Category: Stress

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Failed Mental Health App Highlights Pitfalls of Social Media

00Depression, Featured news, Health, Media, Social Networking, Stress, Suicide July, 16

Source: Jayson Lorenzen on Flickr

On October 29, 2014, The Samaritans—a suicide-prevention organization in the United Kingdom—launched an app for Twitter called Samaritans Radar. Its purpose: to detect alarming, depressive, and suicidal tweets to help prevent suicide. Less than a week later, the app was suspended due to public outcry over privacy concerns.

Social media are being used increasingly for marketing and advertising, with privacy a growing issue. Many marketing apps, like Hootsuite, track users’ social media posts in fairly covert ways. Yet, when social media pits privacy against mental health, ethical conflicts are concerning.

Traditionally in mental healthcare, there are few reasons to break confidentiality between client and therapist, such as harm to self or others.

The Samaritans Radar app worked by tracking tweets from every account the individual follows on Twitter. If alarming content was found—ranging from “I’m tired of being alone.” to “Feeling sad.”—the app would notify the user by email. Along with the email, came a link to the flagged tweet, as well as suicide intervention and prevention resources that the individual could provide to the writer of the alarming content.

At the launch of the app, the organization said that:

“Samaritans Radar turns your social net into a safety net by flagging potentially worrying tweets from friends, that you may have missed, giving you the option to reach out and support them.”

The app was quickly criticized for allowing users to track people’s tweets without their awareness or consent. The Samaritans replied by highlighting that everything posted on Twitter and all the information the app uses was public, and that it was up to the app’s user to decide whether they wanted to respond to any particular tweet.

Adrian Short, who started a petition to shut down Samaritans Radar, stated that it “breaches people’s privacy by collecting, processing, and sharing sensitive information about their emotional and mental health status.”

He also noted that the app may be used by less-than-scrupulous individuals for all sorts of purposes, not just helping individuals overcome mental health issues.

The Samaritans addressed these concerns by launching a “white list,” where people could sign up if they wanted to deny the app access to tracking their account. Many did not see this as a solution since opting out would require people to be aware of the app’s existence, leaving privacy in jeopardy.

But the problem that the app was trying to address is not trivial. In the UK, where the Samaritans are based, suicide is the leading cause of death among males under the age of 35. A free mobile app could be an easily accessible way to reach out to people who are alone and lacking other forms of support.

As one of the few supporters of the app, Hannah Jane Parkinson wrote for the Guardian:

“It is estimated that 9.6% of young people aged 5-16 have a clinically recognised mental health condition. Anything that helps to better this situation is great, and particularly as it is crucial to catch mental ill health early on.”

Yet as Adrian Short and others pointed out, this same easy access also poses potential threats. Internet bullying is common, especially among vulnerable users that Samaritans Radar targeted. The app could therefore be used for nefarious purposes.

“The app makes people more vulnerable online. While this could be used legitimately by a friend to offer help, it also gives stalkers and bullies and opportunity to increase their levels of abuse at a time when their targets are especially down,” says Adrian Short.

The app was an attempt to reach out to people in need of emotional support and to raise awareness about mental health using new media. But it highlighted the potential pitfalls of such platforms for dealing with mental health concerns. While the incidence of mental health problems is concerning, putting peoples’ mental health into the hands of anyone with access to a smartphone is naïve.

Perhaps this unsuccessful launch did successfully show that a greater understanding of social media users and platforms is needed before apps like Samaritan Radar can become commonplace.

– Essi Numminen, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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RUSH Prevention Program Helping Children of Bipolar Parents

00Bipolar Disorder, Emotion Regulation, Environment, Featured news, Health, Parenting, Stress, Therapy May, 16

Source: Rolands Lakis on Flickr

“It was just kind of not knowing what you were going to get every time. Emotionally when I was younger, I always cared about her. She was my mom. As I grew up, I kind of became disconnected because I didn’t know the real her. I only knew her from her diagnosis. I only knew her emotions. I didn’t know the real her.”

– Steven, child of a bipolar mother.

In 2004, the World Health Organization named Bipolar Disorder (BD) the seventh-leading cause of ‘disease burden’ for women between 15 and 44, a measure that combines years of life lost to early death and years lost to living in subpar health. Public Health Agency of Canada reports that BD occurs in one percent of Canadians, and their reported mortality rates are two to three times greater than the general population.

The disorder is marked by alternating periods of manic euphoria and intense depression. In a manic state, people experience elevated moods, racing thoughts, and sleeplessness, in addition to overspending and engaging in risky sex. The depressive phases make for overwhelming feelings of sadness, withdrawal, and thoughts of death and suicide.

