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Sexual abuse

Bipolar Disorder Research Funding – Poorly Directed

Prepare yourself for a bit of a bipolar rant!

An article entitled “Bipolar Disorder in Youth Not as Chronic as Thought” in Medscape Pharmacists e-newsletter came across my email and while I was initially quite interested, I soon became annoyed.
Bipolar and Borderline (BPD)A recent study done at the University of Pittsburgh School of Medicine shows that bipolar disorder may not always be a chronic condition. While this may look like good news and you might see it pop up in the media as a big positive – cheerleader kind of thing, it really isn’t.

The study followed 413 children and adolescents who were 7 to 17 years of age and diagnosed with bipolar disorder at the time of study enrollment.  The patients and family members were interviewed about every eight months, for eight years.  What they found was that some of the patients were “ill” most of the time, some were “well” most of the time, and some were both ill and well.  Sorry, but that result isn’t astounding.

I find a couple of things wrong with the published results.

  1. They didn’t say whether the patients were stabilized on medication during the study – what medication, whether the medication was changed, whether the patients took the medication – in fact the publication doesn’t mention medication at all.
  2. The data collected was based on “interviews.”  Sorry, but being bipolar inherently predisposes you to lack of complete transparency.  Bipolar patients are likely to hide and lie – whether it is purposefully or subconscious behavior, it is a known problem.
  3. The patients were ages 7 to 17 when entering the study, meaning they were 15 to 25 at the end.  Many of the patients went through puberty during the study and what pubescent child or the post-pubescent adolescent is truly stable…or honest for that matter.  Interviews with the family may have partly balanced this but we also know how “well” our families may know us…some, not at all.

What I did find a little more relevant was that the patients tended to be “well” more of the time if they:

Though true, this is not astounding either.  It is easily recognized that if your family has a history of mental disorder, you are more likely to have a mental disorderBipolar disorder and substance abuse go hand in hand, and sexual abuse makes nothing more manageable.

Incidentally they also showed that patients would be more stable if they:

•    Had less history of severe depression, manic or hypomanic symptoms
•    Had fewer subsyndromal episodes

So basically, if the patients had a history of fewer episodes, they would have fewer episodes……really?
Not discounting the fact that any academic attention given to bipolar disorder, especially in juveniles should be welcome, I am disappointed because the study results didn’t show anything.  This is all information that anyone could guess – and the funding for mediocre “non-results” could have gone elsewhere.

This sort of news can easily lead to an “it will go away” thought process, lack of medication and lack of attention to and acknowledgment of the real and long-term challenges that a bipolar patient can face.  Yes, let’s all believe that bipolar disorder is not a chronic medical condition… let’s undo all the progress that has been made.

Melissa Lind

Academic attention given to bipolar disorder should be welcome!

Childhood Sexual Abuse and Mental Health

Mental Health and Childhood Sexual Abuse – Don’t Carry the Secret

Recently I saw something on Facebook that was very sad.  It was a video of a 50 plus year old man named Scott – also called “Spider,” who told the story of his life through written cards, in a fashion similar to Ben Breedlove’s “This is my story” about his heart condition. In the video, this tough looking man, confessed the trauma of his own sexual abuse and the damage it had done to him over the years – drug abuse, divorce, culminating in an arrest for beating his child’s sexual predator with a bat.

The story was naturally sad but is all too common.  In fact, statistics shows that 1 in 6 boys will be sexually molested by the age of 18 and worse for girls with 1 in 3.  The other sad fact is that many, many children who are sexually abused don’t tell anyone.  Either they are threatened or ashamed – or both.  They carry the secret for much of their lives.

Trauma, abuse, neglect – biology didn’t account for its infliction on children.  As children, our brains develop best in a loving,
supportive environment with plenty of nutritional food and quality exercise so that our bodies become the best they can be.  Childhood Trauma - Mental HhealthAround the world we see the damage that poor nutrition, neglect and physical abuse can do to children.  What is not so obvious is the damage wreaked by sexual abuse – it is a hidden traumaSexual abuse is hidden by the child, hidden from the adults, hidden from other children, and sometimes even hidden by the child’s memory.

Secrets are always dark.  Carrying secrets can ruin a relationship or ruin a career.  Carrying secrets imposes a burden of stress on your body – your heart doesn’t work as well, your adrenal system gets burned out, your sleep is affected.  Carrying a secret like that can change a child’s brain.

Studies have shown that abuse or childhood trauma actually causes physical changes to the developing brain.  It can make the child unable to grow to what they would have been.

So what does this have to do with mental health?

