Everybody Knows Somebody: Eating Disorder Awareness

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Eating disorders are some of the most challenging mental illnesses and are serous, life-threatening conditions. Affecting one in 20 people during their lifetime, eating disorders frequently occur in people with other mental illnesses, including depression, anxiety disorders and substance abuse issues and as with other mental illnesses, early identification and early intervention are keys to recovery.

NAMI joins NEDA this week in support of the aim to ultimately prevent eating disorders while reducing the stigma surrounding these conditions and improving access to treatment.

NAMI recently spoke with Andrea Vazzana, Ph.D., a clinical psychologist and eating disorders specialist, to learn more about eating disorders and how to help a friend or loved one living with one of these conditions.

NAMI: What is the current prevalence of eating disorders in America?

Vazzana: Overall, over 10 percent of young women currently meet criteria of one of the eating disorders, anorexia nervosa, bulimia nervosa or eating disorder NOS (not otherwise specified). The new Diagnostic and Statistical Manual (DSM5), set to publish in May this year, includes binge eating disorder as a mental illness. Men can also live with eating disorders. While the prevalence of men to women was previously thought to be a ratio of 1-to-10, it is now believed that the ratio is closer to 1-to-6, meaning that six times more women than men have the condition. Although not as common in men, it is important to recognize that more men are now being treated for these mental illnesses.

Some believe that eating disorders are more prevalent in women because of what is called the “thin-ideal”. Biology and environment are both contributors to this condition, and researchers have found that the cultural pressure to equate thinness with beauty, as well as some sports that encourage low body fat and thinness, are factors. It is not always the ideal cultural “think” to equate thinness in men and therefore that social factor is often removed. Still, there are some sports and cultures where being thin is idealized and therefore a contributor.

What are the types of eating disorders and are there any recent changes in prevalence and conditions?

Vazzana: Eating disorders NOS, will be changing with the new DSM, to be published in May. The criteria and diagnosis will change. Binge eating will be a full-blown disorder all on its own. Binge eating disorder is similar to bulimia in that it includes the binging, but not the purging, aspect of the condition.

What are the most common co-occurring disorders (mental health conditions)?

The most common is depression and dysthymia, what some consider a less-severe but often longer lasting condition than depression. Half to three-fourths of those with eating disorders meet the criteria for depression in their lifetime, and there is a direct relationship to malnourishment and depression.

In addition to depression, the other most common co-occurring conditions are anxiety disorders, specifically social phobias and, with people living with anorexia, OCD, which impacts about 25 percent of individuals with this condition.

Substance abuse, particularly alcohol abuse, is co-occurring in about 5 percent of people living with anorexia and from 25-40 percent of people living with bulimia.

Personality disorders are also common co-occurring conditions, particularly for people living with bulimia.

What are current treatment options available and what are likely outcomes?

Recovery from eating disorders is possible. The right treatment choice depends on the type of eating disorder, but treatment approaches are often similar for the various conditions, and coordination of care between mental health care providers, nutritionists and medical professionals is important, depending on the individual’s treatment plan. Nutritional guidance, as well as individual and family counseling, is an important treatment options to consider.

The best rates of recovery for people living with bulimia involve cognitive behavioral therapy (CBT) where the focus is often on normalizing weight and eating behaviors and challenging distorted thinking patterns that are usually associated with this condition. One of the goals is to interrupt the thought pattern that leads to individuals evaluating themselves in terms of shape and weight. Individual therapy is often another key to recovery.

The best rates of recovery for people living with anorexia include treatment plans that incorporate family-based therapy, often the Maudsley Method, which is often used for adolescents and children with Anorexia still living at home. This intervention involves parent coaching to encourage feeding their children to help restore their weight—eating meals with them and encouraging eating. With anorexia, it is important that the individual restore their weight as soon as possible; the longer they are in a danger zone of thinness and malnutrition, the worse the outcome. Early intervention is key; people living with anorexia (about 5 percent) have the highest probability for mortality, including death by suicide.

