Childhood Traumatic Grief
Childhood traumatic grief is a condition that children may develop after the death of
a significant person under circumstances that have been traumatic for the child.
We are beginning to understand how to identify this condition. In childhood traumatic
grief, a child has reactions and symptoms similar to those found in children
with PTSD. These reactions make it difficult for the child to follow the usual path
of bereavement and reminiscence about the deceased person in a positive and
meaningful way.
There are promising treatments that have been shown to be most helpful for children
with childhood traumatic grief. Treatment can be done with individuals and with groups
of children of different ages, and it should address both trauma and grief symptoms.
Treatment initially involves treating the trauma aspects of the condition and then
moving on to help the child deal with bereavement issues and master specific tasks.
The intervention described in this program draws from a variety of existing approaches.
The treatment includes teaching the child skills for managing stress, helping the child
to create a story about the death, and finally supporting the child while engaging in
specific activities related to bereavement. The goal of the treatment is to enable the
child to remember and cope with previously troubling thoughts and feelings about the
death and go on to have more positive and comforting memories about the person.
OVERVIEW OF CHILDHOOD TRAUMATIC GRIEF
WHAT IS CHILDHOOD TRAUMATIC GRIEF?
After being broadsided, the car was spinning out of control. When it stopped, eightyear-
old Devon, who was buckled up in the back seat and pinned in the car, yelled for
his mother to wake up. He heard the sirens, then watched the paramedics drag his
mother onto the street and saw blood running down her face. Later, whenever he rode
in a car, he refused to put on his seat belt because he wanted to get out as fast as
possible in case of an accident.
Twelve-year-old Anna’s brother drowned in the neighbor’s pool. She had a fight with him
right before he left, teasing the five-year-old about not being able to swim. Later she
frequently had nightmares in which she couldn’t breathe, so she stayed up most of
the night. In school, she was exhausted, sleepy, and couldn’t concentrate. Her grades
plummeted, but she said she didn’t care and deserved whatever punishment she got.
Childhood traumatic grief is a condition in which children who lose
loved ones under very unexpected, frightening, terrifying, traumatic
circumstances develop symptoms of posttraumatic stress and
other trauma symptoms that interfere with their ability to progress
through typical grief tasks, because they are stuck on the traumatic
aspects of the death. —Judith Cohen
Childhood traumatic grief can develop following the death of a significant person
when the death has been perceived by the child as traumatic. The hallmarks of the
condition are reactions related to (1) trauma, a situation that is sudden and terrifying
and that results in death and may have also been life threatening for the child, and
(2) grief, feelings of intense sadness and distress from missing the person who died
and the changes that have resulted. The distinguishing feature of childhood traumatic
grief is that trauma symptoms interfere with the child’s ability to navigate the typical
bereavement process. In other words, a child’s preoccupation and inability to relinquish
a focus on death leaves little or no room for other more helpful thoughts about
the person who died, leaves little emotional energy for adjusting to change, and
compromises the child’s ability to function in school or with friends. According to our
current understanding, childhood traumatic grief is distinct from uncomplicated
bereavement and conditions such as PTSD, yet it shares features of both. The
definition, characteristics, and assessment of childhood traumatic grief are still
evolving and likely vary due to such things as the type of death, age and cognitive
ability of the child, culture and beliefs, and family situation.
The child’s perception, not just the cause of death, plays a key role in determining the
development of symptoms. Not every child develops traumatic grief after a death that
happened in a particularly dramatic or threatening manner, such as death from a homicide,
war, or motor vehicle accident. In some cases, childhood traumatic grief can result
from a death that most would consider expected or normal, such as death from illness
or natural causes. There may be isolated traumatic moments that can be lodged in
the child’s memory, such as seeing a parent in profuse pain, that provoke the child’s
reaction. Childhood traumatic grief can affect children’s development, relationships,
achievement, and later effectiveness in life if not treated or otherwise resolved.
Children loose their developmental momentum that they had been
pursuing. They need support to regain that developmental momentum,
and without the support it often happens that children really stop
gaining these skills that are appropriate for their age, and that has
long-term repercussions. —Alicia Lieberman
The traumatic aspects of the death and the child’s relationship to the person that
died are entwined in such a way that thoughts or reminders of the trauma and
overwhelming painful grief about the person who died are linked together. The child’s
traumatic reaction can stem from the sudden and horrific nature of the death with
or without the child’s life also being in danger. The grief reaction stems from the
sadness of missing the person and all that has changed. The child contends with
the complex mix of trauma and grief. Hence, in providing treatment the clinician must
address both.
A child survivor of a car crash in which her mother was killed may be confronted with
reminders of the smell of rubber and gasoline, the fear of being trapped in the car,
the sight of blood and a mother’s lifeless body, and a caretaker whose absence is felt
every waking moment.
CULTURAL AND INDIVIDUAL VARIATIONS
Communication, expression and behavior following trauma and death can vary according
to one’s race, ethnicity, culture, and religion. It is important to be fully aware of these
variations in order to accurately identify those reactions outside the norm of what is
accepted and that prevent the child from participating fully in productive activities.
For example, intense displays of emotion may be more common in some cultures than
in others, and spiritual beliefs about an afterlife may influence a child’s reactions and
expressions. In some cultures it may be common practice to refrain from using the
name of the deceased for a certain period of time, hence, what may be interpreted
as avoidance in one setting is respectful and necessary in another. Either through
naturally occurring common practices or due to unfortunate war or devastation,
children in different countries may also have more or less exposure to death throughout
their life, which can influence their response. Regarding intervention, you must be
sensitive to instances when certain treatment principles may be contrary to what is
accepted practice in the child’s particular family. For those times when a practitioner is
unfamiliar with a family’s practices and beliefs it is essential to seek consultation or
consider additional referral.
OVERLAP OF CHILDHOOD TRAUMATIC GRIEF,
POSTTRAUMATIC STRESS DISORDER, AND TRAUMA REACTIONS
The typical traumatic stress symptoms that children might experience
with childhood traumatic grief include things like intrusive thoughts
or recurring images associated with the death of their loved one. It
could be the child becoming very constricted emotionally, becoming
numb as a way of not dealing with all the pain associated with the
tragic circumstances of their loved ones death. The child who has
childhood traumatic grief doesn’t have to have all those symptoms,
just some of them. —Anthony Mannarino
There is overlap in the reactions and symptoms of uncomplicated bereavement,
PTSD, and childhood traumatic grief. Children may show different signs of childhood
traumatic grief at different ages. However, difficulties specific to childhood traumatic
grief that can occur across developmental stages include those listed below. Although
the following reactions and symptoms are consistent with characteristics of PTSD,
they are notable as indicators of childhood traumatic grief because of the direct
reference to the traumatic death. A helpful way of understanding the following reactions
is to view them as indicating a child’s distress, communicating to others that the child
is not letting go of thoughts, feelings, and behaviors related to the images, details,
circumstances, and actions surrounding the death.
• Intrusive memories and preoccupations about things that happened before,
during, and after the death: These can appear through nightmares, guilt, or
self-blame about how the person died, or recurrent or intrusive thoughts about
the horrifying manner of death. Thoughts may also focus on wished-for protective
or rescue interventions, such as regret for not doing something that would have
changed the outcome.
A seven-year-old boy keeps thinking he should have done CPR to save the life of
his three-year-old sister who was caught in the crossfire of a drive-by shooting.
• Avoidance and a fear of strong feelings: This can be expressed by withdrawal
or by the child avoiding reminders of the person, the way the person died, or the
event that led to the death. In attempting to keep strong unpleasant feelings
related to the death at bay, the child may also try to dampen all feelings, which
results in what adults would understand as “numbing.”
A 14-year-old girl could not go to any fast-food restaurant after her father was
accidentally shot to death in one while they were getting milkshakes.
• Physical or emotional symptoms of increased arousal: These can include
irritability, anger, trouble sleeping, decreased concentration, a drop in grades,
stomachaches, headaches, increased vigilance, and fears about safety for
oneself or others. The reaction can generalize and occur in a context that
resembles, but is different than, the original situation.
A four-year-old girl started crying and screaming “stop shooting my mommy”
when she heard the fireworks at the park on the Fourth of July.
• Re-enactment: In re-enacting aspects of the events that are perceived to
have led to the death, there is an attempt to intervene, manage feelings of
helplessness, and undo what has been done and identify ways to prevent the
tragedy and death.
A six-year-old bereaved survivor of a motor vehicle crash repeatedly drew and cut
out replicas of the car and steering wheel. He built an oversized speedometer so
the driver of the other car would notice he was driving too fast. The boy went on
to make a car with extra protection that was strong enough to withstand any crash.
HOW IS CHILDHOOD TRAUMATIC GRIEF RELATED TO
OTHER TRAUMA REACTIONS?
Traumatic events can involve an actual death, other loss, serious injury, or threat to
the child’s own life or well-being. These events could include natural or man-made
disasters, violence, war, or accidents. A child may be traumatized by direct exposure,
witnessing the event, or hearing about another person’s experience. For some children,
the response can have a profound effect on how they view themselves and the world.
They may develop changes in their behavior (externalizing problems) or emotional
functioning (internalizing problems). Left untreated, the severe trauma-related reactions
can lead to more serious and chronic difficulties and, in some cases, coalesce into
PTSD. PTSD is diagnosed when the child has specific symptoms that continue for a
month or more following exposure to a traumatic event. The symptoms fall into the
three categories of re-experiencing, hyperarousal, and avoidance.
When children with childhood traumatic grief show reactions and symptoms characteristic of PTSD, the reactions and symptoms are directly related to the death and interfere with the child’s day-to-day functioning and bereavement work. Children may present with other symptoms not necessarily associated with PTSD but related to bereavement and traumatic death. These may include guilt, yearning, anger, and rescue and revenge fantasies.
Eleven-year-old Lisa witnessed her mother’s murder. In an interview with a therapist
five days after her mom was fatally shot and stabbed by her estranged boyfriend, Lisa
revealed her feelings about revenge when describing a dream: “In my dream I had the
same knife he used to stab my mother and the same gun that he shot her with. Then
I went up to him and said ’Do you remember this, now you can feel it’ And I stabbed
him right where he stabbed my mother. Then I said, ’I guess you remember this too,’
and then I shot him.”
It was hard for Lisa to talk about her mother, who she dearly loved, without feeling as
if she was back in that room. In the days and weeks after the murder, when she had
that feeling, she would focus on her mother being killed. But as she stood at the door,
frozen in place, one suspects she worried about herself as well as about her mother
being killed.
In childhood traumatic grief, the interaction of traumatic and grief symptoms is such
that any thoughts or reminders, even happy ones, about the person who died can lead
to frightening thoughts, images, or memories of how the person died.
