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Signs of anorexia
•avoid food and meals
•pick out a few foods and eat these in small quantities
•carefully weigh and portion food
•carefully check calories and fat content of food
•keep lists of food or keep a food diary
•deny you are hungry
•make excuses to avoid eating
•hide food you claim to have eaten
•repeatedly check your body weight
•try other ways of controlling your weight, such as intense and compulsive exercise
•get rid of what you have eaten by vomiting or using laxatives, enemas or diuretics
•put yourself down as being ‘fat’ or say you do not matter
•try to please everybody or get approval from other people.

Effects of anorexia on the body
•Severe weight loss
•Constipation and stomach pain
•Dizzy spells and feeling faint
•Downy, fine hair on your body
•Your hair falling out
•Poor circulation and feeling cold
•Dry, rough or discoloured skin
•Your periods stop or do not start
•Dehydration

Physical effects often improve when you recover, but there is a risk of long-term damage such as osteoporosis or not being able to have a child (infertility). It may be useful to talk to your doctor about any steps you can take to reduce your risk of developing long-term problems.

There is a list of organisations at the end of this factsheet that you could contact if you feel that you may have an eating disorder and would like further advice and information.

Signs of bulimia
•Urges to eat large amounts of food
•Moods swings
•Anxiety and depression
•Not feeling good about yourself (low self esteem)
•Feeling ashamed or guilty
•Vomiting after you eat
•Excessive use of laxatives, diuretics or enemas
•Periods of fasting
•Excessive exercise
•Secrecy and reluctance to socialise

Effects of bulimia on the body
•Sore throat
•Bad breath
•Bad skin
•Irregular periods
•Tiredness
•Puffiness of face and fingers

Signs of binge eating disorder and compulsive eating
•Fear of not being able to control eating, and of not being able to stop eating
•Fear of eating around others
•Believing that life will be better if you lose weight
•Putting yourself down with comments after eating
•Blame your failure in social and professional life on your weight
•Depression/ mood swings
•Fatigue
•Using a variety of popular diet plans
•Hiding food in strange places to eat later
•Vague or secretive eating patterns

Effects of binge eating disorder and compulsive eating on the body
•Getting out of breath after light activity
•Excessive sweating
•High blood pressure and/or cholesterol
•Leg and joint pain
•Weight gain
•Decreased mobility due to weight gain
•Loss of sexual desire or promiscuous sexual activity
•Insomnia
•Poor sleeping habits

What are the causes of eating disorders?

We do not know exactly why someone develops an eating disorder. There is not one single cause. It seems to be a combination of factors, which can include:
•your personality
•your culture
•your family life
•things that have happened to you or that you have seen
•feeling that you need to act on impulse
•feeling that you need to achieve perfection
•physical or genetic factors.

Some people believe that eating disorders are a direct result of the pressure from media and fashion to be thin. Whilst this kind of pressure can play a part in dieting behaviours, there are more complicated issues that could cause you to lose control of your eating behaviours.

Bulimia and other eating disorders are not helpful ways of coping with problems. If you are feeling this way, you may need support to recover.

You can find out more about getting help for your mental health here.

Causes of Anorexia

Causes of Bulimia

Causes of Anorexia

If you have anorexia, your obsession with weight loss may be because you believe that your value as a person depends on your weight and body shape. This can lead you to experience an intense fear of being overweight and eating that most people do not experience, even when dieting.

Anorexia stems from some emotional need, which could be lack of stability in your current relationships, anxiety about growing up or experiencing body change, or trying to cope with something traumatic such as sexual abuse. You can develop anorexia even if you have a very supportive family, partner or friends, so it’s important to remember that it is no one’s fault.

Causes of Bulimia

You may develop bulimia because you need an emotional release for a range of issues, such as experiencing physical, emotional or sexual abuse, or problems with family or other relationships. It might be that there isn’t an obvious reason but you still need an emotional outlet.

Anorexia

Anorexia usually starts when you are a teenager. About 1 in 250 teenage girls and young women and 1 in 2000 teenage boys and young men have anorexia. If you have anorexia, you try to keep your weight as low as possible. It can make eating very distressing and you may have a distorted view of how you look. You are likely to think you are overweight even if you have become dangerously thin.

It helps to get early treatment, but you may not want to get help.