In addition to psychotherapies, medications, specifically, selective serotonin reuptake inhibitors, SSRIs, a type of antidepressant medication, are sometimes used in patients that are responding to CBT as an adjunct therapy.

What myths are the most common and what stereotypes exist that create barriers to understanding and treatment?

The myths surrounding eating disorders are vast and include myths primarily around race, age and social economics.

When people think of anorexia, they often mistakenly think of young, white, high social status females. This is not the case. There are 5-10 million people in America who have eating disorders, and one out of 6 are men, who more deeply experience the negative aspects of stereotypes and have unique barriers to treatment and acceptance.

We also know that eating disorders do not just affect white women. The rates are as common in young Hispanic and Native American women as they are in Caucasian women. With African American and Asian American women, however, there does seem to be a lower prevalence, with the exception of pre-adolescent African American girls. With Caucasian girls, the prevalence is lower and rates increase with puberty and continue to increase as into early adulthood.

Age is another myth; eating disorders do not just affect teens and young adults. More and more are being diagnosed for the first time in middle age. And unless effectively treated, eating disorders will last into adulthood for many.

How can someone help a friend or loved one who may have or one who is living with an eating disorder? How should they/could they intervene if needed and how can the provide support?

Regarding intervention, the key to remember is that the earlier the better. In terms of identifying a problem, it is important to know that it is common to have body dissatisfaction. Most women are more critical. However, when they go beyond dissatisfaction and they are harshly critical and disparaging of their bodies, and when there is noticeable evidence of over-thinness and over concern about food and weight, there may be a problem.

Some people mistakenly wait to intervene, thinking that the individual may grow out of their condition. The best thing to do is to let them know about your concern. You have observed behavior—talking poorly about their body, other signs—and you just want to be honest. Saying something like, “I have noticed these things and I am concerned about your health,” without being judgmental, can be the most natural first step. Because individuals living with eating disorders are generally already self-critical, it is important to so separate the illness from the individual. Try not to focus comments on appearance but rather focus comments on health by expressing concerns and the need for further medical evaluation. Recognizing that people with eating disorders often consider being thin with success, being persistent and consistent while avoiding criticism and comments on thinness, is important.

After an individual is in treatment for an eating disorder, one of the best things a family member or parent can do is to get family-based treatment or therapy. During meals, families and friends should try not to be angry even if they see their friend or loved one struggling with eating. Working to avoid impatience can be challenging, but neutral and supportive reassurance offer the best outcomes.

It is important that friends and family strive to avoid commenting on appearance. Avoid comments like, “You’re gaining some weight, that looks great!” Compliment other things, perhaps superficial aspects of clothing, conversations, other activities and contributions, but avoid mentions of size or appearance if possible.

What do you think is the most important thing for people to know about eating disorders?

The importance of intervening early! Treatment works best the earlier you can begin it. The longer the condition persists, the more deadly it becomes with more physical complications to manage.

Andrea Vazzana, Ph.D.,is a clinical assistant professor of child and adolescent psychiatry at the NYU School ofMedicine and a licensed psychologist at the Child Study Center.

 

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11 Ways to Stop a Panic Attack

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Panic attacks can be scary and can hit you quickly. Here are 11 strategies you can try to stop anxiety when you are experiencing a panic attack.

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Video on Grief & Loss

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Video on Grief & Loss

The Concept of Grief

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Join CARE Counseling and My Talk’s Mom Show as we work to connect Minneapolis Mom’s to Mental Health and Counseling Resources. Special guests this week on The Mom Show includes staff members Shannon Henry and Heidi Bausch as they discuss the concepts of grief and loss.

How a Toxic Work Environment Affects Your Mental Health

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Not only is incivility in the workplace on the rise, but according to a recent study, it is compromising one of our most critical assets—our mental health.

