What is the Typical Duration of a Mental Health Rehab Program?

Someone calls a friend "such an attention seeker," and everyone nods. Maybe it's a coworker who turns every meeting into a story about themselves, a partner who escalates every disagreement, or a teenager whose posts get more dramatic by the week. Or maybe you've wondered whether the label fits you.

Attention-seeking behavior is any behavior aimed, consciously or not, at getting other people to notice, respond, or reassure. Everyone does it sometimes. Wanting to be seen is a basic human need. It becomes a problem when it's persistent, when it disrupts relationships or work, or when it's the visible edge of something harder underneath: loneliness, a mood episode, a personality disorder, or a crisis.

What counts as attention-seeking behavior?

Common examples include:

• Exaggerating stories or symptoms to get a reaction
• Steering conversations back to yourself
• Dramatic emotional displays out of proportion to the situation
• Fishing for compliments or reassurance
• Provocative statements, posts, or clothing meant to stand out
• Starting conflict to get engagement, even negative engagement

None of these, on its own, says anything about mental health. Context matters more than any single behavior: how often it happens, how much it costs the person, and what's driving it.

Why do people seek attention?

There's rarely a single reason. Common drivers include:

• Loneliness and unmet needs for connection. When people feel unseen, any response can feel better than none.
• Low self-worth. External validation can stand in for an internal sense of being okay.
• Learned patterns. In some families, the only reliable way to get a response was to escalate. Habits learned early can carry into adulthood.
• Stress or crisis. Even people who rarely seek attention may reach for it during a breakup, a loss, or a period of instability.
• Social media. Likes and comments offer fast, measurable attention, which makes it easy to chase.

Sometimes, though, behavior that looks like attention-seeking is a symptom of a mental health condition, and treating it as a character flaw misses the point.

Is attention-seeking behavior a sign of a disorder?

Usually not. But persistent, intense attention-seeking can be part of several conditions.

"Attention-seeking disorder" isn't a real diagnosis

People often search for "attention seeking disorder." There's no condition by that name in the DSM-5. The diagnosis most closely tied to attention-seeking is histrionic personality disorder, and attention-seeking can also show up in borderline personality disorder, narcissistic personality disorder, and during manic episodes of bipolar disorder.

Histrionic personality disorder

Histrionic personality disorder (HPD) is defined by a long-standing pattern of excessive emotionality and attention-seeking. According to the MSD Manual, it affects about 2% of people in the U.S. Under DSM-5-TR criteria, a diagnosis requires at least five of the following, beginning by early adulthood:

• Discomfort when not the center of attention
• Inappropriately seductive or provocative interactions
• Rapidly shifting, shallow-seeming emotions
• Consistent use of physical appearance to draw attention
• Speech that is vague and lacking in detail
• Dramatic, theatrical, exaggerated emotional expression
• Being easily influenced by others or situations
• Seeing relationships as more intimate than they are

A StatPearls review on NCBI describes HPD as an enduring condition that typically begins in late adolescence or early adulthood. The key difference from ordinary attention-seeking is that the pattern is pervasive: it shows up across relationships and settings, for years, and causes real distress or impairment.

Borderline personality disorder

In borderline personality disorder (BPD), intense fear of abandonment, unstable relationships, and rapidly shifting moods can lead to behavior that others read as attention-seeking. Usually it's something closer to panic: an attempt to keep someone from leaving. BPD can also look the opposite way, turned inward. We've written about that in quiet BPD and about the outward-facing petulant type of BPD.

Bipolar disorder

During a manic episode, the NIMH describes symptoms such as feeling very up or elated, talking fast about many things, feeling unusually important, talented, or powerful, and an excessive appetite for pleasurable activities. To others, that can look like a bid for attention. It's actually a mood episode, and it needs treatment.

When "attention-seeking" is really a cry for help

Talk of suicide, self-harm, or hopelessness is sometimes dismissed as "just attention-seeking." That's dangerous. The NIMH's warning signs of suicide include talking about wanting to die, feeling like a burden, feeling hopeless or trapped, and withdrawing from friends. These are reasons to respond, not to roll your eyes.