You may not always notice that you are having problems with eating or you may not accept that you might have an eating disorder. If you are concerned though, you may want to change. You might need help to do this.

Bulimia

Bulimia often starts when you are a teenager, although it can sometimes happens later. Men can also have bulimia but it is less common than in women. You can develop bulimia if you have had anorexia in the past.

Bulimia is linked with emotional problems and how you feel about yourself. If you have bulimia, you try to keep your weight as low as possible. You will often binge eat and then try to make up for the amount you have eaten. You might do this by vomiting and/or taking laxatives. This is often referred to as ‘purging’. You may starve yourself or exercise excessively to work off the calories.

You may do these things secretly. Many people feel disgusted and ashamed when they binge eat but feel relieved once they purge. You may often be fascinated by food, buy magazines and cook-books to read recipes and enjoy discussing dieting issues. You may use strict diet plans and exercise.

You will usually have an average body weight so other people may not notice you are having these problems for a long time.

If you are vomiting regularly, this can be very bad for your teeth. You should not brush your teeth after vomiting. Instead, you should use a non-acidic mouthwash and should avoid acidic food and drinks, such as ‘fizzy drinks’.

Other eating disorders

You may not have all the symptoms of a particular eating disorder. If so, you might have a diagnosis of a ‘partial syndrome’.

You might have a particular eating problem, such as chewing and spitting food without swallowing, or swallowing food and then bringing it back up. You may eat items such as tissues to fill up on without eating calories.

You may have elements of an eating disorder, or have symptoms that do not normally fall within the diagnosis of one of the main eating disorders. If so, a doctor will diagnose you with an ‘atypical eating disorder’ or an ‘eating disorder not otherwise specified’ (EDNOS).

Binge eating disorder (BED)

If you have binge-eating disorder you may eat large quantities of food in a short period of time uncontrollably, with the same binge-eating symptoms as bulimia. The main difference is that you do not try to get rid of the food afterwards. This can mean you may be overweight for your age and height.

You may binge as a way to cope with difficult emotions such as unhappiness, guilt or low self-esteem and to cope with daily stresses and problems in your life.

Compulsive overeating

If you have compulsive overeating you pick at food all day. You might do this to deal with difficult feelings and for similar reasons to people with binge eating disorder.

If you have an eating disorder, there are serious changes to the way you eat. For example, you may eat far less or overeat. You may be distressed or concerned about your body shape or weight. This section has information if you have an eating disorder or are worried that you do.
•Eating disorders are illnesses that develop when problems with food or eating patterns spiral out of control.
•Eating disorders often start during adolescence or early adulthood but you can get them in adulthood.
•It is common to have another mental health condition alongside an eating disorder.
•Eating disorders can lead to a wide range of physical health complications. This includes serious heart conditions and kidney failure which can be fatal.
•Medication, talking therapies and family therapy can all be effective treatments for eating disorders.

Anyone can develop an eating disorder regardless of age, sex, cultural or racial background. Females are more likely than males to develop an eating disorder, but it is thought that eating disorders in males are greatly under-diagnosed and should be acknowledged as a growing issue. According to BEAT, the eating disorder charity, at least 10% of people diagnosed with an eating disorder are male.

Alcohol

(Related words – Booze, Bevvy, Drink, Shots).

Some people drink with friends in pubs or at home. Others feel that they need to drink just to get through the day. Many people with a mental illness have problems with alcohol. People with mental illness misuse alcohol more than any other drug. It is easy to get and it is highly addictive. Drinking alcohol can make you unwell again if you have had mental health problems in the past. Doctors call this ‘relapse’.

The short term effects of alcohol depend on how much you drink. In small amounts, alcohol can make you feel more confident and sociable. The more you drink, the more likely it is that you will feel tired, dizzy, confused or unwell.

The long term effects of alcohol also depend on how much you drink, and how regularly you drink it. If you drink too much on a regular basis then you could cause yourself some serious physical and mental harm. Drinking may make it more difficult for you to recover from your mental illness, and may reduce your quality of life.

Some people think that drinking has caused them to develop a mental illness. For example, Patrick told the NHS that:

‘I began to realise I wasn’t functioning that well. I was getting depressed and I think that was connected to alcohol. It makes you moody, morose and introspective. I was forgetting things. I’d started on a new project and it was slipping away from me. I wasn’t on top of it.’