The authors of the study, published in the Journal of Occupational Health Psychology, looked at the correlation between toxicity in the workplace and symptoms of insomnia, a common symptom of clinical depression. They wanted to know how, or via which mechanism, incivility in the workplace negatively affected employees’ sleep quality, as there has been limited research into this factor.

What Is Workplace Incivility?

Workplace civility, as described by McKinsey and Company, is “the accumulation of thoughtless actions that leave employees feeling disrespected—intentionally ignored, undermined by colleagues, or publicly belittled by an insensitive manager.” It has also been defined as “low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect.”

Why Quality of Sleep Matters

Sleep is a critical factor in our overall well-being, including our work performance. It has long been established that poor quality of sleep has significant implications for both our physical and psychological well-being.

For example, insufficient sleep increases a person’s risk of developing serious medical conditions, including obesity, diabetes, and cardiovascular disease. Additionally, lack of sleep over time has been associated with a shortened lifespan.

Effects of Negative Rumination

In examining the indirect effects of workplace incivility on symptoms of insomnia and thus overall health, the determining mechanism was found to be negative rumination, or the mentally replaying of an event or disturbing interaction with a co-worker long after the workday has ended.

“Workplace toxicity leads to adverse effects in part by stimulating people to ruminate on their negative work experiences.” according to the authors. “Negative rumination represents an active cognitive preoccupation with work events, either in an attempt to solve work problems or anticipate future work problems.”

Given that most of us spend the better part of our days and our energy at work, increasing hostility in the workplace doesn’t bode well for our emotional or physical well-being. Research over the past 20 years has associated toxic work environments with increased depression, substance use, and health issues among employees. Further research has shown that organizations are suffering as well. Some of these adverse effects include decreased productivity, lower levels of employee commitment and increased turnover.

Coping Techniques to Reduce Effects of Workplace Incivility

The good news is that sufficient recovery or coping techniques may be able to mitigate the negative effects of a toxic work environment on employee well-being. In particular, relaxation and psychological detachment. The ability to psychologically detach from work during non-work hours and relaxation were shown to be the two mitigating factors that determined how workers were affected or not by a negative work environment.

Employees who were better able to detach psychologically are able to relax after work and sleep better even in the face of workplace incivility. Below are descriptions of these recovery experiences and how they were shown to reduce the negative effects and enable employees to thrive in the most toxic of work environments.

Psychological Detachment

Psychological detachment represents an avoidance of work-related thoughts, actions or emotions. Some of the items used in the study to measure employees’ levels of psychological detachment in the evenings including the following: “I didn’t think about work at all” and “I distanced myself from my work.” Those who were able to detach themselves mentally from this cycle do not suffer as much sleep disruption as those who are less capable of detachment.

Detachment can be fostered through a variety of specific activities, including exercise. Planning future events such as vacations or weekend outings with family or friends are examples of positive distractions outside of work.

Relaxation

It should come as no surprise that prioritizing work-life balance was shown to be another effective buffer against the detrimental effects of workplace incivility. Relaxation has long been associated with fewer health complaints and less exhaustion and need for recovery.

As hypothesized by the authors of the study, relaxation during non-work time served as an important moderator of the relationship between negative work rumination and insomnia symptoms. Additionally, it has been identified as a moderator between work characteristics and occupational well-being, between time demands and exhaustion, and between job insecurity and need for recovery from work. Relaxation provides an opportunity for individuals to halt work-related demands, which is critical for restoring individuals to their pre-stressor state.

Some activities outside of the office that can foster recovery include volunteering, meditation, taking a walk, listening to music, and spending time with friends and other positive social supports.

How Organizations Can Address Workplace Incivility 

Based on the results of the study, the authors suggest the following interventions that companies can address to reduce workplace incivility.

