Category: bipolar disorder

Borderline children – how they function and how you can help

Borderline children – how they function and how you can help

Borderline personality disorder makes a child wonderful yet horrible; lovely yet vindictive; a great friend or manipulative bully; anguished or glowing with joy; self-hating yet self-important; self-centered but also charitable.

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

Children with BPD genuinely 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 or others so as to feel they made the decision.  This will disguise the horrible feelings of abandonment.

 

A borderline child can be very engaging and affectionate… sometimes at random and sometimes when they want something.  They will also turn on the charm as a way to embarrass you in front of others (such as in a meeting with a teacher or family counselor).  Since they seem so wonderful to other people, you may be judged because you get upset at your clearly wonderful child.  People often suggest that you take care of your own issues instead.

Even though their manipulation and upheaval is relentless, strive for compassion.  Trust me, your borderline child will suffer more than you in every important aspect of life.  They make a mess of their relationships because of their anger, instability, substance abuse.  Their clingy behavior is annoying.  They drive away good friends, hate them for leaving, and then suffer from loneliness and depression.  They make a mess of their jobs, often fired or forced to resign, and then bounce from one job to another… and they don’t understand why it happens to them.

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.

When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.
borderline brain
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.”

screaming girl

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.”

“…almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families.  Advances have been made in recent years.  Researchers studied 290 hospitalized patients with the condition over a 10 year period:  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.)

I recommend downloading this PDF file, “Using DBT Skills to Reduce Emotional Dysregulation and Reactivity in Children/Adolescents and Parents.”  It is lengthy, but provides a clear and straightforward set of slides with wonderful practical ideas that parents can implement at home.

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 hospitalizeemergency room

In an emergency, when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others, or incapable of calming down and functioning.

Consider psychiatric residential care when your child has persistent suicidal thoughts, is unable to participate in therapy, has a co-morbid (co-existing) mental disorder (e.g. bipolar, depression, narcissistic personality disorder), a risk of violent behavior, and other severe symptoms that interfere with living.

Other mental health supports your 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.
  • Therapy that focuses on trauma and post traumatic issues.
  • 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.  Anything you say or do will be used against you.


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 redirects and ends a negative 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 ask questions or bring your child back to reality with the following 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.

 

business card

Prevent dangerous risk taking – Teens with borderline personality are exceptionally impulsive and prone to risky behavior.  Consequently, parents should consider:

  • Tightly limiting cell phone use, email, texting, and access to social networking sites
  • Using technology to track their communications (this is legal), or disabling access during certain time periods
  • Reducing the amount of money and free time available
  • Searching their room (this is also legal)

A couple I know fully informed their borderline teen 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, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences repeatedly.  His persistence in the face of obvious monitoring became a great source of private amusement for his parents–humor made the monster smaller.

Be patient – You are unlikely to receive the 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.

knives in your heart
Never expose your heart like this!  Armor yourself. Visualize those knives as fluff balls. Visualize your child as a toddler with a just another temper tantrum.  You can handle it.

Address your own PTSD!  People who live with someone with BPD 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.

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 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 BPD in adulthood, if untreated

Good things:  They can be very financially and publicly successful in many fields, especially 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 child with guidance and mentoring on each of these aspects… and be relentless!

  • 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 child’s future around.

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Unsettling: What psychosis looks like in children and young people

Unsettling: What psychosis looks like in children and young people

kill him street
This eerie painting is by a young woman of 22 diagnosed with schizophrenia. She is encountering a threat, real or imagined, and her paranoia is compounded by being watched from the window above. Note the symbolic references to communications links and satellites.

Odd, eccentric, a little weird:  people experiencing psychosis are living in dream space.  If you haven’t experienced psychosis yourself, it’s a little like the period just before you awake, when you’re in a dream but also aware of your surroundings.  Your dream and emerging consciousness weave together in a wonderful or horrible or simply odd narrative.  If you try to explain it someone, you realize it makes no sense, yet it made a lot of sense while you were dreaming.

To a parent watching a psychotic child, you may observe that they see, feel, hear, move about, and respond to you as if fully conscious, but it’s important to know that they simultaneously inhabit the subconscious. As a result, they don’t notice that what they do and think is any different from anyone else.  The term “anosognosia” refers to their inability to recognize this, and it explains why so many resent being told they have a problem and need treatment.  They simply aren’t aware that anything is different about them.

