Getting Out From Under: Understanding Professional Burnout & Its Consequences

Richard dreaded waking up every morning. The first onerous thought in his head was that of facing work. He felt drained, depleted, and trapped. The temptation to stay in bed, to call in sick, was getting greater every day. But he also knew that if he didn't go, his workload would become more mountainous than ever, making things so much worse. Furthermore, he felt increasingly distant from his wife, Susan, and his two children. There were times he found himself uncharacteristically ill-tempered and emotionally distant from them. He couldn't help thinking they were avoiding him. To add to his misery, bills were getting mislaid, meetings missed, appointments scheduled for different days and times than he had in his PDA. Of course, these troubles were "likely the fault of people telling him the wrong information, messing up his desk, or making schedule changes without notifying him." Or so he thought.

Richard, like many individuals, is experiencing classic signs of "burnout." Burnout can be the result of an excessive workload, emotional strain, unrealistic expectations, or a combination of situations that can lead to self-negativism and feelings of isolation (real or imagined). But burnout is more than simply feeling overworked and in need of a vacation. It has a more insidious nature. Burnout can quickly and easily lead to one of a type of serious disorders known to mental health professionals as "mood disorders." Mood disorders include major depression, dysthymia and bipolar disorder (formerly known as manic-depressive disorder). Additionally, in an attempt to cope with the ever-increasing sense of being overwhelmed, many individuals turn to alcohol or drugs (prescription or illicit), further compounding their problems. If burnout has progressed to the point where depression or substance abuse may be occurring, professional mental health services need to be obtained. These services usually include some form of counseling or therapy, medication, or a combination of both.

In many professions, there is often an unwritten rule that the professional is the problem solver and should never need to have their problems solved by another. Facing the truth, that no one person can do all things all the time, and recognizing when it is time to get support and help, is crucial to surviving burnout. So how do you recognize depression in yourself? Often, a person's first indication is a tendency to lose interest in their appearance and their surroundings. Formerly neat, organized individuals become unkempt and disorganized, and often don't care that they are. Anger management problems may develop, tempers flare, and there is a feeling that everything is a crisis. Forgetfulness and distractibility may be present. Sleep may become fitful or disturbed. Using alcohol or drugs to "get through" the day may occur.

Unfortunately, there is, to some people, a stigma associated with mental health disorders. Unlike many physical disorders, psychological disorders often do not have symptoms obvious to others, giving the impression they are "not real disorders." Some people suffering from mental disorders may feel they will be stereotyped as "mentally ill" and worry about being ridiculed by family and friends. They may fear losing their jobs or promotions. Fortunately, recent medical science has progressed in knowledge and understanding of psychological disorders and, consequently, the embarrassment and shame previously associated with them is not as prevalent.

Major Depression

Major depression can include any or all of the following symptoms: a prolonged period of sadness, loss of interest or pleasure in things that previously were pleasurable, appetite and/or weight change, sleep difficulties, fatigue, difficulty concentrating, thoughts of suicide, or death. While major depression usually begins when a person is in his or her middle to late 20s, it can occur at any time of life, from childhood to old age. The onset of major depression may be sudden or gradual, with episodes lasting from a few weeks to many years.

Dysthymia

Individuals with dysthymia are chronically depressed. Although they have many of the same symptoms as those found in major depression, these symptoms are not usually disabling. Thoughts of suicide or death are not present, and there are no manic or hypomanic episodes, which are seen in bipolar disorder.

Bipolar Disorder

Bipolar disorder, previously known as manic-depression, is a mood disorder that includes at least one manic episode. Manic episodes are periods where a person manifests grandiosity or exaggerated self-esteem, a reduced need for sleep, increased talking, racing thoughts, distractibility, accelerated activity, and poor judgement. These symptoms are obvious and often outrageous (to others). A person with bipolar disorder often experiences a quality of mood that can be described as euphoric or expansive, though some individuals may only be irritable. A hypomanic episode comprises the same symptoms as a manic episode, but to a lesser degree.

To avoid the risk of family members and friends ostracizing them, some sufferers of a mood disorder attempt to medicate themselves via alcohol or drugs. Rather than improving the mood disorder, the individual invariably ends up with a dual diagnosis of substance abuse and a mood disorder. Alcohol itself is a depressant and does nothing but exacerbate the problem. Similarly, drugs further impair the individual, making a bad situation worse. Often the individual who is using alcohol and/or drugs to "self-medicate" develops even lower self-esteem, and exacerbates his/her feelings of shame, guilt and hopelessness.

What Can Be Done to Avoid or Relieve Burnout?

Burnout often starts with the feeling of being overwhelmed, as if there is not enough time in a day to get everything done. Attempts to make more time in a day seem impossible, futile or more trouble then they are worth. Identifying these feelings as burnout and then taking positive steps at this point is key to keeping the situation from becoming critical. The solution does not lie in trying to make a big block of time, but rather in making small changes throughout the day, removing the unnecessary, and making better use of your time. For example, lay your clothes out the night before so you save ten minutes the next morning. Also, prepare breakfast, lunch or dinner the night before to reduce preparation time the next day. Take less time showering in the morning, or shower the night before. Make sure briefcases are packed and prepared for work and you know where you keys are (preferably by the door), so you don't have to spend half the morning looking for them. Do you spend a lot of time on the phone? There are a number of things you can do while on the phone. Look over the table of contents of magazines you've been meaning to read this month. Tear out only the articles that interest you. File those articles and pitch the rest in the wastebasket. Remember, the wastebasket is an essential office item and can be very useful. It helps get rid of the clutter that can make you feel overwhelmed and disorganized. Chances are, if something has been sitting on your desk over a month, you probably don't need it anyway. Throw it out, especially if it is something that, in the unlikely even you do need it, you can get a copy from elsewhere. Little changes throughout the day make BIG results and give you a sense of control back in your life.

