Tag Archives: anxiety

Not happy with how we look: Negative body image & Body Dysmorphic Disorder

Posted on by Shona Innes
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Can you imagine what is would be like to have your beautiful young son or daughter come to you with such hatred for their appearance that they are begging you to take them to a plastic surgeon?

I think from time to time we all check out our image in the mirror and make an evaluation of it.  Some people (young and old) make such critical evaluations of their appearance that they start to believe that they are unable to contribute to any sort of life because of their appearance.  When this becomes debilitating, we usually consider a diagnosis of Body Dysmorphic Disorder.

Our body image is different to an image of our body.  An image or photo of our body captures how it is at any point in time.  Our body image, though, is the representation we have of our own bodies.  It is essentially a judgement or series of judgements we make about how we think we appear.

When you ask people to tell you about their bodies, rather than give you facts , for example, on the colour of their hair or their measure height they usually give you judgemental words like plump, skinny, solid, pale….even ugly.  For most of us, this is not a problem, but for a few, the way their body image becomes central to their level of happiness.

When we determine our worth or happiness by our judgement of how we look, things can get pretty complex.

Body Dysmorphic Disorder or BDD is a diagnosis used when there is an intense preoccupation with a perceived flaw in physical appearance. (For most BDD it is with people’s own appearance, but BDD by proxy can mean that parents become obsessed about flaws in their children’s appearance).  Individuals with BDD often spend lots of time checking and worrying about a particular aspect of their appearance. They may spend a lot of time comparing their appearance with others, and engaging in behaviours designed to try to hide or conceal the area of concern or generally try to avoid being seen by others.

It is thought that BDD affects 1-2 percent of the population and it does not seem to vary with gender.

In the clients I have seen with Body Dysmorphic Disorder, they usually focus on one feature in particular – their teeth or the shape of their lips and sadly, if they do take steps to have these adjusted to their liking (people with BDD are often frequent customers of plastic surgeons), it does not always mean that their happiness improves and they will then go onto to target the next part of their body that they find the most displeasing.

The thinking if ultimately something like “if I can just change the way I look, my life will be wonderful”

BDD is  much more than just vanity or being dissatisfied with how they look, it can become obsessive and often co-morbid (or exists together with) with depression, anxiety (especially social anxiety) and I have seen it accompanied by self harm and suicidal ideas, too.  It can make it hard for a young person to leave the house, go to school or uni, or meet up with friends…or if they do, there needs to be much time trying to cover or adjust a certain aspect of their appearance.

This means BDD can interfere with living with others.  Those with BDD will often continually seek reassurance about their appearance or spend lengthy times in the family bathroom or be frequently late for work or school. There is often quite a deal of secrecy and shame associated with BDD and BDD can quite often be associated with financial difficulties, too, with money being spent on treatments or cover ups.

Oversimplifying it, but in an attempt to explain how BDD starts and is maintained we could consider it  going something like this example (although imagine it being much more complex/less staright forward):

  • Someone tells me I have a crocked nose
  • I believe that I have to look perfect to be liked by others
  • I spend hours trying to cover up my crooked nose with makeup, but that all gets too hard and the products I use have cause swelling and redness, so I start avoiding going out whether others will see me crooked nose. I keep checking with the people I love about my nose, but that doesn’t satisfy me for long.
  • I stop socialising, friendships drop away and I never get to test the idea that I have to look perfect for others to like me or want to be friends with me.

Where does BDD come from?

It is thought that most BDD starts in adolescence and that much goes untreated for many years.  Adolescence is a time of many body changes, and also for some, an increased risk for acne, but other times of life where the body changes can also be triggers – like the emergence of wrinkles or loss of hair with aging or new scarring after an accident or medical issue.

Those at risk of BDD or serious negative body image have often been teased or excluded and are also more likely to associate with peers or even family members who are very focused on appearance. Certain personality types may be more prone but also, social and cultural pressures are thought to contribute including social media. I have also seen BDD that began following a period of childhood and family trauma.

There are so many industries that depend on us being dissatisfied with our body image – Industries worth billions of dollars.  They flood the media with direct and indirect messages about happiness being derived from appearance.

How can we prevent it?

Sadly, at this stage, we don’t’ have any strategies that definitely prevent BDD.  I like to try to educate children about the powers of advertising and the tricks marketers pay to make us buy things.  However, the best the research can suggest is that people seek treatment early.

