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So You Want a Healthier Lifestyle: Are You Ready to Make a Change?

by Rhonda Karg, Ph.D

Nearly everyone has at least one health behavior they would like to change: getting regular exercise, eating a healthier diet, losing weight, drinking less alcohol, and quitting smoking, to name a few. So why do most people struggle with taking action and improving their health behaviors? People struggle with taking action to change because they think that the desire to change equals readiness or motivation to change. However, making the decision to change an unhealthy behavior almost always involves ambivalence, and on an internal level, considering the pros and cons of changing versus staying the same. That ratio of pros to cons is what tells us if a person’s desire equals readiness and motivation. If a person’s readiness/motivation to change the behavior is low, the cause could be that the pros of staying the same outweigh the cons of changing. For example, in the case of health behaviors, the immediate rewards of the unhealthy lifestyles (e.g., getting fast food) often outweigh the costs of implementing healthier choices (e.g., preparing a healthy meal). If readiness and motivation are low, you will need to get support and work on changing your perception of pros and cons, and/or doing more exploration of pros and cons to move into action!

Do you have a behavior you want to change? How ready are you to make this change? Answer the following questions in terms of a problem behavior to find out!

PROS AND CONS OF CHANGING

Rate each item as to its importance in deciding to take action. Rate each item as accurately as you can. Fill in the number that most closely reflects the importance of each item:

Your health is extremely important. Make your self-care and your health a high priority! As a single parent myself, I know how difficult it can be to take time out of your busy schedule to engage in self-care. But if you have desire to make the changes, you can shift that into readiness and motivation, and reach your self-care goals!

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A conversation with Haleh Moddasser of Stearns Financial Services Group

In a nutshell, what are people doing right and what are people doing wrong when it comes to their financial health?

Interestingly, the answer is the same to both questions – and that is “worrying”. People worry about money. They worry about paying for college, upsizing, downsizing, retiring, and a myriad of other unknown financial events such as a job loss or a leaky roof. This type of worry is a good thing when it causes people to take positive actions such as carefully planning their expenditures, saving for retirement and investing wisely. It is bad, however, when it causes otherwise healthy people to lose sleep at night. There is a fine line between enjoying today and saving for tomorrow – most people have a hard time finding that line.

Depression has long been referred to as the ‘common cold’ of mental health, i.e., a lot of people will experience this at some point in their lives. What is the equivalent analogy in financial health? What has historically been thought of by financial experts as the ‘common cold’ of financial health?

The most prevalent “illness” we see are people becoming overly influenced by the daily barrage of negative media, something we often refer to as “newsfluenza”. Unfortunately, our 24/7 media continually feeds us “newsworthy” bites of information that impact the markets in the short term, but have little relevance in the long term. This type of media hype can often lead to emotional decision making that can destroy a long history of prudent saving and investing. Often, investors will sell investments at the bottom of the market, or buy at the top, simply because they become either fearful or greedy. This type of irrational decision making, often referred to in the industry as “behavioral finance”, accounts for at least 60% of the losses most people incur in their investment portfolios.

What steps can people take to prevent that; and which steps can they do themselves versus which are best done with help from a professional?

The key is to adopt an investment approach that includes a diversified, well balanced portfolio of high quality securities, and to stick to it. This can be accomplished in many company retirement plans or by independently using a good mix of mutual funds. For busy professionals, or those who would rather not spend their time continually monitoring their investments, it is often best to use a professional. As an objective third party, a professional can more easily avoid “behavioral finance” mistakes. Additionally, because professional investment advisors are focused on the fundamental values of the companies issuing stocks and bonds, they are better equipped to make wise buying and selling decisions.

It’s funny because as I ask this question, I realize I’m not so sure depression is winning that unpopular race anymore. In my clinical experience I’d have to say that anxiety is perhaps pulling ahead. In our modern society with the plethora of stresses, many of which are financial by the way, I think experiencing anxiety may now be the ‘common cold’ of American mental health. Have you found anxiety impacting people’s financial decisions – budgeting, saving, spending, etc. – more so over the past 10 years than previously?

We see many people who begin to question their ability to achieve their financial goals, especially given the barrage of negative news in the media. Everything from the crisis in the Middle East, to the looming “fiscal cliff” to the inability of congress to work together in a bipartisan way can create feelings of extreme anxiety. Often, people feel insecure about their careers as a result of the changing world around them. In our experience, the very best anecdote to this type of anxiety is a good financial plan, with multiple scenarios that include both “upside” and “downside” scenarios . If we can get people comfortable with their financial future, even in a “downside” scenario by saving enough, investing wisely, living within their means and taking the steps necessary to protect their earnings power, then they often feel a great sense of relief.

Do people with wealth to invest do so, or do people avoid this task?

Often, people are not as conscious about investing as they could be. Sometimes we see people with large amounts of cash sitting in checking or savings accounts, earning little to no interest. Often these folks are simply extremely busy with their careers and have little time to manage their assets. It’s important to know that putting your money to work for you, as early as possible, can have a tremendous positive impact on your overall wealth. For example, a person aged 35 who saves 10% of their $50,000 salary per year into a 401k, will have over $900,000 at age 65. A full two thirds of this amount, $600,000, is due to compound earnings, while only $300,000 equals contributions (includes 3% company match). Pre-tax vehicles such as 401k and IRA accounts further leverage compound earnings, because assets are earning on higher pre-tax savings.

