Psych Central Original articles in mental health, psychology, relationships and more, published weekly. 2016-05-24T17:15:17Z Janet Singer <![CDATA[Obsessive-Compulsive Disorder or Just a Quirk?]]> 2016-05-20T19:29:39Z 2016-05-24T17:15:17Z ]]> OCD or just a quirkAlmost everyone I know who blogs about obsessive-compulsive disorder, myself included, has written at least one post expressing frustration over the use of the phrase “I’m so OCD.” Aside from being grammatically incorrect — nobody is OCD — it trivializes the disorder and lends misunderstanding to an illness that is already often misrepresented.

I don’t believe anyone I know who actually has OCD has ever said, “I’m so OCD.” Certainly nobody who really has obsessive-compulsive disorder would ever wish to be “more OCD,” although many of these ill-informed posts suggest that would be a good thing.

Let’s face it, though. Obsessive-compulsive disorder can be confusing — a tough illness to figure out. For example, some people noticeably obsess a lot. So do they have OCD? Maybe, or maybe not. A friend of yours has to line up his shoes in a particular order before he goes to sleep at night. That’s a compulsion and means he has OCD, right? Well, maybe, but not necessarily. And what about that nice lady you work with who seems calm, cool, and collected all the time, no matter what? Guess what? She has OCD!

How can we even begin to sort this all out? Understanding the definition of OCD can help. Also, it is important to be able to distinguish between what are likely our own unique habits, routines, and idiosyncrasies as opposed to what might be compulsions associated with obsessive-compulsive disorder. The former behaviors might even be classified as “quirks,” which would not fall under the realm of OCD.

So when is it OCD?

Well, referring back to the definition of the disorder, the behaviors (compulsions) of those with OCD are triggered by fear or anxiety. Those with OCD feel they have no choice but to engage in their compulsions. They don’t want to complete their rituals, they have to complete them.

If we don’t have OCD, our behaviors are performed freely. If we do have OCD, left untreated, we are captive; tormented by our obsessions until rituals are completed. It should be noted that those with OCD typically realize their compulsions make no sense, but they are compelled to complete them anyway. For example, someone who has to flick a light switch on and off 10 times to keep her parents safe realizes there is no connection at all between these occurrences. But just in case, just to be certain, she completes the ritual.

Ah, good ol’ uncertainty — the fuel for the fire of OCD.

In a nutshell, those with OCD are tormented. But the torment isn’t always obvious to others. What about that nice lady you work with? You’d never know! Because most of my son’s compulsions were mental, my husband and I didn’t even know he had OCD until he told us. And we were living together! To me this is one of the cruelest aspects of the disorder. It can torture someone from the inside, and nobody else would ever know until things got really bad.

So for all those out there who still say, “I’m so OCD,” unless you are trying to tell us you are tormented, have paralyzing fear, and are living in an almost constant state of distress and anguish, please stop. Chances are you just have quirks.


John M. Grohol, Psy.D. <![CDATA[Facts & Statistics on Bullying]]> 2016-05-24T12:59:35Z 2016-05-24T12:59:35Z Bullying has become more of a problem in children and teens with the popularity of social media and anonymous communication through online apps and websites. Bullying is when a person […]]]>

Bullying has become more of a problem in children and teens with the popularity of social media and anonymous communication through online apps and websites. Bullying is when a person is the victim of aggressive, mean-spirited behavior from another person or group of people. This kind of behavior usually occurs in school or is school-related, and the behavior is constantly repeated and goes on for a long period of time.

Children and teenagers who bully use their unequal power against kids or teens who are younger or unable to fight back in any meaningful way. This imbalance of power is key, because bullies look for victims who cannot defend themselves. While sometimes the bullying is physical, increasingly bullying behavior is done electronically online, through apps, Facebook, other social media, or websites. This form of bullying is referred to as “electronically bullied.” The point of bullying is to exert control and cultivate fear in the victim. In short, a bully seeks to hurt their victim through physical, emotional or psychological means — or through a combination of all three.

Bullying is a serious issue of concern. According to Gentry & Pickel (2014), “victims are more likely than other students to experience physical health issues, anxiety, depression, and suicidal ideation.” In addition, victims’ grades decline “and they might avoid going to school to escape victimization or drop out of school altogether.” It is so serious a problem, nearly all U.S. states have enacted laws to address it. It most often occurs within middle and high school, but has also been documented to occur among university and college students (Chapell et al., 2006) and in the workplace (Hemmings, 2014).

Types of Bullying

According to the U.S. Department of Health & Human Services, there are three primary types of bullying: verbal, social (also called “relational”), and physical.

Physical bullying refers to any bodily assault on the victim, such as hitting, kicking, or pushing.

Verbal bullying involves statements made directly to the victim by the perpetrator, for example, name calling, threats, abusive language, humiliation, and mockery.

In contrast to these direct types, social or relational bullying is indirect, consisting of attempts to damage the victim’s relationships with others by manipulating others’ feelings or actions toward the victim. For instance, the perpetrator might spread rumors or gossip about the victim, deliberately ignore him or her, or enlist others to isolate the victim socially.

Although relational bullying is common (Wang, Iannotti, & Nansel, 2009) and associated with long-lasting emotional distress and depression in victims (Bauman & Del Rio, 2006), studies have consistently demonstrated that teachers and school personnel tend to rate this type as less serious than the others. Additionally, participants report being less likely to intervene when they see incidents of relational bullying, they express less empathy for the victims, and they might not even define this type as “bullying” (Bauman & Del Rio, 2006; Jacobsen & Bauman, 2007; Maunder et al., 2010).

Statistics of Bullying

According to Gentry & Pickel (2014), estimates of prevalence rates differ depending on the methodology and sample used. However, overall data suggest that “24 percent to 45 percent of U.S. school children are bullied during the course of a year, and up to 20 percent are victimized several times per week (Swearer & Cary, 2003). Nansel et al. (2001) found that almost 30 percent of students in Grades 6 through 10 reported moderate or frequent involvement in bullying as victims, perpetrators, or both.”

Boys have been found to engage in physical bullying more often than girls, but the evidence is mixed regarding gender differences in relational/indirect bullying (see Underwood, 2003 for a review of the evidence). Boys tend to be bullied by other boys, whereas girls report being bullied by both girls and boys (Whitney & Smith, 1993).

According to the CDC (2014), 14.8 percent of students had been electronically bullied, including being bullied through e-mail, chat rooms, instant messaging, websites, or texting, during the 12 months before the survey. The prevalence of having been electronically bullied was higher among female (21.0 percent) than male (8.5 percent) students. The prevalence of having been electronically bullied decreased from 2011 (16.2 percent) to 2013 (14.8 percent).

Nationwide, 19.6 percent of students had been bullied on school property during the 12 months before the survey (CDC, 2014). The prevalence of having been bullied on school property was higher among female (23.7 percent) than male (15.6 percent) students. The prevalence of having been bullied on school property did not change from significantly from 2011 (20.1 percent) to 2013 (19.6 percent).



Bauman, S., & Del Rio, A. (2006). Preservice teachers’ responses to bullying scenarios: Comparing physical, verbal, and relational bullying. Journal of Educational Psychology, 98, 219–231. doi:10.1037/0022-0663.98.1.219

CDC. (2014). 1991–2013 high school youth risk behavior survey data. Retrieved from

Chapell, M. S., Hasselman, S. L., Kitchin, T., Lomon, S. N., MacIver, K. W., & Sarullo, P. L. (2006). Bullying in elementary school, high school, and college. Adolescence, 41, 633–648.

