Psychological News You Can Use - March 2006

Whether you are a newspaper reporter, educator, professional, legislator or an interested member of the public, we hope that this quarterly newsletter will help you stay current on mental health issues in Pennsylvania and the entire country.

Think back to how you felt a few weeks ago when you first heard that the coal miners in West Virginia had tragically died.
Now think about how you would feel if these victims had been your husband, son or other family member.

Because of recent wide spread natural and man-made disasters, we have heard a lot about post traumatic stress and the effects it can have on disaster victims. Sixty-one percent of American men and 51% of American women experience at least one serious traumatic event in their lifetime. After a disaster strikes most of the attention is rightly focused on the victims themselves. A much less publicized topic is the secondary trauma that affects families, friends or care givers of these victims, even though they may not have directly experienced the traumatic incident themselves.

Research tells us that family members of disaster victims often experience psychological symptoms that are very similar to the symptoms experienced by those directly affected. These symptoms may include depression, intrusive thoughts, a sense of loss of control, anger, rage, guilt, loss of self-worth and a sense that the world is just not fair or just. Many of these symptoms last for months or even years after the traumatic event itself, and often the coping mechanisms that families use to deal with these life circumstances actually make their conditions worse. Unfortunately, the family members of the victims of disasters are often ignored.

Of course, factors such as the seriousness of the traumatic event, whether victims died or were seriously injured, and whether the disaster caused widespread physical damage to homes or living environments are important in terms of how the family copes with the disaster. The symptoms experienced by family members and others not directly impacted, is referred to as secondary trauma. Secondary trauma often results in two general coping response styles by survivors, and both are ineffective. First, solution-focused behavior geared to dealing with and overcoming the crises. Second, a passive-fatalistic approach that usually leads to failure, hopelessness and continued dysfunction. Here are some suggestions if disaster strikes your family:

1. Seek emotional support from friends, other family members, peer groups or even other traumatized families.

2. Engage in activities that will help you relax, such as exercise, yoga, meditation or prayer.

3. Try not to hold your feelings inside. If you feel the need to cry, do so.

4. Maintain an open and honest communication system with your children.

5. Don’t be afraid to express your feelings or talk about the traumatic event to your friends, and family.

6. Avoid social isolation.

7. Don’t be afraid to engage in activities that you previously enjoyed (and don’t feel guilty afterwards).

8. Try to get enough sleep every night.

9. Take control of your life and your future.

10. Seek out and make use of any support services offered by your local community, state government, school system, employer, church or disaster organizations, such as the Red Cross.

11. Remember that healing is a personal response. Try not to let others dictate the time you need to recover.

12. Join or develop a support group.

13. Try to get back to your normal family routine as soon as possible.

14. As you try to get your life back to normal, set small realistic goals, and take one day at a time.

Many families may not need professional counseling. But if you feel the need, seek-out services from psychologists or other appropriate mental health professionals when you feel overwhelmed, or when your own efforts do not seem to be working. A family doctor, member of the clergy, local mental health association, state psychological or social work association may be helpful in providing a referral.

Resources:

International Society for Traumatic Stress Studies

American Red Cross

Common Reactions To Trauma

Pennsylvania Psychological Association

Information for the General Public

David Baldwin’s Trauma Information Pages

What is Self-Choking?
Self-choking involves self-strangulation in some form. The intent is to induce the high that comes from restricting oxygen intake. This is often played as a “game” among young children, especially those 9-15 years old. Self-choking is harder to predict among young children than suicide attempts, which are often accompanied by warning signs. When either of these happen, they usually happen without any awareness of parents, teachers, or friends.

How Does Self-Choking Differ from Autoerotic Asphyxiation Syndrome (AeA)?
AeA involves a sexual aspect; self choking does not. AeA is prevalent among older adolescents and young adults (16-25) but self choking is found among pre-adolescents and younger adolescents(9-15). The risk of death due to asphyxiation is greater with self choking than with AeA because AeA is more often done with a partner. Finally, AeA is better known than self-choking, although both are not well known.

Other Names for Self-Choking - Space Monkey, fainting, Pass Out Game, Black Out Game, American Dream, Flatliner, Knock Out, Space Cowboy, Gasp, Rising Sun, Airplaning.

Similarities to Other Adolescent Disorders- Cutting, accident prone, drug and alcohol abuse, promiscuity, suicide attempts.

