On Your Mind: Normal teenager or something serious?

on your mind

How can I tell the difference between normal teenage moodiness and something more serious? I’m amazed at how my 15-year-old son can be a happy kid one day and then be sullen, irritable or gloomy the next day. I’ve got emotional whiplash! He seems to be in a “what’s the point of school, grades, college, etc.” phase of life right now, and I don’t know if that’s normal or if I should be concerned. I don’t want to overreact but I don’t want to miss red flags either. Got any advice?

Response by Carla Jones, LMFT, LPC

Thank you so much for reaching out and asking a question many parents have while raising a teenager. As you may recall, moving through your teenage years is challenging, even in the very best of circumstances. We expect some ups and downs while raising a teenager, but sometimes it’s hard to tell whether something more serious is happening.

From the brief information you provided, you’re identifying mood swings, irritability, and maybe even some pessimism or hopelessness. Beyond the dismissive and unhelpful, “congratulations you have a teenage son,” there are a few ways we can try to answer this. While all of these signs can be components of behavioral health problems, such as depression, it might be useful to frame the response within normal adolescent development.

There are three primary developmental milestones teens go through: physical, cognitive, and social.  Each of these milestones has challenges and can contribute to that feeling of emotional whiplash you’re describing.

There’s not space here to overview each area, but we’ll point out an example or two when normal development can run up against the red flags you want to catch. One thing to remember, you’re  going to miss those red flags if you’re not spending time with your son and asking him sometimes difficult and direct questions.

Physical

I am sure you are aware of some of the physical changes that are already happening with your son’s body. Body image is a big deal during this period and impacts how well he navigates healthy social and sexual development. It’s normal for him to be concerned and a little insecure about how he looks, and every teenager has probably at some point thought he/she has some sort of physical defect. It becomes a problem when those negative views about appearance become pervasive. This blends with the milestone below, but a consuming negative view of self can be a sign of a depression. Separate but related to the physical milestones are physical signs of mental health issues. Rapid weight gain or loss can be cause for concern, as can excessive dieting or exercise. And while an increase in sleeping can be a sign of depression, it is normal in adolescence to need more sleep. Insomnia, however, may be more of a concern and can impact decision making and impulsivity. Those are just a few of the areas to be aware of.

teenage-boyCognitive

One of the “jobs” of adolescence is developing a sense of self or identity and direction. All adolescents have some struggle with balancing that need for personal growth and autonomy with a desire to still feel connected to and supported by family. That creates tension, especially when part of your job is to help keep him safe. You are also going to see some resistance and defiance as a normal part of this period of development. Although teens may say they do not need structure, this is a time when structure is very important. Teenagers need to know and feel their parents are providing them with stability, structure and consistence. (Remember teens are not yet ready to enter the adult world. They still need your guidance and support more now than ever.)

Alternately, that struggle between dependence and independence and trying to figure out what the future holds can, at times, look like or become pessimism or hopelessness. It is a problem when there is not the dynamic movement in development and a child gets stuck in a belief that he/she is not capable of success in the future. That pervasive negative view of the future can also be a sign of depression and other behavioral health issues.

Social

We talked about how some rapid changes in weight or behaviors can be a cause for concern. What about rapid changes in appearance or friends? Usually not. (Wearing inappropriate/excessive dress for weather, however, can be an indicator of mental health concerns and can be done to cover up cutting or other self-harm.) Part of forming identity for your son is going to include trying different ones on. Appearance will change. Friends will change. Your son is going to start viewing himself through the eyes of his peers more so than how you have helped define him. Understanding that’s part of normal development is also part of your job, as is balancing that understanding with maintaining some structure. A red flag may be when relationships or peer groups become unhealthy through inappropriate risk taking (some risk taking is also normal). Another flag would be if your son has a completely negative view of others or feels like he does not have anything to offer to friends or a peer group. The feeling of belonging is a huge protector against depression and other mental health concerns.

