As a therapist who specializes in treating adolescents, I have experience working with Eating Disorders (ED). Eating disorders are hard to recognize because they usually affect perfectionist, OCD-type teens. So the initial presentation is that they have a happy, healthy life, they do great in school, they often have friends, and they will say everything is fine. However, the way ED adolescents cope with stress is with eating habits. Some red flags are: excessive exercise, isolation, taking small bites, pushing food around on plate, eating very slowly, focusing on food, weight and body, frequent trips to the bathroom, hiding food in room, vomiting after eating, trips to the grocery store before or after school or work, dunking food, cooking food to a crisp, eating quickly and drinking lots of water.
An ED can make a teen feel isolated and disconnected. This can have a negative impact on many important relationships. This is a very dangerous disorder, as ED has the highest rate of death of all the mental disorders, approximately 20% of those with anorexia die. For this reason, I want to stress that while therapy is important, therapy alone is not enough to treat a teen with ED.
To properly treat an ED, requires a multidisciplinary team consisting of:
A) a psychologist or therapist, B) a physician, C) a dietician/nutritionist, D) a psychiatrist, and E) a family therapist. A team is crucial for the following reasons:
A) Psychologists or therapists help the client with the underlying causes; an eating disorder is not all about food! They work with the patient on relationship skills, developing healthy coping mechanisms, challenging negative cognitions and core beliefs about self, and learning assertiveness skills. They help the patient to reach the goals of cessation of binge eating and/or purging behaviors, cessation of eating disordered ideation including body image disturbance and dissatisfaction, and re-establish social engagement.
B) Medical doctors play the important role of monitoring vitals, monitoring weight, and running important blood tests. They help the patient to reach the important goals of nutritional rehabilitation, weight restoration, medical stabilization, and prevention of serious medical complications and death, and resumption of menses (where appropriate).
C) Dieticians/nutritionists develop an eating plan based on the teen’s particular eating patterns. They help the patient to restore meal patterns that promote health and social connections.
D) Psychiatrists can evaluate if medication is required. Not all Eating Disorders are treated with medication. Having a psychiatric evaluation doesn’t necessarily mean medication. However, some symptoms, depression and suicidal ideation, can improve with medication if needed/indicated.
E) The role of the family therapist is important because parents/guardians are the help-seekers for adolescents. Families often feel responsible and guilty. It is important to help them understand that they did not cause the eating disorder, but they can be supportive during treatment. The family also needs to learn how to help the child overcome the eating disorder and to recognize when the child is talking and when the eating disorder is talking for the child.
Unfortunately, I cannot predict who will live and who will die with an eating disorder and so the treatment must be the same for everyone. There are three types of eating disorders, Anorexia, Bulimia, and Eating Disorder NOS. There is a lot of denial around eating disorders and parents often think their child has eating problems but not severe enough to warrant treatment. However, there is much shame involved in the disorder and lots of hiding of symptoms. Some clients need to be hospitalized, some need in-patient treatment, some need outpatient treatment. A thorough evaluation will help make that determination.
The information in this article was taken from the AED Report 2012, Academy For Eating Disorders www.AEDWEB.ORG. For more information, please visit their website and read the complete AED Report 2012.
I recently attended training by Stephan Hinshaw, a professor at UC Berkeley, on the Stigma of Mental Illness. It is somewhat surprising to learn just how prevalent negative judgments about emotional problems are in our society. Statistics show that in the U. S. we know far more about mental illness than we did in the 1950’s, yet we are equally or more stigmatizing toward it than we have been historically.
Unfortunately, people tend to lump problems as common as anxiety or depression in the same category as some of the more serious, violent, and debilitating mental illnesses displayed so negatively in the media. The vast majority of teens coming in for treatment for a “mental illness,” of course, are not insane or a danger to anyone. They are normal, often high-functioning adolescents who work jobs, attend school, and have friends, but who struggle with depression, anxiety or trouble adjusting to a recent life change.
Societal judgment may be worse for a parent bringing their teenager in for treatment. Goffman cites the reason for this is something called “courtesy stigma.” He found that, “If society has stigmatized a given class of people, it’s common courtesy to stigmatize those associated with such individuals.” He said that parents have been blamed directly for their teenager’s problems for decades and that, even if you view mental illness as having a genetic component, the parents are still left with the blame.
In my experience, teens are neither ashamed of going to therapy themselves nor judgmental about their friends who do. This gives me hope about a future in which more people work on their mental health from an early age. It does cause friction in families, though, as teens tell everyone they know that they're in therapy, and parents, who get the "courtesy stigma" feel justifiably upset. Interestingly enough, though, when they are open about getting help for their children, many parents find that what they receive from the community at large is support, not condemnation. One client of a colleague of mine commented, "ALL parents are having a tough time with their teens, whether they admit it or not. So, when I finally told my friend that I was getting help for my daughter, she was, like, 'give me the name of your therapist so I can get my daughter in, too.'"