It’s December and people are thinking ahead to how to make 2013 better. What are some important behavior changes a person could begin or one thing they could do to begin improving their financial health?

As important as a good investment strategy is, there is no substitute for savings. A solid financial plan will help you determine if your savings will ultimately meet your needs in retirement and will answer questions such as “when can I retire?”, “can I afford a bigger home?” or “can I start my own business?”. A plan such as this is, perhaps, the best investment you can make, because it informs every other major life decision.

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Psychiatry and Depression

How do I distinguish between depression and normal variations in mood?

Everyone has felt fed up, miserable, or sad at times. These feelings can come and go and don’t interfere too much with all of life’s activities and responsibilities. There may or may not be a clear reason for the feelings, but regardless, people usually figure out a way to manage them. In depression, however, these feelings don’t readily improve. They can last for weeks or months, and start to interfere with daily responsibilities. People with depression can struggle with persistently low mood, low energy, loss of enjoyment in activities, difficulty sleeping and eating, feelings of guilt, poor concentration, irritability, and even thoughts of suicide. Some may experience other symptoms, such as agitation, anxiety, and physical problems like headaches and stomach aches. Children also can have depression, but it tends to be more characterized by irritability and loss of interest in previously enjoyed activities.

What causes depression?

There are several factors that can cause or contribute to depression. Stressful circumstances, physical illness, genetics, prior negative life experiences, and alcohol and drug use can all play a role in causing or perpetuating depression.

What can I do to help myself?

Depending on your individual circumstances, finding someone to talk with about your problems can be helpful. Finding ways to reduce stress, such as by reducing your obligations and responsibilities can also be an option. Other strategies for helping your mood might include exercising regularly, practicing relaxation strategies such as meditation or prayer, eating well, avoiding alcohol and drugs, and getting enough sleep. Other forms of self-help include reading books or leaflets and looking for self-help computer/internet programs.

When should I seek help?

You should consider seeking help if you notice your feelings seem worse than usual or don’t seem to be getting any better. Also, you should seek help if your feelings and symptoms interfere with your work, interests, and relationships. Finally, you should seek help if you are struggling with thoughts life isn’t worth living or thinking of suicide.

What kind of help is available?

Besides self-help strategies, two forms of professional treatment are therapy and antidepressant medications. There are several empirically-validated forms of therapy for treating depression to include cognitive-behavioral therapy (CBT), problem-solving therapy, and interpersonal psychotherapy. These forms of depression therapy can be provided in different settings such as individual therapy, couple’s therapy, family therapy, and group therapy. For mild to moderate depression, any of these therapies are good options. Antidepressant medication can also be a good option, particularly in moderate to severe depression. In these cases, a person may be more able to benefit from therapy when taking medication, as antidepressant medication can lift some of the fog and sadness of depression that can sometimes interfere with successful therapy. Studies have shown in general, people with depression have the best chance of getting better by using a combination of both therapy and medication. Relapse rates have been found to be higher when antidepressant medication is used alone without therapy, likely because in therapy you also learn and improve coping skills and strategies. Many people choose to take an antidepressant because of ease of use and cost, depending on the medication.

What Can I Expect From an Antidepressant?

Antidepressants work by altering the concentration of brain neurotransmitters in the synapses. Two neurotransmitters in particular, serotonin and norepinephrine, have been associated with mood. Newer antidepressants can be categorized into those medications that primarily affect serotonin (called selective serotonin reuptake inhibitors or SSRIs) such as Prozac, Zoloft, and Celexa, and those medications that affect serotonin and/or other neurotransmitters such as norepinephrine and dopamine (non-SSRIs). These include medications like Effexor, Wellbutrin, Cymbalta, and Remeron.

In addition to depression, antidepressants can be helpful for several other diagnoses, including anxiety disorders, panic attacks, obsessive-compulsive disorder, posttraumatic stress disorder, and eating disorders. In general, SSRIs are usually the first choice for treating depression due to their mild side effects and lower cost. Side effects, such as nausea and anxiety, tend to be mild and wear off after a few days to weeks. SSRIs can have sexual side effects, too. There has also been controversy regarding whether antidepressants worsen suicidal thinking and behavior in children and teens. At this point, the general consensus is for most people, these medications can be safe and helpful when taken as prescribed, but for a small percentage of people, the medication can make things worse. For this reason, children prescribed these medications should be monitored closely, which is a good reason to have a trained child psychiatrist work with your child.

Your psychiatrist might choose one of the non-SSRIs for a variety of reasons, including a person’s preference, wanting to avoid certain side effects (for example, Remeron has a side effect of sleepiness and weight gain), having a history of a family member responding well to a certain antidepressant, wanting to target concurrent medical problems (Cymbalta is thought to help treat the pain associated with fibromyalgia, and Wellbutrin is helpful for people wanting to quit smoking, for example), wanting to avoid any drug interactions with other medicines a person is taking, and finally, lack of success with the SSRIs.