Gentry, RH & Pickel, KL. (2014). Male and female observers’ evaluations of a bullying case as a function of degree of harm, type of bullying, and academic level. Journal of Aggression, Maltreatment & Trauma, 23, 1038–1056.

Jacobsen, K. E., & Bauman, S. (2007). Bullying in schools: School counselors’ responses to three types of bullying incidents. Professional School Counseling, 11, 1–8. doi:10.5330/PSC.n.2010-11.1

Maunder, R. E., Harrop, A., & Tattersall, A. J. (2010). Pupil and staff perceptions of bullying in secondary schools: Comparing behavioral definitions and their perceived seriousness. Educational Research, 52, 263–282. doi: 10.1080/00131881.2010.504062

Underwood, M. K. (2003). Social aggression among girls. New York: Guilford.

Wang, J., Iannotti, R. J., & Nansel, T. R. (2009). School bullying among adolescents in the United States: Physical, verbal, relational, and cyber. Journal of Adolescent Health, 45, 368–375. doi:10.1016/j.jadohealth.2009.03.021

Whitney, I., & Smith, P. K. (1993). A survey of the nature and extent of bullying in junior, middle and secondary schools. Educational Research, 35(1), 3–25. doi: 10.1080/0013188930350101

Darlene Lancer, JD, MFT <![CDATA[Trauma and Codependency]]> 2016-05-20T19:17:40Z 2016-05-23T17:15:12Z ]]> trauma and codependencyYou can make significant strides in overcoming codependency by developing new attitudes, skills, and behavior. But deeper recovery may involve healing trauma that usually began in childhood. Trauma can be emotional, physical, or environmental, and can range from emotional neglect to experiencing a fire.

Childhood events had a greater impact on you then than they would today because you didn’t have coping skills that an adult would have. As a consequence of growing up in a dysfunctional family environment, codependents often suffer further trauma due to relationships with other people who may be abandoning, abusive, addicted or have mental illness.

Childhood Trauma

Childhood itself may be traumatic when it’s not safe to be spontaneous, vulnerable, and authentic. It’s emotionally damaging if you were ignored, shamed, or punished for expressing your thoughts or feelings or for being immature, imperfect, or having needs and wants. Some people are neglected or emotionally or physically abandoned and conclude they can’t trust or rely on anyone. They hide their real, child self, and play an adult role before they’re ready.

Divorce, illness, or loss of a parent or sibling also can be traumatic, depending upon the way in which parents handled it. Occurrences become harmful when they’re either chronic or severe to the extent that they overwhelm a child’s limited ability to cope with what was happening. For more on shame and dysfunctional parenting, see Conquering Shame and Codependency: 8 Steps to Freeing the True You.

How you’ve encountered these experiences are your wounds. Most everyone manages to grow up, but the scars remain and account for problems in relationships and coping with reality. Deeper healing requires reopening those wounds, cleaning them, and applying the medicine of compassion.

Symptoms of Trauma*

Trauma is a subjective experience and differs from person to person. Each child in a family will react differently to the same experience and to trauma. Symptoms may come and go, and may not show up until years after the event. You needn’t have all of the following symptoms to have experienced trauma:

  • Overreacting to triggers that are reminders of the trauma.
  • Avoiding thinking, experiencing, or talking about triggers for the trauma.
  • Avoiding activities you once enjoyed.
  • Feeling hopeless about the future.
  • Experiencing memory lapses or inability to recall parts of trauma.
  • Having difficulty concentrating.
  • Having difficulty maintaining close relationships.
  • Feeling irritable or angry.
  • Feeling overwhelming guilt or shame.
  • Behaving in a self-destructive manner.
  • Being easily frightened and startled.
  • Being hypervigilant (excessively fearful).
  • Hearing or seeing things that aren’t there.
  • Having restricted feelings — sometimes numb or emotionally flat, or detached from emotions, other people, or events.
  • Feeling depersonalized; a loss of Self or cut off from your body and environment — like you’re going through the motions.
  • Having flashbacks of scenes or reliving the past event.
  • Having dreams or nightmares about the past.
  • Experiencing insomnia.
  • Experiencing panic attacks.

Post-traumatic stress disorder (PTSD) is not uncommon among codependents who experienced trauma either as a child or adult. Diagnosis requires a specific number of symptoms that last for at least 30 days and may start long after the triggering event. Core symptoms include:

  • Intrusive thoughts in the form of dreams, waking flashbacks, or recurring negative thoughts.
  • Avoidance of reminders of the trauma, including forgetting or avoiding sleep and shutting down feelings or numbness.
  • Hyperarousal putting your nervous system on alert, creating irritability, exhaustion, and difficulty relaxing and sleeping.

Trauma is debilitating and robs you of your life. Often a person has experienced several traumas, resulting in more severe symptoms, such as mood swings, depression, high blood pressure, and chronic pain.

The ACE Study of trauma

The Adverse Childhood Experiences (ACE) study found a direct correlation between adult symptoms of negative health and childhood trauma. ACE incidents that they measured were:

  • Emotional abuse
  • Physical abuse
  • Sexual abuse
  • Mother treated violently
  • Household substance abuse
  • Household substance abuse
  • Household mental illness
  • Parental separation or divorce
  • Incarcerated household member
  • Emotional neglect
  • Physical neglect

Other examples of traumatic occurrences are:

  • Betrayal
  • Addiction or living with an addict (usually includes emotional abuse)
  • Death of a loved one or physical or emotional abandonment (can follow divorce)
  • Severe or chronic pain or illness
  • Helplessness
  • Poverty (if accompanied by shame, neglect, or emotional abuse)
  • Real or threatened loss of anything of value
  • Witnessing a trauma to someone else, including survivor guilt

Effects of Childhood Trauma in ACE Study

Almost two-thirds of the participants reported at least one ACE and over 20 percent reported three or more ACEs. (You can take the ACE quiz here.) The higher the ACE score, the higher were the participants’ vulnerability to the following conditions:

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease
  • Liver disease
  • Poor work performance
  • Financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  • Risk for sexual violence
  • Poor academic achievement

Treatment of Trauma

Trauma can be emotional, physical, or environmental, and can range from experiencing a fire to emotional neglect. Healing trauma is like going back in time and feeling what was unexpressed, re-evaluating unhealthy beliefs and decisions, and getting acquainted with missing parts of yourself. Facing what happened is the first step in healing. Many people are in denial of trauma they experienced in childhood, particularly if they grew up in a stable environment. If parents weren’t abusive, but were emotionally unresponsive, you would still experience loneliness, rejection, and shame about yourself and feelings that you may have denied or completely repressed. This is emotional abandonment.

Re-experiencing, feeling, and talking about what happened are significant parts of the healing process. Another step in recovery is grieving what you’ve lost. Stages of grief include anger, depression, bargaining, sometimes guilt, and finally acceptance. Acceptance doesn’t mean you approve of what happened, but you’re more objective about it without resentment or strong emotions. As you release pent-up emotion from your past, you have more energy and motivation to invest in your future.

In this process, it’s essential — and too often omitted — that you discern false beliefs you may have adopted as a result of the trauma and substitute healthier ones. Usually, these are shame-based beliefs stemming from childhood shaming messages and experiences. Recovery also entails identifying and changing how you relate and talk to yourself that leads to undesirable outcomes and behavior and outcomes.

PTSD and trauma do not resolve on their own. It’s important to get treatment as soon as possible. There are several treatment modalities recommended for healing trauma, including CBT, EMDR, Somatic Experiencing, and Exposure Therapy.

