NIMH » Let’s Talk About Eating Disorders with NIMH Grantee Dr. Cynthia Bulik


Transcript

Cynthia Bulik: Hello, thank you for joining me today. My name is Dr. Cynthia Bulik. I’m a professor at the University of North Carolina Chapel Hill’s School of Medicine, and I’m founding director of the University of North Carolina’s Center of Excellence for Eating Disorders. I’m also a National Institute of Mental Health grantee. We’re in the middle of national eating disorders awareness week. The goal of this observance is to focus on eating disorders by educating the public, spreading a message of hope, and putting life-saving resources and information into the hands of those in need. Eating disorders are serious and often fatal illnesses associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder.

Cynthia Bulik: During the next half hour, I’ll discuss signs, symptoms, treatments, and the latest research on eating disorders. In addition, I’ll discuss some of the challenges that the coronavirus pandemic has presented for individuals living with eating disorders. And if there’s still some time at the end, I’ll take a few of your questions from the comments. It’s important to note that I cannot provide specific medical advice or referrals. Please consult with a qualified health care provider for diagnosis, treatment, and answers to your personal questions. If you need help finding a provider, please visit www.nimh.nih.gov/findhelp. If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK or 8255. You can also ask for help in the comments section of this feed and someone from NIMH will assist you. All of the websites and phone numbers that I just mentioned will also be posted in the comments section of this feed so that you can easily access them.

Cynthia Bulik: First I’ll begin by talking about signs and symptoms of anorexia nervosa. People with anorexia nervosa may see themselves as overweight even when they’re dangerously underweight. People with anorexia nervosa severely restrict the amount of food that they eat, often exercise excessively, and may self-induce vomiting or use laxatives to lose weight. They may weigh themselves frequently and engage in body checking to see if they’ve gained weight. Anorexia nervosa has one of the highest mortality rates of any mental disorder. Many people with this illness die from complications associated with starvation, and others die from suicide.

Cynthia Bulik: Symptoms of anorexia nervosa include extremely restricted eating, very low body weight, a relentless pursuit of thinness, and unwillingness or inability to maintain a normal or healthy weight. They have an intense fear of gaining weight or engage in behaviors that interfere with weight gain even when they’re at very low body weights. They may have a distorted body image, which means seeing themselves as larger than they actually are, or they may engage in behaviors that interfere with weight gain even though they’re at a low weight. People with anorexia find that their self-esteem is heavily influenced by perceptions of bodyweight and shape, and they may not be able to recognize the seriousness of their low body weight. You may also have heard of atypical anorexia nervosa, which is when someone has all of the features of anorexia nervosa, but despite considerable weight loss, they’re still within or above the normal weight range.

Cynthia Bulik: A second type of eating disorder is bulimia nervosa. People with bulimia nervosa have recurrent and frequent episodes of eating an unusually large amount of food and feeling a lack of control over these episodes. The binge eating is usually followed by behavior that compensates for overeating, such as self-induced vomiting, use of laxatives or diuretics, otherwise known as water pills, fasting, excessive exercise, or a combination of all of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or overweight. Symptoms of bulimia nervosa include swollen salivary glands in the neck and the jaw area, acid reflux disorder and other gastrointestinal problems, worn tooth enamel, and increasingly sensitive or decaying teeth as a result of exposure to stomach acid. They can have a chronically sore and inflamed throat. They can have intestinal distress and irritation from laxative abuse. They could also have severe dehydration from purging. And they could have electrolyte imbalances, including sodium, calcium, potassium, and other minerals, and this can be quite dangerous and can lead to a heart attack and stroke.

Cynthia Bulik: And then lastly, we’ll talk about binge eating disorder, which is sometimes referred to as BED. Binge eating disorder is also associated with binge eating, but unlike bulimia nervosa, the binge episodes are not followed by purging, excessive exercise, or fasting. Many people with BED fall into higher weight categories, but they can also be in the normal weight range. BED is actually the most common eating disorder in the United States. Symptoms of binge eating disorder include eating unusually large amount of food in a discrete period of time, such as within a two-hour period, eating even when you’re full or when you’re not hungry, eating rapidly during binges, eating until you’re uncomfortably full, often eating alone or in secret to avoid embarrassment, feeling depressed, ashamed, or guilty after binge eating, and also in general just feeling distressed about your binge eating.

Cynthia Bulik: Importantly, eating disorders can affect people of all ages, racial and ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or in young adulthood, but they can develop at any point during childhood or even much later in life. These disorders affect all genders, although they tend to be more common in women. Some studies suggest that people in the LGBTQ community might be at increased risk for eating disorders. Researchers like me are finding that eating disorders are caused by a complex interplay of genetic, biological, behavioral, psychological, and social factors. We’re using the latest technology and the latest science to better understand the causes of eating disorders.

Cynthia Bulik: One approach involves the study of human genes. We know that eating disorders run in families, and twin studies have told us that the reason they run in families is because of genes. But now we’re working to identify DNA variants that are associated with increased risk of developing eating disorders. As founder and co-chair of the Eating Disorders Working Group of the Psychiatric Genomics Consortium, I lead a global effort to identify actionable genomic variation in eating disorders. A recent genome-wide association study funded by the Klarman Family Foundation and in part by NIMH suggest that metabolic processes may play an important role in the disorder and offers a promising new avenue of investigation to understand causes of anorexia. To understand factors that contribute to anorexia, an interdisciplinary team of researchers, led by me, combined genetic data from two resources. First was the Anorexia Nervosa Genetics Initiative, or ANGI, and the second is the PGCED, or the Psychiatric Genomics Consortium Eating Disorders working group. The resulting dataset included almost 17,000 individuals who had anorexia nervosa at any point in their life and 55,000 controls. And that dataset allowed us to conduct a genome-wide association study in which we scanned the entire genome to look for genetic variations that were more common in people with anorexia nervosa than in people without anorexia nervosa.

