Two weeks removed from a Halloween that inspired thousands of people to dress as reality television’s Honey Boo Boo, child beauty pageants have again entered the national consciousness. From small festival- and fair-based competitions to elaborate, expensive, national endeavors, child beauty pageants are a $5 billion industry. Parents who enroll their children in such pageants fiercely defend them as the child’s choice, and many participants—particularly on pageant-centered shows such as TLC’s Toddlers & Tiaras—seem thrilled to be involved. But what effects do beauty pageants have on children and their impressionable minds?

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Why Children Enter Beauty Pageants

Children are the masters of fantastical ideas, so it’s no wonder that many girls involved in the pageant circuits relish spending a few days a year as Cinderella. But children can’t enter pageants without their parents’ blessing, so involvement ultimately hinges on parental choice rather than the child’s. In a new paper published in the Journal of the American Academy of Child and Adolescent Psychiatry, University of Arizona professor Martina M. Cartwright emphasizes this point. She calls the phenomenon “princess by proxy,” explaining that the real attraction of pageants is for parents who can gain social status, self-esteem, and money when their children participate.

Potential Effects of Beauty Pageants: Eating Disorders and Body-Image Distortion

Pageants, particularly those designed for younger children, focus primarily on appearance, attire, and perceived “cuteness.” Talent competitions occur in some pageants and often are a secondary component of the experience. Thus, pageants suggest to young children that there is value in focusing on their appearance as judged through the eyes of others. This can lead to significant body-image distortions, and adults who once participated in child beauty pageants may experience low self-esteem and poor body image.

As with most adult pageants, child pageants often require crash dieting. Parents may encourage children to quickly lose weight so they can fit into small costumes or display tiny bodies in swimsuit-centered fitness competitions. Some parents put their kids on crash diets designed to help them gain energy and enthusiasm. These diets may consist solely of sugary snacks and sports drinks for several days. This can harm both short- and long-term health and teaches children unhealthy approaches to food that can contribute to the development of eating disorders.

Beauty Pageants and the Sexualization of Young Girls

Sexualization is the tendency to view oneself as a sex object, and children who participate in beauty pageants are sexualized very early. Children may dress in highly suggestive costumes and learn that they gain attention and status when sexualized. This may lead to premature sexual activity and can teach the unfortunate lesson that women’s worth is determined at least in part by their status as sex objects.

The Unhealthy Values Built by Beauty Contests

While some pageants are brief events that require little preparation, the world of pageants can be cutthroat and extremely competitive. Children learn a host of unhealthy values, including the desire to defeat their competition at all costs. Tantrums and meltdowns—by children and parents alike—are common backstage at beauty pageants, and long-term participation in pageants can teach children that their primary source of worth is how many pageants they win and how “beautiful” they are perceived to be. Academic achievement, empathy, social skills, athletic pursuits, and other age-appropriate activities may take a backseat in the world of pageants. And because precious few pageant participants grow up to become models or entertainers, this early experience can stunt their development by focusing their attention on something they are unlikely to be able to do as adults.

References:

1. Giroux, H. A. (2009, May 11). Child beauty pageants: A scene from the “other America.” Truthout. Retrieved from http://archive.truthout.org/051109A
2. Sinpetru, L. (n.d.). Child beauty pageants foster adult body dissatisfaction, eating disorders. Softpedia. Retrieved from http://news.softpedia.com/news/Child-Beauty-Pageants-Foster-Adult-Body-Dissatisfaction-Eating-Disorders-302540.shtml

For children and adolescents with attention deficit hyperactivity (ADHD), Ritalin (methylphenidate) is typically the medication of choice. As a psychostimulant drug, Ritalin increases the concentration of the neurotransmitters dopamine and noradrenalin in the brain. These neurotransmitters are partly responsible for impulse control and attention, among other things.

Studies in both rats and humans have verified that Ritalin effectively controls the three primary symptoms of ADHD: inattention, hyperactivity, and impulsivity. When ADHD goes into remission, the person’s quality of life and performance in work or school measurably improve.

Despite these benefits, critics have wondered about the potential negative effects of this heavily prescribed medication. For one thing, no one fully understands how Ritalin functions in the brain. More importantly, little information exists as to the long-term effects of a psychostimulant drug on the developing brain. A recent study with rats highlighted a possibly adverse effect of Ritalin that had previously been overlooked.