Evidence of psychotic behavior

Parents of a child who was eventually diagnosed with a psychotic disorder often report that their child was always a bit different from their peers–slightly eccentric, a unique individual who had an interesting way of looking at the world. Parents have also reported the following behaviors when their child was exhibiting psychosis.  (Not all of these are present in each child.)

  • A belief in something that isn’t rational, and the belief is unusual or unreal or impossible.  The person cannot be talked out of the belief.  And rational, logical reason only increases resistance to reason.
    • If the psychotic episode is positive or magical, the person may have powerful religious feelings and a sense of omnipotence or clairvoyance. They may believe they have been instructed to give a message to save the world, for example.
    • If the episode is negative and paranoid, they can become very agitated, fearful, or they may panic.  They may act negatively on irrational beliefs.  They are attracted to paranoid or extremist views, especially those with high emotional content.
  • Smiling or laughing at nothing in particular and for no apparent reason. It’s as if someone has just told them a joke.
  • Yelling or ranting, this could be at an object or at someone or at nothing apparent. The ranting can happen online.  The ranting has repeated themes, and the themes are unique to each person.
  • Intense, crushing anxiety, irritability, accusations, and obsessive troubling thoughts.
  • Talking and gesturing as if they’re in a conversation with an invisible someone. (Normal people also gesture they think, but they are aware they are not literally communicating with someone.)
  • Wandering eyes and shifting body language as if they are seeing or feeling things that aren’t there.
  • Abrupt personality change from seemingly normal behavior.  Often, a child’s eyes will have a disquieting faraway ‘look’, as if the child is not in their body, and a they’ve been overtaken by a demon.
  • Fear, anxiety, and paranoia–they feel watched, trapped, and controlled in some way. They stop trusting people.  They hide or try to block experiences to protect themselves.
  • Intense obsessions with ideas, things, or events (even if they occurred long past). Themes emerge which often refer to actual events that elicited strong emotions.
  • Seeing patterns and connections in events that aren’t connected.
  • Unusual and confusing responses when communicating with others—a comment that doesn’t seem to apply, or a a string of words that defy interpretation.
  • A preference for solitude and closing themselves off from others.  This is for self-protection.
  • Loss of interest in self-care: not wearing clean clothes, bathing, or organizing their surroundings.

The most common diagnoses that have psychotic features are schizophrenia, schizoaffective disorder, bipolar disorder, and depression.  This story about schizoaffective disorder gives some real world examples of psychosis:  “Life with a Schizoaffective Teen.”

Psychotic behavior can have a long slow onset

brain degeneration in schizophrenia
The image on the left is of a 15-year-old boy with early onset schizophrenia. The purple regions have normal neuron density, red regions have low neuron density. In the 2nd image, the red area at the top of the brain is in the cerebral cortex, the region of executive function and rational thought.

It’s easy to miss signs of early psychosis!  Sometimes a child or young person starts showing eccentric behaviors that aren’t serious or are easy to interpret as something else: creativity and imagination; immaturity; puberty; influences from immature friends; too much video gaming…  Your child may have been experiencing mild visual or aural hallucinations for some time, even a couple of years, and just assumed it happened to everyone so they never reported it.  As psychosis emerges in the early teens, their thoughts and behaviors start affecting friendships or school work.  The child stops doing things they once enjoyed.  Someone might assume they’re experimenting with drugs.  They seem so much like other difficult, distracted, or defiant teens that a parent can be lulled into thinking they are not seriously mentally ill… but psychosis is very serious.

If this describes your child, immediately (and I mean immediately) find a psychiatrist and get an assessment.  The earlier you can treat psychosis, the better the outcome for your child.  Psychosis is degenerative.  The longer a brain stays in a state of psychosis, the more neurons it loses.  Early treatment via therapies, medication, diet, and other physical supports can literally prevent neuron loss and future psychotic breaks that require hospitalization.

Psychosis can emerge abruptly

For disorders on the schizophrenic spectrum, this is common in young men in the late teens and early 20’s.  However, adults in their 30’s and 40’s have also been known to have sudden onset of psychosis.  It’s tragic, you witness this young person launching into adulthood, studying in college or starting employment, and suddenly his or her personality changes.  Their behavior worsens, and it becomes evident they’ll never be able to have the future they planned.  They need immediate treatment, possibly hospitalization if the psychotic break reaches a crisis point.  If this is your child and they are past age 18, use every means possible to get help for them!

Kendall art
Self-portrait by a 24-year-old woman diagnosed with schizoaffective disorder. Her image is a modified mug shot photo taken of her after an arrest.