Cynthia Bulik: Now, everyone has basic variations in the building blocks of their DNA that are called single-nucleotide polymorphisms, or SNPs for short. Researchers can examine these SNPs to identify areas of the genome that we call loci that are associated with different traits. Then linking loci to the specific genes that underlie a trait is not always a straightforward process as these loci can span large regions of the genome that include many genes that have different functions. However, those loci provide important clues about the genes and biological pathways that are likely to contribute to a disorder like anorexia nervosa. In this study, we identified eight loci that varied between this large sample of people with anorexia nervosa and people without an eating disorder. And we found that the genetic basis of anorexia overlapped with a variety of other traits, including certain psychiatric diagnoses, physical characteristic, and metabolic indicators. For example, we found that anorexia nervosa was correlated on a genetic level with mental disorders such as obsessive-compulsive disorder, major depressive disorder, anxiety disorders, and schizophrenia. These genetic correlations mirror findings from clinical and epidemiological studies which have shown that people with anorexia are more likely to have anxiety, depression, and other psychiatric disorders compared with the general population.

Cynthia Bulik: Now, intriguingly, the genetic basis of anorexia nervosa also overlaps with factors associated with metabolic traits such as insulin resistance, fasting insulin, and type 2 diabetes. For example, some of the same genetic factors that are associated with decreased risk of developing type 2 diabetes are associated with increased risk for anorexia nervosa. So together, these links suggest that genetic variations that are associated with anorexia nervosa may also influence some of the chemical and biological processes in the body that are essential for life. People with anorexia nervosa often have considerable difficulty maintaining healthy body weight even when they’re receiving carefully calibrated nourishment as part of their treatment plan. And these disruptions to metabolism that we identified in this study may help explain why. The findings from this study suggest to us that both metabolic and psychological processes are important factors to consider when we’re studying, developing, and implementing treatments for this serious disorder.

Cynthia Bulik: Encouraged by these findings, we’re expanding this line of research. I’m currently the principal investigator of the global Eating Disorders Genetics Initiative, or EDGI, which is funded by the National Institute of Mental Health and is the largest genetic investigations of eating disorders ever undertaken. EDGI is going beyond ANGI to also study the genetic influence on not just anorexia nervosa but also bulimia nervosa and binge eating disorder. You can learn more about EDGI and other current studies on eating disorders by visiting NIMH’s website which will be shared below in the comments.

Cynthia Bulik: Now, turning to some other ongoing studies, more than 18% of people with binge eating disorder and more than 43% of people with bulimia nervosa report severe impairment as a result of their illness. Now, despite the seriousness of these disorders, only 43% of individuals actually seek treatment, and even fewer receive treatment. These findings highlight the need for scalable, accessible, and personalized treatment options for people with these illnesses. Although treatments for eating disorders such as cognitive behavioral therapy work for many people, they don’t work for everyone, and they don’t allow for intervention in real-time, often requiring people to wait for a scheduled appointment to speak with a clinician. In addition, many people in this country don’t have easy access to a clinician who can provide evidence-based treatment for eating disorders. So having the ability to predict binge and purge episodes and intervene in real-time would support the development and scalability of treatments for binge eating disorder and bulimia nervosa.

Cynthia Bulik: In another study funded by the National Institute of Mental Health, my research team and I are using an app called Recovery Record which has been adapted for use on a smartwatch to collect a massive amount of clinical, physiological, and behavioral information from people who have agreed to have their data recorded. Our plan is to aggregate those data to predict in real-time when a binge or purge episode is likely to occur. Then we’ll be able to signal people and encourage them to use their tools and strategies to avoid engaging in disordered eating behavior. And right now, researchers and clinicians don’t have the ability to predict binge and purge episodes with any level of reliability. If this NIMH-supported project is successful, it has the potential to lay the foundation for developing large-scale real-time treatment and prevention efforts in the area of eating disorders.

Cynthia Bulik: Next, I’m going to talk a little bit about treatments and therapies for the eating disorders. It’s very important to seek treatment early for eating disorders. People with eating disorders often have other mental disorders such as depression, or anxiety, or problems with substance use. Importantly, complete recovery from eating disorders is possible. Treatment plans are tailored to individual needs and may include one or more of the following: individual, couple, or group psychotherapy, family-based treatment, medical care and medical monitoring, nutritional counseling, and also medication. Psychotherapies such as family-based treatment, or commonly known FBT, where parents of children and adolescents with anorexia or bulimia nervosa assume responsibility for feeding their children appear to be very effective in helping young people gain weight and improve their eating habits and their [inaudible]. The NIMH has also funded us to develop a series of couple-based treatments for adults with eating disorders. We call them UNITE, or Uniting Couples in the Treatment of Eating Disorders. UNITE enlists partners to be active allies in recovery. Both FBT and UNITE treatments show how family members can be our best allies in the treatment of eating disorders.

Cynthia Bulik: Other forms of psychotherapy have also been found to be helpful in the treatment of eating disorders, including cognitive behavioral therapy, which helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs, and interpersonal psychotherapy that focusing on the role of interpersonal relationships in recovery from eating disorders. Medications can also play a role in the treatment of eating disorders. Evidence suggests that medications such as antidepressants, antipsychotics, or mood-stabilizers might also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. You can check the Food and Drug Administration or the FDA’s website for the latest information on warnings, patient medication guides, or newly approved medications.

Cynthia Bulik: And finally, I want to talk a little bit about how COVID-19 has influenced people who are currently living with eating disorders. People with eating disorders are really struggling during the pandemic. Those who are alone are struggling with a lack of support and are saying that they find themselves swirling around in negative thoughts. Many are also finding it hard to stay motivated to recover. On the other hand, some who are working toward recovery that are living in close quarters with other people are having trouble finding privacy to do things, for example, like have private telehealth sessions with their clinicians. My research team at UNC, together with the National Center of Excellence for Eating Disorders, which is also at UNC, and colleagues in the Netherlands surveyed approximately 1,000 participants who joined a study in April and May of 2020, so early in the lockdowns. We found that studied participants in the United States with anorexia nervosa were reporting increased dietary restriction and fears about not being able to find foods that were consistent with their meal plan. At the same time, people with bulimia and binge eating disorder reported increases in binge-eating episodes and increased urges to binge. Respondents also noted an increase in anxiety levels since 2019 and fears that their eating disorder would worsen due to a lack of structure and a lack of social support. People also highlighted concerns about living in a triggering environment during the pandemic.

