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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February is Eating Disorder Awareness Month

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Eating Disorders Awareness Month

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In Many Minneapolis Schools, the Therapist is Just Right Down the Hall

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When Cathy Moen’s son, Elijah, was in first grade, he was diagnosed with attention deficit hyperactivity disorder. She took him to the pediatrician, who put him on medication and suggested therapy.

The medication part was easy. But getting him therapy proved more difficult — not because Moen couldn’t find a therapist or didn’t have insurance, but because of logistics.

The appointments were always during the day, and between her work schedule and the traffic, it was nearly impossible for them to make it.

But she soon learned Elijah was able to see a therapist in his Bloomington school. More than 15 years ago, Minneapolis Public Schools helped pioneer a national model of bringing community mental health care directly to its students. Today, most of the public schools in Minneapolis — more than 50 of them — have a therapist on site, and many other districts, like Elijah’s, have followed suit.

These days, Elijah’s therapist simply walks down the hall and pulls him from class.

“This is like a godsend,” said Moen.

The family’s health insurance pays for the care the same way it would if the student were being seen in the clinic. The school program was designed so that no student in need will be turned away for lack of insurance.

The Minneapolis program has also provided a road map for schools across the country as more administrators realize that mental health is as important to students’ future success as academics. Studies have shown that students are more likely to show up for appointments when the therapists are on-site.

More and more states are making mental health care in schools a priority. At least two states have recently passed laws that require schools to teach mental health. And more are considering it.

But the benefit of having a therapist on-site goes beyond just getting students to see a therapist. In Minneapolis, it’s also helped make mental health a school-wide priority — and helped get counselors, teachers and others more involved, said Mark Sander, who helped start the district program.

A man wearing a button down shirt.
Mark Sander is the director of school mental health at Hennepin County and Minneapolis Public Schools.
Christine T. Nguyen | MPR News

“Those teachers start learning more and more [about mental health],” said Sander, who directs school mental health for the district and the county.

He said as they learn more about mental health, teachers are feeling like, “‘OK, I get it. And now, you know, I’ve got this other student who’s not diagnosed with anxiety but has some of those anxiety features. And now I know how to better support them.”

At South High School in Minneapolis, the therapists sit in the school clinic, the same one where students go if they feel sick during the day or to get a physical so they can play sports.

The issues the students bring to the therapist run the gamut from stress about grades and colleges to anxiety related to a bad situation at home.

Farah Hussein is a therapist at South. She said it’s hard being a teenager, and she tries to help.

“There’s a lot of conversations about, ‘Who am I? Where do I fit in the world? Where do I belong?’ and just a lot of distress in exploring that,” she said.

All of this has important implications for the students’ well-being beyond just their mental health.

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A group of people sit around a conference table in a school.
Collaborative mental health meetings at South include the school’s social workers, counselors, nurses, psychologists, school-based clinic therapists and occasionally administrators.
Christine T. Nguyen | MPR News
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A sign reads "Mental Health" on a wooden shelf with books.

 

Sharon Hoover, who co-directs the National Center for School Mental Health at the University of Maryland School of Medicine, said more schools are collecting data on outcomes of in-school mental health programs, and the results are clear.

“They are more likely to have good attendance and to graduate and to get improved grades. We even have documentation of having better standardized test scores when you put universal systems in place like classroom-wide social emotional learning,” she said, all of which makes for happier, better adjusted students.

Cathy Moen, the mother whose son, Elijah, is in therapy in school, said she doesn’t know if it’s the medicine, or the therapy, or just that he’s growing up, but she — and his teachers — are already seeing a difference.

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In International Falls, the last psychiatrist for 100 miles just retired

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When Dr. Jeff Hardwig started his job as a psychiatrist in his hometown near the Canadian border, he wasn’t sure there was enough work for him.

Pretty soon, it became clear that there was, in fact, plenty of work in International Falls, Minn., a town of 6,000 people. He split his time between a group family practice and community mental health center and also saw patients in nearby communities.

“Within two or three years, it was clear I was too busy to go out of town anymore,” he said.

After nearly 30 years working as the town’s sole psychiatrist, Hardwig retired in September, leaving no psychiatrists for more than 100 miles around. His departure underscores a difficult reality: A national shortage of psychiatrists is much more acute in rural and remote areas, which leaves many people without access to the kind of services they need.

And the demand for Hardwig’s services has never let up.

Wendy Dougherty, the nurse who worked with him at the clinic, said his calendar was always full.

