The Children’s Center for Psychiatry, Psychology, & Related Services
A full service center offering a variety of clinical, therapeutic, educational and supportive services to children ages two through twenty two in warm and welcoming environment. Anxiety, stress and mood issues are very common around the world. Our goal is to help every person learn how to recognize and face their fears.
If your child is hungry, be wary of letting them reach for the chips or soda – junk foods could affect their mood. In fact, recent studies are showing that food and mental health are more closely linked than we realize.
Felice Jacka, president of the International Society
for Nutritional Psychiatry Research reports that, “a very large body of
evidence now exists that suggests diet is as important to mental health as it
is to physical health. A healthy diet is protective and an unhealthy diet is a
risk factor for depression and anxiety.”
In the U. S., mental health conditions are more common than you might think.The Centers for Disease Control and Prevention (CDC) estimates that around 50 percent of Americans will be diagnosed with a mental health condition some time during their lives. They report that, as of 2018, “mental illnesses, such as depression, are the third most common cause of hospitalization in the United States for those aged 18-44 years old.”
These alarming statistics, coupled with the fact that
the Western diet is often filled with junk food, made scientists wonder if there
was a connection between the two. Could it be that nutrition affects the brain
as much as it does the body? To find out, researchers began to look into the relationship
between food and mental health about a decade ago.
Drew Ramsey, MD, an assistant clinical professor at
Columbia University reports that the last ten years of study has shown that, “the
risk of depression increases about 80% when you compare teens with the
lowest-quality diet, or what we call the Western diet, to those who eat a
higher-quality, whole-foods diet.” He also points out that, “the risk of
attention-deficit disorder (ADD) doubles.”
Because they are seeing that nutrition can play a role
in mental health, researchers are now even thinking that food allergies might affect
bipolar disorder and schizophrenia.
Food and Mental Health
Most of the recent studies have revolved around the connection
between a healthy diet and anxiety and depression. Although direct evidence linking
food and mental health has not been found yet, there are trials in progress to prove
Meanwhile, we do know that a healthy diet affects brain
Changing brain proteins and enzymes to
increase neural transmitters, which are the connections between brain cells.
Boosting brain development.
Raising serotonin levels through various
food enzymes, which improves mood.
Increasing good gut bacteria. This promotes
a healthy gut biome, which decreases inflammation. Inflammation is known to
affect both cognition and mood.
We now know that a nutrient-rich diet creates changes in brain proteins that
improves the connections between brain cells. But diets that are high in refined
sugars and saturated fats have been shown to have a “very potent negative
impact on brain proteins,” Jacka says.
Moreover, we know that a high sugar, high fat diet decreases the healthy
bacteria in the gut. Some studies have shown that a diet that is high in sugar
may worsen the symptoms of schizophrenia. And, a 2017 study of the sugar intake
of 23,000 people by Knuppel, et al., “confirms an adverse effect of sugar
intake from sweet food/beverage on long-term psychological health and suggests
that lower intake of sugar may be associated with better psychological health.”
Foods For Brain Health
It’s logical that the foods that are best for the body should also be the foods that promote brain health. This theory is supported by the results from a large European study that shows that nutrient-dense foods like the ones found on the Mediterranean diet may actually help prevent depression.
The nutrients that may help brain health include:
Zinc – low levels of zinc can cause depression.
B12 – A 2013 report by Ramsey and Muskin that was published in Current Psychiatry, noted that “low B12 levels and elevated homocysteine increase the risk of cognitive decline and Alzheimer’s disease and are linked to a 5-fold increase in the rate of brain atrophy.”
Omega 3s – may improve mood and do help improve memory and thinking.
Vitamin C – The report by Ramsey and Muskin also noted that, “Vitamin C intake is significantly lower in older adults (age ≥60) with depression.”
Iron – iron-deficiency anemia plays a part in depression.
Eating nutrient-dense foods like whole grains, leafy greens, colorful vegetables, beans and legumes, seafood, and fruits will boost the body’s overall health – including brain health. Both the Mediterranean diet and the DASH diet, which eliminates sugar, were found to significantly improve symptoms in the patients who took part in one study.
