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Obsessive-Compulsive (OCD) and Related Disorders

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Obsessive-Compulsive (OCD) and Related Disorders

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Children with OCD have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay. This guide explains the often confusing behaviors that can be associated with OCD, and the treatments most effective for hel…

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As an elementary school counselor, you will create a nurturing environment in which children develop the knowledge, habits, and emotional skills to succeed in middle school, high school, and beyond.

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NYU Steinhardt's Online Master's in School Counseling prepares aspiring school counselors to pursue certification and employment in public and private schools.

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Strategies for Oppositional Defiant Disorder

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Strategies for Oppositional Defiant Disorder

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Version en Español
Raising a child with oppositional defiant disorder (ODD) can be extremely frustrating because you feel like everything is a constant battle. You just want your child to do their homework, pick up their toys, get dressed for school, etc. and you are constantly faced with refusal.

As a behavior specialist and school psychologist, I have had many parents and teachers ask for behavior strategies to help a child with oppositional defiant disorder or behavioral challenges.
Recommended Book: The Explosive Child: New Approach For Understanding And Parenting Easily Frustrated, Chronically Inflexible Children
In my training, I learned a lot about positive behavior support strategies and have used them with my clients and students for the past 21 years, and now with my own children (ages 7 and 3).

I can tell you firsthand that these strategies are extremely effective. They work when I use them and when I teach others how to use them with their children or students.

People often think that positive behavior support is simply giving rewards for good behavior, and when that doesn't work they think that the system doesn't work.

While a piece of positive behavior support is allowing children to earn privileges rather than taking them away, it is so much more than just that. It is a scientific way of speaking, acting, and responding to behavior.

Related Article: How to Use Natural and Logical Consequences to Improve Children's Behavior

FYI: These tips are effective for all kids, not just those diagnosed with oppositional defiant disorder.

1. Set up expectations ahead of time.

Your child should know what you expect of them each day. This can be communicated through a checklist, visual schedule, video recording, etc.

Your child will want to do things that are fun and instantly gratifying. Boundaries are important when enforcing expectations. "Yes, you can do that! But you also need to do this."

This is much more effective for encouraging compliance than punishing your child or taking away privileges when they don't do what you want them to do.

Let your child have a say in what they want to work for. Allowing children to earn privileges by following their expectations (e.g., self-care, kindness) puts the ball in their court.

They know what is expected of them and they know what they have to do to earn the things they enjoy. They also feel a sense of pride when they earn what they worked for.

When your child starts getting off track, remind them of what they are working towards rather than telling them what you will take away if they don't listen.

Research shows that children and adolescents are much more likely to do what is expected when they have the power to earn something, than when being threatened that you will take something from them.

Want to read more about this research? Check out the following research studies:

Related Article: Do Rewards Make Sense? What Can Your Children Earn?

2. Use transition warnings to let your child know what is coming next.

Here are examples of transition warnings, "In ten minutes it is time to turn off your video games and come eat dinner" or "After this show, it is time for homework." Give some more reminders as the time is winding down (e.g., in two minutes it's time for dinner).

A timer or visual timer can be helpful for children who don't have a concept of time.

Related Article: 3 Ways to Use Timers to Encourage Homework and Chore Completion

3. Use empathetic statements to show your child you understand how they feel.

Imagine how you would feel if someone came into your room and said "get off the computer and go to bed." Although they are kids and are expected to follow adults' rules, they still have the same feelings you would have in that type of situation.

You can show them you understand how they feel with a statement such as "I know you are really enjoying your computer time and you don't want to turn it off, but you need to get rest for school tomorrow. You can have some time on the computer again tomorrow."
Recommended: Become a Certified Self-Esteem Coach for Children
4. Phrase directives in the positive and remove the word "can."

For example, instead of "stop jumping on the furniture" or "can you stop jumping on the furniture?" try something like "sit down" or "come down off the couch " in a calm, but confident tone.

If possible provide an alternative activity or redirect them to something they like to do like "let's do jumping jacks together" or "here are some puzzles/blocks to play with."

Children respond much better when you tell them "what to do" rather than "what not to do." Anything you want your child to stop, you can phrase in the positive by giving them a clear direction of what you want them to do. Giving an explanation such as "you can fall" or "that can damage the couch" is often helpful as well.

Related Article: 17 Ways to Get Your Kids to Listen to You and Show You Respect

5. Use specific praise when your child follows your expectations or listens to your directions.

Some examples of specific praise include "excellent job picking up your toys," "you were so focused during homework tonight," "nice job listening to directions" etc. Specific praise or acknowledgment of healthy behaviors reminds the child of what behaviors you are looking for and reinforces those behaviors.

6. Pick your battles.

If your five-year-old is playing in the dirt and you find it disgusting, let them. As long as they are safe, not hurting or disrespecting themselves or anyone else, and not damaging anything, try to give them as much freedom as possible.

7. Give your child choices when possible.

Research indicates that providing children with choices leads to improvement in behavior. Examples include, "Do you want to wear the green or red shirt?" "Do you want to do your math or reading homework first?" "Do you want to set the table or take out the garbage?"

8. Say what you mean and mean what you say.

If you tell your child that he needs to pick up his toys before he can play outside, make sure you follow through on your rule and honor your end of the bargain.

Stay away from empty threats (punishments that you will never follow through on). Your child will come to learn the value of your words. If you don't mean what you say, they won't take you seriously. The National Association of Child Development is with us on this one!

And research indicates the need for consistency when implementing positive parenting practices. Consistency includes integrity, honesty, and respect.

You can build in chores, homework (if applicable), self-help tasks (shower, brush teeth, etc,), and fun activities. Have your child participate in creating the schedule. Embed the fun activities into the schedule so that your child alternates between preferred and non-preferred activities. One part of the schedule needs to be complete before moving on to the next part.

Recommended: Study: Daily Routines Impact Childhood Development

Some children benefit from mini-schedules, which is a shortened variation of a typical schedule. Mini-scedules can include as few as two or three steps.

Also, keep in mind that children with idle time on their hands are looking for things to do, so structuring their time can alleviate some impulsive behaviors like running/jumping in the house.

Related Article: How to Use Schedules to Promote Positive Behavior in Children
10. Avoid arguing, long lectures, or sarcastic remarks about your child's behavior.

Stick to your rules and don't negotiate, go back and forth, or argue with your child. However, also consider your own rules and whether they are appropriate for your child. For instance, you wouldn't expect a three-year old to "never jump in the house" because jumping, and movement, in general, are developmentally appropriate for a three-year-old.

