Dermatillomania (Skin Picking Disorder)

While it’s simply “being human” to occasionally pick at your skin, at calluses, or at the cuticles on your fingers, when a person obsessively self-grooms, it could be a sign of dermatillomania or excoriation disorder. In layman’s terms, this is a skin picking disorder. The condition is a form of obsessive-compulsive disorder and is one of a group of body-focused repetitive behaviors (BFRB). Dermatillomania damages skin and is characterized by compulsively picking, touching, pulling, rubbing, digging into, scratching, or even biting at one’s own skin as a way to get rid of perceived skin irregularities.

Signs of Dermatillomania

Research shows that anywhere between 2% and 5% of people compulsively pick at their skin. Females make up about 75% of those who are diagnosed with excoriation disorder. Skin picking can begin at any age, but commonly shows up in adolescence or at the onset of puberty. The condition made come and go over time, and the location the person picks at may change, but the disorder is generally chronic.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) signs and symptoms of dermatillomania include:

  • Skin picking that results in visible lesions, skin damage, scars and possibly disfigurement
  • The person has made repeated, unsuccessful attempts to stop picking at their skin
  • The symptoms cause clinically significant distress or impairment
  • The symptoms are not caused by a medical or dermatologic condition or by a substance (example: opiate withdrawal)
  • The signs and symptoms are not better explained by another psychiatric disorder

Picking at the skin can cause anxiety, depression and embarrassment in those who have dermatillomania. They may attempt to cover their skin lesions with makeup or clothing and may avoid situations in which their condition may be discovered. This can lead to isolation and emotional distress, which can increase the risk of having a mood or anxiety disorder in addition to their dermatillomania. Another complication can be the need for medical care because it isn’t uncommon for the person to get a skin infection, open wound, or scars from picking too much.

Treatment for Skin Picking Disorder

It is thought that fewer than one in five people will seek treatment for excoriation disorder, however Cognitive Behavioral Therapy (CBT) is very helpful for those who do. CBT helps patients identify the negative or inaccurate thoughts, feelings and behaviors that have become problematic and teaches them how to challenge and change their reaction to them.

While the main therapy for dermatillomania is behavioral therapy, medication is sometimes used to reduce the feelings that lead to compulsive skin picking. Although psychiatric medications have limited success, there are some people who benefit from temporary use of them, particularly if they have a concurrent condition, such as anxiety or depression. Additionally, some skin medications can help the underlying condition (such as acne) that causes the individual to pick at their skin.

As a family member, it can be difficult to be supportive of a person with dermatillomania or other BFRBs. The behavior can strain relationships with friends and family. Remember to communicate with patience and empathy and remain calm when talking to the person. If you feel overwhelmed, join a support group or explore the resources in self-help groups or in books on the subject.

Get Help for Dermatillomania

For more information about how a child psychologist at the Children’s Center can help your child overcome skin picking, contact the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

Read More

ADAA Session Recording -Treatment Resistant Panic Disorder

Our team presented at the 2018 ADAA Conference on Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach. You can access the audio recording of our session here with the below login credentials.

Username: arosen1980@aol.com

Password: 1667947

We hope you find the recording of our presentation helpful and informative!

Read More

LGBTQ Teens and Their Mental Health Risks

It’s only been in the last twenty years or so that young people who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) have become more open about their sexuality. For many of these youths, their fear of not being accepted by their families and peers kept them from telling anyone about their orientation until they were adults. Recently, however, these teens have found more access to support through an increase in social acceptance, internet communities, school diversity programs, and youth groups for LGBTQ adolescents. These resources have allowed them to feel more comfortable with their sexual orientation and helped them come out to others at a younger age than in the past. Even though LGBTQ teens are finding more support, however, they still face unique mental health risks.

LGBTQ Teens Face Mental Health Concerns

Despite the fact that identifying as LGBTQ has become more socially acceptable, a gay teen has a disproportionately higher amount of mental health concerns than their heterosexual counterpart. The Centers for Disease Control and Prevention (CDC) reports that LGBTQ teens have an increased risk of personal violence:

  • 34% reported being bullied on school grounds
  • 23% had experienced sexual dating violence within the past year
  • 18% had experienced sexual dating violence

The National Institutes of Health (NIH) reports that sexual minorities, such as LGBTQ teens, face not only chronic stress from their stigmatized identities, but also victimization, prejudice, and discrimination. How much these external stressors affect these youths depends on their own negative internalization of their sexual orientation, their expectation or personal experience with discrimination or rejection, and their ability to cope with these stressors.