  • Raise awareness
  • Ensure protection for employees
  • Ensure accountability
  • Train and model appropriate behavior
  • Train supervisors on aggression-prevention behaviors
  •  Improve emotional resilience skills
  • Offer training on recovery from work, mindfulness practices, emotional/social intelligence skills

A Word From Verywell

You may not be able to control certain events during work hours or the characteristics of your workplace environment. However, what you do have control over is how you choose to cope. Most importantly, finding time to relax, spending time with friends and family, and engaging in activities that will shift your focus away from work during non-work hours.

If you find that you are still experiencing distressful symptoms and that they are interfering with your functioning, it may be a good idea to speak to a therapist who can help you learn additional strategies for coping.

If despite having done all you can still nothing has changed, it might be time to consider the possibility of removing yourself from the toxic environment and looking for a new, more fulfilling and less distressful job. Your health may depend on it.

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In Minnesota, 4 out of 5 gun deaths are suicide

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Juanita Jensen grew up in a gun family. She doesn’t hunt, but believes in the sport and is used to having guns around.

And as the parents of five children, Juanita and her husband were careful to follow all the rules for firearm safety: Keep the guns separate from the bullets. Lock up everything. Enroll their teen boys in gun-safety classes so they could learn to hunt responsibly.

But despite all of their precautions, they realized just how tough it is to keep guns away from someone who shouldn’t have one.

Most Americans are unaware that suicides — not mass shootings, other murders or accidental gun discharges — account for the majority of gun deaths in the United States, according to a recent survey from APM Research Lab. As many as three-fifths of gun deaths in the U.S. are the result of people intentionally killing themselves.

And in Minnesota, the statistics are even worse: 4 out of 5 deaths by firearms are suicides.

Four years ago, when Jensen’s second oldest was 19, he had a psychotic break and ended up in the hospital. (He didn’t want to talk to MPR News for this story and asked that we not use his name. We agreed to respect his privacy.)

The hospital kept him for three days — what’s known as a 72-hour hold — to see if he might hurt himself or somebody else. Hospital staff didn’t say anything to him or his parents about guns when they sent him home. And with the family’s emphasis on gun safety, and Jensen’s worries about their son’s health, it didn’t occur to her.

“They don’t send you home with … a packet, you know, that said, ‘Listen, the hold is over. We’re gonna discharge him. Here are some meds, just things are good,’” she said.

That was in the spring. By the beginning of the summer, Jensen’s son was worse. Her husband was so concerned that he quietly took the guns — and the ammunition — to her brother’s house in another city.

Then one night in June of 2015, one of their sons woke them up with a gun. “Please do something with this,” she says he told them. He told his parents his brother was upstairs “trying to take his life.”

The 19-year-old had gone to Walmart and bought a shotgun, they learned. His brother had found him just in time.

Red flag laws
Seventeen states have passed red flag laws, which let families petition to have peoples’ guns taken away if there’s reason to believe that they would hurt somebody. In Minnesota, red flag bills have come up in the Legislature a few times, but none have gone through. Some states have seen a drop in suicides as a result of red flag laws.

The night he tried to kill himself, Jensen’s son ended up in the hospital and eventually was committed. That means he was under a court order to follow certain rules, including one that barred him from having firearms. In his case, it was the first time any kind of oversight about guns kicked in.

Commitments are handled at the county level; they require an elaborate set of rules that guarantee the person due process, including medical exams and a judge.

The problem is even though the statute says clearly that a person who is committed may not have guns, it doesn’t say how to get the guns away from the person. So, people like Theresa Couri, who helps handle commitments at the Hennepin County Attorney’s Office, are left trying to figure out what to do.

During the commitment process, her office sometimes finds out that the person has a gun or has access to a gun.

When that happens, Couri said, it’s important to get it away from the person. But doing that can be complicated.

“So, what my staff attorneys often do,” she said, “is contact a family member, they will contact a spouse, if it’s a young person, a roommate,” and ask them to go to the house — or wherever the weapon is — to retrieve it.

If they can’t find somebody close to the person, then attorneys call the local police and have them take the weapons.

