A new venture: Kate’s presentations to promote education and awareness about eating disorder intervention

Tomorrow morning I am giving a presentation at a local high school focusing on how to notice signs of eating disorders, how they affect us emotionally and physically, the dangers of developing an eating disorder, and resources for getting help.  This is a very pertinent topic in schools with all grades — and the need for advocacy is reaching grades even as young as elementary school.  Scary, isn’t it?  I am excited to begin this new venture, because as a counselor I have an ethical duty to be an advocate for issues that concern mental health issues.  I will be giving free talks at local schools (grades elementary-college) and at churches and recreational facilities in the upcoming months, so if you or anyone you know sees a need for this type of presentation in a community you are connected to, please feel free to contact me at kate@katedaiglecounseling.com.

The first sign of a potential eating disorder most always is rooted in going on a diet.  Diets involve limiting amount of food intake and eliminating certain types of food groups for a certain period of time, which can easily get out of control.  As 40-60% of high school girls and 90% of college girls are on a diet at any one time, this statistic coupled with the social and academic pressure of a school environment makes the risk of developing an eating disorder very high.  One last statistic: 25% of pathological dieters will develop partial or full-blown eating disorders.  Diets are “gateway drugs” to eating disorders and must be monitored carefully; diets are part of my presentation at every grade level as this can be a point of early intervention.

Here’s a video that I will be using to show high school students how they can help each other find resources and notice signs of eating disorders.  I am encouraged that increasing numbers of students display awareness of eating disorders and are spreading the word about the dangers of these potentially deadly afflictions!

Another presentation take-away:  download and print off my handout: 15 Signs of an Eating Disorder.  This can give you information for noticing signs of an eating disorder and can help you save your own life or the life of someone you love.

Valentine’s lessons: Offering ourselves a generous helping of love and peace

Valentine’s Day comes with as much baggage as an entire herd of elephants on vacation.  We all have preconceived notions concerning how we feel about Valentine’s Day and honestly, we don’t give ourselves much of a chance to change that opinion.  This holiday has been pooh-poohed for its level of materialism and some call it a “Hallmark holiday” that has lost any true meaning.  Poor St. Valentine with his sneaky arrow of love!  For people who are single or who are in a damaging relationship, Valentine’s day can bring trepidation and anxiety as we worry about “how we will get through it” and we wallow over the fact that we are single/unhappily partnered/missing an ex partner/whatever else.  Valentine’s Day does add a lot of pressure: pressure to single people to take a stance on their relationship status, pressure on newly dating couples to “make it special, even if the partners don’t know each other well yet”, and it puts pressure on longterm couples who are caught in the race of life and desperately try to make time to focus on this holiday and what it means for their relationship.  It brings up anger and resentment for some of us.  In others, it can spark what it was originally meant to convey: love and happiness.  It’s our choice how we want to feel about Valentine’s Day and how it impacts us!

Whatever your history or feelings are about Valentine’s Day, I personally adore this holiday because not only is it an opportunity to show those we love how much we cherish them, but it is a perfect time to give ourselves generous helpings of self-love and acceptance that may have been evading us all year.  You may say that it sounds cheesy to say this, and that it’s “an excuse for lonely souls to cling to on this day centered on couples”.  The truth is, whether you are in a relationship or single, if you do not show yourself love and admire your personal qualities for the wonderfully unique things that they are, you will always be struggling to find inner peace.  As a counselor and as a human being, I have experienced numerous occasions where this philosophy is proven to be absolutely true.  There is the cliche “you won’t find love until you love yourself first”, which in part makes a lot of sense. 

I believe we each enter into relationships for personal and varying reasons.  As we are all unique individuals, we may be looking for certain qualities in a partner and we may have different ideas about what makes a relationship functional based on family and societal influences.  But I would argue that every person in every relationship is looking for one thing in common:  love.  Well, two: and acceptance for who you are.   We may be able to give endless heaps of pure love to a partner and find that it is reciprocated, however if we are not treating ourselves with that same kindness and respect as well, we may start to feel unbalanced and out of sync.  We must feel we deserve the love that we receive in a healthy relationship, and (hate to tell you this) that acceptance does not come from anyone else but our own selves!