*From Codependency for Dummies, John Wiley & Sons, Inc.

©Darlene Lancer 2016


Lauren Carrane <![CDATA[Signs of Psychosis: What You Need to Know]]> 2016-05-20T19:05:07Z 2016-05-22T17:20:06Z ]]> psychotic breakWhen you hear the term “psychotic break,” you might picture someone who’s out of control and experiencing delusions, hallucinations, illogical speech and more.

But the first signs of schizophrenia and other psychotic illnesses — which typically appear in people who are in their early to mid-20s — aren’t always so obvious. Because May is Mental Health Awareness Month, here’s a closer look at these disorders. Parents play a crucial role in treatment.

“Generally, psychosis emerges fairly suddenly,” says Dr. Bryn Jessup, director of family services at Yellowbrick, a psychiatric healthcare facility in Evanston, Ill., that treats young adults with complex mental health difficulties. “It can feel like a bolt from the blue.”

However, there are usually warning signs that a crisis may be imminent. Here are some things parents can look out for that may signal an oncoming psychotic episode:

  • Distorted beliefs and perceptions, often including paranoia
  • Noticeable changes in behavior that don’t have an obvious cause (such as the breakup of a relationship) and last longer than a week or two
  • Withdrawal from family and friends (not answering the phone; avoiding favorite activities)
  • Significant deterioration in self-care (sleeping all day; not showering)
  • Increase in use of drugs or alcohol
  • Agitation or hostility, sustained over days or weeks
  • A comprehensive breakdown in self-regulation (such as a college student who unexpectedly fails all her classes)

If you think that your son or daughter may be heading down the path to having a psychotic episode, it’s important that you act quickly. According to Jessup, people who receive treatment within three months of their first psychotic episode are twice as likely to show improvement compared to those who begin treatment later.

Unfortunately, young adults are especially sensitive to anything that might threaten or compromise their autonomy and self-worth. Keep this in mind when you raise concerns about their struggles with symptoms or behavior. Jessup says some young adults may get angry if you suggest they have difficulties that require professional attention beyond family support. “Parents can contribute to the feeling of being persecuted,” he says.

Here are the best ways parents can approach the subject of getting treatment to their son or daughter:

  • Bring it up, even if you’re afraid of their anger. 
    Yes, some young adults will get angry if you suggest that they need professional help, but not all will be hostile to offers of help. “Once you break through the bubble of isolation, some may be eager for that lifeline,” Jessup says.
  • Explain what you’ve seen. 
    Be prepared to describe specific changes in behavior. “You’re not trying to build a case,” he says. “You’re putting everything on the table so it can be acknowledged.”
  • Know this will take time. Don’t expect everything to be resolved in one conversation. “The message from parents should be, ‘Let’s find out what’s going on, and we’ll figure it out from there,’” Jessup says. Focus on a first step, whether it’s seeing a doctor with you, making an appointment with a college health service, or moving home for a while.
  • Be empathetic. 
    Understand that your son or daughter is likely scared and confused. When offers of help are rejected and insults fly, try to empathize rather than becoming defensive.

While a psychotic diagnosis may be initially upsetting, Jessup wants patients and families to know that treatment options have been steadily improving over the years, leading to better outcomes. “Families play a really important role in supporting a stable recovery,” he says.


Annabella Hagen, LCSW, RPT-S <![CDATA[Mindfulness and OCD]]> 2016-05-20T19:03:11Z 2016-05-21T17:15:44Z ]]> mindfulness and OCDVincent was a young man experiencing intrusive thoughts. All he wanted in life was to get rid of those tormenting images and thoughts once and for all. One day, after coming back from a camping trip he told his therapist, “I was so busy and focused on what I was doing that I didn’t have time to analyze my thoughts and obsess. I was mainly focused in the present moment. If only I could go on camping adventures every day!”

Vincent’s OCD symptoms had begun when he was 12 years old. He had created thinking patterns that weren’t helpful. In the past, he had tried different “distracting strategies” but their effectiveness was short-lived. He also had discovered that fighting his internal experiences was not the best option.

His camping trip adventure helped Vincent realize that his intrusive thoughts were still occurring, but that he didn’t have to react or engage in them. He didn’t have time to evaluate his thoughts or figure out why he was encountering them. His activities took priority. He reported that it had been a great weekend but not because of the absence of unpleasant thoughts. He simply had chosen to focus on what mattered to him that weekend.

Before this event, he had neglected mindfulness practice. As he renewed his mindfulness routine, he discovered that he could allow the presence of thoughts, feelings and sensations without rejecting them. The practice of mindfulness skills enabled him to become more focused in the here and now.

What about you? Do you understand the benefits of mindfulness and how it can enhance your awareness and acceptance? If you struggle with OCD, your instinctive reaction may be to battle unpleasant thoughts and feelings. Mindfulness can help you change your relationship with them.

Here is a mindfulness exercise (Hooker & Fodor, 2008) that may help you start your journey to becoming more open to your internal challenges.

  • Set a timer for 3-5 minutes.
  • Sit comfortably on a chair or couch and close your eyes.
  • Then say to yourself: “I wonder what my next thought is going to be?”
  • Acknowledge the thought as it comes in by saying, “That was my next thought.”
  • Then repeat the question, “I wonder what my next thought is going to be?”
  • Allow the thought and acknowledge it again with the same phrase, “That was my next thought.”
  • Then ask the question and acknowledge it again as indicated above.

Practice this exercise every day.

You can wait for the thought just like a cat would wait for a mouse to come out of its mouse hole, but you don’t need to chase the thought. You may be in the habit of grabbing your thoughts so you can figure them out. Instead, notice their presence without reacting to them.

As you practice this exercise you may lose your focus. Don’t worry. That’s what minds do. Acknowledge that this is happening and bring your attention back to the question, “I wonder what my next thought is going to be?” and wait for the thought.

A thought may show up before you finish saying the question. Your mind may go blank when you finish saying it. Notice it, and continue with the exercise. Sometimes the next thought may be related to the previous thought. Allow it, and ask the question again. Repeat the process until the timer goes off.

Awareness is essential before you can implement additional skills. Remember that your mind is an amazing thought-producing machine. That is its job and you can’t stop it from doing what it was built to do. However, by practicing mindfulness, you can learn to become flexible with your thoughts. You can learn to let thoughts come in and out of your mind without having to obsess over them.

You don’t have to go on camping trips to become present and enjoy what matters most in your life!

Adapted from Hooker, K. & Fodor, I. (2008). Teaching Mindfulness to Children. Gestalt Review, 12(1):75-91.


Marie Hartwell-Walker, Ed.D. <![CDATA[Mental Health Month: Normal Teen Angst or Adolescent Mental Illness?]]> 2016-05-20T18:23:23Z 2016-05-20T18:30:07Z ]]> teen angst or mental illnessMay is Mental Health Month. Mental illness is not an adults-only issue. Almost half of all chronic mental illness begins by age 14; three-quarters by age 24. Yet the stigma associated with mental illness prevents many teens from seeking help. The normal drama, moodiness and withdrawal from family of the teen years can blind parents to a teen’s very real distress. To complicate things further, there are sometimes medical or lifestyle issues at the root of emotional and behavioral change.

We should never ignore talk of self-harm or suicide. We should never minimize a teen’s very real emotional pain. But it’s important that we take care not to jump to the conclusion that there is an emerging mental illness when changes in mood or behavior may be due to something else. The issue may be as simple as too many hours on video games or as complicated as drug addiction. Careful observation and perhaps assessment by a doctor or mental health provider are needed to make an accurate diagnosis and to determine the best treatment.

