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Psychotic disorders are mental health illnesses characterized by an impaired relationship with reality, usually with associated behavioral changes. There are several different psychotic disorders, and they each have diagnostic criteria described in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5).

Psychotic disorders can be highly distressing, impacting a person's quality of life and ability to maintain self-care. However, most of these conditions can be managed with medication and therapy.

If you or a loved one is diagnosed with a psychotic disorder, it's important that you maintain consistent psychiatric care to help reduce the effects of your disorder on your life.

Types of Psychotic Disorders

The different types of psychotic disorders are:

Schizophrenia: Schizophrenia is characterized by delusions, hallucinations, disorganization, unusual behavior, and withdrawal.

Schizoaffective disorder: Schizoaffective disorder is characterized by a combination of psychotic features and mood symptoms.

Schizophreniform disorder: Schizophreniform disorder is characterized by symptoms of schizophrenia lasting for longer than one month and for less than six months.

Delusional disorder: This condition is characterized by delusions, without the other symptoms that are seen in schizophrenia.

Brief psychotic disorder: This condition is characterized by an episode of psychotic behavior that lasts for less than one month.

Substance-induced psychotic disorder: The short-term and long-term effects of certain drugs, such as LSD, can cause symptoms of psychosis.

Psychotic disorder due to a medical condition: Medical conditions can cause temporary or prolonged psychosis.

Psychotic Disorder Symptoms

Psychotic disorders are characterized by a loss of touch with reality characterized by altered thinking, perceptions, and behavior.

Often, people who have psychotic disorders also manifest behavioral symptoms. Symptoms of psychotic disorder are often characterized as positive or negative. Positive symptoms involve hallucinations, delusions, and disorganization. Negative symptoms involve behaviors such as withdrawal from others and diminished emotional expression.

Many psychotic disorders are lifelong illnesses, often beginning during early adulthood. They may progress or stabilize over time. Some psychotic disorders are limited in their duration, however, and can resolve.

Hallucinations

Hallucinations are false sensory experiences. The most common are visual hallucinations (seeing things that aren't real) or auditory hallucinations (hearing voices that aren't real). Other false sensations, such as smell, taste, or touch are less common with psychotic disorders, but they can occur.

Hallucinations can occur intermittently, and they may follow a theme, such as repeatedly hearing voices giving commands or seeing a specific type of animal or person that isn't really there.

Delusions are fixed false beliefs. Often, with psychotic disorders, the delusions involve a sense of persecution and a belief that people are involved in sabotaging or harming the person who is experiencing the delusion.

Sometimes delusions are grandiose, and a person might believe that they have supernatural or superhuman powers, or that they have a special designation that others cannot understand.

A person who has a psychotic disorder might share some of the details of their delusions with a few trusted people, but could be worried that everyone is in on the conspiracy or may avoid telling loved ones about the beliefs in an effort to protect them.

Behavioral Symptoms

Some of the behavioral effects of psychotic disorders include speaking incoherently, erratic or odd behaviors, agitation, and restlessness.

Negative symptoms of psychotic disorders can include apathy, withdrawal, lack of emotional expressions, and lack of self-care. Negative symptoms are not usually as disruptive as hallucinations and delusions, and they can go unnoticed by family and friends, and even by the person who is experiencing them.

A key characteristic of psychotic disorders is that a person may have a lack of insight into their symptoms-genuinely believing their hallucinations or delusions to be true, and may not perceive that the behavioral manifestations are unusual.

Complications

Psychotic disorders can result in a lack of self-care. This can cause a person to neglect things like eating, changing clothes, and/or bathing.

A person who has a psychotic disorder might not seek medical attention for symptoms like pain or discomfort, and this can allow physical problems to worsen-potentially leading to complications of infections, injuries, or medical illnesses. Medical problems can exacerbate the symptoms of a psychotic condition.

People who have a psychotic condition may experience suicidal ideation (thinking about suicide) or might attempt suicide.

Psychotic conditions have a strong genetic component. They are more common among people who have one or more family members with a psychotic disorder. However, a person can develop one of these conditions without having a family history, and a person who has family members with psychotic disorders will not necessarily develop one.

The specific genes involved in psychotic disorders are not well established. Psychotic disorders are associated with brain and neurotransmitter dysfunction. Disruption of dopamine and serotonin, among others, is believed to play a role in these conditions.

Certain psychotic disorders are associated with brain atrophy (shrinking) in certain parts of the brain, such as the frontal and/or temporal lobes. Sometimes the ventricles of the brain can be enlarged. And the presence of certain antibodies has also been associated with psychotic disorders, but the overall significance of immune dysfunction in psychotic disorders is not clear.

The diagnosis of psychotic disorders is based on a set of criteria that is used for each of these conditions. The criteria generally include a list of thoughts, behaviors, and duration of symptoms. Usually, diagnosis of a psychotic disorder requires that a person has a certain number or combination of the clinical criteria, not necessarily all of them.

If you are getting a medical evaluation for a possible psychotic disorder, your healthcare provider might discuss your symptoms with you, and may also listen to friends and family members that you have with you during your evaluation.

Your healthcare provider will also ask about your medical and psychiatric history, any stresses you are undergoing, medications or recreational drugs that you take, and your family medical and psychiatric history as well.

Some of the symptoms of psychotic disorders occur due to other medical, neurological, and psychological conditions. If your assessment does not meet the criteria for a psychotic disorder and/or there is concern that you also might have another medical condition, you might have further diagnostic testing.

There are no blood tests or imaging tests that are considered indicative or that can confirm psychotic disorders. However, diagnostic tests may be used to rule out other potential causes of the symptoms.

Diagnostic tests you might need include:

These tests can help determine if there are other causes of your symptoms. For example, a brain tumor, which can be identified with brain imaging studies, might cause visual hallucinations.

Encephalitis (a brain infection), which could be identified with brain imaging or LP, can cause changes in behavior. Some types of liver disease can cause mental status changes that can seem similar to psychotic disorders.

The treatment of a psychotic disorder is tailored to the underlying condition and may include a combination of prescription medication and counseling. You may be prescribed one or more antipsychotic medications, and you might also be prescribed a medication for treatment of a mood disorder if present.

Your healthcare provider will likely also recommend that you have counseling or psychotherapy as part of your treatment plan for your psychotic disorder.

Medications used to treat psychotic disorders include typical antipsychotics and atypical antipsychotics. Medications in both of these categories can control symptoms, and your healthcare provider will work with you to determine which might be best for managing your condition.

Some typical antipsychotics include:

Haldol (haloperidol)

Prolixin (fluphenazine)

Navane (thiothixene)

Adasuve (loxapine)

Mellaril (thioridazine)

Stelazine (trifluoperazine)

The most common side effect of these medications is sleepiness. Typical antipsychotics are associated with extrapyramidal side effects -tremors, spasms, muscle rigidity, and diminished control of movement. Side effects can diminish with medication adjustments, but sometimes extrapyramidal symptoms remain even after the medication is discontinued.

Some atypical antipsychotics include:

Clozaril (clozapine)

Abilify (aripiprazole)

Risperdal (risperidone)

Zyprexa (olanzapine)

Seroquel (quetiapine)

Atypical antipsychotics are not as likely to cause extrapyramidal side effects as typical antipsychotics. They can cause side effects, including constipation, sleepiness, weight gain, high cholesterol, and decreased sex drive.

You might have episodes during which the effects of your psychotic condition worsen substantially, necessitating in-patient treatment. During this time, you will be kept safe, and your medication may be adjusted. Any other medical problems that you have (like an infection) would be managed as well.

Living with a psychotic disorder can be challenging. You might have fluctuations in your symptoms, and you can experience side effects from your medications.

It can be difficult for you to keep up with employment, and your relationships and social life can be affected as well. The social stigma can affect your life and the lives of your family members.

As you are coping with your condition, it's important that you know that your psychotic disorder is not something that you or anyone else is to blame for. It is an illness, just like any other medical condition. You might consider some approaches that could help you cope with your condition to optimize your quality of life.

Counseling/Therapy

Managing your psychotic illness doesn't have to stop with controlling the symptoms. You might have concerns or apprehensions about your condition. Speaking with a professional therapist or with your psychiatrist about any feelings you have about your condition can help.

Join a Support Group

Sometimes, interacting with others who are going through the same things you are going through can help you feel less alone. Be sure to give yourself a chance to find a group that makes you feel comfortable.

Some support groups are moderated by a professional, and you might find a professionally moderated group to be a good type of group for you. When you feel that the time is right, you can also be a valuable source of support for others who are searching for hope and camaraderie.

Family/Community

How much you want to share about your condition is up to you. But since psychotic illnesses are characterized by altered perceptions of reality, it would be beneficial for you if you can talk about your condition with one or more people who you trust. They can get help for you if your symptoms worsen or if you need urgent medical attention.

Caregiver Support

Psychiatric disorders affect the quality of life of the people who are experiencing them, as well as the lives of family, friends and loved ones. If someone who is a part of your life is showing the symptoms of a psychotic disorder or has been diagnosed with a psychotic illness, the condition can cause distress for you as well.

Even though you want to maintain a relationship with your parent, sibling, spouse, child, or friend suffering from psychosis-but you might not know how best to do so when they have a psychotic disorder.

Talking with someone who you care about when they are not in touch with reality can be overwhelming and you might not know how much you should engage in a discussion about their delusions or hallucinations.

It may be important that you seek professional guidance as you navigate the challenges that your loved one's illness can pose in your own life, rather than trying to reinvent the wheel and learn how to do it on your own.

Consider seeking professional counseling or therapy and/or joining a support group so you can learn how to manage your relationship and how to participate in their care in the way that works best for you.

You and the person who you care about might also decide that you can accompany them to their healthcare appointments and/or help them as they manage their medical and psychiatric care.

You should also make sure that you or another trusted friend, family member, or caregiver understand the signs of an emergency that might necessitate urgent medical attention-and have a plan in place for getting urgent medical help right away if needed.

A Word From Verywell

You can have an emotionally and physically healthy life if you are living with a psychotic disorder. This involves maintaining consistent psychiatric and medical care.

Because insight may be impaired in psychotic illness, it can be difficult to know when your symptoms are recurring or when medication adjustments are needed. Having a routine for taking your medications and going to your medical appointments can help with this process.

A community support structure from family, friends, and your healthcare team can help optimize the quality of life for a person who is living with a psychotic illness.

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Psychotic disorders are mental health illnesses characterized by an impaired relationship with reality, usually with associated behavioral changes. There are several different psychotic disorders, and they each have diagnostic criteria described in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5).

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Schizotypal Personality Disorder: Definition, Symptoms, and Treatment

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What is schizotypal personality disorder and how is it different from schizophrenia? These are the signs, symptoms, and treatment options for SPD.

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Overview

What is delusional disorder?

Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions.

A delusion is an unshakable belief in something that's untrue. The belief isn't a part of the person's culture or subculture, and almost everyone else knows this belief to be false.

People with delusional disorder often experience non-bizarre delusions. Non-bizarre delusions involve situations that could possibly occur in real life, such as being followed, deceived or loved from a distance. These delusions usually involve the misinterpretation of perceptions or experiences. In reality, these situations are either untrue or are highly exaggerated.

Non-bizarre delusions are different from bizarre delusions, which include beliefs that are impossible in our reality, such as believing someone has removed an organ from your body without any physical evidence of the procedure.

People with delusional disorder often continue to socialize and function well, apart from the subject of their delusion. Generally, they don't behave in an odd or unusual manner. This is unlike people with other psychotic disorders, who might also have delusions as a symptom. In some cases, however, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.

What are the types of delusional disorder?

There are different types of delusional disorder, which are determined based on the main theme of the delusions the person experiences. The types of delusional disorder include:

Erotomanic: People with this type of delusional disorder believe that another person, often someone important or famous, is in love with them. They may attempt to contact the person of the delusion and engage in stalking behavior.

Grandiose: People with this type of delusional disorder have an overinflated sense of self-worth, power, knowledge or identity. They may believe they have a great talent or have made an important discovery.

Jealous: People with this type of delusional disorder believe that their spouse or sexual partner is unfaithful without any concrete evidence.

Persecutory: People with this type of delusional disorder believe someone or something is mistreating, spying on or attempting to harm them (or someone close to them). People with this type of delusional disorder may make repeated complaints to legal authorities.

Somatic: People with this type of delusional disorder believe that they have a physical issue or medical problem, such as a parasite or a bad odor.

Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.

What is the difference between delusional disorder and schizophrenia?

Schizophrenia is a spectrum (or range) of conditions that involve psychotic symptoms, which include:

Disorganized speech or behavior.

Negative symptoms (a decrease in emotion in a person's facial expressions and motivation).

Delusional disorder is different from schizophrenia because there aren't any other psychotic symptoms other than delusions.

In addition, in contrast to schizophrenia, delusional disorder is relatively rare, and daily functioning isn't as impaired as it is in schizophrenia.

Who does delusional disorder affect?

Delusional disorder most often occurs in middle to late life, with the average age of onset being 40 years.

The persecutory and jealous types of delusional disorder are more common in people assigned male at birth (AMAB), and the erotomanic type is more common in people assigned female at birth (AFAB).

People who tend to be socially isolated are more likely to develop delusional disorder. These populations include:

Immigrants who have language barriers.

People who are deaf.

People who are visually impaired.

Elderly people.

How common is delusional disorder?

Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Approximately 0.05% to 0.1% of the adult population has delusional disorder.

What is the most common type of delusional disorder?

The most common type of delusional disorder is the persecutory type - when someone believes others are out to harm them despite evidence to the contrary.

Symptoms and Causes

What are the signs and symptoms of delusional disorder?

The presence of delusions is the most obvious sign of delusional disorder, which vary based on the type.

Another characteristic of this condition is that the person often lacks self-awareness that their delusions are problematic. They're unable to accept that their delusions are irrational or inaccurate, even if they recognize that other people would describe their delusions this way.

Anger and violent behavior may be present if someone is experiencing persecutory, jealous or erotomanic delusions.

People with delusional disorder may also develop anxiety and/or depression as a result of the delusions.

Early symptoms of delusional disorder may include:

Feelings of being exploited.

Preoccupation with the loyalty or trustworthiness of friends.

A tendency to read threatening meanings into benign remarks or events.

Persistently holding grudges.

A readiness to respond and react to perceived slights.

What causes delusional disorder?

As with many other psychotic disorders, researchers don't yet know the exact cause of delusional disorder. Researchers are, however, looking at the role of various factors that may contribute to the development of the condition, including:

Genetic factors: The fact that delusional disorder is more common in people who have family members with delusional disorder or schizophrenia suggests there might be a genetic factor involved. Researchers believe that, as with other mental disorders, a tendency to develop delusional disorder might be passed on from parents to their biological children.

Biological factors: Researchers are studying how abnormalities of certain areas of your brain might be involved in the development of delusional disorder. An imbalance of certain chemicals in your brain, called neurotransmitters, has been linked to the formation of delusional symptoms.

Environmental and psychological factors: Evidence suggests that delusional disorder can be triggered by stress. Alcohol use disorder and substance use disorder might contribute to the condition. Hypersensitivity and ego defense mechanisms like reaction formation, projection and denial are some psychodynamic theories for the development of delusional disorder. Social isolation, envy, distrust, suspicion and low self-esteem are also some psychological factors that may lead to a person seeking an explanation for these feelings and, thus, forming a delusion as a solution.

Diagnosis and Tests

How is delusional disorder diagnosed?

Healthcare providers - mainly mental health professionals - diagnose delusional disorder when a person has one or more delusions for one month or more that can't be explained by any other condition. The person must also not have the characteristic symptoms of other psychotic disorders, such as schizophrenia.

If someone is experiencing signs and symptoms of delusional disorder, a healthcare provider will perform a complete medical history and physical examination. Although there aren't any laboratory tests to diagnose delusional disorder, their healthcare provider might use various diagnostic tests - such as imaging tests, a urine drug screen and blood tests - to rule out any physical conditions, medications or substances that could be causing the symptoms.

If their healthcare provider finds no physical reason for the symptoms, a consultation with a psychiatrist or psychologist will likely be made. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. They'll ask questions about the delusions and assess the person's mental status.

The psychiatrist or psychologist may also interview family members and friends so they can provide further details about the person's delusions and a timeline of the symptoms.

As other mental health conditions can cause delusions, mental health professionals carefully assess the person for other symptoms. Delusional disorder can be misdiagnosed as any of the following conditions:

Management and Treatment

How is delusional disorder treated?

Treatment for delusional disorder most often includes psychotherapy (talk therapy) and medication, but delusional disorder is highly resistant to treatment with medication alone.

People with delusional disorder often don't seek treatment for the condition on their own because most people with delusional disorder don't realize their delusions are problematic or incorrect. It's more likely they'll seek help due to other mental health conditions such as depression or anxiety.

People with severe symptoms or who are at risk of hurting themselves or others might need to be admitted to the hospital until the condition is stabilized.

Psychotherapy for delusional disorder

Psychotherapy is a term for a variety of treatment techniques that aim to help people identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to the person and their family.

Through therapy, people with delusional disorder can learn to manage their symptoms, identify early warning signs of relapse and develop relapse prevention plans. Types of psychotherapy include:

Individual psychotherapy: This type of therapy can help a person recognize and correct the underlying thinking that has become distorted.

Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A mental health professional helps people take a close look at their thoughts and emotions. They'll come to understand how their thoughts affect their actions. Through CBT, they can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

Family-focused therapy: This therapy can help people with delusional disorder and their families. This treatment involves psychoeducation regarding delusional disorder, communication improvement training and problem-solving skills training.

Medications for delusional disorder

The primary medications used to help treat delusional disorder are called antipsychotics (neuroleptics). Medications include the following:

First-generation ("typical") antipsychotics: Healthcare providers have used these medications to treat mental health conditions since the mid-1950s. These medicines work by blocking dopamine receptors in your brain. Dopamine is a neurotransmitter believed to be involved in the development of delusions. First-generation antipsychotics include chlorpromazine (Thorazine®), fluphenazine (Prolixin®), haloperidol (Haldol®), thiothixene (Navane®), trifluoperazine (Stelazine®), perphenazine (Trilafon®) and thioridazine (Mellaril®).

Second-generation ("atypical") antipsychotics: These newer antipsychotics are also effective in treating the symptoms of delusional disorder. They work by blocking dopamine and serotonin receptors in your brain. These drugs include risperidone (Risperdal®), clozapine (Clozaril®), quetiapine (Seroquel®), ziprasidone (Geodon®) and olanzapine (Zyprexa®). These medications are usually better tolerated than first-generation antipsychotics.

Other medications that healthcare providers might prescribe to treat delusional disorder include anxiolytics and antidepressants. Anxiolytics might help if the person has a very high level of anxiety and/or problems sleeping. Antidepressants can help treat depression, which often occurs in people with delusional disorder.

Prevention

Can delusional disorder be prevented?

There's no known way to prevent delusional disorder. However, early diagnosis and treatment can help decrease the disruption to the person's life, family and friendships.

Outlook / Prognosis

What is the prognosis (outlook) for delusional disorder?

The prognosis (outlook) for people with delusional disorder varies depending on a few factors, including:

The type of delusional disorder.

The severity of the delusions.

The person's life circumstances, including the availability of support and a willingness to stick with treatment.

Delusional disorder doesn't usually significantly affect a person's daily functioning, but the severity of the delusion may gradually get worse. Most people with delusional disorder can remain employed as long as their work doesn't involve things related to their delusions.

The prognosis of delusional disorder is better if the person sticks to their treatment plan. Almost 50% of people have a full recovery, more than 20% of people report a decrease in symptoms and less than 20% of people report minimal to no change in symptoms.

Unfortunately, many people with this condition don't seek help. It's often difficult for people with mental health conditions to recognize they're not well. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a life-long condition.

What are the possible complications of delusional disorder?

If left untreated, delusional disorder might lead to:

Depression, often as a consequence of difficulties associated with the delusions.

Social isolation.

Legal issues - for example, stalking or harassing the person involved with the delusion could lead to arrest.

Self-harm or harm to others. This is more common in the jealous and persecutory types.

Living With

How can I help someone with delusional disorder?

If you know someone with delusional disorder, you can help by providing support and encouragement for them to seek help and treatment.

People with delusional disorder who feel pressured or repeatedly criticized by others will likely experience stress, which may worsen their symptoms. Because of this, a positive approach may be more helpful and effective.

The friends and family members of people with delusional disorder often experience stress, depression, grief and isolation. It's important to take care of your mental health and seek help if you're experiencing these symptoms.
A note from Cleveland Clinic
It's important to remember that delusional disorder is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to life. Mental health professionals can offer treatment plans that can help manage thoughts and behaviors.

