Nightmares

Everyone dreams. Most people probably remember having at least one nightmare – a very frightening dream. There are some people who are bothered by regular nightmares, so much so that they don’t want to go to sleep. This can happen to children as well as to adults. After experiencing a traumatic event, people can have nightmares virtually nightly, until the trauma is resolved. Whether it’s once in a blue moon or a regular occurrence, a child’s nightmare always requires parental attention.

If your child has had nightmares, consider the following tips:

Some Kids are Sensitive to Images
Some kids are particularly vulnerable to scary images they see in books, movies and on T.V.. They can also create their own frightening images based on what they hear in snippets of conversations around them.  It isn’t possible to always shelter kids from unpleasant images, but parents can certainly respect the child’s vulnerability and try to limit frightening stimulation – for example, there is no need to insist that a child confront a disturbing image that is only recreational in nature (i.e a violent movie). If a child has come across a disturbing image, parents can help the child to talk about it, both accepting the child’s fear and also explaining the pretend-nature of the picture. For children whose vivid imaginations and sensitivity often lead to nightmares, parents can try offering the Bach Flower Remedy called Walnut – a harmless, water-based form of vibrational medicine available at health food stores everywhere. Give two drops in liquid (water, juice, milk, etc.) four times a day until the nightmares stop. Or, for nightmares about ghosts and other vague, scary fantasies, try the Bach Remedy called Aspen. The remedy Mimulus can help with nightmares about more specific fears, such as people dying or scary events like being robbed or chased. A Bach Flower practitioner can help further. You may also find more information about Bach Flower Remedies on this site.

Nightmares can be Triggered by Food Sensitivities
If there is no other apparent reason for the nightmares, you might consider the possibility of food sensitivities. Sometimes such sensitivities can chemical processes that can cause nightmares. Any food can cause problems, so you might need a systematic approach to food elimination in order to find out if there is a sensitivity. Naturopaths and self-help books can help with the process, or you might be able to find a medical specialist who tests for sensitivities (not allergies).

Consider Stress or Traumatic Events
If your child has experienced a stressful event or situation lately (i.e. medical or dental procedures, moving, a mean teacher, examinations, and so on), or even a traumatic experience (car accident, robbery, bullying, assault, family violence), then it’s possible that the nightmare is a sign that he or she is having difficulty coping with the situation. If a child who recently experienced the death of a loved one, for example, gets recurring nightmares, it’s possible that there are feelings he or she can’t identify or express. The child may also have experienced some sort of traumatic or overwhelming experience that you aren’t aware of – at school, at a place of worship, at an extracurricular activity, while volunteering or babysitting or even in your own home with his or her siblings or other relatives.  If you KNOW that something stressful has happened, be sure to talk to your child, naming the feelings that YOU would have if you were dealing with that situation. Help the child to express his or her feelings by using Emotional Coaching  (learn how to use this technique in Raise Your Kids without Raising Your Voice by Sarah Chana Radcliffe). Unremitting nightmares should always best checked out by a child psychologist.

Medicines, Substances and Illness
Certain health conditions can trigger nightmares, as can mind-altering substances and even over-the-counter medications. Withdrawal from substances can also trigger nightmares. If your child has been unwell or on medication and is having unusual nightmares, speak to the pediatrician.

Ways to Help Your Child
Accept your child’s fear and anxiety. Saying things like, “It’s not real. Go back to sleep,” doesn’t do anything to comfort a child and may even make them feel ashamed simply for having a normal reaction. Remember: to a young child, a dream can be so vivid, it feels like it actually happened. Go slowly and gently, taking time to calm and soothe your child to help orient him back to reality. Give a hug or a kiss or rub his or her back. Get him or her a glass of water or even a cracker to munch on, as eating and drinking are “grounding” activities that bring a child back into his body and away from the fantasy in his head. Putting a few drops of Rescue Remedy in the water can be particularly helpful, or even dropping them on a child’s wrists will work (Rescue Remedy is available in health food stores and is a harmless Bach Flower Remedy that quickly turns off adrenaline and restores emotional balance in cases where the fight-or-flight response has been activated.)

After a bad dream, separation anxiety may re-surface. Kids may demand that you stay with them as they go back to sleep, or they might insist on following you back to your room. They may also put up a big fuss when you attempt to leave their presence. Remember that these responses to terrifying dreams are all normal. Because your child is feeling fearful and maybe even disoriented and confused, make the exception if possible, and indulge his or her need for physical presence.

Nightmares are ultimately fantasy, so fantasy is an excellent way to deal with them. If your child’s nightmare did not have a happy ending, perhaps you can continue the story together — with your child emerging triumphant against the object of his or her fear. For instance, if the nightmare is about being attacked by monsters, a child can be encouraged to pretend that he or she is a “monster exterminator.” The child can role-play assertively warning the monster that he’s toast, and capturing the monster with special weapons. Although this may seem silly, this very strategy is used very successfully to help victims of trauma to deal with their terrifying nightmares.

Help Your Child Cope with the Aftereffects of a Nightmare
Sometimes the fear isn’t just an aftershock to a nightmare. It’s also possible that a nightmare creates worry that tragedy will happen in real life. For example, dreaming that a loved one died can create fear in a child that the loved one will indeed pass away. Gently but firmly explain to your child that just because something happened in a dream doesn’t mean it will happen in real life. At the same time, acknowledge your child’s fear. For instance, you can say something like, “I understand that you’re worried that Grandpa will die because he died in your dream. That must make you feel very sad.” When you name the child’s feeling, the feeling will intensify (often to the point of tears) and then disappear. In this example, the child might cry when the parent acknowledges the sad thought and then the child might say, “Anyway, it was just a dream. I know Grandpa is fine.” Allowing a person to feel his feelings is a fast way of helping that person to clear the negative feelings out of his system.

