[fat_widget_right]If you are seeking therapy, you want to make sure you select a therapist who is best suited to help you work through your challenges and reach your goals. If you are seeking help for issues related to your intimate relationships or sexuality, it may be important for you to know that sex therapists and couples therapists are not the same. Here, several therapists explain the difference between a couples therapist and a sex therapist:

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Editor’s note: If you or someone you know is in crisis, please click here for information about seeking help.

Cutting is a popular way for teens to self-injure without the intent of suicide. Using scissors, razor blades, pins, pens, or other sharp objects, some teenagers puncture or cut their skin in various places on the body. If you’re a parent, you are probably wondering, “Why would they do that?” The answers may surprise and scare you.

Simply put, cutting is a maladaptive coping mechanism during times of stress and anxiety that is rarely accompanied by suicidal thoughts. According to the American Association for Marriage and Family Therapy, self-harming behavior such as cutting has no single cause. It does not discriminate across cultural and socioeconomic levels, but the behavior is predominately carried out by females.

Reasons behind teen cutting are varied. Often it can be categorized by those who already feel numb as a way to experience intense emotion and pain. Numbness may be due to being emotionally overwhelmed for too long, which almost short-circuits the system into a feeling of dullness—neither happy nor sad. Teens who feel numb often identify that the only way to feel alive is to cut.

Another way to categorize cutting is as a release of emotions, similar to a drain when the sink is overflowing. Teens who feel burdened by stress, anxiety, depression, and other emotions may use cutting to vent the unwanted leftovers of those difficult feelings.

Other reasons for cutting include an intense and overriding feeling of aloneness, feeling helpless, and feeling the need to punish or blame for something that happened.

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The theory behind why teens use cutting as a coping mechanism reasons that endorphins play a major role. When teens cut, endorphins rapidly invade the bloodstream, resulting in a feeling of pleasure and relief. For some teens, the cutting and the endorphin release make them feel “high.”

Take for example, a 16-year-old girl who is a high academic achiever, member of the elite volleyball team, and a positive role model for her younger sisters. She is an all-around overachiever, earning money babysitting and as a lifeguard, striving to excel in school to make sure she gets into a prominent university. Her volleyball team travels on the weekends, and she is looked at as a leader to the other members. In addition, she volunteers at her church and with her community. She dresses well and in fashion, and is always attempting to make sure her hair is perfect. Although she doesn’t love her body, she knows it could be worse, since she’s an athlete and in somewhat decent shape physically.

Emotionally, however, she’s not in shape, nor positive, nor excelling. She is overburdened by academia, struggling to achieve all A’s in her advanced classes. She has to study from the minute she gets home from school until volleyball practice, and then more upon returning. She is not sure her grades will get her into a “good enough” college. She is worried that her best friend is mad at her, and she’s certain that her father hates her. To make matters worse, her right knee has been bothering her, but she doesn’t tell anyone for fear that her team will be mad at her. She has had to cancel when invited out because she had too much homework and she promised her best friend she’d be available if she needed to talk.

At first glance, this teen seems to have a full and rich life, with opportunity abounding. However, she’s so overwhelmed that at night she uses her desk scissors to slice her wrists repeatedly. To make sure no one suspects anything, she hides the bloody tissues at the bottom of the trash can. She wears stacks of bracelets to cover the damage so no one asks. She doesn’t know what else can release the pressure she feels from school, family, friends, and her team. She heard about cutting during lunch a few years ago, and now uses scissors to pour her emotions out.

This is real life for some teens. As much as parents are disgusted by the idea, and instinctively react with shock about what their child has done to their body, it is an unwanted aftereffect of overworked, overscheduled, overwhelmed children. Never before have we put the same amount of pressure on our children and teens to succeed academically, socially, and beyond.

While it may not make sense that they cut their bodies, it makes sense that they find a way to release the pressure. Without learning new coping skills and understanding their triggers, teens often end up alone in their pressure-cooker lives. Through counseling, teens can learn how to handle distress, how to prioritize in their lives, and how to communicate about their feelings.

The day I had been waiting for had arrived. I’d finished cancer treatment and could move on with my life after nearly a year of difficult treatments. I remember the feeling of elation that followed me after that last day of radiation treatment. I finally felt free. My husband and I took a trip to Hawaii to celebrate, and I felt more alive than maybe ever in my life. It was like I’d been holding my breath for months and now I finally was able to exhale. I’d finally been released from the physical and emotional confinements of cancer treatment.