Kevin, the 17-year-old brother of 15-year-old Briana, was killed in an avalanche. His body
was never found. She was haunted by feelings of guilt for not demanding he stay at the
lodge. She was so distraught that she isolated herself from friends. On further questioning,
it became clear that Briana and Kevin had many of the same friends. So when Briana
was with them, she was reminded of the good times they used to have together. But
this quickly led to her thinking about Kevin suffocating and it being her fault.
Three types of reminders may trigger unpleasant and distressing reactions:
1. Trauma reminders: places, situations, people, sights, smells, or sounds
reminiscent of things associated with the actual death. These may include the
street corner where a fatal accident occurred, the bedroom where a parent died,
or the sound of an airplane reminding a child of a mother who died in a crash.
2. Loss reminders: people, places, objects, situations, thoughts, or memories
that are reminders of particular aspects of the person who died — for example,
photo albums, an empty chair at the dinner table, or a new coach who has
replaced a parent who previously headed a child’s sports team.
3. Change reminders: situations, people, places, or things reminding the child
of changes in his or her life resulting from the death — for example, moving to
a new house or having to walk home with a babysitter rather than an older
sibling who died.
Reminders can certainly provoke sadness or thoughts about the deceased. However,
in childhood traumatic grief, these reminders may lead to the child re-experiencing
the traumatic events that led to the death. The terror associated with these memories
results in increased arousal symptoms. The child then attempts to handle the
distressing re-experiencing and symptoms with avoidance or numbing, often
characterized as a deadening of emotions in older children and a fear of feelings in
younger children. Because traumatic aspects of the death are so upsetting, the child
tries to avoid all reminders of the trauma, loss, or resulting changes so as not to
stir up unpleasant thoughts or feelings.
For example, a younger child may be afraid to sleep alone at night because of
nightmares about a tragic shooting, whereas an older child may avoid flying in a
plane because it brings up painful memories about a father who died in a plane crash.
One of the most common reminders of the trauma, loss, and change is the person’s
own family. Looking across at each other, knowing each has experienced the same
death even if having individual reactions, can be upsetting.
HOW DOES CHILDHOOD TRAUMATIC GRIEF DIFFER
FROM UNCOMPLICATED GRIEF?
Any death can be difficult for a child, and certain reactions are more likely than others.
Uncomplicated bereavement is the intense sadness and longing for the deceased
that children typically feel after the loss of a loved one. Complicated bereavement
has been described in adults as bereavement complicated by separation distress
and traumatic symptoms related to the loss of the security-enhancing relationship
with the deceased. This has not been clearly defined as a condition for children.
Uncomplicated or typical grief reactions in children vary according to age, developmental
level, previous life experiences, culture, beliefs, emotional health prior to the death,
and the family and social environment. Over time, a child is relieved of extreme
sadness and is able to engage in accepted mourning rituals, and, when appropriate,
remember good times and have positive feelings about the person who died. However,
while grieving, a child typically may have:
• Emotional reactions: feeling sad, angry, anxious, numb, lonely, guilty, powerless,
shamed, insecure, and remorseful.
• Changes in behavior: lack of interest and participation in usual activities,
diminished self-care, unpredictable or odd behavior, angry or aggressive
behaviors, increased risk taking, irritability and conflict with others, impulsivity,
regression to earlier behaviors, changes in sleep behaviors (increased or
decreased), difficulty sleeping or sleeping alone, changes in appetite (increase
or decrease in weight), and changes in physical health.
• Difficulty with interpersonal interactions: withdrawal, social isolation, peer
difficulties, clinging, irritability, difficulty sharing memories, difficulty participating
in group or athletic activities, and general lack of interest in others.
• Changes in thinking: constant thoughts and memories about the loved one,
persistent thoughts about the death, disbelief about the death and the finality
of the death, constant or intrusive thoughts about death, preoccupation with
one’s own or a loved one’s physical health and safety, difficulty making decisions,
confusion, impaired memory and concentration, lowered self-esteem and selfconfidence,
disillusionment, thinking that the death was one’s fault, and
survivor guilt.
• Altered perceptions: believing the deceased is still present, feeling the person’s
presence nearby, seeing the person’s face in a crowd, smelling the person’s
perfume, hearing the person’s voice, and experiencing vivid dreams about
the person.
• Physical reactions: susceptibility to illness, loss of energy, fatigue, difficulty or
changes in eating, physical complaints, and changes in physiological arousal
(for example, increased heart rate, respiration, and startle response).
• Changes in academic functioning: poor school performance, difficulty studying
or concentrating, and potential school failure.
In nontraumatic bereavement, kids may be sad, or upset, or feel lonely,
but they are able to continue on with activities and eventually maybe
enjoy life again and be re-engaged with people and situations. The child
with traumatic grief is kind of stuck, so a child may not want to be
around a cousin who is the same age as a sister who died because
it’s too upsetting, or a boy may not want to play baseball anymore
because he can’t bear the thought of looking in the stands and his
father not being there, and he falls apart. So these things segue into
the awful reminders, and the child then avoids every reminder, even a
positive one. —Robin Goodman
Throughout their lives, children continue to adjust to the loss and develop new ways
of coping. Over time, it is helpful for children to relate to their loss by engaging in,
and mastering, certain bereavement tasks. The following chart presents the outcome
of common bereavement tasks and how childhood traumatic grief interferes with
completion of these tasks.
Completion of Bereavement Tasks for Children with Uncomplicated Grief
and Indicators of Difficulty for Children with Childhood Traumatic Grief
In uncomplicated bereavement typically
children will:
Accept the reality and permanence of
death
Experience and cope with difficult
emotional reactions
Adjust to changes in their lives and
changes in their identity that result from
the death
Develop new relationships or deepen
existing ones
Childhood traumatic grief interferes
with bereavement due to:
Difficulty with accepting or unwillingness
to accept that the person has died due
to associations of the death with the
traumatic circumstance
Intense, distressing feelings that are
triggered by reminders leading to
avoidance or lack of feelings
Changes that lead to unpleasant reminders
of the way the person died, possible
overidentification with the person who
died, feeling overly responsible
Feelings such as guilt, anger, and
revenge interfering with the formation
of new relationships
In uncomplicated bereavement, children may feel sad when remembering the
deceased person but are generally able to have positive memories of the person and
continue with necessary life activities. It is important to keep in mind that bereaved
children are at risk for other types of mental health problems such as depression,
anxiety, and substance abuse either alone or in conjunction with childhood traumatic
grief. In childhood traumatic grief specifically, the terrifying and frightening aspects
of the death are so prominent that they get in the way of adjusting to life in ways that
are deemed helpful for the bereaved. Because positive memories of the person
who died lead directly to frightening reminders of the death, without help, the child
never reaches the point of finding comfort in memories, calling up better times, or
participating in what are culturally customary mourning practices. The child may also
have been unable to participate or benefit from various rituals used to ease grief, for
example, avoiding a funeral or being unable to cry for many months. In childhood
traumatic grief, the traumatic reactions make it difficult for the child to
• reminisce or enjoy positive memories of the deceased person when that is
deemed comforting in the child’s culture,
• cope with the many life changes that occur as a result of the death, and
• continue with normal development in ways that are expected and necessary.
In uncomplicated bereavement typically
children will:
Maintain a continuing, healthy
attachment to the deceased person
through remembrance activities
Find some meaning in the death and
learn about life or oneself
Continue through the normal
developmental stages
Childhood traumatic grief interferes
with bereavement due to:
Difficulty or avoidance of positive memories
because they are linked to horrible images
and upsetting thoughts and feelings
Inability or resistance to moving past
the terrifying, unpleasant aspects of
the death, negative feelings about self
related to the death or person
Emotional reactions and resulting
behavior, e.g., withdrawal, anger, and
distrust, interfering with the ability
to engage in positive, age-appropriate
activities and relationships
WHO SUFFERS FROM CHILDHOOD TRAUMATIC GRIEF?
Children can develop childhood traumatic grief when they experience the death of a
significant person, such as a parent, a sibling, or a close friend. Children of all ages,
even a young preschooler, can have a traumatic reaction to a death, especially of a
primary caregiver. It is estimated that five percent of all children in the United States
experience the death of a parent before the age of 15, and children under the age of
three are often present when a sibling or parent dies in a traumatic circumstance,
making young children particularly vulnerable and in need of attention.
However, not all children who have experienced a death develop childhood traumatic
grief. In fact, many recover and do well over time. Although it is true that the majority
of children who experience a death do not develop childhood traumatic grief, the
number of children who do struggle with childhood traumatic grief is quite significant.
For example, up to 70 percent of children in inner city communities have seen
someone shot or stabbed. Even if only five percent of these children develop childhood
traumatic grief, this translates into thousands of children developing this condition
each year. Although all children witnessing a homicide are likely affected in some way,
some are better able to tolerate the experience, whereas others are deeply impacted
and cannot continue on as well as before the death.
October 04, 2010
October 02, 2010
Hoarding
Overview, ceus
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Hoarders, clutterers, pack rats, and collectors are some of the common words used to identify and describe people with a lot of stuff in their apartment, house, office, storage unit, car and/or yard. The accumulation of objects can become a serious safety and health problem, interfere with one’s activities of daily living and/or violate housing codes that may lead to eviction or condemnation. When animals are hoarded, the violations and potential penalties become even greater. Additional authorities may become involved to address the criminal conditions affecting the dependent animals, as well as dependent humans in the household.
Who should use this site
This web page can be helpful for people who
•love or care about some one who hoards,
•struggles with it themselves or
•are working in a professional capacity with a hoarder.
Organizations working with people who hoard may include:
•public health departments,
•housing providers,
•courts,
•mental health professionals,
•social service providers of all kinds,
•elder services,
•visiting nurses and home care organizations,
•legal services and housing lawyers,
•clean-up companies,
•adult, child or animal protective services and
•fire, police and emergency medical technicians.
This site has general information as well as links to related professional, service, government, academic and self-help sites.
What is Hoarding?
--------------------------------------------------------------------------------
People who hoard have difficulty discarding items, have problems with too much clutter, and/or have a problem with acquiring too much. Their living spaces are often so cluttered that they can no longer use rooms, furniture, appliances and/or other objects for what they were originally intended. In some cases, animals may be the victims of hoarding behavior, compromising their welfare as well as the safety and well being of the person and other humans in the household.
Research has shown that object hoarding behavior typically begins at around age 13, although animal hoarding behavior usually begins in adulthood. On average, people seek behavioral health intervention at age 50.
A small number of people come forward for treatment on their own or at the request of family member or friend. However, most cases of hoarding, especially those that become a concern to the community, are brought to the attention of the public health department through a sanitation or code violation.
