Tag Archives: depression

Anger Issues: Innies and Outies

Posted on by Shona Innes
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I love anger.  You’re probably not supposed to have a favourite feeling because all feelings are important, but I do love anger.  Anger has so many great functions.  It can energise us. If unleashed, our anger can help us run faster, bite harder, and throw, move and break bigger things than we can when we are not so angry.

If emotions are the human dashboard that guides us through our body’s journey through life, when someone’s anger flares, it’s a great warning sign.  Anger is a way our body and brain use to yell at us to pull over and make sure we pay attention to something that is not quite right.

Often, anger is behind us when we finally decide to do something about a problem that has been building or neglected for quite some time.  Anger can be useful to get stuff done.

However, anger can also be dangerous and debilitating.  When anger gets out of control, it can be the emotion behind hurtful and destructive behaviour.  Anger can give kids, and adults, a bad reputation and make others disinclined to want to spend time with them.

An important part of parenting or educating a child is helping them to know how to get the best of their anger – helping a child get the best of the motivating and problem solving aspects of anger without hurting someone, breaking something or making a rash decision.

Sometimes we need to consider is the anger a problem, or is the child’s situation the problem.  Some young people have plenty of legitimate things to be upset and angry about.

Managing anger is one of those Goldilocks kind of things.  It’s important that we get the balance “just right” – Expressing too much anger in the wrong kinds of ways at one end and holding anger in and letting it build on the other end.  When we consider anger, we need to consider the problems that might go with externalising anger (letting it out) as well as internalising anger (holding it in).  So, just like belly buttons,  anger problems in kids and adults are usually of two kinds – “outie” anger issues or “innie” anger issues.

“Outie” anger issues are probably those that usually come to mind when we think of anger problems – yelling, profanity, damage to property, verbal abuse, road rage and physically hurting others.  Typically we help people manage outwardly expressed anger by understanding the things that trigger them and learning to take alternative action to deal with the tension that rises in them – to take a slow breath, take other’s perspectives, think about consequences, take a “time out”, exercise or do some hard physical work and learn to problem solve.  There are also new programs emerging that assist those to manage their outwardly expressed anger by tuning into the part of themselves that is grateful for what they have and to be compassionate towards others.  These processes take time, but do work as long as they are modified for each individual’s age and circumstances.

“Innie” anger or anger that is held in or internalised is also a problem and can have big implications for mental health and interpersonal functioning.  Some will hold their anger in until they reach a point where the smallest of things will set them off.  For those watching from the outside, the reactions seem out of proportion with the trigger. That’s usually because the trigger may have little to do with all of the other problems that have been held in and not expressed or dealt with.  When this kind of anger erupts it can take everyone by surprise.  It can seem confusing and can be very hard for a person to control.

“Innie” anger can also be linked to experiences of shame or self loathing.  A young person may learn to respond to something that makes them angry by appearing cheerful for a range of reasons – they may not want to bother others or stand out, they may be told by people who are important to them not to be angry, they may feel that others won’t like them if they are angry or they may be punished for expressing anger.  Instead, they develop a strategy for dealing with things where the  outside part of them doesn’t match the inside.  They lose touch with their ability to feel and express healthy emotions and this can have substantial mental health consequences.

It’s important that we help young people to know, label and understand emotions in themselves and other and learn how to express them in ways that are healthy.

Properly expressed anger is a fine and powerful thing for everyone to have in their interpersonal armor and coping tool box.

To encourage young people to express their anger in useful and safe ways we need to:

  • Model appropriate anger – Speak up in appropriate ways, let people know when we are upset by things and take necessary, responsible action – join a protest, start a group, write a strongly-worded letter, articulate the problem and ask for what they would like to be done
  • If you are responding to a child’s anger, be sure to help them label the feelings and be clear that you want them to manage the feeling differently rather than to banish the feeling
  • Encourage the safe expression of individual opinion in your household or school
  • If someone hurts someone else with their anger outbursts, be sure to have them make some amends – again for the behaviour and not for the feeling
  • Encourage exercise, loud vocalisations (some, myself included, might call that singing) and asking for help.
  • Develop compassion for others and for ourselves by modelling kindness and recognising others needs and our own needs, too.

Anger can be awesome, ferocious, strong, protective and proud. Without anger we can be vulnerable and taken for granted.  Turned in, anger can fuel shame and sadness.  The key to anger is feeling it, knowing it, showing it in the right kinds or ways and then using it’s powers to get problems fixed.

How long has it been since you gave your anger some attention?

