How is grief treated? Taking a pill seems pointless; my doing so is not going to bring my love back to life.
Grief from the death of a loved one can push a person in to depression. But, it is also somewhat different than the common form of depression. When grief, or bereavement becomes more complicated, such as it lasting too long, it can involve issues such as
- a sense of disbelief that the person is dead and gone
- anger or bitterness over the loss
- intense yearning to be reunited
- being overly preoccupied with thoughts of the loss, which can include distressing thoughts of the death
If you are not interested in using medication, talk therapy can be helpful. When dealing with such complicated grief, talk therapy can help the bereaved focus on several issues. These can include
- the grief and loss, and how it effects personal life goals
- adjustment to the loss
- how to go about restoring satisfaction to one's own life
- retelling the story of the death with an eye to confronting certain issues that the bereaved may be trying to avoid
Such an approach has been found to be effective in helping those struck by grief to feel better about the loss and themselves.
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How do I know if I, or someone I love, has an eating disorder?
There are three primary eating disorders: anorexia nervosa, bulimia nervosa, and binge eating. The signs and symptoms vary for each. Anorexia consists of overly restrictive eating and significant weight loss. Bulimia consists of consuming large quantities of food followed by vomiting, taking laxatives or diuretics, fasting, or exercising to compensate for food intake. Binge eating consists of compulsive and emotional eating, without compensating for food consumer.
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How do you distinguish between a true eating disorder and more normal eating and body image concerns?
For people with eating disorders, the restrictive eating, binging and purging, and emotional and compulsive consumption of food satisfy psychological needs, such as soothing oneself or providing a sense of control. Food intake and weight affect the person's feelings about their work, school, relationships and self. Their body image and desire to lose weight become the basis for their decisions. Ultimately, their desire to engage in eating disordered behaviors becomes more important than anything else and gives meaning to their life.
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How do I help a loved one with an eating disorder?
more about eating disorders
in activities that don't involve food
in a supportive, nonjudgmental way
openly with the person about their problem - ignoring it
won't make it go away
you live with the person, figure out division of chores involving
food and cleaning up after purging
that recovery is the person's responsibility, not yours
care of and get support for yourself
not to do:
force the person to eat or fight about eating
comment on food intake, weight, or appearance - yours,
theirs, or others'
blame or get angry with the person for their eating problem
give opinions and advice about recovery
assume the person will get better overnight
act like the person's food monitor, counselor, nutritionist,
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What kind of treatments are available for eating disorders?
multidisciplinary approach is usually indicated. Different
components of treatment include individual, group, and family
therapy, nutritional counseling, medical evaluations, and
psychiatric care. The level and frequency of care should
be determined on an individualized basis. Because eating disorders
are such a specialized problem, it is essential to go to providers
with training and experience in this area. It is also very
important that your treatment team collaborates closely with
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Everyone talks about the common effects of ADHD, being poor attention and hyperactivity. Are there other effects to it as well?
there are a number of common 'co-morbid disorders' as they
are often referred to. In my experience, learning difficulties
affect at least 50-75% of kids who have ADHD. What I
see the most is poor reading skill. Sometimes this may be
due to nothing more than the child is so unfocused, and their
mind going in so many directions, that they can not stay attuned
to what they are trying to read. They typically say that they
have lost their focus after a paragraph or two, or at most
a few pages. Handling chapters at a time is impossible for
them. Given the importance of reading as a means to
learn, especially in the higher levels of education like high
school and college, being a weak reader takes a serious toll
on their ability to do well in school. When the ADHD is appropriately
treated such as through medication, their reading skill improves.
kids may have reading difficulties like dyslexia, which can
exist in their own right independent of poor attention span.
Less common learning disabilities include poor math or writing
other common effects of ADHD include increased risk of substance
abuse. Cigarette smoking in particular is increased.
Nicotine can calm the nervous system, and some kids are probably
smoking in an attempt to self-medicate their hyper qualities.
Use of alcohol and/or marijuana, both known to depress the
nervous system, are also probably a more common problem with
ADHD. They too may be used for self-medication purposes.
Others will abuse the stimulant drugs, like amphetamines or
cocaine, which may also be another attempt at self-medication
in an attempt to make themselves more attentive.
age drinking and/or use of illicit drugs also creates risk
of legal problems, coupled with the damage that those substances
can take on the body. And, such self-medication inevitably
fails relative to effectively treating the poor attention
another problem that occurs with ADHD is an elevated risk
for depression and/or anxiety. This may arise as a reaction
to doing poorly in school. Consider how a child must feel
when they get D's and F's in school, and the teacher and other
kids berate the kid for being 'stupid.' Parents may add to
the psychological toll inadvertently when they harp on the
poor grades too. Taking another test in school, where
the child expects to get a poor grade yet again, also can
create a lot of anxiety and further destroy their self-confidence.