Approximately 5% or nearly 15 million Americans are sufferers of this complicated mental health problem. There is still a lot to be learned about the association of age when hoarding begins, genetics and brain biology as they relate to hoarding
--------------------------------------------------------------------------------
Hoarders, clutterers, pack rats, and collectors are some of the common words used to identify and describe people with a lot of stuff in their apartment, house, office, storage unit, car and/or yard. The accumulation of objects can become a serious safety and health problem, interfere with one’s activities of daily living and/or violate housing codes that may lead to eviction or condemnation. When animals are hoarded, the violations and potential penalties become even greater. Additional authorities may become involved to address the criminal conditions affecting the dependent animals, as well as dependent humans in the household.
Who should use this site
This web page can be helpful for people who
•love or care about some one who hoards,
•struggles with it themselves or
•are working in a professional capacity with a hoarder.
Organizations working with people who hoard may include:
•public health departments,
•housing providers,
•courts,
•mental health professionals,
•social service providers of all kinds,
•elder services,
•visiting nurses and home care organizations,
•legal services and housing lawyers,
•clean-up companies,
•adult, child or animal protective services and
•fire, police and emergency medical technicians.
This site has general information as well as links to related professional, service, government, academic and self-help sites.
What is Hoarding?
--------------------------------------------------------------------------------
People who hoard have difficulty discarding items, have problems with too much clutter, and/or have a problem with acquiring too much. Their living spaces are often so cluttered that they can no longer use rooms, furniture, appliances and/or other objects for what they were originally intended. In some cases, animals may be the victims of hoarding behavior, compromising their welfare as well as the safety and well being of the person and other humans in the household.
Research has shown that object hoarding behavior typically begins at around age 13, although animal hoarding behavior usually begins in adulthood. On average, people seek behavioral health intervention at age 50.
A small number of people come forward for treatment on their own or at the request of family member or friend. However, most cases of hoarding, especially those that become a concern to the community, are brought to the attention of the public health department through a sanitation or code violation.
Approximately 5% or nearly 15 million Americans are sufferers of this complicated mental health problem. There is still a lot to be learned about the association of age when hoarding begins, genetics and brain biology as they relate to hoarding
September 25, 2010
National Strategy for Suicide Prevention
National Strategy for Suicide Prevention: Goals and Objectives for Action CEU Course
1. Increase awareness of suicide prevention methods
2. Increase familiarity with broad based support systems
3. Become familiar with strategies to reduce stigma
4. Learn how to promote efforts to reduce efforts to lethal means of self harm.
5. Identify at risk behavior
6. Implement appropriate treatment and resources
7. Develop and Promote Effective Clinical and Professional Practices
Table of Contents:
1. GOAL 1: Promote Awareness that Suicide is a Public Health Problem that is Preventable
2. GOAL 2: Develop Broad-Based Support for Suicide Prevention
3. GOAL 3: Develop and Implement Strategies to Reduce the Stigma Associated with Being a Consumer of Mental Health, Substance Abuse, and Suicide Prevention Services
4. GOAL 4: Develop and Implement Community-Based Suicide Prevention Programs
5. GOAL 5: Promote Efforts to Reduce Access to Lethal Means and Methods to Self-Harm
6. GOAL 6: Implement Training for Recognition of At-Risk Behavior and Delivery of Effective Treatment
7. GOAL 7: Develop and Promote Effective Clinical and Professional Practices
8. GOAL 8: Improve Access to and Community Linkages with Mental Health and Substance Abuse Services
9. GOAL 9: Improve Reporting and Portrayals of Suicidal Behavior, Mental Illness, and Substance Abuse in the Entertainment and News Media
10. GOAL 10: Promote and Support Research on Suicide and Suicide Prevention
11. GOAL 11: Improve and Expand Surveillance Systems
12. Looking Ahead
13. References
GOAL 1: Promote Awareness that Suicide is a Public Health Problem that is Preventable
Why is this Goal Important to the National Strategy?
In a democratic society, the stronger and broader the support for a public health initiative, the greater its chance for success. The social and political will can be mobilized when it is believed that suicide is preventable. If the general public understands that suicide and suicidal behaviors can be prevented, and people are made aware of the roles individuals and groups can play in prevention, many lives can be saved.
In order to mobilize social and political will, it is important to first dispel the myths that surround suicide. Many of these myths relate to the causes of suicide, the reasons for suicide, the types of individuals who contemplate suicide, and the consequences associated with suicidal ideation and attempts. Better awareness that suicide is a serious public health problem results in knowledge change, which then influences beliefs and behaviors (Satcher, 1999). Increased awareness coupled with the dispelling of myths about suicide and suicide prevention will result in a decrease in the stigma associated with suicide and life-threatening behaviors. An informed public awareness coupled with a social strategy and focused public will lead to a change in the public policy about the importance of investing in suicide prevention efforts at the local, State, regional, and national level (Mrazek & Haggerty, 1994).
Background Information and Current Status
The factors that contribute to the development, maintenance, and exacerbation of suicidal behaviors are now better understood from a public health perspective (Silverman & Maris, 1995). A public health approach allows suicide to be seen as a preventable problem, because it offers a way of understanding pathways to self-injury that lend themselves to the development of testable preventive interventions (Gordon, 1983; Potter, Powell & Kachur, 1995). Although some have criticized the public health model of suicide as being too disease-oriented, it does, in fact, take into account psychological, emotional, cognitive, and social factors that have been shown to contribute to suicidal behaviors (Potter, Rosenberg, & Hammond, 1998).
Did You Know?
In the 10 years 1989-1998, 307,973 people died as a result of suicide.
Suicide is a major public health problem. It is one of the top ten leading causes of death in the United States, ranking 8th or 9th for the last few decades. For the approximately 31,000 suicide deaths per year, there are an estimated 200,000 additional individuals who will be affected by the loss of a loved one or acquaintance by suicide. The economic and emotional toll on the Nation is profound (Palmer, Revicki, Halpern, & Hatziandreu, 1995).
How Will the Objective Facilitate Achievement of the Goal?
The objectives established for this goal are focused on increasing the degree of cooperation and collaboration between and among public and private entities that have made a commitment to public awareness of suicide and suicide prevention. To accomplish this goal, support for innovative techniques and approaches is needed to get the message out, as well as support for the organizations and institutions involved.
Objective 1.1:
By 2005, increase the number of States in which public information campaigns designed to increase public knowledge of suicide prevention reach at least 50 percent of the State's population.
Suicide has been designated as a serious public health problem by the U.S. Surgeon General, and the 105th U.S. Congress has recognized that this problem deserves increased attention [U.S. Senate Resolution 84 (5/6/97) and U.S. House Resolution 212 (10/9/98)]. They recognize suicide as a national problem and declare suicide prevention as a national priority, encouraging the development of an effective national strategy for the prevention of suicide. Public and private organizations have developed information campaigns to educate the public that suicide is preventable, as it can be a consequence of other treatable disorders such as depression, schizophrenia, bipolar illness, alcohol and drug abuse, and certain medical conditions. Campaigns alert professional, community, and lay groups about the common signs and symptoms associated with suicidal behavior. Some organizations with existing campaigns include the American Association of Suicidology (AAS), the American Foundation for Suicide Prevention (AFSP), the Suicide Awareness\Voices of Education (SA\VE), the Suicide Prevention Advocacy Network (SPAN USA), and Yellow Ribbon Suicide Prevention Program.
Ideas for Action Work with local media to develop and disseminate public service announcements describing a safe and effective message about suicide and its prevention.
Public information campaigns can take many forms. No single slogan or message works for everyone. For example, the primary purpose of the annual National Depression Screening Day is to identify, in a variety of settings, individuals with symptoms of depression and refer them for treatment (Jacobs, 1999b). However, such a screening program performed at primary care centers, mental health and substance abuse treatment centers, colleges, universities, and places of employment can play an important role in raising awareness and educating large groups of individuals about this mental disorder and its association with suicidal behaviors. Because no one
is immune to suicide the challenge is to develop a variety of messages targeting the young and the old, various racial and ethnic populations, individuals of various faiths, those of different sexual orientations, and people from diverse socioeconomic groups and geographical regions.
Objective 1.2:
By 2005, establish regular national congresses on suicide prevention designed to foster collaboration with stakeholders on prevention strategies across disciplines and with the public.
Broad-based participation and involvement is needed to ensure progress in reducing the toll of suicide. Open discussion and assessment of suicide prevention programs can only lead to their refinement and better chances for success.
The techniques and tools to create and implement prevention initiatives can be taught and demonstrated. Learning how to develop and disseminate public health messages and to mount public health campaigns is critical to implementing suicide prevention efforts.
A number of organizations have convened annual, national meetings devoted to suicide prevention. Currently, such meetings are sponsored by AAS, AFSP, and biennially by the International Association for Suicide Prevention (IASP). The establishment of regular national congresses on suicide prevention, collaboratively sponsored by more than one organization, will maintain interest and focus on this issue. Ideally, these national congresses should be sponsored by public/private partnerships (see Objective 2.2), and focus on needs and plans for coordinating effective suicide prevention efforts.
Ideas for Action Identify foundations and other stakeholders to contribute to the support of national congresses on suicide prevention.
Objective 1.3:
By 2005, convene national forums to focus on issues likely to strongly influence the effectiveness of suicide prevention messages.
National forums increase awareness of the problem of suicide and serve to mobilize social will. Such meetings keep the subject in the forefront of attention and raise concerns to the national level. Such activities increase connectedness between and among key stakeholders, and serve to bring support, consensus and collaboration to suicide prevention efforts.
Focusing on factors that influence the effectiveness of suicide prevention initiatives is critical to an overall strategy. National forums are opportunities to focus on specific issues that affect all efforts to mount suicide prevention initiatives. By highlighting specific areas, consensus can be reached on how best to incorporate elements into a suicide prevention plan and how best to evaluate effectiveness.
Ideas for Action Incorporate suicide awareness and prevention messages into employee assistance program activities in businesses with greater than 500
employees.
Objective 1.4:
By 2005, increase the number of both public and private institutions active in suicide prevention that are involved in collaborative, complementary dissemination of information on the World Wide Web.
The World Wide Web offers an unparalleled opportunity to bring public health information to a much broader audience because it can be accessed at home, at work, at schools, at community centers, at libraries, or at any other location where there is access to the Internet. Not only does the World Wide Web offer exciting possibilities for the delivery of public health messages (including promoting awareness and referral sources for those in need), but it offers an opportunity to develop preventive interventions as well.
For example, the World Wide Web offers the potential for interactive dialogue and exchange of accurate information. Clear, concise, and culturally sensitive public health messages are key to assisting individuals to evaluate their at-risk status accurately and to know where and how to get help. It therefore is important that both public and private institutions committed to suicide prevention activities collaborate and cooperate to deliver information that is consistent, comparable, complementary, and not competitive. In addition to several Federal websites (see Appendix D); some of the key national organizations currently disseminating suicide prevention information on the World Wide Web include AAS, AFSP, IASP, SPAN USA, and the American Academy of Pediatrics.