Once your rules are in place and your child is aware of them, state them as needed. If your child starts to argue or tantrum after you have stated the rule and given empathy, let them know that you are not going to discuss it anymore. Do not give in to a temper tantrum.

Recommended: How to Handle Temper Tantrums

Once the tantrum is over you can praise your child for calming down, provide empathy again if needed, and listen if your child wants to talk about his/her feelings. Then direct your child back to the task he/she is expected to do.

If your child is acting unsafe, protect him/her and others from harm but do not try to negotiate with your child or give in to the tantrum in order to make it stop. This will only lead to more tantrums in the future. If you are ever concerned for the safety of your child or anyone else, contact the crisis center or emergency number in your area.

While there is no one method that works for every single child, these are the methods that are backed by research, and personal experience has proven just how well they work.

Research suggests that children with Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder who display impulsive behaviors (e.g., acting without thinking), show improvement when positive behavior support strategies such as the ones discussed in this article are used in conjunction with strategies that teach pro-social behaviors (e.g., how to conduct oneself in different situations, how to identify problems and brainstorm solutions, how to recognize which behaviors may be undesirable in certain situations and why).

For more on these research studies see 6 Research-Based Interventions for the Treatment of ADHD in Children and 5 Research-Based Strategies for Treating Youth with Oppositional Defiant Disorder.

For strategies to decrease impulsive behaviors check out 9 Practical Strategies for Decreasing Impulsive Behavior in Children. Impulsive behaviors may include hitting, yelling, blurting something out, taking something without asking, breaking something, etc.

We offer a free five-minute behavior consultation via text for parents, educators, or other interested parties. Please text 484 201 3815 or email rachelwise@educationandbehavior.com for more information.

Video Presentation:

Sometimes toddlers have communication difficulties that interfere with their ability to understand or express themselves. This can lead to behavioral challenges. Toddler Talk: Techniques and Games might be a helpful book for you if you find yourself in this situation with your toddler.

Recommended Articles:

Education and Behavior - A Free Resource for Parents, Educators, Counselors, and Therapists! Keeping Us On the Same Page!

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Try These Top 10 Behavior Strategies for Children with Oppositional Defiant Disorder

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Practical research-based behavior strategies for treatment of a child with oppositional defiant disorder or related symptoms. Shared by a licensed behavior specialist and certified school psychologist.

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Behaviour Problems

Children who meet criteria for a behavioural disorder such as conduct disorder or oppositional defiant disorder have a pattern of behaviours characterised as aggressive or antisocial.

Most children misbehave, or are aggressive, defiant or have tantrums from time to time. That's perfectly normal. To reach a diagnosis of conduct disorder or oppositional defiant disorder, the behaviours have to be more frequent and/or more severe than their same aged peers. But it is important to remember that many children who meet diagnosis of a conduct disorder or oppositional defiant disorder are not necessarily doing different kinds of things compared to their same aged peers, it is just that they stand out for how much or how intensely they do them.

How common are they?

Conduct problems are the most common mental health disorder and found in approximately 5 to 6% of the normal population of children in primary and secondary school. It is about twice as common in boys than girls. Why that might be is not entirely clear. Some people have suggested it is to do with gender socialisation practices; some suggested it is more to do with male biology; others have suggested that perhaps girls have similar rates of antisocial behaviour, but more as relational aggression (e.g., within friendships and harming others' social status) than as overt physical aggression (e.g., fighting and arguing) and so gets noticed less. Probably it is a complicated mix of all those reasons and some others. However, it may be interesting to note that the peak of aggressive behaviour in human development is reliably between 18 and 36 months ("the terrible twos") and that boys and girls reach similar peak levels, although girls' socialisation, away from the aggressive peak, appears to be quicker than boys; perhaps because of their more rapid language development.

Different types - which settings?

It is also important to realise that for some children their conduct disorder is found across settings, for example at home and at school; whereas for other children it can be found only in one place but not the other. Some children only pose significant behavioural challenges at home, others only at school; so it is very important to get the parents' perspective on how the child presents at home and see if some learning and collaboration can be established.

Different types - socialised?

Some children with conduct problems are able to maintain relatively good social relationships with other children, whereas others may get excluded from their peer group, typically because of a history of hurting or harming their peers. These children with less socialised conduct problems are at particular risk of failing to get opportunities to develop more prosocial behaviours, which could address some of their problems, or at least mitigate them.

The course of development

A diagnosis of either oppositional defiant disorder or conduct disorder is not fixed for life - it is certainly not the case that most children with these problems will go on to live seriously antisocial adult lives. The typical course of a child with conduct problems is, over time, to become less antisocial by the time of adulthood. However, research shows that those children who do "recover" from conduct problems by adulthood, remain at risk of living less prosocial and well-functioning adult lives; as if the opportunities they have missed out upon growing up - in education and in the community - have left a legacy on their social development. Therefore, it is extremely important to help these children recover as soon as possible and thereby promote as much opportunity to develop helpful, caring and considerate social relationships with others; as well as to reach their academic potential through education.

While most children do recover over time, there is a small group of children - especially those who started with problems in the early years and whose problems persisted into secondary school - who are more likely to have persistent antisocial behaviour into their adult lives (the so-called "early starter, life course persistent" cohort). These children often have other, frequently neurodevelopmental components to their presentation which seem to make their difficulties more entrenched. However, although intervening with these children may be harder, it is still possible and can be very effective

Co-occurring problems

Children and young people with conduct problems frequently stand out because of aggressive and antisocial behaviours, but a significant number of these children also have other problems that may get "masked" by their overtly negative behaviour.

For example, approximately ¼ of children with conduct disorder will also have ADHD; the two things occur so commonly, that they have their own specific psychiatric disorder called "hyperkinetic conduct disorder". Note that ADHD does not make children naughty, but in some children it can contribute, or at least cooccur, with behaviour problems. Remember that treating ADHD effectively is very important, but it may or may not have an impact on a child's challenging behaviours. They are different things

A further significant proportion of children with conduct problems (probably around 20%) also present with problems to do with anxiety and/or low mood. These are problems that can very easily be masked by challenging behaviours. It may be helpful to remember, as a rule of thumb, that "bad" children can also be "sad" children.

There are also other neurodevelopmental problems that can often cooccur and complicate presentation of conduct problems, including low IQ ("intellectual disability") and autism spectrum disorders.

From an educational viewpoint, conduct problems are also associated with poor academic performance and especially literacy. In the research, again, there has been some debate as to whether conduct problems drive down educational attainment in literacy because children do not engage in school, or whether struggling to read and engage in school triggers increases in behaviour problems, perhaps as a way of avoiding or managing these difficulties in class.