So, if you are a parent of a teen, it is usual for them to spend more time in the bathroom and in front of the mirror as they approach puberty, but if the checking is accompanied by frequent negative statements about their appearance, constant comparisons of themselves to others, regularly needing reassurance that they look okay, and avoiding socialising or leaving the house, you  should increase your level of concern.

The first point of call should be your GP or Mental Health professional.  A proper diagnosis is essential.BDD has some similarities to Eating Disorders in that it is also about body image, but the preoccupation is usually different, with eating disorders normally being about weight and shape and usually leads to a change of eating patterns.

Treatment can include medication and psychological intervention.  Psychological treatment is focused on tackling negative body image by building body acceptance and using techniques to help reduce the amount of time spent obsessing, checking or seeking reassurance about appearance.  Psychologists can also help with uncovering and challenging assumptions and negative predictions that link appearance with ideas of success and happiness.  Psychologists can also help a person to tackle their avoidance or behaviours that set up self fulfilling loops around unhelpful assumptions

There is some very useful information at the BDD Foundation website.

If you have young children (preschool and early primary) and you are concerned about them developing a negative self image, perhaps you could share “You are Like You” with them to open up some conversations about their thoughts about themselves.

 

Meltdowns – How to help when they “absolutely can’t take it any more”

Posted on by Shona Innes
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Meltdowns – We’ve all had them. Some of us have had them more recently than others. Some might live with someone (grown up or little) who frequently melts down.

In psychology, we understand that melt downs are the letting out of built up emotions – frustration, excitement, disappointment, anger, despair, grief….

Strong feelings usually let us know that we have a big problem, or sometimes an accumulation of smaller problems, that need solving. Unresolved problems, worries, fear and distress can build to panic or rage when the brain is overwhelmed at the work it needs to do to coordinate all the information it is getting to come up with an action that will satisfy and solve.   Melt downs are certainly a letting go and letting go can have its advantages. With our cortex back in control after an emotional outburst, we can often think things through more clearly.

However, melt downs can come at a cost. Often, when we let our emotions take the front seat in our brain, we can do and say things that can hurt others physically or emotionally. So, after a meltdown, we can end up with more problems in addition to those that triggered the explosion in the first place.

There are some factors that we know are linked to a higher likelihood of meltdowns.

  • The fight and flight (or freeze) response – Our body is naturally wired to defend itself. If it feels threatened, brain functioning in the cortex or the thinking part of the brain, is compromised or completely by-passed in order to make quicker, life-saving reactions. If someone regularly interprets a situation or a problem as a threat to their own well being or life (or to the life of someone they care about) melt downs are more likely. Sadly, if someone has lived through multiple life-threatening events, their fight and flight response can be, understandably, twitchy.
  • Someone’s temperament – Temperament is a stable pattern of responding that we are born with. Our temperaments are short lived and can be altered with time and parenting. Children who are born with a ‘touchy’ or ‘anxious’ temperament, are more likely to melt down. In adults, we more readily refer to stable character and coping traits as personality. Some people with certain personalities find it very hard to cope without meltdowns
  • Mental health – People who have troubles sustaining attention or who have a depression or anxiety disorder may be more prone melt down. Substance use, be it coffee, alcohol or illicit drugs, will also make a person more prone to melt downs because it alters the amount of stimulation the brain experiences.
  • Difficulties being able to see other peoples’ points of view or think abstractly to solve problems – Children of a certain age are more prone to melt downs because they have not yet developed the capacity to take another’s perspective or to solve problems. As we get older and learn more, we get cleverer and more creative about coming up with solutions to problems. If, however, our brain activity is compromised (by injury, Autism, dementia, stroke), melt downs can become more frequent.
  • Inflexibility – Some people are quite rigid with their ideas and they have trouble changing them, even when they are presented with new ideas or evidence contrary to their opinions. Inflexible people find it hard to imagine. Like the ability to think abstractly, inflexibility can be associated with Autism Spectrum concern, a head injury, a cognitive disability or dementia.

Of course, if you know someone well, you will understand their triggers and the early warning signs that things are going to get messy. Be sure to use this information for good and not evil. Avoid unessential triggers where the avoidance does not affect their quality of life, but we do not want people who have melt downs to have their lives limited by too much avoidance.

