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Physical and Emotional Effects of PTSD

5/10/2018

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Published by Tanya J. Peterson on HealthyPlace

The physical and emotional effects of PTSD have roots in the traumatic event. In the moment, people respond physiologically as their sympathetic nervous system activates the fight-or-flight response; behaviorally as they react to impulses to fight, run, freeze, or avoid; and subjectively with intense thoughts and emotions. When this response is prolonged or reappears, it can become a trauma- and stressor-related disorder such as posttraumatic stress disorder (PTSD). The physical and emotional effects of PTSD can be profound and long-lasting.

HOW THE DSM-5 CATEGORIZES THE PHYSICAL AND EMOTIONAL EFFECTS OF PTSD
People experience both physical and emotional effects of PTSD. The American Psychiatric Association (2013) places PTSD effects into specific categories within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These are
  • Intrusion
  • Avoidance
  • Negative alterations in thoughts and mood
  • Arousal and reactivity
Intrusion involves unwanted, recurrent memories of the trauma. They can be waking memories, flashbacks, and/or nightmares. Intrusion effects of PTSD cause a great deal of distress.

PTSD often leads someone to avoid bothersome events, people, places, and things. The avoidance effects of PTSD can severely limit someone’s life and can even lead to the anxiety disorder agoraphobia.
Changes in thoughts can include problems with memory, concentration, and a new, negative thinking style. PTSD effects involving mood include persistent negative emotions like fear, horror, anger, guilt, or shame as well as an inability to feel positive emotions like happiness, satisfaction, or love. These cognitive and emotional effects of PTSD can make someone feel detached from the world around him/her.

Hyperarousal is an effect of PTSD that makes someone startle easily, feel jumpy and on-edge, and have a heightened sensitivity to sensory stimulation. Someone experiencing arousal effects of PTSD is typically hypervigilant, always watching for danger. Heightened arousal can make sleeping difficult; sleep deprivation in turn worsens the effects of PTSD and prevents healing (Treating Anxiety Related Sleep Disorders).
Additionally, there is a sub-category of PTSD that includes dissociative experiences in which someone feels separate from reality. Dissociation can be but isn’t always part of the effects of PTSD.

Intrusion, avoidance, negative cognitive/emotional changes, arousal, and sometimes dissociation are the official DSM-5 categories of the effects of PTSD. PTSD can also be understood in terms of its physical and emotional effects.

PHYSICAL EFFECTS OF PTSD
The physical effects of PTSD can be felt anywhere in the body and can include, but aren’t limited to:
  • Eating problems and digestive troubles
  • Difficulty sleeping
  • Headaches
  • Fatigue
  • Increased heart rate/pounding heart/heart palpitations
  • Sweating
  • Worsening of existing medical problems
  • Pain
  • Muscle tension
  • Restlessness
  • Shortness of breath

EMOTIONAL EFFECTS OF PTSD
PTSD negatively affects someone’s emotional wellbeing. Emotional effects of PTSD involve:
  • Shame
  • Survival guilt/self-blame
  • Fear of losing control or going crazy
  • Fear that the trauma will happen again
  • Anxiety
  • Depression
  • Numbness
  • Anger/rage
  • Inability to feel pleasure, joy
  • Rumination (thinking about, feeling the emotions of the event repeatedly)
  • Hopelessness
  • Detachment
  • Helplessness
  • Agitation
  • Distrust
  • Feeling alone, abandoned

​The emotional and physical effects of PTSD can be intense and wearing, making one feel as if he or she is living in a nightmare. The DSM-5 criteria for PTSD warns that it is associated with suicidal ideation and attempts. Therefore, understanding PTSD effects and watching for them in yourself or a loved one can be crucial in getting necessary help, support, and treatment (How To Help Someone With PTSD).
​The physical and emotional effects of PTSD can impact how someone interacts with people in their lives. Intimacy issues, work issues, emotional difficulties, cognitive changes, physical problems, intrusion, avoidance, and hyperarousal are effects of PTSD that make life difficult for the person experiencing PTSD as well as family members, friends, and others.
Family and friends of someone experiencing PTSD sometimes find it difficult to know what to do for their loved one. It’s common for family and friends to feel, among other things,
  • Discouraged
  • Anxious
  • Afraid
  • Helpless
  • Hopeless and hopeful, sometimes at the same time
PTSD support groups, family therapy, education classes, the National Center For PTSD and more exist to support friends and families so they, in turn, can support their loved one experiencing PTSD.
PTSD and its effects have a profound impact on people. While these effects of PTSD can be long-term, they do not have to be a permanent part of someone’s life (Does A PTSD Cure Exist?). With treatment and time, these difficult effects of PTSD can come to an end.
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A Look at Acute Stress Disorder and PTSD

5/10/2018

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Published by Harry Kimball on ChildMind

In the wake of an upsetting event, children and adolescents can be expected to react in ways that concern parents. The good news is that these reactions — which can include a return or “regression” to earlier behaviors in young kids, changes in eating or sleeping habits, physical complaints, social withdrawal — are typical of young people who have been through a very stressful experience.