When I returned from my Hawaiian “cancer-cation,” I found that things were already changing from the way they had been during treatment. There were no more supportive cards arriving in the mail, email check-ins from friends started to dry up, and the fruit baskets stopped arriving. Then the calls offering support started to dry up. Medical appointments became less frequent. Support systems began to fade. And then came the feelings—big, dark, troubling feelings. I found myself thinking, “I could have died; I still could die!” and the recognition that I would be living in the shadow of cancer for the rest of my life began to emerge.

Soon it was time to return to work, and I began to feel the weight of expectations from friends, family, and coworkers. I was done with treatment, and everyone wanted me to return to life as normal. Everyone was expecting it. But I knew I was forever changed and there would be no going back to “the old me.” I began to feel the pull of depression and anxiety, as well as the need to make meaning of my cancer experience. I began to wonder if it was a good time to reach out for help.

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Does this experience resonate with you? It seems to be a common theme among cancer survivors I have worked with. In fact, it’s an experience so common and almost universal to people who have had cancer that many cancer hospitals and treatment facilities are now taking action toward creating survivorship programs that address the ongoing mental health needs of their patients. There is a reason they call the period after cancer “the new normal.” It’s an acknowledgment that the old, precancer life is gone and that we have to make our way to finding a new life for ourselves.

Why do so many of us who have experienced cancer face depression and anxiety post-treatment? Getting a cancer diagnosis is one of the most shocking and frightening experiences a person can face. It is, for many people, a traumatic experience. Even for those who don’t feel traumatized by it, it’s a moment that is seared into our minds forever and something we will never forget.

Immediately after diagnosis, we go through an overwhelming period where we struggle to manage our fears and grasp exactly what we will be facing in our treatment. We often have to make quick decisions about treatment options in a very short period of time. There is little time to process all the fear and trepidation we feel. Then treatment begins and we focus on getting through it. We stuff down our emotions and connect with the warrior part of ourselves. And then treatment ends and emotions that were buried as part of self-protection begin to resurface. The intensity of the feelings we experience can catch us totally off guard.

We may experience anxiety and depression. For many, the end of treatment only marks the beginning of a whole new set of challenges to be faced: how to manage the anxiety and fears of recurrence. How to find meaning in an old life that no longer fits. How to process the enormity of what you’ve been through. You may be feeling as I did—lost and rudderless in a your new, post-cancer identity.

You may be wondering how to get your life back on track after cancer. I wish I could provide you with some kind of a map to guide you, or a spreadsheet detailing exactly what to expect in your emotional and physical recovery. The reality is that just as each of us has a unique cancer diagnosis and treatment experience, each of us will have a different experience in how we process our experience with cancer.

Some will need extra time to recover physically and to reconnect with and forgive a body that betrayed them. Some will want to explore a newfound sense of meaning that they found in their cancer experience. Others may need help in implementing a plan to finally start to put their health and self-care into priority. Some may connect to all of this and more.

If any of this resonates with you, you’ll likely find that connecting with a supportive therapist who understands the issues unique to people with cancer will be helpful to you. The kind of emotional exploration done in therapy will arm you with tools for coping with the depth of emotion you feel and allow you to get back on the path to living in your new, post-cancer identity.

Although epilepsy is one of the most common causes of seizures, it’s not the only cause. Extreme emotional states can give rise to seizures. Psychogenic nonepileptic seizures (PNES) are seizures brought on by emotional states, occurring in between 2 and 33 per 100,000 people. According to one study, as many as 20% of people diagnosed with epilepsy might have PNES instead.

New research published in Epilepsy and Behavior aims to discern the differences between the two types of seizures, and researchers were able to correctly differentiate PNES from epilepsy in 83% of cases. They also found a clear connection between anxiety and seizures.

How Anxiety Triggers Seizures

Epilepsy is caused by rapid and chaotic discharge of electrical signals in the brain, but people experiencing psychogenic nonepileptic seizures don’t show this pattern. People with depression, anxiety, and similar mental health concerns can experience PNES, but doctors aren’t sure why. Strangely, a large percentage of people with PNES have epilepsy, making it even more challenging to distinguish psychologically induced seizures from those brought on by epilepsy. 

Differences between Psychogenic Nonepileptic Seizures (PNES) and Epilepsy

Differentiating between PNES and epilepsy can help people experiencing seizures get faster, more effective treatment. To evaluate differences between the two types of seizures, researchers administered questionnaires to evaluate whether and how frequently participants avoided circumstances that made them feel anxious. The group of participants included 30 people with PNES, 25 with epilepsy, and 31 with no history of seizures. Researchers found that PNES was more common among people who regularly experienced anxiety and who took steps to avoid sources of anxiety.

