone with schizophrenia, even if they seem to be doing fine.

In unusual circumstances, electroconvulsive therapy (ECT) can be used to treat schizophrenia. During ECT, an electrical current passes through the patient's brain inducing a seizure. This treatment may be used if the person hasn't responded to antipsychotic medication or, in some circumstances, for those in catatonic states.

Once the delusions and hallucinations of schizophrenia subside, patients also can benefit from psychosocial therapies that help them improve their social skills and teach them how to live independently. These sessions can be provided in group, family or individual settings. Many therapists use behavioral learning techniques, including coaching, modeling and positive reinforcement, all of which can make a big difference in helping patients cope with other stresses in their lives that could contribute to relapses.

Psychoeducational family therapy is another segment of treatment that many psychiatrists see as necessary to help prevent relapses. These family education training sessions teach family members and close friends how to recognize the early warning signs of a relapse and what to do before the situation worsens. Improving communication and problem-solving skills among family members and the person with schizophrenia can help reduce the potential for relapse.

For individuals suffering from schizophrenia who need community services for support, clinical case managers can coordinate the necessary services and make sure medical and psychiatric treatments are addressed. These case managers can also play a key role in crisis management if the person doesn't have a support network of family and friends.

Facts to Know

Facts to Know

  1. About 1 percent of the population has schizophrenia, according to the National Institute of Mental Health.

  2. The number of reported cases is split between men and women, although schizophrenia tends to appear earlier for men—usually in the late teens or early 20s—compared to women, who generally begin to show signs of trouble in their 20s or early 30s. Onset of schizophrenia is rare before puberty and uncommon after age 45.

  3. People with schizophrenia tend to have psychotic symptoms, such as hearing voices when no one is speaking or insisting that other people are listening to their thoughts or attempting to control them. Many people with schizophrenia have active psychotic episodes, a state where hallucinations and/or delusions occur and they lose touch with reality. Most people with schizophrenia experience at least one relapse after their first such episode. Other early signs of the disease include increasing social withdrawal and loss of interest in normal pursuits, unusual behavior or a decrease in overall functioning, often before the delusions and hallucinations begin. These are often the first warning signs that alert friends and family to a problem.

  4. Genetics appears to play a role in schizophrenia. However, genetics alone does not explain the disease. An identical twin of someone with schizophrenia has a 40 percent to 65 percent chance of developing the illness, while children who have a first-degree relative with the disease have about a 10 percent risk of developing it themselves. People with a second-degree relative, such as an aunt, grandparent or cousin, also have an increased risk.

  5. Researchers find that multiple genes are involved in the risk for schizophrenia, but they are not the only cause. Other factors, such as prenatal difficulties (including viral infections and complications around the time of birth), also appear to influence the development of the disease. Researchers suspect that the disease may be the result of inappropriate connections between neurons in the brain that form during fetal development or puberty, times of significant changes in the brain.

  6. There is no way to definitively diagnose schizophrenia with laboratory studies, so clinicians rely on a pattern of psychotic symptoms and functional deterioration, as well as eliminating other possible causes of symptoms, to make a diagnosis. Psychiatrists often diagnose schizophrenia when someone has had active symptoms of the disorder, such as a psychotic episode that includes delusions and hallucinations, for at least a month, with other symptoms, such as decline in functioning and disturbed thought, lasting six months or longer. Many other conditions can resemble schizophrenia, so diagnosis should be performed by an experienced mental health professional.

  7. Schizophrenia appears to improve and worsen in cycles. When it improves, the person suffering from the disease may appear perfectly normal. Unfortunately, this is when many people decide to stop taking their medication and relapse. However, during the acute or psychotic phase, individuals with schizophrenia think without logical reasoning and may lose perception of who they or others around them are.

  8. In most cases, schizophrenia is a chronic condition requiring lifelong treatment. The best treatment blends a combination of antipsychotic medications with psychosocial interventions such as supportive psychotherapy, family participation in therapy and psychosocial and vocational rehabilitation. During crisis periods or times of severe symptoms, hospitalization may be required. Schizophrenia treatment is usually guided by an experienced psychiatrist, but it may also involve psychologists, social workers, psychiatric nurses and possibly a case manager.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about schizophrenia so you're prepared to discuss this important health issue with your health care professional.

  1. What type of medical professional cares for people with schizophrenia? What specialists should I consider visiting?

  2. What criteria should I use to find a psychiatrist or other specialist who will meet my needs or the needs of my family member?

  3. How many patients with schizophrenia have you provided care for in the last 10 years?

  4. What side effects might occur with the antipsychotic medication you are recommending?

  5. Are there any newer medications that could provide the same outcome—or better—with fewer side effects?

  6. Can antipsychotic medication be taken during pregnancy?

  7. If hallucinations or delusions return while taking antipsychotic medication, what should I (or my family member) do?

  8. Are there injectable (and longer-lasting) versions of this antipsychotic medication to improve the chance that it will be taken as directed? Are they just as effective as medications taken orally on a daily basis?

  9. Are there other treatments to consider to further reduce the potential for relapses? What about family psychotherapy sessions and other types of rehabilitation?

