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(Khan Academy, 2019)

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Oppositional defiant disorder (ODD) - Diagnosis and treatment - Mayo Clinic

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This childhood mental health condition includes frequent and persistent anger, irritability, arguing, defiance or vindictiveness toward authority.

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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The Body Project is a selective eating disorder prevention program for young women with body dissatisfaction, an established risk factor for eating disorders. This group-based intervention provides a forum for young women who have internalized the thin-ideal to critique it in verbal, written, and behavioral exercises.

The Body Project is a dissonance-based body-acceptance intervention designed to help high school and college-age women resist sociocultural pressures to conform to the thin-ideal and reduce their pursuit of thinness. A reduction in thin-ideal internalization should result in improved body satisfaction and improved mood, reduced use of unhealthy weight-control behaviors, and decreased binge eating and other eating disorder symptoms.

Consistent with this expectation, randomized prevention trials conducted by eight independent labs have found the Body Project reduces thin-ideal internalization, body dissatisfaction, negative mood, unhealthy dieting, and eating disorder symptoms. This intervention has also been found to reduce risk for future onset of threshold and subthreshold eating disorders. In addition, there is evidence that the Body Project intervention reduces the risk for future onset of obesity, results in improved psychosocial functioning, and reduces mental health care utilization. To our knowledge, no other prevention program has produced intervention effects for eating disorder symptoms in trials conducted by independent labs or shown superior effects relative to alternative active interventions. The Body Project also appears to be the first eating disorder prevention program that has received support when delivered by research-trained staff, real-world providers, and even undergraduate peer leaders.

The conceptual basis for the Body Project is that if girls and young women voluntarily argue against the thin ideal, this will result in a reduced subscription to this ideal and to consequent decreases in eating disorder risk factors and symptoms. Thus, this intervention involves a series of verbal, written, and behavioral exercises in which the students critique the thin ideal. Theoretically, the act of publicly critiquing the thin ideal results in cognitive dissonance among those who originally endorsed this ideal, which causes them to reduce their subscription to the thin ideal. As such, the Body Project intervention attempts to apply persuasion principles, originally identified by social psychologists, to reduce an attitudinal risk factor for eating pathology.

DESCRIPTION OF THIS WEBSITE

In addition to its description of the Body Project, this general website contain several empirical publications supporting the effectiveness of this intervention, copies of the actual facilitator manuals and participants workbooks, links to helpful websites, and frequently asked questions (FAQ).

The website contains two versions of the newly enhanced-dissonance Body Project program: one version consists of 4 one-hour weekly sessions and the second consists of 6 shorter (45-minute) sessions for centers that cannot run one-hour sessions. The site also includes an 6-session dissonance-based intervention focused on the prevention of obesity (called Project Health).

Users interested in providing the Body Project are encouraged to register so they can access the secure area of this website. The secure area contains training videos and mock group segments, additional documents for conducting groups (e.g., recruitment materials, brief assessment surveys, supervision rating forms), information on successfully implementing the program, additional FAQ, and a forum for asking questions and sharing information.

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The Body Project is a selective eating disorder prevention program for young women with body dissatisfaction, an established risk factor for eating disorders. This group-based intervention provides a forum for young women who have internalized the thin-ideal to critique it in verbal, written, and behavioral exercises.

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According to eating disorders statistics estimated by the National Eating Disorder Association, in the USA up to 30 million people suffer from an eating disorder such as anorexia nervosa, bulimia nervosa or binge eating disorder. Worldwide the figure is more like 70 million sufferers!

The problem with statistics on eating disorders is that many sufferers do not come forward for diagnosis due to embarrassment, denial or confusion as to what their symptoms are. Eating disorders can differ vastly in the expression of symptoms and behaviors, and just because a person does not fit into the DSM-5 classification does not mean that they do not have an eating disorder. DSM-5 is the manual used by mental health professionals in the U.S. to classify mental disorders.

Males are often one of the least diagnosed populations of people with eating disorders. This is probably due to shame about admitting to what is wrongly assumed to be a disorder that only affects women. For this reason, the number of men with eating disorders is probably much higher than the statistics claim.
Eating Disorders Statistics and Facts.

Anorexia Nervosa has the highest mortality rate of any mental illness (1).

An estimated 0.5 to 3.7 percent of women suffer from anorexia nervosa at some point in their lifetime. Research suggests that about 1 percent of female adolescents have anorexia (2).

An estimated 1.1 to 4.2 percent of women have bulimia nervosa in their lifetime.

Lifetime prevalence of binge eating disorder is 3.5% in women, and 2.0% in men (3).

Onset of anorexia nervosa is most commonly around the same time as puberty.

Binge Eating Disorder was found to usually start during late adolescence or in the early twenties (4).

A study in 2003 found that people with anorexia are 56 times more likely to commit suicide than non-sufferers (5).

Alcohol and substance abuse are four times more prevalent amongst people that suffer eating disorders (6).

Hospitalizations for eating disorders in children under the age of 12 years old increased by 119 percent between the years of 1999 and 2006 (7).

Twin studies show that there is a significant genetic component to eating disorders (8).

In childhood (5-12 years), the ratio of girls to boys diagnosed with AN or BN is 5:1, whereas in adolescents and adults, the ratio is much larger - 10 females to every one male (9).

Young women with anorexia are 12 times more likely to die than are other women the same age that don't have anorexia (10).

The most common eating disorder in the United States is binge eating disorder (BED). It is estimated that 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder (17).

Statistics and Facts on Dieting and Disordered Eating.
Disordered eating is different than an eating disorder. A person who worries about their looks and as a result their eating patterns are disrupted, but does not have an eating disorder, might fall into this category.

51% of girls 9 and 10 years old feel better about themselves when they are dieting (11).

A 2002 study of boys in grades 9 and 10 found that 4% of them reported anabolic steroid use. This shows that body preoccupation and efforts to change one's body are concerns that affect both women and men (12).

40% of girls in grade ten and 37% of girls in grade nine thought of themselves as being too fat. Of those students that were "normal weight" based on their BMI, 19% still thought that they were too fat, and 12% of the students admitted to trying to lose weight (13).

Body-based bullying can have a severe impact on a girls' attitude and behavior. Girls who suffered teasing by members of their families were 1.5 times more likely to try binge eating and/or other dangerous weight-control methods within five years (14).

91% of women who were surveyed on a college campus had tried to control their weight by dieting, and 22% of them dieted "often" or all the time (15).

Statistics on Eating Disorders Recovery

With treatment, 60% of eating disorder sufferers make a full recovery.

Without treatment 20% of people suffering from anorexia will prematurely die from eating disorder related health complications, including suicide and heart problems (16).

Inpatient treatment of an eating disorder in the US ranges from $500 - $2,000 per day. Long-term outpatient treatment, including therapy and medical monitoring, can cost $100,000 or more. Thankfully insurance companies now usually cover eating disorder treatment.

Only one in ten sufferers will seek and receive treatment.

Treatment is most successful when intervention is early.

Eating disorders statistics tell us that in order for treatment to be successful, it must be multifaceted. It must include medical care, mental health care, and nutritional education and counseling.

Long term treatment is often needed; eating disorders require ongoing care.

Eating disorders research is very under-funded. The National Institute of Health allocates only 93 cents towards research funding for every person diagnosed with an eating disorder. In comparison, they give $88 for every person diagnosed with autism. This is painfully low.

You can follow these links to see charts and graphs on eating disorders or to get the definitions of eating disorders. Here is more information on eating disorders and suicide.

If you would like to get involved with eating disorder advocacy, follow the link for more information. You can make a difference.
Return To Home Page Written by Tabitha Farrar - May, 2014 References:
1. Arcelus, Mitchell, Wales, & Nielsen, 2011

2. The Nat'l Institute of Mental Health: "Eating Disorders: Facts About Eating Disorders and the Search for Solutions." Pub. 2002

3. February 2007 edition of Biological Psychiatry.

4. American Psychiatric Assoc. Diagnostic & Statistical Manual of Mental Disorders 4th Edition. Wash. DC, 1994.

5. Archives of General Psychiatry (Vol. 60, No. 2)

6. Harrop & Marlatt, 2010

7. Agency for Healthcare Research and Quality

8. Steiner, Kwan, Shaffer, Walker, Miller, Sagar, and Lock. (2003). Risk and protective factors for juvenile eating disorders. European Child & Adolescent Psychiatry, 12, 38-46.

9. Public Health Agency of Canada. Canadian Paediatric Surveillance Program, 2003 Results

10. Mortality in Anorexia Nervosa. American Journal of Psychiatry, 152(7), 1073-1074.

11. LM, Irwin CE & Scully S: Disordered eating characteristics in girls: A survey of middle class children. Journal of the American Dietetic Association. 1992

12. Boyce, W. F. (2004). Young people in Canada: their health and well-being. Ottawa, Ontario: Health Canada.

13. Boyce, W. F., King, M. A. & Roche, J. (2008). Healthy Living and Healthy Weight. In Healthy Settings for Young People in Canada.

14. Neumark-Sztainer, D. R., Wall, M. M., Haines, J. I., Story, M. T., Sherwood, N. E., van den Berg, P. A. (2007). Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents. American Journal of Preventative Medicine.

15. Interview validation of survey data. Journal of Psychiatric Research. 1995

16. The Renfrew Center Foundation for Eating Disorders.

17. From www.bedaonline.com

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According to eating disorders statistics estimated by the National Eating Disorder Association, in the USA up to 30 million people suffer from an eating disorder such as anorexia nervosa, bulimia nervosa or binge eating disorder. Worldwide the figure is more like 70 million sufferers!

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Overview

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder.

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Although the term "eating" is in the name, eating disorders are about more than food. They're complex mental health conditions that often require the intervention of medical and psychological experts to alter their course.

These disorders are described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ( 1).

In the United States alone, an estimated 28 million Americans have or have had an eating disorder at some point in their life ( 2).

This article describes six of the most common types of eating disorders and their symptoms.

Eating disorders are a range of psychological conditions that cause unhealthy eating habits to develop. They might start with an obsession with food, body weight, or body shape ( 3).

In severe cases, eating disorders can cause serious health consequences and may even result in death if left untreated. In fact, eating disorders are among the deadliest mental illnesses, second to opioid overdose ( 4).

People with eating disorders can have a variety of symptoms. Common symptoms include severe restriction of food, food binges, and purging behaviors like vomiting or overexercising.

Although eating disorders can affect people of any gender at any life stage, they're increasingly common in men and gender nonconforming people. These populations often seek treatment at lower rates or may not report their eating disorder symptoms at all ( 5, 6).

Different types of eating disorders have different symptoms, but each condition involves an extreme focus on issues related to food and eating, and some involve an extreme focus on weight.

This preoccupation with food and weight may make it hard to focus on other aspects of life ( 3).

Mental and behavioral signs may include ( 7):

dramatic weight loss

concern about eating in public

preoccupation with weight, food, calories, fat grams, or dieting

complaints of constipation, cold intolerance, abdominal pain, lethargy, or excess energy

excuses to avoid mealtime

intense fear of weight gain or being "fat"

dressing in layers to hide weight loss or stay warm

severely limiting and restricting the amount and types of food consumed

refusing to eat certain foods

denying feeling hungry

expressing a need to "burn off" calories

repeatedly weighing oneself

patterns of binge eating and purging

developing rituals around food

excessively exercising

cooking meals for others without eating

missing menstrual periods (in people who would typically menstruate)

Physical signs may include ( 7):

Experts believe that a variety of factors may contribute to eating disorders.

One of these is genetics. People who have a sibling or parent with an eating disorder seem to be at an increased risk of developing one ( 3).

Personality traits are another factor. In particular, neuroticism, perfectionism, and impulsivity are three personality traits often linked to a higher risk of developing an eating disorder, according to a 2015 research review ().

Other potential causes include perceived pressures to be thin, cultural preferences for thinness, and exposure to media promoting these ideals ().

More recently, experts have proposed that differences in brain structure and biology may also play a role in the development of eating disorders. In particular, levels of the brain messaging chemicals serotonin and dopamine may be factors ( 9).

However, more studies are needed before strong conclusions can be made.

Eating disorders are a group of related conditions involving extreme food and weight issues, but each disorder has unique symptoms and diagnosis criteria. Here are six of the most common eating disorders and their symptoms.

Anorexia nervosa is likely the most well-known eating disorder.

It generally develops during adolescence or young adulthood and tends to affect more women than men ().

People with anorexia generally view themselves as overweight, even if they're dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calorie intake.

Common symptoms of anorexia nervosa include ( 1):

very restricted eating patterns

intense fear of gaining weight or persistent behaviors to avoid gaining weight, despite being underweight

a relentless pursuit of thinness and unwillingness to maintain a healthy weight

a heavy influence of body weight or perceived body shape on self-esteem

a distorted body image, including denial of being seriously underweight

However, it's important to note that weight should not be the major focus of diagnosing someone with anorexia.

Using body mass index as a factor in diagnosis is outdated because people who are categorized as "normal" or "overweight" can have the same risks.

In atypical anorexia, for example, a person may meet the criteria for anorexia but not be underweight despite significant weight loss ( 7).

Obsessive-compulsive symptoms are also often present. For instance, many people with anorexia are preoccupied with constant thoughts about food, and some may obsessively collect recipes or hoard food.

They may also have difficulty eating in public and exhibit a strong desire to control their environment, limiting their ability to be spontaneous ( 3).

Anorexia is officially categorized into two subtypes - the restricting type and the binge eating and purging type ( 1).

Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise.

Individuals with the binge eating and purging type may binge on large amounts of food or eat very little. In both cases, after they eat, they purge using activities such as vomiting, taking laxatives or diuretics, or exercising excessively.

Anorexia can be very damaging to the body. Over time, individuals living with it may experience thinning of their bones, infertility, and brittle hair and nails.

In severe cases, anorexia can result in heart, brain, or multi-organ failure and death.

Bulimia nervosa is another well-known eating disorder.

Like anorexia, bulimia tends to develop during adolescence and early adulthood and appears to be less common among men than women ().

People with bulimia frequently eat unusually large amounts of food in a specific period of time.

Each binge eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating.

Binges can happen with any type of food but most commonly occur with foods the individual would usually avoid.

Individuals with bulimia then attempt to purge to compensate for the calories consumed and to relieve gut discomfort.

Common purging behaviors include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.

Symptoms may appear very similar to those of the binge eating or purging subtypes of anorexia nervosa. However, individuals with bulimia usually maintain a relatively typical weight rather than losing a large amount of weight.

Common symptoms of bulimia nervosa include ( 1):

recurrent episodes of binge eating with a feeling of lack of control

recurrent episodes of inappropriate purging behaviors to prevent weight gain

self-esteem overly influenced by body shape and weight

a fear of gaining weight, despite having a typical weight

Side effects of bulimia may include an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances ().

In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium, and calcium. This can cause a stroke or heart attack.

Binge eating disorder is the most prevalent form of eating disorder and one of the most common chronic illnesses among adolescents ().

It typically begins during adolescence and early adulthood, although it can develop later on.

Individuals with this disorder have symptoms similar to those of bulimia or the binge eating subtype of anorexia.

For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges.

People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges ().

Common symptoms of binge eating disorder include ():

eating large amounts of food rapidly, in secret, and until uncomfortably full, despite not feeling hungry

feeling a lack of control during episodes of binge eating

feelings of distress, such as shame, disgust, or guilt, when thinking about the binge eating behavior

no use of purging behaviors, such as calorie restriction, vomiting, excessive exercise, or laxative or diuretic use, to compensate for the binge eating

People with binge eating disorder often consume an excessive amount of food and may not make nutritious food choices. This may increase their risk of medical complications such as heart disease, stroke, and type 2 diabetes ().

Pica is an eating disorder that involves eating things that are not considered food and that do not provide nutritional value ( 14).

Individuals with pica crave non-food substances such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch ().

Pica can occur in adults, children, and adolescents.

It is most frequently seen in individuals with conditions that affect daily functioning, including intellectual disabilities, developmental conditions such as autism spectrum disorder, and mental health conditions such as schizophrenia ( 14).

Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.

However, for the condition to be considered pica, the eating of non-food substances must not be a typical part of someone's culture or religion. In addition, it must not be considered a socially acceptable practice by a person's peers.

