Originally published at PsychCentral.com Many of us hesitate to say no to others. With mindful tips like these, saying no is an emotionally intelligent skill anyone can master — really! It’s just two letters, and yet saying no can feel really hard — even complicated. For many of us, saying no doesn’t just feel awkward. It feels wrong. So, whenever anyone asks you to do almost anything, you might blurt out, “Yes! Sure! Of course! Happy to!” But in reality, you may feel the opposite. Maybe you’d rather be doing about a thousand other things. Or maybe you’re OK with saying yes, but it’s not the best thing for your daily bandwidth or mental health. Here’s the good news: Saying no is a skill you can sharpen. The more you say no, the more natural it’ll feel. Here are several ways to build the skill of saying no in different situations — even if it feels like you’re doing it from the ground up.

Why saying no feels hard

For starters, it’s important to realize that if saying no is challenging for you, you’re not alone. As social psychologist Dr. Vanessa K. Bohns writes in a 2016 research review examining people’s influence over others, “Many people agree to things — even things they would prefer not to do — simply to avoid the considerable discomfort of saying ‘no.’” For example, a series of small studies, published in 2014, found that when asked, many people would acquiesce and commit unethical acts, such as telling a white lie or vandalizing a book — even when they felt these acts were perceived as wrong. As social creatures who want to be part of the herd, we also want to preserve our relationships. So, we might blurt out yes because we don’t want to be seen as difficult, says Dr. Emily Anhalt, a clinical psychologist and co-founder of Coa, an online mental fitness club. Or, we don’t want to disappoint a good friend or hurt someone’s feelings, notes Dr. Nicole Washington, a board-certified psychiatrist and the chief medical officer of Elocin Psychiatric Services. Another reason yes pours out of us? Our past. According to Anhalt, while growing up, you might’ve not learned to advocate for yourself. “It’s also possible that you say yes because you deeply want to help. But you forget that your ability to accommodate others isn’t an endless well,” Anhalt says. In other cases — like a work situation — we might worry that saying no says something about our ability to accomplish a certain task, adds Washington. Put another way, we think declining makes us look incompetent.

Why saying no is a good — no, great — thing

When you struggle with saying no in personal or professional situations, it helps to remember the self-preservation in passing things up. “Saying no is one of the best forms of self-care we can engage in,” Washington says. She notes that saying no supports us in:

• creating space in our schedules to rest and recharge
• engaging in activities that actually align with our current goals
• setting boundaries with loved ones and colleagues

Ultimately, saying no gives us greater navigation over our lives, says Anhalt. This grants us the opportunity to build a fulfilling, meaningful life on our own terms. After all, we can only have power over ourselves — so, let’s exercise that power. Read the full article at PsychCentral.com

Re-posted from an article by Jeannie Ingram, LPC-MHSP Valentine's Day just passed and love is in the air. Not for everyone, unfortunately. As a therapist, I'm often needed when love is no longer in the air. A heart has been broken, and love has turned cruel. Or the pain of loneliness has become unbearable. Only occasionally do people seek therapy when love is blooming like the daffodils. But take heart. Like the words in so many songs, love is indeed the answer; it always has been, and always will be. It's the question that needs examining, that question being, "who do you love"?

Love Yourself First

People often give their love to another before they've ever truly explored what it means to love themselves, and this can be a setup for problems in the relationship. Why? Because until you truly deem yourself worthy of love, you may sabotage the love of another, finding it difficult to trust. It's like building a mansion on quicksand. It may be beautiful at first, but after a short time, it will likely disappear. To experience a sustained, loving relationship with another, you must have a sustained, loving relationship with yourself to receive love with an open and undefended heart. I am not talking about narcissism, which is an ego-inflated sense of self-importance. I'm referring to a healthy and loving understanding of self and truly knowing that your value is at least that of others. All of us have equal value. Believe it or not, many people struggle with this. For some, it's due to leftover childhood shame or negative messages that program us into thinking something is wrong with us or that we're not worthy of love. Again, if we didn't get it as children, it's hard to trust when it tries to come into our adult life.

Love is a Verb

Love is about action. Love is about caring behaviors. Many people believe love is a feeling, and it certainly can be. Still, that feeling is ultimately the result of how we demonstrate our love in both giving and receiving. To expect the feeling of love without actively nurturing it through everyday actions is like expecting fruit from a non-existent tree. If we want to grow the fruit of love, we must first take the action steps of planting and nurturing the tree. Then we can expect the fruit or the feeling of love to blossom.