Help Your Child Prevent Nightmares
If a nightmare has really made a child feel helpless and victimized, you can teach him ways on how to manipulate images in a dream. While controlling one’s dreams takes practice to learn to do, the steps are child-friendly. Just encourage kids to visualize their desired dream content when they get to bed (“think of something nice that you’d like to dream about”), and remind themselves that they are just dreaming when faced with bad dream content. They can wake themselves up and change their focus to a positive storyline as they fall asleep again.

In addition, using effective stress management techniques before bed can help alleviate bad dreams. For instance, you might teach your child EFT (emotional freedom technique – there’s lots of on-line resources for this technique as well as therapists who can teach it to your child) so that the child can remove worries, fears and problems from his mind before falling asleep (YOU should learn it too!). This helps the mind have a better, more peaceful rest.

For a recurring nightmare, ask the child to create a satisfactory ending for the bad dream. Have him tell you the dream along with the new ending. Have him do it over and over until he feels calm. If he’s old enough, he can also write and rewrite the new dream, helping to install it deeper in his unconscious mind.

Therapeutic Bedtime Stories
Parents can make up healing bedtime stories for young children. One way to do this is to create a main character whose name just happens to be the same name as that of your frightened child. By way of example, let’s call the main character in our story “Liam.” The title of the series of stories is “Liam the Brave.” You now make up a different story each night about episodes starring Liam-the-Brave. In each story, Liam fights off scary foes using his arsenal of magic weapons. For instance, on Monday night, Liam-the-Brave takes a canoe trip down the river in deepest Africa. As he passes through the tropical jungle, he encounters crocodiles, warrior tribes, hungry animals and more. Every time he faces a threat, he pulls out a magic weapon from his magic weapon bag and aims it at the “enemy.” By waving, shaking or otherwise triggering the weapon, Liam successfully makes the threat vanish into thin air. He then continues on his trip, observing the beautiful waterfalls, plants and friendly animals, until the next threat appears. And so on. Of course, the story always ends happily with Liam arriving at his destination. On Tuesday night, the parent tells a similar story, this time taking place in outer space. On Wednesday night, the events may take place in the Antarctic and so on. Although the stories are nonsensical, they have been shown to give children a sense of power over internal enemies. Try them for a week or so and see if they help end your child’s nightmares and his fear of having bad dreams.

Consider Professional Help
Your child should not have to suffer from regular nightmares. Be sure to speak to your doctor and/or a child psychologist if your interventions have not resolved the problem.

What is an Eating Disorder?

Eating is a way to get nourishment and sustenance; it is, for the most part, a pleasant and fulfilling act. Sometimes, however, eating becomes part of a disabling or even life-threatening disorder.

What is an Eating Disorder? 
As the term implies, an eating disorder is a mental health condition that is characterized by dysfunctional eating patterns such as overeating, deliberate starvation, binging and purging. Eating disorders are associated with extreme concern or anxiety related to one’s body shape, size or weight. Some family therapists have conceptualized eating disorders as illnesses related to issues of control, like addictions or obsessive-compulsive disorder. Whatever the cause, an eating disorder is conceded as both a physiological and a psychological problem.

Who are at Risk? 
According to the National Institute of Mental Health, eating disorders occur frequently among adolescents and young adults, although there have been reported cases of childhood eating disorders and eating disorders that occur during late adulthood. The disorders are more prevalent among women than men, although in recent years, men are suffering in greater numbers.

What are the Types of Eating Disorders?
Types of eating disorders may include:

Anorexia NervosaAnorexia Nervosa is characterized by the relentless pursuit of thinness despite severe negative consequences. People with Anorexia Nervosa are convinced that they are too fat or too heavy, even if objectively they are already underweight. They may therefore engage in excessive dieting, self-induced vomiting, overexercising, the use of diuretics and laxatives, and abuse of weight management pills. Alarmingly, people with Anorexia Nervosa are ten times more likely to die from the condition than those without the disease.

Bulimia Nervosa. Bulimia Nervosa is an eating disorder characterized by repeated patterns of binging and purging. Binging refers to the consumption of large amounts of food in a short time, e.g. eating several plates of pasta in one sitting. Purging refers to the compensatory action to get rid of the food or calories consumed during the binge episode. Purging techniques include the ones people with Anorexia use to lose weight, e.g. self-induced vomiting, laxatives, diuretics and overexercising. Unlike sufferers of Anorexia, people with Bulimia may have normal body weight.

Obesity. Obesity is a condition of excess weight – essentially the result of consuming more calories than are needed for energy. It can affect a teenager’s self-image and self-confidence and it can also affect his or her health. For instance, obesity is sometimes associated with the development of insulin resistance – a sensitivity to sugars in the blood. This condition can be a precursor to a more serious condition such as diabetes.

How are Eating Disorders Treated?
There are three steps to treating eating disorders.

The first step is the physiological or medical intervention. Eating disorders may be classified under mental health issues, but they carry with them serious medical effects. People with Anorexia Nervosa, for example, can suffer from severe malnutrition that serious and irreversible damage to vital organs occur. Eating disorders may even be fatal if not arrested in time. Therefore the first order of business is to restore the patient to an ideal weight, address nutrient deficiency, and treat the medical side effects of the condition.

The second step to treating eating disorders is psychological assistance. Counseling and therapy must be employed to address the psychological reasons behind the dysfunctional eating patterns. Eating disorders are related to dysfunctions in perception of one’s weight or shape. Often, patients suffer from low self-esteem, obsession about body weight, and a sense of helplessness about their situation. It is also not unusual for other mental health issues to develop because of the eating disorder, such as depression, anxiety and substance abuse.

The last step is maintenance to prevent relapse. Like people with addictions, those with eating disorders must consistently monitor their behavior even after treatment to prevent symptoms from recurring. Joining support groups, on-going family therapy, and education about proper nutrition and weight management are ways to maintain progress in recovery from eating disorders.