What worsens psychosis and what you can do to relieve it

  • Poor sleep and reduced sleep.

Help your child get enough hours of sound sleep. The best sleep environment is a cool very dark room.  Once my child became unable to attend high school, I allowed her to nap any time of the day.

  • Closing themselves off from the world.

Your child needs mental and sensory stimulation to keep their mind from spinning out on their obsessions, hallucinations, and paranoia, but the amount must be tolerable.   Stimulus must come from the tangible, sensory world (e.g. not screen time, videos, books).  Concrete interaction with reality diverts their attention from obsessive thoughts or voices.  They will benefit from regular (perhaps limited) social interaction*, an undemanding therapy animal, creative work (such as art and music), and being out in nature.

  • Marijuana use–specifically the THC in marijuana

CBD in marijuana has many medical benefits and is considered safe, but the THC is not.  THC is also addictive, and available in very highly concentrated oils… extremely dangerous.  Like THC, any addictive substance, from alcohol to methamphetamine, will interfere with treatment for psychosis.  The drug’s influence trumps everything.  Drugs are literally self-induced psychosis.  See:  “Marijuana is Uniquely Harmful to Troubled Teens”;  “Marijuana is Dangerous.”

  • Continual exposure to things they already obsess on or that make them paranoid, angry, or anxious.

In every way possible, keep your child away from any material, people, or messages that upsets them.  These only add gasoline to the fire and increase the likelihood of future psychotic breaks.  They may obsess on the same things for the rest of their lives.  If someone who’s psychotic is exposed to intense emotional experiences that feed their obsessions and paranoia, people have been known to do to horrible things to themselves or others.  An example at the time of this writing is of a young woman with psychotic bipolar mania who tragically pulled out her own eyes.

Find ways to redirect your child’s attention elsewhere and help them get a grasp on the reality.  Help them calm down (“deescalate” them) and help them learn ways to calm themselves down.

A diagnosis of an illness that includes psychosis is devastating

Face to facePsychosis and/or a psychotic crisis in a child who previously led a normal healthy life blindsides everyone, especially the family.  Allow yourself to go through the stages of grief as you would after any death…  because it can feel like the ‘death’ of your child and their future and your hopes for them.  Get help from others as you would after any death.  Here you are, grieving, but your child needs you to be strong!  Get help for your own mental health.

Reason for hope

Children who receive regular social support from family and loved ones do well over the decades.  They can avoid homelessness, hospitalizations, harm.  They can get advanced education, keep strong relationships, maintain employment.  They get a life of wellbeing.  This has happened with my adult child after years of horrendous experiences.

Cognitive Enhancement Therapy

A relatively new therapy has been developed and tested that meaningfully helps people with chronic psychotic disorders.  “CET attempts to increase mental stamina, active information processing, and the spontaneous negotiation of unrehearsed social challenges. It does so with a focus on enhancing perspective taking, social context appraisal, and other components of social cognition… CET has been shown to have remarkable and enduring effects in a study of persons with schizophrenia or schizoaffective disorder…”
–CET Training LLC, “approved and recognized by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based practice.

What are your experiences?  Have you found anything that helps?

–Margaret

 

*Social Interaction Increases Survival by 50%
Psychiatric Times. July 30, 2010

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept.  Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that the benefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”


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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

The Brain Diet for Troubled Kids

The Brain Diet for Troubled Kids

All people with brain disorders need a whole body/whole life approach to treatment–no one medical practice is sufficient. Neither mainstream psychiatry or naturopathy have all the answers for mental health, but both provide important treatments:  diet, medication, therapy, exercise, gut health, and sleep, etc. This article is about brain diet specifically–foods which support or improve brain health.

These are some general rules for this food:

  • Uncooked vegetables are ideal if appropriate. Cooking removes some of the essential nutrients.
  • In the case of fish, raw may not be appropriate except for sushi or pickled herring.  For fish that’s canned, choose fish packed in oil, not water.  Omega-3’s are dissolved in the oil, but removed in the process of packing in water.
  • Variety is important.  Concentrating on a few foods exclusively is not helpful because you and your child still need additional nutrients that are important for your overall health.
  • Food is better than supplements because food nutrients are properly absorbed in the body in the right ‘dosages.’

Be aware of food fads.  There are no miracle foods.

Over the decades, people have been bombarded by different dietary research, and demanded foods that were reported to have benefits at the time.  Food producers then labeled and provided whatever the public wants.