red-flagRisk

We’ve not talked about this, but adolescents are more impulsive. That can put them more at risk of harming themselves when they are not successfully moving through those developmental milestones and may have developed mental health issues. Feelings of not belonging, negative views of self, and others, and the future, can be indicators of depression or other problems. There’s not an expectation that you as a parent are going to make diagnostic assessments or complete comprehensive risk assessments. What you can do is note when you are worried and ask the hard questions. If after some reflection you have concern about your son’s well-being, it’s okay to say something like: “hey, I’m noticing that you’re struggling here. Sometimes when kids go through tough times they have thoughts they might not normally have. One of those thoughts can be about hurting or killing themselves. Are you having thoughts of hurting or killing yourself?” It may feel uncomfortable, but when needed, it’s important to ask the question. You can even provide some resources such as the National Suicide Prevention Lifeline at 1.800.273.8255.   http://suicidepreventionlifeline.org/ He may not agree to using it immediately, but he may hold on to it.

Communication

Even if there is not the concern about depression or self-harm, keeping those lines of communication open is essential. There are some basic ways to do this. First, just try to sit down and have a conversation with your child. Make sure it is a time that he is receptive to talking (sometimes it’s hard to find that time), but you know your teenager best. Remember teenagers will be resistant so approach with love and kindness, reminding him that you love him and care about his life struggles. Focus on listening to your child, not responding, to hear what they have to say. Listening to your teen is one of the best tools you have. Teens want to be heard, as this allows them to feel what they have to say is important. Keep an open mind and make sure you don’t let their behaviors push your buttons or cause you to become defiant or defensive. (Remember they are testing everything just like we did as a teen.)

Help

If you have concerns or have identified some risk after talking to your child, please reach out to a mental health professional. A professional can help a teenager who is stuck or struggling. Thank you so much for your question and Happy Holidays to you and your family.

Therapists at Ozark Guidance would be happy to answer your questions and read what’s on your mind. Click the butterfly icon below to fill out an anonymous submission form with your question or concern. The form contains NO identifying information and is designed to give local women an online place to share concerns with a person qualified to offer feedback.

Disclaimer: This RESPONSE does not provide medical advice It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on nwaMotherlode or Ozark Guidance websites.

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On Your Mind: Could it be an eating disorder?

on your mindMy 13-year-old daughter has lost weight and seems to be obsessed with how much she eats, calories, fat grams, sugar, etc. My husband and I are worried that she could have an eating disorder. Can you give us some advice on how to talk to her about this without causing her to feel like we’re accusing her of something or like we’re trying to control her? What type of doctor do we take her to for an accurate diagnosis?

Response by Sara Laughinghouse, LPC

First and foremost, thank you for reaching out and noticing the changes in your daughter. It is difficult during the teenage years to know what is ‘normal adolescent development’ and what is a more serious issue. I commend you for taking note that your daughter appears to be losing weight and is hyper focused on her food intake. The good news is there are ways to talk to her and gain more understanding as to what is going on.

scale 200My first suggestion would be to schedule an appointment with your primary care physician. This is a great place to start because you can present your information and the physician can rule out any medical concerns.  Also, this allows you to begin the conversation. Simply letting your daughter know what you’re noticing can open the door to the conversation you want.

This is where I suggest you use empathy because you don’t want to push her away. However, something as simple as, “I’ve noticed you’ve lost some weight lately. We want to do a check-in with our doctor to make sure everything is okay,” opens the door to the conversation and the doctor’s visit. Statements of observation keep things simple and do not point blame, allowing the dialogue to open.

You can use information from the doctor’s visit to piggy-back the conversation even further. Try to remember to state your observations and concerns versus blaming or suggesting such as, “you-type statements.”  This will allow your daughter to feel that she can trust you and gives her that sense of control you mentioned.

