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Dying your hair

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Not having a Cell Phone

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Youth/underage drinking

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WHY DO ADOLESCENTS SAY THEY DRINK?

Adolescents say they drink for many of the same reasons as adults ( Dunn and Goldman, 1996). Alcohol-related expectancies are well formed by age 12, among drinkers as well as among those who have never consumed alcohol ( Christiansen et al., 1982; Jones et al., 2001). Although it is always difficult to know if individuals can accurately report the reasons for their behavior, including drinking (see Nisbett and Wilson, 1977), both adolescents and adults indicate that alcohol is an important ingredient in social interactions, allowing them to lower their inhibitions and feel more relaxed in social situations ( Jones et al., 2001; Wood et al., 1992). Other reasons given for drinking include reducing tension, fostering courage, reducing worry, increasing a sense of power, and causing cognitive and behavioral impairment ( Prendergast, 1994). In addition, most individuals assign some costs to drinking, as well, which are discussed later in this chapter.

According to models such as the theory of planned behavior ( Ajzen, 1991), social cognitive theory (e.g., Bandura, 1986), and alcohol expectancy theory (e.g., Goldman et al., 1991; Leigh, 1989), alcohol use can be largely explained by the alcohol-related expectancies for both positive and negative outcomes. Initiation and continuation of drinking, as well as the onset of problem drinking, are strongly and positively associated with expected benefits of drinking and negatively related to perceived negative expectancies ( Christiansen et al., 1989; Christiansen et al., 1982; Chen et al., 1994; Grube et al., 1995; Jones et al., 2001; Smith et al., 1995; Wood et al., 1992; Goldberg et al., 2002).

Although children's and adult's alcohol expectancies are similar ( Dunn and Goldman, 1996), younger children are more likely to report negative expectancies; perceptions of positive outcomes increase with age ( Miller et al., 1990; Goldberg et al., 2002). Specific expectancies also differ by age: 12- to 14-year-olds rank reduced tension and impaired behavioral functioning highest; 15- to 16-year-olds cite enhanced social and physical pleasure and modified social and emotional behavior; and 17- to 19-year-olds cite enhanced sexual performance and increased power as top alcohol expectancies ( Christiansen et al., 1982). There are also gender differences in alcohol expectations, with adolescent males perceiving more positive and fewer negative consequences of alcohol than do adolescent females. Although the relationship between quantity of alcohol use and social and physical outcomes was similar for adolescent males and females, the frequency of alcohol use may be associated with global positive effects, sexual enhancement, and pleasure for men, but reduced tension for women ( Jones et al., 2001).

DEVELOPMENTAL FACTORS

During adolescence, individuals are going through rapid physical, social, and cognitive changes. These enormous changes to body, friendship, and thinking about the world are juxtaposed against changing expectations for behavior and increases in need and opportunities for autonomy. The desire to be autonomous and to be granted more decision making opportunities increases with age ( Steinberg and Cauffman, 1996) and occurs in tandem with several other changes that serve to increase adolescents' desires for autonomy. First, the physical changes of puberty result in adolescents' seeing themselves as more deserving of adult-like privileges and opportunities to make decisions. In addition, as adolescents mature physically and develop secondary sex characteristics, they look older and are presumed to be able to take on more adult-like roles and responsibilities. Second, increased time spent with peers leads to more experiences and comparison of others' authority, power, and privileges. Third, cultural and societal beliefs suggest that adolescence is a time to practice adult roles. All of these factors serve to underscore the importance of autonomy from parents and push adolescents toward assuming more adult roles. In the United States, alcohol use is an important symbol of adult status.

The shift away from childhood and toward independence and adult roles is accompanied by a focus on peer acceptance and perceived norms in addition to parental standards. Adolescents need to develop their own sense of self or identity during this time, although expectations about the appropriate timing for increased autonomy during adolescence varies across cultures (e.g., Feldman and Rosenthal, 1990). Individuals adapt and modify their identities to enable them to function best in their particular social and cultural context ( Baumeister and Muraven, 1996). Adolescents may "try on" various identities that will be defined, in part, by how time is spent and with whom it is spent. While constructing an identity, an adolescent's motivation may be to gain new experiences that will allow them to evaluate what fits and what does not with their newly developing identities. This process allows them to create adult selves that are realistic and comfortable ( Curry et al., 1994). During this period, adolescents report having a "true self" (who they really are inside) and a "false self" (who they want other people to think they are, to impress or please them) ( Harter et al., 1996). At this point, adolescents may knowingly make choices that they know they may later regret "just to see what it is like," to act more like an adult, or to impress others (e.g., Moffit, 1993). Some of these choices are likely to involve alcohol consumption.

In order to understand the shifts that adolescents are undergoing, it is important to consider both changes in cognition and in the social world in which adolescents find themselves during this period.

Cognitive Changes

Cognitive changes during adolescence include gradual improvements in social perspective, to about age 16 ( Steinberg and Cauffman, 1996). These newfound perspective-taking skills allow an adolescent to recognize how the thoughts and actions of one person influence those of another and to imagine how others might perceive them. Although generally an indicator of greater maturity, a downside of this new ability is that adolescents are highly concerned with peer conformity, which may make them particularly susceptible to peer influence. The majority of studies indicate a positive relationship between susceptibility to peer pressure and risk-taking behavior (such as drinking). For reasons not yet known, there is variation in the extent to which adolescents succumb to social influence, including pressure to engage in behaviors that are undesirable (see Steinberg and Cauffman, 1996, for a review).

In general, thinking becomes more abstract and more future-oriented during adolescence, allowing adolescents to consider multiple aspects of any decision at one time, assess potential consequences of a decision, consider possible outcomes associated with various choices, and plan for the future. These cognitive changes enhance the adolescent's capacity for competent decision making (see, for example, Halpern-Felsher and Cauffman, 2001; Steinberg and Cauffman, 1996). However, these newly formed competencies are not always practiced when adolescents are confronted with real-world social situations. Many studies suggest that adolescents, as well as adults, may make less than optimal decisions when personal goals, beliefs, prior experience, values, social expectations, and emotions are added to the decision making equation ( Jacobs and Klaczynski, 2002). This outcome is especially true for social decisions (like choosing whether to drink or how much to drink). This is so for a variety of reasons.

First, outcomes of decisions in social situations are probabilistic, meaning that negative consequences of bad decisions may not occur and may not even be highly likely, although they are devastating if they do occur. For example, while the probability of having a car crash after drinking is much higher than after not drinking, drinking and driving does not always end in a crash or a ticket. Because outcomes are probabilistic, adolescents may interpret the fact that they previously drank too much and drove home without a crash as evidence that they can drink and drive safely ( Jacobs and Ganzel, 1994). In one study, older adolescents who had a lot of experience drinking and driving, but had not experienced a negative outcome, such as a traffic citation or crash, believed that they were in little danger of having an accident after drinking ( Finken et al., 1998), this result suggests that engaging in risky behaviors without consequence may have caused them to lower their perceptions of the risks of drinking and driving. Other correlational studies have shown that greater involvement in risk-taking behaviors was related to lower perceptions of personal risk (e.g., Halpern-Felsher and Cauffman, 2001; Goldberg et al., 2002). Second, the norms for social decisions are not typically known. Instead, individuals are often forced to make judgments on the basis of their own estimates of the norms of social behaviors or attitudes. This general dilemma, faced by people of all ages, is even more difficult for adolescents because they must make decisions based on a limited amount of experience and little feedback from earlier decisions ( Jacobs et al., 1995). Several studies indicate that most adolescents overestimate the number of others who drink alcohol (e.g., Basch et al., 1989; Jaccard and Turrisi, 1987). Not surprisingly, the overestimation is greatest for those individuals who drink. This same pattern has been found for other risk-taking and deviant behaviors (e.g., Benthin et al., 1993; Nucci et al., 1991), and it may be related to the fact that those who drink have friends who drink and so they begin to believe that everyone is drinking. In one longitudinal study, adolescents who spent time with peers who encouraged drinking later reported more positive views of drinkers ( Blanton et al., 1997).

In addition, studies indicate that adolescents make more biased estimates when they are reasoning about populations with greater variability and when they are reasoning about unfamiliar others ( Jacobs, 2004) Underage drinking and other forms of risk taking are likely to occur in social situations and when adolescents find themselves with large groups of unfamiliar peers. In these situations, they are left to estimate how others typically behave and what they think. The outcome may be overestimates of others' drinking and acceptance of such behavior, leading them to believe that the norm is to drink and that they should do it, too. However, providing adolescents with more realistic information about the extent to which people drink alcohol may not by itself reduce alcohol consumption. Instead, a focus on injunctive norms-views concerning what others think about one's drinking-might be more effective ( Cialdini et al., 1990; Kallgren et al., 2000; Prentice and Miller, 1993).

Social Situations

The social situations in which adolescents find themselves also change during this period. Indeed, movement toward autonomy is accompanied by real and perceived changes in the social world as adolescents mature. Most move from environments in which they are protected, scheduled, and dominated by adults into environments that are primarily populated with other adolescents and in which they actually have much more autonomy. On average, middle-class adolescents spend about 20 percent of their time with parents and other relatives, 25 percent of their time alone, and the rest with friends and classmates ( Csikszentmihalyi and Larson, 1984). Younger adolescents report that television and home- and family-centered activities fill much of their leisure time, but this shifts dramatically as they get older and report that peer-focused and solitary activities fill most of their time ( Larson and Kleiber, 1990). Thus, as adolescents get older, they spend greater periods of their leisure time away from adult supervision, increasing the opportunities for becoming involved in such risk-taking behaviors as drinking alcohol.

In addition to the actual changes in supervision, teens are much more focused on real or imagined peer norms. They are most likely to attend to the standards set by their friends than by another same-age group. The often reported, "peer pressure" is, in reality, "friend pressure." As adolescents get older, they are more likely to choose friends who share their tastes and interests than when they were younger. Thus, they are likely to join crowds of teens who have similar values and life-styles. Crowd membership has been associated with alcohol consumption: some crowds or groups include drinking as part of how they spend their time, and an adolescent's choice to be involved in that crowd will include the knowledge that drinking is a typical activity for that group ( Prinstein et al., 1996). For example, participation in competitive sports in high school has been related to higher rates of alcohol use ( Eccles and Barber, 1999).

Unfortunately, information about a particular group's norms may not be available until after an adolescent has had one or more experiences with the group and has been faced with situations in which saying "no" to alcohol will be viewed unfavorably by peers. Younger adolescents report having more trouble moving between crowds than older adolescents, so it may be more difficult for them to go against the norms of a crowd if they feel uncomfortable ( Brown et al., 1994).

INDIVIDUAL DIFFERENCES

Although we have concentrated on describing the normative changes that affect adolescents, there are clear individual differences in development as well, and some of these differences may be associated with higher alcohol consumption. These differences include personality, perceptions of risk, and self-efficacy, as well as gender and racial differences in adolescent alcohol consumption (noted in Chapter 2). Although numerous clinical studies indicate that individuals differ in their likelihood of experiencing alcohol dependency and related disorders ( Kessler et al., 1997; Swendsen et al., 2002), our focus in this chapter remains on nonclinical populations.

Personality Differences

Is there a personality profile that is related to adolescent risk for alcohol abuse? Cloninger (1991) found that three traits, present as early as age 10, were associated with alcoholism at age 28: (1) being easily bored and needing constant stimulation; (2) being driven to avoid negative consequence for actions; and (3) craving immediate external rewards for efforts. In addition, antisocial personality disorder has been linked to alcohol misuse among adolescents ( Clark et al., 1998). Similarly, a recent study of children aged 8 to 15 found that conduct disorder often predates and predicts later alcohol use ( Clark et al., 1998).

In nonclinical populations, a major personality characteristic that has been related to adolescent risk taking is sensation seeking, defined by seeking novel, complex, or risky situations ( Zuckerman, 1979). The appeal of drinking alcohol and other "forbidden" behaviors for adolescents may be the novel and intense sensations provided by the experiences ( Arnett and Balle-Jensen, 1993); students who have higher needs for sensation seeking are more likely to report higher levels of drinking, as well as other delinquent behaviors. Others have also reported associations between sensation seeking or novelty seeking and alcohol use (e.g., Martin et al., 2002). Donohew and colleagues (1999) argued that sensation seeking influences alcohol use indirectly, through peer affiliations: teens who are sensation seekers tend to choose friends with similar sensation seeking desires, and such peer group affiliations increase alcohol use.

Beliefs About Risk

Although many adults believe that adolescents underestimate the risks of engaging in particular behaviors, most research indicates that adults and adolescents actually give similar estimates of various types of risk taking, including drinking alcohol (e.g., Beyth-Marom et al., 1993; Quadrel et al., 1993). Although sweeping age differences in risk estimates have not typically been found ( Millstein and Halpern-Felsher, 2002), individuals' perceptions of risk vary, and their perceptions have been linked to their behaviors. In general, drinkers of all ages view consuming alcohol as less risky than nondrinkers ( Goldberg et al., 2002), although the absolute accuracy of various risk perceptions has been the topic of debate (e.g., Slovic, 2000). Although adolescents generally overestimate their mortality risks for a variety of activities including alcohol (e.g., Fischhoff et al., 2000), recent studies suggest that adolescents who perceive a higher likelihood of negative consequences following alcohol consumption do not drink at all or drink more moderately than others (e.g., Goldberg et al., 2002; Halpern-Felsher and Cauffman, 2001; Small et al., 1993.)

Both adults and adolescents tend to overestimate how many other people are involved in activities in which they, themselves, are engaged (e.g., Kruglanski, 1989). Indeed, adolescents as well as adults who participate in high-risk activities generally believe that the rate of participation by others is higher than do nonparticipants ( Benthin et al., 1993); thus, beliefs about normative practices may be related to older adolescents' decisions to engage in risky behaviors ( Basch et al., 1989; Beck and Treiman, 1996; Olds and Thombs, 2001). In one recent study, adolescents who reported higher levels of alcohol consumption and other risk-taking behavior than their peers overestimated how much other adolescents in their school were participating in the same high-risk behaviors ( Jacobs, 2000). Extreme overestimaters engaged in significantly more mild and severe deviant behaviors than either the moderate overestimaters or those whose estimates were correct, and they reported poorer self-esteem, lower grade point averages, and less rational decision-making skills. One of the most intriguing implications of the research focusing on individual differences is that some adolescents are more likely than others to perceive drinking as low risk, to overestimate the likelihood of others' drinking, and to look for sensation-seeking opportunities. This is the group that one would expect to drink the most and take the most risks when drinking.

Prior Experience

Although correlated with age, drinking experiences have a significant and independent effect on alcohol expectancies, which in turn play a role in alcohol use ( Christiansen et al., 1989; Christiansen et al., 1982; Chen et al., 1994; Grube et al., 1995; Jones et al., 2001; Smith et al., 1995; Wood et al., 1992; Goldberg et al., 2002). More specific expectancies, such as enhanced sexual feelings, power, and reduced tension have been reported by those with greater drinking experiences, while youth with little or no alcohol experiences have more global expectancies of increased pleasure ( Christiansen et al., 1982). As one gains more experience with alcohol, positive outcomes are reinforced and predict future drinking behaviors ( Goldberg et al., 2002; Jones et al., 2001). Furthermore, positive drinking-related expectancies increase and negative expectations for risks decrease among adolescents with more drinking experiences ( Halpern-Felsher et al., 2000; Goldberg et al., 2002).

Self-Efficacy

Drinking refusal self-efficacy, borrowed from Bandura's (1986, 1997) concept of general self-efficacy, refers to one's belief in her or his ability to resist urges or social pressures to drink, to drink in particular situations, or to consume large amounts of alcohol at one time. Adolescents with more positive self-efficacy are less likely to drink or drink excessively ( Oei et al., 1998; Webb and Baer, 1995), and those with fewer refusal skills are more likely to drink ( Hays and Ellickson, 1996). Refusal skills may be a better predictor of problem drinking than alcohol expectancies, especially for heavy or frequent alcohol use ( Connor et al., 2000; Oei et al., 1998). Given that adolescents are more susceptible to peer pressure, it stands to reason that they will have lower drinking refusal skills. However, there is evidence that adolescents can be taught drinking refusal self-efficacy skills and that such skills can then result in less substance use ( Bell et al., 1993; Ellickson et al., 1993).

CONTEXTUAL FACTORS

As noted in the previous chapter, the highest rate of both heavy drinking and frequent heavy drinking is found in young adults between the ages of 18 and 25. In addition, if adolescents between the ages of 14 and 20 drink alcohol, they are more likely to report heavy drinking than other drinking patterns ( National Household Survey on Drug Abuse, 2001). These findings suggest that there may be something about the context of youth drinking that results in this particular pattern of alcohol consumption. Indeed, macrolevel and microlevel contextual factors are likely to contribute to both the number of underage drinkers and their patterns of alcohol use.

Community

U.S. culture is replete with messages touting the attractions of alcohol use, and-notwithstanding the legal norm-suggesting that drinking is acceptable for people under 21. Recent content analyses indicate that alcohol use was depicted, typically in a positive light, in more than 70 percent of a sample of episodes in prime-time television programming in 1999 ( Christensen et al., 2000), and in more than 90 percent of the two hundred most popular movie rentals for 1996-1997 ( Roberts et al., 1999b). Roberts et al. (1999b) also found that 17 percent of the 1,000 of the most popular songs in 1996-1997 across five genres of music popular with youth contained alcohol references, including almost one-half of the rap music recordings. The alcohol industry spent $1.6 billion on advertising in 2001, and probably twice that much in other promotional activity. Young people are exposed to a steady stream of images and lyrics presenting alcohol use in an attractive light.

