Graves’ disease is known for causing physical symptoms such as muscle weakness and fatigue, but it can also worsen your mental and emotional symptoms. In fact, research shows that people with Graves’ are more likely to experience conditions such as depression and anxiety when their thyroid is overactive compared with when their thyroid hormone levels are well controlled.
That’s because excessive thyroid hormones, which is a hallmark of Graves’ disease, may decrease levels and activity of serotonin, a brain chemical that, in lower levels, is linked to anxiety and depression, according to some studies.
Plus, in some cases, what may look like anxiety symptoms may actually be physical symptoms of Graves’ disease, such as rapid heartbeat and feeling shaky and nervous. “With Graves’ disease, everything is revved up — you’re sweating, your heart’s going quickly — and when you’re experiencing those physical manifestations, it feels like anxiety,” says Caroline Messer, MD, an endocrinologist and assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra University–Northwell in New York City.
Whether your symptoms are due to anxiety caused by Graves’ or other physical symptoms of the disease, it’s important to address them as much as possible until the thyroid levels are controlled. Here are some strategies to protect your mental health.
1. Stick With Your Graves’ Treatment Plan
Your first goal is likely to bring your levels of thyroid hormone back down — whether that’s with medication, radioactive iodine, or surgery. This, in turn, can help alleviate any mental-health effects you’re feeling. Similarly, taking your beta-blockers, says Messer, can also effectively treat symptoms such as anxiety, tremors, racing heart, and sleep disturbances related to the excess thyroid hormones until the levels are controlled.
If your disease was diagnosed early, it might be possible to get your thyroid — and any associated mental health issues — under control within only a few weeks, says Messer. If the disease is more severe, it takes longer.
2. Talk With a Mental Health Professional
Talk therapy can help you address anxiety, depression, or stress, and anti-anxiety medications may also be prescribed, usually for a short period of time while your doctors work to get thyroid hormones to a normal level, says Messer.
“Most people end up not needing these medications because they feel so much better so quickly once they get on treatment for their Graves’ disease, but [they] can be helpful for certain people,” says Messer.
3. Reduce Your Triggers
Anything that can worsen Graves’ symptoms can exacerbate the emotional toll of the condition as well. One common trigger, says Dr. Messer, is smoking. “Smoking makes Graves’ so much worse, so I always ask people to quit,” she says.
Psychological stress can make the symptoms of Graves’ disease worse when you’re trying to treat the symptoms of the condition. In addition, once you’ve been treated for Graves’ and the disease is in remission, it is believed that psychological stress can be a trigger for recurrence of symptoms.
Adding stress-reducing activities such as yoga, breathing exercises, or meditation to your daily routine can help not only relieve anxiety but may help reduce your risk of a relapse of symptoms.
4. Make Nutritious Food Choices and Exercise With Your Medical Team’s Guidance
While there is no evidence that any particular diet can help treat Graves’ disease, focusing on healthy eating and exercise habits, such as the Mediterranean diet, can help improve your mood, boost your energy levels, and reduce inflammation in the body, and generally improve your overall health. As an added bonus, some research has shown that it may help improve symptoms of depression.
Research shows that regular physical activity can also help reduce anxiety and boost mood. But if you have Graves’ disease, check with your doctor before starting any exercise plan. Since the condition causes hyperthyroidism, or an overproduction of the thyroid hormone, exercise can potentially increase your heart rate, which is already running at a revved-up speed; overdoing physical activity can potentially lead to increased anxiety, and in even heart failure in cases where the hyperthyroidism is not well controlled.
5. Prioritize Sleep
Getting restful sleep tends to be tricky for people with Graves’ disease, and that lack of sleep can worsen mood and anxiety. Studies have shown that having difficulty falling asleep is associated with anxiety, which can then exacerbate insomnia. Try to log at least seven hours of sleep.
To get enough z’s, practice healthy sleep habits such as limiting caffeine and alcohol in the evening, avoiding screens at least an hour before bedtime, and keeping your bedroom cool.
The Takeaway
Graves’ disease can not only affect your physical health, but can also impact your mental and emotional health.
To ease stress and anxiety, eat a healthy diet, get at least seven hours of sleep, and exercise regularly.
Seeking help from a mental health professional can help improve your mental and emotional health.
As with just about any medical condition, there is abundant speculation and misinformation about dietary practices and Graves’ disease.
“In terms of an overall diet approach, there’s not a lot of good research out there to show that one approach is better than another,” says Kimberly Dorris, executive director and CEO of the Graves’ Disease and Thyroid Foundation. A review article stated that people who follow plant-based diets are less susceptible to autoimmune diseases in general.Another study looked at the effects of a paleo diet on autoimmune thyroid disease with some positive results, but more research is needed.
“Members of our patient community have tried vegan, Paleo, gluten-free, and Mediterranean approaches, but there just hasn’t been good, evidence-based research to help us figure out if one of those might be better than the other,” says Dorris. “What they do have in common is cutting out a lot of the processed foods that have multiple ingredients that you can’t pronounce.”