So in honor of Valentine’s Day, how about we all show our love to those dear and near to our hearts — romantic, friendly, familial (and pets).  I think it’s a beautiful thing to have a day just to show love.  And don’t forget to focus on the most essential and deep form of love (and also one of the most difficult to attain for some reason):  love of ourselves.  Give that negative voice in your mind the boot on Valentine’s Day and treat yourself with the same type of care that you would show to your mother/father/sister/best friend/partner.  It’s amazing the power that self-love and acceptance can have on our lives and our relationships! 🙂

Taking refuge in the present moment with Radical Acceptance

We have all experienced some sort of suffering and emotional pain.  It is part of being human.  But have you noticed how emotional pain devastates some peoples’ lives, while other people can take this obstacle and use it for personal growth and wellness?  For some, suffering is not painful because it is interpreted in an adaptive way.  How do you know how you will handle a certain emergency or tragedy, and can you control your reaction?  The answer, according to Ancient Buddhist philosophers, is “yes”.  Radical Acceptance is a type of mindfulness that was designed to help us determine the difference between “willful” and “willing”.  It underlines the fact that we have a choice, and that being “willing” allows us to choose how we will manage a situation while being “willful” means that we are rigid and not flexible. When we are willing, we can flow with things as they unfold, be spontaneous, and not judge ourselves or others for the way life turns out.  Clinicians cite Borderline Personality Disorder as being particularly challenged by trying to be “willing” instead of “willful”, and note that it requires a certain level of emotional maturity to achieve this.

Radical acceptance is seen as the practice of accepting life on its own terms.  Kind of like “going with the flow”.  Do you ever notice that things can be so much easier if you just let go of the anxiety and pressure that you have associated with a certain situation?  It also involves finding effective strategies for coping with whatever life may present us.  I found a great resource list for ways to cope.  This is different from being passive — radical acceptance involves accepting what is, and knowing that you hold the power to choose how you will interact with reality.  Radical acceptance, along with mindfulness as mentioned in my last blog post, can help ease depression and anxiety and bring an overall sense of peace to our lives.

An interview with clinical psychologist Tara Brach outlines the ways that she uses Radical Acceptance in her practice and in her own life.  She talks specifically about applying the Buddhist principles of the “three refuges” as a method of awakening herself from the all-too-familiar trance of “there’s something wrong with me”.  These involve focusing on the love that is present in your life and giving lots of light to that, taking refuge in the present moment (dharma), and third, turning inward towards awareness itself.  This truly encourages us to discover who we are in the present moment and meditate on what is meaningful to our experience of it.

I like this type of philosophy because it takes the “survivor” approach instead of the “helpless” approach to solving problems.  If we are able to accept what is going on in the present moment, to really examine it and give it credibility, then we can move forward on finding solutions to the moment if it causing us emotional pain.  One of the foundational principles of Radical Acceptance is that we can eliminate suffering by accepting life.  Those that practice Radical Acceptance use three steps to address a problem: thinking about ways to solve the problem, then thinking about changing the way you feel about the problem, and finally, accepting the problem.  How radical is that!  Well, there is a fourth option, which is to stay miserable, but why would you choose that if there are other options?  Here is a website that has many resources and workbooks for helping you to learn Radical Acceptance and apply it to your own life.

Of course, I believe that our situations are all unique based on our backgrounds, resources, socioeconomic class, and mental health history and that choosing Radical Acceptance may be much more difficult for some of us based on these factors.  I do like the thought of having the “power to choose” how we handle life and in turn have the power to choose how life’s surprises affect us.  I utilize a strengths-based and mindfulness approach in my private practice and believe that we all have inner resources that can be weapons for us in the face of adversity.

Seven ways to practice mindfulness in less-than-relaxing circumstances

If you live almost anywhere in the United States, you will have some experience with the blizzard and arctic freeze that has been sweeping every direction of the nation.  Some of us have been stuck in airports due to cancelled flights, some of us have slid across icy intersections in a panic, some of us have had to wait in the sub-zero digits as we wait for a bus to take us to school or work, and some of us have to be separated from loved ones as we wait for the country to revive and breathe again.

