Importantly none of the conditions described above are permanent states. Any one of them can change over time and progress toward more serious depression or toward emotional health. If you think your child may be more depressed than the teens profiled in this chapter, or if you think your child is deteriorating in that direction, see the next chapter for a fuller discussion about assessing teens for depression. If your teen is experiencing depression, you will need to seek professional help. Start by checking with your family doctor to determine whether a medical condition might account for your teen's mood. If not, ask the doctor to refer your teen to a mental health professional in your area.
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Sunday, 14 December 2008
Depressed mood related to difficult life curcumstances
Benny: Benny's family lived on social assistance. His father had left the family years ago because of alcohol problems. His mother had not been able to find work, and had three young boys to raise. They didn't have medical insurance, so he and his siblings often suffered through ear infections or sore throats without antibiotics. Their sneakers were often falling apart by the time their mother could replace them. Benny was embarrassed by all this, and lied to his friends about his home life. His mother was upset that he was ashamed of his family, and smacked him roughly when she heard. Unlike his two younger brothers, he always seemed to be in some sort of trouble. When there was a fight among the boys, Benny usually got blamed. He often thought he should run away from home, but there was nowhere safe to go. He didn't want to end up in a gang like some of the other boys in his neighborhood, but he often wondered how else to find a place to fit in.
Benny's life has been difficult from the start. He is not faced with adjusting to a sudden change, but rather coping and trying to make a good life for himself despite the odds. His environment poses a combination of several risk factors for maladjustment. Poverty, a rough neighborhood, a stressed single-parent household, limited access to medical care, less than optimal parenting, and being made the scapegoat in the family can all contribute to emotional problems. Benny does not necessarily need counseling. Benny needs a source of hope for the future. The ability to excel in some area that would allow him to escape his circumstances would strengthen this. A successful male role model that took an interest in him (for example, a big brother) could also be helpful. Emotional support for his mother could also, indirectly, benefit Benny and his brothers. Although helpful interventions in this case are more social than psychiatric, they are no less important if Benny is to have a chance to make it.
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Benny's life has been difficult from the start. He is not faced with adjusting to a sudden change, but rather coping and trying to make a good life for himself despite the odds. His environment poses a combination of several risk factors for maladjustment. Poverty, a rough neighborhood, a stressed single-parent household, limited access to medical care, less than optimal parenting, and being made the scapegoat in the family can all contribute to emotional problems. Benny does not necessarily need counseling. Benny needs a source of hope for the future. The ability to excel in some area that would allow him to escape his circumstances would strengthen this. A successful male role model that took an interest in him (for example, a big brother) could also be helpful. Emotional support for his mother could also, indirectly, benefit Benny and his brothers. Although helpful interventions in this case are more social than psychiatric, they are no less important if Benny is to have a chance to make it.
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Difficult Temperament And Low self-esteem
Difficult Temperament
Lexy: Lexy had always been considered a "high maintenance" child. She made frequent, loud demands for attention as an infant, and had continued to do so for much of her life. She ate irregularly and slept irregularly, despite numerous attempts by her family to establish routines. She pouted miserably when things were the slightest bit different from what she expected. She insisted on being in charge when playing with her friends. She had difficulty adjusting to high school, where she had to rotate from class to class and had a different teacher in each subject. She became preoccupied with her teachers' different teaching styles, insisting that some were simply wrong. Similarly, her peers could never measure up to her exacting standards, and she soon had a very small circle of friends. If anyone commented on how she was making herself miserable, she blamed that person for the problem.
Low self-esteem,
Carlos: Carlos always seemed to live in the shadow of his older brother, Joe. Joe was an excellent basketball player, top student, and popular among his peers. Carlos was none of these. He was constantly trying to impress his friends with feats of daring, often injuring himself in the process. They merely laughed. Carlos bragged about his computer game system. The other boys thought he was showing off. Their families couldn't afford the latest systems. Inside, Carlos was miserable: constantly comparing himself to others and feeling that he didn't measure up. His stunts and bragging were ineffective ways of looking for praise.