I wish more people were as open as this mom. Research shows that emotional issues often have a genetic component, but that breaking the pattern of shame and silence around mental illness in families can reduce the likelihood of future generations developing a mental illness. We are all human, and many of us suffer from anxiety, depression, addiction, phobias, or other mental disorders. Once we find that we aren’t alone, we are not as ashamed. Once we aren’t as ashamed, our level of anxiety and depression is reduced, making it more likely for us, or our children, to get the help we need.
Raising children can be one the most rewarding jobs in life. It can also be one of the hardest. You start out sleep-deprived and feeling completely incompetent. There are moments you enjoy, and moments that bore you to tears. The days are long, but the years go by so quickly.
As your children get older, everyone gets more freedom. Then you find yourself with a teenager and you ask yourself, “what happened to my baby girl, to my sweet angel who is suddenly a ball of hormones with ups-and-downs and all-arounds?” The teen years are difficult for everyone. Some parents find themselves acting in ways they never thought they would, sometimes saying exactly what they swore they would never say to their children. The moments of awesome wisdom and grace get drowned out by the mistakes, the drama, and the angst of raising a teen.
In my job as a therapist for teens, parents often come to me and say they don’t know why they act the way they do. I tell them that teens know instinctively how push the buttons you didn’t even know you had. One father found himself completely unable to set limits for his out-of-control teen. As we explored the reasons for this, we discovered that the button being pushed in him had nothing to do with his son. It was from a past trauma in his own life. Once we worked through it, he found he had regained his confidence and was able to be firm and fair. His son’s behavior changed dramatically once pushing the button got him nowhere.
A mom came to me and said she felt she was incapable of being a good mother and bound to mess up her kids’ lives. She spent her days worrying about how she would raise the best kids and not make the same mistakes her parents made. She became anxious and paralyzed, unable to make the simplest of decisions regarding her children. Working through this, we discovered that her fears stemmed from some pretty terrible things that happened in her childhood. As we untangled that thread, she was able to allow herself to be an imperfect but kind mom for imperfect but talented children, and the whole family relaxed.
Very few of us had idyllic childhoods. Being a parent of an adolescent often brings up painful issues, many of which have been so long buried we thought they weren’t relevant anymore. This is one of the mixed blessings of being a parent: our children push our buttons, making it important and urgent to finally heal from the mistakes our own parents made and the rough roads we had to travel in our own youths.
Of course, I’m very clear that many teens’ issues are theirs alone! In either case, I enjoy being able to help parents put their childhood issues to rest so they can be the parents they always wanted to be.
A few weeks ago, I received a phone call from a colleague who told me that there had been a suicide of a student who attended Saratoga High School. I was heartbroken. Not again. We have lost so many youths in recent years to suicide. As a therapist who works with teens, I’ve been grateful to have had the opportunity to help many kids to regain hope, to recognize their problems as temporary, and to heal. This poor child, though, was a reminder that all that I do is not always enough.
Depression is a subtle form of mental illness, which is often hard to recognize, especially in the midst of the “normal” moodiness that teens are notorious for. So parents and teachers don’t necessarily realize that something is wrong. Severely depressed teens are unlikely to ask for help. It’s part of the illness, actually, to believe that help is impossible.
Help, though, is very possible. Therapy can make an extraordinary, life-saving difference, not only in helping teens reduce their depression but in helping them to develop/learn strategies they can use in their moments of despair, which can save their lives.
Just this week, one of my clients, who had been making some progress, began having suicidal thoughts again. We developed a plan, which she agreed to. Thank goodness, in her middle-of-the night terrible low spot, she remembered the plan and was able to follow it. The first thing on her plan was to call her therapist. I was not available, but she knew what the next steps were. She called the suicide hotline. She felt they weren’t enough help, so she continued to follow her plan. She let her parents know what she was thinking, that she was having suicidal thoughts. She did this even though she didn’t like her parent’s help and kept trying to kick them out of her room. I had previously prepared her parents for this, and they stayed with her, keeping her safe until the episode passed.
When I awoke in the morning I had several missed calls and messages that my client wanted to hurt herself. My immediate reaction was to call 911, not knowing that her parents were there with her and keeping her safe. I was scared to death, but so proud that my client had reached out for help. I reached her parents around the same time as the police had knocked on her door. She was OK. She had “scratched her arm” but she was OK and alive. She had even verbalized to her parents that she wanted to use alcohol as a way to calm down, but she did not turn to this unhealthy coping mechanism. When I met with her later that day, she said “I can’t believe that everyone made such a fuss over me” with a smile on her face. One of the contributing thoughts to her suicidal ideation was feeling alone…seeing that people cared about her and tried to help her will make a big difference in her life going forward.