Adding fermented foods like sauerkraut, miso, kimchi, pickles, or kombucha, to your diet can improve gut health and increase serotonin levels. Serotonin is a neurotransmitter that helps to regulate sleep and stabilize mood. About 95% of serotonin is produced in the gut, so it is understandable that eating these foods can make you feel more emotionally healthy. The next time your child reaches for the chips and soda, ask yourself if those empty calories are benefiting their developing brains. Since they probably aren’t, hand them some cultured yogurt or an apple instead. Remember – every bite counts!
Note: Dietary changes shouldn’t substitute for treatment.
If your child is on medications for a mental health disorder, don’t replace or
reduce them with food on your own. Speak with their pediatrician or mental
health professional about what they should eat, as well as what they shouldn’t.
Medications will work better in a healthy body than an unhealthy one.
Questions? We Can Help
For more information about how your child’s diet could be affecting their mental health, talk to the professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.
It’s just one month past the first anniversary of the massacre at Marjorie Stoneman Douglas High School and we have all been saddened to hear that two students who survived the attack recently took their lives within days of each other. Also, the father of a child who was killed in the 2012 Sandy Hook school shootings died this week in an apparent suicide. Now experts are concerned that these deaths may be the result of suicide contagion.
What Is Suicide Contagion?
There is strong evidence to suggest that suicides can occur in groups. When the media reports that someone famous has died by suicide, it seems that other, similar deaths quickly follow. It is almost as if suicide somehow becomes “contagious.”
We saw this happen last summer when Anthony Bourdain took his own life within days of Kate Spade’s death. Now we have this most recent suicide cluster involving the Parkland students and the Sandy Hook father. Were they due to suicide contagion?
Suicide contagion is also known as the Werther Effect – a phrase coined in the 1970s by suicide researcher, David Phillips. The name refers to a character called Werther from a 1774 novel by Johann Wolfgang von Goethe. In the book, Werther takes his life when he learns that the woman he loves has married another man.
After its release, Goethe’s novel was blamed for numerous copycat suicides across Europe. In this early example of suicide contagion, many of the victims died in a similar manner to the way the Werther character killed himself in the book. Some people used the same type of gun and some dressed in the style of clothing that Werther wore. Some were even found with a copy of the novel on or near their bodies.
The News Media’s Connection To Suicide Contagion
Phillips’ research into suicide clusters led him to conclude that copycat suicides rise when there is excessive news coverage of the suicide of famous figures. In addition to Phillips’ investigations, several other studies have found that suicide rates go up after media coverage of a notable death. These rates also fall when the media coverage stops.
“The way suicide is reported is a significant factor in media-related suicide contagion, with more dramatic headlines and more prominently placed (i.e., front page) stories associated with greater increases in subsequent suicide rates,” says Dr. Madelyn Gould, a suicide researcher from Columbia University.
As with Goethe’s book, suicide clusters also occur when fictional characters die by their own hand. Dr. Gould has reported that, “Research into the impact of media stories about suicide has demonstrated an increase in suicide rates after both nonfictional and fictional stories about suicide.”
There is an ongoing debate among experts about why suicide contagion follows these reports. Is it that the news coverage itself causes someone else to take their own life or do they do it because they are already in a vulnerable state?
Today, however, we have a new concern. In the twenty-first century, we rely less on standard media reporting and depend more on online sources to find out what is going on in the world. In particular, young people get their news from social media and the internet. These methods can spread a topic far more quickly than a news broadcast and – unfortunately – will do so with no filtering.
Suicide Risk Factors
In the case of the Parkland tragedy, we know that the first student to take her life was struggling with post-traumatic stress disorder (PTSD). She also suffered with survivor’s guilt, as do many of the teens who were at the school that day.
Suicide is already the second leading cause of death for young people between the ages of 10 and 24 and this is without factoring in the trauma of a massacre like the one in Parkland. Clearly, we need to talk more openly with young people about suicide prevention.
We all can help avert this type of suicide by watching for youth suicide signs and risk factors and by asking direct questions.
A risk factor can’t predict if someone will take their own life, but having one or more of them makes it more likely the person will either consider or attempt suicide. These risk factors are:
Talking a lot about the suicide of someone important (or having recently lost someone close to them)
Making jokes about dying or about suicide
Losing interest in activities or relationships they used to enjoy
Sharing feelings of self-contempt or worthlessness, or talking about feeling hopeless and unsure if they will ever being happy again
Giving away possessions they used to care a lot about, such as favorite clothes or mementos
May exhibit extreme mood swings or have violent outbursts of grief or anger
Might have insomnia or may over-sleep or be lethargic
Indulging in risky behavior, especially if this is not characteristic of the person
Asking Questions That Can Help
The first step in preventing a suicide is the awareness that someone is considering ending their life. The next step is determining whether immediate intervention is needed.