Probably, it is a mixture of both these processes, to a greater or lesser extent and differs for different children. However, there is clear evidence that the co-occurrence of behaviour problems, plus ADHD plus impaired literacy has especially poor outcomes for the life chances of children and these children would benefit from being identified and fast tracked for appropriate interventions across education and CAMHS working together.

What to do - Overview

From the perspective of a teacher, or indeed a parent, whether or not a child quite meets criteria for a diagnosis of a conduct problem may be less important than the experience of persistent antisocial or aggressive behaviour. Luckily, the types of interventions that work for children who present with diagnostic levels of behaviour problems, also work for the children who are just below threshold or at risk of developing them. The same kind of things tend to work.

It is also true that the same kinds of approaches tend to work for older children as for younger children. However, interventions tend to be more effective for younger children because older children have more influences beyond the immediate classroom setting that could be feeding into and maintaining the pattern of behaviours. In general, the earlier in a child's life an intervention is started, the greater the improvement is likely to be.

What to do - Balancing Opportunities & Limits

Intervention will seek to balance a) the opportunity for positive, prosocial behaviours (which are noticed and praised) alongside b) consistent boundaries and limits. Generally, approaches that only prioritise one of these components tend to be much less effective.

What to do - Limits

A challenge for any adult attempting to set effective limits for a child with conduct problems is to make them consistent and relevant to the behaviours being addressed. This is why careful observation is incredibly important. Of course, for a teacher, setting limits for one or two disruptive children in a class, has to be balanced with the behaviour management approaches taken for the whole class.

While some children can have effective limit setting working for them as part of a broader whole class approach, there will be others who need something more specific and tailored to their needs. Often this will require an additional pair of hands to make it effective (perhaps, for example, as identified in an EHCP).

What to do - Maintaining gains

Whatever else, while behaviour management techniques that enable the whole class to continue working and which limit the impact of a child with conduct problems are extremely important, they must always be paired alongside opportunities for positive and prosocial interactions if you want any gains in positive behaviour to be maintained.

But this can be extremely hard for any of us to manage - so do get support from your peers and other professionals (see below).

Getting help - getting the information

Unfortunately, there has been an increasing tendency for children with conduct problems not to be formally diagnosed in CAMHS services, and therefore they have become less likely to receive appropriate and effective treatment. Hence, schools will often be the first time the possibility of conduct problems is raised about the child. If you are concerned that a child in your class may have conduct problems, then it is worth keeping track of the kinds of behaviours that are concerning you, as well as how frequent and/or severe they are, compared to his or her same aged peers, so you can use this information when you seek out help.

Getting help - which services

There are a number of services that can help with children with conduct problems in schools. In some areas CAMHS services may be able to help; as may social care. Educational psychologists may be able to assess and advise individual children and consider their management in a whole classroom context. There are also an increasing number of education mental health practitioners who are trained in a range of evidence-based approaches, including parenting interventions for conduct problems.

It could also be helpful to review the MindEd resources.
Dr Matt Woolgar, Consultant Clinical Psychologist Conduct Problems Clinic and Adoption and Fostering Team South London & Maudsley NHS Foundation Trust

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Conduct Disorder: Tips For Teachers Fact Sheet - Nip in the Bud

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Behaviour Problems Children who meet criteria for a behavioural disorder such as conduct disorder or oppositional defiant disorder have a pattern of behaviours characterised as aggressive or antisocial. Most children misbehave, or are aggressive, defiant or have tantrums from time to time. That's perfectly normal.

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Nearly 1 in 10 people in the U.S. struggle with an eating disorder at some point in their lives, according to a recent Deloitte report. Sadly, the report also found that 10,200 people die from eating disorders each year in the U.S alone.

While people of all ages and from all races and socioeconomic backgrounds can develop eating disorders, some people are more susceptible. Young women, for example, experience eating disorders at higher rates than the general population. However, members of the LGBTQ community, women with physical disabilities, people with Type 1 diabetes, and athletes do as well. The common misperception that only young white women develop eating disorders has resulted in the underdiagnosis of people with eating disorders outside that demographic, especially people of color and men.

Eating disorders can cause long-term health effects, such as damage to internal organs, premature osteoporosis, and cardiovascular problems. The high cost of treatment can also affect people financially, as can the loss of productivity eating disorders cause. The Deloitte report estimates that the U.S. spent around $4.6 billion dollars in expenses associated with eating disorders in 2018-2019.

Clearly, the devastating consequences of eating disorders call for a strategic and compassionate response. Comprehensive treatment can play a key role in grappling with the various types of eating disorders, and those in counseling roles can serve as vital allies in the fight.

What Is an Eating Disorder?

Eating disorders are a serious mental health condition marked by a preoccupation with food and weight. They disrupt a person's ability to function both socially and psychologically and can lead to significant physical health problems. Though each eating disorder has unique symptoms, an unhealthy, often obsessive relationship with food and a negative body image characterize most of them.

Eating disorders tend to take over people's lives with excessive thoughts about food and weight. Those thoughts often center on restricting food intake, binging and purging. Underlying feelings of low self-worth and often repressed trauma cause these symptoms and behaviors, which may serve as a way to avoid dealing with uncomfortable emotions.

Eating disorders serve as coping mechanisms, however maladaptive. Individuals with eating disorders use food to relieve stress, achieve more control over their lives or provide themselves comfort in what may feel like an unsafe or unfriendly world.

Impact on Health and Well-Being

The preoccupation with food, weight and body image associated with eating disorders causes unhealthy behavioral patterns. These behavioral patterns damage a person's physical and emotional well-being.

Disordered Thinking Patterns

Eating disorders affect a person's mind and leads to frequent disordered thinking patterns that are hard to control, ignore or redirect. The thoughts relate to food or weight and consume the person's attention. Rather than focusing on the completion of a school or work assignment or dealing with pending responsibilities, someone with an eating disorder may feel overwhelmed and debilitated by thoughts about calories, food they want to eat or guilt about food they have eaten.

This negative channeling of energy can prevent people with eating disorders from engaging in fulfilling relationships, achieving personal goals and enjoying daily life.

Distorted Self-Perceptions

Eating disorders usually cause people to perceive themselves inaccurately. When looking in the mirror, people with eating disorders may see themselves as overweight when in fact they are underweight. This distorted self-perception feeds into disordered thinking patterns and adds to a person's low self-esteem.