“I don’t feel that doing nothing is appropriate, so our lawyers engage in activities that I think are consistent with the statute,” said Couri, who was not involved in the case of Jensen’s son. “The statute says a person committed is ineligible [to have a gun]. If we know there’s a gun, we should be taking some action, in concert with law enforcement, to do our best to effect that part of the statute.”

The other thing that happens when a person is committed, whether they are known to have access to a gun or not, is that the person’s name gets reported to the FBI. It’s then added to a confidential list that licensed gun dealers have to check before they sell somebody a gun.

Who can buy a gun?
Kory Krause, who owns the Frontiersman Sports gun shop in St. Louis Park, said would-be gun buyers are required to fill out a form that asks for the person’s identifying information. It seeks not just the basics like name, birth date and address, but also things like height, weight and race. And it includes a checklist of potential disqualifiers, including whether the person has been convicted of a felony or committed to a “mental institution.”

The gun shop submits the form to the FBI, which then has three days to respond, either giving permission for the person to buy, denying it, or asking for more time. The list is confidential so when a person is denied, neither the seller nor the buyer are told why. Krause said it’s rare that a person who knows he’ll be denied bothers to try buying a gun.

What does happen, though, is people who want to hurt themselves will occasionally come in to buy a weapon. And if they’re not on the list, then it’s up to Krause and his employees to recognize the potential danger and stop the sale.

Krause said he’s never gotten any official training to identify somebody in a mental health crisis, and that he and his employees rely on experience and intuition. They might get suspicious if, say, an old man comes in and wants a revolver and only one or two bullets, or if the person physically can’t operate the gun.

He said if he thinks a person might try to hurt himself, he’ll refuse to sell and call the police to check on the person. But he knows a person who is suicidal will at times slip through.

“We know that when they walk out that door, what they do with it could be good or bad,” he said. “It’s an unfortunate component of the business.”

There are other loopholes or gaps that let people get guns when they shouldn’t, including private sales, which aren’t subject to background checks.

Juanita Jensen’s son is doing better, following the rules of his treatment and living on his own. He could eventually petition the state to be allowed to have guns again.
This reporting is part of Call to Mind, our MPR initiative to foster new conversations about mental health.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingofSuicide.com/resources for a list of additional resources.

If you or someone you know has had guns taken away because of mental health concerns or if you have tried unsuccessfully to get guns taken away from somebody because of mental health concerns, we’d like to hear from you: aroth@mpr.org or 651-290-1061.

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This Is When to See a Mental Health Professional About Your Anxiety

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It seems everyone is talking about anxiety these days, and that’s not a bad thing. Shining a light on mental health helps reduce the stigma that keeps many people from seeking support.

At the same time, it can be hard to know if the worries and racing heart you experience at the thought of, say, meeting new people, is run-of-the-mill stress, or if you’re actually experiencing some level of anxiety and could benefit from seeing a professional.

“I can’t tell you how many people I see who say, ‘I don’t know if I should be coming in here,’” clinical psychologist Robert Duff, Ph.D., author of Hardcore Self Help: F**k Anxiety., tells SELF. “On a broad scale, [talking about anxiety] is positive, but I don’t blame anyone for the confusion.”

Figuring out how serious your anxiety is can be tough because anxiety is a normal and essential part of being a human.

“Anxiety is a reaction to a situation we perceive as stressful or dangerous,” Monique Reynolds, Ph.D., licensed clinical psychologist at the Center for Anxiety & Behavioral Change in Rockville, Maryland, tells SELF. This produces a stress response in your body—specifically, your brain’s hypothalamus triggers your sympathetic nervous system to release norepinephrine (aka adrenaline) and cortisol (a stress hormone) to get you out of harm’s way.

This is actually a good thing when there is a real threat of danger present. “A major part of our brain’s job is to keep us alive, and fear and anxiety are a big part of that,” Reynolds says. For example, the anxiety you would feel at seeing a truck hurtling towards you would make you move from its way more quickly.