How Can You Tell if Your Child is Suffering from an Eating Disorder?
You will not be ablet o diagnose an eating disorder on your own. However, what you CAN do is take your child to a doctor or psychologist for assessment if you suspect that something isn’t right. Most parents are able and willing to do this when they see that their child is overweight. However, kids suffering from bulimia may be a totally normal weight. Kids suffering from anorexia may gradually lose weight and cover it up with clothing (and excuses). However, there are some red flags that can alert a parent to the need to have the child assessed. For instance: consuming large amounts of food without gaining weight is a red flag for bulimia. Playing with food on the plate, cutting it into small bits and moving it around, becoming increasingly picky as to what is fit to eat and clearly not eating much, may be red flags for anorexia. Other symptomatic behaviors include being very cold, growing a thin layer of hair on the skin, engaging in excessive amounts of exercise, buying laxatives and vomiting without being ill. Don’t get into a conversation with your child about whether or not he or she has an eating disorder. Instead, tell your child that diagnosis will be left up to a professional.

Anorexia

The eating disorder known as “Anorexia” has become so common, that almost everyone now knows what it is. When we think of anorexia, we think of excessively skinny people – sometimes with a skeletal appearance of skin and bones – whose lives are at risk due to malnutrition. And this is exactly what the disorder leads to. Anorexia is a condition that causes people to starve themselves.

Anorexia Nervosa used to be a condition that was most commonly found in individuals whose professions demand subscription to particular “body image.” Models, actors and physical trainer, for instance, have long suffered from eating disorders because their jobs require them to look a certain way.

Unfortunately however, the incidence of Anorexia Nervosa is climbing among the general public, with highest rate found in adolescent girls. Furthermore, onset age of the disease get lower and lower each year, with girls now as young as 7 years old succumbing to the illness. It may be that the way the media portrays attractiveness, the decreased focus on healthy eating habits, and the decrease in parental guidance as dual-income families and divorcing couples increase, all contribute to the rise in adolescent anorexia.

What are the Symptoms of Anorexia Nervosa?

Anorexia Nervosa is an eating disorder characterized by an irrational obsession with having a thin body.  A person with Anorexia controls his or her body weight by limiting food intake and also by attempting to “un-do” eating by inducing vomiting, using laxatives or exercising excessively. When kids start restricting their diet to very low calorie foods, start obsessing about and avoiding “bad” foods like fats and carbs, cut up their food in small pieces and shuffle it around their plates, wear baggy clothing to hide protruding bones, claim they’ve eaten when they haven’t, exercise way too much, and so on, it’s time for parents to be concerned.

People with Anorexia suffer from a distorted body image. Regardless of their actual weight and height, or of their objective appearance in the mirror, they still feel that they are “too fat” and need to lose some weight.

Types of Anorexia Nervosa

There are two more common types of Anorexia Nervosa: a “restricting type” and a “binge-and-purge” type. Those who belong to the first type obsessively lose weight by fasting or eating extremely small portions. Those who belong to the second type alternate between binging (eating large quantities of food), and then later finding ways to remove the eaten food before the food is digested.

A Serious, Even Fatal Disorder 

Anorexia, like all eating disorders, must be taken seriously. It is not a “teenage fad,” but rather a serious health risk.  Aside from the psychological impact of the disease, Anorexia Nervosa can result to many serious physical conditions — even death. Starvation alone may result into cardiac arrhythmia, hypotension, gastric issues and low blood pressure — not to mention various complications resulting from many nutritional deficiencies. Anorexics may require hospitalization, and a full physiological therapy, before they can even start dealing with the emotional issues associated with the disease.

What Can Parents Do? 
Given the seriousness of this disease, what can parents do to protect their children?

Preventing Anorexia Nervosa in one’s home begins by promoting a healthy body image for the family. Contrary to what the media promotes, there is no one measure of attractiveness and beauty. Similarly, body size and shape doesn’t necessarily equate to health — ethnicity, bone/muscle mass and body structure must all be taken into account before one can be considered as underweight or overweight. While parents are recommended to be health and diet conscious in the home, they must also be affirming of their child’s natural beauty so as not to encourage a pre-occupation with body image. Neither parent should praise a child for being skinny. A thin body type is simply an inherited characteristic – as is a softer, bigger look. As long as your child is not eating poorly (i.e. living on a diet of coke and cookies, munching chips and ice cream instead of eating dinner), then just help him or her to learn the basics of dressing well. For instance, a “square” shaped child will look better in a certain type of sweater/pant or skirt combination than in a different kind of outfit – teach your adolescents about dressing to highlight their own good looks. Much can be accomplished with a few library books on the subject. If your child is actually eating poorly, encourage good eating habits without becoming so intense about it that the child swings the other way; many anorexics were once overweight and compensated by going too far in the other direction. When parents are too invested in the child’s “look” they may accidentally nurture the seeds of disease.

Even more important, however, is the emotional climate of the home. Kids act out their stress with eating disorders, so try to create and maintain a fairly low-stress environment. This means, work on your marriage (or even your divorce) so that there isn’t a lot of hostility being displayed, refrain from raising your voice or using very stringent punishments, keep demands light and reasonable considering the age of the child, bring laughter and love into everyday interactions EVERY day, and don’t get too stressed yourself. Although nothing a parent does can guarantee that a child won’t succumb to eating disorders, taking these steps can reduce the chances.

If you suspect that your child is developing symptoms of anorexia, then go with the child to a medical appointment to obtain a formal assessment. You can tell your child, “I’m not an expert. I don’t know if the way you are eating and the way you look is fine or not. I am, however, feeling concerned. So I’ve made an appointment for us to see Dr. So and So, who can tell me where things stand. If there’s no problem – great! I’ll leave you alone. But if there is any problem, then we can help you with it.” Such an appointment should never be optional. If you thought that your child’s lump on her skin was suspicious, you wouldn’t ask her to please come for a biopsy. You would TELL her that she needs to be seen by a medical professional. You would not allow your child to refuse to go, knowing that untreated cancer can be life-threatening. In the same way, you need to use all of your parenting power to get your child to a doctor when you suspect the life-threatening disorder of anorexia.