[fat_widget_left]Researchers also found that people who reported more somatic symptoms were more likely to experience seizures. Somatic symptoms are physical symptoms, such as headaches or vomiting, that don’t have an underlying medical cause. The study’s authors note that their research highlights the need for effective interventions among people struggling with anxiety. Because people who experience PNES tend to avoid anxiety, researchers point to the need for treatments that can help people with PNES reduce avoidance behaviors while more effectively managing anxiety.

References: 

1. Mellers, J. D. (2005). The approach to patients with “non-epileptic seizures”. Postgraduate Medical Journal, 81(958), 498-504.
2. New research links anxiety to seizures. (2014, August 1). Retrieved from http://www.lincoln.ac.uk/news/2014/08/932.asp
3. The Truth about Psychogenic Nonepileptic Seizures. (n.d.). Retrieved from http://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures

“What is wrong with you? This is not how I raised you! I raised you to use your brain!”

So went a mom’s reaction when her daughter came to her for help after hurting herself in an effort to feel relief from grief symptoms she was experiencing. As might be the urge of a scared parent in the situation, the mother reacted in anger, screaming and personalizing her daughter’s actions. In this situation, of course the pressing concern is the daughter’s health and safety, and a positive was that the teen had reached out to her mother—though the child later said, “I’ll remember not to do that next time.”

The mother explained that this was her “personality”; she did not “hold anything back,” allowing people to know “exactly how she feels, even if it’s harsh—that’s how I got where I am.” This action did not prove helpful, as the vulnerable child was not in a position to hear a harsh critique and it apparently made the child hesitate about telling her mother the next time she felt unsafe. In this situation, the mother mistook her own common reactionary style (explosive anger) as an unchangeable part of her personality. The truth is, we are able to change the way we respond to others and to ourselves. It isn’t as “fixed” as it can feel.

Feeling doomed to one style of interaction isn’t uncommon. From the child who thinks talking back to her parents is “who she is,” to the significant other who believes it’s OK to berate her boyfriend because “I’m just whiny, that’s how I’ve always been,” to the man who believes “I fall in love fast, I can’t help if it’s with the wrong person,” or, “I just don’t talk about how I feel, I never have,” individuals often treat their patterns as unwavering personality types.

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Why We Believe This

There are a few reasons we may feel afflicted with rather than responsible for our response and communication styles. First, it takes practice to respond differently in the moment than we have before. We typically speak to people without thinking twice, as if filtering our words is someone else’s responsibility and not our own. Second, it can be scary to explore a new way of handling a situation. We can feel particularly vulnerable if we perceive that the change compromises our value system. This is especially true when our reactions have been reinforced in some way.

The mother in the example above perceives herself as successful because of her anger, making anger seem beneficial to hold on to. It’s easy to minimize the negative effects of her anger by focusing on the positives. If the mother values “being authentic,” this might feel like an authentic reaction to her.

Cognitive dissonance is the third idea that allows us hold on to our behavior patterns. Cognitive dissonance is essentially the brain’s way of eliminating discomfort by keeping its ideas consistent. If the mom in our example had failed to change her anger responses in a romantic relationship 10 years ago, she might be motivated to maintain consistency with her anger, as changing now would require her to understand that she could have made a change 10 years ago. Cognitive dissonance allows her to say, “If I couldn’t change it then, I cannot change it now, and I shouldn’t be asked to do so.”

Continuing with the belief that we can’t control our own responses allows us to shift blame outward and focus on the traits of other people—“You should know what I meant,” or, “You should receive my message in whatever tone or verbiage I want to use to send it,” or, “You should know better than to ask how I feel.” The fallacy here is that the only changes each of us is allowed to make are the ones within ourselves; our own reactions, our own coping skills, our own communications. Demanding another person to be less sensitive or expect less of you will stifle rather than grow a relationship.

How Do We Move Forward?