This is as good a time as any to practice ways to be mindful and present in the face of a situation over which we might have no control.  I know it sounds near impossible to be mindful as your fingers turn to ice (and you might want to punch me with those icy fingers for suggesting it), but please bear with me as we explore a few ways to appreciate the moment in a non-judgmental capacity.   First off, what is mindfulness?  Build from a tradition of Buddhist meditation, mindfulness can be described as adopting a calm awareness of one’s body functions, feelings, consciousness and environment, and its practice is said to be key in the development of wisdom.  Rilke, a teacher of ancient mindfulness, states:

“(Have)….. patience with everything unresolved in your heart—-and try to love the questions themselves. Don’t search for answers which could not be given to you now, because you would not be able to live them.

And the point is to live everything.

Live the questions now!

Perhaps, gradually without noticing it you will live the way to your answer.”

So, in truly living in your present moment, how can we achieve a state of acceptance and awareness?

1.) Close your eyes and try to notice what each of your senses are experiencing at that moment.  What do you hear?  What do you feel? Is the temperature warm or cold?  Smell? If you open your eyes, where do you find yourself?  Notice the brick ledge lining the yard of the neighboring house.  How did that get there?  Truly being aware of our surroundings helps us to find meaning in our existence and let go of anxieties about the past or future.

2.) Notice your breathing.  Take deep breaths in and out and really feel it go through your body.  This is a way to naturally calm down your body.

3.) Check in with your body.  Where are you feeling pain?  Stress? Tension? Sadness?  Are you holding anxiety in your neck and shoulders?  Do you feel the loss of a loved one in your chest?  Try to explore your connection to your body and where it might be disconnected from your emotions.

4.) Quiet your mind.  Once you have checked in with yourself and find yourself present in the moment, try to truly sit with it.  Try not to let intrusive thoughts and worries about the past and future ruin your moment.  There is nothing to do about those right now.  This moment is yours, and you have complete control over it.

4.) Don’t give yourself a hard time if this is difficult.  Especially in challenging circumstances where our plans may fall through or we are presented with unexpected news, we must be compassionate with ourselves.  If it is hard to calm your mind, that is okay.  Take those thoughts, acknowledge them, and let them pass through your mind.  Mindfulness meditation is not about eliminating thoughts, it is about noticing them, not judging them, and letting them go.

5.) Follow the words of Deepok Chopra: “Close your eyes and watch yourself breathe for about five minutes.  Put your attention on your heart and ask: Who am I? What do I want? What is my purpose? You don’t need to know the answers.  Live the questions and life will move you to the answers.”

6.) Try yoga.  Yoga is a natural way to spiritually align your mind and body and to heal the spirit through movement.  This not only is healthy for you physically, but it helps to center the mind and work through the breath.

7.)  Get a massage.  Massages naturally encourage us to turn off our mind and notice sensations in our body.  Working through tension held in muscles can release toxins and soothe your mind to help you tackle any challenges that might come your way.

And one last thought — give yourself a break!  If it’s freezing and snowy outside, there’s no better reason for snuggling up at home with a pet and a good book.

For more mindfulness practice and body-centered psychotherapy, feel free to join Kate Daigle Counseling’s Body-Centered Emotional Recovery Group, held each Wednesday at 5:30pm and facilitated by Kate Daigle and Sarah McKelvey.

Don’t miss this video, featuring one of the most peaceful and therapeutic leaders in mindfulness meditation, Jon Kabat-Zinn.  He is one of my personal heroes!:

Tending to our physical health: new dietary guidelines for a new year

It’s the synergy of mental and physical health that helps us feel great in mind, body and soul.  Physical activity can increase levels of energy and endorphins — which in effect increase our ability to feel happiness.  Nurturing our bodies with good, healthy food — not too much, not too little — and finding that delicate balance of nutrition is important and challenging.  There are days that you crave a sweet thing, and days you crave salty things.  Go ahead and treat yourself — maintaining awareness of your emotional needs as you do.  We need a variety of food to fuel our bodies, and it is healthy to incorporate as much of each food group as possible (see Kate’s Denver Post blog post about the dangers of eliminating food groups for reference).

