Self Harm – Is Your Child Engaging in it?

Self harm or self-injury is the intentional wounding of one’s own body. Most often, people who self harm will cut themselves with a sharp object.

Self harming may also include:

  • severely scratching areas of their body with a fingernail or sharpened object
  • carving words or patterns into their skin
  • burning or branding themselves using lighters, cigarettes, lit matches, or other hot objects
  • biting themselves
  • excessively picking at their skin (dermatillomania) or wounds
  • hair pulling (trichotillomania)
  • head banging
  • punching or hitting themselves
  • excessive skin-piercing or tattooing may also be indicators of self harm

Generally, people who self-harm do so in private. Often, they follow a ritual. For example, they might have a favorite object that they use to cut themselves or they may listen to certain music while they self injure.

Self harmers will target any area of the body, but the legs, arms, or front of the body are the most commonly selected. These areas are not only easy to reach, they are also easy to cover up, allowing the person to hide their wounds away from judgmental eyes.

Additionally, self harm can include actions that don’t seem so obvious to others. Activities like excessive substance abuse or binge drinking, driving recklessly or having unsafe sex can all be signs of self harm.

Causes of Self Harm

There are many reasons that people engage in the unhealthy coping mechanism of self-injury.

Oftentimes, a self-mutilator may have trouble understanding or expressing their emotions. Those who self harm report feelings of worthlessness and rejection, loneliness or isolation, guilt, self-hatred, and anger.

When a self harmer attacks their own body, they are really seeking:

  • distraction from painful emotions
  • to release intolerable mental anguish
  • a sense of control over their feelings, their body, or their lives
  • a physical distraction from emotional pain or emotional “numbness”
  • to punish themselves for supposed faults

People who self injure often feel an intense yearning to injure themselves. Even though they know it’s destructive, this feeling grows stronger until they complete the act of mutilation.  Feeling the resulting pain releases their distress and anxiety. This relief is only temporary, though, until their shame, guilt, and emotional pain triggers them to injure themselves again.

Who is At Risk for Self Harm?

Self injury happens in all walks of life. It is not restricted to a certain race or age group, nor to a particular educational or socioeconomic background.

It does happen more often in:

  • people with a background of childhood trauma, such as verbal, physical, or sexual abuse
  • those who have difficulty expressing their emotions
  • those without a strong social support network or, conversely, in those who have friends who also self harm
  • people who also have obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), eating disorders, borderline personality disorder, or those who engage in substance abuse

Although anyone may self harm, the behavior occurs most frequently in teens and young adults. Females tend to engage in cutting and other forms of self-mutilation at an earlier age than males, but adolescent boys have the highest incidence of non-suicidal self injury.

Self-Harming Symptoms

Physical signs of self harm may include:

  • unexplained scars, often on wrists, arms, chest, or thighs
  • covering up arms or legs with long pants or long-sleeved shirts, even in very hot weather
  • fresh bruises, scratches or cuts
  • telling others they are clumsy and have frequent “accidents” as a way to explain their injuries
  • keeping sharp objects (knives, razors, needles) either on their person or nearby
  • blood stains on tissues, towels, or bed sheets

Emotional signs of self harm may include:

  • making statements of feeling hopeless, worthless, or helpless
  • isolation and withdrawal
  • impulsivity
  • emotional unpredictability
  • problems with personal relationships

Help for Self Harm

The first step in getting help for self harm is to tell someone that you are injuring yourself. Make sure the person is someone you trust, like a parent, your significant other, or a close friend. If you feel uncomfortable telling someone close to you, tell a teacher, counselor, religious or spiritual advisor, or a mental health professional.

Professional treatment for self injury depends on the specific case and whether or not there are any related mental health concerns. For example, if the person is self harming but also has depression, treatment with address the underlying mood disorder as well.