“He never ever … in the five years I worked with him, ever had an empty slot,” she said. “And one thing about his patients, if they called and canceled, that empty slot was filled by somebody that had been waiting two months to get in.”

But, she said, he was also the kind of doctor who would always find a way to squeeze in somebody in a crisis, even if it meant missing lunch or canceling his own meetings.

‘You take all comers’

The clinic where Hardwig worked is a primary care center on the outskirts of town, part of the Duluth-based Essentia Health system. It’s a low-slung building across the street from a Menards and a Dollar Tree that offers all the basic services, including annual checkups and mammograms.

Hardwig and others agree that the need for a psychiatrist in town was there, but until he arrived, people mostly counted on their primary care doctors to handle it.

His patients’ diagnoses over the years ran the spectrum of diseases, including anxiety, depression, bipolar disorder and schizophrenia.

“I had to take care of people of all ages — all the way through to the nursing home,” he said. “You can’t really specialize if you’re in a small town. You take all comers.”

And working in a small town, he also couldn’t avoid running into his patients frequently. It might have been hard for some doctors — psychiatry is a profession that particularly prizes its discretion — but Hardwig says he didn’t mind.

“I just had sort of an agreement with my patients if they say ‘hi’ to me, I’ll say ‘hi’ back, but I won’t otherwise out them. And my wife knew not to ask, ‘How do you know that person?’” he said.

He said his patients were respectful of him, too, and didn’t try to squeeze in consultations in line at the grocery store or when he was out to dinner.

One of his longtime patients was a man named Daniel Carr, whom I met at a clubhouse run by a community mental health center where people with serious mental illness can spend their time. The cozy house has battered couches and an armchair in the living room. A Christmas tree sparkles near the front window.

Carr, who has paranoid schizophrenia, was Hardwig’s patient for 25 years. He says he misses Hardwig.

“He knew exactly about how to treat me,” Carr said.

“I had some trouble with my medicine changing a little one way or the other, but he usually knew what was best. I’d tell him what I was experiencing and he knew what to do.”

Hardwig wouldn’t talk about specific patients, including Carr. Carr said his psychiatric care has been transferred back to his primary care doctor, and that it’s been going OK so far.

But Wendy Dougherty, the nurse who worked with Hardwig, said some of the primary care doctors have been less than enthusiastic about taking on the psychiatrist role.

“Jeff took care of the hard ones,” she said. “The schizophrenics, the bipolars … these docs kind of put up their hands and say, ‘Oh, my God, I don’t know what meds to give them.’”

The psychiatric nurse practitioner Hardwig worked with is still at the clinic and handles some of the harder cases, but she’s planning to retire soon, too.

A shortage in nearly every county

International Falls is hardly alone in not having a psychiatrist — particularly in remote areas.

More than 90 percent of psychiatrists only work in urban areas, even though more than 20 percent of Americans live in rural areas. In Minnesota, nearly every county — aside from the Twin Cities metro and Rochester area — is considered to have a shortage of mental-health professionals as determined by federal guidelines.

Hardwig said the hardest part of working in such a remote area was that he didn’t have a continuum of care to work with.

“There just isn’t that inpatient bed when you need it. We have only one crisis bed and we haven’t had that the whole time I’ve lived here. We don’t have residential treatment,” he said.

And International Falls is luckier than some places because there’s a community mental health clinic in town. (Hardwig partnered with it until his retirement, and the nurse practitioner still does.) The clinic is looking to expand in the near future. There’s also a mobile crisis team in town that can help with emergencies.

Still, recruiting mental-health care providers, even those who aren’t psychiatrists, to remote areas is challenging. Paul Mackie, a professor at Minnesota State University, Mankato, has studied the problem. And he said the only way to recruit and retain people in remote areas is to grow them from scratch. That is how Hardwig, who grew up in International Falls, ended up there.

Mackie said there are already physical medicine programs that train people for practice in rural areas. And he said now we need to do the same for mental health, too.

“We need to be a lot more thoughtful about who we’re recruiting and how we’re recruiting them,” he said. “We can have that conversation around what does a rural practitioner look like and look for that person and encourage them.”

But that takes time. People who graduated from high school this year won’t be done with medical school until 2027. And then they still have to complete their residency and any other specialty training.

So in the meantime, International Falls — and communities like it — are doing what they can. Hardwig’s old clinic has hired a child psychiatrist who sees her patients remotely over Skype-like technology.