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Delusional Disorder: Causes, Symptoms, Types & Treatment

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Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions. A delusion is an unshakable belief in something that's untrue. The belief isn't a part of the person's culture or subculture, and almost everyone else knows this belief to be false.

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Verified by Psychology Today

A brief psychotic disorder is an uncommon psychiatric condition characterized by sudden and temporary periods of psychotic behavior, such as delusions, hallucinations, and confusion. Symptoms can endure for only one day or for as long as one month, but may be severe enough to put the person at increased risk of violent behavior or suicide. A majority of cases present for the first time when an individual is in their 20s or 30s, although onset can occur at any age. Brief psychotic disorder is differentiated from other disorders in which psychosis occurs by its limited duration, and it is not triggered by drugs or alcohol abuse. In most cases brief psychotic disorder does not indicate the presence of a chronic mental health condition.

Symptoms

According to the DSM-5, symptoms of brief psychotic disorder may include:

Delusions and hallucinations

Sudden and extreme mood changes

Nonsensical or disordered speech

Disorganized behavior

Catatonia

Women are more likely than men to develop brief psychotic disorder, especially postpartum. The DSM-5 classifies one subtype of brief psychotic disorder as psychosis with onset within one month of giving birth. Most people who develop brief psychotic disorder experience only one episode and are able to resume all activities with no permanent symptoms or impairment. People with certain personality disorders have an elevated risk of experiencing a brief psychotic episode, as are those who have experienced trauma or severe stress. It is important to understand that the prognosis for brief psychotic disorder is generally good. However, an initial psychotic episode may be the first sign of a chronic mental health condition such as schizoaffective disorder, schizophrenia, or a mood disorder with psychotic symptoms. The diagnosis of brief psychotic disorder is generally reevaluated if symptoms persist for more than one month.

Causes

The cause of brief psychotic disorder is unclear, but major stress or trauma - such as the death of a loved one, assault, or natural disaster - can trigger an episode. As with other disorders on the psychotic spectrum, there may be a genetic, biologic, environmental, or neurological basis for this episode. Neurological abnormalities have been found in people with psychotic disorders; some appear to be present before symptoms first appear, while other abnormalities have been recorded after the onset of symptoms. Brief psychotic disorder tends to run in families.

Treatment

Generally, a medical or psychiatric professional will interview the person to rule out any other physical or mental health condition that exists simultaneously or could be causing the symptoms. Antipsychotic medications and, if necessary, antidepressants may be prescribed to help manage symptoms, and the person may need to be supervised at all times to ensure they don't harm themselves or others. Short-term psychotherapy can help a person understand and recover from brief psychotic disorder, manage their medications, and learn to cope with stress. Those who fail to seek treatment after a first psychotic episode are more likely to see a future recurrence of brief psychotic disorder or to subsequently be diagnosed with a chronic disorder on the psychotic spectrum.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

MedlinePlus

Pantelis C, Velakoulis D, McGorry PD, et al. Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet. Jan 2003;361(9354): 281-288.

Fusar-Poli P, Cappucciati M, Bonoldi I, et al. Prognosis of brief psychotic episodes: A meta-analysis. First published online March 2016. JAMA Psychiatry.

Last reviewed 04/13/2017

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A brief psychotic disorder is an uncommon psychiatric condition characterized by sudden and temporary periods of psychotic behavior, such as delusions, hallucinations, and confusion. Symptoms can endure for only one day or for as long as one month, but may be severe enough to put the person at increased risk of violent behavior or suicide.

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Childhood Schizophrenia Causes, Signs & Symptoms

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Childhood Schizophrenia Causes, Signs & Symptoms

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What Is Childhood Schizophrenia?

Childhood schizophrenia is a severe mental health disorder in children younger than age 13 that affects the way they deal with reality. They might have unusual thoughts, feelings, or behaviors. It's also called childhood-onset or very early onset schizophrenia.

The disorder is rare -- less than 1% of children are diagnosed with it -- and may be hard to spot. There's no cure, but treatment can help.

Again, not every child who has these symptoms has schizophrenia. Talk to your doctor if you have any concerns.

Experts divide symptoms of childhood schizophrenia into three categories: positive, negative, and cognitive.

Positive symptoms are psychotic, which means there's a break with reality. These include unusual movements, unusual thoughts, and hallucinations.

Negative symptoms involve behavior and emotion. They include isolation, not speaking much or at all, and showing little or no emotion.

Cognitive symptoms show differences in how a child thinks or remembers, such as trouble focusing or understanding something.

Childhood Schizophrenia Treatment

Schizophrenia treatment for children is like treatment for adults. It includes:

Medications. Your doctor may suggest one or more antipsychotics. These drugs are also called neuroleptics. They manage delusions (beliefs in things that aren't true) and hallucinations (seeing or hearing things that aren't real). Talk with your doctor about side effects and other drugs your child shouldn't take while they're using these medicines.

Psychotherapy. Mental health professionals who specialize in childhood schizophrenia may help your child manage their symptoms. Family therapy and support groups can teach your child and others in the family about the disease and about how to deal with stressful situations.

Life skills training. Special classes can teach your child social skills and how to do daily tasks. They can also get tips on how to overcome challenges in school.

If your child has severe symptoms or a mental health crisis, a stay in the hospital can be the quickest way to get symptoms under control in a safe place. Other options include part-time hospital and home care.

Childhood Schizophrenia Complications

Without treatment, schizophrenia can cause problems in childhood and later in life. These include:

Other mental disorders

Self-harm or suicide

Drug or alcohol use disorders

Conflict with and isolation from family and friends

Legal and financial problems

Trouble living alone, going to school, or keeping a job

Childhood Schizophrenia Outlook

When childhood schizophrenia is diagnosed and treated early, your child may be able to manage it as they grow into an adult. Health professionals will keep tabs on their condition and treatments for life.

Although there's no cure for this disorder, people who have schizophrenia can succeed at school, at work, and in their social lives.

Childhood Schizophrenia Causes

Experts aren't sure exactly what causes schizophrenia or why it starts in childhood for some and at an older age for others.

Your child's genes and brain chemicals may play a role. The disease sometimes happens in more than one family member. If someone in your family has schizophrenia, your child has a higher chance of getting it.

Some experts also think schizophrenia may be linked to things that happened during a woman's pregnancy, such as:

Drug or alcohol use

Contact with viruses, bacteria, or chemicals

Stress

Poor nutrition

Childhood Schizophrenia Diagnosis

A pediatric psychiatrist can diagnose schizophrenia in children. Because different mental health conditions can have similar symptoms, it can be tough to get the right diagnosis. It might take a lot of time and effort for everyone.

Other specialists will get involved to give your child a complete physical exam, blood tests, mental health tests, imaging tests of their brain, and other exams. They're all key in finding the right diagnosis and coming up with a treatment plan to help your child manage the disease.

Childhood Schizophrenia Signs and Symptoms

Some children who develop schizophrenia first go through a period called the prodrome or the prodromal phase. They might withdraw from daily life, with more anxiety and less interest in school or friends. Not all children who show these signs will have a psychotic disorder, so it's important to talk to your doctor if you notice any issues.
Early childhood schizophrenia symptoms
A baby or toddler may have signs of schizophrenia that are different from those in older children, teens, and adults.

The disorder affects how your child develops. You may notice things like:

Long periods in which they're sluggish or not active

Floppy arms or legs

Delays in crawling, walking, or talking

Odd movements such as rocking or flapping their arms

A limp or slumped posture

Some of these symptoms show up in children with other problems besides schizophrenia. And some happen in kids without any mental health conditions. Only your child's doctor can figure out what's really going on.
Later childhood schizophrenia symptoms
In older kids, you might notice the behavior changes of schizophrenia over time or suddenly, as if out of nowhere. Your child may act withdrawn and clingy, or they may talk about strange and disturbed ideas and fears.

Tell your doctor as soon as you see symptoms of schizophrenia. It's important to get a diagnosis and start treatment before your youngster shows signs of a break from reality, called psychosis.
Symptoms in older children include:

They can't tell the difference between reality and dreams, stories, TV shows, etc.

Intense fear that someone or something is hurting them (delusions)

Hearing things that aren't real (auditory hallucinations) such as whispers or voices telling them to do something

Seeing things that aren't real (visual hallucinations) such as flashing lights or patches of darkness

Moodiness or anxiety

A lack of emotional expressions when they speak

Agitated, confused behavior, followed by periods of sitting and staring

Acting like a much younger child

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Childhood schizophrenia is a severe mental health disorder in children younger than age 13 that affects the way they deal with reality. They might have unusual thoughts, feelings, or behaviors. It's also called childhood-onset or very early onset schizophrenia. The disorder is rare -- less than 1% of children are diagnosed with it -- and may be hard to spot.

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Childhood schizophrenia - Symptoms and causes

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This severe mental disorder in children involves hallucinations, delusions, and disordered thinking and behavior that can impair the ability to function.

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Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression.

Many people with schizoaffective disorder are often incorrectly diagnosed at first with bipolar disorder or schizophrenia. Because schizoaffective disorder is less well-studied than the other two conditions, many interventions are borrowed from their treatment approaches.

Schizoaffective is relatively rare, with a lifetime prevalence of only 0.3%. Men and women experience schizoaffective disorder at the same rate, but men often develop the illness at an earlier age. Schizoaffective disorder can be managed effectively with medication and therapy. Co-occurring substance use disorders are a serious risk and require integrated treatment.

Symptoms

The symptoms of schizoaffective disorder can be severe and need to be monitored closely. Depending on the type of mood disorder diagnosed, depression or bipolar disorder, people will experience different symptoms:

Hallucinations, which are seeing or hearing things that aren't there.

Delusions, which are false, fixed beliefs that are held regardless of contradictory evidence.

Disorganized thinking. A person may switch very quickly from one topic to another or provide answers that are completely unrelated.

Depressed mood. If a person has been diagnosed with schizoaffective disorder depressive type they will experience feelings of sadness, emptiness, feelings of worthlessness or other symptoms of depression.

Manic behavior. If a person has been diagnosed with schizoaffective disorder: bipolar type they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania.

Causes

The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder.

Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness.

Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Brain scans are helping to advance research in this area.

Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness.

Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder.

Diagnosis

Schizoaffective disorder can be difficult to diagnose because it has symptoms of both schizophrenia and either depression or bipolar disorder. There are two major types of schizoaffective disorder: bipolar type and depressive type. To be diagnosed with schizoaffective disorder a person must have the following symptoms.

A period during which there is a major mood disorder, either depression or mania, that occurs at the same time that symptoms of schizophrenia are present.

Delusions or hallucinations for two or more weeks in the absence of a major mood episode.

Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the illness.

The abuse of drugs or a medication are not responsible for the symptoms.

Treatment

Schizoaffective disorder is treated and managed in several ways:

Medications, including mood stabilizers, antipsychotic medications and antidepressants

Psychotherapy, such as cognitive behavioral therapy or family-focused therapy

Self-management strategies and education

Related Conditions

A person with schizoaffective disorder may have additional mental health conditions:

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Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression. Many people with schizoaffective disorder are often incorrectly diagnosed at first with bipolar disorder or schizophrenia.

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What Is Catatonia?

Catatonia is a psychomotor disorder that affects both speech and behavior functions. It can manifest as a state of stupor and unresponsiveness or as restlessness, agitation, and confusion.

Catatonia was first identified as a discrete syndrome in 1874 by Karl Kahlbaum.﻿﻿﻿ The early description of the condition was focused on motor symptoms, and treatment was focused on supportive care rather than medical interventions.

Currently, the incidence of catatonia is a little more than 10 percent of patients with acute psychiatric illnesses, particularly affective disorders.﻿﻿﻿ However, some experts believe that many cases go unreported.

There are three main forms of catatonia: akinetic, hyperkinetic, and malignant catatonia.﻿﻿﻿

Akinetic: The most common type of catatonia that features a lack of movement, staring, and non-responsive behavior.

Hyperkinetic: This is the excited type of catatonia that involves impulsive movement.

Malignant: This causes the most severe symptoms and can lead to other health problems, and in some instances, it can result in death.

Catatonia Symptoms

The symptoms of catatonia will vary depending on the severity and type. However, there are some signs and symptoms that will be common across cases of catatonia.

Stupor: Lack of physical movement or speech

Mutism:Non-verbal or very little verbal communication

Posturing: Active maintenance of a posture against gravity

Waxy flexibility: Slight resistance to positioning

Negativism: Opposition or no response to instructions

Stereotypy: Involuntary, rhythmic movement repeatedly performed over time, including body rocking, hand waving, shoulder shrugging, and more

Echolalia:Repeating words said by other people

Echopraxia: Mimicking movements done by other people

Automatic obedience: Exaggerated cooperation on the patient's part when interacting with another person

Some signs occur more frequently. One study involving more than 230 catatonic patients found that staring, immobility, mutism, and withdrawal were reported with a greater frequency than other symptoms.﻿﻿﻿

Causes of Catatonia

The exact cause of catatonia is not clear. However, experts say a catatonic state can be triggered by a range of conditions, including psychiatric illness and neurological and other medical illnesses.

Some common theories include a dysregulation in gamma-aminobutyric acid (GABA), which is the primary inhibitory neurotransmitter in the brain, a dysregulation in glutamate, dysregulation of dopamine, or abnormalities of metabolism in the thalamus and frontal lobes.﻿﻿﻿﻿

Other common hypotheses for catatonia include the following:

Psychiatric disorders: Schizophrenia, mood disorders such as depression and bipolar disorder, and affective disorder are all underlying conditions that can cause catatonia.

Neurological disorders:Catatonia can be caused by brain disorders like neurodegenerative disease and encephalitis. It can also be triggered by strokes, neoplasms, or other diseases.

Medical conditions: Although psychiatric conditions are the most common underlying cause, some medical conditions can also cause catatonia. Renal failure, progressive multifocal leukoencephalopathy, autoimmune, paraneoplastic, infectious, metabolic, and certain drug exposures, and poisonings can lead to the development of catatonia.

It's important to note that the majority of cases will have a detectable underlying cause, but some catatonic cases can also arise from an unknown cause.

Diagnosing Catatonia

Diagnosing catatonia is based on clinical observations. Practitioners can use a scale to diagnose catatonia. One of the most commonly used scales is the Bush-Francis Catatonia Rating Scale. Other tools include the Rogers Catatonia Scale, the Northoff Catatonia Rating Scale, and the Braunig Catatonia Rating Scale.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a patient must present (either during an examination or observed) with three or more of the following symptoms to be diagnosed with catatonia. ﻿﻿﻿

Catatonia was separated from schizophrenia in the DSM-5. This allowed catatonia syndrome to be diagnosed as a specifier to a variety of major mental and medical disorders.﻿﻿﻿ This has made it easier for practitioners to diagnose the condition.

Catatonia Treatment

The treatment of catatonia generally falls under one of two categories: pharmaceutical or electroconvulsive therapy (ECT).

Benzodiazepines:In general, the first line of defense for treating catatonia are medications, with benzodiazepines being the top pick.﻿﻿ Lorazepam, which belongs to the benzodiazepines, is often administered in high doses sometimes ranging to over 20 milligrams per day. At this dosage, patients typically see a response relatively quickly.

Glutamate antagonists: While not used very often, glutamate antagonists, and more specifically, amantadine, has shown some success in treating catatonia.

Electroconvulsive therapy: In cases where a patient does not respond to benzodiazepines, a doctor may recommend electroconvulsive therapy (ECT).﻿﻿ During ECT, a medical professional will administer a brief electrical stimulation through the brain while the patient is under anesthesia. The purpose is to trigger a brief seizure with the goal of causing changes in brain chemistry. In patients demonstrating symptoms of malignant catatonia, ECT is often recommended as the first treatment option since this type of catatonia has a high rate of mortality if not treated immediately.﻿﻿

In many cases, mental health experts or doctors need to treat catatonia before they can accurately diagnose and address any underlying conditions.

Coping With Catatonia

Catatonia is a serious medical condition that requires prompt medical treatment. That said, if a caregiver or loved one is in need of support, information, or other services, reaching out to an expert can help them cope with the physical and emotional aspects of caring and living with someone with catatonia.

A Word From Verywell

If you suspect someone you know is experiencing catatonia, contact a doctor or call 911 right away. In some cases, catatonia can be serious and life-threatening. However, with a proper diagnosis and the right treatment plan, the prognosis is good.

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Catatonia is a psychomotor disorder that affects both speech and behavior functions. It can manifest as a state of stupor and unresponsiveness or as restlessness, agitation, and confusion. Catatonia was first identified as a discrete syndrome in 1874 by Karl Kahlbaum.﻿﻿﻿ The early description of the condition was focused on motor symptoms, and treatment was focused on supportive care rather than medical interventions.

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What is Intellectual Disability?

Intellectual Disability is a term used when a person has certain limitations in mental functioning and in skills such as communicating, taking care of him or herself, and social skills. These limitations will cause a child to learn and develop more slowly than a typical child. Children with Intellectual Disability may take longer to learn to speak, walk, and take care of their personal needs such as dressing or eating. They are likely to have trouble learning in school. They will learn, but it will take them longer. There may be some things they cannot learn.

What Causes Intellectual Disability?

Doctors have found many causes of Intellectual Disability. The most common are:

Genetic conditions. Sometimes mental retardation is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions are Down syndrome, fragile X syndrome, and phenylketonuria (PKU).

Problems during pregnancy. Intellectual Disability can result when the baby does not develop inside the mother properly. For example, there may be a problem with the way the baby's cells divide as it grows. A woman who drinks alcohol or gets an infection like rubella during pregnancy may also have a baby with an intellectual disability.

Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, he or she may have intellectual disability.

Health problems. Diseases like whooping cough, the measles, or meningitis can cause mental retardation. Intellectual Disability can also be caused by extreme malnutrition (not eating right), not getting enough medical care, or by being exposed to poisons like lead or mercury.

Intellectual Disability is not a disease. You can't catch Intellectual Disability from anyone. Intellectual Disability is also not a type of mental illness, like depression. There is no cure for mental retardation. However, most children with Intellectual Disability can learn to do many things. It just takes them more time and effort than other children.

How is Intellectual Disability Diagnosed?

Intellectual Disability is diagnosed by looking at two main things. These are:

the ability of a person's brain to learn, think, solve problems, and make sense of the world (called IQ or intellectual functioning); and

whether the person has the skills he or she needs to live independently (called adaptive behavior, or adaptive functioning).

Intellectual functioning, or IQ, is usually measured by a test called an IQ test. The average score is 100. People scoring below 70 to 75 are thought to have mental retardation. To measure adaptive behavior, professionals look at what a child can do in comparison to other children of his or her age. Certain skills are important to adaptive behavior. These are:

daily living skills, such as getting dressed, going to the bathroom, and feeding one's self;

communication skills, such as understanding what is said and being able to answer;

social skills with peers, family members, adults, and others.

To diagnose Intellectual Disability, professionals look at the person's mental abilities (IQ) and his or her adaptive skills. Both of these are highlighted in the definition of Intellectual Disability provided between the lines below. This definition comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide early intervention and special education and related services to children with disabilities.

Providing services to help individuals with Intellectual Disability has led to a new understanding of how we define Intellectual Disability. After the initial diagnosis of Intellectual Disability is made, we look at a person's strengths and weaknesses. We also look at how much support or help the person needs to get along at home, in school, and in the community. This approach gives a realistic picture of each individual. It also recognizes that the "picture" can change. As the person grows and learns, his or her ability to get along in the world grows as well.

IDEA's Definition of "Intellectual Disability"

Our nation's special education law, the IDEA, defines Intellectual Disability as . . .

". . . significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child's educational performance." [34 Code of Federal Regulations §300.7(c)(6)]

How Common is Intellectual Disability?

As many as 3 out of every 100 people in the country have Intellectual Disability (The Arc, 2001). Nearly 613,000 children ages 6 to 21 have some level of mental retardation and need special education in school (Twenty-fourth Annual Report to Congress, U.S. Department of Education, 2002). In fact, 1 out of every 10 children who need special education has some form of Intellectual Disability.

What Are the Signs of Intellectual Disability?

There are many signs of Intellectual Disability. For example, children with Intellectual Disability may:

sit up, crawl, or walk later than other children;

learn to talk later, or have trouble speaking,

find it hard to remember things,

not understand how to pay for things,

have trouble understanding social rules,

have trouble seeing the consequences of their actions,

have trouble solving problems, and/or

have trouble thinking logically.

About 87% of people with Intellectual Disability will only be a little slower than average in learning new information and skills. When they are children, their limitations may not be obvious. They may not even be diagnosed as having Intellectual Disability until they get to school. As they become adults, many people with Mild Intellectual Disability can live independently. Other people may not even consider them as having Intellectual Disability.