Most commonly, self harm is treated with a psychotherapy modality, such as:

  • Cognitive behavioral therapy (CBT), which helps the person identify negative beliefs and inaccurate thoughts, so they can challenge them and learn to react more positively.
  • Psychodynamic psychotherapy, which helps identify the issues that trigger their self-harming impulses. This therapy will develop skills to better manage stress and regulate emotions.
  • Dialectical behavior therapy (DBT), which helps the person learn better ways to tolerate distress. They’ll also learn coping skills so they can control the urge to self harm.
  • Mindfulness-based therapies, which can teach them skills to effectively cope with the myriad of issues that cause distress on a regular basis.

Treatment for self injury may include group therapy or family therapy in addition to individual therapy.

Self care for self-harming includes:

  • Asking for help from someone whom you can call immediately if you feel the need to self injure.
  • Following your treatment plan by keeping your therapy appointments.
  • Taking any prescribed medicines as directed, for underlying mental health conditions.
  • Identifying the feelings or situations that trigger your need to self harm. When you feel an urge, document what happened before it started. What were you doing? Who was with you? What was said? How did you feel? After a while, you’ll see a pattern, which will help you avoid the trigger. This also allows you to make a plan for ways to soothe or distract yourself when it comes up.
  • Being kind to yourself – eat healthy foods, learn relaxation techniques, and become more physically active.
  • Avoiding websites that idealize self harm.

 If your loved one self-injures:

  • Offer support and don’t criticize or judge. Yelling and arguments may increase the risk that they will self harm.
  • Praise their efforts as they work toward healthier emotional expression.
  • Learn more about self-injuring so you can understand the behavior and be compassionate towards your loved one.
  • Know the plan that the person and their therapist made for preventing relapse, then help them follow these coping strategies if they encounter a trigger.
  • Find support for yourself by joining a local or online support group for those affected by self-injuring behaviors.
  • Let the person know they’re not alone and that you care.

Need More Information?

Are you concerned that your child is engaging in self harm? Don’t wait to seek help – speak to a compassionate child psychologist at The Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us for more information or call us at (561) 223-6568.

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Mental Health and a Slice of Pizza

Mental Health and a Slice of Pizza

I am sure you are wondering what pizza has to do with mental health. It is much more than enjoying a tasty slice or two. A slice of pizza represents a part of a whole and introduces us to the concept of systems theory. The systems concept helps us process a lot of information in a more orderly way, to be able to go back and forth between the whole and its parts, understanding the interaction between the forest and its trees. We can examine the individual trees while at the same time taking in the picture of the entire forest.

One’s mental health represents the forest. The goal of this paper is to better understand the trees, the critical systems that contribute to the whole of our emotional being. We are all aware of the nature versus nurture approach. To what degree can we explain a person’s psychological makeup on genes (nature) or upbringing and life experience (nurture)? I wish it was that simple, just a matter of measuring the degree to which nature and/or nurture matter so we can then direct treatment proportionally to each factor. How does one measure the effect of a problematic childhood or stressful life events? How to quantify the brain-based source of bipolar disorder or schizophrenia? Mental health professionals have some tools to provide these measurements but they are extraordinarily rudimentary. Our technology in not yet at the level to allow for definitive answers. A general systems approach helps us address the biological, psychological and social fields that ultimately contribute to our wellbeing or ill mental health.

The biological field consists of not just our brain but the body systems that ultimately influence brain function such as the cardiovascular, endocrine, pulmonary and gastrointestinal. As an example, chronic obstructive pulmonary disease (COPD) can reduce the availability of oxygen to the brain and consequently alter brain function. A simple experiment decades ago demonstrated that the use of a portable oxygen generator can significantly increase the IQ of a person suffering from COPD. This same individual would subsequently experience less depression and emotional duress. Or the individual on a variety of sedating medications that erroneously creates a clinical picture of memory deficits masquerading as a dementia. Additionally, if one has a medical disorder that will be lifelong, how do we anticipate the psychological toll it will take on the person in the future? Addressing these concerns become an essential part of the treatment team.

The social systems are a bit more difficult to assess due to the subjective nature of data gathering. Family of origin influences are paramount. Negative influences can be mollified by the presence of healthy role models and support systems when young. Interpersonal relations represent an important influence on self concept development. Only recently have we begun to recognize the impact of childhood bullying on the psyche. The goal of a reasonably healthy childhood is to produce a person whose self regard and image is based on their own uniqueness, not necessarily on being good looking, a star athlete, rich of top of their class. This healthy self concept serves as the foundation for the acquisition of future skill, talents and attributes.