Did You Know? Suicide is the eighth leading cause of death for all Americans.
GOAL 2: Develop Broad-Based Support for Suicide Prevention
1. Increase awareness of suicide prevention methods
2. Increase familiarity with broad based support systems
3. Become familiar with strategies to reduce stigma
4. Learn how to promote efforts to reduce efforts to lethal means of self harm.
5. Identify at risk behavior
6. Implement appropriate treatment and resources
7. Develop and Promote Effective Clinical and Professional Practices
Table of Contents:
1. GOAL 1: Promote Awareness that Suicide is a Public Health Problem that is Preventable
2. GOAL 2: Develop Broad-Based Support for Suicide Prevention
3. GOAL 3: Develop and Implement Strategies to Reduce the Stigma Associated with Being a Consumer of Mental Health, Substance Abuse, and Suicide Prevention Services
4. GOAL 4: Develop and Implement Community-Based Suicide Prevention Programs
5. GOAL 5: Promote Efforts to Reduce Access to Lethal Means and Methods to Self-Harm
6. GOAL 6: Implement Training for Recognition of At-Risk Behavior and Delivery of Effective Treatment
7. GOAL 7: Develop and Promote Effective Clinical and Professional Practices
8. GOAL 8: Improve Access to and Community Linkages with Mental Health and Substance Abuse Services
9. GOAL 9: Improve Reporting and Portrayals of Suicidal Behavior, Mental Illness, and Substance Abuse in the Entertainment and News Media
10. GOAL 10: Promote and Support Research on Suicide and Suicide Prevention
11. GOAL 11: Improve and Expand Surveillance Systems
12. Looking Ahead
13. References
GOAL 1: Promote Awareness that Suicide is a Public Health Problem that is Preventable
Why is this Goal Important to the National Strategy?
In a democratic society, the stronger and broader the support for a public health initiative, the greater its chance for success. The social and political will can be mobilized when it is believed that suicide is preventable. If the general public understands that suicide and suicidal behaviors can be prevented, and people are made aware of the roles individuals and groups can play in prevention, many lives can be saved.
In order to mobilize social and political will, it is important to first dispel the myths that surround suicide. Many of these myths relate to the causes of suicide, the reasons for suicide, the types of individuals who contemplate suicide, and the consequences associated with suicidal ideation and attempts. Better awareness that suicide is a serious public health problem results in knowledge change, which then influences beliefs and behaviors (Satcher, 1999). Increased awareness coupled with the dispelling of myths about suicide and suicide prevention will result in a decrease in the stigma associated with suicide and life-threatening behaviors. An informed public awareness coupled with a social strategy and focused public will lead to a change in the public policy about the importance of investing in suicide prevention efforts at the local, State, regional, and national level (Mrazek & Haggerty, 1994).
Background Information and Current Status
The factors that contribute to the development, maintenance, and exacerbation of suicidal behaviors are now better understood from a public health perspective (Silverman & Maris, 1995). A public health approach allows suicide to be seen as a preventable problem, because it offers a way of understanding pathways to self-injury that lend themselves to the development of testable preventive interventions (Gordon, 1983; Potter, Powell & Kachur, 1995). Although some have criticized the public health model of suicide as being too disease-oriented, it does, in fact, take into account psychological, emotional, cognitive, and social factors that have been shown to contribute to suicidal behaviors (Potter, Rosenberg, & Hammond, 1998).
Did You Know?
In the 10 years 1989-1998, 307,973 people died as a result of suicide.
Suicide is a major public health problem. It is one of the top ten leading causes of death in the United States, ranking 8th or 9th for the last few decades. For the approximately 31,000 suicide deaths per year, there are an estimated 200,000 additional individuals who will be affected by the loss of a loved one or acquaintance by suicide. The economic and emotional toll on the Nation is profound (Palmer, Revicki, Halpern, & Hatziandreu, 1995).
How Will the Objective Facilitate Achievement of the Goal?
The objectives established for this goal are focused on increasing the degree of cooperation and collaboration between and among public and private entities that have made a commitment to public awareness of suicide and suicide prevention. To accomplish this goal, support for innovative techniques and approaches is needed to get the message out, as well as support for the organizations and institutions involved.
Objective 1.1:
By 2005, increase the number of States in which public information campaigns designed to increase public knowledge of suicide prevention reach at least 50 percent of the State's population.
Suicide has been designated as a serious public health problem by the U.S. Surgeon General, and the 105th U.S. Congress has recognized that this problem deserves increased attention [U.S. Senate Resolution 84 (5/6/97) and U.S. House Resolution 212 (10/9/98)]. They recognize suicide as a national problem and declare suicide prevention as a national priority, encouraging the development of an effective national strategy for the prevention of suicide. Public and private organizations have developed information campaigns to educate the public that suicide is preventable, as it can be a consequence of other treatable disorders such as depression, schizophrenia, bipolar illness, alcohol and drug abuse, and certain medical conditions. Campaigns alert professional, community, and lay groups about the common signs and symptoms associated with suicidal behavior. Some organizations with existing campaigns include the American Association of Suicidology (AAS), the American Foundation for Suicide Prevention (AFSP), the Suicide Awareness\Voices of Education (SA\VE), the Suicide Prevention Advocacy Network (SPAN USA), and Yellow Ribbon Suicide Prevention Program.
Ideas for Action Work with local media to develop and disseminate public service announcements describing a safe and effective message about suicide and its prevention.
Public information campaigns can take many forms. No single slogan or message works for everyone. For example, the primary purpose of the annual National Depression Screening Day is to identify, in a variety of settings, individuals with symptoms of depression and refer them for treatment (Jacobs, 1999b). However, such a screening program performed at primary care centers, mental health and substance abuse treatment centers, colleges, universities, and places of employment can play an important role in raising awareness and educating large groups of individuals about this mental disorder and its association with suicidal behaviors. Because no one
is immune to suicide the challenge is to develop a variety of messages targeting the young and the old, various racial and ethnic populations, individuals of various faiths, those of different sexual orientations, and people from diverse socioeconomic groups and geographical regions.
Objective 1.2:
By 2005, establish regular national congresses on suicide prevention designed to foster collaboration with stakeholders on prevention strategies across disciplines and with the public.
Broad-based participation and involvement is needed to ensure progress in reducing the toll of suicide. Open discussion and assessment of suicide prevention programs can only lead to their refinement and better chances for success.
The techniques and tools to create and implement prevention initiatives can be taught and demonstrated. Learning how to develop and disseminate public health messages and to mount public health campaigns is critical to implementing suicide prevention efforts.
A number of organizations have convened annual, national meetings devoted to suicide prevention. Currently, such meetings are sponsored by AAS, AFSP, and biennially by the International Association for Suicide Prevention (IASP). The establishment of regular national congresses on suicide prevention, collaboratively sponsored by more than one organization, will maintain interest and focus on this issue. Ideally, these national congresses should be sponsored by public/private partnerships (see Objective 2.2), and focus on needs and plans for coordinating effective suicide prevention efforts.
Ideas for Action Identify foundations and other stakeholders to contribute to the support of national congresses on suicide prevention.
Objective 1.3:
By 2005, convene national forums to focus on issues likely to strongly influence the effectiveness of suicide prevention messages.
National forums increase awareness of the problem of suicide and serve to mobilize social will. Such meetings keep the subject in the forefront of attention and raise concerns to the national level. Such activities increase connectedness between and among key stakeholders, and serve to bring support, consensus and collaboration to suicide prevention efforts.
Focusing on factors that influence the effectiveness of suicide prevention initiatives is critical to an overall strategy. National forums are opportunities to focus on specific issues that affect all efforts to mount suicide prevention initiatives. By highlighting specific areas, consensus can be reached on how best to incorporate elements into a suicide prevention plan and how best to evaluate effectiveness.
Ideas for Action Incorporate suicide awareness and prevention messages into employee assistance program activities in businesses with greater than 500
employees.
Objective 1.4:
By 2005, increase the number of both public and private institutions active in suicide prevention that are involved in collaborative, complementary dissemination of information on the World Wide Web.
The World Wide Web offers an unparalleled opportunity to bring public health information to a much broader audience because it can be accessed at home, at work, at schools, at community centers, at libraries, or at any other location where there is access to the Internet. Not only does the World Wide Web offer exciting possibilities for the delivery of public health messages (including promoting awareness and referral sources for those in need), but it offers an opportunity to develop preventive interventions as well.
For example, the World Wide Web offers the potential for interactive dialogue and exchange of accurate information. Clear, concise, and culturally sensitive public health messages are key to assisting individuals to evaluate their at-risk status accurately and to know where and how to get help. It therefore is important that both public and private institutions committed to suicide prevention activities collaborate and cooperate to deliver information that is consistent, comparable, complementary, and not competitive. In addition to several Federal websites (see Appendix D); some of the key national organizations currently disseminating suicide prevention information on the World Wide Web include AAS, AFSP, IASP, SPAN USA, and the American Academy of Pediatrics.
Did You Know? Suicide is the eighth leading cause of death for all Americans.
GOAL 2: Develop Broad-Based Support for Suicide Prevention
June 09, 2010
Major Depression in Children and Adolescents
Major Depression in Children and Adolescents
What are mental health problems?
How many children and adolescents are affected by these problems?
What is depression?
What are the signs of depression?
How common is depression?
What help is available for a young person with depression?
What can parents do?
Important messages about children's and adolescents' mental health:
What are mental health problems?
In this fact sheet, "mental health problems" for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention- deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders.
Back to top
How many children and adolescents are affected by these problems?
Mental health problems affect one in every five young people at any given time. "Serious emotional disturbances" for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community. Serious emotional disturbances affect 1 in every 10 young people at any given time.
Back to top
What is depression?
Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person's thoughts, feelings, behavior, and body. Major depression in children and adolescents is serious; it is more than "the blues." Depression can lead to school failure, alcohol or other drug use, and even suicide.
Back to top
What are the signs of depression?
Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. Signs of depression often include:
sadness that won't go away;
hopelessness, boredom;
unexplained irritability or crying
loss of interest in usual activities;
changes in eating or sleeping habits;
alcohol or substance abuse
missed school or poor school performance;
threats or attempts to run away from home;
outbursts of shouting, complaining;
reckless behavior;
aches and pains that don't get better with treatment;
thoughts about death or suicide.
Adolescents with major depression are likely to identify themselves as depressed before their parents suspect a problem. The same may be true for children.
Back to top
How common is depression?