  • A good example of a fad years ago was fat-free and oil-free foods.  As it turns out, additional studies proved this was actually harmful–people need fats in their diet, but just a selection of fats.
  • For decades, coffee and chocolate were once considered harmful, but this has since been proven wrong for most people.
  • Diet sodas were supposed to be better than sugary sodas, but as medical research and understanding advanced, this was disproven.  Sugar-free sodas are actually more harmful.
  • There’s been an antioxidant craze. Yes, antioxidants are important, but these nutrients alone are insufficient for brain health.
  • The “paleo diet” was big for a while.  It was the great idea of someone who was not a paleontologist.  Paleontologists themselves aren’t comfortable with the theory because they are still finding evidence of what early humans actually ate.
  • “Gluten-free” foods are considered the only safe options.  Gluten is very bad for a small segment of the population, but not most people. What’s funny as that even water is labeled gluten-free.  This is from a dish detergent label:
Gluten free dish detergent?  Labels like this are for marketing, not health.

Vitamin D deficiency is serious for mental health:  In the case of psychiatric health, severe Vitamin D deficiency was discovered in ~75% of adults tested in a psychiatric hospital.  Other studies have shown that those with mental illness tend to have abnormally low levels of Vitamin D.

“Vitamin D’s effect on mental health extends beyond depression. Schizophrenia has also been linked with abnormal levels of vitamin D.”

“..vitamin D activates genes that regulate the immune system and release neurotransmitters (e.g., dopamine, serotonin) that effect brain function and development. Researchers have found vitamin D receptors on a handful of cells in regions in the same brain regions linked with depression.”

Take the time to learn how to prepare these foods in ways that your and your kids like!

–Margaret

 

Resources:

The Psychological Consequences of Vitamin D Deficiency

These Foods for Anxiety Are the Good Kind of Stress Eating

Should you get your nutrients from food or from supplements? – Supplements can plug dietary gaps, but nutrients from food are most important

Mental Health Medications for Children ages 3 – 12

Mental Health Medications for Children ages 3 – 12

This is an excerpt from an article contributed by Drugwatch, an organization devoted to informing the public about the uses and risks of drugs and medications, and the use of medical devices.

Doctors may prescribe the use of medications to treat the health effects of bullying.

For example, children who suffer from depression or anxiety disorders (two health effects of bullying) may be prescribed selective serotonin reuptake inhibitors (SSRIs), such as Prozac. It’s important for parents to be aware that all SSRIs carry risks.

Childhood Bullying & Its Health Effects

Research shows that bullying behavior can start as early as age 3. Both children who are bullied and those who bully others may have serious lasting health problems as a result of these actions.

Bullying may cause lasting health issues for both parties involved.

A 2017 study by University of Pittsburgh researchers, for example, found that children who are bullied experience mental and physical health issues that can last well into adulthood. The study shows that bullied children are more likely to have trouble with finances and to be treated unfairly by others. They are also more pessimistic about their futures, according to the study.

On the other hand, the study revealed bullies are more likely to be stressed, hostile and aggressive, and to smoke cigarettes and marijuana. Both bullies and their victims are at a higher risk of heart disease, which is the leading cause of death for both men and women.

Doctors may prescribe Cymbalta to treat generalized anxiety disorder in children ages 7 to 17.Childhood developmental or learning disorders are often diagnosed when a child is of school-age. Mental illnesses, however, can be hard for a parent to identify. Although children can develop the same mental health conditions as adults, they sometimes express them in different ways. In 2013 alone, more than 8.3 million children were taking psychiatric medications. About half of the medicated children were between the ages of 6 and 12.

ANXIETY DISORDERS

Anxiety disorders are a group of mental disorders branded by feelings of anxiety and fear. Children may have more than one anxiety disorder. More than 2 million children were on anti-anxiety medications in 2013. The age group with the largest number of medicated children was ages 6 to 12 years.

Generalized Anxiety Disorder (GAD)

It’s perfectly normal for your child to stress about grades or an upcoming sporting event. However, if your child worries excessively or if anxiety and fear affect your child’s ability to perform daily activities, your child may be suffering from GAD. Doctors may prescribe Cymbalta, a serotonin-norepinephrine reuptake inhibitor (SNRI) as treatment. In 2014, the FDA approved Cymbalta for the treatment of generalized anxiety disorder in children ages 7 to 17. SNRI medications carry serious risks, including birth defects, skin disease, suicidal thoughts and liver toxicity. The FDA also warns of Cymbalta discontinuation syndrome, which is when a person experiences withdrawal side effects after stopping Cymbalta. Effexor, another SNRI, has not been approved by the FDA for use in children, but some doctors prescribe it for older teens as an off-label treatment for depression and anxiety.