What if I'm Beyond Just Burnout?

If the steps listed above seem "off the mark," then what you're feeling goes beyond this initial phase of burnout into a deeper sense of isolation and depression. The first step is to identify and acknowledge you are feeling depressed. Realize that feeling depressed is just that -a feeling- not evidence that you (or anything else) are actually bad. Once you realize that feeling bad about yourself is not the same as actually being bad or "screwed up" you might have more power to deal with the "blues." Although our society seems to tell us we have to always be "up," occasional "down" times are just normal. Depression, however, is more than just a normal low period, and shouldn't be minimized.

After identifying that you are depressed, don't dwell on analyzing why you may be depressed. Not only does this keep you focused on feeling bad, but also, if you are depressed, you are probably not in the best frame of mind at the time to be doing self-analysis. When you're depressed, what starts out as constructive introspection can easily turn to harsh self-incrimination and degradation.

The helplessness that ensues depression can be a learned response. Years ago, a study was done using dogs and placing them in cages where they would receive a mild electric shock through the cage floor. They were permitted to jump to the other side of the cage where there was no shock, and initially the dogs responded to the shocks by jumping to safety. Next, the entire cage was electrified in such a way so as to afford no escape. Try as much as the could, the dogs could not escape the shock. After realizing there was no way to avoid the shocks, the animals appeared to resign themselves to their fate and made no attempt to avoid further electrical shocks. The cage was returned to original configuration, again allowing a place of safety and escape from the shocks. However, this time, after receiving the electrical shock, the dogs made no attempt to escape-thus the term learned helplessness. Even after being shown they could escape, the dogs still seemed resigned to their fate. At one point the experimenter attached a harness and dragged the dogs across to safety, and eventually they relearned to avoid the electrical current. So what does all this have to do with feeling depressed? Hopelessness can be unlearned and hope can be relearned. If you have the inner resources and strength to attack this without professional help, take it easy on yourself and don't expect overnight changes. Congratulate yourself for small steps and remember you are doing this for yourself, not for others.

It is important to note that depression is not a definitive term, but rather a continuum of feelings encompassing normal ups and downs, the "blues," situational depression, and chronic depression. Self-help can work well at the lower end of this continuum, but a person may need the help of a mental health professional should these feelings progress beyond that point.

Treatment

Untreated depression can last from six months to several years. With treatments available today, there is no sound reason for a person to suffer needlessly from depression. Seeking professional help is an indication of strength of character and true desire to feel better. Most mental health professionals will take a multi-disciplinary or holistic approach in treating depression and mood disorders. This approach includes therapy, medication, and if necessary, substance abuse counseling and treatment.

Cognitive-behavioral therapy can be useful in identifying ineffective coping behaviors and negative emotions. This therapy can help with changing how an individual thinks about loss, helplessness, failure, and isolation. Interpersonal therapy focuses on interpersonal problems a person experiences when interacting with others. New social skills, as well as emotional expression, are encouraged and developed. Group therapy provides the opportunity to openly discuss problems with others who are having similar experiences. This form of therapy helps with the expression of one's feelings and assists in better understanding and coping with the day-to-day issues of life. Regardless of the particular orientation of the therapist, talking about your feelings in a supportive environment can greatly reduce the stress and isolation of trying to handle it alone. For most people, scheduling the first appointment is the most difficult (and most important) hurdle to jump.

Depression often has physiological effects causing biochemical changes within the body. Individuals with depression tend to have abnormally low levels of certain neurotransmitters, such as seratonin. Antidepressant medications can be used to treat these low levels. There are a number of medications used to treat depression, including Effexor, Serzone, Prozac, Zoloft, Paxil, Wellbutrin, and Elavil. Bipolar disorder is often treated with mood stabilizers, such as lithium derivatives. Of course, if you have any history of alcohol or drug problems, inform your physician, as the use of drugs and alcohol can have a very serious effect when combined with these medications.

If present, substance abuse needs to be treated along with the depression. While the issue of abuse will likely be addresses in therapy, attendance in Alcoholics Anonymous, or a similar support group, is usually a part of treatment.

Could I Be Depressed?

Take this brief questionnaire to find if you are experiencing signs of burnout and depression.

No=0 A Little=1 Sometimes=2 A Lot=3
_________________________________________________________________
Have you been feeling sad, blue,
and downhearted? 0 1 2 3
_________________________________________________________________
Have you been having crying spells
or felt like crying? 0 1 2 3
_________________________________________________________________
Have you been having trouble sleeping
or sleeping too much? 0 1 2 3
_________________________________________________________________
Have you noticed a change (up or down)
in appetite or weight? 0 1 2 3
_________________________________________________________________
Have you been having difficulty
making decisions? 0 1 2 3
_________________________________________________________________
Are you more irritable
or easily annoyed lately? 0 1 2 3
_________________________________________________________________
Have you been tired, fatigued,
or lack energy? 0 1 2 3
_________________________________________________________________
Have you been feeling worthless,
guilty, or hopeless? 0 1 2 3
_________________________________________________________________
Have you lost interest in work,
hobbies or other things? 0 1 2 3
_________________________________________________________________
Have you felt suicidal or that others would be
better off if you were dead? 0 1 2 3

Add your score. Twelve points or higher indicates you may be depressed. It would be advisable to contact a mental health provider to further assess your risk for depression. Even if your score is below 12 points, you may still be at risk. If you suspect you may be suffering from depression or burnouut, contact a mental health provider for more information.