As February is commonly the month that our New Year’s resolutions can tend to fall to the wayside, I encourage you to read the government’s new standards for dietary health.  The full report can be found here: Dietary Guidelines for Americans 2010 The guidelines have changed since they were last revised five years ago.   What do you think of the new guidelines?  How do they reflect the changes that have occurred in our society?

I am fond of the statement that reads: “enjoy your food, but eat less.”  Eat until you are satiated, and then eat again when you are hungry.  Mindful eating helps us tune into our body’s needs and wants:  your body will tell you if you are not feeding it with the wholesome and healthy foods that it needs to help you get through your day.  Treat your body as you would treat a treasured gift.  Listen to what it is telling you it wants, and why.  You may be surprised to find that eating a green salad will calm your anxiety, taste delicious, and soothe you just as a plate of nachos could (and trust me, the salad will leave you feeling better afterwards!)  Your body is there to serve you and it is our job to take good care of it!

Pressure and expectation in religion: lifting the veil on eating disorders in Orthodox Jewish culture

The connection between eating disorder prevelence and religion.  The effect of spirituality on eating disorder recovery.  This topic is one that deserves a rich and comprehensive look not just by mental health clinicians, doctors and religious leaders, but by all of us because it addresses the way we perceive ourselves having faith in something that is based purely on belief.  If we believe in God, is it easier to believe in eating disorder recovery?  There is so much to write about spirituality and eating disorders and I hope to write future blogs about varying facets of this complex ponderance, but today I write about a specific area that is getting more media attention as of late: the rise in eating disorders in the Orthodox Jewish community.  Women in this culture are pressured by expectation from many different places:  the expectation to eat and eat at celebrations such as Jewish holidays and the weekly Sabbath meal because in this culture, a significant way of showing love and appreciation is to eat; expectation to prepare this meal and be prepared to feed large amounts of people;  the expectation to fast for Passover; the limits of eating Kosher food which in and of itself poses restrictions and control concerns; the expectation to be high achievers in school, work, and marriage; the expectation to be respectful to your religion; and, most seriously for young women, the expecation to be skinny so that you are considered “good marrying matieral” in an arranged marriage.  Phew!

In December 2010 an article in the Washington Post stated that in 1996 (which was 15 years ago!) 1 in 9 ultra-Orthodox Jewish girls in Brooklyn had some form of eating disorder: anorexia, bulimia, binge eating, or other types of disordered eating.  At the time that statistic was published, that rate was about 50% higher than the national average.  One can only think about what the rate might be in relation to today’s ED statistics (today, data shows that 1 in 10 women struggles with an ED).  Why is this?  Clinicians and members of the Orthodox faith explain that from an early age, girls are taught to adhere to strict Kosher rules which means cutting out certain types of food, to not give in to temptation, and to control their food.  Over time, this teaches women to resist temptation and, for the sake of religion, say no to foods that they might really like and in some cases such as Yom Kippur, to abstain from food altogether.  Young women who have been interviewed about their experiences have admitted that when fasting during the time they struggled with an eating disorder, their abstinence was related to body image and not religious faith.  Julia Duin of the Washington Times points out that in Judaism, many of the meanings of religious holidays are directly related to food and the consumption of food, whereas those who celebrate Christain holidays certainly overindulge as well (or fast in some cases), but that this is due to the celebration and not to the meaning of the holiday itself. 

Faryn Hart, 24, is an Orthodox Jew from South Africa who struggled with an eating disorder all throughout high school and college.  She recalls sitting down to her family table when she was a teenager, being asked by her mother and grandmother about her grades and her goals for her career, and being able to focus solely on the food.  Dissociation is one of the main coping mechanisms for those struggling with eating disorders, and typically happens when feelings that are painful or uncomfortable are present and food is seemingly the “only” way to deal with the empty and pressured feelings.  The Philadephia-based Renfrew Center, an eating disorder treatment center that has branches in nine locations across the country, did not have means to cater to dietary requirements in Faryn’s religious culture when she tried to go there for help two years ago.  The Kosher requirements for her diet were difficult to manage for the kitchen staff at that time, and when she did eat food that was different than that of the other patients, there was competition, jealousy, complaints of “unfair portion sizes”, and challenges to recovery.  The Renfrew Center now has a special program that caters to the increasing and specialized needs of this community and reports that 13% of its current patients are Jewish Orthodox — up from 5% just three years ago.