Even if someone has said similar things before, take it seriously. Ask directly. Stay with them. If you or someone you know is in danger, call or text 988, the Suicide & Crisis Lifeline, or call 911.

How attention-seeking affects relationships

Persistent attention-seeking tends to wear people down. Friends and partners can feel exhausted, manipulated, or stuck in cycles of crisis and reconciliation. Over time, people pull back, which deepens the loneliness that often drove the behavior in the first place.

That cycle is why labeling someone an "attention seeker" rarely helps. It names the behavior without touching the need underneath.

What helps

When attention-seeking is a habit rather than a symptom, change usually starts with noticing the need before acting on it. Is it reassurance, connection, recognition? Saying that need directly often gets a better response than dramatizing it.

When it's part of a mental health condition, treatment targets the condition:

• Personality disorders. Psychotherapy is the main treatment. The MSD Manual notes that for HPD, psychotherapy focusing on underlying conflicts may help. For BPD, a 2020 Cochrane review found that psychotherapy reduced symptom severity, with dialectical behavior therapy and mentalization-based treatment the most studied.
• Bipolar disorder. According to the NIMH, bipolar disorder usually requires lifelong treatment, typically medication combined with psychotherapy.

If you're on the other side of it, as a partner, parent, or friend, it helps to respond to the underlying need calmly and consistently, while setting clear limits on behavior you can't sustain. For more, see how to help someone with mental health issues.

When to look for more support

Consider a professional evaluation when attention-seeking is constant, damages relationships or work, comes with intense mood swings or fear of abandonment, or comes with any talk of self-harm.

At Amae Health, our clinics specialize in conditions including Borderline Personality Disorder and bipolar disorder. Our care teams bring psychiatrists, therapists, peer mentors, and care coordinators under one roof, working from one treatment plan, so the pattern behind the behavior gets looked at, not just the behavior itself.

Frequently asked questions

What is an attention seeker?

"Attention seeker" is an informal label for someone who often behaves in ways meant to draw notice or reactions from others. It isn't a diagnosis, and it often oversimplifies what's going on.

Is attention-seeking a mental illness?

No. Attention-seeking is a behavior, not a diagnosis. Persistent, pervasive attention-seeking can be part of histrionic personality disorder, and it can also appear in borderline personality disorder and during manic episodes of bipolar disorder.

What causes attention-seeking behavior in adults?

Common drivers include loneliness, low self-worth, patterns learned in childhood, stress or crisis, and the pull of social media. In some cases, it's a symptom of a mental health condition.

How do you respond to someone who is attention-seeking?

Respond to the need behind the behavior, such as reassurance or connection, without rewarding escalation. Set calm, consistent limits. And never dismiss talk of suicide or self-harm as attention-seeking.

Key takeaways

• Attention-seeking behavior is common and human. It becomes a concern when it's persistent and harmful.
• "Attention-seeking disorder" isn't a diagnosis. Histrionic personality disorder is the condition most closely tied to it, and it can also appear in BPD and bipolar disorder.
• Talk of suicide or self-harm should always be taken seriously, never written off as attention-seeking.
• The most useful response is to address the need underneath the behavior.

If attention-seeking is part of a bigger pattern of mood swings, unstable relationships, or self-harm, for you or someone you love, request an intake appointment. Our team will explain how an evaluation works and what to expect from the first visit.

We’re honored to share that Advancements with Ted Danson recently spotlighted Amae Health’s work in transforming mental health care for people with severe mental illness (SMI). This episode offers an inside look into our unique, outcome-driven approach that combines technology and compassionate care to support our members’ journeys toward lasting stability and a higher quality of life.

At Amae, we’re dedicated to providing more than just treatment. Our approach includes personalized therapy, medical support, lifestyle guidance, and a strong community connection. We’re committed to creating spaces where healing and growth are possible.

Catch the full story on Amazon Prime Video, Advancements Season 3, Episode 9, to see how we’re helping those who need it most.