  10. Can you recommend a clinical case manager who can coordinate care and help find appropriate social services that I may need?

Key Q&A

Key Q&A

  1. What is schizophrenia?

    Schizophrenia is a chronic brain disorder that is often progressively debilitating for individuals unless they seek intervention through medications, psychosocial treatments and other types of care.

  2. Are women at greater risk of developing the disorder compared with men?

    The number of reported cases is split rather evenly between men and women, although schizophrenia tends to present itself at different ages for the two sexes. Onset of the disorder tends to occur earlier for men—usually in the late teens or early 20s—compared to women, who generally begin to show signs of trouble in their 20s or early 30s. An identical twin of someone with schizophrenia has about a 40 percent to 65 percent chance of developing the illness. Interestingly, researchers have found there is a further heightened risk for a female identical twin to develop schizophrenia if her twin has the illness. Women tend to have a less severe form of the disorder and respond better to treatment.

  3. Am I at greater risk of developing schizophrenia if I have a close relative who has been diagnosed with the disorder?

    If you have a close relative with the disease, you are more likely to develop it compared with someone who has no close relatives with schizophrenia. Your risk is also slightly elevated if you have a secondary family member with the disease, such as an aunt, uncle, grandparent or cousin.

  4. What are the early warning signs of schizophrenia?

    Most people who develop schizophrenia begin having delusions and hallucinations. Other early signs include increasing social withdrawal, loss of pleasure in everyday life, unusual behavior or decreases in overall functioning before the delusions and hallucinations begin. Speech and behavior tend to become progressively disorganized and confused, and work performance often deteriorates.

  5. What are my treatment options if I am diagnosed with the disorder?

    The primary mode of treatment for schizophrenia is a regimen of antipsychotic medications that make a significant difference in eliminating or significantly reducing the hallucinations and delusions. These drugs, which help restore biochemical imbalances to normal levels, also help the patient regain coherent thinking abilities. However, a major drawback to these medications is a wide array of side effects, some of them quite severe for some patients. In addition to medications, health care professionals strongly recommend patients with schizophrenia supplement their drug regimen with an array of psychosocial interventions.

  6. What are my chances for a relapse once I am taking medications and following a treatment plan?

    When taken as directed, antipsychotic medications can make a huge difference in the long-term potential for minimizing relapses and hospitalizations. Relapses usually happen when people stop taking their medication or take it only occasionally. People often stop their medication because they feel better and don't think they need it anymore. However, you should never stop taking an antipsychotic medication without first checking with your doctor. And even if your doctor gives you the OK, you should taper the dose of your medication gradually and not stop it suddenly.

  7. Is there any way to prevent myself from developing schizophrenia?

    Current research is being done to answer this question, and there are several clinics around the world devoted to identifying and helping "at risk" individuals. It does appear that the onset of schizophrenia can be triggered by stress or by using certain drugs such as marijuana. If a person has a family history of schizophrenia, avoiding illicit drug use is advisable, as well as reducing stress, getting adequate sleep and starting antipsychotic medications as soon as necessary.

Organizations and Support

Organizations and Support

For information and support on Schizophrenia, please see the recommended organizations, books and Spanish-language resources listed below.

American Academy of Child and Adolescent Psychiatry (AACAP)
Address: 3615 Wisconsin Ave., NW
Washington, DC 20016
Phone: 202-966-7300

American Association for Geriatric Psychiatry (AAGP)
Address: 7910 Woodmont Ave, Ste 1050
Bethesda, MD 20814
Phone: 301-654-7850

American Association of Suicidology
Address: 5221 Wisconsin Avenue, NW
Washington, DC 20015
Hotline: 1-800-273-TALK (1-800-273-8255)
Phone: 202-237-2280

American Psychiatric Association
Address: 1000 Wilson Boulevard, Suite 1825
Arlington, VA 22209
Phone: 703-907-7300

American Psychiatric Nurses Association (APNA)
Address: 1555 Wilson Blvd., Suite 530
Arlington, VA 22209
Hotline: 1-866-243-2443
Phone: 703-243-2443

American Psychological Association
Address: 750 First St., NE
Washington, DC 20002
Hotline: 1 -800-374-2721
Phone: 202-336-5500

Bazelon Center
Address: The Bazelon Center for Mental Health Law
1101 15th Street NW, Suite 1212
Washington, DC 20005
Phone: 202-467-5730

International Society of Psychiatric-Mental Health Nurses (ISPN)
Address: 2810 Crossroads Drive, Suite 3800
Madison, WI 53718
Hotline: 1-866-330-7227
Phone: 608-443-2463

Mental Health America
Address: 2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
Hotline: 1-800-969-6642
Phone: 703-684-7722

National Alliance on Mental Illness (NAMI)
Address: Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
Hotline: 1-800-950-NAMI (1-800-950-6264)
Phone: 703-524-7600

National Institute of Mental Health
Address: Science Writing, Press and Dissemination Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892
Hotline: 1-866-615-6464
Phone: 301-443-4513

National Mental Health Consumers' Self-Help Clearinghouse
Address: 1211 Chestnut St., Suite 1207
Philadelphia, PA 19107
Hotline: 1-800-553-4539
Phone: 215-751-1810

SAMHSA's National Mental Health Information Center
Address: P.O. Box 2345
Rockville, MD 20847
Hotline: 1-800-789-2647
Phone: 240-221-4021

Screening for Mental Health (SMH)
Address: One Washington Street, Suite 304
Wellesley Hills, MA 02481
Phone: 781-239-0071

Surviving Schizophrenia: A Manual for Families, Patients, and Providers
by E. Fuller Torrey

The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most Out of Life
by Kim T. Mueser, Ph.D. and Susan Gingerich, MSW

Getting Your Life Back Together When You Have Schizophrenia
by Roberta Temes

I Am Not Sick, I Don't Need Help!
by Xavier Amador, Ph.D.

