Sleep Disorders and Treatment

Sleep is a basic human need, and is as important for good health as diet and exercise. When we sleep, our bodies rest but our brains are active. Sleep lays the groundwork for a productive day ahead. Although most people need seven to nine hours of sleep each night to function well the next day, the National Institute of Neurological Disorders and Stroke reports that about 40 million people in the United States suffer from chronic long-term sleep disorders each year and an additional 20 million people experience occasional sleep problems.

A 2005 NSF Sleep in America poll of all adults revealed that women are more likely than men to have difficulty falling and staying asleep and to experience more daytime sleepiness at least a few nights/days a week. Research has shown that too little sleep results in daytime sleepiness, increased accidents, problems concentrating, poor performance on the job and in school, and possibly, increased sickness and weight gain. Understanding the effects of body chemistry, environmental factors, and lifestyle habits can help individuals enjoy a good night’s sleep.

What types of sleep disorders are there and how are they classified? Below is a list of the more common types and subtypes of sleep disorders.

Insomnia: Difficulty falling or staying asleep with sleepiness, irritability, and decreased cognitive function throughout the day. Insomnia can be caused by stress, life transitions, environmental factors, some medications, depression, anxiety, or environmental problems.

• Chronic: Three nights a week for a month or longer
• Short Term (Acute): One night to a few weeks

Sleep Related Movement Disorders: simple, usually stereotyped movements during the night that can wake an individual up or make it difficult for them to fall asleep. Subtypes are:

• Restless Leg Syndrome (RLS): A sensorimotor disorder characterized by the urge to move one's legs (rarely arms). Associated with tingling, burning, aching sensations in the muscles so that one must move them. Symptoms can be worse at night, affecting sleep.
• Periodic Limb Movements of Sleep (PLMS): Short, jerky movements of the limbs that occur every 20-30 seconds throughout the night and can severely disrupt sleep causing fatigue during the day. More than 80% of people who have RLS also have PLMS.
• Sleep Related Leg Cramps: Muscle tightening and cramping that occurs very suddenly while an individual is asleep. Cramps can last a few seconds to a few minutes and cause sleep disturbance.
• Sleep Related Bruxism: Teeth grinding during sleep that can cause jaw pain, headaches, and tooth damage. Usually caused by anxiety and stress while awake. 

Hypersomnia: Also known as Excessive Daytime Sleepiness (EDS). Characterized by an individual's ability to fall asleep during waking hours, even while driving or working. These individuals usually get normal amounts of sleep during the night but are sleepy during the day and have difficulty with cognitive functioning.

• Primary: Daytime sleepiness occurring most if not all of the time.
• Recurring: Occasional daytime sleepiness. Periods can last one-two days recurring over the span of a year.
• Narcolepsy: A disorder characterized by an individual falling asleep at inappropriate times such as driving or walking. 

Sleep Related Breathing Disorders: A disruption in an individual's normal breathing patterns during sleep. If sleeping alone, an individual may not know he or she suffers from a breathing disorder.

• Sleep Apnea: The most common of Sleep Related Breathing Disorders. 
  • Obstructive Sleep Apnea (OSA): Occurs when the throat and upper airway collapse during sleep causing breathing to stop, which can happen ten-1,000 times per night. This disorder is associated with heart and circulatory problems due to the lack of oxygen in the body.
  • Central Sleep Apnea (CSA): Occurs when the body stops automatic breathing during sleep. CSA can be related to certain medications, diseases that affect the central nervous system, or strokes.
• Other irregular breathing patterns during sleep can be caused by:
  • High altitude: above 15,000 feet
  • Medications or drugs such as opiates 
  • Cheyne-Stokes breathing pattern: a rhythmic increase and decrease of automatic breathing while sleeping

Parasomnias: Disorders classified by abnormal behavior of the nervous system during sleep. Many of these disorders are dissociated sleep states in which the individual is partially aroused between sleep and wake cycles. Subtypes are:

• Somnabulism (Sleep Walking): An individual gets up out of bed, walks around and does other activities while asleep such as urinating or talking. They will not remember these episodes and are very difficult to awaken.
• Sleep/Night Terrors: A disorder characterized by an individual screaming, shouting, and thrashing in bed caused by a nightmare and intense fear. Individuals usually do not remember these episodes and are not consolable at first.
• Sleep Enuresis (Bedwetting): Urinating in one's sleep caused by failure to wake up when the bladder is full, or lack of contraction in the bladder. Most common in children, as they do not have full bladder control yet.
• Sleep Related Eating Disorder: A disorder in which an individual gets up while asleep and binge eats. These episodes can cause fatigue during the day, weight gain, and stomach pain related to eating strange foods or objects.

