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Mental Health Mood Disorders

What Are Teen Disruptive, Impulse Control, and Conduct Disorders?

Disruptive, impulse control and conduct disorders are a group of conditions diagnosed in children and teens, characterized by long-lasting and consistent destructive behavior across multiple situations and a disregard for others and the law. These conditions are understood to be like anxiety and depression.

Still, instead of directing these negative thoughts and destructive forces inward, those diagnosed with a disruptive behavior disorder or impulse control disorder direct them outward. Common conditions that fall under the umbrella of impulse control disorder and disruptive behavior disorders include:

While kleptomania and pyromania are among the rarer ones, affecting under one percent of children, the other disorders are more common. About 6 percent of children are estimated to have an oppositional defiant disorder or conduct disorder, and nearly 3 percent have an intermittent explosive disorder.

More than just another name for unruly behavior, these disorders are only diagnosed in children who display symptoms of severe aggression, destruction of property, constant rule-breaking despite certain consequences, and highly impulsive behavior, among other characteristics.

Teen Intermittent Explosive Disorder (IED)

Teen intermittent explosive disorder is characterized by repeated and sudden physical and verbal violence and extreme anger. While children and even teens are not particularly known for being in control of their emotions, there is a point at which the constant lack of control can cause concern.

IED can be identified by these severe and recurring temper explosions more than just a simple anger management problem. If your teen is likely to throw temper tantrums and lose their temper at the slightest push, repeatedly flying off the handle with little to no warning regardless of the setting or circumstances, then they might be struggling with IED.

They may be separated by weeks of nonaggression, but if they have been an issue for a year or longer and often happen with no discernable reason, they may be a sign that your teen needs treatment. These episodes can manifest in different ways and usually consist of either:

    • Fights
    • Tirades
    • Temper tantrums
    • Property damage
    • Extreme threats against people and/or animals

Teens with the intermittent explosive disorder usually feel relaxed or relieved after an episode has ended. They may regularly express regret or remorse yet fail to control their temper.

Teen Oppositional Defiant Disorder (ODD)

Oppositional behavior is yet another trademark of the average teen. Children and teens may intentionally defy orders and go against the wishes of those around them. The trope of the rebelling teenager is universally understood because, for many of us, a big part of becoming independent is figuring out what we do not like and want.

But normal oppositional behavior has its limits, and teens either know where to draw the line or learn it quickly. When a child or teen repeatedly shows anger, disdain, and even abject hatred towards any authority figure (including their family), they may have oppositional defiant disorder.

ODD is characterized by oppositional behavior that is consistently impairing a teen’s social life and relationships at home and school, rarely developing late into puberty, and the first signs are usually seen in preschool. Its latest onset is during the early teen years. Some common signs of ODD include (but is not limited to):

    • Consistently irritable mood.
    • Argues often with authority figures.
    • Blames others for their mistakes and failures.
    • Refuses to follow or deliberately ignores requests and rules.

The causes behind oppositional defiant disorder can differ from teen to teen, though both temperament and parenting play significant roles. When the bridge between a teen and their parents has been burnt, professional help might be the best next answer.

Teen Conduct Disorder (CD)

Where violent episodes characterize the IED, and ODD is usually directed solely at authority figures, a CD is characterized by behavior that is generally callous and inconsiderate, to the point of completely ignoring others’ needs and rights and causing direct and indirect harm to other people. Conduct disorders can include theft and property destruction, hurting or abusing animals, and cruelty. Other common behaviors include (but is not limited to):

    • Relentless bullying.
    • Physical abuse towards a friend or partner.
    • Lying to no real benefit (for the fun of lying).
    • Stealing items of no value (for the fun of stealing).
    • Deliberately causing harm or annoyance for self-gratification.
    • Coercing people with threats of violence or even death, including wielding a weapon.

Another important characteristic is that conduct disorders are not learned behavior, i.e., they are not something a teen picked up from others and decided was normal. Teens who grew up in abusive households may be more likely to develop a conduct disorder. Still, an important distinction to make is that a teen with a conduct disorder understands that they are hurting others or doing harm but takes pleasure in it. Children and teens with conduct disorders may develop and be diagnosed with antisocial personality disorder.