The Day the Voices Stopped: A Schizophrenic's Journey from Madness to Hope
by Ken Steele and Claire Berman

American Academy of Family Physicians

Medline Plus: Schizophrenia
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894

Last date updated: 
Fri, 2012-04-20

What is it?


What Is It?
Eating disorders are mental illnesses, and although they revolve around eating and body weight, they aren't entirely about food but also about feelings and self-expression.

Eating disorders are devastating mental illnesses that affect an estimated 20 million American women and 10 million American men sometime during their life. Approximately 85 percent to 95 percent of the people who suffer from the eating disorders anorexia nervosa and bulimia nervosa are women.

Although eating disorders revolve around eating and body weight, they are often more about control, feelings and self-expression than they are about food. Women with eating disorders often use food and dieting as ways of coping with life's stresses. For some, food becomes a source of comfort and nurturing, or a way to control or release stress. For others, losing weight may start as a way to gain the approval of friends and family. Eating disorders are not diets, signs of personal weakness or problems that simply will go away without proper treatment.

Eating disorders occur in all socioeconomic and ethnic groups. They usually develop in girls between ages 12 and 25. Because of the shame associated with this complex illness, many women don't seek treatment or get help until years later. Eating disorders also occur in young children, older women and men, but much less frequently.

There are four official eating disorders diagnoses: anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified (EDNOS).

Anorexia is a disorder in which preoccupation with dieting and thinness leads to excessive weight loss. If you suffer from this disease, you may not acknowledge that weight loss or restricted eating is a problem, and you may "feel fat" even when you're emaciated. Women with anorexia intentionally starve themselves or exercise excessively in a relentless pursuit to be thin, losing more than 15 percent of their normal body weight. Roughly half of all women suffering from anorexia never return to their pre-anorexic health, and about 20 percent remain chronically ill. The death rate for anorexia is among the highest of any psychiatric illness. The deaths are about evenly divided between suicide and medical complications related to starvation.

Women with bulimia regularly and sometimes secretly binge on large quantities of food—often between 2,000 and 5,000 calories at a time and, on rare occasions, even up to 20,000 calories at a time—then experience intense feelings of guilt or shame and try to compensate by getting rid of the excess calories. Some people purge by inducing vomiting, abusing laxatives and diuretics, or taking enemas. Others fast or exercise to extremes. If you suffer from this disease, you feel out of control and recognize that your behavior is not normal but often deny to others that you have a problem. Women struggling with bulimia can be normal weight or overweight and may experience weight fluctuations.

Women with binge eating disorder (BED) also binge on large quantities of food in short periods, but unlike women with bulimia, they do not use weight control behaviors such as fasting or purging in an attempt to lose weight or compensate for a binging session. When the binge is over, an individual with BED will often feel disgusted, guilty and depressed about overeating.

A fourth type of eating disorder, eating disorder not otherwise specified, refers to symptoms that don't fit into the other three eating disorders diagnoses. Individuals struggling with EDNOS, may have elements of BED, or be close to a diagnosis of anorexia or bulimia, but don't quite meet full diagnostic criteria. EDNOS is simply a catchall term for anyone with significant eating problems who doesn't meet the criteria for the other diagnoses. The majority of those who seek treatment for eating disorders fall into this category.

Although it has become synonymous with eating disorders, anorexia is relatively rare, affecting between 0.5 percent and 1 percent of women in their lifetimes, according to the National Alliance on Mental Illness. Another 2 percent to 3 percent develop bulimia and 3.5 percent develop binge eating disorder.

Yet, statistics don't tell the whole story. Many more women who don't necessarily meet all the criteria for an eating disorder are preoccupied with their bodies and are caught in destructive patterns of dieting and overeating that can seriously affect their health and well being.

There is no single cause of eating disorders. Biological, social and psychological factors all play a role. Evidence suggesting a genetic predisposition reveals that anorexia may be more common between sisters and in identical twins. Therefore, a woman with a mother or sister who has anorexia is 12 times more likely than the general public to develop that disorder and four times more likely to develop bulimia. Furthermore, among identical twins, whose genetic makeup is 100 percent the same, there is a 59 percent chance that if one twin has anorexia, then the other twin will also develop an eating disorder. For fraternal twins sharing only 50 percent of their siblings’ genes, there is an 11 percent chance that the other twin will have an eating disorder.

Other research points to hormonal disturbances and to an imbalance of neurotransmitters, chemicals in the brain that, among other things, regulate mood and appetite.

