How to Recognize Risk and Help Prevent Suicide by Melissa Howard


Dealing with all the pressures of modern life can be overwhelming, and when someone reaches their breaking point, suicide can seem like the only option. According to the American Psychological Association, there was an “alarming” increase in the US suicide rate, up 30 percent between the years of 2000 and 2016.

It’s crucial to know what to look for, and how to respond. 

If you feel someone is at immediate risk of suicide, call 911. If you are concerned in general, talk things through and offer your contact information as well as that of the National Suicide Prevention Lifeline, which is available 24/7 by calling 1-800-273-8255.  

Along with offering support, those who are struggling can benefit from developing an emotional wellness team. For instance, social workers are often qualified to diagnose psychosocial problems and can help improve personal coping and social skills. The team could include other professionals as well. A counselor can help to address issues such as addiction, and clergy members are often trained to help those in emotional distress.

Here are some indicators that someone you know may be seriously considering suicide.   

Severe Mood Swings   

Sudden mood swings are common in people considering suicide, and may or may not relate to mental health issues such as bipolar disorder.    

Change in Habits   

A marked decrease in caring for one’s appearance, such as no longer shaving or showering, or dressing appropriately for classes or work, could indicate someone is experiencing depression and might be at risk for suicide. Often, making particular preparations, such as giving away personal belongings or even buying pills, guns, or knives, can also signal someone is suicidal.   

Drug and Alcohol Abuse   

Suicide and substance abuse are deeply intertwined. As California Highland Vistas explains, abusing substances can reduce someone’s inhibitions, leading to the conclusion suicide is the best choice. Oftentimes, people use substances in an attempt to self-medicate when they don’t feel good about their lives. High-risk drug use is associated with criminal charges, deteriorating health, financial instability, and spiked depressive disorders –– all risk factors for suicide.  If someone you know is having issues with substance abuse, seek immediate help. Sometimes their insurance may cover counseling for addiction issues. Seniors who are covered by a Medicare Advantage plan (like one from UnitedHealthcare) may have access to counseling for alcohol abuse.  

Isolation from Friends and Family   

People with suicidal thoughts often experience a sharp withdrawal from friends and family. Traumas such as divorce, unemployment, health setbacks, or the death of a loved one can be so jarring that people draw away from others around them. A growing body of research indicates that loneliness can be as much of a “silent killer” as obesity or smoking.   

Hopelessness and Despondency   

Exhaustion or sluggishness, a marked decrease in appetite, diminished interest in sex, a change in sleeping patterns, hopelessness regarding aspects of life (social life, credit card debt, etc.) and a loss of pleasure in one’s favorite activities and hobbies can all signal that someone is seriously considering taking one’s life. Be particularly alert if someone talks about suicide or to describes oneself as a burden to other people.   

Talking things through

Talking with someone you suspect is struggling can be a challenge.

Here are some guidelines to help:

  • Tell the person that you are concerned. Be understanding and gentle but also direct.

  • Act quickly. If you suspect someone plans to commit suicide, assess the severity of the risk. You can call emergency services or a suicide prevention hotline, or take the person in danger to the emergency room. Never leave a suicidal person alone. 

  • Be supportive. The worst thing you can do is act shocked or to pass judgment on someone who is suicidal. Instead, listen, extend your support, and let your loved one know that he or she is not alone.        

Everyone experiences low points throughout their life, and sometimes people see no way out of it.  If you notice someone struggling, reach out to them. By intervening, you could save someone’s life and set them on a path toward hope. 

Melissa Howard is on a mission to prevent suicide.

Learn more by visiting her website,

Photo by Unsplash

Eating Disorders: Myths and Realities

Many people know a little bit about eating disorders, but usually a lot of what people think they know turns out to be flat wrong. Why? There are a ton of misconceptions out there, driven by movies and TV programs where the producers may be aware of the epidemic but do not devote the research dollars needed to portray eating disorders meaningfully.