Adolescent play behavior is important in terms of both mental and social development. Through play, children learn the basic “rules” of social interaction and receive the rewards of companionship. Isolated children often have difficulty adjusting to adult life and navigating social situations. Researchers investigating Ritalin’s effect on social play found that the medication significantly reduces the behavior in rats.

Adolescent rats treated with low doses of Ritalin were apt to ignore invitation to play, instead remaining focused on their general environment. The effect was surprisingly specific. Rats demonstrated the same overall activity levels as untreated counterparts, but less overt play behavior and social interaction. Some rats were isolated for up to 24 hours before release into a play area. Researchers believed a long period of isolation would enhance play despite the effects of Ritalin, but they were mistaken. Regardless of isolation period, Ritalin proved to be a powerful blocker of normal, social play behavior.

The beneficial effects of Ritalin for people with ADHD are inseparable from the possibly negative effects of inhibited play. By its very nature, play is a complex, dynamic, but not necessarily focused activity. One of the primary aspects of Ritalin’s overall effect is to inhibit “unfocused,” freewheeling behaviors—including play, apparently. This calls for more research and possibly long-term studies of the potential consequences of Ritalin prescription throughout childhood and adolescence. It’s possible that this medication poses more risks than previously believed.

References:

1. Attention deficit hyperactivity disorder (ADHD) – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
2. Vandershuren, L., Trezza, V., Griffioen-Roose, S., Schiepers, O., Van Leeuwen, N., De Vries, T.J., and Schoffelmeer, A. (2008). Methylphenidate disrupts social play behavior in adolescent rats. Neuropsychopharmacology, 33, (12), 2946-2956.

If someone is referred to as a perfectionist, it could be considered a compliment or an insult. Perfectionism is an ambiguous categorization, hallmarked by high standards and motivation for success. Being a perfectionist does not necessarily mean that an individual will have negative traits such as neuroticism. But it does not indicate that one will be highly resilient when goals are not met, either. Understanding perfectionism, and the subjective evaluations of perfectionism, is critically important for perfectionists and the clinicians who treat them.

Perfectionism can motivate someone to push themselves further in various domains. Having the desire to achieve something is not a bad thing in and of itself, but when that desire becomes an obsession, it can create problems. Because the definition of perfectionism is so unclear, Jeffrey S. Ashby of the Department of Counseling and Psychological Services at Georgia State University decided to evaluate perfectionism based on its positive and negative influences. In a recent exploratory study, Ashby asked 36 college students with significantly high standards how their perfectionist traits affected different areas of their lives. He also looked specifically at how high versus low levels of worry and stress were related to perfectionism.

Ashby found that although some of the participants did not describe themselves as perfectionists, they still had tendencies that would indicate otherwise. For instance, high worriers who reported stress as a result of their perfectionist traits exhibited less resilience than low worriers, even though they may not have considered themselves perfectionists. Although the levels of worry varied, Ashby found that worry was most closely related to high standards in professional, academic, and work domains. Interestingly, other areas, such as personal appearance, religious involvement, self-esteem, and relationships were mentioned as well, but had distinct significance for each participant. Thus, it seems based on the responses that perfectionism and its effects, positive or negative, could depend on the domain it is attached to.

This exploration into perfectionism also revealed a relationship to obsessive-compulsive traits. In particular, the participants with the highest levels of worry and negative outcomes related to their perfectionism also reported the highest levels of obsessive-compulsive habits or rituals. Also, Ashby found that those who experienced the most stress from their perfectionism were the least likely to call themselves perfectionists, and were for the most part unwilling to give that character trait up. “The apparent inconsistencies between the distress attributed to it, the benign evaluations of it, and the general reluctance to give it up, raise intriguing questions about perfectionism,” Ashby said. He believes that this finding suggests a deep-rooted sense of perfectionism that individuals consider inherent or ingrained. Future work should explore this nuance of perfectionism more thoroughly in order to better understand how this classification of perfectionism may impair change in those who experience negative consequences from their behaviors.

Reference:
Ashby, Jeffrey S., Robert B. Slaney, Christina M. Noble, Philip B. Gnilka, and Kenneth G. Rice. Differences between “normal” and “neurotic” perfectionists: Implications for mental health counselors. Journal of Mental Health Counseling 34.4 (2012): 322-40. Print.

Poor response to treatment is an unfortunate reality for many people with major depression (MDD). By some estimates, as few as 30% of people with MDD achieve complete and lasting remission of symptoms. Primary care physicians deal with this lack of treatment response in one of three ways: They may increase the dosage of an antidepressant medication, add a secondary medication, or switch to an alternative medication.