1. Incorporate awareness, validation, and accountability into each exchange. Notice when you are responding out of habit and not out of a desire to find the most helpful approach. Look for patterns, and consider what fears are allowing the patterns to continue. Think about how different responses might be helpful in different situations. Explore what makes you think certain reactions have been helpful, and what your values are in given situations. This will allow you to be true to yourself while making improvements.
2. Practice validation (the recognition of another person’s experience). It requires the listener in a conversation to realize that it isn’t necessary to agree with the statement, just to understand where the speaker is coming from. To use the example of the mother and daughter, the mother may have expressed validation by responding in an understanding, concerned, and neutral manner to her daughter’s admittance of dangerous behavior. Certainly, this calm response may have taken much more energy in that moment than mother’s typically explosive response type, but it may have resulted in more open communication between mother and child. Additionally, it would role-model for the child how to respond to a situation with the most helpful response rather than the first response.
3. Ask yourself, what am I willing to change? How will I do it? Then practice your responses. Ask for time in a discussion or conflict while you gather your thoughts. Life isn’t like Gilmore Girls, where every communication must be stated immediately and as quickly as possible. You can agree to revisit the topic at a specific time after you’ve been able to find the nugget of truth in the other person’s position. Make sure to explain that you’re taking space to think about the topic so that the person you’re communicating with does not fear the topic has been abandoned. In the ongoing challenge of acting and reacting, it is possible to make small changes that start with simply recognizing the things that can be changed and the benefits that can result.

By the time you’re in your thirties and forties, you’ve met a substantial number of people. A small percentage of that group is made up of people you now call friends. In discussing “friend divorce,” I don’t mean people you see only at work or on Facebook. A friend divorce is when you care enough about yourself and the other person to initiate a difficult conversation wherein you essentially say, “I don’t want you to be a part of my life anymore.”

Before going further, I want to say it takes some confidence and self-worth to make a decision like this. If you considered yourself worthless, you wouldn’t be concerned that someone would be hurt if you cut him or her out of your life. I’m glad you value yourself enough to ensure that people who take up space in your life are doing so because they’ve earned it.

How Do You Know When It’s Time?

Sometimes a friend will do something so shocking that you know that this person cannot remain in your life, but there are also subtler reasons to consider a friend divorce. There’s the friend you’ve known your whole life and your high school days are marked by crazy memories, but now you’re both 37 and your friend’s attempts to relive those antics are embarrassing. There’s the friend who disappeared during a time you were sick or someone close to you died. You may have tried to sort this through with them, but you’re certain that their actions would be no different if a similar situation arose. Other friends might also warrant cutting ties. Do you find that you call or text someone out of obligation or only when you know there’s a clear end to the conversation (e.g., waiting for the bus)? If dread arises when you think about spending time with this person, it’s clear that this is no longer a relationship that brings you joy.

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Six Tips for a Friend Divorce

This is a big step, but once you’ve settled on doing it, there are a few things to remember that may help you move through an admittedly painful and awkward process:

1. Be direct: Your friend may hear that you need some time or that you’ll catch up next summer. You’ve put a lot of thought into this, so make sure you’re clear: you are ending the friendship.
2. Expect anger and sadness: Endings stir up difficult feelings. Just because you’ve put a lot of care and concern into this decision doesn’t mean you’ll be thanked at the end of it. This person is losing you, and that’s no small thing. Don’t try to take away their feelings. Allow them, but be prepared for them. Also, remember that this may be come as a surprise to them—especially if their self-involvement is one of the reasons you’re ending the friendship. (And you now have the added bonus that their reaction reminds you why you’re doing this in the first place.)
3. Expect anger and sadness from yourself: You’re losing a person who meant something to you once. That’s sad. It’s supposed to be.
4. Be concrete (if you can): If there are specific moments, then this is a good time to point to them. Stay away from saying “you” if you can. The person may negotiate, but they can’t deny an action. You may have already had a conversation about the intentions behind that action; your focus here is the action and that it could happen again.
5. Let the person know how much they have meant to you and that you’ll be sorry to lose them: This should not turn into, “It’s not you, it’s me.” Honestly, he or she was your friend for a time. There was a reason for that, and chances are it was a good reason. You may need to dig deep, but you don’t want the person feeling that you never cared for them at all.
6. Let them know the limitations: This seems similar to being direct, and it is, but in the heat of emotions you want to ensure that you set specific boundaries, e.g., “Please do not call me. Do not include me on invitations. I’m not going to say ‘no,’ I’m just not going to respond.”

Saying goodbye under the best of circumstances is difficult, and this is hardly the best of circumstances. The older you are, the more you realize how precious your time is, and a lot of it will probably be spent with people. Make sure those people are the ones you want, the ones who add to your life, and the ones who bring you joy.

Psst. I have a little secret for you. Don’t let anyone know I told you this: Be selfish. I know that sounds like terrible advice. In fact, it’s the extreme opposite of what our mothers told us growing up. What we learned was: to be selfish was a terrible thing; a dirty name; a personality trait that no good girl or boy would ever want to be accused of owning. That word can also be a wonderful tool for inducing shame and getting people to behave the way you want them to. If it were an archaic word, growing dusty on the shelf of our childhood, rarely used, I wouldn’t write this article. Instead, that word is so commonly thrown about, tossed from husband to wife, mother to child, our self to our self, leaving guilt, shame, and self-doubt in its wake, that it demands investigation.