The effects of childhood trauma are hard to predict.  Mental health is hard to identify – particularly the cause.  In some cases, we can easily point to the parents and say “Mom and Grandma have clinical depression; it is no surprise that the daughter has depression.”  Schizophrenia has been shown to be driven by over 100 genes and a child with one schizophrenic person has a 13 percent chance of developing the disorder.  Some people are “born” alcoholics in that they are missing an enzyme that allows them to process alcohol properly and will nearly always become addicted if they drink.

In other cases – we can’t identify the cause.  You have some cases of mental disorders that develop in people with perfect childhoods.  You have people with horrible experiences who are remarkably healthy – rare, but true.  In many cases though, someone with a history of child abuse will develop some mental disorder – but the type is very hard to predict.

In “Spider’s” case, he became a drug addict, had an anger problem and felt that he had to prove he could “conquer” women (his own words), leading to the destruction of his family.  Likely he suffered from depression, anxiety disorder, and possibly Mental Health - Child AbusePost-Traumatic Stress Disorder.  Telling the “secret”, not carrying the weight may, just may have kept him from his self-destructive behavior.  Unfortunately, it may not have stopped his daughter from being a victim, but it might have allowed him better tools than a bat to deal with her problem.

In severe cases, extreme trauma can actually cause the personality to “split,” in “Dissociative Identity Disorder” (DID), which was previously called “Multiple Personality Disorder” (MPD).

(Photo-source: http://blogs.ocweekly.com/navelgazing/2014/08/scott_spider_spideralamode_facebook_molest.php)

Sexual abuse has another problem – that children are often disbelieved which worsens the trauma.  Unlike physical abuse, unlike neglect, unlike starvation – there are no “obvious” signs.  There are signs, but you have to know what they are.  Children who have been sexually abused do exhibit signs:

•    changes in behavior or personality type – a normally outgoing child becomes withdrawn, a normally gregarious child becomes angry and sullen
•    bed wetting and nightmares (oddly the bed-wetting may be punished)
•    refusal to go to school, church, sports or club activities or to a certain friend’s house
•    sudden clinginess or a sudden desire to be left alone

Too often, adults don’t ask.  Too often, children don’t tell.  Sadly, sometimes adults won’t listen.  If you know of a child that has
sudden behavioral changes – ask.  If you are an adult, believe.  If you are a victim, tell.  Even at a late date, telling can change your life and resolve some of your “issues.” I think in the end, “Spider’s” main message was “tell your kids to tell.”

What does this have to do with mental health?

Sexual abuse can contribute to:

PTSD, Depression, Bipolar Disorder, Anxiety Disorder, Intermittent Explosive Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia, Drug Addiction, Alcoholism, Attachment Disorder… and many more.

History of Child Abuse – Free PDF

Melissa Lind

Cutting – An Actual Mental Disorder

Non-Suicidal Self-Injury

A lot of people are shocked and horrified at the thought of self-mutilation and for many years “cutting” was categorized only as a symptom of Borderline Personality DisorderBPD, as you may know, has symptoms of unstable personal relationships, impulsivity, and extreme mood changes (different from Bipolar disorder as they can change on a dime and swing wildly).

The new issue of the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition or DSM-5, includes it as a separate diagnosis of Non-Suicidal Self-Injury (NSSI).  Research has suggested that NSSI can occur independently of BPD but is also often a co-existing or co-morbid illness, occurring alongside BPD, Bipolar Disorder, one of the many anxiety disorders or with other disorders such as anorexia or bulimia.

Cutting DisorderI am the mother of pre-adolescent children – who are beginning to believe they know all about people who act “weird” or do “weird” things (their words, not mine).  My daughter has recently talked about the “EMO” kids – which as a dumb mom, I had to figure out was a social group of kids who were “emotionally dark.”  She includes in her description of an “EMO” as “you know, like kids who are cutters.”  It is stereotypical to think that they all wear black clothing and heavy eyeliner – as some may – but many do not.

Some people who have the disorder would never be suspected of such – but then we are also sometimes surprised when someone who seems to have everything commits suicide, only to find that under the polished exterior was extreme anguish.  Often, cutting will be dismissed as a “stage” and it may be a “stage” – but often it is not.  Many patients – have arms or hips full of patterned scars – proving that it is often a condition all to itself.

Cutting Disorder - Mental IllnessSelf-mutilation most often starts in the early teen years when adolescent emotions are at their height – but often extends well into adulthood.  The majority of “cutters” are female – but not all.  There is often a co-existing mental illness and may have a family history component – but also often occurs following events of abuse – including sexual, physical or emotional abuse.  Sudden life changes such as unemployment or divorce – and isolation may trigger an occurrence.