Research has related BD to aggressive behaviour, substance abuse, hypersexuality, and suicide. But more recently, studies have been showing the kinds of challenges faced by children of those diagnosed with the disorder.

The Pittsburgh Bipolar Offspring Study reports that children of bipolar parents are 14 times more likely to develop bipolar spectrum disorder. Children of two bipolar parents are at an even higher risk.

And these children are also more vulnerable to psychosocial problems. A study by Mark Ellenbogen at Concordia University finds them at greater risk for problems with emotional regulation and behavioral control.

Ellenbogen and colleagues have explained how stressful home environments can alter biology to influence mood disorders in adolescents and adults.

In an interview with the Trauma and Mental Health Report, Ellenbogen stated that OBD individuals (that is, offspring of parents with bipolar disorder) show higher levels of daytime cortisol, a hormone that is released during times of stress. OBD are psychologically more sensitive to stresses in their natural environments.

“We have found that high cortisol levels in offspring may represent a biomarker of risk for affective disorders, particularly in vulnerable populations like the OBD. We believe that these changes in cortisol levels can be linked to stress, inconsistent parenting practices and disorganization in the family environment.”

Reducing the stressors in early childhood may help decrease elevated levels of cortisol, and ward off the development of BD and other problems.

Recognizing the need for early intervention, Ellenbogen initiated a pilot prevention program, Reducing Unwanted Stress in the Home (RUSH), which targets bipolar parents and their vulnerable children between six and eleven.

An assessment measures salivary cortisol, looks at the family environment, and evaluates the child’s behaviour. Then parents and children participate in weekly sessions.

With parents, the focus is on improving communication and problem-solving skills, and increasing structure and consistency in the home. With children, they teach skills for understanding and coping with stress through age–appropriate exercises and educational games.

“The goal of the RUSH program is to prevent the development of affective disorders and other mental disorders by intervening in families well before these serious mental disorders begin. That is, this is a prevention program for children at high risk of developing debilitating mental disorders.”

To date, children and parents have been responding well, but the research is ongoing.

Programs like RUSH aim to prevent the development of mental illness in vulnerable youth. And an ounce of prevention can mean a whole lot to quality of life down the road.

– Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

South Koreans Use Suicide to Preserve Honour.

South Koreans Use Suicide to Preserve Honour.

10Depression, Embarrassment, Featured news, Health, Stress, Suicide, Therapy December, 15

Source: Tanla Sevillano on Flickr

The suicide of a celebrity comes as a shock to fans. In the wake of Robin Williams’ death, there was an outpouring of grief. But suicide, like many aspects of mental health, varies across cultures. In October 2008, one of South Korea’s leading actresses and national icons, Choi Jin-Sil, hanged herself.

The importance of honour in Korean culture is evident throughout Choi’s story. She often spoke of the stigma of being a divorced, single mother in the public eye, which a national entertainment columnist likened to having a personality disorder. The divorce itself was a result of domestic abuse, yet a court cited Choi’s “failure of her contractual obligations” and inability to “maintain dignity and proper social and moral honour” in its ruling.

Choi’s death was only the beginning. It led to a wave of sympathy suicides in 2008, causing a 70% increase in suicides that October. In March 2010, Choi’s younger brother killed himself by hanging, and her ex-husband also hanged himself in January 2013.

This rash of suicides is exemplary of a common Korean belief: Psychological treatment is viewed with skepticism. An interview withKyooseob Ha, a psychiatrist with Seoul National University of Medicine, describes how Koreans are averse to seeking therapy, even for severe depression. Admitting to depression is seen as a character failure, shameful to the family. It is often concealed.

The same cultural norms dictate that preserving family reputation is paramount. Families asked about their loved ones who suffered from depression and committed suicide do not wish to speak about it. A common saying, “do not kill the person twice,” means that even if the person is gone, his or her “public face” can still be ruined.

Psychologist Hyong-soo Kim at Chosun University says this public face holds such sway that even in cases where people choose to see a therapist, Koreans will pay in cash to avoid their insurance companies finding out.

Research by psychiatrist Dae-hyun Yoon, at Seoul National University and the Korean Association for Suicide, shows that Koreans are more likely to seek the aid of a priest, psychic, or room salon (where a female bartender or hostess will listen to problems) than a professional therapist. Westernization hasn’t extended to mental health.

At the same time, Korea’s depression rates continue to rise and 80-90 percent of suicides are related to depression.