The government recommends that women should limit themselves to two to three units a day and men should limit themselves to three to four units a day. To find out more about what this means, visit http://www.nhs.uk/change4life/Pages/alcohol-lower-risk-guidelines-units.aspx.

Amphetamine and methamphetamine

(Related words – Crystal Meth, Meth, Phet, Speed).

In the short term, these drugs can make you feel wide awake and chatty. This can make it difficult for you to relax or get to sleep.

In the long term, amphetamines might make you anxious and depressed. They might also make you experience things that aren’t real. This is called ‘psychosis’.

When you stop taking the drug, you may feel depressed and you might find it hard to sleep.

Benzodiazepines

(Related words – Benzos, Downers, Tranquilisers, Valium).

Sometimes a doctor will prescribe benzodiazepines to help people with anxiety. People also buy them illegally because of their relaxing effects. They are very highly addictive, and so doctors normally only prescribe them for a short time.

In the short term, these drugs can make you feel calmer. Depending on the particular type you are taking, they could make you feel confused, irritable and in some cases they can make you experience things that are not there (hallucinations) and cause psychosis.

In the long term, some people become addicted. This can have a big affect on their day-to-day life. Also, some research has shown that if you use benzodiazepines for a long time, your memory or concentration could be affected.

Cannabis

(Related words – Dope, Draw, Ganja, Grass, Hash, Herb, Marijuana, Pot, Skunk, Weed).

Some people take cannabis because in the short term it makes them feel relaxed or happy. It can also make you feel anxious, paranoid and experience things that aren’t real. This can be a sign of psychosis. Doctors sometimes call this ‘cannabis-induced psychosis’.

Cannabis can have some serious long term effects on your physical and mental health. Recent research has shown that using cannabis can increase your risk of getting schizophrenia. This risk is higher if you:
•use it from a young age,
•use it for a long time or
•use high-strength cannabis like skunk.

Cocaine

(Related words – Crack, Coke, Charlie, Snow).

In the short term, cocaine can make you feel wide awake, talkative and excitable. There is a risk that you could take too much (overdose), and many people feel run down after taking it.

In the long term, cocaine use can affect how you feel. It can also affect your relationships with friends and family. If you use cocaine a lot or become addicted to it, you are more likely to have ongoing problems with depression, paranoia or anxiety.

Ecstasy

(Related words – E, MDMA, Pills, XTC)

In the short term, ecstasy can make you feel like you have a lot of energy, chatty and like you want to dance. It can sometimes make you feel anxious and confused.

In the long term, ecstasy may make you more likely to feel depressed or anxious.

Heroin

(Related words – Brown, Gear, H, Smack)

In the short term, heroin can make you feel relaxed and calm. It relieves pain and can make you feel sleepy. There is a risk that you could take too much (overdose). You can take it in different ways – some people smoke it and others inject it. If you inject it, you may get infections.

Heroin is a very addictive drug. It can have serious long term effects. When you stop taking it you may feel depressed and find it hard to sleep. You may feel that heroin becomes more important than other things in your life. This might make it harder to keep a job, affect your relationships with other people or have somewhere stable to live.

‘Legal Highs’

Legal highs are new drugs that become available before the government has had a chance to decide whether they are dangerous or not. There is often no way of knowing what is in them and what the risks are.

Mephedrone (meow meow, mcat or plantfeed) is an example of a drug that was a legal high but is now illegal because of the effects it was having on people who took it. Liquid ecstasy (GHB) is another ‘legal high’ that was made illegal.

Short term effects of legal highs vary but most are ‘uppers’ like cocaine or speed. This means that they make you feel energetic and talkative, which is why people often take them at clubs and festivals.

No one knows exactly how legal highs will affect you in the long term. The drugs are new and so scientists have not done a lot of research yet. There is evidence that some of these drugs may make you feel worse if you are at risk of having mental health problems.

LSD

(Related words – Acid, Blotter, Trips)

In the short term, LSD will make you experience things that aren’t real. Sometimes the experience will be enjoyable, and sometimes it will be frightening (a ‘bad trip’).

There is mixed evidence about the long term effects of LSD. We don’t know exactly how likely it is to cause mental health problems. Recent research has questioned whether LSD is actually a big factor, but other studies have suggested that people might become unwell after taking it.