Tips to Grow the Love Tree

• Find ways to express your love, and don't be confused by advertising messages. 
• Spending money to show your love is unnecessary. 
• Showing love through your language, thoughtful, caring behaviors, and realistic expectations. 
• Replacing demands with requests and appreciations allow the flow of love.
• Refrain from language that criticizes, condemns, disparages, and shames. It will create misery, not love. Instead, reframe into expressions of desire, encouragement, and gratitude.
• Try seeing mistakes as opportunities for redemption and forgiveness rather than punishment.
• Try seeing yourself as a human being who, like everyone else, is searching and worthy. 
• Practice random acts of kindness toward yourself, as well as toward strangers.

This is the way we should all be treated, and no one, not even you — should be an exception. Because, like being in love, it sets you up for inner peace, success, and joy in life. Who doesn't want that?  When you have love and peace toward yourself, you're much more likely to attract and maintain genuine love with another person. So this Valentine's Day, may I suggest that you give yourself the gift of love. Begin by looking in the mirror and seeing the person who most deserves it. And love that person with your whole heart and your actions. Love is, after all, the answer.

Re-posted from an article by Deborah Fox, M.S.W. How to manage difficult emotions may seem counterintuitive to many people. We humans don't like to be uncomfortable or in emotional pain. How many times have you been told or tell yourself the following:

• "buck up."
• "don't wallow."
• "move on." 
• "don't feel sorry for yourself."
• "think of how many others have it worse than you."

Plenty, I'm sure. The conventional wisdom of our culture is full of "think positive thoughts." The problem is that this wisdom doesn't chart the path we need to follow to that end. The answer to managing difficult feelings, we have to feel them before moving on and regaining our optimism and good cheer. This isn't easy. What may become common parlance, "oh, it's a total 2020," meaning a downer, things couldn't get much worse, is indicative of what many of you are experiencing. We are still in the middle of an uncontrolled pandemic, climate change, and political conflict. How can you not feel sad, or worry, or despair some days? Maybe your distress isn't about current times. Perhaps you struggle with a host of other uncomfortable feelings such as feeling unimportant, insecure, or anxious on an ongoing basis. For many people, the stress of what's going on in the world now exacerbates those feelings.

Managing Positive and Negative Feelings.

Our emotional system is not designed to feel positive feelings only and remove negative ones. That would be nice, but it just isn't so. To find our joy in simple pleasures and with those we're most connected to, we also have to feel our way through the tough ones. The key is to build your tolerance for feeling these difficult feelings and turn towards each other for connection and support. We are social creatures, and we need each other to go through the middle of turmoil to come out the other side.  Tuning into these difficult feelings will inevitably make you feel more vulnerable simply because you will not push the discomfort away. This is a challenge because feeling more vulnerable is uncomfortable, too. However, it's in that state of vulnerability that you can truly connect with another human being. You'll feel less alone, and you can walk through these uncertain times together, rather than just coping in separate silos.  There are moments--- milliseconds that you can grab before they slip away. These are the moments when you can identify that you're feeling down, worried, or despairing. When you're trying to "move on" or distract yourself, you'll find yourself feeling more and more blah or irritable---the perfect hiding places for vulnerable feelings. If you succeed in identifying that you're feeling sad or anxious at the moment, sit there with it. "Sitting with it" means naming it, feeling it, and not allowing yourself to prematurely make it go away by distracting yourself or starting an argument with a loved one. You will feel uncomfortable and vulnerable--- take a deep breath and stay there in that feeling. This sitting with the uncomfortable feeling allows you to know what affects you that you lose touch with when you shut down on the feelings.

Uncomfortable Feelings Have a Lifespan. 

It might be five minutes or five hours, and it may come and go. It's sitting with the feelings that allow you to build your tolerance for feeling vulnerable. You build it slowly, bit by bit. The more tolerance you have, then you can allow its life span to run its course. If you distract yourself by grabbing your phone or turning on the TV, it'll just go underground and lie in wait to ruin your mood for days on end.  Sitting with the feeling allows you to express, usually in a way your partner, or a close friend, can hear and empathize. Their ears open when they listen to you speak from that place of vulnerability. Feeling this connection is what can most alleviate the intensity of the discomfort. It won't make the pandemic uncertainties or anything else go away, but it can allow you to feel less alone. Feeling less alone goes a long way to walking through any crisis feeling stronger. Shutting down or arguing happens so easily because it's a momentary relief from the discomfort. The energy of arguing or the numbness of withdrawing doesn't feel great either, but it can be preferable to feeling vulnerable.  If you're already angry or withdrawn, ask yourself, "what else am I feeling, or what was I feeling earlier?" Maybe not immediately, but this question will allow you to pinpoint what feelings are hiding just below the surface. You know you're irritated, but you might be able to identify that you were anxious before you got annoyed. Then you can choose to sit with the anxiety.

