Category: stress

Borderline children – how they function and how you can help

Borderline children – how they function and how you can help

Children with borderline personality disorder are both wonderful and horrible.
Borderline personality disorder is about opposites and extremes.  A child can be  lovely yet vindictive at times; a great friend or manipulative bully; anguished or glowing with joy; self-hating and self-important.

Are you ready to bang your head on a wall?  Or praying for the day your child turns 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) can traumatize everyone around them.

Children with BPD believe others will abandon them, and this makes them do one of two things:

    1. Do everything possible to obtain and keep love and admiration;
    2. Or if they detect the slightest hint of disapproval, blame themselves and others; break off relationships; or self-harm to bury horrible feelings of abandonment.

 

A borderline child can be very engaging and affectionate… sometimes at random and sometimes when they want something.  Because they can be vindictive, they may also turn on charm as a way to embarrass you in front of others (such as in a meeting with a teacher or family counselor).  Since they often seem wonderful to other people, parents have been judged.  People often suggest they take care of their own issues instead.

Even if their manipulation or drama can be relentless, strive for compassion.  Trust me, your borderline child will suffer more than you in every important aspect of life.  They can make a mess of their relationships because of hurtful or clingy behavior.  Or they create a toxic work environment.  Or they drive away good friends, hate them for leaving, and suffer from loneliness.

A borderline child or teen is not a “drama junkie” on purpose.  There brain is primed to overreact.

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula.  People with borderline personality disorder do not have an internal, natural sense of fairness or social norms, and distrust is their default mentality.  Some suggest that borderlines do not receive the attention they need as an infant and toddler.  Early neglect is also a predictor of reactive attachment disorder, which has similar trust issues.

The brain scan of a normal person shows the areas which make them cooperative.
When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.
A brain scan of a person with borderline personality disorder shows they do not cooperate.
The brain of a borderline person showed no activity whatsoever during the teamwork game.

Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.”  It is estimated 1.4 percent of adults in the United States have this disorder.  A different study reported that BPD occurs as often in men and women, and sufferers often have other mental illnesses or substance abuse problems.  (In my observations, teenagers with borderline personality disorder have many bipolar disorder symptoms.)

From infancy, those who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety, and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as fewer friends and more conflicts with peers and authorities.

As teenagers, borderline children can be promiscuous; impulsive and assaultive; more likely to use drugs and alcohol; and more likely to cut themselves and attempt suicide.  “…research shows that, by their 20’s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

A child with borderline personality disorder can scream and be very hurtful.

Evidence for hope

Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.”

Advances have been made in recent years.  One study tracked borderline patients who had been hospitalized at least once over a 10 year period.  With follow up treatment  “93% of patients achieved a remission of symptoms lasting at least two years, and 86% for at least four years.” Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.  (from “Trying to Weather the Storm”, by S. Roan, September 07, 2009, Los Angeles Times)

“…our message to families is to please stay the course with your (child) because it’s crucial to their well-being.”
(Perry D. Hoffman, president of the National Education Alliance for BPD http://www.borderlinepersonalitydisorder.com.)

Treatment

Psychotherapy is the primary treatment of BPD, and the gold standard is dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  It simply teaches coping skills so patients learn to control their emotions, calm down, and not destroy relationships. Medications support the therapy by reducing depression or anxiety and self-destructive behavior.

(from “What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?” by M. Muscari, 2005, http://www.medscape.com/viewarticle/508832)

When to hospitalize:Borderline children high rate of emergency hospitalizations for suicide attempts.

An emergency hospital stay is recommended if your child has serious suicidal thoughts or an attempt, and/or poses an imminent danger to others, or is incapable of calming down and functioning.

Consider psychiatric residential care if your child has persistent suicidal thoughts; is unable to participate in therapy; or has a co-morbid (co-existing) mental disorder such as bipolar, depression, narcissistic personality disorder.  A child with BPD, at their most extreme, is at very risk risk or suicide or other violent behavior, and other behavioral symptoms that indefinitely interfere with living.

Other mental health supports your borderline child may need:

  • Treatment for substance abuse.
  • Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.  (The most effective therapy is DBT or Dialectical Behavioral Therapy.)
  • Therapy that also focus on trauma and post traumatic issues if present.
  • Reducing stressors in the child’s environment.  Most children with BPD are very sensitive to difficult circumstances, for example:  an emotionally stressful atmosphere; internal and external pressures to succeed or change; inconsistent rules; being around others who are doing better than them.