Kleptomania and Pyromania

Kleptomania (stealing things) and pyromania (arson) are two classic examples of an impulse control disorder and are sometimes associated with obsessive-compulsive disorder (OCD). These conditions are like behavioral addictions, characterized by consistent dangerous behaviors that a teen cannot fully control or refrain from. While some teens steal and other teens fuel fires, the inability to stop oneself from dangerous impulses to cope with anxieties and struggles may hint at an impulse control disorder.

Co-Occurring Conditions

These conditions are often related to or can co-occur alongside other teen mental health issues, including:

When to Seek Professional Help

The main difference between disordered behavior and unwanted or unsavory behavior is the inability to change without intervention, the severity of the behavior, and how it affects others. It is entirely normal for teens to misbehave and push boundaries. Sometimes, they go too far and make mistakes they learn from. Some teens take longer to learn certain lessons than others.

But when a teen repeatedly and remorselessly hurts others, or shows remorse yet fails to control themselves, or otherwise becomes a danger to themselves or those around them, it is time to seek professional advice. Disruptive, impulse control and conduct disorders can be severe and damaging to teens and their loved ones. If you suspect that your teen might not be able to improve their behavior on their own, it may be time to get help.

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Mental Health Mood Disorders Personality Disorder Recovery Self-Care

Mental Health is Mental Wealth

When someone suffers from mental illness, there is a deprivation of the joy and emotional wealth that’s present when there is ideal mental health. Mental illness can drain our joie de vivre, and make for a muddy emotional existence. Relationships with loved ones tend to be difficult, and there tends to be a propensity for loneliness and isolation. Worse yet, when mental illness is left untreated, the toll it can take on the one suffering and their loved ones can be taxing and sometimes devastating.

 

Some types of mental illness are more straightforward in their treatment: anxiety and depression, for example, are often treated with various modalities of psychotherapy and balanced with medication. Personality disorders are complex and there are some instances where the patient doesn’t recognize their illness despite their deep suffering. The work involved in treating all mental illness requires a nexus of therapeutic support and a desire for positive change from the patient themselves. The question many have is, Why are personality disorders so challenging?

 

Personality disorders are grouped into three clusters:

  • Cluster A personality disorders are “characterized by odd, eccentric thinking or behavior.” The disorders that fall into this category are:  paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder
  • Cluster B personality disorders are “characterized by dramatic, overly emotional or unpredictable thinking or behavior.” The disorders that fall into this category are: antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.
  • Cluster C personality disorders are “characterized by anxious, fearful thinking or behavior.” The disorders that fall into this category are: avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

 

Psychotherapy is the most common treatment for all types of mental illness; the most efficacious modality is determined by the needs of the client. Findings show that DBT (Dialectical Behavioral Therapy) in particular is the most effective therapeutic treatment for personality disorders and bipolar disorders. Other effective tools used in treatment may include:

  • Individual psychotherapy
  • MBSR (Mindfulness Based Stress Reduction)
  • Yoga
  • Meditation
  • Somatic Experiencing
  • Neurofeedback

 

To date, the FDA hasn’t approved of any medications to treat personality disorders. However, medications are often used to treat symptoms that are detrimental to the individual’s recovery. Medications like:

 

  • Antidepressents: for depressed mood, anger, irritability, mood swings, impulsivity and hopelessness.
  • Mood stabilizers: to even out mood swings, and to reduce impulsivity, irritability and aggression.
  • Antipsychotic medications (also known as neuroleptics): if symptoms include losing touch with reality (psychosis), and sometimes anxiety and difficulty with anger
  • Anti-anxiety medications: For anxiety, agitation or insomnia. Note, in some cases, they may increase impulsive behavior and are avoided with some personality disorders.