Circadian Rhythm Sleep-Wake Disorders: Disorders in which an individual's circadian rhythm is disturbed caused by work-related changes or other environmental factors. Essentially the individual is awake when everyone else is sleeping and vice versa. Some of the more common include:

• Shift-Work Sleep Disorder: Affects individuals who work night shifts.
• Jet -Lag: Results in a circadian rhythm disturbance caused by traveling across multiple time zones in a short period of time.

 

How are sleep disorders treated?

Sleep disorders can be treated with improved sleep hygiene, programs such as CBTI, and/or medications to help the body fall asleep and rise appropriately.

Good sleep hygiene can also be effective in treating insomnia and other sleep disorders. The following are some guidelines for healthy sleep habits.

1. Avoid caffeine and other stimulants 12 hours before bedtime.
2. Avoid napping during the day.
3. Avoid large meals right before bedtime.
4. Ensure that you are properly hydrated throughout the day.
5. Exercise! Working the body vigorously at any time can promote good and restful sleep.
6. Create a sleep routine before bedtime. This may include relaxing activities such as having a cup of herbal tea, taking a bath, reading a book, or meditating.
7. Go to sleep and wake at the same times to train your brain and body.
8. Associate your bed ONLY with sleeping and sex. Avoid doing work or other activities in your bed.
9. Turn off the TV and other noises, except for white noise or quiet, relaxing music.
10. 30 minutes before bedtime, turn down lights and close the curtains to create a dark space. Do not use electronic devices that have a bright screen during this period as well. Darkness tells your brain that it's time to go to sleep.
11. If you grind your teeth during sleep, ask your dentist for a mouth guard to protect your teeth and jaw and wear it to bed every night.
12. If you are unable to fall asleep in 5-10 minutes, get up out of bed and do something relaxing until you get sleepy. If you watch the clock or become frustrated because you are not falling asleep quickly enough, this can impede your sleep even more.

CBT for Insomnia (CBTI) is a behavioral treatment course for those who have difficulty sleeping and already practice healthy sleep hygiene without success. Usually 4-8 sessions are completed with a therapist intended to teach skills for overcoming insomnia, and it is helpful for recurring episodes. CBTI includes education on sleep hygiene and normal sleep patterns, a review of the patient's sleep patterns and history, and an in-depth analysis of the thoughts, feelings, and behaviors that compromise sleep. The therapist and patient will then discuss skills for the patient to practice to counter the insomnia, such as using a sleep log or restricting sleep. CBTI may or may not include medications, depending on each individual's case.

Common medications for treating sleep disorders include:

• Ambien - Effective in helping individuals fall asleep but some may wake up throughout the night
• Lunesta - Helps to fall asleep quickly but may cause drowsiness the next day
• Rozerem - Works by targeting the sleep-wake cycle rather than depressing the nervous system
• Sonata - Stays active in the body for a short period of time so that if you wake at 2am and take a dose, you will not be groggy the next day
• Silenor - Works to inhibit the histamine receptors to help individuals stay asleep throughout the night
• Benzodiazepines - These medications depress the nervous system and are effective in treating sleep terrors and sleep walking. Common types are Xanax and Klonopin.
• Antidepressants - Effective in treating insomnia caused by depression and anxiety
• OTC Medications: These can be found in your local grocery or drug store. Doxylamine is a common OTC medication and is found in brand names like Unisom and Nighttime Sleep Aid. This medication may cause prolonged drowsiness. It also may not be safe if you're pregnant or breast-feeding or you have a history of enlarged prostate, asthma, or glaucoma. Benadryl and NyQuil can also be used to cause sleepiness.

• Supplements: Supplements made from plants may reduce the amount of time it takes to fall asleep and help you sleep better. However, it's not clear what the active ingredient is. Also, the potencies of various ingredients vary from preparation to preparation. Melatonin and Valerian are examples of supplements that treat insomnia.

If you think you suffer from a serious sleep disorder, talk with your provider about beginning CBTI, completing a sleep study, or possible medications to aid your sleep routine. Always practice good sleep hygiene, even if you do not have trouble sleeping.

How to Calm a Panic Attack

What is a panic attack? In the midst of one it can feel like you're having a heart attack; you can faint, vomit, hyperventilate, or feel like you're dying. This feeling can last anywhere from 5 - 30 minutes. What makes them so scary is that they are unprovoked and unpredictable (unlike an anxiety attack), and are not caused by any external or internal stressor. Sounds horrible, right? Some people suffer panic attacks several times a day and these can be absolutely debilitating.

The DSM defines a panic attack as "an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur. The abrupt surge can occur from a calm state or an anxious state". An individual must have at least 4 of these symptoms for the episode to be qualified as a panic attack:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or going crazy
13. Fear of dying

If you've ever had a panic attack, you know that the fear of one coming on is just as uncomfortable as the attack itself, and can even cause one to happen. No one can stop a panic attack in the middle of it, unfortunately, so you must ride it out until it ends. But there are actions you can take to make it more bearable. So what can you do to calm yourself when you feel one coming on?