Most kids return to their regular selves after a time, and natural recovery times tend to depend on how close, both physically and emotionally, the child was to the event. But some kids can’t recover on their own, and we call this child traumatic stress — when the exposure overwhelms their ability to cope with what they have experienced.

There are two disorders that mental health professionals can diagnose and treat in young people after a traumatic event: acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The key to both of these disorders is not unusual symptoms, since all of the symptoms are part of a typical response to a disruptive event. The key is that these symptoms are severe enough to impair a child’s ability to function in day-to-day life.

ASD and PTSD are essentially on a spectrum. The shared symptoms include:

Foggy, dazed, detached demeanor, difficulty remembering parts of the event
Intrusive thoughts and/or distress when reminded about the traumatic event
Avoidance of reminders of the traumatic event
Anxiety or hyperarousal
Difficulty with basic tasks (school, friendships)
ASD can be diagnosed 2 to 3 days after the event is over, and is a disorder of short-term reactions to trauma. PTSD can be diagnosed beginning one month after the event, and represents chronic, long-term maladaptive coping.

But the time criteria are not that cut and dry, cautions Child Mind Institute trauma response group leader Dr. Jamie Howard. “The lasting effects of a traumatic event might continue for many families,” she says, and after an upsetting event parents and community members should be on the lookout for symptoms of traumatic stress well into the future.

Finally, even if a child or adolescent doesn’t have a traumatic response to an event, changes in routine or displacement from home can still produce impairing symptoms. After a significant life change, professionals can diagnose adjustment disorder, which is defined by impairing symptoms including anxiety or depressed mood, trouble sleeping, regular crying spells, and school refusal. In adjustment disorder these reactions are much more intense than would typically be expected.
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Understanding the Effects of Trauma: Post-traumatic Stress Disorder (PTSD)

5/10/2018

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Published by Lynn Margolies, Ph.D. on PsychCentral

The essential psychological effect of trauma is a shattering of innocence. Trauma creates a loss of faith that there is any safety, predictability, or meaning in the world, or any safe place in which to retreat. It involves utter disillusionment. Because traumatic events are often unable to be processed by the mind and body as other experiences are, due to their overwhelming and shocking nature, they are not integrated or digested. The trauma then takes on a life of its own and, through its continued effects, haunts the survivor and prevents normal life from continuing until the person gets help.

Post-traumatic stress disorder (PTSD) is a condition created by exposure to a psychologically distressing event outside the range of usual human experience, one which would be markedly distressing to almost anyone, and which causes intense fear, terror, and helplessness. The trauma is an assault to the person’s biology and psyche. The event may have happened recently or a long time ago. There are 3 categories of PTSD symptoms: 1) hyperarousal, 2) re-experiencing, and 3) avoidance/numbing.

Hyperarousal is when the traumatized person’s physiology is in high gear, having been assaulted by the psychological impact of what happened and not able to reset. The symptoms of hyperarousal include: difficulty sleeping and concentrating, being easily startled, irritability, anger, agitation, panic, and hypervigilance (being hyper-alert to danger).

Symptoms of re-experiencing include: intrusive memories, nightmares, flashbacks, exaggerated reactions to reminders of the event, and re-experiencing (including re-experiencing physical symptoms when the body ‘remembers’).

Numbing includes feeling robotic or on “automatic pilot” – disconnected from feelings and from vitality, which is replaced by a sense of deadness. Symptoms of numbing/avoidance include: loss of interest in life and other people, hopelessness, isolation, avoidance of thoughts and feelings associated with the traumatic event, feeling detached and estranged from others, withdrawal, depression, and emotional anesthesia. Preoccupation with avoiding trauma or feelings and thoughts related to trauma can become a central focus of the survivor’s life.