Difficult Feelings are a Normal Part of Life. 

This is always true, but these uncertain times are causing tremendous turmoil and challenging our usual coping ways. What's critical is not to allow these feelings to overwhelm us. We're outside of our comfort zone, and we need to grow that zone to go forward and be able to grapple with what comes our way. We can't do it alone. Turning towards one another will serve us well and allow us to come out the other side to experience joyful moments amidst uncertainty.

Originally posted at Beacon Lens The holidays are upon us, and the irony they bring is the potential for isolation and loneliness. Holidays’ essential identity is getting together with loved ones, but some people do not feel as connected as they would like or expect. In 2020, add COVID-19 and its quarantining dictates, and the potential for such feelings can strengthen. The holidays, therefore, present an excellent time to discuss how we can reinforce connections during a time that requires us to be apart to protect our physical health, a requirement that paradoxically can have a damaging effect on our mental health. We can, however, take charge of improving our mental health.

Loneliness and isolation and our health

What is the difference between loneliness and isolation? “Loneliness is the feeling of being alone, regardless of the amount of social contact,” according to the Centers for Disease Control and Prevention (CDC). Social isolation, on the other hand, is a lack of social connections. Put differently, one can have many social connections but still feel lonely. The physical and mental health risks of loneliness and isolation are significant. They include but are not limited to:

• Social isolation increases the risk of premature death by 29 percent, rivalling smoking, obesity and physical inactivity.
• Social isolation is associated with increasing the risk for dementia by approximately 50 percent.
• Loneliness is connected to higher rates of depression, anxiety and suicide.

A 2020 report by the National Academies of Science, Engineering and Medicine (NASEM) states that more than one-third of adults 45 and older feel lonely, and approximately one-fourth 65 and older are socially isolated. Add the holidays and COVID-19 to an already preexisting condition, and the time is ripe for all of us to take action to protect our mental health.

Simple steps for better mental health during the holidays

Specific to the season and the times, there are common-sense tips that we all can practice to help manage loneliness. For example:

• Talk to someone about your sense of loneliness and isolation. There’s stigma around loneliness so it can be hard to do. However, you may well find that you’re not alone in those feelings, and sharing them can help lessen their effect.
• Manage your holiday/COVID-19 expectations. The holidays can fall short of expectations, but this year it may be worse. Understand that the pandemic won’t last forever, and that we’re all in this together. Indeed, many people’s holiday gatherings will likely be different this year.
• Remember to take care of yourself, now more than ever. Sleep, exercise and good nutrition — with the proper amount of holiday indulgence — go a long way in addressing mental health.
• Avoid social media, such as Facebook or Instagram, especially during the holidays. It’s easy to negatively compare one’s life to the “perfect” lives posted on social media, forgetting that people mostly post only the positive.

Loneliness and isolation as its own pandemic

The holidays don’t last forever, and we will get through the COVID-19 pandemic. However, loneliness and social isolation may persist, which presents a challenge for behavioral health providers. The recent NASEM report explores interventions that the healthcare system can take to address loneliness as a societal condition, such as engagement in support groups, cognitive behavioral therapy and mindfulness, social determinants of health, social prescribing and more. Social prescribing is arguably one of the more interesting interventions in that it puts a clinical lens on non-clinical solutions. While there is no hard-fast definition of social prescribing, it is generally accepted as a way to connect people to non-clinical sources of support, according to the NASEM. Specifically, it is a “non-medical referral, or linking service, to help people identify their social needs and develop wellbeing action plans to promote, establish or reestablish integration and support in their communities, with the aim of improving personal wellbeing.” Examples of secondary services that improve social concerns affecting health include housing and food insecurity services. While known to varying community-based organizations, social prescribing is not common among practitioners, but it’s a common-sense solution. An analysis of one pilot program from the NASEM report — albeit a small one — found that social prescribing reduced inpatient admissions by as much as 21 percent and emergency room visits by 20 percent. A modern world — without COVID-19 — is more connected than ever due to social media and other technology. However, studies have shown we are more lonely now than in any other time in recent history. It’s time to think out of the box as we realize more and more how non-physiological conditions — such as issues ranging from a public health emergency to social media — can affect our health.