What parents and caregivers can do

  • With a co-parent or support person:  Maintain a united front.
  • Communicate privately with each other to effectively set limits.  A BPD child will do everything in their power to split authority figures against each other!
  • Have each other’s back even if you’re not in full agreement.
  • Never ever give away power by making democratic decisions or explaining your reasoning. Anything you say or do will be challenged or used against you in the future.

Maintain family balance.

Keep things relaxed.  If you need to set boundaries and apply pressure, do it only to maintain  appropriate behaviors and reminders for self-calming.  Let other things go.

Use praise proactively.  Borderlines crave attention and praise.  When they deserve it, pour it on thick.  And pour it on thick every single time they demonstrate good behavior and positive intention.  One can’t go too far.  When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration.  This does two things:  it reinforces the positive  and it provides a distraction, either of which may end a fraught situation.

Become skilled in Dialectical Behavioral Therapy (DBT).  It is the gold standard for treating Borderline Personality Disorder.  It is the only therapy proven to promote genuine behavioral change and improve mental health.  You can draw upon questions used in DBT to settle your child and bring his or her back to reality, examples:

  • Did your friend really intend to upset you?  It sounds like they were talking about something else.
  • The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
  • The tear in your jacket isn’t a catastrophe.  It is easily fixed and I can show you how.

For specific examples of what your borderline child might say and for how you can respond, see:  How to respond to a manipulative and difficult teenager.

Parents made a business card to ask for help from others for their borderline daughter.

Prevent dangerous risk taking – Young people with borderline personality are  impulsive and prone to risky behavior.  Parents should consider reducing the risks posed by: emotionally-loaded  social contact, excess time or money, freedom to come and go, and places to hide inappropriate materials or actions :

  • Restricting and monitoring  cell phone use, email, texting, and access to social networking sites.  This is legal if it’s in your home and you pay the bills, and there is no expectation of privacy.
  • Using technology to track their communications, or disabling access during certain time periods
  • Reducing the amount of money and free time available
  • Searching their room if in your home (this is also legal).
  • Building a support network, asking for help from trusted others (like Katy’s proud parents, above–a true story).

A couple I know fully informed their borderline son that all internet activity would be tracked, as well as cell phone calls.  The father also installed cameras in the home, at the front and back doors, in plain sight.  Nevertheless, their son continued with bullying and verbally abusing his siblings right in front of those cameras, and he would get caught and deny it each time.  His denials in the face of clear evidence became a great source of private amusement for his parents.

Be patient – You are unlikely to receive your child’s respect, love, or thanks in the short-term.  It may take years.  But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.

A borderline child will stab you in the heart with their words.
Never expose your heart like this!  Armor yourself emotionally.  Visualize those knives as fluff balls, or visualize your child as a toddler with a just another temper tantrum.  Find something that works for you and help the co-parent and siblings armor themselves too.

Address your own PTSD!  Families who live with a borderline child often need help coping with bullying, wrenched emotions, and the instability that person brings into the household.  A parent or family member may need their own therapy, antidepressants, and self-care skills for reducing anxiety.

Simple self-care for you and other family members

  • Three or more (very) deep breaths when stressed, the brain needs oxygen to begin a calming process.  Singing is a superb option.
  • Magnesium or Kava kava, these substances naturally help calm nerves
  • Sleep in a dark, cold room is the best way to promote deep sleep. Avoid screen time an hour before bedtime.
  • An activity that feeds your soul, such as a hobby, a loving pet, a gripping novel, just playing
  • Direct support from a trusted friend–face-to-face is ideal, but calls, texts, and emails as needed are really helpful too.


Characteristics of untreated borderline personality disorder in adulthood

Good things:  They can be very financially and publicly successful in many fields and hold positions of authority, and often succeed in the creative arts and especially acting.  They are so perceptive that they can ‘channel’ any person they want.  They can be enchanting, and alluring, easily attracting devoted fans, friends, and lovers.

Most challenging things:  Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related disconnection from reality and paranoia.

Help your borderline child with each of these aspects!

  • Chronic fear of abandonment which results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Disruptive relationships due to the person’s alternating clinging and distancing behaviors.  When clinging, they may exhibit dependent, helpless, childlike behaviors. They can over idealize the person they want to spend their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. They distance themselves by being hostile and insulting, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the person’s inability feel people are safe, and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
  • Manipulation: Separation fears are so intense that people become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
  • Self-destructive behaviors: Threats are most often manipulative, but some acts can prove fatal.  Cutting is very common.  Suicide attempts are common yet often happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person.  Another behavior is to set up a scenario where they are victim so as to get attention and love.
  • Impulsivity: Extremely rapid shifts in mood can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, and excessive spending or gambling.  These are similar symptoms of bipolar mania, but BPD behaviors happen for different reasons, usually in response to real or imagined abandonment.