Let’s look at a list of some of the common causes of concern. If your child is showing significant negative changes in a number of these issues or if there are changes in intensity, frequency and duration of any one or two of them, a mental health evaluation might be in order. However, before you panic about the possibility of mental illness, do consider whether what you are seeing are normal (though sometimes alarming) adolescent issues or an undiagnosed medical problem that will respond to medical treatment.

Common causes of concern include the following:

  • Mood swings. 
    A teen’s rollercoaster of emotions may be due to hormonal shifts, vitamin deficiencies or an inadequate diet. Before concluding there is a mental health diagnosis, confer with the primary care physician. If the problems persist despite reassurance from the doctor that it will run its course or in spite of treatment for a medical problem, do seek an evaluation by a mental health counselor. It is possible that the mood swings are due to emergence of bipolar disorder. It’s also possible the teen needs only to learn some self-calming techniques or needs someone to talk to about how to handle new social or academic stresses.
  • Feeling tired and low energy. 
    If your teen is getting plenty of sleep but is still tired much of the time, confer with your primary care doctor. If medically fine but still tired, it is possible that your teen is depressed.

    One study reported that teens who went to bed before 10 p.m. are 24 percent less likely to become depressed and 20 percent less likely to have suicidal thoughts than those who went to bed later. It is true that there are other variables to consider but sleep deprivation does probably have a lot to do with a depressed mood.

    If your teen isn’t regularly getting 7 – 9 hours of shuteye every night, try to engage the teen in an experiment. Get the TV, computer and phone out of the bedroom and declare “lights out” by 10 p.m. for two weeks and see if the teen’s mood improves. If not, follow up with an appointment to a mental health provider for an assessment for depression.

  • Confused thinking or problems with concentration. 
    This is a serious concern, especially if it is not related to already-diagnosed ADHD. Sleep deprivation, drug use, vitamin deficiencies or other medical conditions can be the culprit. Consult with the primary care doctor. If the teen is medically healthy, see a mental health specialist for an evaluation.
  • Heightened anxiety. 
    Many teens are stressed now and then. However, if anxiety regularly gets in the way of functioning, it’s time to provide some extra support. Some teens are open to learning how to use meditation, yoga, exercise or other calming techniques. If not, a counselor can help your teen learn new ways to cope with the unexpected and the stressful. If anxiety is constant and upsetting, medication may be needed so the teen can take full advantage of talk therapy or calming techniques. Make an appointment with a counselor for an assessment.
  • Changes in eating habits. 
    If your teen goes on a questionable diet, starts to severely limit food, overexercises or binge eats, talk about whether there is excessive concern about weight or appearance. If the answer is yes, make an appointment for your teen to see a physician or a nutritionist for advice about sensible diet and exercise. If they refuse help and continue to worry obsessively about weight or to dangerously curtail calories, see a counselor who specializes in eating disorders.
  • Substance abuse. 
    Use of alcohol and street drugs can be a way to be accepted, to party or to avoid problems. It also can be a way a teen instinctively self-medicates an emerging mental illness. If your teen is using substances, the first intervention is a frank talk to determine what it is about. If the teen can’t or won’t stop, then it’s time to seek professional help.
  • Avoiding friends. 
    The shifts in social status and group membership during the teen years can be brutal. Your teen may need your support or intervention if there is bullying going on or may need some guidance about how to find and maintain friends. If your teen isolates from local peers, limits social contact to online “friends” he or she has never met or has a generally negative or dismissive attitude about relationships, make an appointment with a counselor. Sometimes it is easier for teens to talk to a supportive therapist than to admit to their parents the extent of their discouragement about their ability to find and hold onto relationships.
  • Being irritable with family. 
    It is normal for teens to separate from family members while carving out their own identity. Sometimes teens have to be find a reason to be angry with parents in order to take that step away. Reevaluate whether you are encouraging enough independence. If anger or irritability is chronic or way out of proportion during normal family conflict, then it may be a sign of depression. See a mental health provider for input about the need for medication and therapy.
  • Changes in school performance. 
    Sometimes teens need help with balancing their responsibilities in school with their passion for an activity or their involvement with friends or a romance. Offer practical help with prioritizing and scheduling. If they have stopped caring about school, are frequently absent or can’t seem to manage their schoolwork regardless of support, delve deeper. It could be a sign that they are abusing substances or are in emotional trouble.
  • Reports of hearing or seeing things others don’t, reports of feeling unreal or separate from others or emergence of new ritualistic behaviors. 
    Seek a mental health evaluation. Although there are sometimes medical causes, such symptoms are often an indication of the onset of mental illness.
  • Self-harm or talk of suicide. 
    Always, always take it seriously. The idea that people who talk about it don’t do it just isn’t true. Yes, it’s possible that self-harm or threats to “end it all” is a way to get attention or a way to manipulate others, in which case it’s important to ask why such extreme behavior is necessary to achieve those goals. Sadly, it’s also possible that cutting or consideration of suicide is the only way a teen sees to stop emotional pain. It’s not safe to sort this out on your own. Get expert advice.

If you have been concerned about negative changes in your teen, take this month as an opportunity to do a thoughtful run-through of the above list. Teasing out mental illness from normal teen distress isn’t easy. But you do know your child. Trust your instincts. If you can’t account for changes that concern you, confer with a professional. You may learn that your teen is a normally abnormal adolescent. If treatment is needed, though, early assessment and intervention is the way to get your teen back on track to be all he or she can be.


John M. Grohol, Psy.D. <![CDATA[Book Review: Psalms for a Child Who Has Lost Her Mother]]> 2016-05-18T17:57:13Z 2016-05-19T14:32:47Z We don’t review a lot of poetry or fiction books on these pages, since our readers tend to want information about specific techniques and strategies they can use in their […]]]>

We don’t review a lot of poetry or fiction books on these pages, since our readers tend to want information about specific techniques and strategies they can use in their own recovery efforts. But we do review books about personal stories, and Carol Japha’s Psalms for a Child Who Has Lost Her Mother is as much a book about the author’s personal sojourn in understanding enormous loss as a child as it is a book of poetry.

From the first poem, Silence, to the last, Vision, the reader is taken on a heartfelt journey of Japha trying to put into perspective — dare I say, “make sense of”? — the loss of her mother. It is something most people can relate to, having to cope with the heartbreaking loss of a loved one. It is a universal theme, and one well-suited to be explored through verse.

The poems are elegant and speak simple truths of our humanity, emotions, and what it feels like — in our hearts and in our guts — to know the suffering associated with loss:

I would have told her,
believing she could hear,
and kept talking and believing
and carrying her with me.
If I had been there.

Reading each poem is like going on a small trek with the author, seeing things through her child-like eyes as she processes the loss of her mother at a young age. But with the wisdom that comes from an adult’s reflection and ability to find just the right words to capture those tender, innocent emotions.

There is some powerful imagery in these poems, imagery that encourages your imagination to be there with her as she explores her emotions connected to her mother’s loss. It’s hard to find the words to express this in a review.

This is a unique resource that can be used to help anyone through the dark days of grief and loss of a loved one. I could even see therapists using the book as a way to help their clients process their grief in session, through reflection and discussion of the themes the poems engender.

The book, consisting only of 29 pages and 22 poems, may seem a little thin for a book of poetry. Yet, composed as a chapbook, this wonderful poetry collection makes up for its small numbers with its enormous quality. I imagine it’ll touch your heart as it touched mine.