While no specific dietary approach is currently recommended for people with Graves’ disease, following a healthy eating plan can help your body function optimally. Eating foods rich in calcium and vitamin D, for example, can help because hyperthyroidism increases bone turnover. Foods high in antioxidants, such as berries, may help bolster your immune system, and limiting caffeine intake can help you avoid aggravating Graves’ symptoms such as heart palpitations, anxiety, and irritability.
Your doctor may also advise you to limit your intake of foods that are rich in iodine, such as iodized salt and seaweed, and recommend supplements such as calcium and vitamin D to help keep your bones strong. Selenium is also recommended as a supplement sometimes, because a deficiency has been associated with an increased risk of thyroid eye disease.
“Selenium is a supplement that has been validated in two randomized controlled trials as being helpful with Graves’ eye disease and slowing the progression of Hashimoto’s thyroiditis,” says Dr. Ross. “But no one has actually proved it ameliorates the hyperthyroidism of Graves’ disease. The downside is that selenium supplements are associated with increased risk of type 2 diabetes.” One review reported that in 9 out of 11 trials, selenium supplementation resulted in faster achievement of normal thyroid function in patients with Graves’ disease.
Even if you’re using a treatment for thyroid eye disease (TED), your symptoms may still flare up in certain situations — like, for example, if you’re in a smoky bar or under a lot of stress.
That’s because your lifestyle habits play a bigger role in managing your condition than you might think. Everything from the food you eat to how you spend your free time can play a role in triggering symptoms such as pain, discomfort (a feeling of grittiness in the eyes), sensitivity to light, double vision, and bulging of the eyes (proptosis).
Here are some of the most common things that can cause TED to worsen — by avoiding them, you can find more relief.
1. Smoking Cigarettes
If you have TED, smoking can make the condition worse, eventually even leading to vision loss. In fact, research shows that, among people with TED, those who smoke are more likely to need eye surgery than people who used to smoke or never smoked.
If you currently smoke, talk to your doctor about creating a smoking cessation plan. You can also try calling a quitline such as 800-QUIT-NOW to talk to a quit coach, who can help you find ways to stop smoking.
2. Eating Processed, Sugary Foods
Foods and drinks such as candy, pastries, and soda can contribute to inflammation in your body — and inflammation can then worsen the symptoms of TED.
Instead, opt for anti-inflammatory foods — foods that may help lower inflammation levels in the body — such as leafy green vegetables, nuts, fruits, whole grains, olive oil, and fatty fish like salmon and tuna.
3. Spending Too Long in Front of a Screen
It’s hard to avoid smartphones, computers, and other personal electronic devices altogether, but it’s a good idea to limit your use as much as possible. Research shows that staring at a screen reduces the number of times you blink, which, for people with TED, can worsen the symptoms of dry eye and lead to eye strain.
To prevent eye strain, try to rest your eyes every two hours for 15 minutes.
And to encourage yourself to blink more, follow the 20-20-20 rule: every 20 minutes you’re looking at a screen, take a 20-second break to look at something 20 feet away.
4. Eating Foods High in Saturated and Trans Fats
Foods high in saturated fats — such as bacon, beef, and hot dogs — can also contribute to inflammation, worsening TED symptoms. The same can be said for foods loaded with trans fats, like fried foods.
5. Eating Foods High in Iodine
If you have TED, it’s important to steer clear of foods that are high in iodine. That’s because iodine can trigger hyperthyroidism in people who have an existing thyroid condition like TED.
High-iodine foods include seaweed and sea vegetables like kelp; seafood (especially haddock and cod); most table salt; bread; and dairy products like milk, cheese, and yogurt. Talk to your doctor about how much iodine is safe to include in your diet.
6. Being Under a Lot of Stress
Stress can trigger inflammation on a cellular level, worsening inflammation in the eyes among people who have TED. While avoiding stress altogether isn’t realistic, there are some habits that can help you stay calmer, such as getting at least seven hours of sleep per night, exercising regularly, eating a mostly plant-based diet, meditating, and staying connected to loved ones.
7. Abandoning Your Treatment Plan
Not taking your “thyroid medications can exacerbate TED symptoms,” says Robert Kinast, MD, vice-chair of ophthalmology at Legacy Devers Eye Institute in Portland, Oregon. An endocrinologist can help you manage thyroid disease; if you have trouble sticking to your treatment plan, ask about ways to make your routine easier, like setting reminders on your phone to take medication regularly.
To treat TED, Glenn Ostriker, MD, director of ophthalmology at Stamford Health in Stamford, Connecticut, recommends seeing an ophthalmologist, who can prescribe eye drops and medications, and in some cases, perform surgery.
By following the steps above, you’ll not only better manage the symptoms of TED, but improve your overall health as well.
The Takeaway
There is no cure for TED, but treatments can help manage symptoms and to slow progression.
TED can be managed in a variety of ways, including with lifestyle changes, eye drops, medications, and sometimes surgery.
Avoiding habits that can worsen TED, such as smoking or eating highly processed foods, can also keep TED symptoms in check and slow the progression of the disease.