Is there a rise in eating disorder rates among this community, or are members just now starting to admit that they have struggled with these issues for years?  I bet that there are eating disorder occurences in every religious culture.  Why this focus on Jewish Orthodoxy now?  I get the sense that this community is very strict and secretive and that there is much need for help but that there is some shame associated with asking for help.  Dr. Catherine Steiner-Adair found this when she visited Israel (which, though research is still being performed and data is difficult to collect, is thought to have one of the highest rates of EDs in the world) and was repeatedly asked to help women who were hiding eating disorders. 

Jewish Orthodox culture is very traditional, with one of its centerpoints being arranged marraiges amongst young men and women.  Arranging a “successful” marriage involves high scholarly credentials, a strong family line, and, for the women, a thin figure.  An article I found unveils that exact sizes, weights, and medical records for each woman (and her mother!) are demanded by some families before a marriage is arranged.  And, because mental illness is a greater stigma than anything, young women are stuck: they must love and eat food, but also fast, and also be thin and mentally “healthy”.  Oh and they must be high achievers.

The culture in the United States is obsessed with body image and equates thinness to healthy, wealth, and happiness.  I can only imagine the difficulty that young Orthodox Jewish women must feel living in the US amongst all of this pressure from every direction.  The history, culture, and tradition of religous culture must be revered and respected.  But how do you tell when it is hurting more than helping?  More awareness, more education, and more acceptance of each person in his or her natural form is imperative.

Does insight pave the way to happiness or is ignorance really bliss?

I know that you have heard that cliche: “ignorance is bliss”.  I had to admit that I have mixed feelings about this.  Sometimes, at the end of a really long, harrowing day, I can feel that I know “too much” and that it would be nice to just turn it off.  Other times, and more frequently, I appreciate the knowledge I do have and am grateful for the teachers, friends, helpers, and books that have given it to me.  What about knowledge of yourself?  Is “the more the better” true, or can having deep insight into why we are who we are and what makes us tick actually decrease the sense of happiness that we feel?

I am intrigued by this debate, which was brought to my attention in a recent New York Times article: “Does Insight in Therapy Equal Happiness? Not Always”.  I am struck by this question because, as someone in the helping profession, I would like to *think* that my work helps people achieve happiness and peace in their lives.  That is what I set out to do when I embarked on this career several years back.  But what if the “help” that I give people actually leads them to “know too much” and place judgment on themselves for, for example, still acting a certain way, even though they have come to learn why they act that way and every single strand of what makes them have that particular reaction.  But, despite this awareness, they are still doing it.  They still feel a particular way.  They still are who they are.  Can this insight (which is what many people go to therapy to discover) actually lead to feelings of depression and less happiness?

The article has a tagline: “more insight, more pain”, wherein the author, who is also a therapist, talks about a client he had who during the therapeutic process discovered that he had chosen his career (which was making him miserable) to please his critical and demanding father when he would have rather followed his passion for art.  The depression he felt due to his dislike for his work was deepened as he berated himself for failing to stand up to his father and follow his own path.  We all know that when we are depressed, we tend to remember negative memories and focus on sad feelings — a selective bias.  When this occurs, the more we know — the more that knowledge can cause us pain.

Gaining insight can give you a sense of control over your life, as you reconcile emotional wounds and recognize behavioral patterns.  If we come to terms with some difficult feelings, we may feel less anxious about having them, and this can decrease pain — but does it increase happiness?  Are a decrease in pain and a rise in happiness levels mutually exclusive?  I don’t think so, but it’s a complicated quandary.  The debate settles on the question of how therapy works: as the common factor between all therapeutic approaches is the client-therapist bond, is insight really a necessary ingredient for therapy?  Some, who focus on more cognitive behavioral or solution focused approaches, may not feel that it is required (or that it can take different forms and be processed at varying levels).  Other therapists, such as psychoanalysts, surround the greatest part of their practice on getting to deeper and richer levels of insight.  If you have a good and strong connection with your therapist, how can you tell which type of therapy “works”?  What do we measure and how do we know when it has succeeded? (and what is success in therapy anyway?).