Inability to Regulate Emotions

People with eating disorders can struggle to regulate their emotions. Even mild stress may trigger them to feel overwhelmed and overreact to situations. This inability to regulate emotions can create feelings of embarrassment. It often prevents people from coping with everyday interactions and events, which can then affect relationships. It is not unusual for people with eating disorders to withdraw from friends and family, feeling incapable of managing those relationships.

Feelings of Isolation and Shame

People often feel ashamed of their eating disorders and want to keep them secret. This can lead them to isolate themselves to hide their behaviors and avoid confrontations. As connections break down, it becomes harder for family and friends to intervene and offer an outside view to the person locked inside their distorted perceptions and shame.

Medical Complications

Though eating disorders usually start by affecting people's minds, the behaviors associated with them often lead to medical complications. Habits of binging and purging, as well as the effects of undernutrition resulting from food restriction, result in a prevalence of health problems.

Long-Term Effects of Eating Disorders

Over time, disordered eating habits can accumulate into serious health problems. Ongoing binging, purging and inadequate nutrition damage the body's organs and weaken the immune system. This can make the body more susceptible to sickness and aggravate preexisting chronic illnesses.

Behaviors common to the different types of eating disorders harm the body's systems in distinct ways.

Cardiovascular System

When a body doesn't get enough calories, it begins to break down and use its own tissue for energy. This leads to muscle atrophy throughout the body, including the heart. Excessive food restriction over time weakens the heart, depriving it of sufficient energy to pump blood. This leads to a drop in blood pressure and pulse and increases the risk of heart failure.

Conversely, binge eating leaves the body with extra energy, which it turns into fat tissue. When fat tissue becomes excessive, the heart strains to pump blood. The additional blood needed also puts pressure on the arteries, raising blood pressure. Fatty deposits may accumulate in the arteries, making them narrower and reducing blood flow. This can lead to heart attacks and strokes as well.

Purging depletes the body of electrolytes, which help the heart beat and contract. This can result in an irregular heartbeat and, over time, it puts a person at risk of heart failure.

Gastrointestinal System

Insufficient nutrition and vomiting disrupt the normal processes of the gastrointestinal system. They compromise the stomach's ability to digest food fully and at an appropriate pace. This can lead to stomach pain, blood sugar fluctuations and blocked intestines. It can even lead to intestines too weak to expel digested food from the body.

Binge eating strains the gastrointestinal system's ability to digest food. In rare cases, it can rupture the stomach, an effect that can be life-threatening.

Endocrine System

The endocrine system, responsible for the hormones that control functions such as metabolism, sleep and wake cycles and reproduction, depends on adequate calories and fat to work.

Food restriction prevents the endocrine system from secreting necessary hormones at the proper levels. This can interfere with menstruation and damage fertility, and cause bone loss.

Additionally, the body can become resistant to the hormone insulin and develop Type 2 diabetes in response to it.

What Are the Different Types of Eating Disorders?

Binge eating disorder (BED), bulimia nervosa and anorexia nervosa are among the most common eating disorders. While these disorders share some similar traits, each has its own behavioral patterns, symptoms and associated health problems.

Binge Eating Disorder

People with BED experience episodes in which they eat extremely large quantities of food in an out-of-control fashion. They may want to stop eating but feel unable to do so. These binges occur within short periods of time and last well past the point of the person feeling full. During and after binging, the person engaged in the behavior feels disgust and guilt. The person also feels depressed and may make promises to themselves to not do it again.

Unlike bulimia nervosa, binge eating is not followed by purging. Though individuals with BED tend to be overweight or obese, they may also be a standard weight.

Symptoms of BED

Weekly episodes of binge eating for three months or more

Weight gain

Loss of sex drive

Eating large amounts of food in the absence of hunger

Eating to the point of discomfort

Feelings of shame after binging

Low self-worth

Depression

Health Problems Associated with BED

High blood pressure

Diabetes

Sleep apnea

Cardiovascular problems

Liver and gallbladder disease

Bulimia Nervosa

Bulimia nervosa involves cycles of binge eating and purging. The disorder takes a severe emotional and physical toll on those who live with it. Like BED, bulimia nervosa is characterized by episodes of out-of-control binge eating. However, after consuming large amounts of food, people with bulimia nervosa frantically search for ways to get rid of the calories.

Some methods of purging include forced vomiting, excessive exercise and laxative abuse. Though people living with bulimia nervosa want to stop binging and purging, their urges to engage in the behavior overwhelm them, and the cycle is repeated. People with bulimia nervosa may be underweight, but more frequently they are standard weight or slightly overweight.

Symptoms of Bulimia Nervosa

Cycles of binge eating and purging

Low self-esteem

Poor body image

Shame and guilt over disordered eating

Withdrawal and isolation from family and friends

Depression

Weight fluctuations

Obsessive thinking about food and weight

Health Problems Associated with Bulimia Nervosa

Damage to teeth from frequent vomiting

Acid reflux

Dehydration

Electrolyte imbalances

Inflamed or ruptured esophagus

Cardiac arrhythmias

Intestinal irritation

Chronic sore throat

Anorexia Nervosa

People living with anorexia nervosa restrict their food intake to the point of self-starvation. No matter how much weight they lose, they continue to obsess over weight loss and cutting calories out of their diets. They also intensely fear weight gain. Despite their lack of food consumption, people with anorexia nervosa frequently exercise compulsively with the hope of becoming thinner. While most anorexic behavior is marked by a refusal to eat, it may also include intermittent cycles of binge eating and purging.

People living with anorexia nervosa often develop rituals when eating food. They may meticulously measure food, cut it into very small bites or chew it excessively. If not allowed to practice these rituals, they may feel extreme anxiety. Sometimes these rituals are intended to make the person feel full despite the small portions of food eaten. Other times the rituals are designed to make the food taste bad to decrease the desire to eat it.

Many people with anorexia nervosa are extremely underweight; however, in some cases, the individuals may be slightly overweight. Nonetheless, a recent study published in Science Daily found that regardless of weight, people with anorexia nervosa experience similar health problems.

Symptoms of Anorexia Nervosa

Denial of hunger and refusal to eat

Overwhelming fear of being "fat"

Refusal to eat in public and the desire to eat alone

Withdrawal and isolation from family and friends

Irritability

Obsession with diet and exercise

Abuse of diet pills and diuretics

Listlessness

Rejection of specific food categories, such as carbohydrates or fats

Health Problems Associated with Anorexia Nervosa

Fatigue

Low metabolism

Loss of menstruation

Disturbed sleep

Slow pulse and low blood pressure heart rate

Bone density loss

Irregular heartbeat

Muscle loss

Heart failure

Kidney failure

Lanugo (a thin layer of soft hair all over the body)

Infertility

The Link Between Eating Disorders and Mental Health

No single issue causes an eating disorder to develop; studies have revealed that a web of complex factors contributes to their development. This web involves interactions between a person's environment, genes, behaviors and psychology, all of which can affect mental health. Research has consistently found a link between eating disorders and mental health.