To further complicate the impact of social systems on mental health we have to add a time dimension to our study that includes the past, present and the future. A person who comes out of a pathological family of origin can then be exposed to corrective emotional experiences in the present (like good friends and role models) that help dilute the damage already done. Likewise, emerging from a healthy childhood only to be currently traumatized in battle can result in enduring psychological difficulties like post traumatic stress disorder. We must also pay attention to the individual’s expectations of the future. Do they look forward with a cup is half empty approach or with a cup is half full attitude? Are they on a life path that will help ensure future stability (like a career, education, marriage, etc.) or are they proceeding towards the future with limited or confused goals and plans? Or, have they been influenced to pursue a career by their family that they really had no say in and find themselves trapped and helpless? These are several examples of the data that must be gathered by mental health professionals.

Psychological systems are not as easily assessed because they represent concepts that must be deduced and not so easily observed or measured. They include attitudes, belief systems and coping styles. They are the product of one’s journey through childhood and later life representing an ongoing learning process, for good of for bad, a process that can be adaptive or maladaptive for healthy growth. When maladaptive traits are significantly pervasive and persistently interfere with function we raise the clinical possibility of a character or personality disorder. The veracity of this diagnosis is important because treatment of personality disorders can be quite difficult and protracted.

Once we gather systems data it is now necessary to develop a treatment plan. How to determine where to direct treatment? If someone presents with depression, is it adequate to prescribe an antidepressant alone and offer no other treatment recommendations? This is where the systems approach becomes essential. For example, treating the depression alone without attending to address the presence of significant marital discord in an individual with childhood trauma will not result in the desired outcome unless the other areas of dysfunction are addressed. Sometimes it is necessary to create a stepwise approach. Let us assume that the individual with depression is so depressed that full participation in psychotherapy would be unproductive until the depression begins to improve. In this case it would be important to improve the depression with medication before proceeding with psychotherapy.

As I have discussed in past articles it is a challenge to determine if a person’s current symptoms represent a brain-based biological disorder or a reaction to a life situation. We know that all behavior, thought processes and emotional expression emanates from our brains but the difference between a biological disorder and a life reactive state is that the former tends to be long-lasting and persistent while the latter tends to be time-limited. It is important to recognize that there is a middle ground between the biological and the situational states disorders is best described as a hybrid state. The hybrid state occurs when an individual with a biological (possibly genetic) predisposition to depression, anxiety or psychotic disorders interacts with a stressful life situation. The biological predisposition is then activated and resulting in a pathological disorder.

Our pizza pie model of mental healthcare would not be complete without a discussion about the importance of assembling a team of professionals to provide both evaluation and treatment. The ideal team is composed of multidisciplinary licensed mental health professionals with multimodality evaluation and treatment capabilities. The ability to provide a comprehensive psychological test battery, perform a focused psychological trauma assessment or obtain a medical neuropsychiatric evaluation makes it possible to  identify which slices of our pizza pie need to be addressed in the treatment plan. Most importantly, the presence of this team under one roof allows for ongoing treatment meetings and consultations among the professionals. Being able to share clinical information in realtime is essential to the management of complex mental health problems. Teamwork also provides mutual support for the clinicians and promotes professional growth.

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7 Tips for Overcoming Back to School Anxiety

Another school year has come around and with it, the possibility of extreme fear and separation anxiety for some children. Although it’s normal for any kid to have a certain degree of back to school anxiety, there is a huge difference between a child who is nervous about the new school year and one whose anxiety is severe enough to seek professional care.

Kids often worry about things like fitting in or whether the teacher will pick on them, which increases their stress. In the week leading up to the beginning of the school year or in the last few days before the end of a school break, younger kids may show some separation anxiety by crying frequently, throwing temper tantrums, or being more clingy than usual. Older children’s school anxiety symptoms can include being moody or irritable, complaining of headaches or stomach aches, or withdrawing into themselves.  So how can a parent tell if their child just has school jitters or if they truly have back to school anxiety?

