Author: Torey C. Richards, LMHC

I'm a passionate Behavioral Scientist and Licensed Mental Health Counselor based in Florida. I've dedicated my career to unmasking the complexities of human behavior, mental health, and substance abuse. My journey in this fascinating field has led me to work extensively with a diverse range of individuals from those grappling with chronic mental illness and substance use to others navigating the trials of daily life. The opportunity to study the nuances of people's thoughts, feelings, and behaviors has been enlightening and truly rewarding. Moreover, guiding people towards transformational changes that break down barriers in their lives is a fulfilling mission I carry with me every day. Currently, I work at a level one trauma center with patients who have suffered unfortunate traumas. Previously, I held the reins as the Director of Mental Health at a county jail for over 8 years, a fulfilling role that offered unique insights into criminal justice and mental health. Additionally, I mentor the next generation of mental health professionals as a qualified supervisor, continuously inspired by their commitment and ambition. Beyond my professional endeavors, I'm a purple belt in Brazilian Jiu Jitsu, an avid reader and writer. I hope you'll join me on this voyage of discovery.

Therapist are Humans Too

Psychiatric Hospital: A Quick Glimpse Inside the Madness of an Institution

18 May 201218 May 2012by Torey C. Richards, LMHCLeave a Comment

I normally try not to post on Friday through Sunday, so today will be a light post and a short break from our discussion on the Pervasive Developmental Disorders and will continue on Monday with Rett’s Disorder. Today however I’d like to share some of my past work experiences.

For three years I worked overnight in a mental hospital. It was three years I’ll never forget. After spending years in undergrad and grad school learning about all the diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it was great to actually get a chance to experience some of those disorders first hand.

Working overnight in a mental health hospital definitely gave me a lot of insight into mental illness and people who are often oppressed by the system that is set up to help them. It is also where I honed my assessment and diagnostic skills as a clinician, being able to work along side other seasoned clinicians, psychiatric nurses and psychiatrists.

The mental health hospital can be a life saver for some (if you have the right insurance/money) or just a revolving door of endless misery and disheartening for those less fortunate, which are usually the ones who need the services the most. With the right resources you get all the help (counseling, medication, case management, etc.) you need, otherwise you just get stabilized and sent back out the door (usually to return again and again without the proper treatment).

Still, for what it is worth, there is nothing like working in a mental health hospital, especially overnight when the clients are usually the most eccentric and usually outnumber the staff 3 to 1. You can go from consoling a woman suffering from post-partum depression one moment, to restraining a highly psychotic person the next, over and over again.

One night in particular I saw a young doctoral candidate who was contemplating suicide due to depression, social anxiety and paranoid thoughts that his peers thought he wasn’t good enough for them. Then I saw a woman who caught her husband in bed with her brother, went out drinking and then decided to try to slash her own throat.

All I could do at 3am in the confines of the mental health hospital was offer those troubled individuals some hope and guidance so that maybe they’d see light at the end of what they perceived to be a dark, endless tunnel of anxiety, depression and despair. So for them, and the other clients, at least for that night, the mental health hospital was a safe place for them to let down their guards, share their fears and lose their minds without judgment or recrimination.

Abnormal Psychology, Popular Psychology

On Asperger’s Disorder

17 May 201217 May 2012by Torey C. Richards, LMHCLeave a Comment

In the 1940s, a pediatrician working in a clinic in Vienna named Hans Asperger treated several patients who displayed similar symptoms. However, because his work was conducted during World War II, none of it was seen amongst the English-speaking world so it wasn’t until the 1980s that his work was discovered by the English-speaking community and was translated in 1991 by Uta Frith. The characteristic first described by Hans Asperger became known as Asperger’s Disorder.

What Is Asperger’s Disorder?

Just like all of the Pervasive Developmental Disorders, children with Asperger’s have trouble relating to others. In some children this means that they do not like interacting with others, or that they do enjoy interacting with others but lack the non-verbal skills (i.e. eye contact, smiling, facial expression, touching) necessary to have full interaction. Having a two way conversation with a child with Asperger’s is often very difficult because they have trouble understanding figures of speech, sarcasm, subtle suggestions and often take speech very literally. These children are also often unaware of their own behavior and can’t relate to other children at their developmental level.