Dosage increases are often the first choice, assuming higher doses remain within reasonable safety parameters. Because of its unique chemistry, the selective serotonin reuptake inhibitor Lexapro (escitalopram) is an ideal candidate for dose escalation. Whereas other antidepressants reach a sort of effectiveness plateau, Lexapro’s mechanism of action becomes stronger in proportion to dose.

Lexapro is approved for daily doses of not more than 20 mg. In practice, however, doctors have prescribed up to 50 mg for patients showing no response to lower dosages. That said, little evidence exists on whether successively higher doses represent a good balance between efficacy and safety.

A recent investigation in Scotland sought to answer this question. A starting group of 60 people diagnosed with MDD was switched from Celexa (citalopram) to Lexapro for a 32-week period. At regular intervals, Lexapro dosage was increased up to a maximum of 50 mg or until remission of symptoms. Researchers employed standard psychological measures to quantify severity of depression and occurrence of side effects.

Results from the study revealed few problems with safety or tolerability of high-dose Lexapro. However, overall effectiveness was somewhat less than desirable. Of the 60 participants, 18 dropped out because of adverse effects or lack of efficacy. Most of these withdrawals happened earlier in the study, before reaching the higher dose levels.

Half of study participants experienced remission of symptoms. Thirty-eight percent of those required a dosage of 50 mg. At doses higher than 40 mg, side effects became more pronounced although not necessarily more severe. Diarrhea was the most frequent complaint for those at doses of 40-50 mg. Other common side effects included headache, nausea, fatigue, and dizziness.

Larger, more controlled studies will be useful in ascertaining whether the benefits of high-dose Lexapro outweigh the risks. The Scotland study indicated only marginal effectiveness, although participants generally tolerated the high doses of medication. It should be noted, of course, that the population in question has a history of poor response to treatment. It’s unlikely that any one avenue will prove beneficial to all.

References:

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
2. Wade, A., Crawford, G., Yellowlees, A. (2011). Efficacy, safety and tolerability of escitalopram doses up to 50 mg in major depressive disorder (MDD): an open-label, pilot study. BMC Psychiatry, 11, 42. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068950/?tool=pmcentrez

I’ve been thinking about grief, mourning, and loss a lot lately. It shows up as a theme in my work as a psychotherapist all the time. I’ve also been studying the literature on methods of providing grief counseling and grief therapy. What I realize is that my sub-specialty in this area is not limited to working with individuals who have experienced the death of a loved one. It is more far-reaching than that. Judith Viorst wrote a wonderful book, Necessary Losses: The Loves, Illusions, Dependencies, and Impossible Expectations That All of Us Have to Give Up in Order to Grow, in the mid-1980s in which she described the losses we experience along the life cycle. It’s a must-read for people who are unfamiliar with it.

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I would venture to say that most of the work we as psychotherapists and spiritual counselors do is about coping with loss. We help our clients grieve about their losses, whether it’s loss of youth, money, job, socioeconomic status, or friends. They need to be helped to grieve the loss of hopes and dreams. They even grieve the loss of fantasies and illusions, although much of this happens unconsciously. In this case, our job as psychotherapists and counselors is to help them recognize that they are in mourning and provide tools to cope. The idea is that grief takes up a lot of psychic space in our beings, and it is only by coming to terms with our losses that we create room for the new.

The focus of this article is how many people typically grieve. The ways—which are not healthy—include:

• deny
• become anxious or depressed, or a combination of both
• engage in risk-taking behavior such as drinking excessively and driving, compulsive spending, and sexually acting out
• become an abuser, a victim, or a combination of the two
• over-eat or under-eat, and other “overs” and “unders”
• become controlling
• hoard

These are just a few of the many ways people attempt to fill the space loss creates in their psyches and spirits. With methods such as these, the loss is not completely grieved or grieved at all. The feelings may even become worse, leading to a cycle of self-harming behavior.

So what predisposes someone to engage in the self-harming and ultimately unsatisfying behavior described above? There can be many factors, including low self-esteem, a history of untreated anxiety and depression, an inability to express feelings—especially difficult ones such as anger—and the lack of a support system. There are also more complex reasons involving one’s family of origin, including trauma in early childhood and the absence of a secure connection with early caregivers.

This sense of emptiness and lack of safety makes loss intolerable rather than simply painful, and it is this inability to tolerate it that leads to the behavior described above.