Within any country, the specific community environment may contribute to drinking to a greater or lesser extent. The drinking environment can be characterized as varying on a "wet-dry" continuum. A "wet" community environment is one in which drinking is prevalent and common, public opinion is generally tolerant or positive, and alcohol is readily available both commercially and at private social occasions and is advertised as available. A "dry" community would be one in which drinking at social occasions is not the norm and is generally frowned on, and alcohol outlets are relatively scarce. One commonly used statistical indicator for the "wetness" of the environment is the per capita consumption of alcohol (the average number of drinks per person) for the population age 14 and over per year. In the United States, for example, per capita consumption ranged from 1.3 gallons of ethanol per capita in Utah to 2.8 gallons in Wisconsin, in 1997; see Table 4-1.

To what extent do environmental factors influence individual drinking choices by youth? It is interesting in this regard to analyze trends in youth drinking over time. Based on their analysis of Monitoring the Future data for high school seniors, Cook and Moore (2001) report that the 30-day prevalence of drinking and also of heavy drinking peaked in 1979, and then declined by approximately one-third (30.6 and 37.5 percent, respectively), reaching a low point in 1993 and increasing only slightly since then. This downward trend is unrelated to demographic changes in the composition of the population of high-school seniors and cannot be fully explained by trends in prices, minimum drinking age, or availability ( Cook and Moore, 2001). However, this trend in drinking prevalence closely tracks the societal trend in drinking, as measured by national per capita consumption. Thus, whatever the reason for the decline in youth drinking during the 1980s, it seems to be related to, and perhaps in some sense is the result of, the overall decline in drinking in the society.

More persuasive evidence of the link between "wetness" and youth consumption comes from a study of individual drinking behavior. Cook and Moore (2001) analyzed data from the National Longitudinal Survey of Youth (NLSY) that included annual items on individual drinking for 1982-1985 and 1988-1989. The initial cohort of 12,000 respondents ranged in age from 17 to 24 at the beginning of this period in 1982, so that the NLSY data provide information on drinking trajectories for older teens and those in their twenties. They found that, even after controlling for family, religion, schooling, aspirations, employment, and cognitive ability, various aspects of the environment contributed significantly to patterns of drinking. Specifically, youth with similar backgrounds and individual characteristics were more likely to drink if they lived in a state with relatively high per capita consumption.

The minimum drinking age and the excise tax on beer are also related to youth drinking. Thus, an 18-year-old living in a state in which his drinking was legal in 1982 would have been more likely to drink (and to drink heavily) than an identical twin living in a state with a higher minimum drinking age. Increases in the beer tax (which has a direct effect on average price) generally tend to lower drinking, although it is harder to pin down with the NLSY data; however, other studies are quite consistent at documenting that taxes and prices influence youth drinking ( Chaloupka and Wechsler, 1996). This research suggests that a "wetter" environment may provide adolescents with more social occasions to drink, more positive attitudes about drinking, more advertising and outlets, and more lenient regulations concerning the sale and consumption of alcohol. In short, such environments have an enabling effect on underage drinking.

In addition to specific community norms for drinking, several other societal factors may affect the prevalence of heavy drinking in adolescence. First, U.S. society is largely segregated by age. As adolescents get older, they spend more and more time alone or with other peers in unsupervised settings, and both age-segregation and lack of adult supervision have been related to higher levels of substance abuse and deviance, including greater alcohol consumption. "Hanging out" with friends in unstructured, unsupervised contexts is generally related to negative outcomes, while spending time with others in adult-sanctioned, structured contexts is generally related to positive outcomes (e.g., Osgood, 1998; Osgood et al., 1996).

A particularly vulnerable time for youth is the after-school period, 3:00 to 6:00 p.m. This time is especially likely to be unsupervised as adolescents get older and parents believe that it is "safe" to leave them at home unattended. Youth who participate in after-school programs, such as sports, clubs, library-based activities, and youth-serving organizations are less likely to use alcohol than nonparticipants ( Eccles and Barber, 1999). The same point about age segregation and lack of supervision applies to adolescents' attendance at unchaperoned parties and other activities. It is not uncommon for caring parents to decide to host an all-night party with alcohol for their teenage children, taking the car keys from the guests as they arrive, on the theory that it is safer to allow drinking at home rather than to forbid it and have teens drink and drive. Individuals or organizations that host and support such events are providing opportunities that enable adolescents to drink to excess. Not surprisingly, having parents who sanction alcohol use (even in "controlled" settings) is related to heavier drinking among adolescents ( Barnes et al., 1995; Peterson et al., 1994).

By and large, adolescents are even segregated by age in the workplace. Adolescents who work for pay are often employed in fast-food and similar jobs in which most of their coworkers are other adolescents ( Mortimer et al., 1992). It is not uncommon for a 17-year-old to be managing a fast-food establishment and supervising 15- and 16-year-olds. Given this situation, it may not be surprising that part-time work during adolescence is positively related to involvement in drugs, alcohol, and other deviant behaviors (e.g., Bachman and Schulenberg, 1993; Greenberger and Steinberg, 1986; Steinberg et al., 1993).

The place in which adolescents are most segregated is likely to be at residential colleges. Although less than one-quarter of college students are in such settings, student-segregated apartments or college residence halls provide the conditions under which binge drinking is likely to occur: cultural norms that support drinking, little supervision by any adults, and peers who are likely to be heavily involved in drinking. In a recent study, Cook and Moore (2001) found support that college students are more likely to engage in drinking, especially heavy drinking, if they live in a dormitory than if they live off campus, even after controlling for other factors (such as age) that might explain this difference.

Social Setting

While adolescents are experiencing community-level influences related to the place of alcohol in our society, each adolescent is also making decisions about drinking within a particular social setting. Of particular importance with regard to social influences are adolescents' peers and friendship networks and their changing relationships with their parents. The effect of parents' and peers' alcohol consumption on adolescents' drinking patterns is both direct, through observation and modeling ( Bandura, 1986) and indirect, through its influence on alcohol-related expectancies and attitudes (see Kuther, 2002, for a review).

Peers

Adolescents in the United States spend approximately twice as much time with peers as they spend with parents or other adults. Accordingly, peers are a major source of socialization and development for adolescents. Research supports the notion that both selection and socialization factors contribute to observed similarities in behavior among friends. That is, adolescents are influenced by the normative behaviors of their peers and they choose peers who reinforce their own norms and values ( Kandel, 1978). The influences of peers are both direct and indirect ( Bauman et al., 1989; Biddle et al., 1980; Ennett and Bauman 1991; Pruitt et al., 1991; Kandel and Logen, 1984). That is, adolescents are influenced directly (e.g., by observing peers' behavior or by peer pressure) and indirectly (e.g., by their perceptions of the extent to which their friends are drinking alcohol). The combination of the normative aspect of alcohol use and peer influences on underage alcohol use is also important. Youth are well aware of the normative nature of alcohol use, and they usually want to go along with their peer group ( Aas and Klepp, 1992; Barnes et al., 1995; Beck and Treiman, 1996; Olds and Thombs, 2001). Perceived use of alcohol by one's peers and friends independently predicts self-reported alcohol use (e.g., Olds and Thombs, 2001; Reifman et al., 1998), with peers having a greater influence on adolescent drinking than do parents ( Kuther, 2002).

It should be noted, however, that interventions that attempt to prevent or reduce alcohol consumption by focusing on changing perceptions of social norms must proceed cautiously. Research conducted by Cialdini and colleagues ( Cialdini et al., 1990; Kallgren et al., 2000) points to the need to distinguish between descriptive norms (perceptions of what most others are doing) and injunctive norms (perception of what other people think one should be doing or not doing). Cialdini argues that focusing on injunctive norms is more effective at changing behavior than targeting only descriptive norms.

Parents

Although peers are one important influence on adolescents' choices, parents remain important during the teen years. Many adolescents report that they turn to their parents for advice regarding educational and career decisions, although they turn to their friends for advice about clothes and music ( Montemayor, 1982). Indeed, most theoretical perspectives today suggest that close connections to both parents and peers are related to easier transitions to independence (e.g., Allen and Hauser, 1996). Yet peer influences also depend in part on the quality of parent-child relationships ( Parke and Ladd, 1992). Adolescents who have positive relationships with their parents may be more likely to have friends who engage in socially valued activities than do adolescents with less positive parental interactions. Similarly, more involved parents may oversee and monitor their child's peer relationships more than do less involved parents, thereby reducing adolescents' engagement in undesired behaviors (see, for example, Fletcher et al., 1995). Parents also have a significant amount of influence on their children's choice of friends. Parents help shape prosocial and antisocial behavior, which leads children to gravitate toward particular crowds.

Parental monitoring and involvement are key components in reducing adolescent alcohol use. Monitoring of an adolescent's behavior involves the parent or guardian supervising the adolescent; knowing the adolescent's whereabouts; knowing the adolescent's friends and peers; setting expectations that are clear and optimally challenging; delivering consequences that are fair, affirming, and useful; and communicating with the adolescent ( Connell et al., 1995; Connell and Halpern-Felsher, 1997; Halpern-Felsher et al., 1997; Lee and Halpern-Felsher, 2001). Similarly, parental involvement is the extent to which parents show interest in, are knowledgeable about, and put effort into their child's activities and development. Both parental monitoring and involvement serve to prevent or reduce adolescents' health-compromising behaviors through the setting of curfews, awareness of and participation in after-school and weekend activities, prevention of adolescents' association with risky peers, and the improvement of social skills ( Beck and Lockhart, 1992; Cohen et al., 1994; Steinberg et al., 1994). Research on parental monitoring consistently shows protective effects on alcohol use ( Barnes et al., 2000; Bogenschneider et al., 1998; Reifman et al., 1998; DiClemente et al., 2001).

Families also provide an arena in which fledgling decision makers try their new skills and in which more experienced decision makers model appropriate behavior or even provide instruction on how to make decisions ( Jacobs and Ganzel, 1994). Learning to make decisions and live with their consequences and learn from them is an important developmental task that may be promoted or hindered by particular parenting practices. Although most parents give their adolescents increasing autonomy to make a wide range of decisions-in friendship, academics, extracurricular involvement, and consumer choices-many do so with little guidance or without letting adolescents experience the consequences of their actions. In addition, many parents provide an inconsistent pattern of restrictions and privileges (e.g., childlike restrictions about bedtime that don't match the adult privilege of driving the family car) that may lead adolescents to make choices that are aimed at rebelling against parental restrictions or that give them adult status (such as drinking alcohol).

Other aspects of parenting, such as parental norms and attitudes regarding adolescents' alcohol use and parents' own alcohol use, influence adolescent risk behavior. For example, Sieving and colleagues (2000) found that, in comparison with other variables, parent norms against underage drinking showed the strongest association with adolescents' abstention from alcohol use. In addition, parents, like other adults, may overestimate or underestimate drinking norms for adolescents, depending on their own experiences or their perceptions of societal norms. If parents believe that most adolescents drink, they may be more willing to "look the other way" when their children drink or to sponsor parties at which alcohol is served. Parents may benefit from knowing about other parents' practices and prohibitions concerning alcohol use by their children.

Parents' own alcohol use has also been linked to underage drinking (e.g., Pandina and Johnson, 1989), as well as to increased chance of experiencing alcohol-related negative consequences ( Pandina and Johnson, 1990). However, family history of alcohol abuse and alcoholism alone may not be adequate to predict drinking patterns among children of parents with such drinking behaviors. It is possible that other factors, such as parental monitoring, personality, and stress coping strategies, mediate between family history of alcohol use and underage drinking (e.g., Johnson and Pandina, 1993; Reifman et al., 1998).

Two studies have demonstrated that sibling alcohol use is a risk factor. Of particular interest is the study by McGue and colleagues (1996) that examined the effect of both parental and sibling alcohol use on both adoptive and biological children raised in the same families: while parental alcohol use only had an effect for the biological children, sibling use had an effect on both adoptive and biological children. The effect was stronger if the sibling was similar in age, gender, and ethnicity.

CONFLUENCE OF FACTORS

In this chapter we have listed many social, cognitive, and contextual factors that are related to the reasons that adolescents drink. In a culture that promotes alcohol use, it is impossible to isolate one factor as the primary cause. Rather, understanding why adolescents drink is more likely to be found in the confluence of factors. Positive aspects of the normal developmental process (e.g., enhanced cognitive abilities and physical maturation) are directly related to the greater autonomy and freedom from supervision enjoyed by adolescents. However, increases in autonomy lead to more opportunities to obtain and use alcohol. Likewise, normal adolescent development includes focusing on peers and searching for one's own identity and friendship niche; however, these normal developmental processes lead to trying risky behaviors and conforming to peer norms that often include alcohol use. Thus, the trends that are typically associated with healthy adolescent development also set the stage for increased opportunities for alcohol use. In addition, adolescents are coming of age in the United States are doing so in a culture that promotes and enables underage drinking.

There is little that one can change about the timetable of cognitive and emotional development or personality characteristics, but one can consider interventions for some of the factors that have been related to adolescent alcohol consumption and can be changed. The most likely targets are adolescent, parent, and community attitudes about the acceptance of underage drinking. Media and educational campaigns with this goal, however, must keep in mind many of the factors that have been reviewed in this chapter. For example, messages to adolescents must consider factors such as developmental level; the need to act adult-like, try on new identities, and make decisions with little experience; and adolescents' peer norms and biased reasoning about these norms.

Communications aimed at parents and others must provide realistic information about the prevalence of underage drinking and the dangers associated with it. In addition, adults must be given clear messages about what they may be doing to enable underage drinking and concrete examples of what they can do to convey their expectations to their children, monitor their children, and provide a community environment that discourages rather than promotes underage drinking.

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Adolescents in the United States grow up in a world filled with messages about alcohol (see Box 4-1 for select vignettes). Most of the messages present drinking in a positive light, and most of them show alcohol as a normal part of adult and teen social life.

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Cannibalism

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Chris Nease

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Unconnected to any utility lines, without a telephone or mail delivery, drawing water from a nearby spring, living in a cabin that is seven miles of dirt roads from the state highway, Rocky Richards and his wife, Deby, have been here in the backwoods of northern Idaho for eight years. The winters are brutal, and the muddy spring known as ''breakup'' is often even more trying.

That is how it is in pockets of the country that are ''off the grid,'' a way of living unfathomable to most Americans.

But if one thing can be said for such an arduous existence at a time of national crisis and anxiety, it is this: nobody living off the grid here can identify any way his or her life has changed since Sept. 11.

''I just can't say it's affected the way I go about the day,'' said Mr. Richards, 45, a lanky man with a scruffy beard and a blond ponytail who built his house here with his own hands. ''I know people are anxious in the cities, but I think we're not important enough to be a target.''

Such an odd consolation also occurs to Frank and Sharon Thiers, who have lived here at the foot of tamarack-covered Jasper Mountain since 1976, rearing five children after fleeing what they considered to be the unsafe streets of Sacramento. They do not worry about anthrax in the mailbox, because they have no mailbox, and they do not think anyone is likely to travel so far into the woods to poison their well. Mrs. Thiers said she might be afraid to get onto an airplane, but that was a moot point because she had not flown anywhere in 22 years.

Mrs. Thiers, 56, understands that the nation is at war with terrorists, and she grieves over what they have done on the East Coast. But, she said, she does not worry that terrorists are coming after her.

''They're going for the power structure,'' she said above the cacophony of the cat, 4 dogs, 30 chickens and assorted turkeys that share the property. ''Then I guess they're going for the lines of communication, the lines of supply. Then they'd try to wipe out the outlying areas. But really, we'd be last on the list.''

To live off the grid, as perhaps 2,000 or so people do in a woodsy swath of northern Idaho and western Montana, does not mean that these residents are completely unconnected to what is going on.

Though Mr. Richards and many others use solar panels to generate as much electricity as they can, it is rarely enough, so most have generators that run on gasoline, which makes them, like virtually all Americans, dependent on a national supply of oil. Most pick up mail from time to time in town, where they also go to stock up on food and other supplies. Nearly all have televisions or radios.

It is impossible to ascribe a single worldview to the people out here. Many resented that the news media become interested in their way of life and part of the world only when some ''nutball'' or ''loser loudmouth,'' to use their words, does something to command attention.

The most recent example was last spring when five children living near Sagle, about 17 miles east of here, staged a brief armed standoff with the local police who had come to rescue them from what the authorities described as deplorable living conditions. And the Western backwoods can provide a haven for a sociopath like Theodore J. Kaczynski, the Unabomber, who lived in a remote Montana cabin for years before he was captured there in 1996.

Randall C. Weaver, the survivalist whose wife and son were killed along with a federal agent during a siege in 1992, used to live in Ruby Ridge, only a few miles (as the crow flies) from the people outside Priest River. Mark Fuhrman, the Los Angeles police officer involved in the O. J. Simpson murder trial, moved to northern Idaho, where he started a local talk-radio program. James G. Gritz, a former Green Beret commando who is known as Bo, established a community called Almost Heaven, where he said patriots could gather to live in self-sufficiency and await Armageddon.

For years, a neo-Nazi group, the Aryan Nations, had its headquarters in Hayden Lake, about 40 miles south of here, until the group was forced to give up the property after being successfully sued by a woman and her son who were assaulted by guards at the compound. A philanthropist has since bought the property and plans to turn it into a center for human rights. The leader of the Aryan Nations, Richard G. Butler, 82, recently turned over power to a new leader, who, the authorities say, is looking to move the group's headquarters to rural Ohio or Pennsylvania.