If you see warning signs, act to de-escalate. Different de-escalations will work for different people so it’s wise to review all your past attempts. De-escalation will involve different strategies for different ages. For toddlers, it might be a noise or a shiny object, for older children it might involve humour.

The idea of de-escalation is to get the brain to focus on what it can do and offer it some really basic tasks rather than suggest that it do something that might just inflame emotions further. I like to tell people about the Three Things Thing.

The Three Things Thing involves asking the person to tell you three things that they can see right now, then three things that they can feel with their skin right now and then three different sounds that they can hear in their space right now. If they are a little calmer, but need more, try for another two of each thing, then another one. Your aim is to get their brains to a point where they no longer feel that they are out of control. Focusing on the very basic senses in the here and now can help. Try it with your friends and family! You can almost feel your brain changing down a few gears. Bonus points if you can get them to try to slow their breathing down, too!

Longer term, we need to help the person to prevent more meltdowns. This may include planning to gradually introduce a watered-down version of a troubling scenario, a step at a time, and help the person to stay relaxed and celebrate as they tolerate a little bit more of a feared or distressing situation at a time.   However, living or spending time with people who have meltdowns can be very wearying and you may wish to get some extra help

You as a parent, partner, teacher, case-manager or friend might have some really useful information, but a visit to a psychologist can help you and your partner-in-melt-downs to work on a comprehensive plan tailor made for their temperament/personality, mental health, history, triggers, thinking patterns and behaviours. The plan should also involve teaching the person other ways for dealing with strong emotions or new ways of thinking about problems.

 

Talking to your child about media coverage of tragedy

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The world is not always a predictable place. Sometimes it can be just cruel and awful. This week, the incident involving the Malaysian Airlines passengers flying above the Ukraine has been a terrible example of the unexpected side of the people of our world. Our special wishes need to be extended to all of those who are some way involved or related to those who lost their lives in the tragedy.

News of such a tragedy usually starts to flood our heads and our homes via screens or over the sound waves.  Often, the updates are accompanied by graphic pictures on the television and in the papers.  Special updates interrupting normal viewing or listening habits. Our conversations and our tones of voice change. So, it is important that we are mindful of our children’s responses to these kinds of events. The way that we react can affect the way that they react and how they learn about the world and coping when tragedies occur.

If your child seems to be upset about it, how do you explain or counsel them when it is truly an atrocity?

Depending on your child’s age and understanding, you may want to explain the known circumstances. For a late primary school child, if they have questions, you may like to get out a map and just briefly (and age appropriately) explain the goings on in the Ukraine – “a place where people are fighting about who should run and make decisions about their country”. The newspapers have some handy diagrams you can use to explain the areas of the world that are involved. Look for reliable and sensible information and screen it first before showing your child.

It might also be handy to explain to your child that whenever their is an awful event, some people who are sad will sometimes get angry or want to blame someone.  You might see or hear some of these people in the news. Sometimes  sad people want answers to their questions.  Some questions have no easy answer or the right answers can take time to get.  it is understandable that people might be upset.  More anger usually doesn’t fix things, but if your child feels angry, help them to express it. They might like to write a letter to someone they think is important or who they think could make thing better in the future.
If your child is sad, in a grieving kind of way, they might like to write about their feelings, draw a picture, light a candle or plant a flower or shrub in the garden. They may need a little extra time at bedtime and a few more hugs.  It is perfectly okay to feel upset by upsetting events.

If your child is anxious, it can be helpful to reassure them about the things that you know. Be sure to explain about the role of news broadcasts in our lives. I like to tell children that the reason news is called “news” is because it’s not something that happens every day. If it was something that happened every day, it would not really be “news”.   We might even have to call it “olds”.  “CHARLIE EATS BREAKFAST” is not a common headline. Charlie eats breakfast every day. It’s not a “news” thing.  It happens everyday. The news reporters like to talk about things that don’t happen very often. The reason these event are news is because it is something that happens, thankfully, very rarely. The chances of it happening are usually very small. While this horrible situation did actually happen, it would be silly and sad to spend time ruining our life with worry about something that happened so rarely.  I also usually say that

“if worry really could help, then I would tell everyone to worry their hearts out”

but worry just tends to make us uptight and upset and we are better to spend that thought space being kind to others and doing nice things.
If your child is truly distressed, it is a really important time to try to make life as predictable as it can be. Try to make bedtimes and meal time’s routine. Do whatever you might normally do. It can be tricky when normal television programming is replaced with scenes of a traumatic incident. If that is happening a lot at your place, maybe switch off the news channels.  It might be a good time to get out a packet of cards or a board game and have a family games night instead of watching the “tele”.