• An important part of struggling with panic attacks is to accept that this is a problem you have. Denying or ignoring this fact will only make your panic attacks worse and more frequent. Although it may sound like it, acceptance is not the same thing as liking your attacks or giving up working on your mental health issues. Acceptance means that you let go of wishing you didn't have this problem and acknowledging your present reality. This will eventually lead to overcoming your attacks. When you start to feel you are panicking, tell yourself that it is OK that you will be in the midst of a full-fledged panic attack in a few minutes. They are not dangerous and cannot harm you even though it may feel that way during them. However, you should also know the warning signs of a heart attack or stroke and not to pass these symptoms off as a panic attack when inappropriate. If you are unsure, call 911 or go to your nearest emergency room!
• Take yourself out of your current situation and go to a quiet, uncrowded place where you will be able to calm yourself down. If you have a friend that you trust who is with you, ask him or her to come with you and help you through your panic attack. However, if you would rather be alone or you feel your friend would not be helpful, skip this step. If you have a piece of paper and a pen with you, begin writing down how you feel. Your mental health provider can give you a panic diary worksheet if you ask them, which will help to identify your feelings, bodily sensations, and thoughts. Things to ask yourself may include, "What sensations am I feeling in my body right now?" or "What are the thoughts I am having about my panic attack?" This exercise allows you to think about your symptoms in an objective way and puts a little bit of space in between you and your panic attack. 
• Belly breathing! Breathing properly is a very important part of relaxation in general, and can be extremely beneficial in the midst of a panic attack. Most of us breathe with our chests when really we should be breathing from our diaphragm (a muscle below our lungs that extends across the body and is crucial in the respiratory process). To make sure you are belly breathing, you can place your hand on your belly and watch as it rises and falls while you inhale through your nose and exhale out your mouth. Try inhaling for a count of 4 seconds, hold for 4 seconds, exhale for 4 seconds, and hold for 4 seconds. This is called square breathing (because of the 4x4 seconds and because you can also visualize outlining the lines of a square as you breathe). While you are belly breathing, try to keep your body and muscles relaxed, and pay attention to your bodily sensations. Be sure to practice this type of breathing during a calm state, so that you know how to do it properly to calm yourself down during a panic attack.
• Another distraction technique you can try is engaging with your surroundings. Staying in the present moment is an important part of making it through a panic attack, as thinking about the past or future may have been what sparked your panic attack in the first place. Obviously if your situation is in fact dangerous, if you are being robbed for example, your body is responding appropriately to a threat. But if you are actually safe, naming and describing objects in your view can be helpful to keep your mind in the present. For example, if you see a tree in your surroundings, you can think in your head, "Tree. Green. Brown. Leaves. Bark. Birds' nest. Smooth. Rough". Or you can also keep something textured interestingly with you at all times, like a smooth rock or a stress ball, and play with it mindfully to keep yourself focused. 
• In addition to practicing relaxation and grounding techniques in the midst of a panic attack, there are some preventative measures you can take to reduce the frequency of your attacks. Avoidance or minimization of stimulants is very helpful. Avoid caffeine and minimize the use of asthma medications if possible (bronchodilators, theophylline). Some cold and cough medications like nasal decongestants as well as diet pills can increase anxiety, so try to stay away from these. Good sleep habits are also crucial in decreasing panic attacks. Getting adequate, restful sleep improves response to interventions to treat anxiety disorders. Furthermore, identifying and removing or reducing stressful tasks or situations at home, school and work can help to minimize anxiety.
• If these behavioral techniques aren't effective enough, pharmacological treatment is a very successful intervention. Always remember to take all medications as prescribed by your provider.
  Benzodiazepines: Long-acting ones are best (Klonopin, Ativan, Valium, Librium, Serax) to quickly (almost immediately) reduce the symptoms of a panic attack.
  SSRIs: Work to balance serotonin in the brain. Serotonin is a neurotransmitter responsible for regulating many bodily functions. Effective SSRIs for anxiety include Luvox, Prozac, Zoloft, Paxil. These are daily medications that can take up to 4-6 weeks to work fully.
  Tricyclic Antidepressants (TCAs): Older antidepressants with more side effects typically than the serotonergic agents, but are also effective. Takes 4 to 6 weeks for full response (Tofranil, Elavil, Pamelor, Sinequan)
  Antihistamines: Older medications have been used for mild to moderate anxiety for many years. These, like the benzodiazepines, work fairly quickly (Atarax, Vistaril).
  Buspirone (BuSpar): a serotonergic combination agonist/antagonist. Is nonaddicting, but may take 2 to 4 weeks for full effect.
  Major Tranquilizers: Have been used in situations where anxiety is severe enough to cause disorganization of thoughts and abnormal physical and mental sensations, such as the sense that things around you aren't real (derealization) or that you are disconnected with your body (derealization). Commonly used neuroleptics: Zyprexa, Risperdal, Seroquel.
• Most importantly, remember that panic attacks END and that they are not harmful to you. You can and WILL get through them, and if you practice your techniques, you can eventually overcome them.