I almost never see ADHD exist in isolation. There is inevitably
one or more other problems, be it with learning, substance
abuse, anxiety or depression, or legal problems. Older
kids, from perhaps age 12 and up, more frequently have the
latter three categories as co-morbid disorders, while young
kids are mostly affected by the learning disabilities.
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What are the effects of dyslexia? When is it best to diagnose and treat it?
refers to problems with reading. The classic symptoms that
everyone probably recognizes and knows about are the reversals
of letters like 'b' and 'd' or 'p' and 'q'. Numbers also can
be reversed, in how they are written and/or their sequence
(e.g. '107' might become '017'). The other common effects
of dyslexia beyond reading fluently and being able to comprehend
written material, are in writing and spelling. There
can be a tremendous breakdown in spelling, which impacts on
writing. For instance, 'queen' might be spelled as 'tzrl'
- which will leave anybody who sees it utterly confused.
At least with phonetic misspellers (e.g. 'queen' becoming
'kween') the intent of written language is still being
is a second common effect of dyslexia that is not talked about
as much, which I see in virtually all adults who have the
disorder. And that is the shame and embarrassment they
feel for not being able to read. I have had dyslexic
adults tell me that their 6 year old child has helped them
fill out job applications. Or, that their little kids are
reading Dr. Seuss books to them. I also hear all too
often that the schools they attended 'pushed them through
the system' without their ever mastering how to read. With
such statements come unexpressed anger and frustration over
that having occurred.
best time to diagnose and treat a child with dyslexia is as
early as possible. Realistically, that means by 2nd or 3rd
grade, when reading skills should be developing very quickly.
For families where one or both parents have reading difficulties,
a child in 1st grade who is not progressing should be considered
very carefully. It is hard to know for sure with 1st grade
kids what is happening, because not everyone progresses at
an average rate. That is, a child may not have dyslexia but
can still be a bit slow to develop the skill in 1st grade.
But, genetics do take a toll here as they do with any other
medical or psychological problem, and family history of dyslexia
increases the risk of a child having the same problem.
becomes much harder to treat dyslexia past about 4th or 5th
grade. It is not impossible, but the percentage of kids
who can close the reading deficit gap shrinks appreciably.
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What are seizures, or epilepsy? And do they have an impact on intelligence or personality?
Seizures involve an abnormal electrical discharge in the brain. Epilepsy can be thought of as involving two or more seizures due to the same underlying cause. Roughly two-thirds of seizures occur for unknown reasons. They just happen. For the third of seizures that occur for known reasons, there are numerous possible causes. Some of the more common include blows to the head (e.g. from car accidents; sports-related injuries; falls such as out of a tree, off a ladder or down stairs;) high fevers; strokes; use of various legal and illegal substances (e.g. alcohol, cocaine, amphetamines); and brain tumors.
There are a number of different types of seizures. Perhaps the best known are often referred to as 'grand mal' and involve loss of consciousness for a brief period of time, and a lot of jerking and contraction of the limbs. 'Petit mal' are less obvious to the observer, and are also fairly common. They are a situation where the person remains conscious but in an altered state of awareness. They may be described as having staring spells and being unresponsive such as to others talking to them. There may be a paranoid quality, turning one's head in an odd way as if to check on something that is not there. Drooling sometimes occurs. These types of seizures are also fairly brief.
A third type of seizure, which I see most frequently, are more controversial. They are called 'sub-clinical' seizures, or what I call 'little electrical blips.' That is, the electrical activity in the brain is not normal, but it is also not at the stage of being a full blown seizure. It is somewhere between these two states. Various sensory oddities may be reported, such as hearing one's name called out when no one is speaking to the person. Or, seeing shadowy ghost-like images out of the peripheral vision. Smells may be noticed that others can not detect, or a feeling that bugs are crawling on one's skin when nothing is there. Such sensory oddities typically last just seconds at a time.
As to the effect of seizures: most individuals who have them lead normal lives. Medication is available and helps most people control the seizures entirely or fairly well. When medication does not work, there are alternative approaches, but most of these involve brain surgery, and so are not undertaken lightly. Individuals who have more severe cases, such as having many seizures per day or per week, can become disabled by them, in that their lives are less functional.
However, even with people who have seizures that are nominally well controlled, there can be a subtle price exacted. There is an elevated rate of depression among individuals with seizures. Manic episodes also occur at a higher than expected rate, although not as frequently as depression. Other problems can include impaired memory, altered sexuality (having too much or too little drive for instance), slower thinking, and sometimes reduced IQ.