 

Treating mental illness requires the cultivation of balance. Participation from the client, a cohesive treatment team, and the correct combination of medication can create the desired environment of mental health.  It takes work, dedication, and a willingness to unveil one’s difficulties in order to create a healthy shift toward mental health. I have experienced the shadow side of untreated mental illness with family members who are unwilling to get help. It does, in fact, take a toll on everyone involved. I have learned that one of the key pieces for my own recovery is developing clear communication skills, creating firm, compassionate boundaries, and building consistent program of self-care. Families struggling with mental illness need to ensure that their own wells are filled, that they are getting their own needs met, and that they have a community of support around them.

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Dialectical Behavioral Therapy (DBT) Mental Health Mood Disorders Recovery Therapy Treatment

DBT With Dr. Georgina Smith, Ph.D

We are pleased to welcome Dr. Georgina Smith, Ph.D to the Visions clinical team. She has been working with adults, families, and children since 2001, making her vast knowledge of neurofeedback and Dialectical Behavorial Therapy (DBT) accessible to a wide range of clientele. Dr. Smith specializes in treating survivors of trauma, abuse, and those suffering from eating disorders, and addiction. She also treats individuals suffering from chronic depression, self-injury, mood, personality, and anxiety disorders. Her knowledge and use of neurofeedback and DBT allows her to help her clients in a way that empowers them be engaged in their own recovery. Dr. Smith’s approach is holistic, and caring, and she ardently believes in ensuring that her clients feel seen. Her work with adolescents has built an authentic treatment style where she is able to form a genuine connection with her clients, so they feel seen, heard, validated and challenged. Dr. Smith encourages them to be ok in the skin they’re in. That particular tenant of treatment spreads healing throughout one’s mind, body, and spirit.

With the addition of Dr. Georgina Smith, clients have access to DBT in all phases of their treatment. DBT, in particular, is one of the most efficacious treatments for mood disorders, namely Borderline Personality Disorder. DBT uses mindfulness, self-awareness, and skill building in the areas of trauma, emotional regulation, interpersonal effectiveness and crisis management.  One of the most remarkable pieces of DBT is its effectiveness in teaching clients to regulate their emotions and recognize when they are becoming deregulated. Self-awareness in someone trying to manage extreme emotions is undeniably helpful.

Currently, Dr. Smith is seeing Visions’ clients for DBT as well as running a DBT group on a weekly basis. We are looking forward to working with Dr. Smith and are excited to have her as part of our clinical staff.  She is down to earth, and brings a sense of realness to her groups and throughout her clinical practice. She says it best, “So many of the kids I’ve worked with are struggling to make sense of things they’ve been through, struggling with their sense of self and others, and a confusing, chaotic world. The space I create with them is about being ok wherever they are, whoever they are, so we can open the doors to choice and change. It is about ownership, realness & empowerment.” Welcome to the VTeam, Georgina!

Categories
Bipolar Disorder Mental Health Mood Disorders Personality Disorder Recovery Therapy

Behavioral Health Educational Seminar: Complex Approaches for Complex Disorders

Christina Howard introducing David Miklowitz, PhD.

On Friday, September 28, we had the honor of co-hosting a Behavioral Health Educational Seminar, addressing Treatment Resistant Mood Disorders, and BiPolar Disorders. We co-hosted the seminar with Austen Riggs and PCH Treatment at the beautiful Victorian in Santa Monica, California.

Eric Plakun, MD, DFAPA, FACPsych and Director of Admissions and Public Relations at Austen Riggs Center spoke about A Psychodynamic Approach to Treatment Resistant Mood Disorders.

David J. Miklowitz, PhD, Professor of Psychiatry in the Divisions of Child and Adolescent Psychiatry at the UCLA Semel Institute and the Bipolar Treatment Consultant at PCH Treatment Center spoke about Bipolar Disorder: Current Thinking About Diagnosis and Treatment. Dr. Miklowitz is also a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University.

These informational seminars are a wonderful way to build upon one’s education, building upon the ever-changing information surrounding mental health care. Things will change with the new DSM-V slated to come out in the next year. We are incredibly fortunate to have so many knowledgable professionals in our midst.

Check out a few photos from the event. I must say, aside from incredible information from the speakers, the food was out of this world.

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