HELPING PARENTS UNDERSTAND THE RISKS AND WARNING SIGNS OF THEIR TEENAGERS April 27th, 2015 - Oak Ridge High School Amy Olson, LCSW Gail E.
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HELPING PARENTS UNDERSTAND THE RISKS AND WARNING SIGNS OF THEIR TEENAGERS April 27th, 2015 - Oak Ridge High School Amy Olson, LCSW Gail E. Gnade, Ph.D. Stephanie Weatherstone, LCSW HOW WE’LL SPEND OUR TIME What are risky behaviors? Substance Abuse Self-harm Eating Disorders Mental Illness Resources available “AT-RISK” BEHAVIOR? ENTER - RISKY Alcohol Tobacco Marijuana Cutting Hair pulling Substance Abuse Inhalants Burning Rx SelfMutilation Branding Opiates Erasing Cocaine Head banging Picking Acting Out & Acting IN Drugs Disordered Eating Pornography Theft Promiscuity Running Away Self-Harm Bullying Gambling Disruptive Behavior Suicide Homicide Behavior has meaning. . . . What do I have to do to show you I matter? How far do I have to go before you see me? My pain, my fear, my worth? I can’t be you, I can only be me – how do I know if that’s enough? I feel like I can’t win, the target keeps moving. Can you hear me now? DEVELOPMENTAL TASKS DURING ADOLESCENCE During adolescence the primary developmental task is to cultivate identity the moody chameleon Who Am I? Where do I fit? Define self in others’ reflection Oppositionality “I’m not you!” Fitting in “Yeah, I’m into that too” Experimentation “I’m invincible!” Need for peers in order to invest in/cultivate the future SUBSTANCE ABUSE • Smoking marijuana changes in the brain similar to those caused by cocaine, heroin and alcohol. • Alters the hippocampus and affects short-term memory • For young users, marijuana increased anxiety, panic attacks, depression and other mental health problems. For those already prone to depression or anxiety attacks, marijuana use may accelerate or exacerbate problems Marijuana Marijuana - Research Kids who use marijuana in early adolescence are more likely to engage in risky behaviors that may put their futures in jeopardy: delinquency; having multiple sexual partners; perceiving drugs as not harmful; and having more friends who exhibit deviant behavior. Marijuana use is 3 times more likely to lead to dependence among adolescents than among adults Marijuana - Facts A 50% concentration of THC can be found in the body up to 8 days after using marijuana and traces can be found in the body up to 3 months after use . THC, the active ingredient in marijuana, accumulates particularly in the testes, liver and brain of users. Marijuana use narrows the arteries in the brain, “similar to patients with high blood pressure and dementia and may explain why memory tests are difficult for marijuana users.” Associated blood flow problems in the brain which can cause memory loss, attention deficits, and impaired learning ability. A student using Marijuana may present with symptoms appearing consistent with ADHD, inattentive type & be misdiagnosed. . . . •More than half of the 20 million alcoholic adults in the U.S. started drinking heavily when they were teenagers. • Each year more that 10,000 young people in the United States are killed and 40,000 injured in alcoholrelated automobile accidents. Alcohol Alcohol & the brain More damaging for teens Alcohol abuse during the teenage years negatively impacts the development of the memory center of the brain (the hippocampus). Upsets hormone balance & impairs organ development & development of the reproductive system • Duster • Model airplane glue • Nail polish remover • Cleaning fluids • Hair spray • Gasoline • Aerosol whipped cream • Spray paint • Fabric protector • Freon • Cooking spray • White out Inhalants Inhalants How abused? sniffed, snorted, bagged (fumes inhaled from a plastic bag), or “huffed” (inhalant-soaked rag, sock, or roll of toilet paper in the mouth) Resulting high? After heavy use of inhalants abusers may feel drowsy for several hours and experience a lingering headache. Within seconds of inhalation, the user experiences intoxication along with other effects similar to those produced by alcohol. Alcohol-like effects may include slurred speech, an inability to coordinate movements, dizziness, confusion and delirium. Nausea and vomiting are other common side effects. In addition, users may experience lightheadedness, hallucinations, and delusions. Symptoms of long-term abuse: weight loss, muscle weakness, disorientation, inattentiveness, lack of coordination, irritability, and depression. OTHER DRUGS Methamphetamine Heroin Oxycontin Cocaine Crack Peyote Xanax Hydrocodone Ecstasy What is self-harm? Intentional Physical Immediate No lethal intention Something people do to intentionally damage one’s own bodily tissue without intending to die. WHO DOES IT? Most common among adolescents & young adults (age 15-35) Onset typically age 13 or 14 Equal opportunity – statistically no difference of frequency between males & females No cultural differentiation 20% of high school students & 40% of college students have