Rumination disorder is another newly recognized eating disorder.

It describes a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out ( 15).

This rumination typically occurs within the first 30 minutes after a meal ( 16).

This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3 and 12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.

If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal.

Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight ( 16).

Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.

The term has replaced the term "feeding disorder of infancy and early childhood," a diagnosis previously reserved for children under age 7 ( 17).

Individuals with this disorder experience disturbed eating due to either a lack of interest in eating or a distaste for certain smells, tastes, colors, textures, or temperatures.

Common symptoms of ARFID include ():

avoidance or restriction of food intake that prevents the person from eating enough calories or nutrients

eating habits that interfere with typical social functions, such as eating with others

weight loss or poor development for age and height

nutrient deficiencies or dependence on supplements or tube feeding

It's important to note that ARFID goes beyond common behaviors such as picky eating in toddlers or lower food intake in older adults.

Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.

In addition to the six eating disorders above, other less known or less common eating disorders also exist.

These include ( 18):

Purging disorder. Individuals with purging disorder often use purging behaviors, such as vomiting, laxatives, diuretics, or excessive exercising, to control their weight or shape. However, they do not binge.

Night eating syndrome. Individuals with this syndrome frequently eat excessively at night, often after awakening from sleep.

Other specified feeding or eating disorder (OSFED). While it is not found in the DSM-5, this category includes any other conditions that have symptoms similar to those of an eating disorder but don't fit any of the disorders above.

One disorder that may currently fall under OSFED is orthorexia. Although orthorexia is increasingly mentioned in the media and in scientific studies, the DSM does not yet recognize it as a separate eating disorder ( 19).

Individuals with orthorexia tend to have an obsessive focus on healthy eating to an extent that disrupts their daily lives. They may compulsively check ingredient lists and nutritional labels and obsessively follow "healthy lifestyle" accounts on social media.

Someone with this condition may eliminate entire food groups, fearing that they're unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress.

Individuals with orthorexia are rarely focused on losing weight. Instead, their self-worth, identity, or satisfaction is dependent on how well they comply with their self-imposed diet rules ( 19).

If you have an eating disorder, identifying the condition and seeking treatment sooner will improve your chances of recovering. Being aware of the warning signs and symptoms can help you decide whether you need to seek help.

Not everyone will have every sign or symptom at once, but certain behaviors may signal a problem, such as ( 20):

behaviors and attitudes that indicate that weight loss, dieting, and control over food are becoming primary concerns

preoccupation with weight, food, calories, fats, grams, and dieting

refusal to eat certain foods

discomfort with eating around others

food rituals (not allowing foods to touch, eating only particular food groups)

skipping meals or eating only small portions

frequent dieting or fad diets

extreme concern with body size, shape, and appearance

frequently checking in the mirror for perceived flaws in appearance

extreme mood swings

If these symptoms resonate with you and you think you may have an eating disorder, it's important to reach out to a medical professional for help.

Making the decision to start eating disorder recovery might feel scary or overwhelming, but seeking help from medical professionals, eating disorder recovery support groups, and your community can make recovery easier.

If you're not sure where to start, you can contact the National Eating Disorders Association helpline for support, resources, and treatment options for yourself or someone you know.

To contact, call: (800) 931-2237

Monday-Thursday 11 a.m.-9 p.m. ET

Friday 11 a.m.-5 p.m. ET

Text: (800) 931-2237

Monday-Thursday 3 p.m.-6 p.m. ET

Friday 1 p.m.-5 p.m. ET

Eating disorder treatment plans are specifically tailored to each person and may include a combination of multiple therapies.

Treatment will usually involve talk therapy, as well as regular health checks with a physician ( 21).

It's important to seek treatment early for eating disorders, as the risk of medical complications and suicide is high ().

Treatment options include:

Individual, group, or family psychotherapy. A type of psychotherapy called cognitive behavioral therapy (CBT) may be recommended to help reduce or eliminate disordered behavior such as binge eating, purging, and restricting. CBT involves learning how to recognize and change distorted or unhelpful thought patterns ().

Medications. A doctor may recommend treatment with medications such as antidepressants, antipsychotics, or mood stabilizers to help treat an eating disorder or other conditions that may occur at the same time, such as depression or anxiety ().

Nutritional counseling. This involves working with a dietitian to learn proper nutrition and eating habits and may also involve restoring or managing a person's weight if they have experienced significant weight changes. Studies suggest that combining nutritional therapy with cognitive therapy may significantly improve treatment outcomes (22).

If you think someone in your life has an eating disorder, your best bet is to support and encourage them to seek help from a healthcare professional.

This can be extremely difficult for someone living with an eating disorder, but supporting them in other ways will help them feel cared for and encouraged in their recovery.

Recovering from an eating disorder can take a long time, and this person may have periods of relapsing into old behaviors, especially during times of stress. If you're close to this person, it's important to be there for them, and be patient, throughout their recovery ( 21).

Ways to support someone with an eating disorder include ( 21):

Listening to them. Taking time to listen to their thoughts can help them feel heard, respected, and supported. Even if you don't agree with what they say, it's important that they know you're there for them and that they have someone to confide in.

Including them in activities. You can reach out and invite them to activities and social events or ask if they want to hang out one-on-one. Even if they do not want to be social, it's important to check in and invite them to help them feel valued and less alone.

Trying to build their self-esteem. Make sure they know that they are valued and appreciated, especially for nonphysical reasons. Remind them why you are their friend and why they are valued.

The categories above are meant to provide a better understanding of the most common eating disorders and dispel myths about them.

Eating disorders are mental health conditions that usually require treatment. They can also be damaging to the body if left untreated.

If you have an eating disorder or know someone who might have one, you can seek help from a healthcare professional who specializes in eating disorders.

You can book an appointment with an eating disorder specialist in your area using our Healthline FindCare tool.
Read this article in Spanish.

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Learn about 6 common types of eating disorders and their symptoms

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Eating disorders are characterized by unusual or disturbed eating habits. Learn more here.

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Depression and Bipolar Support Alliance of Dallas

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At support group meetings, people share experiences, personal feelings, information, and strategies for living successfully with mood disorders. There are six key elements of a DBSA chapter's support groups.

Each person has the ability to make appropriate use of available resources to meet her or his own needs. Some people may utilize this ability more fully than others, but it is present in everyone.

All of us together know more than any one of us. Everyone has value and has something to add to a group process.

Each person is the ultimate authority on what s/he needs and on what will work for her or him. (Adapted from Leading Self-Help Groups by Lucretia Mallory, 1984)

5 .
The group determines how often, when, and where it meets. It is suggested that support groups meet at least once every month; most groups meet weekly or twice monthly.

Support groups th at are part of a DBSA chapter must hold meetings that are open to the pu blic and free of charge. No fee is required to attend. Groups may reque st optional donations to defray meeting costs, such as refreshments, or m ay establish optional group dues to be used for group-related purposes (f or example, to place an advertisement in a local newspaper or publ ish and mail a newsletter), but attending the support group must be free

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Depression and Bipolar Support Alliance of Dallas

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At support group meetings, people share experiences, personal feelings, information, and strategies for living successfully with mood disorders. There are six key elements of a DBSA chapter's support groups. Each person has the ability to make appropriate use of available resources to meet her or his own needs.

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Once your child has been diagnosed with a bipolar disorder and perhaps a co-morbid condition such as ADHD or OCD and/or learning disabilities of any kind, your child can become eligible for accommodations in the academic environment. He or she is protected by two federal laws: Section 504 of the Rehabilitation Act of 1973; and the more powerful statute enacted in 1975 and reauthorized in 1997 known as the Individuals with Disabilities Education Act (IDEA).

Section 504 mandates that individuals with impairments that substantially limit a major life activity, such as learning, are entitled to academic adjustments and auxiliary aids and services, so that courses, examinations, and services will be accessible to them. Parents often ask why they should certify their child under the IDEA instead of under Section 504.

A Section 504 is intended primarily for use in the mainstream classroom. If a child needs minor accommodations such as a bathroom pass because he or she has frequent urination as a result of a drug such as lithium, or needs seating close to the teacher so that he or she can pay better attention, then accommodations under Section 504 may be adequate.

However, bipolar disorder is by nature an episodic illness which may become acute at times. A student with this illness typically needs more services outside the classroom and may need accommodations such as time spent in a resource room, an aide, or a later start to the school day (these accommodations will be explained in the pages below). These more flexible, all-encompassing accommodations are rarely available unless the student has an Individual Education Plan provided by an IDEA classification. (The IDEA provides federal funds to elementary and secondary schools for public education, whereas no such funding supports a Section 504.)

In other words, accommodations under a Section 504 may work as an emergency measure while the IEP process is being conducted (to help ease the stress on the child) but they are probably not adequate for the majority of children with bipolar disorder throughout the span of their time spent in school.

Under IDEA, schools are responsible for identifying and evaluating students with disabilities who may need special education and services. This federal law also requires schools to continue providing services for the student as long as they are needed through their K-12 schooling and up to age 22. The services are provided through a plan or blueprint called an Individualized Education Program-the IEP.

Before the IEP can take place, however, the student must be tested and found eligible for services. For your child to qualify for special education under IDEA, it is not enough that he has one of these disabilities. There must also be evidence that your child's disability adversely affects his educational performance.

There are 13 categories under IDEA which entitle a child to services and accommodations throughout the school day. The two that most often apply to a child with a bipolar disorder are "other health impaired" (OHI), or "seriously emotionally disturbed" (SED). The SED classification may be referred to in some states as "emotionally disordered" (ED), behaviorally disturbed (BD), or some variant of these.

The phrase "severely emotionally disturbed" may sound exceedingly ominous to parents, but in some states an ED label may make it easier to access better services such as out of district placements or a therapeutic day school or residential school if this becomes necessary. If parents do accept this label, they must be certain that the ED classification (and the IEP team) does not place the child in an inappropriate placement with students who have more delinquent behaviors.

Since every state has different laws and ways of classifying students, it may be best to speak with an educational consultant or educational attorney before setting out on this journey.

Initiating the IEP Process

A child cannot receive services until a full evaluation is completed and the child has qualified as disabled under the IDEA. A parent should request an evaluation in writing after having first talked with the special education director and guidance counsellor to find out how their system initiates the process. In many states, the parents are asked to sign a consent form which makes their child a "focus of concern." Once the process begins the child will be observed in the classroom, and a number of standardized tests that assess IQ, academic strengths and weaknesses, and language and communication abilities will be administered. Various psychological assessment tests may be administered as well. Additionally, an observation by a qualified person (such as the school psychologist) must be made as part of the assessment to qualify and place a student in an ED program.

All the testing will be done by the school system at no expense to the parents. However, parents may bring their own independent assessments to the meeting. Doing so allows a parent to handpick an experienced tester who will do more in-depth testing and supply a very specific report. Since the IEP is the critical document from which all services and progress benchmarks flow, the quality and comprehensiveness of the baseline assessments cannot be underestimated. The professional most qualified to provide this kind of focused assessment is a neuropsychologist-for all the reasons we are about to discuss.

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Eligibility and classification for services under federal law - Juvenile Bipolar Research Foundation

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Section 504 Option Versus Eligibility and Classification under the IDEA Once your child has been diagnosed with a bipolar disorder and perhaps a co-morbid condition such as ADHD or OCD and/or learning disabilities of any kind, your child can become eligible for accommodations in the academic environment.

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Bipolar disorder is best controlled when treatment is constant. Mood changes can happen even when there are not any breaks in care, though. Tell your doctor about any changes right away. Your doctor may be able to help you put off a flare-up. Work with your doctor and talk about your concerns and choices. This can help make treatment work better.

Keep a chart of your daily mood, treatments, sleep patterns, and life events. This may help you and your family learn more about the illness. It can also help your doctor track and treat it better.

Treatment may be:

Medications Other treatments Lifestyle changes Alternative and complementary therapies

Revision Information

Reviewer: EBSCO Medical Review Board Rimas Lukas, MD

Review Date: -

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Bipolar disorder is best controlled when treatment is constant. Mood changes can happen even when there are not any breaks in care, though. Tell your doctor about any changes right away. Your doctor may be able to help you put off a flare-up. Work with your doctor and talk about your concerns and choices.

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

To get an IEP, there are two requirements: A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others. And the disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And the disability must interfere with the child's ability to learn in a general education classroom. Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team must include:

The rules about who's on the 504 team are less specific than they are for an IEP. A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

* The child's parent or caregiver

* General and special education teachers

* The school principal

* The child's parent or caregiver

* At least one of the child's general education teachers

* At least one special education teacher

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document. A 504 plan generally includes the following:

* Specific accommodations, supports, or services for the child

* Names of who will provide each service

* Name of the person responsible for ensuring the plan is implemented

* The child's present levels of academic and functional performance - how the child is currently doing in school

* Annual education goals for the child and how the school will track progress

* The services the child will get - this may include special education, related, supplementary, and extended school year services

* The timing of services - when they start, how often they occur, and how long they last

* Any accommodations - changes to the child's learning environment

* Any modifications - changes to what the child is expected to learn or know

* How the child will participate in standardized tests

* How the child will be included in general education classes and school activities

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations. Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

How to resolve disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

* Mediation

* Alternative dispute resolution

* Impartial hearing

* Complaint to the Office for Civil Rights (OCR)

* Lawsuit

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

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IEP vs. 504 Plan: What's the Difference?

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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Many treatment options are available for depression, but how well treatment works depends on the type of depression and its severity.

Psychotherapy

Psychotherapy (or talk therapy) has an excellent track record of helping people with depressive disorder. While some psychotherapies have been researched more than others, many types can be helpful and effective. A good relationship with a therapist can help improve outcomes.

For most people, psychotherapy and medications give better results together than either alone, but this is something to review with your mental health care provider. Further, many clinicians are trained in more than one kind of psychotherapy, so ask your clinician what kind of psychotherapy they practice and how it can help you. A few examples include:

Cognitive behavioral therapy (CBT) has a strong research base to show it helps with symptoms of depression. This therapy helps assess and change negative thinking patterns associated with depression. The goal of this structured therapy is to recognize negative thoughts and to teach coping strategies. CBT is often time-limited and may be limited to 8-16 sessions in some instances. Learn more about CBT.

Interpersonal therapy (IPT) focuses on improving problems in personal relationships and other changes in life that may be contributing to depressive disorder. Therapists teach individuals to evaluate their interactions and to improve how they relate to others. IPT is often time-limited like CBT.

Psychodynamic therapy is a therapeutic approach rooted in recognizing and understanding negative patterns of behavior and feelings that are rooted in past experiences and working to resolve them. Looking at a person's unconscious processes is another component of this psychotherapy. It can be done in short-term or longer-term modes. Learn more about psychodynamic therapy.

Psychoeducation and Support Groups

Psychoeducation involves teaching individuals about their illness, how to treat it and how to recognize signs of relapse. Family psychoeducation is also helpful for family members who want to understand what their loved one is experiencing.

Support groups, meanwhile, provide participants an opportunity to share experiences and coping strategies. Support groups may be for the person with the mental health condition, for family/friends or a combination of both. Mental health professionals lead some support groups, but groups can also be peer-led.

Explore NAMI's nationwide offerings of free educational programs and support groups that provide outstanding education, skills training and support.

Medications

For some people, antidepressants may help reduce or control symptoms. Antidepressants often take 2-4 weeks to begin having an effect and up to 12 weeks to reach full effect. Most people will have to try various doses or medications to find what works for them. Here are some antidepressants commonly used to treat depression:

Selective serotonin reuptake inhibitors (SSRIs) act on serotonin, a brain chemical. They are the most common medications prescribed for depression.

​Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second most common antidepressants. These medications increase serotonin and norepinephrine.

Norepinephrine-dopamine reuptake inhibitors (NDRIs) increase dopamine and norepinephrine. Bupropion (Wellbutrin) is a popular NDRI medication, which causes fewer (and different) side effects than other antidepressants. For some people, bupropion causes anxiety symptoms, but for others it is an effective treatment for anxiety.

Mirtazapine (Remeron) targets specific serotonin and norepinephrine receptors in the brain, thus indirectly increasing the activity of several brain circuits. Mirtazapine is used less often than newer antidepressants (SSRIs, SNRIs and bupropion) because it is associated with more weight gain, sedation and sleepiness. However, it appears to be less likely to result in insomnia, sexual side effects and nausea than the SSRIs and SNRIs.

