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Anxiety Depression Mental Health Self-Harm Stress Suicide

New study: Self-harm in Teens

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Even as someone in recovery from self-harming behavior, the statistics regarding who and how many continue to self-harm still hits home. A recent study by Dr. Paul Moran at the Institute of Psychiatry at King’s College at the Murdoch Children’s Research Institute, Melbourne, found that “1 in 12 young people self-harm as adolescents, with the balance skewed toward girls.” Moran’s study followed a group of “young people from Victoria, Australia, from adolescence (14-15 years old) to young adulthood (28-29 years old) between 1992 and 2008.” According to the study, out of the 1802 participants responding to the adolescent phase, 149 (8%) reported self-harm. More girls (10%) than boys (6%) reported self-harm, which translates to a 60% increased risk of self-harm for girls compared to boys.1 Self-cutting/burning was the most common type of self-harming behavior seen in adolescents, but other forms of self-harm include self-battery, poisoning and overdose. Additional findings in Dr. Moran’s study show that self-harm was also associated with “antisocial behavior, high-risk alcohol use, cannabis use, and cigarette smoking,” but that “most adolescent self-harming behavior resolves itself spontaneously.”

Self-harming behaviors are often symptomatic of anxiety and depression, acting as a salve to those otherwise unable to feel or process their feelings in a more skillful way. It is, in many ways, an effort by the one self-harming to regulate their mood and can also act as a kind of emotional steam valve for difficult emotions or even as a means of self–punishment. Regardless, self-harming behaviors indicate mental-health issues that do need to be addressed. No one self-harms out of pride or because they’re happy about something. The truth is, there is a lot of shame associated with self-injurious behaviors.

Still, there continues to be a high risk for suicide completion in those who have a history of self-harming, particularly those who continue to do it into adulthood. When addressing this, we must remember that it’s not usually a self-aggrandizing act, but rather something one does in a poor attempt to feel better, or to simply feel something. The rate of suicide rates are sobering: according to this significant report from the World Health Organization, almost a million people die from suicide each year, giving a mortality rate of 16 per 100,000, or one death every 40 seconds. In the last 45 years, suicide rates have increased by 60 percent worldwide. And according to the CDC, “suicide rates are among the 10 leading causes of death in the US.”2

More often than not, you won’t see signs of self-harm, because typically, injuries are inflicted in places easily hidden by sleeves or other articles of clothing. Still, if you’re worried about your child, make an effort to show concern and get them some help. Keep in mind, if your parenting style has been of the lecturing or authoritarian type, or the particularly reactive type, this may be a good time to use a different tactic. Someone who’s suffering in this way will only shut down when faced with an impending firm, albeit worried, lecture. If your child shows signs of stress, anxiety, or begins isolating more than usual, it’s likely that trouble may be brewing. Worrying aside, your kids need to know you are there for them, no matter what.

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1: https://www.kcl.ac.uk/newsevents/news/newsrecords/2011/11November/Studyfinds1in12teenagersself-harmbutmoststopbytheirtwenties.aspx

2: https://www.afsp.org/index.cfm?page_id=04ea1254-bd31-1fa3-c549d77e6ca6aa37

For more information, see:

Medscape

Canadian Medical Association

National Institute of Health

Categories
Anxiety Body Image Eating Disorders Mental Health

Thanksgiving and Eating Disorders: A Mini Survival Guide

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On the heels of my recent blog about fat talk and its negative ramifications, I am broaching the subject of food, anxiety, and eating disorders once again. It’s almost Thanksgiving, after all, a holiday which not only acts as a huge trigger for many suffering from or recovering from an eating disorder, but is often used as fodder for fat jokes and the subsequent fat talk. As if sitting down to dine with your already dysfunctional family isn’t enough.

As we set our gaze upon Thanksgiving and give thanks for all that we have, those suffering from an eating disorder may be having an entirely different experience. For one thing, the entire day is purportedly built upon the foundation of food; one is expected to eat…a lot.  With an eating disorder, those expectations can bring about a legitimate sense of fear, shame and anxiety. For example, an anorexic may be overly concerned with the appearance that he or she is not only eating, but enjoying a “normal” amount of food, while someone suffering from bulimia or binge-eating disorder may struggle with trying to manage their urges to binge and/or purge.  For both, there are triggers everywhere, from the wide array of food being offered to someone’s not-so-subtle commentary about your, or even their, current weight, shape, size, et cetera.