It can be difficult to treat a complicated autoimmune disorder such as thyroid eye disease, which is why you may need to recruit multiple doctors and experts to your healthcare team if you have the condition.
Thyroid eye disease is also known as Graves’ ophthalmopathy, in part because it commonly goes hand in hand with Graves’ disease, which causes an overactive thyroid. In many cases, both diseases need to be treated at the same time. People with mild cases may experience redness, tearing, and dry eye due to inflammation, while people in the later stages can experience eye bulging (proptosis) and even vision loss.
Thyroid eye disease “is a very challenging disease for patients, because it changes the way they look, see, and feel,” says Andrea Kossler, MD, an associate professor of ophthalmology at Stanford University Medical Center in Palo Alto, California.
What’s more, the condition is relatively uncommon. The National Organization for Rare Disorders (NORD) estimates that thyroid eye disease affects 16 out of 100,000 women and nearly 3 out of 100,000 men.
“Up until recently, patients didn’t have the support, enough resources, and doctors who knew how to properly treat them,” says Dr. Kossler. In recent years, though, there has been a renewed focus on the condition, as well as new treatments developed for it.
The key is to find a group of doctors who know how to manage and treat thyroid eye disease. “It’s important that they all work together,” says Kossler. “We need a customized team approach.” A study reported that about 90 percent of thyroid eye disease is associated with Graves’ disease and requires multispeciality collaboration, including ophthalmology, endocrinology, and otolaryngology, because Graves’ involves different systems of the body.
Here are a few experts who can help treat thyroid eye disease.
1. A Primary Care Physician to Organize Your Care
Your primary care physician may be your main point of care if you have Graves’ disease. They will also refer you to an ophthalmologist for more comprehensive eye care and generally keep track of your care and the medications you might be taking.
2. An Ophthalmologist to Monitor Your Eyes for Changes
No matter what stage — mild, moderate, or severe — your disease is in, “if someone has Graves’, they should be seeing an ophthalmologist to get a baseline eye exam,” says Madina Falcone, MD, the director of oculoplastics and orbital surgery at University of Connecticut Health in Farmington. Your ophthalmologist will recommend an appropriate interval for exams and watch for any disease progression in your eyes.
3. A Thyroid Eye Disease Specialist for Moderate to Severe Cases
If your disease advances to moderate or severe, Dr. Falcone recommends seeing an ophthalmologist who specializes in thyroid eye disease or an oculoplastic and reconstructive surgeon. They will develop a treatment plan that’s best for you.
4. An Endocrinologist to Manage Your Thyroid Hormone Levels
An endocrinologist, who specializes in treating hormone conditions, can help you balance your thyroid hormones, even though doing so doesn’t treat or correct the symptoms of thyroid eye disease, such as eye bulging. “An endocrinologist will monitor a patient’s hormone levels and make sure that they get to a stable thyroid state,” says Falcone.
5. An Ear, Nose, and Throat Doctor and an Oculoplastic Surgeon for Emergency Treatment
A sudden flare of severe thyroid eye disease can cause vision loss. That’s because the enlarged fat and muscle tissues surrounding the eyes can push the eyeball so far forward that it compresses the optic nerve, which tethers the eyeball to the brain.
“When patients come in with really severe disease and are actively losing their vision, you don’t have time to waste,” says Falcone. In that instance, an oculoplastic surgeon might work with an otolaryngologist (ear, nose, and throat doctor) to perform decompression surgery, she says.
“The goal of surgery is to remove some of the bony structures behind and around the eye, creating room in order to release pressure around the optic nerve,” says Falcone. Later, your surgeon might correct any eyelid sagging caused by stretching due to eye bulging.
6. A Smoking Cessation Expert to Help You Quit, if Needed
“Smoking cigarettes is one of the biggest risk factors for developing and worsening of the disease,” says Kossler. If you have been diagnosed with Graves’ disease or thyroid eye disease, make a plan right away for how you’ll quit. A good place to start is the Centers for Disease Control and Prevention’s quitline for free, over-the-phone, nonjudgmental coaching. The hospital or medical center that’s treating your eye disease may also be able to recommend a smoking cessation program.
7. A Mental Health Professional to Help You Process Changes Related to the Disease
If your thyroid eye disease leads to eye bulging or the “thyroid stare,” where bulging keeps the eyelids open in such a way that it looks like you’re staring, it may be difficult to emotionally process the changes to your appearance.
Depression is common in people who have thyroid eye disease, according to NORD. One study concluded that the disease has a significant effect on quality of life. Your doctor can refer you to a psychologist or therapist for in-person or telehealth services to help you process the complicated emotions that can arise.
As worried as you may be about your diagnosis, keep in mind that there are ways to treat thyroid eye disease. “I want patients to feel reassured that there are good treatment options to get them looking and feeling [more] like they did before,” says Kossler. “Help is on the way.”
The Takeaway
Recruiting a variety of healthcare professionals, such as an endocrinologist, ophthalmologist, and mental health professional, can provide comprehensive care for both your thyroid eye disease and its impact on your eyes and emotional health.