People who “cut” often express a desire to “feel” as if they cannot truly attach to their own emotions.  Others will say they “cut” to kill the pain – this is because the act of producing pain also causes the body to release endorphins (the body’s natural painkiller) that makes them feel better.  Unfortunately, even though the action may induce temporary euphoria – it is often followed by guilt and a return of the negative feelings.

NSSI is defined as:

• 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent – in the past year.
Patients must be intending to:
o Seek relief from negative feelings or thoughts and/or
o Resolve interpersonal problems and/or
o Induce a positive emotional state
• The behavior must be associated with 1 of:
o Interpersonal problems
o Negative thoughts or feelings
o Premeditation
o Ruminating on injury (obsession)

NSSI includes not only “cutting” but also burning, hitting or punching, head banging, biting, non-aesthetic piercing or carving of skin (tattoos and body piercing don’t apply), pulling out hair or other “topical” mutilation.  If a patient has expressed suicidal thoughts or shows suicidal tendencies – it is not classified as NSSI as the intent of a person with NSSI is not to commit suicide.
NSSI should be first viewed as a serious medical condition that truly requires treatment.  It may be resolved by treating an existing co-morbid psychiatric condition – but likely it will also require psychotherapy to resolve some of the underlying issues.

Definition of Self-injury/cutting (Mayo Clinic)

Cutting and Self-Harm: Warning Signs and Treatment (WebMD)

If you see signs of NSSI or “cutting” in a child, teen, or adult that you know – encourage them to seek help.

Melissa Lind (WriterMelle)

An Actual Mental Disorder – Cutting

Mental Illness in Children

Mental Illness In Children – Are We Too Afraid To Find Out?

Up until about 20 years ago, the idea of mental illness occurring in children was pretty much unthinkable.

Boys who were extremely active were sent outside to play.  Defiant children were punished or sent outside to play.  Irritable children were sent outside to play.  Depressed children were sent outside to play.  Get the picture?Get the Idea

Today we do know a lot more about mental illness and have a lot more medication to treat it.  As mental illness becomes more easily diagnosed in adults, it is natural that we begin to look at our children and wonder.  It is also natural that we look back on our own childhoods and wonder or even know that we were ill then too.

Even though most psychiatric diseases are not diagnosed until the teens or early adulthood, it should be fairly obvious that those diseases did not suddenly happen when the kid turned 18. Likely there were signs of existing mental disorder long before the diagnosis.  Unfortunately, some parents may be too afraid to look.

The problem with recognizing mental illness in childhood is that symptoms of mental illness are different from the symptoms in adults.  Children’s symptoms can be masked with other signs or even opposite to those in adults, so they are not obvious. In addition, the symptoms of many different psychiatric disorders are so similar that it is difficult to distinguish one disorder from another.  Some examples:

Depression in children can show as: Depression, Insomnia, Nightmares, Bedwetting, Anxiety, Combativeness, Lack of interest, Anger, Poor grades

Anxiety in children can show as: Insomnia, Nightmares, Bedwetting, Fearfulness, Depression, Poor grades, Social inadequacies, Lack of interest, Combativeness, Anger.

Mental Illness in ChildrenADHD can show as: Inattentiveness, Lack of interest, Fidgetiness, Poor grades, Irritability, Inability to make friends, Excessive anger, Lack of organization

Asperger’s can show as: Lack of interest, Poor grades, Inability to make friends, Excessive anger, Lack of organization

On the other hand normal childhood occurrences such as puberty can show as: Lack of attention, Difficulty getting along with friends, Unexpected anger, Excessive sleep, Inability to sleep, Nightmares, Irritability, Mood swings, Excessive anger, Excessive crying, Poor grades

And Sexual abuse can show as: Nightmares, Bed-wetting, Excessive anger, Anxiety, Depression, Mood swings, Irritability, Disinterest

So how can we determine if it is something that happened to the child, something that is temporary or something like a mental illness?

The best things we can do are to pay attention, know your children.  If they change, find out why.  Know your family history.  If they seem “different”, talk to their teachers.  If they are continuously exhibiting behavior outside of the range of “normal”, there may be something wrong.  Listen to your kids, if they tell you that something is wrong, it probably is.

Don’t be afraid to ask for help.  Educate yourself.  Take the self-test quizzes.  Have your spouse or the child’s other caregivers take the tests.  Take all of this information to your healthcare provider and if that doesn’t work, find someone who will listen.

Most mental disorders are not diagnosed until the late teens or early adulthood – bipolar disorder, depression, anxiety disorder and schizophrenia.  There is more recognition today, but a lot of resistances to – both from parents and health professionals.  Don’t be afraid to seek help just because you are afraid of medication, knowing what is wrong and knowing your options can head off problems.

Recognizing an oncoming issue may help prevent years of anguish for your child and yourself.

Melissa Lind