Eating disorders and disordered eating are complex conditions, emerging from a combination of behavioral, biological, psychological, emotional, interpersonal and social factors. For many, food becomes the one thing that is controllable, giving someone who feels inherent powerlessness some perceived power. My own experience is just that: I grew up in an out-of-control, dysfunctional environment, where food was used as a vehicle for mixed messages; controlling its intake became paramount to my own survival. Or at least I thought it did. What it really ended up doing was leaving an indelible mark of low self-esteem and body dysmorphia. I still occasionally encounter negative behaviors from some family members when I see them, but now I view it as an opportunity to stand up in the face of adversity, plant my feet in my recovery, and dine with dignity. See here for NEDA’s “Factors that may Contribute to Eating Disorders.”

Some things to think about for the holidays:

Get support: either via a therapist, a sponsor, or a good friend. Make sure that you have someone you can lean on during this holiday season. You don’t have to manage Thanksgiving alone.

Make a plan: I always make sure I have what I call an “escape” plan for these sorts of things. In other words, make yourself a schedule so you don’t have to wing it.

Don’t skip meals in “preparation” for the holiday: Maintain your regular eating schedule that’s become a part of your recovery. For example, don’t skip breakfast so you can “have room” for the Thanksgiving meal.

Ignore and don’t engage in the fat talk: It’s neither an act of self-care or helpful. If someone is engaging in this age-old, negative behavior: walk away or disengage. Other people’s issues surrounding food are not yours to manage.

Be kind to yourself: If you fall down and slip into old behavior, don’t use it as a springboard to self-destruction. Allow yourself to enjoy the things you like. I find that knowing my triggers allows me to navigate the stormy sea of family and impulse with better judgment. You can do this!

Breathe: Yes, that’s right. Breathe. If you’re feeling overwhelmed, take a step back and take 10 deep breaths and find your center. This really does help. (This is also the other reason bathrooms exist!)

Lastly, remember what Thanksgiving is really about: It’s not about the food. Not really. It’s about being grateful for those around you and for the blessings in your life. Bask in the glory of your recovery and sobriety, for without those, the least of your worries would be whether or not you can eat a piece of pumpkin pie!

Resources and articles used as reference:
Categories
Parenting Recovery Transparency

Tell It Like It Is

One thing is clear, there isn’t a definitive handbook for child-rearing. And while we

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parents try our darndest to “do the right thing,” we often fall flat on our faces as a result of being mired by our own childhood stories. I think I can safely say that most of us didn’t grow up in some idealized version of Leave it to Beaver, which is not to say that all of us suffered hellish childhoods either. Still, we have to be careful that we don’t project our own experiences and expectations onto our children. If anything, parenting provides us the opportunity to do things differently. For those of us in recovery, that may also mean facing very real fears that our kids will follow in our sullied footsteps: drinking and using much like we once did.

Adolescence is all about pushing boundaries, experimentation, breaking rules, rebellion, and other assorted behaviors us parents typically loathe. And somewhere in the midst of diaper changes, spit up, and pre-adolescence, many of us simply forget what it was like to grow up. So, if we come across our very own “little Bobby” hung over or high, we are tend to fly off the handle. The truth is, that’s the last thing we should be doing. Our indignation and outrage automatically puts our kids on the defensive, making us the bad guys and the enemy, preventing them from opening up to us. They’re already exerting their independence, distancing themselves from us as much as possible, so being reactive parents will just push them further away. Precisely what we don’t want to do during adolescence. Face it, our teens will rebel. It’s in their nature. But it’s our responsibility to learn to respond to that rebellion skillfully. Even if it means confronting suspected or known drug and alcohol use.