Link to an article written by Ashley Anderson, PsyD, CEDS In the wake of COVID-19, we have come to find our actions restricted slightly. It is possible that you live in one of the many states that have implemented some form of a “shelter in” plan, where public activities are limited to necessities and other essentials. While it may be easy to focus on what we cannot do, I encourage you to focus on things within your control and what you can do. Our routines have changed, temporarily. So it is important to create a new structure or routine, filled with various activities. Create a schedule, where each day has at least one different activity for the day. Work, school work, meals, social time, family time, individual time, creative/artistic time, relaxation time, and movement can all be worked into your weekly schedule. Blocking time for each of these helps reduce the likelihood that you will tire or get bored of an activity. Read the full article here...

Winter can be a difficult time.  Here are some ways that you can care for yourself:

Self-care is always important

Self-care includes all the things we do to maintain or improve our wellbeing. We all know how important basic self-care activities such as adequate sleep, exercise, healthy eating, hobbies, and spending time with friends are. And we know that when we don’t prioritize self-care, we feel lousy. Our health suffers. We get sick. We’re irritable, lonely, sluggish, and unfulfilled.

Self-care for the winter

As the seasons change, we often need to change our self-care routines to accommodate the weather, amount of daylight, our schedule, and so forth. The winter months can be particularly tough on us both physically and mentally. We’re more prone to colds and flu. some of us suffer from seasonal depression (the winter blues or Seasonal Affective Disorder (SAD) because of the lack of sunlight. And it’s hard to get out and be active. So, we need some self-care activities to meet the specific needs we have in the darker, colder months. Below, you’ll find 10 of my favorite self-care activities that are well-suited to winter.

1. Write in a Journal

It’s the beginning of a new year and a perfect time to start writing in a journal. Journaling is great for your mental health. It provides a place to dump your feelings, process and reflect, and clear your head. Even if you’ve already got a journal, you may want to consider starting a new one. I hear from many avid journalers that there’s something uplifting about the fresh, clean-start feeling of a new journal.

2. Enjoy Nature’s Beauty

Yes, winter can be cold and dreary. But it can also be beautiful – fresh snow on the trees, icicles hanging from the roof, red cardinals at your birdfeeder, a full moon. When we’re mindful and take the time to look, there’s a lot to take pleasure in.

3. Go to Therapy

Have you been thinking about starting therapy? It can be daunting to find a therapist you feel comfortable with, get yourself there consistently, and pay for it – but most people find the results are well worth the effort. And since we’re already inside so much during the winter, it seems like a good time to start or resume therapy. And if the weather or transportation are significant barriers, there are more and more options for online therapy, as well.

4. Get More (Sun)Light

Exposure to light (sunlight or artificial light) improves your mood and energy. So, if you’re living in the Northern Hemisphere during the winter, you’ll probably feel better if you spend an extra 20-30 minutes outside when it’s sunny. Even opening the curtains and turning on the lights in your office or home can help.

5. Relax and Get Cozy

On a cold winter’s day, there’s nothing better than staying home in your pajamas, cuddling up with a good book (or your significant other or your cat!), sitting in front of a fire, or binge-watching your favorite show. Occasionally, give yourself permission to stay home and just relax.

6. Connect with Friends

We all need to socialize, connect with others, and feel like we belong. And yet, spending quality time with friends or your spouse may end up at the bottom of your to-do list. How about meeting this self-care need by planning a game night, potluck dinner, or hosting a party to watch the Oscars with your friends? Not only is spending time with friends good for our mood, doing so may encourage us to relax, laugh, do something active, or try something new. And again, if it’s hard to get out and do things in person, have a virtual coffee date on FaceTime or Skype, or schedule a time for an old-fashioned phone call.

7. Enjoy a Hot Drink

A hot drink on a cold day is so comforting – a true simple pleasure. I’m a big coffee drinker, but I can easily overdo it. So, I try to mix things up with a collection of herbal teas and homemade sugar-free hot cocoa (just warm milk and a little cocoa powder and your favorite sweetener).  Maximize this self-care practice by slowing down. Instead of gulping it down in the car, take a few minutes to sit and relax and savor your drink. This is a quick, easy, and inexpensive way to pamper yourself.

