The combination of substance abuse and forms of mental illness are common. In fact, it’s what most clinicians, therapist, and counselors often expect to find when one diagnosis is confirmed. According to the NAMI (National Association on Mental Illness) more than
half of all adolescents with substance abuse issues also have a diagnosable mental illness. These diagnosable mental illnesses consist of ADHD (Attention Deficit Hyperactivity Disorder), Depression, and Bipolar Disorder. Unfortunately, history has not shown treatment for both at the same time. Typically a teenager who is in treatment for substance abuse is not referred out to a qualified mental health professional to discover a source of their drug and alcohol abuse. Self-medicating with alcohol and illegal drugs is prevalent when there is a mental health issue.
Over the years, the psychiatric and drug counseling communities have begun working together, agreeing that both of these disorders must be treated at the same time. Often with one diagnosis you have the other. With a dual diagnosis it’s been found that suicide attempts and psychotic episodes decrease rather quickly. Treatments consist primarily, but not exclusively to 12-Step programs. However, special peer groups that focus on treating both the illness and substance abuse are found to strengthen social networks.
Adolescents often seek acceptance, and support each other as they learn the role alcohol and drugs have taken in their lives so far. Learning, and in some cases re-learning, social skills will help replace self-medication with patterns of healthful and helpful behaviors.
In order to discover the presence of a confirmable dual diagnosis, one must seek a professional assessment from a psychologist or psychiatrist. Once the dual diagnosis has been established confirmed, then family members and mental health professionals are urged to work together to seek a strategy that works best for the adolescent.
Here are five tips on what to do if your adolescent has a substance abuse disorder.
Your teen is NOT a disgrace to the family.
Establish consequences for behaviors, and don’t be afraid to call upon law enforcement if your child is drinking on your property.
Don’t threaten unless you plan to follow through. Typically a parent surrenders and their addicted child learns their parent doesn’t mean what they say.
Try not to nag or lecture.
And, if your teenager is seeking and working at his or her recovery you should offer support, love and encouragement.
BIO:
Recovery Rob is a 47-year-old man who has more than nineteen years of sobriety, whose drugs of choice at one time were alcohol and drugs, and he has worked in and around the field of addiction for more than 20 years. Recovery Rob is a professional writer who has published two novels and is currently working on his third. He has been writing and working as Pat Moore Foundation’s premiere blogger and content writer, which helps keeps Pat Moore Foundation’s addiction and recovery blog top-rated.
I was recently asked to participate in Pat Moore Foundation’s Guest Blogging program. What an honor! It’s wonderful to be a part of a blogging community that not only supports other recovery bloggers but is willing to join forces with them. The blog I wrote is called “Obscure Thoughts of Suicide are Still Thoughts of Suicide” and addresses suicide and addiction from a more introspective and personal perspective. I wrote it on the heals of one of our more recent blogs entitled “Suicide, Neither an Answer nor a Solution.” With the onslaught of bullying and teen suicides, It’s important we pay closer attention to the subtle signs so we can offer help and solutions. It doesn’t feel good to suffer from suicidal ideation. It’s scary and it’s lonely. We as parents, friends, teachers, counselors, therapists, and doctors can help—one active-listening moment at a time.
Check out the guest blog from Rob Grant aka Recovery Rob on Twitter as well as the wonderful write-up he did about it. He has almost two decades of recovery and writes regularly for the Pat Moore Foundation. He is essentially, the “me” of the Pat Moore Foundation. You can also see some of his blogs here.
Suicide so often “comes as a surprise” to those left behind, but in all honesty, the signs
were more than likely always there. The identifying factors that lead up to this type of tragedy are many, but in our busy, multitasking lives, we tend to overlook them or dismiss them as part and parcel to growing up, particularly the subtle hints. While I can’t speak for most kids or adults, I can tell you that the inner turmoil which occurs in the mind of someone who’s suffering from suicidal thoughts is akin to severe emotional isolation—with it comes the delusion that one is “the other,” so different from those around them, they can’t even begin to integrate. Often times, those who are bullied struggle with suicidal ideation. Often times, no one even knows.