Children with Asperger’s also often have unusual behaviors and interests. Some children become almost obsessed with an object or ideal to the point that they exclude everything else. For example, a young man I worked with was very interested in sports and would talk you to death about sports, but only sports and if you tried to talk to him about anything unrelated to sports he would just go back to talking about sports. In other children, they may have extreme reactions to simple changes to their environment (i.e. movement of furniture or objects) or routine.

While all children with Asperger’s have impairment in social and behavior functions, the degree of impairment differs in each child. To be diagnosed with Asperger’s the symptoms have to be severe enough that it impacts their life (i.e. school functioning, family function, or social life).

How Does Asperger’s Differ from Autistic Disorder?

Asperger’s differs from Autistic Disorder in that there are no significant delays in cognition or language development. Many children with Asperger’s have difficulty with non-verbal communication, hand eye-coordination and may appear clumsy. Some children with Asperger’s have an exceptional vocabulary and may speak earlier than expected. Because children with Asperger’s appear to develop normally, they usually aren’t diagnosed before the age of five while children with Autistic Disorder are generally diagnosed earlier. Some people reach all the way to adulthood without being diagnosed with Asperger’s, whereas children with Autistic Disorder generally aren’t expected to live independently.

Risk for Other Issues

Children with Asperger’s Disorder are often also diagnosed with Attention Deficit/Hyperactivity Disorder. They are also at a higher risk for Obsessive-Compulsive disorder. Undiagnosed children with Asperger’s often experience depression and social isolation, especially in their adolescent years when peer interactions and relationships become more important.

Diagnostic Criteria (Diagnostic and Statistical Manual of Mental Disorders IV)

I) Qualitative impairment in social interaction, as manifested by at least two of the following:

(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity

(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.”

I Think My Child May Have Asperger’s Disorder, What Do I Do?

If you think your child has symptoms of Asperger’s Disorder, contact your physician, school psychologist or a licensed psychologist to initiate an evaluation. Thorough medical, family and developmental histories will be taken, as well as interviews with the family and child as well as behavioral observations to help determine if a diagnosis of Asperger’s Disorder is correct.

All of the interventions and prognosis for Asperger’s Disorder are basically the same for all the other Pervasive Developmental Disorders and you can find those on my post about Pervasive Developmental Disorders.

Resources

Attwood, Tony. (2006) The Complete Guide to Asperger’s Syndrome. Jessica Kingsley Publishers.

Online Asperger Syndrome Information and Support

(OASIS) http://udel.edu/bkirby/asperger/

Center for Autism and Related Disabilities (CARD): http://card.ufl.edu/

Abnormal Psychology, Popular Psychology, Uncategorized

On Autistic Disorder

16 May 201216 May 2012by Torey C. Richards, LMHCLeave a Comment

In my years in the field of mental health, I’ve had the privilege to work briefly with children who had Autistic Disorder. That brief time gave me a tremendous amount of respect for these children, those who work with them regularly as well as the parents who care for them around the clock. The degree of impairment in each child was sometimes drastically different. Some didn’t move from the same spot all day, staring out into space and rocking back and forth while others were very mobile and verbal (even if I couldn’t understand a word they were saying). Most of them were very rigid however in appearance, behavior and psychomotor activity.

If you haven’t done so already, you may want to read the post I wrote on Pervasive Developmental Disorders in order to get a better understanding of Autistic Disorder and all of the other Pervasive Developmental Disorders under the Autism Spectrum.

Autistic Disorder shares a lot in common with all the previously discussed Pervasive Developmental Disorders and is sometimes referred to as early infantile autism or childhood autism. To add to the confusion of labeling, some professionals use Autistic Disorder to describe all five of the pervasive developmental disorders (Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s disorder, Pervasive Developmental Disorder Not Otherwise Specified) under the Autistic spectrum.

Brief Introduction to Autistic Disorder

Autistic Disorder is four times more common in boys than in girls. Children with Autistic Disorder have a moderate to severe range of communication, behavior problems and socialization abilities. Many of them also have mental retardation. It is also thought to be high genetic.

Like all of the other Pervasive Developmental Disorders, parents of children with Autistic Disorder normally notice signs within the first two to three years of life. They usually develop gradually, but sometimes the child will develop normally at first and then regress.