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Lexy: Lexy had always been considered a "high maintenance" child. She made frequent, loud demands for attention as an infant, and had continued to do so for much of her life. She ate irregularly and slept irregularly, despite numerous attempts by her family to establish routines. She pouted miserably when things were the slightest bit different from what she expected. She insisted on being in charge when playing with her friends. She had difficulty adjusting to high school, where she had to rotate from class to class and had a different teacher in each subject. She became preoccupied with her teachers' different teaching styles, insisting that some were simply wrong. Similarly, her peers could never measure up to her exacting standards, and she soon had a very small circle of friends. If anyone commented on how she was making herself miserable, she blamed that person for the problem.
Low self-esteem,
Carlos: Carlos always seemed to live in the shadow of his older brother, Joe. Joe was an excellent basketball player, top student, and popular among his peers. Carlos was none of these. He was constantly trying to impress his friends with feats of daring, often injuring himself in the process. They merely laughed. Carlos bragged about his computer game system. The other boys thought he was showing off. Their families couldn't afford the latest systems. Inside, Carlos was miserable: constantly comparing himself to others and feeling that he didn't measure up. His stunts and bragging were ineffective ways of looking for praise.
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Grief Reaction
Tyler: Tyler's parents had divorced when he was a toddler, and his mother remarried when he was ten. Now fourteen, Tyler had never gotten along with his stepfather, and his older sisters tended to pick on him. He always looked forward to Sundays, though. On Sundays, he visited his grandfather, Bill. Grandpa Bill knew more about baseball than anyone Tyler had ever met, and could describe key moments of every World Series going back to the '40s. Tyler shared his passion. Sometimes, they'd get to watch a game together. Other times, they just went through Grandpa's baseball cards, autographed balls, and other memorabilia and the stories they brought to mind. Grandpa Bill was determined to live alone, even though his health was failing.
One day, Tyler's mother looked very serious. Gently, she tried to break the shocking news to him: his grandfather had had a stroke. He wasn't expected to recover. Three days later, he passed away and Tyler was inconsolable. He had nothing to look forward to anymore. He pined in his room for days. Eventually, his mother suggested he write a tribute to his grandfather for the local newspaper. He was proud to do it. With more encouragement, he began to volunteer to pass out programs when his town's team played a home game. He had never been a great player, but his knowledge of the game soon made him a fixture behind the bench. He set a goal of becoming a sportscaster one day.
Like Nadine, Tyler had to adjust to a major life change. Loss of a key person in a is life can be devastating, especially if unexpected. For Tyler, his grandfather's was doubly important because of the more strained relationships he had with ?r family members. It was not going to be possible to replace his grandfather, as it ly is when the lost person is significant. Instead, he had to find a way to honor his memory, maintain an important aspect of the relationship in his life (in this case, the love of baseball), and go on. Fortunately, his mother was sensitive to these issues and helped him grieve appropriately
As adults, we should never assume that a loss is insignificant to a teen. Apparently distant friends or relatives, even pets, can be missed terribly. Even a famous person the teen admires (for example, a famous musician or actor) can be mourned, especially if that person symbolizes an important aspect of the teen's emerging identity. Don't be shy about asking how your teen's life is different, now that the person is gone. The answer may surprise you. If a grief reaction is prolonged or accompanied by symptoms suggestive of more serious depression, counseling should be sought.
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One day, Tyler's mother looked very serious. Gently, she tried to break the shocking news to him: his grandfather had had a stroke. He wasn't expected to recover. Three days later, he passed away and Tyler was inconsolable. He had nothing to look forward to anymore. He pined in his room for days. Eventually, his mother suggested he write a tribute to his grandfather for the local newspaper. He was proud to do it. With more encouragement, he began to volunteer to pass out programs when his town's team played a home game. He had never been a great player, but his knowledge of the game soon made him a fixture behind the bench. He set a goal of becoming a sportscaster one day.