Immediate medical attention from an oculoplastic surgeon and otolaryngologist is crucial in severe cases where eye bulging leads to vision loss risk through optic nerve compression.
Quitting smoking can significantly reduce the risk of developing or worsening thyroid eye disease, so smoking cessation resources can be a helpful part of your treatment plan.
Family and friends are often your first line of support, but online and in-person groups offer interaction with others who share the experience of RA. A chance to vent and hear about other people’s experiences can be a huge de-stressor, says Bella Fradlis, MD, a rheumatologist at Garnet Health in Goshen, New York.
You can also pick up smart coping strategies that others with RA have tried, from ways to get dressed quickly for work in the morning to setting a peaceful tone and rhythm for your day, she says. As time goes by and you get your RA under control, you may even discover a desire to mentor new members, which can give you a sense of purpose.
Research also suggests that seeking support from others can improve levels of inflammatory proteins known as CRP in those living with RA. Higher CRP levels imply higher levels of disease activity and inflammation.
Talk to your doctor about joining either an in-person support group near your home or an online forum, such as one of the Arthritis Foundation’s Connect Groups or CreakyJoints, a free online community of support and resources for people with all forms of arthritis.
3. Get Practical Help
You may be more prone to stress with RA if you have:
High pain levels
Low mobility
A lower income
Limited social support
Personality traits such as sensitivity to anxiety and excessive worrying
If you’re struggling to navigate the health system, or worrying about mobility or how to pay for medication, ask your local health center for advice on who to speak to.
A link to chat online on their Helpline webpage
A helpline to call, 800-283-7800
A helpline form to fill in with any questions
4. Keep a Gratitude Journal
During an RA flare, it’s easy to focus on the joint pain and stiffness. This is where journaling may help.
Some people find that writing in a gratitude journal can really help them focus on the good things in life, Dr. Fradlis says. It can help you relax, improve your mood, and even distract you from RA pain. Journaling in general can also be an effective and inexpensive way to release stress.
A review published in 2023 found that people who underwent gratitude interventions experienced better mental health, lower levels of anxiety and depression, and improved satisfaction with life overall.
Ways of getting started include:
Journal with a focus on positive experiences.
Post photos online with captions of gratitude.
Express gratitude to people around you.
Take time to reflect on things you’re grateful for.
Similarly, focus on what you can do, despite RA, to improve how you feel about your body and reduce depression. Cognitive behavioral therapy (CBT) may also help: A meta-analysis showed CBT could significantly reduce levels of anxiety depression and relieve fatigue in RA symptoms.
5. Accept and Adjust to the Challenges
A chronic illness diagnosis can be stressful in itself.
Here are some tips from the Arthritis Foundation to help you adjust:
Remember you are not your RA. Keep being the person you were before, with friends, interests, and so on, only with extra challenges.
Accept the bad days. RA comes in flares, and most people do experience remission. There’s a good chance a better day is around the corner.
Monitor your symptoms. If you know certain factors increase the risk of a flare, try to minimize them. If symptoms are worsening, contact your medical team.
Seek help as needed. If you feel a flare coming on, make sure you have the medications you need at hand. Keep a list of helpful phone numbers handy and don’t be afraid to ask for help.
Express yourself. Share with others how RA is affecting you. It will help them understand your needs and when you might need help.
6. Practice Mindfulness
Take time out to relax, breathe, and focus to manage the pain and stress of RA.
A review published in 2021 found that people with RA who learned mindfulness had less depression, stress, and disease activity than those who didn’t, although more research is needed.
In 2022, researchers published the findings of a pilot study in which 28 people with RA received mindfulness-based stress reduction (MBRS) therapy in weekly sessions lasting 2.5 hours for eight weeks, plus a 6-hour retreat between weeks 6 and 7. Up to 12 months after treatment, participants continued to have significantly lower levels of anxiety and depression and a greater ability to sleep, function, and cope with their emotions.
Guided meditation
Mindful movement, such as yoga or mindful walking
Mindful eating
Alongside mindfulness, it can be helpful to identify thoughts, emotions, and body sensations that are linked with your experience of RA, stress, or both.
7. Cultivate Your Sense of Humor
“The old adage ‘Laughter is the best medicine’ might not be so crazy after all,” says Victoria K. Shanmugam, MD, the director of the division of rheumatology at George Washington University in Washington, DC. “Our emotional and immune states share a complex and bidirectional relationship with one another.” And research backs this up: A sense of humor can be an effective coping strategy for people with RA and stress.
Lighten your mood
Stimulate the heart and other body organs by increasing your intake of oxygen-rich air
Activate and relieve your stress response, leaving you feeling more relaxed
Soothe tension by boosting circulation and relaxing stressed muscles
In the long term, it may:
Support your immune system by releasing stress-reducing neuropeptides
Help relieve pain by stimulating the body to produce natural pain killers
Make tough situations easier to face
Help you connect with other people
Reduce stress and anxiety and boost your self esteem
Here are some tips to help you get a regular laugh:
See the humor in your own experiences and laugh with others about them
Find a funny book or film to enjoy
Share online jokes and funny clips with others
Spend time with people who like to laugh or tell jokes
Find a local “laughter yoga” class
Play with or watch animals or children
8. Get a Good Night’s Sleep
People with RA often find it hard to get a good night’s sleep, which can worsen pain, mood, and fatigue. But, getting enough sleep can help you manage stress and RA, Fradlis says.