Psalms for a Child Who Has Lost Her Mother
by Carol Japha
Finishing Line Press, 2015
Chapbook, 29 pages

Janet Singer <![CDATA[Psychotropic Medication for Children: A Doctor’s View]]> 2016-05-13T22:34:58Z 2016-05-18T17:50:29Z ]]> psychotropic medication for childrenI have had concerns for years about the use of atypical antipsychotics in children and young adults. My feelings are based on my son Dan’s experiences with these medications, which wreaked havoc on him, physically and mentally. These drugs also exacerbated his OCD and left him with a slew of side effects. And Dan is certainly not the only one who has been negatively affected by these medications. The potentially dangerous side effects of these drugs have been well-documented.

Dr. Allen Frances, a world-renowned psychiatrist and professor emeritus at Duke University, wrote an important article in July 2015 for Psychiatric Times which begins with this sentence: “A perfect storm of interacting detrimental factors has resulted in the recent massive overuse of psychotropic medication in children.”

I highly recommend reading this easy-to-understand article, even though it is primarily written for psychiatrists. Dr. Frances makes excellent points and cites a checklist meant to help doctors evaluate whether or not a child should be prescribed these drugs. He says:

Doctors have swallowed the misleading sales pitch that typical problems in children are really underdiagnosed and undertreated “mental disorders” — very easy to diagnose and very easy to treat with a pill. Just the opposite is true. Children change so much in response to environment and development that their diagnosis and treatment always require the greatest care, patience, and time. I can’t picture ever starting a child on medications after a brief evaluation, but this is often done.

I have said many times before that I believe parents’ thoughts, feelings and opinions should always be considered and taken seriously when it comes to any kind of treatment for their children. Collaboration is important as nobody knows, cares, about, or loves their children more than they do. So it’s not surprising that the paragraph below is my favorite one of the article, and it is even more meaningful because it comes from such a well-respected doctor:

Parents far too readily follow doctors’ advice about medication for their children. I recommend always becoming a fully informed consumer and getting second and third opinions before allowing your child to take any psychiatric medicine. This is an important decision that requires careful deliberation and full parental input.

When talking about OCD and these drugs, it is important to realize that studies have shown atypical antipsychotics to be no more beneficial than a placebo for those already taking an SSRI. Exposure and response prevention (ERP) therapy, the psychological approach to treat OCD as recommended by the American Psychological Association, continues to be the gold standard for treating OCD. And it can be utilized in an age-appropriate manner for children as young as four or five years of age with no side effects.

Every child’s situation is unique and pros and cons of medication should be weighed carefully. However, if you are seriously considering using an atypical antipsychotic as part of your child’s treatment plan for OCD, please read Dr. Frances’s article. You might just change your mind.

Peter Hermes Furian/Bigstock

Jane Framingham, Ph.D. http:// <![CDATA[Quick Facts About Eating Disorders: Anorexia, Binge-Eating, & Bulimia]]> 2016-05-18T12:01:04Z 2016-05-18T12:01:04Z ]]> This article describes quick facts and statistics about the three most common eating disorders, anorexia, binge-eating, and bulimia.

Facts About Anorexia

An estimated 0.5 to 3.7 percent of women suffer from anorexia nervosa in their lifetime. In any given year,the prevalence rate is approximately 0.4 percent in women (it is unknown in men). Women experience this condition 10 times more often than men.

Symptoms of anorexia include:

  • Resistance to maintaining body weight at or above a minimally normal weight for age and height
  • Intense fear of gaining weight or becoming fat, even though underweight
  • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
  • Infrequent or absent menstrual periods (in females who have reached puberty)

Related: Symptoms of Anorexia

People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years.

The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade. This rate is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.

The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

Facts About Binge Eating

An estimated 2 to 3 percent of women suffer from binge-eating in their lifetime. In any given year,the prevalence rate is approximately 1.6 percent in women and 0.8 percent on men. The disorder is more prevalent in those seeing weight-loss treatment than in the general population.

Symptoms of binge eating include:

  • In a given period of time, an episode of eating an amount of food larger than most people would eat in a similar period of time and circumstances.
  • A feeling of a lack of control over eating during the episode of over-eating.
  • Eating more quickly.
  • Eating until feeling uncomfortably full.
  • Eating large amount of food even when not hungry.
  • Eating alone out of embarrassment.
  • Feeling digested with oneself for one’s eating behaviors.
  • Must occur at least once a week for 3 months or longer and cause significant distress in the person.

Related: Symptoms of Binge Eating Disorder

The essential feature of binge-eating disorder (BED) is recurrent episodes of binge eating that occur at least once a week, for at least three months. These episodes result in a person feeling uncomfortably full, depressed, guilty, and embarrassed. As with other eating disorders, a person with binge eating disorder feels ashamed of their eating behaviors and attempt to hide them or engage in them inconspicuously.

Binge-eating disorder occurs in both normal-weight and overweight individuals. It appears to be equally prevalent across all racial and ethnic groups. Binge eating appears to run in families.

Facts About Bulimia

An estimated 1.1 percent to 4.2 percent of women have bulimia nervosa in their lifetime. In the past 12 months, the prevalence rate among women is between 1 and 1.5 percent (it is unknown in men). Women experience this condition 10 times more often than men.

Symptoms of bulimia include:

  • Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
  • Self-evaluation is unduly influenced by body shape and weight

Related: Symptoms of Bulimia

Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.



Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

National Institute of Mental Health

Jane Framingham, Ph.D. http:// <![CDATA[Psychotherapy & Other Non-Medication Treatments for Schizophrenia]]> 2016-05-18T10:45:53Z 2016-05-18T10:49:34Z While most treatment of schizophrenia involves one or more antipsychotic medications, other treatments have also proven effective and vital to helping a person with schizophrenia maintain their recovery. Medications seem […]]]>

While most treatment of schizophrenia involves one or more antipsychotic medications, other treatments have also proven effective and vital to helping a person with schizophrenia maintain their recovery. Medications seem to work best on certain symptoms of schizophrenia, such as hallucinations, delusions, and incoherence.

Even when people with schizophrenia are relatively free of psychotic symptoms, many still have extraordinary difficulty with communication, motivation, self-care, and establishing and maintaining relationships with others. Moreover, because patients with schizophrenia frequently become ill during the critical career-forming years of life (their 20s), they are less likely to complete the training required for skilled work. As a result, many people with schizophrenia not only suffer thinking and emotional difficulties, but lack social and work skills and experience as well.

We’ve also learned in recent years that early psychotherapy interventions — when a teenager is having early signs of possible schizophrenia — can help reduce the risk of later being diagnosed with schizophrenia, or reduce its severity.

It is with these psychological, social, and occupational problems that psychosocial and psychological treatments may help most. While psychosocial approaches have limited value for acutely psychotic patients (those who are out of touch with reality or have prominent hallucinations or delusions), they are beneficial for those whose psychotic symptoms are under control. Numerous forms of psychosocial therapy are available for people with schizophrenia, and most focus on improving the patient’s social functioning — whether in the hospital or community, at home, or on the job. Some of these approaches are described here. Unfortunately, the availability of different forms of treatment varies greatly from place to place.

Individual Psychotherapy for Schizophrenia

Psychotherapy or other forms of talk therapy may be offered, with cognitive behavioral therapy being the most frequently used. This may focus on the direct reduction of the symptoms, or on related aspects, such as issues of self-esteem, social functioning, and insight. Cognitive-behavioral therapy (CBT) has been found effective in helping treat schizophrenia, especially when used early on, before a full-blown psychotic episode takes place.