You really can turn your borderline child’s future around.

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The best vitamins for your child’s brain

The best vitamins for your child’s brain

avocadoThe vitamins listed here are absolutely essential for your child’s brain, and it’s highly likely your child doesn’t have enough.  People with psychiatric disorders commonly have physical problems that are symptoms of vitamin deficiency.  Take digestive problems, for example–low levels of B vitamins cause digestive disorders, especially B12.

“One of the most common deficiencies seen in patients with mental disorders is B vitamins”*

B1 – Thiamine helps neurons to send electrical signals.  A proper level in the blood stream wards off depression. B1 is found in beans, asparagus, beef, oranges, sunflower seeds, oats, and green peas.

canteloupeB2 Riboflavin is also needed for neurons to send electrical signals.  B2 is found in sunflower seeds, fish, poultry, bananas, leafy greens, and sweet potatoes.

B6 prevents memory loss, improves memory, and helps reduce depression, and increase hemoglobin in the blood which supplies oxygen to the body and brain.  B6 is found in sunflower seeds, fish, poultry, bananas, leafy greens, sweet potato

B9 – Folic acid helps in formation of nerve tissue, or the neurons in the brain.  B9 is found in spinach, asparagus, beans, avocado, lentils, and broccoli.

kiwisB12 is needed for the myelin sheath that covers and protects neurons, and signs of deficiency are bowel and stomach problems. Probiotics for gut health are helpful, but so is sufficient B12.  It is found in seafood, eggs, cheese, leafy greens, milk, and red meat.

All vitamins are best obtained through food, not pills.

Vitamin CAscorbic acid regulates the production of neurotransmitters like dopamine, and protects the brain against oxidative stress, which is when there are too many “free radicals” (one kind of chemical), and too few “antioxidants” (another kind of chemical).  Vitamin C is found in citrus, tomato, kiwi, strawberry, mango, pineapple, cantaloupe, and green vegetables.

strawberry

Calcium is an actual nerve cell messenger.  It controls how signals pass between neurons.  Calcium is found in dairy (milk, hard cheese, and yogurt), sardines and salmon, beans and lentils, almonds, collard greens, tofu, and figs.

Magnesium is essential for many chemicals in the brain and body. It promotes the metabolism of B vitamins as well as signal transmission between neurons.  Magnesium calms people.  It is found in nuts, pumpkin seeds, black beans, avocado, brown rice, and leafy green vegetables.

Zinc helps regulate the electrical signals between neurons.  It is found in pumpkin seeds, beef, shrimp, nuts, chocolate, wheat germ, and oysters.

chardVitamin D is essential because it directs the production of neurotransmitters, nerve growth, and nerve connections.  Lack of Vitamin D is a common problem in people with psychiatric disorders.  (Did you know that ~75% of individuals who are hospitalized for mental illness have severe Vitamin D deficiency?) The best forms are from egg yolks, milk with vitamin D, and sunlight.  Supplements have some benefit, too.

See the list of brain foods in this article, The Brain Diet for Troubled Kids.

“Essential Vitamins and Minerals for Brain Function”


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Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Inattention and distractibility are caused by many medical conditions and life situations.  You child may not have ADHD or ADD if they didn’t show signs when they were young.

Children don’t just catch ADHD or ADD

If your child has a behavioral change you haven’t seen before, there may be an underlying medical or co-occurring mental disorder that’s causing ADHD symptoms… especially if they’re on ADHD-ADD medications which are not working well.

“It is vital not to mistake another medical or psychiatric condition as ADHD.”
Richa Bhatia, MD, Fellow of the American Psychiatric Association

The medical conditions listed below produce ADHD and/or ADD symptoms such as slow processing speed, impulsive behavior, and limited attention and focus.

  • Epileptic seizures: some types cause a brief freeze in thinking–the child’s brain goes blank for a few moments (“absence seizures”)
  • Diseases of the brain: Lyme disease, HIV infection, parasitic and viral infections, brain tumors
  • Brain damage from head injury or toxins (e.g. narcotics)
  • Chemotherapy side-effects, “stupor”
  • Hypothyroidism.  Too little thyroid hormone results in memory, attention, and concentration problems. It decreases blood flow in brain regions that mediate attention and executive functioning (the hippocampus and cerebral cortexes).
  • Hyperthyroidism. At the other extreme, too much thyroid hormone causes anxiety and tension, irritability and impatience, and hyperactivity and distraction.
  • Sleep apnea. A condition where a child stops breathing during sleep, for a few seconds to a few minutes several times per night.  The following day, the child can’t pay attention, remember, or follow a sequence of steps.  It also causes hyperactivity and belligerence.