Metabolic psychiatry is an emerging field that examines how metabolic dysfunction (insulin resistance, mitochondrial problems, and chronic inflammation) affects brain function.Rather than treating symptoms alone, it looks at the metabolic factors that may underlie conditions such as depression, bipolar disorder, and schizophrenia. The interest is strongest in complex mental illness, where standard treatment often falls short and where physical and psychiatric problems tend to travel together. This article explains the science behind the field, the therapies it uses, the evidence so far, and who researchers think it may help, along with the honest limits of what is still an early area of study.

What Is Metabolic Psychiatry?

Metabolic psychiatry views serious mental illnesses not solely as chemical imbalances or psychological phenomena, but as conditions also connected to disruptions in brain energy metabolism, inflammation, and cellular health. It does not discard the standard understanding of psychiatric illness. It adds a layer, asking whether the way the brain produces and uses energy is part of the picture.

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The term was introduced in 2015 by Dr. Shebani Sethi, who founded the first academic metabolic psychiatry clinic and research program at Stanford University after noticing how often her patients with treatment-resistant psychiatric conditions also had metabolic problems. The approach builds on more than a century of ketogenic-therapy research in neurology, where the ketogenic diet has long been used to treat drug-resistant epilepsy. Metabolic psychiatry is still emerging, and reputable clinicians frame it as a promising area of research rather than a finished or proven model of care.

The Link Between Metabolism and Mental Health

The brain is an energy-hungry organ. It makes up about 2% of body weight but uses roughly 20% of the body's energy, and it depends on a steady fuel supply to function. When metabolism breaks down, through insulin resistance, unstable blood sugar, or chronic inflammation, the brain can struggle to access the energy it needs, and researchers believe this may contribute to psychiatric symptoms.

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The connection runs in both directions. Roughly a third of people with schizophrenia or bipolar disorder also have metabolic syndrome, a cluster of conditions including high blood sugar, high blood pressure, and abnormal cholesterol (Vancampfort et al., World Psychiatry, 2015). People living with serious mental illness carry roughly 1.5 to 2 times the risk of metabolic syndrome and type 2 diabetes compared with the general population, an elevation driven partly by the illness, partly by medication side effects, and partly by shared biology. This is an association, not proven causation. But it is strong and consistent enough that the field takes it seriously.

How Does Metabolic Psychiatry Work?

The central idea, articulated most fully in Dr. Chris Palmer's Brain Energy theory, is that many mental disorders may be, in part, metabolic disorders of the brain. Palmer, a psychiatrist at McLean Hospital and Harvard Medical School, places mitochondria, the structures that produce energy inside cells, at the center of the model.

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Here is the mechanism in plain terms. When brain cells cannot get or use energy properly, often because insulin resistance blocks glucose from entering cells, it can trigger a cascade: mitochondrial dysfunction, oxidative stress, and inflammation. That cascade can disrupt neurotransmitters and interfere with the brain regions that regulate mood, thinking, and perception. Metabolic therapies aim to work upstream of that cascade, restoring the brain's energy supply and lowering inflammation rather than only adjusting neurotransmitters downstream. The theory is compelling and biologically plausible, and it remains a theory under active investigation, not settled fact.

Metabolic Therapies Used in Metabolic Psychiatry

One point clinicians in this field stress is that the toolkit is broader than a single diet. Metabolic health is shaped by many inputs, and a metabolic approach typically addresses several at once:

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• Ketogenic therapy: the clinically supervised use of a well-formulated ketogenic diet to shift the brain toward ketones as fuel (the cornerstone intervention, covered below).
• Nutritional changes: reducing sugar, ultra-processed foods, and refined carbohydrates.
• Intermittent fasting: may improve insulin sensitivity and reduce inflammation.
• Exercise: improves insulin sensitivity, supports mitochondrial function, and reduces inflammation.
• Sleep optimization: poor sleep worsens insulin resistance and mitochondrial function.
• Stress management: chronic stress raises cortisol, which disrupts glucose regulation.
• Removing metabolic stressors: reducing smoking, excess alcohol, and sedentary time.