Population studies show that at any point in time 10 to 15 percent of children and adolescents have some symptoms of depression. Having a family history of depression, particularly a parent who had depression at an early age, also increases the chances that a child or adolescent may develop depression. Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next 5 years. This young person is also at risk for other mental health problems.
Back to top
What help is available for a young person with depression?
While several types of antidepressant medications can be effective to treat adults with depression, these medications may not be as effective in treating children and adolescents. Care must be used in prescribing and monitoring all medication.
Many mental health care providers use "talk" treatments to help children and adolescents with depression. A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions. This "system of care" is designed to improve the child's ability to function in all areas of life--at home, at school, and in the community. For more information on systems of care, call 1.800.789.2647.
Back to top
What can parents do?
Make careful notes about the behaviors that concern them. Note how long the behaviors have been going on, how often they occur, and how severe they seem.
Make an appointment with a mental health professional or the child's doctor for evaluation and diagnosis.
Get accurate information from libraries, hotlines, or other sources.
Ask questions about treatments and services.
Talk to other families in their community.
Find family network organizations.
Back to top
Important messages about children's and adolescents' mental health:
Every child's mental health is important.
Many children have mental health problems.
These problems are real and painful and can be severe.
Mental health problems can be recognized and treated.
Caring families and communities working together can help.
Information is available-publications, references, and referrals to local and national resources and organizations-call 1.800.789.2647; (TDD) 866-889-2647 or go to http://mentalhealth.samhsa.gov.
What are mental health problems?
How many children and adolescents are affected by these problems?
What is depression?
What are the signs of depression?
How common is depression?
What help is available for a young person with depression?
What can parents do?
Important messages about children's and adolescents' mental health:
What are mental health problems?
In this fact sheet, "mental health problems" for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention- deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders.
Back to top
How many children and adolescents are affected by these problems?
Mental health problems affect one in every five young people at any given time. "Serious emotional disturbances" for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community. Serious emotional disturbances affect 1 in every 10 young people at any given time.
Back to top
What is depression?
Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person's thoughts, feelings, behavior, and body. Major depression in children and adolescents is serious; it is more than "the blues." Depression can lead to school failure, alcohol or other drug use, and even suicide.
Back to top
What are the signs of depression?
Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. Signs of depression often include:
sadness that won't go away;
hopelessness, boredom;
unexplained irritability or crying
loss of interest in usual activities;
changes in eating or sleeping habits;
alcohol or substance abuse
missed school or poor school performance;
threats or attempts to run away from home;
outbursts of shouting, complaining;
reckless behavior;
aches and pains that don't get better with treatment;
thoughts about death or suicide.
Adolescents with major depression are likely to identify themselves as depressed before their parents suspect a problem. The same may be true for children.
Back to top
How common is depression?
Population studies show that at any point in time 10 to 15 percent of children and adolescents have some symptoms of depression. Having a family history of depression, particularly a parent who had depression at an early age, also increases the chances that a child or adolescent may develop depression. Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next 5 years. This young person is also at risk for other mental health problems.
Back to top
What help is available for a young person with depression?
While several types of antidepressant medications can be effective to treat adults with depression, these medications may not be as effective in treating children and adolescents. Care must be used in prescribing and monitoring all medication.
Many mental health care providers use "talk" treatments to help children and adolescents with depression. A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions. This "system of care" is designed to improve the child's ability to function in all areas of life--at home, at school, and in the community. For more information on systems of care, call 1.800.789.2647.
Back to top
What can parents do?
Make careful notes about the behaviors that concern them. Note how long the behaviors have been going on, how often they occur, and how severe they seem.
Make an appointment with a mental health professional or the child's doctor for evaluation and diagnosis.
Get accurate information from libraries, hotlines, or other sources.
Ask questions about treatments and services.
Talk to other families in their community.
Find family network organizations.
Back to top
Important messages about children's and adolescents' mental health:
Every child's mental health is important.
Many children have mental health problems.
These problems are real and painful and can be severe.
Mental health problems can be recognized and treated.
Caring families and communities working together can help.
Information is available-publications, references, and referrals to local and national resources and organizations-call 1.800.789.2647; (TDD) 866-889-2647 or go to http://mentalhealth.samhsa.gov.
May 22, 2010
Children’s Mental Health Facts: Bipolar Disorder
Children’s Mental Health Facts: Bipolar DisorderHelping Children and Youth With Bipolar Disorder: Systems of Care
This fact sheet provides basic information on bipolar disorder in children and describes an approach to getting services and supports, called “systems of care,” that helps children, youth, and families thrive at home, in school, in the community, and throughout life.
What Is Bipolar Disorder?
Bipolar disorder is a brain disorder that causes persistent, overwhelming, and uncontrollable changes in moods, activities, thoughts, and behaviors. A child has a much greater chance of having bipolar disorder if there is a family history of the disorder or depression. This means that parents cannot choose whether or not their children will have bipolar disorder.
Although bipolar disorder affects at least 750,000 children in the United States 1 , it is often difficult to recognize and diagnose in children. If left untreated, the disorder puts a child at risk for school failure, drug abuse, and suicide. That is why it is important that you seek the advice of a qualified professional when trying to find out if your child has bipolar disorder.
Symptoms of bipolar disorder can be mistaken for other medical/mental health conditions, and children with bipolar disorder can have other mental health needs at the same time. Other disorders that can occur at the same time as bipolar disorder include, but are not limited to, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, anxiety disorders, autistic spectrum disorders, and drug abuse disorders. The roles that a family’s culture and language play in how causes and symptoms are perceived and then described to a mental health care provider are important, too. Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses—which are serious problems when a child needs help. That is why it is important that supports be in place to bridge differences in language and culture. Once bipolar disorder is properly diagnosed, treatment can begin to help children and adolescents with bipolar disorder live productive and fulfilling lives.
What Are the Signs of Bipolar Disorder?
Unlike some health problems where different people experience the same symptoms, children experience bipolar disorder differently. Often, children with the illness experience mood swings that alternate, or cycle, between periods of “highs” and “lows,” called “mania” and “depression,” with varying moods in between. These cycles can happen much more rapidly than in adults, sometimes occurring many times within a day. Mental health experts differ in their interpretation of what symptoms children experience. The following are commonly reported signs of bipolar disorder:
Excessively elevated moods alternating with periods of depressed or irritable moods;
Periods of high, goal-directed activity, and/or physical agitation;
Racing thoughts and speaking very fast;
Unusual/erratic sleep patterns and/or a decreased need for sleep;
Difficulty settling as babies;
Severe temper tantrums, sometimes called “rages”;
Excessive involvement in pleasurable activities, daredevil behavior, and/or grandiose, “super-confident” thinking and behaviors;
Impulsivity and/or distractibility;
Inappropriate sexual activity, even at very young ages;
Hallucinations and/or delusions;
Suicidal thoughts and/or talks of killing self; and
Inflexible, oppositional/defiant, and extremely irritable behavior.
What Happens After a Bipolar Disorder Diagnosis?
If a qualified mental health provider has diagnosed your child with bipolar disorder, the provider may suggest several different treatment options, including strategies for managing behaviors, medications, and/or talk therapy. Your child’s mental health care provider may also suggest enrolling in a system of care, if one is available.
What Is a System of Care?
A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families, children, and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. Specifically, a system of care can help by:
Tailoring services to the unique needs of your child and family;
Making services and supports available in your language and connecting you with professionals who respect your values and beliefs;
Encouraging you and your child to play as much of a role in the design of a treatment plan as you want; and
Providing services from within your community, whenever possible.
How Can I Find a System of Care for My Child With Bipolar Disorder?
Contact the system of care community in the box on the back of this fact sheet. If none is listed or that system of care community is not in your area, visit mentalhealth.samhsa.gov/cmhs and click “Child, Adolescent & Family” and then “Systems of Care” to locate a system of care close to you. If you prefer to speak to someone in person to locate a system of care, or if there is not a system of care in your area, contact the National Mental Health Information Center by calling toll-free 1.800.789.2647 or visiting mentalhealth.samhsa.gov.
Are Systems of Care Effective?
National data collected for more than a decade support what families in systems of care have been saying: Systems of care work. Data from systems of care related to children and youth with bipolar disorder reflect the following:
Children and youth demonstrate improvement in emotional and behavioral functioning.
Caregivers report that children and youth have a reduction in conflicts with others in the family.
Caregivers experience an increased ability to do their jobs.
Caregivers report fewer missed days and a reduction in tardiness from work.
Children and youth with bipolar disorder improve in school-related tasks, such as paying attention in class, taking notes, and completing assignments on time.
Children and youth with bipolar disorder have fewer contacts with the juvenile justice system after enrolling in a system of care.
The Core Values of Systems of Care
Although systems of care may be different for each community, all share three core values. These values play an important role in ensuring that services and supports are effective and responsive to the needs of each child, youth, and family. These core values are:
Systems of care are family-driven and youth-guided.
Systems of care are culturally and linguistically competent.
Systems of care are community-based.
Austin’s Story
At age 12, Austin appears to be a typical sixth grader—he likes to play basketball and video games, and is enrolled in an after-school horseback riding program. He is an honor roll student, and his mother describes him as compassionate, loyal, and a champion for the “underdog.” Austin and his family also manage the challenges of bipolar disorder each day.
Austin was diagnosed in first grade with attention-deficit/hyperactivity disorder and separation anxiety disorder, but Austin’s mother, Kim, recalls a series of incidents that led her to question whether her son’s mental health needs were being met. At age 9, Austin set two fires within a week. The first time it happened, Kim thought it was an isolated incident that would not be repeated— Austin said he was lighting candles.
The second time Austin set a fire, however, the situation was very different. While bringing groceries into the house, Austin set a small fire in the car. When Kim discovered signs of the fire the next morning, she says, “I immediately got on the phone and started calling his physician. Thoughts were flashing through my mind about what could have happened.”
After Kim received a referral from Austin’s physician for diagnostic testing and other mental health services, she learned that her son had been experiencing hallucinations, which were causing him to set the fires. She also learned that his extreme mood swings, as well as his unusual sleep patterns, were signs of bipolar disorder. As a result, Austin was hospitalized for 20 days and diagnosed with bipolar disorder. During this time, Austin was accepted into a system of care through a referral from his school guidance counselor.
Kim says the system of care played an important role in helping Austin make the transition from the hospital to his home—even providing transportation, as Kim’s car was being repaired at the time. System of care staff helped Kim learn more about her son’s disorder. They also helped her locate services and supports tailored to Austin’s needs, including counseling, health care, specialized schooling, after-school programs, transportation, and child care.
The system of care also empowered Kim to be a more effective advocate for Austin’s needs. Before joining the system of care, she says, “I tried to fit the service to the need, rather than fit the need to the service. That was a mistake.”