Obsessive Compulsive Disorder (OCD)

Prozac, Zoloft and Luvox are among the drugs used to treat OCD in children.

Children with OCD experience unwanted and intrusive thoughts — or obsessions. They feel compelled to repeat rituals and routines to try to lessen their anxiety. OCD can affect children as young as 2 or 3, though most children with OCD are diagnosed around age 10. The FDA has approved several drugs to help control the symptoms of OCD in children, including Prozac, Zoloft and Luvox.

The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.

Tourette Syndrome

Children with Tourette syndrome may make unusual movements or sounds known as tics. The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.  All three medications have the potential to cause unwanted side effects, so most doctors prescribe the blood pressure medications guanfacine or clonidine. This is known as “off-label” use because the FDA has not approved either drug for treatment of tics.

MOOD DISORDERS

Every child can feel sad or depressed at times, but mood disorders are more extreme and harder to manage than typical sadness. Doctors may prescribe antidepressants or antipsychotics to treat mood disorders in children. SSRIs are popular antidepressants, despite an increased risk of suicidal thoughts in children. Prozac is the only SSRI approved for use in children older than 8 years of age. Antipsychotics prescribed to children include Abilify (aripiprazole), Thorazine (chlorpromazine), Risperdal (risperidone) and Invega (paliperidone).

These new kinds of drugs called atypical antipsychotics can have serious side effects in children like drastic weight gain, sedation and movement disorders. Risperdal and Invega also include a side effect called gynecomastia, a condition where boys develop breasts.

Nearly 2.2 million children were on antidepressants in 2013, and more than 830,000 were taking antipsychotics. In addition, doctors often prescribe the anti-seizure drug Depakote for children with bipolar disorder, a use not approved by the FDA. The medication has a black box warning for increased risk of liver failure and pancreatitis in children and adults.

(Blog owner’s note: Antidepressants are sometimes mistakenly prescribed to depressed children who are actually experiencing the depressed phase of bipolar disorder. The risk is that antidepressants can bump a child’s mood way too high, into mania.)

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Doctors use stimulants like Ritalin and Adderall to treat ADHD.

Doctors have been diagnosing children as young as 4 with ADHD. In the past nearly 30 years, the number of children diagnosed with ADHD has grown six-fold. Scientists estimate about 5 percent of children actually have ADHD, but the CDC shows that 15 percent are diagnosed.

Doctors usually treat children with ADHD with stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine). Side effects of these drugs include decreased appetite, sleeping problems and headaches. Less common but more severe side effects include the development of tics and personality changes. Data from 2013 showed more than 4.4 million children were on ADHD drugs.

Children with a history of heart conditions may have a higher risk of strokes, heart attacks and sudden death when taking stimulants. Studies have also found rare cases of children developing hallucinations – such as hearing voices and increased suspicion without reason – or becoming manic.

Children & Medications

Children are particularly vulnerable to the potentially harmful side effects of drugs during important stages of physical and mental development. The amount of mental health drugs prescribed to youth has increased at an alarming rate, and each comes with its own risk.

AUTHOR

Emily Miller
emiller@drugwatch.com
407-955-4198

 

This is the full article from which the above post is excerpted:
“Children’s Comprehensive Health Guide – From Newborn to Preteen”

 

What will happen in your troubled child’s future?

What will happen in your troubled child’s future?

Are you scared for your child’s future? Is he or she is falling behind? On a scale of 1 to 5, where 1 is “Normal” and 5 is “Worst Case Scenario”, what will your child’s future adulthood look like?

This chart depicts a spectrum of outcomes of mentally ill children when they become adults.  No matter how ill your child is, if he or she gets support and treatment early, their future adult life could end up in the NORMAL column, and out of the RED column.  A network of family, friends, and professional staff can keep them from the worst-case scenario in the far right column, and move them in the direction of normalcy.

“Wellbeing” is possibly the most important.

This is a checklist of childhood problems that lead to poor future outcomes as adults.  Jump on them one by one.