Second-generation antipsychotics (SGAs), or "atypical antipsychotics," treat schizophrenia, acute mania, bipolar disorder and bipolar mania and other mental illnesses. SGAs can be used for treatment-resistant depression.

Tricyclic antidepressants (TCAs) are older medications, seldom used today as initial treatment for depression. They work similarly to SNRIs but have more side effects. They are sometimes used when other antidepressants have not worked. TCAs may also ease chronic pain.

Amitriptyline (Elavil)

Desipramine (Norpramin)

Doxepin (Sinequan)

Imipramine (Tofranil)

Nortriptyline (Pamelor, Avantyl)

Protriptyline (Vivactil)

Monoamine oxidase inhibitors (MAOIs) are less used today because newer, more effective medications with fewer side effects have been found. These medications can never be used in combination with SSRIs. MAOIs can sometimes be effective for people who do not respond to other medications.

Phenelzine (Nardil)

Isocarboxazid (Marplan)

Tranylcypromine Sulfate (Parnate)

Selegiline patch (Emsam)

Brain Stimulation Therapies

For some, brain stimulation therapies may be effective, typically after other treatments have not been effective.

Electroconvulsive Therapy (ECT) involves transmitting short electrical impulses into the brain. ECT does cause some side effects, including memory loss. Individuals should understand the risks and benefits of this intervention before beginning a treatment trial.

Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new type of brain stimulation that uses a magnet instead of an electrical current to activate the brain. It is not effective as a maintenance treatment.

Vagus Nerve Stimulation (VNS) has a complex history. For a fuller understanding of this treatment, read the NIMH summary of this and other brain stimulation interventions.

Complementary and Alternative Medicine (CAM)

Relying solely on CAM methods is not enough to treat depression, but they may be useful when combined with psychotherapy and medication. Discuss your ideas of CAM interventions with your health care professional to be sure they will not cause side effects or adverse reactions.

A national center reviews research on complementary treatments. You can search for each intervention on their website.

Exercise. Studies show that aerobic exercise can help treat mild depression because it increases endorphins and stimulates norepinephrine, which can improve a person's mood.

Folate. Some studies have shown that when people with depression lack folate (also called folic acid or vitamin B9), they may not be receiving the full benefit from any antidepressants they may be taking. Studies suggest that in some situations taking L-methylfolate (an active form of folate) can be an additional treatment with other psychiatric medications.

St John's Wort. This supplement has similar chemical properties to some SSRIs. Risks of combining St John's Wort with SSRIs and other medications are well-known and substantial.

Experimental Treatments

These following treatments are not FDA-approved but are being researched:

Ketamine. Ketamine, which may offer a new model in treating depression, may have potentially quick and short-term impact on depression and suicidal thoughts. Ketamine is an anesthetic with a street value (special K) that has not been studied for long-term use. It can make psychosis worse and is not an ideal choice for people with substance use disorders.

Deep Brain Stimulation. This treatment has been used to treat Parkinson's disease. See the NIMH page on brain stimulation for more information.

Reviewed August 2017

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Many treatment options are available for depression, but how well treatment works depends on the type of depression and its severity. Psychotherapy (or talk therapy) has an excellent track record of helping people with depressive disorder. While some psychotherapies have been researched more than others, many types can be helpful and effective.

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Types of depression treatment offered at Cross Creek Hospital in Austin, TX

At Cross Creek Hospital, a depression treatment center in Austin, Texas, we are devoted to providing everyone who seeks care at our hospital for the treatment of depression with the respect and dignity that they deserve. Our all-encompassing goal for depression treatment is to help men, women, and adolescents improve their overall functioning by helping them to stabilize and to continue their recovery with new tools that they will be taught in the treatment setting. We are proud to be able to achieve this goal by utilizing the structure and processes of a treatment model that combines cognitive-behavioral therapy, experiential therapies, and didactic therapies.

All of the treatment methods implemented in our inpatient treatment center for depression utilize a multidisciplinary focus in order to ensure that an integrated approach to treatment that facilitates increased stabilization and growth is received by all patients. Furthermore, we place a high regard on the involvement of our patients' families, knowing that their contribution to the therapeutic process is paramount to successful healing.

The emphasis of our depression treatment center here at Cross Creek Hospital in Austin, Texas is not diagnosis-specific, but rather focuses on treating the symptoms that are plaguing each individual. We are devoted to implementing a truly holistic approach at our hospital that aims to maximize patient care and help them achieve their highest level of functioning.

The following methods for care may be incorporated into the individualized treatment plans that are given to each adolescent, adult, and senior adult who are engaged in services at Cross Creek Hospital:

Medication management at our hospital: The use of psychotropic medications, namely anti-depressants and/or anti-anxiety agents, are commonly used in conjunction with other therapeutic methods as a means of fully treating the symptoms of depression. A patient's need for medication, however, is always determined on a case-by-case basis. Patients meet with a psychiatrist at least once each day so that the therapeutic effectiveness of any medications that have been prescribed can be monitored and changes can be made when necessary. Additionally, there are also nurses on staff who assist in monitoring medication needs.

Individual therapy at our treatment center: This individual case consultation will occur at a minimum of once each week, but additional sessions can be added whenever needed or deemed beneficial to the patient. Various members of our patients' treatment teams, including their assigned individual therapists, provide such consultations and afford patients a time to meet one-to-one to discuss any concerns they have, process through various emotions they are experiencing, and to track treatment goals.

Family therapy at our hospital: Family involvement is important in the overall success of depression treatment for our patients. Keeping this in mind, family therapy sessions are held at least once each week for our adolescent patients and are held on as-needed basis for our adult patients. For the family members of those who are struggling with depression, this can be a time for them to learn about the illness itself, while also gaining valuable knowledge on ways in which they can be of best support to their loved one.

Group therapy at our treatment center: Group therapy is a significant component to the treatment options offered here at Cross Creek Hospital. The types of groups that our patients may engage in can include:

Education groupsteach patients about the origin and the nature of the disorder(s) that they are suffering from, including depression. In these groups, patients learn to identify problems, form a treatment plan, and work effectively on obtaining recovery and maintaining stability.

Process groups provide a structured setting for the discussion of issues and concerns that are identified by patients. This group focuses on the processing of feelings, internal communication and cooperation, and participation in healthy group feedback.

Addictions groups apply the 12-step addictions model for recovery to a wide range of self-destructive behaviors, including self-mutilation, disordered eating, and unhealthy personal relationships.

Journaling groups provide a structured setting for developing therapeutic and recovery skills in the form of journaling, keeping a diary, completing homework assignments, and other writing tasks.

Music therapy groups provide an emotionally evocative group setting that is designed to provide the participants with an opportunity to practice effective management skills.

Healthy relationships groups focus on developing social skills and practicing health interactions. It provides a forum for structured, supportive risk-taking and practicing assertiveness, and the giving and taking of feedback.

Discharge planning groups provide an opportunity for building skills that will improve the quality of life after discharge and reduce the likelihood of readmission.

Experiential therapy: In an attempt to provide a truly holistic approach to treatment, the staff at Cross Creek Hospital offers a number of experiential therapeutic options for our patients using things such as psychodrama and recreational techniques. These therapies are designed to teach patients skills for appropriate risk-taking, internal communication and cooperation, and expressing needs and fears.

Examples of the experiential therapies that patients may engage in at our depression treatment center include:

Physical wellness and exercise therapy program

Animal assisted therapy

Art therapy - This type of therapy is used to teach nonverbal strategies for expressing thoughts, feelings, and behavior in a healthy fashion. It is meant to be a technique for individuals to learn how to "tell without talking." The art therapy groups also involve verbal processing of the artwork that is created.

Relaxation integration - This type of experiential modality is designed to increase self-esteem, motivation, and energy levels by providing a forum for learning and practicing leisure and social skills, while also developing healthy support systems.

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Depression Treatment Center | Austin, TX | Cross Creek Hospital

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At Cross Creek Hospital, a depression treatment center in Austin, Texas, we are devoted to providing everyone who seeks care at our hospital for the treatment of depression with the respect and dignity that they deserve.

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Denton Outpatient Clinic

Flower Mound Outpatient Center

1001 Cross Timbers Road, Ste. 1250
Flower Mound, TX 75028
214-488-0121
Map

McKinney Outpatient Clinic

Morse Street Clinic

3827 Morse Suite 101
Denton, TX 76208
940-381-5000

Psychiatric Triage Clinic

2509 Scripture Street, Suite 100
Denton, TX 76201
940-381-9965
Map

The Center for Integrated Health

2519 Scripture Street, Rm 173
Denton, TX 76201
972-556-5836
Map

Denton County Crisis Residential Center

Now Open
Call for Information
940-381-5000

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If you are having a psychiatric emergency, CALL 9-1-1

The NNDC office is the coordinating center for the network and is unable to schedule appointments. If you would like to make an appointment, please call one of our member centers. Please also note that NNDC members cannot respond to email requests for specific recommendations regarding treatment. Diagnosis and treatment are complex and highly individualized processes that require comprehensive face-to-face assessment. Please use one of the site's main numbers to make an appointment.

For more general information, please visit NAMI: National Alliance on Mental Illness or call the NAMI helpline at 800-950-6264.

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Get Help - National Network of Depression Centers

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If you are having a psychiatric emergency, CALL 9-1-1 The NNDC office is the coordinating center for the network and is unable to schedule appointments. If you would like to make an appointment, please call one of our member centers. Please also note that NNDC members cannot respond to email requests for specific recommendations regarding treatment.

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Depression is a serious mental disorder that negatively affects how people feel, think and act. It involves an imbalance of brain chemicals, called neurotransmitters and neuropeptides, that create a variety of emotional and physical symptoms. People with depression most commonly experience a deep feeling of sadness, emptiness, fatigue, and/or a marked loss of interest or pleasure in activities. Episodes of depression can often follow stressful events like marital problems or the death of a loved one. Depression is not an everyday bout of "the blues," the result of a character flaw, or a sign of weakness. It is a medical illness, and it is treatable.

Types of Depression

There are several forms of depressive disorders.

Major depressive disorder is characterized by symptoms that interfere with a person's ability to work, sleep, study, eat and enjoy life, which can range from mild to severe. Most often, individuals with major depression will have several episodes of depression over their lifetime, but some people may have only a single episode.

Persistent depressive disorder is characterized by a depressed mood that lasts for at least two years. Individuals diagnosed with persistent depressive disorder may have episodes of major depression as well as periods with less severe symptoms.

Depression may have psychotic features such as disturbing false beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). Depression may occur in a seasonal pattern, which is characterized by the onset of depression during the winter months when there is less natural sunlight. This form of depression generally lifts during spring and summer. In addition, depression may occur with peripartum onset: that is, during or after pregnancy. This occurrence of depression is experienced by an estimated 10-15 percent of women after giving birth. It is much more serious than common "baby blues" when many women feel overwhelmed with the responsibility of caring for a newborn.

Bipolar disorder , also called manic-depressive disorder, is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by mood changes that typically cycle from highs (e.g., mania) to lows (e.g., depression). However, some people with bipolar disorder do not get depression. Rather, they have manic symptoms that alternate with normal moods.

How Common is Depression?

Major depressive disorder is one of the most common mental disorders in the United States. According to the National Institute of Mental Health, approximately 6.7 percent of U.S. adults experience major depressive disorder each year. Women are nearly twice as likely as men to experience depression during their lifetimes. Depression affects more than 6.5 million of the 35 million Americans aged 65 years or older. In addition, 3.3 percent of teenagers (13 to 18 years old) have experienced a seriously debilitating depressive disorder. Fortunately, it is a highly treatable disorder.

Signs and Symptoms

Symptoms of depression do not necessarily come on suddenly; often, they can creep up slowly, evident in a gradual withdrawal from normal life activities. Depression can also develop in relation to a distinct event, such as a death or other loss, family problems, divorce, etc.

The hallmarks of major depression are feelings of sadness and hopelessness, although they are not always present. Each individual may experience it differently in terms of the severity, frequency and duration of symptoms. The following are the most common symptoms of depression. The American Psychiatric Association suggests that professional help is advisable for those who have four or more of the following symptoms continually for more than two weeks:

Prolonged sadness or unexplained crying spells

Feelings of hopelessness, pessimism or indifference

Feelings of guilt, worthlessness, or helplessness

Disturbed thinking - beliefs not based in reality

Irritability, anger, agitation, restlessness

Loss of interest and pleasure in activities formerly enjoyed

Social withdrawal

Fatigue and decreased energy; feeling slowed down

Difficulty concentrating, thinking or remembering details

Inability to make decisions

Sleep problems: inability to sleep, fitful sleep, early-morning wakefulness, or sleeping too much

Physical symptoms, such as headaches, digestive problems or chronic pain that do not improve with treatment

Noticeable change of appetite, with either significant weight loss without dieting, or weight gain

Recurring thoughts of death or suicide, or suicide attempts -Individuals with this symptom should receive treatment immediately! Get help now

Depression in Older Adults
Although it is closely associated with dependency and disability in older adults, depression is not a normal part of growing old, and causes great suffering for the individual and family alike. Older adults with depression may have less obvious symptoms, or may be less likely to admit to feelings of sadness or grief. Certain medications and medical conditions may also cause or contribute to depression.
Depression in Children and Young People
Young children with depression may pretend to be sick, refuse to go to school, cling to a parent or worry that a parent will die. Older children or teens may be irritable or get into trouble at school. Diagnosis can be more difficult in young people because of normal developmental mood swings.

Diagnosis

The first step to getting appropriate treatment is to visit a physician or mental health specialist. A doctor should conduct a thorough diagnostic evaluation to rule out other medical causes for the symptoms of depression, such as a thyroid disorder, vitamin B12 deficiency, virus or certain medications. The evaluation should include a physical exam, an interview and lab tests. If the doctor finds no medical condition causing the depression, he or she may refer you to a mental health professional for an evaluation.

Treatment

The good news is that even the most severe cases of depression can be treated effectively, and nearly all find some relief from symptoms. The sooner treatment can begin, the better the results. Depending on the results of evaluations, depressive disorders are commonly treated with medication, psychotherapy or a combination of the two. The specific depression treatment prescribed will depend on the individual's age, general state of health and medical history, as well as the extent of the depression, among other factors.

Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain called neurotransmitters, especially serotonin and norepinephrine. Other antidepressant medications act on the neurotransmitter dopamine. Patients may experience some improvement within the first week or two of treatment. However it can take two to three months to realize the full benefits. If there has been little to no improvement after several weeks, their doctor will alter the dose of the medication, or will add or substitute another medication. Typically, psychiatrists will advise patients to take medication for depression for six months or longer after symptoms have improved. If there have been two or three episodes of major depression, they may recommend long-term maintenance treatment to reduce the risk of future episodes. Psychiatrists sometimes use other types of medications to increase the effectiveness of antidepressant medications or to target specific symptoms, such as medications for sleep and anxiety, antipsychotic medications, lithium, and thyroid medications.

For mild to moderate depression, psychotherapy, "or talk therapy," may be the best option. However, for moderate to severe depression, or for certain people, psychotherapy is often coupled with antidepressant medications. Therapy may be provided by a psychiatrist, a psychologist, a social worker, a counselor or a psychiatric nurse. Providing educational and emotional support, psychotherapy focuses on helping people with depression cope with their symptoms and feelings, change behaviors that may contribute to depression, and find effective solutions to psychosocial problems. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are effective in treating depression. CBT helps people with depression restructure negative thought patterns. IPT helps people understand and work through troubled relationships that may cause their depression or make it worse.
Other treatments Electroconvulsive therapy (ECT)
Electroconvulsive therapy is a medical treatment that involves a brief electrical stimulation of the brain while the patient is under anesthesia. One of psychiatry's oldest and most effective treatments, ECT is indicated for treating severe major depression in patients:

Whose severe major depression does not respond to medication and psychotherapy

Who cannot tolerate medication, such as women who are pregnant

Who cannot participate effectively in therapy

Who have certain life-threatening or serious psychiatric conditions requiring urgent intervention

Formerly known as "shock therapy," ECT has been greatly improved and is used to treat about 100,000 patients with depression each year. Usually, patients will require several treatments over the course of 2-3 weeks.
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a helpful, noninvasive procedure for treating primarily milder cases of depression. Approved by the Food and Drug Administration in 2008, it is another option for patients who have not found relief from medication, or who cannot - or choose not to - take medications. A special electromagnetic coil is placed against the scalp by the forehead, and it sends short bursts of magnetic energy to stimulate nerve cells in the shallow part of the brain involved with mood regulation. TMS treatments can be performed in a physician's office without anesthesia. To be effective, patients typically must undergo daily treatments lasting 30 to 60 minutes for four to six weeks.