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Several of these are ordinary lifestyle measures. What is different in metabolic psychiatry is the reason behind them: they are used deliberately to improve brain energy metabolism, tracked with lab data, and coordinated with conventional psychiatric care.

Ketogenic Therapy: The Cornerstone Intervention

The ketogenic diet was developed more than a century ago to treat drug-resistant epilepsy, and that long neurological track record is part of why it draws the most research attention in psychiatry. A ketogenic diet is very low in carbohydrates, which shifts the body into nutritional ketosis: the liver begins converting fat into ketones, an alternate fuel the brain can use when insulin resistance limits its access to glucose.

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Beyond supplying fuel, ketones may reduce inflammation, lower oxidative stress, support mitochondrial function, and help rebalance neurotransmitters. Those are plausible mechanisms, and they are still being studied.

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The most important thing to understand is that ketogenic therapy, as used in this field, is a clinical intervention, not a do-it-yourself diet. It is supervised by clinicians, monitored with regular lab work, and integrated with a person's other treatment. It is not presented by responsible practitioners as a cure, and it is not a replacement for medication. Any change to psychiatric medication belongs in the hands of a treating clinician who knows the person's history.

What Does a Metabolic Psychiatry Evaluation Involve?

A metabolic approach usually starts with screening that goes beyond a standard psychiatric assessment, adding blood work to build a picture of a person's metabolic health. That panel commonly includes:

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• Fasting glucose and insulin, plus hemoglobin A1C, to assess blood sugar regulation
• A lipid panel: triglycerides, HDL, and LDL
• A thyroid panel
• Inflammatory markers such as C-reactive protein (CRP)
• Key vitamin and mineral levels, including B12, folate, magnesium, and omega-3s

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The point of this data is not to produce a standalone diagnosis. It is to identify metabolic factors a clinician can address alongside conventional psychiatric care, and to establish a baseline that lab work can track over time.

Metabolic Psychiatry vs. Standard Psychiatry

Metabolic psychiatry is best understood as a complement to standard psychiatric care, not a replacement for it.

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The honest framing matters. Standard psychiatry, medication and therapy, remains the evidence-based foundation. Metabolic psychiatry adds a layer that some clinicians and researchers believe addresses root-cause biology, and it works best woven into conventional treatment rather than substituted for it.

How Metabolic Psychiatry Fits Within Precision Psychiatry

Metabolic psychiatry is often considered part of the broader precision psychiatry movement, which tailors treatment to each person's unique biology rather than applying population averages. Both reject one-size-fits-all, trial-and-error prescribing in favor of care informed by an individual's own data. Metabolic screening is one example of that data. Precision psychiatry is the larger shift, and it is the philosophy behind research programs like the Amae Institute, which studies how to match people living with complex conditions to more effective, individualized care.

Who Might Benefit from Metabolic Psychiatry?

Research and clinical interest are concentrated in complex mental health conditions, the situations where standard treatment most often falls short. The strongest focus so far has been on:

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• Bipolar disorder and schizophrenia, where metabolic syndrome is common and where the first clinical trials have concentrated. People navigating a recent diagnosis can learn more about bipolar disorder treatment and how it is managed within an integrated model.
• Treatment-resistant depression, where conventional approaches have not produced adequate relief.
• People with co-occurring metabolic conditions such as insulin resistance, type 2 diabetes, or obesity.
• People who have not responded well to, or cannot tolerate, standard treatments.

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Two caveats belong with every one of these. The field is emerging, so the evidence is still being built. And metabolic therapies are used alongside, not instead of, conventional psychiatric care, always under medical supervision. Whether a metabolic approach is appropriate for any individual is a clinical judgment, made by a clinician who knows that person's full history.

The Evidence So Far

The evidence is a mix of a strong foundation and promising but early results. Ketogenic therapy has more than a century of established use in epilepsy, which gives the underlying biology real credibility. For psychiatric conditions specifically, the picture is younger.

