0 Talking to Men about Mental Health

By Sarah Johnson, M.D.

While
visiting with my dad for Father’s Day last month, I was inspired to write about
the importance of talking to the male species about mental health. When I was a
medical student coming home over Christmas (hyper-vigilant about all
potential medical issues as most med students are), I noticed a mole on my
father’s forehead that looked cancerous to my post-dermatology rotation eyes. After
nearly a year of “reminders” to go to the doctor and have it checked, he
finally agreed and luckily it was benign.

Now
that I’m a psychiatrist, I often get calls from patients and friends who are
worried about the mental health of men in their lives (fathers, husbands, boyfriends, brothers, friends) but have met resistance when trying to talk about their concerns with these men.

Reflecting
on my personal challenge of getting one of the important men in my life to have
something as minor and non-stigmatized as a mole checked out, I would like to
offer some suggestions to help start the mental health conversation with a man
or anyone you believe may be suffering from a mental illness.

• Use “I” statements. People are
  less likely to feel attacked and be open to suggestions when approached with
  “I” statements. For example, “I am concerned that you seem down, and I would
  like for you to consider seeing a counselor because I care about you,” instead
  of “You seem depressed and need to see someone.”

• Present mental health
  conditions such as anxiety and depression as medical conditions - which they
  are (your brain is part of your body). Unfortunately, many individuals
  stigmatize mental illness and do not like to see themselves as suffering from
  one. One of my favorite questions to ask those who resist getting care for
  their mental health is, “Would you seek help for high blood pressure or
  diabetes?” Of course you would!

• Offer factual evidence regarding
  mental health conditions. Many patient resources are available at www.psychiatry.org/mentalhealth (check out the Let’s Talk Facts brochures you can print). It is helpful to realize that psychiatric
  conditions are common. Remind him that he’s not alone.

• Be encouraging and reassure him that he won't be seen as “less of a man” if he seeks
  help. Seeking help is a sign of strength.

• Ask him to consider
  seeking help rather than telling him. Most people are more likely to
  follow through with a task they view as unpleasant when they are asked rather than told.

• Be mindful and also take care
  of your own mental health needs. It can be very stressful and tiring to be close to someone suffering from an untreated mental illness. Use your family and
  friends for support and don’t be afraid to seek help yourself if you find
  you’re struggling with excessive worry.

We are lucky to live in a time when there are effective treatments readily available for mental health disorders. Try these tips the next time you start the mental health conversation with the important men in your life. Your support and care can
make a big difference in his recovery. 

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0 Raising Awareness for Binge Eating Disorder

By Sarah Johnson, M.D.

What is Binge Eating Disorder?

Binge Eating Disorder involves frequent overeating during a discreet period of time (at least once a week for three months), combined with lack of control and is associated with three or more of the following:

• 
  Eating more rapidly than normal
  
  


• 
  Eating until feeling uncomfortably full
  
  


• 
  Eating large amounts of food when not feeling physically hungry
  
  


• 
  Eating alone because of feeling embarrassed by how much one is eating
  
  


• 
  Feeling disgusted with oneself, depressed, or very guilty afterward 
  
  

Binge Eating Disorder also causes marked distress and does not occur during the course of another eating disorder, such as Anorexia Nervosa or Bulimia.

What is the Diagnostic and Statistical Manual of Mental Disorders?

The Diagnostic and Statistical Manual of Mental Disorders is used by mental health professionals around the world to help them accurately diagnose psychiatric disorders. The fifth edition of this manual (DSM-5) will be released in May 2013 after 14 years of extensive research studies and input from the best experts in the field.

What is different about Binge Eating Disorder in DSM-5?

Binge Eating Disorder was previously categorized as a “diagnosis for further study.” In DSM-5, it is defined as a unique psychiatric condition with more specific criteria.

Why is it important that Binge Eating Disorder is being recognized as a unique psychiatric condition in DSM-5?

Being recognized as a true mental disorder will raise public awareness of this troubling condition and may help individuals identify themselves as needing support. Increased awareness can lead to increased interest and funding in the research community, so that we may continue to learn more about this disorder and find better treatments. This designation as a “disorder” may also make insurance companies more likely to cover therapy and medications used to treat Binge Eating Disorder. 

What should I do if I think I am suffering from Binge Eating Disorder?

Binge Eating Disorder treatment is complex and individualized. It can include therapy, medications, and addressing other psychiatric conditions or health problems such as obesity that are also occurring. If you think that you, or a loved one, are suffering from this condition, you should contact a mental health professional for diagnosis and treatment recommendations.

How is Binge Eating Disorder treated?

If you decide to see a psychiatrist for treatment of Binge Eating Disorder, he or she will start by asking questions about your medical and psychiatric history and symptoms that you are concerned about. Common components of a treatment plan might include addressing any underlying medical problems such as obesity or high blood pressure and psychotherapy to help with depression, anxiety, or other emotional problems. Medications may also be used if your doctor thinks it is indicated. There is no magic cure for Binge Eating Disorder, and your psychiatrist will work with you to create an individualized treatment plan.

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0 Yes, Food Addiction is Real. Do You Know Someone Suffering?

By Sarah Johnson, M.D.

The obesity epidemic is a huge problem (no pun intended) due to associated medical problems and their burden on the healthcare system. In 2009, an estimated 25% of Americans met criteria for obesity. This figure has steadily increased since the 1970’s.



Obesity leads to heart disease, strokes, high blood pressure, diabetes, and may be associated with increased risk for depression. It has been suggested that over-eating and other eating behaviors associated with obesity may share features with drug and alcohol addiction. This would certainly explain why this epidemic is so difficult to combat.  



The DSM IV-TR defines substance dependence as three or more of the following symptoms occurring within one year: tolerance, withdrawal symptoms, substance taken in larger amounts or for a longer duration than intended, attempts to cut back, excessive time spent pursuing, using, or recovering from use, reduction or discontinuation of important activities because of use, and continued use despite adverse consequences. 

Food cravings associated with binge eating can trigger the same area of the brain that is activated in drug craving. Although research is preliminary and limited at this time, specific foods such as carbohydrates may actually have a direct effect on mood in those who crave them.


Certain eating behaviors, such as restriction combined with overeating or binge-purge cycles may emulate addictive behaviors. Personality traits such as impulsivity have been found in samples of addicts and obese individuals. Children with behavior disorders such as ADHD and Conduct Disorder may be at increased risk for both addictions and obesity.  



Prevention is the best way to reduce the impact of behaviors associated with obesity. While eating may have similarities with addiction, we live in a toxic food environment, and awareness is key in prevention. Family members can seek help from medical professionals for loved ones who may be exhibiting pathological eating behaviors. 



For more information: Corsica JA, Pelchat ML. Food addiction: true or false? Curr Opin Gastroenterol. 2010 Mar;26(2):165-9.
Wilson GT. Eating disorders, obesity, and addiction. Eur Eat Disord Rev. 2010 Sep-Oct; 18(5):341-51.

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