If your child starts to change their behaviour (more fearful, clingy, challenging than usual) over a lengthy period of time they may need some extra help.  Be sure to let your child’s teachers and other carers know that they are not quite themselves.  Talking to your GP is a good place to start.  Your doctor can help you workout if further psychological intervention might be needed.

Kids These Days – What’s Going On Out There?

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Every day, the phone rings at our psychology practice with a range of calls about children with problems. Parents, carers, doctors, psychiatrists, paediatricians, teachers and welfare workers all call about children that need help. We get calls about tots, teens and “tweens”.

Looking at the types of calls coming through can tell us a bit about what is going on for kids out there these days. The health and happiness of our children is a great measure of how we are doing as a society. So, if children aren’t healthy and happy, what are the things that are not working for them? What is it they need?

In no particular order, here is a broad sample of our current, most common, requests to help young people and some ideas about what these problems tell us about children’s needs. Please keep in mind that the enquiries we have won’t include the huge number of wonderful things happening for children in the world. Remember, in a psychology practice, we are always going to see a skewed sample. It’s the nature of our business.

Anxiety – There are so many things in the World you could be worried about.

When we see children who are anxious or frightened, it tends not so much to be about the fear of the dark or the bogey men anymore. It seems to be more of a generalised sense they have that the world is a dangerous place. Children might reflect the anxieties of their grown-ups. For some children and their families there is so much heightened arousal about the world and their role in it. There is so much that can go wrong or so much that you might get wrong – exams, fitting in, missing out. The child is convinced they need to be constantly prepared for catastrophe.

Children need a balanced view of the world – sometimes it is beautiful and sometimes it is tragic – always has been and, likely, always will be.

Friendship and loneliness issues – from bullies to heart break.

A number of children present with significant sadness and worry about having no friends, feeling left out or being avoided by other who used to be friends. Some have broken hearts – not necessarily of the boyfriend/girlfriend type, but more about the abandonment of previously held friendships. Some of these children have autism and developmental problems and need help with skills. It is so easy for some children to give up and stop trying to make friends because they can get so caught up in what’s wrong with them that they just don’t see how much of them is perfectly fine.

Children need connections.

Family breakdown – Can you really hate your ex more than you love your child?

The time and effort that ex-partners can put into hating each other is astounding. It is tough to see a child who loves both parents being torn because the parents are at war with each other. It’s great to know that many separated families can do an exceptional job or raising a child across two homes, but the Family Court is still busy with the couples who have a situation so complex, that the child or children miss out on so much of what is needed to be settled, healthy and content. Long and extended Court battles over custody seldom bring out the best in grownups.

Children need grownups who put their needs ahead of their hate for the ex-partner. They certainly don’t need to hear what an awful person Mum thinks Dad is or vice versa.

Self harm – Trying to find ways that can soothe when life gets hard

Self harm – cutting, burning or injuring yourself – has spiked in referrals in recent years and can be complex to understand. Ironic as it sounds, some of the presenting self harm issues are attempts to soothe when life gets too hard. Sometimes talking and posting about your self harm is a way to belong with a large online community – an attractive proposition to the otherwise lonely. The more recent trend in referrals to treat self harm include younger children in their late primary school years. Self harm is something that needs a proper, professional assessment.

Generally speaking, children need to be encouraged to speak up about their problems to attentive adults and to learn how to soothe themselves without the need for inflicting pain on themselves, or others.

Child maltreatment and trauma – Oh, how I would love to live in a world where children could grow up without early exposure to abuse or neglect.

Brain research is now showing us the biological and long term impacts of child maltreatment on young brains and the protective factors that abound when there is healthy early attachment to a predictable and loving grown up. Attention problems, hyperactivity, anxiety, depression, anger and difficulties regulating emotions and behaviours can all stem from abuse and neglect. Mum and Dad may love you, but they may also be what I call “parentally-challenged”. Their substance abuse issues, working hours, or their priorities about keeping up with the Joneses can trump time at home with the children. These days neglect can also mean long hours spent on the internet or gaming devices without supervision or without someone to tell you to go to sleep or eat some breakfast.