All of these philosophical questions can go around and around, but I feel that when the client is able to tell that he or she has seen some change — however that is qualified — then we can know that we have helped in some way.  Whether that change is figuring out a solution to a family communication issue or if it is understanding that our avoidance of conflict is due to an early childhood experience where we felt helpless, it is the client’s call.  If we are insight-oriented therapists, it is our job to monitor how this change is affecting our clients and, if we have any energy left at the end of the day, how this insight is affecting ourselves.

Let’s focus: bringing clarity and truth to the ADHD conversation

Why is ADHD diagnosed so readily in today’s society?  Are there other ways to deal with issues related to the symptoms other than diagnosis and medication?  Many feel that ADHD is misunderstood and that either a) it is diagnosed by doctors and mental health professionals too quickly and possibly inaccurately, or b) it is given a negative connotation and the symptoms are not taken seriously enough.  ADHD (or ADD — they are used interchangeably) is short for Attention Deficit Hyperactivity Disorder and is classified as a neurobehavioral developmental disorder.  It is primarily characterized by the “co-existence of attentional problems and hyperactivity or impulsivity”, with symptoms typically beginning before age seven.  The criteria for diagnosis for this disorder is subjective and symptoms may be caused by a variety of factors ranging from brain defects to allergies to giftedness.  With an array of possible causes stemming from physical reactions (allergies) to high intelligence, to a defect in the brain, it seems that ADHD would be very difficult to pinpoint in individual circumstances!

ADHD is diagnosed in 2-16% of school aged children and is a chronic disorder, with symptoms continuing into adulthood for about 30-50% of individuals.  Controversy has swirled around ADHD diagnosis since it began to gain notoriety in the 1970s.  One factor in this category is the statistic that ADHD is diagnosed two to four times more frequently in boys than it is in girls, prompting some parents and participants to think that teachers have a bias in their conceptualization of the disorder.  Management of ADHD typically involves medication, lifestyle changes, behavior modifications, and counseling.  Vitamins and exercise have been known to be helpful to counteract the effects of ADHD.  I am curious about the percentage of how many cases are treated with medication initially, and how many cases are fully assessed, offering options such as psychotherapy and behavioral modification before medication is used.  I would like to know more about the statistics concerning what type of treatment is most effective — and specifically the efficacy of medication.

I am not anti-medication.  I fully realize and understand that medication is essential for daily functioning for many individuals and from my own past experience with medication for a different issue, I found it to be helpful.  Sometimes our brain chemistry is slightly out of alignment and medication can help rebuild those bridges and raise our serotonin levels.  I just wonder at the prevalence of medication prescriptions these days and am curious if taking medication without going to therapy simultaneously (as I know is frequently the case) will truly get to the root of the issue.

To help me understand a bit more about the ways that ADHD affects peoples’ lives, I talked to one of my clients who had been diagnosed with this disorder and for which she takes medication.  She told me that it has helped her concentrate but that it is also aligned with other issues such as OCD and anxiety and the interconnectivity of these issues does not allow medication alone to help ease them.  A friend of mine related to me the almost debilitating effect that ADHD has had on her life, causing her to cry at moments when she could not organize a drawer.  ADHD poses challenges while trying to focus on reading, and she is amazed and proud that she finished grad school while managing this life-altering disorder.  I am sure that there are millions of others in this world that can relate to this accomplishment and the hard road to get there.  I would be grateful to hear the stories of others who have lived with and flourished in the midst of a disorder that affects their daily functioning, and to learn their tools for success.

I found a quiz that can be useful for trying to determine if you might have some symptoms of ADHD.  There are also blogs written by those who are living with ADHD and who give support and tools for success in school and work.  As I was doing research, I was curious about the question of how ADHD affects interpersonal relationships.  Some blogs talk about how self-esteem and self-confidence can be improved by treating ADHD, which I am sure improve communication and intimacy in personal relationships.  An interesting fact I learned is that 20-45% of criminals in jail have been diagnosed with ADHD, and that those with this condition are 4 to 9 times more likely to commit a crime (this statistic makes me a little wary and I would like to know more about what other conditions are co-morbid with ADHD if this is true).

