Category: borderline personality disorder

Is my teen ‘normal’ crazy or seriously troubled?

Is my teen ‘normal’ crazy or seriously troubled?

girl in rear view mirrorA high percentage of teenagers go through a rebellious or ‘crazy’ phase that is normal for their age and brain development. The difference between normal teen-crazy and truly troubled behavior is when the teenager falls behind his or her peers in critical areas: school, social activity, emotional maturity, self-control or self discipline, risk awareness, self-fulfillment.

At a bare minimum, a normal teen, no matter how troublesome, will be able to do the following:

  • Attend school and do some school work if they want to;
  • Have and keep a friend or friends their own age who also attend school;
  • Develop a maturity level roughly the same as his or her peers;
  • Exercise self-control when he or she wants to;
  • Demonstrate basic survival instincts, risk awareness, and avoid doing harm to themselves, others, or property.
  • Enjoy activities that interest them.

boy in baseball capIt is normal for many teens to be inconsistent, irrational, insensitive to others, self-centered, and childish.  Screaming or swearing is normal–regard this the same as a toddler temper tantrum.  Outlandish imagination and ideas are normal in the adolescent phase too. These are behaviors that crazy teens grow out of unless something else is holding them back.  What you’d call troubled behavior, the kind that necessitates mental health treatment, is a matter of degree.

So how do you tell the difference?

Look for pervasive patterns of social and behavioral problems that stand out against their peers, patterns which persist or occur in different settings Look back at how long these patterns have been occurring.  Are the ‘crazy’ patterns repeating themselves, or did they start suddenly?

screaming boySigns of abnormal behavior

A sudden change in behavior.

  • An abrupt change in friends and interests, and loss of interest in things your teenager used to enjoy.  This might indicate the onset of a serious mental illness or drug use or both.
  • Unusual ideas, or obsessive beliefs, or unrealistic plans, see:  “Unsettling: what psychosis looks like in children and young people.”
  • Others have concerns about your child.  (e.g., your child’s friend comes forward, their teacher calls, other parents keep their children from your child, or someone checks to see if you’re aware of the nature of his or her behaviors).

Unsafe behaviors (“Unsafe” means there’s a danger of harm to themselves or others, property loss or damage, running away, seeking experiences with significant risk (or easily lured into them), abusing substances, and physical or emotional abuse of others.)

  • If a troubled teenager does something unsafe to themselves or others, it is not an accident, but something impulsive, intentional, and planned.
  • They have a history of intentional unsafe activities.
  • They have or seek the means to do unsafe activities.
  • They talk about or threaten unsafe behavior.


How psychologists measure the severity of a child’s behavior 

“Normal” is defined with textual descriptions of behaviors, and these are placed on a spectrum from normal to abnormal (or “severe emotional disturbance” – SED).  Below are a few examples of a range of behaviors in different settings.  These descriptions are generalizations and should not be used to predict your child’s treatment needs, but they do offer insight into severity and the need for mental health treatment.

School behaviors

Not serious – This child has occasional problems with a teacher or classmate that are eventually worked out, and usually don’t happen again.

Mildly serious – This child often disobeys school rules but doesn’t harm anyone or property.  Compared to their classmates, they are troublesome or concerning, but not unusually badly behaved. They are intelligent, but don’t work hard enough or focus enough to have better grades. They could use help from a school counselor, teachers, and possibly a therapist for themselves or the family.

Serious – This child disobeys rules repeatedly, or skips school, or is known to disobey rules outside of school.  They stand out in the crowd as having chronic behavior problems compared to other students and their grades are poor even if they’re very intelligent.  This child needs mental health or substance abuse treatment.

Very serious – This child cannot be in school or they are dangerous in school.  They cannot follow rules or function, even in a special classroom, or they may threaten or hurt others or damage property.  It is feared they will have a difficult future, perhaps ending up in jail or having lifetime problems.  If they cooperate, this child requires intensive mental health and or substance abuse treatment.

Home behaviors

boy looking right

Not serious – This child is well-behaved most of the time but has occasional problems, which are usually worked out.