Early behavioral and cognitive interventions are essential in helping children with Autistic Disorder learn to improve their skills of self-care, communication and socialization. Most children with the disorder will never live independently as adults and while there is no cure, they have been reported cases of children who have appeared to recover from it.

Diagnostic Criteria for Autistic Disorder

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) uses these criteria to aid in the diagnosis of Autistic Disorder.

Six or more items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
1. 1. qualitative impairment in social interaction, as manifested by at least two of the following:
    1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
    2. failure to develop peer relationships appropriate to developmental level
    3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
    4. lack of social or emotional reciprocity
1. qualitative impairments in communication as manifested by at least one of the following:
  1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
  2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
  3. stereotyped and repetitive use of language or idiosyncratic language
  4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
1. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
  1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
  2. apparently inflexible adherence to specific, nonfunctional routines or rituals
  3. stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements)
  4. persistent preoccupation with parts of objects
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

For more information visit http://www.autismspeaks.org

Abnormal Psychology, Uncategorized

Pervasive Developmental Disorders

15 May 201215 May 2012by Torey C. Richards, LMHCLeave a Comment

Pervasive Developmental Disorders (PDD) are also known as Autistic Spectrum Disorders. They include a group of five neurological disorders characterized by developmental delays of basic functions such as the ability to communicate, understand language, and socialize with others including peers and family. The five developmental disorders are:

Autistic Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Asperger’s Disorder
Pervasive Developmental Disorders Not Otherwise Specified

Many parents are often confused by the term Pervasive Developmental Disorders when their child is diagnosed. Often this is because a lot of doctors are hesitant to diagnose very young children with a specific PDD, but PDD is not a true diagnosis, but a category that includes all five of the disorders listed above. The official diagnosis in this case should be Pervasive Developmental Disorders Not Otherwise Specified (PDDNOS) which simple means that there is a pervasive developmental disorder present, but the doctor has yet to narrow down which exact disorder it is.

I could write a very long post that tried to cover all of the PDDs, but that would be very long and perhaps confusing, so what I am going to do is post one at a time over the next few days. To understand each PDD it is good to have a definition of the overall disorder and so we will start with PDDNOS.

Pervasive Developmental Disorders Not Otherwise Specified

All PDDs are neurological disorders that are usually evident by the time the child is three years old. They generally have trouble playing with their peers, socializing and relating to others. They also often have stereotyped behavior, interest and activities, inappropriate fascination with objects and often don’t like changes, even small ones. One parent vented her frustration to me saying that it felt like her child was always rejecting her.

Children with PDDNOS either do not fully meet the criteria of the other PDDs or do not have the degree of impairment usually considered suitable to fulfill the diagnosis of the other four disorders. According to the Diagnosis and Statistical Manual of Mental Disorders IV (DSM-IV), this diagnosis should be used “when there is a severe and pervasive impairment in the development of social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder” (American Psychiatric Association).

In general, children are usually diagnosed with PDDNOS when they have behaviors that are seen in Autism, but doesn’t meet the full diagnostic criteria.

Part of the confusion with PDDs is that the DSM-IV should be used as a guideline for diagnosing PDDS. Many doctors use it as a checklist. There are no clear guidelines for measure severity of symptoms which cause the lines between Autism and PDDNOS to become blurred. Confusion is also added in the fact that some doctors feel that Autistic Disorder only covers those who show extreme symptoms that meet every single criteria for it, while other doctors are comfortable using Autistic Disorder to define those with a broad range of symptoms related to language and social skills. Therefore, it is not uncommon for an individual to be diagnosed by one doctor as having Autistic Disorder and by another as having PDDNOS. There is growing evidence that PDDNOS and Autistic Disorder aren’t actually separate disorders, but are on a continuum which is why the term Autistic Spectrum Disorders is now frequently used to refer to PDDs. Multisystem Developmental Disorders is another term thrown around seldomly, but it is the same as PDDNOS and Autistic Spectrum Disorder.

Causes of PDDNOS

Studies that include behavioral and biological studies all suggest that PDDNOS is caused by neurological abnormalities (problems with the nervous system). However, no specific cause is known. There’s been controversy about childhood vaccinations being responsible for PDDNOS, but no clear evidence or studies have been able to show consistent evidence supporting that.