LGBTQ: What is it and how can I support someone struggling with these issues?

The LGBTQ community has widely increased support and equality for its members in the past few years, but many individuals, especially adolescents, are still in need of help emotionally, economically, and medically. In the mental health profession, practitioners strive to create a respectful, inclusive, and affirmative environment so LGBTQ individuals will be more likely to seek out the treatment they need.

Even though LGBTQ knowledge is more widespread today, the wording and language can still be confusing, and no one wants to be offensive. So let’s define some terms. Here are a few that will be useful to define as part of this post. Note that there are many sexual and gender identities and expressions, and this list is not comprehensive. A more detailed list of resources can be found at the end of the article. It is also important to remember that terms are meant for understanding and learning, rather than labeling. Each person is unique and deserves to be treated with respect and individuality. One size does not fit all!

• LGBTQ - Stands for Lesbian, Gay, Bisexual, Transgender, Queer. It is an umbrella term for non-heterosexual and gender-variant individuals, and does not include all sexualities
   
• Lesbian - a woman who is sexually attracted to other women
   
• Gay - a man who is sexually attracted to other men
   
• Bisexual - an individual who is sexually attracted to both men and women
   
• Transgender - an individual who has been assigned a gender and sex at birth but identifies differently
   
• Queer - an umbrella term for anyone who identifies as outside of the social norms of gender and sexuality
   
• Sex vs. Gender vs. Sexual Attraction - One’s sex is determined by biology and anatomy (i.e. Male or Female or other). Gender expression is the outward portrayal of who one feels they are on the inside and is largely influenced by culture and social norms (male, female or other). Gender identity and expression can be different for the same individual. Sexual orientation refers to whom an individual is sexually attracted (heterosexual, homosexual, bisexual, etc.).
   
• LGBTQ Ally - A heterosexual individual who supports equality and rights for the LGBTQ community.
   
• Coming Out - A term used to describe an individual disclosing to others about their sexual orientation, gender identity, etc. It comes from the phrase “coming out of the closet”.

The following are statistics from lgbthealtheducation.org illustrating the severity of problems this community faces:

1. LGBT youth are 2 to 3 times more likely to attempt suicide, and are more likely to be homeless (it is estimated that between 20% and 40% of all homeless youth are LGBT). LGBT youth are also at higher risk for becoming infected with HIV and other sexually transmitted diseases (STDs).
2. LGBT youth are at higher risk of being bullied.
3. Gay men and other men who have sex with men (MSM) are at higher risk of HIV and STDs, especially among communities of color.
4. LGBT people are much more likely to smoke than others; they also have higher rates of alcohol use, other drug use, depression, and anxiety.
5. LGBT people are less likely to get preventive services for cancer.
6. LGBT people have higher rates of behavioral health issues.
7. Transgender individuals experience a high prevalence of HIV and STDs victimization, and suicide.
8. Elderly LGBT individuals face additional barriers to health care because of isolation, diminished family supports, and reduced availability of social services. Some report discrimination from their peers when living in communal elderly housing. 

These are just some of the issues LGBTQ individuals are tackling. It is essential that we spread accurate knowledge, practice respect for all individuals, and create an inclusive environment for everyone. You can make a difference, even if it’s just with someone you love. Not everyone is an activist, and that’s just fine.

Having a friend or family member come out to you can be surprising, upsetting, or even relieving, and knowing what to say and do is an important part of supporting them. Here are some tips for when a loved one trusts you enough to tell you their story:

• Keep open and welcoming body language. Even if your gut reaction is discomfort, be aware to straighten your posture, uncrossing your arms and legs, and maintain eye contact. Be aware of your facial expressions as well.
• Be nonjudgmental. Remember that your beliefs do nothing to change your loved one’s identity and judging them negatively will only hurt them. Ask questions respectfully, as it is natural to be curious after hearing this information, and keep in mind they may be sensitive to any inquiries.
• If you’re already an Ally, don’t assume that the rest of the world is also. Acting like it’s not a big deal may offend your loved one, as they have undoubtedly experienced or fear experiencing discrimination, physical violence, or judgment. Ask them how others have responded to their coming out story, and offer support or say “I’m sorry you had to go through that” if reactions have been negative. 
• Remember that this person is still the same friend/son/sister/coworker they have always been. Just because they have come out, does not mean they have suddenly changed or are different than you knew them before. Also do not assume that they are attracted to you, unless they specifically say so.
• Use the term your loved one has described themselves as. This shows respect as well as validates that you were listening and care.
• If you have already responded negatively when your loved one came out to you, remember there is always the opportunity to apologize and try again.
• Do your research! There is a multitude of information out there waiting for you to dig in. Reading this article was a very smart first step.