Bulimia

Bulimia is an eating disorder – but one that is not necessarily easy to spot in one’s own child. Other eating disorders are more visible. For instance, pills almost anyone can recognize obesity – a condition in which the sufferer is significantly overweight. People can also often recognize cases of anorexia nervosa – the condition in which a person is severely under his or her ideal weight (and may therefore look painfully skinny and boney). However, it is not possible to identify someone with Bulimia Nervosa just by looking. The sufferer of this eating disorder may be a perfectly normal weight. It is not the WEIGHT that is disordered in this condition, but rather the way in which the person maintains that weight.  A bulimic (one who suffers from bulimia nervosa) eats way too many calories in one sitting (for example, a number of grilled cheese sandwiches, a full tub of ice cream, a box of crackers, a bag of chips and a plate of waffles). This episode of overeating is called “bingeing.” It is normally followed by feelings of panic (about gaining too much weight), shame and guilt and an intense effort to “undo” the eating behavior by engaging in excessive exercise or using laxatives to empty the gut, or inducing vomiting for the same purpose. Episodes of bingeing and purging (over-eating and then “undoing” the calories somehow) can sometimes occur many times a day. On average, people with Bulimia binge 12 times a week, consuming as much as 11,500 calories. Foods rich in processed sugar and fat, such as pastry, ice cream, bread and donuts are the most common objects of binges.

Bulimia Nervosa is more common than Anorexia, and affects girls more than boys.

Signs of Bulimia
Although parents can’t tell from LOOKING at their child that the youngster is suffering from bulimia, they may be able to discern a problem by observing their child’s behavior. Those suffering from bulimia usually feel a lack of control when it comes to eating. While most of us stop eating when we feel full, those with bulimia keep on eating to the point of feeling pain.  This inability to control their eating can be very embarrassing and typically bulimics try to hide their binging and purging.  Some typical symptoms that may indicate bulimia are:

  • Wanting to eat alone
  • Eating very little in public
  • Frequent trips to the bathroom after meals
  • Disappearance of food
  • Hidden stashes of junk food
  • Eating large amounts of food without putting on weight
  • Excessive exercising
  • Using laxatives, enemas or diuretics

People with bulimia may also have physical symptoms caused by purging.  These include:

  • Puffy cheeks caused by repeated vomiting
  • Discoloured teeth caused by exposure to stomach acid when throwing up
  • Frequent fluctuations in weight
  • Calluses or scars on knuckles and hands caused by putting fingers down the throat to induce vomiting

An Impulse-Control Issue
Are sufferers of Bulimia Nervosa aware that their eating pattern is dysfunctional? Yes. However, they have difficulty controlling themselves; the act of binging and purging is a compulsion. In fact, many Bulimics report that they only stop a cycle of binging or purging when they feel physical pain. Otherwise, they can’t help themselves. They have a compulsion that is too strong for them to overcome, much like an addicts relationship to his substance.

Bulimia Nervosa has been linked to emotional stress as well as body image issues. Low self-esteem, a history of abuse, a difficult life transition, traumatic experiences and other stresses have been found to be higher in those suffering from Bulimia. In addition, there is a higher rate of bulimia in those who are drawn to a body-conscious hobby or profession like modeling, ballet, gymnastics or physical fitness training. It is not clear whether the activity and peer pressure found in the activity actually induces bulimia or whether those with bulimic tendencies (obsession about body image) may choose those activities to begin with.

A Serious Health Threat
Bulimia is a serious health issue. Chronic bingeing and purging can cause serious gastro-intestinal diseases. The purging (in the form of vomiting, laxatives, and diuretics) can lead to electrolyte imbalances, usually in the form of low potassium levels. Low potassium results in symptoms such as lethargy, confusion, irregular heartbeat, and cardiac and kidney dysfunction. In severe cases it can even cause death. Other effects of bulimia may include:

  • Weight gain
  • Constipation caused by chronic laxative use
  • Abdominal pain and bloating
  • Tooth decay
  • Chronic sore throat and hoarseness
  • Broken blood vessels in the eyes
  • Weakness and dizziness
  • Loss of menstrual periods
  • Acid reflux

Risk Factors
Bulimia generally begins in adolescence and 90 – 95% of those with the disease are women.  There is no single cause for bulimia but low self-esteem and poor body image are often contributing factors.  Some of the more common risk factors for bulimia are:

  • Dieting – people who diet on a regular basis are more likely to develop an eating disorder than those who don’t.
  • Involvement in professions/activities that emphasize weight control – the pressure placed on gymnasts, dancers, models, actors, and other athletes to maintain a certain weight can lead to the development of eating disorders.
  • Low self esteem – this can be a result of abuse, depression, a critical home environment, and a desire for perfection.
  • Poor body image – young women are often influenced by our culture’s glorification of thinness and beauty.
  • Major life changes – bulimia is sometimes a reaction to stress, which can accompany a major life change.  Examples of major life changes may be; moving away from home, puberty, divorce, and the break-up of relationships.
  • Biological factors – since eating disorders run in families there is likely a genetic component.  In addition, research indicates that low serotonin levels play a role in bulimia.

Treatment for Bulimia
Treatment for Bulimia should be a combination of a medical and a psychological program. At times, an in-patient weight management program needs to be implemented alongside counseling in order to address the two critical aspects of the illness. Most often, however, bulimia is effectively treated on an out-patient basis. People do heal from this disorder. They may have relapses occasionally but when they learn effective stress-management techniques they can usually prevent relapses over the long-run. Seeking counseling and using self-help strategies are both important for long term recovery.