Cynthia Bulik: We know that eating disorders thrive in isolation, and having social support can deter individuals with eating disorders from engaging in health-damaging behaviors, like excessive exercise, restriction, or purging. When you’re alone, like during the pandemic, there are no social deterrents, so the eating disorder can escalate unchecked. That is why reaching out and staying connected is so important even if it is virtually, especially as the pandemic continues to drag on.

Cynthia Bulik: We also found that over 80% of US study participants who were already in eating disorders treatment before COVID-19 reported having transitioned to telehealth services. Fortunately – and we followed these people up monthly since the beginning of the study – satisfaction with telehealth has increased as the pandemic has dragged on, and we have all become more creative and comfortable with using that modality. But troublingly, 47% of US participants reported not being in any treatment for their eating disorder. We’re hoping that the wide availability of telehealth options will remain long after the pandemic is in our rearview mirror so that we will continue to be able to deliver evidence-based treatment to people with eating disorders in all corners of the country. We hope the preliminary data that we’re sharing now and additional data collected in this year-long study will inform best practices for clinicians and caregivers and provide a roadmap for eating disorders care. From this work that we’ve done, we’ve created information sheets to help individuals with lived experience, their family members, and their clinicians deal with eating disorders during the pandemic. These sheets can be found on the website of the National Center of Excellence for Eating Disorders at NCEED, N-C-E-E-D-U-S dot org.

Cynthia Bulik: Now, we have a couple minutes for questions which I will take from the comments, and I will start with the one that is– the first question is, “Why isn’t obesity added as an eating disorder?” That’s an excellent question, and when the DSM-5 was created back in 2013, there was a lot of discussion about whether obesity should be an eating disorder. But interestingly, what we can see – and I’m going to go back to our genetics study, which is quite intriguing – is that in some ways, anorexia nervosa, the same genes that influence obesity also influence anorexia nervosa but in the opposite direction. So we know that there’s a relationship between weight regulation and appetite regulation, but obesity itself is a heterogeneous condition. And when we’re looking at anorexia nervosa, bulimia nervosa, and binge eating disorder, importantly, those disorders occur across the weight spectrum. And I think one of the take-home messages that I really want people to think about today is that eating disorders occur in all body weights. There have been so many myths around that eating disorders only– you can see them because people are underweight. That is not the case. Eating disorders do not discriminate in terms of body weight, body shape, body size, or really any other demographic factor.

Cynthia Bulik: A couple other questions that are popping up in here are whether bulimia and purging are related to thyroid issues. That has actually not been a consistent finding, but anyone who has concerns, especially, for example, if you have a family history of thyroid disease, you should always get that checked out by your general practitioner, your family physician, because one of the things that we really like to recommend for people who are in treatment for any of the eating disorders is that they are monitored carefully by a physician along with their mental health care providers.

Cynthia Bulik: Another question that just popped up is how about other neuropsychological disorders like PANDAS? Now, this is really interesting because I think we’ve seen– and this is basically when a psychiatric illness like autism obsessive-compulsive disorder, eating disorders might pop up after exposure to strep, for example. We have seen this in a subset of people with anorexia nervosa, but again, it’s just a subset. And I think another thing that I’m going to hammer home – and this is what we hope some of our genetic research will lead to – is that even these three disorders that we talked about today – and by the way, they’re not the only eating disorders – we even think that we’re going to be able to find subgroups within anorexia, within bulimia, and within binge eating disorder that are identifiable genetically that might help us unpack the heterogeneity within each of the disorders. And right now, we’re using a one-size-fits-all approach to treat these eating disorders, and one of the goals of this genetic research is to move away from one-size-fits-all and to use the genetic information to help parse out different subtypes, different origins or causes so that we can actually tailor interventions to the underlying biology of a particular individual’s eating disorder.

Cynthia Bulik: And now we’re going to– we’re reaching the end of our time, so we’re going to wrap up with some closing remarks. And we’ve reached the end of our discussion today on eating disorders. I thank you so much for your attention, and for your questions, and for joining me today. And if there are other questions that I didn’t get to, please feel free to put them in the comments, and we’ll try to get to them afterwards and make sure that those answers are posted. So please learn more about eating disorders by visiting the following website, www.nimh.nih.gov/eatingdisorders with no space between eating and disorders. I thank you all so much for your attention today, and I hope that you all stay well.

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Evidence of disturbed gene activity in the brain as a result of heart problems — ScienceDaily


Heart problems cause disturbed gene activity in the brain’s memory center, from which cognitive deficits arise. Researchers at the German Center for Neurodegenerative Diseases (DZNE), the University Medical Center Göttingen (UMG) and the German Center for Cardiovascular Research (DZHK) come to this conclusion based on laboratory studies. They consider that they have found a possible cause for the increased risk of dementia in people with heart problems. In mice, a specific drug which is known to affect gene activity alleviated the mental deficits. The involved experts see these results as potential approaches for therapies. The study data are published in the scientific journal EMBO Molecular Medicine.

In Germany, about four million people are affected by what is called “heart failure”: Their heart muscle is too weak to pump enough blood through the body and is therefore abnormally enlarged. Physical fitness and quality of life suffer as a result. Moreover, affected individuals have an increased risk of developing dementia. “People with cardiological problems and heart failure in particular may experience noticeable cognitive deficits and increased risk of developing Alzheimer’s disease. Possible reasons include impaired blood supply to the brain and dysfunction of the hippocampus, which is the memory’s control center,” explained André Fischer, research group leader at the DZNE’s Göttingen site and professor at the Department of Psychiatry and Psychotherapy at UMG. “Yet, there is a lack of therapies to effectively treat cognitive deficits in people with heart problems. This is because it is completely unclear which deficiencies are triggered in neurons. There was no data on this so far.”