Co-occurring Conditions

Other psychiatric illnesses may come on before or after the onset of a depressive disorder, but depression and other illnesses interact differently in different people. In any case, co-occurring illnesses need to be diagnosed and treated. Some of the most common psychiatric disorders that can co-occur with depression are anxiety disorders, such as post-traumatic stress disorder (PTSD); obsessive-compulsive disorder (OCD); panic disorder; social phobia; generalized anxiety disorder (GAD); and alcohol and drug use disorders.
Find help for depression now Sources:
American Psychiatric Association

Dallas Depression Center (UT Southwestern Medical School)

National Alliance for the Mentally Ill

National Institute of Mental Health

Depression and Bipolar Support Alliance
Helpful links:
Depression and Bipolar Support Alliance
http://www.DBSAlliance.org/
Depression and Bipolar Support Alliance - Texas Support Group Locator:
http://www.dbsalliance.org/site/PageServer?pagename=peer_support_group_locator
Dallas Depression Center
http://depressioncenter.utsouthwestern.edu/ http://www.nimh.nih.gov/health/topics/depression/index.shtml http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7515

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Depression is a serious mental disorder that negatively affects how people feel, think and act. It involves an imbalance of brain chemicals, called neurotransmitters and neuropeptides, that create a variety of emotional and physical symptoms. People with depression most commonly experience a deep feeling of sadness, emptiness, fatigue, and/or a marked loss of interest or pleasure in activities.

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Talk therapy (also known as psychotherapy) can be an important part of treatment for depression, bipolar disorder or other mood disorders. A good therapist can help you cope with feelings, problem solve and change behavior patterns that may contribute to your symptoms.

Understanding Talk Therapy

Talk therapy is not just "talking about your problems"; it is also working toward solutions. Some therapy may involve homework, such as tracking your moods, writing about your thoughts, or participating in social activities that have caused anxiety in the past. You might be encouraged to look at things in a different way or learn new ways to react to events or people.

Most of today's talk therapy is focused on your current thoughts, feelings and life issues. Focusing on the past can help explain things in your life, but focusing on the present can help you cope with the present and prepare for the future. You might see your therapist or counselor more often when you first begin working with them, and later, as you progress towards your goals, you might have appointments less often.

Talk therapy can help you

understand your mental health condition;

define and reach wellness goals;

overcome fears or insecurities;

cope with stress;

make sense of past traumatic experiences;

separate your true personality from the moods caused by your condition;

identify triggers that may worsen your symptoms;

improve relationships with family and friends;

establish a stable, dependable routine;

develop a plan for coping with crises;

understand why things bother you and what you can do about them; and

end destructive habits such as excessive drinking, using drugs, overspending or unhealthy sex.

Who provides talk therapy?

Many kinds of mental health specialists may provide talk therapy. Some common professionals include: psychiatrists (MD), psychologists (PhD, PsyD, EdD, MS), social workers (DSW, MSW, LCSW, LICSW, CCSW), counselors (MA, MS, LMFT, LCPC), or psychiatric nurses (APRN, PMHN). Your ability to talk honestly and openly with your therapist, set clear goals and make real progress are the most important things. Think of your relationship with your therapist as a partnership. The two of you will work together to help you feel better. You do not need to feel ashamed or embarrassed about talking openly and honestly about your feelings and concerns.

Getting the most out of talk therapy

When you first begin therapy, make a list of the things that are bothering you and the issues you would like help with. Bring the list with you to your first appointment. Your list might include topics such as

issues in your family or other relationships;

symptoms like changes in eating or sleeping habits;

anger, anxiety, irritability or troubling feelings; and

thoughts of hurting yourself.

In your first few sessions, you will probably do most of the talking. You should tell the therapist why you are there and what you would like to get from therapy. This is also your time to make sure the therapist is a good fit for you. Ask questions about the types of therapy they offer and what they think might be a good fit for your specific needs. After a few sessions, your therapist may be able to give you an idea of how long therapy will take and when you can expect to see changes in your moods. If the therapist isn't a good fit for you, you should consider asking your therapist for other professionals he or she recommends.

How will I know if I'm making progress?

Within the first few weeks, make a list of short and long-term goals with your therapist. It may be helpful to track how you feel each day and how you cope with difficult situations. After some time has passed, check the list and see if you're closer to reaching your goals. Review your progress with your therapist. Improvement won't happen overnight, but you should see some change, even if it's just a better understanding of your own thoughts and feelings. It is also helpful to learn everything you can about depression and bipolar disorder (LINK TO MOOD DISORDERS) and their treatments. If after some time you don't begin to feel some relief, you may consider changing therapists. You have a right to have the best treatment possible, and you can feel better.

What kinds of talk therapy are there?

CBT or Cognitive Behavior Therapy is goal-oriented and works best when the patient takes an active role. One aspect of CBT helps a person recognize the automatic thoughts or core beliefs that contribute to negative emotions. The therapist helps the person see that some of these thoughts and beliefs are false or don't make sense and helps the person change them. The behavioral aspect of CBT takes place after a person has a more calm state of mind. The person can then take actions that help him or her move closer to planned goals. For example, if depression has caused someone to withdraw from life, that person may be encouraged to participate in hobbies or spend time with friends. Or a person may be gently coached, under supervision, to confront situations, things, or people that cause fear or panic. Through practice, a person learns new, healthier behaviors.

DBT or Dialectical Behavior Therapy is a form of Cognitive Behavior Therapy. The therapist assures the person that their behavior and feelings are valid and understandable. At the same time, the therapist coaches the person to understand that it is their personal responsibility to change unhealthy or disruptive behavior. The therapist reminds the person when their behavior is unhealthy or disruptive-when boundaries are overstepped-and then teaches the skills needed to better deal with future similar situations. Often times DBT involves both individual and group therapy.

Interpersonal therapy (IPT) is time-limited and goal-oriented, and addresses a person's symptoms, social relationships and roles. IPT focuses on what is happening "here and now" and attempts to help a person change, rather than just understand their actions and reactions. It looks at conscious, outward action, and social adjustment. It does not try to change the personality, but rather to teach new skills that can lessen symptoms.

Family Focused Therapy (FFT) works to identify difficulties and conflicts among family and support system members that may be impacting the person's health. Therapy is meant to help support system and family members find more effective ways to resolve those difficulties. The therapist educates individuals about their loved one's mental health condition and how to help them manage it more effectively. FFT also focuses on the stress family members and support systems feel when they care for someone with a mental health condition. The therapy aims to prevent "burning out" or disengaging from the effort. Often the person experiencing the mental health condition will attend sessions with support system or family members.

Additional Types of Therapy

While talk therapy is the most common, there are many other forms of therapy that people find helpful.

Prolonged Exposure Therapy combines cognitive talk therapy with the re-living of a traumatic experience and/or exposure to things that trigger specific responses but are not dangerous. Often times the therapist may begin by encouraging the person revisit the trauma in their mind and share what they experienced. This often helps the person better process the trauma that occurred. Additionally, the therapist may assign homework where they request the person to confront a situation or thing that would cause them distress, beginning with something that likely will only cause minor distress and working up to things that will cause a lot of distress. This stepping process helps the person increase their tolerance and decreases the anxiety associated with each event or experience.

Eye movement desensitization and reprocessing (EMDR) therapy is a type of psychotherapy where the clinician asks the person to think about a traumatic event while watching an object or the clinician's hand move from the left to the right. In addition to eye movement, clinicians also sometimes use tapping on the left side and then the right side of the body or headphones that produce sound in the left ear only, followed by the right ear.

Light therapy is often used for the treatment of Seasonal Affective disorder where a person experiences depression in the months of the year when there is a minimal amount of sunlight, but may also be used to treat other types of depression. During a light therapy session the person in treatment would sit near a light box that gives off a bright light, similar to natural sunlight. The amount of time people spend near their light box each day varies but often falls in the 20-30 minute range. People can read or work while using the light box as long as they don't look directly at the light.

Art therapy uses the creative process of art-making to improve a person's overall wellness-physical, mental and emotional. Participating in art activities has been shown to help people reduce their stress levels and better address problems in their life. For some, the positive effects can come from self-directed participation in any form of art, but in true art therapy, a trained art therapist would select specific materials and assignments that are chosen to target the exact needs of the participant.

Animal assisted therapy is when animals are used as part of treatment to improve a person's social, emotional, or cognitive state. Animal assisted therapy occurs when the owner and the animal are trained in a specific way to help people. In contrast, animal assisted activity is often less structured and may focus more on the presence of the animal rather than a specific job they are performing. Both can be very helpful to individuals living with mood disorders.

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Therapy - Depression and Bipolar Support Alliance

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Talk therapy (also known as psychotherapy) can be an important part of treatment for depression, bipolar disorder or other mood disorders. A good therapist can help you cope with feelings, problem solve and change behavior patterns that may contribute to your symptoms. Talk therapy is not just "talking about your problems"; it is also working toward solutions.

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Characterized by dramatic mood swings from severe depression to frenzied mania, bipolar disorder is a chronic, lifelong mental health disorder that can create difficulty in many areas of functioning. When severe, phases of depression can lead to suicidal thoughts, while manic periods can include risk-taking behavior, reckless decisions, impulsivity, and substance use. ¹⁻⁴

If you or a loved one needs help coping with bipolar disorder and managing the effects of depression or mania, call a bipolar crisis hotline for confidential assistance. If you are in danger of harming yourself or others, call 911 immediately.

Should I Call a Helpline?

The extreme highs and lows of bipolar disorder can leave you with unanswered questions and fears about the future. Whether you're in the midst of a crisis or seeking to prevent another episode, the trained support specialists at a bipolar hotline can provide information about the disorder, connect you with potential treatment options, and provide guidance on how to reduce the impact of the illness on your daily functioning.

Many hotlines are available 24/7 to learn about how to encourage and support someone with bipolar disorder.

Bipolar disorder helplines are completely anonymous, so you shouldn't be afraid to bring up any questions or personal concerns. Many hotlines are available 24/7 for your convenience, and they are also a helpful resource for family members, friends, and loved ones to learn about how to encourage and support someone with bipolar disorder.

Some reasons to call a bipolar disorder hotline include:

To gain more information about bipolar disorder, as symptoms can vary from person to person.

To talk to someone who understands what you are going through.

To learn about treatment options and resources.

To get help finding other support services, including a counselor, social worker, therapist, psychiatrist, or treatment facility that can provide appropriate care.

To access support services available to those who are caretakers, family members, spouses, coworkers, or friends of individuals with bipolar disorder.

What Questions Should I Ask?

Some people may be uncomfortable discussing their bipolar disorder due to the stigma surrounding mental health issues in society. Making a confidential call to a bipolar helpline can help you learn more about the illness and ask any questions in a safe, judgment-free zone.

Bipolar hotlines are a no-cost way to obtain reliable information about the disease and support resources, as well as crisis intervention if needed. If you are experiencing a severe manic or depressive episode, or just have general questions about bipolar disorder, you might consider calling a helpline.

Some common questions include:

Do I really have bipolar disorder?

How is bipolar disorder diagnosed?

What are the symptoms of bipolar disorder?

How is it treated?

Will I have to take medication?

If so, will I have to be on medication forever?

What are the potential side effects of treatment drugs?

How else can I manage symptoms?

Will I have to go to a treatment program?

How long does treatment last?

How much does treatment cost? Will my health insurance cover it?

What can I do if I'm having a bipolar episode?

What if I have other mental health issues as well?

Will I ever feel normal?

How will bipolar disorder affect my ability to attend school, work, and socialize?

What are the next steps I should take?

If you think that a family member, friend, or loved one may be bipolar, knowing more about the disorder can help you be as supportive as possible. Bipolar help hotlines can help you learn more about the condition and how to be most helpful to someone with bipolar disorder.

Questions you may have include:

What should I do if I think someone needs help for bipolar disorder?

What are the symptoms of bipolar disorder?

What types of treatment are available?

How can I help someone with bipolar disorder get treatment?

Are there any resources available for family members of people with bipolar disorder?

What should I do if I think my loved one may hurt himself or someone else?

How can I speak to someone with bipolar disorder to show my support, without making him feel defensive or judged?

What Is Bipolar Disorder?

Sometimes known as manic depression, bipolar disorder can appear at any age but is generally diagnosed in the late teens or early twenties. ³ The term "bipolar disorder" actually represents a cluster of related mood disorders that, in general, are characterized by the lifetime existence of manic and depressive episodes of varying magnitudes. Bipolar disorder can be debilitating, especially if proper medical treatment is avoided. Individuals with bipolar disorder are 15 times more likely to commit suicide than the general population. ⁴

Other complications due to bipolar disorder can include performance issues at work or school, legal problems, financial troubles, strained relationships, substance abuse, and increased risk of sexually transmitted diseases due to risky sexual behavior. 3,4

Nearly 75% of individuals with bipolar disorder also suffer from anxiety disorders.

Below are some common symptoms of the different phases of bipolar disorder: ¹⁻⁴

Signs of mania: agitation, distractibility, euphoric or grandiose mood, taking on multiple projects at once, high levels of energy and activity, decreased need for sleep, irritability, psychosis, racing thoughts or flight of ideas, and reckless or risky behaviors.

Signs of depression: change in eating or sleeping habits; trouble focusing, concentrating, or remembering; feeling overwhelmingly sad, hopeless, or empty; inability to enjoy activities that were once pleasurable or engaging; fatigue or low energy; unintentional change in weight; and thinking about or planning suicide.

People with bipolar disorder are also at higher risk of other mental health issues. Common co-occurring illnesses include anxiety disorders, substance abuse, eating disorders, psychosis, attention-deficit hyperactivity disorder (ADHD), and other impulse control or conduct disorders. ²⁻⁴ Nearly 75% of individuals with bipolar disorder also suffer from anxiety disorders, while more than half also struggle with substance use disorders. ⁴

What Happens During Manic and Depressive Episodes?

Mania and depression involve much more than the normal ups and downs of mood that most people experience. When going through a manic episode, individuals may experience the following: ¹⁻⁴

Agitation.

Distraction.

Elevated mood or euphoria.

Engaging in multiple projects at the same time.

Grandiosity.

High energy levels.

Impaired judgment.

Increased levels of activity.

Irritability.

Psychosis, in some cases.

Racing thoughts.

Rapid rate of speech, or jumping from one topic to another quickly.

Reckless or risk-taking behavior, such as stealing, shopping sprees, risky sexual behavior.

Reduced need for sleep.

Unpredictable behavior.

In contrast, episodes of depression may be characterized by the following symptoms: ¹⁻⁴

Unintentional change in eating habits, such as eating more or less than usual.

Difficulty concentrating or focusing.

Feeling depressed, sad, empty, hopeless, or down.

Forgetfulness.

Lack of enjoyment in daily activities.

Low energy levels.

Reduced activity.

Sleeping more or less than usual.

Thoughts or plans of suicide or death.

Unintended weight loss or gain.

Treating Bipolar Episodes and Symptoms

It can also be helpful to keep track of moods, sleep patterns, life events, and response to treatment methods to determine the best course of treatment.