Symptoms/Signs of PDDNOS

These are some of the symptoms and signs of PDDNOS. Since it is a spectrum disorder, not all children will show the same symptoms, all of the symptoms or have the same intensity of symptoms as other children with PDDNOS.

Impairment in Nonverbal Communication
Impairment in Understanding Speech
Impairment in Speech Development
Abnormal Attachments and Behaviors
Unusual Responses to Sensory Experiences
Disturbance of Movement
Resistance to Change
Intellectual and Cognitive Deficits

They may also have associated features such as emotional expressions that are flat, excessive or inappropriate to the situation. They may scream, cry or laugh at any time for no apparent reason. They may not be afraid of real dangers such as falling or getting hit by a car, yet be terrified by a specific doll or stuffed animal.

Diagnosis

The DSM-IV is only one tool used to help diagnose PDDNOS. Medical assessments, occupational assessments (used to determine how the child’s different senses work together), interviews with the child’s parents, teachers, behavioral rating scales, psychological assessments, educational assessments and direct behavioral observations are some of the many other tools used to help diagnose PDDNOS. There are no specific test such as blood tests, or x-ray exams that can determine if a child has PDDNOS or not.

Treatments

Treatments for PDDNOS are usually the same used to treat all PDDs, but no one treatment will help all children and often they need to be individualized. Common treatments include:

behavior modification
structured educational approaches
medications
speech therapy
occupational therapy
counseling
family counseling
psychological treatment
facilitated communication
Auditory Integrative Therapy
Sensory Integrative Therapy
Dietary Therapies

The aim is typically to promote more acceptable and appropriate social and communication behavior as well as to minimize negative behaviors such as repetitive behaviors, self-injury, hyperactivity and aggression.

It is also important for parents of children with PDDNOS or any PDD (just like parents of children with any other disorder) to seek out help in the form of parent support groups in order to educate, remember that they are not alone and also to replenish themselves.

I hope that this post on PDDNOS was helpful. I realized halfway through writing this how tough it was going to be to try to cover PDDNOS in one post, partway through I was like, “What was I thinking” but hopefully I’ve laid out a decent basis to start discussing the other four disorders starting with Autistic Disorder tomorrow.

For those of you who want more information I’ve included the names, contact information and web addresses of some organizations below.

Resources

Autism Coalition

http://www.autismcoalition.com

Autism Patient Center
http://www.patientcenters.com/autism

Autism-PDD Resources Network
http://www.autism-pdd.net

Division TEACCH: http://www.teacch.com

Indiana Resource Center for Autism
http://www.iidc.indiana.edu/irca

National Institute of Child Health and
Human Development
http://www.nichd.nih.gov/publications/
pubskey.cfm

Asperger Syndrome Coalition of the United States, Inc. (ASCU.S.)

2020 Pennsylvania Ave., NW, Box 771, Washington, DC 20006

Telephone: 1-866-427-7747

Web: http://www.asperger.org

Autism Society of America

7910 Woodmont Avenue, Suite 300

Bethesda, MD 20814

Telephone: 1-800-328-8476

Web: http://www.autismsociety.org

International Rett Syndrome
Association, 9121 Piscataway Road,
Clinton, MD 20735. Telephone:
1-800-818-RETT; (301) 856-3334.
Web: http://www.rettsyndrome.org

Uncategorized

14 May 2012by Torey C. Richards, LMHC1 Comment

Another great post I will be passing along and sharing with parents!

help4yourfamily

It’s Monday, May 14th- Parent Affirmation day at Help 4 Your Family! Today’s affirmation is one I use a lot:

I give my children age appropriate time and space to solve their own problems.

This affirmation is good for many kinds of situations. One is watching our children struggle with something. This affirmation helps us to remember that there are some struggles that are age appropriate and that our children will benefit from resolving on their own because they want to learn it. Rebecca from Mom Meets Blog writes about this in her sweet post about her son that you can read here.

Another situation where this affirmation is helpful is when our children are struggling with something and do not want to learn it- but we know it is age appropriate for them to do so. A child who works really hard to get to you to give him the answers…

View original post 176 more words

The Perplexed Minds of Teenagers

Is Pretending to be Pregnant a Mental Illness?

14 May 201217 Sep 2012by Torey C. Richards, LMHC166 Comments

In The Pregnancy Project: A Memoir, Gaby Rodriguez faked her own pregnancy as a social experiment, but teenage girls pretending to be pregnant is not a new phenomenon.