Following trauma, it is normal to experience the range of symptoms typical of PTSD. However, when these symptoms persist longer than 3 months, they are considered part of the syndrome of posttraumatic stress disorder. In some cases, however, symptoms may take a long time to appear. Delayed PTSD is often typical in cases of childhood sexual or physical abuse and trauma. Symptoms can be hidden by emotional constriction or dissociation and then suddenly appear following a major life event, stressor, or an accumulation of stressors with time that challenge the person’s defenses. Risk factors for PTSD include lack of social support, lack of public acknowledgment or validation of what happened, vulnerability from previous trauma, interpersonal violation (especially by trusted others), coping by avoiding — including avoiding feeling or showing feelings (seeing feelings as a weakness), actual or symbolic loss — of previously held beliefs, illusions, relationships, innocence, identity, honor, pride.

Many people suffering from post-traumatic stress disorder fail to seek treatment because of not having correctly identified or recognized their symptoms as trauma-related or not knowing their symptoms are treatable. Also, the inherent avoidance, withdrawal, memory disruption, fear, guilt, shame, and mistrust associated with PTSD can make it difficult to come forward and seek help.

Post-traumatic stress disorder is treatable. Treatment for PTSD through psychotherapy involves helping the trauma become processed and integrated so that it ultimately functions as other memories do, in the background, rather than with a life of its own. Therapy for PTSD initially focuses on coping and comfort, restoring a feeling of safety, calming the nervous system, and educating the person about what they are experiencing and why and – through the process of talking – interrupting the natural cycle of avoidance (which actually perpetuates PTSD symptoms though it is initially adaptive and self-protective). Therapy provides a safe place for trauma survivors to tell their story, feel less isolated, and tolerate knowing what happened. Psychologists help patients make connections between feelings and symptoms occurring in the present and aspects of the traumatic event(s). Through treatment, survivors begin to make sense of what happened and how it affected them, understand themselves and the world again in light of it, and ultimately restore relationships and connections in their lives.

Even in the absence of full-blown PTSD, people may also be traumatized by an event, such as the death of a loved one, in a way that continues to be painful or interfere with their lives. Trauma and unresolved grief can cause overwhelming feelings, depression, agitation and anxiety, mistrust of others, difficulty in relationships, shame, guilt, despair or a sense of meaninglessness, and helplessness and hopelessness. Trauma involves feelings of grief and loss. And grief can be traumatic, especially when it involves sudden or unnatural deaths.

Successful treatment of PTSD allows the traumatic feelings and memories to become conscious and integrated – or digested – so that the symptoms are no longer needed and eventually go away. This process of integration allows the trauma to become a part of normal memory rather than something to be perpetually feared and avoided, interfering with normal life, and frozen in time. Recovery involves feeling empowered, reestablishing a connection to oneself, feelings, and other people, and finding meaning in life again. Recovery allows patients to heal so that they can resume living.
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Debunking 11 Domestic Violence Myths

9/22/2015

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Published by Victor M. Parachin on YourTango.com on PsychCentral


Know the facts.

“If anything is truly equal opportunity, it is battering. Domestic violence crosses all socioeconomic, ethnic, racial, educational, age and religious lines.” – K. J. Wilson, author of When Violence Begins At Home.

Sadly, a US Department of Justice study indicates that approximately one million violent crimes are committed by former spouses, boyfriends, or girlfriends each year, with 85 percent of the victims being women.

For domestic violence to be defeated, it must begin with information. Here are eleven myths and facts about domestic violence.

Myth #1: Domestic Violence Is Only Physical.
Fact: Abusive actions against another person can be verbal, emotional, sexual, and physical. There are four basic types of domestic violence:

  • Physical: Shoving, slapping, punching, pushing, hitting, kicking and restraining.
  • Sexual: When one partner forces unwanted, unwelcome, uninvited sexual acts upon another.
  • Psychological: Verbal and emotional abuse, threats, intimidation, stalking, swearing, insulting, isolation from family and friends, forced financial dependence.
  • Attacks against property and pets: Breaking household objects, hitting walls, abusing or killing beloved pets.



Myth #2: Domestic Violence Is Not Common.

Fact: While precise statistics are difficult to determine, all signs indicate that domestic violence is more common than most people believe or want to believe.

For example, due to lack of space, shelters for battered women are able to admit only 10 to 40 percent of women who request admission. Another example is from divorced women. Though they make up less than 8 percent of the US population, they account for 75 percent of all battered women and report being assaulted 14 times more often than women still living with a partner. Whatever statistics are available are believed to be low because domestic violence is often not reported.