Studies have also shown that teens and adolescents who identify as LGBTQ are at greater risk for mental health problems across all developmental stages. Among other things, they have:

  • A suicide risk that is nearly three times higher than that of heterosexual youths
  • Higher rates of suicide ideation
  • Elevated rates of anxiety and depression
  • Almost 18% of lesbian and gay youth participants met the criteria for major depression
  • 3% met the criteria for PTSD in the previous 12 months
  • 31% of the LGBT sample reported suicidal behavior at some point in their life

How Parents Can Support Their LGBTQ Teen

Positive parenting behaviors can have a huge impact on an LGBTQ teen’s mental and physical health, both now and in the future. When parents show their child they are valued, their teens have healthier mental and emotional outcomes. Not unsurprisingly, the CDC reports that parental rejection has been linked to drug and alcohol use, risky sexual behavior, and depression in LGBTQ youths.

As a parent, you can support your LGBTQ teen in many ways:

  • Provide support by relating to your child respectfully and without judgement. This begins with you taking the time to come to terms with your child’s sexual orientation when they first tell you about it.
  • Talk and listen to your child. Open, honest conversations help your teen feel loved and accepted. By communication openly, you can guide your child into making good decisions that will help them avoid risky sexual behaviors and putting themselves into unsafe situations.
  • Stay involved with your child. Knowing their friends, who they are dating, and what they are up to can help your child feel cared for and safe.
  • Be proactive and seek out organizations and support groups for your teen (and for yourself, if necessary).
  • If you think your child is depressed or in need of mental health support, speak with a school counselor, a social worker, child psychologist or other mental health professional.

Learn More about Supporting Your LGBTQ Teen

For more information about how you can support your LGBTQ youth, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

 

Read More

Toxic Stress and Child Development

Social Skills Training can help children and young adults connect with other.Stress surrounds us on a daily basis. From traffic delays to work projects, worries about finances or health, and news reports of world events, the demands of our everyday lives produce both positive and negative stress. Stressors (which are the things that cause your stress) can be physical, emotional, theoretical, or environmental. Even positive events like weddings and job promotions cause stress.

Whether negative or positive, one thing is certain – stress raises the body’s anxiety levels. When we’re under stress, the “fight or flight” response kicks in. It raises your heart rate and your blood pressure. It sometimes causes you to lose sleep or feel like you can’t breathe. While this response generally subsides after the stressor is removed, a prolonged or permanent stress response can develop in someone who is under frequent or constant stress. This is called toxic stress and it can affect children just the same as adults.

Effects of Stress on Kids

The incidence of diabetes, obesity, heart problems, cancer and other diseases increases when a child lives with toxic stress. Additionally, a child’s chances of smoking, depression, substance abuse and dependence, teen pregnancy and/or sexually transmitted disease, suicide and domestic violence escalates. So does their tendency to be more violent or to become a victim of violence.

Studies done by the Centers for Disease Control and Prevention (CDC) show that when a child is subjected to frequent or continual stress from thing like neglect, abuse, dysfunctional families or domestic abuse – and they lack adequate support from adults – their brain architecture is actually altered and their organ systems become weakened. As a result, kids who live with stress risk lifelong social and health problems.

Of the 17,000 people participating in the CDC study, two thirds reported an Adverse Childhood Experiences (ACE) score of 1 or higher. Of these, 87% had more than one ACE. By measuring and scoring ten types of trauma ranging from neglect or bullying to childhood sexual abuse and even divorce, researchers could assess the chronic disease risk for the study’s mostly white, middle class participants. Their results showed that the problem of toxic stress isn’t limited to children of certain ethnic groups or those who face poverty – children from all walks of life can have high ACE scores which will affect their entire lives.

If you would like to find out your ACE score and what it might mean for you, go here.