If you think someone you know may be at risk, you can help them by using the Columbia Protocol suicide risk assessment. The Columbia Protocol was developed jointly by researchers from Columbia University, the University of Pennsylvania, and the University of Pittsburgh, along with the National Institute of Mental Health (NIMH). It was adopted by the CDC in 2011 and today it is used worldwide to assess at-risk individuals.
If your child or someone you know tells you they are considering suicide, don’t judge them. Instead, show empathy for their feelings and let them know you care about them. Next, get help from a mental health professional or a suicide crisis hotline. A crisis hotline is especially critical if the person is in immediate danger of attempting suicide.
Never leave someone alone if they are threatening suicide. If you believe they are in immediate danger, call 911 or the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) in the United States. The line is open 24/7.
Talk To Us
If you are worried about your child or a loved one who may be at risk for suicide, talk to the specially trained mental health professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.
Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Contagion of Violence: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Feb 6. II.4, THE CONTAGION OF SUICIDAL BEHAVIOR.Available from: https://www.ncbi.nlm.nih.gov/books/NBK207262/
Recently, the media has been reporting that 2018’s online Momo challenge has resurfaced. They talk about children encountering it in seemingly innocent YouTube videos. Originating on WhatsApp, the reemergence of the scary social media game has prompted schools and police stations to issue warnings about the challenge so that parents can discuss it with their kids.
What Is The Momo Challenge?
The Momo figure was actually a sculpture called “Mother Bird”. It was created by Japanese artist, Keisuke Aisawa. The sculpture featured a wraith-like figure with bulging eyes and long, stringy hair. To date, no evidence suggests that the artist or his special effects company had anything to do with the Momo challenge and the sculpture has since been destroyed.
Reports say that when the game first started, children were contacted to participate in the Momo challenge through their interaction with WhatsApp. More recently, however, the media is warning that the figure has apparently been popping up in Peppa Pig or Fortnight YouTube videos.
When a child participates in the game, they are actually interacting with someone who tells them to perform certain tasks to avoid being “cursed.” Reportedly, these assignments often require the child to do something harmful to themselves or others. They might be told to take pills or stab or otherwise hurt someone. The tasks even go as far as telling the child to take their own life.
The Momo figure asks the child to prove they have completed a task by providing a photograph of themselves while engaged in the assignment. To advance through the game, the child must show this proof. At the end of the game, the child’s final assignment is to commit suicide while recording it for social media.
Is The Momo Challenge A Hoax Or A Real Thing?
When the Momo game initially came out on social media, critics were quick to dismiss it as a hoax. While there have been a few child suicides that were thought to have been a result of the challenge, there has never been any definitive proof linking them to the game.
Additionally, it is difficult to find online images of kids participating in the game. Doubters think that if the challenge was real, there would be many more social media pictures of Momo collaborations.
ReignBot, a YouTuber who is famous for videos that explore creepy things on the Internet says, “Finding screenshots of interactions with Momo is nearly impossible and you’d think there’d be more for such a supposedly widespread thing.”
Often, the warnings about dangerous online challenges spread farther and faster than the actual game. That said, it is potentially dangerous for a child who is vulnerable to self-esteem and other psychological issues to be exposed to something that could be harmful.
Talking To Your Kids About Momo
Regardless of whether the game is real, experts agree that parents need to address the topic with their children preemptively. Dr. Ryan Seidman, a child and adolescent psychologist and the Clinical Director at our Children’s Center, says parents should warn their kids about these online challenges.
“Discuss with younger children what to do if they see the face,” she advises. You might start by asking the child if they have heard of Momo, then tell them to get a parent or other adult if something scary or threatening ever pops up on an app or video.
For teens and adolescents who want more independence, it’s good to have periodic discussions about online encounters, as well as anything in their lives that is frightening or threatening to them.
Encourage your kids to tell you if they are being bullied (by the way, Momo is a form of cyber-bullying). Be sure they understand that you are trusting them to let you know.