Myth #3: Domestic Violence Only Affects Women.


Fact: Abuse can happen to anyone! It can be directed at women, men, children, the elderly. It takes place among all social classes and all ethnic groups; however, women are the most targeted victims of domestic violence. Here are more statistics:

  • One in four American women report being physically assaulted and/or raped by a current or former spouse, cohabiting partner, or date at some time in their life.
  • Every day in the US three women are murdered by a husband or boyfriend.
  • A woman is beaten every 15 seconds, according to the FBI.
  • It is estimated that up to 10 million children witness an act of domestic violence annually.
  • Boys who witnessed domestic violence are more than twice as likely to abuse their wives or girlfriends than sons of nonviolent parents.
  • Around the world, at least one in every three women has been beaten, coerced into sex, or otherwise abused in her lifetime.
  • While men are victims of domestic abuse, 92 percent of those subjected to violence are women.



Myth #4: Domestic Violence Only Occurs Among Lower Class or Minority or Rural Communities.


Fact: Domestic violence crosses all race and class lines. Similar rates of abuse are reported in cities, suburbs and rural areas, according to the Bureau of Justice.

Abusers can be found living in mansions, as well as mobile homes. In Not to People Like Us – Hidden Abuse in Upscale Marriages, by Susan Weitzman, PhD., she presents case studies of domestic violence in families with higher than average incomes and levels of education.

Myth #5: Battered Women Can Just Leave.


Fact: A combination of factors make it very difficult for the abused to leave. These include family and social pressure, shame, financial barriers, children, and religious beliefs.

Up to 50 percent of women with children fleeing domestic violence become homeless because they leave the abuser. Also, many who are abused face psychological ambivalence about leaving.

One woman recalls, “My body still ached from being beaten by my husband a day earlier. But he kept pleading through the door. ‘I’m sorry. I’ll never do that to you again. I know I need help.’ I had a 2-week-old baby. I wanted to believe him. I opened the door.”

Her abuse continued for two more years before she gained the courage to leave.

Myth #6: Abuse Takes Place Because of Alcohol or Drugs.


Fact: Substance abuse does not cause domestic violence. However, drugs and alcohol do lower inhibitions while increasing the level of violence, often to more dangerous levels.

The US Department of Health and Human Services estimates that one-quarter to one-half of abusers have substance abuse issues.

Myth #7: Victims Can Just Fight Back or Walk Away.


Fact: Dealing with domestic violence is never as simple as fighting back or walking out the door.

“Most domestic abusers are men who are physically stronger than the women they abuse,” notes Joyce Zoldak in her book When Danger Hits Home: Survivors of Domestic Violence.

“In the case of elder abuse, the victims’ frail condition may limit their being able to defend themselves. When a child is being abused, the adult guardian is far more imposing — both physically and psychologically — than the victim.”

Myth #8: The Victim Provoked the Violence.


Fact: The abuser is completely responsible for the abuse. No one can say or do anything which warrants being beaten and battered. Abusers often try to deflect their responsibility by blaming the victim via comments, such as:

  • “You made me angry.”
  • “You made me jealous.”
  • “This would never have happened if you hadn’t done that.”
  • “I didn’t mean to do that, but you were out of control.”
Victims need to be assured that the abuse is not their fault.

Myth #9: Domestic Abuse Is a Private Matter and It’s None of My Business.


Fact: We all have a responsibility to care for one another.

Officials at the National Domestic Violence Hotline offer this advice to people who see or suspect domestic violence:

“Yes, it is your business. Maybe he’s your friend, your brother-in-law, your cousin, co-worker, gym partner or fishing buddy. You’ve noticed that he interrupts her, criticizes her family, yells at her or scares her. You hope that when they’re alone, it isn’t worse. The way he treats her makes you uncomfortable, but you don’t want to make him mad or lose his friendship. You surely don’t want to see him wreck his marriage or have to call the police.

What can you do? Say something. If you don’t, your silence is the same as saying abuse is OK. He could hurt someone, or end up in jail. Because you care, you need to do something…before it is too late.”

Myth #10: Partners Need Couples Counseling.


Fact: It is the abuser alone who needs counseling in order to change behavior.

Social worker Susan Schechter says couples counseling is “an inappropriate intervention that further endangers the woman…It encourages the abuser to blame the victim by examining her ‘role’ in his problem. By seeing the couple together, the therapist erroneously suggests that the partner, too, is responsible for the abusers behavior.