But if racists, misanthropes and fugitives have come here looking for their own private Idaho, so have plenty of other people who say they bear no ill will toward anyone else, but simply like the solitude.

The Idaho panhandle, in particular, has attracted back-to-the-land enthusiasts who live in tepees or cabins and are often described here by locals as ''those 60's hippies.'' It has also drawn fundamentalist Christians who see it as an ideal place to raise families away from corrupting influences.

''I think we've done pretty well by ourselves,'' Mrs. Thiers said, speaking of her children. ''No drug addicts, no alcoholics; I have two who are born-again Christians; the others are, like, 'Mom, I don't have the time,' but they're all good kids. All three boys served their country,'' two in the Navy, one in the Army.

''There was nothing ever militant about us moving out here,'' said Mr. Richards, who is earning a living this month building wooden panels for a renovation of the Mangy Moose, a cafe in town.

Many of the residents do seem to be linked by a fierce attachment to the right to bear arms and say that the terrorist attacks validated their view.

''This seems to have knocked some intelligence into the anti-gun people,'' said Mary Olinger, 74, who has lived with her husband, Stan, for 21 years in a 720-square-foot cabin they built themselves. ''Why, even the pilots are saying they want guns now. People are realizing that it's all right to carry guns.''

The off-the-gridders come into town occasionally, sometimes picking up a local newspaper or a magazine to check on the latest news. But asked to say how they changed their routine after Attorney General John Ashcroft's warnings about terrorist attacks, they struggled to come up with an answer.

Mrs. Olinger was silent for several moments, then her face brightened a bit with a small nugget: she had written a letter to her daughter, who works in the optical department of a Sears store in Bellingham, Wash., near the Canadian border, to suggest that she stay away from the mall on Halloween.

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Off the Grid in Idaho, Life Is Unchanged by Crisis

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Lives of approximately 2,000 people who live 'off the grid' in backwoods of northern Idaho and western Montana remain unchanged by terrorist attacks of September 11 and anthrax outbreak; they are mostly self-sufficient and unconnected with what goes on elsewhere in country; photo (M)

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Michael Forbes

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Psychopathy is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility, among others.

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The Sovereign Citizen Movement

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Piercings and Tattoos (Kahleigha Harris)

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Piercings and Tattoos (Kahleigha Harris)

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https://www.sun-sentinel.com/health/fl-xpm-2010-01-30-sfl-body-art-012810-story.html

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Will legalization change social norms around 🤬?

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Will legalization change social norms around 🤬?

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Abbey Beck

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From a 1930s propaganda film calling it "the burning weed with its roots in hell" to massive companies such as Coca Cola and Molson now looking to cash in on the emerging marijuana market, attitudes towards the drug have shifted dramatically over the past century.

Those social norms are soon likely to change again as Canada prepares to become the second in the world to legalize recreational pot use next month.

"We need to have the discussion about how are we going to influence our society, not with the law and with administrative controls, but with our social norms," Mark Haden, a population professor at the University of British Columbia told CTV News as part of the "Going Green" series.

"We need to find a way that integrates cannabis while minimizing the harms for us."

Pot use in public

Even though pot won't be legal until Oct. 17, there are already more dispensaries than Tim Hortons restaurants in Vancouver, but that doesn't mean we're ready to accept open use.

"When you're walking downtown, you can smell it everywhere," one woman told CTV.

For now, laws will limit public marijuana use to accepted tobacco smoking areas, but will walking down the street with a joint ever be socially acceptable?

"We need to develop social norms around cannabis use (which) we haven't done yet. You don't walk down the street holding a beer. That is our social norm-unacceptable behaviour," Haden said.

"Public use will be frowned upon, should be frowned upon, but maybe you want to have some special areas such as beaches, concerts-so some outdoor use. Some public use is acceptable."

And with tight quarters in stratas, don't be surprised if residential smoking bylaws are strictly enforced.

Experts say that could lead to legislated exceptions such as Amsterdam-style coffee shops that allow marijuana use.

"There should be clubs where people can go to smoke it in facilities like cannabis use clubs, not that dissimilar from bars," Haden said. "You want to separate them out. You don't want cannabis use with alcohol."

Weed in the workplace

Most us wouldn't drink alcohol on the job, but will the same expectations apply when it comes to pot?

"It's definitely something employers are concerned about," employment lawyer Hilary Henley told CTV. "I think in some ways, it will be quite similar to alcohol."

But employers' concerns could extend beyond what happens during work hours.

"It depends what the concern of the employer is," Henley said. "If someone is talking about being a big fan of cannabis, an employer might be entitled to say, 'We're a conservative business and we have codes of conduct and your public social media is bringing a shroud of disrepute that could be an issue.'

"It's all about image and employers are always going to be looking to protect their image."

Some, however, say that once marijuana is legal, their bosses shouldn't have a say on their consumption.

"If my boss has a problem, I wouldn't want to work for someone like that," one man told CTV.

Ganga-tainment goes mainstream

Personal consumption aside, it seems likely that virtually all Canadians will be exposed to media and entertainment that normalizes marijuana use.

Netflix's "Cooking on High," for example, is being billed as "the first-even competitive cannabis cooking show."

And with companies such as Molson and Coca Cola looking to get into the soon-to-be-legal pot industry, TV and internet ads promoting cannabis products could soon be on their way too.

Haden said it's important to balance such commercialization with a public health approach that emphasizes safe, responsible use of the drug.

"I hope it isn't totally dominated by the commercial voice. I hope it isn't big money that comes in and moves and takes over," he said.

"I really hope the voice of public health is heard here, and the voice of public health is all about regulation and control and understanding how social norms do influence behaviour and how... we influence those is really the question we need to ask."

With files from CTV Vancouver's Penny Daflos

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Will legalization change social norms around marijuana?

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From a 1930s propaganda film calling it "the burning weed with its roots in hell" to massive companies such as Coca Cola and Molson now looking to cash in on the emerging marijuana market, attitudes towards the drug have shifted dramatically over the past century.

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(Samantha daniels)

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(Britney Geer)
https://ifstudies.org/blog/counterintuitive-trends-in-the-link-between-premarital-sex-and-marital-stability/
https://ifstudies.org/wp-content/uploads/2016/05/wolfinger-sex-partners-divorce-figure-1-1.png

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Facial piercings

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https://courses.lumenlearning.com/alamo-sociology/chapter/reading-theoretical-perspectives-on-sex/

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https://www.thespruce.com/etiquette-rules-of-defining-personal-space-1216625

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https://www.adl.org/education/resources/tools-and-strategies/10-ways-youth-can-engage-in-activism

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People who violate social norms fill us with disgust

Over 200 introductory psychology students at a large U.S. Midwestern university agree: People who don't have children are not only miserable, but deserving of our moral outrage. That is the result of a new study that found that deliberately not breeding makes you look like a bad person who lives a purposeless life devoid of real joy. Bonus finding: Men and women without kids were equally despised, proving that there is no gender limit to our disgust toward those who do not procreate as directed in the handbook Being a Correct Adult.

The study, published in Sex Roles, carries the torch of three decades of cited research that has consistently found that deliberate non-breeders (as opposed to the infertile, who get a pass) have always been disliked. Previous studies have found these rogues among us are rated less positively, are seen as being less psychologically fulfilled and are, in essence, maladjusted bastard people. (One exception: A 1983 study found that the only thing we hate more than a child-free person is a pregnant woman who is not happy about her pregnancy.)

The question then, isn't whether we hate people who don't want children, but why we hate them so much. Study author Leslie Ashburn-Nardo, an associate professor of psychology at Indiana University-Purdue University Indianapolis, set out to prove this based on a few hypotheses. Her theory is that because having children is such a powerful, strongly held norm - something we're conditioned to want from our own childhoods - that opting out violates the social code. (She cites Pew Research from 2010 saying that just one in five women in the U.S. will choose not to breed.)

Those who violate it face backlash just as women face backlash for being too aggressive, and men do for being too humble. The moral outrage this violation of the social code causes makes people think of the child-free as less happy. In other words, because most of us have kids, it's very difficult for us to imagine that everyone doesn't want them - and anyone who doesn't is probably miserable, the suckers.

To test the theory, she had the college students read one of four paragraphs about a fictitious former student, James or Jennifer, who had either no children or two children, under the guise that the study would be about testing intuition. The story read as follows:

James (Jennifer) lives in Columbus, Ohio. He (She) graduated from [name of university] with a degree in biology in December 2002. After graduating, he (she) worked as a pharmaceutical sales rep to pay back some student loans, but after a couple of years he (she) decided that career wasn't a good fit and investigated other options. In summer 2003, James (Jennifer) married his (her) college girlfriend (boyfriend). They decided to have no (two) children and when surveyed in 2005 they had stuck with this decision.

Students were then asked to predict how happy they thought these people were, with their marriages and lives overall, as well as their decision to have or not have children, or their likelihood of getting divorced. Then they ranked their disapproval, anger, outrage, annoyance and disgust toward these characters.

Ashburn-Nardo said in the study's press release that she believes the results - that the child-free were believed to have less fulfilling lives, and evoke disgust - demonstrate that we're so invested in the idea that one should procreate that anyone who doesn't is simply seen as wrong. "Having children is obviously a more typical decision, so perhaps people are rightfully surprised when they meet a married adult who, with their partner, has chosen to not have children," she explained. "That they are also outraged by child-free people is what's novel about this work."

Not only does this make people with children sound like smug assholes they are (though the study was conducted with young adults who have not yet procreated), it's also not great news for the child-free, who will likely feel the need to offer up more reasons why not having kids is just fine.

If my child-free lifestyle and preference causes "moral outrage" then SO BE IT pic.twitter.com/7CbrLsMW5o

- Nina Holzer 👻 (@NinaHolzerCLE) March 2, 2017

That cottage industry has already produced justification after justification from childless people - mostly women - defending themselves against charges of selfishness. (Though sometimes they take the reverse tack, admitting they are definitely selfish and wouldn't spoil their interesting lives for anything.)

Lately, though more men have begun to chime in with their reasons for opting out of fatherhood. They aren't that different from women's, and pretty much all center around wanting the kind of autonomy that children tend to derail ruthlessly - a perfectly reasonable desire.

Hating people who don't want kids is such a strange, short-sighted waste of perfectly good disgust. If the child-free were actually miserable, they could simply change their minds. That so many don't must mean they've figured something out. And while those of us who do have children may occasionally envy the child-free, it's hardly worth hating them. Save that for Comcast.

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The Real Reason Why Society Hates You If You Don't Have Kids | MEL Magazine

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People who violate social norms fill us with disgust Over 200 introductory psychology students at a large U.S. Midwestern university agree: People who don't have children are not only miserable, but deserving of our moral outrage.

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theft

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Kids before marriage

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Off-Grid Living: Disconnecting From The Beaten Path

By Loralie Pearce Last updated Nov 13, 2019

Off-grid living. Those words often conjure up visions of people like Grizzly Adams, living off the land in a one-room log cabin with their bear bestie Ben, completely cut off from civilization. For some, that sounds like heaven — for others, not so much. The beauty of off-grid living is that it can look like whatever you want it to look like, from a tiny house deep in the
woods to a dream home just off the beaten path — the sky’s the limit. Beards and bears are optional.

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Kneeling during the pledge of allegiance 

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Kneeling during the pledge of allegiance 

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-Michaela

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https://www.drugabuse.gov/publications/drugfacts/nationwide-trends

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https://www.riverfronttimes.com/newsblog/2010/01/14/new-study-heavily-tattooed-people-are-more-prone-to-deviant-behavior

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Amanda Echevarria

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No phones during a movie in a movie theater

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-Abi Southard

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-Buster Brown

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-Crystal Rieger

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See all the wonderful things Jonelle Graves has made

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Monogamy is still very much the norm in today's societies, but different types of romantic relationships are gaining ground. For this Spotlight feature, we have spoken to some polyamorous people and asked: What is fact and what is fiction about polyamorous relationships?

In most societies around the world, people dream of finding "the one" and forming a committed relationship with that one person - for life.

Movies and books are filled with "happily ever after" stories involving soulmates that were simply "made for each other."

Yet, over the past few decades, more and more people have been speaking out, saying that monogamy is not for them.

According to recent studies, approximately 4-5% of all adults in the United States have consensual nonmonogamous relationships.

One form of nonmonogamous practice that has been attracting attention in the media is polyamory. But what is polyamory, really, and how does it differ from other nonmonogamous practices?

Is it a dream come true, a way of "having your cake and eating it, too," as the saying goes? Or, is being in a polyamorous relationship really not that different from being in any other kind of relationship?

For this Spotlight feature, we have spoken to four polyamorous people, asking them about polyamory facts and misconceptions and about how this lifestyle works for them.

When speaking to polyamorous people about how they would define polyamory, the same reaction came up over and over again.
"It's probably the hardest [question] to answer," one interviewee, Ella, said. Another, Sebastian, exclaimed, "quite a hard question, to be honest!"
The difficulty comes from the fact that polyamorous relationships can take various forms. They can be hierarchical, with one partner being the "primary" partner, or nonhierarchical, in which all partners have equal standing.

Moreover, a person could be in separate relationships with different partners or in a relationship in which all or several partners are also romantically engaged with each other.

Yet, there is usually a common theme, when it comes to defining the notion of polyamory. Christian Klesse, Ph.D., a researcher and lecturer at Manchester Metropolitan University, in the United Kingdom, specializes in sexualities. Klesse explains this conundrum in a paper that features in the journal Sexualities.
"Polyamory it is a contested term. Its concrete meanings have been an issue of ongoing debate," Klesse writes. However, he continues, "Love is central to the discourses on polyamory, [which] is clearly revealed in an analysis of the etymological roots of the term."
Indeed, the word "polyamory" comes from the Greek root "poly," meaning "many," and the Latin root "amor," meaning "love." Quite literally, it means "many loves" - being romantically involved with multiple people at the same time.

Despite noting how hard it was to define polyamory, this was actually what all the polyamorous people who spoke with us said: Polyamory is about spreading the love.

"It's a lifestyle where, essentially, I am not confined to the things that everyone else is confined [to] in relationships. The way that I see it [...] is that you have multiple loving relationships with multiple people at the same time," said Ella.

"For me, it's about doing stuff that I think a lot of people want to do anyway, but it's a kind of honest and ethical way of doing so," Mary told us. At the moment, she said, she happens to only have one partner. But the framework of a polyamorous relationship would allow her to also become involved with other people:

"Even though I do only have the one partner at the moment, I could have others, and that wouldn't be a sign that there's anything wrong with me. It would just be an opportunity to increase the amount of love and pleasure that you get in life."

The polyamorous people who spoke with us also agreed on another issue: the main misconception that non-polyamorous individuals tend to have about this practice.

Polyamory is not just about having more sex, and it is not a creative form of cheating on one's partner.

"Many people mistake polyamorous relationships for open relationships," Jim told us. So what's the difference between the two, really?
He explained: "An open relationship allows its partners to pursue nonserious sexual and romantic relationships with people outside the relationship. However, open relationships share with monogamous relationships the obligation to not pursue any serious romantic relationships with other people."
By contrast, polyamorous people often - though not always - start seeing different people with a view of pursuing a meaningful romantic relationship with them. Sex can be part of the deal, but it is not usually the focus.

"People don't really understand what [polyamory] means. [...] A lot of people call it an 'open relationship.' A lot of people think that it's just a [single] one-on-one emotional relationship with an open sexual element, which isn't really true for [my polyamorous relationship] - that's not how we do it," Sebastian told us.

Another common misconception is that polyamory is a creative form of cheating on a stable partner. Mary, who is in a relationship with a person who already had a romantic partner when he started seeing her, told us that she often encounters this stereotype.

"Sometimes I'll chat to people about [polyamory, and] even people I'm quite close to [...] they'll make little jokes like, 'Oh, no wonder [your polyamorous partner] is having an affair.' And it's like... no, that's not really it," she told us.

"No one is cheating," Ella also said, when pointing out common misconceptions that she encounters about polyamory. "The idea is that we're all open and honest and that we follow a moral code that [we agreed on within our relationship]."

Are all people "secretly" polyamorous, but just unwilling to admit that this is how they would prefer to lead their romantic lives? Mary thought not. She said, "Some people, I think, can get quite evangelical about [polyamory] and say, 'Oh, everybody's [polyamorous],' and I think that's not the case at all."

And yet, what kind of a person do you have to be in order to practice polyamory? And how do you get into it?

Some of the individuals who spoke to Medical News Today said that they had known for years that their natural inclination was to be in love with several people at once.

"I actually realized [I was polyamorous] very, very early on - I was 13, 14. But I didn't have a framework [...] or a concept for it until I was 21," Ella told us. Mary, too, said that she had been interested in polyamory for years before she entered into her first polyamorous relationship.

But others said that they had never considered that polyamory was an option for them until they just... accidentally fell into it.

"Although I know that some people get something of a 'eureka moment' when they discover polyamory for themselves, that hasn't been the case with me. I'm not sure why I'm polyamorous. It's probably because many of my close friends are, which made me curious about it," Jim told MNT.

Something similar happened to Sebastian, who explained: "I met someone who was already involved with that [scene] [...] so I kind of fell into the scene, really. As I started to do it, I realized it was completely normal to me, [and that] it felt quite natural."

He also noted that this came as a complete surprise to his friends, who had perceived him as being quite a conventional person:

"My best friend [was] quite surprised. I think his exact words were: 'Sebastian, you're the last person I would expect to do that!'"

Although people who practice polyamory may not have any magical superpowers, sometimes it may seem as if they do. Healthy polyamorous relationships are based on good time management skills and great communication, according to the people who spoke to MNT.