Of late, there have been several anti-bullying videos, songs, as well as organizations who are ardently amping up their efforts to bring awareness to this issue. It’s not that bullying in and of itself is tantamount to suicide, but those that are bullied often get to a place emotionally where they simply give up trying. If drugs and alcohol can’t numb the pain, or if cutting can’t raise the endorphins enough to eradicate one’s uncomfortable emotions, then suicide suddenly can look like an option. According to the National Institute of Mental Health (NIMH) and the CDC, “Nearly five times as many males as females ages 15-19 died by suicide,” and “Just under six times as many males as females ages 20-24 died by suicide.” Risk factors for suicide attempts include things like:
Depression and other forms of mental illness
Addiction;
A family history of mental disorders or substance abuse;
Family history of suicide;
History of physical or sexual abuse;
Firearms in the home
Incarceration
Exposure to suicidal behavior of others (family members, friends, media)
It’s important to note, however, that suicide is an extreme reaction to stress. There are many people in and out of recovery who can check off many of the above factors but are not suicidal. Regardless, the risks are notable and should be viewed with great concern and scrutiny.
I remember being a teen and feeling isolated and very much like “the other.” The irony is, the one and only time I was directed to the suicide hotline, I wasn’t actually suicidal. I was just a surly teen. Later, however, the internal dialogue of self-loathing and lack of self-worth drove me to put myself in more and more unsafe places. It wasn’t until many 4th steps later when I realized my actions were not only a cry for help, they were, in fact a means of subversive suicidal ideation. As a teen, I needed my parents and didn’t have them, either due to their emotional unavailability or their absence. As a parent myself, I have learned that despite the adolescent, parent-hating bluster, I am needed—we are needed. A child who can come home and talk openly to a parent is, in my opinion, less likely to revert inward. Talking about being bullied, asking for help, and getting it, is invaluable, and we, as parents, need to provide the environment in which our kids can safely do that. If not, then we risk being left behind, drowning in grief and unanswerable questions.
**If you or someone you know is thinking about or talking about suicide,take it seriously. You can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). It is available 24/7.
Social anxiety/social phobia is an anxiety disorder characterized by a significant fear
of social interactions and interactions with other people which bring about feelings of “self-consciousness, judgment, evaluation, and criticism”1 by those they interact with. In other words, “the extreme fear of being scrutinized and judged by others in social or performance situations.”2 What social anxiety is NOT is simple shyness, but rather a more deeply internalized anxiety disorder. Recently, the National Institute of Health analyzed data gleaned from a study done by the National Comorbidity Survey Replication Adolescent Supplement (NCS-A S), which surveyed more than 10,000 adolescents (ages 13-18). The survey involved a structured, diagnostic interview, assessing a “broad range of mental health disorders.” Those who met all eight “lifetime DSM-IV criteria for social phobia, including one or more social fears, were classified as having social phobia, regardless of shyness.”3
Results of this survey are interesting:
Overall, 43% of males and 51% of females rated themselves as shy, but only 12% of these youth met criteria for social phobia.
5% of youth who did not rate themselves as shy met social phobia criteria.
Prevalence of social phobia increased with age:
6.3% of 13- 14-year-olds
9.6% of 15- 16-year-olds
10.4% of 17- 18-year-olds
Compared to shy adolescents, those with social phobia/social anxiety were more likely to suffer from some form of an anxiety disorder, major depressive disorder, oppositional defiant disorder, or addiction. Also notable were definitive issues with school, work, family relationships, and social interactions. Additionally, the statistics show “only 23% of adolescents with social phobia sought professional treatment for anxiety, and just 12% received psychiatric medication.” More than anything, what these results challenge is the perceived perception that social anxiety/social phobia is the “‘medicalization’ of a normal human emotion.”
To outsiders, someone stricken with social anxiety may seem particularly shy, quiet, or reserved, but to the individual suffering, the internal pull of panic-ridden thoughts is often unbearable. What’s interesting, however, is that when alone, one suffering from social anxiety is usually okay. A key factor in the behavior being more than “just shyness” is when the mere thought or suggestion of any social interaction coming into play brings about the emergence of internal panic. Those that suffer may experience “significant emotional distress”4 in these types of situations:
Being introduced to other people
Being teased or criticized
Being the center of attention
Being watched while doing something
Meeting people in authority (“important people”)
Most social encounters, particularly with strangers
Making “small talk” at parties
Going around the room in a circle and having to say something
Our friends and family members suffering silently need our support. It’s time we gave this disorder the attention it deserves so those suffering can find some solace and relief. It’s one more thing that requires us to remove the stigma so healing can begin.