Stressed Cells

Now, a team led by Prof. André Fischer and Prof. Karl Toischer (Clinic of Cardiology and Pneumology at UMG and DZHK’s Göttingen site) is presenting findings on this subject for the first time. The researchers observed in mice that impaired gene activity developed in the hippocampus as a result of heart problems. “In memory tests, mice with heart failure performed significantly worse than their healthy mates,” Fischer explained. “We then examined the neurons of the hippocampus. In the mice with heart failure, we found increased cellular stress pathways and altered gene activity in neurons.”

Tight Windings

The genome of a mouse — and also of humans — comprises around 20,000 genes. In any given cell, however, only a part of them is active, switched on, so to speak. This is not a mere on or off state: the activity can be strong or less strong. This depends, among other things, on how tightly the DNA (the thread-like molecule that carries the genome) is wound and how accessible the genes on it are. In both mice and humans, the DNA is more than a meter long. But in a cell, the molecule is so tightly packed that it fits into the nucleus. “Genes can only be active if they are accessible to the cell’s machinery. To this end, the DNA needs to be wound a little more loosely at the relevant sites. This is similar to a ball of yarn with loops sticking out of it,” said Fischer. In the current study, the DNA was found to be more tightly wound in neurons of mice with heart problems than in healthy mates. Various genes important for hippocampal function were therefore less active than in healthy mice.

A Drug Improved Memory

The scientists identified chemical changes in the histones as the cause of the tight winding. Histones are special proteins: The DNA wraps around them, much like yarn around a spool of thread. Fischer’s research group has been studying histones and other players that influence gene activity for quite some time — in technical jargon they are called “epigenetic mechanisms.” In this context, the researchers are also investigating drugs. In previous studies, they were able to show that the cancer drug “vorinostat” can alleviate genetically driven as well as age-related memory problems in mice. Currently, vorinostat is being investigated for the therapy of people with Alzheimer’s in a clinical trial of the DZNE. In the current study, the scientists treated mice with heart failure with this drug. They found that the heart’s pumping capacity did not change significantly, but memory performance improved.

Interdisciplinary Cooperation

“Vorinostat has been shown to act on histones and thus on gene activity. Our study thereby provides initial clues about the molecular processes that contribute to cognitive dysfunction following heart problems, and it indicates potential approaches for therapy,” Fischer commented on the results. “Fact is, however, that we do not yet understand why, as a result of heart failure, gene activity in the hippocampus is disturbed. What is the role of the deficient blood supply to the brain? Does the troubled heart release substances that affect the histones? We intend to investigate this in patients with heart problems. As with our current study, which involved experts from neuroscience and cardiac research, we aim to address these questions in an interdisciplinary way.”

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Weekly CEO Update: It’s understanding and communicating the ‘WHY?’ that really matters in the workplace


As we near the 12-month mark of the disruption and change as a result of the COVID-19 pandemic, and look to learn from those subsequent changes and challenges across many workplaces, I had the chance to reflect on and discuss these issues for the public sector as part of a Mandarin webinar this week.

Looking back and looking forward in a period of constant churn and change is difficult… and on reflection it’s the ‘why’ we’ve done things in the workplace, and how we’ve communicated this that really piqued my interest.

It was also the understanding that we need to pace ourselves, and manage expectations going forward by encouraging each other to take the time to plan, think and reflect for the year ahead, especially following the year that has been and the sustained peak for many.
In the public sector, many departments and thousands of public servants, both state and federal, have had to ‘surge’ from March last year to deliver new policies, programs and systems, and have had to maintain that surge for 12 months now.

For those on the frontline of service delivery, be it the many people who administered and processed nearly 40,000 COVID tests in a single day in Melbourne, or those providing home delivery services, or trucking resources around the country and across borders, the stress levels and challenges have been high and constant.

At Mental Health Australia one of the ways we’ve tried to manage the sustained stress and challenges resulting from COVID is to elevate the conversations in the workplace and not assume they are occurring. By this I mean talking about how the changes are working, where they are not working, and identifying team-based opportunities for improvement and reflection.

For those not on the frontline, who have been fortunate to be able to work from home, this has meant missed interpersonal benefits of being present in workplaces, so we’ve had to look for ways to schedule it in. We’ve had to do more than assume, and work together to find the balance of what works for some people, what works for others, and then what works as a team.

The additional challenges of working from home and knowing when to stop, and what is work, and what is home time, has really challenged people, especially in the public sector, and again when workplaces, managers and leaders reflect on this, and the sustained nature of such activity, there will be a lot to learn both positive and challenging.

Personally, and having started in this role during the pandemic, leading Mental Health Australia in this type of environment has been tough, but equally rewarding. And I’m sure that has been the case across many organisations and sectors, particularly the public sector where changes in an office working environment, or post-election changes, or the machinery of government changes, have always thrown up challenges.

In every workplace there has always been the need to respond to critical issues, crises and change and we need to acknowledge that these have only been amplified as a result of COVID.

Ultimately what the pandemic has shown us is that there is no certainty, so managing uncertainty has become part of our day-to-day business. Acknowledging this, and understanding and managing change in an organisation, is about over communicating and involving people to engage both with the problems and with the solutions.

We know that when there IS NOT good communication about the ‘why?’ behind changes people are often left to try and understand it themselves. When the uncertainty and change is constant like we have experienced together through this pandemic, the why, why, why is even more important, especially how it fits with an organisations values and how it is communicated.

Reflecting and learning from the ‘why?’ we did things — why we need to make changes and how we communicated then and now — can only help organisations and individuals move forward in 2021, and that can only benefit workplace mental health.