Psychotherapy is the main form of treatment for bulimia.  Specifically, cognitive behavioural therapy is often used to break the binge-and-purge cycle and change unhealthy thought patterns.

Medication such as anti-depressants may also be used.  These help to reduce binge eating and treat the depression that is often a part of bulimia.

Suicidal Feelings

A certain number of people kill themselves each year, most of whom were suffering from severe depression. Fortunately, 90% of people with depression are able to live full lives while managing their episodes of depressed mood. Only about 10% will end their lives (this number depends on where a person lives – countries vary in their availability of effective treatments and support for depression, so there is a wide international variability in suicide rates).  The pervasive sad mood that comes with depression, as well as the increased tendency among the depressed to obsess on negative thoughts, makes them susceptible to the hopelessness and irrationality characteristic of the suicidal person. People do not “choose” suicide; they fall victim to it as part of their illness.

What are the Implications for Parents?
The link between suicidality and depression should serve as alarm bells when helping our children deal with mental health issues. If we have a loved one who is suffering from depression, it is always prudent to watch out for signs of suicidality. A depressed child is at risk for succumbing to suicidal thoughts; it is up to parents to help prevent this. Vigilant parents can be familiar with the warning signs of suicidality and take action. Moreover, they can do everything possible to get their child the right kind of help. In addition, they can work hard to reduce the other stressors in the child’s life – like school work (negotiate accommodations with the school) and conflict in the home. In fact, when the parents work on their own marriage and parenting skills to increase peace in the home, this can help tremendously.

What are the Warning Signs?
According to the American Academy of Child and Adolescent Psychiatry these signs are:

  • Change in eating and sleeping habits
  • Withdrawal from friends, family, and regular activities
  • Violent behavior or running away
  • Substance abuse
  • Neglect of personal grooming
  • Personality change
  • Difficulty concentrating, persistent boredom
  • Drop in academic performance
  • Marked personality change
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Loss of interest in previously enjoyable activities
  • Speaking positively about death or romanticizing dying (“If I died, people will appreciate me more.”)
  • Writing about death, dying, or suicide
  • Engaging in reckless or dangerous behavior; being injured frequently in accidents
  • Giving away or discard favorite possessions
  • Saying permanent sounding goodbyes to friends and family
  • Seeking out weapons, pills, or other lethal tools

A child or teen  who is planning to commit suicide may also:

  • Complain of being a bad person or feeling rotten inside
  • Give verbal hints with statements such as: “I won’t be a problem for you much longer.”, “Nothing matters.”, “It’s no use.”, and “I won’t see you again.”
  • Become suddenly cheerful after a period of depression
  • Have signs of psychosis (hallucinations or bizarre thoughts)

The risk of suicide is high among those who have attempted suicide before, know someone who has killed themselves, and are pessimistic about the chances of getting relief from chronic depression. Also, teens who have a family history of mental illness and suicide are more likely to attempt suicide as are teens who have clinical depression or who suffer from active addiction. Teens who’ve already made a suicide attempt have a higher chance of committing suicide successfully. Vulnerable teenagers who suffer a serious loss (like the breakup of a romantic relationship) may try to stop the pain with suicide. A history of physical or sexual abuse, incarceration, alienation from parents and refusal to access mental health services all increase suicidal risk. Males have a higher “success” rate for suicide than females, but females make many more suicide attempts than do males. Also take note if your depressed child suddenly seems unusally happy. Sometimes this switch in attitude happens because a child has decided to end his suffering and he is actually experiencing a state of relief. Remember that depressed mood is a serious and potentially life-threatening condition and should always be professionally treated.

The American Academy of Child and Adolescent Psychiatry recommends taking a child’s suicidal statements seriously. If a child or adolescent says, “I want to kill myself,” or “I’m going to commit suicide,” ask him what he means. Don’t be afraid of saying the word “suicide.” You won’t be giving the teen an idea that he hadn’t thought about. Instead, you’ll help him or her think things through. Ask about depression, anxiety and unhappiness. Don’t just tell the child no to talk that way.  Show interest and concern and get your child to a qualified mental health professional (such as a psychiatrist or clinical psychologist).

Suicidal Behavior in Teens
Teenagers are a vulnerable group. They experience tremendous pressure from all sides: from inside their changing bodies, from their parents, from their schools and from their peers. No one can be perfect in every area and so everyone is doing poorly in something. But teenagers can feel isolated with their failures and setbacks, lacking the perspective that older people have that “we’re all in this together.” Teenagers are intent on fitting in, looking good, being acceptable. If the only group they can fit into is a violent, drug-ridden street gang, then that’ll be the group they might very well join, especially if they have little support elsewhere or few sources of success and strength.

Because the pressure is so intense, many teens do not cope well. Their survival strategies depend to a large extent on their genetic make-up and the strategies they learn at home. Some teenagers have “hardy” genes that help them survive and thrive under stressful conditions. They can laugh their way through almost anything or simply tough it out. Others are genetically vulnerable to bouts of depression. However, the depressed teen is more at risk than depressed adults. Teens are very focused in the present. They have trouble imagining that in a few years life can improve tremendously. Their impulsivity can lead them to put an end to it all right now because they just can’t see any way out.

What You Can Do
Parents can also help buffer teens from stress by keeping the doors of communication open. Make it easy for your kids to talk to you. Keep criticism to a minimum; instead, give praise and positive feedback generously. Have fun with your teenager and try to make your home pleasant, comfortable and safe. Keep conflict down with your spouse. Avoid drama. Take care of yourself and create a healthy model of stress management strategies for your kids to learn from. Create a positive atmosphere. Have a dinner table several times a week and use it to have discussions on politics, human nature, interesting things in the news or whatever—keep talking with your kids. Make your values clear. Bring tradition and ritual into your home.  Accept all feelings without correction or disapproval. Ask for behavioral change gently and respectfully. Never yell at your teenager. Never insult, name call, use sarcasm or any other form of verbal abuse. Instead, be sensitive to your teen’s feelings at all times. Discipline when necessary but only after you’ve warned a child that discipline will occur and only with mild discipline—never affecting the teen’s social life (see Raise Your Kids without Raising Your Voice for safe and effective ways of guiding teenagers).