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.
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!
“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
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.
I honestly wish this commentary occurred less than it actually does, but the reality is, it doesn’t. It occurs on a daily basis in the lives of girls (and boys) from elementary school age to women in their older years. It’s the baseline for many conversations and it’s more often than not done without concern for those around them. Think about this: when someone who’s a size 2 says to a friend who’s a size 10 that she feels “fat,” there is an implication of body-image judgment, regardless of intent or level of self-esteem of the person hearing the comment. As soon as we start adding to the ever-present dialogue that one body type is somehow better than another, we inadvertently fuel the fire of low self-esteem and negative body image. In fact, when asked about the consequences of fat talk, Elizabeth Easton, PsyD and clinical director of child and adolescent services at the Eating Recovery Center says, “Negative body image is an easy hook for individuals who struggle with self-esteem or identity to latch onto as a way to feel more confident and even accepted by others.” Fat talk is damaging, no matter how you look at it.
Parents play a huge part in this as both contributors and as allies in our efforts to combat this type of language. We need to be mindful of what we say about ourselves, letting go of the delusion that we are “just talking about ourselves,” because in the eyes of an impressionable young girl or boy, the negative impact is very real. We are our kids’ first teachers, and if we teach them to hate themselves because of our own perceived weight problem, we potentially create a lifetime of body-image issues that can translate into disordered eating and/or eating disorders. I’ll never forget the kindergartener at my son’s school who burst into tears during a dress rehearsal because her costume made her look fat (she was playing Toto!); or the 8-year-old who won’t eat because she’s afraid she might get fat. Neither of these kids have a weight problem: rather, they have a perception problem brought on by the fear-inducing commentary from their parents, peers, and media. Fat talk is a real issue and one we need to ardently address. There are some very real consequences to this constant barrage of body bashing, and it shows in these eating-disorder statistics from NEDA:
In the US, as many as 10 million females and 1 million males are struggling with an eating disorder such as anorexia or bulimia;
80% of American women are dissatisfied with their appearance;
The mortality rate for 15- 20-year-old females who suffer from anorexia is 12 times the death rate of all other causes of death;
Anorexia has the highest premature fatality rate of any mental illness;
40% of newly identified cases of anorexia are girls 15-19;
54% of women would rather be hit by a truck than be fat;
81% of 10 year olds are afraid of being fat (Mellin et al., 1991).
42% of 1st-3rd grade girls want to be thinner (Collins, 1991).
67% of women 15-64 withdraw from life-engaging activities like giving an opinion, going to school, and going to the doctor because they feel badly about their looks;
Most fashion models are thinner than 98% of most American women (Smolak, 1996);
Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (Neumark-Sztainer, 2005);
46% of 9-11 year-olds are “sometimes” or “very often” on diets, and 82% of their families are “sometimes” or “very often” on diets (Gustafson-Larson & Terry, 1992);
91% of women recently surveyed on a college campus had attempted to control their weight through dieting, 22% dieted “often” or “always” (Kurth et al., 1995);
35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full syndrome eating disorders (Shisslak & Crago, 1995);
25% of American men and 45% of American women are on a diet on any given day (Smolak, 1996).
Next time you wonder if you look fat in your outfit, or feel compelled to use body bashing as a conversation starter, name 3 things that are positive about yourself. Challenge yourself to be kinder to YOU so you can affect positive change on those around you. You’re worth it.
References for aforementioned Statistics as documented at NEDA:
Collins, M.E. (1991). Body figure perceptions and preferences among pre-adolescent children. International Journal of Eating Disorders, 199-208.
Crowther, J.H., Wolf, E.M., & Sherwood, N. (1992). Epidemiology of bulimia nervosa. In M. Crowther, D.L. Tennenbaum. S.E. Hobfoll, & M.A.P. Stephens (Eds.). The Etiology of Bulimia Nervosa: The Individual and Familial Context (pp. 1-26) Washington, D.C.: Taylor & Francis.