How Environment, Culture and Emotional Factors Impact Eating Disorders

Many factors can cause a person to develop an eating disorder as a coping mechanism. Consider how culture, environment and emotional factors can each play a role.

Environment

Environments can influence emotional health and may play a role in the development of an eating disorder. Experiences such as bullying and teasing about one's appearance by peers or family members can create self-doubt and negatively affect body image. A poor self-image can lead a person to engage in disordered eating habits to both console themselves and take control.

What people witness in their environment or experiences growing up can also play a role in the development of an eating disorder. For example, if parents model emotional eating or disordered eating patterns, their children may emulate those behaviors and slip into a full-blown eating disorder. Similarly, if a person works in an environment that places a great deal of emphasis on appearance, that pressure could lead to extreme dieting, which could then lead to an eating disorder.

Culture

Societal pressure to achieve unrealistic beauty standards can affect how people view themselves and make them overly concerned with what they eat and how much they weigh, both risk factors for developing an eating disorder.

Today's diet culture and the media's idealization of thinness lead many to connect specific body types to success and beauty. In response, some people take extreme measures in pursuit of these ideals. Such a cultural environment can also lead to severe body dissatisfaction, which also sets people up to develop eating disorders.

Emotional Factors

Low self-esteem brought on by a history of abuse, trauma or difficult relationships, along with other factors, may trigger people to turn to eating disorders as a way of coping with unresolved or painful feelings.

Perfectionism, impulsivity and inflexibility also make individuals more prone to developing eating disorders. Additionally, studies have shown that many people experience problems with anxiety and obsessive-compulsive symptoms prior to developing eating disorders.

Other Factors That Contribute to the Development of Eating Disorders

In addition to environment, culture and emotional factors, genetics and significant life changes may contribute to behavioral patterns that can lead to the development of eating disorders.

Genetics and Biology

People who have close relatives with eating disorders have a higher probability of developing one themselves. The same holds true for other mental health conditions - having a parent or sibling with an addiction, depression or anxiety puts a person at greater risk for developing an eating disorder.

These findings suggest genetics play a role in the development of eating disorders. This has prompted the examination of DNA to locate variations linked to eating disorders.

Biology may also factor into the eating disorder equation. Brain imaging has revealed that people with eating disorders have distinct brain activity patterns compared to people without eating disorders. Additionally, evidence in numerous studies, including one recently published in European Psychiatry, have found serotonin plays a role in some eating disorders, further indicating biology can influence a person's vulnerability to eating disorders.

Significant Life Events

Significant life events that cause stress or require major adjustments may also trigger behavior patterns that develop into eating disorders. Entering adolescence, heading off to college, getting married and pregnancy often spark strong feelings that people use food to cope with.

How Eating Disorder Counseling Can Help

Mental health counselors play a vital role in helping individuals overcome the different types of eating disorders. They work with individuals at various stages of recovery, teaching them skills to manage obsessive thoughts and behaviors and then replace them with healthy ones.

Strategies Counselors Use to Address Eating Disorders

Counselors employ several strategies to address eating disorders, including the following:

Identifying and Addressing Contributing Factors

Effective treatment plans identify the factors that contribute to a person's eating disorder and devise tangible solutions to address them. For example, depression may cause someone to binge eat to soothe emotional pain. With effective therapeutic techniques, counselors can help alleviate a person's depression, and this can lessen the need that person feels to binge eat.

Additionally, as already mentioned, many people use eating disorders as coping mechanisms. By teaching healthy coping skills, counselors can help their clients manage their pain, feelings of isolation and low- self-esteem in productive ways.

Counselors can also teach their clients mindfulness practices to help them recognize and redirect invasive thought patterns about food. This serves as a critical first step for replacing disordered thinking. Likewise, it can serve as a useful tool for teaching people how to regulate emotions that trigger cycles of binging and purging and other destructive behaviors.

Goal Setting

By setting measurable, achievable benchmarks, counselors can help their clients focus on what they need to do to recover. Goals offer guidance toward healthy coping mechanisms, and they help ensure that people do not replace one destructive behavior with another.

Starting with small goals can build confidence. Once patients achieve one goal, they often feel empowered and ready to go after bigger ones. Some manageable goals to begin with might include the following:

Unfollowing social media that triggers low self-esteem

Sticking to a meal plan for a full day

Countering negative thoughts with a positive mantra three times a day

Enhanced Cognitive Behavioral Therapy

Mounting evidence suggests that enhanced cognitive behavioral therapy (CBT-E) is especially effective for treating people with different types of eating disorders. An F1000Research study found that CBT-E achieves high levels of remission, with nearly 45% of those who received it reporting no binging, vomiting or misuse of laxatives after treatment.

CBT-E involves four stages:

Stage one focuses on building an understanding of the problem at hand and trying to stabilize the person's disordered eating behaviors.

Stage two involves reviewing the progress made and planning next steps.

Stage three concentrates on examining the processes that keep the eating disorder going and developing methods that address body image and eating concerns and deal with daily life and moods.

Stage four considers strategies for managing setbacks and progress maintenance.

Collaborating to Develop Comprehensive Therapeutic Plans

Successful treatment of eating disorders requires a multipronged approach to properly address the associated physical and psychological problems. Counselors may work with dieticians, psychiatrists and other health professionals to build a cohesive therapeutic plan that emphasizes healthy coping habits and nutrition education.

Dieticians can help assess issues of malnutrition, provide education on topics about nutrition and offer critical advice about a patient's nutritional needs. Without addressing these needs, progress in recovery may stall or not even lift off the ground. Additionally, many cases of anorexia demand urgent weight gain, which requires the expertise of dieticians.

To address biological factors that contribute to eating disorders, counselors can collaborate with psychiatrists. Chemical imbalances may play a part in a person's compulsive or obsessive behavior, depression and other contributing factors. However, appropriate medications can help address those issues. With a psychiatrist on the recovery team, people in recovery can get the prescriptions they need.

Make a Positive Impact on People's Lives

Eating disorders are potentially deadly mental health conditions. However, with proper treatment, individuals living with them can recover. Research over the years has revealed vital insights about how counselors and other professionals can effectively treat the various types of eating disorders.