Self Harm And Suicide – Who Is At Risk From The Momo Challenge?
It’s unlikely that an online challenge would affect a psychologically healthy child, but it could push kids who self harm or who are contemplating suicide to act on their thoughts.
Self harm isn’t restricted to a certain age group or race, or to someone with a certain socioeconomic or educational background. Anyone may engage in self harm, but the behavior happens most often in teens and young adults.
Self harm happens most frequently in:
People who have difficulty expressing their emotions
Those individuals who have a background of childhood trauma, such as physical, verbal, or sexual abuse
People who don’t have a strong social support network. Conversely, we know it happens more often in those who have friends who also self harm
Those who also have post traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), borderline personality disorder, eating disorders, or in those who engage in substance abuse
Keep in mind that suicide is the result of a mental illness. People who are vulnerable to online cyber-bullying and content like the Momo challenge are often already suffering from mental health issues, such as low self esteem, anxiety, or depression.
As mentioned above, the Momo game is thought to have led to several teen suicides last year, although the link hasn’t been proven.
Suicide is the second leading cause of teen deaths, but could a dangerous challenge increase risky behavior in an susceptible teen?
Madelyn S. Gould, Ph.D., a psychiatrist at Columbia University, thinks so. She says, “The magnitude of the increase [in the number of suicides] is proportional to the amount, duration, and prominence of media coverage. We know from a number of studies that the celebrity status of a suicide victim increases the impact of the suicide.”
Add to that the feeling of being alone in their pain and it’s possible a challenge could push a distressed teen over the edge.
Adolescents and teens who are considering suicide usually give unmistakable warning signs:
Making jokes about dying or about suicide
Sharing feelings of self-contempt or worthlessness, or talk about feeling hopeless and unsure they will ever being happy again
Giving away possessions they used to care a lot about, such as favorite clothes or mementos
Losing interest in activities or relationships they used to enjoy
Talking a lot about the suicide of someone important (or may have recently lost someone close to them)
Might have insomnia or may over-sleep, may be lethargic
May exhibit extreme mood swings or have violent outbursts of grief or anger
An increase in drug or alcohol use
Indulging in risky behavior, especially if this is not characteristic of the person
Your child needs to know you are taking them seriously and that you care about them. If you are concerned that they are exhibiting some of these signs, ask the child directly if they are considering suicide (or have someone else they trust ask them). Be assured that it is okay to use the word “suicide” – saying the word will not raise the chance that they will act on the idea.
If your child admits that they are considering suicide, be empathetic about their feelings – don’t judge them. Seek help from a mental health professional such as those at our Children’s Center, from your child’s pediatrician, or from a suicide crisis hotline. The crisis hotline is especially critical if you think your child is in imminent danger of attempting suicide.
Worried about the Momo challenge’s influence on your child? Talk with a Child Psychologist at our Children’s Center
For more information about our children’s mental health services, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.
This week marks the first anniversary of the school shootings at the Marjory Stoneman Douglas High School in Parkland, FL. On February 14, 2018, 17 students and teachers were senselessly killed and 14 more were wounded.
Reflecting on the tragedy and remembering those who lost their lives will no doubt bring up strong emotions in some children. Even those who weren’t personally connected to the event may feel sad and re-experience a sense of loss. For some kids, the anniversary may even trigger or worsen symptoms of post-traumatic stress disorder (PTSD).
Distressing events such as school shootings can affect children just like they can affect adults. In fact, it’s normal for kids to go through a range of emotions when they hear about a tragedy – they might have trouble sleeping or may express fear, sadness, anger, and grief.
PTSD After Trauma
While many people have moved past the distress brought on by the Parkland shootings, some students may have developed post traumatic stress disorder (PTSD) afterward. This is because children who saw the news coverage or heard about the event may have felt scared, threatened, and unsafe in their own school. Now, the anniversary may bring these troubling thoughts to the surface again.
PTSD is often the result after exposure to a terrifying event or ordeal, especially one in which intense physical harm has occurred or was threatened. It isn’t uncommon for people who were not personally present during a tragedy to find themselves going through some of the symptoms of PTSD, as well.
