Understanding Adolescent Pain

1. Understanding Adolescent Pain Providing essential pieces for dealing with issues of an adolescent with depression

2. Key understandings • All kids are good • Kids are trying to do the best they can • They want to fit in/be accepted • They want to be liked and loved • They want to please others • They are stressed • They are scared about the future • They don’t feel that anyone understands • They want to feel secure and in control • They want to feel good

3. They want to be… • LOVED • UNDERSTOOD • ACCEPTED

4. DEPRESSION Anger turned inward

5. What to look for: Warning Signs • Unexplainable changes in… • Friends • Grades • Behavior • Habits • Hobbies • Activities • Body appearance

6. Unsure? • At this point, If you’re unsure if an adolescent in your life is depressed or just “being a teenager,” consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self. • dramatic, long-lasting changes in personality, mood, or behavior are red flags of a deeper problem. 2-3 weeks… More often than not. Duration-Severity-Real Change

7. Key Understanding • If a teenager can identify the causes of there depression then it normally isn’t clinical depression • Name it, Claim it, and Tame it! • Depression will not just go away • Depression needs intervention • Depression is hard to understand

8. Major Depression • Considered a Mood Disorder • Can be episodic or recurrent • Psychological and physical components • Highly treatable • Often misunderstood and undiagnosed especially in teenagers

9. Major Depression • A combination of symptoms that interfere with ability to work, study, sleep, eat and enjoy once pleasurable activities and which may occur only once or several times

10. Symptoms: Depression • Major Depressive Disorder requires two or more major depressive episodes. Diagnostic criteria: • Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day

11. At least 5… • 1.Depressed mood most of the day. • 2.Diminished interest or pleasure in all or most activities. (Quit) • 3.Significant unintentional weight loss or gain. • 4.Insomnia or sleeping too much. • 5.Agitation or psychomotor retardation noticed by others. • 6.Fatigue or loss of energy. • 7.Feelings of worthlessness or excessive guilt. • 8.Diminished ability to think or concentrate, or indecisiveness. • 9.Recurrent thoughts of death (APA, 2000, p. 356).

12. Teen specific… The difference between teenage and adult depression • Irritable or angry mood– As noted above, irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts. • Unexplained aches and pains- Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression. • Extreme sensitivity to criticism- Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.” • Withdrawing from some, but not all people- While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

13. Untreated Depression Can Lead to… • Problems at school -Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student. • Running away - Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help. • Substance abuse - Teens may use alcohol or drugs in an attempt to “self-medicate” their depression. Unfortunately, substance abuse only makes things worse. • Low self-esteem - Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness. • Eating disorders - Anorexia, bulimia, binge eating, and yo-yo dieting are often signs of unrecognized depression.

14. Cont. • Internet addiction - Teens may go online to escape from their problems. But excessive computer use only increases their isolation and makes them more depressed. Cyberbullying and harrassment. Falsifying identity on Social networks like Twitter and Facebook. • Self-injury - Cutting, burning, and other kinds of self-mutilation are almost always associated with depression. (Piercings and Tattoos) • Reckless behavior - Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, out-of-control drinking, and unsafe sex. • Illegal behaviors – Shoplifting and Theft (Chemical High) • Violence - Some depressed teens (usually boys who are the victims of bullying) become violent. As in the case of the Columbine school massacre, self-hatred and a wish to die can erupt into violence and homicidal rage. • Suicide - Teens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. Suicidal thoughts or behaviors should always be taken very seriously.

15. Suicide warning signs • Talking or joking about committing suicide • Saying things like, “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out.” • Speaking positively about death or romanticizing dying (“If I died, people might love me more”) • Writing stories and poems about death, dying, or suicide • Engaging in reckless behavior or having a lot of accidents resulting in injury • Giving away prized possessions • Saying goodbye to friends and family as if for the last time • Seeking out weapons, pills, or other ways to kill themselves These are serious issues…they are scary…any serious illness is!

16. Suicide is a game changer • Ask the tough questions? • Do you want to kill yourself? • How will you do it? • Do you have the means? Help before the sun goes down! • Get an assessment…Call 911 or ER! • Do not leave alone!

17. Realize this… Depression effects 20% of teens 2x as many girls as boys Experts say only one in five depressed teens receive help. 1 in 5…Why? Very treatable illness take them to a doctor!

18. If not depression, then what is it?

19. Terminology is Essential • Depression – clinical sadness often linked to Serotonin and other unknown reasons -DISTRACT or RUMINATE • Persistent Depressive Disorder (Dysthemia) • Seasonal Affective Disorder • General Anxiety Disorder • Worrier • Grief or Bereavement • Sadness • Unhappiness • Stressed out • Blahs

20. Stress • What is stress: physiological response to a psychological or physical stimuli • Ultimately, energy to respond • Eustress v. Distress • Eustress: positive energy to respond • Distress: negative amount of energy

21. Analogy of the Bucket • Puppies must be walked…OR ELSE! The Bucket must be either… Emptied or Made Larger

22. Unhappiness: Why? • Too High or Too Low of expectations from self or others – never good enough or always successful but no fulfillment • Missing or Broken tile syndrome – Christmas tree lights- one out…all out! • Comparison to others: the Uberperson

23. Is this what you want? • master-photoshopper merging Catherine Zeta-Jones, Charlize Theron, Angelina Jolie and Keira Knightly.

24. The negative symptoms dart board • Adolescence tend to go from one symptom to another searching for help and relief • Drinking and Drugs • Cutting • Sex/ bad relationships • Stealing • Lying • Escape – Internet and Video gaming • Change of behaviors – anger and acting out

25. When to act? When symptoms persist or get worse • persistent sad, anxious, or “empty” mood • feelings of hopelessness, pessimism • feelings of guilt, worthlessness, helplessness, • loss of interest or pleasure in hobbies or activities once enjoyed • decreased energy, fatigue, being “slowed down” • difficulty concentrating, remembering, making decisions • insomnia, early morning awakening or oversleeping • appetite and/or weight loss or overeating and weight gain • thoughts of death or suicide, attempts of suicide • restlessness and irritability • persistent physical symptoms which do not respond to treatment • headaches, digestive disorders, chronic pain...

26. Helping a depressed teenager • Talk to your teen • Ask the school for guidance • Visit your family doctor • Call your insurance company • Seek out a specialist • Explore the treatment options • Talk Therapy, Medication, Family support services, Educational Classes, Behavior Management techniques, as well as Family therapy

27. TIPS FOR TALKING TO A DEPRESSED TEEN • Offer Support • Be gentle but persistent • Listen without lecturing • Validate feelings

28. The positive dartboard • Given the opportunity and training, teens will opt for healthy responses too • Exercise and sports • Appropriate emotional expression • Positive social interactions • Prayer • Playing • Relaxation • Talking

29. What to do… • The most important thing we can do is have a consistent relationship with our children. • THIS INCLUDES: • providing them limits, • providing guidance and support in decision-making, • providing them discipline • being aware of what's happening in their lives daily AND • Seeking advice and help when needed

30. Remember… • …the peer group is important to young adolescents, and there’s nothing wrong with that. Parents are often just as important, however. Don’t give up on the idea that you make a difference.

31. Final Thoughts… • Step back; Put the puzzle together • Learn to be aware • Once you start seeing these symptoms • Talk about it (Saying it doesn’t make it) • Seek Help (MUCH EASIER EARLY, than LATER) • If you suspect that a teenager in your life is suffering from depression, speak up right away and do something.

33. resources • Cuyahoga County Board of Mental Health • Helpguide .org • National Institute of Mental Health http://www.nimh.nih.gov