Antidepressant medication, like therapy, does not work immediately. In general, it can take four to six weeks of consistent use before a person obtains maximum benefit from the medication. For people with other psychiatric conditions, such as obsessive-compulsive disorder, panic attacks and anxiety, the medication can take up to six to twelve weeks to have full effect. A given antidepressant typically has about a 50-65% chance of being helpful and is dependent on a person taking it as prescribed. Though these medications are not addictive, stopping them abruptly can lead to withdrawal symptoms such as flu like symptoms, vivid dreams, dizziness, stomach upset, anxiety, and a return of the depression. It is therefore recommended you discuss a taper off the medication with your doctor and engage in therapy during that time period. Psychiatrists can work in concert with your therapist to manage your care, so your use of medication and therapy is well-coordinated and most beneficial to you.

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THERAPY AT A GLANCE
(CBT, DBT, & Family Therapy)

COGNITIVE-BEHAVIORAL THERAPY is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.

Cognitive-Behavioral Therapy (CBT) is a general term for different types of therapy such as Rational Emotive Behavior Therapy and Dialectic Behavior Therapy. Most cognitive-behavioral therapies have similar characteristics.

• CBT is based on the idea that our thoughts cause our feelings and behaviors rather than external things, like people, situations, and events. The benefit of this idea is that we can change the way we think in order to feel or act better even if the situation does not change.
• CBT can be brief and time-limited. CBT is considered among the most rapid in terms of results obtained. The average number of sessions clients receive (across all types of problems and approaches to CBT) is only 16. Other forms of therapy, like psychoanalysis, can take years. What allows CBT to be briefer is its highly instructive nature and the fact that it makes use of homework assignments.
• CBT is time-limited in that we help clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end. The ending of the formal therapy is a decision made by the therapist and client. Therefore, CBT is not an open-ended, never-ending process.
• A sound therapeutic relationship is necessary for effective therapy, but not the focus. Some forms of therapy assume that the main reason people get better in therapy is because of the positive relationship between the therapist and client. CBT therapists believe it is important to have a good, trusting relationship, but that is not enough. CBT therapists believe that the clients change because they learn how to think differently and they act on that learning. Therefore, CBT therapists focus on teaching rational self-counseling skills.
• CBT is a collaborative effort between the therapist and the client. CBT therapists seek to learn what their clients want out of life (their goals) and then help their clients achieve those goals. The therapist’s role is to listen, teach, and encourage, while the client’s role is to express concerns, learn, and implement that learning.
• CBT teaches the benefits of feeling, at worst, calm when confronted with undesirable situations. It also emphasizes the fact that we have our undesirable situations whether we are upset about them or not. If we are upset about our problems, we have two problems — the problem, and our upset about it. Most people want to have the fewest number of problems possible. So when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem.
• CBT uses the Socratic Method. CBT therapists want to gain a very good understanding of their clients’ concerns. That’s why they often ask questions. They also encourage their clients to ask questions of themselves, like, “How do I   really know that those people are laughing at me?”  “Could they be laughing    about something else?”
• CBT is structured and directive. CBT therapists have a specific agenda for each session. Specific techniques and concepts are taught during each session. CBT    focuses on the client’s goals. We do not tell our clients what their goals “should” be, or what they “should” tolerate. We are directive in the sense that we show our clients how to think and behave in ways to obtain what they want. Therefore, CBT therapists do not tell their clients what to do — rather, they teach their clients how to do.
• CBT is based on an educational model. CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. Therefore, CBT is more than just talking. The educational emphasis of CBT has an additional benefit — it leads to long term results. When people understand how and why they are doing well, they know what to do to continue doing well.
• CBT theory and techniques rely on rational thinking that it is based on fact. Often, we upset ourselves about things when, in fact, the situation isn’t like we think it is. If we knew that, we would not waste our time upsetting ourselves.   Therefore, CBT encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested. If we find that our hypotheses are incorrect (because we have new information), then we can change our thinking to be in line with how the situation really is.
• Homework is a central feature of CBT. If when you attempted to learn your multiplication tables you spent only one hour per week studying them, you might still be wondering what 5 X 5 equals. You very likely spent a great deal of time at home studying your multiplication tables, maybe with flashcards. The same is the case with psychotherapy. Goal achievement could take a very long time if a person were to only think about the techniques and topics taught for one hour per week. That’s why CBT therapists assign reading assignments and encourage their clients to practice the techniques learned.
• Cognitive Behavioral Therapy has been found to be effective with mood, anxiety, personality, eating, substance use, and psychotic disorders. There are different goals for different disorders. CBT has been found to be more effective than medication alone for mild to moderate depression and anxiety. CBT in conjunction with medication (not medication alone) is the best course of treatment for severe depression and anxiety. CBT with personality disorders is often more behaviorally focused at first, meaning, focusing on changing behavior and then looking at deeply ingrained beliefs. CBT with psychosis helps people develop social skills, problem solving skills, decision making skills, and countering delusional thoughts. CBT and SSRIs is the best combination for anorexia.