Neurologists, and neurological tests such as EEG's, are generally the best way to diagnose seizures. However, other professionals such as family doctors, pediatricians, psychiatrists, or psychologists, may alert an individual that seizures are occurring.
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What is Asperger's?
Asperger’s Syndrome (AS) is one of the autism spectrum disorders. It is characterized by social and communication difficulties and a tendency to focus on interests that are more narrow than would typically be expected. People with AS may also experience the sensory world differently (e.g., be especially sensitive to light or noise), have difficulty with organization and planning, and experience some motor clumsiness. AS is a lifelong disorder caused by an atypical pattern of brain development but the specific cause is unknown. Symptoms are usually present by the age of 3 although many people with AS are not diagnosed until much later as their learning and behavioral difficulties are often ascribed to other disorders, such as mood disorders, ADHD, learning disabilities, or just being odd. People with AS have IQs in the average to above average range, often have excellent memories, and an eye for detail. AS used to be considered an uncommon disorder. Currently autism spectrum disorders are thought to occur in 1:250 people and 10-20 percent of those people may meet criteria for AS. It is possible that the incidence is even higher as some people with AS are never diagnosed. There is no cure for AS. The primary treatment has two components: 1) Education for the person with AS to help him or her develop strategies to compensate for AS symptoms, and 2) Education for the people who know the individual with AS so that they can understand and provide appropriate accommodations for that individual. With this treatment, most people with AS live relatively typical lives both personally and professionally. Below is a list of common characteristics seen in people with AS. These examples are seen in some but not all people with AS and it should be emphasized that all people with AS are different.
- May seem odd or unfriendly
- May have difficulty reading social cues or their own social behavior may be misinterpreted
- May understand and express emotions differently
- May be less motivated to participate in social activities or be bothered by some social settings, particularly among large groups
- May find it difficult to make friends
- May have trouble carrying on conversations or conversations may seem one-sided
- May not be as interested in social chat, such as sharing about the day
- Nonverbal communication such as eye contact and gesture may be used differently
- May need extra time to process the language of others
Narrow Interests and Inflexible Behavior:
- May have one or two interests that are pursued to the exclusion of other interests
- Interests may seem unusual
- May prefer routines and be bothered by changes that don’t bother others
- May be bothered by unpredictable events
- Difficulties with organization and time management
- Problems with prioritization
- May prefer writing to talking
- Excellent memory for detail
- Good ability to focus
on and develop skills in one area of specialty
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elderly parent is claiming to see things that aren’t
there, like bugs or people in the room. Or thinks there are
people living under the bed or up in the attic. What’s
There are different possibilities that may be responsible for such phenomena. One is that when a person’s vision deteriorates such as from glaucoma, cataracts, or macular degeneration, their ability to see and distinguish what is around them will obviously be lessened. With such poor eyesight shadows that do exist in the room, whether they are from interior objects, or cast by something outside like a tree’s branch may take on seemingly real shapes such as a person. Couple the poor vision with an aging mind, that is not thinking as quickly or clearly as possible, and the type of complaint you mention, of ‘seeing people who aren’t there’ is easier to understand.
As to the ‘person living under the bed’ or ‘the family living in the attic’, one possible culprit is the presence of delirium. What can bring on delirium? There are dozens of possibilities.
The biology of life requires a lot of stability, such as our body temperatures remaining fairly constant. The blood levels of sodium and potassium, pH, sugar, and many other components also need to be tightly regulated. Our organs, such as kidneys, liver, heart and lungs have to function well enough to supply nutrients like oxygen, and effectively remove toxins from our system. When any of those tightly regulated processes becomes defective we have problems. Organs age and break down. Infections including something as seemingly innocuous as one in the urinary tract (UTI’s) can throw a monkey wrench in to part of our biological processes.
Still other possible causes of delirium include medication side effects. In my experience after roughly the age of 60 people are virtually guaranteed to have trouble with tolerating different prescription medications. And the problem grows worse with increasing age, in to the 70’s, 80’s or beyond. Unfortunately, as our bodies tolerate medication less well doctors are prescribing ever more pills to treat the increasing health problems that arise with advancing age. At some point that becomes a recipe for pushing a person ‘over the edge’ and delirium results.
Other common causes of delirium can include recent surgeries, even for seemingly routine issues like hip replacement, which is another way to stress an aged body too much. Dietary problems arise, especially with individuals who live alone. Many elderly women have what I call ‘tea and toast’ diets which are far from being well balanced nutritionally. Others may eat better, but their bodies ability to digest and absorb food deteriorates with age, and so nutritional deficiencies still result.
Determining what is occurring to cause the delirium is very important. Delirium is symptomatic of some life threatening process being present, so that some needed biological stability has been lost. An evaluation by a family doctor, psychiatrist or neuropsychologist is strongly advised, sooner rather than later.
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