Refusal of professional treatment, along with wide public acceptance of suicide may be why South Korea was ranked by the Washington Post in 2010 as having the world’s highest suicide rate(in 2014, it ranked third-highest, following Greenland and Lithuania).

This has motivated South Korea’s government to develop intervention programs such as jump-barriers on bridges, glass doors along subway platforms, and 24-hour government-funded suicide hotlines. Though progress has been slow, some Koreans believe the traditional mindset to be flawed.

Currently, the Korean government is increasing funding for mental healthcare and suicide awareness. Online monitoring has led to the closure websites that encourage people to kill themselves. Gramoxone (a pesticide that was a common means of committing suicide) is now banned in Korea. And an expanded state pension system, as well as aid from major corporations, are giving less fortunate individuals the ability to access mental health services they could not previously afford.

Turning traditional ideals on themselves, public service messages now emphasize that the shame of a loved one committing suicide outweighs whatever circumstances led them to consider suicide in the first place. They focus on the idea that honour can be regained by living.

Local therapists know first-hand the values and lifestyles of their clients, and culturally based therapeutic approaches are key to curbing South Korea’s suicide rate. In a country where honour is tantamount to life, solutions must build on tradition, not break it.

– Olivia Jon, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Officers with PTSD at Greater Risk for Police Brutality

Officers with PTSD at Greater Risk for Police Brutality

00Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma November, 15

Source: Thomas Hawk on Flickr

After dropping off a colleague on September 14, 2013, Jonathan Ferrell began his journey home.  That night, the North Carolina highway proved more treacherous than he expected.  He veered off an embankment and, shaken but uninjured, made his way over to the first house he saw to get help.  But residents mistook his intentions and called police.

It’s unclear what transpired when three officers arrived 11 minutes later.  In moments, Ferrell lay dead with 10 bullets in his body.  Autopsy reports suggest he was on his knees when shot.

Victims of police brutality have been people of all ages, races, and walks of life – from 84-year old Kang Wong, beaten for jaywalking, to a 14-year-old boy disfigured for shoplifting, to two married university professors, one of whom had undergone open heart surgery only several days prior to being struck and dragged off in handcuffs.

Police violence does not confine itself to any one area.  Hundreds of protestors suffered physical and sexual assaults at the hands of police officers during the 2010 Canadian G20 protests.  Civilians were killed and publicly tortured by police as protestors pushed for democracy in Kiev, Ukraine.

But what puts officers at risk for engaging in police brutality?  New research from the Buffalo School of Medicine and Biomedical Science points to links between police brutality and pre-existing post-traumatic stress disorder (PTSD) in the officers themselves.

PTSD is a diagnosis traditionally used for victims of overwhelmingly stressful experiences, such as rape, combat, and natural disasters.  Many victims of police violence often experience PTSD, which manifests as severe agoraphobia and paralyzing panic attacks.  This creates a downward spiral of isolation, depression, and even suicide.  Treatments for PTSD involve facing the trauma and reconsolidating the memories in more constructive ways.

But the link between PTSD and police violence appears to be a two-way street.  Not only does police brutality have the potential to cause PTSD in victims, but according to psychiatrist, Ben Green of the University of Liverpool, violence among officers may be exacerbated by their prior experiences, their previous high incidence of PTSD, which stems from being exposed to many of the same traumas as soldiers in combat.

Yet because mental health issues continue to be a source of stigma in law enforcement, many police officers suffer in silence.

In the U.S., police officer deaths from gun violence and other causes have gone up by 42% from 2009 to 2011.  And each year, 10% of all law enforcement officials are assaulted, with a quarter of them sustaining injuries.  At the same time, public pressure on police to restrain their use of firearms against the public has reduced the number of bullets fired by officers by over 50% in the last decade.  This means that police officers are finding themselves in life-threatening situations more often, but are less able to respond, creating a state of fear and tension, factors that give rise to PTSD.

For the public, the danger of police officers developing PTSD comes from an increased startle response, suspicion, and aggressiveness.  These tendencies can make officers more likely to lash out at the public and result in the deadly overreactions that sometimes occur.

Symptoms of PTSD are often triggered by the same situations that caused the trauma.  This may be why officers who kill unarmed civilians report feeling confused and suffer from memory loss when they lose control.

While many officers cite unmanageable work stress and traumatic incidents suffered on the job when explaining misconduct, few law enforcement agencies offer comprehensive mental health care for dealing with PTSD.  Among the officers themselves, talking about trauma and mental health is oftentimes discouraged, leaving sufferers isolated or stigmatized.  At the same time, the justice system also serves to cover up the problem, imposing minimum punishments for officers and giving victims of police brutality no closure to initiate their own recoveries.