Polyamory can involve a lot of tight scheduling, and this can be a challenge.

For one, the partners in a polyamorous relationship have to be great at explaining what their expectations, needs, and limits are and at checking in emotionally with their partners at every step of the way.

Different types of polyamorous relationships, therefore, come with different sets of rules, depending on the needs of the romantic partners.

Ella also noted that, early on in her life as a polyamorous partner, she had to learn to fully understand where any negative emotions, such as jealousy, might come from.

By doing so, she said, she came to understand that not all negative emotions were, in their essence, related to aspects of her relationship. Moreover, this allowed her to find better coping strategies for such emotions.

"I've had to face anxiety and jealousy and whatever difficult feelings that might come with [knowing that my partner is on a date with someone else]," Ella told us.

"I've experienced the fact that [my primary partner] has dated and has seen people, and I've had to confront the fact that I was home on my own while my boyfriend is out there seeing someone who they may or may not end up having sex with that night, " she continued.

Ella explained that she worked to understand what she was feeling in the moment and why she was feeling that way. She acknowledged:

"I am someone who doesn't like to be alone [...] and I was noticing that that was the thing that I was getting stressed out about the most. [I realized] that this is not, in fact, related to polyamory. It's not the fact that he's seeing someone, it's just the fact that I'm alone right now, and that's something that I can fix."

Indeed, the issue of jealousy seemed to come up time and again for other polyamorous people, too. Mary told us that she had experienced jealousy when thinking about her partner being with someone else and that this is an emotion that she still sometimes reckons with.

Sebastian, instead, told us that jealousy has not really been an issue for him because his partner is great at continually showing him that she cares about him and his feelings.
As for time management, both Ella and Mary agreed that this can be one of the most challenging aspects of maintaining polyamorous relationships.
Ella, in particular, noted that this could sometimes be a source of worry. Currently, she is in two separate relationships with two different polyamorous men, but her relationships are hierarchical: She has a primary and a secondary partner, which means, among other things, that she dedicates a set - and distinct - amount of time to each.

While she said that this has worked well for them so far, she explained that she could well imagine a situation in which time might become even more difficult to negotiate.

"The thing that I've found more challenging is if I've reached my quota [of time with my secondary partner] and my secondary partner is having a difficult time for some reason [...] like, imagine [that one of his family members has] died, then that's something that I would like to be there for him, for a prolonged period of time," Ella told us.

And, she continued: "What if that happens? Am I going to have to neglect [my primary partner] for like a week or two?"

Despite these challenges, there seems to be an overarching sentiment that polyamory is worth the effort, purely for the amount of love and support that goes around among the partners.

"I'm living my best life," Ella told us.

Disclaimer: We have changed the names of all the interviewees featured in this article to protect their identities.

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What polyamorous people want you to know about polyamory

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Monogamy is still very much the norm in today's societies, but different types of romantic relationships are gaining ground. For this Spotlight feature, we have spoken to some polyamorous people and asked: What is fact and what is fiction about polyamorous relationships?

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Living together before marriage

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"Some couples move in together without really having a plan for their relationship, and they can 'wind up' getting married even though they may not have if they hadn't been living together," she says. Which in turn leads to a lower degree of marital satisfaction and a higher risk of divorce.
Read: The age of 'shotgun cohabitation'
But as Justin Lehmiller, a sex researcher at the Kinsey Institute and the author of the book Tell Me What You Want, says, there might be more to the scholarly controversy over cohabitation than just disagreements about methodology or analysis.

"It's not just that we're talking about different outcomes; we're talking about using the same data and showing different outcomes," he told me. It comes down to: "Whose judgment do we trust more?"

One reason Lehmiller thinks premarital cohabitation may be controversial among researchers is because the practice is controversial in general. It has historically been culturally frowned upon-it is, after all, an unapologetic signal to the outside world that premarital sex is being had in a particular household. In many places, that stigma lingers today, which could give the studies linking it to unsuccessful marriages some staying power.

"Popular beliefs tend to die hard, even in the face of evidence that might disconfirm them," Lehmiller said. "Some people might want to believe certain things about the impact of living together before marriage, maybe stemming from religious or moral beliefs."

But Rhoades pushed back on the suggestion that some bias toward confirming researchers' own beliefs may be at work. "In general that can be true in psychology and in sociology; any scientific field, I think that can happen," she said. "But because there's such heated debate, I would bet that good researchers are extra careful about what they wind up publishing."

As researchers move toward a more nuanced understanding of what cohabitation means for the future of unmarried romantic partners, several factors urgently need to be considered, according to the experts I spoke with. Lehmiller said studies of cohabitation should start working with data sets that include same-sex couples and move away from equating the stability of a marriage with its success. "Some people have views about marriage that would lead them to stay in one even if it's not satisfying," he said. In other words, just because a marriage lasts doesn't necessarily mean it's the best outcome for either party.

Rhoades, though, believes that research should acknowledge the many simultaneous ways marriage itself is changing versus just couples' living situations before they tie the knot. As the average age of when Americans marry rises, so does the average number of Americans' sexual partners before marrying. People are simply experiencing more before committing to one partner for life, she said, and expectations of the institution are shifting accordingly. As the research on what makes people get married and stay married matures, it's important for researchers to think about all those premarital experiences as having an aggregate impact on marriages and families. "Cohabitation is just one part of it," she said. "There's a larger landscape for us to be considering."

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Ashley Fetters is a writer based in New Jersey, and a former staff writer at The Atlantic.

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So Is Living Together Before Marriage Linked to Divorce or What?

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"Some couples move in together without really having a plan for their relationship, and they can 'wind up' getting married even though they may not have if they hadn't been living together," she says. Which in turn leads to a lower degree of marital satisfaction and a higher risk of divorce.

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https://prezi.com/p/4ib2vc1b9ncz/social-deviance

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Addiction

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https://books.google.com/books?id=oEVmQXgFA0IC&lpg=PA154&ots=mO4WE8exj5&dq=social%20deviance%20and%20depression&lr&pg=PA154#v=onepage&q=social%20deviance%20and%20depression&f=false

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This is a great source to better understand deviancy!!

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The word connotes odd or unacceptable behavior, but in the sociological sense of the word, deviance is simply any violation of society's norms. Deviance can range from something minor, such as a traffic violation, to something major, such as murder.

Each society defines what is deviant and what is not, and definitions of deviance differ widely between societies. For example, some societies have much more stringent rules regarding gender roles than we have in the United States, and still other societies' rules governing gender roles are less stringent than ours.

Relativism and Deviance

Deviance is a relative issue, and standards for deviance change based on a number of factors, including the following:

Location: A person speaking loudly during a church service would probably be considered deviant, whereas a person speaking loudly at a party would not. Society generally regards taking the life of another person to be a deviant act, but during wartime, killing another person is not considered deviant.

Age: A five-year-old can cry in a supermarket without being considered deviant, but an older child or an adult cannot.

Social status: A famous actor can skip to the front of a long line of people waiting to get into a popular club, but a nonfamous person would be considered deviant for trying to do the same.

Individual societies: In the United States, customers in department stores do not try to negotiate prices or barter for goods. In some other countries, people understand that one should haggle over the price of an item;not to do so is considered deviant.

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The word connotes odd or unacceptable behavior, but in the sociological sense of the word, deviance is simply any violation of society's norms. Deviance can range from something minor, such as a traffic violation, to something major, such as murder. Each society defines what is deviant and what is not, and definitions of deviance differ widely between societies.

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Non-Suicidal Self-Injury (aka self harm)

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Non-Suicidal Self-Injury (aka self harm)

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https://www.med.upenn.edu/psychotherapy/newsletter_selfinjury.html

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Drug Abuse

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Males painting their nails/wearing makeup 

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Males painting their nails/wearing makeup 

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Edward Martinez

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'My Five Wives': A Different Look at Modern Polygamy

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http://lotusstudy.com/30367/

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Deviant behavior could be as simple as wearing Gothic clothing or formal deviance being something horrible such as 🤬.

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Should couples live together before they get married? If you ask people this question, they often have strong beliefs, one way or the other. Religious views aside, what can relationship science tell us about the pros and cons of pre-marital cohabitation?
First the Facts: How Common is Cohabitation?
Cohabitation (i.e., living together in a sexual relationship before marriage) is an increasingly common trend in United States. Today, most heterosexual couples live together before marriage. A survey of over 12,000 heterosexual women aged 15-44 between 2006 and 2010 showed that approximately half (48 percent) of women cohabitate prior to their first marriage (Copen, Daniels, & Mosher, 2013). This number is up from 34 percent in 1995.

In addition to frequency, the average cohabitation duration has increased. These days, the typical length of cohabitation has grown from 13 months in 1995 to an average of 22 months. Tracking cohabitating couples revealed that three years out, 32 percent were still cohabiting, 40 percent had transitioned to marriage, and 27 percent had dissolved (Copen et al., 2013).
Relationship Outcomes
Concerns about pre-marital cohabitation may be legit. Substantial evidence associates cohabitation with negative relationship outcomes. Pre-marital cohabitation is viewed as a risk factor for divorce as it predicts later marital instability, poorer marriage quality, and less relationship satisfaction (Kamp, Dush, Cohan, & Amato, 2003; Stanley et al., 2004). Compared to married couples, cohabiting couples argue more, have more trouble resolving conflicts, are more insecure about their partners' feelings, and have more problems related to their future goals (Hsueh, Rhabar, Morrison, & Doss, 2009). These findings are concerning for couples considering pre-marital cohabitation, but a closer look shows a much more complicated picture.
Why Do People Cohabitate Before Marriage?
First, why do people cohabitate? Turns out, unmarried couples have very different motivations for living together. For most people (61.2 percent), the number one reason to cohabitate is quite positive: they want to spend more time with the person they're dating (Rhoades, Stanley, & Markman, 2009a). Others cite that cohabitation makes financial sense (18.5 percent), that they want to test out the relationship (14.3 percent), or that they don't believe in the institute of marriage (6 percent).

Cohabitating out of convenience (i.e., expired leases; financial sense) or to test a relationship can lead to problems down the road. In the former case, women tend to perceive the couple as having less relationship confidence and less dedication. In the testing situation, both men and women report more negative interactions, more psychological aggression, and less relationship confidence, adjustment, and dedication (Rhoades et al., 2009a). Such evidence suggests that differences in why people are cohabiting may be driving some of the associations between cohabitation and poorer relationship outcomes.
The Inertia Effect
Cohabitation is recognized as a strong predictor of marriage, in part because of the inertia effect (Stanley, Rhoades, & Markman, 2006). Once a couple cohabitates, a momentum towards marriage begins and it's more difficult to break up because of the greater investment. The inertia effect is problematic when it drives a couple that would otherwise not have married, to become married.

Maybe this is why married men who cohabited before marriage are less dedicated to their wives than married men who did not first cohabitate (Stanley, Whitton, & Markman, 2004).

The inertia effect is only relevant to cohabiters who are not already engaged prior to cohabitation. Compared to those who are engaged before living together, those who aren't are less satisfied in the relationships, report less relationship dedication, and less relationship confidence (Rhoades et al., 2009b). Interestingly, both engaged and non-engaged cohabiting couples tend to report less relationship dedication, less relationship confidence, and more negative communication compared to those who wait to live together until marriage.
Types of Cohabiting Couples
It's hard to imagine that the relationship troubles associated with living together before marriage are universal for all cohabitating couples. So how to do we make sense of the patterns? Willoughby and colleagues (2012) chose to examine differences among cohabitating couples. They sorted couples into types based on 1) whether the couples were engaged or not, and 2) whether couple members agreed on their trajectory towards marriage.

The resulting categories of cohabiters were:

1. Incongruent engaged cohabiters (47 percent). This category describes couples who are engaged but in disagreement over how quickly they're moving towards marriage.

2. Engaged cohabiters moving fast (13 percent). These cohabiters are engaged and in agreement that they are on the fast track towards marriage.

3. Engaged cohabiters moving slow (12 percent). They may be engaged, but they agree they are not moving quickly towards a wedding day.

4. Incongruent non-engaged cohabiters (20 percent). These individuals are not engaged and they differ in their views on the relationship's future, i.e., if and when they will get married.

5. Non-engaged cohabiters without marital plans (6 percent). As the name suggests, this group of cohabiters are in agreement that they have no plans in the work for marriage and do not necessary view cohabitation as a path towards marriage.

How happy and successful are the relationships defined by these categories? In general, being a fast or slow moving engaged couple predicted the highest relationship satisfaction. The couples with the least happiness and satisfaction were the incongruent engaged cohabiters and the incongruent non-engaged cohabiters.

Further, the non-engaged cohabiters without plans for marriage had the most doubts about their relationship stability, but it was the incongruent groups (engaged or non-engaged) that seemed to have the most relationship problems. Meanwhile, Incongruent non-engaged cohabiters, as well as the non-engaged cohabiters without marital plans, tended to report less positive communication patterns. Finally, the engaged cohabiters moving fast and the engaged cohabiters moving slow reported the least relationship conflict, not surprising since they also reported a high degree of relationship satisfaction (Willoughby et al., 2012).
In Sum
So, in sum, what do we know about cohabitation? Is it a good idea?

As in most cases, the answer depends on the couple, but evidence points to a few patterns. First, we need to consider couples' motivations for living together before marriage. Are they wanting to spend more time together, or are they unsure of the relationship and want to test it? Second, couples who cohabitate seem to be most successful when they've already committed to each other. Engaged couples who live together before marriage are not subject to the slippery slope of the inertia effect, which pushes two people who might otherwise not marry, to marry. The inertia effect may explain the heightened divorce rates associated with premarital cohabitation.
Follow me on Twitter for relationship related research articles, updates, and more.

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The transition from dating to marriage often includes a period of pre-marital cohabition, but is living together a smart choice for dating couples? A nuanced look at the literature reveals important information for individuals wondering if this is the right "next step."

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Centers for Disease Control and Prevention

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Children and adolescents who do not get enough sleep have a higher risk for many health and behavior problems. Learn how much sleep students need and how many are not getting it.
Importance of Sleep

Children and adolescents who do not get enough sleep have a higher risk of obesity, diabetes, injuries, poor mental health, and problems with attention and behavior. ¹⁻⁴

How much sleep someone needs depends on their age. The American Academy of Sleep Medicine has recommended that children aged 6-12 years should regularly sleep 9-12 hours per 24 hours and teenagers aged 13-18 years should sleep 8-10 hours per 24 hours. ¹

Students who get enough sleep may have fewer attention and behavior problems.

Are Students Getting Enough Sleep?

CDC analyzed data from the 2015 national and state Youth Risk Behavior Surveys. 5 Students were asked how much sleep they usually got on school nights. Students who were 6 to 12 years old and who reported sleeping less than 9 hours were considered to not get enough sleep. Teenagers aged 13 to 18 years who reported sleeping less than 8 hours also were considered to not get enough sleep.
Middle school students (grades 6-8)

Students in 9 states were included in the study

About 6 out of 10 (57.8%) did not get enough sleep on school nights

High school students (grades 9-12)

National sample

About 7 out of 10 (72.7%) did not get enough sleep on school nights

Help Your Child Get the Sleep They Need

Parents can support good sleep habits such as:

Sticking to a consistent sleep schedule during the school week and weekends. This means going to bed at the same time each night and getting up at the same time each morning. Adolescents whose parents set bedtimes are more likely to get enough sleep.⁶ To help decide on a good bedtime for your child, go to the Bedtime Calculator.External

Limiting light exposure and technology use in the evenings.

Parents can limit when their children may use electronic devices (sometimes referred to as a "media curfew").

Parents can limit where their children may use electronic devices (for example, not in their child's bedroom).

Other tips for better sleep are available at CDC's Tips for Better Sleep.

1. Paruthi S, Brooks LJ, D'Ambrosio C, et al. Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. J Clin Sleep Med 2016;12:1549-61.

2. Owens J; Adolescent Sleep Working Group; Committee on Adolescence. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics 2014;134:e921-32.

3. Lowry R, Eaton DK, Foti K, McKnight-Eily L, Perry G, Galuska DA. Association of sleep duration with obesity among US high school students. J Obes 2012;2012:476914.

4. Fitzgerald CT, Messias E, Buysse DJ. Teen sleep and suicidality: results from the Youth Risk Behavior Surveys of 2007 and 2009. J Clin Sleep Med 2011;7:351-6.

5. Wheaton AG, Everett Jones S, Cooper AC, Croft JB. Short sleep duration among middle school and high school students - United States, 2015. MMWR Morb Mortal Wkly Rep 2018;67:85-90.

6. Short MA, Gradisar M, Lack LC, et al. A cross-cultural comparison of sleep duration between US and Australian adolescents: the effect of school start time, parent-set bedtimes, and extracurricular load. Health Educ Behav 2013;40:323-30.

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Children and adolescents who do not get enough sleep have a higher risk for many health and behavior problems. Learn how much sleep students need and how many are not getting it. Children and adolescents who do not get enough sleep have a higher risk of obesity, diabetes, injuries, poor mental health, and problems with attention and behavior.

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Anxiety is a natural emotion. However, it can also cause physical symptoms, such as shaking and sweating. Anxiety disorders can affect daily life and can improve with treatment.

Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry.

This article discusses the symptoms, causes, and treatments for anxiety.

According to the Anxiety and Depression Association of America (ADAA), around 40 million people in the United States have an anxiety disorder. It is the most common group of mental illnesses in the country. However, only 36.9% of people with an anxiety disorder receive treatment.

The American Psychological Association (APA) defines anxiety as "an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure."