In some women, an event or series of events triggers the eating disorder and allows it to take root and thrive. Triggers can be as subtle as a degrading comment or as traumatic as rape or incest. Times of transition, such as puberty, divorce, marriage or starting college, can also provoke disordered eating behaviors. Parents who are preoccupied with eating and overly concerned about or critical of a daughter's weight, and coaches who relentlessly insist on weigh-ins or a certain body image from their athletes, especially in weight-conscious sports such as ballet, cheerleading, diving, wrestling and gymnastics, may also unintentionally encourage an eating disorder. Additionally, the pressure of living in a culture where self-worth is equated with unattainable standards of slimness and beauty can also perpetuate body image and/or eating issues.

Furthermore, the discrepancy between our society's concept of the "ideal" body size for women and the size of the average American woman has never been greater—leading many women to unrealistic goals where weight is concerned.



Because the consequences of eating disorders can be so severe, early diagnosis is crucial for lasting recovery. Eating disorders in general can disrupt physical and emotional growth in teenagers and can lead to premature osteoporosis, a condition where bones become weak and more susceptible to fracture. Additionally, the triad of osteoporosis, amenorrhea and disordered eating behaviors has the risk of leading to hormonal imbalances, which could also contribute to increased infertility and a higher risk of miscarriages.

Anorexia nervosa

Anorexia nervosa, a serious, potentially life-threatening disease characterized by self-starvation and excessive weight loss, has the highest mortality rate of any mental illness. Its onset is typically in early to mid-adolescence, and it is one of the most common psychiatric diagnoses in young women seeking treatment. Among the physical effects of anorexia are:

  • anemia, often caused by iron deficiency, which reduces the blood's ability to carry oxygen and causes fatigue, difficulty breathing, dizziness, headache, insomnia, pale skin, loss of hunger and irregular heartbeat

  • elevated cholesterol, which occurs because eating disorders affect liver function, reducing bile acid secretions that contain cholesterol and enabling more cholesterol to remain in the body rather than being secreted

  • low body temperature and cold hands and feet

  • constipation and bloating

  • shrunken organs

  • low blood pressure

  • slowed metabolism and reflexes

  • slowed heart rate, which can be mistaken as a sign of physical fitness

  • irregular heartbeat, which can lead to cardiac arrest

  • slowed thinking and cognitive and mood changes secondary to long-term starvation

Women with anorexia have an intense fear of becoming fat and, therefore, are obsessed with food, body shape and size. It is common for women with anorexia, for example, to collect recipes and prepare gourmet meals for family and friends, but not eat any of the food themselves. Instead, they allow their bodies to wither away and "disappear," gauging their hunger as a measure of their self-control. Women struggling with anorexia diet because they want to improve their feelings of self-esteem and love, not to lose a few pounds. Depression and insomnia often occur with eating disorders.

Women struggling with anorexia may tend to keep their feelings to themselves, seldom disobey authority and are often described as perfectionists. These individuals are often good students and excellent athletes. Anorexia is common in dancers and competitive athletes in sports such as gymnastics and figure skating, where success is measured not only on athletic performance, but also on having the "ideal" body.

Symptoms of anorexia nervosa can include:

  • distorted body image and intense persistent fear of gaining weight

  • excessive weight loss

  • menstrual irregularities

  • excessive body/facial hair

  • compulsive exercise

Bulimia nervosa

Bulimia nervosa involves using food and eating for emotional calming or soothing. Bingeing becomes a way to relieve stress, anxiety or depression. Purging the calories, through self-induced vomiting, laxative or diuretic abuse or over-exercising, relieves the guilt of overeating and may also be a way of releasing emotional tension or stress until the binge-purge cycle becomes a habit. Women struggling with bulimia are usually more impulsive, more socially outgoing and exhibit less self-control than those struggling with anorexia. They are also more likely to abuse alcohol and other substances.

Only 6 percent of those struggling with bulimia receive mental health care. Eating disorders are incredibly secretive illnesses, and the symptoms can be hidden or appear subtle, even to friends and loved ones. For example, women struggling with bulimia are not necessarily thin; they can be at an average weight and even a little bit overweight. Even so, they may be starving nutritionally because they are not getting the vitamins, minerals and other nutrients they need.

Symptoms of bulimia include:

  • preoccupation with food, weight and appearance

  • binge eating, usually in secret

  • vomiting and extreme use of laxatives or diuretics after binges

  • menstrual irregularities

  • compulsive exercise

Among the physical effects of bulimia are:

  • dehydration

  • chronic diarrhea

  • extreme weakness

  • damage to bowels, liver and kidneys

  • electrolyte imbalance and low potassium levels, which lead to irregular heartbeat, and in some cases, cardiac arrest

  • tooth erosion from repeated exposure to stomach acid

  • broken blood vessels in the eyes and a puffy face due to swollen glands, which can be indications of self-induced vomiting

  • cuts and calluses across the fingers from self-induced vomiting

  • tears of the esophagus due to forced vomiting

Binge eating disorder

Binge eating disorder (BED) affects approximately 1 percent to 5 percent of people in the United States. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), released in 2013, recognizes BED as an official eating disorder.