Children need safety, affection, attention and boundaries.

The cyber world – faster, broader, easier to access, difficult to monitor, but the way of the future.

At the nuisance level, children (and indeed adults), can have trouble moving from a most preferred activity to a least preferred activity – asking a child to get off the computer can sometimes cause a huge reaction. There can also be a gap between what Mum and Dad know and what children are actually exposing themselves to online. At the more sinister end is the exploitation of young ones who inadvertently click or swipe their way into a dangerous liaison. There is also a trend to seeing more young people in trouble with the Law for sharing too much of themselves, or too much of their boy/girlfriend, with others. On the other hand, there are not too many school rooms with chalk boards these days – chalk boards may as well be stone tablets etched Fred Flintstone style. Connection to the cyber world is a really important part of current educations and learning.

Children need to be exposed to the cyber world because it will continue to be a large component of their lives and future lifestyles. However, children need someone on yard duty in the cyber playground!

Access to substances – using alcohol and illicit substances can make the dumb decisions sometimes expected in adolescence, even dumber!

It would be great if we knew that children were never going to be exposed to substances that could harm them. Some of the most harmful substances are the ones that are legal and used often in the household. While the brain is still growing, it needs to be sheltered form additional toxic chemistry associated with alcohol and drugs. The thrill seeking that naturally accompanies adolescence means that often alcohol and substance use is combined with fast cars and other potential dangers.

Children need to learn about harms and their risk-taking in age appropriate ways and to feel supported to make a brave, smart decision even though it may be unpopular with their friends.

Perfectionism and body image – Eat (or starve), sleep, school, repeat.

While eating disorders remain some of the most dangerous mental health problems amongst young people, there is also an insidious amount of perfectionism sneaking into to the belief systems of our younglings. Some young people can freeze or melt down at the thought of making a mistake or not getting an “A” on an assignment. They are driven to make tighter and tighter rules and higher benchmarks for themselves to avoid an ever present fear of letting someone down or not being good enough.

Children need to know that it’s human to make mistakes and to know that they are already so very loveable. There is also a need for children to understand the importance of balance and healthy fun with good friends.

So, the issues that children bring to their psychological treatment reflect a lot about what is going on in our society. Child safety and the need for affectionate and warm relationships with grownups are still paramount. Their current issues show difficulties adapting to, and getting the most out of, our fast paced and changing society without compromising themselves. Children need healthy and safe grownups and lots of opportunities for connecting and communicating with others to help them find their way.

Shona’s tips

Everyone – It’s really important to remember that there is always going to be more right with a child than wrong with them. When we help, we need to consider what is happening with their developing biology and brain and their thinking and beliefs, but also their home, their school, their friends and the society that they live in.

The Chook Brain and the Cortex

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The human brain never ceases to amaze me. It is truly an amazing piece of equipment made up of miniscule and precise parts that coordinate and move our body in ways we think about and ways we don’t even have to think about. You would think that having had a brain for as long as humans have existed, we might know a bit more about it by now. Technology and machines that go “ping” are helping us to advance our knowledge further and further each day. In the meantime, I find it easy to explain a lot of human behaviour by thinking about the brain being made up of sections or parts that each have a an important job to do when we react to things.

The brain seems to have some really quite primitive parts and some really extra clever bits. The primitive parts are the bits that look after our essential survival – things like breathing, eating, pooing and running away from dangerous things.

The Chook Brain

I have two backyard chickens, Daphne and Valma. Now, while I love them lots, I can acknowledge that Daphne and Valma are great at eating, pooing and laying eggs, but they are not great at more complex things like playing the piano, helping me with my homework problems or knowing the difference between my vegie seedlings and weeds. Compared to human brains, Daphne and Valma have very primitive brains. Daphne and Valma have chook brains that help them with the things they really need to know how to do – eat, poo, lay eggs and run away from danger – “Bercark!!!”

Humans have a part of their brain that is kind of like a chook brain. The chook brain part in our brain is really quite primitive and responsible for helping us with basic jobs and with keeping our bodies safe.