 

 

Not happy with how we look: Negative body image & Body Dysmorphic Disorder

Posted on by Shona Innes
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Can you imagine what is would be like to have your beautiful young son or daughter come to you with such hatred for their appearance that they are begging you to take them to a plastic surgeon?

I think from time to time we all check out our image in the mirror and make an evaluation of it.  Some people (young and old) make such critical evaluations of their appearance that they start to believe that they are unable to contribute to any sort of life because of their appearance.  When this becomes debilitating, we usually consider a diagnosis of Body Dysmorphic Disorder.

Our body image is different to an image of our body.  An image or photo of our body captures how it is at any point in time.  Our body image, though, is the representation we have of our own bodies.  It is essentially a judgement or series of judgements we make about how we think we appear.

When you ask people to tell you about their bodies, rather than give you facts , for example, on the colour of their hair or their measure height they usually give you judgemental words like plump, skinny, solid, pale….even ugly.  For most of us, this is not a problem, but for a few, the way their body image becomes central to their level of happiness.

When we determine our worth or happiness by our judgement of how we look, things can get pretty complex.

Body Dysmorphic Disorder or BDD is a diagnosis used when there is an intense preoccupation with a perceived flaw in physical appearance. (For most BDD it is with people’s own appearance, but BDD by proxy can mean that parents become obsessed about flaws in their children’s appearance).  Individuals with BDD often spend lots of time checking and worrying about a particular aspect of their appearance. They may spend a lot of time comparing their appearance with others, and engaging in behaviours designed to try to hide or conceal the area of concern or generally try to avoid being seen by others.

It is thought that BDD affects 1-2 percent of the population and it does not seem to vary with gender.

In the clients I have seen with Body Dysmorphic Disorder, they usually focus on one feature in particular – their teeth or the shape of their lips and sadly, if they do take steps to have these adjusted to their liking (people with BDD are often frequent customers of plastic surgeons), it does not always mean that their happiness improves and they will then go onto to target the next part of their body that they find the most displeasing.

The thinking if ultimately something like “if I can just change the way I look, my life will be wonderful”

BDD is  much more than just vanity or being dissatisfied with how they look, it can become obsessive and often co-morbid (or exists together with) with depression, anxiety (especially social anxiety) and I have seen it accompanied by self harm and suicidal ideas, too.  It can make it hard for a young person to leave the house, go to school or uni, or meet up with friends…or if they do, there needs to be much time trying to cover or adjust a certain aspect of their appearance.

This means BDD can interfere with living with others.  Those with BDD will often continually seek reassurance about their appearance or spend lengthy times in the family bathroom or be frequently late for work or school. There is often quite a deal of secrecy and shame associated with BDD and BDD can quite often be associated with financial difficulties, too, with money being spent on treatments or cover ups.

Oversimplifying it, but in an attempt to explain how BDD starts and is maintained we could consider it  going something like this example (although imagine it being much more complex/less staright forward):

  • Someone tells me I have a crocked nose
  • I believe that I have to look perfect to be liked by others
  • I spend hours trying to cover up my crooked nose with makeup, but that all gets too hard and the products I use have cause swelling and redness, so I start avoiding going out whether others will see me crooked nose. I keep checking with the people I love about my nose, but that doesn’t satisfy me for long.
  • I stop socialising, friendships drop away and I never get to test the idea that I have to look perfect for others to like me or want to be friends with me.

Where does BDD come from?

It is thought that most BDD starts in adolescence and that much goes untreated for many years.  Adolescence is a time of many body changes, and also for some, an increased risk for acne, but other times of life where the body changes can also be triggers – like the emergence of wrinkles or loss of hair with aging or new scarring after an accident or medical issue.

Those at risk of BDD or serious negative body image have often been teased or excluded and are also more likely to associate with peers or even family members who are very focused on appearance. Certain personality types may be more prone but also, social and cultural pressures are thought to contribute including social media. I have also seen BDD that began following a period of childhood and family trauma.

There are so many industries that depend on us being dissatisfied with our body image – Industries worth billions of dollars.  They flood the media with direct and indirect messages about happiness being derived from appearance.

How can we prevent it?

Sadly, at this stage, we don’t’ have any strategies that definitely prevent BDD.  I like to try to educate children about the powers of advertising and the tricks marketers pay to make us buy things.  However, the best the research can suggest is that people seek treatment early.

So, if you are a parent of a teen, it is usual for them to spend more time in the bathroom and in front of the mirror as they approach puberty, but if the checking is accompanied by frequent negative statements about their appearance, constant comparisons of themselves to others, regularly needing reassurance that they look okay, and avoiding socialising or leaving the house, you  should increase your level of concern.