Just think of your reaction to the events on September 11, 2001. We all watched countless news images of the planes impacting the Twin Towers and of their eventual collapse. Many Americans had strong emotional responses during the tragedy – it seemed as if that’s all we talked about for weeks afterward.
In simple terms, we felt threatened. In this way, you can see how varying degrees of PTSD were the result for many people. Kids can feel the same symptoms after something that hits close to home for them, such as a school tragedy.
The symptoms of PTSD fall into three categories:
With hyperarousal, the person may have problems sleeping or anger easily. They may also be easily startled or seem to be constantly tense and on alert.
Those kids who experience avoidance symptoms might have strong feelings of guilt or worry. Some may be depressed or emotionally numb or may lose interest in the things they used to enjoy. Others might avoid anything that reminds them of the ordeal.
Kids whose PTSD falls into the group that re-experiences the trauma may be burdened with nightmares or frightening, overwhelming thoughts.
Younger children may reenact the event or draw it out on paper. They may also regress or show fearful behavior.
How Is PTSD Treated Professionally?
With time and a period of adjustment, most people will recover from a traumatic event. If a child has gone through a trauma, however, and still has PTSD symptoms for more than a month, seek help from an expert.
A therapist can work with your child to address their symptoms and depression. They will move at the child’s own pace while helping your teen or child adjust.
The therapist may use cognitive behavioral therapy (CBT), which is very effective for dealing with the negative feelings and thoughts that come with PTSD. CBT helps the child replace the destructive emotions with positive ones.
For young children, engaging in play therapy can be a great way to help them deal with a trauma.
Medication is sometimes prescribed to help a child cope after a tragic event. This is usually reserved for serious symptoms of depression and anxiety.
Helping Your Child At Home
A child who has been through a trauma needs an adjustment period to help them process the event. During this time, they will need plenty of love, support, patience and understanding from you.
Let them talk about what happened, but don’t force them to do so – they need to be ready to talk. If they won’t talk, encourage them to draw or write about their feelings.
Let the child know their emotions and thoughts are normal. Get immediate professional help if they are thinking about self-harming or are talking about suicide.
Keep their routine as close to normal as possible. Try not to let them take too much time off from school or away from activities like sports or music classes, etc.
Support groups can be very helpful for expressing emotions after a trauma. Ask the school counselor or your child’s pediatrician for nearby groups.
Don’t condemn behaviors like sleeping with a stuffed animal or keeping the lights on when they go to bed. Sometimes these things can give the child an added measure of comfort during a distressing period in their lives.
After School Violence – We Can Help
Our Children’s Center staff has specially trained clinicians to help those who need help dealing with the anniversary of the school shooting or other traumatic situations. For more information, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.
Studies have shown that children in the United States have many mental health needs that remain unidentified. In 2015, the Centers for Disease Control and Prevention (CDC) reported that about 20% of the nation’s youth have or will have an emotional, mental, or behavioral disorder. Only about 7.4% of these children report having received any type of mental health services, however.
A 2014 National Center for Biotechnology Information (NCBI) study by Jane Burns and Emma Birrell noted that many mental health problems escalate in adolescence and young adulthood. The effects of these under treated childhood mental health issues can be higher rates of substance abuse, anxiety, and depression, as well as suicidal ideation and self harm.
There is a stigma surrounding mental illness and its treatment. This disapproval is a barrier that keeps young people from seeking assistance. The consequence is that they are not receiving appropriate care, which translates to an increased chance of dropping out of school, employment or relationship problems, future incarceration, or even suicide.
Impact of Childhood Mental Disorders
The most prevalent mental disorder in children is attention deficit hyperactive disorder (ADHD). Other common conditions are:
Autism spectrum disorders
A 2013 study by Khong, et. al. stated that “The highest-ranking top 25 causes of disability include anxiety disorders, drug and alcohol problems, schizophrenia, and bipolar effect disorders. By age 5, mental health and behavioral problems become an important and soon dominant cause of years lost to disability, peaking between ages 20–29.”
There is often a gap of up to 15 years between the onset of symptoms and the person getting the appropriate care. Because behavioral and mental health concerns are not being addressed early enough, they become issues down the road – major depression is one of the top four causes of disability in adulthood.