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In 2024, a Stanford pilot trial led by Dr. Sethi followed more than 20 adults with bipolar disorder or schizophrenia who also had metabolic abnormalities through a four-month ketogenic intervention. It was the first U.S. clinical trial of a ketogenic diet for serious mental illness since 1965. Most participants showed improvement in their psychiatric symptoms, reduced medication-related weight gain, and better metabolic markers; by the study's end, none still met the criteria for metabolic syndrome (Sethi et al., Psychiatry Research, 2024). It was a small, single-arm pilot, not a randomized controlled trial, so the results are encouraging rather than definitive.

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Alongside trials like this, case series and clinical reports describe stabilized mood and, in some cases, reduced reliance on medication under supervision. Larger, more rigorous randomized trials are now underway (Nature Mental Health, 2026). The honest summary: a solid mechanistic foundation, genuinely promising early psychiatric results, and a field that still needs bigger and better-controlled studies before anyone can call it established.

A Whole-Person Approach at Amae Health

The logic underneath metabolic psychiatry, that physical and mental health are not separate systems, is the same logic behind integrated care. At Amae Health, primary care physicians and registered dietitians are part of the psychiatric care team, so physical health, nutrition, sleep, and metabolic comorbidities are treated alongside mental health rather than as an afterthought. That is not the same as offering a specific metabolic-psychiatry program, but it reflects the same whole-person, precision-oriented conviction: complex conditions deserve care that looks at the whole biology of a person.

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If you or someone you love is living with a complex mental health condition, our care model and resources for patients and families explain how integrated treatment works. To ask about care, reach out to our team.

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If you are in crisis or thinking about suicide, call or text the 988 Suicide and Crisis Lifeline at 988 for free, confidential support, available 24/7.

Frequently Asked Questions

What is metabolic psychiatry?

Metabolic psychiatry is an emerging field that addresses metabolic dysfunction, such as insulin resistance, mitochondrial problems, and inflammation, that may affect brain function and mental health. It targets underlying metabolic factors alongside, not instead of, conventional psychiatric care.

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How does metabolic psychiatry work?

The brain depends on a steady energy supply. When metabolism is disrupted, often through insulin resistance that keeps cells from using glucose, the brain can struggle to access fuel, which researchers believe may worsen psychiatric symptoms. Metabolic therapies aim to restore that brain energy and reduce inflammation, working upstream of the neurotransmitter changes that standard treatment targets.

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What is ketogenic therapy for mental health?

It is the clinically supervised use of a well-formulated ketogenic diet to shift the brain toward ketones as fuel. Originally developed for epilepsy, it is the most-studied metabolic therapy for serious mental illness. It is used under medical supervision with regular lab monitoring, not as a do-it-yourself diet.

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Is metabolic psychiatry evidence-based?

Ketogenic therapy has strong evidence in epilepsy. For psychiatric conditions, the evidence is emerging: promising pilot studies and the early stages of larger trials, but still preliminary. It is used alongside conventional care, not in place of it.

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Can metabolic psychiatry replace medication?

No. It is designed to complement conventional psychiatric care, not replace it. Some people reduce their reliance on medication under close medical supervision, but changing psychiatric medication should never be attempted alone.

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Who is metabolic psychiatry best for?

Research has focused most on bipolar disorder, schizophrenia, and treatment-resistant depression, especially alongside co-occurring metabolic conditions. A clinician who knows the person's history determines whether a metabolic approach is appropriate. Support is available, and no one should navigate a serious condition alone.

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Citations

1. Vancampfort D, Stubbs B, Mitchell AJ, et al. "Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis." World Psychiatry, 2015. PubMed 26407790. Tier 1 (peer-reviewed meta-analysis).
2. Sethi S, Wakeham D, Ketter T, et al. "Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial." Psychiatry Research, 2024. PubMed 38547601. Tier 1 (peer-reviewed pilot trial).
3. "Metabolic psychiatry targeting metabolic dysregulation in mental health." Nature Mental Health, 2026. nature.com. Tier 1 (peer-reviewed review).

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Further reading (external resources): Stanford Metabolic Psychiatry (Dr. Shebani Sethi); Metabolic Mind (Baszucki Group).

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