Speaking of control, you’re right on track. Teenagers are developing their own sense of autonomy and they want control. I would encourage the following when starting to develop the conversation with your daughter:

1. Promote Empathy. Empathy means you’ll put yourself in your 13-year-old daughter’s shoes and try to think what it must be like to be her. Try to feel the pressure she maybe experiencing about her current life, including the weight issues, and go from there. Sometimes parents get lost in trying to immediately fix the problem and can neglect to listen to what may be an underlying source of the problem. Your daughter could be experiencing other stressors that are connected to her choices with food that may not mean a full on eating disorder.teenage-girl

2. Promote Support. You already seem to have support for her with your desire to ‘not control her or accuse her’ however, making sure you let her know you support her and have noticed changes is a crucial factor. Often, parents make assumptions that “their kids just know” because it appears to make sense but there is power in saying the actual words. It reinforces that you are there for her no matter what.

3. Promote Communication. Communication is hard. It’s especially challenging with teenagers. However, the more you model healthy communication and overcome hard conversations, the more comfortable they will become with doing it, too. If you can come at this conversation from a place of love and understanding versus accusing and blaming, the more apt she will be to respond positively. If you’re looking for something more concrete in regards to a response, I really like opening a hard conversation with vulnerability. Vulnerability happens when we let others see what’s going on inside of us. Letting your daughter know exactly what you are feeling allows her to see that vulnerability is okay, which can reduce fear associated with the situation. Statements such as “I feel worried about how you may react to what I want to talk to you about, but I feel concerned about ______,” is an example of how to open with your own feelings. This is another way to open this dialogue and provide a safe environment to encourage your daughter.

4. Promote listening. Listen to what she has to say before you make a decision, and involve her in that decision. This is what adolescence is all about! There is an art to teaching and listening. This is a great time to give her some control by listening to what she has to say on her issues while still reinforcing that you are responsible for her safety and ability to make informed decisions. The more she feels part of the conversation and decision, the more likely she is to respond positively.

Today, I focused on how to start this conversation with your daughter, but I want you to remember that eating disorders are complex. Don’t forget about the messages you send yourself as a parent. Modeling healthy eating patterns and confronting misconceptions about food are great ways to provide an example that reinforce positive messages about weight and food.

Remember adolescents receive messages about food and weight daily. Therefore, it’s important to make sure you’re promoting positive, healthy messages at home while exploring your concerns with your daughter.

Finally, you don’t have to explore these concerns alone. Seek support through a mental health professional. There could be other contributing factors that are impacting her eating patterns. A mental health professional will be able to provide support in helping you determine the best course of treatment.

Thank you for reaching out!

Therapists at Ozark Guidance would be happy to answer your questions and read what’s on your mind. Click the butterfly icon below to fill out an anonymous submission form with your question or concern. The form contains NO identifying information and is designed to give local women an online place to share concerns with a person qualified to offer feedback.

Disclaimer: This RESPONSE does not provide medical advice It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on nwaMotherlode or Ozark Guidance websites.

On Your Mind: “He didn’t mean it…”

on your mindI am in a very committed relationship of six years. While we aren’t married, we live as we are and present our relationship to the world as if we were.

Today, after an argument I would not deem at all “heated” my boyfriend told me he’d put me through a wall. I sat down next to him and said to not say stupid things he does not mean. He has said this very thing to me before. woman2 200Today, he put his hands on me. He lifted me up off the couch and shoved me forcefully to the ground. It hurt, but not as much as the shock, pain and slight loss of integrity did.

In the past, like I said, he has said he’d “put me through a wall” but it was always heat of the moment arguments and he didn’t mean it. He has thrown things at me, but it has been years since he has done so and our relationship has matured in many aspects in comparison from then to now.

We haven’t talked since this happened. He’s currently on the couch asleep and I don’t know what I should be planning to do. I know it’s likely he’d do it again, but I don’t know if this is the kind of thing where you leave him now before anything else can happen or tell him if he does it again, I’m gone.