Knowing the difference between typical feelings of anxiety and an anxiety disorder requiring medical attention can help a person identify and treat the condition.

Learn more about anxiety in our dedicated hub.

Anxiety and anxiety disorders

Anxiety is a complex response to real or perceived threats. It can involve cognitive, physical, and behavioral changes.

Real or perceived danger causes a rush of adrenaline, a hormone and chemical messenger in the brain, which in turn triggers these anxiety reactions in a process called the fight-or-flight response. Some people may experience this response in difficult social situations or around important events or decisions.

The duration or severity of feelings of anxiety can sometimes be out of proportion to the original trigger or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. These responses move beyond anxiety into an anxiety disorder.

Once anxiety reaches the stage of a disorder, it can interfere with daily function.

Learn more about anxiety disorders here.

The Diagnostic and Statistical Manual of Mental Health Disorders: 5th Edition, text revision (DSM-5-TR) classifies anxiety disorders into several main types.

In previous editions of the DSM-5-TR, anxiety disorders included obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), as well as acute stress disorder. However, the manual no longer groups these mental health difficulties under anxiety.

Anxiety disorders now include the following:

GAD

This chronic disorder involves excessive, long lasting anxiety and worries about nonspecific life events, objects, and situations. GAD is the most common anxiety disorder, and people with it are not always able to identify the cause of their anxiety.
Learn more about GAD here.
Panic disorder

Brief or sudden attacks of intense terror and apprehension characterize panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly.

Panic disorders usually occur after frightening experiences or prolonged stress but may also occur without a trigger.
Learn about panic disorder and panic attacks here.
Specific phobia

This is a fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause.

A person with a phobia might acknowledge fear as illogical or extreme but remain unable to control feelings of anxiety around the trigger. Triggers for a phobia range from situations and animals to everyday objects.
Learn more about phobias and how they develop here.
Agoraphobia

This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or where help would not be available in emergencies.

People often misunderstand this condition as a phobia of open spaces and the outdoors. A person with agoraphobia may fear leaving home or using elevators and public transport.
Learn more about agoraphobia here.
Selective mutism

Some children experience this form of anxiety, in which they cannot speak in certain places or contexts, even though they may have excellent verbal communication skills around familiar people.
Learn more about selective mutism in adults and children here.
Social anxiety disorder

This is a fear of adverse judgment from others in social situations or of public embarrassment. Social anxiety disorder includes a range of feelings, such as stage fright, a fear of intimacy, and anxiety around humiliation and rejection.
Learn more about social anxiety disorder.
Separation anxiety disorder

High anxiety levels after separation from a person or place that provides feelings of security or safety characterize separation anxiety disorder. Separation anxiety is most common in young children but can affect people of all ages.

Learn all about separation anxiety in adults here.

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.

Possible causes include:

environmental stressors, such as relationship problems or family issues

genetics

medical factors, such as disease symptoms or the effects of a medication

substance withdrawal

Learn more about anxiety and how it affects the body here.

Treatment often consists of psychotherapy, behavioral therapy, and medication.

Sometimes, alcohol dependence, depression, or other underlying conditions require treatment before treating an anxiety disorder can take place.

Self-treatment

Sometimes, a person can treat an anxiety disorder at home without clinical supervision. However, this may not be effective for severe or long-term anxiety disorders.

There are several exercises and actions to help a person cope with milder, more focused, or shorter-term anxiety disorders, including:
Learn about some other ways to treat anxiety naturally.
Counseling

A standard way of treating anxiety is psychological counseling. This can include cognitive behavioral therapy (CBT), psychotherapy, or a combination of therapies.

CBT is a type of psychotherapy that aims to recognize and change harmful thought patterns that form the foundation of anxious and troublesome feelings.
Learn more about different types of therapy here.
Medications

A person can support anxiety management with several types of medication.

Medicines that might control some physical and mental symptoms include antidepressants, benzodiazepines, and tricyclic antidepressants.

Benzodiazepines: A doctor may prescribe these for certain people with anxiety, but they can cause addiction. Diazepam, or Valium, is a common benzodiazepine.

Antidepressants: These commonly help with anxiety, even though they also target depression. Serotonin reuptake inhibitors (SSRIs), fluoxetine, and citalopram are examples.

Tricyclic antidepressants: These are an older class of drugs that benefit most anxiety disorders other than obsessive-compulsive disorder (OCD). Imipramine and clomipramine are two examples of tricyclics.

Additional drugs a person might use to treat anxiety include:

Seek medical advice if the adverse effects of any prescribed medications become severe.
Learn more about anxiety medications here.
There are ways to reduce the risk of anxiety disorders. Remember that anxious feelings are a natural factor of daily life, and experiencing them does not always indicate the presence of a mental health disorder.

People may benefit from the following:
Learn about some foods that can help prevent anxiety.
Anxiety is not a medical condition but a natural emotion that is vital for survival when an individual faces danger.

An anxiety disorder develops when this reaction becomes exaggerated or out-of-proportion to the trigger that causes it. There are several types of anxiety disorders, including panic disorder, phobias, and social anxiety.

Treatment involves a combination of therapy, medication, and counseling alongside self-help measures.

An active lifestyle with a balanced diet can help keep anxious emotions within healthy limits.

Read the article in Spanish.

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Anxiety: Symptoms, types, causes, prevention, and treatment

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Anxiety is a normal emotion that causes increased alertness, fear, and physical signs, such as a rapid heart rate. Read on to learn more.

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Homosexuality is considered a social deviance.

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Homosexuality is considered a social deviance.

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Deviance is a behavior that does not adhere to social norms, for that reason is socially created. Given that many people in the United States believe that homosexuality is incorrect, society has created homosexuality to be a deviance. Given that deviance is relative and not outright to a society, homosexuality is not a universal form of sexual deviance. There are numerous cultures that accept forms of homosexuality. The Western society is not accepting of it however, and sometimes this non-accepting view cause discrimination towards homosexuals.

Is homosexuality a method for some people to deviate, or is it simply the way some people need to live their lives? If that is the way of living for some people than society needs to become accepting towards this lifestyle.

Homosexuals are a minority given that they differ from the accepted sexual preference. They end up being things of discrimination and contempt. A few of societies anti-homosexual mindsets come from homophobia. Homophobia is "the irrational fears of homosexuality in others, the worry of homosexual feelings within oneself, or self-loathing due to the fact that of one's homosexuality.

It stems from ignorance and popular misconceptions that generate homosexual bias"(Crooks 255). Homophobia is expressed in many methods, both subtle and direct.

Telling jokes about queers, belittling their way of life, denying them housing, employment, membership into organizations, and engaging in violence versus homosexuals. Heterosexuals also reveal homophobia by preventing acts that would cause individuals to think they were gay. It affects men the most like this due to the fact that it prevents male friendships. Guys do not want to get too close to their male friends, or express feelings due to the fact that they might be considered gay. Homophobia limits the lives of both gay and straight people.

Laws against homosexual behaviors have been very punitive. In the American colonies homosexuals were put to death by burning or drowning. Sodomy, which is oral or anal sex, was against the law in the United States until 1961. Illinois became the first state to repeal the sodomy laws. Now only 13 states continue to have sodomy laws. Even though these laws apply to all segments of the population, they are usually enforced against homosexual men. " Sodomy laws are used to harass homosexuals, especially gay men, because women in general and lesbians in particular are socially invisible in society"(Eitzen 304). An example of the injustice of sodomy laws is the case of Matthew Leeman. He has been sentanced to 17 years in prison under Kansas State sodomy laws. The details of the case are 18 year old Leeman was convicted of giving a 15 year old boy consensual oral sex due to violation of the state's sodomy laws.

In Kansas sex with any minor is illegal, but there is also a Romeo and Juliet law that states sex with a minor is less of an offense if there is little age difference. Therefore if Leeman had given consensual oral sex to a 15 year old girl he would have received a 12 month sentance. But under the sodomy laws all same sex activities are illegal regardless of age, so the Romeo and Juliet exception does not apply to him. The case was appealed all the way to the Kansas State Supreme Court with the ruling upheld. So 18 year old Matthew Leeman will be in jail until he is 36 years old. The Supreme Court has upheld the right of states to prohibit sodomy in the case Bowers v. Hardwick in 1986. Recently the Supreme Court has decided it will revisit the issue of whether states can continue to prosecute homosexual men for having consensual sex in their homes.

A descion is expected in June of 2003. Bars where homosexuals frequent are often raided by the police and many are arrested under the sodomy laws. This practice makes it difficult for homosexuals when they apply for jobs. Applications for employment ask if a person has a criminal record. Since some gays have records for violation sodomy laws, they must write it on their application. Both these offenses, having a record and being gay, makes employment less likely.

Homosexuals, especially males, are highly discriminated against in activities considered to be super manly. Up until recently a person could not be gay in the military. Homosexuals were honorably discharged from the military. In 1993 President Clinton attempted to change this tradition. He received much opposition from politicians, citizens and the military. The result was a compromise, a don't ask, don't tell rule. This meant that the military personal was not to inquire about sexual preference, and that service members were not to be blatant about their sexual orientation. Another macho activity is sports. Gay men in sport have not been accepted. " There is much at stake in maintaining the silence about gay men in sports and in discouraging gay male athletes from revealing their identities"(Coakley 234).

To even talk about homosexuals in sports would threaten the system of gender classification. The fact is though there are homosexuals in sports and they are discriminated against. In the locker room athletes use anti- gay banter as part of daily life. Homosexuals in sports live in fear of the truth about their sexuality coming out. Although recently studies have shown that organized sports are becoming less homophobic. People in sports are becoming more tolerant of homosexuals. But the value of a homosexual athlete is of core importance. " Gay athletes with high human capital are much more likely to come out of the closet to their teams than are gay athletes with medium or low human capital"(Anderson 12). As homosexuals are slowly accepted by society, the gender lines that inhibit so many will slowly be erased.

Another way homosexuals are discriminated against is through family rights. No State in America allows marriage between members of the same sex. Aside from the emotional benefits, there are legal benefits that come with marriage. Health insurance coverage, inheritance of property, and tax benefits are just a few advantages that come with a legally recognized relationship. Parenthood is another aspect of life that homosexuals are disadvantaged. The rights of gay parents are usually denied. When two people divorce it is most often the mother that gains more custody. "However if the mother is an acknowledged lesbian, this may jeopardize her claim to custody"(Crooks 266).

A homosexual man has an even harder time gaining custody, because he has a double disadvantage. Many gay couples are also denied the right to adopt children; in some states it is even illegal. Some lesbian couples have children through artificial insemination. The problem with this is that only the mother of the child is legally recognized as the parent. There are only eight states that "second-parent adoptions by lesbians and gays have been approved in California, Oregon, Alaska, Washington, New York, New Jersey, Massachusetts, and Washington D.C."(Strong 356). Being homosexual should not prohibit people from raising a legally recognized family.

There are two ways that homosexuals deal with living in a hostile society. The first is to conceal their sexual preference from the world. When they are in the straight world they act heterosexual, and only within the confines of privacy do they act gay. The second strategy is to be a gay liberationist. Instead of keeping their sexuality a secret, they are openly gay at all times. They challenge societal norms in hopes that there will be a change in attitudes. Gay liberationist rose about in the early 1970s, after an event that took place earlier. On June 28, 1969, the police raided Stonewall Inn, a gay hangout. Instead of dispersing as usual, the customers rioted. This incident drew a lot of needed attention to problems of police harassment that homosexuals faced. "In effect Stonewall resistance came to symbolize the birth of the modern gay rights movement"(Eitzen 312).

Since Stonewall there have been many positive changes for gay rights. Now there are laws to protect the rights of homosexuals, where as before they had no laws protecting them. More and more people are coming out of the closet and are proud to be gay (A). As time continues homosexual rights will become stronger. This will only happen with the help of heterosexuals. Education is very important in the fight for gay rights. People must be informed that homosexuality is not a disease, or a sin; it is just the way of life for some people.

Homosexuals are not monsters who should be put to death. Homosexuality has been around since before the written word, and each society deals with it differently. Our own society is not accepting of it. These are just humans who have a different sexual preferences than the members of normal society. Homosexuals have relationships, families, and even children, most of which are happy and healthy. They do things heterosexuals do such as serve in the armed forces and play sports. Yet society discriminates against them, even to the point of violence. Even though gay activists have made some difference in how society views their lifestyles, it is not enough. There needs to be more of a change. We as society should be more accepting of these people. If not we are the ones being deviant, with our policies of discrimination and harassment.

Work Cited.

Anderson, Eric. Openly Gay Athletes: Dealing with hegemonic Masculinity

And Homophobia. University of California

Coakley, Jay. "Sport in Society: Issues and Controversies" 7th ed.

Boston: McGrawHill, 2001.

Crooks, Robert. Our Sexuality. 6th ed. Pacific Grove: Brooks and Cole, 1996.

Curtan, Jim. "Gay Liberation=Spiritual Liberation." Genre 81 (2000): 74.

Eitzen, D. Stanley. Social Problems. 7th ed. Boston: Allyn and Bacon, 1997.

Strong, Bryan. The Marriage and Family Experience, Intimate Relationships in a

Changing Society. 7th ed. Belmont: Wadsworth, 1998.

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Homosexuality as a Deviance: Discrimination In Society

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Deviance is a behavior that does not adhere to social norms, for that reason is socially created. Given that many people in the United States believe that homosexuality is incorrect, society has created homosexuality to be a deviance. Given that deviance is relative and not outright to a society, homosexuality is not a universal form of sexual deviance.

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Homosexuality is considered a social deviance.

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Homosexuality is considered a social deviance.

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I reposted this because I forgot to sign in last time..oops haha.

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Deviance is a behavior that does not adhere to social norms, for that reason is socially created. Given that many people in the United States believe that homosexuality is incorrect, society has created homosexuality to be a deviance. Given that deviance is relative and not outright to a society, homosexuality is not a universal form of sexual deviance. There are numerous cultures that accept forms of homosexuality. The Western society is not accepting of it however, and sometimes this non-accepting view cause discrimination towards homosexuals.

Is homosexuality a method for some people to deviate, or is it simply the way some people need to live their lives? If that is the way of living for some people than society needs to become accepting towards this lifestyle.

Homosexuals are a minority given that they differ from the accepted sexual preference. They end up being things of discrimination and contempt. A few of societies anti-homosexual mindsets come from homophobia. Homophobia is "the irrational fears of homosexuality in others, the worry of homosexual feelings within oneself, or self-loathing due to the fact that of one's homosexuality.

It stems from ignorance and popular misconceptions that generate homosexual bias"(Crooks 255). Homophobia is expressed in many methods, both subtle and direct.

Telling jokes about queers, belittling their way of life, denying them housing, employment, membership into organizations, and engaging in violence versus homosexuals. Heterosexuals also reveal homophobia by preventing acts that would cause individuals to think they were gay. It affects men the most like this due to the fact that it prevents male friendships. Guys do not want to get too close to their male friends, or express feelings due to the fact that they might be considered gay. Homophobia limits the lives of both gay and straight people.

Laws against homosexual behaviors have been very punitive. In the American colonies homosexuals were put to death by burning or drowning. Sodomy, which is oral or anal sex, was against the law in the United States until 1961. Illinois became the first state to repeal the sodomy laws. Now only 13 states continue to have sodomy laws. Even though these laws apply to all segments of the population, they are usually enforced against homosexual men. " Sodomy laws are used to harass homosexuals, especially gay men, because women in general and lesbians in particular are socially invisible in society"(Eitzen 304). An example of the injustice of sodomy laws is the case of Matthew Leeman. He has been sentanced to 17 years in prison under Kansas State sodomy laws. The details of the case are 18 year old Leeman was convicted of giving a 15 year old boy consensual oral sex due to violation of the state's sodomy laws.

In Kansas sex with any minor is illegal, but there is also a Romeo and Juliet law that states sex with a minor is less of an offense if there is little age difference. Therefore if Leeman had given consensual oral sex to a 15 year old girl he would have received a 12 month sentance. But under the sodomy laws all same sex activities are illegal regardless of age, so the Romeo and Juliet exception does not apply to him. The case was appealed all the way to the Kansas State Supreme Court with the ruling upheld. So 18 year old Matthew Leeman will be in jail until he is 36 years old. The Supreme Court has upheld the right of states to prohibit sodomy in the case Bowers v. Hardwick in 1986. Recently the Supreme Court has decided it will revisit the issue of whether states can continue to prosecute homosexual men for having consensual sex in their homes.

A descion is expected in June of 2003. Bars where homosexuals frequent are often raided by the police and many are arrested under the sodomy laws. This practice makes it difficult for homosexuals when they apply for jobs. Applications for employment ask if a person has a criminal record. Since some gays have records for violation sodomy laws, they must write it on their application. Both these offenses, having a record and being gay, makes employment less likely.

Homosexuals, especially males, are highly discriminated against in activities considered to be super manly. Up until recently a person could not be gay in the military. Homosexuals were honorably discharged from the military. In 1993 President Clinton attempted to change this tradition. He received much opposition from politicians, citizens and the military. The result was a compromise, a don't ask, don't tell rule. This meant that the military personal was not to inquire about sexual preference, and that service members were not to be blatant about their sexual orientation. Another macho activity is sports. Gay men in sport have not been accepted. " There is much at stake in maintaining the silence about gay men in sports and in discouraging gay male athletes from revealing their identities"(Coakley 234).