“Many women have been brutally beaten following couples counseling sessions in which they disclosed violence or coercion. The abuser alone must take responsibility for assaults and understand that family reunification is not his treatment goal: the goal is to stop the violence.”

Myth #11: Abusers Are Evil People.


Fact: “Anyone can find himself or herself in an abusive situation and most of us could also find ourselves tempted to be abusive to others, no matter how wrong we know it to be,” notes Joyce Zaldak.

Abusers are people who may be strong and stable in some areas of their lives, but weak, unreasonable, and out of control in other ways. This does not excuse their behavior because abuse is always wrong.

Abusers need to be held accountable for their actions and encouraged to seek help promptly by meeting with a psychologist, psychiatrist, therapist or spiritual leader.

With an informed community, with the help of family and friends, the cycle of abuse can be broken.

If you or someone you know is a victim of domestic violence, please call The National Domestic Violence Hotline at 1-800-799-7233 or visit their website.





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3 Tips for Talking to Children About Traumatic Events

12/10/2014

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Published by Paul C. Milford, MCSW, RCSWI, on PsychCentral


It is almost impossible to shield children from negative world events. In our ever-connected society, breaking news stories reach far beyond the evening news. All too often, these tragic stories involving mass casualties are in the news for days and become the topic of conversation for many.

We see this with any major domestic or international story. As adults, these heartbreaking stories often take an emotional toll on us. Some make us cry; others evoke anger or frustration. For children, however, these reactions can be far more complex.

Children may withdraw, become easily irritable, experience decreased appetite or have nightmares. Even worse, some children can develop strong responses to locations that remind them of these tragedies (e.g., an airplane or school) and experience an aversion to these locations.

There are a few important differences in the way adults and children receive and process the information on the news. When adults hear about a tragedy, they are able to identify this as an isolated incident. Adults are able to receive the story in context.

Children, however, do not yet possess the ability to do so. This means a child isn’t automatically able to identify the event as isolated or interpret the event’s context to better understand the cause.

Additionally, adults do not typically re-experience the event every time it is mentioned on the news. We become increasingly numb to the information over time. The same is not true for children, who are likely to hear every news report as if the event is occurring over and over.

Talking to children about tragic events does not have to be complicated. Here are a few tips to try:

  • When you notice the information being broadcast around your child, ask them what they feel about hearing the information. It’s completely normal for a child to say “nothing.” Do not try to press for an emotional response if the child doesn’t immediately offer one. You can also ask the child if they want to ask any questions about the event. This lets the child know that you’re available and open to talking with them about the event. If the child doesn’t express any feelings or questions about the event, a simple explanation of the information should be sufficient.
  • If the child asks questions, respond to them honestly and in a way they will understand. Often, a question such as “Why did the plane crash?” is really the child asking “Can the same thing happen to me on a plane?” Be sensitive to what the child is really asking and tailor your response appropriately.
  • Follow up with your child. A day or two after talking to your child about a tragic event, let him or her know that you’re still available to talk if they have any other questions. Children often privately reflect on the things they experience. Checking in a few days after explaining the event to the child allows an opportunity to address any new questions the child may have.

Processing news of traumatic events is crucial for helping our children understand these events. It’s a good learning opportunity for the child and provides a great opportunity for bonding in a meaningful way.

** If your child is struggling with a traumatic event, contact Aspen Counseling Services to schedule an Initial Assessment. 
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Teen Suicide: Out of Sight Is Not Out of Mind

7/16/2014

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Published by Gabrielle Katz on PsychCentral


As a Master of Social Work student, my first field placement was at an acute mental health inpatient facility on an adolescent unit. Each day I went to my placement, I saw an increasing number of rotating teenagers coming into the hospital due to suicidal ideation or a suicide attempt.

My experience in the adolescent unit showed me just how much suicide affects the teen population. As a result, I have become an advocate for education on, and the prevention of, suicide.

Suicide is the tenth leading cause of death in America. For every person who dies by suicide, more than 30 others attempt it. While this is the case for the general population in the United States, suicide is the third leading cause of death for those 12-18 years old.

Recently in the news, there have been many articles discussing suicide and reporting on the numerous college students who have died by it. These stories are bringing this epidemic to the forefront.

Every suicide attempt and death affects countless other individuals. Family members, friends, coworkers, and others in the community all suffer the long-lasting consequences of suicidal behaviors.