The Webster’s Dictionary definition of selfish is: “Devoted to or caring only for oneself; concerned primarily with one’s own interests, benefits, welfare, etc., regardless of others …” If we look at the definition closely, we can see what all those mothers were upset about: “caring only for oneself,” “concerned primarily with one’s own …” and “… regardless of others.” Those phrases do sound pretty heartless, bringing the image of Scrooge to mind. But the rest, “caring for oneself” and “concerned with one’s interests, benefits, welfare, etc.,” address a way of being that we all are, or should be, instinctually doing: taking care of ourselves. That makes it a little confusing; the word “selfish” contains both something integral to human safety, and a harsh censure against it.

This is not to say there aren’t people who act within the literal definition of “selfish,” and whoshould be made aware that their behavior is harmful to themselves and others. I’m concerned about the nonliteral, inappropriate use of the word “selfish.” I worry about the people, so wary of incurring condemnation for their actions and receiving the title of “selfish,” that they confuse healthy behavior with unhealthy, and become immobilized.

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The phrase “self-care” is the argument for the necessity of taking care of our physical and emotional well-being, becoming much more popular and widely used in recent years, encouraging people to take better care of themselves: getting regular check-ups, eating healthy foods, getting adequate sleep, enjoying their favorite activities and so on. Even if people are aware of the necessity of self-care, especially in regards to emotional well-being, it may still be hard to do.

We need to take care of ourselves, but too many people don’t. The reasons are numerous; usually stemming from lessons learned in childhood, possibly suggesting a history of neglect, low self-esteem, poor role models, and more than we can consider here. Those deep personal reasons, in combination with society’s excessive concern about not being “selfish,” may stop many people from taking care of themselves in the ways they should.

The truth is, the way the word is misused, everything we do for ourselves could be considered selfish if there is another person who doesn’t want us to do it. But what if the action we are attempting to take is important, healthy, and necessary, and the desire of the other person to stop us from doing it is selfish? No, disregarding others is not an accurate measure to determine whether you are being selfish. Sometimes we must disregard others in order to take care of ourselves. That can be an extremely difficult thing to do.

I’m sure you’ve had numerous experiences of putting your needs ahead of someone else’s: disappointing the cook by resisting the cake, refusing your child to care for yourself, saying no to the friend and yes to you. On the other hand, how many of you have regretfully eaten that cake, given in to the child, or sacrificed your own wishes for your friend’s? And if these are the small choices, how well do we manage the major ones? People acquiesce to having children they don’t want, pursuing careers they didn’t choose, marrying partners they don’t love. This doesn’t lead to happiness for anyone involved.

If we become so afraid to take care of ourselves because we fear being judged, then who is supposed to take care of us? Having received harsh warnings about selfishness, many people become dependent on others for their happiness. They hope others will know what they need and will provide it. This can become a helpless position to be in, hindering the individual’s self-awareness and self-efficacy.

It seems both a heavy burden and a confusing task to ignore your wants and needs and to instead focus on guessing and fulfilling the wants and needs of others, all while expecting others to be doing the same for you. It’s like the adage, “You wash my back and I’ll wash yours,” except that in this case, they can’t wash their backs unless the other person does it for them. Wouldn’t it make more sense if we, who should know ourselves better than anyone else, were responsible for taking care of our own needs?

So my suggestion next time the word “selfish” comes up, either with another person or with you, is that instead of shame and shutdown it leads to thought and exploration. “Selfish” can lead to greater insight into yourself or your relationships. “Selfish” should be examined on a case-by-case basis, examined to see if the accuser is attempting to get their own way, examined as a guide to what you really want, examined to see if you really are being inconsiderate of others, examined in order to generate solutions that could satisfy both parties, or, if that fails, examined to see if your personal need is important enough to you that you must proceed regardless of the other.

“Selfishness is not living as one wishes to live, it is asking others to live as one wishes to live.” —Oscar Wilde

Two-thirds of parents admit to spanking their children, and 81% of parents say that it’s sometimes acceptable to spank children. Yet study after study has shown the deleterious effects of spanking. A recent CNN article highlighted some of the worst effects of spanking, and parenting experts continue to emphasize that spanking is not an appropriate discipline strategy.

Spanking and the Child’s Brain

Severe spankings may undermine brain development. One recent study, for example, found that children who were frequently spanked, often with objects like belts, at least 12 times a year for 3 years or more had less gray matter in areas of the brain linked to mental health challenges and addiction. Another study found that children who were spanked by their mothers had fewer cognitive skills compared to other children. Researchers suggest this may be because children who are spanked don’t learn to control their own behavior. Rather than learning impulse control and other important skills, these children are perpetually afraid of being punished by external authorities and may to defer to authority as a result. 