Finding people to work on-site is proving much trickier, though. It was two years ago that Hardwig told the clinic he was planning to retire. It’s been looking for a replacement since then. But nobody has applied for the job.

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Holiday Tips

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I recently saw a meme on social media that said “It’s almost time for my normal anxiety to turn into my fancy holiday anxiety.” I had to chuckle when picturing anxiety showing up in a glittery ugly sweater or draped in all things sparkly. Humor aside, it shows that during the holidays, our existing anxiety (or depression) does not just “take a holiday” but rather increases due to stress and societal pressures.

This time of year can be an incredibly stressful and frustrating time. On one hand, we fill our days to the brim with spending time with family and friends, social events, potlucks, baking, preparing meals, finding the right present within your means, and many other tasks guised in the name of the holidays.  All of this “fun” can turn to chaotic quickly. Then on the other hand, some of us may have unwelcome reminders or memories associated with the holidays or feel more alone during this time as we watch others join together and celebrate. Whatever the reason for your distress, here are some helpful strategies to help manage the rise of our fancy anxiety (or depression) in finding ways to relax during the busy time of year or help with our perspective on the season.

  • Self-soothe – Using all 5 senses, focus on what you notice. Cast any judgments away and focus on the experience in the moment. Here are some examples.
    • Taste – slowly eat and notice different flavors in a favorite holiday treat or dish
    • Smell – light a candle or smell a pine tree or cup of tea
    • Sound – listen to your favorite holiday music, point our different instruments or lyrics you might have over looked
    • Sight – watch the fireplace flicker with light or notice the holiday lights all around
    • Touch – when baking or wrapping gifts, bring attention to the different textures you feel
  • Pay it forward – doing something kind for others or contributing can make us feel good about ourselves and give perspective. This could be anything from holding a door open for someone, greeting someone with a smile, adopting a family for the holiday, or volunteering. It does not need to be a large act to bring a sense of contribution to your holiday.
  • Be intentional about breaks – Set aside 15 minutes to check in with yourself and pause from all of the holiday excitement. Read a favorite book, do a meditation, sit in silence, or snuggle up with someone you love.
  • Simplify and slow down – With your to-do list growing, it may feel like you need to be in multiple places at once; however, what we know about the brain is that it cannot think 2 things at once. So, focus your entire attention to the task at hand rather than jumping from task to task (aka multitasking).
  • Follow traditions (or make your own new ones) – Partake in something that brings you meaning for the season, whether this be a family tradition, baking Grandma’s cookies, or finding something new to do this time of year (i.e., sledding, ice skating, driving around to see holiday lights, etc).
  • Put down the phones – I know, I said it. Just hear me out. Often times social media can impact our level of stress by comparing ourselves to others, especially when those others seem to have it all together. They have the catalog ready decorations, Martha Stewarts holiday food spread, or gifts we cannot afford. This can lead us into a down spiral. So, try to limit your access to your phone and engage with those around you.
  • Reach out to someone– The holidays can be a lonely time for some. Sometimes we can still feel lonely in a room full of people, feel so far away and disconnected from others, or feel forgotten. Use all of your willingness to reach out to someone or connect. Whether that be grabbing a cup of hot cocoa with a friend, attending a service, volunteering, or making a phone call to someone you have lost touch with in the past. We are social creatures and need human connection.
  • Be real with yourself – This includes preparing to spend time with family or friends. You likely already know who is going to be the Grinch, who is going to over indulge in the holiday punch, who is going to bring up politics, and who is going to ask about your love life. Just because it is the holidays, does not mean we are going to change who we are or the roles we play. Have an action plan for how you are going to deal with the likely interactions or dynamics.
  • Life in moderation – Life is about balance. Enjoy the holidays by partaking in the indulgences and socialization. Moderation is key. Listen to your body and the signals it is giving you.
  • Gratitude– Research is growing on the importance and efficacy of practicing gratitude in daily life. Our brains are inherently negative so being intentional about shifting out of the holiday stress (and negativity) can help bring perspective and renew our enjoyment of the season.
    • Write down things you are thankful for in life. Focus on the small things (i.e., clean water, fresh air, etc). Nothing is too small to be grateful for in life.
    • Reflect one thing you believe you did well over the past year.
    • Compare yourself to a time in your past when you might have handled the holiday stress less effectively.
  • Permission grant yourself – The holidays are not always candy canes and sprinkles. Often times we hold ourselves to high expectations and forget we are in control of our own actions. Grant yourself permission to: take time outs/breaks, have fun, do things “out of order”, celebrate differently than family/friends/the past, start a project and stop, be honest with people (and yourself), or have days that are “humbug” or just okay.