It seems that we are still deep in the trenches of understanding what causes this disorder and how best to treat it.  I think that when we might suspect that someone has ADHD, we must do a full assessment of them before we diagnose.  Symptoms of ADHD such as hyperactivity and difficulty focusing can also be symptoms of other issues, such as trauma.  Living with a chronic condition creates a huge impact on one’s life, and I am in admiration of those who thrive daily in the midst of this and other life-altering disorders.

Shaken Baby Syndrome: a trauma that lasts a lifetime

Don’t shake the baby.  I am sure you have heard that phrase before, as it is used by multiple mental health and physical health organizations to spread the word about the dangers of shaken baby syndrome.  For new parents, the birth of a child is a momentous event that changes their lives forever.  With the new arrival comes joy, adjustment, stress, sleep deprivation, and possibly financial or family dynamic stressors.  It’s an overwhelming period where parents learn for the first time how to take care of another being that is utterly and completely dependent on them for survival.  That’s a lot to handle.  We all know that babies cry, and that sometimes they cry for long periods of time and we might not be able to understand why.  This crying, when compounded by sleep deprivation and any other type of new parent stressor, can seriously try a caregiver’s patience.  If that patience wears out, the result can be Shaken Baby Syndrome (SBS).  What is SBS?  SBS is a form of Abusive Head Trauma that occurs when a frustrated caregiver viciously shakes, slams, hits, or punches a child’s head, usually to stop them from crying or to get the child to respond to the expectations of the caregiver.  One of the scariest things about SBS is that there may be no outward or physical sign of the trauma, as the brain may incur the greatest amount of damage.  Another disturbing fact about SBS is that the shaking may appear to have the desired outcome: while the baby may cry more initially because of the shaking, he or she may then stop because their brain is damaged. An estimated 1,200 to 1,400 cases of SBS (and these are only those that are reported) occur in the United States each year.  One in four children will die from it, and those who survive will need medical and mental health attention throughout their lives.

Studies find that about 60% of victims of SBS are male, and that families who are living at or below the poverty level are at increased risk for this type of trauma.  It is also estimated that the perpetrators in 65%-90% of cases are males, more commonly the child’s father, stepfather, mother’s boyfriend, or caregiver, and the perpetrator is commonly in his mid twenties.  SBS is classified as a form of child abuse.  It is very unfortunate to learn these statistics, and it makes me wonder what type of circumstances influence them.  For families that have few resources and limited financial or social support, the stress level could be higher and education about the effects of SBS and other ways of coping with parental stress may be in short supply.  There is no excuse for any type of child abuse, however we have to look at all angles: often times, perpetrators of child abuse are victims of abuse themselves who, for a variety of reasons, do not know any other way of reacting. 

The lifelong effects that a victim if SBS will incur are devestating.  When a baby’s head is shaken and its neck muscles are not strong enough to withstand the strain, the child’s head rotates around its neck.  A violent movement such as this shakes the baby’s brain back and forth within its skull, possibly rupturing blood vessels and nerves throughout the brain and tearing brain tissue.  This can also cause bleeding and bruising to the brain.  If a baby’s head hit a solid object such as a bed frame, this may cause its brain to swell.  Signs of SBS can include: irritibility, lethargy, disrupted eating patterns, vomiting, seizures, failure to thrive, altered breathing, deformed pupils, and increased size of head.  This abuse is also fatal in some cases, with estimates ranging from 15%-38% mortality in infants.

What can we do to prevent Shaken Baby Syndrome?  Treatment needs to focus on the victims of this abuse, but also on the abusers.  Counseling and education for those who have shaken a baby can heal wounds in victim and perpetrator, and can possibly heal families.  We can help a perpetrator understand what else he or she can do when their baby is screaming and give them other options for responding.  The National Center on Shaken Baby Syndrome offers resources for victims and for parents who are stressed by their baby’s crying.  It helps parents understand what might be causing their child to cry, and gives them tools for soothing their child in healthy and nurturing ways.  There is no shame in reaching out for help if you or someone you know has shaken a baby.  It is possible to stop destructive behavior in the middle of its cycle, and there are many resources and counselors available to aid in this process.