Individual psychotherapy involves regularly scheduled sessions between the person with schizophrenia and a mental health professional such as a psychologist or therapist. The sessions may focus on current or past problems, experiences, thoughts, feelings, and relationships. By talking about these issues with an experienced professional, individuals with schizophrenia may gradually come to understand more about themselves and their problems. They can also learn to sort out the real from the unreal and distorted. Recent studies indicate that supportive, reality-oriented, individual psychotherapy, and cognitive-behavioral approaches that teach coping and problem-solving skills, can be beneficial for outpatients with schizophrenia.

Rehabilitation for Schizophrenia

Broadly defined, rehabilitation includes a wide array of non-medical “coping with everyday living” interventions for those with schizophrenia. Rehabilitation programs emphasize social and job training to help patients and former patients overcome difficulties in these areas. Programs may include vocational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training. These approaches are important for the success of the community-centered treatment of schizophrenia, because they provide discharged patients with the skills necessary to lead productive lives outside the sheltered confines of a mental hospital.

Family Education

Very often, patients with schizophrenia are discharged from the hospital into the care of their family. Therefore, it is important that family members learn all they can about schizophrenia and understand the difficulties and problems associated with the illness.

It is also helpful for family members to learn ways to minimize the patient’s chance of relapse — for example, by using different treatment adherence strategies — and to be aware of the various kinds of outpatient and family services available in the period after hospitalization. Family psychoeducation, which includes teaching various coping strategies and problem-solving skills, may help families deal more effectively with their ill relative and may contribute to an improved outcome for the patient.

Related: Culturally Guided Family Therapy for Schizophrenia Helps Individual and Caregivers

Self-Help Strategies

Self-help groups for people and families dealing with schizophrenia are becoming increasingly common. Although not led by a professional therapist, these groups may be therapeutic because members provide continuing mutual support as well as comfort in knowing that they are not alone in the problems they face. Self-help groups may also serve other important functions. Families working together can more effectively serve as advocates for needed research and hospital and community treatment programs. Patients acting as a group rather than individually may be better able to dispel stigma and draw public attention to such abuses as discrimination against the mentally ill.

Family and peer support and advocacy groups are very active and provide useful information and assistance for patients and families of patients with schizophrenia and other mental disorders. A list of some of these organizations is included at the end of this document.

Jane Framingham, Ph.D. http:// <![CDATA[Schizophrenia: The Challenges of Taking Medication]]> 2016-05-18T10:14:26Z 2016-05-18T10:14:26Z For people with schizophrenia, a common question is, “How long is medication needed to treat schizophrenia?” The answer is usually: people most benefit from taking medication for schizophrenia most of […]]]>

For people with schizophrenia, a common question is, “How long is medication needed to treat schizophrenia?” The answer is usually: people most benefit from taking medication for schizophrenia most of their lives. But there are a few challenges with taking any medication for such a long period of time, including reduced effectiveness and unwanted long-term side effects.

Antipsychotic medications — including newer atypical antipsychotics — reduce the risk of future psychotic episodes in patients who have schizophrenia. Even with continued drug treatment, some people will typically suffer relapses — but far higher relapse rates are seen when medication is discontinued. In most cases, it would not be accurate to say that continued drug treatment prevents relapses; rather, it reduces their intensity and frequency. The treatment of severe psychotic symptoms generally requires higher dosages than those used for maintenance treatment. If symptoms reappear on a lower dosage, a temporary increase in dosage may prevent a full-blown relapse.

Sticking to the Treatment Plan

Because relapse is more likely when antipsychotic medications are discontinued or taken irregularly, it’s beneficial when people with schizophrenia stick to their treatment. Sticking to treatment is also called “adherence to treatment,” which simply means keeping to the treatment plan arrived at between the patient and their psychiatrist or therapist.

Good adherence involves taking prescribed medication at the correct dose and proper times each day, attending doctor’s appointments, and following other treatment efforts. Treatment adherence is often difficult for people with schizophrenia, but it can be made easier with the help of several strategies and can lead to improved quality of life.

There are a variety of reasons why people with schizophrenia may not adhere to treatment. Patients may not believe they are ill and may deny the need for medication, or they may have such disorganized thinking that they cannot remember to take their daily doses. Family members or friends may not understand schizophrenia and may inappropriately advise the person with schizophrenia to stop treatment when he or she is feeling better.

Psychiatrists and doctors, who play an important role in helping their patients with their treatment, may neglect to ask patients how often they are taking their medications. Or such professionals may be unwilling to accommodate a patient’s request to change dosages or try a new treatment.

Some patients report that side effects of the medications seem worse than the illness itself — and that’s the reason they stop taking their medication. Further, substance abuse can interfere with the effectiveness of treatment, leading patients to discontinue medications. When a complicated treatment plan is added to any of these factors, good adherence may become even more challenging.

Fortunately, there are many strategies that patients, doctors, and families can use to improve adherence and prevent worsening of the illness. Some antipsychotic medications, including ones like haloperidol (Haldol), fluphenazine (Prolixin), perphenazine (Trilafon), are available in long-acting injectable forms that eliminate the need to take pills every day.

A major goal of current research on treatments for schizophrenia is to develop a wider variety of long-acting antipsychotics, especially the newer agents with milder side effects, which can be delivered through injection. Medication calendars or pill boxes labeled with the days of the week can help patients and caregivers know when medications have or have not been taken. Using electronic timers that beep when medications should be taken, or pairing medication taking with routine daily events like meals, can help patients remember and adhere to their dosing schedule. Engaging family members in observing oral medication taking by patients can help ensure adherence. In addition, through a variety of other methods of adherence monitoring, doctors can identify when pill taking is a problem for their patients and can work with them to make adherence easier. It is important to help motivate patients to continue taking their medications properly.

In addition to any of these adherence strategies, patient and family education about schizophrenia, its symptoms, and the medications being prescribed to treat the disease is an important part of the treatment process and helps support the rationale for good adherence.

Schizophrenia Medication Side Effects

Antipsychotic drugs, like virtually all medications, have unwanted side effects along with their beneficial, therapeutic effects. During the early phases of drug treatment, patients may be troubled by side effects such as drowsiness, restlessness, muscle spasms, tremor, dry mouth, or blurring of vision. Most of these can be corrected by lowering the dosage or can be controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs. A patient may do better with one drug than another.

The long-term side effects of antipsychotic drugs may pose a considerably more serious problem. Tardive dyskinesia (TD) is a disorder characterized by involuntary movements most often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the body such as arms and legs. It occurs in about 15 to 20 percent of patients who have been receiving the older, “typical” antipsychotic drugs for many years, but TD can also develop in patients who have been treated with these drugs for shorter periods of time. In most cases, the symptoms of TD are mild, and the patient may be unaware of the movements.

Antipsychotic medications developed in recent years all appear to have a much lower risk of producing TD than the older, traditional antipsychotics. The risk is not zero, however, and they can produce side effects of their own such as weight gain. In addition, if given at too high of a dose, the newer medications may lead to problems such as social withdrawal and symptoms resembling Parkinson’s disease, a disorder that affects movement. Nevertheless, the newer antipsychotics are a significant advance in treatment, and their optimal use in people with schizophrenia is a subject of much current research.