The problem stems from lack of education. Children and adolescents are unaware of the signs and symptoms; therefore, they are unable to distinguish between suicidal thoughts and other emotions. School-aged children do not know how to get help, which numbers to call, or where to go if they need assistance.

Therefore, education on suicide and certain mental illnesses should be taught in a health course. We are allowed to teach information regarding alcoholic beverages, sexually transmitted diseases, and more to inform our children. Bringing awareness to suicide in an informational way will help people become more knowledgeable and aware of the signs, symptoms and resources available for help.

Adolescents are impulsive and reactive. If students were taught safety and resources surrounding suicide they would at least know what to do if their depression, anxiety or stress overwhelms them to an “I can’t take it anymore” level. Schools need to incorporate suicide and mental health education in their health class curricula.

This does not need to be a psychology class. It should include the mental illnesses of anxiety and depression and how to recognize suicidal ideation. Every student at one point in their school career will at least feel anxious, whether it be over a boy or girl, schoolwork, or being late to school.

Depression and anxiety can become so overwhelming to some people that the only way they know how to get away from the feeling is to contemplate or attempt suicide. We need to teach our children that suicide is not the answer.

For any student, parent or friend reading this and thinking they know someone who is suicidal, please call this number: 1-800-273-TALK (8255). It is the National Suicide Prevention Lifeline. You can also visit suicidepreventionlifeline.org to learn about suicide, the help you can receive, and a practical tool kit to help school staff manage the situation in the aftermath of suicide.

Let’s start talking and making a toolkit of preventative measures for suicide awareness so we do not have to use the toolkit for any more aftermath management. What may be out of sight may not actually be out of mind.


** If you or someone you know is struggling with thoughts of suicide, if it is an emergency, contact 911. Then contact Aspen Counseling Services to schedule an Initial Assessment. 

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How to Get a Friend to See a Therapist

12/30/2013

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Published by Sophie Henshaw, DPsych, on PsychCentral
You probably regularly come across people who need professional help. They may be in the midst of a crisis, an important relationship isn’t working, they are emotionally unstable or their behavior is erratic. When drugs or alcohol are involved, especially around children, then it’s critical to take action.

However, it’s not easy to say to someone “I think you should see a therapist.”

It may offend them, shame them or disrupt your relationship. Your friend may hear: “You think there’s something wrong with me” and get angry, defensive or vehemently deny there’s a problem.

Rarely does a direct approach work in these circumstances.

To get the outcome you want, you need to attentively listen to the person complain about the problem in order to find a non-confronting way in. Focus on normalizing the problem — making it seem like a normal, everyday behavior — and creating an alliance with the person. Do not be tempted to offer advice, which comes across as “I’m normal; you’re not.”

For example, if you hear your friend complain about a relationship, you might say something like: “I know what you mean; I’ve come across that before. You know, I was reading something about that just the other day and I found it very informative. Would you like me to send you the link?”

Once your friend feels like you’re on her side and she doesn’t feel “bad” or “wrong” about having the problem, you can enter into a second level of encouragement, such as: “I’ve heard from a friend that “X” is a real expert in this area and deals with this stuff all the time. I’m even thinking about seeing her myself. I wonder what she would make of it? She might help to give you a different perspective.”

A gentle and sensitive approach works well to open another up to alternative ways of viewing the problem. This is especially the case when you are the main support person and your friend is leaning way too heavily on you. You may be feeling overwhelmed and not know what to do. The advice you give is unhelpful and it seems like your whole relationship revolves around the problem. You never discuss anything else, your own needs are ignored and you can’t cope with the hour-long phone calls late at night anymore. So how do you say: “I’ve had enough” in an effective and compassionate way?

As a rule of thumb, consider if this problem is something that an adult could and realistically should take responsibility for. After all, the problem is hers, not yours. Reflect on what is happening within you that is allowing you to be so put upon. Are you a “knight in shining armor”? Do you have a need to be needed? Are you driven by a desire for control?

A careful consideration of the secondary gains you might be receiving from participating in a draining relationship is an essential first step. What started out as you “doing the right thing” ends up dragging you down and it’s serving neither you nor the person you are “helping.” You have gone beyond kindness into neediness as well as denying her the opportunity to take responsibility for her own growth.

Therefore, it’s in both your best interests to implement a firm boundary and allow another, more objective person to step in and help, either for her alone or both of you. A way out is to listen carefully for a request for something that you are unable to provide. For example, if she comes to you with an issue that is out of your depth (e.g., domestic violence), say: “I don’t know that I can be of much help there. This problem is out of my depth. However, I do know someone who knows a lot about that sort of thing — how about I get her to give you a call? She might suggest something I haven’t thought of.”