Sex addiction: scapegoat or diagnosable mental health condition?

What is sex addiction? Is it a real mental health condition? Or is it a term used to make excuses or avoid accountability for indecent and rash behavior?  This issue is one that is often debated in the media as celebrities, sports players, and politicians have publicly ‘struggled’ with this condition (hello, Tiger Woods and David Duchovny), but there appears to be a lack of clinical research into the true symptoms of this potential disorder.  Sex addiction is not included in the current version of the Diagnostic and Statistical Manual (DSM), and has been rejected from inclusion in the DSM-V, coming out in 2012.  The closest indicator in current mental disorder classification would be “Sexual Disorders Not Otherwise Specified”, putting it closely with diagnosable conditions such as hypersexuality.

Sexual addition is a term used to describe the behavior of an individual who has an increasingly and unusually intense sex drive and an obsession with anything to do with sex.  Sex, suggestions, or thoughts about sex seem to dominate the thinking of a person who has this condition, and this makes it challenging for him or her to have meaningful and trustful relationships.  A sex addict may have disorted thoughts or take risks that can seem dangerous and out of character.  Clinicians see similarities between behaviors associated with sex addiction and behaviors linked with Obsessive Complusive Disorder, Narcissistic Personality Disorder, and manic-depression.  People who are linked to sex addiction can find it displays in various avenues: an addiction to pornography, masturbation, frequenting strip clubs and becoming linked to male and female dancers, and even more abstract displays such as exhibitionism.

Sex addiction is also described as “a progressive intimacy disorder characterized by compulsive acts and thoughts”, that over time can have detrimental affects on the person’s relationships and family.  Evidence towards classifying this as an addiction points to factors that sex addiction might have in common with other addictions: feeling out of control, feeling like you need a “fix” so that you can avoid feeling emotions and consequences that might surface if the addiction is not fed.  Some argue that, like alcohol and drugs, sex can become a source of numbing and relief for those that struggle with this disorder and can ease anxiety and stress.  As an eating disorder therapist, this brings up the question of: are we addicted to food in the same way?  Is an eating disorder an addiction?  Where does addiction draw the line, and what exactly defines an addiction?  This can be debated for hours in all avenues.

I think that sex addiction is so controversial and so difficult to discuss because it jumps directly to one of the most sensitive and special parts of a human relationship: intimacy.  Physical intimacy is linked to emotional intimacy, and both can be shattered in the event of a sex addiction.  Another controversial aspect of sex addiction surrounds the question of infidelity.  If a partner in a committed relationship is unfaithful, is sex addiction a forgivable offense?  Does the straying partner have control over his or her impulses, and might find that using sex addiction as a reason for the actions will bring less judgment and more hope for reconiliation?  Or, does a sex addict really feel out of control towards his or her behaviors in terms of addiction, and deserve to be treated as a person affected by a justifiable mental condition? 

The mental anguish experienced by a partner of someone with sexual addiction is intense and can feel almost unbearable.  It can bring up feelings of anger, denial, depression, and confusion about what is really going on.  Parnters may be able to recognize when their partner is in the “mind of his/her addiction”, sensing that their actions towards sexually related things shift them into a different state of mind and they “don’t recognize them”.  This may throw the whole relationship into a tailspin and cut off intimacy completely.  Being able to notice when the addiction is active could also help a couple heal as they work together to uncover the reasons and feelings behind the addiction.

I encourage anyone who might feel that he or she has a sex addiction or anyone who is a partner of someone with a sex addiction to seek help.  Individual therapy is a good place to start for each partner, as they can each explore their emotions and questions around the situation in a non-judgmental space;  couples therapy is imperative for the couple to come together in honesty and, hopefully, understanding.  As research into this condition continues, we hope to have more solid guidelines for sex addiction, leading possibly to more compassion towards this sensitive topic and treatment models that are effective.  Currently, there is Sex Addicts Anonymous, which is a group that sends the message: “a fellowship of recovering addicts, we offer the message of hope to anyone who suffers from a sexual addition”.