DIALECTICAL BEHAVIOR THERAPY was originally developed for people with Borderline Personality Disorder. Clients with BPD who received CBT found the focus on change that is inherent to CBT invalidating of their emotions.

• DBT was developed as an acceptance-based intervention. Validation strategies were developed to communicate to the client their feelings were acceptable and understandable, including those that were self-harming, and made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: Clients also must change if they want to build a life worth living. Thus, the focus on acceptance did not occur to the exclusion of change based strategies; rather, the two enhanced the use of one another.
• In order to balance the strategy of acceptance versus change, dialectical strategies served to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies look at all parts of a situation in a holistic, rather than black and white, manner.
• DBT includes group skills training, individual therapy, telephone check-ins, and a consultation group for the therapist. This was how it was developed and conducted in a research setting. Many people find it useful to have DBT skills training in individual therapy or to attend a group but not have individual therapy. It is best to evaluate individual needs to determine what format is the best fit.
• DBT is not just for people with Borderline Personality Disorder anymore! It has been found helpful for people with anxiety and depression as well as Antisocial Personality Disorder.
• The general goals of skills training are to learn and refine skills in changing behavioral, emotional, and thinking patterns associated with problems in living that are causing misery and distress.
• The Specific Goals of skills training are:

1. Core mindfulness training: Learning to go within to find oneself and learning to observe oneself.
2. Interpersonal effectiveness: Learning to deal with conflict situations, to get what one wants and needs, and to say no to unwanted requests and demands. It focuses specifically on doing this in a manner that maintains self-respect and other’s liking and/or respect.
3. Emotional regulation training: Enhancing control of emotions.
4. Distress tolerance training: Discusses the connection between the inability to tolerate distress and impulsive behavior which reduces intolerable distress such as alcohol, drugs, eating, spending, and self harm.

FAMILY THERAPY is a form of psychotherapy that involves all the members of a nuclear or extended family. It may be conducted by a pair or team of therapists. Although some forms of family therapy are based on behavioral or psychodynamic principles, the most widespread form is based on family systems theory. This approach regards the family, as a whole, as the unit of treatment, and emphasizes such factors as relationships and communication patterns rather than traits or symptoms in individual members.
Family therapy is often recommended in the following situations:

• Treatment of a family member with schizophrenia or bipolar disorder. Family therapy helps other family members understand their relative’s disorder and adjust to the psychological changes that may be occurring in the relative.
• Families with problems across generational boundaries. These would include problems caused by children being reared by grandparents.
• Families that may not have internal problems but may be troubled by outsiders’ judgmental attitudes such as gay couples rearing children.
• Families with members from a mixture of racial, cultural, or religious backgrounds.
• Families who are undermining the treatment of a member in individual therapy.
• Families where the identified patient’s problems seem inextricably tied to problems with other family members.
• Blended families with adjustment difficulties.

Family therapy tends to be short-term treatment, usually several months in length, with a focus on resolving specific problems. It is not normally used for long-term or intensive restructuring of severely dysfunctional families.
In family therapy sessions, all members of the family and the therapist are present at most sessions. The therapists seek to analyze the process of family interaction and communication as a whole; they do not take sides with specific members. They may make occasional comments or remarks intended to help family members become more conscious of patterns or structures that had been previously taken for granted. Family therapists, who work as a team, also model new behaviors for the family through their interactions with each other during sessions.
Family therapy is based on family systems theory, which understands the family to be a living organism that is more than the sum of its individual members. Family therapy uses “systems” theory to evaluate family members in terms of their position or role within the system as a whole. Problems are treated by changing the way the system works rather than trying to “fix” a specific member. Family systems theory is based on several major concepts:
The identified patient (IP) is the family member with the symptom that has brought the family into treatment. The concept of the IP is used by family therapists to keep the family from scapegoating the IP or using him or her as a way of avoiding problems in the rest of the system.
Homeostasis (balance) means that the family system seeks to maintain its customary organization and functioning over time. It tends to resist change. The family therapist can use the concept of homeostasis to explain why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and what is likely to happen when the family begins to change.
The extended family field refers to the nuclear family, plus the network of grandparents and other members of the extended family. This concept is used to explain the intergenerational transmission of attitudes, problems, behaviors, and other issues.
Differentiation refers to the ability of each family member to maintain his or her own sense of self, while remaining emotionally connected to the family. One mark of a healthy family is its capacity to allow members to differentiate, while family members still feel that they are “members in good standing” of the family.
Triangular relationships occur whenever any two persons in the family system have problems with each other. They will “triangle in” a third member as a way of stabilizing their own relationship. The triangles in a family system usually interlock in a way that maintains family homeostasis. Common family triangles include a child and its parents; two children and one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law.
Family therapists will usually evaluate a family for treatment by scheduling a series of interviews with the members of the immediate family, including young children, and significant or symptomatic members of the extended family. This process allows the therapist to find out how each member of the family sees the problem, as well as to form first impressions of the family’s functioning. Family therapists typically look for the level and types of emotions expressed, patterns of dominance and submission, the roles played by family members, communication styles, and the locations of emotional triangles. They will also note whether these patterns are rigid or relatively flexible.
Preparation also usually includes drawing a genogram, which is a diagram that depicts significant persons and events in the family’s history. Genograms also include annotations about the medical history and major personality traits of each member. Genograms help in uncovering intergenerational patterns of behavior, marriage choices, family alliances and conflicts, the existence of family secrets, and other information that sheds light on the family’s present situation.