Better mental health awareness would help.  Allowing police officers to speak freely and receive treatment for their job-related stress would reduce PTSD.  Teaching fellow officers to recognize the symptoms of PTSD –including social withdrawal, personality changes, and poor decision-making – would allow them to help their partners and coworkers before problems escalate.

Giving officers access to treatment and support early on can reduce future incidents of police brutality and ensure that they get the help they need.

And understanding that police officers are often victims of violence is important for continued public trust in law enforcement.  The key is education and access to treatment.

– Nick Zabara, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma & Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Sensory Sensitivity Can Strain Parent-Child Relations

Sensory Sensitivity Can Strain Parent-Child Relations

00Attachment, Child Development, Featured news, Parenting, Relationships, Stress, Trauma November, 15

Source: Camp ASCCA/Flickr

“For a child that has sensory hypersensitivity, every touch is painful. A hug is perceived as a painful gesture.”

So says Yael Ohri, a preschool teacher who specializes in identifying and alerting parents to potential issues their children may have with sensory sensitivity.

Sensory sensitivity is an important concern for some children and their parents. Low sensory thresholds characterize sensory hypersensitivity, in which any touch or experience can overwhelm the child, while sensory hyposensitivity occurs when a child is “under-sensitive” to stimuli.

Ohri was trained by clinical-developmental psychologist Rami Katz at Tel Aviv University, who trains professionals who work with children, in the Neuro-Developmental & Functional Approach (NDFA). Developed by Katz, NDFA aims to address early developmental issues by targeting the underlying source of the problem, rather than the external manifestations like the behavioural and learning difficulties resulting from sensory sensitivity.

Sensory hypersensitivity comes in various forms as it may be experienced through any of the five senses: sight, hearing, touch, smell, or taste. Ohri states that “a child’s skin may be so sensitive that she might complain that the tag in the back of the shirt, or the stitching in the socks is bothersome. Every little thing is experienced so intensely in a way that a child with normal sensitivity would not feel at all.”

Also of concern, over- or under- sensitivity in children can negatively affect the formation of attachment between parent and child.

As Ohri explains, “imagine a new mother who gives her baby a bath, and throughout the duration of the bath, the baby does not stop screaming, it can be very frustrating. The mom may blame herself and say, ‘I’m such a terrible mother, I can’t even bathe my baby,’ or worse, she may get angry with her baby for acting up and proclaim, ‘my baby hates me,’ causing an attachment issue right off the bat.”

To help young children struggling with average intensity stimuli, occupational therapists may stimulate the child’s skin with different brushes that allow the body to moderate the sensory input.

This, as well as other techniques, is designed to help sensory sensitivity. Still, Ohri believes that a critical element of treatment is simple awareness.

“It is essential that parents understand their child’s hyper- or hypo- sensitivity, and that it’s not something that the child is doing to them on purpose.” By raising early awareness, the issue is addressed when it is still relatively easy to treat. Ohri views it as much worse when the issue is not targeted early, leading to fights and stress in the family, as well as parents labelling the child as having a personality problem.

A sensory hyper-sensitive child may be labelled as irritable or whiny. Similarly, a hypo-sensitive child, who tends to be rougher, does so “not because he’s doing it on purpose, but instead, because he needs to hold and feel you and in order to do that, he does so more strongly. This kind of child is often labelled as violent.”

The problem is that this type of labelling can result in a self-fulfilling prophecy where the child ends up thinking of himself as difficult or rude, identity characteristics that become difficult to break free of later on.

Ohri argues that awareness helps. “Once parents become aware that the child has a sensory sensitivity, and begin asking themselves the right questions about the child’s day-to-day behaviours, they learn to alter their interaction with their child in order to avoid conflicts.”

Does simply being aware solve the problem altogether? No, but it’s a start.

“It doesn’t necessarily mean that the child stops being sensitive, but it helps moderate the difficulties and makes the child’s environment more understanding. This applies to both the child and the family. As both sides become more aware, living with sensory sensitivity becomes more tolerable. Mothers are amazing, if they are made aware, they find the solution.”

But what about parents who struggle with their own mental health? Parents dealing with personal trauma may find it harder to perceive signals coming from their child and may interpret them inaccurately.