Research from 2022 suggests that better sleep may improve your pain and quality of life.
The authors define better sleep as:
A regular number of sleep hours each night
Reduced sleep disturbances
Falling asleep soon after turning the lights out
Tips for achieving this include:
Establish a regular bedtime and morning routine.
Ensure your room is cool, quiet, and dark enough for your comfort.
Avoid large meals in the evening and caffeine after midday.
Exercise regularly.
Switch off electronic devices at least 30 minutes before bedtime and leave them outside the room.
Keep a sleep diary to track your sleep patterns and causes of disturbances.
Ask your doctor to adjust your medication if pain keeps you awake.
Food allergies — particularly ones that may lead to life-threatening anaphylaxis — can be stressful for parents and children alike. In one study, 77 percent of caregivers of children with food allergies reported psychological distress related to food allergies, and 52 percent of them said their child experienced similar distress. The most common issue was anxiety about having an allergic reaction.
“It’s common for children to experience distress and worry related to their allergies, especially as they get older — and especially children managing multiple and severe allergies,” says Despina Petsagourakis, PhD, a licensed psychologist with the pediatric allergy program at Hassenfeld Children’s Hospital at NYU Langone in New York City. While a bit of anxiety can be good, because it helps you and your child adhere to allergy-safe practices, too much can lead to dysfunctional behaviors, she notes. “These can include extreme isolation and disordered eating.”
Fortunately, studies have shown that a child’s emotional distress and anxiety can be eased with coping strategies and support from parents.
Here are seven strategies to help your child — and yourself — cope with the stress of food allergies.
1. Teach Your Child About Their Food Allergies
Knowledge is power when it comes to managing food allergy–related anxiety. “Educating a child on their food allergies can increase confidence in their efforts to manage [them],” says Amy Hahn, PhD, a pediatric psychologist with the allergy clinic at Nationwide Children’s Hospital in Columbus, Ohio. “Providing accurate education can also dispel any myths or worries they may have, particularly if the child has access to information in the media that may be sensationalized.”
It’s also important to educate your child on the benefits of epinephrine, the injectable or nasal spray medication that treats severe allergic reactions. “It should always be available in case of emergencies and accidental exposures and is incredibly effective,” she says.
2. Have a Plan of Action
Knowing what to do in an emergency helps ease anxiety for your child and everyone who comes in contact with them. Developing a food allergy safety plan not only prepares your family for allergic reactions, but can also help ease anxiety, knowing everyone knows what to do should an emergency occur. The action plan should include roles and responsibilities for parents, children, and any other adults who routinely interact with your child, such as school staff.
Dr. Petsagourakis advises consulting with your child’s medical team about what to include in the action plan. “Your plan could include both daily steps and responsibilities, such as checking food labels, asking an adult before eating a new food, and packing epinephrine,” she says. “[It should also include] signs and symptoms that an emergency plan should be activated, emergency phone numbers, and when to administer epinephrine.”
She advises keeping your action plan up to date and increasing responsibilities for your child as they get older to help prepare them to manage their allergies independently in the future.
3. Be a Calm and Confident Role Model
Children look to their parents to determine whether a situation is safe or not, so your actions can increase or quell anxiety in your kids. “If a parent is demonstrating anxious and overly vigilant behaviors related to food allergies, the child will often adopt similar behaviors and mindset,” Dr. Hahn says. “For this reason, it’s important for parents to model behaviors around food and food allergies.”
Feeling anxious as a caregiver is normal at times, but it’s important to use appropriate coping skills in these moments. “For example, when dining out, a parent can confidently state the child’s allergies to servers and chefs, model safe selection of restaurants and menu options, and regularly bring medication and epinephrine auto-injectors to demonstrate to the child safe ways to eat when away from home,” Hahn says.
4. Validate Your Child’s Feelings
Acknowledging what your child is going through can help them feel understood, and it also lays the foundation for continued emotional openness and sharing, Petsagourakis says. “By saying, ‘I totally understand why you feel scared when we eat at a new restaurant,’ you not only help reduce the stigma of your child’s fear, but you also increase the likelihood that they will be willing to move forward with a strategy to help manage their anxiety,” she explains.
Petsagourakis suggests following up your acknowledgment with an actionable next step you and your child can take together, such as practicing allergy safety questions when you get to the restaurant or even writing them down beforehand.
5. Empower Your Child to Safely Participate in Normal Activities
To help your child manage anxiety around their allergies, it’s important to encourage them to continue to do the things they love. But at the same time, make sure they have a plan to safely manage food allergies in these situations.