The remaining 13% of people with Intellectual Disability score below 50 on IQ tests. These people will have more difficulty in school, at home, and in the community. A person with more severe Intellectual Disability will need more intensive support his or her entire life. Every child with Intellectual Disability is able to learn, develop, and grow. With help, all children with Intellectual Disability can live a satisfying life.

What About School?

A child with Intellectual Disability can do well in school but is likely to need individualized help. Fortunately, states are responsible for meeting the educational needs of children with disabilities.

For children up to age three, services are provided through an early intervention system. Staff work with the child's family to develop what is known as an Individualized Family Services Plan, or IFSP. The IFSP will describe the child's unique needs. It also describes the services the child will receive to address those needs. The IFSP will emphasize the unique needs of the family, so that parents and other family members will know how to help their young child with mental retardation. Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income. In some states, early intervention services may be at no cost to parents.

For eligible school-aged children (including preschoolers), special education and related services are made available through the school system. School staff will work with the child's parents to develop an Individualized Education Program, or IEP. The IEP is similar to an IFSP. It describes the child's unique needs and the services that have been designed to meet those needs. Special education and related services are provided at no cost to parents.

Many children with Intellectual Disability need help with adaptive skills, which are skills needed to live, work, and play in the community. Teachers and parents can help a child work on these skills at both school and home. Some of these skills include:

communicating with others;

taking care of personal needs (dressing, bathing, going to the bathroom);

health and safety;

home living (helping to set the table, cleaning the house, or cooking dinner);

social skills (manners, knowing the rules of conversation, getting along in a group, playing a game);

reading, writing, and basic math; and

as they get older, skills that will help them in the workplace.

Supports or changes in the classroom (called adaptations) help most students with Intellectual Disability. Some common changes that help students with Intellectual Disability are listed below under "Tips for Teachers." The resources below also include ways to help children with Intellectual Disability.

Tips for Parents

Learn about Intellectual Disability. The more you know, the more you can help yourself and your child. See the list of resources and organizations at the end of this publication.

Encourage independence in your child. For example, help your child learn daily care skills, such as dressing, feeding him or herself, using the bathroom, and grooming.

Give your child chores. Keep her age, attention span, and abilities in mind. Break down jobs into smaller steps. For example, if your child's job is to set the table, first ask her to get the right number of napkins. Then have her put one at each family member's place at the table. Do the same with the utensils, going one at a time. Tell her what to do, step by step, until the job is done. Demonstrate how to do the job. Help her when she needs assistance. r Give your child frequent feedback. Praise your child when he or she does well. Build your child's abilities.

Find out what skills your child is learning at school. Find ways for your child to apply those skills at home. For example, if the teacher is going over a lesson about money, take your child to the supermarket with you. Help him count out the money to pay for your groceries. Help him count the change.

Find opportunities in your community for social activities, such as scouts, recreation center activities, sports, and so on. These will help your child build social skills as well as to have fun.

Talk to other parents whose children have Intellectual Disability. Parents can share practical advice and emotional support.

Meet with the school and develop an educational plan to address your child's needs. Keep in touch with your child's teachers. Offer support. Find out how you can support your child's school learning at home.

Tips for Teachers

Learn as much as you can about Intellectual Disability. The organizations listed at the end of this publication will help you identify specific techniques and strategies to support the student educationally. We've also listed some strategies below.

Recognize that you can make an enormous difference in this student's life! Find out what the student's strengths and interests are, and emphasize them. Create opportunities for success.

If you are not part of the student's Individualized Education Program (IEP) team, ask for a copy of his or her IEP. The student's educational goals will be listed there, as well as the services and classroom accommodations he or she is to receive. Talk to specialists in your school (e.g., special educators), as necessary. They can help you identify effective methods of teaching this student, ways to adapt the curriculum, and how to address the student's IEP goals in your classroom.

Be as concrete as possible. Demonstrate what you mean rather than just giving verbal directions. Rather than just relating new information verbally, show a picture. And rather than just showing a picture, provide the student with hands-on materials and experiences and the opportunity to try things out.

Break longer, new tasks into small steps. Demonstrate the steps. Have the student do the steps, one at a time. Provide assistance, as necessary.

Give the student immediate feedback.

Teach the student life skills such as daily living, social skills, and occupational awareness and exploration, as appropriate. Involve the student in group activities or clubs.

Work together with the student's parents and other school personnel to create and implement an educational plan tailored to meet the student's needs. Regularly share information about how the student is doing at school and at home.

American Association on Mental Retardation. (2002). Mental retardation: Definition, classification, and systems of supports (10th ed.). Washington, DC: Author. (See contact information below.)

Baker, B., & Brightman, A. (with Blacher, J., Heifetz, L., Hinshaw, S., & Murphy, D.). (2004). Steps to independence: Teaching everyday skills to children with special needs (4th ed.). Baltimore, MD: Paul H. Brookes. (Telephone: 800.638.3775. Web: www.brookespublishing.com)

Kaufman, S. (1999). Retarded isn't stupid, Mom! (Rev. ed.). Baltimore, MD: Paul H. Brookes. (See contact information above.)

Trainer, M (1991). Differences in common: Straight talk on mental retardation, Down syndrome, and life. Bethesda, MD: Woodbine House. (Telephone: 800.843.7323. Web: www.woodbinehouse.com)

The Arc of the United States
1010 Wayne Avenue, Suite 650
Silver Spring, MD 20910
301.565.3842
Info@thearc.org E-mail
www.thearc.org Web
www.TheArcPub.com Web (Publications)

American Association on Intellectual and Developmental Disability (AAIDD)
501 3rd Street, NW Suite 200
Washington, DC 20001
202.387.1968; 800.424.3688 (outside DC)
www.aaidd.org Web

Division on Developmental Disabilities
The Council for Exceptional Children
1110 North Glebe Road, Suite 300
Arlington, VA 22201-5704
888.232.7733; 703.620.3660
866.915.5000 TTY
cec@cec.sped.org E-mail
www.dddcec.org Web

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assistive technology and mental retardation

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National Association of Special Education Teachers: Comprehensive Overview of Intellectual Disability

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Child Mental Retardation Teaching – National Association of Special Education Teachers

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Many children with ADHD show signs of the disorder before they reach school age. But it's in school, when they are having trouble meeting expectations for kids in their grade, that most are referred for diagnosis.

ADHD is one of the first things that's suspected when a child's behavior in class, or performance on schoolwork, is problematic. A child who can't seem to sit still, who blurts out answers in class without raising his hand, who doesn't finish his homework, who seems to be daydreaming when the teacher gives instructions-these are well-known symptoms of ADHD.

But these are also behaviors that can be a result of other factors, from anxiety to trauma to just being younger than most of the kids in the class, and hence a little less mature.

That's why it's important for teachers and parents both to be aware of what ADHD looks like in the classroom, and how it might be confused with other things that could be influencing a child's behavior. Observing kids carefully is especially important when kids are too young to be able to articulate what they are feeling. And referring struggling kids for diagnosis and appropriate support can help them succeed in school and other parts of their lives, too.

There are three kinds of behavior involved in ADHD: inattention, hyperactivity and impulsivity. Of course all young children occasionally have trouble paying attention to teachers and parents, staying in their seats, and waiting their turn. Kids should only be diagnosed with ADHD if their behavior is much more extreme in these areas than other kids their age.

These symptoms of ADHD are divided into two groups-inattentive and hyperactive-impulsive. Some children exhibit mostly inattentive behaviors and others predominantly hyperactive-impulsive. But the majority of those with ADHD have a combination of both, which may make it very difficult for them to function in school.

Here are behaviors you might observe in school in those two categories.

Inattentive symptoms of ADHD

Makes careless mistakes in school work, overlooks details

Is easily distracted or sidetracked

Has difficulty following instructions

Doesn't seem to be listening when spoken to directly

Has trouble organizing tasks and possessions

Often fails to finish work in school or chores in the classroom

Often avoids or resists tasks that require sustained mental effort, including doing homework

Often loses homework assignments, books, jackets, backpacks, sports equipment

Hyperactive or impulsive symptoms of ADHD

Often fidgets or squirms

Has trouble staying in his seat

Runs and climbs where it's inappropriate

Has trouble playing quietly

Is extremely impatient, can't wait for his turn

Always seems to be "on the go" or "driven by a motor"

Talks excessively

Blurts out answers before a question is completed

Interrupts or intrudes on others conversations, activities, possessions

Serious impairment

It's important to keep in mind that not every high-energy or impulsive child has ADHD. Children are diagnosed with ADHD only if they demonstrate these symptoms so often that they are causing real difficulty in at least two settings-i.e. at school and at home. And the pattern that's causing them serious impairment must persist for at least 6 months.

It's also important, when considering a child's behavior, to compare it to other children the same age-not to the range of kids in his class or grade. Within any given grade, kids' ages can differ by almost a year, and a year can make a big difference in a child's ability to self-regulate.

Two studies in the last few years concluded that kids who are youngest in their class are disproportionately diagnosed with ADHD. A Michigan study found that kindergarteners who are the youngest in their grade are 60% more likely to be diagnosed with ADHD than the oldest in their grade. And it doesn't affect just kindergarteners: a North Carolina study found that in fifth and eighth grade, the youngest children were almost twice as likely as the oldest to be prescribed medication for ADHD.

When children exhibit behaviors that we associate with ADHD, it's important to keep in mind that they could be caused by other underlying factors. A child who is inattentive could be distracted by chronic anxiety, by a worrisome or painful situation at home, or because she's being bullied in the playground. These are all things a child might be embarrassed by and go to some lengths to keep secret.

Another thing children often hide is undiagnosed learning disorders. If a child is fidgeting when she's supposed to be reading, it may be that dyslexia is causing her great frustration. And if she bolts from her chair, it could be because she is ashamed that she doesn't seem to be able to do what the other kids can do, and intent on covering that fact up.

The stereotype of ADHD is boys disrupting the classroom by jumping up from their seats, getting in other kids' business, or blurting out answers without raising their hands. But girls get ADHD too, and they tend to be diagnosed much later because their symptoms are more subtle. More of them have the only inattentive symptoms of ADHD, and they get written off as dreamy or ditzy. If they have the hyperactive-impulsive symptoms they are more likely to be seen as pushy, hyper-talkative, or overemotional. Impulsive girls may have trouble being socially appropriate and struggle to make and keep friends.

But a big reason that many girls aren't diagnosed is that they knock themselves out to compensate for their weaknesses and hide their embarrassment about falling behind, losing things, feeling clueless. The growing awareness, as they get older, that they have to work much harder than their peers without ADHD to accomplish the same thing is very damaging to their self-esteem. Girls who are chronically hard on themselves about their lapses may be struggling with thoughts that they're stupid or broken.

Keeping a keen eye on kids' behavior in the classroom is important not just because it affects their learning-and potentially the ability of other kids in the class to learn-but also because it's a window into their social and emotional development. When kids are failing or struggling in school for an extended period of time, or acting out in frustration, without getting help, it can lead to a pattern of dysfunctional behavior that gets harder and harder to break.

That's why it's important for parents to get a good diagnosis from a mental health professional who takes the time to carefully consider the pattern of a child's behavior and what it might (and might not) indicate. Being not only caring but precise about defining and treating a child's problems when he is young pays off many times over in the long run.

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What's ADHD (and What's Not) in the Classroom - Child Mind Institute

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Learn what is ADHD in the classroom and what's not. Child Mind Institute explains that some of the symptoms of ADHD in children may be signs of other mental health problems.

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Centers for Disease Control and Prevention

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How to help children with ADHD with changes in schooling

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Centers for Disease Control and Prevention

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Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention. It is important to note that some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging.
Learn more about ASD
Social Communication and Interaction Skills

Social communication and interaction skills can be challenging for people with ASD.

Examples of social communication and social interaction characteristics related to ASD can include

Avoids or does not keep eye contact

Does not respond to name by 9 months of age

Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age

Does not play simple interactive games like pat-a-cake by 12 months of age

Uses few or no gestures by 12 months of age (for example, does not wave goodbye)

Does not share interests with others by 15 months of age (for example, shows you an object that they like)

Does not point to show you something interesting by 18 months of age

Does not notice when others are hurt or upset by 24 months of age

Does not notice other children and join them in play by 36 months of age

Does not pretend to be something else, like a teacher or superhero, during play by 48 months of age

Does not sing, dance, or act for you by 60 months of age

Restricted or Repetitive Behaviors or Interests

People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by problems with social communication and interaction only.

Examples of restricted or repetitive behaviors and interests related to ASD can include

Lines up toys or other objects and gets upset when order is changed

Repeats words or phrases over and over (called echolalia)

Plays with toys the same way every time

Is focused on parts of objects (for example, wheels)

Gets upset by minor changes

Has obsessive interests

Must follow certain routines

Flaps hands, rocks body, or spins self in circles

Has unusual reactions to the way things sound, smell, taste, look, or feel

Other Characteristics

Most people with ASD have other related characteristics. These might include

Delayed language skills

Delayed movement skills

Delayed cognitive or learning skills

Hyperactive, impulsive, and/or inattentive behavior

Epilepsy or seizure disorder

Unusual eating and sleeping habits

Gastrointestinal issues (for example, constipation)

Unusual mood or emotional reactions

Anxiety, stress, or excessive worry

Lack of fear or more fear than expected

It is important to note that children with ASD may not have all or any of the behaviors listed as examples here.
Learn more about screening and diagnosis of ASD Learn more about treating the symptoms of ASD

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Signs & Symptoms | Autism Spectrum Disorder (ASD) | NCBDDD | CDC

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Autism Spectrum Disorder (ASD) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. CDC is working to find out how many children have ASDs, discover the risk factors, and raise awareness of the signs.

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Specific Learning Disorders - Types & Signs

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Specific Learning Disorders - Types & Signs

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A specific learning disability is a disorder that interferes with a student's ability to listen, think, speak, write, spell, or do mathematical calculations. ¹ Students with a specific learning disability may struggle with reading, writing, or math. ²

The term "specific learning disability" is commonly used in federal and state law, the Diagnostic and Statistical Manual of Mental Disorders (DSM), and by many private and public schools. ³

63% Of people know someone who has a learning disability⁵

43% Of people wrongly think that learning disabilities are correlated with IQ⁵

10-15% Of school-aged children have a learning disability⁴

types of specific learning disabilities

"Specific learning disability" is an umbrella term that can describe many different types of learning issues. An educational evaluation may show that your child has a specific learning disability in a certain subject area.
For example:

A specific learning disability in reading, also known as dyslexia

A specific learning disability in writing, also known as dysgraphia

A specific learning disability in mathematics, also known as dyscalculia

signs of specific learning disabilities

Persistent difficulties in reading, writing, arithmetic, or mathematical reasoning⁵

Inaccurate or slow and effortful reading or writing⁵

Poor written expression that lacks clarity⁵

Difficulties remembering number facts⁵

Inaccurate mathematical reasoning⁵

What to Do if You Notice Signs of a Specific Learning Disability

What to Do if Your Child is Diagnosed with a Specific Learning Disability

Get to Know Your Child's Specific Diagnosis

The more you know about your child's specific learning disability, the more you can do to help. Develop a deep understanding of your child's diagnosis, as well as his or her strengths.

For more information on specific diagnoses, see Churchill's learning disability guides, including:

Common Specific Learning Disability Myths

Myth:Smart students don't have specific learning disabilities.

Specific learning disabilities and IQ are not connected, and many individuals who struggle with reading, writing, or math are bright and successful students.

Myth:All specific learning disability diagnoses are the same.

"Specific learning disability" is an umbrella term that can describe many different types of learning issues including dyslexia, dysgraphia, and dyscalculia. Different types of specific learning disabilities require different interventions.

Myth:Specific learning disabilities are rare.

According to the National Institutes of Health, approximately 10-15% of school-aged children have a learning disability. ⁴

Myth:If my child is struggling in school, he or she probably has a specific learning disability.

The only way to find out whether your child has a specific learning disability is by completing a full educational evaluation. You can request this testing through your public school, or through a private evaluator.

Myth:Specific learning disabilities are a result of a poor diet or too much TV.

Specific learning disabilities are brain-based disorders, and are not caused by external factors such as diet or activity.

Additional Resources on Specific Learning Disability

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References

1. IDEA - Building The Legacy of IDEA 2004. Retrieved from http://idea.ed.gov/explore/view/p/,root,statute,I,A,602,30

2. What's the Difference Between Learning Disabilities and Learning and Attention Issues? Understood. Retrieved from https://www.understood.org/en/learning-attention-issues/getting-started/what-you-need-to-know/difference-between-learning-disabilities-and-learning-and-attention-issues

3. Types of Learning Disabilities. Learning Disability Association of America. Retrieved from https://ldaamerica.org/types-of-learning-disabilities/

4. Lowell, S. C., Felton, R. H., & Hook, P. E. Basic Facts About Assessment of Dyslexia: Testing for Teaching

5. Cortiella, Candace and Horowitz, Sheldon H. The State of Learning Disabilities: Facts, Trends and Emerging Issues. New York: National Center for Learning Disabilities, 2014, from http://www.ncld.org/wp-content/uploads/2014/11/2014-State-of-LD.pdf

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What is a Specific Learning Disability? | Symptoms & Strategies

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A specific learning disability is a disorder that interferes with a student's ability to listen, think, speak, write, spell, or do mathematical calculations. 1 Students with a specific learning disability may struggle with reading, writing, or math.

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Communication & Motor Disorders in Learning

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Communication & Motor Disorders in Learning

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Learning, Motor Skills, and Communication Disorders

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Most learning problems encountered by children with ADHD are not due to learning disabilities. About 40% of children with ADHD experience such learning challenges as work production problems and organizing difficulties that are categorized as learning “problems,” not disabilities.

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What Are Signs of OCD in Children and Teens?

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All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can't stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again.

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Obsessive Compulsive Disorder Fact Sheet

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Obsessive Compulsive Disorder Fact Sheet

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What Teachers Should Know

Students with obsessive-compulsive disorder (OCD) have upsetting or scary thoughts or images (called obsessions) pop into their minds that are hard to shake. Common obsessions include contamination, safety, and need for symmetry. Unwanted and intrusive thoughts can be of an aggressive or sexual nature.

People with OCD feel strong urges to repeatedly do certain things - called rituals or compulsions - to banish the scary and intrusive thoughts; ward off things they dread; or make sure that things are safe, clean, or right in some way. Common compulsions include cleaning, checking, counting, repeating, arranging, touching, seeking reassurance.

Doctors consider obsessive thinking and rituals to be OCD when they do one or more of the following:

take up more than 1 hour each day

cause distress

interfere with daily activities

OCD in kids is usually diagnosed between age 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with peers, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone. Stressful events (such as starting school or a loved one's death, for example) can trigger or worsen OCD.

Students with OCD may:

miss class time to talk to a school counselor or other mental health specialist

need extra time to complete assignments because they reread and rewrite assignments

need to take medicine

have rituals and preoccupations that seem odd to other students, which may make them a target for bullies

benefit from special education services, such as individualized education programs (IEPs) or 504 education plans

What Teachers Can Do

Because OCD symptoms can interfere with learning, some students with the disorder require instructional accommodations, including extra time with assignments or learning breaks if they're feeling anxious.

Teachers need to understand that a student's ritualistic behaviors are part of the disorder. Talking with a school counselor and the student's parents or guardians to learn about the student can help. You might be asked to help the student redirect the behavior or ignore the behavior instead of correcting it or issuing a consequence.

OCD is treatable, but overcoming it isn't a quick or easy process. Students with OCD usually need to work with a therapist and take medicines to help manage their behaviors and the accompanying thoughts and feelings.

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Students with obsessive-compulsive disorder (OCD) have upsetting or scary thoughts or images (called obsessions) pop into their minds that are hard to shake. Common obsessions include contamination, safety, and need for symmetry. Unwanted and intrusive thoughts can be of an aggressive or sexual nature.

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave.
Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate. But they are really very busy focusing on their nagging urges or confusing, stressful, and sometimes terrifying OCD thoughts and images. They may also be focused on completing rituals, either overtly or covertly, to relieve their distress.

While frustrating to educators, OCD may be torture for the students who have it. This disorder may be difficult to identify because its observable symptoms are similar to other conditions and mental disorders, and mental rituals cannot be observed. Symptoms in children and adolescents can change over time, and they tend to wax and wane for no apparent reason. School personnel who have a good understanding of the variety of behaviors that may signal OCD are better equipped to initiate a plan to assist the student.

The Effect of OCD on Academic Performance

Even very bright and motivated students can struggle with OCD. Although students with OCD typically have average to above-average intelligence levels, they may be unable to learn the same way others do because their focus is frequently on their obsessions or compulsions. Depending on the severity of the symptoms, some students find it difficult to learn and, for some, it's almost impossible to concentrate on and complete schoolwork.

Although they want to pay attention, participate in discussions or presentations, study, and complete homework, they feel compelled to respond to their obsessions or urges.