Seeking professional treatment for bipolar disorder is essential in managing these symptoms. Bipolar disorder is treated with a combination of medication, therapy, and lifestyle changes. Medications that are commonly used include mood stabilizers to reduce the extreme highs and lows, antidepressants to manage symptoms of depression, and antipsychotics to treat psychotic symptoms, if necessary. ¹⁻³ Psychotherapy, including cognitive-behavioral therapy (CBT), education about the disease, and family-focused therapy, have been found effective when used in conjunction with medication. 1,2 In severe cases, electroconvulsive therapy (ECT) may help reduce the symptoms. 1,2

Making lifestyle changes can also reduce the intensity and impact of symptoms and help maximize the effectiveness of other forms of treatment. Simple changes that can make a big impact include eating a healthy diet, maintaining normal sleep cycles, avoiding stressors and triggers, and avoiding use of alcohol or other drugs. It can also be helpful to keep track of moods, sleep patterns, life events, and response to treatment methods to determine the best course of treatment. ¹⁻³

Free Hotline Numbers

If you or a loved one is showing signs of bipolar disorder, a hotline can help you through a crisis or find a treatment program where you can learn to manage symptoms and other mental health issues or substance abuse you may be experiencing.

If you're feeling hopeless and unable to carry on because of the severe impact bipolar symptoms have on your life, this national hotline is available 24/7 to provide confidential crisis intervention and emotional support at no cost. An online live chat option is also available if you don't want to speak to a person over the phone.

When you're ready to get help, SAMHSA's behavioral health treatment locator is an easy, confidential, and free way to find an appropriate program to meet their needs. Support is available in English and Spanish, and the 24-hour service can also help you find local support groups or community organizations in your area.

Bipolar disorder can be especially challenging for adolescents. Boys Town is an excellent resource for teenagers to seek counseling and advice about a range of mental health issues, including bipolar disorder. Their free hotline offers support in English, Spanish, and many other languages, and their sister site Your Life Your Voice offers support offered via telephone, online chat, text, and e-mails, as well as informational articles and a forum for users to post their questions.

The compassionate staff at NAMI are trained to help you manage a mental health crisis and understand the struggles people with bipolar disorder face. This free hotline is open Monday through Friday from 10am to 6pm, EST. Get answers to your questions and information on mental health treatment, education, support groups, vocational assistance, and legal assistance. NAMI is also an excellent resource for friends and loved ones of people struggling with mental health issues like bipolar disorder.

This helpline provides support via text message during crisis situations and can also be used if you simply need to talk because you are feeling angry, frustrated, scared, or hurt because of a bipolar episode. Counselors provide confidential support around the clock, and the text message does not appear on your phone bill to maintain privacy.
Sources

1. National Alliance on Mental Illness. (2015). Bipolar disorder.

2. National Institute of Mental Health. (2016). Bipolar disorder.

3. Mayo Clinic. (2017). Bipolar disorder.

4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th) Arlington, VA: American Psychiatric Publishing. 123-132.

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Characterized by dramatic mood swings from severe depression to frenzied mania, bipolar disorder is a chronic, lifelong mental health disorder that can create difficulty in many areas of functioning. When severe, phases of depression can lead to suicidal thoughts, while manic periods can include risk-taking behavior, reckless decisions, impulsivity, and substance use.

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National Institute of Mental Health (NIMH)

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Overview

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely "up," elated, irritable, or energized behavior (known as manic episodes) to very "down," sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

Bipolar I Disorder- defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.

Bipolar II Disorder- defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.

Cyclothymic Disorder (also called Cyclothymia)- defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, which is referred to as "other specified and unspecified bipolar and related disorders."

Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman's pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels.

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NAMI FAMILY SUPPORT GROUPS
for adult family members, caregivers, and friends of people diagnosed with a mental health condition PARENT SUPPORT GROUP
for parents and caregivers of children & adolescents NAMI CONNECTION RECOVERY SUPPORT GROUPS
for adults diagnosed with a mental health condition
​ LEWISVILLE
​2nd & 4th Monday of each month
7 PM-8:30 PM
First Baptist Church Lewisville, Room 101
1251 Valley Ridge Blvd.,
Lewisville, TX 75077

RICHARDSON
3rd Thursday of each month
7:00 PM - 8:30 PM
The Warren Center
320 Custer Road
Richardson, TX 75080
Info: Cheryl (214) 923-2576 or​ David (214) 923-2523

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NAMI FAMILY SUPPORT GROUPS for adult family members, caregivers, and friends of people diagnosed with a mental health condition PARENT SUPPORT GROUP for parents and caregivers of children & adolescents NAMI CONNECTION RECOVERY SUPPORT GROUPS for adults diagnosed with a mental health condition ​ LEWISVILLE​2nd & 4th Monday of each month7 PM-8:30 PMFirst Baptist Church Lewisville, Room 1011251 Valley Ridge Blvd.,Lewisville, TX 75077 RICHARDSON 3rd Thursday of each month7:00 PM - 8:30 PMThe Warren Center 320 Custer Road Richardson, TX 75080 Info: Cheryl (214) 923-2576 or​ David (214) 923-2523

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Inside Higher Ed | Higher Education News, Events and Jobs

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More than half of the college students who visited their campus counseling centers during the 2015-16 academic year reported symptoms of anxiety, according to a survey by the Association for University and College Counseling Center Directors.

This marks the seventh year in a row that anxiety has been the top complaint among students seeking mental health services. This year, 51 percent of students who visited a counseling center reported having anxiety, followed by depression (41 percent), relationship concerns (34 percent) and suicidal ideation (20.5 percent). Many students reported experiencing multiple conditions at once.

Since 2009, when anxiety overtook depression as the No. 1 concern among college students, the number of students experiencing anxiety has steadily increased.

This survey was conducted between September 2015 and August 2016. In total, 529 counseling center directors representing that many institutions responded to the survey, with an even split between public and private institutions. The majority of respondents came from four-year colleges, but community colleges, professional schools and art schools were also included.

In an effort to reflect the makeup of their student bodies, counseling centers have diversified their clinical staff members. Of new hires, 62.2 percent are white, 15.3 percent black, 7.5 percent Latino and 10 percent Asian. This compares to current clinical staff, who are 70.9 percent white, 10.1 percent black, 7.3 percent Latino and 7.9 percent Asian.

"Student populations have become more diverse," said Micky Sharma, president of the AUCCCD and director of counseling and consultation services at Ohio State University. "Counseling services work to create a staff that represents their student bodies."

At Ohio State, for example, the counseling center now offers clinical services in nine different languages to meet the needs of their international students, who make up about 12 percent of the student body, Sharma said.

Regardless of race, ethnicity, gender or sexual orientation, "anyone could show up with anxiety or depression or a relationship issue," Sharma said. "A university counseling center is charged with providing help for everybody."

Another key finding in the survey is that 41.6 percent of counseling centers hired additional staff members in the last academic year, compared to about 26 percent in 2011 and 36 percent in 2016.

College counseling centers continue to grow to match the demands of their students, according to David Reetz, the lead researcher and coordinator for the 2016 survey and director of counseling and psychological services at the Rochester Institute of Technology.

"More students are seeking services because we continue to be more and more aware that a student's health and well-being have a lot to do with their success in their academic programs and the quality of their student life experience," Reetz said.

In fact, of the students surveyed, about 72 percent who used counseling services said it helped their academic performance in some way.

As more students continue to seek out mental health services and campus counseling centers try to keep up with new hires, the question of student wait times becomes key.

For the first time, this year's survey asked counseling center directors about average wait times for students based on the number of business days between when the appointment was scheduled and when it occurred.

The survey team found that, on average, students waited between six and eight business days for counseling services. However, as might be expected, institutions with a lower ratio of professional staff to students saw shorter wait times.

Reetz noted that the wait-time average is a "tricky number," given that some students opt to schedule their first appointment farther out to accommodate their own schedules.

"Students don't necessarily want to be seen right away," Reetz said, adding that, generally, "the more staff a center has, the shorter that wait time is between initial contact and first appointment."

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Anxiety and depression are the primary concerns for students seeking counseling services

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Survey of campus counseling centers finds increased demand for services, as well as additional positions and more diversity in hiring.

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety.

Credit... Getty Images

By

Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York. Anxiety may be missed because it doesn't necessarily declare itself with attention-getting disruptive behaviors; in fact, symptoms may keep some children quiet and inhibited, though in other children, alternatively, anxiety may be misunderstood as oppositional behavior.

Adults may also assume that anxiety in a child is just a phase to be outgrown. A certain amount of anxiety is a normal aspect of development for young children - consider separation anxiety, for example - and it can even be protective, since children need to learn to keep themselves safe and anticipate certain kinds of dangers. But when worrying or avoiding possible threats gets in the way of a child's functioning or a child's enjoyment, it should be a signal to parents that help is needed, not just watching and waiting, not arranging the child's life to avoid the occasions of anxiety.

Kathleen Merikangas, the senior investigator and chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health, said, "To me, anxiety is one of the most underrecognized or under-treated conditions of childhood and adolescence." These children can get missed, she said, because they may seem to be functioning well; many don't have the kinds of developmental problems or attention issues that draw attention in school, though they may be suffering.

Consider the child whose anxiety about speaking in public gets in the way of participating in class. The child may be silent out of a fear of being laughed at or otherwise rejected, Dr. Merikangas said, but to the teacher, it may look like the child is just not interested. Environmental modifications can really help these children thrive in school, she said; for example, working in small groups with children they know.

The new report, released in September, summarizes the evidence that early temperament in children predicts their later behavior patterns around anxiety; toddlers who show what are called "behaviorally inhibited" behaviors, which parents are likely to perceive as extreme shyness, or anxiety around new people, are more likely to develop social anxiety later on. That doesn't mean that shyness is pathological (as with all varieties of temperament, there's a wide range of function), but it does suggest how important it is to help a child with this temperament who develops difficulties.

The tendency toward anxiety - and toward some specific forms of anxiety, like phobias - may persist throughout childhood and adolescence and into adulthood. And anxiety is closely tied to depression, Dr. Merikangas said. Although there have been reports that anxiety rates among American teenagers have soared, she cited evidence that the international rates of the underlying disorders had stayed consistent from 1998 to 2013; there is no global "epidemic" of clinical anxiety disorders, she said.

But with rates of suicide and suicidal ideation on the rise, it's particularly important to provide information to schools and to parents about recognizing anxiety and getting children help.

Dr. Harold Koplewicz, the president of the Child Mind Institute, said that when anxiety disorders in children are left untreated, anxiety can inhibit their lives, making standard daily activities difficult, from attending school to sleeping in their own beds, and lead to many extra visits to the school nurse or the pediatrician.

But beyond that, he said, "people underestimate that this is a gateway disorder." If children don't get help with these disorders, they may be at risk to develop other mental health problems; the child with severe separation anxiety may develop panic disorder, he said; the child with untreated general anxiety may be at greater risk for depression.

Dr. Merikangas was a co-investigator on a national study of mental disorders in adolescents, which has shown both that anxiety disorders were the most common mental health problems in adolescents in the United States, and also the problems that showed up earliest in those children's lives - the mean age of onset for anxiety disorders was 6. But many adolescents had never received treatment. That makes it essential to get the word out, Dr. Merikangas said, that anxiety is "one of the most treatable symptoms and syndromes, we can really change their lives with minimal intervention."

"All these disorders are remarkably treatable," Dr. Koplewicz said. There are highly effective behavioral and psychosocial therapies, including cognitive behavioral therapies, to help children cope with the demands of daily life. For children who don't respond to psychosocial therapies, he said, medications can be added.

But perhaps because anxiety is a normal response, parents often believe that even severe and disabling anxiety symptoms are just a phase, and on average, there is a two-year lag between the time children develop anxiety and the time they get help. "It's bad for these children's brains," he said. "Having your brain's thermostat miss-set is not good for your brain."

"Anxiety can manifest itself along a continuum," said Rachel Busman, the senior director of the anxiety disorders center at the Child Mind Institute. The report shows that there is some overlap with physical illnesses, such as chronic headaches or stomach aches, often coordinated with school. "That could be a kid's way of saying, 'I'm anxious,'" she said.

And when a child who is having a lot of difficulty with separation gets into the classroom, Dr. Busman said, that child may start throwing things, or running and hiding, and that "bad behavior" may represent the fight or flight response of anxiety. "We've also seen kids who have intense social anxiety and their way of managing it is to be class clown," she said.

Treating children with anxiety always means working with their parents. Jerry Bubrick, senior clinical psychologist at the anxiety disorders center of the Child Mind Institute, said that when children are little, it's normal for parents to operate in "fix-it mode," blocking the staircase so a toddler doesn't tumble down, averting problems before they happen.

As children get older, parents normally pull back, helping children find solutions of their own. "But anxious parents of anxious children remain in fix-it mode," he said, helping their children avoid the situations that make them anxious. Therapy involves exposing children to those situations and helping them develop strategies to manage them; with treatment, Dr. Bubrick said, parents can "let the child experience the anxiety and learn to tolerate and overcome it on their own."

"If you see things you're not sure about, talk to the preschool, talk to the pediatrician, be open to the idea that maybe there is anxiety," even in a young child, Dr. Busman said. Separation anxiety can be a problem even in children who are able to go to school, she said. Parents should pay attention if a child can't be left with a babysitter, a child can't sleep alone at home."These are the kids, they go into the bathroom, and they're like, are you still there?" she said. "We do see really young anxious children."

"If your child is suffering distress and dysfunction, reach out to your pediatrician," Dr. Koplewicz said. When you get to a mental health professional, "make sure you ask the right questions," he said, including asking whether that person has specific experience with treating anxiety and how long the treatment is expected to take.

"You want a professional who understands what they're doing and can explain to you what they're doing."

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How to Help a Child With an Anxiety Disorder

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety. By Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York.

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Child Mind Institute | Transforming Children’s Lives.

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The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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A Tale of Two Conversations is a two-part video showing actors playing a parent of a child with a disability and a school administrator. The meeting was requested by the parent and takes place in the administrator's office. Take One shows the parent and administrator talking about the child's special education program. They are talking, but not listening. Their communication is unproductive. Take Two shows each person using more effective communication skills.

Both video conversations are available for viewing online at CADRE, as is a companion Study Guidethat looks more deeply into the effective communication skills shown in the second video. Read more about and access the resources here.

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Center for Parent Information and Resources | Your Central Hub for Parent Centers Serving Families of Children With Disabilities

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A Tale of Two Conversations is a two-part video showing actors playing a parent of a child with a disability and a school administrator. The meeting was requested by the parent and takes place in the administrator's office. Take One shows the parent and administrator talking about the child's special education program.

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Characteristics of students with emotional disturbances

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Characteristics of Students with Emotional Disturbances

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Oppositional Defiant Disorder (ODD) in Children

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Oppositional Defiant Disorder (ODD) in Children

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What is oppositional defiant disorder (ODD) in children?

Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.

What causes ODD in a child?

Researchers don't know what causes ODD. But there are 2 main theories for why it occurs:

Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.

Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child's ODD behaviors. That's because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.

Which children are at risk for ODD?

ODD is more common in boys than in girls. Children with the following mental health problems are also more likely to have ODD:

Mood or anxiety disorders

Conduct disorder

Attention-deficit/hyperactivity disorder (ADHD)

What are the symptoms of ODD in a child?

Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is especially true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often. They also interfere with learning and school adjustment. And in some cases, they disrupt the child's relationships with others.

Symptoms of ODD may include:

Having frequent temper tantrums

Arguing a lot with adults

Refusing to do what an adult asks

Always questioning rules and refusing to follow rules

Doing things to annoy or upset others, including adults

Blaming others for the child's own misbehaviors or mistakes

Being easily annoyed by others

Often having an angry attitude

Speaking harshly or unkindly

Seeking revenge or being vindictive

These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is ODD diagnosed in a child?

If you notice symptoms of ODD in your child or teen, you can help by seeking a diagnosis right away. Early treatment can often prevent future problems.

A child psychiatrist or qualified mental health expert can diagnose ODD. He or she will talk with the parents and teachers about the child's behavior and may observe the child. In some cases, your child may need mental health testing.

How is ODD treated in a child?

Early treatment can often prevent future problems. Treatment will depend on your child's symptoms, age, and health. It will also depend on how bad the ODD is.

Children with ODD may need to try different therapists and types of therapies before they find what works for them. Treatment may include:

Cognitive-behavioral therapy. A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger.

Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding.

Peer group therapy. A child develops better social and interpersonal skills.

Medicines. These are not often used to treat ODD. But a child may need them for other symptoms or disorders, such as ADHD.

How can I help prevent ODD in my child?