Then institute an appropriate referral as soon as you can. The sooner you can allow her to get appropriate help, the sooner you can breathe, relax and heal.


** If you or someone you know is struggling, contact Aspen Counseling Services to schedule an Initial Assessment.

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Most Teen Mental Health Problems Go Untreated

12/23/2013

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Published by Rick Nauert, Ph.D. on PsychCentral

A Duke University review of a survey involving more than 10,000 American teenagers reveals that more than half of adolescents with psychiatric disorders receive no treatment of any sort.

Moreover, when treatment does occur, the providers are rarely mental health specialists, said Dr. E. Jane Costello, a Duke University professor of psychology and epidemiology, the study leader.

The country’s mental health system has come under scrutiny in recent years following a string of mass shootings in which mental illness seems to have played a role.

The new study, published online in the journal Psychiatric Services, underlines the need for better mental health services for adolescents, Costello said.

“It’s still the case in this country that people don’t take psychiatric conditions as seriously as they should,” Costello said.

“This, despite the fact that these conditions are linked to a whole host of other problems.”

Costello noted that not all teens in the study fared the same. Treatment rates varied greatly for different mental disorders, for instance.

Adolescents with ADHD, conduct disorder or oppositional defiant disorder received mental health care more than 70 percent of the time.

By contrast, teens suffering from phobias or anxiety disorders were the least likely to be treated.

Results also varied greatly by race, with black youths significantly less likely to be treated for mental disorders than white youths.

The care that teenagers received also varied greatly.

In many cases, care was provided by pediatricians, school counselors or probation officers rather than by people with specialized mental health training. There simply are not enough qualified child mental health professionals to go around, Costello said.

“We need to train more child psychiatrists in this country,” Costello said. “And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion’s share of the work.”


** If you or someone you know is struggling with a mental health issue, contact Aspen Counseling Services to schedule an Initial Assessment.

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Helping Kids with Trauma Succeed At School

12/16/2013

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Published by Yourtango Experts on PsychCentral

Those early school years, when children ages 6 to 12 are transitioning from a caregiving environment to an educational environment, are challenging from a child development standpoint.

Children are learning academic skills, socialization (how to get along with others), and structure and boundaries (how to follow rules). Perhaps for the first time, they are also being influenced by adults other than their own parents.

Primary or elementary school is a time to find out how people are different in so many ways: race, ethnicity, gender, physical abilities, culture, upbringing, values, etc.

A child’s self-esteem develops based on academic and social successes or failures. Adult expectations for responsible behaviors increase as children are expected to need less adult interactions to maintain established routines at home and school.

The adult world looks upon this transition from home to school as a natural part of what it takes to grow into a competent, capable, responsible adult. It is a time to learn what to do and how to do it. Most children make the transition easily, get into alignment with learning and do what is expected of them with the usual glitches or hiccups along the way. This is normal in the world of child development.

Children of Trauma React DifferentlyFor other children, those who have undergone some sort of trauma in their lives, the transition is a nightmare — not only for them, but also for their caregivers and parents.

Trauma for these children wasn’t a single-incident trauma; they had experienced multiple traumas that had been ongoing their entire lives. They come from families of intergenerational abuse, alcoholism, drug addiction, neglect, physical and sexual abuse, frequent moves, absent fathers, mothers who were depressed or had to work two or three jobs, poverty, and emotionally-absent caregivers. Some children eat only when they are in school. On weekends and in the summer they may get to eat once a day.

This was the population of children I worked with in a small east Texas rural community in a drop-out prevention program. Beginning with pre-K and ending in high school, the children I worked with taught me what I knew, what I didn’t, and what I needed to learn.

I was surprised at the intense behavioral issues of the children who were referred to me in pre-K to fifth grade. For those of us who love to learn and read, it is difficult at first to understand children who refuse to read or do their work. Compounding that are those children who are aggressive, defiant and hostile to teachers. “I would have never thought of doing any of that when I was growing up,” is what I said to myself, and what you’re probably thinking right now.

As I got to know these children, heard their stories, and listened to their parents, I learned it wasn’t that parents didn’t love their children. They had been traumatized as well and did not know how to give their children what they never got. This kept them from being able to meet basic attachment and emotional needs. If that foundation has not been met minimally, a child has difficulties with social and emotional issues in groups, which shuts down their ability to learn.