“Parents should consider the child’s age, developmental level, social skills, and other factors unique to their child when developing a plan for activities.” Hahn says. “For example, a young child with food allergies can safely participate in sports, but their family should discuss a plan for handling snacks, informing the coach and other parents of the child’s food allergy, and ensuring access to their epinephrine auto-injector.”
6. Consider Cognitive Behavioral Therapy
If your child’s worries, fears, and anxiety interfere with their daily functioning, consider talking to their pediatrician about cognitive behavioral therapy (CBT), which has been shown to decrease food allergy-related anxiety significantly in both children and parents.
“CBT is a well-established, evidence-based treatment that incorporates cognitive and behavioral strategies for managing distress and is commonly used in food allergy treatment,” Hahn says. “CBT helps a child recognize the link between their thoughts, feelings, and actions and learn ways to have more helpful thoughts,” Hahn says. For example, CBT may be able to help if your child is struggling with extreme avoidance of social situations because they’re worried about allergen exposure.
CBT can also include relaxation training to manage anxiety symptoms and distress. “Your child may learn skills, such as diaphragmatic breathing, visual imagery, mindfulness, and progressive muscle relaxation, to decrease the body’s stress response when anxious,” Hahn explains.
7. Don’t Forget to Take Care of Your Own Health
Parenting a child with serious food allergies comes with unique, stress-inducing challenges. “This may lead you to overfocus on your child’s physical and mental health, to the detriment of your own,” Petsagourakis says. “But remember that children look to their parents to know they are okay, so taking care of your own mental health is taking care of your child’s.”
If you’re feeling a great deal of stress related to managing your child’s food allergies, know that you’re not alone. Ask your child’s pediatrician or allergist about available support systems and resources for you, such as local or national organizations for parents of children with food allergies. You can also search for groups in your area through organizations such as Food Allergy Research & Education and the American Academy of Allergy, Asthma & Immunology. “This can decrease a sense of isolation and burden, as well as provide some helpful tips from others in the food allergy community,” Petsagourakis says.
The Takeaway
Living with food allergies can lead to anxiety and distress in both children and their parents, but coping strategies can help mitigate these mental and emotional struggles.
Teaching your child about their food allergies, having a plan of action, validating their feelings, and modeling calm, confident behavior are all effective ways to help manage food allergy–related anxiety.
Children look to their parents for safety and comfort, so taking care of your own mental health is crucial for helping your child cope with their allergies.
Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.
Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.
Dr. Biggee graduated cum laude with a bachelor’s degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.
In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed “introduction to clinical medicine” for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.
Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.
The U.S. Food and Drug Administration (FDA) has just made it easier for patients to get clozapine, the only drug approved for treatment-resistant schizophrenia.
The agency has removed a long-standing requirement for patients to submit lab test results showing healthy levels of white blood cells known as neutrophils in order to receive prescriptions for clozapine.
The requirement was originally put in place to prevent a rare side effect known as severe neutropenia: a dangerously low white blood cell count that makes people prone to life-threatening infections. The FDA said lifting the lab test requirement could help expand access to schizophrenia treatment.
“This is a major advance, as it removes a significant barrier to clozapine use,” says Frederick Nucifora, DO, PhD, an associate professor and the director of the adult schizophrenia clinic at Johns Hopkins School of Medicine in Baltimore.
“This change ensures that patients will not be denied medication simply because they missed a blood draw due to illness, transportation issues, or other barriers,” Dr. Nucifora says. “As a result, more patients will be able to start and stay on clozapine without unnecessary disruptions, improving their stability and overall quality of life.”
Clozapine Plays an Important Role in Schizophrenia Treatment
Many people with schizophrenia can manage their condition with antipsychotics. But about 1 in 3 of them are considered treatment-resistant because they don’t respond enough — or at all — to these drugs.
Clozapine is the only approved option for these treatment-resistant patients.
“Clozapine treatment can enable patients to stay out of the hospital, complete their education, and even maintain employment,” Nucifora says. “Without clozapine, these individuals may experience relentless psychotic symptoms, leading to frequent hospitalizations, severe functional impairment, and an alarmingly high suicide risk — up to 10 percent.”
Serious Risks of Untreated Schizophrenia
The risks of untreated schizophrenia far outweigh the risk of severe neutropenia with clozapine, Nucifora adds. One recent study of 974 adults with schizophrenia found no cases of severe neutropenia among clozapine users.
“Clozapine is associated with a very low risk of severe neutropenia,” says Deanna Kelly, PharmD, a psychiatry professor at the University of Maryland School of Medicine in Baltimore.
Periodic Blood Testing Will Still Be Needed
People who take clozapine will need periodic blood testing to monitor for signs of neutropenia, but the FDA change to the prescribing rules removes a cumbersome paperwork trail that often resulted in delayed care, Dr. Kelly says.
Lab tests are most important during the initial weeks of clozapine treatment, when the risk of neutropenia is higher than it is after longer periods of treatment, says John Kane, MD, a psychiatry professor at the Donald and Barbara Zucker School of Medicine at Hofstra Northwell in Hempsted, New York.