Mental health disorders with ADHD-like symptoms:

Anxiety disorders are common to most other mental health conditions, and create problems with concentration.  The chronic stress from anxiety affects the brain regions responsible for memory and cognitive functions.   If a child does not have a history of ADHD symptoms, than significant and pervasive anxiety may be the cause of inattention and distraction.

Abuse or trauma. Difficulty concentrating is one of the core symptoms of post-traumatic stress disorder (PTSD), and recent abuse or trauma can cause agitation, restlessness, and behavioral disturbance—symptoms that mimic ADHD.

Depression – Difficulty concentrating also is a criterion for major depressive disorder.

Bipolar disorder – ADHD symptoms are apparent in children with suspected bipolar disorder. Both disorders can cause distractibility, increased energy, and instant mood swings. (Some children are eventually diagnosed with both disorders.)

Drug abuse using marijuana, cocaine, ecstasy, produce similar symptoms of ADHD because they affect the same brain regions affected by anxiety.  MRI scans of the brain were taken of young children who were exposed to cocaine in the womb. The scans revealed frontal lobe malformations which predicted long-term problems with attention and impulse control.

Common stimulant foods and beverages with excess caffeine or sugar

Insomnia from medical conditions. Sleep plays a huge role in memory and attention. Sleep disorders (e.g., sleep apnea, restless legs syndrome) can produce chronic tiredness and significantly reduce attention, concentration, and cognitive functioning in children, adolescents, and adults.

Plain old lack of sleep in healthy children can cause inattention and reduce academic achievement.  There are many causes of sleep loss:  early school hours; screen time at least an hour before bed (because the blue light suppresses sleepiness); or allowing the use of technology in the bedroom at nighttime.  What helps getting to sleep and staying asleep:

  • A cool, dark room
  • Thirty minutes of reading or drawing on paper before lights out.
  • Removing phones, laptops, or desktops from the bedroom at night.


Learning disorders:
Children with an undiagnosed learning disorder often present with ADHD symptoms. An undiagnosed reading or mathematics disorder (dyslexia), or an autism spectrum disorder that’s not yet diagnosed, can have a significant impact on classroom behavior.  The child might not be paying attention because of his (her) restricted ability to grasp the subject matter, or because they are frustrated and irritated with the struggle to keep up.

Caution:  Teachers often report a student’s inattention and confused thinking to parents, and suggest a diagnosis of ADHD when the real problem may be lack of sleep or something else.  It’s useful to hear classroom observations of your child, but teachers are not trained in mental health diagnosis—get a second opinion from a professional!

More on the consequences of untreated ADHD or another underlying disorder is in this article:  “ADHD kids become troubled adults.”

–Margaret


Subject matter was drawn from this article by psychiatrist Dr. Richa Bhatia.

“Rule out these causes of inattention before diagnosing ADHD”
Richa Bhatia, MD, FAPA, Current Psychiatry. 2016 October; 15(10):32-C3

How to pick the ideal therapy pet for your child or teen

How to pick the ideal therapy pet for your child or teen

“A pet is an island of sanity in what appears to be an insane world. Whether a dog, cat, bird, fish, turtle, or what have you, one can rely upon the fact that one’s pet will always remain a faithful, intimate, non-competitive friend, regardless of the good or ill fortune life brings us.”
–Boris Levinson, PsyD, Child Psychologist

Any animal can be a therapy pet, but put thought into finding the ideal pet

therapy catIt depends on your child’s individual needs and his or her innate appreciation of or connection with the creature.  Parents often think of furry animals like dogs or cats or “pocket pets” as the best therapy animals.  Dogs and cats are the most common, but they are not the only effective options.  (And some are problematic:  perhaps a family dog or cat is of no interest to your child, or is stressful because its behavior–easily agitated cats and chronically fussy dogs aren’t therapeutic!

What fascinates your child? What do they want–what creature(s) are they drawn to?  And are you willing to take care of this pet?  Your child’s therapy pet is not a lesson in responsibility… though that may be an outcome someday.  The pet is a therapist first, not a teaching tool.  Since you may be the responsible one, the pet must work for your needs and household too.

The right creature will reduce your child’s stress and continually delight them in some way.