Fears about new teachers, harder school work, and being away from their parents are common for kids and usually stop within a couple of weeks once the child settles into the routine of the new school year. For those children whose anxiety symptoms continue beyond the first four or five weeks of school or seem extreme or inappropriate for their developmental level, a consultation with a therapist may be in order.

Tips to Ease School Fears

If your child is worried about the new school year, these back to school anxiety tips can help

  • Help you child identify what it is they are worrying about. Assure them that it’s normal to have fears. Give them your full attention and be sure to set a regular time and place to talk to them about their concerns. For example, bath time might be a good time to talk to a younger child, while a teen might be more receptive later in the evening.
  • Focus on the positives: In order to redirect your child’s attention from their worries, ask them to tell you a couple of things that are positive about school. Generally, even the most nervous child can think of something they like about it. Maybe they have a new friend or enjoy a certain subject or look forward to working on an art project. Looking for the positives can make the negatives seem a little less overwhelming.
  • Don’t pacify the child, instead coach them to come up with ways to solve their problem. Telling your child that “things will be okay” doesn’t help them get past their fears. What does is giving them some control. Encourage the child to give you some ideas of ways they can deal with what’s concerning them. This type of problem-solving helps them learn coping skills and teaches them critical thinking so they can develop a plan instead of simply reacting negatively.
  • Try role-playing. Going through a particular scenario can often help your child feel confident. Let the child be the “bad guy” teacher or scary bully, while you play the part of the child. Your responses can help them learn how to deal with the situation appropriately and allow them to respond with less fear.
  • Reinforce positive behaviors and reward their successes and their bravery in facing what they fear.
  • Be supportive, but don’t allow them to stay home from school. Even though it is normal for your child to worry about going to school, it is crucial that they attend. Allowing them to avoid school only increases and reinforces their fears. The longer they stay out of school the harder it can be for them to go back.
  • Seek professional help for back to school anxiety that gets worse or lasts more than about four weeks. Additionally, medication is sometimes appropriate in severe cases of separation anxiety.

Help Your Child Overcome Back to School Anxiety

If your child is struggling with back to school anxiety, it may be time to seek help from a compassionate child psychologist at Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us for more information at (561) 223-6568.

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jBaby – An Educational Program Series from The Jewish Federation of South Palm Beach County

Introducing jBaby, an educational program series from The Jewish Federation of South Palm Beach County. This six part program series for parents focuses on important pre-natal topics presented by local topic experts. See below for the full schedule and be sure to RSVP to this program series here.

6-part program series for parents (pre-natal) – $118

For more information, please call Liana Konhauzer at 561.852.5015 or email lianak@bocafed.org.

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Does Rapid Onset Gender Dysphoria Exist?

When a person feels strongly that they don’t identify with the biological gender they were born with, the American Psychiatric Association terms them as having gender dysphoria. Although children as young as age four may express gender nonconformity, many times gender dysphoria doesn’t become evident to the person until they reach puberty and realize they are not comfortable with the changes going on in their bodies. For a gender dysphoria diagnosis, the person must feel these symptoms for at least six months. Recently, however, some researchers have been exploring a new development in gender dysphoria that seems to occur very suddenly and without the child having expressed any prior distress with their physical gender. This is called Rapid Onset Gender Dysphoria (ROGD).

What is Rapid Onset Gender Dysphoria?

Rapid Onset Gender Dysphoria is a term that has sprung up within the past couple of years. It is important to note that ROGD has not been established as a distinct syndrome. This dysphoria has been casually (not scientifically) observed.

In ROGD, an adolescent or young adult who has always identified as their physical (birth) gender suddenly starts to identify as another gender. Prior to this, the child would not have met the criteria for gender dysphoria nor would they have displayed any discomfort with their gender. Additionally, often multiple friends within the same peer group simultaneously identify with another gender and become gender dysphoric around the same time.

Why is ROGD Controversial?

Recently a Brown University researcher published a study “to empirically describe teens and young adults who did not have symptoms of gender dysphoria during childhood but who were observed by their parents to rapidly develop gender dysphoria symptoms over days, weeks or months during or after puberty.” The study author was Lisa Littman, an assistant professor of the practice of behavioral and social sciences at Brown’s School of Public Health.