Similarly to bulimia, people with BED engage in binge eating, or a rapid consumption of large quantities of food, but they do not use compensatory behaviors such as fasting or purging to "undo" the effects of binge eating and control their weight. People with BED eat large amounts of food even when they aren't hungry. They struggle to differentiate between physical and emotional hunger, feel uncomfortably full after eating and often feel distressed about their binge sessions.

Like the other two official eating disorders diagnoses, BED can occur together with other psychiatric disorders, such as depression, substance abuse or anxiety disorders. Over time, women with BED tend to gain weight due to overeating, so the disorder is often (but not always) associated with obesity.

Symptoms of binge eating disorder include:

  • episodes of binge eating when not physically hungry

  • cycles of frequent dieting

  • feeling unable to stop eating voluntarily

  • awareness that eating patterns are abnormal

  • weight fluctuations

  • depressed mood

  • feelings of shame

  • antisocial behaviors

  • obesity

  • feeling "numb" or "spaced out" during a binge episode

  • feeling out of control while eating

  • losing track of time while eating

If BED is left untreated, it can lead to obesity, which has its own medical consequences such as:

  • high blood pressure

  • high cholesterol

  • gall bladder disease

  • diabetes

  • heart disease

  • certain types of cancer

Tests for Eating Disorders

Eating disorders are complex mental illnesses and there is no medical test that can diagnose an eating disorder. However, when seeking eating disorders treatment, your health care professional may draw some of your blood to determine if you are suffering from any medical consequences related to an eating disorder. Here are some things that may be tested:

  • Electrolyte balance. This primarily checks for dehydration but may also be indicative of malnutrition brought about by self-induced vomiting or laxative and/or diuretic abuse. Electrolytes are a specific combination of minerals your body needs to maintain balance to function properly, such as sodium and potassium. Common symptoms of imbalance are leg cramps, heart palpitations, high or low blood pressure and swelling in the legs and feet. An electrolyte imbalance can lead to kidney failure, heart attack and even death.

  • B12 and folic acid intake assessment. Lack of B12 and folic acid can lead to, or be caused by, problems with the metabolism of protein, carbohydrates and fat, and with the body's ability to absorb nutrients. Low levels of B12 or folic acid can contribute to depression and anxiety.

  • Blood glucose (blood sugar) level. Low levels of blood glucose can be the result of dehydration and malnutrition.

  • Liver function test. The malnourishment associated with eating disorders can lead to liver damage.

  • Cholesterol measurements. Anorexia or binge eating disorder can increase blood cholesterol levels.

  • Thyroid function test. This test rules out any problems with the thyroid, which can affect weight. It is an important test for someone in recovery who may be having a hard time gaining or losing weight. If necessary, medications would be prescribed to regulate the thyroid.

Your health care professional will probably also perform a complete analysis of your urine. This helps evaluate kidney function, urine sugar levels and ketone levels, as well as helps diagnose systemic diseases and urinary tract disorders. Ketones, which can accumulate in the blood rather quickly when the body is starved of food and nutrients, indicate the body is "eating its own fat" for energy. Accumulation of ketones in the blood can lead to ketoacidosis, which can cause coma and death.

Your health care professional may also take a blood pressure reading, provide a referral for a bone density test to evaluate for osteopenia or osteoporosis and perform an electrocardiogram to look for heartbeat irregularities.



Many women don't realize how damaging eating disorders are to their health. Women struggling with eating disorders may believe that their state of emaciation is normal and sometimes even attractive. Or they think that purging is the only way to avoid gaining weight. Therefore, it is critical that all health care professionals remain educated on the signs and symptoms of eating disorders and intervene if they become concerned.

People fail to realize that a potentially serious eating disorder may underlie their weight loss. Also, it is easy to confuse eating disorders with other emotional problems. Although women with depression may lose or gain weight, for example, that doesn't necessarily make them anorexic or mean they are binge eating. Unlike those with anorexia, bulimia or binge eating disorder, women struggling with depression do not have a distorted body image, a drive to be thin or a compulsion to binge and/or purge.

Eating disorders can be fatal; in fact, they are the deadliest mental illness. If you think you may have an eating disorder, you should seek treatment immediately. The sooner you recognize there is an issue and choose to seek treatment, the greater your chances are for lasting recovery.

Depending on the severity of your disordered eating behaviors, there are various treatment options:

  • Inpatient treatment programs offer 24/7 support and medical monitoring and are designed for those whose eating disordered behaviors have led to extremely low body weight and/or serious medical complications.
  • Residential treatment programs also offer 24-hour observation and support, but individuals in residential eating disorders treatment do not require the same level of medical and psychiatric supervision as is available at the inpatient level of care.
  • Partial hospitalization programs are daytime treatment programs that allow people in treatment to practice recovery skills with guidance during the day and on their own in the evenings and at night.
  • Outpatient programs offer individuals struggling with eating disorders the opportunity to "step down" from a higher level of care while maintaining their daily activities. These types of programs provide additional support for anyone struggling with self-esteem or body image issues.