  • Friend problems:  they have inappropriate friends, or no friends, or they mistreat friends (and siblings).
  • Behavior problems:  they do or say disturbing things (swearing, hurting, breaking, manipulating, sinking in depression, attempting suicide…). Everyone is stressed.
  • School problems:  disruptive behavior; poor grades (or a sudden drop in good grades); bullying or being bullied.
  • Health problems:  physical health problems become mental health problems, and vice versa:
    • trouble with sleep
    • digestive system and gut problems
    • poor diet and lack of exercise
    • epilepsy or neurological disorders
    • hormones during puberty
    • substance abuse.
Age 16, starting mental health treatment

We designate legal adulthood between the ages 18 and 21.  That’s too young.  Many normal healthy young people at this age are immature and irresponsible, but your son or daughter may lag well behind them.  Your child may need support and rescuing well into the 20’s or early 30’s–this is not unusual.

You’ll survive the marathon of tough years by pacing yourself, finding support for yourself, and protecting your mental health.

There is reason for hope.  Your child may take many horrible directions in their teens and 20’s, and you may feel hopeless about their future, or helpless as you witness their life nosedive.  If you can hang on and marshal support, your child will find a circuitous path to recovery.  It will have sharp turns and back steps and falls, but they’ll find it… and enter stable adulthood.

Age 20, after consistent mental health treatment

Some parents and families have seen the worst.  They’ve endured violence due to their child’s addiction; sat in court when their son or daughter was convicted of a crime; or they waited in the Emergency Room when their son or daughter was admitted for psychiatric care.  They also lived to see their child achieve the sanity to finish their education, support themselves, develop good relationships, and get that future you always wanted for them.

How two parents handled a “worst case scenario” and supported their child’s wellbeing:

These are true stories of mothers who stuck by their very ill adult children and provided what little they could to bring a bit of wellbeing.  These mothers found some peace by simply doing what they could.  Their child still had hope.

One had a grown son with schizophrenia and a heroin addiction who lived in squalor in supported housing.  He spent all of his disability assistance money on heroin and nothing else.  Her efforts to help him met with verbal abuse and threats of violence, and she feared for her safety.  What could she do, witness his slow suicide by starvation or overdose?  She arranged to visit him once a week in the parking lot, and brought 2 sacks of groceries in the trunk of her car.  He was to come out and get the groceries while she stood at a safe distance.  This worked.  He was still verbally abusive when he got the groceries, but he got food and she stayed safe.  Did he have wellbeing?  Was his life humane?

He lived indoors
He had enough food and clothing
He had encounters with social services and police, which led to some health care
A support system was available if he was ready for help.

One had a son addicted to methamphetamine who was lost to the streets. One day, she discovered a nest of old clothes and rags in an overgrown area behind her garage, and instinctively knew it was from her son.  “Good,” she thought, “He’s alive; I can keep him safe.”  She rarely saw him come and go, but she replaced the rags with clean blankets and a sleeping bag, and put out food for him, and provided a tent.  She couldn’t free her son from addiction, but she could keep him safe from the streets and its desperate people, and fed and sheltered in a way he accepted.

Like in the previous story, her son had a modicum of safety and support, and ongoing monitoring if he was ready for help.

 

–Margaret

Please share your story.

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.

Spirituality and mental health, some research

Spirituality and mental health, some research

Scientists worldwide have been studying the effect of religion and spirituality on mental health and addiction recovery in children, teens, and adults.  Below are research findings that show religion and spirituality improve adult and adolescent mental health, including recovery from mental crises and substance abuse, when the spiritual approach carries messages of love, kindness, tolerance, and moral responsibility.  But when religion had a punitive or unforgiving message to those with mental or substance abuse disorders, the results were disheartening: a worsening of psychotic symptoms; inability to sustain recovery from substance abuse; and physical abuse.

If you look at the dates of some of these studies, you’ll see that researchers have been measuring of the value of spirituality for mental health and addiction for ~30 years, and results have consistently shown statistically significant positive benefits.

Below are summaries research reports–clinical writing that can be difficult to wade through if you’re not a mental health geek, so key findings and conclusions are highlighted in brown to make it easier to scan.

–Margaret

A second article in this blog documents both positive and negative effects of parents’ experiences in a religious community, Faith can help, & harm, a family’s mental health.


God Imagery and Treatment Outcomes Examined
Currier JM, Foster JD, Abernathy AD, et al. God imagery and affective outcomes in a spiritually integrative inpatient program. [Published online ahead of print May 5, 2017]. Psychiatry Res. doi:10.1016/j.psychres.2017.05.003.

Patients’ ability to derive comfort from their religious faith and/or spirituality emerged as a salient mediating pathway between their God imagery at the start of treatment and positive affect at discharge, a recent study found. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually-integrative inpatient program over a 2-year period, researchers tested direct and indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes.