Mental Health Australia is a proud member of the Mentally Healthy Workplace Alliance and to find out more, including a number of COVID specific resources available to small, medium and large workplaces, please click here.

Have a good weekend.

 

Leanne Beagley
CEO


The Select Committee on Mental Health and Suicide Prevention is now calling for submissions by 24th March 2021. The Committee has been established to consider a range of strategic reviews of the current mental health system, and whether the recommendations are fit for purpose to address the fallout from bushfires and the COVID-19 pandemic. Mental Health Australia will be developing a submission pointing the Committee to previous policy positions and submissions relevant to their deliberations. Members are welcome to provide input to this process by emailing policy@mhaustralia.org

On Monday we have a Mental Health Australia Governance Committee meeting and then I’m meeting with Mohammad Al-Khafaji from the Federation of Ethnic Communities’ Councils of Australia (FECCA)

On Tuesday I’ll be taking part in the Culturally and Linguistically Diverse Communities COVID-19 Health Advisory Group meeting and on Wednesday I’ll be meeting with Pain Australia CEO, Carol Bennett.

On Thursday the National Safety and Quality Community Mental Health Service Standards Advisory Group Meeting will be held and then later that day I’ll be meeting with the Australian Borderline Personality Disorder Foundation.

 

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Like breathing, swallowing is essential to everyday life. Around one million Australians have a swallowing difficulty, which can occur at any stage of life. Swallowing Awareness Day 2021, 17 March, is an opportunity to bring attention to swallowing disorders and to connect people with speech pathologists, the professionals who can help. The strong correlation of mental health conditions and swallowing conditions reinforce the importance of speech pathology involvement in the mental health system. Find campaign resources here.

Gayaa Dhuwi (Proud Spirit) Australia have been asked by the Australian Government to renew the 2013 National Aboriginal and Torres Strait Islander Suicide Prevention Strategy (NATSISPS) in consultation with stakeholders and community members. The NATSISPS will be available for comment here in the coming weeks.

  

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My girlfriend has severe mental health problems and is suicidal and I need advice on how I can help and what I should do? : mentalhealth


My girlfriend has been constantly telling me she’s suicidal but also assures me that she won’t do anything but I keep fucking up by saying things that upset her. For instance, last night she was telling me she was feeling suicidal because of the crappy week that she had and I kept trying to be optimistic but then she kept saying that it’s all pointless. As I’m trying my best to help out by telling her these optimistic and uplifting things she’s saying things in a passive aggressive, sarcastic and somewhat mean way from my point of view. This then starts to cause me to get a bit angry and then I said something that my anger caused me to say which was: “I don’t think we should talk for the rest of the night. I feel like I can’t do anything for you which is making me feel useless” then she was like “ouch goodnight” and then I said “I’m trying my best to be of help but nothing seems to be working and I’m trying to give you reassurance and love but I feel like it’s doing nothing” then she proceeded to explain that I made it about me getting my feelings hurt and was implying how I need to focus on her temporary suicidal and negative feelings. I just feel like it’s been taking so much of my positive energy away from me and it’s bringing my mind into negativity but at the same time I need to understand that I need to suck it up and not show that negativity for her sake and the relationship’s sake. If anyone can just show me the right direction I should be bringing my mind and feelings towards that would be great. I really want to be able to say and do the right things for her and getting the opinions of people in this community would mean the world to me. Me and this girl truly love each other and have talked about marriage and kids a lot and I have a good feeling that she’s my soulmate but I need advice. Thank you.

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preventative counselling for new parents


They say nothing can prepare you for your first baby, and that might well be true. But here, with the help of a counsellor, we explore preventive relationship counselling, and uncover the benefits that it can unlock for you and your family

It goes without saying that the decision to start a family is a monumental one. For many people, the ‘right time’ may have come after years of thought and reflection, and is bundled up with a plethora of fears and anxieties about this new, unknown, pathway.

From time management to body image, exhaustion, frustration, disappointment, external expectations, internal expectations, and boredom – family life has a lot to contend with, and all of that can take its toll on our relationships.

According to a study by ChannelMum.com and The Baby Show, a third of parents reported that their relationships suffered in the months following the birth of their babies, and a fifth ended their relationships during the first year of parenthood.

If the outlook seems bleak, know that the stats only show part of the story, and that relationships can break down for many complicated, and sometimes unavoidable, reasons. And although it’s fair to say that children can put a huge amount of strain on couples, it’s also true that there are steps you can take to address potential problems way before you hear the pitter-patter of little feet echoing around your home.

What is preventive counselling?

If you’ve ever been under the impression that counselling is just for when you reach crisis point or are living with a diagnosed mental illness, it’s time to throw everything you thought you knew out the window – because counselling offers so much more.

Preventive counselling aims to do what it says on the tin: prevent issues from escalating further. It helps you to nip any potential problems in the bud before they have time to grow, and it can also aid you in building resilience for the times to come.

Think about it: how often can you sit down with another person and say exactly what’s on your mind, without the fear of upsetting the listener or feeling judged? To really explore what’s going on, deep within you? Preventive counselling is a space to do that and, when it comes to preparing to expand your family, it could be the missing piece in your pre-baby prep plan.

Talkin’ it out

“There are many benefits to a couple seeking support as a prevention to long-term issues,” says Natasha Crowe, a counsellor and psychotherapist. “It provides a safe and comfortable space for couples to explore life’s challenges, and it gives the opportunity for solid communication – to feel heard is key to a healthy relationship.”

All this is part of the day-to-day job of a counsellor, who is there to facilitate difficult but meaningful conversations, and uncover the key to a working dynamic between two people – examining how they communicate, be that verbally or non-verbally.

“As individuals, we all have different perspectives, attachment styles, opinions, habits, and family narratives that we may bring to a relationship,” Natasha continues. “We sometimes don’t recognise these in ourselves because they are often subconscious elements and behaviours that we may have learned from previous intimate relationships throughout our lives, or the relationships we experienced growing up.