What are you scared of?

Every human feels anxiety on occasion; it is a part of life. All of us know what it is like to feel worry, nervousness, fear and concern. We feel nervous when we have to give a speech, go for a job interview, or walk into our boss's office for the annual performance appraisal. We know it is normal to feel a surge of fear when we unexpectedly see a photo of a snake or look down form the top of a tall building. Most of us manage these kinds of anxious feelings fairly well and are able to carry out with our lives without much difficulty. These feelings do not tend to disrupt our lives.

But millions of people (an estimated 15 percent of the population) suffer from devastating and constant anxiety that severely affects their lives, sometimes resulting in living in highly restricting ways. These people experience panic attacks, phobias, extreme shyness, obsessive thoughts and compulsive behaviors. The feeling of anxiety is a constant and dominating force that disrupts their lives. Some become prisoners in their own homes, unable to go to work, drive, or visit the grocery store. For these people, anxiety is much more than just an occasional wave of apprehension.

Types of Anxiety Disorders

An anxiety disorder affects a person's behavior, thoughts, feelings and physical sensations. The most common anxiety disorders include the following:

Social anxiety or social phobia is a fear of being around other people. People who suffer from this disorder always feel self-conscious around others. They have the feeling that everyone is watching them and starring at them, being critical in some way. Because the anxiety is so painful, they learn to stay away from social situations and avoid other people. Some eventually need to be alone at all times, in a room with a door closed. The feeling is pervasive and constant and even happens with people they know.

People who have social anxiety know that their thoughts and fears are not rational. They are aware that others are not actually judging or evaluating them at every moment. But this knowledge does not make the feelings disappear.

Panic disorder is a condition where a person has panic attacks without warning. According to the National Institutes of Mental Health, about 5 percent of the adult American population suffers from panic attacks. Some experts say that this number is actually higher, since many people experience panic attacks but never receive treatment.

Common symptoms of panic attack include:

• Racing or pounding heart
• Trembling
• Sweaty palms
• Feelings of terror
• Chest pains or heaviness in the chest
• Dizziness and light-headedness
• Fear of dying
• Fear of going crazy
• Fear of losing control
• Feeling unable to catch one's breath
• Tingling in the hands, feet, legs, or arms

A panic attack typically lasts several minutes and is extremely upsetting and frightening. In some cases, panic attacks last longer than a few minutes or strike several times in a short time period.

A panic attack is often followed by feelings of depression and helplessness. Most people who have experienced panic say that the greatest fear is that the panic attack will happen again.

Many times, the person who has a panic attack doesn't know what caused it; seemingly to have come "out of the blue." At other times, people report that they were feeling extreme stress or had encountered difficult times and weren't surprised that they had a panic attack.

Generalized anxiety disorder is quite common, affecting an estimates 3 to 4% of the population. This disorder fills a person's life with worry, anxiety and fear. People who have this disorder are always thinking and dwelling on the "what ifs" of every situation. It feels like there is no way out of the vicious cycle of anxiety and worry. The person often becomes depressed about life and their inability to stop worrying.

People who have generalized anxiety disorder usually do not avoid situations, and they don't generally have panic attacks. They can become incapacitated by an inability to shut the mind off, and are overcome with worry, dread, fatigue, and a loss of interest in life. The person usually realizes these feelings are irrational, but the feelings are very real. The person's mood can change from day to day, or even hour to hour. Feelings of anxiety and mood swings become a pattern that severely disrupts the quality of life.

People with generalized anxiety disorder often have physical symptoms including headaches, irritability, frustration, trembling, inability to concentrate and sleep disturbances. They may also have symptoms of social phobia and panic disorder.

Other types of anxiety disorders include:

Obsessive-compulsive disorder (OCD), a system of ritualized behaviors or obsessions that are driven by anxious thoughts.

Post-traumatic stress disorder (PTSD), severe anxiety that is triggered by memories of a past traumatic experience.

Phobia, fearing a specific object or situation. The top ten phobias include:

• Arachnophobia: Fear of spiders.
• Social Phobia: Fear of being negatively evaluated in social situations.
• Aerophobia: Fear of flying.
• Agoraphobia: Fear that prevents on form leaving home or another safe place.
• Claustrophobia: A fear of being trapped in small, confined spaces.
• Acrophobia: Fear of heights.
• Emetophobia: Fear of vomit.
• Carcinophobia: Fear of cancer.
• Brontophobia: Fear of thunderstorms.
• Necrophobia: Fear of death or dead things.

Treatment Options

Most people who suffer form anxiety disorders begin to feel better when they receive the proper treatment. It can be difficult to identify the correct treatment, however, because each person's anxiety is caused by a unique set of factors. It can be frustrating for the client when treatment is not immediately successful or takes longer than hoped for. Some clients feel better after a few weeks or months of treatment, while others may need a year of more. If a person has an anxiety disorder in combination with another disorder (such as alcoholism or depression), treatment is more complicated and takes longer.