Littman surveyed over 250 parents whose children had suddenly developed gender dysphoria symptoms. Of the parents who answered the survey, about 45 percent reported that their child had increased their social media use and that the child had one or more friends who became transgender-identified around the same time as their child.

This led to Littman’s hypothesis that gender dysphoria could be at least partially spread by social contagion. She proposed that social media and a child’s peers could cause the child to embrace certain beliefs, such as the idea that feeling uneasy with the gender you were born with meant you were gender dysphoric. Because many RODG teens also push for medical transition to another gender, Littman suggested that this could actually be a harmful coping tool in the same way that drugs, alcohol or substance abuse are negative coping mechanisms.

Transgender advocates fiercely criticized Littman’s study, saying it was methodologically flawed because Littman only interviewed parents and not the transgender-identifying children themselves. They also called the study “antitransgender” and a denial of transgender affirmation while citing the fact that a person who is questioning their gender and seeking answers would naturally read up on the subject and spend time with supportive friends who may have similar thoughts and feelings. Advocates pointed out that a true gender dysphoria diagnosis requires evaluation by specialists, while Rapid Onset Gender Dysphoria only required the parent’s perspective.

As a result of the criticism, Brown withdrew its press release about the study and wrote a statement explaining its decision to conduct a post-publication re-review. They worried that the study “could be used to discredit efforts to support transgender youth and invalidate the perspectives of members of the transgender community.”

Gender Dysphoria Treatment

Clearly, more research is needed in order to settle the question of whether Rapid Onset Gender Dysphoria is real, however we know that gender dysphoria exists. Early diagnosis, gender-affirming approaches by parents, and individual and family counseling can help the transgender person and their loved ones deal with the emotional challenges of gender transition.

Many transgender people take action to be more in alignment with who they feel they are. They might change their name to one more suited to the gender they express or dress as that gender. Other options include taking puberty blockers, hormones to develop physical traits for the gender they identify with, or sex-reassignment surgery.

We know that people with gender dysphoria have higher rates of mental health conditions like depersonalization disorder, anxiety, depression and mood disorders, and increased substance abuse. They also experience higher suicide rates, therefore it is important for them to seek mental health treatment. The goal of treatment is not to change the person’s feelings about their gender, rather it is to give them a way to deal with the emotional issues that come with gender dysphoria.

Get Answers about Gender Dysphoria and ROGD

If you or a loved one are distressed, anxious, or depressed about your gender identity, we can help. Contact the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida for more information or call us today at (561) 223-6568.

 

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Bullying Kids With Food Allergies

anti bullying group counseling for teens in Delray Beach, FLImagine being a child who lives with severe food allergies. Ingesting even the tiniest amount of the allergen (or having it touch your skin) can be enough to trigger anaphylaxis, which can kill you. Your condition is so severe that you must extremely vigilant about your food and you carry an epinephrine injector everywhere you go in case your inadvertently miss something and begin having trouble breathing or your throat starts to close. Now imagine fellow students bullying you because of your life-threatening allergies or having a fellow student force you to touch or eat the food that might kill you. It sounds far-fetched in view of the danger, but that’s a real life scenario for approximately 31.5% of children with food allergies, according to a 2013 study reported in Pediatrics.

These children are being singled out for harassment and are more than twice as likely to be bullied specifically because their food allergies.

Food Intolerance or Food Allergy?

5.9 million kids in the U. S. have food allergies. In fact, the Centers for Disease Control and Prevention (CDC) reports that “among children aged 0–17 years, the prevalence of food allergies increased from 3.4% in 1997–1999 to 5.1% in 2009–2011”. That means about 1 child out of every 13 in a given classroom has a food allergy.

According to the American College of Allergy, Asthma & Immunology, food allergies occur “when your body’s natural defenses overreact to exposure to a particular substance, treating it as an invader and sending out chemicals to defend against it.”