Researchers don't know what causes ODD. But certain approaches can help prevent the disorder. Young children be helped by early intervention programs that teach them social skills and how to deal with anger. For teens, talk therapy (psychotherapy), learning social skills, and getting help with schoolwork can all help reduce problem behaviors. School-based programs can also help to stop bullying and improve relationships among teens.

Parent-management training programs are also important. These programs teach parents how to manage their child's behavior. Parents learn positive reinforcement methods, and also how to discipline their child.

How can I help my child live with ODD?

Early treatment for your child can often prevent future problems. Here are things you can do to help:

Keep all appointments with your child's healthcare provider.

Take part in family therapy as needed.

Talk with your child's healthcare provider about other providers who will be involved in your child's care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child's care team will depend on his or her needs and how serious the disorder is.

Tell others about your child's conduct disorder. Work with your child's healthcare provider and school to develop a treatment plan.

Reach out for support. Being in touch with other parents who have a child with ODD may be helpful. If you feel overwhelmed or stressed out, talk with your child's healthcare provider. He or she may direct you to a support group for caregivers of children with ODD.

When should I call my child's healthcare provider?

Call your child's healthcare provider right away if your child:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others

Feels out of control

Hears voices that others don't hear

Sees things that others don't see

Can't sleep or eat for 3 days in a row

Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about ODD in children

Oppositional defiant disorder (ODD) is a type of behavior disorder. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

Developmental problems may cause ODD. Or the behaviors may be learned.

A child with ODD may argue a lot with adults or refuse to do what they ask. He or she may also be unkind to others.

A mental health expert often diagnoses ODD.

Therapy that helps the child interact better with others is the main treatment. Medicines may be needed for other problems, such as ADHD.

Next steps

Tips to help you get the most from a visit to your child's healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child's condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child's provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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Oppositional Defiant Disorder (ODD) in Children

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Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

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The present study investigated the effectiveness of an intervention comprising posted classroom rules, token economy, response cost, and mystery motivators in reducing disruptive classroom behavior. Participants were three male second grade students identified as having oppositional defiant disorder. To serve as an additional control, a class composite was formed using five male classmates whose behavior was judged appropriate. The study employed a multiple baseline across subjects design. Results showed an immediate and pronounced decrease in disruptive behaviors for all three students. Furthermore, their rates of disruptive behaviors were consistently below that of the class composite control. This decrease in inappropriate classroom behavior continued during follow-up. The teacher reported that the intervention was relatively easy to implement, and together with its effectiveness in reducing disruptive behaviors, functioned to reinforce her willingness to incorporate the intervention into daily instructional practice.

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A Classroom-Based Intervention to Reduce Disruptive Behaviors

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The present study investigated the effectiveness of an intervention comprising posted classroom rules, token economy, response cost, and mystery motivators in reducing disruptive classroom behavior. Participants were three male second grade students identified as having oppositional defiant disorder. To serve as an additional control, a class composite was formed using five male classmates whose behavior was judged appropriate.

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This study uses a cohort-sequential longitudinal design to examine the patterns of change and codevelopment of anxiety, depression, and oppositional defiant symptoms (ODS) from late adolescence to young adulthood. Four waves of data were collected biennially by individual interview with a random, community-based sample of 662 youth ages 12 to 18 years at Time 1 (18-26 years at Time 4). Using latent growth curve modeling, we examined co-occurring changes in the levels, rates of change, and variability in symptoms of anxiety, depression, and oppositional defiance. Sex differences were also assessed. Levels of anxiety, depression, and ODS were correlated at each time point. Moreover, adolescents with high initial levels in one domain tended to have high initial levels in the other domains. In addition, increases in depressive symptoms were significantly correlated with increases in anxiety and in ODS, but adolescent levels of symptoms did not predict increases over time. Symptoms of anxiety (for female and male individuals) and depression (for male individuals) continue to increase in young adulthood, whereas ODS stabilize or decline. Adolescent levels of these problems have a significant impact on later levels, suggesting that preventive interventions may be needed in adolescence to defer negative consequences of mental health problems in young adults.

Additional information

Acknowledgments

This research was supported by grants from three Canadian Institutes for Health Research including grants #838-20000-075, #79917, and #93533, as well as a Canadian Institute for Health Research Doctoral Award held by Kara Thompson (#104612). We also appreciate the dedication of the data collection teams lead by Vincenza Gruppuso and the generosity of our participants.

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Co-occurring Trajectories of Symptoms of Anxiety, Depression, and Oppositional Defiance From Adolescence to Young Adulthood

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This study uses a cohort-sequential longitudinal design to examine the patterns of change and codevelopment of anxiety, depression, and oppositional defiant symptoms (ODS) from late adolescence to young adulthood. Four waves of data were collected biennially by individual interview with a random, community-based sample of 662 youth ages 12 to 18 years at Time 1 (18-26 years at Time 4).

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Home - ADDA - Attention Deficit Disorder Association

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Empowering adults with adhd to live their best lives A Different Brain Requires a Different Approach Whether you're newly diagnosed, wondering if you have ADHD, or simply ready to take charge of your life - we're here to help. Have ...

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry. These are called obsessions. To alleviate the anxiety caused by their obsessive thoughts, they perform repetitive, ritualized actions called compulsions. A child with OCD might need to line things up, touch things in a certain order when leaving the room or wash his hands repeatedly.

Obsessions Common in Kids With OCD

Contamination: Kids with this obsession are sometimes called "germaphobes." In schools, this plays out with kids worrying about other kids sneezing and coughing, touching things that might be dirty or getting sick in many different ways. This is the most common obsession seen in children.

Magical thinking: This is a kind of superstition, like "step on a crack, break your mother's back," taken to extremes. For example, kids might worry that their thoughts can cause someone to get hurt, or get sick. A child might think, "Unless my things are lined up in a certain way, mom will get in a car accident."

Catastrophizing: Some kids easily jump to the conclusion that something terrible has happened. For example, if her parents are five minutes late picking her up, a girl who is catastrophizing might tell herself that they've decided to abandon her.

Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.

What ifs: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. "What if I hurt someone? What if I stab someone? What if I kill someone?"

The "just right feeling": When OCD first develops, from about 6 to 9 years of age, kids may not know why they are doing something, but just that they need to do it until they get what we call the "just right feeling." So: "I'll line these things up until it just kind of feels right, and then I'll stop." And then over time - in the 9- to 12-year-old range - it evolves into magical thinking and becomes more superstitious in nature.

Behaviors You Might See in Students With OCD

Frequent requests to go to the bathroom: This could be to wash hands, if someone near the child was coughing or sneezing, or if she touched something that she perceives as contaminated. She could be washing items-pens, pencils, backpacks, books. It could also be an excuse to get out the classroom and just be away from everyone, and have some respite.

Constant reassurance-seeking: This takes the form of repetitive questions. "Are you sure that's the answer? Could you tell me again? Did you hear what I said?" Checking doors, windows, lockers, desks. Over and over and over again.

Getting stuck on tasks: Sometimes kids with OCD will need to finish something to completion, or understand it to completion, before they're able to move on. So if a child is working out what he did wrong on a math test, and the teacher says, "Now let's open the textbook and start a new chapter," he's not going to be able to shift gears.

Retracing: If a child leaves the classroom and worries that she left a pencil behind, she'll go back into the classroom and go to her desk and check. If she had a bad thought as she went through the doorway, she might have to "fix it" by going back through the doorway again saying a good word. If she had a bad thought when she went down a flight of stairs on the way to class, she might need to go back up that same stairway at the end of the period, even if it means being late to her next class.

Obsessive erasing: A child could be erasing a lot because the letters have to look perfect. Or he could have used a word that disturbs him. For example, if he has a fear of vomiting and he's written the word vomit, he might not be able to stand seeing that word, so he erases it. Kids start having erasers worn down to the metal. Teachers start to see holes in the paper. Words will be drawn over on the back of the page. A lot of different areas of writing become problematic.

Behaviors Often Confused With Another Disorder

Some behaviors associated with OCD are easy to confuse with ADHD, learning problems or being oppositional.

Distraction: If a child is busy thinking that if she doesn't turn the pen cap and count to four the right way then her mom is going to get sick, she's not going to be paying attention in class. And if her teacher calls on her to answer a question, her distraction might look like ADHD, but it isn't.

Slowness on exams, papers and tasks: Sometimes when kids take a long time, they're struggling with the perfectionism of needing to do things the right way. This could look like learning problems, or inattention, but it isn't.

Avoidance: Teachers might see a child who doesn't want to sit on the floor, or pick things up that touched the floor, or get his hands dirty in art class. He may avoid a lot of playground activities - kids with germ fears will view the playground the way some adults view the subway: it's gross. Why touch anything there?

Tapping and touching symmetrically: If a child sits down at her desk and she accidentally kicks the chair of the kid next to her with her right foot, she's going to have to then kick it with her left foot. That might look like somebody who's being oppositional, or somebody who's got too much energy, but actually it's OCD.

Complaints of anxiety and fatigue: There's one interesting theory that kids with OCD are smarter than other kids. And if you consider how much thinking they're doing, they're really using their brain more frequently than a lot of other kids are. But when that's coupled with a lot of anxiety, you can have a lot of fatigue. So it's common for kids with OCD to want to come home and take a nap after school.

How to Help Students With OCD

For children struggling with OCD, functioning in school can be complicated and very difficult. Here are some things you can do to help them, and the class as a whole, focus on learning:

Seating arrangement: If the school has noisy hallways, you might not want to have a child with OCD sit by the door. You might have her sit in the front, where she's less able to hear the noise and can stay more focused on her work. On the other hand, a child who has very observable symptoms, and doesn't want other kids to see her fidgeting with her hands, rocking or getting up a lot, might be better off closer to the door, toward the back of the room.

Extended time for tests and papers: If writing is a problem for a child who needs to find the perfect way to say something, he's going to need more time to finish those essay questions or papers.

Laptops for writing: If writing and rewriting/erasing is really problematic for a child, consider letting her use a laptop for taking notes, and having all assignments be typed instead of handwritten.

Private testing rooms: Research is quite clear that kids with OCD do better, are less overwhelmed and are more in control of their thoughts and their reactions if they're in a quiet place away from the other kids.

Skip reading out loud: Kids who feel they need to read perfectly may have to go back and reread sentences or whole paragraphs over and over to make sure they've got them right. So reading becomes a very laborious task, and reading in front of the class can become a nightmare. So if we know doing this is a problem for children, we can spare them.

Books on tape: If kids get so hung up reading that it takes forever, listening to the books can be a solution.

Break homework into chunks: If looking at a whole page of math makes kids feel overwhelmed and anxious - think of the potential for mistakes! - the problems can be broken up over four pages. It helps kids stay focused on doing the problems instead of worrying.

How to Minimize Behavioral Problems

Plan an escape route: Try working out a communication system so that if the student feels symptoms coming on, she can signal to you and leave the classroom, or go to a protected place in the classroom, without interrupting the class. It can prevent an embarrassing and disruptive blowup of symptoms in the classroom, and the other kids picking on or bullying her about it.

Be aware of triggering events: It's very important for teachers to know what kind of things might trigger the symptoms. Fatigue is a huge piece of OCD, and it can be exacerbated by medication. So it's important to know that if a child is drowsy in class, and maybe he's putting his head down, it's not because he's being oppositional or disrespectful, but because he's overwhelmed with fatigue.

Advance notice: Irritability and frustration are two of the longer-lasting things that kids with OCD are feeling on a daily basis. Changes in schedule can be very disruptive for a child with OCD, so it can be helpful for teachers to give advance notice of things. Kids who know what to expect are less likely to be thrown by the change.

Children with OCD are often teased and bullied because of their symptoms. Kids feel very uncomfortable about their rituals, knowing that they're being watched. It can be helpful to educate the whole class about what's going on, especially if a child is going to be in the same school for a number of years, and it can inspire a surprising amount of support from other children.

Peer understanding program: A peer understanding program includes a presentation in the classroom that explains (with the child participating) what OCD is. The child might say, "Listen, I have OCD. It's an anxiety disorder. It makes me think that my hands are dirty and I have to wash my hands a lot, so if you see me getting up and going to the sink to wash my hands, that's why." Psychologists can role-play with the teacher and child ahead of time, to anticipate questions his classmates might ask, and how to answer them.

A buddy system: A buddy is like a peer coach who sits next to the child and prompts him to keep up with note taking and staying on task. It can be great for the buddy, to foster a sense of confidence and pride and to be able to help someone in need, and great for fostering friendship.

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry.

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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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Credit: Julius-Maximilians-Universität Würzburg, JMU

An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection.

Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body. They are trapped in a vicious circle, as the fear of new contamination returns quickly after washing. Sufferers see no way out. They are even incapable of changing their behaviour when the excessive washing has led to skin irritation or damage.

Around two percent of the general population suffer from some kind of obsessive-compulsive disorder (OCD) at least once in their life. The disorder is characterised by persistent intrusive thoughts which the sufferers try to compensate for by repetitive ritualized behaviour.

Like depression, eating disorders and other mental diseases, OCD is treated with antidepressants. However, the drugs are non-specific, that is they are not tailored to the respective disease. Therefore, scientists have been looking for new and better targeted therapies that have fewer side effects.
Missing protein triggers urge to wash
Professor Kai Schuh from the Institute of Physiology at the Julius-Maximilians-Universität (JMU) Würzburg (Germany) and his team explore the underlying causes of obsessive-compulsive disorder in collaboration with the JMU's Departments of Psychiatry and Neurology.

"We were able to show in mouse models that the absence of the protein SPRED2 alone can trigger an excessive grooming behaviour," Schuh says. He believes that this finding is crucial as no clear trigger for this type of disorder has been identified until now. Previous research pointed to multiple factors being responsible for developing OCD.

Occurring in all cells of the body, the protein SPRED2 is found in particularly high concentrations in regions of the brain, namely in the basal ganglia and the amygdala. Normally, the protein inhibits an important signal pathway of the cell, the so-called Ras/ERK-MAP kinase cascade. When it is missing, this signal pathway is more active than usual.
Hyperactive signal cascade in the brain
"It is primarily the brain-specific initiator of the signal pathway, the receptor tyrosine kinase TrkB, that is excessively active and causes the overshooting reaction of the downstream components", biologist Dr. Melanie Ullrich explains.

Administering an inhibitor to attenuate the overactive signal cascade in the animal model improves the obsessive-compulsive symptoms. Moreover, the JMU research team was able to treat the OCD with an antidepressant, similarly to standard therapy in humans. Their detailed results have been published in the journal Molecular Psychiatry.
New targets for therapies pinpointed
"Our study delivers a valuable new model that allows the disease mechanisms to be investigated and new therapy options for obsessive-compulsive disorders to be tested," Professor Schuh says.

The recently discovered link between OCDs and the Ras/ERK-MAP kinase cascade also opens up new targets for therapy. Drugs that inhibit this cascade are already available and some of them are approved for human treatment.

According to Melanie Ullrich, these are cancer drugs, as overactivation of the Ras/ERK-MAP kinase cascade is also a frequent trigger of cancer: "So we are wondering whether such drugs could also be effective in the treatment of obsessive-compulsive disorders and whether they are beneficial in terms of side effects."

More information: M Ullrich et al. OCD-like behavior is caused by dysfunction of thalamo-amygdala circuits and upregulated TrkB/ERK-MAPK signaling as a result of SPRED2 deficiency, Molecular Psychiatry (2017). DOI: 10.1038/mp.2016.232

Provided by Julius-Maximilians-Universität Würzburg

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An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection. Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body.

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Suffering in Silence- Examining OCD in School Setting

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Obsessive-compulsive disorder (OCD), as defined by the Mayo Clinic, is classified as a type of anxiety disorder. People with OCD are driven by unreasonable thoughts and unwarranted fears, referred to as "obsessions," to perform repetitive behaviors, referred to as "compulsions." People suffering from OCD might understand their obsessions are unreasonable, but trying to stop or ignore them causes compounding anxiety and stress. The repetitions must ultimately be reinstated to alleviate mounting stressful feelings and anxiety.

Statistics from the Department of Psychiatry at the University of California, San Diego (UCSD) lists OCD as the fourth most common neuropsychiatric illness in the US. At any given time, more than 5 million Americans are living with the symptoms of OCD. That is one in 40 adults and one in 200 children.

What Causes OCD?