What does ‘psychosis’ mean?

In some of the sections above we have mentioned ‘psychosis’. This means losing touch with reality. It can involve having unusual thoughts or experiencing things that aren’t real. It can be a symptom of mental illness and can also be a short-term effect of some drugs. You can find out more about this in our psychosis section.

You may use drugs to help you to deal with the symptoms of your illness, or you may use them because they make you feel good for a while. However, using drugs can have a long term negative effect on you. The possible long term effects include:
•Needing to take more to get the same effect
•Feeling like you have to take the drug (‘dependence’)
•Withdrawal symptoms – including feeling sick and feeling cold, sweaty or shaky
•Having sudden mood changes
•Having a negative outlook on life
•Loss of motivation
•Doing less well at work, school, college or university
•Problems with relationships
•Borrowing or stealing money from friends and family
•Being secretive.

Generally speaking, using drugs can mean it takes longer for your mental health to get better. Drugs can make you more unwell and can make you more likely to try and harm yourself or take your own life.

Using drugs could give you a mental illness that you didn’t have before. For example, recent research has shown that cannabis can increase your chances of developing schizophrenia.

•Drugs can make the symptoms of mental illness worse. Also, some scientists think that certain drugs can make it more likely for you to develop a mental illness. For example, recent research has shown that using cannabis may be linked to developing schizophrenia.
•If you have a mental illness and use drugs, doctors sometimes call this ‘dual diagnosis’.
•There are many reasons why you might use drugs. Some people use them to try and deal with the symptoms of their illness. This is called ‘self-medication’. Other people take them at social events or to feel calm.
•Drugs can make your mental illness worse in the long term. It can mean that your illness is harder for doctors to treat and you may find it hard to work or find stable housing. However, you can get help if you have dual diagnosis.
•Mental health and drug services should work together to give you the support you need.

The first step to getting treatment is to see your GP. They should rule out any physical problems which might cause symptoms of depression.

Common treatments for depression include:

Talking therapies

Talking therapy is available on the NHS, from private healthcare providers and sometimes from charities. You will meet a trained therapist for a fixed number of sessions. Sometimes this will be with a group of people with the same diagnosis as you.

There are many different types of talking therapy. According to the National Institute of Health and Care Excellence (NICE), cognitive behavioural therapy (CBT) is one of the most effective therapies for depression. It should normally be available in your area.

Other common therapies include:
•Psychodynamic therapy,
•Problem-solving therapy,
•Interpersonal therapy, and
•General counselling.

These therapies may not be widely available in your area but it is worth asking your GP about them if you are interested.

Computerised cognitive behavioural therapy (CCBT)

Computerised cognitive behavioural therapy (CCBT) is a relatively new way of treating mild to moderate depression. It is a way of learning CBT techniques online through a computer. You will complete regular sessions to learn new ways to deal with your depression.

In a lot of areas, the NHS uses CCBT programmes such as ‘Beating the Blues’, ‘COPE’ and ‘Overcoming Depression’. One of these, or something similar, may be available free of charge through your GP.

Antidepressants

Your doctor might offer you an antidepressant. You may need to try different types before you find one that works for you. Antidepressants can have unpleasant side effects and can affect other medicines you are taking. It is important to talk to your doctor before you stop taking them, because stopping suddenly can cause problems.

Exercise Therapy

Having good physical health and exercising can help with depression. Some GP surgeries will put you in touch with local exercise schemes. These might sometimes be called ‘exercise on prescription’.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a procedure sometimes used to treat severe depression. In this treatment, an electrical current is briefly passed through your brain while you are under general anaesthetic. ECT is only offered if other kinds of treatments have not helped and your depression is very severe.

Transcranial Magnetic Stimulation (TMS)

TMS involves using magnetic fields to try to change the way the brain works. Scientists think that this could help people with depression and does not cause any major safety concerns.

Complementary/ Alternative Therapies

Complementary therapies are treatments which are not part of mainstream medical care. They can include aromatherapy, massage, mindfulness, meditation and yoga. These are aimed at improving your emotional well being.

What causes depression?

Nobody knows exactly what causes depression. This section looks at some of the things that might increase your risk.