“These narratives, and sometimes mistaken beliefs, aren’t always helpful.
Therefore it’s important to really understand your partner’s perspective, concerns, and beliefs. Counselling can then help to give a couple the tools to communicate, build greater intimacy, and deeper levels of trust.”

Crossed wires, conflicting priorities, and rising emotions – they’re all commonplace in any relationship. And that’s not necessarily a bad thing, if they are handled in a calm and productive way.

Managing the baby boom

Of course, you could seek preventive relationships counselling at any point in your life, but for those about to start a family, the offerings are particularly ripe.

“Starting a family is a big life decision that comes with much joy, expectation, and anticipation,” says Natasha. “Quite often, couples seeking support may have avoided conversations about how they view parenting or family life – it doesn’t even cross our minds to think our partner may have different ideas about bringing up a child, and how our parenting styles might differ.”

Perhaps one parent believes in being firm and setting clear boundaries, where the other wishes to be more intuitive and flexible. Or maybe there are cultural differences that may feel more distinctive when parenthood arrives. As Natasha highlights, these disparities can creep up on us, where they were once just an undercurrent on an otherwise smooth tide.

Additionally, not every journey to starting a family is easy, and those who are experiencing fertility issues or IVF may find counselling particularly helpful. There should be no shame in admitting that you need extra support – it’s not an indication of a ‘failing’ relationship, rather it’s a sign of commitment and, as Natasha highlights, can help you move forward with optimism – something we all deserve.

What’s the craic?

So, let’s say you decide to give preventive pre-baby counselling a try, what might you expect from a session?

“During sessions, we may explore and challenge old beliefs and parenting ideals, understanding that the couple’s journey together is unique to them as they build their own family, exploring fears or worries,” explains Natasha. “There may be unresolved childhood trauma or emotional pain that hasn’t yet healed, which may manifest in unhealthy behaviours within a relationship, and often these are discussed and explored.”

“Starting a family is a big life decision that comes with much
joy, expectation, and anticipation”

As Natasha sees it, these sessions can help both the couple and the individual, and could possibly uncover some areas where one person might want more support in the future.

“Parenting is a transitional journey, there is no right or wrong way, and there will be lots of changes ahead – personal sacrifices can be hard to accept,” Natasha continues. “You can never be fully prepared, as it’s such a life-changing experience, yet you can begin to build the foundations of a solid partnership where each parent feels supported, listened to, and respected by the other person.”

There’s no time like the present

The decision to start counselling is a daunting one. This could be the first time in your life that you open up to another person – really open up – and the courage it takes to reach out shouldn’t be underestimated. But understanding preventive counselling to be the deeply positive step it is, makes the journey that much easier.

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“Being curious, open-minded, and adaptable to other ideas can really help open clients up to a new self-awareness,” says Natasha. “It helps build confidence and allows the couple to grow, and to face the challenges and joy of becoming a family together.”

Good mental wellbeing is the foundation of any healthy lifestyle. It can help us face the problems that come our way with resilience, compassion, and a clear mind. Of course, our mental health will often fluctuate, particularly during immense life changes, such as starting a family. But with communication, companionship, and the support of our loved ones, the challenges that once seemed incomprehensible become a little more manageable.

For more relationship and perinatal mental health support visit counselling-directory.org.uk



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Understanding and Treating Eating Disorders


Millions of Americans suffer from eating disorders, serious and sometimes fatal illnesses that cause severe disturbances in a person’s eating behaviors. The behavioral and physiological consequences of these illnesses can result in significant comorbidities, and death from medical consequences or suicide are all too frequent. As we enter National Eating Disorders Awareness Week, I wanted to take the opportunity to provide an update on NIMH-funded research aimed at diminishing the impacts of eating disorders.

Optimizing and Improving Existing Treatments

Psychosocial interventions, like cognitive behavioral therapy (CBT) and family-based therapy, are the mainstays of treatment for people with eating disorders. For some, anti-anxiety and antidepressant medications also play a role in management of the illness. While these treatments can be helpful, not everyone benefits equally from even the best treatments. For this reason, one area of focus for NIMH is research aimed at improving the efficacy and availability of existing treatments.

CBT, for example, works by teaching individuals with eating disorders to recognize and describe their food-related behaviors, examine their underlying cognitive and emotional motivations, and develop strategies to reduce these motivations and counter maladaptive eating patterns. But CBT can be challenging to deliver and reaching individuals with eating disorders in treatment, especially adolescents, can also be difficult.

One potential solution is to leverage technology to engage individuals in treatment. Three investigators at Washington University in St. Louis, home to a center for eating disorders research, are working hard in this area. Early stage investigator Ellen Fitzsimmons-Craft, Ph.D., is developing and testing an optimized conversational agent, or “Chatbot,” to facilitate mental health service use for individuals with eating disorders. In another project, Patricia Cavazos-Rehg, Ph.D., and Denise Wilfley, Ph.D., are leveraging social media to identify and connect teens who have eating disorders with a low-cost, personalized mobile health intervention to support and motivate recovery. Dr. Wilfley is also testing a similar approach in college-age youth, covering a particularly vulnerable population.

Other efforts are leveraging what we know about how the brain controls behavior to build on existing treatments in order to help more individuals with eating disorders. One approach, being studied by Stephanie Manasse, Ph.D., of Drexel University, takes advantage of the brain’s natural abilities to inhibit habitual behavior, the so-called inhibitory control system. Dr. Manasse is developing and testing a targeted adaptation of CBT for individuals with binge-eating disorder to see if enhancing inhibitory control will help reduce the frequency of binges. Another approach, pioneered by Claire Aarnio-Peterson, Ph.D., of Cincinnati Children’s Hospital, addresses the importance of engaging families in the treatment of adolescents with anorexia nervosa. Dr. Aarnio-Peterson is studying the effectiveness of a family therapy aimed at equipping parents with the skills necessary to effectively support their child through the treatment process. With these studies, researchers hope to expand the reach and effectiveness of current therapies.