If you suspect drugs or alcohol abuse or already know your child is using, these are some tips from The Partnership for a Drug Free America:

  • Talk to your partner or spouse and get in alignment with one another. You need to have a united front.
  • Expect denial and even anger.
  • Let your teen know you are coming from a place of love and concern.
  • Prepare to be called a hypocrite.
    • If you are in recovery, show some transparency. Your experience and its outcome is a teaching tool.
    • If you smoke or drink, you will more than likely be called out on it by your teen.
    • Have some evidence. Denial is a key component during these sorts of confrontation.
    • Work toward a desirable and realistic outcome: don’t expect full disclosure.
    • Formulate rules and consequences with your partner/spouse beforehand. The last thing you want to do is make snap decisions.
      • Don’t set rules you can’t enforce.
      • If you have addiction within the family, discuss your child’s pre-disposition toward addiction.
      • Be transparent. Talking about your past in a general way is helpful. If we aren’t honest with our kids, how can we expect them to be honest with us?

On occasion, our young ones will ask us questions we may feel are inappropriate or too revealing to answer truthfully, but as puberty hits, and curiosity burgeons, it’s really the time to answer these things as best we can. Our fears and issues need to be set aside, because it’s in those teachable moments where we can affect change. It’s in those moments of honesty and openheartedness where we can provide outlines for healthy perspectives on alcohol, drugs, sexuality, media use, et cetera. Our kids, whether they admit it or not, rely on us to be steady and forthright. If they can’t lean on us, or depend on us, who can they lean on? Who can they trust if we stumble and trip over our own lies while we encourage them to tell the truth? It’s time to be transparent with our teens; they need us to.

Categories
Addiction Opiates

At Death’s Door: An Overdosing “Epidemic”

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According to preliminary data from the U.S. Centers for Disease Control and Prevention(CDC), “Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide.”

What we have is a growing epidemic of pharmaceutical overdoses, where the age of users and overdose victims vary from teens trying to achieve a heroin-like high to adults attempting to manage a slipped disc, or other painful injury. Some of the most commonly abused drugs are OxyContin, Vicodin, Xanax and Soma, but I would be remiss if I didn’t mention Fentanyl, a relative newcomer, but a dangerous one nonetheless. Fentanyl’s allure is its heroin-like high along with its unassuming portability: it comes in the form of lollypops and patches and packs a punch 100 times harder than morphine. It’s drugs like these which are responsible for more deaths than heroin and cocaine combined.

  • Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. This is more than 3 times the 4,000 people killed by these drugs in 1999.
  • In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year.
  • Nearly half a million emergency department visits in 2009 were due to people misusing or abusing prescription painkillers.
  • Enough opiates were prescribed last year to medicate every American adult with a standard pain treatment dose of 5mg of hydrocodone (Vicodin and others) taken every 4 hours for a month.
  • The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices in 2010 had quadrupled since 1999.

According to a recent CDC report, “3% of physicians accounted for 62% of the OPR (Opiod Pain Relievers) prescribed.” Still, there are many doctors voicing concern about this very issue. There is legitimate concern regarding prescriptions being handed out without sufficient evaluations or follow-ups. We see a lot of this in the often illegitimate pain clinics (pill-mills), who provide easy access to patients and don’t question the potentiality of doctor shopping. Still, it would benefit more physicians to become more judicious with their prescription pads and in the practice of writing a 3-day prescription rather than the ubiquitous 30-day bucket of pain meds, at least for those dealing with acute pain. So far, 48 states have instituted Prescription Drug Management Programs (PDMPs) that will flag doctors who have profiles of heavy prescribing and use. This may some of the problems, but I fear it may also marginalize those who actually need to take pain medications to manage chronic pain issues. According to CDC director Thomas Frieden, they “are still figuring out how to use them (PDMP laws) effectively.” At this point, PDMPs only provide monitoring for physicians and their patients. What they do not monitor is the fact that “seven out of 10 medication abusers get their drugs from friends and family.”

Which brings us to the other issue here, which lies in our homes, hanging out in our medicine cabinets

. Gil Kerlikowske, the director of the White

House Office of National Drug Control Policy says, “As much of 40% of all prescription drugs go unused.” Think that sounds like a lot? Check your medicine cabinets—there’s more than likely something there from some old root canal or surgery you had. As parents, we need to take stock and inventory those medicine cabinets. Safely dispose of what you don’t need and lock up the prescriptions you do need. This not only safeguards our kids, it also eases our own temptation to take an unprescribed medication for our own relief or pleasure. Our kids look to us for guidance. We are their first role models, and if we teach them that medication is their go-to release valve, then the natural byproduct is a lesson in numbing out. Use this as an opportunity to talk to your burgeoning adult about healthier ways in which to manage discomfort. Your kids’ lives are worth it.