I recently read a statistic that 20% of teens have mental health problems. Many of these are going untreated. This led me to question, what are the barriers to getting therapy for teens who are depressed or anxious? The first and most important might be initial screening
Since teens often hide their feelings pretty well, parents and teachers need to be direct, even if they don’t think there’s a problem, and just say: “I’ve read that many teens sometimes feel so bad, they consider suicide. Have you ever felt that way?” If the answer is yes, talk to them and be ready to listen, don’t judge, don’t offer quick fixes. The next step, though, is to find some professional help by taking the child to their pediatrician, a school nurse or counselor, a pastor, or to a therapist trained to work with teens.
Sometimes teens won’t talk to their parents. They want so much for their parents to be proud of them, that they can’t admit they are having problems. They may not want anyone to know they need therapy or that they have depression or anxiety or are targets of bullying or abuse. If asking direct questions is unproductive or too hard, you could also just let your child know that it is OK to ask for help sometimes. Until they are ready, give them a place – a youth group, a pastor, their pediatrician, a counselor - where they can talk without fear of being judged.
My goal is to make it no more of a stigma to see a therapist or other mental health provider than it is to see a doctor. Our young people shouldn’t have to die. I believe therapy can help. Parents can get involved and, together, we can show our youth that whatever the problem is, suicide is not the answer.
One of the best-researched current therapeutic techniques, which I have found to be exceptionally useful with teens, is Eye Movement Desensitization and Reprocessing (EMDR). This technique is often used to treat Post Traumatic Stress Disorder (PTSD), but I have found it to be very effective for “small “t” trauma,” such as:
· Invasive medical procedures
· Witnessing a dramatic event such as a house fire
· Hearing their parents fight
· The death of a pet
Victims of big “T” traumatic events, such as rape, sexual molestation, a natural disaster or a combat experience, can end up with self-attributions such as “I’m powerless,” “I’m worthless,” or “I’m not in control.” In my experience, teens with small “t” trauma can have the same self-attributions and symptoms. It seems that children are particularly vulnerable to the lasting effects of trauma, even if the actual events are things that others might not be so profoundly affected by.
I personally like EMDR because it targets a negative life event that causes a negative thought or belief that is stuck in the brain and cannot be released. With EMDR the memory is processed and becomes unstuck and negative thoughts/beliefs are replaced with positive beliefs that are internalized and become a part of the child’s belief system. Teens are able to process the traumatic memories, and the emotions, physical sensations and sounds associated with it diminish quickly. They are spared unnecessary suffering, and symptoms go away.
Symptoms that may respond well to EMDR:
· low self-esteem
· Suicidal thoughts
· Somatic symptoms
For more information on EMDR please visit the following websites: EMDR International Association: www.emdria.org EMDR Humanitarian Assistance Programs www.emdrhap.org The EMDR Institute www.emdr.com
Teenagers in Silicon Valley are under tremendous pressure. Often very bright, with successful parents, they feel a lot of pressure to get into the “right” college. That pressure includes thinking they must earn a GPA higher then a 4.0, that they must take AP classes, that they have to be involved in extra curricular activities, do volunteer work, and score high on the SAT’s. The expectations start in middle school with the same sort of extreme pressure to get into the “right” high school to prepare them for the “right” college. Motivated teens often sacrifice sleep to get their homework done or study for a test. And, all of this pressure and lack of rest occurs at the same time teens are also experiencing all of the “normal” stressors of boyfriend/girlfriend problems, family issues, peer difficulties, worries about their future vocation, etc. This is a great recipe for anxiety and in some cases panic attacks. Most teens just don’t have the tools needed to cope with the stress.
One complicating factor with anxiety is that people who have panic attacks or extreme anxiety become anxious about what happens to their bodies when they’re stressed out. They get so afraid that they will have a panic attack in public or that their anxiety will inhibit them that they actually become more anxious about the anxiety itself. One thing that often helps is becoming okay with feelings of stress and anxiety, just acknowledging that they are there rather then letting them take you over. In treatment, teens need to process not just what causes the anxiety, but the anxiety itself, the physical symptoms such as heart racing, sweating and feeling light-headed. Once a teen can get comfortable with having stress and even feelings of anxiety, then we can begin to reduce it, learn ways to handle it and not let it control their lives anymore.
There are many treatment options for treating anxiety (Individual and group). EMDR (Eye movement Desensitization and Reprocessing) is effective with teens and anxiety as it can target the anxiety itself. I like this approach because it teaches relaxation techniques, mindfulness techniques and replaces maladaptive cognitions with more adaptive ones. It also encourages teens to set goals, look at the future, plan on how they want to handle stresses in their future as well as building off their strengths and past successes teaching them how to be successful in the future.
I am currently accepting new clients for individual, family and group therapy. I have over 8 years of experience working with adolescents and their families. I also offer parenting classes and parent coaching.