To even talk about homosexuals in sports would threaten the system of gender classification. The fact is though there are homosexuals in sports and they are discriminated against. In the locker room athletes use anti- gay banter as part of daily life. Homosexuals in sports live in fear of the truth about their sexuality coming out. Although recently studies have shown that organized sports are becoming less homophobic. People in sports are becoming more tolerant of homosexuals. But the value of a homosexual athlete is of core importance. " Gay athletes with high human capital are much more likely to come out of the closet to their teams than are gay athletes with medium or low human capital"(Anderson 12). As homosexuals are slowly accepted by society, the gender lines that inhibit so many will slowly be erased.

Another way homosexuals are discriminated against is through family rights. No State in America allows marriage between members of the same sex. Aside from the emotional benefits, there are legal benefits that come with marriage. Health insurance coverage, inheritance of property, and tax benefits are just a few advantages that come with a legally recognized relationship. Parenthood is another aspect of life that homosexuals are disadvantaged. The rights of gay parents are usually denied. When two people divorce it is most often the mother that gains more custody. "However if the mother is an acknowledged lesbian, this may jeopardize her claim to custody"(Crooks 266).

A homosexual man has an even harder time gaining custody, because he has a double disadvantage. Many gay couples are also denied the right to adopt children; in some states it is even illegal. Some lesbian couples have children through artificial insemination. The problem with this is that only the mother of the child is legally recognized as the parent. There are only eight states that "second-parent adoptions by lesbians and gays have been approved in California, Oregon, Alaska, Washington, New York, New Jersey, Massachusetts, and Washington D.C."(Strong 356). Being homosexual should not prohibit people from raising a legally recognized family.

There are two ways that homosexuals deal with living in a hostile society. The first is to conceal their sexual preference from the world. When they are in the straight world they act heterosexual, and only within the confines of privacy do they act gay. The second strategy is to be a gay liberationist. Instead of keeping their sexuality a secret, they are openly gay at all times. They challenge societal norms in hopes that there will be a change in attitudes. Gay liberationist rose about in the early 1970s, after an event that took place earlier. On June 28, 1969, the police raided Stonewall Inn, a gay hangout. Instead of dispersing as usual, the customers rioted. This incident drew a lot of needed attention to problems of police harassment that homosexuals faced. "In effect Stonewall resistance came to symbolize the birth of the modern gay rights movement"(Eitzen 312).

Since Stonewall there have been many positive changes for gay rights. Now there are laws to protect the rights of homosexuals, where as before they had no laws protecting them. More and more people are coming out of the closet and are proud to be gay (A). As time continues homosexual rights will become stronger. This will only happen with the help of heterosexuals. Education is very important in the fight for gay rights. People must be informed that homosexuality is not a disease, or a sin; it is just the way of life for some people.

Homosexuals are not monsters who should be put to death. Homosexuality has been around since before the written word, and each society deals with it differently. Our own society is not accepting of it. These are just humans who have a different sexual preferences than the members of normal society. Homosexuals have relationships, families, and even children, most of which are happy and healthy. They do things heterosexuals do such as serve in the armed forces and play sports. Yet society discriminates against them, even to the point of violence. Even though gay activists have made some difference in how society views their lifestyles, it is not enough. There needs to be more of a change. We as society should be more accepting of these people. If not we are the ones being deviant, with our policies of discrimination and harassment.

Work Cited.

Anderson, Eric. Openly Gay Athletes: Dealing with hegemonic Masculinity

And Homophobia. University of California

Coakley, Jay. "Sport in Society: Issues and Controversies" 7th ed.

Boston: McGrawHill, 2001.

Crooks, Robert. Our Sexuality. 6th ed. Pacific Grove: Brooks and Cole, 1996.

Curtan, Jim. "Gay Liberation=Spiritual Liberation." Genre 81 (2000): 74.

Eitzen, D. Stanley. Social Problems. 7th ed. Boston: Allyn and Bacon, 1997.

Strong, Bryan. The Marriage and Family Experience, Intimate Relationships in a

Changing Society. 7th ed. Belmont: Wadsworth, 1998.

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Homosexuality as a Deviance: Discrimination In Society

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Deviance is a behavior that does not adhere to social norms, for that reason is socially created. Given that many people in the United States believe that homosexuality is incorrect, society has created homosexuality to be a deviance. Given that deviance is relative and not outright to a society, homosexuality is not a universal form of sexual deviance.

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Plastic surgery, body modifications are very common but could be considered deviant

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https://www.taylorfrancis.com/books/e/9781315744858/chapters/10.4324/9781315744858-20

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Not letting my children celebrate Halloween.

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Not letting my children celebrate Halloween.

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https://www.crosswalk.com/special-coverage/halloween/why-we-dont-celebrate-halloween.html

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Being a "sex worker" stripper, cam girl, 🤬 star, etc.

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Being a "sex worker" stripper, cam girl, 🤬 star, etc.

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Liking to cosplay in more rural communities

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Liking to cosplay in more rural communities

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Carola is a disability advocate with many years of experience working in the disability community. She is also a freelance writer.

As a freelance writer and disability advocate, I scan international news headlines for the latest trends and info in the disability world. You would think that in this day and age, the media would be enlightened in their portrayals of people with disabilities, but many are still not.

The media seems to genuinely believe that they are doing a good thing by praising and singling out people with disabilities; however, they are often reinforcing negative and demeaning attitudes towards disability. This practice contributes to current stereotypes and stigma. While the media may be well-intended in most cases, sometimes the language that is used in the headlines and the articles depict people with disabilities as objects of pity, lesser beings, out of the norm, limited, or extraordinary heroes.

Bad News for Disabled People: How the newspapers are reporting disability, a report by the Strathclyde Centre for Disability Research in the UK, identified that the media is covering people with disabilities more than ever. Some stories detail the day to day lives of disabilities, educating the public and decreasing myths and stigma. Many stories, however, are intended to be "feel good" articles about overcoming adversity, being exceptional, or being an "inspiration" to others. Some stories to be saying: "Look how bad this poor disabled person's life is and feel better about yourself."

While reading or covering stories about disabilities, here of some things that the media should know when writing these articles, and the public should know before sharing these types of stories on social media.

Facts Disabled People Want the Media to Know

Disabled People Do Not Want To Be Objects Of Pity

Here are some examples of problematic headlines:

"Holidays made brighter for the deaf and hard of hearing children"

"Child suffering from muscular dystrophy gets a heartwarming surprise"

"Local boy with cerebral palsy gets wish granted"

"Stolen adapted van replaced by local charity in touching act of kindness"

The media loves to feature "poor" disabled people who were robbed and then reimbursed. In one way, letting the public know alerts people who can help replace whatever has been stolen, on the other, it can set people with disabilities up as objects of pity. The poor little cripple lost his van or special bike so a community or organization must swoop in to rescue them.

Disabled people do not want people to feel sorry for them, and find pity to be condescending. Instead, they want to be seen as competent individuals who are equal to others.

Disabled People Are Not "Held Back" By Their Condition

Headlines:

"Intellectual disabilities don't hold back these athletes"

"Student with Asperger's syndrome thrives beyond circumstances"

These headlines suggest that people are normally held back by their disabilities. Stories like this imply that anything that disabled people achieve is miraculous and an exception to the rule. What does that say about disabled people who do not seem to be in a state of overcoming perceived barriers? Disabled people want to be seen as being able to accomplish anything they strive to do, whether it be in education, success in the workplace, or other areas.

Disabled People Are not "Limited" By Their Condition

Headlines:

"Woman overcomes Down Syndrome to become a model"

"Woman swims 1 million yards despite suffering from multiple sclerosis"

"I can't move or speak but I am happy"

Another assumption is that their condition limits them and that any accomplishment they have is extraordinary enough to be newsworthy. People with disabilities may have to do some things differently, but are not necessarily limited because of their condition.

Disabled people are not poor and deprived

Headlines:

"People with mental illness must choose between food and medication"

"Funding cuts hitting people with disabilities"

It is good that the media is highlighting government inequities, funding cuts, and abuses of government assistance, however, the media must be careful not to stereotype all people with disabilities as helpless disability benefits recipients. Many disabled people are out in the workforce or self-employed, and are not affected by government decisions.

Disabled People Do Not Want to be Inspirational

Headlines:

"Selfless youngster battling cerebral palsy completes charity walk"

"Amputee overcomes incredible odds"

Many disabled people do not want to be put on a pedestal, told they are heroes, and lauded just because they live with a disability.

The late advocate Stella Young has said this attitude creates the assumption that disability is a bad thing and living with it makes people exceptional. She pointed out that people with disabilities are living normal lives just like the rest of us.

Disabled people are not suffering or battling their condition

Headline:

"Woman suffering from spina bifida receives community award"

The media seems to assume that disability equals suffering and constant struggle. Many disabled people, however, are often not in pain or a state of suffering and do not struggle against their condition. They may face certain challenges or need help in some daily living tasks, but that does not mean that they are battling difficulties.

Disabled people are not evil

Headline:

"Florida mass killer was mentally ill, court told"

Sometimes people with disabilities are vilified, especially those with mental illness. This kind of story perpetuates the misconception that the mentally ill are all violent. Numerous research studies have found that this myth is not true and that people with mental illness are more likely to be victims of violence than to be violent themselves.

Concluding Thoughts

Overall the main message in these statements is that people with disabilities want to be treated as equals. They do not want people to feel sorry for them and regard them as helpless. The disabled also do not want to be put on a pedestal or seen as heroes. The media should keep the views of people with disabilities in mind when writing stories about them. The public should also consider these views when sharing stories about disabled people on social media.

This content is accurate and true to the best of the author's knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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What People With Disabilities Want the Public and the Media to Know

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Carola is a disability advocate with many years of experience working in the disability community. She is also a freelance writer. As a freelance writer and disability advocate, I scan international news headlines for the latest trends and info in the disability world.

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Specifically BPD, for self-destructive and suicidal tendencies.

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Borderline Personality Disorder and Emotion Dysregulation

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Abstract

Background

Childhood maltreatment, such as severe emotional, physical, and sexual abuse and neglect, has been linked to impulse control problems and dysfunctional emotional coping. In borderline personality disorder (BPD), a history of childhood maltreatment may worsen difficulties in emotion regulation, which may in turn give rise to impulsive behaviours. The aim of this self-report study was to investigate associations between childhood maltreatment severity, emotion regulation difficulties, and impulsivity in women with BPD compared to healthy and clinical controls.

Methods

Sixty-one female patients with BPD, 57 clinical controls (CC, women with Attention Deficit Hyperactivity Disorder and/or Substance Use Disorder, without BPD), and 60 female healthy controls (HC) completed self-report scales on childhood trauma (Childhood Trauma Questionnaire, CTQ), difficulties in emotion regulation (Difficulties in Emotion Regulation Scale, DERS), and impulsivity (UPPS Impulsive Behaviour Scale). A conditional process analysis was performed to investigate whether emotion dysregulation statistically mediated the effect of childhood maltreatment severity on impulsivity depending on group (BPD vs. CC vs. HC).

Results

Childhood maltreatment, particularly emotional maltreatment, was positively associated with impulsivity and emotion regulation difficulties across all groups. Difficulties in emotion regulation statistically mediated the effect of childhood maltreatment on impulsivity in BPD, but not in the other groups.

Conclusion

In the context of current conceptualizations of BPD and previous research, findings suggest that problems with emotion regulation may be related to a history of childhood maltreatment, which may in turn enhance impulsivity. Targeting emotion dysregulation in psychotherapy and discussing it in relation to childhood maltreatment can help decreasing impulsive behaviors in individuals with BPD. Given the correlational design of our study which does not allow causal conclusions, future studies have to employ prospective, experimental designs and include larger sample sizes to corroborate associations between childhood maltreatment, emotion dysregulation, and impulsivity.

Introduction

Borderline personality disorder (BPD) is a severe mental disorder, characterized by a pervasive pattern of instability in affect, cognition (i.e., self-image), interpersonal relationships, and impulsive behaviour [ 1].

One risk factor for the development of BPD is severe childhood maltreatment, such as emotional, physical, and sexual abuse, and neglect [ 2, 14, 15, 16, 17, 18, 19, 20, 21]. Current conceptualizations of BPD propose that an interplay of genetic, neurobiological dispositions (e.g., increased affective sensitivity and reactivity) and stressful / traumatic life events hinders the acquisition of functional/adaptive emotional coping mechanisms, resulting in a pervasive form of emotion dysregulation, which is believed to be at the core of the disorder [ 7, 27]. The biosocial therory by Linehan [ 27] particularly emphasizes the role of an invalidating (e.g., abusive, neglectful, unstable) environment in the development of emotion dysregulation and impulsivity [ 2].

Specifically, this theory proposes that difficulties in emotion regulation, stemming from childhood adversities, lead to an increased use of impulsive coping strategies that help down-regulating negative emotions, i.e., that impulsivity is mainly occurring as a response to stress [ 2]. In line with this, there is growing evidence that deficits in impulse control (e.g., response inhibition) in BPD are substantially modulated by negative, individually salient emotions and primarily occur under stress [ 9, 10, 11, 12, 13].

A remaining research question is whether the effect of childhood maltreatment on impulsivity is mediated by emotion dysregulation and whether this is specific to BPD since emotion dysregulation and impulsivity are also core features of other mental disorders that frequently co-occur with BPD, e.g., ADHD and substance use disorder.

In general, severe childhood maltreatment can have devastating consequences on the development of self-control capacities, i.e., the regulation of impulses and emotions [ 22, 23, 24, 25, 26]. Throughout infancy, childhood, and adolescence, emotions and emotion regulation play an important role in psychosocial development [ 24]. Early caregiver interactions are essential in shaping healthy emotion regulatory processes, such as adaptations to changes in the environment and other social-cognitive demands [ 24, 25]. Children exposed to early adverse experiences are at increased risk for developing mood and anxiety disorders, probably due to changes in neurobiological systems involved in the regulation of stress and emotion, e.g., increased stress responsiveness [ 23]. This can have detrimental consequences across various life domains, since inhibiting strong emotions is crucial to maintaining goal-directed behaviour and self-control [ 26].

In summary, evidence suggests that childhood maltreatment is linked to difficulties in emotion regulation and impulsivity, which put individuals at higher risk for developing various psychopathologies. It is not yet entirely clear whether the effect of childhood maltreatment severity on impulsivity is statistically mediated by emotion dysregulation and whether this is more pronounced in BPD, as compared to other clinical samples. Investigating this relationship might help enhancing the understanding of impulsivity in BPD. As a first step in this direction, the present study made use of self-report data to examine the role of emotion dysregulation in the relation between childhood maltreatment and impulsivity in women with BPD compared to healthy controls and clinical controls without BPD.

Given that impulsivity is a complex heterogeneous construct [ 29, 30, 44], impulsive behaviour was operationalized based on the UPPS Impulsive Behaviour model by Whiteside and Lynam [ 44]. This model conceptualizes impulsive behaviour as comprising multiple facets: 1) a lack of premeditation (difficulties considering the consequences of an action and making accurate plans or precautions), 2) increased sensation seeking (tendency to pursue exciting activities, openness to try new potentially dangerous experiences), 3) lack of perseverance (maintaining task-related attention and goal-directed behaviour in demanding situations), and 4) urgency (tendency to act without forethought during emotional states) [ 44, 45].

Based on that, the present self-report study investigated whether: 1) higher childhood maltreatment severity predicts higher impulsivity, 2) difficulties in emotion regulation statistically mediate the relationship between childhood maltreatment severity and impulsivity, and 3) this mediating relationship is particularly strong in patients with BPD, as compared to clinical controls (CC, without BPD) as well as female healthy controls.

We hypothesized that, across all participants, childhood maltreatment would positively predict emotion regulation difficulties and impulsivity. We further expected that this mediating relationship would be stronger in BPD patients compared to the other groups.

Methods

Participants

N  = 181 women participated. General inclusion criteria were age between 18 and 46, sufficient language proficiency, and female gender. Recruitment took place at two sites: 1) the Central Institute of Mental Health (CIMH) in Mannheim, Germany, and 2) Leiden University, the Netherlands.

Patients in the BPD group ( n = 61) were all recruited at the CIMH, in the context of two larger projects designed to investigate impulsivity and provoked aggression [ 28, 46]. Inclusion criterion for this group was meeting criteria for BPD according to DSM-IV [ 47]. Exclusion criteria were substance abuse disorder, diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), lifetime history of bipolar-I affective disorder and psychotic disorder, current suicidal crisis, mental deficiency, developmental disorder, and psychotropic medication within 2 weeks prior to the study. Since participants also participated in neuroimaging research, further exclusion criteria were pregnancy and magnetic-resonance-imaging related criteria (brain injury, metal implants, left-handedness, claustrophobia). To ensure that BPD diagnosis was met and to rule out other diagnoses, interested participants were invited for an extensive diagnostic screening and intake session, including the International Personality Disorder Examination (IPDE) [ 48] and the Structured Clinical Interview for DSM-IV Axis-I (SCID I) [ 49], as described in more detail below. To assess/exclude adult ADHD diagnosis, the Wender-Reimherr Adult Attention Deficit Disorder Scale and checklists on ADHD symptoms in childhood and adulthood (["Homburger ADHS-Skalen für Erwachsene"], HASE) [ 50] were used (see below).

Healthy controls (HC, n = 60) were recruited via both sites (CIMH, Leiden University). They were included if they did not have a lifetime history of mental disorders, based on the SCID and the IPDE [ 48, 49]. Exclusion criteria were severe somatic/neurological disorders and drug use. In addition to the SCID and IPDE, healthy controls further completed the BSL23, WURS-k; ADHD-CL, CAARS, and WRI.