Further reading and resources:

http://www.lgbthealtheducation.org
http://www.pflag.org
http://www.cdc.gov/lgbthealth
http://www.glbtnearme.org

When a Sibling Has an Eating Disorder

Eating disorders effect the entire family, not just the individual diagnosed with the disease.  Each family member deals with unique emotions and challenges as he or she journeys with the affected loved through illness and toward recovery.  While parents play the role of primary caregiver, siblings play a different but often equally important role.  If brothers and sisters can navigate the confusing and often disparate feelings and thoughts that come along with having an ill sibling, they can become an invaluable companion and ally to that sibling in the fight against ED.

Finding out a sibling has an eating disorder can bring up a lot of different feelings.  A sibling’s first reaction might be fear or confusion, often stemming from lack of knowledge about the disease.  Confusion about why this has happened to the family can lead to feelings of guilt, anger and fear.  A sibling can often feel angry that the ill family member has taken priority in the family circle, or that the sibling with the eating disorder is to blame for unwelcome changes in family routines and/or the home environment in general.  “Healthy” siblings can feel isolated or neglected because the majority of the parents’ time and energy is given to the “sick” sibling.  Previously commonplace questions from parents, friends or teachers like “How was your day?” or “How are you doing?” can suddenly be conspicuously replaced by questions about the status of the ill sibling.

A variety of other emotions are likely to be experienced at different times as the ill sibling moves through the processes of diagnosis, treatment and recovery.  Commonly experienced emotions include grief and sadness, for a variety of reasons.  There are many losses that come along with eating disorders: loss of the “old” sibling relationship and loss of the way the family used to interact and function are difficult changes to seemingly unshakable institutions.  It isn’t easy for family members to see loved ones in distress, and eating disorders often cause a great deal of anguish for all involved.  The stress level in the home usually rises greatly when a family member is struggling with an Eating Disorder; often parents don’t have the time or energy to recognize the pressure the unaffected sibling is under.  The “healthy” sibling may be even further stressed by not wanting to talk about their uncomfortable feelings with their already-burdened parents.  They may feel pressured to be the “good” kid, and not cause any additional problems.

Sometimes they just have questions:  Why is this happening?  Is he/she ever going to get better?  What can I do to help?  What should I NOT do or discuss with them?  Often parents feel conflicted about whether or not to involve siblings in the treatment of the affected child.  There is no one “right” answer to these difficult questions, but the right treatment team can provide guidance and helpful information.

Teen Eating Disorder Signs

Early adolescence is a tumultuous time for teens and parents. Add a possible eating disorder into the mix, and things can feel downright out of control.  Eating disorders are sneaky.  Rarely does a teen with Anorexia or Bulimia identify a problem and ask his or her parents for help; far more commonly, the teen says that everything is fine, and repeatedly denies symptom use.  So what is a parent to do?  How does Mom or Dad know there might be a problem if the teen in question is denying anything is wrong?  Thankfully, there are some clues (both physical and psychological) that can alert parents to the need for more thorough investigation and evaluation.  Lets take a look at them by diagnosis.

A teen with Anorexia Nervosa will usually restrict food and have ›noticeable weight-loss.  Clothes will fit more loosely, or she may start wearing very baggy clothes to hide her body. She might spend excessive time in front of the mirror, and make disparaging comments about her body or appearance.  She may lose interest in doing social things or other previously-enjoyed activities. She may be moody, irritable or depressed, have difficulty concentrating, or look very sad or withdrawn.  Sometimes school performance drops, but other times grades continue along their typical trajectory (which may be quite good).

Her concern about weight gain or the desire to lose weight may come up in conversation with family or friends.  Any comments from others telling her she looks normal are met with disbelief; this cognitive distortion (inability to see her body the way others see it) is a core part of the disease.  She may stop getting her period.  Sometimes fine, thin hair called lanugo begins to grow over her body.  Her skin may become dry and dull, hair less shiny, and eyes sunken or hollow. Eating patterns change: she may skip meals, refuse to eat in front of others, take very small portions, or no longer eat the variety of foods she once did.  She may say she “already ate,” or “had a big meal earlier” in the day and just isn’t hungry.  Diet drinks and calorie-free caffeinated beverages are consumed frequently, sometimes in the place of meals or snacks.  