In addition to these internal factors, society in general and specific cultures in particular make grieving difficult. Part of this stems from our lack of recognition of the universality of loss, i.e., as something that permeates all aspects of life and isn’t just about death. In addition, we have become a culture of short-term fixes—the “just-get-over-it-and-move-on” philosophy. This puts pressure on individuals to minimize their sense of loss.

Finally, there is the over-arching reason grief is given short shrift. It makes many, if not most, people uncomfortable because it touches unhealed grief in themselves.

Next month, I will discuss some effective and healing ways to cope with grief and loss.

When parents view their child’s “problematic” behavior, attitudes, or troubles as a reflection of them, it can be a terrible blow to the ego. For parents with positive self-feelings, anger, hurt, and disappointment can occur when they don’t see themselves reflected in their children. (“My child should be just like me.”) For parents who do not feel very good about themselves, seeing a child as being “just like me” can feel devastating. Parents who lack self-esteem often feel like their child’s problems are their fault. Their inability to differentiate themselves from their children can also result in guilt and painful feelings of responsibility that are often overstated and inaccurate. Many parents who struggle with the idea that their child is a reflection of them (for better and worse) have not separated from their children. These parents tend to feel some responsibility for their child’s situation. Most often they believe that, either in their early behavior with their children or in their biological contribution (or both), they have profoundly affected their child’s life and character.

“Peter” came to his therapy session in a rage about “Adam,” his 25-year-old son. He had just come from his son’s apartment and was disgusted about the dirt and disarray he encountered: “What is the matter with that kid? He’s such a slob. There is stuff everywhere. It feels so chaotic! I have the same feeling when I think about how he gets drunk with his friends on the weekend. He’s a mess!”

When I asked Peter what made him so angry about this, he began to express remorse about being so enraged. Choking up, he said, “I guess I’m really hurt. I feel like Adam is being disrespectful to me. He knows I hate his messes and his drinking behavior. I feel like he’s on a terrible path of disorganization and disaster. I keep asking myself, ‘How did he turn out this way?’ ”

I asked Peter what he thought about why Adam was like this. “I don’t really know,” Peter said. “But I honestly believe it’s my fault. You know I was a terrible workaholic during Adam’s first 10 years. I neglected him when he was growing up. Then I think, if I was a workaholic, will he be an alcoholic? I know I made him this way. I’m a mess of a father.” Peter was tortured by his painful feelings and disappointment that his son hadn’t turned into the ideal adult that Peter wished he could be.

Over time, as we explored Peter’s feelings, it became apparent that he put all the responsibility for the person Adam was at age 25 on himself. He found it very difficult to see Adam as a separate individual with his own reasons for behaving the way he did. Slowly, Peter was able to consider that his influence hadn’t only been negative and that he wasn’t the only influence on Adam’s development. Adam’s mother was nurturing; Adam had many friends growing up. Peter could even recall some teachers who were influential in Adam’s life. He acknowledged, for example, that a high school teacher had encouraged Adam to stay with his music, and Peter admitted that Adam was a successful musician.

“I guess I haven’t focused enough on Adam’s successes, just on the ways I see him as a failure and blame myself,” Peter said. “Sometimes I still think that maybe Adam is punishing me when he messes up in ways he knows I hate. I guess I really have to admit that it isn’t all about me. Adam is a different person from me. It’s just hard to be OK with that. But I do want to get there. I know that would be best for our relationship.”

Peter is slowly beginning to separate from Adam and experience Adam’s successes and failures as more about Adam than him. He is also beginning to take Adam’s character and behavior less personally. Giving up the idea that “it was all my fault” makes space for Peter to see Adam as a separate individual.

“Rose,” another client, began to talk about her 10-year-old daughter, “Jessica,” in our therapy sessions.  Rose was obsessed with worry that Jessica, who had learning disabilities, would never have a successful life. She said with some sadness: “Her brain is damaged. How will she ever be OK?”

“What do you mean, ‘Her brain is damaged’?” I asked.

“You know that we had her tested and she has so much trouble focusing and organizing her thoughts,” she responded.

“Yes, I know she has some learning disabilities, but seeing her as ‘a person with a damaged brain’ seems a rather extreme way of defining your daughter,” I said.

“I sort of know what you’re saying is true,” she said. “But you know I had learning disabilities as a kid. No one identified them; no one did anything about it. I still struggle at work and in my life in general with being focused and organized. I get so depressed and anxious when I forget things or don’t get stuff done like I promise my husband or my boss. I know my brain is messed up, and Jessica is just like me. Why would I think her fate is going to be any different?”