Your body

Scientists think that if you have depression, some of the chemicals in your brain are out of balance. In particular, having lower amounts of a chemical called ‘serotonin’ in your brain may cause depression.

Changes in your hormones can affect your mood. These changes might be particularly noticeable for women during pregnancy or menopause.

The family connection

Depression seems to run in families. This could be because:

a) it is passed down in your genes, or

b) you have experienced other people’s low moods.

Your background or situation

Problems during your childhood might cause depression. Bad experiences can lead to you thinking negative thoughts about yourself or about the world.

Stressful events, including problems at home, a breakup, the death of someone you know, or losing your home or a job can also affect your mood. Doctors sometimes call these ‘triggers’ or ‘triggering events’ if they think that these problems have caused your depression.

Lifestyle

Good food, exercise and hobbies can make it less likely that you will become unwell. Having other illnesses or using drugs or alcohol might make it more likely. There is more information on these things below.

Food

If we eat badly then we may be at risk of physical health problems like obesity, heart disease and diabetes. In the same way, the things we eat may affect our moods and our risk of becoming mentally unwell. Some people deal with their depression by eating high-fat and high-sugar foods. This is called ‘comfort eating’, and it can make things worse in the long term.

Some top tips include:
•Eat regularly throughout the day,
•Drink plenty of water,
•Try to avoid too much caffeine – tea, coffee and chocolate,
•Try to keep a healthy weight,
•Eat fruit, vegetables and wholegrain cereals,
•Don’t drink too much alcohol.

If you have depression, eating well will probably not have an instant impact on your mood. However, it might make you feel better in the long term.

Exercise

Exercising regularly can help your mood. Finding something that you enjoy doing is important so that you will want to keep it up. Exercise may also help you to get to sleep. Getting proper sleep is important for your mental health.

You can try increasing the amount of exercise you do gradually. The amount you can do will depend on your age, physical health and your fitness. We have listed some options below:
•Going for a walk
•Cycling
•Gardening
•Jogging
•Playing a sport
•Going to the gym

In some areas, you may be able to get ‘exercise on prescription’ from your GP. For example, you could get some free sessions at a local gym.

Drug and alcohol use

Using drugs can affect the way your brain works. Scientists think that this can have long lasting effects on you. Regularly drinking too much alcohol may also cause depression.

There is more information on drugs and alcohol in our ‘Drugs, Alcohol and Mental Health’ section.

Other illnesses

You may feel low if you have a physical illness. This risk might be higher if you have a long-term or life-threatening illness. Some people with brain injuries and dementia will also have changes in their moods.

What are the different types of depression?

You might have heard a number of terms used to describe depression. In this section, we explain what some of these terms mean.

Clinical depression

Clinical depression is a very common term but it is not a diagnosis. It just means that a doctor has given you a diagnosis.

Depressive episode

Your doctor might say that you are going through a ‘depressive episode’. This is the formal name that doctors give depression when they make a diagnosis. They may say that you are going through a ‘mild’, ‘moderate’ or ‘severe’ episode.

Recurrent depressive disorder

If you have had a number of ‘depressive episodes’, your doctor might say that you have ‘recurrent depressive disorder’. Again, they may say that your current ‘episode’ is ‘mild’, ‘moderate’ or ‘severe’.

Reactive depression

If your doctor thinks that your depression was caused by stressful events in your life, they may say that it is ‘reactive’.

Dysthymia

Your doctor might diagnose you with dysthymia if you have felt low for several years but have never had symptoms that would be enough to diagnose depression.

Manic depression

Manic depression is a different illness to depression. It is also known as ‘bipolar disorder’. People with this illness have severe highs (mania) and lows (depression).

Psychotic depression

If you are severely depressed, you may start to hallucinate or believe things that aren’t true. This is called ‘psychosis’. For example, you might start to hear voices that say that you are worthless and that things will never improve, or you may start to believe that someone is poisoning your food.

Post-natal depression

Postnatal depression is a common illness which affects between 10 to 15 in every 100 women who have had a baby. You may get symptoms that are similar to those in other types of depression.

Seasonal affective disorder (SAD)

This type of depression affects you at the same time of year, usually in the winter. The symptoms are similar to depression but you may sleep more rather than less. You might also eat more carbohydrates like chocolate, cakes and bread.