Although what causes obsessive-compulsive disorder is not fully known, three theories have been developed. OCD may have a biological basis and be the result of changes in a person's higher cognitive functions brought about by neurochemical imbalances. Specific genes responsible for OCD have not been identified. The second theory is that OCD may be caused by environmental factors and be born of behavior-related habits a person has been learning over time.

The third theory blames OCD on insufficient serotonin levels. Serotonin is a neurotransmitter; it is one of the brain's chemical messengers. Medications that work by improving serotonin action reduce obsessive-compulsive disorder symptoms, which lends much credence to this theory.

Is There a Cure for OCD?

There is no cure for obsessive-compulsive disorder, but there are methods of treatment that provide relief from the symptoms to the extent that most patients can lead normal lives. Treatment-resistant OCD does not seem to respond to therapies; however, all OCD cases were once considered resistant to treatment. After further study, it is now possible to treat 40 to 60 percent of OCD patients using medication alone, and new information emerges as treatments progress, according to the National Center for Biotechnology Information (NCBI).

Therapies for OCD

Therapies for obsessive-compulsive disorder typically consist of medication, psychotherapy or both. OCD responds well to cognitive behavioral therapy. This type of therapy coupled with prescribed medication, usually antidepressants or anti-anxiety medications, alleviates the symptoms for most people who suffer from OCD.

Cognitive Behavioral Therapy Treatment for OCD

Cognitive behavioral therapy treatment for OCD may take place in individual, group or family sessions. OCD patients can experience some relief through cognitive behavioral therapy, particularly a form called exposure and response prevention. This entails gradually exposing the patient to the feared obsession. For instance, if the patient is obsessed with cleanliness, they are exposed to dirt for gradually increasing amounts of time. This helps the patient to learn new thought patterns and behaviors about their obsession with dirt. Although this form of therapy takes a lot of effort and practice, the reward is a much better quality of life for the patient.

The basic premise behind exposure and response prevention is that compulsion allows obsession to exist by interrupting the habituation process. The process of habituation is what causes a person to have less interest in a certain event once that person has witnessed the same event many times. For example, if your friends threw you a surprise party every day, you would eventually stop being surprised and thrilled. In the same manner, if the compulsion did not exist, the obsession would become less and less interesting until it eventually disappeared. Once a compulsion is fulfilled by an obsession, the person feels short-term relief of anxiety. The relief serves to reinforce the compulsion like a reward, and it becomes a perpetual cycle. Simply put, without compulsion, obsession would not occur and vice versa.

If you are interested in learning about different treatment options, please contact us at . We are happy to help you achieve your goals.

Medically Assisted OCD Therapy

The National Library of Medicine (NLM) lists medications commonly prescribed in medically assisted OCD therapy. The most effective medications prescribed for obsessive-compulsive disorder are selective serotonin reuptake inhibitors (SSRIs), which are antidepressants. These medications include:

Sertraline (Zoloft)

Paroxetine (Paxil)

Fluvoxamine (Luvox)

Fluoxetine (Prozac)

Citalopram (Celexa)

If a patient fails to respond to an SSRI, doctors revert to clomipramine. Clomipramine is an older tricyclic antidepressant and was the first medication used to treat OCD. Although its efficacy is greater than that of other medications, it has unpleasant side effects that may make the patient uncomfortable. Sometimes an SSRI and clomipramine are combined in treatment. The side effects of clomipramine include:

Sleepiness

Drop in blood pressure when rising from a seated position

Difficulty starting urination

Dry mouth

Atypical antipsychotics have also proven to be helpful in low doses. Among these antipsychotics are:

In some cases, benzodiazepines can offer anxiety relief, but they are typically only used in conjunction with more reliable treatments. Cognitive therapy is the preferred form of treatment, but many patients benefit from combining medication with therapy.

Psychosurgery

Psychosurgery is used to alleviate symptoms of obsessive-compulsive disorder in patients who do not respond to medications or behavioral therapy. As per the International OCD Foundation, four types of brain surgery have proven effective in treating OCD. The first is anterior cingulotomy. This surgery involves drilling into the skull and burning an area of the brain called the anterior cingulate cortex with a heated probe. This surgery has provided benefits for 50 percent of those with treatment-resistant OCD.

The second surgery is known as anterior capsulotomy. This surgery is similar to the anterior cingulotomy surgery, but doctors operate on a different area of the brain called the anterior limb of the internal capsule. The surgery has succeeded in giving relief to 50 to 60 percent of patients with treatment-resistant OCD.

The third procedure is called the gamma knife. This treatment does not involve opening the patient's skull. Rather, the skull is penetrated by multiple doses of gamma rays. While a single dose of gamma rays will not harm brain tissue, when multiple sources of gamma rays intersect, they create an energy level adequate to destroy targeted brain tissue. The gamma knife procedure has been helpful to about 60 percent of treatment-resistant OCD patients.

Finally, there is deep brain stimulation (DBS). Although this procedure requires opening the patient's skull, it does not involve destroying brain tissue. Instead, electrodes are placed at strategic points inside the brain and wired to a pulse generator. The battery-powered generator, also called an implantable neurostimulator, sends pulses to the brain. It works in a similar fashion to a pacemaker. So far, only small studies have been conducted with deep brain stimulation, but the response rate is similar to the other surgeries.

Other Therapeutic Methods

Intensive treatment programs are available. Some programs last only a weekend while others require a three-month stay at a treatment center. At these facilities, OCD patients undergo intensive individual, group and family cognitive therapy every day. A specifically devised medication regimen is also used. Other therapeutic methods are in development. Research involving the manipulation of neurotransmitters is currently under way.

The National Alliance on Mental Illness (NAMI) discusses the use of electroconvulsive therapy (ECT). During ECT, the psychiatrist uses a machine to deliver electric shocks to the brain of the patient. The shock triggers a controlled seizure to activate neurons that bring about changes in neurochemical levels in the brain. This method is very effective for OCD.

Transcranial magnetic stimulation utilizes magnetic fields to stimulate the nerve cells in the patient's brain. This process decreases the severity of some symptoms of depression. The method is used when others fail.

Residential and Inpatient OCD Treatment Centers

Residential or inpatient OCD treatment centers are available for patients who do not respond to other therapies. They offer hospital and residential care, and some centers conduct research. These centers offer in-depth, structured therapy and psychopharmacological approaches.

We would be happy to assist you with understanding treatment options and locating licensed treatment centers. Please, contact us at today to discuss your options.

The Benefits of Residential OCD Treatments

The benefits of residential OCD treatments are not limited to intensive inpatient and outpatient treatment. The residential centers are valued for their research and for providing treatment programs far more tailored to each patient's needs. Comorbid conditions are also diagnosed and treated, and some centers offer traditional care along with intensive therapy.

Luxury OCD Disorder Facilities

Luxury OCD treatment facilities offer such amenities as forward-thinking rehab, expert staff members, gourmet chefs, exotic activities and pristine grounds. Some are akin to resorts, and some unite Eastern spiritual practices, like meditation and yoga, with traditional therapy.

Executive OCD Disorder Programs

As with luxury treatment facilities, executive OCD programs offer a wide array of high-class amenities. The major difference is that these programs are geared toward business executives and corporate managers who cannot attend a full-time residential program, and who need to be able to carry on with their business affairs while in treatment.

Outpatient OCD Rehab and Treatment Programs

Outpatient OCD rehab and treatment programs offer intensive outpatient treatment conducted by dedicated staff members. They assist individuals with OCD as well as their families. Many of these facilities conduct research into OCD and use research-based treatment options.

Prescription and Over-the-Counter Medications

According to the International OCD Foundation, medication can reduce symptoms of OCD by 40 to 60 percent in most patients. The majority of drugs used to treat OCD are antidepressants, as depression often stems from the effects of OCD. Both disorders can be treated with one medication. Not all antidepressants are effective for OCD symptoms. There are eight antidepressants known to work well for OCD. They are as follows:

Sertraline (Zoloft)

Paroxetine (Paxil)

Fluvoxamine (Luvox)

Fluoxetine (Prozac)

Citalopram (Celexa)

Escitalopram (Lexapro)

Clomipramine (Anafranil)

Venlafaxine (Effexor)

These antidepressants have been studied and tested for their effectiveness against OCD. However, there are hundreds of case reports citing other drugs that help treatment-resistant OCD patients. These drugs must generally be administered in high doses to be effective.

A common mistake made by patients living with obsessive-compulsive disorder is taking doses of antidepressants during times of stress. Antidepressants need to be taken in consistent and prescribed doses every day and are not to be taken like an anxiety medication.

While many patients feel the effects of antidepressants in the first few days, for other patients it can take as long as 10 to 12 weeks before the drugs begin to work. Some people are able to stop their antidepressant regimen after 12 months while approximately 50 percent must maintain doses for years or even their entire lives.

How to Find the Best OCD Treatment Facility

Your psychiatrist may be able to advise you about how to find the best OCD treatment facility. You can also check with local mental health facilities for advice. The easiest way to get information about treatment programs that meet your needs is to contact us at . We are here 24/7 to assist you.

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Obsessive-compulsive disorder (OCD), as defined by the Mayo Clinic, is classified as a type of anxiety disorder. People with OCD are driven by unreasonable thoughts and unwarranted fears, referred to as "obsessions," to perform repetitive behaviors, referred to as "compulsions." People suffering from OCD might understand their obsessions are unreasonable, but trying to stop or ...

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When someone in your family has OCD, everyone is affected. It's natural to have strong emotions about this intruder in your home. Feelings can include frustration, resentment, anger, embarrassment and exhaustion from trying to live in a household where OCD seems to be in control.

Even if you think you've already tried everything possible to get rid of OCD, you can make changes now that really can help bring relief to the whole household.

If you are at a point where you only suspect that OCD may be the problem, it's important for your loved one to have a thorough evaluation and get an accurate diagnosis so treatment can begin - whether for OCD or another mental disorder that may be causing distress. If your loved one is undergoing OCD treatment, you can play an important role in supporting his or her recovery. If he or she is diagnosed with OCD but refuses to get treatment, it will be important for you to learn why some people avoid treatment and how you may be able to encourage your loved one to seek help.

You already know there are no quick fixes for OCD. But even if you think you've already tried everything possible to get rid of OCD, there are some changes you can make now that may help bring relief to the whole household. And once you see some of these strategies working, you'll be able to experience more positive emotions, including optimism, hope and feelings of success.

What's Behind The Problem of OCD

It's extremely important to realize that people with OCD aren't performing rituals and engaging in other behaviors deliberately to frustrate, upset or annoy you or others. Individuals with OCD experience obsessions, which are persistent, uncontrollable thoughts, impulses, or images that are intrusive, unwanted and disturbing. Obsessions cause anxiety or discomfort that significantly interferes with their lives. To relieve the distress caused by obsessions, people with OCD feel compelled to perform repetitive actions called compulsions, or rituals. For example, a person with an obsessive fear of intruders may check and recheck door locks repeatedly to ensure that no one can get in.

OCD is a disorder that has a neurobiological basis. Your loved one's brain isn't functioning in the same way as the brain of an individual without OCD. The brain of people with OCD is constantly sending "error messages," leading to constant uncertainty, including worries and fears that go well beyond what most of us will ever experience. Their anguish is real. Individuals with OCD are no more at fault for having the disorder than those who have other medical conditions such as diabetes or asthma.

Regardless of how frustrating it may be for you to watch your loved one perform rituals, repeatedly seek reassurance or even bark orders at you or other family members, he or she doesn't do this on purpose. And people with OCD can't stop just because you want them to. In fact, if they could just stop their behavior, they'd be the first ones on the face of the planet to stop! When OCD is present, the person isn't in control anymore - OCD is.

One of the most important ways you can support your loved one is by learning about OCD. You can learn more about OCD in the OCD Facts, Individuals or Parents sections of this web site.

Your Role as Change Agent

There are a number of other ways you can help a family member with OCD. First and foremost, you can help your loved one find appropriate treatment for OCD and encourage him or her to actively participate in the therapy process. Effective treatment is the most important step in gaining relief.
Learn how to find the right therapist.
It's also very important that you try to establish a positive emotional climate in the home. How you communicate with your loved one as well as the level of support you provide cannot be overemphasized.

You can also help the person with OCD when you stop accommodating the disorder. Family members sometimes participate in their loved one's rituals, provide constant reassurances or help the person with OCD avoid feared objects, places or people. In other words, you accommodate OCD behavior. Sometimes you do it just to "keep peace in the family" or because it seems like the only way you can help the one you love. You may desperately want to stop being involved in the OCD behavior your family member has drawn you into. But you've stayed involved, fearing that stopping would make the OCD worse. OCD is a master at manipulating the person who has the disorder and, in turn, his or her family.

Today, OCD treatment experts know that it is important to involve families in Cognitive Behavior Therapy (CBT). Family members can greatly enhance their loved one's chances for recovery by not accommodating OCD. You can't stop all at once, of course. But a cognitive behavior therapist can help you gradually change the way you respond to OCD.
Learn more about how to stop accommodating OCD behavior
Another very important facet of your role as a change agent involves taking care of yourself. Research has indicated that family members report some - if not severe - distress adjusting to a loved one's OCD. And yet they seldom seek the professional help they need; instead, they usually focus on the individual with OCD. Living with or caring for a family member with OCD can be extremely stressful, and it's critical that you take care of your own physical and psychological needs. Be sure to seek out help when you need it; it's a sign of strength, not weakness. And when you're less overwhelmed by frustration, guilt, and other negative emotions, you are in a better state of mind and will actually be more effective in helping your loved one.

You may find it helpful to talk with your loved one's cognitive behavior therapist for guidance or seek help on your own. You may also want to consider attending a local OCD support group that is open to family members or an online group. Talking with others who have had similar experiences and learning about how they have approached family difficulties can be extremely helpful, if not therapeutic.

The CBT Therapist's Role in Restoring Family Life

When you stop accommodating OCD, you will maximize your loved one's opportunity to gain control over the disorder and help your family return to normalcy. But family members usually need guidance on how to stop reinforcing and enabling their loved one's OCD.

The cognitive behavior therapist who is treating your loved one should be able to help spouses, siblings, parents or extended family members learn to respond more appropriately to the person with OCD. In fact, many cognitive behavior therapists work with families to develop a written agreement known as a "family contract" or "behavioral contract." It's a "roadmap" you follow when you agree to work together as a team to fight OCD. When all members of the family agree upon the specific OCD behaviors they'll stop accommodating, the chances of reducing symptoms of OCD can dramatically increase.
Learn more about family contracts

No one said making changes would be easy.

Managing Emotions

Living with and/or caring for a loved one with OCD can be extremely stressful. When OCD seems to have control over a household, emotions can fly high. And when your loved one is undergoing Cognitive Behavior Therapy - which involves a great deal of hard work - it's very common for anxiety levels to increase not only for the person undergoing therapy but also for family members. And increased anxiety may lead to heightened stress, frustration, conflict, exhaustion and feelings of failure for everyone in the family. Fortunately, there are some strategies you can use to help keep emotions in check.
Learn more about managing emotions at home
Risks and Rewards for Couples

When you or your partner has OCD, it can place an enormous strain on your relationship. Instead of enjoying the strong emotional bond of a loving relationship, you may find yourself in the throes of confusion and disappointment. Unfortunately, some partners find the stress caused by OCD simply too much to bear, and the relationship does not survive.

The risk of emotional pain or exhaustion, as well as the potential risk of irreparable damage to the relationship, make it imperative that the person with OCD be evaluated and treated as soon as possible. With appropriate treatment, the chances of your relationship getting back on track are greatly improved.
Learn more about the spouse's role in overcoming OCD
Behind Relationship Troubles

OCD in and of itself can have a devastating impact on a relationship. But OCD can present many other challenges in a relationship, as well, including threats to physical and emotion intimacy, and interference in social activities and relationships with others, not to mention fears about the future. You may also be experiencing any other number of daily stressors in your relationship that all couples face (e.g., financial difficulties, job-related concerns). Therefore, if your loved one has OCD, and you're experiencing relationship troubles, it's a good idea for you to have a conversation with his or her therapist, as well. By taking a step back and looking at the whole relationship - not just the OCD - the therapist can teach you strategies for rebuilding your relationship.
Learn more about getting to the cause of OCD-related relationship difficulties Go to OCD Facts section Go to Parents section Read personal stories of successful OCD treatment Contact Beyond OCD for more information Back to Home

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When someone in your family has OCD, everyone is affected. It's natural to have strong emotions about this intruder in your home. Feelings can include frustration, resentment, anger, embarrassment and exhaustion from trying to live in a household where OCD seems to be in control.