Rose had a very strong belief that biology was determining her future as well as her daughter’s. She was reluctant to consider that her daughter’s life could take a different path from hers. She had a difficult time thinking about Jessica as a separate person with her own unique characteristics. I reminded her that she and her husband had been addressing Jessica’s learning problems and getting help for her. I also pointed out that this was very different from her own experience growing up. I emphasized that there are many influences other than biology that influence a person’s development. I also asked Rose to tell me anything she could think of about Jessica’s accomplishments. We both listened to the list Rose came up with: “Great piano player, really good artist, hula-hoop champion, kind person, good swimmer, and I guess other stuff, too.” Rose reluctantly acknowledged, “Yes, I suppose her brain works OK in some ways.”

Rose and I spent a lot of time talking not only about Jessica, but also about Rose’s negative sense of self. It was harder for her to take seriously that she has her own accomplishments. It was even more difficult to consider that Jessica was like her in some ways and not others. (Rose is a terrible artist and swimmer!) Our work has centered on Rose’s struggle to experience herself in positive ways and on seeing Jessica as a separate, differentiated individual. We have also been talking about how painful it is to see your child have areas of deficit, and even worse when you feel you are the cause. Helping Rose to talk about her impaired sense of self and its development has allowed her to make distinctions between her own experience and Jessica’s. I have tried to help Rose consider that while there could be some biology at work in regard to Jessica’s learning disabilities, so much more than being “just like me” is involved in what makes Jessica who she is.

We are familiar with parents feeling great pride in how they played a role in their children’s successes. But when parents boast incessantly about their children’s accomplishments to the extent it doesn’t feel like typical parental pleasure, we typically consider them to be narcissistic. For Peter and Rose, their great dismay in what they perceived as their children’s deficits, problems, and failures was also narcissistic.

The term narcissism comes from the Greek myth of Narcissus, in which Narcissus falls in love with his own reflection in a pool. The notion of reflection is pertinent to the experiences of Peter and Rose. Rather than experiencing narcissistic pleasure, these distraught parents experienced a narcissistic wound. They couldn’t tolerate the pain of looking into the pool (i.e., at their child who also represents the parent) and seeing something that is not “beautiful” reflected back. When they looked at their children, they saw a reflection of themselves. It was intolerable that the reflection they saw was “a mess” or had a “damaged brain.” It was not “beautiful.”

These parents are responding narcissistically, and they have not differentiated themselves from their children. One has to wonder how parents, who view their children as reflections of themselves, may have influenced their child’s separation/individuation process. As parents become more aware that their beliefs that their children are or are supposed to be “just like them” are assumptions, they will be in a better position to examine those beliefs. As a result, parents will experience less pain, and their children will be helped to develop into separate, unique individuals.

Some people become emotionally overwhelmed when they see or hold a small baby. They develop a longing to have a baby, even when they may already have children. In popular culture, this phenomenon is known as “baby fever.” This type of event can happen to virtually anyone. However, it seems to affect only certain people, while others appear to be immune. The curious nature of “baby fever” was of interest to Gary L. Brase at the Department of Psychology at Kansas State University, so he decided to conduct a series of studies to determine if there were biological causes for the phenomenon and why it occurs.

Brase recruited 853 nonstudent young adults and 337 college students and measured their desire for a baby, if this desire differed by gender, and how it related to sexual desire, emotions, and experience with other children. After an exhaustive examination, Brase found evidence for the existence of “baby fever.” “Three factors strongly and consistently underlie desire for a baby: Positive Exposure, Negative Exposure, and Tradeoffs,” Brase wrote. One contributing factor that led to “baby fever” was positive experience with children. Individuals who had bad experiences with children were less likely to develop “baby fever” than those who had only good experiences. Trade-offs also played a major role. Participants who were comfortable with trading time, intimacy, financial resources, and energy for a baby were at increased risk of “baby fever” when compared to those who were less willing to trade those commodities.

Although Brase discovered that the desire for a baby was present in men and women alike, it was more evident in the women. He also noted that desire for sex was quite different than the desire for a baby for both sexes. Despite the fact sex leads to babies, the reproductive/sexual desire is independent from the desire to nurture and parent. The results of this study clearly show that “baby fever” is a unique occurrence unrelated to sexual motivation and cultural expectations, but future research should look further at the psychological origins.

Reference:
Brase, Gary L., and Sandra L. Brase. Emotional regulation of fertility decision making: What is the nature and structure of “baby fever”? Emotion 12.5 (2012): 1141-154. Print.