According to developmental psychologist, Sarah Landy, at the Hincks-Dellcrest Centre in Toronto, parents who don’t have their personal needs met due to past trauma, find it difficult to emotionally connect with their children and respond sensitively to their needs. “When parents are unavailable due to trauma,” says Ohri, “awareness alone won’t do the trick, since the parents might not be able to get there on their own.”

So, parents who work toward resolving their own struggles with mental health will likely become better attuned to their children’s cues and respond to them more sensitively.

Sensory hyper- and hypo-sensitivity can be resolved relatively easily when targeted early, but can become a more complex issue when ignored or treated incorrectly, or when parents are not emotionally available to notice the problem.

Through the difficulties, Ohri emphasizes, “awareness is key.”

– Noam Bin-Noon, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Underage Models Need Federal Protection and Regulation

Underage Models Need Federal Protection and Regulation

00Environment, Ethics and Morality, Featured news, Gender, Law and Crime, Post-Traumatic Stress Disorder, Stress, Work October, 15

Source: Anna Fischer/Flickr

When Jennifer Sky launched her career at age fourteen, she imagined a glamorous lifestyle, fame, and designer clothes.  Flash forward to seventeen:  Her experiences turned out to be very different.

For Jennifer and many other young models, the fashion world includes foreign locations and a cascade of highly sexualized situations with little supervision, grueling twelve-hour days with few breaks, and high-stress photo-shoots.

In a recent interview with the Trauma & Mental Health Report, Jennifer shared her experiences as a young model abroad, and discussed the repercussions she’s now facing.

Jennifer: In Japan I was molested several times on the subway.  In France, I stood in hypothermic-temperature waters every day for a week.  In Mexico, I was given drugs and coerced into going topless at age sixteen.  The human trafficking elements of fashion were all around me.  

It was during this time that Jennifer began experiencing symptoms of what was later diagnosed as Post-Traumatic Stress Disorder (PTSD). In her latest book, Queen of the Tokyo Ballroom, and herYouTube video that went viral earlier this year, Jennifer describes how her normally gregarious personality started to change.  She became withdrawn, easily startled, and feared new places.  Eventually, she felt so timid she barely spoke.

Although the symptoms began in the 1990s, Jennifer did not seek treatment until 2010 when she moved back to New York City.

Jennifer: I moved back to finish college and the symptoms returned with such a force that I could no longer ignore them.

Jennifer experienced panic attacks during stressful events, which were sometimes followed by dissociative episodes where she would lose, in her words, “whole swaths of time.” These overwhelming symptoms led her to visit her university’s clinic where she was formally diagnosed.

Almost twenty years since modeling, through anti-anxiety medication and psychotherapy, Jennifer is managing her symptoms and is now a graduate student and activist.

Jennifer: I’m working toward transforming a problematic and corrupt industry into a positive one. Fashion can be fun.  It can be a rewarding opportunity.  It can also be abusive, opportunistic, corrupt, and traumatizing.

So what is currently being done to make youth modeling a safer profession?

In the Fall of 2013, New York State passed the Child Model Law, which ensures protection for individuals under eighteen, who work in the fashion industry.  The law requires tutors and chaperones, and that 15% of the model’s earnings be held in financial trust.  It also requires that all working children and adolescents be in possession of a permit while on set, and limits the amount of time they are allowed to be there.

The changes to labour laws in New York State saw instant successat the 2014 New York Fashion week, where only three underage models obtained permits, and were able to work the fashion shows.  Previously, as many as 60% of the models were under eighteen.

As promising as these changes are, the new labour laws are not federal – they only protect models that are working in the state of New York. In general, models still face a working world devoid of adequate labour regulation or protection.

Jennifer still questions whether the modeling industry is the right environment for children. But, by raising awareness and promoting models’ rights, Jennifer hopes to convince the U.S. federal government to change laws on underage modeling.

Jennifer: When we are talking about the protection of children, there really should be no debate.

– Magdelena Belanger, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright: Robert T. Muller

This article was originally published on Psychology Today

LGBTQ Refugees Lack Mental Healthcare

LGBTQ Refugees Lack Mental Healthcare

00Featured news, Health, Law and Crime, Loneliness, Sexual Orientation, Stress, Trauma September, 15

Source: William Murphy/Flickr

In 2012, the Canadian government introduced cuts to the Interim Federal Health Program (IFHP), which provides health coverage for immigrants seeking refuge in Canada. Coverage was scaled back for vision and dental care, as well as prescription medication. At the same time, the introduction of Bill C-31, the Protecting Canada’s Immigration System Act, left refugees with zero coverage for counselling and mental health services.