Signs of stress

Children who are exposed to toxic stress exhibit:

  • Poorly developed executive functioning skills
  • Lack of self-reflection and self-regulation
  • Reduced impulse control
  • Maladaptive coping skills
  • Poor stress management

Research on children who face continued toxic stress shows they are more likely to have:

  • Trouble learning in school
  • Difficulty trusting adults, forming healthy relationships and will have an increased chance of divorce as an adult
  • Higher incidence of unhealthy behaviors such as engaging in sexual experimentation and unsafe sexual practices, participating in high-risk sports, smoking, substance abuse and alcohol abuse
  • Higher incidence of depressive disorders, post-traumatic stress disorder (PTSD), behavioral disorders, and even psychosis
  • Poor health outcomes such as heart disease, obesity, diabetes, cancer, and have a higher suicide risk

Help for Toxic Stress

The key to preventing and reducing toxic stress in kids is awareness. Now that we know about the effects of ACEs, many states have conducted their own research. Some cities formed task forces, while others are working with pediatricians, schools, daycare centers and the justice system to set up screening programs that can turn lives around.

Protecting children from toxic stress involves a multi-faceted approach that targets both the caretaker and the child in order to strengthen family stability. Treatment includes intervention and implementation of methods that reduce stressors and reinforce the child or caregiver’s response to stress.

As more programs are formed, researchers have found that children can benefit even when the solutions are solely focused on their caregiver and aren’t aimed at the child. This is most likely because the caregiver’s altered interaction with the child makes the child feel safer. Parenting classes, family-based programs, access to social resources for parents, peer support and telephone support are beneficial. Cognitive behavioral therapy and relaxation methods like yoga and mindfulness are also helpful. Additionally, community-based programs like Head Start have been shown to be effective.

Do you have Questions?

For more information about toxic stress and its effects on child development, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

Read More

Tips to Improve Your Child’s Executive Functioning Skills

Children's Center Now OpenThe first time you hear the term “executive functioning”, you may think it refers to the leaders of a worldwide conglomerate, but nothing could be further from the truth. Executive functioning is actually a life skill we learn in childhood. It forms the basis of the actions we perform every day. From taking a bath and getting dressed, to getting ready for school or doing homework, executive functioning helps us plan things, organize our lives, control our emotions, and learn from our mistakes. It lets us evaluate information, come up with a solution, and carry it out.

Some kids learn executive functioning with ease, but for others, it can be difficult to choose appropriate actions, develop time-management skills, or anticipate the consequences of their actions. Kids who have poor executive functioning often need constant guidance for simple tasks, such as packing their backpacks for school. They may forget to turn in the homework they worked on so diligently the evening before or have difficulty making decisions because they get bogged down in the mental strain of weighing pros and cons. Fortunately, there are ways to help these children acquire organizational skills. Apps, like our Giant Leap app, are great learning tools for, among other things, teaching behavior strategies and generating lists to help kids start and complete tasks.

Learning Tools for Executive Functioning

Executive functioning learning tools help children overcome struggles with organization and follow-through.

Some keys to building executive functioning abilities are:

  • Checklists – Checklists make tasks easier for a child with executive dysfunction. Often, these kids don’t follow through because they can’t visualize the steps required to complete a task, but a checklist lays it all out in front of them. You can make a checklist for anything. If your child consistently misses the bus, for example, you can make a checklist of the things he/she needs to do before leaving the house. This eliminates their need to ponder what they’ve just done and trying to decide what they must do next. Instead, when they follow a checklist, they know they have to move from brushing their teeth to putting on their clothes, then onto putting on their jacket, and picking up their back pack. Laying things out the night before can also help eliminate morning drama.
  • Planners – Teach your child to write things down. No one can remember everything, and noting tasks in a planner or on a checklist ensures they won’t forget to do it.
  • Rationale – Remember when your child was about two years old and constantly asked, “Why?” In the same way, children who have trouble with executive functioning do better when they understand the reason behind what they need to do. Without a rationale, they may feel like planning or following a chart is a waste of time.
  • Figure out how your child learns best. Are they visual learners? Then charts and apps are great for them. Are they tactile learners? Counting necessary steps on their fingers might be better for these types. Do they learn more easily when they hear something? Try laying out the steps for something like a homework routine in story form or in a song.
  • Make it a routine – this is especially good for older children. Set a time to start the task and a time limit in which to finish it. Practice breaking down tasks with your child so they develop an awareness of how long something takes, which allows them to better plan their time. For instance, a child might need thirty minutes to write a book report, but not think about the fact they need three days to read the book. Learning to think through each step of a task also builds organization skills and helps the child anticipate that Step A comes before Step B, etc. In the book report example, a child might think about the task of selecting a book and the task of writing the report. If they have executive dysfunction, they may completely forget they have to read the book or turn in the report.