Students who have untreated OCD re likely to have a very difficult time concentrating in the classroom and completing homework assignments. They may experience overwhelming anxiety or strong urges, possibly describing the feeling of mounting anxiety or intensifying urges as if they were a rising volcano or a tea kettle about to boil - and relief comes when the pressure is released. Unfortunately, the release is usually a compulsive behavior that may be disruptive to learning and possibly to the classroom.

It may not be long before the student who has OCD falls behind and sees a drop in grades. In some cases, academic performance deteriorates abruptly and dramatically. And it may be nearly impossible to catch up unless a student can learn to manage the symptoms. For these reasons, it's important that school personnel take OCD seriously and work with the student and the family to provide support.

What Does OCD Look Like at School?

A student may enter a classroom at the beginning of the school year with a diagnosis of OCD, or the disorder may develop later. Whenever a student begins to falter - academically, socially, or emotionally - educators need to intervene. A proactive approach can make an impressive difference in a student's coping ability, academic performance, and interpersonal capabilities.

The first step is being aware of the behaviors that can signal OCD. The disorder includes a wide variety of symptoms in children and adolescents, which are not always obvious. It is important to keep in mind that OCD symptoms can look like other disorders, so it is critical that a mental health specialist trained in OCD and related disorders conduct a diagnostic assessment OCD can be confused for symptoms of ADHD and anxiety disorders, as well as acting out" or misbehavior not associated with a neurobiological disorder. Also, OCD changes in nature or scope from one set of obsessions and compulsions to another, with differing behaviors, and symptoms can worsen and or seem to disappear, often for no obvious reason.

Common Symptoms of OCD at School

Below are common OCD symptoms of children and adolescents in school.

Obsession: Fears of germs or contamination
Compulsions
* Repeatedly washing hands, using antibacterial wipes or hand-sanitizer
* Protecting what is perceived as clean space -- personal desk, locker, or other property
* Avoiding touching surfaces that others may have touched, such as doorknobs, desks, shared supplies, lab tables or equipment, computer keyboards, paints, paste, soap, cafeteria trays, etc.
* Avoiding contact play or sports either because of a fear of catching a disease or fear of contaminating another student
* Avoiding the use of bathrooms
* Seeking reassurance that they or others are not sick or dirty
* Refusing to share items or supplies with others
* Refusing to eat in the cafeteria
* Avoiding certain products because they may contain poison, such as substances used in chemistry

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions (Note: People with OCD who have violent or aggressive thoughts do not have a history of violence or act upon these urges or ideas.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is safe
* Avoiding leaving a perceived safe zone (classroom); avoiding going into unsafe zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions ( Note: People with OCD who have violent or aggressive thoughts do not act upon these urges or ideas OR have a history of violence.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is "safe"
* Avoiding leaving a perceived "safe" zone (classroom); avoiding going into "unsafe" zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears, feelings, or urges related to numbers
Compulsions
* Counting, touching, or saying words a certain number of times due to believing in a magical significance to certain numbers or using those numbers to keep harm away; counting the number of steps between locations and having to start over if interrupted
* Touching objects a certain number of times; not being able to move on unless this touching has been accomplished
* Reading words or pages a certain number of times
* Going back and forth through doorways a certain number of times before it's OK to enter the room
* Avoiding using certain numbers that are perceived as unlucky or not safe; only using numbers that are perceived as safe or lucky. (math problems may be answered improperly, pages may not be read or pages may be numbered out of sequence )

Obsession: Fears, feelings, or urges related to discarding items because something bad will happen; feelings of incompleteness if something is discarded or the need document and preserve all life experiences; fears of contamination; need to buy items in multiples of a particular number; not discarding objects to avoid repetitive rituals such as washing or checking. (Note: This form of hoarding is related to the obsessions and compulsions of OCD and is distinct from hoarding disorder.)
Compulsions
* Saving scraps of paper, candy wrappers, bottle caps, broken items, or other useless items; inability to part with unneeded things
* Keeping books, toys, food, school papers, clothing, or other items for fear that they might be needed sometime in the future
* Buying every item in a store that one has touched (and therefore contaminated) to prevent others from being contaminated
* Accumulating items or objects in a particular area (desk drawer) because they are contaminated and cannot be touched
* Buying multiples of the same item (buying three of everything because it's a magic number)

Obsession: Scrupulosity, or the excessive fear of violating religious or moral rules
Compulsions
* Apologizing or confessing that something is wrong, such as breaking religious, classroom, or school rules
* Constantly seeking reassurance that a task has been completed right or perfectly; seeking affirmation that a mistake was not made
* Saying prayers a certain number of times; excessive praying to atone for being bad; repeatedly confessing perceived sins or bad behavior
* Repetitive praying, confessing to neutralize or undo bad thoughts, intrusive sexual thoughts, or visions of cursing or blaspheming in school or church
* Avoiding answering questions for fear of telling a lie

Obsession: Fears, feelings, or urges related to symmetry or order
Compulsions
* Constantly evening up books or other items on a shelf or desk; aligning edges to be even
* Rearranging items to be in a certain order, such as by color or alphabetical order
* Avoiding a room with square tiles because seeing the tiles would require tracing each of the edges visually
* Fears, feelings, or urges related to sexual content
* Seeking reassurance that one is not gay or lesbian, despite being heterosexual
* Excessive praying to atone for having inappropriate sexual thoughts or images
* Avoiding magazines, books, DVDs, websites, or other media for fear of seeing sexual content

Obsession: Excessive doubting or dread of uncertainty
Compulsions
* Constantly rechecking to see that everything is in a backpack or book bag
* Asking to leave the classroom to recheck a locker or its contents
* Avoiding a school locker to prevent checking the lock over and over again

Obsession: Fears, feelings, or urges related to having something just right or perfect
Compulsions
* Getting up and sitting down repeatedly at a desk, until feeling just right
* Repeatedly revising the way letters, words, or numbers are written to make them look just right; getting stuck rewriting the same letter or word
* Repeatedly filling in circles on answer sheets; getting stuck on one or two questions because too much time is spent carefully filling in the circles, erasing, refilling until it looks perfect
* Erasing and rewriting words over and over
* Extreme slowness with activities or school work until everything is just right
* Repeating various actions for no apparent reason
* Avoiding a hallway until walking in it until it feels just right

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave. Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate.

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Overview

Body dysmorphic disorder is a mental health condition in which you can't stop thinking about one or more perceived defects or flaws in your appearance - a flaw that appears minor or can't be seen by others. But you may feel so embarrassed, ashamed and anxious that you may avoid many social situations.

When you have body dysmorphic disorder, you intensely focus on your appearance and body image, repeatedly checking the mirror, grooming or seeking reassurance, sometimes for many hours each day. Your perceived flaw and the repetitive behaviors cause you significant distress and impact your ability to function in your daily life.

You may seek out numerous cosmetic procedures to try to "fix" your perceived flaw. Afterward, you may feel temporary satisfaction or a reduction in your distress, but often the anxiety returns and you may resume searching for other ways to fix your perceived flaw.

Treatment of body dysmorphic disorder may include cognitive behavioral therapy and medication.

Products & Services

Symptoms

Signs and symptoms of body dysmorphic disorder include:

Being extremely preoccupied with a perceived flaw in appearance that to others can't be seen or appears minor

Strong belief that you have a defect in your appearance that makes you ugly or deformed

Belief that others take special notice of your appearance in a negative way or mock you

Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control, such as frequently checking the mirror, grooming or skin picking

Attempting to hide perceived flaws with styling, makeup or clothes

Constantly comparing your appearance with others

Frequently seeking reassurance about your appearance from others

Having perfectionist tendencies

Seeking cosmetic procedures with little satisfaction

Avoiding social situations

Preoccupation with your appearance and excessive thoughts and repetitive behaviors can be unwanted, difficult to control and so time-consuming that they can cause major distress or problems in your social life, work, school or other areas of functioning.

You may excessively focus over one or more parts of your body. The bodily feature that you focus on may change over time. The most common features people tend to fixate about include:

Face, such as nose, complexion, wrinkles, acne and other blemishes

Hair, such as appearance, thinning and baldness

Skin and vein appearance

Breast size

Muscle size and tone

Genitalia

A preoccupation with your body build being too small or not muscular enough (muscle dysmorphia) occurs almost exclusively in males.

Insight about body dysmorphic disorder varies. You may recognize that your beliefs about your perceived flaws may be excessive or not be true, or think that they probably are true, or be absolutely convinced that they're true. The more convinced you are of your beliefs, the more distress and disruption you may experience in your life.

When to see a doctor

Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms, see your health care provider or a mental health professional.

Body dysmorphic disorder usually doesn't get better on its own. If left untreated, it may get worse over time, leading to anxiety, extensive medical bills, severe depression, and even suicidal thoughts and behavior.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with body dysmorphic disorder. If you think you may hurt yourself or attempt suicide, get help right away:

In the U.S, call 911 or your local emergency number immediately.

Call a suicide hotline number. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use its webchat at suicidepreventionlifeline.org/chat.

Call your mental health professional.

Seek help from your primary care provider.

Reach out to a close friend or loved one.

Contact a minister, spiritual leader or someone else in your faith community.

Causes

It's not known specifically what causes body dysmorphic disorder. Like many other mental health conditions, body dysmorphic disorder may result from a combination of issues, such as a family history of the disorder, negative evaluations or experiences about your body or self-image, and abnormal brain function or abnormal levels of the brain chemical called serotonin.

Risk factors

Body dysmorphic disorder typically starts in the early teenage years and it affects both males and females.

Certain factors seem to increase the risk of developing or triggering body dysmorphic disorder, including:

Having blood relatives with body dysmorphic disorder or obsessive-compulsive disorder

Negative life experiences, such as childhood teasing, neglect or abuse

Certain personality traits, such as perfectionism

Societal pressure or expectations of beauty

Having another mental health condition, such as anxiety or depression

Complications

Complications that may be caused by or associated with body dysmorphic disorder include, for example:

Low self-esteem

Social isolation

Major depression or other mood disorders

Suicidal thoughts or behavior

Anxiety disorders, including social anxiety disorder (social phobia)

Obsessive-compulsive disorder

Eating disorders

Substance misuse

Health problems from behaviors such as skin picking

Physical pain or risk of disfigurement due to repeated surgical interventions

Prevention

There's no known way to prevent body dysmorphic disorder. However, because body dysmorphic disorder often starts in the early teenage years, identifying the disorder early and starting treatment may be of some benefit.

Long-term maintenance treatment also may help prevent a relapse of body dysmorphic disorder symptoms.

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Body dysmorphic disorder - Symptoms and causes

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Body dysmorphic disorder is a mental health condition in which you can't stop thinking about one or more perceived defects or flaws in your appearance - a flaw that appears minor or can't be seen by others. But you may feel so embarrassed, ashamed and anxious that you may avoid many social situations.

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Learn more about the characteristics of Hoarding, discover potential treatments, and access other useful resources on Hoarding here.

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Ruth Golomb, MEd, LCPC
Senior Clinician, Behavior Therapy Center of Greater Washington
TLC Foundation for Body-Focused Repetitive Behaviors Scientific Advisory Board Member

What can teachers, guidance counselors, or administrators do when they notice a child pulling out hair or picking at their skin? Here are some do's and don'ts for faculty and staff who become aware of this behavior and wish to assist.

Do:

Educate yourself with solid information from a reputable source

Notify the family

Determine if/how to include the child in problem solving

Contact the teacher(s)

Decide whether or not the members of the class need to be informed

Immediately handle teasing and/or bullying

Don't:

Make assumptions about what motivates a child to engage in hair pulling

Insist on the use of interventions that you think will work without consulting the child

Eliminate challenging classes

Instruct a family to medicate their child before exploring other options

Let's talk about these do's and dont's in more detail.

Do:

Educate yourself with solid information from a reputable source
There is no shortage of websites that claim to have "The Answer" to these problems. Many websites charge money in order to obtain the elusive solution. Good, solid information is no secret. There have been quite a few smart, qualified professionals studying trichotillomania and skin picking (part of a larger family of behaviors called Body-Focused Repetitive Behaviors,or BFRBs) for years. There are still many questions yet to be answered, but research is out there that sheds some light on these misunderstood disorders. If a website claims "research shows" but does not specify what research and by whom, then the site likely contains information that is assumed (but not necessarily accurate), wishful thinking, or simply unfounded.

Notify the family
The next step is to have a conversation with the parents. Be clear, concise, and descriptive of the behavior when speaking with parents. Report only the behavior that has been observed, not assumptions or perceived motives for the behavior. Inquire about the child's pulling /picking behavior in the home. Is this the first time the family is aware of this behavior, or has the child experienced this in the past? Is the child receiving therapy for BFRBs currently? If so, how can the school assist the child? If a treatment provider is not easily available, or if the family chooses not to pursue therapy, there are books and web-based programs that might be useful in such circumstances.

Ask the family if they would be interested in having the child use some strategies in school to contend with this behavior. If so, do they have any suggestions of techniques that work for the child at home? Might some of those same tactics work in the school setting?

Determine if/how to include the child in problem solving
Some children are willing to use interventions in school, but hope to maintain some privacy and therefore are not interested in discussing the behavior or engaging in problem solving with the adults in the school. Other children are delighted to talk with the teacher, guidance counselor or other member of the school staff.

It is important to be sensitive to the child's wishes. If the child is not willing to speak with school personnel, would the child be comfortable with a parent speaking to the school on behalf of the child? Parents can sometimes arrange special accommodations for the child that can be used in the classroom to address these behaviors. (See "504 Plans and IEPs: How Can They Help My Child?" located in the Fall 2009 issue of In Touch and on your member CD, The Comprehensive Information Guide).

If the child is interested in working with his/her teacher, details of the process should be thought out ahead of time. How will the intervention be used? Will the teacher be involved in any way? What can the teacher do to support the student? (Ideas for alternative behaviors to be used in the classroom can be discussed with a therapist, found in books regarding hair pulling, or searched on the computer.)

Contact the teacher(s)
Once strategies have been discussed and decided upon, it is now time to ensure that there is appropriate communication between teachers, counselors or other school personnel. Explain the information you have gathered regarding BFRBs, inform the teacher or other school personnel who might be involved in the use of the interventions about the discussion with the parents, and introduce the idea of the child using some specific alternative behaviors designed to address BFRB behaviors in the classroom.

Teachers work tirelessly caring for, educating, encouraging, cajoling and pushing our children to reach their potential. If you are a counselor or the person with primary contact with the family, convey the information about the techniques to be used in the classroom clearly. Explicitly state what you are asking the teachers to do with each tactic that will be used by the child. Very often, the teachers are asked to be aware that these strategies will be used in the classroom and nothing further. Other times, the teachers could be asked to keep a supply of finger bandages in a desk drawer, devise a secret signal that alerts the student that his/her hand is drifting toward a pulling/picking site, or allow the child to take breaks when necessary.

The teachers should have ample opportunity to consider whether or not the suggestions being discussed will work in their particular classrooms. If not, consider alternatives. Teacher and student may need to negotiate in order to come to an agreement regarding specific intervention use that would be manageable for each of them in the classroom.

Do the other members of the class need to be informed?
Sometimes, other classmates might need to be informed that a fellow student will be using some unique items to help with a particular behavior. When informing the class, it will be important to present information in a way that engenders sensitivity to the plight of the child and includes information for the students about what they can do to support their classmate. It also should be made clear that there will be zero tolerance for teasing, bullying, or mean comments.

Is there any teasing or bullying?
What if teasing or bullying does occur? It is crucial that these behaviors are dealt with immediately and effectively. Sometimes children who tease or bully are utterly and completely misinformed, if they have any knowledge at all about the problem, and would benefit from some very direct information regarding the disorder itself, the effect that teasing has on an individual and the specific consequences to an individual who continues exhibiting hurtful behavior. If teasing or bullying persists, the child should experience punishments that are consistent with the rules or laws of the county, community or township regarding bullying.

Now that we have considered some procedures that could be effective for school personnel to pursue when a child is struggling with hair pulling in the classroom, let's take a look at some actions that might not be as useful.

Don't:

Assume motivations, feelings, or thoughts that the child "must" be having due to the fact that the student is pulling out hair or picking skin
There is a tremendous amount of misinformation and assumptions made about hair pulling and skin picking disorders. These are complex behaviors that are multi-faceted, and each child who struggles with it has his/her own unique experience. Some children find that feelings of sadness are a major contributing factor to their hair pulling, while others do not, for example. For a teacher or guidance counselor to automatically assume that the child is depressed, or having problems at home because he/she is engaged in pulling/picking behaviors is an example of being misguided and misinformed. Other common erroneous hypotheses about pulling and picking include stating that the behavior is a form of self-mutilation, a sign that the child has been a victim of abuse, or an indication that the child is losing touch with reality. Do not make assumptions. Educate yourself before sharing information with others.

Insist that a specific intervention be used
A teacher or guidance counselor could think that a certain suggestion is the "perfect" solution to the hair pulling problem. Ideas such as these generally do not work well when forced on a child. Most children find unsolicited advice to be unwelcome. Many adolescents experience a great deal of embarrassment as a result of their unwanted behavior. Having an alternative behavior thrust upon them can be mortifying. Even if younger children do not experience the same degree of discomfort, being forced to use a technique that does not feel right can lead to frustration and fail to provide effective aid for the behavior.

Children respond differently to each intervention. Two children might pull their hair out; one could respond extremely well to a silent signal from a teacher, while another finds that having a textured item in hand works well. Strategies work best when the child has been able to contribute thoughts, discuss how to use them, and understands the specific role of the teacher in the classroom during this process. Children also need the opportunity to "nix" ideas that they feel might not work for them at this time. The recommendation is always to discuss any and all considerations with the family and/or the child about how to better handle the BFRB behavior in the classroom.

Reduce the child's academically challenging classes
A guidance counselor or teacher may think that a child's BFRB behavior is due to stress as a result of academically advanced classes. In an attempt to try to solve this problem, the child is moved to a less challenging class. Unfortunately the usual result of a move such as this is that a bright child is now bored in a class that is less stimulating, continues to pull or pick and may develop feelings of low self-esteem.

If the child is placed correctly in a rigorous academic class, leave the schedule as is. Some very bright, academically gifted children engage in BFRBs. It is crucial to advocate for the child academically while at the same time providing encouragement and aid to manage the hair pulling or skin picking.

Suggest that the family pursue medication
There are certainly times when it is appropriate to suggest to a family that they consult with a professional to learn about medication options for a child who is exhibiting behaviors that interfere with learning. However, BFRBs are not those types of behaviors. Currently there is no medication recommended by the Food and Drug Administration to treat hair pulling or skin picking, or any BFRB for that matter.

Therefore, using medication is not the first recommendation to make when exploring treatment options outside of the school setting. Remember, cognitive behavior therapy is currently the recommended treatment for these behaviors.

(To learn more about this, see "Expert Consensus Treatment Guidelines for Trichotillomania, Skin Picking and Other Body-Focused Repetitive Behaviors").

School personnel now have an opportunity to offer assistance in an organized, effective manner designed to provide accurate information to the faculty and family. Families of children with BFRBs can have allies in the school who are knowledgeable about these behaviors and are willing to provide effective assistance to the student. The school, child and family members can work together in order to design a plan using specific strategies to effectively address these behaviors. Be aware of the "Do's and Don'ts" when working in a school setting in order to create a safe, supportive environment for children so that they may employ the tools necessary for them to successfully address the challenges inherent in struggling with BFRBs.

Ruth Goldfinger Golomb, MEd, LCPC, is a senior clinician, supervisor, and co-director of the doctoral training program at the Behavior Therapy Center of Greater Washington. She has conducted numerous seminars, and participated as an expert in panel discussions covering many topics, including Tourette Syndrome, Obsessive Compulsive Disorder, Trichotillomania, and managing anxiety disorders in the classroom. In addition to publishing articles for professional journals and newsletters, Ms. Golomb is an author of The Hair Pulling 'Habit' and You: How to Solve the Trichotillomania Puzzle, a book describing the comprehensive treatment of trichotillomania in children, and The Parent Guide to Hair Pulling, a book aimed at helping parents of children with trichotillomania. Ms. Golomb is a member of The TLC Foundation for Body-Focused Repetitive Behaviors Scientific Advisory Board.

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Ruth Golomb, MEd, LCPC Senior Clinician, Behavior Therapy Center of Greater Washington TLC Foundation for Body-Focused Repetitive Behaviors Scientific Advisory Board Member What can teachers, guidance counselors, or administrators do when they notice a child pulling out hair or picking at their skin?