I was recently told a statistic that didn’t really surprise me, but was kind of an eye-opener nonetheless: Married individuals daydream about being single at least once a day. Well, I’d argue that single people dream about being in a relationship once in a while, too. The point is that the grass is always greener.

The other point is that there is some truth to the statistic, and people should be aware of what is happening biologically. The chemicals in our brains when we meet someone, start dating and “fall in love” are akin to being on a cocaine high. Dr. Helen Fisher, author of Why We Love: The Nature and Chemistry of Romantic Love, coined this the “lust” and “romance” phases of love­—when things are exciting, albeit chaotic. This is not a sustainable way of living. Most people want to fall in love so they can settle down. A friend once said to me, “But isn’t doing your laundry on a Saturday with your partner what it’s all about?” Yes, a long-term relationship is comfortable, secure, stable, and, well, biologically speaking, perfect for raising children. You wouldn’t want to raise kids in a chaotic state of mind, would you?

Now, this final phase of love, which Dr. Fisher calls “the attachment phase,” is not that exciting, perhaps, but it really isn’t supposed to be. I think a lot of people get disillusioned by messages in the media, romance in films, and passionate sex in movies. It seems that if you want something exciting, you have to keep jumping from one relationship to another. And, trust me, many people do. Although many use the term serial monogamy, this can be a sign of a love addiction—people finding themselves addicted to the rush of romance.

Love addiction also has a flip side to it: It might cause you to stay in an abusive relationship. Love addicts often are afraid of being alone, and don’t like their own company. Love addiction can take over and cause people to make bad choices, fail to see red flags, and continue down a path with someone despite the obvious. Many love addicts have more than one partner.

We all have the tendency to be love addicts because, in the end, we all want love and connections with people, for that is how we grow, but a true love addiction is compulsive and obsessive in nature. A love addict may feel that true love will solve everything. A love addict may consume his or her mind with all things relationship-oriented. A love addict may fantasize about someone who is unavailable, believe he or she just can’t find the right one, or, once the early passion fades, fear he or she is no longer “in love.” Some may jump from one relationship to another in search of that excitement, while others stay in their current situation despite feelings of dissatisfaction, fantasies about leaving, or affairs both emotional and physical, and are prone to blame their partner(s) instead of addressing the matters at hand.

So how do we start to address a possible love addiction? Here are some guidelines I’ve come up with, for starters:

1. Stop blaming the other person. If you are in a relationship, take a close look at what is going on. Are you being fair? Are you being honest? Are you being clingy? A love addict may expect the other person to treat him or her special, make everything, and fix things for him or her. If you are single, stop blaming the ex, take a break from dating, stop interacting with the ex, get into therapy, and talk to someone.
2. Accept your feelings of sadness, fear, anxiety, and loneliness on a daily basis. These are common feelings that everyone feels, but a love addict may try to fight them by finding a relationship. Recognize that you will feel these feelings and it is OK.
3. Take responsibility for your life. This means your happiness and your successes. Take charge of your life, make healthy choices, and spend time doing the things you love.
4. Learn to accept yourself. Accepting your partner, if in a relationship, is key, too. In the end, without acceptance we are continuously searching, and that is at the root of any addiction.

Integrating live animals into the therapeutic process has been gaining recognition as a viable and effective approach in a clinical setting. Equine-assisted therapy is a widely popular form of therapy that has shown remarkable results with clients who do not respond well to other types of treatment. Similarly, children who are resistant to traditional therapies have demonstrated improvement in animal-assisted therapies. For individuals who experience disassociation, animals represent an unconditional source of love and acceptance. For people who may have experienced early life trauma, especially trauma or abuse that undermined attachment relationships, animals can replace missing secure attachment bonds.

Although animals as therapy adjuncts, even pets, can help reduce anxiety, depression, loneliness, and isolation, owning or working with an animal may not be a viable option for everyone in need. Therefore, stuffed animals, which represent a source of comfort in times of stress for young people, may serve as a suitable replacement. Rose M. Barlow of the Department of Psychology at Boise State University in Idaho wanted to see if stuffed animals would serve clients equally as well as live animals. In a recent study, Barlow surveyed a sample of high and low dissociative female college students and those with dissociative identity disorder (DID) about attachment to live and stuffed animals. She found that the DID women had significantly stronger attachments to both live and stuffed animals than any of the other women. She also found that those with high dissociation and those with DID reported higher levels of attachment to stuffed animals than live animals when compared to the low dissociative group.