Over the past three years I’ve grown more and more concerned about teenage girls pretending to be pregnant, the reasons they do this and the mental and social rewards and consequences of it. I have to wonder if part of this is because of shows like 16 and Pregnant and Teen Mom, but I also think that the alarming number of their peers who actually are pregnant or have kids has an effect on them. Why would a teenage girl want to put up with the scrutiny and criticism that comes along with being pregnant in high school? This is what I think:

1. Attention

Some of these young girls are starving for attention no matter if it’s positive or negative. Perhaps they see all the attention their peers or siblings got when they were pregnant and crave some of that same attention. I often see that their friends, while at times judgmental, often start bonding with the young girl in a nurturing way, something that she doesn’t get normally from them.

2. To Keep a Boy Interested

I think this may be the most common reason young girls pretend to be pregnant. I see it played out over and over again each year in the high school I work at. A relationship ends or is on the break of ending and all of a sudden the young girl blurts out she’s pregnant or thinks she’s pregnant. This usually sends the young man into a panic and even if he’s skeptical, he tends to at least try to stay on her good side until the pregnancy is confirmed or denied. Like a lot of young teens who pretend to be pregnant, these ladies may go through great lengths to convince their boyfriends (ex-boyfriend) that they are pregnant and often times in the process, continue to try to really get pregnant. These drastic attempts to keep a boy are seldom successful.

3. Biology

Evolutional psychology may say that it is normal for young teens to pretend to be pregnant since it’s in their biology to want to conceive children. During my research it appears that pretending to be pregnant is to some extend normal, but I think what is abnormal is the way that some young adults go about pretending to be pregnant. Perhaps pretending to be pregnant to yourself is normal, while pretending to be pregnant and in effect lying to your friends/boyfriend is more on the abnormal end of the scale. However, if it is to some extend normal to pretend to be pregnant, can it ever go so far that it can be classified as a mental illness. To what extent does a young girl have to go to inorder convince people she is pregnant, before she moves into the realm of psychopathology?

More recently, Annette Morales Rodriguez was arrested and suspected of stalking, beating and choking to death a pregnant woman and using an xacto knife to remove her unborn child because she had had four miscarriages and had been faking her pregnancy.

One source said that she panicked as her fake due date approached and she had to produce a baby. She was willing to kill in order to “have” a child.

Pretending to be Pregnant as a Mental Illness

I have a client I’ve known for three years and each year she “gets pregnant”. I was originally referred to her when she “gave birth” to a premature baby and was back at school the next day showing pictures of “this baby” in neo-intensive care. One of her teachers was concerned about her physical and mental health and referred her to me. When I met with her she told me that the baby had died and I spend several weeks helping her get through the grieving process and even helped her with a memorial ceremony. A few months later I found out that this was all a lie. She was never pregnant. The pictures of the baby in NIC-U had come from Google Images, and this wasn’t the first time she had pretended to be pregnant. The extend to which this young girl went through to convince people she was pregnant and had given birth to a premature baby that died concerned me. I thought surely she was mentally ill, but I let it go as the next year her problems turned to the more normal problems teenage girls come and see me about (boys, family, school, friends, drugs).

And then this year she said she was pregnant again. This time I believed her (call me gullible, but I tend to believe people until I have evidence not to) because from her pretending to be pregnant last year, I felt like she wanted to get pregnant, and from my experience, young girls that talk a lot about being pregnant, pretend to be pregnant, and are sexually active, they usually end up pregnant within twelve months. Well this young girl started to gain weight, starting looking pregnant (even wore too small clothing to enhance the effect) up to a certain extend when she suddenly stopped “growing”. She claimed to feel the baby moving and said she went to doctor appointments, but would never let her friends go with her. She told her boyfriend she was pregnant and all of her friends, but not her family. She even went as far as to have her friends plan a baby shower. I offered over and over to help her break the news to her mom, but she refused and then one day her best friend came to my office in tears, telling me that she thinks the young girl is “crazy” because she really isn’t pregnant and keeps pretending to be pregnant. Her best friend told me that all of her friends and even her boyfriend are concerned for her, but they haven’t confronted her out of fear that she really is mentally ill.