Fairburn, C.G., Hay, P.J., & Welch, S.L. (1993). Binge eating and bulimia nervosa: Distribution and determinants.
In C.G. Fairburn & G.T. Wilson, (Eds.), Binge Eating: Nature, Assessment, and Treatment (pp. 123-143). New York: Guilford.
Gordon, R.A. (1990). Anorexia and Bulimia: Anatomy of a Social Epidemic. New York: Blackwell.
Grodstein, F., Levine, R., Spencer, T., Colditz, G.A., Stampfer, M. J. (1996). Three-year follow-up of participants in a commercial weight loss program: can you keep it off? Archives of Internal Medicine. 156 (12), 1302.
Gustafson-Larson, A.M., & Terry, R.D. (1992). Weight-related behaviors and concerns of fourth-grade children. Journal of American Dietetic Association, 818-822.
Hoek, H.W. (1995). The distribution of eating disorders. In K.D. Brownell & C.G. Fairburn (Eds.) Eating Disorders and Obesity: A Comprehensive Handbook (pp. 207-211). New York: Guilford.
Hoek, H.W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 383-396.
Mellin, L., McNutt, S., Hu, Y., Schreiber, G.B., Crawford, P., & Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: The NHLBI growth and health study. Journal of Adolescent Health, 27-37.
National Institutes of Health. (2005). Retrieved November 7, 2005, from https://www.nih.gov/news/fundingresearchareas.htm
Neumark-Sztainer, D. (2005). I’m, Like, SO Fat!. New York: The Guilford Press. pp. 5.
Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18 (3), 209-219.
Smolak, L. (1996). National Eating Disorders Association/Next Door Neighbors Puppet Guide Book.
Sullivan, P. (1995). American Journal of Psychiatry, 152 (7), 1073-1074.
A history of sexual violence can create an ideal environment for a variety of mental-health issues, addiction, and alcoholism. Often, the triggering event or events are hidden in the annals of one’s mind and perceived as shameful, deep, dark secrets too horrible to share…with anyone. As a result, drugs, alcohol, and risk-taking behaviors are often seen as the primary issue when one enters treatment. Time and again, we see that this isn’t always the case; That becomes clear when we look at it in terms of statistics:
One out of every 6 American women has been the victim of an attempted or completed rape in her lifetime (14.8% completed rape; 2.8% attempted rape)[1];
29% are age 12-17;
44% are under age 18;
80% are under age 30.; 12-34 are the highest risk years.
Girls ages 16-19 are 4 times more likely than the general population to be victims of rape, attempted rape, or sexual assault;
7% if girls in grades 5-8 (approx. ages 10-13) and 12% of girls in grades 9-12 (approx. ages 14-17) said they had been sexually abused;
3% of boys grades 5-8 and 5% of boys in grades 9-12 said they have been sexually abused[2].
As I frequently tweet Intervention, one of the things I notice on a regular basis is the consistency in which the women on the show are frequently struggling with a history of sexual violence, and are using drugs, alcohol, and promiscuity as their primary coping skill. From the outside looking in, it’s clear that the goal is to try to desensitize and anesthetize feelings of shame and guilt, et cetera; in other words, do anything and everything NOT to feel, remember, re-experience, or suffer from the emotional attachment to the event itself.