The first point of call should be your GP or Mental Health professional.  A proper diagnosis is essential.BDD has some similarities to Eating Disorders in that it is also about body image, but the preoccupation is usually different, with eating disorders normally being about weight and shape and usually leads to a change of eating patterns.

Treatment can include medication and psychological intervention.  Psychological treatment is focused on tackling negative body image by building body acceptance and using techniques to help reduce the amount of time spent obsessing, checking or seeking reassurance about appearance.  Psychologists can also help with uncovering and challenging assumptions and negative predictions that link appearance with ideas of success and happiness.  Psychologists can also help a person to tackle their avoidance or behaviours that set up self fulfilling loops around unhelpful assumptions

There is some very useful information at the BDD Foundation website.

If you have young children (preschool and early primary) and you are concerned about them developing a negative self image, perhaps you could share “You are Like You” with them to open up some conversations about their thoughts about themselves.

 

Why just Mothers’ Day? The importance of everyday self-care for Mums.

Posted on by Shona Innes
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Yes – it’s on! Mother’s day is upon us and so, too, the carefully crafted junk mail and television commercials – Images of blow-waved children bouncing onto a perfectly ruffled bed on a sun-streamed morning bringing breakfast on a delicately manicured tray while a handsome man with the just right amount of five o’clock shadow smiles on from the bedroom door. Ahhh! Motherhood!

We all know that motherhood is rarely perfect. But – how much leeway is there from “perfect” before it starts to have a detrimental effect on families?

It is very clear that family violence is a toxic influence on the lives of little ones and that violence needs to be avoided at all costs. However, the other sometimes hidden, toxic, risk factor for eroding well being of children is maternal (and parental) mental health problems.

When you look into the literature on risk factors for child mental health, there is one factor that repeatedly screams out – parental depression. Depression is more than stress or fatigue. To some extent, some stress and fatigue are very much a part of parenting. Depression, however, is the big player in family wellbeing. Even when families are challenged by children with special needs or complex behaviours, it is the presence of absence of parental depression that often determines the outcome for the child’s mental wellbeing.

Parental mental health is critical to positive child well being. A parent with poor mental health can have a huge impact on the entire family – the other parent/s, the children, the ability to work and earn income and the ability to stay socially engaged with friends and extended family. A mother needs to be “fit enough” to be able to:

  • provide affection
  • be responsive to her child’s needs
  • be encouraging
  • teach every day lessons in moment by moment situations
  • engage with the child and the world
  • discipline positively when it is called for
  • support her partner in co-parenting and encourage the partners healthy relationship with the child.

If a mother’s ability to do these things is affected for any lengthy period of time, then that’s when a child’s well being may be affected unless support is rallied. Some mothers have difficulty relying on others or being relied upon themselves. Often, this difficulty can be a sign that something has gone on in the mother’s early years that interfered with the attachment between her and her own parents.

While some parents have clearly defined mental health problems, many parents may suffer from what we refer to as “subclinical” mental health disorders. A subclinical disorder is one where a mother can still soldier on and get to work, feed the family and attend all of the after school sport and activities, but underneath she is just not coping and may be leaning heavily on alcohol, other substances, or over working in order to get by.

Some mothers soldier on through their non-coping periods. Sometimes they do this because they don’t want to be a burden or a nuisance to others, because they are “so lucky” compared to some of the things they see people go through on the news and because they think they just need to “snap out of it”. Some get a bit of a Super Mum complex and then become resentful when their mood takes a hit.

Mothers need to prioritise self care. This doesn’t mean selfishness. It means genuinely looking after the person who, if not travelling well, has the ability to disrupt the whole family.

Just like we should check in and service our motor vehicles, Mum’s need time to reflect and take stock. A mum who is “firing” on all of her mental health “cylinders” uses healthy ways to regulate her emotions and manage her stresses and seeks and provides support from, and to, others. She watches the signs on her own emotional “dashboard” and refills when her “fuel levels” are low. Driving herself by being clear about her signs optimises her mental health, helps her make decisions, keeps her stable in her work and for her family and helps her exercise some sharp parenting skills.

Promoting self care for mums should be more than Mothers’ Day marketing madness. It’s imperative that mothers are supported to have, and maintain, good mental health that stays well clear of subclinical levels of concern.

So, what does a mother need this mother’s day?  Self-care!  She needs to do some basic stuff really well and really consistently and not just on Mothers’ Day.