A teenager with Bulimia will have certain symptoms in common with one struggling with Anorexia.  Commonly shared warning signs include discomfort with her body, dieting behavior, moodiness and irritability, and frequent comments about her “need” to lose weight.  Additionally, she may eat unusually large amounts of food, eat particularly quickly, eat when she isn’t hungry, eat alone, and eat past the point of comfortable fullness.  Like the teen with Anorexia, she may not want to eat in front of others.  She may also go to the bathroom after meals or snacks (to purge by vomiting), or may exercise intensely and for long periods of time to “make up” for what she has eaten.  She may buy laxatives, diet pills, or weight-loss supplements, though these are commonly well-hidden from friends and family.  

Like a teen with Bulimia Nervosa, someone with Binge Eating Disorder may be observed ›eating unusually large amounts of food, ›eating quickly and past the point of comfortable fullness.  Experiencing negative feelings after overeating, or noticeable weight gain are also common.  Like with all eating disorders, an increase in emotional ups & downs, anxiety or irritablility is common, and often observable by friends and family members.

Non-eating-related behavioral changes can also be indicators of a possible eating disorder.  Behaviors such as ›self-harm (cutting or burning) and wearing long sleeves or bracelets at all times to hide self-induced injury are sometimes present in patients with eating disorders.  She may avoid discussion of stressors or emotional topics, which can be frustrating for concerned family members.  Development of an obsession w/ recipes and cooking shows could be warning a sign that your teen has a serious problem.  Going to “Pro-ANA / Pro-MIA websites” (sites that glorify eating disorders and give instructions on how to have one), as well as frequently getting on the scale to monitor his/her weight are also indicators that intervention is needed.

The bottom line is: eating disorders are serious, life-threatening conditions.  If you see any of the above signs, don’t hesitate - seek professional help right away!

Depression: Common Symptoms

Have you ever been worried about someone because they’ve started acting differently?  A friend, a loved-one, a coworker?  Maybe even a child or teen you know?  You might sense that something’s not right, that they’ve changed, and not in a positive way.  They might be more irritable or moody or perhaps just more withdrawn... and its not a fleeting change - it lasts for weeks, maybe even months.  This isn’t something to ignore, even if you’re not very close to the person; this could be Major Depressive Disorder, a very severe, debilitating and sometimes lethal illness that requires treatment.

Depending on how close you are to the person in question, you might notice a  persistent sadness about them.  Requests to hang out, or participate in activities once enjoyed are met with refusals, excuses and weak smiles, perhaps even promises of “next time, definitely,” or “I’ll take a rain check.”  The person’s appetite or body weight may change.  Their performance at work, and motivation to keep appointments may decline.  It may even seem like the person doesn’t care that things they once took pride in are slipping away.  

If the sufferer is school-aged, he or she may have difficulty articulating emotions or moods which can lead to acting out or misbehavior instead of

communicating about feelings.  School performance may decline, and a once diligent student may begin failing tests or not completing assignments.  Sometimes the depressed person’s body lets him or her know that things aren’t okay by increasing numbers and frequency of physical complaints such as stomachaches, headaches, and tiredness.  Sometimes a depressed teen will insist that they are fine, but admit to feeling"bored" on a regular basis.  Nothing, even previously enjoyable activities or people, seems to ease the boredom.  Finally, a school-aged child who was previously engaged with friends and extracurriculars may become socially isolated and drop out of activities.

Other symptoms the depressed person might be experiencing include problems sleeping (too much or too little, waking up early in the a.m. and being unable to fall back asleep).  They may feel incredibly tired, and once previously-easy tasks might feel overwhelming and exhausting.  It may be hard to get out of bed, or get off the couch.  Concentration is often impaired; reading, writing, working or even following conversations is difficult or impossible.  On the inside, the person suffering from depression may be experiencing feelings of worthlessness, hopelessness and helplessness.

In some cases, the depressed person may also experience recurrent thoughts of death or suicide, the most dangerous symptom of depression.

Having a friend or relative who suffers from depression is not an uncommon experience.  It is estimated that 20 million Americans suffer from this disorder, which is caused by a combination of genetic, biological, environmental, and psychological factors.  It is as legitimate a medical illness as high blood pressure, diabetes or cancer.  It is not a sign of weakness, or something that someone can just ‘get over.’ Telling someone to ‘pull themselves out of it’ only further demoralizes the sufferer.

Thankfully, there is help.  If someone you care about is depressed, it affects you too. The most important thing you can do is help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor.  Since individual therapy, group therapy, and treatment with an anti-depressant medication are all viable parts of a potential treatment plan to help your loved one, multiple visits may be necessary, especially in the beginning stages.  Seeking an appointment with a primary care doctor with whom your friend already has a relationship may be a good place to start.  Talking to a psychiatrist or psychologist in your area, or the counselor at your loved one’s school may also be useful.

Encourage your loved one to stay in treatment, or to seek different treatment if no improvement occurs after 6 to 8 weeks.

In the meantime, the following guidelines may be useful in dealing with the depressed person you care about:

• Offer emotional support, understanding, patience, and encouragement.