Insurance coverage for eating disorders treatment varies depending on the individual and their insurance policy. Eating disorders treatment centers work with patients and their families to secure the best possible option to foster lasting recovery.

And treatment is no easy task. When a woman with anorexia starves herself, she feels better. When a woman with bulimia or binge eating disorder binges, she feels less depressed. The eating disorder serves a purpose in the mind of the woman who has it. It becomes a kind of companion that is hard to let go of.

Not surprisingly, relapses are common and lasting eating disorders recovery often comes only after engaging in multiple treatment approaches. You may find it most effective to work with a multidisciplinary treatment team. This team of dietitians, psychotherapists and physicians may use a variety of treatment methods, including:

  • psychological counseling or cognitive-behavioral therapy to help you replace negative attitudes about your body with healthier, more realistic ones
  • medical evaluations to stabilize you physically
  • nutritional counseling to teach you good nutritional habits
  • medications, such as antidepressants, to address coexisting conditions
  • family therapy to establish the support system you need for lasting recovery

Treatment of anorexia is often approached as a three-step process:

  • restoring weight loss due to severe dieting and purging
  • treating psychological conditions such as distorted body image, low self-esteem and interpersonal conflicts
  • long-term remission and rehabilitation or full recovery

A one-year study published in the Journal of the American Medical Association determined that there was no significant difference between those with anorexia who took antidepressants and those who received a placebo—evidence that there is no "magic pill" to make your disorder go away and keep it away.

The only antidepressant approved by the Food and Drug Administration for treatment of bulimia is the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac), but doctors may also prescribe other antidepressants for the condition, including the SSRIs sertraline (Zoloft) and paroxetine (Paxil), and the tricyclic antidepressants amitriptyline (Elavil) and desipramine (Norpramin). The antidepressant bupropion (Zyban) may also be used, although it is not typically recommended as individuals struggling with bulimia because they may experience seizures as a side effect.

While health care professionals may find it beneficial to prescribe various medications to their eating disorders patients, medications are primarily reserved for coexisting conditions.

Some physicians may also prescribe antipsychotic medications to help reduce the rigid and distorted thinking and agitation that can accompany anorexia, but these drugs can frighten patients by dramatically increasing appetite, so they should be used with caution. For people struggling with anorexia who experience extreme anxiety surrounding eating, antianxiety drugs, such as benzodiazepines, may be used.

Cognitive behavioral therapy (CBT) is currently the primary evidence-based treatment approach for bulimia and binge eating disorder. By addressing both structured eating patterns and thoughts that interfere with self-worth and mood management, CBT teaches skills to help you manage triggering situations. Another often utilized treatment philosophy is dialectical behavioral therapy (DBT), which teaches self-regulatory skills and focuses on emotional management.

Another approach to treating eating disorders is family-based treatment. In a family-centered treatment program, the family assumes responsibility for making the patient eat. No one is "blamed" for triggering the illness; rather, the eating disorder is treated as a medical condition, and the family is taught to care for the sick person. The power shifts back to the individual after he or she reaches an acceptable weight. This method works best on people with anorexia, but it also works on some with bulimia. It is typically utilized in adolescents and is being researched for use in young adults.



Eating disorders screening and prevention programs on college campuses across the country aim to educate young women and men about the signs, symptoms and dangers of eating disorders and teach them how to develop a healthy body image and self-worth and positive coping skills.

Screening is important because it is so difficult to change body image attitudes and unhealthy eating patterns once they form. Primary prevention needs to take place early, before young people learn to feel bad about their bodies. Therefore, eating disorder prevention efforts are beginning to occur in high schools, middle schools and even as early as elementary schools.

How a person perceives his or her body is only one component of a complete self-image, but too often it becomes the sole factor in determining self-esteem. When "how I look" becomes more important than "who I am," the groundwork is laid for crippling and life-threatening eating disorders.

Parents, loved ones and other role models can help prevent poor self-images from occurring by examining their own attitudes about their bodies and by fostering a healthy, positive body image in their children. Take these steps, even with young girls, to discourage unhealthy behaviors:

  • Accept that puberty will influence girls' perception of their bodies, but be prepared to step in if certain behaviors become unhealthy.
  • Don't reinforce the message that women have to look a certain way.
  • Teach girls how their bodies change during adolescence and that it is normal and healthy to gain weight during puberty.
  • Talk about images of women portrayed in the media and invite discussion on whether or not the images are realistic or create an unattainable "ideal" body shape and size.
  • Take women and girls seriously for what they say, feel and do, not for how slim they are or how they look. It is about what the body does, not what it looks like.
  • Encourage children to be active as a way to have fun and to enjoy what their bodies can do.
  • Exercise with your children to promote a healthy family lifestyle.
  • Model healthy attitudes about your own body. Girls need to see women who are satisfied with their bodies and appearance or who take positive and healthy steps toward making changes. Girls who see their mothers worrying about their own appearance and weight are more likely to believe that being thin will make them happy.
  • Don't nag about eating or focus on eating habits, which could make a child more self-conscious and secretive about her or his relationship with food.
  • Don't compare young children and teenagers to others and don't be judgmental about other people's weight.
  • Be on the lookout for the use of diet pills, which has been documented in children as young as 10 years old.