Like Nadine, Tyler had to adjust to a major life change. Loss of a key person in a is life can be devastating, especially if unexpected. For Tyler, his grandfather's was doubly important because of the more strained relationships he had with ?r family members. It was not going to be possible to replace his grandfather, as it ly is when the lost person is significant. Instead, he had to find a way to honor his memory, maintain an important aspect of the relationship in his life (in this case, the love of baseball), and go on. Fortunately, his mother was sensitive to these issues and helped him grieve appropriately
As adults, we should never assume that a loss is insignificant to a teen. Apparently distant friends or relatives, even pets, can be missed terribly. Even a famous person the teen admires (for example, a famous musician or actor) can be mourned, especially if that person symbolizes an important aspect of the teen's emerging identity. Don't be shy about asking how your teen's life is different, now that the person is gone. The answer may surprise you. If a grief reaction is prolonged or accompanied by symptoms suggestive of more serious depression, counseling should be sought.
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Acute Depressive Conditions
Sometimes depressed mood starts suddenly, in response to a stressful event. There are two such "acute" depressive conditions recognized by mental health professionals. These are: Adjustment Disorder with Depressed Mood and Grief Reaction(s).
In this case, a teen is experiencing a very distressing event that is not extreme enough to be considered a trauma, but nevertheless profoundly affects her mood. School changes or breaking up with a boyfriend or girlfriend, for example, are common triggers of depressed moods. When the depressed mood persists for a month or more, this is called an adjustment disorder. Although unpleasant, adjustment disorders are usually not accompanied by the disturbances of sleep, appetite, energy and concentration, nor by the extreme hopelessness or extremely low self-worth characteristic of major depression. In an adjustment disorder, the change in mood is entirely related to the distressing event, and tends to resolve as the teen adjusts to the new reality (usually, a few days to a few weeks at the most) and finds new sources of enjoyment.
In Nadine's case, for example, she contacted some of her old friends and found out about the struggles they faced at their new school. Her predicament didn't seem so uniquely difficult, and she found comfort in commiserating with them. Eventually, she found a sympathetic teacher at the new school who encouraged her to write for the yearbook, and the peers involved in this activity became her friends. In some cases, supportive counseling is needed to help teens adapt.
If your son or daughter experiences mood changes related to a distressing event, try to provide comfort while maintaining normal routines. If the mood change persists for several months, or you think there might be a risk of self-harm, have him seen by a doctor to clarify the diagnosis and assess whether or not treatment is needed.
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In this case, a teen is experiencing a very distressing event that is not extreme enough to be considered a trauma, but nevertheless profoundly affects her mood. School changes or breaking up with a boyfriend or girlfriend, for example, are common triggers of depressed moods. When the depressed mood persists for a month or more, this is called an adjustment disorder. Although unpleasant, adjustment disorders are usually not accompanied by the disturbances of sleep, appetite, energy and concentration, nor by the extreme hopelessness or extremely low self-worth characteristic of major depression. In an adjustment disorder, the change in mood is entirely related to the distressing event, and tends to resolve as the teen adjusts to the new reality (usually, a few days to a few weeks at the most) and finds new sources of enjoyment.
In Nadine's case, for example, she contacted some of her old friends and found out about the struggles they faced at their new school. Her predicament didn't seem so uniquely difficult, and she found comfort in commiserating with them. Eventually, she found a sympathetic teacher at the new school who encouraged her to write for the yearbook, and the peers involved in this activity became her friends. In some cases, supportive counseling is needed to help teens adapt.
If your son or daughter experiences mood changes related to a distressing event, try to provide comfort while maintaining normal routines. If the mood change persists for several months, or you think there might be a risk of self-harm, have him seen by a doctor to clarify the diagnosis and assess whether or not treatment is needed.
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Adjustment disorder with depressed mood
Nadine: Nadine had a gift for music. Everyone encouraged her to nurture this talent. When the opportunity came along to attend a special high school for the performing arts, there was no doubt that this was where Nadine belonged. Unfortunately, none of Nadine's friends were able to join her at the new school. They all were enrolled in the college preparatory program at the local high school. She missed them terribly, and found it harder than she expected to fit in with her new, artistic peers. Furthermore, at her old school, she was praised regularly for her exceptional talent. At the new school, she actually lagged behind her peers in some areas. Many of them had performed in recitals for years and were already entering professional competitions. Rather than feeling privileged to attend the school, Nadine felt like a fish out of water. She regretted deciding to go there. She became sullen and discouraged as she dragged herself to school every morning. By October, she was skipping classes and withdrawing from peers and family.