Kim also assumed that professionals were best able to determine how to meet her child’s needs. After working in partnership with the system of care, Kim now knows that services and supports should be responsive to Austin’s needs and that her and her son’s input into the services and supports is crucial.
Despite the successes her family has had, Kim emphasizes that the journey to wellness is not over. In addition to coping with the symptoms of bipolar disorder, she and Austin also must overcome the stigma associated with mental illnesses. Together, Kim and Austin counter this stigma by educating others that he, and others with mental illnesses, should be known for who they are rather than the disorders they happen to have. Despite the ongoing challenges of stigma and bipolar disorder, Kim believes that the system of care has made a huge difference in terms of helping her family move forward.
What Steps Are Necessary To Enroll in a System of Care?
Although each community’s system of care is different, most children and youth in a system of care go through the following steps to be enrolled:
Step One: Diagnosis and Referral—To be considered for system of care enrollment, your child must have a diagnosed behavioral, emotional, or mental health disorder that severely affects his or her life. Additionally, most children and youth are referred to a system of care by mental health providers, educators, juvenile justice professionals, child welfare professionals, physicians, and others who might already be serving your child.
Step Two: Assessment and Intake—Once your child has been diagnosed and has been referred to the system of care, the system of care may ask you to answer some questions that will help you determine whether or not your child and family are eligible to receive services and supports. If your child and family are eligible, you may have to answer more questions so the system of care can begin to understand your needs. Throughout these steps, the system of care will work with you to fill out all of the necessary paperwork.
Step Three: Care Planning and Partnership Building—After your child and family are enrolled, the system of care will work with you to determine what services and supports best fit your child’s and family’s needs. Once the care planning is complete, the system of care will develop partnerships among you and all of those who are helping your child and family to ensure that services and supports are as effective as possible.
For More Information
Federal Government Resources
National Mental Health Information Center
Substance Abuse and Mental Health Services Administration
mentalhealth.samhsa.gov
Tel: 1.800.789.2647 (toll-free; English/Spanish)
TDD: 1.866.889.2647
National Institute of Mental Health
National Institutes of Health
www.nimh.nih.gov
Tel: 1.866.615.6464 (toll-free; English/Spanish)
TTY: 301.443.8431
Additional Resources
Following are some other resources that may be helpful. This list is not exhaustive, and inclusion does not imply endorsement by the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services.
Child and Adolescent Bipolar Foundation
www.bpkids.org
Tel: 847.256.8525
Federation of Families for Children’s Mental Health
www.ffcmh.org
Tel: 703.684.7710
NAMI (National Alliance on Mental Illness)
www.nami.org
Tel: 1.800.950.6264 (toll-free)
National Mental Health Association
www.nmha.org
Tel: 1.800.969.6642 (toll-free)
For information about children’s mental health contact the National Mental Health Information Center toll-free: 1.800.789.2647 (English/Spanish) 1.866.889.2647 (TDD)
This fact sheet provides basic information on bipolar disorder in children and describes an approach to getting services and supports, called “systems of care,” that helps children, youth, and families thrive at home, in school, in the community, and throughout life.
What Is Bipolar Disorder?
Bipolar disorder is a brain disorder that causes persistent, overwhelming, and uncontrollable changes in moods, activities, thoughts, and behaviors. A child has a much greater chance of having bipolar disorder if there is a family history of the disorder or depression. This means that parents cannot choose whether or not their children will have bipolar disorder.
Although bipolar disorder affects at least 750,000 children in the United States 1 , it is often difficult to recognize and diagnose in children. If left untreated, the disorder puts a child at risk for school failure, drug abuse, and suicide. That is why it is important that you seek the advice of a qualified professional when trying to find out if your child has bipolar disorder.
Symptoms of bipolar disorder can be mistaken for other medical/mental health conditions, and children with bipolar disorder can have other mental health needs at the same time. Other disorders that can occur at the same time as bipolar disorder include, but are not limited to, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, anxiety disorders, autistic spectrum disorders, and drug abuse disorders. The roles that a family’s culture and language play in how causes and symptoms are perceived and then described to a mental health care provider are important, too. Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses—which are serious problems when a child needs help. That is why it is important that supports be in place to bridge differences in language and culture. Once bipolar disorder is properly diagnosed, treatment can begin to help children and adolescents with bipolar disorder live productive and fulfilling lives.
What Are the Signs of Bipolar Disorder?
Unlike some health problems where different people experience the same symptoms, children experience bipolar disorder differently. Often, children with the illness experience mood swings that alternate, or cycle, between periods of “highs” and “lows,” called “mania” and “depression,” with varying moods in between. These cycles can happen much more rapidly than in adults, sometimes occurring many times within a day. Mental health experts differ in their interpretation of what symptoms children experience. The following are commonly reported signs of bipolar disorder:
Excessively elevated moods alternating with periods of depressed or irritable moods;
Periods of high, goal-directed activity, and/or physical agitation;
Racing thoughts and speaking very fast;
Unusual/erratic sleep patterns and/or a decreased need for sleep;
Difficulty settling as babies;
Severe temper tantrums, sometimes called “rages”;
Excessive involvement in pleasurable activities, daredevil behavior, and/or grandiose, “super-confident” thinking and behaviors;
Impulsivity and/or distractibility;
Inappropriate sexual activity, even at very young ages;
Hallucinations and/or delusions;
Suicidal thoughts and/or talks of killing self; and
Inflexible, oppositional/defiant, and extremely irritable behavior.
What Happens After a Bipolar Disorder Diagnosis?
If a qualified mental health provider has diagnosed your child with bipolar disorder, the provider may suggest several different treatment options, including strategies for managing behaviors, medications, and/or talk therapy. Your child’s mental health care provider may also suggest enrolling in a system of care, if one is available.
What Is a System of Care?
A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families, children, and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. Specifically, a system of care can help by:
Tailoring services to the unique needs of your child and family;
Making services and supports available in your language and connecting you with professionals who respect your values and beliefs;
Encouraging you and your child to play as much of a role in the design of a treatment plan as you want; and
Providing services from within your community, whenever possible.
How Can I Find a System of Care for My Child With Bipolar Disorder?
Contact the system of care community in the box on the back of this fact sheet. If none is listed or that system of care community is not in your area, visit mentalhealth.samhsa.gov/cmhs and click “Child, Adolescent & Family” and then “Systems of Care” to locate a system of care close to you. If you prefer to speak to someone in person to locate a system of care, or if there is not a system of care in your area, contact the National Mental Health Information Center by calling toll-free 1.800.789.2647 or visiting mentalhealth.samhsa.gov.
Are Systems of Care Effective?
National data collected for more than a decade support what families in systems of care have been saying: Systems of care work. Data from systems of care related to children and youth with bipolar disorder reflect the following:
Children and youth demonstrate improvement in emotional and behavioral functioning.
Caregivers report that children and youth have a reduction in conflicts with others in the family.
Caregivers experience an increased ability to do their jobs.
Caregivers report fewer missed days and a reduction in tardiness from work.
Children and youth with bipolar disorder improve in school-related tasks, such as paying attention in class, taking notes, and completing assignments on time.
Children and youth with bipolar disorder have fewer contacts with the juvenile justice system after enrolling in a system of care.
The Core Values of Systems of Care
Although systems of care may be different for each community, all share three core values. These values play an important role in ensuring that services and supports are effective and responsive to the needs of each child, youth, and family. These core values are:
Systems of care are family-driven and youth-guided.
Systems of care are culturally and linguistically competent.
Systems of care are community-based.
Austin’s Story
At age 12, Austin appears to be a typical sixth grader—he likes to play basketball and video games, and is enrolled in an after-school horseback riding program. He is an honor roll student, and his mother describes him as compassionate, loyal, and a champion for the “underdog.” Austin and his family also manage the challenges of bipolar disorder each day.
Austin was diagnosed in first grade with attention-deficit/hyperactivity disorder and separation anxiety disorder, but Austin’s mother, Kim, recalls a series of incidents that led her to question whether her son’s mental health needs were being met. At age 9, Austin set two fires within a week. The first time it happened, Kim thought it was an isolated incident that would not be repeated— Austin said he was lighting candles.
The second time Austin set a fire, however, the situation was very different. While bringing groceries into the house, Austin set a small fire in the car. When Kim discovered signs of the fire the next morning, she says, “I immediately got on the phone and started calling his physician. Thoughts were flashing through my mind about what could have happened.”
After Kim received a referral from Austin’s physician for diagnostic testing and other mental health services, she learned that her son had been experiencing hallucinations, which were causing him to set the fires. She also learned that his extreme mood swings, as well as his unusual sleep patterns, were signs of bipolar disorder. As a result, Austin was hospitalized for 20 days and diagnosed with bipolar disorder. During this time, Austin was accepted into a system of care through a referral from his school guidance counselor.
Kim says the system of care played an important role in helping Austin make the transition from the hospital to his home—even providing transportation, as Kim’s car was being repaired at the time. System of care staff helped Kim learn more about her son’s disorder. They also helped her locate services and supports tailored to Austin’s needs, including counseling, health care, specialized schooling, after-school programs, transportation, and child care.
The system of care also empowered Kim to be a more effective advocate for Austin’s needs. Before joining the system of care, she says, “I tried to fit the service to the need, rather than fit the need to the service. That was a mistake.”
Kim also assumed that professionals were best able to determine how to meet her child’s needs. After working in partnership with the system of care, Kim now knows that services and supports should be responsive to Austin’s needs and that her and her son’s input into the services and supports is crucial.
Despite the successes her family has had, Kim emphasizes that the journey to wellness is not over. In addition to coping with the symptoms of bipolar disorder, she and Austin also must overcome the stigma associated with mental illnesses. Together, Kim and Austin counter this stigma by educating others that he, and others with mental illnesses, should be known for who they are rather than the disorders they happen to have. Despite the ongoing challenges of stigma and bipolar disorder, Kim believes that the system of care has made a huge difference in terms of helping her family move forward.
What Steps Are Necessary To Enroll in a System of Care?
Although each community’s system of care is different, most children and youth in a system of care go through the following steps to be enrolled:
Step One: Diagnosis and Referral—To be considered for system of care enrollment, your child must have a diagnosed behavioral, emotional, or mental health disorder that severely affects his or her life. Additionally, most children and youth are referred to a system of care by mental health providers, educators, juvenile justice professionals, child welfare professionals, physicians, and others who might already be serving your child.
Step Two: Assessment and Intake—Once your child has been diagnosed and has been referred to the system of care, the system of care may ask you to answer some questions that will help you determine whether or not your child and family are eligible to receive services and supports. If your child and family are eligible, you may have to answer more questions so the system of care can begin to understand your needs. Throughout these steps, the system of care will work with you to fill out all of the necessary paperwork.