Patients in the CC group ( n = 57) were partly recruited at the CIMH and partly at Leiden University. Recruitment took place via the outpatient unit of the Department of Psychiatry at the Central Institute of Mental Health (CIMH) in Mannheim, Germany, internet platforms, and/or the research participation website of Leiden University. In Leiden, the recruitment was targeted at individuals experiencing impulse control problems related to substance (drug/alcohol) abuse. The SCID, IPDE, and Mini-International Neuropsychiatric Interview (MINI) respectively [ 51, 52, 53] were used for screening and diagnostic purposes. Exclusion criteria for this CC group was having a diagnosis of BPD as well as scoring higher than Mean = 1 (15th percentile rank) on the Borderline Symptom List 23 Behaviour Checklist [ 54].

Major diagnoses in the CC group ( n = 57) were substance use disorder (SUD) ( n = 29, ~ 50%) and adult ADHD ( n = 28, ~ 50%, n = 3 with comorbid SUD); n = 17 (30%) had a comorbid eating disorder, n = 27 (47%) had a comorbid anxiety disorder.1 The CC group showed similarly high levels of impulsivity and emotion regulation difficulties as the BPD group (see Table 1; for ADHD and SUD separately, see Additional file 2: Table S2, Additional file 3: Table S3 and Additional file 4: Table S4).

Table 1 Age, years of education, childhood trauma severity (CTQ sum scores), difficulties in emotion regulation (DERS sum scores), and impulsivity (UPSS Impulsive Behaviour Scale mean scores) in BPD, CC and HC

Both patient groups (BPD, CC) scored significantly higher in impulsivity and emotion regulation difficulties than HC (all p < 0.001) (Table 1). Age did not differ significantly between BPD and HC, while patients in the CC were significantly older than participants in the BPD group and HC ( p < 0.05, see Table 1). Moreover, there was a trend for differences in years of education, with patients in the BPD group and CC group showing lower education than HC ( p < 0.05, see Table 1). Therefore, age and education were included as statistical covariates in all analyses.

Measures

Diagnostic instruments

Diagnostic assessment of DSM-IV axis I disorders

The Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) is a semi-structured clinical interview, designed to determine DSM-IV major mental disorders, administered by trained mental health professionals. It comprises separate modules corresponding to major categories of DSM-IV diagnoses; symptoms are coded as present, subthreshold, or absent based on diagnostic algorithms. Good internal consistency, and moderate to excellent inter-rater reliability of the axis I disorders were reported [ 49]. The Mini-International Neuropsychiatric Interview (MINI) is a well-established screening tool and semi-structured interview developed for systematic diagnostic assessment of mental disorders [ 51]. The MINI is based on DSM-IV criteria for 17 axis I disorders. It has been found to show very good inter-rater reliability (α > .79), good test-retest reliability (α > .63), high concordance rate with other structured interviews, high patient acceptance, and very good specificity and sensitivity [ 52, 53].

SUD assessment (SCID-I, MINI)

The section on Substance Use Disorder was introduced by the question "Have you ever used alcohol or taken any drugs more than once to get high, to feel better or to change your mood?". From an indicated drug category, symptoms within the past 12 month were explored (tolerance effects; withdrawal symptoms; ending up taking more drugs than attempted; failure reducing or stop taking drug, spending substantial time (> 2 h) on obtaining, using or in recovering from drug; social, financial, legal, health and/or mental problems, e.g., from being intoxicated, high or hungover while having to fulfil responsibilities at school, at work or at home).

BPD assessment

The International Personality Disorder Examination ( IPDE) is a semi-structured clinical interview based on the International Classification of Diseases (ICD 10) and the DSM-III-R classification systems. Reasonably good interrater reliability and temporal stability after an interval of 6 months were reported [ 48]. In the current study, the IPDE was administered by trained clinicians, interrater reliability was κ =0.77. The Borderline Symptom List (BSL-23) is a self-report measure used to assess BPD symptom severity in the past week. Twenty-three statements, such as "I hated myself" and "I thought of hurting myself" are rated on a 5-point Likert scale (0 =  not at all to 4 =  very strong). In addition, behavioural aspects related to BPD symptom severity (e.g., NSSI) in the past week are assessed. This scale previously showed high test-retest reliability ( r = 0.82) [ 54]. Previously, Cronbach's a for BSL-23 were found to be between 0.94 and 0.97, denoting a high internal consistency. In the current study, Cronbach's a for the BSL-23 was excellent (α =0.97).

ADHD assessment ("Homburger ADHS-Skalen für Erwachsene", HASE) [ 50]. The short version of the Wender Utah Rating Scale ( WURS-k) is a self-report scale consisting of 25 items which retrospectively assess ADHD symptoms in childhood. Items are answered on a five-point Likert scale (0 = "not applicable" to 4 = "applicable"). The Connor Adult ADHD Rating Scale ( CAARS) and the ADHD-Checklist ( ADHD-CL) were used to assesses symptoms of adult ADHD, based on the DSM-IV criteria for ADHD in adulthood [ 47]. The 66 items of the CAARS are rated on a 4-point Likert scale (0 = "not applicable" to 3 = "very often"), while the 22 items of the ADHD-CL are answered on a three-point scale (0 = "not applicable" to 2 = "applicable"). To verify/exclude ADHD diagnosis, the Wender-Reimherr Interview (WRI) was used, a clinical interview, based on the Wender Adult Attention Deficit Disorder Scale that is conceptualized for adult ADHD. In the current study, Cronbach's a for all ADHD scales were very good to excellent (WURS-k: a = 0.89 CAARS: a = 0.98; ADHD-CL: a  = 0.96;)

Primary measures

Childhood Trauma Questionnaire (CTQ)

Childhood maltreatment severity was assessed using the CTQ [ 55, 56, 57], a self-report scale with five subscales measuring emotional, sexual, and physical abuse, emotional neglect, and physical neglect (5 items each, overall 25 items, between 1 = "never true" to 5= "very often true"). Higher scores indicate the frequency of abuse experiences. The CTQ has demonstrated good psychometric properties, with test-retest reliability ranging from .79 to .84, internal consistency coefficients between α = .66 and α = .94, and good convergent validity with therapist ratings [ 55, 56, 57, 58]. Cronbach's alpha in the present study suggested very good internal consistency (emotional abuse: α = .96, physical abuse: α = .84, sexual abuse: α = .97, emotional neglect: α = .95) except from the subscale physical neglect (α = .56).

UPPS Impulsive Behavior Scale

The UPPS scale was used to assess multiple facets of impulsivity, based on the Five Factor Model of Personality [ 44, 45]. The scale consists of 45 items related to the four subscales Urgency (12 items; e.g., "I have trouble resisting my cravings (for food, cigarettes).", "When I feel bad, I will often do things I later regret in order to make myself feel better now."), (Lack of) premeditation (11 items; e.g., "I don't like to start a project until I know exactly how to proceed", "My thinking is usually careful and purposeful."), (Lack of) perseverance (10 items, e.g., "I generally like to see things through to the end."), and Sensation seeking (12 items; e.g., "I generally seek new and exciting experiences and sensations."). Participants rate each item on a 4-point Likert scale (1 = strongly agree to 4 = strongly disagree). Good psychometric properties have been reported, including high internal consistency (α = .82 to .91) [ 44, 45, 59, 60]. In order to create a score for impulsivity, items for the UPPS subscales' (lack of) premeditation' and '(lack of) perseverance' were reversed, so that higher scores indicated more impulsivity. Cronbach's alpha in the present study suggested good internal consistency (Premeditation: α = .86, Urgency: α = .89, Sensation Seeking: α = .85) except from the subscale Perseverance (α = .63).

Difficulties in Emotion Regulation Scale (DERS)

The DERS was used to assess difficulties in emotion regulation [ 25]. Within a multidimensional framework, the DERS assesses emotion regulation as being aware of current emotional experiences, understanding them, being able to accept and reflect on these emotions, having a clear idea about how to effectively regulate them and how to successfully use effective and mature regulation strategies [ 25]. The DERS consists of 36 items which reflect difficulties within each dimension of emotion regulation: ACCEPTANCE (e.g., "When I'm upset, I feel guilty for feeling that way"), STRATEGIES (e.g., "When I'm upset, I know that I can find a way to eventually feel better."), GOALS (e.g., "When I'm upset, I have difficulty getting work done"), IMPULSES / CONTROL (e.g., "I experience my emotions as overwhelming and out of control."), AWARENESS (e.g., "When I'm upset, I believe that my feelings are valid and important."), and CLARITY (e.g., "I have difficulty making sense out of my feelings"). Items are answered on a 5-point Likert scale (between 1 = almost never and 5 = almost always). Internal consistency of overall DERS score (α = .94) and subscales (α = .80 to .91) are good, and high validity with other emotion regulation scales was reported [ 61]. In the present scoring version, higher scores on the DERS indicate more difficulties in emotion regulation. Internal consistency of the total scale was α = .84.

Procedure

The study was approved by the ethical committee of the medical faculty of the University of Heidelberg in Mannheim, Germany as well as by the Psychology Ethics Committee of Leiden University. All participants were informed about the background of the study and provided informed consent, study participation could be terminated at any time point without negative consequences. Participants in the BPD and HC group completed the questionnaires (UPPS Scale, DERS, CTQ), in part as paper-pencil versions, and in part ( n  = 28, 15%) via the online survey software Qualtrics (© 2015, Qualtrics, Provo, UT), which included the scales in randomized order. At the end of the study, all participants were debriefed, thanked for their participation and reimbursed (paid a small fee for their participation, 12 Euro/h).

Statistical analysis

Software IBM SPSS Statistics 22.0 with a-priori defined α-value of p  < .05, two-tailed, was used. Prior to all analyses, assumptions of linearity, normality of residuals, homoscedasticity and independence of residuals, and outliers (Cook's distance, Leverage values) were checked. Two extreme outliers were identified (> 3.5 SD from the mean) and removed from the analysis. Multicollinearity was checked based on VIF and tolerance values.

The hypotheses were tested using the PROCESS macro, based on principles by Hayes and Preacher [ 62, 63]. Childhood maltreatment severity, represented by CTQ sum scores, was defined as predictor (X variable). Impulsivity (mean UPPS scores) as outcome variable (Y), and difficulties in emotion regulation (DERS sum score) as statistical mediator variable (M). Group (BPD, CC, HC) was conceptualized as conditional moderator variable (W).2 We tested both the direct effect of childhood maltreatment on impulsivity (path c′) and its indirect effects through the mediator variable. Path a corresponds to the effects of the predictor variable on the statistical mediator variable, while testing for interactions with group (IE1). Path b refers to the effect of the mediator variable on the outcome variable, testing for interactions with group (IE2). The model also evaluates interactions of group with the statistical mediator variable, i.e., whether the mediating effect is significantly depending on group (IE3). Age and education were added as covariates. A bootstrapping function based on 5000 samples and a confidence interval of 95% was used to quantify effects. In separate analyses, we tested whether results changed, when testing for the four UPPS subscales separately.

The mediator (DERS total) and the dependent variable (UPPS) were significantly but only moderately moderated ( r = .360, p < .001; for correlations between subscales see Additional file 5: Table S5). Due to a potential conceptual overlap between the UPPS subscale Urgency (tendency to act without forethought during emotional states) and DERS, we repeated the above-mentioned conditional mediation analyses excluding the UPPS Urgency subscale (i.e., only using the other three UPPS subscales). We further tested whether the predictor and mediator variable would interact in predicting the outcome variable, when controlling for group, which would give ground for examining moderation. The interaction effect was not significant ( F(1,168) = 0.62, p  = .432).

Total effects of childhood maltreatment (without taking effects of the intervening variable and group into account - path c) were tested using multiple regression analyses (MRA)3 with UPPS scores as dependent variable, controlling for age and education. In a first step, the sum score on the CTQ was entered as predictor. In case of a significant overall effect, the CTQ subscales instead of the sum score were entered as predictors. Since multicollinearity diagnostics revealed very low tolerance values for the subscales emotional abuse and emotional neglect (< 0.24), means for "emotional maltreatment" (emotional abuse and neglect) and "physical maltreatment" (physical abuse and neglect) were created. Additional multiple linear regression analyses were performed to investigate the total effects of different subtypes of childhood maltreatment on DERS and DERS on impulsivity respectively.

Results

Means with standard deviation (SD) for the CTQ, DERS, and UPPS subscales and results of the MANOVAs can be found in Table 2. Patients in the BPD and CC reported higher impulsivity on all UPPS scales than HC, while CC reported significantly higher lack of premeditation than BPD (Fig. 1). On the DERS, the BPD and CC group reported higher lack of clarity, lack of regulation strategies, and more difficulties in accepting emotions than HC, while not differing significantly from each other; levels of emotional awareness and self-perceived goal-directed behaviour were comparable across the three groups (Fig. 2). On the CTQ, BPD patients reported significantly higher levels of emotional abuse and neglect, physical abuse and neglect, and sexual abuse than the other groups; patients in the CC group reported significantly higher levels of emotional maltreatment (abuse and neglect) than HC (Fig. 3).

Table 2 Descriptive values for scores on Impulsivity (UPPS Impulsive Behaviour Scale), Emotion Regulation Difficulties (Difficulties in Emotion Regulation Scale) and Childhood Maltreatment Severity (Childhood Trauma Questionnaire) in patients with Borderline Personality Disorder (BPD), Clinical Controls (CC) and Healthy Controls (HC) and results of the MANOVA

Multiple regression analyses (total effects)

Childhood maltreatment severity and impulsivity (path c)

The overall model was significant ( F(3,168) = 24.14, p < .0001, R 2 = .295, R 2(adj) = .283, CI: [1.903, 4.209]), with childhood maltreatment severity being a significant predictor for UPPS scores ( B = 0.027, SE = 0.004, t₍₁₇₃₎ = 7.56, p < .0001, CI: [0.020, 0.034]), while controlling for age ( B = − 0.004, SE = 0.011, t₍₁₇₃₎ = 0.33, p = .742, CI: [− 0.026, 0.018]) and education ( B = − 0.246, SE = 0.152, t₍₁₇₃₎ = 2.33, p = .021, CI: [− 0.455, − 0.037]). Among the subscales, emotional maltreatment ( B = 0.065, SE = 0.010, t₍₁₆₈₎ = 6.40, p < .0001, CI: [0.045, 0.086]) and physical maltreatment ( B = − 0.043, SE = 0.019, t₍₁₆₈₎ = 2.26, p = .025, CI: [− 0.081, − 0.010]) were significant predictors, while sexual abuse had no unique significant effect ( B = 0.020, SE = 0.017, t₍₁₆₈₎ = 1.18, p  = .240, CI: [− 0.014, 0.054]).

Childhood maltreatment severity and difficulties in emotion regulation (path a)

The overall model was significant ( F(3,172) = 4.26, p = .006, R 2 = .069, R 2(adj) = .053, CI: [89.067, 137.190]), with childhood maltreatment severity being a significant positive predictor for DERS scores ( B = 0. 221, SE = 0.084, t₍₁₇₂₎ = 2.52, p = .013, CI: [0.046, 0.377]), while controlling for age ( B = 0.236, SE = 0.262, t₍₁₇₂₎ = 0.262, p = .369, CI: [− 0.754, 0.281]) and education ( B = − 5.039, SE = 02. 52, t₍₁₇₂₎ = 2.00, p = .047, CI: [− 10.013, − 0.065]). Emotional maltreatment was again a unique significant predictor ( B = 1.384, SE = 0.414, t₍₁₇₂₎ = 3.35, p = .001, CI: [0.568, 2.201]. Neither physical maltreatment ( B = − 0.904, SE = 0.778, t₍₁₇₂₎ = 1.16, p = .247, CI: [− 2.440, 0.633]) nor sexual abuse ( B = − 0.248, SE = 0.410, t₍₁₇₂₎ = 0.61, p  = .547, CI: [− 1.057, 0.562]) were significant predictors.

Difficulties in emotion regulation and impulsivity (path b)

The underlying association between the statistical mediator variable (DERS) and outcome (impulsivity, UPPS) could also be established ( F(3,173) = 18.27, p < .001, R 2 = .241, R 2(adj) = .227, CI: [1.833, 4.130]). More difficulties in emotion regulation predicted more impulsivity ( B = 0.021, SE = 0.003, t₍₁₇₃₎ = 2.25, p < .0001, CI: [0.015, 0.028]), when controlling for age ( B = 0.010, SE = 0.011, t₍₁₇₃₎ = 0.86, p = .392, CI: [− 013, 0.32]), and education ( B = − 0.250, SE = 0.111, t₍₁₇₃₎ = 2.25, p  = .025, CI: [− 0.468, − 0.031]). Thus, results suggest that a statistical mediation effect may occur.

Conditional mediation analysis

The overall regression model was significant ( F(7,164) = 179.29, p < .0001, R ² = .884), suggesting that approximately 88% of the variance in self-reported impulsivity (UPPS mean scores) was explained by all predictors in the model. Specifically, higher levels of childhood maltreatment severity ( B = 0.035, SE = 0.004, t = 8.26, p < .0001; CI: [0.026, 0.044]) and more difficulties in emotion regulation ( B = 0.010, SE = 0.003, t = 3.27, p = .001; CI: [0.004, 0.015]) predicted more impulsivity. Group, age, and education also had significant effects, with younger age and lower education being related to higher impulsivity (age: B = − 0.013, SE = 0.005, t = 2.67, p = .008; CI: [− 0.022, − 0.003]; education: B = − 0.091, SE = 0.045, t = 2.02, p = .045; CI: -[0.180, − 0.002]). The effect of group was also significant ( B = 2.070, SE = 0.185, t = 11.16, p < . 0001; CI: [1.70, 2.434]).