Most important, do not ignore disordered eating behaviors. Eating disorders are devastating and potentially fatal diseases. But people can and do recover from these illnesses, once they are accurately diagnosed and properly treated.

Facts to Know

Facts to Know

  1. Eating disorders affect an estimated 20 million American women and 10 million American men sometime during their life. Eighty-five to 95 percent of those suffering from anorexia and bulimia are women.

  2. Eating disorders most often begin early, usually between the ages of 12 and 25, but are not limited to people within these ages.

  3. Between 0.5 percent and 1 percent of women suffer from anorexia, between 2 percent and 3 percent of women suffer from bulimia and 3.5 percent suffer from binge eating disorder.

  4. Women struggling with anorexia, though often well-liked and admired for their competence, often strive to seek approval and may have very low self-esteem and feel inadequate. They may use food and dieting as ways of coping with life's stresses.

  5. An eating disorder usually does not go away without treatment. Eating disorders are mental illnesses that can be deadly if not treated and are difficult to recover from; however, recovery is possible. Many women have recovered successfully and gone on to live full and satisfying lives.

  6. Treatment for eating disorders encompasses a mixture of strategies, including psychological counseling, nutritional counseling and individual, group and family therapy.

  7. Thereis a high incidence of depression among women suffering from bulimia, thus the utilization of antidepressants for some people. But antidepressants are most effective when combined with cognitive-behavioral therapy.

  8. The self-starvation of anorexia can cause severe medical complications, such as: anemia; shrunken organs; low blood pressure; slowed metabolism and reflexes; bone mineral loss, which can lead to osteoporosis; and irregular heartbeat, which can lead to cardiac arrest.

  9. The bingeing and purging of bulimia can lead to liver, kidney and bowel damage; tooth erosion; tears of the esophagus and stomach lining; and electrolyte imbalance, which can lead to irregular heartbeat and, eventually, cardiac arrest.

  10. If obesity results from bingeing, medical consequences include high blood pressure, high cholesterol, gall bladder disease, diabetes, heart disease and risk factors for certain types of cancer.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about eating disorders so you're prepared to discuss this important health issue with your health care professional.

  1. What are my options for treatment?

  2. How would you describe your approach to eating disorders treatment?

  3. How do you address depression and/or anxiety? What if I do not feel like I am depressed (or anxious)?

  4. Will you involve my family?

  5. What role, if any, will medication play? What percentage of people who see you take medication? Which medications?

  6. What can I expect from the medications?

  7. What can I expect during a counseling session?

  8. When, if ever, do you hospitalize patients?

  9. What goals would we set for my treatment?

  10. What does the recovery process look like?

Key Q&A

Key Q&A

  1. How can I tell if I have an eating disorder?

    If you have lost a fair amount of weight in a short amount of time, you may have eating disorders symptoms. If you binge by consuming large amounts of food at a time, often in secret, and perhaps follow it by purging and feelings of guilt and shame, you may be struggling with an eating disorder. If you are preoccupied with your body and caught up in destructive patterns of dieting and overeating, these are signs of disordered eating behaviors. All of these behaviors can affect your health and overall well-being. Talk to a health care professional about your feelings and constant need to diet, control your food intake and/or your fixation on food. Have him or her assess the diets you are trying; if they do not offer enough nutrients or calories, they will be almost impossible to stick to.

    If you are concerned about your behaviors or those of a friend or loved one, it is important to seek an eating disorders assessment and talk with an eating disorders professional to determine an official diagnosis and proper course of treatment.

  2. My daughter is neither overweight nor underweight, but I have found evidence of secretive eating, like dozens of candy wrappers under her bed. What's going on?

    Bulimia is often hard to recognize because individuals struggling with the disease do not tend to be at an extreme weight-high or low. However, if a person takes in a significant amount of calories at a time, as in a dozen candy bars at one time, for instance, then purges by making himself or herself vomit, taking laxatives or enemas, fasting or exercising to the extreme, he or she may have bulimia. If asked, there is a good chance that he or she will deny that fact. Parents and loved ones concerned for their children and their children's health should speak to a health care professional, such as their children's pediatrician, about the child's eating behaviors.

  3. Is a compulsion to exercise to the extreme, such as several hours a day, part of an eating disorder?

    If the compulsion is driven by a desire to lose weight, despite being within a healthy weight range, or if the compulsion is driven by guilt due to bingeing, then, yes, this compulsion to exercise is a dimension of an eating disorder. There are also individuals who compulsively exercise because that has become their sole way of coping with stress or emotions. These individuals may not be as motivated by body image distortions or desires to lose weight, but rather by an inability to tolerate emotions and daily stressors. This is also a dimension of an eating disorder.

  4. How is anorexia treated? Does it require hospitalization?

    Your health care professional may hospitalize you if your anorexia has resulted in life-threatening complications that are best treated in a hospital, or if continued starvation will soon lead to such complications. In any case, you will likely be treated with a combination of psychological counseling, nutritional education, and individual, group and family therapy.

  5. How is binge eating treated?

    Frequent binge eating is a symptom of bulimia and binge eating disorder. Psychological counseling, nutritional education, medications and individual, group and family therapy can all play a role in recovery from these eating disorders.