As the study noted, mental health conditions can begin to emerge as early as 5 or 6 years old. Symptoms of anxiety disorders often include:
numerous, lingering, or intense periods of stress, anxiety, or fear that seem out of proportion to the triggering event and which affects the child’s daily life
Ways to Destigmatize Mental Health Services
Children with mental health challenges are often marginalized or bullied by their peers. This social exclusion keeps them suffering in silence, discouraging the majority of adolescents and teens from seeking help.
To destigmatize mental health in general, we need to:
Equate mental illness with physical illness. Mental illness is a disease, just the same as physical illnesses like diabetes or cancer, but mental health conditions are often thought of as something the person could overcome if they just “tried harder.” They are disorders of brain function, however, which means they are based in the physical body in much the same way as something like a heart condition or high blood pressure. We certainly wouldn’t expect a heart patient to just “try harder” to get their blood pressure or irregular heartbeat under control.
Show compassion to those with mental illness and don’t treat them differently. People with mental health conditions live meaningful lives, but they often have to fight to keep from being judged.
Watch what you say. Don’t use words like “freak” or “crazy” because this type of language continues the negativity against mental illness.
Change the culture by taking a good look at children who are acting out. Try to figure out why they are behaving in certain ways, instead of writing them off as bad kids.
Don’t judge yourself if you are struggling with mental health issues. Your condition is out of your control. Being ashamed only adds to the burden and can keep you from seeking help.
Encourage family members or friends to seek help if they are facing mental health challenges.
Familiarize your child with mental health concerns like anxiety and depression from a young age. For example, help them understand that everyone has days when they are sad or angry or feel stressed, but if they can’t shake those feelings, it is okay to ask for help.
People who are challenged with mental health issues often feel alone. The reality is that the majority of us have some type of mental health condition. Great examples include the new mother with postpartum depression, the college student with ADHD, and the coworker who has post-traumatic stress disorder from their military service.
By destigmatizing mental health problems and services from a young age, we can teach children to challenge negative attitudes so they are more comfortable asking for help.
Connect with a Child Psychologist at our Children’s Center
For more information about our services to treat mental disorders in children, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.
Monshat K, Khong B, Hassed C, et al. “A conscious control over life and my emotions:” mindfulness practice and healthy young people. A qualitative study. J Adolesc Health. 2013;52(5):572–577.
excessive skin-piercing or tattooing may also be indicators of self harm
Generally, people who self-harm do so in private. Often, they follow a ritual. For example, they might have a favorite object that they use to cut themselves or they may listen to certain music while they self injure.
Self harmers will target any area of the body, but the legs, arms, or front of the body are the most commonly selected. These areas are not only easy to reach, they are also easy to cover up, allowing the person to hide their wounds away from judgmental eyes.
Additionally, self harm can include actions that don’t seem so obvious to others. Activities like excessive substance abuse or binge drinking, driving recklessly or having unsafe sex can all be signs of self harm.
Causes of Self Harm
There are many reasons that people engage in the unhealthy coping mechanism of self-injury.
Oftentimes, a self-mutilator may have trouble understanding or expressing their emotions. Those who self harm report feelings of worthlessness and rejection, loneliness or isolation, guilt, self-hatred, and anger.
When a self harmer attacks their own body, they are really seeking:
distraction from painful emotions
to release intolerable mental anguish
a sense of control over their feelings, their body, or their lives
a physical distraction from emotional pain or emotional “numbness”
to punish themselves for supposed faults
People who self injure often feel an intense yearning to injure themselves. Even though they know it’s destructive, this feeling grows stronger until they complete the act of mutilation. Feeling the resulting pain releases their distress and anxiety. This relief is only temporary, though, until their shame, guilt, and emotional pain triggers them to injure themselves again.
Who is At Risk for Self Harm?
Self injury happens in all walks of life. It is not restricted to a certain race or age group, nor to a particular educational or socioeconomic background.
It does happen more often in:
people with a background of childhood trauma, such as verbal, physical, or sexual abuse
those who have difficulty expressing their emotions
those without a strong social support network or, conversely, in those who have friends who also self harm
people who also have obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), eating disorders, borderline personality disorder, or those who engage in substance abuse
Although anyone may self harm, the behavior occurs most frequently in teens and young adults. Females tend to engage in cutting and other forms of self-mutilation at an earlier age than males, but adolescent boys have the highest incidence of non-suicidal self injury.