Dogs and cats

Under the best circumstances, the right dog or cat will choose your child, calming them down or drawing them out of their shell. Dogs and cats are ideal for symptoms of anxiety, autism spectrum disorders, or depression. The right dog or cat is calm, loyal, and patient, and helps an insecure child or one who can’t handle emotional demands. Dogs also support physical exercise, and provide opportunities for significant life lessons.

True story – Some juvenile prison systems have dog programs, where the inmate is assigned a troubled shelter dog to train and teach appropriate dog behavior. Young inmates often empathize with a dog’s abuse history, and training the dog helps them learn patience, forbearance, and anger management.  The trained dogs are them adopted out to the community.  A program I personally know about has had very positive outcomes.

Pocket pets

Pocket pets help children who like touch, and bring out a child’s nurturing side. Small animals can also be playful and amusing–ferrets have especially silly antics.  It’s important the pet likes to be held, but it’s also important to prevent it from escaping and hiding. Their small size and habitat needs are better for small living spaces, and they can go anywhere with the child in a small carrier.  A concern may be their shorter lifespans. Is your child able to handle loss and learn from it?

Birds

Birds are smart ‘pocket pets’ and very loyal to the person they bond with.  A bird that’s purchased young or been hand-fed as a chick is tame and will readily perch on a child’s shoulder or finger… or happily hide out in a pocket.  Most birds can be taught words, whistles, or even songs in human language.  They are pretty, charming, highly interactive, and long-lived.  Birds are good for depressed children who need energy and stimulation, and children with ADHD who need attention and interaction.  Like a pocket pet, a bird can also travel with a child in a small carrier.

Reptiles

Reptiles aren’t often considered as therapy pets, but reptile lovers will tell you that they are indeed therapeutic and have inidividual personalities. Most are quite beautiful. Many like to be held and carried.

“She fell asleep in my shirt and nobody saw her. I noticed I was able to communicate with other people without problems. When I started to feel anxiety I put my hand over her and it calmed me downI was able to go in [a store], do what I needed to do and get out without a panic attack.”
–Teen with social anxiety disorder speaking about her Bearded Dragon.

Ask if a pet store will allow your child to hold one of their reptiles for sale.  Common pet store lizards that are good for children are:  leopard geckos, bearded dragons, and iguanas (which need lots of handling at first).  Like other small animals, reptiles can escape. Turtles are usually easy to find, but not lizards or snakes.  There are lizard leashes on the market for this reason.  Most snakes available on the market like to be held, or will accept it if handled often.

Fish

Beautiful calming aquariums are excellent sources of visual delight and serenity. There is a reason aquariums are placed in waiting rooms and in psychiatric hospital settings.  They provide gentle entrancing movement in a miniature natural world—they are healing like Nature is healing.  An aquarium is good for children with intense anxiety they can’t express, often with schizophrenic or autistic symptoms.  The soft bubbling sound can be calming because it is steady and hides noises that may overstimulate a child who’s grappling with a stream of upsetting thoughts.  Read more about “calming rooms” and how visual and audio environments help children with tantrums, “Calming room ideas to prevent tantrums in autism and other disorders.”

Insects (yes, insects)

I have two stories about therapy with insects

True story – A depressed 9-year-old boy was regularly teased at school, then came home to a single mother who was always too distracted by dating concerns to spend time with him. His father found a second wife and started a new family and showed little interest in him.  The boy was smart and very interested in science.  He befriended a neighbor who kept hissing cockroaches to feed her lizards, and he would visit often and ask to hold a roach and pet it to make it hiss.  The neighbor allowed the boy to borrow one to take to school for show-and-tell, which he brought along in a plastic container.  The students were both fearful and intensely curious about this giant roach.  Except for the squeamish, everyone wanted to pet it to make it hiss.  He became the coolest kid in class.  His teacher was impressed because he told the story about hissing cockroaches, where they were from, and how they were part of a forest ecosystem.  He stopped being teased, and his teacher gave him more attention with science studies… all thanks to a lowly roach.

True story – An 11–year-old boy with ADHD found a praying mantis in his backyard and picked it up. He knew from school it wouldn’t bite, and that it caught and ate other insects.  He wandered around nearby homes looking for bugs to feed it.  When he caught something, he enjoyed watching the mantis snatch the bug from his finger and eat it with gross crunching sounds and goo…. awesome for a kid like him. He was allowed to keep the mantis in an empty aquarium. As Nature has it, it died in the Fall. His parents, however, purchased mantis eggs from a nursery to populate the yard the next summer. When they hatched, the boy spent hours amusing himself by finding and feeding the baby mantis population,and watching them grow to adulthood.  It reduced the hours he’d spend indoors on video games,and connected him with nature outdoors.

 

–Margaret