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Other Negative Effects of Spanking

“Many parents spank when they are angry, which essentially teaches children that it’s okay for them to hit if they are large enough and angry enough,” says Grace Malonai, PhD, LPCC, a GoodTherapy.org parenting Topic Expert. Research backs Malonai up, with studies repeatedly finding that spanking increases aggression and antisocial behavior. One study found that children were 50% more likely to be aggressive by age 5 if they had been spanked more than twice in the previous month. Another study found a link between spanking and adult criminal behavior.

Parents who spank their children argue that some behaviors are so bad that spanking is the only way to teach children to avoid them. Malonai says this is wrong. “If your goal is to change behavior, spanking doesn’t work. In general, punishment has a very low effectiveness rate.” In addition to its ineffectiveness, Malonai points out that spanking can be damaging to the relationship between parent and child, “because spanking may teach a child to be afraid of his or her parent, which can reduce trust and sense of safety.” This lack of trust and safety in childhood influences the attachment style that the child develops, thus influencing his or her relationship patterns throughout life.

Parents who remain unconvinced of the connection between spanking and aggression should note that there are many other reasons not to spank. A 2013 study that found that children who were spanked by their fathers were more likely to have language and vocabulary problems. The same study also found that spanked children were more likely to behave defiantly.

In 2006, the United Nations Committee on the Rights of the Child moved to end spanking around the world, calling spanking violence against children.

References:

1. Castillo, M. (2013, October 21). Spanking young kids linked to aggressive behavior, language woes by age 9. Retrieved from http://www.cbsnews.com/news/spanking-young-kids-linked-to-aggressive-behavior-language-woes-by-age-9/
2. Kovac, S. (2014, July 23). Spanking the gray matter out of our kids. Retrieved from http://www.cnn.com/2014/07/23/health/effects-spanking-brain/
3. Park, A. (2010, May 03). The long-term effects of spanking. Retrieved from http://content.time.com/time/magazine/article/0%2C9171%2C1983895%2C00.html
4. Smith, B. L. (2012, April). The case against spanking. Retrieved from http://www.apa.org/monitor/2012/04/spanking.aspx
5. Spanking children slows cognitive development and increases risk of criminal behavior, expert says. (2013, December 11). Retrieved from http://www.sciencedaily.com/releases/2013/12/131211103958.htm
6. Tomoda, A., Suzuki, H., Rabi, K., Sheu, Y., Polcari, A., & Teicher, M. H. (2009). Reduced prefrontal cortical gray matter volume in young adults exposed to harsh corporal punishment. NeuroImage, 47, T66-T71. doi: 10.1016/j.neuroimage.2009.03.005

When a family member is diagnosed with a chronic illness, he or she is not the only person who has to deal with the diagnosis—the entire family is affected by it. Think of a car: every part has to work properly and in conjunction with the other parts in order to run smoothly, right? Something as simple as a flat tire can cause the entire system to slow down. The family system is like that car. Each member has roles and responsibilities, and when one person has a medical diagnosis, it can throw off the entire system.

So when a child is diagnosed with a chronic illness, the entire family system is affected. Having a child with a chronic illness can be difficult for everyone. Managing schedules and doctor appointments, going to different therapies, and dealing with sudden changes of symptoms can be exhausting for the child with the illness as well as for the parents.

But what about the nondiagnosed siblings? How are they affected? Family routines and dynamics can drastically change when a child is diagnosed with a chronic illness. This change can affect the nondiagnosed siblings in different ways. Some normal emotions for nondiagnosed siblings include:

• Guilt (because they are healthy and their sibling isn’t)
• Anger (that parents spend more time with the diagnosed sibling)
• Resentment (that the diagnosis has changed the family routine)
• Worry (that their sibling will get worse or die)
• Fear (that they or another family member will contract the illness)

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What can you do as a parent to help your nondiagnosed children cope with their sibling’s illness? Here are a few tips:

Express Feelings

Encourage your kids to talk about their feelings, even when it’s not so positive, and validate them when they do open up. Model this behavior by expressing yourself in a truthful and age-appropriate way to your children.

Maintain Rules

Keep your family rules intact. Many parents feel guilty enforcing rules when there is an illness, but structure can help children know what to expect; it helps them feel safe.

Include Siblings

Do not allow siblings to be caretakers per se, but invite them to doctor or therapy appointments when possible. This can help them understand what your diagnosed child is going through.