The Cortex

As well as a chook brain, we humans also have a part of the brain that allows us to do all those things that chicken cannot do – solve problems, think things through, focus on one thing for a long time and put off things that we want to do because there are other things we know are more important. This region of the brain is generally referred to as the human cortex.

It takes about 25 years for humans to have a fully grown cortex. When we are newborns, our brains are very primitive. When we are newborn we can poo and eat and startle if we get a fright. As we age and our brain grows, the cortex gets able to do more and more things.

Until we have a fully developed cortex part of our brain, we really need to borrow the cortex of safe and loving adults to help us make good decisions.

Reacting to Threats

The other amazing thing about our chook brain and cortex, is how they react to danger. If something is a really big threat, then our chook brain (the bit that looks after us if we need to run away) kicks in and takes over total control of our brain and body. If it’s a really big scary thing, our chook brain will get us ready to run away or to fight it off.

When you think about it, this is really important. If you are, say, walking through the jungle and see a tiger, this is not a good time to sit down to do homework, remember to get milk and bread on the way home, make and eat a sandwich, or to calculate the square root of a very large number. We don’t have time to use our cortex much.

When you see a tiger in your jungle, its a good time to run – and run fast. Our chook brain helps us do this. The cortex shuts down thinking and planning and our body gets ready to take care of us. Our heart goes faster to beat more blood to our big muscles, our breathing changes, our muscles get tense, our vision changes, our bellies can get uptight and sore (and our bowels can get loose), we get sweaty and all we can focus on is the scary thing. “Bercarck!!!”

After we have run from the tiger or have beaten it down with our bare hands and big oxygen-rich-blood-filled muscles, we can take a big breath out and sigh with relief. Our cortex can start to come back online. We can start to think, remember and make sense of more things. The process of moving from chook brain to cortex mode might take awhile and we can feel a bity wobbly while this happens and sometimes we can be on high alert for quite some time.

Tigers These Days

These days, not many of us come across actual tigers in jungles. Many of the things our brain thinks are scary are ideas or worries or memories that frighten us. We can go chook brained even just thinking about or imagining something that threaten us – an accident, a trauma, or something that causes death – bodily death or social death. We don’t run or take on too many tigers, instead we react in a range of different ways – maybe tantrums, panic or meltdown.

Calming the Chook Brain

The chook brain and the cortex have lots to answer for when it comes to managing anxiety, worries and trauma. They can also help us understand what we need to do to be able to stay calm and help children (who don’t yet have a fully grown cortex) to stay calm.

To get to know your chook brain a little better, think about the things that threaten you or that might be threatening your child. The threat may be real and current, a memory of a past threat (trauma) or a prediction about a threat that hasn’t even happened yet (worry).

Get to know the early warning signs that you (or your child) are about to go chook-brained. Do you notice a change in your heart rate, a change in your breathing, or tightness in your muscles? When you notice the warning signs, try to keep a hold of your cortex or step in to help your child use more cortex. Check in with your breathing and try to slow it and try to encourage your child to do the same. Try to stretch your muscles or check in with your thoughts to see if you really need to be so alarmed. Think, say and do things that will soothe you and soothe your child.

When your cortex comes back, have a talk about what happened and use your full brain to problem solve plan ahead for what you might do if the scary thing, thought or memory comes back again. Your child might like to draw or write a story or poem to help them.

Shona’s tips

Parents and Carers – In your role as the extra cortex for you child, be sure you try to model healthy ways of dealing with fears and worries. Your child will look to you when they are unsure and if you look calm, they will fell better. If you look like you are chook-brained……then there may be more than one of you going “Bercarck!!!”.

Teachers – Children who are chook-brained are not going to be able to concentrate on learning. Calmer classrooms is a great resource for assisting children who have been traumatised, but also can give you ideas that can calm many anxieties in children.

Psychologists and Helpers – Make sure you don’t make assumptions about what may soothe your client based on the things that soothe you – different things soothe different people differently. Encourage them to explore, experiment and gather the information for themselves. The Centre for Clinical Interventions has some useful workbooks for adult clients.

Kids – You might like to draw a picture about what you are like when you are chook-brained and where you notice it in your body. It might also be nice to keep a box full of things that make you feel relaxed and calm – things to cuddle, things that smell nice, nice music and sounds or pictures of people you love. Staying calm helps you keep your whole brain working together.