Jane Framingham, Ph.D. http:// <![CDATA[Health Consequences of Eating Disorders]]> 2016-05-17T23:39:00Z 2016-05-17T23:39:00Z ]]> Eating disorders — such as anorexia, bulimia, and binge eating — are serious, potentially life-threatening conditions that affect a person’s emotional and physical health. Eating disorders are neither a fad nor a phase that a person goes through. Such a belief minimizes the seriousness of these disorders and discourages their treatment. There are serious health consequences that result from leaving these disorders go untreated,

Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery.

Health Consequences of Anorexia Nervosa

In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences:

  • Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
  • Reduction of bone density (osteoporosis), which results in dry, brittle bones.
  • Muscle loss and weakness.
  • Severe dehydration, which can result in kidney failure.
  • Fainting, fatigue, and overall weakness.
  • Dry hair and skin, hair loss is common.
  • Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

Health Consequences of Bulimia Nervosa

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:

  • Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
  • Potential for gastric rupture during periods of bingeing.
  • Inflammation and possible rupture of the esophagus from frequent vomiting.
  • Tooth decay and staining from stomach acids released during frequent vomiting.
  • Chronic irregular bowel movements and constipation as a result of laxative abuse.
    Peptic ulcers and pancreatitis.

Health Consequences of Binge Eating Disorder

Binge eating disorder often results in many of the same health risks associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:

  • High blood pressure.
  • High cholesterol levels.
  • Heart disease as a result of elevated triglyceride levels.
  • Secondary diabetes.
  • Gallbladder disease.

Know that despite these potential health consequences, effective treatment is available for eating disorders. A mental health professional experienced in the treatment of eating disorders can help a person learn to develop new eating skills that help the person maintain a healthy weight, while also teaching a person how to nurture a healthier body image and relationship to their own body.

Marie Hartwell-Walker, Ed.D. <![CDATA[Narcissistic Personality Disorder vs. Normal Narcissism]]> 2016-05-13T22:36:50Z 2016-05-17T17:45:46Z ]]> narcissistic personality disorder vs. normal narcissismIn Greek mythology, Narcissus was a proud young man who fell in love with his own reflection in a pool of water. He was so enchanted by his image that he couldn’t leave it, so he starved to death. Now, if he had just looked into the pool (as many of us do when we check the mirror as we go out the door in the morning), said to himself something like, “Lookin’ good, dude” and moved on, he would have been okay.

That quick check in the mirror is normal, healthy narcissism. Feeling good about oneself, talking about it, even bragging now and then, isn’t pathological. Indeed, it is essential to a positive self-esteem. As comedian Will Rogers once said, “It ain’t bragging if it’s true.”

But there are those, like Narcissus, who need to see themselves as especially attractive, interesting and accomplished most of the time — whether they deserve it or not. They have Narcissistic Personality Disorder. According to the U.S. National Institutes of Health (NIH), this is only 6.2 percent of the U.S. population.

Let’s look at the distinction with more detail: For the sake of this discussion, I’ll contrast the characteristics of people with diagnosable narcissistic personality disorder (NPD), those who are always checking their reflection in the “mirror” of other people’s admiration, with the traits of people with healthy normal narcissism (NN), those who are deservedly proud of themselves.

Remember: An important difference between the two is that NPD is an enduring, consistent pattern of self-aggrandizing attitudes and behaviors. Thoughtless, selfish behavior once in a while is just what normal people do when they are having a bad day.


At their core, those with NPD have desperately low self-esteem. It can look to others like they have egos as big as Texas, but that is only a front for the scared little person inside. Their feelings of low self-worth make them need constant reassurance, even admiration, from others.

Those with NN have healthy self-esteem. They are usually engaged in doing things that contribute to their families, jobs and communities and that give meaning to their lives. Appreciation from others feels good but they don’t need it to feel good about themselves.

Relationship with others

To ease painful insecurity, people with NPD surround themselves with people who will stroke their egos. They are always checking to make sure they have more power, more status and more control than others. Their relationships are often based on whether others are useful to them or make them look good. It’s not unusual for them to drop someone once he or she is no longer needed to forward their personal agenda. Because they need to be in control to feel safe, people with NPD manipulate partners, coworkers and those who think they are friends through cycles of approval and rejection.

Those with NN are secure within themselves. They don’t need to feel superior in order to feel “enough.” They may seek relationships with other doers but it’s because of shared excitement about what they are doing, not in order to use them. Their friendships are based in equality and are characterized by balanced give and take. They make enduring relationships of mutual acceptance and support.

Capacity for empathy

People with NPD can act caring, but only if it will further their need for the relationship. To them, sympathetic behavior is seen as a way to gain status as a “good” person in the eyes of others. If it will cost attention to issues other than their own, their show of sympathy is short-lived.

Those with NN genuinely want to be there for others. If they do talk about their charitable actions, it is to enlist more support for someone in need. Their empathy is selfless and their love is unconditional.

Relationship with success and failure

People with NPD often inflate their accomplishments and overestimate their abilities. It’s not unusual for them to take credit for others’ work. If they can’t dazzle with what they have done, they will work to look good by contrast, emphasizing what others haven’t done or have done badly. Not surprisingly, they are unwilling to talk about their failures or mistakes, fearing that it will have a negative impact on other people’s opinion of them.

When people with NN talk about an achievement, it is without embellishment and with deserved pride and appropriate humility. Unlike those with NPD, they have no need to put their efforts in contrast with the efforts of others. They are quick to give credit to others. People with NN are comfortable sharing their failures or missteps. They understand that to err is only human and that talking about their imperfections doesn’t diminish their worth.

Response to criticism

People with NPD are oversensitive to criticism and are highly reactive to any real or perceived slight. They don’t take responsibility for making a poor decision or for behaviors others find offensive. If they are held accountable for a mistake or insult, they quickly shift the blame to someone else. If that isn’t successful, they will protest that someone else made them do it.

Those with NN may not like conflict or criticism either and may avoid it if they can. But once they think about it, they are able to participate in healthy dialogue when things go wrong. They take responsibility for their missteps and are willing to make changes in their perceptions and behavior. They are able to apologize to others without feeling diminished for doing so.

Narcissistic behavior or a narcissist?

People with NN are certainly capable of moments of narcissistic behavior. Everyone is self-centered or selfish at times. Everyone has the capacity to inflate an achievement, duck responsibility or treat people badly now and then. In people with NN, such things don’t last. They quickly realize when they have been inappropriate, work to heal their relationships and move on. They see no shame in getting support from friends or help from a professional if they need it.

In contrast, true narcissists (NPD) are preoccupied with themselves most of the time. They are always looking over their shoulder, scared that someone else may be more competent, have more status, or take control away from them. Their black hole of need for admiration never gets filled. Although there is treatment, those with NPD usually don’t agree that they have a problem or truly believe relationship issues are the other person’s fault.

Kasia Bialasiewicz/Bigstock

Claire Nana <![CDATA[Book Review: Mindful Relationships]]> 2016-05-11T14:22:56Z 2016-05-16T20:21:36Z While most of us devote a considerable amount of energy and attention to improving our relationships, in their new book, Mindful Relationships: Creating Genuine Connection With Ourselves and Others, Dr. […]]]>

While most of us devote a considerable amount of energy and attention to improving our relationships, in their new book, Mindful Relationships: Creating Genuine Connection With Ourselves and Others, Dr. Richard Chambers and Margie Ulbrick argue that mindfulness itself is a relationship — one we should be spending a bit more time on.

Dr. Chambers, a clinical psychologist and internationally recognized mindfulness expert who specializes in mindfulness-based therapies, and Margie Ulbrick, a collaborative family lawyer, relationship counselor and psychotherapist, draw upon their combined experience to offer a practical and evidence-based guide to using mindfulness to improve all aspects of our lives.