Stay Active

Although some extracurricular activities might have to be altered, it’s important to find doable hobbies in which everyone can participate. Being able to enjoy the fun things in life can help the family cope better and feel “normal.”

Make Time

The diagnosed child gets a lot of your undivided attention. Be sure to take time out for your nondiagnosed children, too. It will help them know that they are still important to you.

It’s not always easy to see when a nondiagnosed child is struggling because he or she doesn’t always know how to express feelings. A few things you can look for are changes in sleep, mood, or appetite. You should also be aware of regressed behaviors or changes in school functioning. If you see these changes consistently, consider seeking the assistance of a therapist to help the child cope more effectively.

Children and teens with Asperger’s syndrome (AS) often miss basic social cues, impeding their ability to interact successfully with others. Included in the missed social cues are personal hygiene considerations, which often go unnoticed by kids with Asperger’s. Parents of children with AS frequently complain that it is difficult to get their children to brush their teeth or comb their hair. As the child matures into adolescence, additional hygiene issues, such as the use of deodorant, become problematic. Understanding the causes of these challenges can help improve personal hygiene by enabling parents and loved ones to provide appropriate supports for proper behaviors.

Why Is Hygiene Such a Difficult Issue?

Problems with hygiene for the child or adolescent with AS appear to stem from two things: sensory issues and social awareness. Many children with AS will refuse to shower or to brush their teeth. Although caregivers may initially believe that these responses are due to laziness on the part of the child, in many instances refusal to engage in personal hygiene activities results from sensory issues encountered by the child. In an effort to illustrate this point, consider the AS child who has difficulty trying new foods because of their texture. Inserting a toothbrush with abrasive toothpaste into the mouth can overwhelm the child’s senses, creating an aversion to brushing one’s teeth. As a result, the AS child may not willingly brush his or her teeth each night despite efforts to educate the child about the potential harm that may result.

A lack of social awareness may also impact decision making when it comes to personal hygiene. As children mature into adolescence, their personal hygiene needs become more extensive. Boys and girls will need to use deodorant, shave, comb their hair, and make sure they are properly and appropriately dressed. These hygiene issues are particularly important for adolescents in order for them to project a positive self-image that is acceptable to their peers. Because many adolescents with AS lack a basic understanding of social awareness, hygiene issues may not be an important consideration for this group. Putting on deodorant may not be viewed as important by the adolescent with AS despite the fact it is necessary to prevent body odor: an obstacle which can hinder peer interaction.

What Can Be Done?

With the realization that hygiene is such a difficult and challenging issue for children and adolescents, it is important for caregivers to consider what they can do to promote personal hygiene without overwhelming their child or adolescent with sensory issues or negative criticism. Although the specific hygiene needs of each child will be different, there are some steps that parents and caregivers can take to improve outcomes in these areas:

• Make personal hygiene a part of the daily routine: Routine and structure are important components for reducing stress in children and adolescents with AS. By making personal hygiene activities such as brushing teeth and showering a part of daily life, individuals with AS will come to view these activities as an integral part of their daily lives. This can reduce the stress of engaging in activities that may cause sensory challenges.
• Model personal hygiene for your child: Same-sex parents should work with the child or adolescent to model personal hygiene activities. For instance, a male caregiver should help a teenage boy learn to shave. By modeling behavior, the caregiver not only provides an important teaching support but also serves as a role model for the importance of certain hygiene activities.
• Consider the use of accommodations to make personal hygiene easier: One example that is useful in this area is the use of electric toothbrushes to address sensory issues related to teeth brushing. Electric toothbrushes can provide stimulation to the gums and teeth that is soothing for the child with AS. The use of accommodations may make personal hygiene activities more enjoyable for children with AS.
• Consider professional help and support: If you continue to struggle to promote personal hygiene issues with your child or adolescent, consider professional help. Therapists may be able to assess your child’s needs to provide instruction and education that is commensurate with your child’s ability to understand hygiene issues. Therapists can work with you to translate skills learned in the therapeutic setting to the home. As your child matures into adolescence and sexual maturation occurs, help in guiding your child through professional expertise may be essential.

Being deserving means having an expectation of goodness in your life. It is the goodness of people, relationships, and situations that we all want and deserve in our lifetime. We are all deserving of:

• a safe place to live and work
• relationships and people who love us
• colleagues and employers who respect and support us

The idea of being deserving isn’t a new one. But for someone who is not used to feeling deserving or worthy, it can be a difficult concept.