Articles linked to and used as reference:

https://www.cdc.gov/Features/VitalSigns/PainkillerOverdoses/

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w

https://www.npr.org/blogs/health/2011/11/01/141914150/cdc-calls-for-action-to-curb-shocking-epidemic-of-narcotics-overdoses?ft=1&f=1001

https://www.pbs.org/newshour/rundown/2011/11/painkiller-epidemic-deepens-in-us.html

Categories
Mental Health

The Process of Grief

“To spare oneself from grief at all cost can be achieved only at the price of total detachment, which excludes the ability to experience happiness” Erich Fromm

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Grief is an experience, and while it differs from person to person, one thing is certain: there isn’t a predetermined end time for grieving. It is, in and of itself, a process.

We often hear this process of grief described in stages:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

This grief cycle, which is often referred to as DABDA, was described by Elisabeth Kübler-Ross in her famous book On Death and Dying, written in 1969. She did not, describe this cycle as a rigid depiction of grief, but rather as the framework with which to view and work with the process of grieving.  It’s also important to note that this isn’t a linear process. In fact, everyone who’s experienced loss may not experience each of these factors; if/when they do, they certainly won’t experience them in any particular order. In fact, if you are grieving, you may notice that you transition between these emotive states from moment to moment, much like the ebb and flow of the tides.

Adolescents process grief differently than adults. While they may be feeling a wide array of emotions, they may not exhibit them outwardly. For teens in particular, the vulnerability brought about by the onslaught of emotions associated with death and dying is sometimes too much. Developmentally, they are in the process of discovering their autonomy and independence, so cleaving to family in times of loss may seem “uncool” to a teen, regardless of need. That said, teens tend to do particularly well in peer support groups, which provide an ideal environment where kids help each other as they stand on common ground.

This doesn’t mean that adults can’t help their teen during this time. As Dr. J. Earl Rogers writes in his book The Art of Grief, “Most teens will respond to adults who choose to be companions on the grief journey rather than direct it.” This, then, requires a role change, one that may prove difficult for some parents, who are accustomed to presiding over most situations. Still, what is paramount, regardless of our role as parent or peer is to actively and deeply listen. Summarize what you hear, and repeat it back; Listen deeply, without judgment; Retain a regular schedule and routine. Remember, there is great comfort in regularity, something that death defies in its very nature.

We know that death can be sudden or expected. A sudden death can be described as an accident, homicide, suicide, drug overdose. The feelings associated with this type of loss are varied and often intense. You may experience:

  • The shock and disbelief last longer;
  • Sudden death can be more confusing, bringing up many feelings to process all at once;
  • There is not time to say goodbye;
  • You may have strong feelings of guilt because:
    • Of something you have or have not said about the person that died
    • Of something you thought or felt or wished about the person you died
    • You think you  could have prevented their death
    • You survived and your loved one didn’t
    • Wanting to feel normal again
    • This may seem unfair, especially if the person is young;
    • You may experience reoccurring thoughts, dreams, or flashbacks. These are normal and should decrease. If they don’t, ask for help.
    • You may feel the need for more information about the incident to gain a better understanding of how the person died. Be sure you can handle this. (It’s my experience that what we think we can handle and what we can actually handle are two different things.)
    • You may feel vulnerable or jumpy and nervous.

Someone dealing with expected loss, as in a death of  someone who’s been fighting cancer or another terminal illness may find themselves:

  • Grieving little losses along the way (not being able to do the same things or go to the same places with your loved one)
  • Experiencing symptoms of grief even before a loved one has died;
  • Having strong feelings of guilt because
    • Of something you said or didn’t say about the person who died
    • Of something you thought or felt or wished about the person that died
    • You think you could have prevented the death
    • You survived and your loved one did not
    • You want to feel normal again.

In the case of an expected death, you may also have had time to prepare and honor the wishes of your loved one. You also may have been able to say goodbye, which would give you a sense of closure.
So, as we begin to sit with the discomfort of death and loss, hopefully, we can also take the opportunity to recognize its transformative nature. Instead of regretting the past, perhaps we can remember the footprints of those who have left our sides, allowing them to blossom in our own hearts as we continue to forge our own paths.

Remember to be kind to YOU in this process.

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