The authors begin by reminding us that mindfulness lives in both our relationship with ourselves and the relationship we create with the world around us. A mindful relationship with ourselves embodies true intimacy,the kind that allows and accepts all parts of ourselves, even the less desirable ones. From there, intimacy ripples out to our partners, children, loved ones, work colleagues, and the world as a whole.

A mindful relationship, the authors write, is an “everyday experience,” but getting there depends on first recognizing our “default mode,” which is often a state of distraction. Here, Chambers and Ulbrick point to the work of Daniel Gilbert and Matthew Killingsworth, who found that our attention is off task 47% of the time, and the result is that we are consistently less happy. To overcome our default mode and bring mindfulness into our everyday lives, the authors offer several easy tips to develop mindful qualities, such as attention, awareness, embodiment, curiosity, non-judgement, gentleness, and self-compassion.

When we use mindfulness throughout our lives, the authors contend, we gain a host of neural benefits. Mindfulness not only strengthens executive functions, but also reduces “amygdala hijack” and lowers cortisol. Of particular interest is the way in which mindfulness activates our “tend and befriend” circuits, which build our capacities for empathy and compassion for those around us. Here again, Chambers and Ulbrick offer several useful mindfulness exercises, such as grounding and soothing ourselves and performing a loving-kindness meditation.

In learning how to meditate, the authors suggest that we treat meditation as an experiment, understanding that there is no ideal time or way to meditate. Of highest importance is that we tune in and not tune out. Here, the authors write, “Many people were originally globally positive about mindfulness and talked about it as if it were some kind of magic potion or panacea, but now (thankfully) the research is becoming more nuanced and people are acknowledging that what we experience when we tune in and get present is not always positive.”

Chambers and Ulbrick follow with numerous wise and insightful tips, such as understanding that stress has more to do with what we are experiencing than with the situation itself, and suffering can be expressed as an equation, where it is equal to our discomfort multiplied by our resistance. Instead of feeding resistance, we can simply notice the effect it has on our lives. As emotions such as anger often reflect unmet needs, we can also learn to pause and recognize these needs.

In looking at how mindfulness affects those around us, the authors write, “Intimacy is the ability to be in touch with our inner experiences — both ours and others.” As the presenting problem for most couples is their avoidance patterns and not the underlying core wound, the path to healing begins with each partner healing themselves. How we go about healing ourselves, the authors tell us, is through recognizing that the way we relate to ourselves is the way we relate to others. By learning to be kinder to ourselves, we learn to be kinder to others. But improving our intimate relationships also means noticing our partner’s bids for contact, taking responsibility for our emotions, becoming aware of our projections, and employing empathy to improve our ability to tolerate vulnerability. And when things go wrong, the authors offer several useful tips, such as repairing, taking space, using a differentiated stance, fighting fair, and seeking help.

Mindfulness also has a profound effect on how we parent our children. As we learn to re-parent ourselves, we will learn to tolerate our children’s distress and avoid attempts to distract them from it. Here, the authors write, “The extent to which parents can manage their own feelings of loss will determine how much they can tolerate and accept the feelings of loss in their children.”

Packed with several easy-to-do and useful exercises, tips on meditation and common sense wisdom, Mindful Relationships is a practical guide to developing a culture of awareness that will not only help us handle difficult emotions, but also help us take responsibility for our own actions, make better decisions, develop intimacy, tolerate failures, and cultivate a growth mindset — all invaluable skills that improve our lives and the lives of those around us.

Mindful Relationships: Creating Genuine Connection With Ourselves and Others
Exisle Publishing, March 2016
Paperback, 221 Pages

Dave Schultz <![CDATA[Book Review: Foundational Concepts in Neuroscience: A Brain-Mind Odyssey]]> 2016-05-11T14:19:07Z 2016-05-15T14:27:40Z For some reason, chemistry has always been hard for me to understand. Granted, it is a complex subject, so maybe it is hard for most people to understand. In Foundational […]]]>

For some reason, chemistry has always been hard for me to understand. Granted, it is a complex subject, so maybe it is hard for most people to understand. In Foundational Concepts in Neuroscience, Dr. David E. Presti tries to make chemistry understandable by laying a foundation and then adding layer after layer to it. I think he has achieved success with this book. While it can be read for pleasure, it is also designed to be a textbook for college-level students. So, if you want to be challenged a bit in learning how we function, this could be a good book for you.

I enjoyed the book. It was difficult and challenging for me at times, especially in the earlier chapters, but I knew that I was making progress and learning about a fascinating human subject — the mind. There is so much we have learned about the brain and mind, and yet, as Presti points out, there is still so much to learn. And this book isn’t just about the biological side of our mind and brain. It also gets well into behavioral aspects.

Presti is a college professor with two PhDs — one in molecular biology and biophysics and the other in clinical psychology. He has a very interesting background, which includes counseling veterans with post-traumatic stress and addictions at the VA Medical Center in San Francisco and teaching Tibetan monastics in India. He doesn’t bring stories from these experiences into the book, but rather writes much as a college professor would deliver lectures in the classroom.

Foundational Concepts in Neuroscience begins with a very brief background and then we are introduced to the brain and nervous system with an historical review of our developing knowledge. Then we are led to chemistry and its role in how nerve cells function in our systems. Presti explains atoms, chemical elements, electrons and and how molecules are structured in fairly easy terms and using diagrams. While these don’t need to be memorized, of course, it is important to recognize that molecules and cells are at the core of life and we need to have a basic understanding if we are to know how we function.

There are chapters on neurons and how they communicate messages throughout our nervous system. Presti then explains cranial nerves, along with how our bodies react to stimuli with such effects as dilated or restricted pupils, faster or slower heart rates, and others. I thought the chapter titled, “Poison, Medicine and Pharmacology” was fascinating. This was followed by a chapter on psychoactive drugs, including nicotine, caffeine, opium, cocaine and more. This, too, is a subject we all know something about, so the chapter is interesting.

Following these are separate chapters on all of the senses. Presti uses what he has taught us about molecules to explain how different aromas, such as perfumes, spices, and flowers, affect our sense of smell. A similar approach is used with taste, hearing, touch, and vision.

There is an interesting chapter on brain imaging, with a chronological approach to the different methods researchers have developed and the methods’ relative merits or negative features. The author also explains both short-term and long-term memory. With so much attention on Alzheimer’s and other cognitive illness today, this is helpful base information.

Another fascinating chapter covers sleep. Readers learn about the sleep rhythms of our body and how society has fought against our natural rhythms to adapt to the working world. Dreaming is an important part of sleep, and Presti addresses this, too.

This is followed by a chapter on emotions. The author reminds us that emotions are not just the mental experience we have, but include a physical component as well. For example, we may feel sadness and then begin to cry. Or we become angry and our blood pressure rises.

The book closes with a provocative chapter on “Mind, Consciousness and Reality.” Presti suggests that intelligence can exist without awareness or what we may experience. In this way, a computer can become intelligent. However, it does not experience consciousness like humans do. As researchers further explore the brain and mind, scientists will be exploring machines and trying to get them to be more and more like humans.

For readers who have a fear of science, this may be more challenging than they want. For readers who are comfortable with concepts like molecules and neurons and how they guide our mind and brain, this will be an interesting and informative book.

Foundational Concepts in Neuroscience: A Brain-Mind Odyssey
W.W. Norton & Co., Inc, February 2016
Hardcover, 264 Pages