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Substance/medication-induced obsessive compulsive disorder is the diagnostic name for drug-induced OCD. Obsessive-compulsive behavior is a group of seemingly uncontrollable and repetitive behaviors that are driven by obsessions. Obsessions are unwanted thoughts, urges or images that intrude on an individual's consciousness. They are associated with compulsive behaviors which are actions that the person feels compelled to carry out often in response to, and in an effort to control an obsession. These behaviors can be body-focused, for example, picking at one's own skin, or pulling out one's own hairs. Obsessions and compulsions can occur on their own or in combination and can be part of several different obsessive compulsive disorders, of which substance-induced OCD is just one.

Unlike the transient feelings and intrusive thoughts that everyone experiences from time to time, especially during times of stress, or the occasional habitual behaviors we also all engage in from time to time, substance-induced obsessive compulsive disorder is considerably worse and more difficult for the individual to control. Although substance-induced OCD is rare, the consequences can be severe.

The compulsions rarely have any realistic connection to the obsessions they are designed to neutralize or prevent. Rather, they form a ritualistic behavior that is designed to reduce anxiety but ultimately worsen the overall condition.﻿﻿ And while some people with obsessive compulsive disorders are aware that the beliefs that are part of their obsessions are probably not true, some are less certain, and others are convinced that they actually are true, to the point where their beliefs are delusions.

When physicians or psychologists give a diagnosis of substance/medication-induced obsessive compulsive disorder, they check to make sure that the obsessions or compulsions were not there before the use of the drug thought to be responsible. This is because there are different types of obsessive compulsive disorders, and if the symptoms were there before the substance use, it probably isn't the substance/medication-induced type of OCD.

How Soon After Taking the Drug Can OCD Be Induced?

In some cases, almost immediately. There is even a category "with onset during intoxication," which means that the obsessive compulsive episode actually begins when the individual is high on the drug.﻿﻿ It can also occur during withdrawal, during which severe mental problems are common.﻿﻿ It is important that the person receives ongoing assessment as they move through the detox process, to ensure they are properly diagnosed and treated if symptoms persist.

Generally, the diagnosis isn't given if the person has a history of obsessive compulsive disorder without substance use, or if the symptoms continue for more than a month after the person becomes abstinent from the drug.

Obsessive compulsive behaviors can sometimes be part of delirium, which can also be substance-induced.﻿﻿ If this is the only time that the symptoms are experienced, then the diagnosis of Substance/Medication-Induced Obsessive Compulsive Disorder is not usually given.

Finally, for the diagnosis of Substance/Medication-Induced Obsessive Compulsive Disorder to be given, there has to be some sort of significant impact that the obsessive compulsive behavior is having on the person's life, either by causing a great deal of distress, or by impairing some aspect of their life, such as their social life, their employment situation, or another part of their life that is important to them.﻿﻿

Drugs That Can Cause the Condition

Unlike many other substance- or medication-induced disorders, the number of substances that are recognized as causing obsessive compulsive is quite limited. They include:﻿﻿

Amphetamine-induced obsessive compulsive disorder

Other stimulant-induced obsessive compulsive disorder

Cocaine-induced obsessive compulsive disorder

Other substance-induced obsessive compulsive disorder

Unknown substance-induced obsessive compulsive disorder

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When Drug Use Causes Obsessive Compulsive Disorder

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Substance/medication-induced obsessive compulsive disorder is the diagnostic name for drug-induced OCD. Obsessive-compulsive behavior is a group of seemingly uncontrollable and repetitive behaviors that are driven by obsessions. Obsessions are unwanted thoughts, urges or images that intrude on an individual's consciousness.

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What Causes Disruptive Behavior Disorders?

The causes of disruptive behavior disorders are unknown. But the disorders are thought to spring from different factors working together:

Heredity. Children with disruptive behavior disorders often have parents with mental health disorders, including

Substance abuse.

Attention-deficit/hyperactivity disorder.

A mood disorder.

Schizophrenia.

Antisocial personality disorder.

However, affected children have also been known to come from healthy families that function well.

Environment. There is an increased risk for disruptive behavior disorders among children who were:

Rejected by their mothers as infants.

Separated from their parents.

Recipients of poor foster care.

Physically, emotionally, or sexually abused or neglected.

In addition, children who have lived in poverty, or witnessed domestic violence or substance abuse, are at a greater risk for developing the disorders.

Physical. There is a greater risk for developing disruptive behavior disorders among children who:

Had low birth weight.

Have suffered neurological damage.

Psychological. Children who have suffered from attention-deficit hyperactivity disorder are at a higher risk for developing disruptive behavior disorders.

Approximately one-third to one-half of all children with ADHD may have coexisting oppositional defiant disorder. Conduct disorder may occur in 25 percent of children and 45 percent of adolescents with ADHD.

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The causes of disruptive behavior disorders are unknown. But the disorders are thought to spring from different factors working together: Heredity. Children with disruptive behavior disorders often have parents with mental health disorders, including Substance abuse. Attention-deficit/hyperactivity disorder. A mood disorder. Schizophrenia. Antisocial personality disorder.

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By Gail Belsky

Quick tips for managing impulsivity

How many times have you seen kids act without thinking? Probably a lot. Most kids have moments when they're impulsive and say or do things before they can stop themselves. They might blurt out something inappropriate or run into the street after a ball without looking.

When it happens once in a while, it can look like everyday kid behavior. When it happens a lot, though, a child may be having trouble with self-control.

Sometimes, it's a matter of maturity. Not all kids develop at the same rate, and some just take longer than others to gain the ability to stop and think before acting.

But some kids really are unable to put on the "mental brakes." They may often interrupt people, grab things, and take physical risks. For those kids, there may be something else causing the impulsivity.

Impulsive behavior often makes kids seem younger than they are. An 8-year-old might have the self-control more expected from a 5-year-old, for example. You might see behaviors that you thought would have ended long ago.

Struggling with impulsivity or any other behavior challenge can impact how kids feel about themselves. When kids have more control over their actions, they feel more "mature" and have more positive self-esteem.

Dive deeper

Examples of impulsive behavior in kids

When ADHD is the cause of impulsivity

Other causes of impulsivity

Tell us what interests you

About the author

About the author

Gail Belsky is executive editor at Understood. She has written and edited for major media outlets, specializing in parenting, health, and career content.

Reviewed by

Reviewed by

Bob Cunningham, EdM serves as executive director of learning development at Understood.

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Quick tips for managing impulsivity How many times have you seen kids act without thinking? Probably a lot. Most kids have moments when they're impulsive and say or do things before they can stop themselves. They might blurt out something inappropriate or run into the street after a ball without looking.

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Quick Guide to Conduct Disorder - Child Mind Institute

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Download our free guide to conduct disorder. Children who have conduct disorder are unkind and often violent, and they don’t care about other people’s feelings. Conduct disorder can also involve crimes like theft and vandalism.

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Quick Guide to Oppositional Defiant Disorder - Child Mind Institute

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Download our free guide to oppositional defiant disorder. Oppositional defiant disorder (ODD) is a children’s mental health disorder that involves defying parents, breaking rules, and other serious behavior problems.

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It's normal for children to exhibit positive and negative social behaviors as they age and develop. Some kids lie, some rebel, some withdraw. Think the smart but introverted track star or the popular but rebellious class president.

But some children exhibit high levels of antisocial behaviors. They are hostile and disobedient. They may steal and destroy property. They might be verbally and physically abusive.

This type of conduct often means your child is showing signs of antisocial behavior. Antisocial behavior is manageable, but can lead to more severe problems in adulthood if left untreated. If you're worried that your child has antisocial tendencies, read on to learn more.

Antisocial behavior is characterized by:

aggression

hostility toward authority

deceitfulness

defiance

These conduct problems usually show up in early childhood and during adolescence, and are more prevalent in young boys.

There is no current data that reveals the number of children who are antisocial, but previous research places the number between 4 and 6 million, and growing.

Risk factors for antisocial behavior include:

school and neighborhood environment

genetics and family history

poor and negative parenting practices

violent, unstable, or tumultuous home life

Hyperactivity and neurological problems can also cause antisocial behavior. Youth with attention deficit hyperactivity disorder (ADHD) have been found to be at a higher risk of developing antisocial behavior.

Antisocial behavior can occasionally be identified in kids as young as 3 or 4 years old, and can lead to something more severe if not treated before age 9, or third grade.

The symptoms your child might exhibit include:

abusive and harmful to animals and people

lying and stealing

rebellion and violating rules

vandalism and other property destruction

chronic delinquency

Research shows that childhood antisocial behavior is associated with a higher rate of alcohol and drug abuse in adolescence. This is because of shared genetic and environmental influences.

Severe forms of antisocial behavior can lead to conduct disorder, or an oppositional defiant disorder diagnosis. Antisocial children may also drop out of school and have trouble maintaining a job and healthy relationships.

The behavior could also lead to antisocial personality disorder in adulthood. Adults living with antisocial personality disorder often display antisocial behavior and other conduct disorder symptoms before age 15.

Some signs of antisocial personality disorder include:

lack of conscience and empathy

disregard and abuse of authority and people's rights

aggression and violent tendencies

arrogance

using charm to manipulate

lack of remorse

Early intervention is key to preventing antisocial behavior. The Center for Effective Collaboration and Practice suggests that schools develop and implement three different prevention strategies.

1. Primary prevention

This would include engaging students in school-wide activities that could deter antisocial behavior, such as:

teaching conflict resolution

anger management skills

emotional literacy

2. Secondary prevention

This targets students who are at risk for developing antisocial tendencies and engaging them in individualized activities, including:

specialized tutoring

small group social skills lessons

counseling

mentoring

3. Tertiary prevention (treatment)

The third step is continuing intensive counseling. This treats antisocial students and students with chronic patterns of delinquency and aggression. The center suggests that families, counselors, teachers, and others coordinate efforts to treat children with antisocial behavior.

Other ways to treat antisocial behavior include:

problem solving skills training

cognitive behavioral therapy

behavioral family intervention

family therapy and adolescent therapy

Parents can also undergo parent management training to address any negative parenting issues that may contribute to the child's antisocial behaviors.

Research has found that warmth and affection, reasonable discipline, and an authoritative parenting style have positive outcomes for children. This can help them create positive relationships and improve school performance.

It is normal for children and teenagers to exhibit some antisocial tendencies, like being withdrawn or mildly rebellious. But for some kids, those tendencies can signal something more alarming.

Speak with your child if you're worried about their behavior so you can have a better sense of what's happening from their perspective. Make sure to also speak with a doctor so you can come up with an effective plan to treat your child's antisocial behavior.

It's important you address conduct problems as early in childhood as possible to prevent a more severe diagnosis in the future.

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It's normal for children to exhibit positive and negative social behaviors as they age and develop. Some kids lie, some rebel, some withdraw. Think the smart but introverted track star or the popular but rebellious class president. But some children exhibit high levels of antisocial behaviors. They are hostile and disobedient.

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What is intermittent explosive disorder (IED)?

Intermittent explosive disorder (IED) is a mental health disorder in which kids have short periods of intense, unexpected anger and violent behavior. These feelings seem to come out of nowhere. They feel they have no control over their anger. IED usually shows up in late childhood or the early teen years.

Kids with IED often have less serious tantrums, outbursts or fights. Sometimes, they also have more serious rages where they physically harm people, animals or things. IED causes problems with kids' family lives, school performance and friendships.

What are the symptoms of intermittent explosive disorder?

Signs that a child or teenager might have IED include:

Frequent outbursts such as tantrums, fights or arguments

Feeling unable to control their sudden bursts of anger

Sometimes having bigger, more severe bursts of anger and even violence. During these episodes, kids harm people, animals or objects

Aggressive outbursts in frustrating situations

Explosive bursts of anger that last less than 30 minutes and aren't directed at any one thing

Road rage, breaking furniture and getting into physical fights are all common behaviors in kids with IED.

How is intermittent explosive disorder diagnosed?

In order for a doctor to give a diagnosis of IED, they first have to rule out other possible causes for the child's behavior. These other causes could include:

Other mental health disorders

Alcohol or drug abuse

Physical causes like a head injury

If none of these is the cause, a doctor will give a diagnosis of IED if child:

Can't control their anger

Sometimes has outbursts of rage and violence that are destructive and out of proportion to the situation

Often has tantrums or gets into fights

How is intermittent explosive disorder treated?

Treatment for IED usually involves both therapy and medication.

Cognitive behavioral therapy (CBT) is used to help kids with IED learn which situations cause their episodes of rage. In CBT, they learn to recognize and manage their anger in a healthier way that makes them feel better and keeps everyone safe. A therapist will work with the child, their family and sometimes teachers to help the child avoid angry outbursts.

There are no medications specifically for IED, but a number of medications are used to help kids with IED. Medications sometimes used for IED include antidepressants, anti-anxiety medications and mood regulators.

Risk factors for other disorders

Anxiety, depression and substance abuse are more common in people diagnosed with IED. Kids with IED are also at a higher risk of harming themselves and attempting suicide. If you think your child or teenager is suicidal, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 or 911 if there is an emergency. Don't wait - the risk of suicide in children and teenagers is very real.

We have over 60 guides and 700 articles available to help you (in Spanish too!).
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Quick Guide to Intermittent Explosive Disorder - Child Mind Institute

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Download our free guide to intermittent explosive disorder in children and teens. Kids with intermittent explosive disorder (IED) have short periods of intense, unexpected anger and violent behavior that seem to come out of nowhere. They feel they have no control over their anger. IED usually shows up in late childhood or the early teen years.

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Kleptomania: What It Is, Causes, Symptoms & Treatment

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Kleptomania is an impulse control disorder where a person feels an uncontrollable urge to steal. This condition is often treatable with medication, therapy or both.

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When an interest or fascination with fire deviates from healthy to unhealthy, people may instantly say it's "pyromania."

But there's a lot of misperceptions and misunderstandings surrounding pyromania. One of the biggest is that an arsonist or anyone who sets a fire is considered a "pyromaniac." Research doesn't support this.

Pyromania is often used interchangeably with the terms arson or fire-starting, but these are different.

Pyromania is a psychiatric condition. Arson is a criminal act. Fire-starting is a behavior that may or may not be connected to a condition.

Pyromania is very rare and incredibly under-researched, so its actual occurrence is hard to determine. Some research states that only between 3 and 6 percent of people in inpatient psychiatric hospitals meet the diagnostic criteria.

Pyromania is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an impulse control disorder. Impulse control disorders are when a person is unable to resist a destructive urge or impulse.

Other types of impulse control disorders include pathological gambling and kleptomania.

To receive a pyromania diagnosis, the DSM-5 criteria states that someone must:

purposefully set fires on more than one occasion

experience tension before setting fires and a release after

have an intense attraction to fire and its paraphernalia

derive pleasure from setting or seeing fires

have symptoms that aren't better explained by another mental disorder, such as:

A person with pyromania can only receive a diagnosis if they don't set fires:

for a type of gain, like money

for ideological reasons

to express anger or vengeance

to cover up another criminal act

to improve one's circumstances (for instance, getting insurance money to buy a better house)

in response to delusions or hallucinations

due to impaired judgement, such as being intoxicated

The DSM-5 has very strict criteria on pyromania. It's rarely diagnosed.

Pyromania vs. arson

While pyromania is a psychiatric condition dealing with impulse control, arson is a criminal act. It's usually done maliciously and with criminal intent.

Pyromania and arson are both intentional, but pyromania is strictly pathological or compulsive. Arson may not be.

Although an arsonist can have pyromania, most arsonists don't have it. They may, however, have other diagnosable mental health conditions or be socially isolated.

At the same time, a person with pyromania may not commit an act of arson. Although they may frequently start fires, they can do it in a way that isn't criminal.

Someone who has pyromania starts fires at a frequency around every 6 weeks.

Symptoms may start during puberty and last until or through adulthood.

Other symptoms include:

an uncontrollable urge to set fires

fascination and attraction to fires and its paraphernalia

pleasure, a rush, or relief when setting or seeing fires

tension or excitement around fire-starting

Some research says that while a person with pyromania will get an emotional release after setting a fire, they may also experience guilt or distress afterward, especially if they were fighting the impulse as long as they could.

Someone may also be an avid watcher of fires who goes out of their way to seek them out - even to the point of becoming a firefighter.

Remember that fire-setting itself doesn't immediately indicate pyromania. It can be associated with other mental health conditions, such as:

The exact cause of pyromania isn't yet known. Similar to other mental health conditions, it may be related to certain imbalances of brain chemicals, stressors, or genetics.

Starting fires in general, without a diagnosis of pyromania, can have numerous causes. Some of these include:

having a diagnosis of another mental health condition, such as a conduct disorder

a history of abuse or neglect

misuse of alcohol or drugs

deficits in social skills or intelligence

Pyromania and genetics

While research is limited, impulsivity is considered somewhat heritable. This means there may be a genetic component.

This isn't only limited to pyromania. Many mental disorders are considered moderately heritable.

The genetic component may also come from our impulse control. The neurotransmitters dopamine and serotonin, which assist in regulating impulse control, may be influenced by our genes.

Pyromania isn't often diagnosed until around age 18, though pyromania symptoms may start showing up around puberty. At least one report suggests pyromania onset could occur as early as age 3.

But fire-starting as a behavior can also occur in children for a number of reasons, none of which include having pyromania.

Often, many children or adolescents experiment or are curious about lighting fires or playing with matches. This is considered normal development. Sometimes it's called "curiosity fire-setting."

If setting fires becomes an issue, or they have the intent to cause serious damage, it's often investigated as a symptom of another condition, such as ADHD or a conduct disorder, rather than pyromania.

There isn't enough research to indicate risk factors for someone developing pyromania.

What little research we have indicates that people who have pyromania are:

predominantly male

around age 18 at diagnosis

more likely to have learning disabilities or lack social skills

Pyromania is rarely diagnosed, in part because of the strict diagnostic criteria and lack of research. It's also often hard to diagnose because someone would need to actively seek help, and many people don't.

Sometimes pyromania is only diagnosed after a person goes in for treatment for a different condition, such as a mood disorder like depression.

During treatment for the other condition, a mental health professional may seek out information about personal history or symptoms the person worries about, and fire-starting may come up. From there, they can further evaluate to see whether the person fits the diagnostic criteria for pyromania.

If someone is charged with arson, they may also be evaluated for pyromania, depending on their reasons behind starting the fire.

Pyromania can be chronic if left untreated, so it's important to seek help. This condition can go into remission, and a combination of therapies can manage it.

There's no single treatment doctors prescribe for pyromania. Treatment will vary. It may take time to find the best one or combination for you. Options include:

Cognitive behavioral therapy has shown promise for helping work through a person's impulses and triggers. A doctor can also help you come up with coping techniques to deal with the impulse.

If a child receives a pyromania or fire-setting diagnosis, joint therapy or parental training may also be needed.

Pyromania is a rarely diagnosed psychiatric condition. It differs from fire-starting or arson.

While research has been limited due to its rarity, the DSM-5 does recognize it as an impulse control disorder with specific diagnostic criteria.

If you believe you or someone you know is experiencing pyromania, or are worried about an unhealthy fascination with fire, seek help. There's nothing to be ashamed of, and remission is possible.

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Pyromania Disorder Symptoms, Causes, Diagnosis, and Treatment

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When an interest or fascination with fire deviates from healthy to unhealthy, people may instantly say it's "pyromania." But there's a lot of misperceptions and misunderstandings surrounding pyromania. One of the biggest is that an arsonist or anyone who sets a fire is considered a "pyromaniac." Research doesn't support this.

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Mood disorders can take various forms, from major depressive disorder to less common conditions, such as bipolar disorder and disruptive mood dysregulation disorder. Specialists at the Child Study Center, part of Hassenfeld Children's Hospital at NYU Langone, can help determine whether your child has a mood disorder and, if so, how to improve his or her symptoms.

Major Depressive Disorder

Major depressive disorder-commonly known as depression-is characterized by chronic feelings of sadness, guilt, or worthlessness. Children and teenagers with depression may be irritable and moody, complain that they're bored all the time, and have little interest in friends and activities they once enjoyed.

Other signs of depression include weight loss or gain, sleeping too much or too little, and thoughts of death or wanting to die. Parents or teachers may also notice that grades drop and the child has difficulty concentrating.

A combination of genetic, biological, environmental, and psychological factors causes depression. Depression runs in families, but it can also occur in people without a family history of the condition.

Stressful situations, such as moving, changing schools, relationship problems, or the death of a loved one, may trigger a depressive episode. However, an episode may occur without an obvious trigger.

Children and adolescents of any age can be depressed, but the condition is more common in adolescents than in younger children. Depression affects an equal number of boys and girls in elementary school, but by adolescence it affects twice as many girls as boys.

It's common for adolescents to feel sad or cranky from time to time. If the feelings pass, your teenager may be experiencing normal mood swings.

The irritability and moodiness typical of teenagers can be difficult to distinguish from depression. If you're concerned your child may be depressed, our experts can evaluate his or her symptoms and determine if treatment is appropriate.