The bill affects all refugees and immigrants, but individuals seeking asylum based on persecution for sexual orientation or gender identity have been hit especially hard by these cuts.

LGBTQ refugees are affected by psychological trauma stemming from sexual torture and violence aimed at ‘curing’ their sexual identity. Often alienated from family, they are more likely to be fleeing their country of origin alone, at risk for depression, substance abuse, and suicide.

On arrival in Canada, refugees struggle with the claim process itself, which has been cited by asylum seekers and mental health workers as a major source of stress for newcomers. For LGBTQ individuals, the process is even harder, having to come out and defend their orientation after a lifetime spent hiding and denying their identity.

In 2013, six Canadian provinces introduced individual programs to supplement coverage. The Ontario Temporary Health Program (OTHP) came into effect on January 1, 2014, and provides refugees and immigrants short-term and urgent health coverage. But it still lacks provisions for mental health services.

Envisioning Global LGBT Human Rights, an organization and research project out of York University in Toronto, has been collecting data from focus groups with LGBTQ refugee claimants both pre- and post-hearing. A recent report by lawyer and project member Rohan Sanjnani explains how the refugee healthcare system has failed. LGBTQ asylum seekers are human beings deserving respect, dignity, and right to life under the Canadian Charter of Rights and Freedoms. Sanjnani argues that IFHP cuts are unconstitutional and that refugees have been relegated to a healthcare standard well below that of the average Canadian.

Arguments like these have brought legal challenges, encouraging courts and policy makers to consider LGBTQ rights within the framework of global human rights.

In July of this year, Bill C-31 was struck down in a federal court as unconstitutional, but the government filed an appeal on September 22. Only if the appeal fails could immigrant healthcare be reinstated to include many of the benefits removed in 2012.

Reversing the cuts to IFHP funding would not solve the problem entirely. LGBTQ asylum seekers face the challenge of finding service providers who can deal with their specific needs. The personal accounts collected by Envisioning tell a story of missed opportunity, limited access to essential services, and ultimate disappointment.

In the last two years, programs have sprung up to address these special needs. In Toronto -one of the preferred havens for LGBTQ refugees- some health providers now offer free mental health services to refugees who lack coverage. Centers like Rainbow Health Ontario and Supporting Our Youth have programs to help refugees come out, and to assist with isolation from friends and family back home, and with adjusting to a new life in Canada.

Still, the need for services greatly outnumbers providers; and accessibility issues persist.

Organizations like Envisioning try to create change through legal channels, but public opinion on LGBTQ healthcare access needs to be onside for real change to occur. Recent World Pride events held in Toronto were a step in the right direction. But specialized training of healthcare professionals and public education would go a long way in providing the LGBTQ community with the care they need.

– Sarah Hall, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Dysregulation: A New DSM Label for Childhood Rages

Dysregulation: A New DSM Label for Childhood Rages

00Anger, Child Development, Cognition, Featured news, Health, Parenting, Self-Control, Stress July, 15

Source: Mary Anne Enriquez/Flickr

With the many changes in the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), among the most significant has been the inclusion of Disruptive Mood Dysregulation Disorder (DMDD)—a direct response to the dramatic increase in the diagnosis of bipolar disorder in children and adolescents during the 1990s.

Diagnosing bipolar illness in children is considered elusive at best.  Characterized by extreme and distinct changes in mood, bipolar illness ranges from depressive symptoms to manic “highs.”  In younger populations, the shift between manic and depressive episodes is not so clear.

Children often experience abrupt mood swings, explosive and lengthy rages, impairment in judgment, impulsivity, and defiant behavior.  Such parent-reported symptoms became a popular basis for childhood bipolar disorder diagnoses.

In recent years, Ellen Leibenluft, a senior investigator at the National Institute of Mental Health and an associate professor at Georgetown University, developed the concept of “severe mood dysregulation” as distinct from bipolar disorder.  Her research highlights the difference between unusual intense rages, and the distinct mood swings in bipolar disorder.

Anchored in her research, the DSM-5 task force attempted to develop a new classification for a disorder that shared some characteristics with bipolar disorder but did not include the abrupt shifts in mood.  By doing so, the task force hopes the rate of diagnoses for bipolar disorder in children will decline.

The DSM-5 characterizes DMDD as severe recurrent temper outbursts that are “grossly out of proportion in intensity or duration” to the situation.  Temper outbursts occur at least 3 times per week and the mood between outbursts remains negative.  To separate DMDD from bipolar disorder, children must not experience manic symptoms such as feelings of grandiosity, and reduced need for sleep.