If your teen demonstrates any of the symptoms of depression or suicidality, talk to him or her about what you are observing and arrange an appointment with a mental health professional. You can call suicide helplines in your area to get information about how to help your child. You can take your child for a mental health assessment. If your child is uncooperative, seek mental health guidance yourself. Since a suicidal person feels isolated and hopeless, any steps that family members take to address the situation can be powerfully preventative. Remember, too, that many parents have walked this road before you. Access on-line and community support if your child has been threatening suicide.

Types of Depression

“Depression” is a common mental health condition. However, the word refers to many types of mood issues, rather than just one straightforward condition. In fact, there are many types of depression, depending on symptoms, severity, cause and duration of the illness.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the following are some of the types of depression:

Major Depressive Disorder
When people use the term depression, they usually mean a Major Depressive Disorder. Unlike short-term feelings of sadness, which can be due to any situation that can cause one to feel rightly sad and upset, major depressive disorder is an intense and debilitating condition affecting many aspects of one’s mood, energy and physical functioning.

A person with Major Depressive Disorder can suffer from feelings of hopelessness and despair, self-incriminating thoughts, crying spells, fatigue, weight loss, sleep disturbances, lost of interest in activities and relationships, inability to work, and thoughts of suicide. Major Depressive Disorder, also called clinical depression, is diagnosed if the debilitating symptoms are manifested by the patient for at least two consecutive weeks and causes significant distress and/or impairment in functioning.

Dysthymic Disorder
A less severe form of depression is called Dysthymic Disorder or Dysthymia. The feelings of sadness and helplessness in Dysthymia are less debilitating, and are often merely aggravated by other physical or mental illnesses. Symptoms of Dysthymia come and go, and vary in intensity per episode. However, it can be a chronic disease that runs in families. Diagnosis requires at least two years of chronic low mood. People with dysthymia tend to underfunction at home and at work, due to low energy, low mood, chronic irritability and negativity, low motivation, sleep issues, low self-esteem and other symptoms. If left unmanaged, Dysthymia can progress to a Major Depressive Disorder.

Bipolar Depression 
Bipolar Depression, also called manic-depressive disorder or bipolar disorder, is a mood disorder that is characterized by cycles of extreme elevated moods (called mania) and depressive episodes. During the manic stage of the disorder, patients can exhibit symptoms like extreme alertness, difficulty sleeping, increased energy and erratic euphoria. But this “high” is often followed by an extreme low typical of a Major Depressive Disorder. Bipolar Depression comes in two types – Bipolar I and Bipolar II. The first is a very disturbed state in which manic episodes can lead to high risk behaviors, highly inappropriate behaviors and troubles with the law (picture a teenager standing naked on a neighbor’s rooftop singing at the top of his lungs). Bipolar II is characterized by more eccentric-looking behavior that is out of character for the person (picture someone enthusiastically filling her entire house with antiques that she’s thinking of selling in order to make an enormous fortune – even though she’s never done anything like this before).

Loved ones of people with Bipolar Depression often miss the illness in the patient, because the manic stage is mistaken for a sign of recovery. But note that the mania stage has a particular irrational urgency to it, and is not to be mistaken for actual happiness. In fact, a depressed person with Bipolar Depression is anxious, irritable and prone to self-defeating behaviors during their emotional high.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) refers to depression that only comes during particular times of the year. For instance, there are patients who exhibit symptoms of depression only during the cold winter months, but they are otherwise fine during the summer. In other cases the opposite is true; it’s the summer that brings in the blues. In tropical countries, the rainy season can be the most troublesome part of the year.

Psychotic Major Depression (PMD)
There are occasions when the depression is so intense; it causes a loss of contact with reality. A person with Psychotic Major Depression may experience hallucinations (sensing things that don’t really exist) or delusions (irrationally interpreting events and observations). Psychotic symptoms in PMD are often temporary, and will go away once the cause of the depression is addressed. The condition is not to be confused with schizophrenia, which can also cause depression.

Atypical Depression
A kind of depression that is difficult to diagnose and treat is called atypical depression. As the term implies, atypical depression is depression whose symptoms don’t always follow what is traditionally associated with clinical depression. The symptoms also appear to come and go, and can be lifted by positive life events. It is believed that atypical depression is primarily biological in origin, a product of chemical imbalance in the brain.

Symptoms of atypical depression may include loss of energy, unexplained and uncontrollable crying, insomnia or hypersomnia, irritability, unexplained aches and pains, difficulty concentrating and loss of interest in daily tasks.

Depression in Teenagers

The teenage years are known to be emotionally challenging. Kids are going through so many transitions and are experiencing so many pressures at this time. Aside from the physical changes of puberty and their effect on body image and personal confidence,  there’s also adjustments to high school and dating and new challenges in the realms of alcohol, drugs, sexuality and the virtual social universe. For the most part, adolescents negotiate all of this without too much trouble. However, a percentage of teenagers will struggle with addictions and mental health challenges. Adolescence is the time when many people first experience panic attacks, eating disorders and mood episodes.

Teenage depression is one mood disorder that is fairly common, affecting around 20% of teenagers. Some forms of depression are comparatively mild while others can be so intense that they are life-threatening. In all cases, adolescent depression must be taken seriously. Parents need to know about depression and what they can do to help their kids.