self-harmed at least once 15-17% of college students report they self-harm frequently Slightly more common in the non-heterosexual population Why Self-Harm? release tension express anger, or other unacceptable feelings Coping mechanism to help release tension, relieve stress, and overcome feelings of depression. punish themselves This kind of behavior can be used almost like a drug - to provide temporary relief from pain or other overwhelming feelings the teen can't otherwise deal with. need for control Emotion regulation "numb out" feel "alive" relieve feelings of emptiness stop "bad" thoughts to calm down feel euphoric MYTHS VS. FACTS Self-harm is a suicide attempt Myth Hazard of this assumption = increased frustration for the selfharmer; feeling even more unheard; increased feeling of isolation Self-harm is not really harmful Myth Issue of tolerance Accidentally going too far Self-harm is manipulative Often done during dissociative state Yes and No. . . . HOW DOES IT START? • How are others managing their frustration/stress/sadness? • Impact of peer group formation Social Contagion By accident • Recognizing how their attention is diverted by pain sensation HOW DOES IT END? Some simply outgrow it Some need intensive therapy interventions Some don’t quit • Experimenters • Addiction • Intermittent coping tool EATING DISORDERS Binge-Eating Disorder Anorexia Nervosa Bulimia Nervosa Rumination Disorder Pica • aka, Emotional or Compulsive Overeating Avoidant/Restrictive Food Intake Disorder (formerly known as “feeding disorder of infancy or early childhood”) Other Specified Feeding or Eating Disorder • We used to use ED, NOS • New criteria encourages us to be at least loosely specific Unspecified Feeding or Eating Disorder RECOGNIZING WHEN EATING PROBLEMS BECOME “DISORDERED” ANOREXIA NERVOSA Restriction of energy Intense fear of gaining intake relative to Specify weight or becoming fat, requirements, leading severity as or persistent behavior to a significantly low determined that interferes with body weight in the by BMI weight gain, even context of age, sex, percentile. though at a significantly developmental low weight. trajectory, and Disturbance in the way in physical health. which one’s body weight Significantly low or shape is experienced, weight defined as undue influence of body weight less than weight or shape on selfminimally normal or, evaluation, or persistent for children and lack of recognition of the adolescents, less seriousness of the than minimally current low body weight. expected. Anorexia Nervosa – Other markers Obsession with euphoria of exercise &/or restricting Increased isolation or dishonesty Prolonged or otherwise excessive exercise Other observable markers Strong need for control Dizzy spells, fainting, blackouts Increased “downy” hair Loss of hair from head Bulimia Nervosa • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1) Eating, in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time, under similar circumstances; 2) 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, misuse of laxatives, diuretics, or other medications, fasting or excessive exercise. • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. • Self-evaluation is unduly influenced by body shape & weight. • The disturbance does not occur exclusively during episodes of anorexia nervosa. Bulimia Nervosa – Other markers Increased isolation or dishonesty Heart Arrhythmias Dental erosion Dehydration Other markers Strong need for control Dizzy spells, fainting, blackouts At or around normal weight Acid Reflux Chewing food & spitting it out BINGE EATING DISORDER Potential complications of BED include: Binge Eating Disorder affects 3.5% of women and 2% of men. Research shows that up to 1.6% of adolescents experience binge eating disorder. • Type 2 diabetes • High cholesterol and blood pressure • Gallbladder and heart disease • Osteoarthritis/ Joint and muscle pain • Gastrointestinal problems • Depression and Anxiety • Sleep Apnea • PCOS BINGE EATING DISORDER Marked distress regarding binge eating Binge eating episodes are associated with three (or more) of the following: Recurrent and persistent episodes of binge eating •Eating much more rapidly than normal •Eating until feeling uncomfortably full •Eating large amounts of food when not feeling physically hungry •Eating alone because of being embarrassed by how much one is eating •Feeling disgusted with oneself, depressed, or very guilty after overeating Absence of regular compensatory behaviors (such as purging). Binge Eating Disorder Sense of calm with binging Increased social isolation &/or dishonesty Confused emotions or fear of expressing them Other markers Strong need for control Avoids eating with others Repeated participation in diet fads Guilt after eating When acting out rises to the level of real risk or harm When you are compelled to ask that question. . . When peer groups shift dramatically When do we intervene? When you see mood changes •Are they more