Persistent Depressive Disorder

The most prominent sign of persistent depressive disorder is a consistent depressed or irritable mood lasting for one year or longer. This disorder resembles major depressive disorder but differs in that symptoms are fewer, less severe, and last longer, sometimes for years.

Because of the long duration and lower intensity of symptoms associated with persistent depressive disorder, children and those around them may not recognize that they have this condition. Many people simply grow accustomed to the symptoms.

Bipolar Disorder

A child or adolescent with bipolar disorder experiences cyclical swings between depression and mania, which is marked by feelings of grandiosity, excessive exuberance and silliness, and chronic, severe irritability.

Bipolar disorder may be diagnosed if your child experiences a manic episode in which he or she shows a dramatic change in mood and seems unusually happy or excited. He or she may talk excessively, rapidly, or loudly, and change the topic of conversation frequently or abruptly.

The child may also have unrealistically high self-esteem, ambition, and increased activity. Other signs of mania include increased energy, a decreased need for sleep, losing touch with reality, and risky behavior, such as drug or alcohol abuse, reckless driving, or sexual promiscuity.

During a depressive episode, a person may experience irritability, persistent sadness, or frequent crying. He or she may have thoughts of death or suicide and lose interest in favorite activities. Other signs of depression include a low energy level, fatigue, poor concentration, and a change in eating or sleeping habits.

Disruptive Mood Dysregulation Disorder

Occasional temper tantrums are a normal part of growing up, but if your child is chronically angry or irritable, or has frequent, intense, and ongoing temper tantrums, he or she may have disruptive mood dysregulation disorder.

This condition is characterized by frequent angry outbursts that seem grossly out of proportion with a given situation. The outbursts occur, on average, three or more times each week for one year or more. Between outbursts, children with the disorder are persistently irritable or angry.

Disruptive mood dysregulation disorder occurs more commonly in boys than in girls.

Disruptive mood dysregulation disorder is a newly defined diagnosis that was developed to better characterize children who are chronically, severely irritable. These children may have been previously, and incorrectly, diagnosed with bipolar disorder, even though they did not meet the full criteria for this diagnosis.

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Mood disorders can take various forms, from major depressive disorder to less common conditions, such as bipolar disorder and disruptive mood dysregulation disorder. Specialists at the Child Study Center, part of Hassenfeld Children's Hospital at NYU Langone, can help determine whether your child has a mood disorder and, if so, how to improve his or her symptoms. Major depressive disorder-commonly known as depression-is characterized by chronic feelings of sadness, guilt, or worthlessness.

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What Teachers Should Know

It's normal for students to feel sad, angry, or moody at times. But when a sad or bad mood lasts for weeks, months, or even longer - and when it affects a student's ability to do well in school and with peers - it might be depression.

Depression is not uncommon among students. But it can go unrecognized or undiagnosed. Many students with depression don't receive the care they need.

Depression can get better with the right treatment and support. Mental health professionals treat depression with therapy, medication, or both. Effective early treatment can reduce the risk of future episodes of depression.

Teachers can help by knowing the signs of depression, taking steps to guide students toward the help they need, and by being a source of support and encouragement.

Teachers should know the signs that could mean a student is depressed. Students with depression may:

seem sad or irritable more often than not

seem tired, lack energy, give up easily

put little effort into schoolwork

have trouble concentrating in class

fail to turn in work, get lower grades

seem not to enjoy things

withdraw from friends or activities

miss school days, or be frequently late

Some students with depression may:

have experienced trauma or adverse life events

have other mental health issues, such as anxiety

engage in risky or self-harming behaviors (for example, be reckless or turn to alcohol, drugs, or self-injury)

talk about death or suicide

Teachers should know student behaviors that can be warning signs for suicide, including:

talking about suicide or death

hinting that they might not be around anymore

writing songs, poems, or letters about death

giving away treasured possessions

losing interest in school, classmates, sports, or other activities

engaging in risky behaviors

Teachers should be aware of suicide prevention methods, and follow their school's protocol for how to:

notify parents if a student appears suicidal

get help for a student at risk of suicide

supervise an at-risk student

work with the school's crisis team to set up a support system at school and at home

Students with depression may need:

treatment from mental health professionals

emotional support from a school counselor or school psychologist

a 504 plan for accommodations at school

short breaks throughout the day to avoid feeling overwhelmed

extra time or extra help to complete assignments

to take medication

treatment for other mental health issues or healing for trauma they've faced

What Teachers Can Do

Offer support and encouragement. Help students with depression feel welcome and included. Let them know you're available to help. Encourage their strengths and their interests. Look for opportunities for them to succeed in the classroom. Let them know you see their efforts - even the small steps.

Give extra time to complete assignments. Offer extra help. Consider having students work with a supportive peer to work on assignments or to study for tests.

Make physical activities a part of your daily classroom routine. This can help ease mild depression symptoms. It can energize all of your other students, too.

Make brief mindfulness practices a part of everyday instruction. At random or scheduled times, invite your class, "Let's all pause and take a few slow, calm breaths." This helps students learn and practice this simple but effective self-calming skill.

Use trauma-informed education approaches. Create and maintain an environment where every student can feel a sense of safety and inclusion. This helps every student thrive.

Date reviewed: April 2022

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What teachers should know about depression and how to help a student who is depressed.

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Have You Heard of This Milder Form of Bipolar Disorder?

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Cyclothymic disorder, or cyclothymia, is a mood disorder in which a child experiences alternating episodes of hypomania and depressive symptoms. Cyclothymia is considered to be part of the bipolar disorder spectrum, with mild but chronic symptoms. This article discusses the course that cyclothymia takes, including its onset and potential for developing into bipolar disorder.

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Bipolar disorder is a mental health condition defined by periods (better known as episodes) of extreme mood disturbances. Bipolar affects a person's mood, thoughts, and behavior.

There are two main types of bipolar disorders: bipolar I and bipolar II. According to the Diagnostic and Statistical Manual of Mental Disorders, bipolar I disorder involves episodes of severe mania and often depression. Bipolar II disorder involves a less severe form of mania called hypomania.

Despite the major difference when it comes to mania in the two types of bipolar disorder, there are quite a few similarities in symptoms.﻿﻿

In bipolar I disorder, a major depressive episode (one or more) usually occurs, but it is not required. Bipolar II disorder involves one or more major depressive episodes. Common symptoms that occur in a major depressive episode include:﻿﻿

Insomnia or hypersomnia

Unexplained or uncontrollable crying

Severe fatigue

Loss of interest in things the patient enjoys during euthymia

Recurring thoughts of death or suicide

Both disorders may include periods of -symptom-free or "normal" states.

Manic episodes last at least seven days. An individual experiencing a manic episode may experience:﻿﻿

Feelings of euphoria

Less need for sleep

Increased sexual desire

Hallucinations or delusions

Marked increase in energy

During a manic episode, individuals may engage in risky or reckless behavior. For example, someone may indulge in risky sexual behavior, spend excessive amounts of money, or make impulsive decisions.

It's important to note that experiencing mania does not automatically mean a person will become violent or dangerous.

Sometimes people assume a "manic episode" means someone turns into a "maniac." That's not true.

An individual experiencing a hypomanic episode may experience similar symptoms but their functioning won't be markedly impaired. Many individuals who experience hypomania associated with bipolar II enjoy the increased energy and decreased need for sleep.

An episode of hypomania does not escalate to a point that a person needs hospitalization, which may happen with a person experiencing mania-especially if he or she is becoming a danger to others and/or themselves.

While the exact cause of bipolar I disorder remains unclear, genetics is believed to play a major role. This is evidenced, in part, by studies of twins in which one or both had a bipolar I diagnosis. In 40% of identical twins (those with identical gene sets), both twins were found to be bipolar compared to less than 10% of fraternal twins (who don't share all the same genes).﻿﻿

Other contributing factors include abnormalities in a person's brain circuitry, irregularities in neurotransmitters, and environmental factors such as childhood trauma or abuse.

Bipolar disorder cannot be diagnosed like other illnesses where a blood test, X-ray, or physical exam can provide a definitive diagnosis. The diagnosis is based on a set of criteria that a person must meet in order to be considered bipolar.

An informed diagnosis would likely include specific tests to exclude other physical causes. This may involve a drug screen, imaging tests (CT scan or MRI of the brain), electroencephalogram (EEG), and a full battery of diagnostic blood tests. Your doctor will also ask you questions, and you should do your best to work closely with your healthcare team to confirm a diagnosis and find the right treatment plan for you.

Bipolar Disorder Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Mood stabilizers are the core of the treatment process, and other agents are often used, such as:﻿﻿
Both Types Should Be Properly Treated
Since hypomania is less severe than the mania that occurs in bipolar I disorder, bipolar II is often described as "milder" than bipolar I-but this is not completely accurate. Certainly, people with bipolar I can have more serious symptoms during mania, but hypomania is still a serious condition that can have life-changing consequences and so should be properly addressed.

In addition, research suggests that bipolar II disorder is dominated by longer and more severe episodes of depression. In fact, over time, people with bipolar II become less likely to return to fully normal functioning between episodes.﻿﻿

One study specifically concluded that bipolar type II was linked to a poorer health-related quality of life compared to type I. This remained true even during long periods of euthymia.

Thus, experts tend to believe that bipolar II disorder is equally (if not more) disabling than bipolar I disorder because it can lead to more lifetime days spent depressed and not doing as well overall between episodes.﻿﻿ Proper treatment should be pursued for all types of bipolar disorders, and you should work closely with your healthcare team to figure out the best treatment for you.

As with many mental health conditions, bipolar disorder is associated with a certain stigma in society, which may make coping with the condition more difficult for you or a loved one.﻿﻿ Know that stigma very often develops because of lack of knowledge-those who make comments or discriminate are usually ignorant or have fear based on what they think they know about the disorder.

Whether or not someone with bipolar faces stigma directly, know that the best way to cope with the condition is to connect with others who are experiencing it and get professional help. You can also fight stigma to help you cope better, and read up on your rights.

Bipolar disorder can occur in kids of any age.﻿﻿ It's important for parents and caregivers to be aware of the unique signs-they should pay attention to a child's functioning, feelings, and any family history of the disorder. With a timely diagnosis, a treatment plan for symptom management can be better established.

A Word From Verywell

Bipolar disorder is a complex mood disorder. If you are worried that you or a loved one has symptoms of a bipolar episode, seek medical attention for a proper evaluation.

Although bipolar is not curable, it is treatable. With the right medication and support, symptoms can be managed to the point where quality of life isn't drastically affected.

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How Mania Varies Between the Bipolar Types: An Overview

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Bipolar disorder is a mental health condition defined by periods (better known as episodes) of extreme mood disturbances. Bipolar affects a person's mood, thoughts, and behavior. There are two main types of bipolar disorders: bipolar I and bipolar II. According to the Diagnostic and Statistical Manual of Mental Disorders , bipolar I disorder involves episodes of severe mania and often depression.

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Warning Signs of Bipolar Manic Episodes in Children

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Warning Signs of Bipolar Manic Episodes in Children

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By knowing the early warning signs you can avoid a full-blown episode. Here are seven behaviors that are associated with mania.

#1 Severe changes in mood

When heading for a manic episode, children with bipolar disorder become either overly elated or extremely irritable. In many cases, a child will display an abnormal sense of happiness and euphoria that may make him act silly in an unusual way. You may notice intense tantrums in younger children or see uncontrollable impatience and frustration in teens that can be long lasting.

#2 Unrealistic highs in self-esteem

A distorted sense of self-importance or delusions of grandeur will be exhibited. For example, a child or teen who feels "all-powerful" or like a superhero with special powers. They may believe they're able to do things they're not, and brag that they are smarter than adults or better than other kids.

#3 Elevated energy

A significant increase in intense energy levels that last a long period of time. This goes hand in hand with the ability to go with very little to no sleep for days without feeling tired.

#4 More talkative

Being in a manic state for adolescents generally means an increase in talking, speaking extremely fast and excitedly, changing topics too quickly and refusing to be interrupted.

#5 Rapid thoughts and distractibility

These children will be easily distracted and unable to focus. Their attention will move constantly from one thing to the next and they will jump from task to task. Their thoughts will race and it will seem like they're on 'fast-forward,' flying from idea to idea.

#6 Obsessions and compulsions

Your child may have periods of time when he becomes fixated on a certain idea and can become agitated and frustrated when an obstacle gets in his way. You may see an intense focus on reaching a goal or pursuing a hobby; for example, a child who likes to write poetry may stay up all night writing pages of poems.

#7 Extreme behavior that causes problems

Repeated high risk-taking behavior, such as abusing drugs and alcohol, reckless driving, or binge shopping. Watch for signs of hypersexuality: increased sexual thoughts, feelings, or behaviors; use of explicit, sexual language, or if your child is overly sexual for their age.
code:bphopekids

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Kids & Bipolar: 7 Warning Signs of a Manic Episode | bpHope.com

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When heading for a manic episode, children with bipolar disorder become either overly elated or extremely irritable. In many cases, a child will display an abnormal sense of happiness and euphoria that may make him act silly in an unusual way.

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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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Eating Disorders in Children 12 and Under

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Eating Disorders in Children 12 and Under

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What Are Eating Disorders?

Eating disorders are problems that affect a person's eating behaviors as well as their attitudes and feelings about food - and about their body.

Eating disorders affect a person's mental health and can cause serious harm to a person's physical health.

There are several types of eating disorders.

What Are the Different Types of Eating Disorders?

Common types of eating disorders are anorexia, bulimia, binge eating, and avoidant/restrictive food intake disorder (ARFID).

Anorexia. People with anorexia:

eat very little on purpose, leading to a very low body weight

have an intense fear of weight gain and fear looking fat

have a distorted body image and see themselves as fat even when they are very thin

People with anorexia are very strict about what and how much they will eat. They may think about food or calories almost all the time.

To lose weight, some people with anorexia fast or exercise too much. Others may use laxatives, diuretics (water pills), or enemas.

Bulimia. People with bulimia:

overeat and feel out of control to stop, called binge eating

do things to make up for overeating, such as:

make themselves throw up on purpose after overeating, called purging

use laxatives, diuretics, weight loss pills, fast, or exercise a lot to prevent weight gain

judge themselves based on body shape and weight

People with bulimia eat much more (during a set period of time) than most people would. If a person regularly binges and purges, it may be a sign of bulimia. Unlike people with anorexia who are very low weight, people with bulimia may be thin, average weight, or overweight. People with bulimia often hide their eating and purging from others.

Binge eating. People with binge eating disorder:

overeat and feel out of control to stop

eat large amounts even when they are not hungry

may feel upset or guilty after binge eating

often gain weight and may become very overweight

Many people with binge eating disorder eat faster than normal. They may eat alone so others don't see how much they are eating. Unlike people with bulimia, those with binge eating disorder do not make themselves throw up, use laxatives, or exercise a lot to make up for binge eating. If a person binge eats at least once a week for 3 months, it may be a sign of binge eating disorder.

ARFID. People with avoidant/restrictive food intake disorder:

are not interested in food or avoid foods

lose weight, or don't gain expected amount of weight

are not afraid of gaining weight

don't have a poor body image

People with ARFID don't eat because they are turned off by the smell, taste, texture, or color of food. They may be afraid that they will choke or vomit. They don't have anorexia, bulimia, or another medical problem that would explain their eating behaviors.

How Do Eating Disorders Affect Health and Emotions?

Eating disorders can cause serious problems throughout the body.

Anorexia can lead to health problems caused by undernutrition and low body weight, such as:

low blood pressure

slow or irregular heartbeats

feeling tired, weak, dizzy, or faint

constipation and bloating

irregular periods

weak bones

delayed puberty and slow growth

People with anorexia may find it hard to focus and have trouble remembering things. Mood changes and emotional problems include:

feeling alone, sad, or depressed

anxiety and fears about gaining weight

thoughts of hurting themselves

Bulimia can lead to health problems caused by vomiting, laxatives, and diuretics, such as:

low blood pressure

irregular heartbeats

feeling tired, weak, dizzy, or faint

blood in vomit or stool (poop)

tooth erosion and cavities

swollen cheeks (salivary glands)

People with bulimia may have these emotional problems:

low self-esteem, anxiety, and depression

alcohol or drug problems

thoughts of hurting themselves

Binge eating can lead to weight-related health problems, such as:

diabetes

high blood pressure

high cholesterol and triglycerides

fatty liver

sleep apnea

People with binge eating disorder may:

have low self-esteem, anxiety, or depression

feel alone, out of control, angry, or helpless

have trouble coping with strong emotions or stressful events

ARFID may lead to health problems that stem from poor nutrition, similar to anorexia. People with ARFID may:

not get enough vitamins, minerals, and protein

need tube feeding and nutrition supplements

grow poorly

People with ARFID are more likely to have:

What Causes Eating Disorders?

There's no one cause for eating disorders. Genes, environment, and stressful events all play a role. Some things can increase a person's chance of having an eating disorder, such as:

poor body image

too much focus on weight or looks

dieting at a young age

playing sports that focus on weight (gymnastics, ballet, ice skating, and wrestling)

having a family member with an eating disorder

mental health problems such as anxiety, depression, or OCD

How Are Eating Disorders Diagnosed?

Health care providers and mental health professionals diagnose eating disorders based on history, symptoms, thought patterns, eating behaviors, and an exam.

The doctor will check weight and height and compare these to previous measurements on growth charts. The doctor may order tests to see if there is another reason for the eating problems and to check for problems caused by the eating disorder.

How Are Eating Disorders Treated?

Eating disorders are best treated by a team that includes a doctor, dietitian, and therapist. Treatment includes nutrition counseling, medical care, and talk therapy (individual, group, and family therapy). The doctor might prescribe medicine to treat binge eating, anxiety, depression, or other mental health concerns.

The details of the treatment depend on the type of eating disorder and how severe it is. Some people are hospitalized because of extreme weight loss and medical complications.

What if I Have an Eating Disorder?

If you think you may have an eating disorder:

Tell someone. Tell a parent, teacher, counselor, or an adult you trust. Let them know what you're going through. Ask them to help.

Get help early. When an eating disorder is caught early, a person has a better chance of recovery. Make an appointment with your doctor or an eating disorders specialist.

Go to all appointments. Treatment takes time and effort. Work hard to learn about yourself and your emotions. Ask questions any time you have them.

Be patient with yourself. There's so much to learn, and change happens a little at a time. Take care of yourself and be with people who support you.

Where Can I Learn More About Eating Disorders?

For more information on eating disorders, visit the National Eating Disorders Association (NEDA).

For more help and support, the National Association of Anorexia Nervosa and Associated Disorders (ANAD) offers these free resources:

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Eating disorders are problems that affect a person's eating behaviors as well as attitudes and feelings about food and their body. This article for teens describes how different eating disorders impact a person's health and emotions.

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National Institute of Mental Health (NIMH)

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What is anxiety?

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, or family problems. But anxiety disorders involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

What are the signs and symptoms of anxiety?

What are the risk factors for anxiety?

How is anxiety treated?

How can I find a clinical trial for anxiety?

Where can I learn more about anxiety?

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Learn about anxiety disorders, including signs and symptoms, types, risk factors, and potential treatments and therapies.

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By Amanda Morin

It's not uncommon for students who learn and think differently to also struggle with anxiety. They might worry a lot or be withdrawn at school. They may hesitate to participate in the classroom, make frequent trips to the bathroom or the nurse's office, or even refuse to go to school at all. All of this can get in the way of learning.

What are some classroom accommodations for kids with anxiety? Here are strategies teachers can try.

Providing emotional support

Encourage the student to use self-calming or anxiety-reducing techniques that were taught by a counselor or therapist.

Allow the student to have a self-calming object or family pictures on hand.

Build in "call home" breaks (for students with separation anxiety).

Let the student seek help from a designated staff member with mental health expertise when feeling anxious.

Classroom setup, schedules, and routines

Provide classroom seating where the student is most comfortable (near a door, near the front of the room, near the teacher or a friend).

Let the student sit near the back of the room or by an exit during assemblies.

Assign the student a designated buddy for lunchtime, recess, and/or hallways.

Allow preferential grouping for field trips so the student is with a teacher or friends.

Provide a "take a break pass" to let the student walk down the hallway, get a drink, or leave the classroom when needed.

Create a plan for catching up after an absence or illness (for example, excusing missed homework or having a known time frame for making up work).

Give advance notice of planned substitute teachers or other changes in routine.

Give the student notice and extra time before upcoming transitions, like before recess and lunch, and rehearse transitions in a private or low-stress environment.

Giving instructions and assignments

Clearly state and/or write down classroom expectations and consequences.

Break down assignments into smaller chunks.

Check in frequently for understanding and "emotional temperature."

Provide a signal before calling on the student and a signal for the student to opt out of answering.

Offer written instructions in addition to spoken directions.