It’s easier to describe people with eating disorders as vain, attention seeking, or willful than to delve into the complex emotional world that drives these behaviors. These myths work their way into the general population, and it wouldn’t be surprising if you believe them too, even if only an unconscious level.

Myth: Only women get eating disorders.

Reality: The National Eating Disorders Association estimates that 10 percent of people receiving treatment for eating disorders are male (American Addiction Centers 2018). Unfortunately, many have interpreted this as meaning only 10 percent of people with eating disorders are male (Anorexia Nervosa and Related Eating Disorders 2018). However, the number of men suffering is much higher, closer to 25 to 40 percent of the general population, according to Hudson et al. (2007).

This percentage may be even greater, as men are much less likely to seek treatment for eating disorders. There’s a huge stigma surrounding the idea of having a “girl’s disease,” so men often don’t get treatment for it. Also, disordered eating may look very different for males, who have different “ideal” body types manufactured and promoted to them.

Myth: Only teenagers get eating disorders.

Reality: Eating disorders in midlife are increasingly common and growing at an alarming rate. The National Eating Disorders Association reports that 13 percent of women over fifty have eating disordered symptoms (Gagne et al. 2012). There is less information available on men in midlife for the reasons already stated, but I would bet my bottom dollar that eating disorders are much, much more common in middle-aged men than people think.

Midlife has unique stressors, such as bearing and raising children and supporting aging parents, work stress, and household responsibilities. In the current cultural climate, ideas like “fifty is the new thirty” increase the pressure to maintain a certain body type during this stressful time, - at the very same time that the body slows its metabolism, changes its chemistry, and responds differently to food and exercise. For many women, having children can change the body significantly as well. For men, lowered testosterone contributes to similar changes. Add to this all of the cultural messages about what it means to become “old,” and you have a recipe for disaster.

Eating disorders strike without care to gender, creed, race or nationality. The only difference is who gets diagnosed and treated.

Eating disorders strike without care to gender, creed, race or nationality. The only difference is who gets diagnosed and treated.

Myth: Only white people get eating disorders.

Reality: It is true that different races and ethnicities may have different “body ideals”, and that a curvier body may be more acceptable in some cultures than others. Many people think that this makes certain groups somehow immune to eating disorders, but that is not the case at all. Eating disorders are not only about body shape and size. They often evolve as ways of managing overwhelming stress, often including negative thoughts and feelings about oneself. In our dominant culture, which pushes not only a thin ideal (the idea that thin is better than not thin) but also a white ideal, these thoughts and feelings might even be much worse among some people of color, who experience daily racism and discrimination. A 2013 review of studies focusing on this topic showed both that ethnic minorities were less likely to seek treatment for disordered eating and that referrers were significantly less likely to send ethnic minorities to specialists in disordered eating (Hudson et al. 2007).

Myth: Eating disorders are only about food.

Reality: An eating disorder is about using food and the body as a way to cope with deep and complex emotional issues. The exact psychological reason behind disordered eating behavior is different for everyone. It may be about numbing anger or coping with shame. Sometimes it’s a way to try to feel good enough when that feeling is hard to find. The rules of the eating disorder often feel to the sufferer like they were written in stone—it really doesn’t seem to be okay to eat after a certain time of night, to have seconds, or to stop exercising before the clock has reached whatever-o’clock. Following these food rules is done for deep psychological reasons.

Myth: Eating disorders are not dangerous.

Reality: Reality: The unfortunate reality is that eating disorders can be quite dangerous. The behaviors associated with these diseases are very hard on the body and can have extremely serious consequences. Restriction, or not eating enough to fuel the body’s needs, can lead to slow heart rate, low blood pressure, and even heart failure. Osteoporosis, or brittle bones, is often caused by not having enough calcium. Dehydration is quite common with restriction and may lead to kidney issues. Malnutrition can also cause further mental health problems or make existing ones worse.