The findings of this study have several important clinical implications. Even though comorbid issues such as depression, anxiety, and bipolar were not considered in this research, the evidence suggests that stuffed animals may be particularly helpful to those with high levels of dissociation. Because symptoms of dissociation, even disorganized attachment, can begin in childhood and result from emotionally unavailable parents, divorce, or abuse, integrating stuffed animals into therapy for young children can provide a sense of security and help to rebuild impaired attachment bonds. “Animals, live or stuffed, can aid therapy for both children and adults by providing a way to experience and express emotions, a feeling of unconditional support, and grounding,” Barlow said.

Reference:
Barlow, Rose M., Lisa DeMarni Cromer, Hannah Prairie Caron, and Jennifer J. Freyd. Comparison of normative and diagnosed dissociation on attachment to companion animals and stuffed animals. Psychological Trauma: Theory, Research, Practice & Policy 4.5 (2012): 501-06. Print.

The average age of sexual initiation is roughly between 16 and 19. Although some teens wait until much later, many begin engaging in sexual behavior before the age of 15. Numerous studies have looked at the negative consequences associated with early sexual initiation, such as emotional problems, HIV/AIDS, pregnancy, and intimate partner violence. But recently, researchers at the University of Texas looked at how sexual-initiation age could benefit people later in life. In a study led by Paige Harden, 1,659 sibling pairs were evaluated from middle adolescence through young adulthood. They were asked when they began having sexual intercourse, how many partners they had, and, if they were in current relationships, how happy they were.

Harden found that the participants who were in satisfying, committed relationships in adulthood were those that started having sex in their late teens or early twenties. These individuals reported less relationship conflict and more respect, affection, and love for their partners than the participants who had earlier sexual-initiation ages. Harden tested this outcome further by including factors such as physical appearance, body mass index, and education and came up with the same results. She believes that people who begin sexual activity after they have reached physical and cognitive maturity may make better partner decisions and be more discriminating in their choices. They may also have stronger communication skills that can benefit their overall relationship.

The results of this study don’t suggest that earlier sexual initiation can increase negative outcomes. Rather, these findings demonstrate that being a late bloomer can act as a protective factor. “We still don’t understand precisely why delaying sexual intercourse is correlated with more satisfied adult relationships,” Harden said. She hopes that future research will look at the flip side of her study, and in particular if early sexual activity among teens decreases their chances of having satisfying, positive relationships in adulthood.

Reference:
Ochsner, David. Does true love wait? Age of first sexual experience predicts romantic outcomes in adulthood. (n.d.): n. pag. The University of Texas at Austin. 18 Oct. 2012. Web. 18 Oct. 2012. http://www.utexas.edu/news/2012/10/18/does-true-love-wait-age-of-first-sexual-experience-predicts-romantic-outcomes-in-adulthood/

People who are discriminated against cope with that discrimination in various ways. Although some cope adaptively and use strategies that are constructive and empowering when they are faced with adversity, others turn to maladaptive coping mechanisms. One such mechanism is the use and abuse of alcohol and drugs. Racial discrimination has been shown to be related to increased drug and alcohol use, but has not been proven to be the cause of the increase. So why is it that some people use alcohol and drugs to cope while others do not? Meg Gerrard of the Norris Cotton Cancer Center at Dartmouth Medical School in New Hampshire wanted to explore this question further. In a recent study, Gerrard looked at whether people used drugs/alcohol as a method of coping consistent with their habitual coping strategies, or if they believed that substance use would decrease their feelings of stress and negativity stemming from the discrimination.

Gerrard conducted three separate studies designed to elicit feelings of discrimination among a sample of African-American adolescents. In her third study, she followed the level of substance use for eight years to determine the long-term influence of the discrimination-use relationship. She found that the participants who felt that substance use was an acceptable way to cope with problems were more likely to use drugs/alcohol when they felt discriminated against than those who did not endorse substance use. Over time, the results revealed that those who did support substance use as a method of coping continued to use drugs/alcohol throughout adolescence and into early adulthood, while those who never supported this belief did not. These findings suggest that adopting substance-use behaviors early on can lead to long-term maladaptive coping strategies for some individuals.

The findings from this study were gathered only from African-American participants. Future work should look at the coping-discrimination dynamic among other minority individuals, as evidence exists that prejudice and discrimination increases stress across all ethnicities. Gerrard noted that one domain that was not examined in her study was the effect of parental support. When parents teach their children how to handle stressful situations prior to their occurrence, children have a better chance of dealing with challenges such as discrimination in productive and adaptive ways rather than trying to relieve the stress with drugs or alcohol. Research should explore the buffering effects that family and parental support can have on this segment of the population. Until then, these studies demonstrate that acceptance of maladaptive coping strategies can increase negative behavior in people facing discrimination. “The current studies also provide evidence that use-as-coping is not caused by discrimination—instead, it increases the relation between discrimination and subsequent substance use,” Gerrard said.