After an intense session with the young girl she admitted to me that she really wasn’t pregnant, but couldn’t tell me why she kept pretending to be pregnant and was still planning on letting her friends and boyfriend think she was pregnant. As of Friday she was still planning her baby shower. That lead me to truly believe that this girl has a mental illness, but if so, what?

Factitious Disorders

The first thing that came to my mind was that she had a factitious disorder. Factitious disorders occur when a person acts like they have an illness and purposely produces symptoms of that illness. They may go as far as contaminating urine samples, manipulating documents and taking substances to make themselves ill. The benefits they seek usually are attention, sympathy, nurturance and mercy. The old term for factitious disorder is Munchausen Syndrome, and many of you have probably heard of Munchausen by proxy, which is when the person uses someone else, usually a child or elderly person, to produce the sick symptoms of an illness unto, often times with alarming and deadly results. But does a young girl who continues to pretend to be pregnant and goes to great lengths to convince people she is pregnant suffering from a factitious disorder? Through all my research I couldn’t find a definite answer, but this as of right now is my number one guess.

Personality Disorders

Borderline Personality Disorder

I also have to wonder if this girl and others like her may have some type of personality disorder. Borderline personality disorder is very popular these days, but I have only known about three people I would diagnose with borderline personality disorder and only one of them have pretended to be pregnant in a very similar manner to the young girl I’ve been talking about. I also don’t think this young girl qualifies to be diagnosed with borderline personality disorder, but it is possible.

Histrionic Personality Disorder

People with histrionic personality disorder are always seeking attention and can be very inappropriately seductive, have exaggerated emotions and feel shallow. I’m not sure if this describes the young lady I’m talking about either.

Dependent Personality Disorder

People who have dependent personality disorder are dependent psychologically on other people. Pretending to be pregnant would increase the likelihood that the people this person is dependent on will be more nurturing and present, but from knowing this girl I highly doubt she has dependent personality disorder, but it may explain why some other young ladies pretend to be pregnant.

Psychopathy

Some people are just psychopaths as defined by:

lack of remorse or empathy
shallow emotions
manipulativeness
lying
egocentricity
glibness
low frustration tolerance
episodic relationships
parasitic lifestyle
persistent violation of social norms

Is it necessary that I diagnose this young lady and those like her? Probably not. I prefer not to diagnose clients unless I have to or it is a diagnoses that is literally screaming in my face. I don’t like labeling clients, but there are many reasons to give a diagnosis. Most insurance companies require a diagnosis and a diagnosis does help give a framework for developing a treatment plan. It is however, in my opinion, essential that I figure out what is driving this young girl and others like her to go through such great extents to pretend to be pregnant in hopes of helping them deal with whatever it is they are trying to get externally, and be able to give it to themselves so that they can develop into emotionally and mentally healthy adults.

If you have any opinions or if you’ve been through this or even pretended to be pregnant before, please comment. I would love to hear your story.

Abnormal Psychology, Popular Psychology

Bipolar Disorder in Children and Adolescents

10 May 201210 May 2012by Torey C. Richards, LMHC3 Comments

Often times bipolar disorder is thought of as an illness that effects mostly young adults, and while the average age of bipolar disorder is around the age of 21, younger children and teens can also be effected with the disorder, sometimes referred to as pediatric bipolar disorder.

Working in a high school with students who mostly have anger problems, I hear a lot of them talking about their “mood swings” and some of them even call themselves “bipolar” although they have never been officially diagnosed. But almost everyone has mood swings from time to time, so what exactly is bipolar disorder?

Bipolar Disorder

Bipolar disorder (sometimes called manic-depressive disorder) is a brain illness characterized by episodes of intense mood swings and behaviors known as mania (high energy, elated, impulsive, etc.) and depression that are usually high or low and shift, generally over days or weeks, and sometimes even blend (mixed episodes). It is not the same as the normal ups and down adolescents and teens go through, it is much more severe.

Early onset bipolar disorder happens in adolescence and the early teenage years and may be more severe than bipolar that develops later in life. There was a time in the past when most experts did not believe that bipolar disorder could happen in childhood, but research shows that at least half of bipolar disorder cases start before the age of 25. Children with bipolar disorder often have co-occurring disorders such as attention deficit-hyperactivity disorder and anxiety disorders.