8. Get a Flu Shot

Getting a flu shot isn’t necessarily enjoyable, but that’s true of a lot of self-care. It’s something you do for your health. And it’s not too late in the season to get one. So, speak to your doctor or pharmacist about whether a flu shot is a good choice for you.

9. Exercise

Many of us need to change our exercise routine or physical activities to accommodate winter weather. If you don’t have a regular exercise plan for the winter months, consider adding some winter sports (skiing, ice skating, snowshoeing, winter hiking) to your routine. Alternatively, there are lots of indoor exercise options such as yoga or dance classes, exercise equipment at a gym or home, or using exercise videos on YouTube or television. Don’t let winter weather be an excuse – you know you’ll feel better if you get a little movement into every day.

10. Encourage Your Creative Side

If you’re stuck inside, tap into your creativity. Did you know that arts and crafts are good for your mental health? Benefits such as reduced stress, depression, and anxiety, a sense of accomplishment, increased confidence and self-esteem have been reported. Crafts are nice because they can be done alone or in a group. And there’s something for everyone – everything from painting, scrapbooking, knitting, quilting, woodworking, jewelry making, and more. Pull out an old favorite or try something new this winter!

Put self-care on your calendar

Now that you’ve got a few ideas for your winter self-care, it’s time to put it on your calendar. Self-care (like most things) is much more likely to happen if you create a plan for when and what you will do to take care of yourself. Where will you begin? Perhaps, just add one new self-care activity to your schedule this week.

Hurricane Dorian pounded the Bahamas and is anticipated to move up the east coast of the U.S. Some of you may be directly affected. Others may be reminded of past traumatic experience in natural disasters. Feelings of fear and powerlessness or overwhelming worry of being trapped may well be elicited.Even though you may not personally experience physical injury, it is not uncommon to have strong emotional reactions. Understanding your responses to these disturbing events can help you cope with your feelings, and thoughts and help you along the path to recovery. The American Psychological Association has described common reactions and responses to disaster. Initially people may feel stunned and disoriented. Once these initial reactions subside, it is common to feel anxious and overwhelmed or more moody than usual. You may experience vivid, repeated memories of the event. They can occur for no apparent reason and may lead to physiological reactions such as rapid heartbeat or sweating. You may have difficulty concentrating or making decisions. You may find yourself more irritable or become more withdrawn than usual. Your sleep and eating patterns may also be disrupted or you may find yourself oversensitive to loud sounds smells or other environmental sensations which may serve as triggers. Fortunately, research shows that most people are resilient over time. Talking with friends and family about the event can reduce stress and help you feel less alone. Do not repeatedly watch or read news about the event. Get plenty of rest and exercise and eat properly. Make time for activities that you enjoy: read a good book, take a walk, or go to the movies. Do something positive. Helping others can give you a sense of purpose in a situation that feels out of control. Do not turn to drugs or alcohol. In the long run, they only create additional problems. If your feelings do not go away or continue to interfere with your daily functioning, join a support group or seek help from a licensed mental health professional. Asking for help is a sign of strength not weakness.

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Resources:

• Mental Health America, 2019, Kevin Rowell, PhD, and Rebecca Thomley, PsyD
• Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2007). What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. Journal of Consulting and Clinical Psychology, 75 (5), 671. doi: 10.1037/0022-006X.75.5.671
• Bonanno, G. A., Papa, A., & O'Neill, K. (2001). Loss and human resilience. Applied and Preventive Psychology, 10(3), 193-206. doi: 10.1016/S0962-1849(01)80014-7
• Butler, L. D., Koopman, C., Azarow, J., Blasey, C. M., Magdalene, J. C., DiMiceli, S., ... & Spiegel, D. (2009). Psychosocial predictors of resilience after the September 11, 2001 terrorist attacks. The Journal of Nervous and Mental Disease, 197 (4), 266-273. doi: 10.1097/NMD.0b013e31819d9334
• Silver, R. C., Holman, E. A., McIntosh, D. N., Poulin, M., & Gil-Rivas, V. (2002). Nationwide longitudinal study of psychological responses to September 11. JAMA: The Journal of the American Medical Association, 288 (10), 1235-1244. doi: 10.1001/jama.288.10.1235
• Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2007). What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. Journal of Consulting and Clinical Psychology, 75 (5), 671. doi: 10.1037/0022-006X.75.5.671
• Bonanno, G. A., Papa, A., & O'Neill, K. (2001). Loss and human resilience. Applied and Preventive Psychology, 10(3), 193-206. doi: 10.1016/S0962-1849(01)80014-7
• Butler, L. D., Koopman, C., Azarow, J., Blasey, C. M., Magdalene, J. C., DiMiceli, S., ... & Spiegel, D. (2009). Psychosocial predictors of resilience after the September 11, 2001 terrorist attacks. The Journal of Nervous and Mental Disease, 197 (4), 266-273. doi: 10.1097/NMD.0b013e31819d9334
• Silver, R. C., Holman, E. A., McIntosh, D. N., Poulin, M., & Gil-Rivas, V. (2002). Nationwide longitudinal study of psychological responses to September 11. JAMA: The Journal of the American Medical Association, 288 (10), 1235-1244. doi: 10.1001/jama.288.10.1235