While a treatment plan must be specifically designed for each individual, there are a number of standard approaches. Mental health professionals who specialize in treating anxiety most often use a combination of the following treatments. There is no single correct approach.

Cognitive Therapy
The client learns how to identify and change unproductive thought patterns by observing his or her feelings and learning to separate realistic from unrealistic thoughts.

Behavior Therapy
This treatment helps the client alter and control unwanted behavior. Systematic desensitization, a type of behavior therapy, is often used to help people with phobias and OCD. The client is exposed to anxiety-producing stimuli one small step at a time, gradually increasing his or her tolerance to situations that have a produced disabling anxiety.

Relaxation Training
Many people with anxiety disorders benefit form self-hypnosis, guided visualization and biofeedback. Relaxation training is often part of psychotherapy.

Medication
Anti-depressant and anti-anxiety medications can help restore chemical imbalances that cause symptoms of anxiety. This is an effective treatment for many people, especially in combination with psychotherapy.

The treatment for anxiety disorder depends on its severity and on the length of time it's been a problem. The client's willingness to actively participate in treatment is also an important factor. When a person with panic is motivated to try new behaviors and practice new skills and techniques, he or she can learn to change the way the brain responds to familiar thoughts and feelings that have previously caused anxiety.

Anxiety disorders as a whole are some of the most easily treatable. However, they can also be the most prone to worsening and generalizing if not treated. For example, if a person starts out feeling very uncomfortable in some social situations (Social Anxiety), and its not treated, he may then begin to experience panic symptoms (Panic Disorder) in the same social situations. Eventually, the person may strive to avoid all social contact (Agoraphobia) in his efforts to avoid the symptoms of panic and its potentially embarrassing consequences.

The 6 Truths of Marriage

Marriage, by its very nature, tends to be complicated and difficult. It is a friendship, a partnership, and a business relationship all rolled into one. Problems can, and usually do, crop up in any and all these three areas. Complicating matters even more, when a problem occurs in one area, it is likely to bleed over into the other areas. This can make it difficult, if not impossible, to tease out what the real “issue” is (was), and then hopefully work out a reasonable solution.

While many marriage issues can be resolved through simple communication skills and the desire by both people in the marriage to use them, very often communication is one of the first skills to close down when feelings get hurt. Mountains can develop out of molehills to the point that we feel that the energy required to climb the mountain is not worth the problem. Resignation sets in, defenses go up, and lines are drawn.

In an effort to simplify the complexity of marriage problems, two psychologists, Dr. Clifford Notarius and Dr. Howard Markman, spent twenty years observing and studying couples during the good times and the bad. In 1993 they published a book, We Can Work it Out: Making Sense of Marital Conflict, outlining their observations, as well as techniques couples could use to resolve marital difficulties. One part of the book, “The Six Simple Truths of Marriage,” offer an opportunity to take some of the complexity out of marriage, and serve as a guide for couples as they navigate through difficult times.

The “Six Truths,” according to Drs. Notarius and Markman, are:

1. Each relationship contains a hidden reservoir of hope. Simply stated, this refers to the fact that “most partners retain their wish for relationship improvement even when the going is the toughest”. When a couple is fighting and statements are being exchanged, each statement is usually being said with the hope that it will help. Likewise however, each statement made by one person stands a good chance of being misunderstood as a hurtful comment. The “reservoir of hope,” is that couples must learn to listen to one another with the understanding that each is, in his or her own way, trying to help the relationship.
2. One “zinger” will erase twenty acts of kindness. Notarius and Markman state that “it takes one put-down to undo hours of kindness you give to your partner.” This is comparable to the fact that you can exercise for an hour to help lose weight, but wipe out that progress in less than a minute by eating a candy bar. In general, couples need to monitor their negative exchanges.
3. Little changes in you can lead to huge changes in the relationship. It is a natural tendency on the part of most people to believe that when they are in conflict with someone else, it is that someone else who is wrong. The deeper belief is that if that someone else would only change, or realize I’m right, everything would be fine. The “Simple Truth” is that this approach is a dead-end. It is only through making even little changes in ourselves that meaningful change in the relationship can be realized. Using the previous “Truth” described above as an example, while one or two “zingers” may not be too detrimental to a relationship, if those one or two are multiplied by 365 days in a year, the damage sustained may become insurmountable.
4. It’s not the differences between partners that cause problems, but how the differences are handled when they arise. There are always going to be differences between partners in a relationship…differences are inevitable. Oftentimes however, these differences lead couples to believe they are just not compatible. This belief can quickly become set in stone, resulting in a stand-off between partners. Rather than let this happen, partners must accept their differences and learn how to better handle them. The development of better listening skills is a good place to start. As Notarius and Markman say, “Having a good listener is having a good friend.”
5. Men and women fight using different weapons, but suffer similar wounds. “Men and women differ very little in their desire for intimacy and connection. For a variety of reasons, both biological and cultural, men have a harder time handling conflict, while women have a harder time coping with emotional distance.” Thus, men are more prone to withdraw from uncomfortable discussions while women are more prone to working through issues. Appreciating these differences and learning to work around them is an important step in developing a more effective style for working through issues.
6. Partners need to practice relationship skills in order to become good at them. Relationships are complicated, disagreements are inevitable, and fights are uncomfortable. Most of us are not very good at resolving conflicts using the methods discussed in this article, therefore our conflicts usually don’t turn out well. As a result, we typically try to avoid conflict so as not to makes matters worse. Without practice using the skills mentioned above, as well as the basic relationship needs for closeness and intimacy, it will be difficult to make improvements in your marriage.