Reference:
Gerrard, Meg, Michelle L. Stock, Megan E. Roberts, Frederick X. Gibbons, Ross E. O’Hara, Chih-Yuan Weng, and Thomas A. Wills. Coping with racial discrimination: The role of substance use. Psychology of Addictive Behaviors 26.3 (2012): 550-60. Print.

Depression makes it difficult to function in daily life, but adding discrimination to the equation makes it even more troublesome.

A new study in the journal The Lancet stated that out of the 1,082 adult participants with major depressive disorder, 79% reported that they have experienced discrimination. People who experienced discrimination while depressed had more depressive episodes, social difficulties, and issues finding and keeping a job. They also were less likely to reveal a diagnosis of depression.

These results suggest that more works needs to be done in the area of preventing discrimination and eliminating stigma. Discrimination can prevent people with depression, who may be worried about disclosing their diagnosis, from getting the help they need. While getting a job and growing social networks can help fight depression symptoms, those pursuits become more challenging in the face of discrimination.

How, specifically, does discrimination affect people with depression? How can the general public be more understanding? And what options do people with depression have? Mental health experts and other professionals have some answers.

Dr. David Sack, CEO of Elements Behavioral Health and Promises Treatment Centers, said by email that sensitivity toward people with depression often is lacking.

“The most common example has to do with intolerance toward peers/friends/relatives that comes from not understanding that depression is a disease that the individual cannot simply will themselves out of,” he said.

Sack said a supervisor might question an employee’s motivation and commitment due to symptoms of depression, even if those symptoms don’t reflect how the employee really is.

“How often have we heard that this or that person claims that they are depressed just so they can get time off from work or won’t have to take responsibility for mistakes they’ve made?” Sack said.

Although many people know the basics of depression thanks to widespread awareness initiatives, prejudice, bias, and stigma still are rampant.

Viola Drancoli, a clinical psychologist, said in an email that friends and family members of people with depression might exhibit discriminatory behavior with them because they may feel drained from being around someone who expresses sadness, pessimism, irritability, and a lack of motivation.

This could push someone with depression into isolation. A person with depression might prefer being alone so he or she doesn’t have to attempt to hide feelings from others.

“The social isolation often starts a vicious cycle in which the (client’s) negative outlook on life is reaffirmed, they feel let down by family and friends, and symptoms may worsen,” Drancoli said. “This is especially dangerous for individuals who have suicidal ideations and need support and monitoring.”

Drancoli said it’s important for family and friends to be supportive. She suggests volunteering to help out with chores that might be difficult for someone with depression to complete when he or she is struggling to function, as well as patiently listening without judgment. Loved ones can gently encourage a person with depression to exercise as well, as this has been shown to boost mood.

People with depression who believe they have been discriminated against have the law on their side. Sack said that discrimination against people with any disabilities, including mental issues such as depression, is forbidden by the Americans with Disabilities Act. The civil rights law, enacted in 1990, defines disability as “a physical or mental impairment that substantially limits a major life activity.” Some states have additional laws against discriminatory behavior.

“An individual who is concerned about discrimination at work will want to speak with their supervisor or the director of human resources first,” Sack said. “Most companies have strong policies to promote fairness and nondiscrimination.”

Justine Lisser, a senior attorney advisor in the Office of Communications & Legislative Affairs at the U.S. Equal Employment Opportunity Commission, said by email that if an employer has at least 15 employees, it must abide by the ADA. Employers need to provide “reasonable accommodations” for people with disabilities, as long as the employer isn’t deeply burdened as a result.

“For example, if a person with depression is hired for a position that requires an 8 a.m. start time, but due to the effects of (antidepressant) medication the person could not start until 10 a.m., it would be a reasonable accommodation to permit the employee with depression to start at 10 a.m., assuming that it would not cause an undue hardship for the employer,” Lisser said.

The EEOC has successfully enforced employee discrimination laws in a few cases involving people with mental health issues. In one case, a sales associate at a video retailer experienced harassment because of his social anxiety disorder and depression. His employer was ordered to pay $70,000 to settle the discrimination suit, according to an EEOC press release from March 2012.