There was a significant interaction of childhood maltreatment severity and group on impulsivity ( B = 0.017, SE = 0.004, t = 2.67, p < .0001; CI: [0.024, 0.010]). Within the three groups, childhood maltreatment severity positively predicted impulsivity in BPD (Rho = .232, p = .037, R ² = .05) but not in HC and ADHD ( p > .05), see Fig. 4. The interaction between group and childhood trauma in predicting DERS was not significant ( B = 0.019, SE = 0.188, t = 0.10, p = .917; CI: [− 0.392, 0.352]; CTQ: B = 0.154, SE = 0.212, t = 0.72, p = . 471; CI: [− 0.266, 0.573]).

There was a significant interaction between DERS and group ( B = − 0.005, SE = 0.002, t = 4.61, p = .032; CI: [− 0.010, − 0.0004]). Furthermore, there was a conditional effect of group regarding the effect of childhood maltreatment through difficulties in emotion regulation on impulsivity: Based on the bootstrapping confidence interval, difficulties in emotion regulation statistically mediated the effect of childhood trauma on impulsivity in the BPD group ( B = 0.001, SE = 0.001, CI: [0.001, 0.002]) but not in the other groups (HC: B = 0.001, SE = 0.002, CI: [− 0.002, 0.006]; CC: B = 0.0001, SE = 0.001, CI: [− 0.004, 0.002]). As shown in Fig. 5, in the BPD group, childhood trauma had a significant effect on DERS (path a), which in turn significantly predicted impulsivity (path b). The total effect of childhood maltreatment on impulsivity was significant, while this link was not significant anymore, when controlling for DERS in the regression model.

Analyses for the four UPPS subscales separately revealed similar results. Analyses without the UPPS subscale Urgency revealed the same results (see Additional file 6).

Discussion

This self-report study aimed at investigating the effect of childhood maltreatment severity on impulsivity and whether difficulties in emotion regulation statistically mediated this relationship in BPD compared to healthy controls and clinical controls. Higher childhood maltreatment severity, particularly emotional maltreatment, predicted more difficulties in emotion regulation and impulsivity across all groups. There was a significant interaction effect of childhood maltreatment and group in predicting impulsivity: The effect of childhood maltreatment severity on impulsivity was significantly more pronounced in BPD than in HC and ADHD. Moreover, a significant statistical mediation effect was found, depending on group: In the BPD group, the effect of childhood maltreatment on impulsivity in BPD was not significant anymore, when controlling for difficulties in emotion regulation.

Interestingly, the effect of childhood maltreatment severity on impulsivity was significantly more pronounced in BPD than in the control groups. While a history of trauma is neither necessary nor sufficient for the etiology of BPD, childhood abuse, especially emotional and sexual abuse, was found to aggravate BPD symptomatology. This is in line with the biosocial theory by Linehan [ 27] and current conceptualizations of BPD highlighting the role of an invalidating or traumatic environment in the etiology of the disorder [ 2]. At the same time, childhood maltreatment may put individuals at higher risk for developing other psychopathologies, such as ADHD and SUD, which frequently co-occur with BPD [ 32, 33, 34, 35, 36, 37, 38].

In the present study, emotion regulation difficulties statistically mediated the relationship between childhood maltreatment severity and impulsivity in BPD, but not in the other groups. Since impulsive behaviour in BPD mainly occurs under emotional distress [ 9, 10, 11, 12], it has been conceptualized as a consequence or facet of malfunctioning emotion regulation mechanisms [ 2, 3]. In previous research, stress-dependent increases in impulsivity were found in BPD but not in adults with Attention Deficit Hyperactivity Disorder (ADHD) [ 9, 11]. In line with this and in the context of other previous experimental and neurobiological research [ 9, 10, 11, 12, 13], our findings suggest that difficulties in emotion regulation may underlie self-perceived impulsive behaviour in BPD.

While the inclusion of well-characterized patient groups and the exclusion of mutual comorbidity between the groups (i.e., BPD, SUD/ADHD) is a clear strength of our study, this strict recruitment restricted our samples sizes, which may have limited the statistical power to detect effects, especially in smaller subsamples (ADHD, SUD patients). While we only included women, further research should also include male participants. Since the cross-sectional correlational design of our study does not allow causal conclusions, prospective and longitudinal studies with larger samples are required to gain more insights into causal relationships. In particular, to replicate the statistical mediation effect observed in our study and to identify a directional, potentially causal link, studies with experimental and/or repeated-measure data are needed, in which the independent variable precedes the dependent variable in time. This is of particular importance since mediation analyses with cross-sectional data can lead to an over-estimation of effects [ 69]. Likewise, the use of self-reports generally involves the risk of potential biases, such as social desirability, limited awareness and insight, different subjective interpretations of measured concepts, and/or a 'coloring' of reports by current mood [ 70]. Childhood maltreatment was assessed in a retrospective and subjective manner which is particularly prone to recall biases. It is possible that individuals with BPD may suffer from more traumatic re-experiencing, associated with more vivid negative memories, and may consequently recall childhood experiences more negatively or have a tendency to report more negative childhood adversities.

Previous research suggests that there self-reports and behavioural or psychophysiological measures of emotion regulation and impulsivity in BPD are only weakly or not at all correlated [ 29, 30, 31]. Therefore, future research should additionally use experimental tasks of emotion regulation (e.g., cognitive reappraisal task), impulsivity (e.g., Go/NoGo tasks, stop signal tasks, or delay discounting task) and emotional distress (e.g., experimental psychosocial stressor tasks) [ 9, 10, 11, 12, 13], preferably combining multiple measures (self-reports, behavioural tasks, psychophysiological measures such as heart rate or skin conductance, neuroimaging) at different assessments points.

Including a control group of healthy participants who had been exposed to severe childhood maltreatment without having developed a mental disorder would help corroborating associations between childhood maltreatment, emotion dysregulation, and impulsivity. In general, a full factorial design, with additional control groups for high versus low levels of childhood maltreatment in HC as well as BPD and CC would allow a better investigation of the impact of childhood adversities on impulsivity (and interactions with mental disorders such as BPD). Future research may take the duration and onset of childhood trauma into account to further extend our findings.

A remaining research question is to which degree different components of emotion regulation and multiple facets of impulsivity overlap or can be disentangled from each other. In a previous study, we showed that deficits in action withholding / response inhibition (Go/NoGo task) were influenced by acute experimental stress, while delay discounting was a more stable feature in BPD [ 11]. To identity common and distinct components of impulsivity in relation to emotion regulation in BPD, ADHD, and SUD, future research might employ network analyses, aimed at visualizing inter-relations (node strengths centrality) between factors in a pre-defined model. For instance, this method might help addressing the centrality of factors, such as childhood adversities, emotion dysregulation, and impulsivity, and their place in a network, i.e., how distinct and/or connected these factors are in predicting BPD severity [ 71].

Since positive urgency (acting impulsively while experiencing extreme positive affect) was not assessed in our study, future research should investigate this factor of impulsivity in more detail. Likewise, the DERS mainly focuses on negative feelings of emotional distress. Typical expressions of impulsivity in BPD, such as gambling, substance abuse, promiscuity, or risky sexual activities, may not only serve reducing negative feelings but also increasing positive feelings (e.g., joy, excitement, belonging), which can have devastating consequences on physical/mental health and across different life domains (work, relationships, etc.).

More research is needed to replicate our novel findings and to gain deeper insight into other factors (e.g., positive emotions) that may contribute to impulsivity in BPD.

Conclusion

In conclusion, our findings point to a significant association between childhood maltreatment severity, difficulties in emotion regulation, and impulsivity in BPD. Emotion dysregulation was found to underlie self-perceived impulsive behaviour in BPD. Strengthening emotion regulation strategies, especially in interpersonal contexts, is a main focus of evidence-based BPD treatments, such as Dialectical Behavioural Therapy [ 27], Mentalization-Based Therapy [ 72], Transference-focused psychotherapy [ 73], and Schema Therapy [ 74]. In combination with emotion regulation training, addressing the consequences of childhood adversities (e.g., using psychoeducation to highlight associations with stress tolerance and impulsivity) and integrating traumatic experiences into autobiographical memory (e.g., exposure-based treatment in combination with skills training and stabilizing interventions) might help to reduce impulsive behaviour, such as self-harm and suicidal attempts, in BPD.

Notes

1. 1.

We decided to not split the CC group into subgroups of patients with ADHD and SUD, because these subsamples were too small to perform a meaningful group comparison and regression analysis. ADHD and SUD did not differ significantly in age (Additional file 1: Table S1) and ACE (Additional file 2: Table S2) and together showed similarly high levels of impulsivity and emotion regulation difficulties as the BPD group.

2. 2.

In Process model 59, there is no option for multi-categorical variables. Therefore, the analysis was re-run with changed group labels, which ensured that results were robust.

3. 3.

In Process model 59, there is no option for a total effect model, therefore separate MRAs were performed.

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Acknowledgements

We thank all participants of this study for their essential contribution.

Funding

The project was partly funded by a grant of the German Research Foundation (Deutsche Forschungs Gemeinschaft, DFG, grant number: SCHM 1526/13-1, EN 361/12-1).

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Author information

Author notes

Ezgi Erol and Athina V. Brousianou contributed equally to this work.

Affiliations

1. Department of Clinical Psychology, Institute of Psychology, Leiden, The Netherlands

Annegret Krause-Utz

, Ezgi Erol

, Athina V. Brousianou

& Bernet Elzinga

2. Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands

Annegret Krause-Utz

, Ezgi Erol

, Athina V. Brousianou

& Bernet Elzinga

3. Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany

4. Medical Faculty, University of Heidelberg, Mannheim, Germany

Ezgi Erol

, Sylvia Cackowski

, Christian Paret

& Gabriele Ende

5. Department of Psychosomatic Medicine and Psychtherapy, Central Institute of Mental Health (CIMH), Mannheim, Germany

Sylvia Cackowski

& Christian Paret

6. Department Neuoimaging, Central Institute of Mental Health (CIMH), Mannheim, Germany

Contributions

AK-U, EE, AVB, and BE designed the study and drafted the first version of the paper. SC, EE, AK-U, and CP contributed to data collection. AK-U, EE, AVB, and BE discussed statistical analyses. AK-U and BE provided supervision throughout each stage of writing. SC, CP, and GE provided in depth feedback that contributed to the final version of the paper, which has been approved by all authors.

Corresponding author

Correspondence to Annegret Krause-Utz.

Ethics declarations

Ethics approval and consent to participate

This study has been approved by the Ethics Committee of the Medical Faculty Mannheim of Heidelberg University in 2011 as well as by the Psychology Ethics Committee of Leiden University in 2016 (CEP16-1219/381). All participants were informed about the background of the study and provided informed consent, study participation could be terminated at any time point without negative consequences.

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Not applicable.

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The authors declare that they have no competing interests.

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# data[].attributes.attachment_link.title
Self-reported impulsivity in women with borderline personality disorder: the role of childhood maltreatment severity and emotion regulation difficulties

# data[].attributes.attachment_link.description
Childhood maltreatment, such as severe emotional, physical, and sexual abuse and neglect, has been linked to impulse control problems and dysfunctional emotional coping. In borderline personality disorder (BPD), a history of childhood maltreatment may worsen difficulties in emotion regulation, which may in turn give rise to impulsive behaviours.

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Tattoos used to be considered part of a counterculture. It's probably a fair statement to say that for years, many people associated tattoos with gangs, bikers, and other groups that were thought to operate outside of the social center. Today, tattoos have gained wider social acceptance and more and more people, men and women alike, have them. People with tattoos work in a variety of industries and hold entry-level jobs as well as top executive positions. So, what's an employer to do? Is body art a workplace issue? Does having a visible tattoo say anything about an individual that is relevant to his or her job?

In today's global marketplace, employers are taking more seriously the need to provide a work environment that welcomes employees from many different backgrounds. The competition to attract and retain skilled workers has resulted in corporate cultures that strive to demonstrate the value placed on individual and group contributions. And there is increasing attention paid to offering a company culture and benefit package that supports a variety of lifestyles. Should someone with a visible tattoo be treated any differently?

Depending on what and where the tattoo is, there may or may not be an issue for employers. The laws still tend to support employer dress code/appearance policies in general and employers retain some flexibility in creating rules that require employees to present themselves in a way that is consistent with the employer's image. But that doesn't mean that banning tattoos altogether is appropriate. In some cases, it can still violate the law.

Many employers have policies that do not allow visible tattoos. Depending on the employer's industry and the type of job, this may make sense. For example, the odds are that a four-star hotel may not want the concierge to have large tattoos of skulls and crossbones on the back of each hand. But the same hotel may have less concern if a dishwasher in the kitchen has those same tattoos because direct contact with the hotel's customers is minimal. From a business perspective, the issue for the hotel is to write a policy that draws appropriate lines between jobs in which visible tattoos may or may not be appropriate.

This example is probably a simple one. It can get more complicated, however, if an employer is not thoughtful. For example, what if a bank employs a valued administrative assistant who never has contact with customers? His desk is located in the corporate headquarters and his interactions are strictly internal. Is it okay if this person arrives at work one day with a star tattooed under his eye? The answer, in part, is dependent on the corporate culture and the bank's general attitude toward tattoos. It also, however, is dependent on the difficulty in recruiting and retaining good administrative assistants.

The odds are that while the bank may not appreciate a facial tattoo, it's probably not worth the chance of losing a good employee or not being able to retain a new one by having a policy that would prohibit the tattoo altogether. On the other hand, the bank may be more concerned about a teller with the same tattoo who regularly interacts with bank customers. In that situation, a policy prohibiting the tattoo may be understandable.

In drafting the policies, it's important to stay focused on the business issues at hand. Policies that prohibit tattoos should not reflect value judgments about tattoos or the people who get them. In fact, many employers would likely be surprised to find out how many current employees have tattoos and simply cover them up at work. So negative assumptions about what tattoos say about the people who have them are very often misplaced.

Issues raised by tattoos can get more complicated when it comes to gender and religion. And employers should be aware of these issues before writing and enforcing policies that prohibit visible tattoos at work. For example, historically, it is likely that more men wore visible tattoos than women. As a result, an interviewer who notices a tattoo on a man's arm may have no reaction. But more and more women are getting tattoos, some of which are visible, and the same interviewer may have an adverse reaction if a tattoo is visible on a female applicant's ankle. In this situation, an employer can be exposed to liability for sex discrimination if the presence of the tattoo was an issue in making the hiring decision.

Religious tattoos can pose even more challenging questions. What if an employee who works directly with customers has a tattoo around his wrist and the company has a policy that prohibits visible tattoos in customer service positions? Is it okay to require the employee to wear sleeves that are long enough to cover the tattoo? The answer is: it depends.

If the tattoo is part of a sincerely held religious belief or practice, and that practice or belief prohibits the employee from covering the tattoo up, the employer may need to allow an exception to the "no visible tattoo" policy. That's because employers are obligated to reasonably accommodate sincerely held religious beliefs and practices unless doing so poses an undue hardship. In that situation, it is a good practice to ask the employee about the tattoo and find out whether there is a religious basis for it that prohibits them from covering it.

Managers should coordinate with human resources before having that sort of conversation because if it is not handled properly, the manager could say something unintentionally that exposes the company to liability for religious discrimination. But done properly, the manager may find out that the employee is able to cover the tattoo. If not, this employee may be permitted an exception under the policy as a reasonable accommodation. And doing so as an accommodation will not result in having to allow all employees an exception under the "no visible tattoo" policy.

The key for employers is to have a written policy that employees are required to read and sign, and then to enforce that policy consistently. That way, employees are not able to claim that the policy was applied differently to them. And the policies should be based on sound judgment that is in the best interest of the business. That means that employee and customer interests also need to be considered before the policy is drafted.

Work with your human resources department to develop written dress code/appearance policies that are reasonable and can be enforced consistently. Check with human resources and/or legal counsel before talking with an employee about covering a tattoo unless it is clear that the tattoo has no religious significance and having the employee cover the tattoo is consistent with your policy. And remember, making assumptions about the qualifications of people who have tattoos is not only unfounded, it may result in discrimination claims against your company. A woman with a tattoo of a skull on her arm is no less entitled to be judged based on legitimate business factors than a former U.S. naval seaman whose arm is adorned with a tattoo of a ship's anchor.
Barrie Gross is former Vice President and Senior Corporate Counsel (Employment Law) for an international Fortune 1000 company and is a regular contributor to AllBusiness.com. She is the founder of Barrie Gross Consulting, a human resources training and consulting firm dedicated to assisting companies to manage and develop their human capital. Visit Note: The information here does not constitute legal advice and should not be relied upon as legal advice. If you have a legal issue or wish to obtain legal advice, you should consult an attorney in your area concerning your particular situation and facts. Nothing presented on this site or in this article establishes or should be construed as establishing an attorney-client or confidential relationship between you and Barrie Gross. This article is provided only as general information, which may or may not reflect the most current legal developments or be complete. www.barriegrossconsulting.com to learn more about Barrie and the services BGC provides.

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Tattoos in the Workplace: What's an Employer to Do? | AllBusiness.com

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Tattoos used to be considered part of a counterculture. It's probably a fair statement to say that for years, many people associated tattoos with gangs, bikers, and other groups that were thought to operate outside of the social center. Today, tattoos have gained wider social acceptance and more and more people, men and women alike, have them.

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Sep 14, 2017 - Mandalas are considered sacred symbols in numerous spiritual and ritual practices. Depicted as a representation of the universe, mandalas are commonly used in various religions and philosophies, especially Buddhism. They originate from ancient India, where they have been used in meditation and healing practices for cen…

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Murder

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