Symptoms

Adolescents and teens exhibiting a manic episode of bipolar disorder may:

Feel very happy and act silly in a way that is unusal
Talk really fast about a lot of different things
Have a short temper
Do risky things (i.e. jumping off of things, dashing in front of cars)
Have trouble sleeping, yet not feel tired
Have trouble staying focused
Talk and think about sex more often (if they are sexually active they may actively seek out sexual encounters)

Adolescents and teens exhibiting a depressive episode of bipolar disorder may:

Sleep too little or too much
Be very sad/depressed
Complain about various pains such as stomach and headaches
Eat too little or too much
Feel very guilty
Be overly emotional and/or sensitive
Have little energy or interest in doing anything
Think/talk about suicide and/or death

Treatments

Treatments for bipolar disorder include medications and psychotherapies including family therapy (it is important that parents taking care of a child with bipolar disorder, just like any other illness, take the time for self-care in order to be healthy and effective caregivers themselves). There is a concern that many children are being over diagnosed with bipolar disorder since in children, bipolar disorder can also look like other disorders such as severe mood dysregulation or temper dysregulation disorder, and some children may not have a disorder at all but be expressing another, normal biopsychological response to life stressors. While there is no way to prevent bipolar disorder, there is ongoing research trying to find a way to delay the onset of symptoms in children with a family history of the disorder.

I currently see 69 adolescents and adults for various reasons and only about three or four I would seriously evaluate for bipoloar disorder and two I have diagnosed with it. One of them is a 15 year old female and her parents are currently in denial of the seriousness of her illness, yet don’t understand why she isn’t getting better although I’ve had to Baker Act (Florida’s statue for involuntary examination of an individual where they are kept up to 72hrs in a hospital for their saftey) due to suicidal thoughts and self-injury. I’ve also referred them repeatedly for medication evaluations, but again, her parents are in denial and think her issue is all behavioral and not a real illness like bipolar disorder. I have another 15 year old girl I diagnosed with bipolar disorder and she is now on medication (Trilecta) and seeing me for cognitive behavioral therapy and is doing a lot better.

Where to go for Help?

As always, your family doctor or mental health professional should be able to direct you to the proper source of help for your child. If not, look up a doctor or mental health facility in your area to have your child evaluated and treated if necessary. If you know someone who is in crisis do not leave them alone, instead get them help, go to an emergency room or call 911 if it is necessary to keep them safe from themselves. If you are in need of help, the same applies and you can also call a free suicide hotline at 1-800-273-TALK (8225). Also, www.thebalancedmind.org . Their “Library” section has terrific information on pediatric bipolar disorder as well as an excellent checklist to help you monitor your child’s behavior.

Uncategorized

Looking at the Five Stages of Grief in Our Daily Lives

9 May 20129 May 2012by Torey C. Richards, LMHC1 Comment

Elizabeth Kubler-Ross developed the five stages of grief theory after her work with terminally ill patients. It is a widely used theory used to explain what happens when people are coping with dying and now is even used outside of death to include any experience of loss including divorce, separation and bereavement. The five stages are:

Denial- “I am fine”
Anger- “Why me! It’s not fair!”
Bargaining- “I’ll do anything for a few more years!” “I promise to go to church everyday!”
Depression- “I’m dying, what’s the point of trying to be happy?”
Acceptance- “I can’t fight it. It’s happening. I might as well be prepared for it the best way I can.”

People often go through these stages in different orders and sometimes from one to the other and back again. For example, someone can be in acceptance and go back to bargaining, or go from denial to depression while skipping anger and bargaining. While this theory has most widely been studied and accepted in dealing with the dying and grieving, in my experience, I’ve notice that it seems to apply outside of these populations.

The Five Stages of Grief Outside of The Grieving Population

Substance Abuse

In working with substance abuse users, they often times also experience the five stages of grief. There is a period of denial that there is a problem, anger that there may be a problem, pleading with themselves or a higher power to take away the problem, a period of depression as the reality of the problem starts to set in and then acceptance eventually sets in, more so in those seeking treatment compared to those who do not seek help and seem to remain in the denial stage. Even family members of substance abusers tend to go through the stages of grief in dealing with the family member who is abusing substances.