Exempt the student from reading aloud or demonstrating work in front of the class.

Let the student present projects to the teacher instead of to the entire class.

Introducing new concepts/lessons

Give extended time on tests and/or separate test-taking space to reduce performance anxiety.

Allow use of word banks, cheat sheets, or fact cards for tests (for students who freeze or "go blank" during in-class tests).

Set time limits for homework or reduce the amount of homework.

Assure that work not completed in that time won't count against the student.

Provide class notes via email or a school portal for the student to preview.

Give notice of upcoming tests (no "pop quizzes").

When students are being treated for anxiety, it's crucial for all of the people working with them to be in contact with their mental health providers about using school strategies like these. Together, you can all ensure the accommodations are a good fit for the student.

Does your student have anxiety?

Does your child have anxiety?

Tell us what interests you

About the author

About the author

Amanda Morin is the director of thought leadership at Understood and author of "The Everything Parent's Guide to Special Education." She worked as a classroom teacher and early intervention specialist for more than a decade.

Reviewed by

Reviewed by

Jerome Schultz, PhD is a clinical neuropsychologist and lecturer in the Harvard Medical School Department of Child Psychiatry.

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Accommodations for Students With Anxiety Disorders

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It's not uncommon for students who learn and think differently to also struggle with anxiety. They might worry a lot or be withdrawn at school. They may hesitate to participate in the classroom, make frequent trips to the bathroom or the nurse's office, or even refuse to go to school at all.

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Separation Anxiety - Ways Schools Can Help

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Separation Anxiety - Ways Schools Can Help

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This article is a follow up from my first article: Strategies for Parents to Help Their Child with Separation A nxiety.

The intro is the same, but as you go further down the article, you will see strategies for schools to use to help children with separation anxiety.

What is Separation Anxiety Disorder?

According the the American Psychiatric Association, a person with separation anxiety disorder is excessively fearful or anxious about separating from the people they feel attached to.

To meet criteria for separation anxiety disorder, a child must have anxious feelings about separating that would not be expected based on their age. The feelings must persist for at least four weeks and they must cause problems with functioning.
Only a trained professional such as a developmental pediatrician, psychiatrist, or psychologist can diagnose separation anxiety disorder.
A person with separation anxiety disorder may be persistently worried about losing the person closest to them, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation.

Physical symptoms of distress often develop in childhood, but symptoms can carry through to adulthood. Children with separation anxiety disorder may be at-risk for school refusal in the future.

Behaviors related to school refusal may include:

severe emotional distress about attending school (e.g., anxiety, temper tantrums, depression, or somatic symptoms - such as pain or fatigue)

the child often tries to persuade parents to allow them to stay home

the child often attempts to conceal absence from parents

child stays home during school hours because it is safe and secure

child expresses willingness to do schoolwork and complies with completing work at home

Is Some Separation Anxiety Typical?

Some separation anxiety is typical in young children around three or four years old. It is common for them to cling to parents, cry, and resist when going to another caregiver (e.g., school, daycare, babysitter, etc.). However, if the anxiety seems severe (in young or older children) in that it is causing extreme distress and interfering with daily functioning, support and intervention is recommended.

Strategies for Symptoms of Separation Anxiety

Some children may receive a diagnosis of separation anxiety disorder. Other children may manifest symptoms that are never officially diagnosed. Regardless of whether there is an official diagnosis, there are strategies we can put into place to assist a child with symptoms of separation anxiety.

Some children would benefit from therapy with a child psychologist or counselor, but in addition to that, there are ways that schools can provide support to children with symptoms of separation anxiety.

A person with separation anxiety disorder may be persistently worried about losing the person closest to them, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation.

Children with separation anxiety disorder may be At-Risk for school refusal in the future. Without the right supports their future can be impacted into adulthood.

How Can Schools Help Students with Separation Anxiety?

When examining therapeutic options for treating separation anxiety disorder, research indicates that psycho-educational interventions are effective methods of treatment. The interventions include:

education of staff and parents on the topic of separation anxiety

collaboration between parents and school team regarding intervention and strategies

training to increase a child's independence and sense of competence (e.g., counseling to build self-esteem and sense of adequacy, positive feedback from school staff and caregivers, opportunities to meet and celebrate small successes)

For more on this research see Separation Anxiety in Children and Adolescents.

Remember to see Part 1: Strategies for Parents to Help their Child with Separation Anxiety

Strategies Schools Can Use to Assist Children with Separation Anxiety

1. Have a trusted, familiar school staff present when the child arrives at school.

Meeting a friendly face when they approach or come into the building will likely reduce some of the initial anxiety and increase feelings of security.

2. Younger children, who are not in kindergarten yet, may benefit from a shorter school day that is increased gradually.

3. Identify a safe place where the child can go to reduce anxiety during stressful periods.

Some children benefit from taking some time to adjust in the counselor's office or other safe space before going to the classroom.

4. Identify a safe adult to whom the child can go to during times of stress.

This adult should speak to the child with empathy, being understanding of their feelings. However, they should encourage the child to return to their class or activity once they are calm.

5. Review self-calming strategies that the child can use when anxiety arises.

Self-calming strategies may include deep breathing, counting, stretching, muscle relaxation, holding an object that provides comfort (e.g., picture of parent, favorite item from home), drawing a picture, writing down their feelings, thinking of a funny time, thinking of another time that they had anxiety but got through it and it turned out fine, reminding themselves that they will be okay and they will be going home at a certain time.

6. Provide reasonable reassurance.

If a child asks questions like, "will I be okay, is my mom coming back, when am I going home," it is okay to reassure them one time, but stay away from reassuring them over and over, as this could just prolong the time they stay away from the classroom or class activity and feed into the anxiety.

You can say something like, I am here if you need me, but I am confident that you will be okay. At three o'clock your mom will pick you up. If they keep asking questions seeking more reassurance, remind them the you already reassured them once, and it is not effective to reassure over and over.

7. Educate children about anxiety.

Talk about what anxiety feels like (e.g., knot in stomach, pounding heart, sweating) so children know how to recognize it when it occurs. Remind them that everyone experiences some anxiety sometimes and it is completely normal. Some anxiety is good because it is our body's way of warning us of potentially dangerous situations.

However, sometimes anxiety occurs due to a perceived fear that may be highly unlikely or non-existent. When anxiety tells us to stay away from non-dangerous situations and causes us to avoid experiences that may actually be good for us or when normal anxiety becomes so intense that it is hard to focus, get through an activity, or interact with others, we need to learn coping strategies to get through these times. Avoiding the situations will not address the problem.

8. Encourage/model small group interactions (e.g., games, art projects, discussions).

Interactions can start with only one classmate. With time, if the child increases their competency, the group may be enlarged gradually. This is something that can be done in the counselor's office or when students are paired up with peers for classroom activities.

9. Give positive feedback for effort.

Notice when your student makes efforts to get through anxiety provoking situations or uses strategies they have learned to cope with anxiety. You can say something like, "I know you were anxious to come to school this morning, but you were brave when you walked in;" "I'm proud that you went to the school craft fair and stayed until it was over;" "You should be so proud of yourself! You calmed yourself down by drawing a picture when you came into class this morning".

10. Help the child prepare for transitions.

For instance, give your student time to prepare that a change is coming (e.g., in five minutes we will be going to music class, or after math is over we will be working on an art project). Children with anxiety may be apprehensive to change from one activity to the next, especially if they are unprepared for the change.

11. Collaborate with parents.

School staff should meet with parents to agree on which supports a child with have in school for separation anxiety. It is important for parents and school to handle problems related to separation anxiety in a consistent way using a team approach. Expectations for how the child copes with their anxiety should be similar in school and at home.

What if a Child is Refusing to Attend School?

If the child is refusing to attend school, assess what may be the trigger for the refusal and work with the child to address the concern if possible (e.g., are there problems with friends, fear of a teacher, etc.?).

If the child will not return to school or if the school feels that a child may need more than they can offer, it is important to discuss these concerns with the parent(s). A mental health professional such as a child psychologist or developmental pediatrician will likely need to be involved.

What Therapeutic Treatments Are Effective for Separation Anxiety in Children?

When working with a therapist, the most effective/research-based non-pharmacological (not involving medication) method for reducing separation anxiety in children is cognitive-behavioral therapy (CBT). To read more about CBT and how it has effectively been utilized to treat separation anxiety, see Separation Anxiety Disorder in Youth: Phenomenology, Assessment, and Treatment.

Two research-based programs for treating Separation Anxiety Disorder include the Coping Cat Program and the FRIENDS Program. These programs are intended to be utilized by mental health professionals treating children for anxiety related conditions such as separation anxiety disorder. For more on the research regarding the effectiveness of these programs see Separation Anxiety Disorder in Youth: Phenomenology, Assessment, and Treatment.

If homeschool or cyber school is utilized for children with separation anxiety, it is important that students' behavioral and social-emotional needs are addressed through community outlets such as therapy, sports, art, music, groups/clubs, and nature.
Related Article: Evidence Suggests That the Coping Cat Program Reduces Anxiety in Children and Teens
Thank you for visiting educationandbehavior.com. We are a free resource for parents, caregivers, educators, and counselors. We provide free academic, behavioral, and social-emotional support for children. Receive our updates on Facebook!

Recommened Boooks for Separation Anxiety in Children

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Schools Can Try These 12 Strategies to Help Children with Separation Anxiety - Education and behavior

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This article is a follow up from my first article: Strategies for Parents to Help Their Child with Separation A nxiety. The intro is the same, but as you go further down the article, you will see strategies for schools to use to help children with separation anxiety.

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Dziegielewski, S. F.  (2014). DSM-5 in Action: Vol. Third edition. Wiley.

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Tobin, R. M., & House, A. E. (2016). DSM-5® Diagnosis in the Schools. The Guilford Press.

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Texas Education Agency. (2018). The Texas model for comprehensive school counseling programs (5th ed.). Texas Counseling Association.  https://tea.texas.gov/sites/default/files/Pub_2018_Texas-Model_5th-Edition.pdf.

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Mental illness is a general term for a group of illnesses that may include symptoms that can affect a person's thinking, perceptions, mood or behaviour. Mental illness can make it difficult for someone to cope with work, relationships and other demands. The relationship between stress and mental illness is complex, but it is known that stress can worsen an episode of mental illness. Most people can manage their mental illness with medication, counselling or both.This page lists some of the more common mental health issues and mental illnesses.

Anxiety disorders

Anxiety disorders is a group of mental health disorders that includes generalised anxiety disorders, social phobias, specific phobias (for example, agoraphobia and claustrophobia), panic disorders, obsessive compulsive disorder (OCD) and post-traumatic stress disorder. Untreated, anxiety disorders can lead to significant impairment on people's daily lives.

Behavioural and emotional disorders in children

Common behaviour disorders in children include oppositional defiant disorder (ODD), conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). Treatment for these mental health disorders can include therapy, education and medication.

Bipolar affective disorder

Bipolar affective disorder is a type of mood disorder, previously referred to as 'manic depression'. A person with bipolar disorder experiences episodes of mania (elation) and depression. The person may or may not experience psychotic symptoms. The exact cause is unknown, but a genetic predisposition has been clearly established. Environmental stressors can also trigger episodes of this mental illness.

Depression

Depression is a mood disorder characterised by lowering of mood, loss of interest and enjoyment, and reduced energy. It is not just feeling sad. There are different types and symptoms of depression. There are varying levels of severity and symptoms related to depression. Symptoms of depression can lead to increased risk of suicidal thoughts or behaviours.

Dissociation and dissociative disorders

Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories or sense of identity. Dissociative disorders include dissociative amnesia, dissociative fugue, depersonalisation disorder and dissociative identity disorder.

Eating disorders

Eating disorders include anorexia, bulimia nervosa and other binge eating disorders. Eating disorders affect females and males and can have serious psychological and physical consequences.

Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is an anxiety disorder. Obsessions are recurrent thoughts, images or impulses that are intrusive and unwanted. Compulsions are time-consuming and distressing repetitive rituals. Ttreatments include cognitive behaviour therapy (CBT), and medications

Paranoia

Paranoia is the irrational and persistent feeling that people are 'out to get you'. Paranoia may be a symptom of conditions including paranoid personality disorder, delusional (paranoid) disorder and schizophrenia. Treatment for paranoiainclude medications and psychological support.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop as a response to people who have experienced any traumatic event. This can be a car or other serious accident, physical or sexual assault, war-related events or torture, or natural disasters such as bushfires or floods.

Psychosis

People affected by psychosis can experience delusions, hallucinations and confused thinking.. Psychosis can occur in a number of mental illnesses, including drug-induced psychosis, schizophrenia and mood disorders. Medication and psychological support can relieve, or even eliminate, psychotic symptoms.

Schizophrenia

Schizophrenia is a complex psychotic disorder characterised by disruptions to thinking and emotions, and a distorted perception of reality. Symptoms of schizophrenia vary widely but may include hallucinations, delusions, thought disorder, social withdrawal, lack of motivation and impaired thinking and memory. People with schizophrenia have a high risk of suicide. Schizophrenia is not a split personality.

Where to get help

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Types of mental health issues and illnesses

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Mental illness is a general term for a group of illnesses that may include symptoms that can affect a person's thinking, perceptions, mood or behaviour. Mental illness can make it difficult for someone to cope with work, relationships and other demands.

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Need for School-Based Mental Health Practices

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Need for School-Based Mental Health Practices

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COVID-19 and its repercussions highlight the critical need for school-based mental health services. Each year, an estimated 1 in 5 U.S. children experience a mental, emotional, or behavioral disorder, including anxiety, depression, attention-deficit hyperactivity disorder, and disruptive behavioral…

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Mental Health Symptoms in School-Aged Children

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Mental Health Symptoms in School-Aged Children

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Centers for Disease Control and Prevention

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A CDC study examined mental health symptoms in four different U.S. school districts during 2014-2018. Based on teacher and parent reports, about 1 in 6 students had enough behavioral or emotional symptoms and impairment to be diagnosed with a childhood mental disorder; rates varied among the different sites. Schools, communities, and healthcare providers can use this information to plan for the healthcare and school service needs of children and adolescents with mental disorders. Screening, identifying, and referring children and adolescents to effective treatments can help prevent or lower the negative effects of mental disorders.
Read the scientific summary
Main Findings

For this study, teachers in selected school districts were first asked to complete a short questionnaire (screening) to determine a student's risk for a mental disorder. Then, the parents of selected students were invited to complete a more structured diagnostic interview to determine if their child met criteria for a mental disorder.

Overall, 1 in 6 students had enough symptoms and impairment to meet the criteria for one or more childhood mental disorders.

Anxiety disorders were the most commonly reported mental disorders, followed by oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD).

Risk for disorders varied greatly from community to community.

Based on the screen done by teachers, between 1 in 6 and 1 in 3 students were at high risk for a mental disorder, depending on which community they were from. Teachers identified a higher percentage of boys, non-Hispanic Black students, and students receiving free or reduced-price lunch as high risk for mental disorders than their peers at all or most sites, but there were generally no demographic differences in the percentage of students who met the criteria for a mental disorder based on parent report. This means that estimating effects of race or income on symptoms gave different results depending on the way that symptoms were examined.

Helping Students at Risk

Schools may consider screening students for mental health concerns and providing effective prevention services.

Pediatric and family medicine clinics can use these estimates to understand how many students may need services.

Communities can work with schools to integrate mental health services in schools and provide referral and treatment services.

Public health can use these estimates to plan for healthcare and school service needs, as well as to watch changes over time.

About This Study

The Project to Learn About Youth-Mental Health (PLAY-MH) was a school-based study designed to estimate how many K-12 students had specific mental disorders. Information was collected from 2014-2018 in four different school districts in four U.S. states (Colorado, Florida, Ohio, and South Carolina). The school districts were in urban, suburban, and rural areas, varied in size, and included students from different socio-economic and racial and ethnic backgrounds.

Information was collected in two stages. In Stage 1, teachers in selected school districts completed validated screening questionnaires to describe students' emotional, behavioral, or tic symptoms. A sample of students at high risk and students at low risk were invited to participate in the second stage. In Stage 2, parents completed a structured diagnostic interview about their child's emotional or behavioral symptoms. The information was used to determine whether children had enough symptoms and impairment to meet the criteria for a mental disorder.

Although the students come from four school districts in four states and represent a variety of backgrounds, it is not known whether the same findings would apply to students in other school districts or regions.

About Children's Mental Health

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions that causes distress and problems getting through the day. Many children experience occasional fears and worries, or disruptive behaviors. If symptoms are severe and persistent and interfere with school, home, or play activities, the child may be diagnosed with a mental disorder. Among the more common mental disorders that can be diagnosed in childhood are ADHD, anxiety, and behavior disorders, such as ODD.

It is important to watch for mental disorders in children and understand how they are treated because they can have a significant effect on overall health and relationships throughout life. Identifying problems early can help children get the support they need.

Our Work

CDC's National Center on Birth Defects and Developmental Disabilities (NCBDDD) works to provide a better understanding of mental, emotional, and behavioral disorders so affected children and adolescents and their families get the support they need.

More Information

References

Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Charania, S. N., Claussen, A. H., PhD; McKeown, R. E., Cuffe, S. P., Owens, J. S., Evans, S. W., Kubicek, L., & Flory, K. (2020). Community-based prevalence of externalizing and internalizing disorders among school-aged children and adolescents in four geographically dispersed school districts in the United States. Child Psychiatry & Human Development. Published online July 31, 2020. [Read summary]

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Mental health symptoms in school-aged children

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A CDC study examined mental health symptoms in four different U.S. school districts during 2014-2018.

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How can you create a culture of wellness in your school or classroom?

General 'wellness' is an important concept for leading a healthy life wrapped up in a generic term. What does wellness look like and how can you encourage it in a class setting? Sketch-noter Sylvia Duckworth created the graphic above to share tips for supporting a culture of well-being in schools.

Children spend a significant amount of each week day in a classroom, making it not only a place to learn academics but also an opportunity to teach life skills that will serve them beyond the schoolyard, like self-care, community involvement, and fostering a sense of connection and belonging.
9 Ways To Support A Culture Of Wellness In Your School
1. Listen to student voice and 'allow them' to explore and change the education system

Give students the opportunity to speak up and feel heard by encouraging them to give feedback and provide alternatives to school, new learning forms, or even reasons to go to school.

2. Consider activism and fundraising

Fundraising for a local cause is an important lesson in community activism and can lead to a sense of interdependence and purpose in students. You can also come up with ideas for project-based learning-or even ways to help students come up with their own ideas for projects!

3. Teachers and staff lead by example and model healthy behaviors, relationships, and positive interactions

Be the change you want to see in the world - and start locally. Students should see adults modeling integrity, accountability, and positive communication.

4. Acknowledge and respect the individuality of each unique school community

Every community is different and those differences must be understood and honored in order to feel a sense of peace and belonging - both in the world and at school.

5. Inspire engagement using fun and meaningful learning activities

While they matter and are deeply embedded in our profession, teaching isn't simply about state standards and assessments. Crafting lessons using strategies that promote curiosity and a true desire to seek knowledge to create a mental environment for a lifelong love of learning.

6. Create a welcoming environment

Everyone just wants to feel like they belong. Greet students at the door by name or with a handshake. Make sure your students know they are seen, heard, and valued as individuals.

7. Ensure easy access to services and support in schools

Services may be offered, but do students know what that entails and who or how to ask? Outline the help available before help is necessary so they know where to turn.

8. Focus on building and serving the local community

Contributing to something greater can lead to feeling purposeful and a change of perspective about the circumstances of others. Get involved in community learning projects to model compassion on a grander scale.

See also 4 Education Strategies for Sustained Community Improvement

9. Create a sense of belonging through meaningful connections

Help create an environment of engagement and curiosity about others to encourage the development of deeper social relationships.

Wellness is really the lifelong practice of positivity - adopting a positive attitude, enacting positive policies and practices, surrounding yourself with positive people and places, and forming positive partnerships - and it's never too early (or late!) to start.
9 Ways To Support A Culture Of Wellness In Your School

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9 Ways To Support A Culture Of Wellness In Your School

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How can you create a culture of wellness in your school or classroom? General 'wellness' is an important concept for leading a healthy life wrapped up in a generic term. What does wellness look like and how can you encourage it in a class setting?

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American Counseling Association | A professional home for counselors

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Lone Star State School Counselor Association

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Lone Star State School Counselor Association

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Welcome to the Lone Star State School Counselor Association (LSSSCA). Our goal is to provide services and resources to meet the needs of school counselors across our great state of Texas. We are the chartered state division of the American School Counselor Association ( ASCA) in Texas.

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Lone Star State School Counselor Association | Home

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Welcome to the Lone Star State School Counselor Association (LSSSCA). Our goal is to provide services and resources to meet the needs of school counselors across our great state of Texas. We are the chartered state division of the American School Counselor Association ( ASCA) in Texas.