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The spectrum of teen depression
Feeling sad from time to time is normal for people of all ages. Feeling depressed is not. What's the difference? Sadness is an unpleasant emotion in response to certain events in our lives. Loss of a loved one or close friend, disappointment at missing a hoped-for opportunity, or struggling to adapt to sudden unwelcome changes, all result in sadness for most of us. Even seeing someone else experience these events in a movie can bring us to tears. Often, the tears, the grieving, the process of getting through the sadness bring relief. V,"e take some time to stop our daily routine, reflect on what has happened, cry, and gradually replenish our energy so we can carry on. This is a healthy process.
Depression is not healthy. Depressed mood, a major symptom of depression, occurs when sadness is partnered with a change in how we perceive ourselves and others. We tend to think less of ourselves than usual. We can't forgive ourselves the slightest mistake. We see others as cold and uncaring. We can't appreciate partial success, or see the silver lining in the cloud. We feel helpless and defeated. We can't imagine facing life's challenges and going on. In short, sadness repairs while depression impairs.
We shouldn't expect our children to be free from sadness. In fact, denying sadness or grief in ourselves or others can cause emotional problems. We should, however, expect our children to be free from depression. The occasional down mood occurs in most teens. Ongoing depression does not. How, as a parent, can you tell the difference? In truth, there is no single test that will tell you. In part, this is because teens don't tell you everything that goes on in their minds. They shouldn't be expected to. A certain amount of privacy is part of growing up and becoming your own person. In part, this is because there is a whole range or "spectrum" of experiences between uncomplicated sadness and clinical depression.
This blog discusses teens all the way along that spectrum. The approach described applies to any teen whose sadness is complicated by feelings of low self-worth, overly negative appraisals of events, helplessness, or hopelessness. In more severe cases, it serves as an adjunct to clinical treatments. In milder depressive states, it may allow you to get your teen back to a more average frame of mind, appropriate to his or her stage of development. Before discussing how to do this, however, let's examine some of the depressive states along the spectrum. Think about which one (or ones) might apply to your teen. In this chapter, we illustrate some of the more common, milder depressive conditions. In the next chapter, conditions on the more severe end of the spectrum (Dysthymic Disorder, Major Depression, Bipolar Disorder) are discussed.
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Depression is not healthy. Depressed mood, a major symptom of depression, occurs when sadness is partnered with a change in how we perceive ourselves and others. We tend to think less of ourselves than usual. We can't forgive ourselves the slightest mistake. We see others as cold and uncaring. We can't appreciate partial success, or see the silver lining in the cloud. We feel helpless and defeated. We can't imagine facing life's challenges and going on. In short, sadness repairs while depression impairs.
We shouldn't expect our children to be free from sadness. In fact, denying sadness or grief in ourselves or others can cause emotional problems. We should, however, expect our children to be free from depression. The occasional down mood occurs in most teens. Ongoing depression does not. How, as a parent, can you tell the difference? In truth, there is no single test that will tell you. In part, this is because teens don't tell you everything that goes on in their minds. They shouldn't be expected to. A certain amount of privacy is part of growing up and becoming your own person. In part, this is because there is a whole range or "spectrum" of experiences between uncomplicated sadness and clinical depression.
This blog discusses teens all the way along that spectrum. The approach described applies to any teen whose sadness is complicated by feelings of low self-worth, overly negative appraisals of events, helplessness, or hopelessness. In more severe cases, it serves as an adjunct to clinical treatments. In milder depressive states, it may allow you to get your teen back to a more average frame of mind, appropriate to his or her stage of development. Before discussing how to do this, however, let's examine some of the depressive states along the spectrum. Think about which one (or ones) might apply to your teen. In this chapter, we illustrate some of the more common, milder depressive conditions. In the next chapter, conditions on the more severe end of the spectrum (Dysthymic Disorder, Major Depression, Bipolar Disorder) are discussed.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
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