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Wasting Away

An eating disorder is characterized by extreme reduction or increase in food intake, or Feelings of extreme distress or concern about body weight or shape. A person with an eating disorder may start out by eating smaller or larger amounts of food than normal but at some point takes it to an extreme. The two main types of eating disorders are anorexia nervosa and bulimia nervosa.

In her book, “Wasted: A Memoir of Anorexia and Bulimia,” Marya Hornbacher, describes how her eating disorder started with bulimia.

“It was that simple: One minute I was your average nine-year-old, shorts and a T-shirt and long brown braids, sitting in the yellow kitchen, watching the Brady Brunch reruns, munching on a bag of Fritos, scratching the dog with my foot. The next minute I was walking, in a surreal haze I would later compare to the hum induced by speed, out of the kitchen, down the stairs, into the bathroom, shutting the door, putting the toilet seat up, pulling my braid back with one hand, sticking my two fingers down my throat, and throwing up until I spat blood. Flushing the toilet, washing my hands and face, smoothing my hair, walking back up the stairs of the sunny, empty house, sitting down in front of the television, picking up my bag of Fritos, scratching the dog with my foot.”

Bulimia nervosa is characterized by recurrent and frequent patterns of eating unusually large amounts of food (binge-eating) followed by purging (e.g. vomiting, abuse of laxatives or diuretics), fasting and/or excessive exercise. People with bulimia believe that the act of purging compensates for the binge eating. Unlike those with anorexia, those with bulimia are often within the normal weight range for their age. However, they are still preoccupied by the desire to lose weight, are unhappy with their body shape and size and have an intense fear of gaining weight. Bulimic behavior is done secretly because it is usually accompanied by feelings of shame or disgust. In most cases, the binging and purging cycle is repeated several times a week. Bulimia is often comorbid with psychological disorders such as depression or anxiety and accompanied by physical health complications.

Marya Hornbacher also described how she became anorexic.

“Anorexia started slowly. It took time to work myself into the frenzy that the disease demands. There were an incredible number of painfully thin girls at Interlochen, dancers mostly. The obsession with weight seemed nearly universal. Whispers and longing stairs followed the ones who were visibly anorexic. We sat at our cafeteria tables, passionately discussed the calories of lettuce, celery, a dinner roll, rice. We moved between two worlds. When we pushed back our chairs and scattered to our departments, we transformed. I would watch girls who’d just been near tears in the door-room mirrors suddenly become rapt with life, fingers flying over a harp, a violin, bodies elastic with motion, voices strolling through Shakespeare’s forest of words.”

Anorexia nervosa is the inability or unwillingness to maintain a normal body weight for a person’s age and height. A clinician will usually diagnose the disorder when a person fails to meet 85% of their normal or expected weight. Some symptoms include distorted body image and extreme fear of gaining weight, obsession with food and weight control, and extremely disturbed eating behavior. Girls and women may experience lack of menstruation. Some methods of weight loss used are excessive diet and exercise, self-induced vomiting and misuse of diuretics, laxatives or enemas. Other signs of anorexia are yellowish skin, and growth of fine hair all over the body. A person with anorexia may also experience mild anemia, muscle weakness and loss, severe constipation, low blood pressure, slow breathing and pulse, a drop in internal body temperature (feeling cold all the time), and feeling lethargic.

How to Get Help

A trained psychologist can be instrumental in treating eating disorders and helping the patient recover. He or she can help identify the issues that need attention and develop a treatment plan, then helps the patient replace destructive thoughts and behaviors with more positive ones. For example, a psychologist might work with the patient to focus on health instead of weight, or ask the patient to keep a food journal to become aware of what situations trigger disordered eating.

However, psychotherapy goes beyond just changing thoughts and behaviors. The psychologist must work with the patient to uncover the psychological issues underlying the eating disorder, which sometimes involves improving personal relationships and going beyond the specific situations that triggered the disorder. Incorporating group therapy, family therapy, or marital therapy can be helpful for allowing family members to understand the disorder and how they can help. Cognitive-behavioral therapy (CBT) is a common method of psychotherapy used to treat eating disorders. CBT therapists believe that the clients change because they learn how to think differently and then act on that learning. Therefore, an important part of the therapy is teaching self-counseling skills.

Treatments do not work instantly and for many patients may need to be long-term. As with any medical or psychological disorder, the sooner treatment is sought, the better. The longer disordered eating continues, the more difficult it is to treat. The prospects for long-term recovery are good for those who seek help from qualified professionals.

Eating Disorders – General Info and Symptoms

A third category is “eating disorders not otherwise specified” (EDNOS) and includes several other less common types, including binge-eating disorder. These are much more common in women and girls than in men, and according to the National Institute of Mental Health, adolescent and young women account for 90% of the cases. Eating disorders most frequently surface during adolescence or young adulthood, though they can develop at other times and in men or boys.