Years ago, Eric Berne wrote a book called Games People Play. He stated that most interactions involve “games” we play out with each other on a daily basis; some good, some bad, some dangerous. Marriage tends to be a very intense game with very complicated and ever-changing rules. When the rules become too complicated, the game loses its fun factor. If the fun and intrigue vanishes for very long, most people want to stop playing. Simplifying the rules and making them more understandable and easily applicable can revitalize the game, making it more enjoyable, rewarding, and less likely to result in disagreements.

Parenting Teens 101

How to Maintain Communication

Even though teens need to separate from their parents during adolescence, they also need to know that the safety net of home and family is always there for them. They are not yet capable of thriving emotionally; they need parental support and input. If the lines of communication are shut down, giving your teenager support and input is virtually impossible. Let’s take a look at a few guidelines for keeping the lines of communication open between parents and teenagers.

• Pay attention to the small things along with the significant things. If you are generally a good listener, your teen will be more likely to talk to you.
• When your teen talks to you, pay attention. Don’t be doing something else.
• If you can’t pay attention right at the moment, explain why. Ask if you can talk about the issue later, at a specific time --- then follow through.
• Ask questions for clarification, but watch out for coming across as critical. If your teen gets defensive or closes down when you ask questions, stop asking them.
• Expect your teen to change his mind frequently. Avoid commenting on the inconsistencies.
• Express interest and encouragement in your teen’s activities.
• Accept your teen’s opinions, even if you don’t agree with them.

Preventing High-Risk Behavior

All parents fear their teens becoming involved in high-risk behaviors such as drinking, smoking, and sexual activity. There are some very specific things you can do to minimize your teen’s need to act out. Here are some tips for preventing high-risk behavior:

• Be part of your teen’s life. If possible, be present when she is likely to be home.
• Encourage your teen to talk to you openly at any time.
• When your teen tells you things, watch your reaction. Avoid reactions that will cause him to think twice about being candid with you in the future.
• Be specific about what kind of behavior you expect and what is unacceptable.
• Keep harmful substances out of the house. When teens have access to these items, they are more likely to use them.
• Expect good things from your teen. Teens who know their parents expect the best have greater emotional well-being.
• Encourage your teen to become involved in school activities. Those who are involved at school engage in fewer high-risk behaviors.

Preventing Teen Substance Abuse

Now let’s talk about some of the risks that teens face. First, let’s look at drugs and alcohol. These are a few things you can do to help your teen stay away from drugs and alcohol.

• State your expectations clearly.
• Pay attention to where your teen is.
• When your teen leaves home, ask her where she is going. Ask for specifics.
• If your teen says he is going to one place but actually goes somewhere else, consider restricting his freedom for awhile.
• Remember that your teen is innocent until proven guilty. Stay open to the possibility that there is a reasonable explanation for any story you might hear.
• Build relationships with other parents and agree on the rules. If none of the kids in the group have complete freedom, there will be less peer pressure and more safety.

Teen Depression

Teens are known for their mood swings. It is common for them to feel sad or gloomy. Many parents become concerned about a teen’s mood. Depression is different from the blues because it lasts longer and is more intense. Clinical depression is an illness that can lead to very serious problems, with lifelong implications. Some of the warning signs that your teen may have something more serious than the blues are:

• She shows less interest in her appearance.
• She seems to feel hopeless.
• He seems to hate himself.
• He seems indifferent about most things.
• She seems numb or emotionless.
• She lacks energy.
• He talks or thinks about death and dying.
• He changes his sleeping or eating habits.
• She loses interest in her friends or hobbies.
• She stops caring about her pets or cherished possessions.
• He has a sudden change in his grades at school.
• He complains of extraordinary stress.
• She withdraws from people.

If you think your teen’s mood may be depression, here are some things you can do about it:

• Talk to your teen about how he is feeling. Help him get it off his chest. Encourage him to think of solutions to what is bothering him.
• Encourage your teen to participate in some kind of physical activity.
• Check in with her more often than usual.
• If these steps don’t help and the problem seems serious, call a school counselor, teacher, pastor, or doctor. Ask for a referral to a qualified, licensed professional who specializes in working with adolescents who have emotional problems.

Eating Disorders

Eating disorders affect more girls than boys during adolescence. They are emotional disorders that require the intervention of a health professional before they become life-threatening. If you think your teen suffers from either anorexia or bulimia, do not hesitate to seek the advice of your physician.

These are the warning signs for anorexia:

• She has lost 25% of normal body weight without being on a diet.
• She has a distorted body image.
• She diets constantly even though she is thin.
• She fears gaining weight.
• Her menstrual periods have stopped (this is known as amenorrhea).
• She is preoccupied with food, calories, and eating.
• She exercises excessively.
• She binges and purges.

The warning signs for bulimia include the following:

• She eats uncontrollably (binges), often in secret.
• She purges by vomiting, abusing laxatives or diuretics, or vigorously exercising. She may also compensate for binges with strict dieting or fasting.
• She frequently visits the bathroom after eating a meal.
• She is preoccupied with her body weight.
• She experiences depression or mood swings.
• She has irregular periods.
• She has dental problems, swollen cheek glands, or is bloated.

If you think your teen suffers from either anorexia or bulimia, do not hesitate to seek the advice of your physician. Early treatment greatly enhances the chances of recovery.