“The risks in the first six months justify the weekly monitoring,” Dr. Kane says. “Many experts believe that monitoring could be discontinued after one or two years.”
Even if the new FDA approach to clozapine doesn’t immediately lead to a surge in prescriptions, the potential to access this drug more easily may be truly life-altering for patients, says David Goldsmith, MD, an associate professor of psychiatry at Emory University School of Medicine in Atlanta.
“Many patients I work with have remarkable responses to clozapine, including stopping frequent hospitalizations, overall symptomatic improvements, and true functional gains including getting back to work, school, and living independently,” Dr. Goldsmith says. “The number of patients who are able to get access to clozapine is woefully low, and I strongly believe that if we increased access to clozapine, we could make remarkable changes to people’s lives and the psychiatric system overall.”
Chronic autoimmune diseases such as rheumatoid arthritis, lupus, and vasculitis (inflammation of the blood vessels) can be difficult to diagnose and are often wrongly identified as psychiatric or psychosomatic (emotional symptoms that manifest physically, like a stress-induced stomachache).
When doctors misdiagnose these conditions as “all in your head,” people may experience damaging effects on their well-being and self-esteem, and lose trust in healthcare services, according to a new study based on responses from more than 3,000 participants.
“Although many doctors were intending to be reassuring in suggesting a psychosomatic or psychiatric cause for initially unexplainable symptoms, these types of misdiagnoses can create a multitude of negative feelings and impacts on lives, self-worth, and care,” said lead study author Melanie Sloan, DrPH, a researcher with the department of public health and primary care at the University of Cambridge in England, in a statement.
“These [issues] appear to rarely be resolved even after the correct diagnoses. We must do better at helping these patients heal, and in educating clinicians to consider autoimmunity at an earlier stage,” Dr. Sloan said.
Misdiagnosis Can Lead to Mistrust — and Self-Doubt
For this analysis, Sloan and collaborators reviewed surveys from two large groups of people with an autoimmune disease, totaling nearly 3,400 participants. Questions were designed to measure self-reported depression, anxiety, and mental well-being, in addition to medical relationships and healthcare behaviors. They also conducted in-depth interviews with 67 patients and 50 clinicians.
In the findings, published this week in the journal Rheumatology, more than 80 percent of participants said that a misdiagnosis of their condition as psychosomatic damaged their self-worth. Almost three-quarters of patients reported that the misdiagnosis still upset them, often even decades later.
“One doctor told me I was making myself feel pain and I still can’t forget those words. Telling me I’m doing it to myself has made me very anxious and depressed,” said one participant with multiple autoimmune diseases.
Another participant shared how not being taken seriously led to self-destructive thoughts: “When a rheumatologist dismissed me I was already suicidal, this just threw me over the edge. Thankfully I am terrible at killing myself, it’s so much more challenging than you think. But the dreadful dismissiveness of doctors when you have a bizarre collection of symptoms is traumatizing and you start to believe them, that it’s all in your head.”
Misdiagnosed patients also reported lower levels of satisfaction with every aspect of medical care, and they were more likely to distrust doctors, downplay their symptoms, and avoid healthcare services.
As one patient said, the erroneous diagnosis “has damaged my trust and courage in telling doctors very much. I even stopped taking my immunosuppressive medicine because of those words.”
A Tricky Problem to Resolve
“We don’t yet have precise data on how frequently autoimmune diseases are misdiagnosed as psychiatric or psychosomatic conditions,” says Lola Falasinnu, MD, an assistant professor of medicine specializing in immunology and rheumatology at Stanford University in California.
“However, diagnostic errors are a recognized issue across medicine, with an estimated 11.1 percent overall misdiagnosis rate across diseases,” she says.
A key challenge in diagnosing autoimmune diseases is that neuropsychiatric symptoms are often part of the disease itself, rather than separate conditions, says Dr. Falasinnu, who was not involved in the study. This overlap complicates the diagnostic process, as patients may initially be labeled with psychiatric conditions when their symptoms are actually driven by underlying autoimmunity issues.
Additionally, autoimmune disease symptoms often wax and wane, with periods of more intense symptoms followed by quieter phases, further complicating diagnosis.
Many of these conditions also lack definitive diagnostic tests, increasing the likelihood of misdiagnosis or delayed recognition.
Bias May Also Drive Misdiagnosis and Dismissal
Another critical factor, Falasinnu says, is that autoimmune diseases disproportionately affect women.
“Research suggests that their symptoms are more likely to be dismissed as psychosomatic,” she says. “This gender bias in medicine may contribute to delays in proper diagnosis and the unnecessary labeling of autoimmune symptoms as psychological rather than physiological.”
How to Advocate for Yourself at the Doctor’s Office
Falasinnu offers these tips on how patients can speak up for themselves in order to get a proper diagnosis and optimal treatment.
Be confident. Know that your condition is valid and real. Advocate for your needs politely yet assertively when discussing symptoms and concerns.
Track your symptoms. Take an active role in your care by keeping a detailed symptom diary — noting the timing, triggers, and severity of specific manifestations. Tracking medications and treatments, including their effects, can provide valuable insights for doctors.