Discover how Wake Forest University's online Master of Arts in Counseling program and its clinical mental health concentration prepare graduates to make a positive impact on people's lives and achieve their professional goals.
Recommended Readings Treating Anxiety in Children: Treatment Options & Tips for Parents What Is a Substance Abuse Counselor? A Career Path in Clinical Mental Health 6 Types of Behavior Therapy Used by Counselors Today Sources: Beaumont, Health Effects of Obesity Bentham Science Publishers, "Medical Complications in Anorexia and Bulimia Nervosa" BMC, "Balancing Nutrition Management and the Role of Dietitians in Eating Disorder Treatment" Bulimia.com, Medical Issues from Anorexia, Bulimia and Other Eating Disorders
Cambridge University Press, "Neuronal Variability of Resting State Activity in Eating Disorders: Increase and Decoupling in Ventral Attention Network and Relation with Clinical Symptoms"`
CBT-E, A Description of CBT-E Center for Discovery, "What Are Food Rituals?" Deloitte Access Economics, "Social and Economic Cost of Eating Disorders in the United States of America" IntechOpen, "The Neurobiology of Anorexia Nervosa" National Center for Biotechnology Information, "Recent Advances in Therapies for Eating Disorders" National Center for Biotechnology Information, "Review of the Burden of Eating Disorders: Mortality, Disability, Costs, Quality of Life, and Family Burden" National Center for Biotechnology Information, "Shining the Light on Eating Disorders, Incidence, Prognosis and Profiling of Patients in Primary and Secondary Care: National Data Linkage Study" Mayo Clinic, Eating Disorder Treatment: Know Your Options Medical News Today, "How to Find an Eating Disorder Therapist" MedlinePlus, Eating Disorders Monte Nido, How Eating Disorders Affect the Mind and Body and How Anorexia Treatment Can Help Monte Nido, Eating Disorder Recovery: Setting Positive Resolutions National Alliance on Mental Illness, Eating Disorders National Association of Anorexia Nervosa and Associated Disorders, Eating Disorder Statistics ScienceDaily, "Anorexia Nervosa Comes in All Sizes, Including Plus Size" The Eating Disorder Foundation, About Eating Disorders WebMD, Signs of an Eating Disorder Wiley Online Library, "Comparing Eating Disorder Characteristics and Treatment in Self‐Identified Competitive Athletes and Non‐Athletes from the National Eating Disorders Association Online Screening Tool"

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Types of Eating Disorders and How Counselors Can Help | Wake Forest University

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Nearly 1 in 10 people in the U.S. struggle with an eating disorder at some point in their lives, according to a recent Deloitte report. Sadly, the report also found that 10,200 people die from eating disorders each year in the U.S alone.

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Take it Seriously

Eating disorders are illnesses that have biological and psychological components. The symptoms can be life threatening. Every organ system of the body can be damaged, including: brain, heart, kidney, cardiovascular, gastrointestinal, endocrine, skin and bones.

Create a Safe Environment

Create an environment where students feel safe to discuss matters privately and confidentially. Remember the saying, "We have two ears and one mouth, so we should listen twice as much as we talk." Listening without judgment helps students feel safe enough to tell you what they're thinking, feeling, and doing.

People with eating disorders are 18 times more likely to die early compared with people of similar age in the general population.

Eating disorders have the highest mortality rate of any psychiatric disorder.

Eating disorders are the third most common chronic illness among adolescents.

Prevention is the First Line of Defense

Coaches, teachers, and other school personnel are role models for young people. It's important to be a resource for them. The environment you create will help students and athletes form healthy attitudes about weight, body image, nutrition, strength and even success.

Focus on Healthy Habits Rather Than on Body Weight or Fat

The factors listed below can enhance performance by improving both physical and psychological health. Emphasizing healthy behaviors in this way does not put students at risk for eating disorders.

Nutrition and Exercise - Young people need information about healthy meal planning and regular exercise, especially if they're athletes. Educate your students by providing nutritional information through the school curriculum and as part of their athletic training. Having knowledge about healthy habits will help them avoid overeating or under-eating. Some examples are:

Eat Breakfast! Grandmother was right. Breakfast is the most important meal of the day. People who eat breakfast, eat healthier the rest of the day, have more energy, and do better in school.

Meals and snacks should be nutritional and well balanced.

Plan for a regular mealtime schedule rather than eating on the run or skipping meals. Students with unusual or no meal schedule are at risk for eating disorders.

Sleep and Rest - Young adults and teens require between 8 to 9 hours of sleep a night. Many student-athletes sleep less than 6 hours a day. Encourage students to form regular sleep habits. The teen lifestyle of staying up late and getting up early is difficult to change but getting enough sleep is essential to health and wellbeing, which in turn helps to maximize both physical and mental performance. Lack of sleep can also lead to:

Body aches and pains

Irritability

Difficulty concentrating

Increased appetite

Decreased resilience and performance

Substance Use and Abuse - Provide your students with information about the consequences of drug and alcohol use, and teach them interpersonal and behavior skills. Include information about:

Alcohol and prescription or illegal drugs

Nicotine

Performance enhancing drinks or supplements

Dietary or "stacker" supplements

Peer pressure

Psychological Factors - Both thinking and emotional factors can affect performance. Educate young people to resist visual and social messages that imply they should achieve unrealistic body types such as extreme thinness. Mixed messages fill the media. Ultra-thin models happily eat fast food, while the nightly news reports an increasing number of Americans are obese. Replacing these messages with an emphasis on healthy eating habits can help the student make informed decisions and good choices for their own health and wellbeing.

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What Can I Do - Educators & Coaches - Eating Disorder Program - Adolescent Medicine - Golisano Children's Hospital - University of Rochester Medical Center

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Eating disorders are illnesses that have biological and psychological components. The symptoms can be life threatening. Every organ system of the body can be damaged, including: brain, heart, kidney, cardiovascular, gastrointestinal, endocrine, skin and bones. Create an environment where students feel safe to discuss matters privately and confidentially.

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Bipolar Disorder Strategies to use in School and Classroom

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Bipolar Disorder Strategies to use in School and Classroom

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Schizophrenia Spectrum and Other Psychotic Disorders

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Schizophrenia Spectrum and Other Psychotic Disorders

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Fight Flight Freeze – A Guide to Anxiety for Kids

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Sometimes anxiety is easy to identify - like when a child is feeling nervous before a test at school. Other times anxiety in the classroom can look like something else entirely - an upset stomach, disruptive or angry behavior, ADHD, or even a learning disorder.