How to Build Your Teen’s Self-Esteem

Having strong self-esteem is critical, especially during the teen years. This is true for the following reasons:

• Self-esteem is a significant factor in how each of us manages our life.
• How we feel about ourselves guides the choices we make, how we feel, how we respond to events, and just about everything else we do.
• Strong self-esteem enables us to make constructive choices for ourselves and others.
• When our self-esteem is weak, we tend to make choices based on what others think and want, rather than on what is really best for us.

You can help your teen build and maintain his or her self-esteem in the following ways:

• Listen to what your teen is saying to you, in words and actions.
• Ask your teen’s opinion about things and accept it.
• Remind yourself that your teen needs to differentiate herself from you. That is her job as an adolescent, and it is healthy. Allow her to do it.
• Let him know that you love him.
• Let her know that you will always be there for her.
• Give him permission to explore ideas.
• Don’t be threatened when she expresses herself.
• Encourage him to express his feelings appropriately.

Parenting teens requires a great deal of finesse. While “parenting” (adult definition: guiding & supporting) more actively than ever before, you must also strive not to “parent” (teen definition: babying & controlling).

Divorce Through A Child’s Eyes

As a psychologist, I have the opportunity to work with many individuals, couples, and families who are affected by divorce. I see the devastating effects breakups can have on the family. The decision to divorce has a major impact on everyone in the family, but has the most powerful impact on the children.

A divorce can (eventually) represent an opportunity for a “second chance” for parents. For their children, however, the divorce has nothing to do with a second chance. Instead, the divorce represents a loss of the family environment they’ve grown up in and had every reason to believe would remain intact until they decided they no longer needed it. This loss, in turn, results in a disruption in the continuity of their daily routines, which, in turn, leads to deterioration in their sense of security.

Among the many changes in routine that children of divorced families may face are decreased contact with their parents, financial changes in the home, possible relocation, increased daycare and babysitting time, and less frequent family “sit-down” meals. Also, children often must cope with significant changes in one or both of their parents, including feelings of depression, irritability, moodiness, decreased availability, increased drinking, and eventual dating.

Lots of Feelings

Divorce profoundly affects children. In Surviving the Breakup, author Judith Wallerstein describes the experience of 60 divorcing families. She outlines the following key issues for children of divorcing families:

Fear: Divorce is frightening to children, and they often respond with feelings of anxiety. Children feel more vulnerable after a divorce because their world has become less reliable.

Fear of abandonment: One-third of the children in Wallerstein’s study feared that their mother would abandon them.

Confusion: The children in divorcing families become confused about their relationships with their parents. They see their parents’ relationship fall apart and sometimes conclude that their own relationship with one or both parents could dissolve, as well.

Sadness and yearning: More than half of the children in the Wallerstein study were openly tearful and sad in response to the losses they experienced. Two-thirds expressed yearning, for example: “We need a daddy. We don’t have a daddy.”

Worry: In Wallerstein’s study, many children expressed concern about one or both of their parents’ ability to cope with their lives. They wondered if their parents were emotionally stable and able to make it on their own. Over half of the children expressed deep worries about their mothers. They witnessed their mothers’ mood swings and emotional reactions to the events in the family. Some children worried about suicide and accidents.

Feeling rejected: Many children who experience a parent moving out of the home feel rejected by that parent. The parent that moves out is usually preoccupied with problems and pays less attention to the child than in the past. Many children take this personally and feel rejected and unlovable.

Loneliness: Since both parents are preoccupied with their problems during the divorce process, they are less able to fulfill their parenting roles with their children. The children may feel like their parents are slipping away from them. If the father has moved away and the mother has gone off to work, the children often feel profound loneliness.

Divided loyalties: The children may (accurately) perceive that the parents are in a battle with each other. The children feel pulled in both directions and may resolve the dilemma by siding with one parent against another.

Anger: Children in divorcing families experience more aggression and anger. It is often directed toward the parents, expressed in tantrums, irritability, resentment, and verbal attacks. Many children see the divorce as a selfish act and feel very resentful about the resulting destruction of their lives.

More than one-third of the children in Judith Wallerstein’s study showed acute depressive symptoms such as sleeplessness, restlessness, difficulty in concentrating, deep sighing, feelings of emptiness, compulsive overeating, and various somatic (body) complaints.

The symptoms that many children may have during the divorce process typically lessen or disappear within 18 months after the breakup. Of the symptoms that remain, the most common are manipulative behaviors and depression. The symptoms of depression in children include:

• Low self-esteem

• Inability to concentrate

• Sadness

• Mood swings

• Irritability

• Secretiveness

• Isolation

• Self-blame

• Eating disorders

• Behaving perfectly

• Being accident-prone

• Stealing

• Skipping school

• Underachieving at school

• Sexual acting out

Ways You Can Help:

There are several things parents can do to help lessen the adverse affects of divorce on their children. Of primary importance is the need for a child’s parents to remain “parents” to their child. Yes, it is highly unlikely that parents will come through a divorce without battle wounds and feelings of anger and resentment toward one another. But, it is extremely important to continue to work together as a team with regard to the children. Each parent must put aside their own feelings and display respect for the other parent and the rules and decisions that are made by each parent. If it is uncomfortable to talk person to person, use email, letters or even an objective third party to discuss differences you may have. Refrain from ever putting a child in the middle of the battle. Parents very often use their children as sounding boards for their own feelings of hurt and frustration. Don’t do this! ---this puts children in a friend role with the parent, and that is inappropriate. Be strong role models to your children. Show them how adults work out problems…with strength, good decision-making, and cooperation in the face of adversity.