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Overview

Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ( obsessions) and/or behaviors ( compulsions) that he or she feels the urge to repeat over and over.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ( obsessions) and/or behaviors ( compulsions) that he or she feels the urge to repeat over and over. Signs and Symptoms Risk Factors Treatments and Therapies Join a Study

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OCD Treatment Guide: Best Evidence-Based Therapies, Medications, and New Advances

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OCD can be a chronic and sometimes debilitating disorder. Fortunately, effective treatments are available to help manage OCD symptoms, greatly reduce suffering and possibly experience full relief. While there is... Read more »

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Is it Normal for Kids to Have Fears?

It's normal for children to feel afraid at times. Fear is an emotion that can help kids be cautious. Things that are new, big, loud, or different can seem scary at first. Parents can help kids feel safe and learn to feel at ease.

What Do Kids Feel Afraid of?

What kids feel afraid of changes as they grow. Some fears are common and normal at certain ages.

For example:

Infants feel stranger anxiety. When babies are about 8-9 months old, they can recognize the faces of people they know. That's why new faces can seem scary to them - even a new babysitter or relative. They may cry or cling to a parent to feel safe.

Toddlers feel separation anxiety. At some time between 10 months and 2 years, many toddlers start to fear being apart from a parent. They don't want a parent to leave them at daycare, or at bedtime. They may cry, cling, and try to stay near their parent.

Young kids fear "pretend" things. Kids ages 4 through 6 can imagine and pretend. But they can't always tell what's real and what's not. To them, the scary monsters they imagine seem real. They fear what might be under their bed or in the closet. Many are afraid of the dark and at bedtime. Some are afraid of scary dreams. Young kids may also be afraid of loud noises, like thunder or fireworks.

Older kids fear real-life dangers. When kids are 7 or older, monsters under the bed can't scare them (much) because they know they're not real. At this age, some kids begin to fear things that could happen in real life. They may have a fear that a "bad guy" is in the house. They may feel afraid about natural disasters they hear about. They may fear getting hurt or that a loved one could die. Schoolage kids may also feel anxious about schoolwork, grades, or fitting in with friends.

Preteens and teens may have social fears. They might feel anxious about how they look or whether they will fit in. They may feel anxious or afraid before they give a report in class, start a new school, take a big exam, or play in a big game.

How Can I Help When My Child Is Afraid?

When your child is afraid, you can help by doing these things:

Comfort your infant, toddler, or very young child by saying, "It's OK, you're safe, I'm here." Let your child know you're there to protect them. Give hugs and soothing words to help your child feel safe.

As your child grows, talk and listen. Be calm and soothing. Help your child put feelings into words. Help kids try new things.

Help your baby get used to a new person while you hold him and let him feel safe. Soon, the new person won't seem like a stranger anymore.

Let your toddler be apart from you for short times at first. When you need to part from your child, say you'll be back, give a hug and a smile, and go. Let your child learn that you always come back.

For your young child who's afraid of the dark, have a soothing bedtime routine. Read or sing to your child. Let your child feel safe and loved.

Help your child slowly face fears. For example, check together for under-bed monsters. With you there to support her, let your child see for herself there's nothing to fear. Help her feel her courage.

Limit the scary images, movies, or shows kids see. These can cause fears.

Help kids and teens learn to prepare for challenges, like tests or class reports. Let them know you believe in them.

Is My Child's Fear Normal, or Do We Need More Help?

Most kids cope with normal fears with gentle support from their parent. As they grow, they get over fears they had at a younger age.

Some kids have a harder time, and need more help with fears. If fears are extreme or keep a child from doing normal things, it might be a sign of an anxiety disorder.

Talk to your doctor if your child's fears:

seem extreme or last past the normal age

cause your child to be very upset or have tantrums

keep your child from doing things - like going to school, sleeping alone, or being apart from you

cause physical symptoms (like stomachaches, headaches, or a racing heart) or your child feels breathless, dizzy, or sick

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It's normal for children to feel afraid at times. Fear is an emotion that can help kids be cautious. Things that are new, big, loud, or different can seem scary at first. Parents can help kids feel safe and learn to feel at ease. What kids feel afraid of changes as they grow.

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Psychosis is characterized by an impaired relationship with reality. It's a symptom of serious mental disorders. People who are experiencing psychosis may have either hallucinations or delusions.

Hallucinations are sensory experiences that occur within the absence of an actual stimulus. For example, a person having an auditory hallucination may hear their mother yelling at them when their mother isn't around. Or someone having a visual hallucination may see something, like a person in front of them, who isn't actually there.

The person experiencing psychosis may also have thoughts that are contrary to actual evidence. These thoughts are known as delusions. Some people with psychosis may also experience loss of motivation and social withdrawal.

These experiences can be frightening. They may also cause people who are experiencing psychosis to hurt themselves or others. It's important to see a doctor right away if you or someone you know is experiencing symptoms of psychosis.

Symptoms of psychosis include:

Delusions and hallucinations are two very different symptoms that are both often experienced by people with psychosis. Delusions and hallucinations seem real to the person who is experiencing them.

Delusions

A delusion is a false belief or impression that is firmly held even though it's contradicted by reality and what is commonly considered true. There are delusions of paranoia, grandiose delusions, and somatic delusions.

People who are experiencing a delusion of paranoia might think that they are being followed when they aren't or that secret messages are being sent to them. Someone with a grandiose delusion will have an exaggerated sense of importance. Somatic delusion is when a person believes they have a terminal illness, but in reality they're healthy.

Hallucinations

A hallucination is a sensory perception in the absence of outside stimuli. That means seeing, hearing, feeling, or smelling something that isn't present. A person who is hallucinating might see things that don't exist or hear people talking when they're alone.

Each case of psychosis is different, and the exact cause isn't always clear. There are certain illnesses that cause psychosis, however. There are also triggers like drug use, lack of sleep, and other environmental factors. In addition, certain situations can lead to specific types of psychosis developing.

Illnesses

Illnesses that can cause psychosis include:

Some types of dementia may result in psychosis, such as that caused by:

It's not currently possible to precisely identify who is likely to develop psychosis. However, research has shown that genetics may play a role.

People are more likely to develop a psychotic disorder if they have a close family member, such as a parent or sibling, who has a psychotic disorder.

Children born with the genetic mutation known as 22q11.2 deletion syndrome are at risk for developing a psychotic disorder, especially schizophrenia.

Some kinds of psychosis are brought on by specific conditions or circumstances that include the following:

Brief psychotic disorder

Brief psychotic disorder, sometimes called brief reactive psychosis, can occur during periods of extreme personal stress like the death of a family member. Someone experiencing brief reactive psychosis will generally recover in a few days to a few weeks, depending on the source of the stress.

Drug- or alcohol-related psychosis

Psychosis can be triggered by the use of alcohol or drugs, including stimulants such as methamphetamine and cocaine. Hallucinogenic drugs like LSD often cause users to see things that aren't really there, but this effect is temporary. Some prescription drugs like steroids and stimulants can also cause symptoms of psychosis.

People who have an addition to alcohol or certain drugs can experience psychotic symptoms if they suddenly stop drinking or taking those drugs.

Organic psychosis

A head injury or an illness or infection that affects the brain can cause symptoms of psychosis.

Psychotic disorders can be triggered by stress, drug or alcohol use, injury, or illness. They can also appear on their own. The following types of disorders may have psychotic symptoms:

Bipolar disorder

When someone has bipolar disorder, their moods swing from very high to very low. When their mood is high and positive, they may have symptoms of psychosis. They may feel extremely good and believe they have special powers.

When their mood is depressed, the individual may have psychotic symptoms that make them feel angry, sad, or frightened. These symptoms include thinking someone is trying to harm them.

Delusional disorder

A person experiencing delusional disorder strongly believes in things that aren't real.

Psychotic depression

This is major depression with psychotic symptoms.

Schizophrenia

Schizophrenia is a lifelong disease that is generally accompanied by psychotic symptoms.

Psychosis is diagnosed through a psychiatric evaluation. That means a doctor will watch the person's behavior and ask questions about what they're experiencing. Medical tests and X-rays may be used to determine whether there is an underlying illness causing the symptoms.

Diagnosing psychosis in children and teenagers

Many of the symptoms of psychosis in adults aren't symptoms of psychosis in young people. For example, small children often have imaginary friends with whom they talk. This just represents imaginative play, which is completely normal for children.

But if you're worried about psychosis in a child or adolescent, describe their behavior to a doctor.

Treating psychosis may involve a combination of medications and therapy. Most people will experience an improvement in their symptoms with treatment.

Rapid tranquilization

Sometimes people experiencing psychosis can become agitated and be at risk of hurting themselves or others. In these cases, it may be necessary to calm them down quickly. This method is called rapid tranquilization. A doctor or emergency response personnel will administer a fast-acting injection or liquid medicine to quickly relax the patient.

Medication

Symptoms of psychosis can be controlled with medications called antipsychotics. They reduce hallucinations and delusions and help people think more clearly. The type of antipsychotic that is prescribed will depend on the symptoms.

In many cases, people only need to take antipsychotics for a short time to get their symptoms under control. People with schizophrenia may have to stay on medications for life.

Cognitive behavioral therapy

Cognitive behavioral therapy means meeting regularly to talk with a mental health counselor with the goal of changing thinking and behaviors. This approach has been shown to be effective in helping people make permanent changes and better manage their illness. It's often most helpful for psychotic symptoms that don't completely resolve with medications.

Psychosis doesn't have many medical complications. However, if left untreated, it can be challenging for people experiencing psychosis to take good care of themselves. That could cause other illnesses to go untreated.

Most people who experience psychosis will recover with proper treatment. Even in severe cases, medication and therapy can help.

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Psychosis: Symptoms, Causes, and Risk Factors

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Psychosis is a serious mental disorder characterized by a loss of contact with reality. People who are psychotic may experience hallucinations or delusions. For example, they may see something, like a person, who isn't actually there. We'll explore the symptoms, causes, risk factors, diagnosis, and treatment.

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Most children and parents will have some distress or upset - so how do I know when a child or family needs additional help?

Ask your patients (and their parents) about reactions and coping.

Listen for ongoing or severe traumatic stress symptoms.

Consider a referral for a more thorough evaluation with a mental health professional if:

Traumatic stress reactions are severe or prolonged (more than a month).

Traumatic stress reactions interfere with recovery or with returning to normal activities.

Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Steps for making a referral Effective mental health treatment for traumatic stress Online resources - help in finding a mental health professional Distinguishing between types of mental health professionals
Therapist Resource Guide: There are many ongoing stressors that children and families endure after diagnosis of an illness or an injury. This guide focuses specifically on medical traumatic stress and responses that children and families may have.

Steps for making a referral

Mention concerns you have identified.
Say something like: "I'm concerned that (you are / your child is) having these upsetting thoughts and feelings. It might be useful to talk with a specialist who can help your family more."

Involve child and family in making a plan.
Ask for their ideas about what is needed now
Say something like: "What issues or difficulties are impacting you / your family the most right now? What would help make things better?"

Ask for permission to offer advice. Present advice as range of possibilities; be sure to incorporate patient/family ideas

Say something like: "I have some suggestions that have helped other patients in the past in situations similar to yours. May I share them with you?"

Range of possibilities might include: patient education materials / websites; speaking with social worker, local clergy, school counselor; seeking out support group, referral to therapist / community mental health center.

Ask about their readiness to act on this now or in the future.
Say something like: "Is this (suggested plan) something you would be willing to do when you leave today, or if you need it next week...month?"

Ask about barriers to potential plans / referrals, and strategies to overcome barriers.
Say something like: "What kinds of things would interfere with following-up on this plan we just discussed? How can we work through this so you end up getting the help you need.?"

Involve the child and parent in setting the agenda*:*Adapted from Wissow et al. (2008)

Keep the door open.

If your patient or their parents are not quite ready to act on a suggested referral now, arrange to follow up to see how your patient is doing.

You might say: "I'd like to talk with you again in a few weeks to see how things are going."

Promote continuity of care.
If your care for this patient is ending, ask permission to communicate your concerns about traumatic stress reactions or risk factors to the child's primary care provider, or to other providers who will continue to take care of this patient.

Facilitating collaboration between pediatric health care and mental health providers: The American Academy of Pediatrics Task Force on Mental Health has developed tools to facilitate collaboration between pediatric health care providers and mental health professionals, including a Physician Referral and Feedback Form template

Effective mental health treatment for traumatic stress

There are very good and helpful treatments for children who continue to have traumatic stress symptoms.
What treatment approaches are effective?
Evidence-based treatments include cognitive-behavioral treatment approaches, and in particular Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

Click here for a fact sheet about effective treatments for youth trauma from the National Child Traumatic Stress Network.

A recent article includes informative summaries of effective mental health treatments for child traumatic stress symptoms, and guidance for health care professionals:
Cohen, J, Kelleher, K, Mannarino, A.. Identifying, treating, and referring traumatized children: The role of pediatric providers. Archives of Pediatric and Adolescent Medicine 2008;162(5):447-452 How can I help parents find effective treatment for their child?
When helping parents find a counselor or therapist to help their child with traumatic stress symptoms, you might suggest that they ask prospective therapists questions such as:

Do you have experience working with children after trauma?

What is your approach to working with this type of problem?

What is your success rate?

How do you work with parents?

The National Child Traumatic Stress Network offers useful tips and information about finding a mental health professional to help children and their families after trauma.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) has trauma-trained, child mental health professionals and community-based treatment centers in 35 states in the US. For information about or referral to a NCTSN center near you, please go to the NCTSN Organizational Members site.
American Psychological Association - Psychologist Locator National Association of Social Workers - Find a Licensed Social Worker American Academy of Child and Adolescent Psychiatrists - Psychiatrist Finder Anxiety Disorders Association of America - Find a Therapist Sidran Institute Help Desk - Locate Trauma Resources ISTSS Clinician Directory - Find a Clinician, Counselor or Mental Health Professional
Distinguishing between types of mental health professionals

Psychologists are professionals who have earned a doctoral degree (Ph.D. or Psy.D.) after 4-6 years of graduate-level training in human behavior and development, psychological testing and evaluation, and psychotherapy. Psychologists are licensed by the state in which they practice.

Psychiatrists are physicians (M.D. or D.O.) who have completed medical school, plus additional advanced training in the evaluation and treatment of psychiatric disorders and emotional and behavioral problems. Psychiatrists are licensed by the state in which they practice. As medical doctors, psychiatrists can prescribe and monitor medications.

Clinical Social Workers are professionals who have earned a master's degree (M.S.W.) after 2-3 years of graduate training. Clinical Social Workers are licensed by the state in which they practice (LCSW or similar credential - varies by state).

Marriage and Family Therapists are professionals who have completed a master's degree (M.A. or M.S.) after 2-3 years of graduate training. Some Marriage and Family Therapists have completed a required amount of clinical hours and passed a state-administered examination to become licensed marriage and family therapist (LMFT).

Licensed Professional Counselors (LPC) & Licensed Mental Health Counselors (LMHC) are mental health professionals who have earned a master's degree (M.A. or M.S.) after 2-3 years of graduate training and have obtained a required amount of clinical experience and passed a state-administered licensing examination.

For more information on the training and credentialing of mental health professionals, see Mayo Clinic: Mental health providers.

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When and How to Refer for Mental Health Care

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Pediatric providers can follow specific steps to determine if and how to refer a child and familiy for further mental health services after a medically traumatic event. Providers can also become familiar with current evidence-based treatments and online resources for mental health services for traumatic stress.

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Difference between a normal brain and one affected by a Psychotic Disorder

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Difference between a normal brain and one affected by a Psychotic Disorder

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(Vanderbilt University, 2019)

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(National Center on Birth Defects and Developmental Disabilities, 2019)

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Percentage of Children with ADHD and Another Disorder

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Percentage of Children with ADHD and Another Disorder

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(National Center on Birth Defects and Developmental Disabilities, 2019)