Step Three: Care Planning and Partnership Building—After your child and family are enrolled, the system of care will work with you to determine what services and supports best fit your child’s and family’s needs. Once the care planning is complete, the system of care will develop partnerships among you and all of those who are helping your child and family to ensure that services and supports are as effective as possible.
For More Information
Federal Government Resources
National Mental Health Information Center
Substance Abuse and Mental Health Services Administration
mentalhealth.samhsa.gov
Tel: 1.800.789.2647 (toll-free; English/Spanish)
TDD: 1.866.889.2647
National Institute of Mental Health
National Institutes of Health
www.nimh.nih.gov
Tel: 1.866.615.6464 (toll-free; English/Spanish)
TTY: 301.443.8431
Additional Resources
Following are some other resources that may be helpful. This list is not exhaustive, and inclusion does not imply endorsement by the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services.
Child and Adolescent Bipolar Foundation
www.bpkids.org
Tel: 847.256.8525
Federation of Families for Children’s Mental Health
www.ffcmh.org
Tel: 703.684.7710
NAMI (National Alliance on Mental Illness)
www.nami.org
Tel: 1.800.950.6264 (toll-free)
National Mental Health Association
www.nmha.org
Tel: 1.800.969.6642 (toll-free)
For information about children’s mental health contact the National Mental Health Information Center toll-free: 1.800.789.2647 (English/Spanish) 1.866.889.2647 (TDD)
May 21, 2010
Eating Disorders
EATING DISORDERS
What are eating disorders?
Who has eating disorders?
What are the symptoms of eating disorders?
What medical problems can arise as a result of eating disorders?
What is required for a formal diagnosis of an eating disorder?
How are eating disorders treated?
For a referral to the nearest therapist specializing in eating disorders
What are eating disorders?
Eating disorders often are long-term illnesses that may require long-term treatment. In addition, eating disorders frequently occur with other mental disorders such as depression, substance abuse, and anxiety disorders (NIMH, 2002). The earlier these disorders are diagnosed and treated, the better the chances are for full recovery. This fact sheet identifies the common signs, symptoms, and treatment for three of the most common eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder (NIMH, 2002).
Back to Top
Who has eating disorders?
Research shows that more than 90 percent of those who have eating disorders are women between the ages of 12 and 25 (National Alliance for the Mentally Ill, 2003). However, increasing numbers of older women and men have these disorders. In addition, hundreds of thousands of boys are affected by these disorders (U.S. DHHS Office on Women's Health, 2000).
Back to Top
What are the symptoms of eating disorders?
Anorexia nervosa - People who have anorexia develop unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small amounts, weighing their food, and counting the calories of everything they eat. Also, they may exercise excessively.
Bulimia nervosa - People who have bulimia eat an excessive amount of food in a single episode and almost immediately make themselves vomit or use laxatives or diuretics (water pills) to get rid of the food in their bodies. This behavior often is referred to as the "binge/purge" cycle. Like people with anorexia, people with bulimia have an intense fear of gaining weight.
Binge-eating disorder - People with this recently recognized disorder have frequent episodes of compulsive overeating, but unlike those with bulimia, they do not purge their bodies of food (NIMH, 2002). During these food binges, they often eat alone and very quickly, regardless of whether they feel hungry or full. They often feel shame or guilt over their actions. Unlike anorexia and bulimia, binge-eating disorder occurs almost as often in men as in women (National Eating Disorders Association, 2002).
Back to Top
What medical problems can arise as a result of eating disorders?
Anorexia nervosa - Anorexia can slow the heart rate and lower blood pressure, increasing the chance of heart failure. Those who use drugs to stimulate vomiting, bowel movements, or urination are also at high risk for heart failure. Starvation can also lead to heart failure, as well as damage the brain. Anorexia may also cause hair and nails to grow brittle. Skin may dry out, become yellow, and develop a covering of soft hair called lanugo. Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur as a consequence of this eating disorder. Severe cases of anorexia can lead to brittle bones that break easily as a result of calcium loss.
Bulimia nervosa - The acid in vomit can wear down the outer layer of the teeth, inflame and damage the esophagus (a tube in the throat through which food passes to the stomach), and enlarge the glands near the cheeks (giving the appearance of swollen cheeks). Damage to the stomach can also occur from frequent vomiting. Irregular heartbeats, heart failure, and death can occur from chemical imbalances and the loss of important minerals such as potassium. Peptic ulcers, pancreatitis (inflammation of the pancreas, which is a large gland that aids digestion), and long-term constipation are also consequences of bulimia.
Binge-eating disorder - Binge-eating disorder can cause high blood pressure and high cholesterol levels. Other effects of binge-eating disorder include fatigue, joint pain, Type II diabetes, gallbladder disease, and heart disease.
Back to Top
What is required for a formal diagnosis of an eating disorder?
Anorexia nervosa - Weighs at least 15 percent below what is considered normal for others of the same height and age; misses at least three consecutive menstrual cycles (if a female of childbearing age); has an intense fear of gaining weight; refuses to maintain the minimal normal body weight; and believes he or she is overweight though in reality is dangerously thin (American Psychiatric Association [APA], 1994; NIMH, 2002).
Bulimia nervosa - At least two binge/purge cycles a week, on average, for at least 3 months; lacks control over his or her eating behavior; and seems obsessed with his or her body shape and weight (APA, 1994; NIMH, 2002).
Binge-eating disorder - At least two binge-eating episodes a week, on average, for 6 months; and lacks control over his or her eating behavior (NIMH, 2002).
Back to Top
How are eating disorders treated?
Anorexia nervosa - The first goal for the treatment of anorexia is to ensure the person's physical health, which involves restoring a healthy weight (NIMH, 2002). Reaching this goal may require hospitalization. Once a person's physical condition is stable, treatment usually involves individual psychotherapy and family therapy during which parents help their child learn to eat again and maintain healthy eating habits on his or her own. Behavioral therapy also has been effective for helping a person return to healthy eating habits. Supportive group therapy may follow, and self-help groups within communities may provide ongoing support.
Bulimia nervosa - Unless malnutrition is severe, any substance abuse problems that may be present at the time the eating disorder is diagnosed are usually treated first. The next goal of treatment is to reduce or eliminate the person's binge eating and purging behavior (NIMH, 2002). Behavioral therapy has proven effective in achieving this goal. Psychotherapy has proven effective in helping to prevent the eating disorder from recurring and in addressing issues that led to the disorder. Studies have also found that Prozac, an antidepressant, may help people who do not respond to psychotherapy (APA, 2002). As with anorexia, family therapy is also recommended.
Binge-eating disorder - The goals and strategies for treating binge-eating disorder are similar to those for bulimia. Binge-eating disorder was recognized only recently as an eating disorder, and research is under way to study the effectiveness of different interventions (NIMH, 2002).
Back to Top
For a referral to the nearest therapist specializing in eating disorders, contact:
National Association of Anorexia Nervosa and Associated Disorders
P.O. Box 7
Highland Park, IL 60035
Hotline: 1-847-831-3438
http://www.anad.org/
National Eating Disorders Association
Informational and Referral Program
603 Stewart Street, Suite 803
Seattle, WA 98101
1-800-931-2237
http://www.nationaleatingdisorders.org
Note: The above is a suggested resource. It is not meant to be a complete list.
What are eating disorders?
Who has eating disorders?
What are the symptoms of eating disorders?
What medical problems can arise as a result of eating disorders?
What is required for a formal diagnosis of an eating disorder?
How are eating disorders treated?
For a referral to the nearest therapist specializing in eating disorders
What are eating disorders?
Eating disorders often are long-term illnesses that may require long-term treatment. In addition, eating disorders frequently occur with other mental disorders such as depression, substance abuse, and anxiety disorders (NIMH, 2002). The earlier these disorders are diagnosed and treated, the better the chances are for full recovery. This fact sheet identifies the common signs, symptoms, and treatment for three of the most common eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder (NIMH, 2002).
Back to Top
Who has eating disorders?
Research shows that more than 90 percent of those who have eating disorders are women between the ages of 12 and 25 (National Alliance for the Mentally Ill, 2003). However, increasing numbers of older women and men have these disorders. In addition, hundreds of thousands of boys are affected by these disorders (U.S. DHHS Office on Women's Health, 2000).
Back to Top
What are the symptoms of eating disorders?
Anorexia nervosa - People who have anorexia develop unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small amounts, weighing their food, and counting the calories of everything they eat. Also, they may exercise excessively.
Bulimia nervosa - People who have bulimia eat an excessive amount of food in a single episode and almost immediately make themselves vomit or use laxatives or diuretics (water pills) to get rid of the food in their bodies. This behavior often is referred to as the "binge/purge" cycle. Like people with anorexia, people with bulimia have an intense fear of gaining weight.
Binge-eating disorder - People with this recently recognized disorder have frequent episodes of compulsive overeating, but unlike those with bulimia, they do not purge their bodies of food (NIMH, 2002). During these food binges, they often eat alone and very quickly, regardless of whether they feel hungry or full. They often feel shame or guilt over their actions. Unlike anorexia and bulimia, binge-eating disorder occurs almost as often in men as in women (National Eating Disorders Association, 2002).
Back to Top
What medical problems can arise as a result of eating disorders?
Anorexia nervosa - Anorexia can slow the heart rate and lower blood pressure, increasing the chance of heart failure. Those who use drugs to stimulate vomiting, bowel movements, or urination are also at high risk for heart failure. Starvation can also lead to heart failure, as well as damage the brain. Anorexia may also cause hair and nails to grow brittle. Skin may dry out, become yellow, and develop a covering of soft hair called lanugo. Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur as a consequence of this eating disorder. Severe cases of anorexia can lead to brittle bones that break easily as a result of calcium loss.
Bulimia nervosa - The acid in vomit can wear down the outer layer of the teeth, inflame and damage the esophagus (a tube in the throat through which food passes to the stomach), and enlarge the glands near the cheeks (giving the appearance of swollen cheeks). Damage to the stomach can also occur from frequent vomiting. Irregular heartbeats, heart failure, and death can occur from chemical imbalances and the loss of important minerals such as potassium. Peptic ulcers, pancreatitis (inflammation of the pancreas, which is a large gland that aids digestion), and long-term constipation are also consequences of bulimia.
Binge-eating disorder - Binge-eating disorder can cause high blood pressure and high cholesterol levels. Other effects of binge-eating disorder include fatigue, joint pain, Type II diabetes, gallbladder disease, and heart disease.
Back to Top
What is required for a formal diagnosis of an eating disorder?