• Talk to him or her, and more importantly, listen carefully.  

• Don’t say, “You shouldn’t feel that way,” or otherwise minimize or invalidate their experience.

• Don’t dismiss feelings (even if they seem illogical or far-fetched), but point out realities and offer hope.

• Never ignore comments about suicide, and report them to your loved one's therapist or doctor.  If suicide is imminent, call 911.

• Invite your friend out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon.

• Offer to help your family member get to their doctor's appointments or remember to take medications.

• Remind your loved one that with time and treatment, the depression will lift.

Borderline Personality Disorder

BPD:  a personality disorder is “an enduring pattern of inner experience and behavior” that meets the following criteria:

• deviates from the expectations of the individual’s culture (e.g., is not what would be normally expected from a person in their particular culture)

• is pervasive and inflexible (e.g., affects all aspects of a person’s life and is not easily modified depending on the situation)

• has an onset in adolescence or early adulthood

• is stable over time

• leads to impairment or distress

problems in interpersonal relationships, self-image, emotions, behaviors, and thinking.

-Borderline personality disorder accounts for only about twenty percent of hospitalizations

-bipolar accounts for about fifty percent of hospitalizations.

-Borderline personality disorder is most common in young women

- bipolar is equally common in both men and women, as well as all age groups.

-both experience mood swings that may involve violent outbursts, depression, or anxiety.

1. People with BPD cycle much more quickly, often several times a day.

2. The moods in people with BPD are more dependent, either positively or negatively, on what's going on in their life at the moment. Anything that might smack of abandonment (however far fetched) is a major trigger.

3. In people with BPD, the mood swings are more distinct. Linehan says that while people with bipolar disorder swing between all-¬encompassing periods of mania and major depression, the mood swings typical in BPD are more specific. She says, "You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down."

Biologically, individuals with BPD are more likely to have abnormalities in the size of the hippocampus, in the size and functioning of the amygdala, and in the functioning of the frontal lobes

BPD is associated with specific problems in interpersonal relationships, self-image, emotions, behaviors, and thinking.

• Relationships

• People with BPD tend to have intense relationships characterized by a lot of conflict, arguments, and break-ups. BPD is also associated with strong sensitivity to abandonment, which includes intense fear of being abandoned by loved ones and attempts to avoid real or imagined abandonment.

• Self-image

• Individuals with BPD have difficulties related to the stability of their sense of self. They report many "ups and downs" in how they feel about themselves. One moment they may feel good about themselves, but the next they may feel they are bad or even evil.

• Emotions

• Emotional instability is a key feature of BPD. Individuals with BPD may say that they feel as if they are on an emotional roller coaster, with very quick shifts in mood (for example, going from feeling okay to feeling extremely down or blue within a few minutes). BPD is also associated with feelings of intense anger and emptiness.

• Behaviors

• BPD is associated with a tendency to engage in risky and impulsive behaviors, such as going on shopping sprees, drinking excessive amounts of alcohol or abusing drugs, engaging in promiscuous sex, or binge eating. In addition, people with BPD are more prone to engage in self-harming behaviors, such as cutting, or to attempt suicide.

• Stress-Related Changes in Thinking

• Under conditions of stress, people with BPD may experience changes in thinking, including paranoid thoughts (for example, thoughts that others may be trying to cause them harm), or dissociation (feeling spaced out or numb).

• many people diagnosed with BPD have experienced childhood abuse or neglect, or were separated from their caregivers at an early age. However, not all people with BPD had one of these childhood experiences (and, many people who have had these experiences do not have BPD).

There is also evidence of genetic contributions and differences in brain structure and function in individuals with BPD.

Bipolar Disorder

Bipolar disorder, sometimes called manic depression, causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). 

Common signs and symptoms of mania include:

• Feeling unusually “high” and optimistic OR extremely irritable

• Unrealistic, grandiose beliefs about one’s abilities or powers

• Sleeping very little, but feeling extremely energetic

• Talking so rapidly that others can’t keep up

• Racing thoughts; jumping quickly from one idea to the next

• Highly distractible, unable to concentrate

• Impaired judgment and impulsiveness

• Acting recklessly without thinking about the consequences

• Delusions and hallucinations (in severe cases)

A person must have had a manic (or hypomanic) episode to be diagnosed with Bipolar Disorder,  although the most common mood-state in people with this disorder is by far, Depression.  

Mood Swings: Is It Bipolar Disorder?

I can’t count the number of times I’ve heard people talk about mood swings (their own or someone else’s) and conclude that the person in question has Bipolar Disorder. While it is true that people who have Bipolar Disorder do have mood swings, there are very specific symptoms that distinguish the mood swings of someone with this severe and often debilitating disorder from the mood swings of someone with less intense issues.