Mildly serious – This child has to be watched and reminded often, and needs pushing to follow rules or do chores or homework.  They don’t seem to learn their lessons and are endlessly frustrating.  They can be defiant or manipulative, but their actions aren’t serious enough to merit intensive treatment, though a school counselor or private counselor would be very beneficial.

Serious – This child cannot follow rules, even reasonable ones.  They can’t explain or take no responsibility for their behavior, which can include damage to the home or property, or harm to themselves or others.  They need mental health treatment or substance abuse treatment.

Very serious – The stress caused by this child means the family cannot manage normally at home even if they work together.  Running away, damaging property, threats of suicide or violence to others, and other behaviors require daily sacrifices from all.  Police are commonly called.  This child needs intense psychiatric treatment and/or substance abuse treatment, and likely residential treatment.

Relationship behaviors

somber boyNot serious – The child has and keeps friends their own age, and has healthy friendships with people of different ages, such as with a grandparent or younger neighbor.

Mildly serious – This child may seem extra immature.  They will argue, tease, bully or harass others, and most schoolmates avoid them. They are quick to have temper tantrums and childish responses to stress that always require extra attention from parents and caregivers.

Serious – The child has no friends their age, or risky friends, and can be manipulative or threatening. They can have violent tendencies, poor judgment, and take dangerous risks with themselves and others.  They don’t care about others’ feelings, or may readily harm others physically or emotionally.  This child needs therapy and psychiatric mental health treatment or substance abuse treatment.

Very serious – The child’s behavior is so aggressive verbally or physically that they are almost always overwhelming to be around.  The behaviors are repeated and deliberate, and can lead to verbal or physical violence against others or themselves.  This child needs intensive psychiatric and/or substance abuse treatment.

Pay attention to your gut feelings.

If you’ve been searching for answers and selected this article to read, your suspicions are probably true.  Trust your intuition. Most parents have good insight into their child.  If you’re looking for ways to “fix” or change your child, there just aren’t any easy methods or medications or therapies to do this except over time.  Treatment means multiple life changes in addition to medication and therapy, and these can include help for insomnia, a change in diet, treatment for digestive system problems, and household changes to reduce stress.

Mental illness is serious and recovery is a long slow process.  It is  understandable if you want them to recover quickly–your stress can be intolerable.  Avoid pushing for recovery because it will only stress your child and lead you to disappointment.  Instead, cooperate with professionals (teachers, treatment providers), and prepare yourself for a parenting marathon.  What’s the best way to prepare?  Work hard on your own mental health and wellbeing.  Lower your expectations for steady progress.  This advice and wisdom from other parents may help you face this daunting task.

boy in plaid shirtEarly treatment, while your troubled teenager is young, can prevent a lifetime of problems.  Find a professional who will take time to get to know your child and you and the situation, and who will listen to what you have to say–a teacher, doctor, therapist, psychiatrist or other mental health practitioner.

–Margaret

Your comments are encouraged.  Your story helps others who read this article.


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Faith can help, and harm, a family’s mental health

Faith can help, and harm, a family’s mental health

When faith helps

Most of the time, people can heal and find peace and self-acceptance through faith. All the world’s great faiths, those that have lasted centuries, are kept alive for this reason. All have common themes of healing and service to others. When things go poorly, meditation and prayer, with others or in private, lead to connection and wholeness. Faith reveals that things are better, and will be better, than they seem.

When families are in crisis because of their troubled child, parents tell me they depend on faith, even parents who don’t profess a faith practice. They say it’s their only source of strength. Most families with a child who is sick, disabled, or mentally ill will go through dark times, when a parent’s world is simply too overwhelming. Most often, no answers are forthcoming, nor any rescue. The only choice is to hand over their burden to a “higher power,” God, the Buddha, Allah, the Great Spirit… This act of “handing over” is a foundation of healing in Alcoholics Anonymous, Narcotics Anonymous, and dialectical behavioral therapy (DBT).