 

Feel free to make these tips your own by adding your own personal flair to them. It is important to find what works for you and your fancy holiday distress.

 

Happy holidays,

Dr. Alison Dolan

7 Ways Loneliness (and Connectedness) Affect Mental Health

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Loneliness is finally starting to get at least some of the attention it deserves—we may not be as “on it” as other countries, like the U.K. with its Minister for Loneliness, but we’re getting there. Like the push to dissolve the stigma around mental health issues, there’s been a similar increase in people’s honesty about their social connection, or lack thereof. And it turns out that people are pretty lonely these days. The percentage of people saying they have few or no confidants has risen precipitously in recent years. So if you’re feeling lonely, you’re…well, not alone.

As the research shows just how important social connection is for our health and mental health, and how detrimental loneliness can be, the value of speaking out—and changing our habits—becomes all the more clear. Here are some of the ways in which loneliness hurts us and social connectivity helps us, psychologically and physiologically. 

Loneliness is contagious

A fascinating study looked at how loneliness is present in communities, and found that it spreads through a contagious process in which people seemed to “catch” loneliness from one another. As people became lonelier, they moved to the edges of social networks, creating a kind of domino effect. For instance, when one person reported an increase of one day per week of loneliness, his or her close friends also reported an increase. As the authors write, “efforts to reduce loneliness in society may benefit by aggressively targeting the people in the periphery to help repair their social networks and to create a protective barrier against loneliness that can keep the whole network from unraveling.”

Other work has shown that people who become lonelier over time also begin to trust others less, which creates a vicious cycle of loneliness and social isolation. These types of studies suggest that social connection is precarious, and vulnerable to different forces, making it all the more important to do what we can to keep our networks together and oneself involved.

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Past Trauma May Haunt Your Future Health

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Adverse childhood experiences, in particular, are linked to chronic health conditions.

A rocky childhood. A violent assault. A car accident. If these are in your past, they could be affecting your present health.

These are all examples of traumatic events — which, in psychological terms, are incidents that make you believe you are in danger of being seriously injured or losing your life, says Andrea Roberts, a research scientist with the Harvard T.H. Chan School of Public Health. Research shows that these events can trigger emotional and even physical reactions that can make you more prone to a number of different health conditions, including heart attack, stroke, obesity, diabetes, and cancer.

Understanding trauma

Traumatic events encompass anything from a sexual assault or childhood abuse to a cancer diagnosis. Child abuse is particularly likely to affect your adult life because it occurs at a time when your brain is vulnerable — and it often occurs at the hands of people who are supposed to be your protectors, says Roberts. “By abuse, we often mean things that are a lot milder than things people typically think of as abuse. It might include being hit with a hard object, like a whip, a belt, or a paddle,” says Roberts. “The behavior doesn’t necessarily need to be illegal to induce a traumatic response.”

A child’s perception of events is as important as what actually occurred. “While a child’s life may not have actually been in danger, the child may have seen it as life-threatening,” says Dr. Kerry Ressler, a psychiatry professor at Harvard Medical School.

People who experience traumatic events sometimes develop post-traumatic stress disorder (PTSD), a psychiatric condition that affects 5% to 10% of the general population, says Dr. Ressler. It’s more common in women, affecting twice as many women as men. And it also occurs more frequently in people who have certain risk factors, including those living in poverty, soldiers in active combat, and first responders, he says. PTSD can develop after a person experiences violence or the threat of violence, including sexual violence. It may affect people who have a close relative who experienced those things as well, says Dr. Ressler. These traumatic events are generally incidents that are considered outside the ordinary and are exceptional in their intensity.

Exposure and risk

Your risk for mental and physical health problems from a past trauma goes up with the number of these events you’ve experienced. For example, your risk for problems is much higher if you’ve had three or more negative experiences, called adverse childhood experiences (ACEs), says Roberts.

These include

  • physical abuse
  • sexual abuse
  • emotional abuse
  • physical neglect
  • emotional neglect
  • witnessing domestic violence
  • substance misuse within the household
  • mental illness within the household
  • parental separation or divorce
  • incarceration of a household member.