There are many different kinds of anxiety, which is one of the reasons it can be hard to detect in the classroom. What they all have in common, says neurologist and former teacher Ken Schuster, PsyD, is that anxiety "tends to lock up the brain," making school hard for anxious kids.

Children can struggle with:

Separation anxiety: When children are worried about being separated from caregivers. These kids can have a hard time at school drop-offs and throughout the day.

Social anxiety: When children are excessively self-conscious, making it difficult for them to participate in class and socialize with peers.

Selective mutism: When children have a hard time speaking in some settings, like at school around the teacher.

Generalized anxiety: When children worry about a wide variety of everyday things. Kids with generalized anxiety often worry particularly about school performance and can struggle with perfectionism.

Obsessive-compulsive disorder: When children's minds are filled with unwanted and stressful thoughts. Kids with OCD try to alleviate their anxiety by performing compulsive rituals like counting or washing their hands.

Specific phobias: When children have an excessive and irrational fear of particular things, like being afraid of animals or storms.

Here are some tips for recognizing anxiety in kids at school, and what might be causing it.

Inattention and restlessness

When a child is squirming in his seat and not paying attention, we tend to think of ADHD, but anxiety could also be the cause. When kids are anxious in the classroom, they might have a hard time focusing on the lesson and ignoring the worried thoughts overtaking their brains. "Some kids might appear really 'on' at one point but then they can suddenly drift away, depending on what they're feeling anxious about," says Dr. Schuster. "That looks like inattention, and it is, but it's triggered by anxiety."

Attendance problems and clingy kids

It might look like truancy, but for kids for whom school is a big source of anxiety, refusing to go to school is also pretty common. School refusal rates tend to be higher after vacations or sick days, because kids have a harder time coming back after a few days away.

Going to school can also be a problem for kids who have trouble separating from their parents. Some amount of separation anxiety is normal, but when kids don't adjust to separation over time and their anxiety makes going to school difficult or even impossible, it becomes a real problem. Kids with separation anxiety may also feel compelled to use their phones throughout the day to check in with their parents.

Disruptive behavior

Acting out is another thing we might not associate with anxiety. But when a student is compulsively kicking the chair of the kid in front of him, or throws a tantrum whenever the schedule is ignored or a classmate isn't following the rules, anxiety may well be the cause. Similarly, kids who are feeling anxious might ask a lot of questions, including repetitive ones, because they are feeling worried and want reassurance.

Anxiety can also make kids aggressive. When children are feeling upset or threatened and don't know how to handle their feelings, their fight or flight response to protect themselves can kick in - and some kids are more likely to fight. They might attack another child or a teacher, throw things, or push over a desk because they're feeling out of control.

Trouble answering questions in class

Sometimes kids will do perfectly well on tests and homework, but when they're called on in class teachers hit a wall. There are several different reasons why this might happen.

"Back when I was teaching, I would notice that when I had to call on someone, or had to figure out who's turn it was to speak, it was like the anxious kid always tended to disappear," says Dr. Schuster. "The eager child is making eye contact, they're giving you some kind of physical presence in the room like 'Call on me, call on me!' " But when kids are anxious about answering questions in class, "they're going to break eye contact, they might look down, they might start writing something even though they're not really writing something. They're trying to break the connection with the teacher in order to avoid what's making them feel anxious."

If they do get called on, sometimes kids get so anxious that they freeze. They might have been paying attention to the lesson and they might even know the answer, but when they're called on their anxiety level becomes so heightened that they can't respond.

Frequent trips to the nurse

Anxiety can manifest in physical complaints, too. If a student is having unexplained headaches, nausea, stomachaches, or even vomiting, those could be symptoms of anxiety. So can a racing heart, sweaty palms, tense muscles, and being out of breath.

Problems in certain subjects

When a child starts doubting her abilities in a subject, anxiety can become a factor that gets in the way of her learning or showing what she knows. Sometimes this can be mistaken for a learning disorder when it's really just anxiety.

However anxiety can also go hand in hand with learning disorders. When kids start noticing that something is harder for them than the other kids, and that they are falling behind, they can understandably get anxious. The period before a learning disorder is diagnosed can be particularly stressful for kids.

Not turning in homework

When a student doesn't turn in her homework, it could be because she didn't do it, but it could also be because she is worried that it isn't good enough. Likewise, anxiety can lead to second guessing - an anxious child might erase his work over and over until there's a hole in the paper - and spending so much time on something that it never gets finished. We tend to think of perfectionism as a good thing, but when children are overly self-critical it can sabotage even the things they are trying their hardest at, like school work.

You might also notice that some anxious kids will start worrying about tests much earlier than their classmates and may begin dreading certain assignments, subjects, or even school itself.

Avoiding socializing or group work

Some kids will avoid or even refuse to participate in the things that make them anxious. This includes obvious anxiety triggers like giving presentations, but also things like gym class, eating in the cafeteria, and doing group work.

When kids start skipping things it might look to their teachers and peers like they are uninterested or underachieving, but the opposite might be true. Sometimes kids avoid things because they are afraid of making a mistake or being judged.

Dr. Schuster notes that when kids get anxious in social situations, sometimes they have a much easier time showing what they know when teachers engage them one-to-one, away from the group.

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How Does Anxiety Affect Kids in School? - Child Mind Institute

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Sometimes school anxiety is easy to identify - like when a child is feeling nervous before a test at school. Other times anxiety in the classroom can look like something else entirely - an upset stomach, disruptive or angry behavior, ADHD, or even a learning disorder.

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Here are things you can do at home to help your child manage his or her anxiety disorder:

Pay attention to your child's feelings.

Stay calm when your child becomes anxious about a situation or event.

Recognize and praise small accomplishments.

Don't punish mistakes or lack of progress.

Be flexible, but try to maintain a normal routine.

Modify expectations during stressful periods.

Plan for transitions (For example, allow extra time in the morning if getting to school is difficult).

Keep in mind that your child's anxiety disorder diagnosis is not a sign of poor parenting. It may add stress to family life, however. It is helpful to build a support network of relatives and friends.

It's important that you have the same expectations of your anxious child that you would of another child, according to psychologist Lynn Siqueland, PhD. She has specialized in treating children and adolescents with anxiety disorders for more than 15 years. She offers these parenting tips for anxious kids, as well as ways to manage siblings, whose lives are also affected.

SAMHSA Report: how to help children who have experienced traumatic events.

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Here are things you can do at home to help your child manage his or her anxiety disorder: Pay attention to your child's feelings. Stay calm when your child becomes anxious about a situation or event. Recognize and praise small accomplishments. Don't punish mistakes or lack of progress.