Many of us have had similar experiences -

• Hanging upside down
• Pressing arms against immovable barriers
• Holding your breath
• Breathing forcefully and rapidly
• Hang gliding
• Parachuting
• The rush of doing something on the edge

The Signs of the Choking Game -

• Marks or bruises on the throat that defy explanation
• Frequent and severe headaches
• Eye redness
• Finding belts, ropes, leashes, or similar things in strange places
• Cuts and bruises that can’t be explained
• Disorientation after spending time alone
• Locked bedroom doors

For more information with real life examples of how this has affected young children, visit Stop-the-Choking-Game.com

Most people think Attention-Deficit/Hyperactivity Disorder (ADHD) is just for kids - like the boy who can’t sit still. But this is only part of the picture—most kids with ADHD become adults with ADHD. Unfortunately, adults with ADHD typically receive no treatment, or are misdiagnosed and receive inappropriate treatment. Fortunately, most of what works so well for kids with ADHD is just as effective for ADHD adults. (ADHD is sometimes also called ADD which is the older term for it.)

Diagnosing ADHD in Adults - Although we all have our “ADHD moments,” a true diagnosis requires that one meet certain specific symptoms. These symptoms fall into two subtypes. Most people are familiar with the first subtype, which is hyperactive/impulsive. These symptoms are easy to observe, at least in children. As one presenter jokingly said, “The school janitor can diagnose the hyperactive/impulsive kids.” During late adolescence, the hyperactivity and impulsivity tend to quiet down, so that the child who couldn’t sit quietly through a fifteen minute meal may become an adult who feels antsy when watching a movie.

The hyperactive symptoms include:

• Fidgety
• Difficulty remaining seated
• Overly active
• Difficulty doing things quietly
• Often on the go
• Talks excessively

The impulsive symptoms include:

• Blurts out answers
• Difficulty waiting one’s turn
• Interrupts or intrudes on others

There are also people with ADHD who don’t have much difficulty with the hyperactive/impulsive symptoms, but instead have difficulty with inattention. Unlike the hyperactive/impulsive people who are pretty obvious about their symptoms, the predominantly inattentive folks are much quieter about their difficulties. By contrast, one often can’t tell that the inattentive person isn’t paying attention or is scattered in their thoughts.

The inattentive symptoms include:

• Careless mistakes
• Difficulty sustaining attention
• Doesn’t seem to listen
• Poor follow through
• Difficulty organizing
• Avoids sustained mental effort
• Loses things
• Easily distracted
• Forgetful

Although these symptoms seem pretty straight-forward, they may also indicate other conditions. If you suspect that you or someone you know has ADHD, it’s best to be evaluated by a psychologist with specific experience with ADHD in adults. In order to qualify as ADHD, the symptoms have to have been present from childhood, be present in multiple situations, and cause significant impairment.

What Does ADHD Look Like? Of course everybody is an individual, but there are certain common traits shared by many ADHD adults. As people develop from adolescence into adulthood, they are expected to take on increasing responsibility in running their lives. Unfortunately, many ADHD adults really struggle with this. They know what they are supposed to do, but have great difficulty actually doing it. They can probably do it sometimes, but success in life usually requires doing the right thing at the right time -- every time. Some things in life have a high price for even occasional lapses—e.g., losing bills before paying them; forgetting to meet a friend somewhere; getting to work late; etc.

In a thousand small ways, ADHD adults shoot themselves in the foot. As a result, others often see them as irresponsible or selfish and can’t understand why they don’t just do better. There’s a book about ADHD with a title that says it all: “You Mean I’m not Lazy, Stupid, or Crazy?”

Understandably, ADHD can cause a lot of frustration, not only for the ADHD person, but also for family, friends, romantic partners, coworkers, and bosses. The ADHD adult often shows great potential but has equally great difficulty living up to that potential—which is sometimes worse than having no potential at all. As a result, they are often troubled by a constant sense of anxiety about what disastrous thing will happen next, and later by crashing disappointment when things do go bad.

This is a very difficult way to go through life. Fortunately, there is effective treatment available for those who work at it.