Response by Jared Sparks, LCSW, PhD, Clinical Director

Thank you so much for reaching out. I’m sorry you’re going through this, but you’re not alone. And the fact you’re recognizing that this is not okay and you’re actively thinking about options is really positive.

What’s clear from the brief information you’ve shared is that you’ve invested a lot in this relationship. It also seems like making changes in this commitment of 6 years would be noticed by others. Obviously, there’s more to it than that, but even on the surface, concerns about the time and energy placed in a long-term relationship and how others may respond to a change in that relationship can be barriers to leaving.

First things first though, you were asking about leaving now or waiting to see if he threatens and hurts you again….and, yes, framing it that way may sound really off-putting and dismissive, but that’s not the intent. The fact that abusers have the ability to, at times, appear kind and supportive makes it really disorienting when you’re trying to look at the big picture, including violence.

The difficulty in reconciling the abuse with all the good qualities of the person you’ve cared about for so long can lead to some minimizing of what happened. You’re certainly not the first person to say, “He did not mean it.” What’s important to remember though is this: What you are describing is a pattern of verbal, emotional, and physical abuse that is more easily triggered over time. That means that the violence originally started after heated interactions and now it can be triggered after only an argument.

When you say “it’s likely he’d do it again,” you’re speaking directly to that reality. As compelling as all of that may be, it’s important to acknowledge the decision to stay or leave an abusive relationship is complex.

This decision does not have to rely solely on trying to figure out how likely it is that he’ll do it again or trying to determine if there is a certain threshold of abuse that, once crossed, should be a clear indicator to leave. There are other ways to assess whether you’re in an abusive relationship. A few of the common characteristics of an abusive partner include:

  • red-flagDenying or minimizing the violence or impact on the victim, friends, or family.
  • Blaming something external for the abuse. This can range from blaming the victim to drugs, alcohol, stress, etc.
  • Being charming between periods of violence.
  • Having low self-esteem and feelings of powerlessness but outward appearances of success.
  • Being controlling, possessive, jealous. Examples are: constant calling, checking on the victim (including tracking), or even restricting access to friends or family. (Many phones have the ability to locate others through GPS. Checking your privacy settings can be one way to control whether you want your movements followed.  Sometimes it’s necessary to scan the victim’s car for a tracking system that may have been placed there by the offender.)

domestic-abuseMore offender characteristics can be found at the National Coalition Against Domestic Violence, http://www.ncadv.org/ This site has helpful pointers on both recognizing abusive partners and how to plan ahead for leaving.

We’re fortunate in Northwest Arkansas to have wonderful resources for dealing with domestic violence:

  • Peace at Home Shelter provides crisis services, shelter, advocacy, and support groups http://peaceathomeshelter.org/. It can be a great place both to start and receive some ongoing support.
  • There are also counseling services through Ozark Guidance or other community providers.

A photo by María Victoria Heredia Reyes. unsplash.com/photos/0Hvh69RZjXsWe mentioned that the decision to leave is not only about evaluating the potential for violence. It’s about evaluating your relationships with others and where you are in your readiness to change. Counseling can help with that process. It can also help with the trauma. Experiencing violence directly or even witnessing it can create mental health problems that need attention.

As we said earlier, the decision to leave can be complicated. We’ve only touched on some of the issues related directly to the offender and the violence. For many, other issues (such as worrying about children and finances) weigh heavily in the decision to leave or stay. Whatever the reason(s), it’s easy to see why it can take multiple attempts to leave before the decision is made to permanently end the abusive relationship.

As you are working your way through this, there a few important things to always keep in mind.

  • Physical assault/battery is a crime. Call 911 if you feel you are in danger.
  • An incident of domestic violence is rarely an isolated occurrence. Physical violence tends to escalate in frequency and intensity.
  • The most dangerous time in the relationship is when the decision has been made to leave the abuser.
  • Abusers need treatment themselves before they can engage in a healthy relationship. This type of treatment is often more effective when it’s tied to a court mandate.

We’re hoping for the best for you and that you keep reaching out to others for support.