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Home - American School Counselor Association (ASCA)

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Bulimia Nervosa Signs, Symptoms, and Treatment Guide

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√ Develop a student assistance program (SAP) and protocol, if one is not already in place (see sample SAP student information form), for students, faculty, and staff to channel nonacademic concerns about a student. This should create an appropriate pathway that adheres to the local laws and regulations governing communications among teachers/parents/students/outside healthcare.

√ Designate a subgroup (of at least two members) of the SAP to "get smart" about eating disorders and share their knowledge and expertise with other school personnel and plan an in-service, if possible.

√ If a full in-service is not possible, plan some time at a faculty meeting to discuss eating disorders or hand out basic information to staff on healthy body image, nutrition, signs and symptoms of eating disorders, and coach and teacher tip sheets. It is extremely important to educate teachers, administrators, and coaches on not only signs and symptoms of eating disorders, but also on ways to support and encourage concerned peers and teammates to express concerns about a student with a suspected or known eating disorder. Many schools do not currently have training on this for school personnel outside the guidance department.

√ Create specific guidelines on referrals for students suspected of having an eating disorder. Be prepared to refer students and families to appropriate local counseling resources and medical practitioners that specialize in eating disorder treatment.

√ Update school policy on anti-harassment and anti-discrimination policies to ensure they include provisions about physical appearance and body shape. Ensure that a protocol is in place for students to report teasing, bullying, or harassment based on weight or appearance. Be sure the consequences for bullying behavior are clear.

√ Decide which staff will take responsibility for monitoring and communicating changes in a student's well-being through appropriate channels to concerned parties (and in accordance with confidentiality, laws, and SAP protocols). That teacher or staff person should take on the role of "checking in" with the student each week for a few minutes to see how he/she is. This may involve informal chat during lunch, recreation time, or before or after school as appropriate.

√ Distribute to staff checklists they can use about typical physical, social, behavioral, and psychological signs and symptoms of eating disorders to facilitate monitoring changes that could signal progression to a more serious condition so that a student can be referred to specialist support as warranted.

√ Make it a policy not to weigh students publicly or in close proximity to fellow students. Consider eliminating weigh-in policies for sports programs if they are not absolutely necessary.

√ Advocate for nutritious foods in school cafeterias and elimination of unhealthy foods and vending machines with unhealthy (junk) foods.

√ Consider offering a community outreach program on eating disorders with invited experts.

√ Review posters/books/materials in the school to ensure they include all body shapes, sizes, and racial groups.

√ Ensure that students of all sizes are encouraged to participate in school activities, such as band, cheerleading, student government, and theater groups. Ensure that students are not typecast by appearance in drama roles

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School strategies for assisting students with eating disorders

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√ Develop a student assistance program (SAP) and protocol, if one is not already in place (see sample SAP student information form), for students, faculty, and staff to channel nonacademic concerns about a student. This should create an appropriate pathway that adheres to the local laws and regulations governing communications among teachers/parents/students/outside healthcare.

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Anorexia Nervosa Signs, Risk Factors, & Complications

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Anorexia Nervosa Signs, Risk Factors, & Complications

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What is anorexia nervosa?

Anorexia nervosa, also known as just anorexia, is an eating disorder. This disorder makes you obsess about your weight and food. If you have this problem, you may have a warped body image. You may see yourself as fat even though you have a very low body weight.

With anorexia, you may use unusual eating habits to cope with stress, anxiety, and low self-esteem. Limiting food may give you a sense of control over your life.

This problem affects more women than men. It often starts during the teenage years. The number of young women between the ages of 15 to 19 who have anorexia nervosa has increased every 10 years since 1930.

What causes anorexia nervosa?

Experts don't know what causes anorexia. It often begins as regular dieting. Over time it can lead to extreme and unhealthy weight loss. You may use extreme dieting and food limiting tricks due to fear of getting fat.

Anorexia has two subtypes:

Restrictor type. People with this type of anorexia severely limit how much food they eat. This usually includes foods high in carbohydrates and fats.

Bulimic (binging and purging) type. People with bulimia eat too much food and then make themselves throw up. They may take large amounts of laxatives or other methods to clear their bowels.

What are the risk factors for anorexia nervosa?

A person with anorexia is more likely to come from a family with a history of certain health problems. These include weight problems, physical illness, and mental health problems. Mental health problems may include depression and substance abuse.

Other things that may play a role in anorexia are:

Social attitudes

Family influences

Genetics

Brain chemical imbalances

Developmental issues

You may also be at risk if you take part in certain sports and activities that focus on body shape and size. These include:

What are the symptoms of anorexia nervosa?

Anorexia can cause a variety of symptoms. They may be related to food or weight. They may be physical or emotional.

Food or weight-related symptoms can include:

Altered body image

Low body weight

Extreme fear of becoming fat

Excessive physical activity

Denial of hunger

Fixation with food preparation

Unusual eating behaviors

Physical symptoms can include:

Poor nutritional status

Dehydration

Being very thin

Stomach pain or bloating

Constipation

Lethargy or fatigue

Unable to handle cold temperatures

Fine, downy body hair (called lanugo)

Dry or yellowish skin

Thinning hair

Brittle nails

Emotional symptoms can include:

Withdrawal from social situations

Loss of interest in sex

Irritability

Mood changes

Depression

How is anorexia nervosa diagnosed?

When you have anorexia, you may try to hide your problem from others. Over time, family members, teachers, and coaches may start to worry about your weight and behavior. Early treatment can help prevent serious health problems. Your healthcare provider will ask you about your medical history. He or she will give you a physical exam. Your healthcare provider may advise psychological testing. Talking with family members and other concerned adults can also help.

How is anorexia nervosa treated?

Treatment for anorexia can depend on your age, overall health, medical history, symptoms, and other factors. Urgent medical care may be needed for physical problems. Nutrition counseling can help you learn how to make healthy food choices. It can also help bring you back to a healthy weight.

Therapy can help you learn how to deal with emotions. It can also help you improve your coping skills and adopt healthy habits. Therapy can be done one-on-one, with your family, or with a group. Some medicines can also help to treat mental health problems such as depression and anxiety.

What are the complications of anorexia nervosa?

Anorexia is very harmful on the body, and can lead to serious problems such as:

Anemia

Heart problems (arrhythmias, slow heart rate, heart failure, and mitral valve prolapse)

Low blood pressure

Kidney problems

Electrolyte imbalance

Lack of menstruation in women

Low testosterone in men

Bone loss

Death

Can anorexia nervosa be prevented?

Experts don't know how to prevent anorexia nervosa. It may help if family members have healthy attitudes and actions around weight, food, exercise, and appearance. Adults can help children and teens build self-esteem in various ways. This includes academics, hobbies, and volunteer work. Focus on activities that aren't related to the way a person looks.

Living with anorexia nervosa

If you have anorexia, talk with your healthcare provider. You can recover from anorexia and get back your health. To do this you will need to follow a full treatment plan. During recovery, you will need to not weigh yourself all the time. You will also need to not spend a lot of time alone. It's also important to learn and avoid things that that lead to your anorexic behaviors. Dietary supplements will help make sure you get enough nourishment. Relaxation methods, such as yoga, may also help ease symptoms.

Key points about anorexia nervosa

Anorexia nervosa is an eating disorder that causes a severe and strong fear of gaining weight. You may have an altered view of being fat even when you are dangerously thin.

You may use extreme exercise, calorie and food limitations, or binging and purging to control your weight. It may give you a sense of control in your life.

This problem is dangerous because it can cause organ damage and can be fatal.

Treatment can include nutrition aids, therapy, and medicines.

A stay in a hospital may be needed. This is to help make sure the person is eating enough and not exercising too much.

This problem is more common in women than men. It may be more common for those who take part in sports and activities that focus on body shape and size. This can include modeling, dancing, and other athletic areas.

Both individual and group therapy can help in treating this disorder.

Next steps

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

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

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you.

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.

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

Ask if your 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 you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your provider if you have questions.

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Anorexia nervosa (or simply anorexia) is an eating disorder that causes people to obsess about their weight and food. People who suffer with this behavior problem have a distorted body image and see themselves as overweight even when their weight is dangerously low.

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Bulimia Nervosa Causes, Symptoms, & Risks

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Bulimia Nervosa Causes, Symptoms, & Risks

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What is bulimia nervosa in children?

Bulimia nervosa is an eating disorder. It's also called bulimia. A child with bulimia overeats or binges uncontrollably. This overeating may be followed by self-induced throwing up (purging).

A child who binges eats much larger amounts of food than would normally be eaten within a short period of time (often less than 2 hours). The binges happen at least twice a week for 3 months. They may happen as often as several times a day.

Bulimia has two types:

Purging type. A child with this type regularly binges and then causes himself or herself to throw up. Or the child may misuse laxatives, diuretics, enemas, or other medicines that clear the bowels.

Nonpurging type. Instead of purging after binging, a child with this type uses other inappropriate behaviors to control weight. He or she may fast or exercise too much.

What causes bulimia nervosa in a child?

Researchers don't know what causes bulimia. Some things that may lead to it are:

Cultural ideals and social attitudes about body appearance

Self-evaluation based on body weight and shape

Family problems

Which children are at risk for bulimia nervosa?

Most children with bulimia are girls in their teens. They tend to be from a high socioeconomic group. They may have other mental health problems, such as an anxiety or mood disorders.

Children with bulimia are more likely to come from families with a history of:

Eating disorders

Physical illness

Other mental health problems, such as mood disorders or substance abuse

What are the symptoms of bulimia nervosa in a child?

Each child may have different symptoms. But the most common symptoms of bulimia are:

Usually a normal or low body weight but sees him or herself as weighing too much

Repeated episodes of binge eating, often in secret

Fear of not being able to stop eating while bingeing

Self-induced throwing up, often in secret

Excessive exercise or fasting

Strange eating habits or rituals

Improper use of laxatives, diuretics, or other medicines to clear the bowels

In girls, irregular periods, or no period at all

Anxiety

Discouragement because he or she is not satisfied with his or her appearance

Depression

Obsession with food, weight, and body shape

Scarring on the back of the fingers from self-induced throwing up

Overachieving behaviors

The symptoms of bulimia nervosa may look like other health problems. Make your child sees his or her healthcare provider for a diagnosis.

How is bulimia nervosa diagnosed in a child?

Parents, teachers, and coaches may be able to spot a child with bulimia. But many children with it first keep their illness hidden. If you notice symptoms of bulimia in your child, you can help by seeking a diagnosis and treatment early. Early treatment can often prevent future problems.

A child psychiatrist or a mental health expert can diagnose bulimia. He or she will talk with you, your partner, and teachers about your child's behavior. Your child may need psychological testing.

How is bulimia nervosa treated in a child?

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment often involves a mix of the following:

Individual therapy

Family therapy

Behavior changes

Nutritional rehabilitation

Medicine for depression or anxiety, if needed

What are the possible complications of bulimia nervosa in a child?

Bulimia can lead to malnutrition. It can harm nearly every organ system in the body. That's why early diagnosis and treatment is important. Some health problems it may cause are:

Damage to the throat, stomach, and bowels

Dehydration

Tooth decay

Health complications may happen during treatment. Because of this, both your child's healthcare provider and a registered dietitian nutritionist (RDN) must be part of the care team. You as a parent play a vital role in treatment.

How can I help prevent bulimia nervosa in my child?

Experts don't know how to prevent bulimia. But early detection and treatment can lessen symptoms. They can also help your child's normal development. It can also improve his or her quality of life. Encouraging your child to have healthy eating habits and realistic attitudes toward weight and diet may also help.

How can I help my child live with bulimia nervosa?

Here are things you can do to help your child:

Keep all appointments with your child's healthcare provider.

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, psychiatrists, and registered dietitian nutritionists. Your child's care team will depend on your child's needs and how serious the bulimia is.

Tell others about your child's bulimia. Work with your child's healthcare provider and schools to develop a treatment plan.

Reach out for support from local community services. Being in touch with other parents who have a child with bulimia may be helpful.

When should I call my child's healthcare provider?

Call your child's healthcare provider if your child has:

Symptoms that don't get better, or get worse

New symptoms

Key points about bulimia nervosa in children

Bulimia nervosa is an eating disorder.

A child with this eating problem overeats or binges uncontrollably. He or she may also engage in other activities to control weight. He or she may cause himself or herself to throw up or exercise too much.

Social attitudes toward body appearance and family problems may lead to bulimia.

A mental health expert can diagnose this eating problem.

A child may need therapy and nutritional rehab.

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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Bulimia nervosa is an eating disorder. It's also called bulimia. A child with bulimia overeats or binges uncontrollably. This overeating may be followed by self-induced throwing up (purging). A child who binges eats much larger amounts of food than would normally be eaten within a short period of time (often less than 2 hours).

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What is binge eating disorder?

Binge eating disorder is an eating disorder that can affect children and teenagers. Kids who have binge eating disorder often eat way too much food very quickly. They usually do it in secret and feel guilty and ashamed. Children and teenagers with binge eating disorder cannot control their eating.

Kids with binge eating disorder may be normal weight or overweight. Unlike another eating disorder called bulimia nervosa, children with binge eating disorder do not try to get rid of the food by making themselves vomit or taking laxatives.

Signs of binge eating disorder include:

Eating very large amounts of food

Eating when not hungry

Eating very fast

Eating so much that they feel sick

Eating in secret when they think no one will notice

Feeling depressed, anxious or ashamed about overeating

Repeatedly losing weight and then gaining it back

Kids with binge eating disorder may be overweight, but they can also be normal weight.

How is binge eating disorder diagnosed?

To be diagnosed with binge eating disorder, a child must eat a lot of food very quickly and not be able to control their overeating. This must happen at least twice a week for at least six months. The child must also show at least three of the symptoms listed above.

Kids who vomit or take laxatives after overeating are diagnosed with bulimia nervosa instead of binge eating disorder.

How is binge eating disorder treated?

The main goal of treatment for binge eating disorder is to build healthier eating habits and stop binging. Treatment can involve therapy, medication and self-help programs.

Cognitive behavioral therapy (CBT) is one of the most common therapies for binge eating disorder. CBT teaches kids healthier ways of dealing with upsetting emotions so that they can replace overeating with more positive habits that leave them feeling better about themselves. A form of CBT called interpersonal therapy can help the child to understand the difficult relationships that may make them turn to overeating.

If therapy on its own doesn't work, kids with binge eating disorder may also be prescribed antidepressant or anticonvulsant medication.

Sometimes, treatment for binge eating disorder includes behavioral programs to help with weight loss. However, not all children with binge eating disorder need to lose weight.

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Quick Guide to Binge Eating Disorder - Child Mind Institute

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Get tips on understanding binge eating disorder in children and teenagers. Kids who have binge eating disorder often eat way too much food very quickly. They usually do it in secret and feel guilty and ashamed. Children and teenagers with binge eating disorder cannot control their eating.

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Emotional & Behavioral Disorders in the Classroom

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Emotional & Behavioral Disorders in the Classroom

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by Becton Loveless

"Emotional and Behavioral Disorder" is an umbrella term under which several distinct diagnoses (such as Anxiety Disorder, Manic-Depressive Disorder, Oppositional-Defiant Disorder, and more) fall. These disorders are also termed "emotional disturbance" and "emotionally challenged." According to the Individuals with Disabilities Education Act (IDEA), children with emotional and behavioral disorders exhibit one or more of these five characteristics:

1. An inability to learn that cannot be explained by intellectual, sensory, or health factors.

2. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

3. Inappropriate types of behavior or feelings under normal circumstances.

4. A general pervasive mood of unhappiness or depression.

5. A tendency to develop physical symptoms or fears associated with personal or school problems.

IDEA guarantees students access to a Free and Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE) possible. As such, students diagnosed with emotional disorders (ED) are often included in general education classrooms. However, severe cases often require students to be taught in special education "cluster units," self-contained programs, or even separate schools.

Under the umbrella term of Emotional and Behavioral Disorders, there are two categories: Psychiatric Disorders and Behavioral Disabilities.

Psychiatric Disorders

This category encompasses a wide range of conditions. Psychiatric disorders are defined as mental, behavioral, or perceptual patterns or anomalies which impair daily functioning and cause distress. Some of the most common examples of these diagnoses include:

Anxiety Disorder

Bipolar Disorder (aka Manic-Depressive Disorder)

Eating Disorder (such as anorexia, bulimia, and binge-eating disorder)

Obsessive-Compulsive Disorder

Psychotic Disorder

From a teacher's perspective, psychiatric disorders present a profound challenge for a number of reasons. For one, schools are not hospitals, and teachers can not be expected to "treat" these disorders. Students who struggle with these sorts of challenges are often undergoing treatment and may be receiving medication. Medication can affect people in unexpected ways and, because medical information is confidential, teachers may be unaware why students are acting the way they are. This makes it difficult to respond appropriately to certain behaviors. Additionally, students suffering from these conditions may be simply unable to meet academic and behavioral expectations. In such cases, students need to receive special education interventions of some sort, and may need to be moved into a special education classroom.

Behavioral Disabilities

Children with behavioral disabilities engage in conduct which is disruptive to classroom functioning and/or harmful to themselves and others. To be diagnosed as a behavioral disability, the behaviors must not be attributable to one of the aforementioned psychiatric disorders.

There are two categories of behavioral disabilities: oppositional defiant disorder and conduct disorder.

Oppositional defiant disorder is characterized by extreme non-compliance, negativity, and an unwillingness to cooperate or follow directions. Children with this condition are not violent or aggressive, they simply refuse to cooperate with adults or peers.

Conduct disorder is much more severe. This disorder is characterized by aggression, violence, and harm inflicted on self and others. Students with conduct disorder typically need to be taught in special education classrooms until their behavior has improved enough to allow contact with the general education population.

Strategies for Teaching Students with Emotional and Behavioral Disorders

As with other conditions, students with emotional and behavioral disorders need a positive, structured environment which supports growth, fosters self-esteem, and rewards desirable behavior.

Rules and Routines

Rules need to be established at the beginning of the school year, and must be written in such a way as to be simple and understandable. The wording of rules should be positive: "Respect yourself and others" is a better rule than "Don't hurt anyone." Keep it simple: 6 rules or less.

Consequences for breaking rules should also be established at the beginning of the school year, and applied consistently and firmly whenever the rules are broken. The consequences must be consistent and predictable. When administering consequences, provide feedback to the student in a calm, clear manner. That way, the student understands why the consequence is necessary. Try to avoid becoming emotionally reactive when rules are broken. Emotional reactivity gives the student negative attention, which many children find very rewarding. Remain calm and detached, be firm yet kind. It's a difficult balance to achieve, but crucially important for positive results.

Routines are very important for classroom management. Students with emotional and behavioral disorders tend to struggle with transitions and unexpected change. Going over a visual schedule of the day's activities is an effective way to start the day, and helps the students feel grounded.

Techniques for Supporting Positive Behavior

Students with emotional and behavioral disorders often need to receive instruction in a special education setting because their behavior is too maladaptive for a general education classroom. Here are a few ideas to guide and support growth towards more positive, adaptive behavior:

Token Economy - Students earn points, or tokens, for every instance of positive behavior. These tokens can then be used to purchase rewards at the token store. In order for a token economy to be effective, positive behavior must be rewarded consistently, and items in the token store must be genuinely motivating for the student. This takes a fair amount of preparation and organization, but has proven to be quite effective.

Classroom Behavior Chart - A chart which visually plots the level of behavior of every student in the classroom. Students who are behaving positively progress upwards on the chart; those who are behaving negatively fall downwards. This makes every student accountable, and helps you monitor and reward progress. This won't work if difficult students perpetually stay on the bottom of the chart. Focus on the positive to the fullest degree possible, and keep them motivated.

Lottery System - Similar to the token economy, students who behave in positive ways are given a ticket with their name on it. These tickets are placed in a jar, and once or twice a week you draw one out. The winner of the lottery is rewarded with a prize.

Positive Peer Review - Students are asked to watch their peers, and identify positive behavior. Both the student who is behaving positively and the student who does the identifying are rewarded. This is the exact opposite of "tattle-telling," and fosters a sense of teamwork and social support in the classroom.

Teaching children with emotional and behavioral disorders can be extremely challenging. Remember: fostering and rewarding positive behavior has proven to be vastly more effective than attempting to eliminate negative behavior. Punishment and negative consequences tend to lead to power struggles, which only make the problem behaviors worse. It is not easy to remain positive in the face of such emotionally trying behaviors, but don't give up. Your influence could mean a world of difference to these students who are struggling with an incredibly difficult condition.

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Emotional and Behavioral Disorders in the Classroom

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Explore the characteristics of children with emotional and behavioral disorders, as well as strategies for teaching these student.