Over time, I came to learn more about what these children have been going through for years at home. It’s difficult to view life from their perspective and relate to the number of stressors they experience every day at home and at school, yet that is exactly what we must do to help them succeed.

Trauma Reactive Behaviors in School-Age Children
The following is a list of trauma reactive behaviors you may observe in early school-age children:

  • Regressive behaviors: clinging, crying, baby talk
  • Competitiveness and jealousy with younger siblings or peers
  • Hyperactivity or always on guard; can’t sit still
  • Anxious talking
  • A child who has been compliant may become irritable, aggressive or oppositional
  • Uncharacteristic fears of people, place, objects
  • Drops in school performance
  • Staying off task, withdrawn, shut down
  • Day dreaming, spacey eyes, pupils dilated
  • Sexual acting out behaviors with siblings, peers, or in play
  • Difficulty concentrating or paying attention
  • Appearing confused
  • Uncoordinated and clumsy
  • Acting emotionally younger than their age



Children who have undergone trauma feel like no one understands them, that they are not loved and that they are failures. Imagine day in and day out going somewhere that only reflects how much you have failed, all that you do wrong, and the vast difference between you and your peers. You don’t fit in.


** If you know a child struggling with trauma, contact Aspen Counseling Services to schedule an Initial Assessment.

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Recognizing the Signs of Domestic Violence

10/18/2013

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Published by Donna M. White, LPCI, CACP on PsychCentral


Domestic violence is a far too common occurrence. It does not discriminate and can happen at any time during a relationship. It takes place in both heterosexual and homosexual relationships. It crosses all ethnic, social, and economic levels.

Signs of domestic violence often are overlooked, denied, or excused. The truth is that there is never an excuse. The only way to end domestic violence is to be aware.

Domestic violence can be more than physical abuse. It can include sexual and emotional abuse as well.

Physical abuse includes any type of abuse that causes physical harm or injury. Sexual abuse is any form of a sexual situation in which you are forced to participate in sexual activity that is unwanted, unsafe, or degrading. Emotional abuse diminishes self-worth and self-esteem. This is usually done in the form of verbal abuse – including name-calling, yelling, and shaming.

Abusers commonly use tactics to gain control over their victims. Abusers often may try to make their partner feel bad or “less than.” This tactic is used to make their partners stay. By engaging in behavior such as insulting, name-calling or other forms of humiliation, the abuser is able to diminish self-worth. Many victims start to believe the negativity and begin to feel they do not deserve anything else and no one else would want them.

An abuser may also take on the dominant role. This is often overlooked because it can be mistaken for “being in control” or “taking on responsibility.” This type of abuser will make all decisions and expect things to be done the way they want it without question or input.

The last thing an abuser wants is for their victim to realize that they could be okay without the abuser, or for others to point out that the relationship is unhealthy. While there are quite a few tactics to create this belief, an abuser may begin to isolate their partner from family and friends. In extreme cases, they may try to prevent their victim from going to work, school, or other outside activities.

Intimidation and threats also are commonly used. An abuser may threaten to hurt themselves, their partner or family. They may also use tactics such as destroying things, damaging personal possessions, harming pets, or any other intimidating gestures. Even when these threats are not physical, they should be taken very seriously because it is highly likely that they will escalate.

Abusers also are very good at minimizing their behaviors and placing the blame elsewhere. They will commonly make statements like “it wasn’t that bad,” “you’re making it bigger than it needs to be,” “if only you didn’t make me so mad,” or “I’m just having a bad day.” The truth is there is no excuse and no one is ever to blame for any form of abuse.

There are warning signs of abuse. If you are concerned about your relationship or the relationship of someone you care about, consider these signs:

  • Having a partner with a bad temper, or one who is jealous or possessive
  • Being overly eager to please the abuser
  • Checking in with abusive partner frequently to outline daily activities or confirm prior plans
  • Frequent injuries and claiming of “accidents”
  • Inconsistent attendance at work, school, or other social activities
  • Excessive clothing or accessories to hide signs of physical abuse
  • Low self-esteem and self-worth
  • Limited access to friends, family, transportation, or money
  • Depression or anxiety or other personality changes
If you or someone you know is experiencing these signs or others that may indicate abuse, talk to someone. If you are not sure if you are being abused, ask someone. If you have questions about someone being abused, ask them. You may save yourself as well as someone else.

** If you or someone you know is experiencing domestic violence, contact Aspen Counseling Services to schedule an Initial Assessment. 
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