But if you have anxiety, that stress response can kick in when it shouldn’t. “You feel very much the way you do when in a dangerous situation…[but] there’s no real danger there,” Duff says. Instead of being helpful, this misfiring of your fight or flight reaction can hinder you.

While a little anxiety can also help you to perform at an optimal level under stress, giving you a burst of adrenaline and hyper-focus to finish a business proposal before deadline or nail that dance number at a performance, living in a constant heightened state of anxiety can be distracting at best and debilitating at worst. When anxious thoughts are interfering with your life and causing you significant distress, that isn’t something you should just chalk up to nerves and push through. That’s something you can get help with.

Anxiety is the most prevalent mental illness in the United States, and it comes in various forms.

Anxiety affects about 40 million American adults each year, according to the Anxiety and Depression Association of America (ADAA). But it’s not as cut-and-dry as saying that anxiety is simply when you feel nervous all the time. This mental health condition comes in many forms.

Generalized anxiety disorder (GAD) is characterized by having excessive worries and fears for months, according to the National Institute of Mental Health (NIMH). Per the ADAA, GAD affects 6.8 million U.S. adults each year. Panic disorder involves spontaneous bouts of debilitating fear known as panic attacks, along with intense worry about when the next attack will come, according to the NIMH. Per the ADAA, it affects 6 million American adults each year. Social anxiety disorder (also known as social phobia) happens when you have a marked fear of social situations in which you might be judged or rejected, as well as avoiding these situations or experiencing symptoms like nausea, trembling, or sweating as a result.

Then there are other issues that are closely related to anxiety, like obsessive-compulsive disorder, which involves intrusive thoughts and urges, and posttraumatic stress disorder, which happens when people have a prolonged stress response to harrowing situations.

These are just some of the various anxiety and anxiety-adjacent disorders out there. That these issues can present in myriad ways can make it even harder to know if what you’re experiencing is anxiety that could benefit from outside help.

“Some people feel they can control their anxiety, some feel it’s something they ‘should’ be able to manage, some feel shame, some fear they might be ‘crazy,’ and others downplay how much their anxiety is impacting them,” Reynolds says.

If anxiety interferes with your daily life—whatever that might look like to you—that’s reason enough to see a mental health professional.

“When your world starts to become limited because of anxiety, that is a good signal that it’s time to seek treatment,” Reynolds says. “What is it doing to your life, your relationships, your sleep, health, work, and ability to learn and pursue things that are important to you?”

This “functional impairment,” as Reynolds calls it, can show up in different ways in different people. Is anxiety making you avoid doing things with loved ones because you’re too nervous to go outside? Do you skip school or work out of fear of what people may think of you? Can you not get enough sleep because you’re up all night worrying about the next day? Is your anxiety over certain tasks, like paying bills, leading to procrastination so extreme it comes with consequences, like getting your lights turned off?

Keep tabs on whether you’re blowing up at people, too. Anger and irritability can sometimes be a sign of anxiety. “We often forget that fight or flight includes ‘fight,’” Reynolds says. “If you have a shorter fuse or are always on edge for triggers, it could be related to anxiety.”

So, too, could physical issues. “We think of ourselves as these disembodied heads floating around,” Reynolds says. “We forget that there is a big feedback loop between the nervous system and the body.” Every part of you, from your head to your stomach to your feet, has nerves to regulate important processes, which is why your sympathetic nervous system’s stress response can be so far-reaching. You even have an entire nervous system reserved for gastrointestinal function, known as your enteric nervous system, which may help explain why there’s such a strong link between issues like irritable bowel syndrome and anxiety.

Constant fatigue can also kick in if your anxiety is in overdrive. “The physical reaction to anxiety, by nature, is supposed to be short-term. The body is supposed to come back down to baseline,” Duff says. “But a prolonged period of anxiety depletes your resources and exhausts you.”