Anorexia is a treatable condition, and some recover completely. However some who have anorexia set well but have relapses, while others have a more chronic form of the illness in
which their health continues to deteriorate for many years. Treatment of anorexia involves three major components: restoring the person to a healthy weight, treating the psychological issues related to the eating disorder, and reducing or eliminating thoughts and behaviors that lead to disordered eating and preventing relapse.

Other symptoms include:

• Chronically inflamed sore throat
• Swollen glands in the neck and below the jaw
• Worn tooth enamel and increasingly sensitive and decaying teeth as a result of
  exposure to stomach acid
• Gastroesophageal reflux disorder
• Intestinal distress and irritation from laxative abuse
• Kidney problems from diuretic abuse
• Severe dehydration from purging of fluids

Binge-eating disorder is characterized by a lack of control of one’s eating, resulting in recurrent episodes of binge-eating. People with the disorder are often overweight or obese and experience guilt and shame or distress over the episodes, which can lead to more binge-eating. Like other eating disorders, binge-eating coexists with other physical and psychological illnesses.

Some people live with eating disorders without family or friends expecting a thing. Withdrawal from social contact, hiding the behavior and denial that there is a problem are often indicators that an eating disorder is present. There are some risk factors that predispose a person to developing eating disorders, including low self-esteem, feelings of helplessness and very negative body image or dissatisfaction with appearance in general. Genetics, gender and ethnicity, and weight and shape can also play a role. It is important to realize that environmental factors like teasing, traumatic or stressful events often trigger the development of an eating disorder.

Eating disorders are some of the most often unreported and untreated mental illnesses because ol the misperception that they will go away on their own. Making an accurate diagnosis and treatment should be left to a licensed psychologist or mental health expert. Because each case is different, there is no generalized treatment plan for eating disorders; treatment plans are often tailored to the patient’s specific needs.

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Wasting Away

An eating disorder is characterized by extreme reduction or increase in food intake, or Feelings of extreme distress or concern about body weight or shape. A person with an eating disorder may start out by eating smaller or larger amounts of food than normal but at some point takes it to an extreme. The two main types of eating disorders are anorexia nervosa and bulimia nervosa.

In her book, “Wasted: A Memoir of Anorexia and Bulimia,” Marya Hornbacher, describes how her eating disorder started with bulimia.

It was that simple: One minute I was your average nine-year-old, shorts and a T-shirt and long brown braids, sitting in the yellow kitchen, watching the Brady Brunch reruns, munching on a bag of Fritos, scratching the dog with my foot. The next minute I was walking, in a surreal haze I would later compare to the hum induced by speed, out of the kitchen, down the stairs, into the bathroom, shutting the door, putting the toilet seat up, pulling my braid back with one hand, sticking my two fingers down my throat, and throwing up until I spat blood. Flushing the toilet, washing my hands and face, smoothing my hair, walking back up the stairs of the sunny, empty house, sitting down in front of the television, picking up my bag of Fritos, scratching the dog with my foot.

Bulimia nervosa is characterized by recurrent and frequent patterns of eating unusually large amounts of food (binge-eating) followed by purging (e.g. vomiting, abuse of laxatives or diuretics), fasting and/or excessive exercise. People with bulimia believe that the act of purging compensates for the binge eating. Unlike those with anorexia, those with bulimia are often within the normal weight range for their age. However, they are still preoccupied by the desire to lose weight, are unhappy with their body shape and size and have an intense fear of gaining weight. Bulimic behavior is done secretly because it is usually accompanied by feelings of shame or disgust. In most cases, the binging and purging cycle is repeated several times a week. Bulimia is often comorbid with psychological disorders such as depression or anxiety and accompanied by physical health complications.

Marya Hornbacher also described how she became anorexic.

Anorexia started slowly. It took time to work myself into the frenzy that the disease demands. There were an incredible number of painfully thin girls at Interlochen, dancers mostly. The obsession with weight seemed nearly universal. Whispers and longing stairs followed the ones who were visibly anorexic. We sat at our cafeteria tables, passionately discussed the calories of lettuce, celery, a dinner roll, rice. We moved between two worlds. When we pushed back our chairs and scattered to our departments, we transformed. I would watch girls who’d just been near tears in the door-room mirrors suddenly become rapt with life, fingers flying over a harp, a violin, bodies elastic with motion, voices strolling through Shakespeare’s forest of words.

Anorexia nervosa is the inability or unwillingness to maintain a normal body weight for a person’s age and height. A clinician will usually diagnose the disorder when a person fails to meet 85% of their normal or expected weight. Some symptoms include distorted body image and extreme fear of gaining weight, obsession with food and weight control, and extremely disturbed eating behavior. Girls and women may experience lack of menstruation. Some methods of weight loss used are excessive diet and exercise, self-induced vomiting and misuse of diuretics, laxatives or enemas. Other signs of anorexia are yellowish skin, and growth of fine hair all over the body. A person with anorexia may also experience mild anemia, muscle weakness and loss, severe constipation, low blood pressure, slow breathing and pulse, a drop in internal body temperature (feeling cold all the time), and feeling lethargic.