As a black woman, I grew up with conflicting messages from my family telling me that I was capable and deserving of whatever my heart desired. But then I went into the world only to be told directly and indirectly how undeserving I was. Whether I was undeserving of the same respectful treatment my colleagues were given, of being seated at a restaurant, or of the promotion that I’d worked hard for, I was constantly told and reminded how undeserving I was.

For many people, there is a tension between what we come to believe we deserve and what others tell us we deserve. Whether it’s an outsider or ourselves limiting our expectations, though, it makes it more challenging to live a fulfilled life. Perhaps the limitations you experience in life are a result of a deeper belief that you don’t deserve more. Though it doesn’t feel good, it is familiar to stay in a situation that you’re used to.

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But it doesn’t have to be this way. There are steps you can take toward having the life you want and deserve.

First, ask yourself, “Do I deserve good things in my life?” If the answer is no, why not? Why can’t you have the relationship, job, or life that you want? Take the time to write your answers. You may surprise yourself with the thoughts that are unconsciously swirling around your head. Many times, these buried thoughts come from long-ago experiences that hurt us and continue to influence us today. If you don’t uncover them, you can’t change them!

Now that you know where your feelings of being undeserving come from, you have some investigating to do. Are the comments that were made to you 20 years true today? Were they true then? Don’t give yourself an automatic answer; take the time to expose the validity, or lack thereof, of these thoughts.

A true investigation requires more than just your perspective. Gather three people who are honest, who love and encourage you. Ask for their opinion and thoughts about the messages you received when you were younger. Picking the right three people is key. They shouldn’t be people who will agree with you no matter what; otherwise, you won’t believe them. Nor should they be the people who initially conveyed these messages! They need to be people who will be honest with you while loving and supporting you.

Once your investigation is complete, you need to review this new information. Ask yourself again, “Am I deserving?” and “What am I deserving of?” Are your answers any different than the original ones?

What do you want to do with this new information? Do you want to hold onto it and ponder it? Or are you ready to take action and make changes in your life?

If you are ready to make a change, repeat the following daily: “I am worthy and deserving of goodness.”

Imagine the difference on your psyche and in your interactions with others if you move from saying “I’m worthless” day after day to saying “I am worthy and deserving of goodness.” Repeat “I am worthy and deserving of goodness” each time you go outside. Whether you’re leaving for work in the morning, taking a lunch break, or going to the store, say it. In doing so, you will challenge your thinking and your beliefs about your worth. It will lead you to the interactions, relationships, and situations that you are truly deserving of!

What or who makes you feel deserving? Let us know in the comments section below.

What if we told you that with a single simple phrase, you could turn a bad day into a great one and turn pessimism into an instantly brightened attitude? You could write “I am beautiful” in the fog on the bathroom mirror. You could repeat Aibileen’s mantra from The Help: “You is kind. You is smart. You is important.” Or, you could print out these nine affirmations and hang them around your home or office, tape them on the dashboard of your car, or commit them to memory to pull out during trying times.

Affirmations are statements that reflect a positive outlook on life, one’s abilities, one’s potential, and more. Because the verb “to affirm” means “to maintain as true” (Dictionary.com), affirmations inherently uphold truths. In other words, by repeating these phrases you aren’t teaching yourself anything new—you’re simply repeating and reinforcing truths. Sometimes it’s difficult to remember that you are kind, smart, and important. You may need to continue to tell yourself those things so your brain can recognize and accept them.

Repeating affirmations can relieve anxiety, ease day-to-day pressure and stress, and even have a positive effect on healing from other mental health issues, like addiction. Don’t believe us? It’s scientifically proven!

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GoodTherapy.org has reported before on the astounding benefits of using affirmations:

• For toddlers with autism, affirmations can increase language development.
• Teens develop a stronger sense of identity when using affirmations.
• Simply stating affirmations in times of stress can increase likelihood of success.
• Self-affirming can help people consume less alcohol.

Add these affirmations to your daily routine, and let us know in the comments how they’re helping you achieve goals, gain self-esteem, and foster positivity in life!

1. I have the strength to face the challenges before me.

2. I am worthy of love and respect.

3. I accept myself with all my imperfections.

4. I recognize my own talents and gifts.

5. I am unique. There is beauty in my differences.

6. I focus on what I can do, not what I can’t.

7. I have value and worth in my community and in society.

8. I am grateful for every learning experience I have had.

9. I can change.

Having a hard time accepting these statements to be true? You’re not alone—many people experience self-esteem issues, low self-worth, or reluctance to accept oneself. Therapy can help. Search the GoodTherapy.org directory for the right therapist for you, and take the first step to making a change in your life.