Another kind of trauma

While severely traumatic events are believed to have the greatest effect on long-term health, other stressful events that don’t necessarily meet the psychological definition of trauma can still cause problems. This might include a sudden death in the family, a stressful divorce, or caring for someone with a chronic or debilitating illness, says Roberts. These milder events might lead to a mental health disorder, such as anxiety or depression. “Trauma pushes your ability to cope, so if you have a predisposition toward anxiety, for example, it may push you over the edge,” says Roberts.

In addition, incidents like these can also produce PTSD-like symptoms in certain people. “When people go through traumatic or complicated grief, they can experience pretty similar symptoms to those they might experience with trauma, such as intrusive thoughts,” says Dr. Ressler.

Medical conditions resulting from trauma

Most of the research related to trauma and chronic disease risk has focused on childhood trauma, says Dr. Ressler. Early childhood trauma is a risk factor for almost everything, from adult depression to PTSD and most psychiatric disorders, as well as a host of medical problems, including cardiovascular problems such as heart attack and stroke, cancer, and obesity.

These effects likely reflect two factors:

Behavioral changes resulting from trauma. People who are suffering from traumatic memories may try to escape them by participating in risky behaviors such as drinking, smoking, drug use, or even overeating for comfort. “Those can all be used as a coping mechanism, a way of dealing with emotional dysregulation that occurs when someone has been traumatized,” says Roberts. These habits, in turn, lead to health problems.

Physical effects related to trauma. The problem goes beyond unhealthy habits. Experts believe that there is actually a direct biological effect that occurs when your body undergoes extreme stress. When you experience something anxiety-provoking, your stress response activates. Your body produces more adrenaline, your heart races, and your body primes itself to react, says Roberts. Someone who has experienced trauma may have stronger surges of adrenaline and experience them more often than someone who has not had the same history. This causes wear and tear on the body — just as it would in a car where the engine was constantly revving and racing, she says. Stress responses have also been demonstrated in people who have experienced discrimination throughout their lives. “It ages your system faster,” says Roberts.

Chronic stress can increase inflammation in the body, and inflammation has been associated with a broad range of illness, including cardiovascular disease and autoimmune diseases, says Roberts. Early trauma disrupts the inflammatory system. This can lead to long-term aberrations in this system and chronic health problems triggered by constant inflammation. Typically, the more trauma you’ve experienced, the worse your health is.

Barriers to getting help

People who have experienced trauma may also struggle with getting help. “One of the most common outcomes of trauma is avoidance,” says Dr. Ressler. “It makes sense. If you experience something traumatic, you want to avoid thinking about it and going to places that remind you of it.” Unfortunately, health settings — with their doctors, therapists, and counselors — are triggers for many people because when someone experiences a traumatic event, he or she often ends up in the health care system.

In addition, if you’ve experienced trauma, you may believe that health care providers will want you to talk about it and dredge up feelings from the past. For these reasons, people who have experienced trauma may avoid medical care.

Some people may be in denial about the role past trauma is playing in their life. “I would say that a lot of people are unaware of how trauma is affecting them,” says Roberts. One of the hallmarks of trauma is the fact that people often use defense mechanisms to protect themselves from stress. Denial is one of those, as is trying to normalize past problems. “People may say things like, ‘oh, everybody I know got hit as a child,'” says Roberts.

Seek out resources

To get more information about trauma and PTSD or to find treatment resources, here are three very good, well-vetted websites from leading professional organizations:

Getting help

If you suspect that past trauma is affecting your life, there is help. This is a treatable problem. “You don’t have to be stuck,” says Dr. Ressler. “There is a good chance that you can move past this.”

Taking steps to address the problem may also help others in your life. Very often people who have experienced trauma pass problems on to others in their family through a process called observational learning, he says. So, helping yourself may help those around you. Consider these steps.

Work with a therapist. A trained therapist can help you reframe what happened to you and help you move past it. “One of the most successful treatments is exposure therapy, where the idea is to expose yourself in small doses to the thing that was most traumatizing, with someone there to support you,” says Roberts. Treatment may also include medication to address any mental health disorders you are experiencing.

Take care of yourself. There are numerous lifestyle measures that can help you reduce stress and anxiety. These include yoga, tai chi, and meditation. Regular exercise can also help you manage stress and other symptoms.

Reach out to others. Research has shown that maintaining strong social ties with friends and family members is crucial to good mental health.

“Unfortunately, all of these things are hard to do when in depressive states,” says Roberts.

That’s why many people may need to start with therapy, and then add other strategies later on.

 

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