Physical signs of self harm may include:
unexplained scars, often on wrists, arms, chest, or thighs
covering up arms or legs with long pants or long-sleeved shirts, even in very hot weather
fresh bruises, scratches or cuts
telling others they are clumsy and have frequent “accidents” as a way to explain their injuries
keeping sharp objects (knives, razors, needles) either on their person or nearby
blood stains on tissues, towels, or bed sheets
Emotional signs of self harm may include:
making statements of feeling hopeless, worthless, or helpless
isolation and withdrawal
problems with personal relationships
Help for Self Harm
The first step in getting help for self harm is to tell someone that you are injuring yourself. Make sure the person is someone you trust, like a parent, your significant other, or a close friend. If you feel uncomfortable telling someone close to you, tell a teacher, counselor, religious or spiritual advisor, or a mental health professional.
Professional treatment for self injury depends on the specific case and whether or not there are any related mental health concerns. For example, if the person is self harming but also has depression, treatment with address the underlying mood disorder as well.
Most commonly, self harm is treated with a psychotherapy modality, such as:
Cognitive behavioral therapy (CBT), which helps the person identify negative beliefs and inaccurate thoughts, so they can challenge them and learn to react more positively.
Psychodynamic psychotherapy, which helps identify the issues that trigger their self-harming impulses. This therapy will develop skills to better manage stress and regulate emotions.
Dialectical behavior therapy (DBT), which helps the person learn better ways to tolerate distress. They’ll also learn coping skills so they can control the urge to self harm.
Mindfulness-based therapies, which can teach them skills to effectively cope with the myriad of issues that cause distress on a regular basis.
Treatment for self injury may include group therapy or family therapy in addition to individual therapy.
Self care for self-harming includes:
Asking for help from someone whom you can call immediately if you feel the need to self injure.
Following your treatment plan by keeping your therapy appointments.
Taking any prescribed medicines as directed, for underlying mental health conditions.
Identifying the feelings or situations that trigger your need to self harm. When you feel an urge, document what happened before it started. What were you doing? Who was with you? What was said? How did you feel? After a while, you’ll see a pattern, which will help you avoid the trigger. This also allows you to make a plan for ways to soothe or distract yourself when it comes up.
Being kind to yourself – eat healthy foods, learn relaxation techniques, and become more physically active.
Avoiding websites that idealize self harm.
If your loved one self-injures:
Offer support and don’t criticize or judge. Yelling and arguments may increase the risk that they will self harm.
Praise their efforts as they work toward healthier emotional expression.
Learn more about self-injuring so you can understand the behavior and be compassionate towards your loved one.
Know the plan that the person and their therapist made for preventing relapse, then help them follow these coping strategies if they encounter a trigger.
Find support for yourself by joining a local or online support group for those affected by self-injuring behaviors.
Let the person know they’re not alone and that you care.
Need More Information?
Are you concerned that your child is engaging in self harm? Don’t wait to seek help – speak to a compassionate child psychologist at The Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us for more information or call us at (561) 223-6568.
I am sure you are wondering what pizza has to do with mental health. It is much more than enjoying a tasty slice or two. A slice of pizza represents a part of a whole and introduces us to the concept of systems theory. The systems concept helps us process a lot of information in a more orderly way, to be able to go back and forth between the whole and its parts, understanding the interaction between the forest and its trees. We can examine the individual trees while at the same time taking in the picture of the entire forest.
One’s mental health represents the forest. The goal of this paper is to better understand the trees, the critical systems that contribute to the whole of our emotional being. We are all aware of the nature versus nurture approach. To what degree can we explain a person’s psychological makeup on genes (nature) or upbringing and life experience (nurture)? I wish it was that simple, just a matter of measuring the degree to which nature and/or nurture matter so we can then direct treatment proportionally to each factor. How does one measure the effect of a problematic childhood or stressful life events? How to quantify the brain-based source of bipolar disorder or schizophrenia? Mental health professionals have some tools to provide these measurements but they are extraordinarily rudimentary. Our technology in not yet at the level to allow for definitive answers. A general systems approach helps us address the biological, psychological and social fields that ultimately contribute to our wellbeing or ill mental health.