Differentiating between bipolar disorder symptoms and rages unrelated to mood swings may very well be a step in the right direction.

But some studies suggest that DMDD may not be all that distinct or useful as a diagnostic entity different from those already in use, such as oppositional defiant disorder or conduct disorder.  It may be that DMDD is not a condition of its own, but rather a primary symptom of a larger issue.  Irritability and rages may be an indication of a disorder already established in previous versions of the DSM.

Aside from diagnostic labels, taking social situations into account may lead to a sharper understanding of rages in children.

While the role of biology cannot be discounted in the development of mental disorders, childhood behavioral problems may be affected by social and economic circumstances. Financial hardships and other parental stresses have an effect on children’s mental well-being, and stress may be detrimental to the communication between the parent and child.

Along with biological conditions, the DSM task force should consider the impact of the child’s social experience.  Helena Hansen, assistant professor of psychiatry at the New York University School of Medicine, argues that the recent revisions in the DSM-5 have missed key social factors that trigger certain biological responses.  Her article, published in the journal Health Affair, emphasizes the importance of understanding how social and institutional circumstances influence the epidemiological distribution of disorders.

For example, differing temperaments can explain why some children appear to cope well with life stresses while others develop problem behaviors.  Lashing out in the form of rages and tantrums may be a natural response to intolerable anxiety and stress for some children.

As new terms for disorders are coined, such as DMDD, we need to ask if the development of another category is the best alternative.  Is substituting one label of childhood behavioral problems for another really our best option?

Due to the many possible causes for temper outbursts, giving the child a single label may not be all that helpful.  Instead, determining the core issues surrounding the rages may be more useful in providing the patient with an effective treatment plan.

Also, let’s keep in mind that mental disordersare simply constructs, not unique disease states.  They are developed to allow better understanding of a group of behavioral, emotional, and cognitive symptoms, and are regularly revised based on new research and changing cultural values.  While the DSM is useful for the purpose of understanding the challenges faced by patients, it should not be given “bible” status.

Along with mental health care providers, it is important for parents to get informed about DMDD, to ask questions, and to get involved in discussions when considering treatment options for their child.

– Khadija Bint Misbah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Taboo of Male Rape Keeps Victims Silent

Taboo of Male Rape Keeps Victims Silent

00Depression, Featured news, Friends, Gender, Post-Traumatic Stress Disorder, Sex, Stress June, 15

Source: Mitchell Joyce/Flickr

“My name is Will, and I think rape is hilarious…when it happens to a dude,” begins the monologue in a recently posted video written and performed by actor, Andrew Bailey. In this powerful mostly-satirical piece, Bailey opens discussion about how male sexual assaults are brushed off. “A male can’t be raped because he must have wanted it.”

Rape can and does happen to men. Approximately 1 in 6 men have experienced some form of sexual abuse as children, and 1 in 33 American men are reportedly survivors of attempted or completed rape.

And these statistics are likely an under-representation. According toRAINN, an anti-sexual violence organization, about 60% of all sexual assaults are not reported to police.

Although women are more likely to be sexually assaulted, Western notion of masculinity and gender have made it difficult to view men as victims of abuse. Men are often expected to welcome sexual advances, not view them as unwanted, rendering them less able to identify a sexual assault when it occurs to them.

“Male survivors may be less likely to identify what happened to them as abuse or assault because of the general idea that men always want sex,” Jennifer Marsh, the vice president for Victim Services at RAINN told CNN.

A further challenge is the widely-held view that physical strength makes men incapable of being overpowered or assaulted. James Landrith, a sexual assault survivor, spoke to CNN: “We [men] are conditioned to believe that we cannot be victimized.”

But, a research study led by Janice Du Mont from the University of Toronto, reported that male victims are often drugged prior to assault. While the assailant is usually male, female aggressors who violently sexually abuse male victims are not uncommon.

After an assault, the victim often feels troubled by his inability to protect himself, questioning his masculinity, feeling that a sense of control has been taken from him. They may also feel ashamed about the incident, making them reluctant to speak out. In fact, 71% of adult sexual assault survivors hold the view that “nobody would believe me” as a reason for not reporting the incident.

Many report receiving little to no support from family and friends, as they often fear disclosing the abuse. In an interview with theDepartment of Justice Canada, a male sexual assault victim recounts, “no one knew about it, so I just felt very alone, and I didn’t communicate any of that.”