Anorexia nervosa - Weighs at least 15 percent below what is considered normal for others of the same height and age; misses at least three consecutive menstrual cycles (if a female of childbearing age); has an intense fear of gaining weight; refuses to maintain the minimal normal body weight; and believes he or she is overweight though in reality is dangerously thin (American Psychiatric Association [APA], 1994; NIMH, 2002).
Bulimia nervosa - At least two binge/purge cycles a week, on average, for at least 3 months; lacks control over his or her eating behavior; and seems obsessed with his or her body shape and weight (APA, 1994; NIMH, 2002).
Binge-eating disorder - At least two binge-eating episodes a week, on average, for 6 months; and lacks control over his or her eating behavior (NIMH, 2002).
Back to Top
How are eating disorders treated?
Anorexia nervosa - The first goal for the treatment of anorexia is to ensure the person's physical health, which involves restoring a healthy weight (NIMH, 2002). Reaching this goal may require hospitalization. Once a person's physical condition is stable, treatment usually involves individual psychotherapy and family therapy during which parents help their child learn to eat again and maintain healthy eating habits on his or her own. Behavioral therapy also has been effective for helping a person return to healthy eating habits. Supportive group therapy may follow, and self-help groups within communities may provide ongoing support.
Bulimia nervosa - Unless malnutrition is severe, any substance abuse problems that may be present at the time the eating disorder is diagnosed are usually treated first. The next goal of treatment is to reduce or eliminate the person's binge eating and purging behavior (NIMH, 2002). Behavioral therapy has proven effective in achieving this goal. Psychotherapy has proven effective in helping to prevent the eating disorder from recurring and in addressing issues that led to the disorder. Studies have also found that Prozac, an antidepressant, may help people who do not respond to psychotherapy (APA, 2002). As with anorexia, family therapy is also recommended.
Binge-eating disorder - The goals and strategies for treating binge-eating disorder are similar to those for bulimia. Binge-eating disorder was recognized only recently as an eating disorder, and research is under way to study the effectiveness of different interventions (NIMH, 2002).
Back to Top
For a referral to the nearest therapist specializing in eating disorders, contact:
National Association of Anorexia Nervosa and Associated Disorders
P.O. Box 7
Highland Park, IL 60035
Hotline: 1-847-831-3438
http://www.anad.org/
National Eating Disorders Association
Informational and Referral Program
603 Stewart Street, Suite 803
Seattle, WA 98101
1-800-931-2237
http://www.nationaleatingdisorders.org
Note: The above is a suggested resource. It is not meant to be a complete list.
May 19, 2010
Mood Disorders
Mood Disorders
How much of the population is affected by mood disorders?
What causes mood disorders / mental illness?
Are mood disorders treatable?
What are some common mood disorders?
More information about bipolar disorder: description; symptoms; formal diagnosis;
treatment
More information about depression: description; symptoms; formal diagnosis;
treatment
For more information and referrals
How much of the population is affected by mood disorders?
Each year, almost 44 million Americans experience a mental disorder. In fact, mental illnesses are among the most common conditions affecting health today.
What causes mood disorders / mental illness?
Researchers believe most serious mental illnesses are caused by complex imbalances in the brain's chemical activity. They also believe environmental factors can play a part in triggering, or cushioning against, the onset of mental illness.
Are mood disorders treatable?
Like other diseases, mental illnesses can be treated. The good news is that most people who have mental illnesses, even serious ones, can lead productive lives with proper treatment. Mood disorders are one form of serious mental illness.
What are some common mood disorders?
Two of the most common mood disorders are depression and bipolar disorder, also known as manic-depressive illness.
Bipolar Disorder
Description:
Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder. Bipolar disorder tends to run in families. This disorder typically begins in the mid-twenties and continues throughout life. Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide.
Symptoms:
Mania-expansive or irritable mood, inflated self-esteem, decreased need for sleep; increased energy; racing thoughts; feelings of invulnerability; poor judgment; heightened sex drive; and denial that anything is wrong. Depression-feelings of hopelessness, guilt, worthlessness, or melancholy; fatigue; loss of appetite for food or sex; sleep disturbances, thoughts of death or suicide; and suicide attempts. Mania and depression may vary in both duration and degree of intensity.
Formal Diagnosis:
Although scientific evidence indicates bipolar disorder is caused by chemical imbalances in the brain, no lab test exists to diagnose the disorder. In fact, this mental illness often goes unrecognized by the person who has it, relatives, friends, or even physicians. The first step of diagnosis is to receive a complete medical evaluation to rule out any other mental or physical disorders. Anyone who has this mental illness should be under the care of a psychiatrist skilled in the diagnosis and treatment of bipolar disorder.
Treatment:
Eighty to ninety percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy. Self-help groups can offer emotional support and assistance in recognizing signs of relapse to avert a full-blown episode of bipolar disorder. The most commonly prescribed medications to treat bipolar disorder are three mood stabilizers: lithium carbonate, carbamazepine, and valproate.
Depression
Description:
When a person's feelings of sadness persist beyond a few weeks, he or she may have depression. According to the National Institute for Mental Health, three to four million men are affected by depression; it affects twice as many women. Researchers do not know the exact mechanisms that trigger depression. Two neurotransmitters-natural substances that allow brain cells to communicate with one another-are implicated in depression: serotonin and norepinephrine.
Symptoms:
Changes in appetite and sleeping patterns; feelings of worthlessness, hopelessness, and inappropriate guilt; loss of interest or pleasure in formerly important activities; fatigue; inability to concentrate; overwhelming sadness; disturbed thinking; physical symptoms such as headaches or stomachaches; and suicidal thoughts or behaviors.
Formal Diagnosis:
Four or more of the previous symptoms have been present continually, or most of the time, for more than 2 weeks. The term clinical depression merely means the episode of depression is serious enough to require treatment. Major depression is marked by far more severe symptoms, such as literally being unable to drag oneself out of bed. Another form of depression, known as seasonal affective disorder, is associated with seasonal changes in the amount of available daylight.
Treatment:
Some types of cognitive/behavioral therapy and interpersonal therapy may be as effective as medications for some people who have depression. Special bright light helps many people who have seasonal affective disorder.
Three major types of medication are used to treat depression: tricyclics; the newer selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAO inhibitors). Electroconvulsive therapy uses small amounts of electricity applied to the scalp to affect neurotransmitters in the brain. Usually referred to as ECT, this highly controversial and potentially life-saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines and anesthesia have significantly reduced the possibility of side effects.
For more information and referrals to specialists and self-help groups in your State, contact:
Depression and Bipolar Support Alliance (DBSA)
(formerly the National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, IL 60601-3526
Telephone: 800-826-3632
Fax: 312-642-7243
www.dbsalliance.org
Note: These are suggested resources. It is not meant to be a complete list.
How much of the population is affected by mood disorders?
What causes mood disorders / mental illness?
Are mood disorders treatable?
What are some common mood disorders?
More information about bipolar disorder: description; symptoms; formal diagnosis;
treatment
More information about depression: description; symptoms; formal diagnosis;
treatment
For more information and referrals
How much of the population is affected by mood disorders?
Each year, almost 44 million Americans experience a mental disorder. In fact, mental illnesses are among the most common conditions affecting health today.
What causes mood disorders / mental illness?
Researchers believe most serious mental illnesses are caused by complex imbalances in the brain's chemical activity. They also believe environmental factors can play a part in triggering, or cushioning against, the onset of mental illness.
Are mood disorders treatable?
Like other diseases, mental illnesses can be treated. The good news is that most people who have mental illnesses, even serious ones, can lead productive lives with proper treatment. Mood disorders are one form of serious mental illness.
What are some common mood disorders?
Two of the most common mood disorders are depression and bipolar disorder, also known as manic-depressive illness.
Bipolar Disorder
Description:
Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder. Bipolar disorder tends to run in families. This disorder typically begins in the mid-twenties and continues throughout life. Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide.
Symptoms:
Mania-expansive or irritable mood, inflated self-esteem, decreased need for sleep; increased energy; racing thoughts; feelings of invulnerability; poor judgment; heightened sex drive; and denial that anything is wrong. Depression-feelings of hopelessness, guilt, worthlessness, or melancholy; fatigue; loss of appetite for food or sex; sleep disturbances, thoughts of death or suicide; and suicide attempts. Mania and depression may vary in both duration and degree of intensity.
Formal Diagnosis:
Although scientific evidence indicates bipolar disorder is caused by chemical imbalances in the brain, no lab test exists to diagnose the disorder. In fact, this mental illness often goes unrecognized by the person who has it, relatives, friends, or even physicians. The first step of diagnosis is to receive a complete medical evaluation to rule out any other mental or physical disorders. Anyone who has this mental illness should be under the care of a psychiatrist skilled in the diagnosis and treatment of bipolar disorder.
Treatment:
Eighty to ninety percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy. Self-help groups can offer emotional support and assistance in recognizing signs of relapse to avert a full-blown episode of bipolar disorder. The most commonly prescribed medications to treat bipolar disorder are three mood stabilizers: lithium carbonate, carbamazepine, and valproate.
Depression
Description:
When a person's feelings of sadness persist beyond a few weeks, he or she may have depression. According to the National Institute for Mental Health, three to four million men are affected by depression; it affects twice as many women. Researchers do not know the exact mechanisms that trigger depression. Two neurotransmitters-natural substances that allow brain cells to communicate with one another-are implicated in depression: serotonin and norepinephrine.
Symptoms:
Changes in appetite and sleeping patterns; feelings of worthlessness, hopelessness, and inappropriate guilt; loss of interest or pleasure in formerly important activities; fatigue; inability to concentrate; overwhelming sadness; disturbed thinking; physical symptoms such as headaches or stomachaches; and suicidal thoughts or behaviors.
Formal Diagnosis:
Four or more of the previous symptoms have been present continually, or most of the time, for more than 2 weeks. The term clinical depression merely means the episode of depression is serious enough to require treatment. Major depression is marked by far more severe symptoms, such as literally being unable to drag oneself out of bed. Another form of depression, known as seasonal affective disorder, is associated with seasonal changes in the amount of available daylight.
Treatment:
Some types of cognitive/behavioral therapy and interpersonal therapy may be as effective as medications for some people who have depression. Special bright light helps many people who have seasonal affective disorder.
Three major types of medication are used to treat depression: tricyclics; the newer selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAO inhibitors). Electroconvulsive therapy uses small amounts of electricity applied to the scalp to affect neurotransmitters in the brain. Usually referred to as ECT, this highly controversial and potentially life-saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines and anesthesia have significantly reduced the possibility of side effects.
For more information and referrals to specialists and self-help groups in your State, contact:
Depression and Bipolar Support Alliance (DBSA)
(formerly the National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, IL 60601-3526
Telephone: 800-826-3632
Fax: 312-642-7243
www.dbsalliance.org
Note: These are suggested resources. It is not meant to be a complete list.
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