Purging can also have severe health consequences, including electrolyte imbalances, which can lead to heart failure. If a person is purging by vomiting, the esophagus often becomes inflamed and may even rupture. If someone is using laxatives, the gastrointestional tract can stop functioning properly and the person can become severely dehydrated (again, possible kidney failure). Peptic ulcers and pancreatitis are associated with purging as well. The health consequences of bingeing are largely those associated with clinical obesity, such as high cholesterol, high blood pressure, and type 2 diabetes. In addition, the uncontrolled nature of the binge may lead to gastric rupture, a tear in the stomach that can potentially be fatal.

Myth: Eating disorders do not require professional treatment.

Reality: Because eating disorders are so complex—involving emotions, behaviors, and physical consequences—attempting to deal with an ED on your own can be difficult and potentially harmful. It is absolutely vital to work with a team who knows the terrain, often a psychotherapist, dietitian, medical doctor, and perhaps a psychiatrist . Attempting recovery on your own after a prolonged period of restriction can even be dangerous, because the body may have difficulty adjusting to having normal amounts of food again. Having food intake monitored by a professional is important to make sure that recovery doesn’t put the body through more trauma.

Additionally, as previously discussed, the emotional factors involved in eating disorders are multifaceted and deep. A spouse, boyfriend, or girlfriend can never be the only support for someone working through these types of issues—you are just too close to the problem. Psychotherapists who specialize in eating disorders are trained to know what to look for and what questions to ask. They also bring value as an objective outside party without the same type of stake in the outcome. Without treatment, up to 20 percent of people with serious eating disorders die. With treatment, that number falls to 2 to 3 percent (Powers et al. 2012). Luckily, effective help is available. Reach out to schedule an appointment or ask for help finding a provider near you.

American Addiction Centers. 2018. “Finding the Best Anorexia, Bulimia and Eating Disorder Treatment for Men.” Retrieved from

Anorexia Nervosa and Related Eating Disorders. 2018. “Statistics: How Many People Have Eating Disorders?” Retrieved from

Gagne, D. A., A. Von Holle, K. A. Brownley, C. D. Runfola, S. Hofmeier, K. E. Branch, and C. M. Bulik. 2012. “Eating Disorder Symptoms and Weight and Shape Concerns in a Large Web-Based Convenience Sample of Women Ages 50 and Above: Results of the Gender and Body Image (GABI) Study.” International Journal of Eating Disorders 45 (7), 832–44.

Hudson, J. I., E. Hiripi, H. G. Pope, and R. C. Kessler. 2007. “The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication.” Biological Psychiatry 61 (3): 348–58.

Powers, M. A., S. Richter, D. Ackard, S. Gerken, M. Meier, and A. Criego. 2012. “Characteristics of Persons with an Eating Disorder and Type 1 Diabetes and Psychological Comparisons with Persons with an Eating Disorder and No Diabetes.” International Journal of Eating Disorders 45 (2): 252–56.

What is bulimia?

Bulimia Nervosa

Bulimia is characterized by two main behaviors- binging and purging. Purging is an attempt to rid the body of calories. Many people associate vomiting with bulimia, and in fact this is one of the more common forms that purging can take. Those who purge through vomiting often do it immediately after a binge, but sometimes a significant amount of time can lapse between binging and purging.

What many people don’t know is that purging can also take other forms - some people may exercise excessively, fast for a period of time, or take diuretics or laxatives. For some people purging may feel like a “necessary evil” in order to relieve guilt about binging, but others find the sense of relief and emptiness that they gain from purging a motivation in itself.

Another part of the diagnosis is that a person’s “self-evaluation is unduly influenced by body shape and weight”. For someone with any eating disorder, weight gain is associated with a terrible spiral of guilt, shame, and unworthiness. It can be difficult to understand from the outside why somebody would be so preoccupied with their body shape and size, but it is enough to know that your partner’s weight likely symbolizes much more to them. A person must also be able to maintain a minimum healthy weight in order to qualify for the bulimia diagnosis (although the person may not see their weight as healthy), or else anorexia, binge-purge type, would be a more appropriate label. According to the National Association of Anorexia Nervosa and Associated Disorders, 1.5% of American women will suffer from bulimia at some point in their lifetimes.