The biological field consists of not just our brain but the body systems that ultimately influence brain function such as the cardiovascular, endocrine, pulmonary and gastrointestinal. As an example, chronic obstructive pulmonary disease (COPD) can reduce the availability of oxygen to the brain and consequently alter brain function. A simple experiment decades ago demonstrated that the use of a portable oxygen generator can significantly increase the IQ of a person suffering from COPD. This same individual would subsequently experience less depression and emotional duress. Or the individual on a variety of sedating medications that erroneously creates a clinical picture of memory deficits masquerading as a dementia. Additionally, if one has a medical disorder that will be lifelong, how do we anticipate the psychological toll it will take on the person in the future? Addressing these concerns become an essential part of the treatment team.
The social systems are a bit more difficult to assess due to the subjective nature of data gathering. Family of origin influences are paramount. Negative influences can be mollified by the presence of healthy role models and support systems when young. Interpersonal relations represent an important influence on self concept development. Only recently have we begun to recognize the impact of childhood bullying on the psyche. The goal of a reasonably healthy childhood is to produce a person whose self regard and image is based on their own uniqueness, not necessarily on being good looking, a star athlete, rich of top of their class. This healthy self concept serves as the foundation for the acquisition of future skill, talents and attributes.
To further complicate the impact of social systems on mental health we have to add a time dimension to our study that includes the past, present and the future. A person who comes out of a pathological family of origin can then be exposed to corrective emotional experiences in the present (like good friends and role models) that help dilute the damage already done. Likewise, emerging from a healthy childhood only to be currently traumatized in battle can result in enduring psychological difficulties like post traumatic stress disorder. We must also pay attention to the individual’s expectations of the future. Do they look forward with a cup is half empty approach or with a cup is half full attitude? Are they on a life path that will help ensure future stability (like a career, education, marriage, etc.) or are they proceeding towards the future with limited or confused goals and plans? Or, have they been influenced to pursue a career by their family that they really had no say in and find themselves trapped and helpless? These are several examples of the data that must be gathered by mental health professionals.
Psychological systems are not as easily assessed because they represent concepts that must be deduced and not so easily observed or measured. They include attitudes, belief systems and coping styles. They are the product of one’s journey through childhood and later life representing an ongoing learning process, for good of for bad, a process that can be adaptive or maladaptive for healthy growth. When maladaptive traits are significantly pervasive and persistently interfere with function we raise the clinical possibility of a character or personality disorder. The veracity of this diagnosis is important because treatment of personality disorders can be quite difficult and protracted.
Once we gather systems data it is now necessary to develop a treatment plan. How to determine where to direct treatment? If someone presents with depression, is it adequate to prescribe an antidepressant alone and offer no other treatment recommendations? This is where the systems approach becomes essential. For example, treating the depression alone without attending to address the presence of significant marital discord in an individual with childhood trauma will not result in the desired outcome unless the other areas of dysfunction are addressed. Sometimes it is necessary to create a stepwise approach. Let us assume that the individual with depression is so depressed that full participation in psychotherapy would be unproductive until the depression begins to improve. In this case it would be important to improve the depression with medication before proceeding with psychotherapy.
As I have discussed in past articles it is a challenge to determine if a person’s current symptoms represent a brain-based biological disorder or a reaction to a life situation. We know that all behavior, thought processes and emotional expression emanates from our brains but the difference between a biological disorder and a life reactive state is that the former tends to be long-lasting and persistent while the latter tends to be time-limited. It is important to recognize that there is a middle ground between the biological and the situational states disorders is best described as a hybrid state. The hybrid state occurs when an individual with a biological (possibly genetic) predisposition to depression, anxiety or psychotic disorders interacts with a stressful life situation. The biological predisposition is then activated and resulting in a pathological disorder.
Our pizza pie model of mental healthcare would not be complete without a discussion about the importance of assembling a team of professionals to provide both evaluation and treatment. The ideal team is composed of multidisciplinary licensed mental health professionals with multimodality evaluation and treatment capabilities. The ability to provide a comprehensive psychological test battery, perform a focused psychological trauma assessment or obtain a medical neuropsychiatric evaluation makes it possible to identify which slices of our pizza pie need to be addressed in the treatment plan. Most importantly, the presence of this team under one roof allows for ongoing treatment meetings and consultations among the professionals. Being able to share clinical information in realtime is essential to the management of complex mental health problems. Teamwork also provides mutual support for the clinicians and promotes professional growth.