Hopefully this article will work to help clarify what can be a very confusing (and important) topic.

First of all, Bipolar Disorder isn’t that common: about 4% of the US adult population carries this diagnosis, and somewhere between zero and 3% of children and adolescents suffer from the disorder.  (There is some debate over how exactly to classify these mood changes in younger people.)  It typically begins in late adolescence.

Like all mood disorders, having a family member with the disorder increases your risk for developing that same disorder (or another mood disorder).  Other factors that can contribute to the development of Bipolar Disorder include experiencing a stressful life event, being in your late teens or early twenties, and using alcohol and drugs

Bipolar Disorder is doesn’t always occur alone.  Many people with this condition also suffer from Anxiety Disorders (PTSD and Generalized Anxiety to name a few), ADHD, and Substance Use Disorders. People with the aforementioned diagnoses can also (independently of Bipolar Disorder) have ‘mood swings’, which further complicates the diagnostic picture.  It is important to treat the whole person, not just the disorder, so these other conditions need to be addressed also.  People with the aforementioned conditions (whether or not they have Bipolar Disorder also) can have mood swings.  This further complicates the diagnostic picture, making it even more imperative for someone with fluctuations in mood that interfere with their day-to-day functioning get evaluated by a mental health provider skilled in making these sometimes tricky distinctions.

The mood swings in Bipolar consist of Manic episodes alternating with periods of depression, mixed episodes (symptoms of depression and mania together) or relatively normal moods.  Although people who have Bipolar Disorder can certainly be irritable or have outbursts, their moods are generally more prolonged and last several days to weeks or even months. In rare cases moods may shift as many as several times per day, but it is much more common for mood states to last for longer periods of time.  The most common mood for someone with Bipolar Disorder to be in is a depressed one.  

Even though Depression is the prominent mood state seen in people with Bipolar Disorder, someone has to have had a period of Mania to be officially diagnosed with Bipolar Disorder.

What is Mania?  It is, in a sense, the opposite of Depression, but with some additional features.  Common signs and symptoms of mania include:

• Feeling unusually “high” and optimistic OR extremely irritable

• Unrealistic, grandiose beliefs about one’s abilities or powers

• Sleeping very little or much less than normal, but feeling extremely energetic

• Talking so rapidly that others can’t keep up

• Racing thoughts; jumping quickly from one idea to the next

• Being highly distractible and unable to concentrate

• Impaired judgment and impulsiveness

• Acting recklessly without thinking about the consequences

• Delusions and hallucinations (in severe cases)

• Thinking about sex a lot and acting promiscuously

For more information on symptoms of Depression, click here. Link to blog on depression.

Bipolar Disorder in children and adolescents can present somewhat differently from that in adults.  Its clear, though, in the description of possible manic symptoms in children and teens below that the similarities are many.

During a manic episode kids may:

• Feel very happy or act silly in a way that's unusual for them

• Have a very short temper

• Talk really fast about a lot of different things

• Have trouble sleeping but not feel tired

• Have trouble staying focused

• Talk and think about sex more often

• Do risky things (drive fast, spend lots of money, have unprotected sex, use drugs or alcohol)

• Have delusions of grandeur or paranoia

-aggression or temper tantrums.

- have sudden outbursts of anger or crying jags

- show agitation or restlessness

- perceive themselves to be fine, blaming conditions or people in their environment for their difficulties.

-can have psychotic symptoms (hallucinations, delusions)

- may be very difficult to tolerate / work with

Thankfully, Bipolar Disorder, once diagnosed, can be treated successfully with medications and psychotherapy.  There is no cure, but it can be managed (just like any other chronic illness).  Diagnosis may take several months to years, given the cyclic nature of the condition.  Staying on medication and maintaining a good relationship with a trusted psychiatrist are both musts!

A disorder commonly confused with Bipolar Disorder due to a great number of shared symptoms, is Borderline Personality Disorder.  For more on this topic, click here....

Effective Parenting classes

Behavioral parent training programs have been in use for many years and have been shown to be very effective.

Although many of the ideas and techniques taught in behavioral parenting classes are "common sense," most parents need careful teaching and support to learn and implement effective parenting skills in a consistent fashion. Help from a professional is often necessary, especially if your child is "oppositional," "explosive," or has ADHD.  Effective Parenting Classes at Developing Minds are specifically tailored to the needs of a particular child and family.  Classes focus on your individual areas of need, but topics covered typically include: improving communication skills (between parents, and between parent and child), boundary and limit setting, co-parenting teamwork/challenges, and dynamic use of rewards and discipline.

Individual classes are offered through a series of sessions at our clinic at the "Individual therapy" rate.

Group parenting classes (ideal for "mom's groups" or neighborhood organizations) offer the convenience of having a child mental health professional provide teaching and answer questions in a setting of your choice.  Call (919) 794-3919 for details.