Few things help a family more than a supportive community of believers.  There will be one person who listens to a frightened parent on the phone, and another person who takes a traumatized sibling on an outing, and another person who provides hugs and cookies. If a mentally ill child continues to decline, a good faith-based support network will stay on. The child may not thrive, but the family does, and has the strength and forbearance to handle the years’ long task of supporting their mentally ill loved one.

Science shows that faith results in better lifetime outcomes for a child

This writer typically trusts science, but in the depths of my family’s despair, only faith and the prayers of others kept me from falling apart.

There are scientists among the faithful who have asked the question: does faith really help the mentally ill? In another blog post, Spirituality and mental health, some research are summaries of research going back 36 years.  (Follow this link for the research citations.)  The answer?  Yes, faith makes a real and measurable difference in improving mental health.

More recent scientific research shows clear evidence from brain scans that meditation and prayer change brain electrical activity, from anxious or agitated to serene and grounded.  The person actually feels and behaves better.  This article has more information on this, Yoga – Safe and effective for depression and anxiety.

Like prayer, “talk therapy” or psychotherapy also shows improvement on brain scans. Imagine, just talking with someone improves the physical brain. According to the article appended below, “When God Is Part of Therapy,” many prefer therapists who respect and encourage their faith. It just makes sense.

When faith harms

This section is a personal appeal to faith communities who have unconscionably failed families and their children with mental disorders.

Faith communities depend on people, and people have biases and foibles.  Many of ‘the faithful’ hold negative beliefs about others, right or wrong.  Children who suffer, and their families, are identified as possessed, of evil character, disbelievers, victims of abuse, or cruelest:  those who are paying for their sins. Families are repeatedly told these very things today.

“Sometimes, people hide from the Bible. That is, they use the Christian holy book as an authority and excuse for biases that have nothing to do with God.”
–Leonard Pitts Jr., Miami Herald

Stigmatization from a faith community is a cruel betrayal.

A child’s inappropriate behavior is not a choice, it is a verifiable medical illness, one with a higher mortality rate than cancer:  Mental illness more deadly than cancer for teens, young adults.  Families with sick children need support; our sense of loss is devastating.

Testimonials

Mother with five children, one with bipolar disorder:

“We were members of our church since we were first married, all our daughters grew up here, but when my youngest spiraled down, I was told the sins of the father are visited on the sons. Or we weren’t praying enough. I knew they thought (Dad) had done something bad to her. We left and went church shopping until we found a pastor who understood and supported us.”

Mother of two children, one with acute pervasive development disorder:

“I wish we had a “special needs” church. We’re so afraid our kid is going to say something and we’re not going to be accepted. We haven’t gone to church for years because of this. They just turned their backs on us, it happened to another family with a deaf child. They avoid parents in pain. Deep down in my heart I believe in the Lord, but there are days when I wonder “where is God?” People call out to pray for a job, or a kid’s grades, but we wouldn’t dare ask for us, no one would get it, we’d be told we were bad parents or didn’t punish him enough.”

Mother of two children, one with schizoaffective disorder:

“When I went up to the front to light a candle and ask for a prayer for my daughter, I expected people would come up afterward and give a hug or something, just like with other families with cancer and such. But it didn’t happen. No one even looked at me. I left alone and decided never to go back.”

Some good news

FaithNet

The National Alliance on Mental Illness (NAMI) has recognized the need for the mentally ill to be part of faith communities, and the negative experiences most face when they attempt to participate in a religious community. NAMI started FaithNet to encourage and equip NAMI members to engage with and share their story and NAMI resources with local faith groups, and appeal for their acceptance.

Key Ministry

Key Ministry: Welcoming Youth and Their Families at Church
Stephen Grcevich, M.D., president, Key Ministry and child & adolescent psychiatry in private practice, Chagrin Falls, Ohio

“Key Ministry believes it is not okay for youth living with mental illness and their families to face barriers to participation in worship services, educational programming and service opportunities available through local churches.”

Churches in American culture lack understanding of the causes and the needs of families impacted by mental illness, which poses a significant barrier to full inclusion.