From Brain Mechanisms to Novel Therapies

Eating disorders research is also benefiting from advances in neuroscience and the understanding of brain-behavior relationships. A series of studies supported over the past few years has begun to change how we think about eating disorders and potentially how we treat them. Studying the neural mechanism of food choice, a group of investigators—including Joanna Steinglass, M.D., B. Timothy Walsh, M.D., and Daphna Shohamy, Ph.D., of Columbia University—showed that individuals with anorexia had differences in activity in the striatum and prefrontal cortex that accounted for their decisions to avoid high-fat foods and these differences correlated with their restrictive eating behaviors. Around the same time, Guido Frank, M.D., and colleagues at the University of California, San Diego, showed differences in striatal reward-related signals in a separate study of individuals with anorexia.

What do these two NIMH-funded studies have in common? Reward signals in the striatum teach the striatally-based decision-making system how to choose from available options, including food options. Changes in the way these reward signals work (such as the changes discovered by Dr. Frank) could cause the striatum to change how it responds to foods (as shown by the Columbia group), triggering the maladaptive food avoidance behaviors seen in anorexia.

This neuroscience work lays the foundation for novel approaches to treating anorexia. Other NIMH-funded research has shown that striatal reward signals are mediated by the neurotransmitter dopamine. Accordingly, Dr. Frank is studying the potential of drugs that alter dopamine signaling as a way to reverse behaviors associated with anorexia nervosa. He has already published promising preliminary efficacy data from research investigating a currently available dopamine receptor blocker in individuals with anorexia nervosa. Meanwhile, Dr. Steinglass and Jonathan Posner, M.D., also of Columbia University, are studying the time course of striatal dysfunction in anorexia with the goal of developing behavioral treatments that target specific phases of the illness, preventing or reversing maladaptive food choice behaviors.

The burden of eating disorders is substantial for patients, families, and loved ones. At NIMH, we support these and other studies with the aim of reducing this burden and bringing hope to the many who bear it.

References

DeGuzman, M., Shott, M. E., Yang, T. T., Riederer, J., & Frank, G. (2017). Association of elevated reward prediction error response with weight gain in adolescent anorexia nervosa. The American Journal of Psychiatry, 174(6), 557–565. https://doi.org/10.1176/appi.ajp.2016.16060671

Foerde, K., Steinglass, J. E., Shohamy, D., & Walsh, B. T. (2015). Neural mechanisms supporting maladaptive food choices in anorexia nervosa. Nature Neuroscience18(11), 1571–1573. https://doi.org/10.1038/nn.4136

Frank, G. K., Shott, M. E., Hagman, J. O., Schiel, M. A., DeGuzman, M. C., & Rossi, B. (2017). The partial dopamine D2 receptor agonist aripiprazole is associated with weight gain in adolescent anorexia nervosa. The International Journal of Eating Disorders, 50(4), 447–450. https://doi.org/10.1002/eat.22704

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Submission – To the Draft National Children’s Mental Health and Wellbeing Strategy


Submission – To the Draft National Children’s Mental Health and Wellbeing Strategy

In August 2019, The Minister for Health, the Hon Greg Hunt MP announced that a National Children’s Mental Health and Wellbeing Strategy would be developed as a part of Australia’s Long Term National Health Plan. Mental Health Australia provided a submission in February 2020 on the content of the draft Strategy, developed by the National Mental Health Commission (NMHC).

Mental Health Australia supports the intent of the Strategy’s Wellbeing Continuum to shift away from a diagnosis-driven approach to instead focus on the child’s functioning. Unfortunately, the narrative of the Wellbeing Continuum does not appear to be well reflected in concrete Actions. The Strategy’s centrepiece, the proposed model of integrated child and family care, appears to be framed largely in a medical model, and neglects to leverage successful community and social programs and therefore does not address the social determinants of mental health. The danger here is a well intentioned policy, which unintentionally perpetuates the existing gaps in children’s mental health services. 

Mental Health Australia’s submission outlines a range of recommendations designed to strengthen the Strategy Actions to meet the current and future challenges of Australian children’s mental health and wellbeing. These recommendations will assist the NMHC to design a Strategy that influences governments to build the mental health system Australian children need: a comprehensive system of child and family supports, spanning the continuum from prevention and early intervention through to crisis responses and therapeutic interventions for those with established serious conditions.

 

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I’m struggling, and don’t know how to talk to the people around me about it. : mentalhealth


I have declined again in the past few weeks, I’ve tried to prevent my sadness and grief by all the physical things like keeping my room clean, eating well, meditation, “treating myself”. It doesn’t work really, only temporarily do I feel okay and then retreat to a corpse-like state.

I don’t know how to healthily reach out to my friends without weighing on them, worrying them, or creating an awkward situation. They have only really approached my well being when I’m visibly upset.

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Decluttering tips for low periods


With help from a decluttering expert, we explore tips for tackling mess when you’re going through a difficult time

When we’re going through periods of low mood and depression, it can be easy to let clutter build up in our homes to the point where it becomes overwhelming. As our motivation wavers and things start to slip, we can get caught in a clutter cycle – our mood only made worse by our chaotic environment.

Here, decluttering expert Dilly Carter explores five tips for breaking the cycle and creating a soothing environment:

1. Create a corner of calm

It’s important that we have at least one area in our home where we can sit, relax, and unwind, without being surrounded by clutter. So focus on that first – even if you move the clutter to another spot for now – so that you have an area in your home where you can unwind from the stress of the day, free of mess.

2. Work out areas that are most valuable

What space do you need to reclaim the most? Maybe it’s your bedroom? Any good therapist or doctor will tell you that sleep is vital for wellbeing. So, if you’re not getting a good night’s sleep, could the chaos in your bedroom be contributing to that?