Apps Turn Daily Routines into Fun Activities

For children who can’t read (and even those who can), the colorful images on an app can make all the difference. Eye-catching charts and graphics give the child something to focus on. They also make it easier for these kids to understand the bigger picture – for example, by showing when a task needs to be completed or by listing action steps that need to be taken.

Once parents set up their child’s chart, these visual aids help the child see the tasks they need to complete. Additionally, engaging images capture kid’s attention, making it more likely that these visual reminders will instill the routine in the child’s mind.

Some apps, like our Giant Leap app, are customizable. This flexibility allows parents to generate personalized charts with the specific behaviors their child needs to learn. Giant Leap gives children executive functioning issues an easy way to stay organized and can support their unique needs. Additionally, Giant Leap permits parents to update their child’s charts in real time within the app and allows them to print each chart out for daily or weekly use.

Apps encourage consistency and make daily routines easier to set and follow. When a child completes the tasks on their chart, they not only begin to acquire executive functions, they also gain self-confidence. Successfully learning organization skills translates to self-reliant, responsible in kids and gives them the tools they need for future success.

Learn More about Giant Leap and Executive Functioning

For information about how our Giant Leap app can help your child improve their executive functioning skills, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

Read More

School Violence – Tips for Dealing with This Week’s Mass Shooting

The nation has been horrified to hear about another school shooting. For many in South Florida, however, the trauma surrounding school violence has hit particularly hard because this week’s shooting happened right in our own backyard. Many people likely know someone or know of a family with a child who attends the Marjory Stoneman Douglas High School in Parkland, FL. Because of this, you might find it challenging to deal with your feelings about the event.

Keep in mind that it is normal to experience strong emotions, such as anger, fear, sadness, grief, and shock – even if you don’t know someone who is personally connected to the shooting. You might also have trouble concentrating or difficulty sleeping and you may even feel numb when talking about the incident with others. All of these reactions are typical responses of trauma psychology.

Tips for Overcoming Trauma

It will take a while to move past this heartbreaking tragedy, but we have some tips for managing your emotions during this horrific time. Following these guidelines can help you build resilience – the inner strength that you can draw on when you’re exposed to trauma or adversity.

  • Take care of yourself. It’s significantly harder to work through strong emotions when you’re tired or not eating well. Try to eat a balanced diet and get plenty of rest. Set aside some time during the day for physical exercise, which is proven to reduce stress. Also, try not to use alcohol or drugs to dull your emotional pain – studies show they intensify negative emotions.
  • Turn off the news coverage of the event. Watching endless repeats of the news coverage overexposes you the anxiety and raw emotions of the violence. Reading numerous reports on the internet can increase your stress. In particular, images of the school violence can prolong episodes of distress or trigger new anxiety about the event. Try to focus on something positive to help raise your optimism, which will, in turn, help you feel more encouraged.
  • Keep to your routines. Patterns can provide a sense of comfort and security when your world has turned upside down.
  • Don’t suppress your feelings. Everyone processes a stressful situation in different ways. Give yourself time to mourn the tragedy and remember that working through grief takes a long time. Don’t try to rush it. If you have a more intense reaction than you feel you should, talk to a mental health professional.
  • Talk about it with others. By sharing your shock and distress, you’ll feel more supported, less alone, and less overwhelmed.
  • Help out someone else. Not only does being of service to someone distract you from life’s problems, it boosts serotonin levels which helps you feel more positive.
  • If you and your family or friends have been directly impacted by this mass shooting, you will experience some form of grief. You may also have some survivor’s guilt, particularly if you have a loved one who was at the school during the violence. You may feel alone and want to avoid others. Grief is unpredictable – it can seem to lessen, then reappear when you least expect it. Milestones, such as birthday or holidays, will often trigger a fresh round of mourning. Understand that this is part of grief and grieving is a long process.

*If you can’t move past this school violence or another traumatic event that has happened in your life, it may be beneficial to seek out a support group or turn to a qualified, licensed mental health professional in order to move forward. It is especially important to do so if you are unable to carry out the daily tasks of living, such as sleeping, eating, and other functions.

The Aftermath of School Violence – We Can Help

Our Children’s Center  has specially trained clinicians on staff to help those who need help dealing with the school shooting or other traumatic situations. For more information, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

Read More
Call Us (561) 223-6568