“A study published recently by investigators at Baylor University examined the relationship between mental illness and family stressors, strengths and faith practices among nearly 5,900 adults in 24 churches representing four Protestant denominations. The presence of mental illness in a family member has a significant negative impact on both church attendance and the frequency of engagement in spiritual practices.” When asked what help the church could offer these families, they ranked “support for mental illness” 2nd out of 47 possibilities. Among unaffected families, support for mental illness ranked 42nd.

________________________________________

When God Is Part of Therapy
Tara Parker Pope, March 2011, New York Times

Faith-based therapy is growing in popularity, reports Psychology Today, as more patients look for counselors who can discuss their problems and goals from a religious frame of reference.

Studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twenty-somethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it’s important for them to see a professional counselor who integrates their values and beliefs into the counseling process.

The problem for many patients in therapy is that many patients are far more religious than their therapists.

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.

When children are hospitalized with other ailments, the family draws sympathy and support from others.  But because of mental health stigma, most families like ours don’t when our child is hospitalized.  If not blame, we are second-guessed, or as bad, met with silence or a change of subject.

Things that protect troubled girls from delinquency

Things that protect troubled girls from delinquency

 

Both boys and girls get in trouble with the law.  Boys are in the majority for arrests for crime, but statistics indicate that girls’ arrests are increasing:  “…between 1996 and 2005, girls’ arrest for simple assault increased 24%.”  Of 1528 girls studied over a period from 1992 and 2008, 22% committed serious property offenses and 17 % committed serious assaults.  (Girls Study Group, U.S. Department of Justice, 2008. www.ojp.usdoj.gov).

  

Troubled girls easily become criminal, but also risk being a victim

 

Girls who have behavioral disorders, from addictions or past trauma or emotional disorders, begin to have delinquent or criminal behaviors as early as middle school.  What makes a girl’s criminal activities different from boys is that girls put themselves at high risk of being victimized themselves.  How can a parent or caregiver prevent their daughter from engaging in criminal behavior, and trapping themselves in a social world where their stresses and disorders can worsen?

 

The Girls Study Group quoted above studied which factors protected girls from becoming criminal, or helped them stop and reengage in activities that improve and stabilize their lives.  Protective factors did not prevent all criminal activity however, yet the first one has been shown to be the most effective.

 

  • Support from a caring adult.  THIS IS THE SINGLE MOST IMPORTANT FACTOR in preventing girls from criminal activities of any kind.
  • Success in school helped prevent aggression against people, but not property crimes.
  • “Religiousity,” or how important religion was to troubled girls, meant they were less likely to be involved with drugs.

Risks to girls that are different from boys: 

    

Early puberty is a risk if the girl has a difficult family and comes from a disadvantaged neighborhood.  Biological maturity before social maturity causes more conflicts with parents and more negative associations with older boys or men.

 

Sexual abuse, which girls experience much more than boys, including sexual assault, rape, and harassment.  But abuse of any kind affects both boys and girls equally.

 

Depression and anxiety, which girls tend to suffer more from than boys.

 

Romantic partners.  Girls who commit less serious crimes are influenced by their boyfriends.  But for serious offenses, both boys and girls are equally influenced by a romantic partner.

 

Once she’s regularly breaking rules, it’s not easy to turn things around for a troubled girl.  It requires constant, persistent efforts to:

  • Keep her away from risky associates.
  • Keep her in school and up with studies. 
  • Keep telling her what’s great about her, what’s special, what’s powerful and good.

If you are a parent or caregiver, and you are lucky enough to have a strong mentoring relationship with your troubled daughter, keep it up despite any occasional law-breaking activities.  She’ll need consequences, but they should be obstacles to overcome rather than punishments—such as earning back privileges by having good behavior for a period of weeks or months.

 

If you don’t or can’t have a mentoring relationship, find out who can (or already does).  Admit you might not be the sole support for her success, and work in partnership with a caring adult.  Find out who believes in her already.  Find out who she asks for help if she’s feeling fearful or down about herself.  Listen to her if she talks about someone she’s grateful for for helping her through difficulties.  Girls respond really well to someone who believes in them.