What is Depression?
Depression is a mood disorder characterized by low mood (which, in teenagers, is most often expressed as irritability or “moodiness,” but can also be expressed as sadness), hopelessness, trouble making decisions, feelings of guilt or worthlessness, weight gain or weight loss and sleeping problems (most commonly, waking up around 2 or 3 a.m. or getting up way too early).  Unlike episodic sadness, depression is stronger and seems harder to manage. A person who is depressed cannot simply “shake the blues away” or decide to cheer up. In fact, they feel flat, like there is nothing that can make them happy or give them pleasure. When this state of mind is so intense that it interferes with a child’s social functioning (i.e. she is withdrawing from her friends) and/or academic functioning (i.e. she can’t concentrate, can’t study, is doing poorly in her schoolwork and grades are slipping) and it has occurred pretty consistently for a two week period, it may be an episode of “Major Depressive Disorder.” When the state of mind is less intense (does not interfere with social or academic functioning) and chronic (lasting for at least 2 years fairly consistently), then it may be a form of depression called “Dysthymia.” Of course, diagnoses of either of these disorders occurs when the mood disorder is NOT being caused by something else (like withdrawal from drugs or use of alcohol or a traumatic experience, etc.). The only real way to know if a child is depressed is to have her assessed by a psychiatrist or clinical psychologist. The child’s symptoms may indicate another disorder entirely or the child may be “normal” – just going through a rough time. However, it’s crucial that parents don’t try to diagnose their child themselves. Clinical depression can lead to suicide in teenagers.

Experts believe that depression has a biological origin. While a family history of depression doesn’t automatically condemn a teen to get the disease, it increases the likelihood of depression when other risks factors are present in the child’s life. Risk factors for teen depression include a history of childhood depression (chronic unhappiness in childhood), instability in the family, troubled or weak relationship with parents, poor emotional management skills (too much anger, moodiness or anxiety), lack of social support (good friends and/or loving relationships) and stressful life events like loss (of a significant relationship) or failure (to make the team, or get desired grades, etc.).

How can Parents Help a Teenager with Depression?
It’s ideal if you can establish an open relationship with your child before depression strikes. This way, she is more likely to come to you for help when what she is feeling becomes too overwhelming to ignore. You can help by listening. In fact, it is more important to listen than to talk. A depressed child does not need a pep talk. She needs professional care. Let her talk about her feelings without offering her advice or easy solutions. Instead, use emotional coaching (name her feelings). For instance, you can say things like, “That sounds really hard,” or “I can see how much that’s bothering you” or “I hear how hopeless you feel.” Follow such remarks with, “I think the best help for these kinds of feelings is professional help. A psychologist who works with teenagers knows all about this stuff and knows how to help kids feel so much better. These are such important issues and they deserve the best help that we can find. How would you feel if I asked Dr. Green (the child’s pediatrician) for a referral to a good psychologist?” If the child doesn’t want to accept help, wait a couple of days and raise the subject again. The best help you can give your child is to get her to a mental health professional. If firmness is required, then use it. Do whatever you would do if you suspected that your child had diabetes. (You would do whatever was necessary to get your child to a doctor; do the same thing for this condition). Your child will thank you once she is experiencing an improved mood!

Treatment for Depression

Contrary to popular belief, depression isn’t  simply a case of “bad attitude.” Someone suffering from depression can’t just talk him or herself out of it or cheer him or herself up with a good movie or a round of exercise. Depression is a serious mental illness, whether it comes in the form of severe sporadic episodes (major depressive episode) or whether it is a chronic state that affects overall functioning (dysthymia).  If you’ve suffered from depression yourself, you know that the sadness and lethargy that comes with the condition can be debilitating. But while depression can be overwhelming, it’s also a mental health condition that is very treatable. Many people recover even from severe depression, and many treatment options are known to be effective.

The following are some of the  ways a person can cope with depression:

Work with a Qualified Mental Health Practitioner
Seek a highly trained psychologist or psychiatrist to help you overcome depression. While social workers, psychotherapists and counselors may be trained in general counseling techniques, they are not necessarily trained in the treatment of serious mental health conditions. You have a right to know what kind of training your practitioner has in the condition that you are suffering from. Just ask. Clinical psychologists and psychiatrists have training in the diagnosis and treatment of depression. Psychologists provide therapy such as CBT (cognitive-behavioral therapy), Mindfulness Psychotherapy for Depression, Interpersonal Therapy, Experiential Therapy,  and many other treatments. Psychiatrists may or may not have training in psychological treatments for depression, but they DO have the appropriate training in the biological aspects of the disorder and can provide appropriate medication and other biological treatments. If you suffer from mild depression that doesn’t interfere with your ability to function, you may benefit from the services of any therapist who works with mood issues (as opposed to clinical depression).

Consider Alternative Therapies
Some people don’t need or don’t want psychotropic medication for their depressive symptoms. There are many excellent alternative therapies that can contribute to the relief of mood issues. Herbal medicine, homeopathy, Bach Flower Therapy, acupuncture, nutritional therapies and more, are all available to address symptoms of depression. You can find more information about these therapies in books or online.

Additional Aids in Fighting Depression
The following may also prove useful to you in reducing symptoms of depression:

  • Following a structured exercise program (look for a qualified fitness trainer to guide you), yoga or martial arts program may provide a chemical boost that reduces the symptoms of depression.
  • Some hospital programs for depression offer 8 or 12 week courses in mindfulness meditation to reduce depression. Ask your doctor about these, or find a private program in your area.
  • Support groups may prove effective in reducing depression symptoms. These can be done in person, but there are also online support groups available. Look for one in your area or speak to your doctor to get reccomendations.

Self-Help
There are many excellent books and on-line resources for depression. Take advantage of them! You can also find CD’s with guided imagery for depression, affirmations, hypnotic suggestions and more. There are emotional-relief strategies that you can learn on-line as well such as Emotional Freedom Technique (EFT) – an effective tool for combating mood symptoms. Do research and learn what’s out there. It may not all be for you, but there will be something that you can benefit from.