Twelve-step programs were written with specific goals in mind: to stop the alcoholic/addict from drinking and using. The steps work well in that regard, mostly because they are based on the disease model, addressing issues of alcoholism and addiction accordingly. However, the same tools provided to address addiction issues don’t always work in concert with mental-health issues, particularly those attached to sexual violence. We know the steps adequately provide an alcoholic/addict with the necessary skills needed to learn to take responsibility for and subsequently change their negative behaviors. They do so by asking the addict/alcoholic to take responsibility for their actions, face their fears, and acknowledge that they took part in creating their own demise. However, being sexually abused or raped isn’t a negative behavior to be changed but rather a causative, biting factor in things like:
Depression
Post-Traumatic Stress Disorder (PTSD)
Alcohol and Drug Abuse
Suicidal Ideation
Eating Disorders
What then, do we do from a recovery standpoint when the predominant disease model isn’t geared to address issues of this caliber? The Big Book, the 12-step primer, was written by men addressing men’s issues, in a time when women were typically viewed as the ones affected by their spouse’s alcoholism and not as the alcoholics themselves. As more women began to come forward as alcoholics and addicts, the tools didn’t always adapt to the new issues that arose because of gender disparity, but rather, they stayed the same, assuming a one-size-fits-all mentality. In the cases of women dealing with sexual violence, being asked to take responsibility for an abuse event has the potentiality to create more or actually deepen the existing trauma, particularly if the innate issues of shame and guilt associated with it are ignored. The reality is, being victimized by sexual violence is not the fault of the victim. What does need to be addressed, however, is the anger, self-victimization, and negative behavioral byproducts occurring as a result.
We clearly have a multi-layered healing process on our hands, so first, the negative coping skills must be eliminated: Sobriety is an obvious first step and necessary component to support the healing process. Additionally, working with meditation and mind-body awareness techniques are also useful in helping one manage their anxiety, negative feelings toward oneself, and in re-building self-esteem. A therapist skilled in treating PTSD and this sort of trauma is also important, particularly since this is often a lifelong process.
It is in forgiving ourselves that we have the ability to become free.
[1] National Institute of Justice & Centers for Disease Control & Prevention. Prevalence, Incidence and Consequences of Violence Against Women Survey. 1998.
[2]1998 Commonwealth Fund Survey of the Health of Adolescent Girls. 1998
OCD is a form of anxiety occurring when the brain has difficulty dealing with worries and concerns. As a result, someone with OCD will constantly worry and obsess over things that may seem banal to a non-sufferer. For some kids, their worries are focused on cleanliness or germs, resulting in repetitive hand-washing rituals. For others, it could be repeatedly straightening out an area, trying to achieve perfection. These obsessive and repetitive behaviors are done ritualistically or compulsively in order to quell the pervasive anxiety induced as a result of obsessive thought patterns. Often, an OCD sufferer will focus on things being in “order” or “just right,” also as a means to reduce the lingering, scary thoughts infiltrating their minds. While some kids may recognize they don’t need to act on these behaviors, the disorder itself propels then to do it anyway. It’s not their fault. Interestingly, acting on the repetitive thought patterns does minimally reduce the anxiety, albeit temporarily.
I want to point out that worrying is also a natural part of childhood, so is having small rituals (like wearing your lucky t-shirt before a game), being super organized, double-checking to make sure the door’s locked, et cetera. Kids and teens naturally worry about things, be it school, whether they’re liked, whether they “look cool” for school or to impress that guy or girl, or whether their parents are ever going to get along. With OCD, these rituals become extreme. So, if you notice repetitive, ritualistic, and compulsive behaviors becoming more extreme and negatively impacting one’s day-to-day life, then it’s appropriate to take a closer look at the cause and take action.
That means seeing a psychologist or psychiatrist who will ask questions about obsessions or compulsions. Some of these questions may include:
Do you have worries, thoughts, images, feelings, or ideas that bother or upset or scare you?
Do you feel you have to check, repeat, ask, or do things over and over again?
Do you feel you have to do things a certain number of times, or in a certain pattern?
Once the diagnosis is made, then treatment can begin. Cognitive Behavioral Therapy (CBT) is a preferred treatment for OCD. A CBT therapist will work with a child or adolescent with OCD and help them learn that they are in charge, not the OCD. Often the CBT will integrate Exposure and Response Prevention (ERP) as part of the treatment. With ERP, the strategy is to gradually expose the sufferer to their trigger (fears) so they can develop skills and learn not to respond to them with such urgency. The process allows the OCD sufferer to begin to recognize that their fear is just that: a fear, not a reality; it also helps the brain “reset” the very mechanisms that trigger the obsessive behavior. It’s important to remember that treatment for Obsessive-Compulsive Disorder takes patience, time, diligence and hard work.
Remember, there is no shame in asking for help or in getting treatment. Having OCD doesn’t mean you’re crazy, or broken in some way. There is a solution.