How to Get Help

A trained psychologist can be instrumental in treating eating disorders and helping the patient recover. He or she can help identify the issues that need attention and develop a treatment plan, then helps the patient replace destructive thoughts and behaviors with more positive ones. For example, a psychologist might work with the patient to focus on health instead of weight, or ask the patient to keep a food journal to become aware of what situations trigger disordered eating.

However, psychotherapy goes beyond just changing thoughts and behaviors. The psychologist must work with the patient to uncover the psychological issues underlying the eating disorder, which sometimes involves improving personal relationships and going beyond the specific situations that triggered the disorder. Incorporating group therapy, family therapy, or marital therapy can be helpful for allowing family members to understand the disorder and how they can help. Cognitive-behavioral therapy (CBT) is a common method of psychotherapy used to treat eating disorders. CBT therapists believe that the clients change because they learn how to think differently and then act on that learning. Therefore, an important part of the therapy is teaching self-counseling skills.

Treatments do not work instantly and for many patients may need to be long-term. As with any medical or psychological disorder, the sooner treatment is sought, the better. The longer disordered eating continues, the more difficult it is to treat. The prospects for long-term recovery are good for those who seek help from qualified professionals.

Eating Disorders – General Info and Symptoms

A third category is “eating disorders not otherwise specified” (EDNOS) and includes several other less common types, including binge-eating disorder. These are much more common in women and girls than in men, and according to the National Institute of Mental Health, adolescent and young women account for 90% of the cases. Eating disorders most frequently surface during adolescence or young adulthood, though they can develop at other times and in men or boys.

Anorexia is a treatable condition, and some recover completely. However some who have anorexia set well but have relapses, while others have a more chronic form of the illness in
which their health continues to deteriorate for many years. Treatment of anorexia involves three major components: restoring the person to a healthy weight, treating the psychological issues related to the eating disorder, and reducing or eliminating thoughts and behaviors that lead to disordered eating and preventing relapse.

Other symptoms include:

• Chronically inflamed sore throat
• Swollen glands in the neck and below the jaw
• Worn tooth enamel and increasingly sensitive and decaying teeth as a result of
  exposure to stomach acid
• Gastroesophageal reflux disorder
• Intestinal distress and irritation from laxative abuse
• Kidney problems from diuretic abuse
• Severe dehydration from purging of fluids

Binge-eating disorder is characterized by a lack of control of one’s eating, resulting in recurrent episodes of binge-eating. People with the disorder are often overweight or obese and experience guilt and shame or distress over the episodes, which can lead to more binge-eating. Like other eating disorders, binge-eating coexists with other physical and psychological illnesses.

Some people live with eating disorders without family or friends expecting a thing. Withdrawal from social contact, hiding the behavior and denial that there is a problem are often indicators that an eating disorder is present. There are some risk factors that predispose a person to developing eating disorders, including low self-esteem, feelings of helplessness and very negative body image or dissatisfaction with appearance in general. Genetics, gender and ethnicity, and weight and shape can also play a role. It is important to realize that environmental factors like teasing, traumatic or stressful events often trigger the development of an eating disorder.

Eating disorders are some of the most often unreported and untreated mental illnesses because ol the misperception that they will go away on their own. Making an accurate diagnosis and treatment should be left to a licensed psychologist or mental health expert. Because each case is different, there is no generalized treatment plan for eating disorders; treatment plans are often tailored to the patient’s specific needs.

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How Does Bipolar Disorder Affect Your Life or the Life of Someone You Love?

Colloquially known as manic-depression, how does bipolar disorder affect your life or the life of someone you love? Learn about how treatment can help.

Jonathan is a 35-year-old attorney who moved from Colorado to North Carolina. He started seeing a psychiatrist to continue his medication treatment with a mood stabilizer. He had been successful in work and relationships since he was diagnosed with bipolar disorder and treated in college. Moving to North Carolina was difficult because he worked all the time and had not made many new friends. About six months after he moved, he noticed a change in his mood. For about a month, he felt increasingly energetic although was not sleeping more than three hours at night. Co-workers noticed he was talking very quickly, and he seemed to have so many thoughts going through his head that he could not get them all out. He started working longer and longer hours, but did not really get anything completed, and jumped from project to project. He also went out to bars after work each night and drank until they closed. What was going on with Jonathan?

Jonathan had a Manic Episode, which includes a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (Jonathan’s mood would be described as elevated). Three or more of the following symptoms generally persist (four if the mood is only irritable) and are present to a significant degree.

1. Inflated self-esteem or grandiosity. – This did not appear to happen with Jonathan.
2. Decreased need for sleep. – Jonathan felt rested after only three hours of sleep.
3. More talkative than usual or pressure to keep talking. – This was noted by Jonathan’s co-workers.
4. Flight of ideas or subjective experience that thoughts are racing. – Jonathan felt he had so many thoughts going through his head that he could not get them all out.
5. Distractibility. – This was evident in Jonathan’s inability to finish projects at work.
6. Increase in goal-directed behavior – This was demonstrated by his longer and longer hours spent at work.
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences such as unrestrained shopping sprees, sexual indiscretions, or foolish business investments. – Jonathan drank until the bars closed each night after work.