It is also important for children to continue to maintain relationships with both parents. While parents recovering from a divorce are often left with a desire to “just get away from it all,” their children are left with an increased desire to be with their parents and reorganize their ideas of “how is it going to be now.”

Re-establishing a sense of predictability in the family is of the utmost importance. Since many of the traditions and routines present in the family are lost through a divorce, it is vital to the well-being of the child to quickly develop new routines and traditions. This facilitates the development of predictability in life which, in turn, helps in the development of a sense of safety and security.

Consider Professional Help When:

· Your child has shown uncharacteristically poor school performance for a semester or so.

· Your child is losing friends because he or she is unusually aggressive or apathetic.

· Your child shows uncharacteristically intense anger, throws many tantrums, or overreacts to minor situations.

· Your child has had prolonged mood swings that range from hostility to extreme affection.

· Your child continues to grieve unrestrainedly for the absent parent or the former family life.

· You see other radical changes in your child’s behavior, such as continuous problems in school, cheating, lying, or stealing, use of alcohol or other drugs.

Managing Difficult Life Transitions

Life is a process of beginnings and endings. In both life and nature, there are times when things move slowly and don’t seem to change very much. Then, suddenly, changes may be thrust upon us dramatically and unexpectedly. The ebb and flow of transitions are as natural as day and night.

A life transition can be positive or negative, planned or unexpected. Some transitions happen without warning, and they may be quite dramatic, as in cases of accidents, death, divorce, job loss, or serious illness. Other life transitions come from positive experiences such as getting married, going away to college, starting a new job, moving to a new city, or giving birth to a child. Change, by nature, is stressful.

Examples of Life Transitions

Life transitions can include any of the following:
• Accidents
• Serious illness
• Leaving for college
• Buying a house
• Getting married
• Having a baby
• Changing jobs
• Divorce
• Selling a house
• Relocation
• Retirement
• Significant loss (of a person, job, pet, or anything important)

Life transitions can also occur because we feel in a rut. We may have the nagging feeling that something is wrong, although we can’t quite put our finger on the reason. Our lives may seem like they’re not going the way we thought they would and that time is passing us by. This often leads to the feeling that it’s time for a change.

Life transitions are challenging because they force us to let go of the familiar and face the future with a feeling of vulnerability. Any significant loss makes most people feel fearful and anxious. Since the future may now be filled with questions, it is normal to feel afraid. We live in a culture that has taught us to be very uncomfortable with uncertainty, so we are anxious when our lives are disrupted. On the positive side, these transitions give us a chance to learn about our strengths and to explore what we really want out of life. This time of reflection can result in a sense of renewal, stability, and a new equilibrium.

Stages of Life Transitions

Successfully moving through a life transition usually means experiencing the following stages:

1. Shock.
2. Negative feelings (anger, anxiety, confusion, numbness, self-doubt, etc).
3. Loss of self-esteem.
4. Beginning to accept the change.
5. Letting go of the past.
6. Beginning to feel more hopeful about the future.
7. Feeling increased self-esteem.
8. Feeling optimistic view about the future.

The process of moving through a transition does not always proceed in these nice, predictable stages. People typically move through the stages in different ways, often cycling back and forth several times, but with a decreasing amount of time spent in the more negative stages.

Coping Skills

Life transitions are often difficult, but they have a positive side, too. They provide us with an opportunity to assess the direction our lives are taking. They are a chance to grow and learn. Here are some ideas that may help make the process rewarding.

Accept that change is a normal part of life. People who have this attitude seem to have the easiest time getting through life transitions. Seeing changes as negative or as experiences that must be avoided makes them more difficult to navigate and less personally productive.

Expect to feel uncomfortable. A time of transition is confusing and disorienting. It is normal to feel insecure and anxious. These feelings are part of the process, and they will pass.

Don’t be in a rush. When your life is disrupted, it takes time to adjust to the new reality. Expect to feel uncomfortable during a transition as you let go of old ways of doing things. Try to avoid starting new activities too soon, before you have had a chance to reflect and think about what is really best for you.

Take good care of yourself. Transitions are very stressful, even if they are supposed to be happy times. You may not feel up to participating in your normal activities, but you should find something fun to do for yourself each day. Get plenty of rest, exercise, and eat well.

Learn to identify and express your feelings. While it’s normal to try to push away feelings of fear and anxiety, you will move through them more quickly if you acknowledge them. Make them real by writing them down and talking about them with trusted friends and family members. These feelings will have less power over you if you face them and express them.

Focus on the payoffs. Think about what you have learned from other life transitions. Recall the stages you went through, and identify what you gained and learned from each experience. Such transitions can provide a productive time to do some important self-exploration. They can be a chance to overcome fears and to learn to deal with uncertainty. These can be the gifts of the transition process: to learn more about yourself and what makes you happy and fulfilled.

Stay sober. Using alcohol or drugs during this confusing time is not a good idea. It can make the process more difficult.

Build your support system. Seek the support of friends, family members, and/or, if necessary, a mental health professional. These individuals can help you voice your concerns, while lending support through difficult times.