Loss of a Relationship/Affair

Often times the unseen or unwanted end of a relationship sends someone through the five stages of grief. The same sometimes happens when an affair is discovered or sensed. The person first is in denial and then as further evidence is discovered, the person becomes angry and then bargains with themselves, the other person, the universe or whoever for this not to be happening, and then they usually fall into a depression and then eventually acceptance which allows them to try to deal with the reality of the situation in a healthy way.

Sexual Abuse

In cases of sexual abuse, families often go through the five stages of grief. Sometimes it’s a mother who goes through the stages when confronted with evidence or suspicion that one of her kids is being molested by a new boyfriend. Recently I started working with a young girl who was sexually abused by her uncle, who had recently gotten out of prison for sexually assaulting a minor, but still no one in her family believed her until a year later when her younger sister became pregnant with her uncle’s baby. That tragedy could have been avoided if the family would have not stayed in the denial stage for so long in realizing that her uncle was a sexual predator.

Mental Illness

I wrote in a previous post about parents denial of their child’s mental illness. From my experience, parents often go through the five stages of grief when it comes to facing the fact that their child has certain challenges such as ADHD, anxiety or mood disorders or even more severe issues. Mentally ill individuals also sometimes go through the fives stages of grief, not wanting to admit or accept that they may have a depressive disorder, an anger problem, or whatever it may be. This is what usually keeps them from seeking help for years until they finally reach the acceptance stage.

Everyday Life

I know there are many other times and situations in which the five stages of grief can be applied, but the ones I named above are the ones I seem to deal with the most. How have the five stages of grief showed up in your life? Have you been diagnosed with an illness and went through a period of denial, anger, bargaining, depression and finally acceptance? I know when I was diagnosed with type II diabetes I went through the five stages of grief and it was only when I reached the acceptance stage that I was able to actively take control of my life.

Uncategorized

Can Tanning and UV Rays be Addictive?

8 May 20128 May 2012by Torey C. Richards, LMHCLeave a Comment

To be honest, before “Tan Mom” I had never ever heard of tanorexia. I assumed that she was a sick woman in need of mental help. I wasn’t judging her, or maybe I was. It just didn’t make sense to me why someone would do that to themselves, but maybe she really has a problem.

Tanorexia is a physical or psychological addiction to tanning. According to a study done by dermatologists, really frequent tanners tend to lose control of their tanning schedules and become a lot like smokers and other substance abusers, wanting more and more. Research says that tanning releases an opioid that tanners can become addicted to and even have withdrawal symptoms from.

Negative side effects of tanorexia include all of the negative things that come along with prolonged exposure to UV rays including cancer. In some cases of tanorexia, it may even be a form of body dysmorphic disorder (which I originally thought “Tan Mom” had) where the person sees themselves as always too pale no matter how dark their skin gets, and/or finds their pale skin to be disgusting, unattractive and unacceptable. It’s this way it is a lot like anorexia where the person sees themselves as overweight no matter how thin they get.

Currently tanorexia is not an official diagnosis in the Diagnosis and Statistical Manual of Mental Disorders IV (DSM IV), but an updated version of this manual (the DSM V) is scheduled to come out soon and it will be interesting to see if tanorexia will be an official diagnosis. Further more, The Archives of Dermatology appear to make a case for diagnosing the addiction to UV rays as a type of substance abuse disorder so along with alcoholics we may soon have tanaholics.

I’ve always heard that you can become addicted to anything and everything should be done in moderation. Tanorexia seems to prove that statement.

Uncategorized

7 May 2012by Torey C. Richards, LMHC1 Comment

I really like this. Especially as I sit here in my office with students and parents coming for help. I will pass this along and I know it will make a difference to someone today.

help4yourfamily

From now on, Monday is going to be parent affirmation day at Help 4 Your Family. Sometimes I will share affirmations I have created and used, other times I will quote affirmations from teachers I have come to trust.

For this Monday, May 7, 2012 your parenting affirmation is:

My children give me constant opportunities to learn and grow.

Now, you know this one makes you smile, even when you are tired. I would suggest that, to make this part of your self-talk, you repeat it many times throughout the day. Say it to yourself in the mirror, and mention it to your friends in conversations.

If you have a parenting affirmation that you would like to share, please feel free to let me know. Maybe you will see it some other Monday 🙂

All the best to your family,

Kate

View original post