Bipolar disorder is often comorbid with other disorders such as alcohol or drug abuse or dependence, anxiety disorders, eating disorders, and personality disorders.

So, what can be done to help Jonathan?

Bipolar disorder is the result of genetic and biological vulnerability that leads to mood disorder symptoms and dysregulation. This, combined with life and family stressors, triggers episodes.

The most common forms of treatment are medications such as mood stabilizers (for example, Lithium & Depakote). Sometimes, in an acute manic phase, an antipsychotic (such as Risperdal) is prescribed. After someone has been stabilized for a while, they might be prescribed an antidepressant (such as Prozac). Because people often go through phases when they do not take their medication, (and even when they do, they have ‘breakthrough episodes’ – similar to what happened to Jonathan; breakthrough episodes develop when there is a reoccurrence of symptoms.) It is recommended to people with bipolar disorder that they also attend therapy.

In individual therapy, people learn the importance of medication adherence and stress management. They develop an understanding of their signs of depressive and manic episodes. They realize the importance of self-care such as balanced eating, exercise, regular sleep routines, and relaxation. They develop a plan with family and friends to recognize their symptoms and intervene when necessary. They also learn to challenge their depressive thinking and increase positive experiences to help manage their emotions.

In family and marital therapy, individuals learn how to express emotions, communicate, and recognize when they are experiencing stress and other symptoms. Education about bipolar disorder is often completed with families to help them understand their loved one’s vulnerability to future episodes and the need for medication. Families also need to be taught the difference between symptoms and personality, how to recognize and learn to cope with their own stressors, and the importance of reestablishing relationships after episodes.

What happened to Jonathan?

Jonathan was taken to the emergency room and a call was placed to his psychiatrist. The psychiatrist was able to work with him on an out-patient basis to adjust his medication, although Jonathan did take a week off of work to help reduce his stress level. The psychiatrist also recommended Jonathan see a clinical psychologist trained to do therapy with people with bipolar disorder. Jonathan started to readjust within a week and started to really feel better within about a month. For the past year, he has learned to only work 40-hours a week, get enough sleep, exercise, eat healthfully, take his medication, and spend time getting to know people and relaxing. He has also learned to recognize his symptoms in case he starts to feel depressed or manic.

Bipolar disorder is not unmanageable, but it cannot be treated by self-help alone. If you think you or someone you know suffers from bipolar disorder, now is the time to seek a consultation regarding prevention and treatment.

References:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: APA.

Miklowitz, D. (2001). Bipolar Disorder. In Barlow, D. (Ed.). Clinical handbook of psychological Disorders, 3rd ed. (pp. 523-561). New York: Guilford Press.

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Understanding Autism

Parents are usually the first to notice their child having difficulty and failing to meet developmental milestones. Some things parents might notice are lack of joyful facial expressions by six months, difficulty engaging in give and take interactions by nine months, and delayed language development.

There are three distinctive areas of difficulty which characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling.

The hallmark feature of autism is impaired social interaction. Some children show hints of problems within the first few months of life, while others may not show deficits until they are two years old or later. Some children may develop normally until the age of two, but then they stop making gains in language and social skills or they lose skills that they had already acquired. No two children with autism are alike and presentation may vary significantly.

Autism impacts 1 in 150 people. It occurs in all racial, ethnic, and socioeconomic groups. Autism is four times more likely to occur in boys. Autism impacts one’s overall ability to communicate with and relate to others. Symptoms range from mild to severe. There are five disorders that fall under the Autism Spectrum. These include Asperger Syndrome, Rett Syndrome, Pervasive Developmental Disorder, NOS, and Childhood Disintegrative Disorder.

As children with autism grow up, they may respond differently to their environment. Many adolescents are overwhelmed by the transition between childhood and adulthood. Parents should expect this to be true of adolescents with autism as well. While some behaviors improve during teenage years, some tend to get worse. You may notice an increase in repetitive and aggressive behaviors as the teen has difficulty managing the stress and confusion associated with adolescence. Not to mention the physical and hormonal changes! This is also a time where the teen is at risk for developing anxiety or depression as they become increasingly aware that they are different from their peers.

Treatment: The presentation of autism and other spectrum disorders varies significantly in adults. Some are able to live independently and maintain employment while others have significant difficulty completing daily tasks.

Long before your child finishes school, parents should research available social supports to assist your child with autism in adjusting to the “adult world.”

While there is no identifiable fully effective cure for autism, early intervention obtains maximum benefits for your child. Early intervention should focus on improving communication, social, and cognitive skills.

Although there is no single treatment protocol for all children with autism, most individuals respond best to highly structured behavioral programs.

Psychosocial and behavioral interventions are key parts of comprehensive treatment programs. In addition to these interventions, therapies often include occupational therapy, sensory integration therapy, and speech therapy.

If you have concerns about your child’s development, speak to your pediatrician to determine the best course of action and complete screenings with other qualified professionals, such as a psychologist.

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