Effective Treatment - Often the first step in treating ADHD is medication. The good news is that the current medications are generally quite safe and very effective. Certainly there are risks and side effects with any medication, but there are also risks and side effects to not treating ADHD—that whole “Lazy, Stupid, or Crazy” thing. Therefore, I often recommend at least trying medication to test the benefit. It doesn’t make every problem suddenly disappear, but it does make it easier to do what needs to be done and with less effort. There’s a great saying that “pills don’t teach skills” and it’s definitely true, but it’s a lot easier to learn those skills with a proper medication regimen, as long as one is motivated to work at it.

I always recommend that people with ADHD, and their families, learn as much as they can about ADHD. Partly this is a matter of getting rid of the unproductive blame and guilt that the person has accumulated over the years of struggle. If one understands how ADHD is a neurological condition, it’s easier to let go of those painful feelings. Of course, ADHD is not a Get Out of Jail Free card—one still needs to be a productive member of society. Learning about what kinds of strategies tend to be helpful for folks with ADHD makes it easier to make the necessary changes without trying a bunch of strategies that are less likely to help. (The Resources section at the end has a number of places to get good information about ADHD.)

A psychologist can work with the ADHD adult (and possibly family members) to understand how ADHD has impacted the person’s life and why it is that certain things worked out the way that they did. Undiagnosed and untreated ADHD has a profound effect on someone’s life that is much more powerful than good intentions, a loving family, or strict teachers. After a lifetime of struggle, many ADHD adults also suffer from some depression or anxiety which makes it even harder to apply oneself effectively. A therapist can help the person let go of those unproductive feelings and take a more active approach to success. In addition, many ADHD adults benefit from coaching to teach the skills that were missed along the way (e.g., time management, organization, prioritizing, etc.) and that are causing so many problems in daily life. This coaching can be done by a separate coach or by the psychologist.

ADHD Resources - There are two great nonprofit organizations that advocate for those with ADHD. The first is CHADD which publishes a monthly magazine, holds an annual conference, and does outreach and education. There are also 150 local chapters that hold one or more monthly meetings and support groups and can provide local resources. There is also the Attention Deficit Disorders Association (ADDA) which focuses exclusively on adults with ADHD. Both have excellent websites with lots of good information. The ADD Warehouse has an extensive list of books and other materials related to ADHD.

It can be overwhelming sometimes to understand the impact of ADHD, find qualified help, stick with treatment, and change ingrained habits. Fortunately, the investment of time, energy, and money is usually well worth it. Swimming upstream against untreated ADHD takes a lot of effort with not enough to show for it. With an accurate diagnosis and effective treatment, all those good intentions can really amount to something.

"What helps you get calm?" In answering that question, most people describe a scene from nature: the beach, mountains, or lush greenery. Sometimes the scene also includes the sound of birds or gentle rain, or the fragrance of flowers.

A dose of nature during your workday is a great way to relieve - and even to prevent stress. Just a five- to fifteen-minute break outside in a natural area can help you feel refreshed and alert.

Instead of hanging around the coffee machine, step outside. Find an aspect of nature to focus on - a bird, a tree, breeze, sunshine, or the clouds in the sky. No matter where you work, some natural attraction is likely to be available.

If you cannot go outside, bring nature in to you. Enjoy an indoor plant, fresh flowers a beautiful rock, seashell, or listen to recorded soothing sounds of nature.

There are many ways to relieve stress, but nothing is as natural as nature!

What can parents do to help children overcome addiction to drugs and alcohol? Three time-tested approaches are for parents to make certain that a child attends AA and NA meetings, avoids peers who use drugs, and stays away from the temptation to use again.

But that’s only part of the story. Here are four other recommendations from psychologists:

Try to improve family harmony. In families where there is harmony children are less likely to relapse. Harmony means fewer arguments and more listening, sharing, and compromise. When parents have a strong relationship with each other children tend to feel more secure and confident, and they will have less need to use drugs.

Allow your child an opportunity to earn trust every day. Children need a chance to prove they can stay away from drugs. Although parents may be afraid to trust a child who has abused drugs, it’s important to give him a chance. Find small ways to do this each and every day.

Resume normal conversations, normal interests, and normal routines. It is not necessary to speak about addiction and recovery every day. Children feel they are a burden when they are responsible for draining the family of money, time, and effort to fight their drug addictions.

Participate in your child’s recovery. This means attending support groups for parents, reading, and learning about the disease process of addiction. Showing your child that you are interested in and willing to make the effort to learn about such problems will facilitate recovery.