Eric Samuel Stachowiak, MSW, LSW

Some people with bulimia may have swollen parotid glands (salivary glands near the cheeks) that give their face a puffy "chipmunk" appearance. Their skin may look dehydrated and dull from repeated purging. Red scars and marks on the backs of the knuckles are prevalent in those with bulimia. Eating disorder experts may refer to these as "Russel's sign," named after a well-known psychologist.

However, others with bulimia may not show any outward signs of having an eating disorder. They may deliberately hide their eating habits or conceal their purging after a meal. It is important that family members and friends help loved ones with bulimia seek treatment. While many people with bulimia are still able to lead outwardly successful and active lifestyles, bulimia may have lasting and severe consequences to one's health. Electrolyte imbalance from bulimia is particularly dangerous and may lead to heart attack or stroke. Similarly, continued dehydration and disturbances in electrolyte levels can cause kidney damage and reduced kidney function.

Treatment for bulimia typically includes therapy and nutrition counseling. Eating disorder support groups, both online and in person, are often beneficial to recovery. Medical professionals may also look to treat the mental health problems that frequently accompany bulimia, which are body dysmorphia, post-traumatic stress disorder (PTSD), and depression. Dietary specialists can assist patients with reintegrating foods into their diet and increasing consumed calories. Some patients may attend inpatient rehabilitation or eating disorder clinics, which provide all of the above treatments in a residential facility.

Fortunately, many people recover from bulimia and are able to fully restore their health.

We don't yet know what causes depression, but it's thought that it is a combination of genetic, biological, environmental, and social influences. Because of this, the most effective treatments for depression combine medication with psychotherapy. Therapy, especially cognitive-behavioral therapy, can be extremely helpful in resolving the negative thoughts and feelings that come with depression. It gives patients new tools that they can use themselves to cope when their depression is making them feel down.

Some of the common medications used to treat depression include antidepressants such as SSRI's (Prozac, Paxil, Zoloft) or atypical antidepressants (Cymbalta, Wellbutrin). It's important to remember that these medications have different effects on everybody, and no one medication works right for everyone. Patients may have to try a couple before finding the one that works just right for them. If the first medication they try doesn't work, they should talk to their doctor about trying something else. In extreme cases where medication is not enough, electro-convulsive therapy and hospitalization may be the answer to keeping a severely depressed person safe.

Depression is a difficult illness to deal with, but it is more common than believed and there are many people who can help. With the right treatment, individuals with depression can get back to fully enjoying life again.

• Accidents
• Sexual or physical assault
• Combat
• Childhood abuse
• Domestic abuse
• Natural disasters
• Torture and kidnapping

People who have experienced significant and repeated trauma are more likely to develop PTSD. Those who have disorders like depression or a family history of depression may also be more prone to PTSD. PTSD symptoms typically begin one month to one year following the traumatic event. There are four main categories of PTSD symptoms:

• Intrusive memories: Intrusive memories include unwanted memories, feelings of reliving the traumatic event, distressing nightmares, and emotional disturbances from triggers (signs that serve as reminders of the traumatic event). Intrusive memories can lead to elevated heart rate, anxiety, combativeness (fight), withdrawal (flight), and many other responses.
• Avoidance: Avoidance is an attempt to avoid speaking or thinking about an upsetting event. People with this response might also try to avoid certain people or locations that prompt memories of an event.
• Changes in physical and emotional reactions: These changes may include difficulty sleeping, hypervigilance, self-destructive behavior, and feelings of guilt and irritability.
• Alterations in cognition and mood: Alterations can cause negative self-beliefs, depression, shame, and detachment from others.

The intensity and frequency of these symptoms can vary over time. PTSD symptoms may suddenly return after disappearing for years. Many PTSD patients find treatment helps to gradually reduce their symptoms over time.

The most common treatments for PTSD are psychotherapy and oral medications. Psychotherapy for PTSD can include cognitive therapy (therapy to change thought patterns), exposure therapy (therapy to confront memories of the traumatic incident) and eye movement desensitization and reprocessing therapy (EMDR). EMDR integrates exposure therapy with guided eye movements to help patients confront and process their trauma. Certain oral medications may help with PTSD, such as antidepressants and anti-anxiety medications. Self-care, support groups, and relaxation may also benefit those with PTSD.

The path to overcoming PTSD can be long and challenging and people with PTSD can benefit greatly by seeking professional treatment from a mental health care provider. Treatment can reduce PTSD symptoms, provide essential coping strategies, and improve one's quality of life.