If you are working from home, simplifying your WFH space can help you feel more motivated. A dedicated home office space is the dream, but even if you only have a corner of your kitchen, you can still create a space that is clear of clutter – and unwashed dishes! If you try to work surrounded by disorganised paperwork, it’s harder to focus and concentrate. Maintaining an organised space and a healthy work-life balance is vital to your productivity, creativity, and wellbeing.

Now ask, what tools do you need to reclaim it? Do you need help from someone else, be it a professional or family member? Write down the steps you need to achieve your goal.

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3. Set aside dedicated time

Time is our most valuable commodity. Where you can, set aside time to make your vision become reality. Often, when we’re struggling, jobs get started but are not completed. So think about the time you need to complete the task ahead. Is it achievable in the time frame you have set yourself? How can you make it work?

4. Try a ‘Dolly Dash’

A ‘Dolly Dash’ is a quick 15-minute challenge to change something in your home (you’ll find lots of suggestions for these in my book).

You might give your sock drawer a whirl, and once you have finished the sense of achievement might drive you on to declutter the chest of drawers. Perhaps you’ll even be inspired to tackle the whole room!

When did you last ‘Dolly Dash’ your cutlery drawer? Are you keeping excessive numbers of knives, forks, and utensils in one drawer? What can be moved out? What can be recycled? Do you have a ‘good’ cutlery set that only comes out on special occasions? Why not use that every day? It’s amazing how just a small change can make a big difference to your day.

If all else fails, put a load of washing on or set the dishwasher going. I guarantee you’ll feel like you’ve achieved something just by doing that.

5. Don’t give up

It’s easy to feel overwhelmed or unmotivated, but keep going until you reach your goal. These things take time. Don’t put yourself under pressure to achieve everything at once. Be kind, forgive yourself, and just keep that end vision in mind.

To speak to a counsellor about managing low periods, visit www.counselling-directory.org.uk



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NIMH » Study Identifies Risk Factors for Elevated Anxiety in Young Adults During COVID-19 Pandemic


Findings on impact of childhood temperament could help with anxiety prevention efforts

A new study has identified early risk factors that predicted heightened anxiety in young adults during the coronavirus (COVID-19) pandemic. The findings from the study, supported by the National Institutes of Health and published in the Journal of the American Academy of Child and Adolescent Psychiatry, could help predict who is at greatest risk of developing anxiety during stressful life events in early adulthood and inform prevention and intervention efforts.

The investigators examined data from 291 participants who had been followed from toddlerhood to young adulthood as part of a larger study on temperament and socioemotional development. The researchers found that participants who continued to show a temperament characteristic called behavioral inhibition in childhood were more likely to experience worry dysregulation in adolescence (age 15), which in turn predicted elevated anxiety during the early months of the COVID-19 pandemic when the participants were in young adulthood (around age 18).

“People differ greatly in how they handle stress,” said Daniel Pine, M.D., a study author and chief of the National Institute of Mental Health (NIMH) Section on Development and Affective Neuroscience. “This study shows that children’s level of fearfulness predicts how much stress they experience later in life when they confront difficult circumstances, such as the pandemic.”

Behavioral inhibition is a childhood temperament characterized by high levels of cautious, fearful, and avoidant responses to unfamiliar people, objects, and situations. Previous studies have established that children who display behavioral inhibition are at increased risk of developing anxiety disorders later. However, less research has investigated the specific mechanisms by which a stable pattern of behavioral inhibition in childhood is linked to anxiety in young adulthood.

The authors of this study hypothesized that children who demonstrate a stable pattern of behavioral inhibition may be at greater risk for worry dysregulation in adolescence—that is, difficulties managing worry and displaying inappropriate expressions of worry—and this would put them at greater risk for later heightened anxiety during stressful events like the pandemic.

In the larger study, behavioral inhibition was measured at ages 2 and 3 using observations of children’s responses to novel toys and interaction with unfamiliar adults. When the children were 7 years old, they were observed for social wariness during an unstructured free play task with an unfamiliar peer. Worry dysregulation was assessed at age 15 through a self-report survey. For the current study, the participants, at an average age of 18, were assessed for anxiety twice during the early months of the COVID-19 pandemic after stay-at-home orders had been issued (first between April 20 and May 15 and approximately a month later).

At the first assessment, 20% of the participants reported moderate levels of anxiety symptoms considered to be in the clinical range. At the second assessment, 18.3% of participants reported clinical levels of anxiety. As expected, the researchers found that individuals with high behavioral inhibition in toddlerhood who continued to display high levels of social wariness in childhood reported experiencing dysregulated worry in adolescence, and this ultimately predicted increased anxiety in young adulthood during a critical stage of the pandemic. This developmental pathway was not significant for children who showed behavioral inhibition in toddlerhood but displayed low levels of social wariness later in childhood.

“This study provides further evidence of the continuing impact of early life temperament on the mental health of individuals,” said Nathan A. Fox, Ph.D., Distinguished University Professor and director of the Child Development Lab at the University of Maryland, College Park, and an author of the study. “Young children with stable behavioral inhibition are at heightened risk for increased worry and anxiety, and the context of the pandemic only heightened these effects.”

The findings suggest that targeting social wariness in childhood and worry dysregulation in adolescence may be a viable strategy for the prevention of anxiety disorders. The findings also suggest that targeting dysregulated worry in adolescence may be particularly important for identifying those who might be at risk for heightened anxiety during stressful life events like the COVID-19 pandemic and preventing that heightened anxiety.

Reference:

Zeytinoglu, S., Morales, S., Lorenzo, N. E., Chronis-Tuscano, A., Degnan, K. A., Almas, A. N., Henderson, H., Pine, D. S., Fox, N. A. (2021) A Developmental Pathway from Early Behavioral Inhibition to Young Adults’ Anxiety During the COVID-19 Pandemic. Journal of the American Academy of Child and Adolescent Psychiatry. doi: 10.1016/j.jaac.2021.01.021

Grant:

MH093349, HD017899

###

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

NIH…Turning Discovery Into Health®

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