Findings  —  Analyses revealed that patients generally experienced reductions in negative emotion in God imagery over the course of their admissions.


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.


“[Spirituality] enables neurotic conflicts typical for adolescence to be more easily overcome.”

The influence of religious moral beliefs on adolescents’ mental stability.
Pajević I, Hasanović M, Delić A., : Psychiatry Danub. 2007 Sep;19(3):173-83

University Clinical Centre Tuzla, Trnovac b.b, 75 000 Tuzla, Bosnia & Herzegovina. zikjri@bih.net.ba.
This study included 240 mentally and physically healthy male and female adolescents attending a high school, who were divided into groups equalized by gender (male and female), age (younger 15, older 18 years); school achievement (very good, average student); behaviour (excellent, average); family structure (complete family with satisfactory family relations), and level of exposure to psycho-social stress (they were not exposed to specific traumatizing events).  Subjects were assessed with regard to the level of belief in some basic ethical principles that arise from religious moral values.

Conclusions — A higher index of religious moral beliefs in adolescents enables better control of impulses, providing better mental health stability.  It enables neurotic conflicts typical for adolescence to be more easily overcome.  It also causes healthier reactions to external stimuli.  A higher index of religious moral beliefs of young people provides a healthier and more efficient mechanism of anger control and aggression control.  It enables transformation of that psychical energy into neutral energy which supports the growth and development of personality, which is expressed through socially acceptable behaviour.  In this way, it helps growth, development and socialization of the personality, leading to the improvement in mental health.


Religion, Stress, and Mental Health in Adolescence: Findings from Add Health
Nooney, J. G. 2008-10-23 from http://www.allacademic.com/meta/p106431_index.html

A growing body of multidisciplinary research documents the associations between religious involvement and mental health outcomes, yet the causal mechanisms linking them are not well understood.  Ellison and his colleagues (2001) tested the life stress paradigm linking religious involvement to adult well-being and distress.  This study looked at adolescents, a particularly understudied group in religious research. Analysis of data from the National Longitudinal Study of Adolescent Health (Add Health) reveals that religious effects on adolescent mental health are complex.  While religious involvement did not appear to prevent the occurrence of stressors or buffer their impact, some support was found for the hypothesis that religion facilitates coping by enhancing social and psychological resources.


Study Links Religion and Mental Health
David H. Rosmarin and Kenneth Pargament, Bowling Green State University, Ohio, (IsraelNN.com) 2008

A series of research studies – known as the JPSYCH program – reveals that traditional religious beliefs and practices are protective against anxiety and depression among Jews.  The research indicates that frequency of prayer, synagogue attendance, and religious study, and positive beliefs about the Divine are associated with markedly decreased levels of anxiety and with higher levels of happiness.  “In this day and age, there is a lot to worry about,” Rosmarin notes, “and the practice of religion may help people to maintain equanimity and perspective.”


The Once-Forgotten Factor in Psychiatry: Research Findings on Religious Commitment and Mental Health (excerpt)
David B. Larson, M.D., M.S.P.H., Susan S. Larson, M.A.T., and Harold G. Koenig, M.D., M.H.Sc., Psychiatric Times.  Vol. 17 No. 10, October 1, 2000

“The data from many of the studies conducted to date are both sufficiently robust and tantalizing to warrant continued and expanded clinical investigations.”

Treatment of Drug Abuse

  • The lack of religious/spiritual commitment stands out as a risk factor for drug abuse, according to past reviews of published studies.  Benson (1992) reviewed nearly 40 studies documenting that people with stronger religious commitment are less likely to become involved in substance abuse.
  • Gorsuch and Butler (1976) found that lack of religious commitment was a predictor of drug abuse.  The researchers wrote:  “Whenever religion is used in analysis, it predicts those who have not used an illicit drug regardless of whether the religious variable is defined in terms of membership, active participation, religious upbringing or the meaningfulness of religion as viewed by the person himself.”
  • Lorch and Hughes (1985), as cited by the National Institute for Healthcare Research (1999), surveyed almost 14,000 youths and found that the analysis of six measures of religious commitment and eight measures of substance abuse revealed religious commitment was linked with less drug abuse.  The measure of “importance of religion” was the best predictor in indicating lack of substance abuse.  The authors stated, “This implies that the controls operating here are deeply internalized values and norms rather than fear or peer pressure.”
  • Developing and drawing upon spiritual resources can also make a difference in improving drug treatment.  For instance, 45% of participants in a religious treatment program for opium addiction were still drug-free one year later, compared to only 5% of participants in a nonreligious public health service hospital treatment program-a nine-fold difference(Desmond and Maddux, 1981).
  • Confirming other studies showing reduced depression and substance abuse, a study of 1,900 female twins found significantly lower rates of major depression, smoking and alcohol abuse among those who were more religious (Kendler et al., 1997).  Since these twins had similar genetic makeup, the potential effects of nurture versus nature stood out more clearly.