We constantly receive messages from family, friends and even physicians implying that there is a correlation between weight and well -being. You will be happy, healthy, and successful if you are skinny. You must lose weight in order to live a good life. If you do not fit this mold, you may feel shame or be stigmatized. Unfortunately, this approach has not been successful. Most people who diet gain the weight back. People resort to sneak eating and are unable to enjoy the foods that they love. They may under-eat or over exercise. Periods of food deprivation only result in the body raising the set point and becoming heavier over time. Weight cycling has been shown to lead to poorer health. BMI has often been used as to assess a person’s health status. However, it has been found that people who fall into the obese category according to their BMI are often physically fit than those who are slimmer. Surprisingly, they have actually been shown to have half the mortality of people who are thin and more sedentary. A much better approach is to focus on wellness, encouraging people of all sizes to respect and take care of themselves. Physical activity could be encouraged for pleasure as well as for health benefits. Eating would be in response to hunger and satiety cues rather than a diet plan. Foods would not be labeled as “good or bad”. This approach would respect people of all sizes. They would not be judged based on their body size but instead encouraged to take care of their physical and emotional needs.

Obesity and inactivity could someday account for more cancer deaths than smoking if current trends continue, a leading cancer expert says.  As the rate of smoking decreases, other unhealthy habits threaten to offset the progress in reducing cancer deaths, says Richard Wender, a physician and chief cancer control officer at the American Cancer Society (ACS). A study in the New England Journal of Medicine last fall found 13 types of cancer were linked to excess body weight.  There's no guarantee that obesity and inactivity will surpass smoking as a cancer cause, Wender says, but the possibility is startling. "Who would’ve thought we’d ever see the day where what you eat (and) exercise, could account for more cancer deaths than smoking?” he asks.  The connections between smoking and too much exposure to the sun and cancer are well known, but the connections between nutrition and exercise and cancer are less known and harder to determine. Calculating cancer's link to obesity is difficult in part because of an overlap in cancer risk factors, says ACS' Rebecca Siegel, strategic director of ACS' surveillance information services.   Siegel comments that 20% of cancers are caused by poor diet, alcohol consumption, a lack of physical activity and/or excess weight.  However, that 20% cannot be combined with the 30% of cancer deaths caused by cigarette smoking since poor people are more likely to be obese and to smoke than those who are more affluent people.  A striking 50% of all cancer deaths could be prevented by following the basics of a healthy lifestyle, says Wender. That includes diet and exercise and having regular cancer screenings and getting the HPV vaccine that helps prevent cervical cancer and likely oral cancer and for Hepatitis B, which can lead to liver cancer.

• I think about food all the time
• I panic if I eat too much
• I am terrified of gaining weight
• I feel fat, friends tell me I'm thin
• I don't get regular menstrual periods
• I prefer to eat when no one will see me
• I have lost more than 15% of my normal weight
• I find myself compulsively eating
• I exercise a lot
• I tend to be a perfectionist
• I consume less than 1200 calories a day
• I want to be thinner than all my friends
• I hate my body
• I have been depressed and irritable lately
• I use laxatives or diuretics for weight control
• I binge and make myself vomit
• I feel food is my enemy
• I am preoccupied with food and weight
• I have extreme mood swings
• I feel tired all the time
• I often feel cold when no one else does
• I have noticed that my hair is dry and brittle
• I have noticed my skin is drier
• I have noticed my nails break easily
• I have more cavaties recently
• I have noticed my teeth are discolored

It would be a good idea to consult an eating disorder specialist if you have more than five of these behaviors.