A mother (or any parent or carer) needs to look after herself every day.  She needs to know how to ask for and accept support. She needs time to check in and make sure that she has balance and that her coping skills are healthy – more laughter, exercise, fun and sharing and less lonely, hard-working, stoic resentment.   She needs to be curious about life, be open to meeting new people and to trying new things. If there is something that is getting in the way, whether it is from the past or in the present, she needs to work on shifting it.

Banish stoic, perfect super mums and their bouncy, sun-filled mother’s day breakfast expectations and bring on healthy, open, warm, vulnerable, human mothers who can give and receive cuddles and have them gladden their hearts without fear that snot or crumbs will mean that there will be even more work to do before she can relax and genuinely “be” with her favourite people.

Mum, do right by yourself and your children and if you feel that your mental health could be wobbly, take time to check in on yourself. Your partner, best friend or even your GP may be great people to start a check in with. You might be surprised at how much they can tell you about yourself and what it is like when you may not be coping.

Tertiary Education Life 101

Posted on by Shona Innes
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It’s that time of the year. University and other tertiary education institutions are gearing up for another influx of new students. Togas and silly hats may dominate the landscape of our university precincts as the more academic of the next generation step up to take their sought-after places in the hallowed corridors of learning.

Parents who may be sending younglings off to tertiary education for the first time, might be a little worried. Parents’ worry may be affected by their own recall of events from when they, themselves, first left home for academic pursuits (that is, given their recall has not been affected by poor brain-care habits over ensuing years). Parents may be both excited for their young adult children and a little apprehensive about the hi-jinks they may be exposed to and/or engaged in.

The student-child is somewhat of a developmental and social grey area.

The job of the parent/carer becomes even more fuzzy and tricky to define while the offspring is both dependent and independent. The student-child is still on your Medicare card, but they also have one of their own. They are enrolled to vote and licensed to drive, but many heading to a university or college will still be quite financially dependent and will still require a safe base to come back to in times of need.

You have done much to assist your children to get to this point. Their university entrance scores are shiny. Their neurobiology is still simultaneously quick to react and primed for socialising. They have likely survived the adventures of schoolies, likely seen or experienced some sort of illicit substance and no doubt partaken in an alcoholic beverage or two – despite growing up in an era when they know more about the concerning effects of this on their brain and body health than ever before. They have a new laptop/tablet or similar learning device that Nan’s Christmas money assisted to purchase. Some hold down regular casual work where they may hold quite a deal of responsibility. They have survived the social-media-goes-mobile-phone teen years, have veered somewhat away from Facebook (because their parents are enjoying Facebook, too, these days), and they can text, inbox and post selfies at a rapid pace.

So, what on Earth should your student-child pack with them for this next chapter of their life?

Well, researchers probably know more about students than any other population on the planet. The job of many under-graduate students (aside of course from pursuing their academic best) is to participate in numerous studies as the test subjects/guinea pigs/lab rats. It is easy for academic researchers to access cohorts of university students without even having to pack their clip boards into their motor vehicles. Thus, cumulatively, we know a lot about the university student sample.

Research has helped inform us about students and their emotional health. One group of university researchers surveyed undergraduate students to determine the strategies that best assisted student to “flourish” in their emotional health. It turns out that the students who were involved in the study used a lot of strategies to help their emotions including understanding and analysing feelings, talking to someone, doing something enjoyable, being grateful, using alcohol and coffee, treating oneself, and consulting an advisor or mentor.

Importantly, though, it was not so much what the students did to manage emotionally rather than what they did not do that seemed to separate the languishing students from the flourishing students.

Flourishing students did not avoid as much as languishing students. Flourishing students engaged and took part rather than used avoidance to manage their emotions. The researchers recommended less avoidance and more engagement when it came to student emotional health.

Additionally, a different group of researchers looked at students who were living away from home and sharing a living space with other students. After studying 103 pairs of students sharing a residence in their first year, the researchers concluded that first years were more likely to “catch” a vulnerability to depression if they shared with a cognitively vulnerable room mate.

Your student-child could do well to engage in student life and a variety of different coping measures and encourage their room-mates to do the same.

So, parents…., it would be wise to keep an eye on your student-child if you notice they are avoiding and living in close proximity to others who may be vulnerable to not coping. Be alert if they are spending less time with others, less time at the books and more time doing, well…, not much. Meanwhile, if you garner evidence that your student-child is interacting, participating, sharing and venting, then you may feel a little more at ease about their transition to tertiary learning. You could continue to worry about them if you wanted to, but that’s not a strategy that researchers can recommend at this point in academic history. The worrying and ruminating parent is a whole other body of research – it’s lucky we have a new bunch of academics researchers on the rise!