Get specific. Ask whether there are certain tests to rule out or rule in a particular diagnosis.
Don’t stop at blood tests. Ask whether your condition may be due to a rheumatic autoimmune disease — even in the absence of abnormal blood tests.
Bring an ally to your appointments. Bring a trusted family member or friend along to a doctor’s appointment to help reinforce key points, take notes, and provide emotional support.
Seek out a specialist. Ask for referrals to specialists who may help clarify the cause of the symptoms.
Find support. Connect with patient support groups or online forums. They can offer guidance, shared experiences, and encouragement throughout the diagnostic journey.
Get a second opinion. Consider seeking a second opinion if you are facing a complex or unresolved medical issue. A second opinion can provide fresh insights, confirm a diagnosis, or open the door to additional testing or alternative treatment options.
For Falasinnu, this study recognizes an important issue that many people with autoimmune diseases must deal with.
“Still, more research is needed to distinguish between misdiagnosis and the evolving recognition of neuropsychiatric features as a core part of autoimmune disease pathology,” she says.
You can take steps to banish your gas pain at home. Whether you get your gas moving through abdominal massage and yoga or you drink warm tea and change your diet, there are plenty of gas-busting home remedies to try.
Movement and Abdominal Massage
To get your gas moving, often your body just needs some movement or gentle massage. For example, walking for 10 to 15 minutes after you eat can keep gas moving.
Another technique involves gentle massage. Abdominal massage may jump-start intestinal movement, pushing its contents through more efficiently, although more research is needed to say for sure.
One popular belly massage follows the “I Love U” technique, also known as “I-L-U.” Here’s how you can do it:
Lie on your back and push gently against the upper left area of your abdomen.
For the “I,” move your hand down to the lower left area of your belly (from just under your rib cage to the top of your hip) and repeat 10 times.
Next, you’ll trace a capital “L.” With gentle pressure, move your hand from the upper right abdomen across to the upper left in a straight line.
Then, retrace your I line from top to bottom. Repeat your L tracing 10 times.
For the “U,” gently press at your right hip bone, and trace an upside-down U: up to the upper right abdomen, straight across to your left upper abdomen, then down to your left hip. Repeat this step 10 times.
Massage your stomach or go for a quick walk every morning after breakfast for best results.
Yoga and Stretching
Any exercise may help relieve gas pain — yoga poses and stretching included. Core movement common in some yoga poses can help gas move through your system. Here are some that may work well for gassiness.
Wind-Relieving Pose (Pawanmuktasana) Lie faceup on the floor with your legs extended. Pull your right knee up to your chest and squeeze it to you with both hands. Breathe out and lift your forehead toward your knee, holding for a few breaths. Repeat with your left leg, then both legs together.
Child’s Pose (Balasana) Kneel, with your knees hip-width apart. Walk your hands in front of you and bend at the hips until your torso rests on your thighs. If it’s comfortable, move your arms around to your sides, with palms facing up. Hold this position for eight breaths.
Bridge Pose (Setu Bandhasana) Lie on your back with your knees bent and feet about a foot away from your glutes. Tighten your core and lift your glutes, hips, and back off the ground. Hold the position as long as you can (up to two minutes), lower to the ground, and repeat.
Seated Forward Bend (Paschimottanasana) Sit with your legs stretched out together in front of you. Exhaling, slowly bend forward at your hips, stretching your fingers toward or past your toes. Raise back up into your starting position and repeat three or four times.
Plenty of other yoga poses may help you — try a few out to see which you like best for gas pain relief.
Complementary Therapies
For centuries, cultures around the world have used complementary therapies such as spices in food or teas to improve digestion and manage excess gas. While recent research shows mixed results on how well these spices work for gas pain, some people find they offer relief.
Spices that may ease gas include:
Warm teas with these spices may help a gassy system, but steer clear of carbonation, which can add to gas buildup.
Diet Changes
If you often deal with gas pain, consider adjusting your diet. A low-FODMAP diet, for example, steers you clear of certain carbohydrates that can be difficult to digest. Instead, the low-FODMAP diet recommends foods like:
Green beans (vs. asparagus)
Grapes (vs. apples)
Almond milk (vs. cow’s milk)
Eggs (vs. beans)
Rice cakes (vs. white bread)
You can also try cutting down on high-fiber foods like oranges, broccoli, and quinoa. You need some fiber to keep your gut healthy, but too much can make you gassy.
If you’re not sure what foods are causing your gas, try keeping a food diary. Write down everything you eat for all meals and snacks, and record how you feel after each meal. Over time, you may see a pattern and be able to identify your dietary gas triggers. Working with a nutritionist may be helpful to introduce foods back into your diet as a low-FODMAP diet can be restrictive and is not meant to be forever.
Eating Technique
To minimize swallowed air, avoid using straws, sucking on hard candy, or chewing gum. Try not to talk while you eat, sit down for your meals, and chew slowly. Smaller, more frequent meals may also help you take in less air while you eat.