“lack of religious commitment was a predictor of drug abuse”

Treatment of Alcohol Abuse

  • Religious/spiritual commitment predicts fewer problems with alcohol (Hardesty and Kirby, 1995).  People lacking a strong religious commitment are more at risk to abuse alcohol (Gartner et al., 1991).  Religious involvement tends to be low among people diagnosed for substance abuse treatment (Brizer, 1993).
  • A study of the religious lives of alcoholics found that 89% of alcoholics had lost interest in religion during their teen-age years, whereas 48% among the community control group had increased interest in religion, and 32% had remained unchanged (Larson and Wilson, 1980).
  • A relationship between religious or spiritual commitment and the non-use or moderate use of alcohol has been documented.  Amoateng and Bahr (1986) reported that, whether or not a religious tradition specifically proscribes alcohol use, those who are active in a religious group consumed substantially less alcohol than those who are not active.
  • Religion or spirituality is also often a strong force in [addiction] recovery.  Alcoholics Anonymous (AA) invokes a Higher Power to help alcoholics recover from addiction.  Those who participate in AA are more likely to remain abstinent after inpatient or outpatient treatmen t(Montgomery et al., 1995).

“…adolescents [who were] frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory.”

Suicide Prevention – Surging suicide rates plague the United States, especially among adolescents.  One in seven deaths among those 15 to 19 years of age results from suicide.

  • One study of 525 adolescents found that religious commitment significantly reduced risk of suicide (Stein et al., 1992).
  • A study of adolescents found that frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory (Wright et al., 1993).  High school students of either gender who attended church infrequently and had low spiritual support had the highest rates of depression, often at clinically significant levels.
  • How significantly might religious commitment prevent suicide?  One early large-scale study found that people who did not attend church were four times more likely to kill themselves than were frequent church-goers (Comstock and Partridge, 1972).  Stack (1983) found rates of church attendance predicted suicide rates more effectively than any other evaluated factor, including unemployment.  He proposed several ways in which religion might help prevent suicide, including enhancing self-esteem through a belief that one is loved by God and improving moral accountability, which reduces the appeal of potentially self-destructive behavior.
  • Many psychiatric inpatients indicate that spiritual/religious beliefs and practices help them to cope. Lindgren and Coursey (1995) reported 83% of psychiatric patients felt that spiritual belief had a positive impact on their illness through the comfort it provided and the feelings of being cared for and not being alone it engendered.

Potential Harmful Effects

Psychiatry still needs more research and clearer hypotheses in differentiating between the supportive use of religion/spirituality in finding hope, meaning, and a sense of being valued and loved versus harmful beliefs that may manipulate or condemn.”

  • Alcoholics often report negative experiences with religion and hold concepts of God that are punitive, rather than loving and forgiving (Gorsuch, 1993).
  • Bowman (1989).  In assessing multiple personality disorder, children in rigid religious families, whose harsh parenting practices border on abuse, harbor negative images of God.  Josephson (1993). Individual psychopathology is linked with families whose enmeshment, rigidity and emotional harshness were supported by enlisting spiritual precepts.
  • Sheehan and Kroll (1990).  Of 52 seriously mentally ill hospitalized patients diagnosed with major depression, schizophrenia, manic episode, personality disorder and anxiety disorder, almost one-fourth of [psychiatric patients] believed their sinful thoughts or acts may have contributed to the development of their illness.  Without the psychiatrist inquiring about potential religious concerns, these beliefs would remain unaddressed, potentially hindering treatment until discovered and resolved.  Collaboration with hospital chaplains or clergy may help in some of these instances of spiritual problems or distress.

Conclusion

Religious/spiritual commitment may enhance recovery from depression, serious mental or physical illness, and substance abuse; help curtail suicide; and reduce health risks.  More longitudinal research with better multidimensional measures will help further clarify the roles of these factors and how they are beneficial or harmful.

–Margaret