“All the guys would laugh at me about it,” Bailey says in his monologue. Uncomfortable disclosing the reality of the experience, Bailey’s character gives in to rape humour, to fit in with friends. “I was like ‘psych’, I totally did enjoy it; then they high-fived me and told me I was cool.” Indeed, it is not unusual for male victims to fear rejection and harassment from others. Many keep silent.

Victims also report a complex range of emotional difficulties: isolation, anger, sadness, shame, guilt, and fear. Post-traumatic stress disorder (PTSD), major depression and anxiety disorders are also common among victims.

Raising awareness and encouraging male survivors to reach out for support may be challenging, but education regarding sexual abuse and demystifying misconceptions surrounding rape is essential to help male survivors heal.

In research by the Department of Justice Canada, survivors suggested raising awareness through campaigns to better inform male survivors about available resources.

A recent UK initiative created a £500,000 fund for male victims of sexual abuse, bringing considerable public attention to the issue. The UK Ministry of Justice began an international social media campaign using the hash-tag #breakthesilence to end stigma and raise awareness.

Duncan Craig of Survivors Manchester, a survivor-led/survivor-run organization states, “In the future I would like to see both the government and society begin talking more openly about boys and men as victims and see us trying to make a positive change to pulling down those barriers that stop boys and men from speaking up.”

– Khadija Bint Misbah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

empathy sand sculpture_1

I Feel Your Pain: The Neuroscience of Empathy

00Empathy, Featured news, Neuroscience, Relationships, Stress April, 15

Source: Empathy Sand Sculpture/photopin

“I saw you doubling over and it felt like a shot right through me. I didn’t see any blood and there was nothing that scared me. Just you, in your misery, and a horrible sensation…I could feel your pain.”

This was my mother’s explanation for fainting while watching the doctor treating me in the operation room.

While fainting from another person’s pain may be uncommon, it brings into view an interesting aspect of human experience: the ability to relate to and feel the sensations of others.

Empathy is understanding and experiencing emotions from the perspective of another, a partial blurring of lines between self and other. We put ourselves in the shoes of others with the intention of understanding what they are going through, we employ empathy to make sense of their experiences.

Pain empathy takes the concept of empathy to the next level, describing physical sensations occurring to others. The concept has been portrayed in the form of sympathetic pregnancy, men reporting symptoms similar to those of their pregnant partners.

A subset of motor command neurons, mirror neurons are thought to be responsible for these sensations, firing in our brain when we perform an action, or when we observe someone else perform an action. These neurons can make you feel like you know what the other person is feeling. Witnessing someone getting hit by a ball, you feel a twinge of pain too.

Originally discovered in primates, mirror neurons have been used to explain how humans relate, interact, and even become attached.

Mirror neurons connect us to others. Neuroscientist Vilayanur Ramachandran, at the University of California, has described mirror neurons as dissolvers of physical barriers between people (he even nicknamed them Gandhi neurons), explaining that it is our skin receptors that prevent us from getting confused and thinking we are actually experiencing the action.

Though not entirely responsible for empathy, mirror neurons do help us detect when another person is angry, sad or happy, and allow us to feel what the person is feeling as if we were in their place.

Ramachandran suspects that mirror neuron research will lead to understanding purported mind reading abilities, which may in fact have an organic explanation, such as a strong empathic occurrence in which one’s emotional/physical sensations are experienced by the other.

Mirror neurons are important in learning and language acquisition. Through imitation, vicarious learning allows for the construction of culture and tradition.

When malfunctioning, mirror neurons may have a big impact. Individuals diagnosed with autism have difficulty with empathy. And as Ramachandran suggests, it is indeed mirror neuron dysfunction that is involved in autism.

The discovery of mirror neurons also helps us rethink other concepts, such as human evolution. Ramachandran says that mirror neurons are what make culture and civilization possible because they are involved in imitation and emulation. In other words, historically, to learn to do something, we have adopted another person’s point of view, and for that we’ve used mirror neurons.

Empathy allows for intimacy and closeness, and mirror neurons provide evidence that humans are biologically inclined to feel empathy for others. More than just an abstract concept, empathy seems rooted in our neurological makeup.

My mother fainted because she couldn’t endure my pain. Perhaps my suffering triggered great anxiety that her body was unable to manage. Or maybe she physically felt my pain.

Mirror neurons are the interface that joins science and humanities. The connection allows us to reconsider concepts like consciousness, the self, even the emergence of culture and civilization.

Indeed, it’s not surprising that Ramachandran compares the discovery of mirror neurons in psychology, to the discovery of DNA in biology.

– Contributing Writer: Noam Bin Noon, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today