 


Teen girls can be turned around and it’s always worth the effort.  She might be hard to take sometimes, but find something, anything, that’s good about her and let her know.  Over time, you’ll start noticing more and more great things about her, and then she’ll start noticing them too.

Gang Up on Your Kids: Network with Other Parents to Track Troubled Kids

Gang Up on Your Kids: Network with Other Parents to Track Troubled Kids

An article in the local paper told the story of a mother who desperately tried to get help for her at-risk son to keep him out of a gang.  Yet he became a victim of a drive-by shooting and was in intensive care for days, but he lived.  In the article, she said something I’m very familiar with; she said other parents never told her what they suspected, nor did anyone let her know if her son was at their house when he ran away.  Just knowing her son’s whereabouts could have helped her intercept dangerous activities.  Like her, I never got information from other parents who might have been (or should have been) concerned about my troubled child.  Why didn’t other parents stay in touch and help each other control their children?

 

At-risk kids hang out together, they know each other’s stories (true or not), and protect each other, and parents are out of the loop.  What if parents got together too, shared stories, and supported each other’s goal of protecting their child from making mistakes?  Kids’ unsafe plans and activities are no match for the many eyes and ears (and cleverness and wisdom) of all their parents combined.

 

How to track at-risk kids and join forces with other parents:

 

Go on the internet, check out Facebook and other social media, and look for your child’s page and the pages of his or her friends.  The police do this all the time; it’s one of their main investigative tools!  At-risk children share everything over the internet:  photos, favorite places and people, favorite activities (even illegal ones), and other incriminating information. It’s easy to identify kids who are at-risk.

 

Contact the parents or caregivers of your child’s friends, by phone or email anytime you find out that their child or teen was with your own child while doing unsafe activities.

 

I did this.  Some parents were thrilled to find support, but a couple were angry with me at first.  After all, I was delivering bad news.  They defended their child, or accused my child of telling stories.  I just said, “I thought you’d want to know.  My kid is in trouble, but you may want to know your child was also involved.”  It took some backbone to stay online, but they eventually calmed down and expressed disappointment in their child.  They often hadn’t suspected anything.  Then I asked if we could join-up and inform on each other’s kids to keep them safe.  Always, I received a strong yes.

 

Compare notes and share news about friends, friends of friends, which houses were dangerous (e.g. adult not at home, or adult provides drugs or alcohol), which places they hang out, and who might victimize them or be victimized by them.

 

Call a teacher and ask who your child hangs out with at school, or if they know another parent who is worried about their kid, call that parent and make a pact to keep each other informed.  Whether they help you or not, at least they know someone’s watching and paying attention.

 

True story – One mother I know recruited a “spy network” with her son’s friends’ parents and with employees of businesses he regularly frequented, such as a skateboard shop near his school and a coffee house.  She was able to keep track of where he was if he ignored her curfews, and inform the community police of adult associates (usually 18-24) who were known to provide drugs, alcohol, and cigarettes to youth.  Her information helped empower other parents who hadn’t known what to do, but were then able to restrict their teen’s activities away from home and make it uncomfortable for unsafe people to associate with them.

 

True story – A father I met took the “spy network” idea a step further and had contact cards, like business cards, which he gave away to police, teachers, other parents, and anyone he met who knew his daughter.  The contact cards basically said “Please help us keep Kari safe and call us, her parents, anytime she is at the following places [ … ] or doing something you believe is inappropriate.  Thank you very much for your help.  We will keep your calls confidential from our daughter.”  Then the card gave the parents’ names, number, and email address.  This greatly limited their daughter’s contact with unsafe or inappropriate friends and adults, because they knew they might be watched and reported if she was around.  Surprisingly, this attention improved the girl’s progress in family therapy, as she stated she felt more like her parents cared.

 

Word gets out quickly among the groups of at-risk kids and the adults who enable them.  If you let enough people know that they may be watched when at-risk kids are around, then they will avoid these kids and even ask them to leave their company.  Don’t forget:  you are smarter and more experienced than young people.  You, as a parent, are not alone with your concerns about your child.


Reach out to the other parents in your community.  You will be surprised how many will thank you.

–Margaret