Symptoms of Depression

Depression is the most common complaint presented to mental health practitioners. This is not surprising; almost all of us have experienced sadness at some point in our lives, with some episodes being quite intense. However, clinical depression is not just sadness. It is a multifaceted illness that affects every aspect of a person’s functioning. It causes major distress and disrupts the sufferer’s ability to carry on with work, school, or other responsibilities. The illness can occur among the young and old, the rich and poor, the educated and the uneducated, and it can come at any point in a person’s lifetime. The good news is: depression is treatable. When sufferers are trained to spot the early symptoms, the onset of depression can be managed and relapses can be avoided.

What are the Symptoms of Depression?
Symptoms of depression can be classified into four categories: emotional, mental, behavioral and physiological symptoms. Let’s take a closer look at each one:

Emotional Symptoms of Depression
Mood disturbance is the most significant among the symptoms of depression. An individual with depression may be prone to feelings of sadness, emptiness, dejection, helplessness, hopelessness and lack of self-worth. Episodes of crying, irritability and/or of anger are also common. A marked loss of interest in work, relationships and self-care may also be seen.

Mental Symptoms of Depression
There are also cognitive symptoms associated with depression. Psychologist Beck believes that people with depression are tortured by what he calls the cognitive triad: a negative view of one’s self, a negative view of the world and a pessimistic view of the future.

Self-accusation and mental anguish are typical, especially when the obsessions start to come. For instance, a depressed individual may constantly tell himself that he is ugly, incompetent or unwanted; that others do not care about his welfare; and that tomorrow will offer no relief. It is this cognitive triad that keeps a depressed person stuck in the rut, unless some form of therapy is conducted to correct and heal the debilitating thoughts.

Depression can also cause a person to have difficulty making decisions or concentrating on tasks.

Behavioral Symptoms of Depression
Depression may be about an internal state, but symptoms of depression can be objective and observable. In many cases, physical appearance already provides a clue regarding the depressed person’s mental health. People with severe depression may not care much about their appearance or even their hygiene. They may gain or lose significant amounts of weight. Their movements may be slower or faster than those of the average person, and there may be a delay in their communication. They may have difficulty in accomplishing their job or otherwise carrying on their normal tasks. They may withdraw from others.

Physiological Symptoms of Depression 
Depression is an illness that affects the entire person — his or her physicality and biological processes included. People with depression suffer from disturbed patterns of eating and sleeping. They can have loss of appetite or an increase in appetite (what is called emotional eating). They can suffer with various forms of insomnia (trouble falling asleep, staying asleep, waking up in the wee hours, etc. Or, they can end up sleeping much longer than the average person. They may be more prone to ailments such as heart conditions, stomach disturbances, infections, unexplained pain and vague disorders.

If you or loved one has symptoms like those above, consult a doctor or mental health practitioner. Treatment not only provides more rapid relief than “waiting it out,” but also helps prevent recurrences of the disorder.

Asperger’s Syndrome

Named after Hans Asperger, the pediatrician who first described its symptoms, Asperger’s is a part of an umbrella of neurological and social conditions called “autism spectrum disorders.” Asperger’s Syndrome (AS) is more difficult to identify and diagnose than many autism-related disorders, mostly because symptoms can be attributed to many other conditions. But the diagnosis of AS is usually empowering, as persons with Asperger’s typically have an easier time mainstreaming than those with other autism spectrum disorders.

The onset of the disease is usually at 3 to 5 years old.

What is Asperger’s Syndrome?
Asperger’s Syndrome (also called Asperger’s Disorder) is a neurological condition characterized by:

Severe Impairment in Social Interaction and Skills
People with Asperger’s tend to be self-focused (which is not to say they are self-centered). They prefer to be alone and have very little need for companionship. They are more interested in their inner musings, and are prone towards introspection and daydreaming. They can appear rude when spoken to, and may have difficulty following the subtext of a conversation (they can’t “read between the lines”). They can be very selective  when it comes to associating with peers or adults. Additionally, many kids and adults with AS are prone to random bursts of temper.

Limited Repetitive Behavior
People with Asperger’s are also prone to various obsessions and narrow interests. For instance, they might be interested in  parts of objects (like clocks) or they might like spinning things over and over and over. They flap their hands (particularly when excited).  Some children with Asperger’s are called “little professors,”  as they like to recite to others (as if teaching) whatever it is they are currently obsessing about.

Lack of Emotional Reciprocity
People with Asperger’s have difficulty identifying their own emotions as well as empathizing with other people. They can’t read non-verbal cues that communicate feelings, and may even appear cold and dismissive of other’s distress or pain. They are also poor at using non-verbal cues themselves such as maintaining eye contact, showing appropriate facial expressions or using gestures naturally. Not surprisingly, considering all this, people with AS have trouble making friends. However, they often don’t care so much about this as they are not all that interested in social relationships.

People with Asperger’s Syndrome tend to have excellent language and cognitive skills, and may even excel in areas they obsess on. Some may have motor problems and clumsiness.

What Can Parents Do?
If parents suspect that their child may have Asperger’s, the best thing to do is to get a diagnosis by a qualified mental health practitioner. Developmental psychologists, as well as psychiatrists, are generally competent at diagnosing autism spectrum disorders, but it’s always better to consult one who specializes in the disease. Because Asperger’s is primarily biological in origin (it is not caused by trauma nor by bad parenting), it has an early onset; symptoms that look like Asperger’s, but appear later in life, are unlikely to stem from Asperger’s Disorder.

Early intervention is critical in managing Asperger’s Syndrome. Currently, there are no cures for the illness, but medications and therapy can assist in managing symptoms. Many with AS are able to live highly functioning and productive lives. It does help for parents and other care-providers to be educated about their children’s particular needs. Training in social and communication skills, as well as occupational therapy can help with the various symptoms of AS.