A true food allergy isn’t the same as the more common food intolerances we think of when we avoid a certain food because it will negatively affect our body (for example: lactose intolerance). Instead, food allergies trigger a person’s immune system, sending it into overdrive. This overreaction can bring on symptoms ranging from mild (like hives, itchiness, or gastric problems) all the way up to anaphylaxis, which can be life-threatening.

Food allergy reactions can start in as little as two minutes and as long as two hours after eating or touching the food. The Mayo Clinic reports that the most common food allergy signs and symptoms include:

  • Tingling or itching in the mouth
  • Hives, itching or eczema
  • Swelling of the lips, face, tongue and throat or other parts of the body
  • Wheezing, nasal congestion or trouble breathing
  • Abdominal pain, diarrhea, nausea or vomiting
  • Dizziness, lightheadedness or fainting

Anaphylaxis

In some people, a food allergy can trigger a severe allergic reaction called anaphylaxis. This can cause life-threatening signs and symptoms, including:

  • Constriction and tightening of the airways
  • A swollen throat or the sensation of a lump in your throat that makes it difficult to breathe
  • Shock with a severe drop in blood pressure
  • Rapid pulse
  • Dizziness, lightheadedness or loss of consciousness

Emergency treatment is critical for anaphylaxis. Untreated, anaphylaxis can cause a coma or even death.

Impact of Food Allergy Bullying

Often, kids think it is funny to tease and bully kids who have food allergies. This may be because they don’t really understand what can happen to children who have severe food allergies, although older kids and teens clearly have an idea. A 2018 New York Times article reported that a parent stated on Twitter that his son was “taunted by ‘friends’ with a PB & J sandwich,” who said, “‘let’s see if he dies.’” In other cases, “children with food allergies have had milk poured over them, peanuts waved in their faces, cake thrown at them, and peanut butter smeared on them.”

This harassment and stress can cause allergic children to fear school, leading to school refusal, and can make them depressed or cause them to isolate themselves socially. Parental involvement can help keep down the attacks, but children only report the harassment to their parents about 52.1% of the time. Additionally, teachers often make insensitive remarks or single-out and exclude children with food allergies from certain activities or school functions, further contributing to the child’s feelings of isolation and anxiety.

Increasingly, there have been legal consequences for food allergy bullying. In 2017, a 13 year-old U. K. boy was arrested for attempted murder after flicking a piece of cheese into a fellow student’s mouth, causing an anaphylactic reaction that led to the victim’s death. That same year in the U. S., a Michigan student with a peanut allergy (who was unconscious due to a hazing incident) was smeared in the face with peanut butter, resulting in an anaphylactic reaction. Thankfully, he later recovered, but the perpetrator pleaded guilty to assault and battery charges.

What Should Parents Do?

  • Know what’s going on by staying involved at your child’s school.
  • Know the signs of bullying: your child refuses to go to school, has stomach aches, stops talking about peers or friends, their grades may drop, or their sleep patterns may change.
  • Teach your child what to do if they are being bullied – make sure they know they should tell the school nurse or their teacher. Also teach them to tell you. Studies show that children experience a reduction or cessation in bullying if a parent knows they are being bullied.
  • Discuss your child’s allergies and their severity with the school principal and with your child’s teacher before your child starts the school year. Find out about the school’s anti-bullying policies and the procedures for handling an incident.
  • Seek help from your child’s friends and classmates. They will often see things a teacher may not and can report any threats to your child’s teacher or warn your child of impending danger.
  • Teach your children compassion and caring so they learn it’s not funny to bully others and that people can be hurt or can die from what might seem like a harmless prank.

Get Help for Bullying

It’s important to seek help as soon as possible if your child becomes the target of food allergy bullying. For more information about how a child psychologist at the Children’s Center can help your child stand up to bullying, contact the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

 

Article Resources

https://www.allergicliving.com/2017/09/06/michigan-student-pleads-guilty-in-peanut-butter-face-smearing-case/

https://www.nytimes.com/2018/02/15/well/family/in-allergy-bullying-food-can-hurt.html

https://snacksafely.com/2017/07/food-allergy-bullying-leads-to-death-of-13-year-old-boy-arrest-of-another/

 

 

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