quiet? •Are they more extroverted? •More defiant? When to pay attention & ask questions Frequent unexplained “flu” Consider withdrawal Wearing clothes incongruent to the weather Poor hygiene Change of dress from conservative to provocative Art Words Intervention How do we intervene? With care Stay out of the boxing ring Negotiate on your terms, but with respect Ask the hard questions Ask what you want to know, not what you think they might answer Be direct Facilitate self-determination Learn how to advocate & negotiate No secrets COMMUNICATION communication COMMUNICATION Intervention Create a team • Work with school administrators • Enlist relevant professionals (e.g., physician, dietitian, therapist, psychiatrist) • Collaborate with anyone that the teen seems to trust (e.g., coach, pastor, teacher) • Role model within the family • Family therapy WHAT IS A MENTAL ILLNESS? Something that disrupts a person’s thoughts, moods, feelings, their ability to relate to others, and/or their ability to cope with everyday stressors. MENTAL ILLNESS 50% of mental health disorders show 1st signs before age 14, and 75% of mental health disorders begin before age 24. Less than 20% of children and adolescents with diagnosable mental health problems receive the treatment they need Can affect ANYONE at ANYTIME Is not a sign of personal weakness or a character flaw Does not affect a person’s intelligence Recovery is possible MAJOR DEPRESSIVE DISORDER Affects about 12.5 % of all adolescents (1 in 8) 5 or more symptoms nearly everyday for 2 weeks An episode of Major Depressive Disorder may last 7 to 9 months if untreated SYMPTOMS OF DEPRESSION Sadness Loss of interest in activities Self-criticism Feelings of being unloved Hopelessness about the future Thoughts of suicide Irritability indecisiveness Trouble concentrating Lack of energy WARNING SIGNS: 2 WEEKS OR LONGER Seems or looks very sad or hopeless Starts getting bad grades Gets angry more easily than usual Has nightmares every night Wants to be alone all the time Talks about death more than usual Has major changes in eating or sleeping patterns Starts using alcohol or drugs Talks about suicide ANXIETY DISORDERS Excessive worry Tension & irritability Fear surrounding certain situations Physical symptoms, e.g. headaches, GI difficulty Difficulty making decisions Avoidant behaviors Mental illness can cause problems if left untreated Relationship problems Problems in school Problems in the workplace Suicide Drug and alcohol abuse SUICIDE STATISTICS IN TEENAGERS 2nd leading cause of death in young people in TN (age 15-24) Occurs among teens of all races Among high school students, more than 17% have seriously considered suicide, more than 13% have made a suicide plan, and more than 8% have attempted suicide. Ten Leading Causes of Death in Tennessee 2010, All Races, All Sexes Source: Centers for Disease Control and Prevention by way of Tennessee Department of Health WARNING SIGNS Talking about suicide, death, and/or no reason to live Preoccupation with death and dying Withdrawal from friends and/or social activities Experience of a recent severe loss (especially a relationship) or the threat of a significant loss Experience or fear of a situation of humiliation of failure Drastic changes in behavior Loss of interest in hobbies, work, school, etc. Preparation for death by making out a will (unexpectedly) & final arrangements Giving away prized possessions Previous history of suicide attempts, as well as violence and/or hostility Unnecessary risks; reckless and/or impulsive behavior Loss of interest in personal appearance Increased use of alcohol and/or drugs General hopelessness Recent experience humiliation or failure Unwillingness to connect with potential helpers WHAT YOU CAN DO If you believe someone may be thinking about suicide: Ask them if they are thinking about killing themselves. This will not put the idea into their head or make it more likely that they will attempt suicide. Listen without judging and show you care. Stay with the person (or make sure the person is in a private, secure place with another caring person) until you can get further help. Remove any objects that could be used in a suicide attempt. Call SAMHSA’s National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and follow their guidance. If danger for self-harm seems imminent, call 911. HOW TO GET HELP Contact: A community mental health agency A private therapist A school counselor or psychologist A family physician A suicide prevention/crisis intervention center A religious/spiritual leader LOCAL RESOURCES Ridgeview Behavioral Health Services 481-6170 Oak Ridge Psychotherapy Practice 482-2003 Focus Treatment Centers 1-800-675-2041 Eating Disorder IOP for ages 12 and up Eating Disorder PHP coming summer of 2015 for ages 12 and up Mobile Crisis for Youth 866-791-9224 Youth Villages 865-560-2550 Oak Ridge Helpline 482-4949 1-800-SUICIDE/1-800-784-2433 Tennessee REDLINE 1-800-889-9789 (Substance Abuse) THANK YOU!