Therapists at Ozark Guidance would be happy to answer your questions and read what’s on your mind. Click the butterfly icon below to fill out an anonymous submission form with your question or concern. The form contains NO identifying information and is designed to give local women an online place to share concerns with a person qualified to offer feedback.

Disclaimer: This RESPONSE does not provide medical advice It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on nwaMotherlode or Ozark Guidance websites.

On Your Mind: Bed-wetting issues

on your mind

My son just started Kindergarten and he is still having issues with bed-wetting. Are there any mental health problems that could be causing this to happen to a 6-year-old? What can we do to help?

Response by Maya Damet-Powell, LCSW and Haden Shepherd, LPE-I

This is a great question and one that comes up more often than you probably think. While this can definitely be frustrating to deal with, the good news is that your family is not alone in dealing with bed-wetting issues, even at your child’s age.moon-1082759_640 (2)

The range of ‘normal’ childhood development is actually pretty broad. Unfortunately, understanding the issues underlying the behavior can often be more complex and not as well understood.

The first step in dealing with the issue would be to set up an appointment with your child’s pediatrician. The pediatrician will be able to help determine if there are any underlying medical issues that may be contributing to the bed-wetting your child is experiencing. Assuming the doctor determines that medical concerns are not contributing to the issue, the next step would be to consider any potential stressors your child is experiencing.

Have there been any major life changes or traumatic events that may have precipitated the bed-wetting? Even things that we consider to be a typical a part of growing up, such as starting school, can be especially stressful for children.

Do you notice any anxiety around bedtime? Are there nightmares associated with the bed-wetting? If these things are occurring in excess of what you would expect to be typical for your child, then they may indicate a possible mental health issue and consulting with a mental health professional may be appropriate. Taking the time to speak with a mental health professional would help you assess your child’s situation from a knowledgeable and objective standpoint, something that can be very important when dealing with an issue that is likely causing you as a parent stress and anxiety.

As for some simple ideas you may want to try out at home, avoid giving your child liquids a couple of hours before bedtime and have your child use the bathroom immediately before crawling into bed. You may want to try setting an alarm for the middle of the night for your child to get up and use the restroom (not an easy thing to do!).

If your child experiences fear of the dark, leaving a light on or having nightlights could be helpful.

Lastly, the most important thing you can do as a parent is to be available to help your child process any difficult emotions or thoughts that might be causing your child stress. Helping to normalize and validate your child’s emotions and experiences will help reduce any stress and anxiety that may be linked to the bed-wetting.

Your child is also likely to feel frustrated or embarrassed about the bed-wetting behaviors, so showing your child patience and understanding, rather than getting angry, shaming, or making your child feel guilty, will help to defuse the tension in a stressful situation. That way, the situation can get better before it gets worse.

Therapists at Ozark Guidance would be happy to answer your questions and read what’s on your mind. Click the butterfly icon below to fill out an anonymous submission form with your question or concern. The form contains NO identifying information and is designed to give local women an online place to share concerns with a person qualified to offer feedback.

Disclaimer: This RESPONSE does not provide medical advice It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on nwaMotherlode or Ozark Guidance websites.

On Your Mind: A mom’s mid-life crisis?

on your mindNOTE: The question below reached us through our “online hotline” button which lets anyone send a question to a local counselor at Ozark Guidance — in a completely anonymous way. The email comes in with no email address and no identifying information. We set it up this way so women would feel free to write about anything on their mind.

I’ve always heard jokes about people having a mid-life crisis. Now I’m wondering if I’m having one. I turned 41 a few months ago and I keep feeling periods of overwhelming dissatisfaction and sometimes sadness. I’m married with kids and there’s nothing in particular that’s going wrong, but I keep feeling like the best woman2 200parts of my life are already behind me. Then I feel guilty for thinking this way because I know other people have “real problems.” Is a mid-life crisis a real thing? Is this what I’m having? What can I do to get over it?