Bulimia is an eating disorder characterized by obsession over weight and tendency to eat food and then get rid of it in some manner.

Bulimia is an eating disorder characterized by obsession over weight and tendency to eat food and then get rid of it in some manner.

Common Behaviors Associated with Purging/Bulimia:

  • Anger, irritability and/or anxiety if unable to purge after binging
  • Excusing oneself to the bathroom immediately after eating
  • Running the shower or faucet while in the bathroom
  • Spending an unusual amount of time in the bathroom
  • Returning with watery, red eyes after suspected purging
  • Spending hours at the gym
  • Exercising even when injured
  • Fasting or dieting in order to compensate for food eaten
  • Hiding boxes of laxatives, diuretics, or enemas
  • Obsessing over weight, body shape or size

Is it Anxiety or Just Stress?

There is a tendency to explain away symptoms of anxiety by attributing difficulty functioning to work stress, travel stress and family stress.  Generally speaking, "stress" is external and passes when the situation passes.  For example, work stress should be expected to typically abate around the end of the work day.

Anxiety is an internal experience, an emotional reaction to both external and internal life events.  This distinction is murky because stress also engenders anxiety, but it is important.  Let's go back to work stress:  you have a deadline, the phone is ringing off the hook, and you can never tell what mood your boss will be in (as an aside, unpredictability and uncertainty are the two greatest predictors of stress).

That is stress.  But ruminating over the possibility of getting fired, feeling like you aren't good enough, and being unable to "turn off" work worries at the end of the day are closer to anxiety.  Stress is about things, anxiety is about you.

Some other symptoms of anxiety include:

  • Difficulty sleeping
  • Disturbing dreams
  • Irritability
  • Fatigue
  • Stomach aches
  • Muscle tension
  • Clenched jaw, sometimes with tongue "glued" to the top of the mouth
  • Tinnitus (ringing in the ears)
  • Racing thoughts
  • Thoughts that seem to "bounce" from topic to topic
  • Difficulty getting certain thoughts "out of your head"
  • Difficulty concentrating

Anxiety, once it is understood as a separate problem from stress, is extremely treatable.  While stress can be ameliorated through external actions such as meditation and moderate exercise, anxiety requires a different approach and it is usually helpful to consult a professional.  A good therapist can help you to understand where your anxiety is really coming from and address the issue at its root to help you learn to approach stressful situations differently.  


anxiety or stress

Mental Health Awareness Week

It is Mental Health Awareness Week, a week chosen by the National Alliance on Mental Illness to promotes awareness about mental health.  Some important issues affecting mental health are listed below; please click each link for more information.

Anxiety:  feeling worried, tense, and irritable much of the time

Depression:  feeling lethargic, worthless, or down much of the time

Post Traumatic Stress Disorder:  feeling hypervigilant, numb, &/or suffering flashbacks in response to a discrete trauma

Complex Post Traumatic Stress Disorder:  feeling chronically hypervigilant, impulsive, numb or empty in response to repeated trauma such as emotional or physical neglect or abuse

Eating Disorders:  being preoccupied with food and weight, patterns of not eating enough, eating too much, or oscillating between the two

Panick Attacks/Panic Disorder:  sudden periods of acute, very intense anxiety

Screening instruments for these and other mental health issues can be found here.

But let's not forget the other important piece of mental wellness.  It's not just about being free of a diagnosable mental health condition (especially as there is a great deal of controversy surrounding our current diagnostic system).  

It's about being well:  Cultivating peace of mind, enhancing vitality, creating satisfying and meaningful relationships with others and yourself.  It's about being able to work, love and play.  Being free from fear and constant self-recrimination.  Being comfortable in your skin.  Feeling free.

Everybody has a mind, and mental health is about everybody.