  6. Who gets eating disorders?

    Eating disorders are mental illnesses that cut across the socioeconomic and ethnic spectrum; they know no gender, age or lifestyle. However, 85 percent to 95 percent of those suffering from eating disorders are women.

  7. What causes eating disorders?

    There is no single cause of eating disorders. Biological, social and psychological factors all play a role. A person may even have a genetic predisposition to eating disorders. In many people, an event or series of events-a degrading comment, traumatic event, a transition such as divorce or starting college-may trigger eating disordered behaviors and allow the eating disorder to take root and thrive. Parents or coaches who are preoccupied with eating and overly concerned or critical of a young child or teenager's weight or body image may also unintentionally "encourage" an eating disorder, as can societal and cultural pressures.

  8. How do I prevent my young daughter from developing an eating disorder?

    The best thing you can do is start young. First, instill in her a healthy body image and good eating patterns by modeling these yourself and having open conversations with her. Teach her about how her body will change as she enters puberty so she will expect the changes in body shape and size. Show her that women of all body types and sizes can be successful and independent. Talk to her about the unrealistic expectations formed by constant exposure to models and actresses who starve themselves to look emaciated. Don't nag her or focus on her eating habits, but, rather, set a healthy example and emphasize that it is what our bodies do for us that is important, not how they look.

Organizations and Support

Organizations and Support

For information and support on coping with Eating Disorders, please see the recommended organizations, books and Spanish-language resources listed below.

Academy for Eating Disorders
Address: 111 Deer Lake Road, Suite 100
Deerfield, IL 60015
Phone: 847-498-4274

American Psychological Association
Address: 750 First St., NE
Washington, DC 20002
Hotline: 1 -800-374-2721
Phone: 202-336-5500

Harris Center for Education and Advocacy in Eating Disorders
Address: 2 Longfellow Place, Suite 200
Boston, MA 02114
Phone: 617-726-8470

Multi-service Eating Disorder Association (MEDA)
Address: 92 Pearl St.
Newton, MA 02458
Hotline: 1-866-343-MEDA (1-866-343-6332)
Phone: 617-558-1881

National Association of Anorexia Nervosa and Associated Disorders (ANAD)
Address: P.O. Box 640
Naperville, IL 60566
Hotline: 630-577-1330
Phone: 630-577-1333

National Eating Disorders Association (NEDA)
Address: 603 Stewart St., Suite 803
Seattle, WA 98101
Hotline: 1-800-931-2237
Phone: 206-382-3587

Overeaters Anonymous
Address: P.O. Box 44020
Rio Rancho, NM 87174
Phone: 505-891-2664

Renfrew Center
Address: 475 Spring Lane
Philadelphia, PA 19128
Hotline: 877-367-3383

Shape Up America!
Address: 15009 Native Dancer Road
North Potomac, MD 20878

Anorexia Nervosa: A Guide to Recovery
by Lindsey Hall, Monika Ostroff

Anorexia Nervosa: When Food is the Enemy
by Erica Smith

A Starving Madness: Tales of Hunger, Hope and Healing in Psychotherapy
by Ph.D. Judith Ruskay Rabinor, Judith Ruskay Rabinor

Body Wars: Making Peace with Women's Bodies
by Margo Maine

Bulimia: A Guide to Recovery
by Lindsey Hall, Leigh Cohn M.A.T.

Como entender y superar la anorexia nervosa
by Lindsey Hall, Monika Ostroff

Como entender y superar la bulimia
by Lindsey Hall, Leigh Cohn M.A.T., Leigh Cohn

Cure Your Cravings - The Revolutionary Program Used by Thousands to Conquer Compulsions
by Yefim Shubentsov, Barbara Gordon

Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments and Prevention of Eating Disorders
by Carolyn Costin

Eating in the Light of the Moon: How Women Can Transform Their Relationship with Food Through Myths, Metaphors, and Storytelling
by Anita A. Johnston PhD.

Hunger Within: A Twelve-Week Self-Guided Journey from Compulsive Eating to Recovery
by Marilyn Migliore

If You Think You Have an Eating Disorder
by John Barnhill, Nadine Taylor

Inner Hunger - A Young Woman's Struggle Through Anorexia and Bulimia
by Apostolides Marianne

Making Weight: Healing Men's Conflicts with Food, Weight, Shape and Appearance
by M.D. Arnold Andersen, Leigh Cohn M.A.T., M.D. Tom Holbrook, Leigh Cohn, et al.

Self-Esteem Comes in all Sizes: How to Be Happy and Healthy at Your Natural Weight
by Carol A. Johnson M.A., Gary Foster Ph.D., M.A., Carol A. Johnson, Gary Foster

Women Afraid to Eat: Breaking Free in Today's Weight-Obsessed World
by Frances M. Berg

Medline Plus: Eating Disorders
Address: Customer Service
US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20984

National Easting Disorders Associations
Address: Information and Referral Helpline
603 Stewart Street, Suite 803
Seattle, WA 98101
Hotline: 1-800-931-2237
Phone: 206-382-3587

Last date updated: 
Mon, 2013-08-26