Thank you for submitting your situation. I think your question has the potential to interest many readers because most people reaching your age may feel this way at times. Thoughts and feelings can range anywhere along the continuum from pride and satisfaction to resentment and despair.

So, in short, yes, a mid-life crisis is an actual phenomenon that your letter appears to be describing as happening to you — at least in part. So how does a person “…get over it?” Realizing that every person is a unique individual, not knowing a great deal that is specific about you, and that there is no perfect answer that would satisfy every reader, I’ll offer these brief tips:

1)      Truly appreciate what you have.

2)      Be more in the present moment and practice acceptance.

3)      Think about living a value-driven life.

Let’s look at truly appreciating what you have. Ever hear of unfavorable comparisons? For example, one unfavorable comparison could be the 41 year old you comparing yourself (presumably physically) to the 26-ish year old you (or whatever age you feel was near your peak physical abilities). Another could be comparing your assets to “the Jones’” next door and the everlasting attempts to keep up. It sounds like you could benefit from a greater sense of inner contentment. While many would like to think about how things were or the various decisions they’ve made and come away with a smile, many come away with feelings similar to yours. This can occur when we think of lost opportunities or comparing where we are with others who appear to be more successful. It’s more beneficial to think about and appreciate those things that we have versus longing for things we think we want. This aspect of living ties in with another aspect called acceptance.

Be more in the present moment and practice acceptance. Being “mindful” refers to having complete awareness of the present moment while remaining non-judgmental — to fully experience what is happening around and to you by accepting your experience versus trying to manipulate things to give yourself a feeling that agrees with how you think the experience should feel.

For example, in Acceptance and Commitment Therapy, developed by Steven C. Hayes, PhD., he uses a metaphor (one of many) about a person (let’s name her Tina) inviting her entire family over to her place for a party. I will paraphrase here in the spirit of brevity, but all of Tina’s family shows up for the party, except Aunt Ida, who arrives later. Aunt Ida is known to complain about most everything, provides everyone with insults, and thanks no one for anything.

Tina’s choice, as she watches Aunt Ida’s car pull up to her place, is to allow her Aunt to come in or try to keep her out. Remember, Tina invited her entire family! She can block her Aunt from entering, but that would keep Tina at the door, not enjoying her party, and disrupt the party goers who are wondering what Tina’s doing at the front door. Tina’s night would appear to be ruined. So, Tina can attempt to keep Aunt Ida out OR she can accept the fact that Aunt Ida has arrived, welcome her, show her to food and drink, and then go and enjoy the party as planned. Accepting Aunt Ida’s arrival allows Tina the freedom to do what’s important to her and what she wanted to do in the first place — spend time with the family. This brings me to the final tip — living a valued-woman flower200driven life.

Living a value-driven life means engaging in those things that you value, those things that are important to you. For example, if being close to family is something you value, then keeping in touch frequently, visiting frequently, and sharing your experiences and feelings with your family members is meaningful to you. If you follow through with these actions, this part of your life would presumably be fulfilled. Conversely, if being close to family is something you value, and you are not able to see them often or at all, not able to share meaningful time with them, you will probably not be satisfied with this aspect of your living. Value-driven living is not obtaining a goal; it is a way of living.

In sum, by truly appreciating all you have, being in the present moment and accepting your experience, and living a value-driven life, you have the opportunity to live a more fulfilling and happy life. However, if your thoughts and feelings continue to develop into feelings of overwhelming dissatisfaction, sadness, and guilt, please consider seeking out a mental health professional (MHP) in your community. It was my pleasure to respond to your concern.

Therapists at Ozark Guidance would be happy to answer your questions and read what’s on your mind. Click the butterfly icon below to fill out an anonymous submission form with your question or concern. The form contains NO identifying information and is designed to give local women an online place to share concerns with a person qualified to offer feedback.

Disclaimer: This RESPONSE does not provide medical advice It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on nwaMotherlode or Ozark Guidance websites.