Acknowledge what you are leaving behind. This is the first step to accepting the new. Think about how you respond to endings in your life: Do you generally avoid them, like the person who ducks out early on her last day on the job because she can’t bear to say good-bye? Or do you drag them out because you have such a hard time letting go? Perhaps you make light of endings, refusing to let yourself feel sad. Before you can welcome the new, you must acknowledge and let go of the old.

Keep some things consistent. When you are experiencing a significant life change, it helps to keep as much of your daily routine as consistent as you can. This is not the time to make big decisions in others areas of your life.

Accept that you may never completely understand what has happened to you. You are likely to spend a lot of time feeling confused and afraid. This makes most of us very uncomfortable. The discomfort and confusion will pass, and clarity will return.

Take one step at a time. It’s understandable to feel like your life has become unmanageable. To regain a sense of power, find one small thing you can control right now. Then break it down into small, specific, concrete steps. Write them down and post them on your computer monitor or mirror. Cross off each step as you accomplish it.

In the same manner that a caterpillar transitions into becoming a butterfly, changes occurring in our lives are natural and unavoidable. Accepting the inevitability of change, and learning to better cope with the process, can result in a stronger, more capable self. Be patient.

Obsessive-Compulsive Disorder

Can’t get that thought out of your head? Losing sleep over a comment you made to a person at work? Feel like you just have to get the house clean so you can feel better? Gotta mix those eggs and grits together? Are these normal concerns and habits? Or are they over the top…a sign of a mental disorder?

Obsessive-Compulsive Disorder (OCD) is a neurobiological disorder that affects approximately 2.5 percent of the population, or one out of every 40 people. People with OCD often say that they feel as though their brain is stuck on a certain thought and they are unable to let go of it. They are bombarded by unwanted thoughts over which they have little control…except by engaging in repetitive, and oftentimes nonsensical, behaviors.

If we were to break down the term “Obsessive-Compulsive”, we would find a good definition of the disorder; an “obsession” is a worry, thought, or mental image that persistently intrudes into an individual’s thinking. The individual may then utilize a “compulsion” (i.e., repetitive behaviors or mental exercises), to relieve the discomforting thoughts and images created by the obsession.

An example of this might be as follows: Upon going to bed at night, a person begins to think about someone breaking into the house. This thought becomes persistent, and may also be accompanied by other, perhaps more disturbing, thoughts. This, of course, is the “obsession.” As the psychological and physical discomfort increases for the person, he/she may get out of bed, turn all the lights on, and go around to all the doors, making sure they are locked. This is the “compulsive” act. If performing this action doesn’t relieve the fear and discomfort, the person may perform the compulsion numerous times.

Common obsessions include:

- Thinking about germs and contamination

- Thinking that one has done harm to another

- Fearing that one will be harmed

- Having a need for neatness and order

- Needing things to be a certain way

- Fearing that one will make a mistake

- Fearing one will lose control of oneself

Common compulsions include:

- Excessive handwashing

- Checking and rechecking locks (or the stove & oven)

- Repeated arranging of objects

- Repeated counting of objects

- Silently repeating words

- Saving or hoarding things

While most of us include pleasant rituals in our lives, such as lighting candles for religious events and celebrations, or reading prior to retiring for bed, the rituals that are a part of OCD are anything but pleasant. The worries of leaving the house unlocked, or of becoming contaminated by germs, can become extremely stressful and interfere with normal functioning.

Most people with OCD first show symptoms before the age of 40, with as many as half first experiencing symptoms during childhood. The symptoms may fluctuate over time, ranging from mild to extremely severe. Men and women appear to be equally affected by the disorder.

Most people with OCD realize that their obsessions and compulsions are excessive and irrational, but feel unable to control them. Because they are aware of them AND they feel embarrassed by them, people also tend to be secretive about their symptoms.

In many cases, individuals suffering from OCD are able to keep their rituals a secret from everyone, including family members. Sure, family members may have some idea that the OCD sufferer is a little strange in some ways (i.e., takes too long in the shower, washes hands frequently, vacuums the house every day, won’t throw anything away, etc.), but they wouldn’t say the loved one has a “problem”.

During the course of a normal visit to ones physician, it would take a very astute doctor to pick up on OCD. The secrecy with which the OCD individual guards his/her problem poses yet another obstacle to diagnoses and treatment.

The most effective treatment for OCD is a combination of medication and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors (SSRIs) are frequently used by physicians to treat OCD. Examples of SSRIs include Prozac, Luvox, Zoloft, and Lexapro.

Cognitive-behavioral therapy involves teaching patients how to change their behavior so that they can change their thoughts and feelings. The cognitive aspect of the therapy helps the patient change thought patterns and reduces the catastrophic thinking and exaggerations typical of people with OCD. Completing as many as 20 sessions of cognitive-behavioral therapy has been reported to reduce OCD symptoms by up to 80 percent.

Treatment with medication alone is helpful, but not as effective as combining it with cognitive-behavioral therapy. Medication can help to reduce the number and duration of intrusive thoughts, but it doesn’t teach an individual the tools for coping with the thoughts when they occur. Thus, relying on medication alone results in a higher relapse rate; the intrusive thoughts return when the medication is discontinued.

So, in answer to the original questions posed at the beginning of this article, most of these thoughts and habits are pretty normal, meaning that most of us indulge in those, or others that are similar. If, however, these types of thoughts and behaviors interfere with your everyday living—taking up more than an hour each day and interfering with work and relationships—it is important to talk with your doctor about it. Don’t make the mistake of keeping it a secret, especially when effective treatments are available.