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There are fewer more frightening or challenging psychiatric conditions for a family to face than psychosis, an extreme mental state in which impaired thinking and emotions cause a person to lose contact with reality. This could mean hearing or seeing things that aren't there (hallucinations), or believing things that aren't true (delusions).

The illness most often associated with psychosis, schizophrenia, usually doesn't show up until very late adolescence or early adulthood. Recently, however, experts in the field have been working to identify high-risk kids who show symptoms that could serve as early warning signs of psychosis, and several academic centers have been set up to focus on this crucial period when it may be possible to change the trajectory of mental illness.

Not all the kids who are identified with what experts call "prodromal" symptoms will progress, or "convert" to full-blown psychotic illness. But early intervention has been shown to improve outcomes for those who do. And since psychotic symptoms cause disruption across a teenager's life, from school to friendships to family, researchers are hoping quick action can prevent impairment and prolong typical functioning.

What's more, some of the approaches that show promise in delaying onset of psychosis or mitigating symptoms include fairly simple lifestyle changes like stress reduction and sleep hygiene, and managing co-occurring disorders like anxiety. The key: identifying at-risk kids earlier when these low-impact measures are still effective.

What are "prodromal" symptoms?

Prodromal symptoms are "attenuated" or weak symptoms of psychosis. Moreover, "they are a warning sign," says Dr. Christoph Correll, the medical director of the Recognition and Prevention Program (RAP) at Zucker Hillside Hospital in Queens, NY, which specializes in diagnosing and treating early symptoms of mental illness in teenagers and young adults. "These signs can happen in people who don't go on to develop psychosis-but if we follow these people who are in the risk state based on these watered-down versions, one third will probably go on to develop psychosis. That's a lot more than in the general population."

Prodromal symptoms occur on a spectrum from very, very mild to severe and can include:

Withdrawing from friends and family/feeling suspicious of others

Changes in sleeping or eating patterns

Less concern with appearance, clothes or hygiene

Difficulty organizing thoughts or speech

Loss of usual interest in activities or of motivation and energy

Development of unusual ideas or behaviors

Unusual perceptions, such as visions or hearing voices (or even seeing shadows)

Feeling like things are unreal

Change in personality

Feelings of grandiosity (belief he has a superpower, etc)

In some cases, these symptoms represent the early stages of a disorder, and will eventually convert. In others, the symptoms actually fade or remain mild. Dr. Tiziano Colibazzi is a psychiatrist at Columbia Presbyterian's COPE clinic (Center for Prevention and Evaluation), which was established to research and treat prodromal symptoms. "We can identify a group of people that are at clinically high risk," says Dr. Colibazzi. "What we can't do is narrow that group down further to identify the 30 percent who will convert."

First step if you feel your child is at risk: An evaluation

The right treatment for prodromal symptoms depends entirely on how severe they are when they are diagnosed. The first step is a proper and complete diagnosis by a mental health professional with experience in assessing psychotic illness.

If you see marked changes in motivation, thinking, and/or behavior in your child, the first place to start is with her pediatrician to rule out a medical illness. Substance use also needs to be ruled out as the cause of any behavior changes in adolescents. After that, you're going to want to have your child evaluated by a qualified psychiatrist or psychologist. This in itself might be a multi-step process.

"You can't just look at the kid once and get a bit of a history and then know what's going on, " says Dr. Correll. "Kids develop; symptoms develop. And the trajectory-how things change, get better or worse, what other symptoms add on to it-will be highly informative in telling us something about the prognosis, what we expect to happen."

One aid to predicting the evolution and severity of symptoms, notes Dr. Colibazzi, is the patient's ability to doubt his symptoms. If your child retains the self-awareness to know that it's his mind that is playing tricks on him, it's an indication that symptoms are still in the very early stages. As symptoms become more severe, the patient's beliefs (whether paranoid, grandiose or hallucinatory) become increasingly difficult to challenge.

Lifestyle and mental health options

Psychotic symptoms and illnesses have been shown to vary quite a bit depending on the environment-the health of our bodies, our interpersonal relationships, our mindsets. As with any illness, but particularly important in at-risk youth, healthy living is key. Regardless of the severity of prodromal symptoms, Dr. Correll says that your child's outcome can be improved by making sure your kid sticks to a routine that includes:

Eating well

Getting regular exercise

Adhering to a regular sleep schedule

Reducing stress as much as possible

Staying away from drugs-particularly marijuana, which can interact with prodromal symptoms and increase the risk for psychosis significantly

Also, don't forget to address depression and anxiety. According to Dr. Correll, "adults who eventually developed schizophrenia identified a three to five year period during which they experienced depression or anxiety before developing the prodromal symptoms of psychosis and then developed full-blown psychosis." "So treating the depression early," he says, "might actually interrupt the progression from depression to psychosis in some patients."

Treatment for prodromal psychotic symptoms

Dr. Correll recommends trying several approaches. Mild symptoms call for more low-key treatments including:

Psycho-education: teaching both the kid and the family more about the symptoms and the illness.

Therapy, particularly cognitive behavioral therapy: "CBT can be good to change one's thinking patterns," says Correll, "and also to address developing self-esteem. We have to be careful that kids with a psychiatric diagnosis don't self-stigmatize and get into a hopeless or negative mode where they feel they can't achieve."

Lifestyle adjustments: Assessing whether the current school environment is best for the child. Perhaps a therapeutic social group to help the child cope.

Reducing Stress: Stress is often a trigger for symptoms, so reducing stress in these kids' lives is crucial and may prevent or delay conversion to psychotic illness.

Understanding prodromal symptoms and monitoring kids who are at high risk for psychotic illness means that parents can do more for their kids than wait for symptoms to get worse or merely hope for the best. Early monitoring and intervention can give high-risk kids an advantage, which researchers hope will eventually change the odds when it comes to psychotic illness.

"The duration of untreated psychosis does actually seem to affect the course of the illness," Dr. Colibazzi says. The longer the illness goes untreated, the greater the chance that it will cause serious disruption in all areas of the patient's life. "So it is reasonable to think that just following someone very closely and treating them very early, as soon as they develop symptoms, would be helpful."

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Psychosis Symptoms and Signs in Teens | Child Mind Institute

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There are fewer more frightening or challenging psychiatric conditions for a family to face than psychosis, an extreme mental state in which impaired thinking and emotions cause a person to lose contact with reality. This could mean hearing or seeing things that aren't there (hallucinations), or believing things that aren't true (delusions).