“If your anxiety is bothering you and you are suffering, you deserve to get help,” Duff says. That’s true whether or not you think your anxiety is serious, whether or not you think you meet diagnostic criteria you read online, and whether or not your friends and family treat your anxiety with the weight it deserves. And if your anxiety is getting to the point where you’re worried for your safety, call 9-1-1 or the National Suicide Prevention Lifeline (it’s available 24 hours a day, seven days a week at 1-800-273-8255), or go to the emergency room, Reynolds says.

Seeing a therapist can be anxiety-inducing on its own, but it’s worth it. Here are a few ways to make it easier.

Knowing what to expect at your first therapy session may make the experience less scary. Although every professional is different, you’re likely to get a lot of questions at the first visit. Ultimately, your psychologist or therapist’s goal is to learn what troubles you’re having so that they can create a plan to help you build the skills you need to address your anxiety.

They’ll also want to figure out which kind of therapy best matches your needs. Different forms, like cognitive behavioral therapy, which aims to help people change negative thought patterns, work for different people.

Since the cost of therapy can be prohibitive, know that there are resources to help you find affordable treatment, like the National Alliance on Mental Health’s HelpLine at 1-800-950-6264. The HelpLine is available Monday through Friday, from 10 A.M. to 6 P.M., and you can explain your specific situation to the staffer or volunteer who answers. They may be able to refer you to local organizations that offer more affordable treatment. You can also try the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator tool, which can help you find mental health providers who take various forms of insurance, offer payment assistance, or use a sliding scale. Resources like GoodTherapy also allow you to limit search results to therapists who use sliding scales.

And don’t stress about meeting some arbitrary threshold of anxiety for your appointment to be worth the effort. “Somebody with anxiety [may] think there is a risk to seeing someone. ‘If I go and don’t have an anxiety disorder, there’s something bad about that,’” Duff says. “That’s not true. If you are suffering and seeing some of these signs, that’s enough.”

It may be that all you need is a few sessions, or you may meet weekly for months or years based on your goals. Your psychologist or therapist might decide medication would help you live your healthiest, happiest life, or just having someone to talk to might work for you. Also, if you decide you’re not really into the person you’re seeing but you still want help, there’s absolutely nothing wrong with trying someone else, Duff says.

Ask yourself what kind of life you want to live and what’s holding you back from achieving it, Reynolds says, adding, “If there’s anything related to fear and anxiety, it’s a great sign that maybe you need support around those things.”

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Smiling Depression: What You Need to Know

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What are the symptoms of smiling depression?

Someone experiencing smiling depression would — from the outside —appear happy or content to others. On the inside however, they would be experiencing the distressful symptoms of depression.

Depression affects everyone differently and has a variety of symptoms, the most distinguished being deep, prolonged sadness. Other classic symptoms include:

  • changes in appetite, weight, and sleeping
  • fatigue or lethargy
  • feelings of hopelessness, lack of self-esteem, and low self-worth
  • loss of interest or pleasure in doing things that were once enjoyed

Someone with smiling depression may experience some or all of the above, but in public, these symptoms would be mostly — if not completely — absent. To someone looking from the outside, a person with smiling depression might look like:

  • an active, high-functioning individual
  • someone holding down a steady job, with a healthy family and social life
  • a person appearing to be cheerful, optimistic, and generally happy

If you’re experiencing depression yet continue to smile and put on a façade, you may feel:

  • like showing signs of depression would be a sign of weakness
  • like you would burden anyone by expressing your true feelings
  • that you don’t have depression at all, because you’re “fine”
  • that others have it worse, so what do you have to complain about?
  • that the world would be better off without you

A typical depressive symptom is having incredibly low energy and finding it hard to even make it out of bed in the morning. In smiling depression, energy levels may not be affected (except when a person is alone).

Because of this, the risk of suicide may be higher. People with major depression sometimes feel suicidal but many don’t have the energy to act on these thoughts. But someone with smiling depression might have the energy and motivation to follow through.

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