Anorexia is a serious psychiatric illness marked by an inability to maintain a normal body weight, which usually means dropping below 85 percent of the ideal body weight. Those affected by anorexia, who happen to still be growing, fail to make the expected increases in weight and bone density, therefore leading to other serious medical conditions. Despite increasing weight loss, individuals with anorexia, continue to obsess about weight, remain dissatisfied with the perceived size of their bodies, and engage in an array of unhealthy behaviors to enable weight loss (i.e. purging, compulsive dieting, excessive exercise, and fasting). Individuals with anorexia place central importance on their shape and weight as a marker of self-worth and self-esteem, although they are never fulfilled due to the fact that they never believe they are thin enough. Typical personality features of individuals with anorexia include perfectionism, obsession, anxiety, harm avoidance, and low self-esteem. The most common co-morbid psychiatric conditions include major depression and anxiety disorders.
Melissa Sestito is a marriage and family therapy graduate student at Fairfield University.
Non-Suicidal Self Injury (NSSI) can be defined as behaviors (i.e. cutting/burning/skin scratching) resulting in physical damage with no explicit or implicit intent to die but rather to gain relief from negative emotion or obtain social reinforcement (Weissman, 2009). Other names and definitions have been ascribed to this phenomenon. It has been called parasuicide (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991), self mutilation (Briere & Gil, 2010), and deliberate self harm (Odershaw, et al., 2009). Some studies have classified NSSI amongst other “self destructive behaviors” (i.e. substance abuse, binge eating, smoking, and reckless endangerment) (Herrenkohl, Catalano, Hemphill, & Toumbourou, 2009). Currently NSSI is not considered a disorder in the current Diagnostic and Statistical Manual of Mental Disorders (DSM), but a proposed revision is being considered for the creation of an NSSI diagnosis in the DSM-V (Nonsuiciadal Self Injury – Proposed Revision, 2010).
An important distinction of NSSI is that it is non-fatal by nature. If it were fatal then it would be considered suicidal behavior. NSSI events differ from suicidal events in that the intent is not death, but an improvement in psychological state (Roth & Presse, 2003). The distinction is further made by the argument of some researchers that NSSI is an “anti-suicide” behavior, suggesting that NSSI is used as a coping mechanism to avoid suicide (Suyemoto, 1998). While NSSI may be considered an attempt to avoid suicide, researchers have found a strong link between suicide and adolescents who engage in NSSI behaviors (Stanley, Gameroff, Michalsen, & Mann, 2001).
Michael Romano is a marriage and family therapy graduate student at Fairfield University.
“It’s the most wonderful time of the year.” For many the holiday season ushers in excitment around family gatherings and traditions; however for many others those same thoughts bring reminders of loss, traumatic experiences, grief and seasonal depression.
When working with this population it is important to support clients in managing their symptoms. Clients who struggle with low or moderate levels of depression often decompensate to becoming severely depressed during the holiday season. Helping clients to anticipate and visualize the difficult moments or events that they may face during the holiday season and working them to develop coping strategies for getting through them is an invaluable intervention. Often clients will be empowered to move through those difficult moments with more confidence as they can use those coping strategies to help get through them.
For other clients, overwhelming female, seasonal depression has nothing to due with loss or trauma and may be related to their body’s natural chemical makeup. According to the Mayo Clinic, Seasonal Affective Disorder (SAD) can be caused when reduced levels of sunlight interrupt the body’s internal clock or “ circadian rhythm” and create feelings of depression. Other causes include a disruption in Melatonin levels caused by the change of seasons as well as a drop in Serotonin levels which can result from reduced amounts of sunlight. The most common treatment for SAD is light therapy, psychotherapy and medication in some combination. More information about SAD can be found on the Mayo Clinic’s website at the following link http://www.mayoclinic.com/health/seasonal-affective-disorder/DS00195.
Whatever the form, seasonal depression is no less debilitating or dangerous than depression at any other time of year; many would argue the very opposite. As many agencies close around the holidays, leaving clients with less access to their clinicians, it is all the more important to start working with them early on their coping strategies. Make sure they are compliant with their medication and that they have enough refills to get them though to their next medication management appointments. Preparation and helping to manage clients’ expectations can be surprisigly effective in helping depressed clients make it through the holiday season closer to their baseline levels of functioning rather than in the hospital. For many of the clients that we work with that’s a huge win.
“Some therapeutic models have been found effective in the treatment of mental health issues and illness, and we cannot be certain about why they are effective. We as a field do not know why psycho pharmaceuticals work, and although we have theories about why they work, we have still not been able to truly decipher the mystery of mental illness. Most of our methods and interventions do help to ameliorate symptoms, and some are more helpful and change-producing than others. At times, the uncertainty surrounding visits to psychiatrists or a therapists can resemble a visit to witch doctor; a psychiatrist will tell you, “Take this medication and if the symptoms do not diminish come back and we will try another.” A therapist will try multiple therapeutic interventions, and will test multiple therapeutic hypotheses until an effective treatment is found.
I believe that only the client can indicate what is and what is not working. Only the client knows which interventions are helping to diminish the symptoms and which are not. We have much left to be discovered in terms of providing and facilitating relief for our clients. For this reason, it is critical that we continue researching the causes of mental ailments. We must try to understand how and why relationships go awry, which entities are not relating in a satisfactory way, which faulty relationships are causing the ailment and how can we correct the deficiency in such relationships. How can we aid these entities in achieving their full relational potential? We must adopt a sense of urgency and we must acknowledge that we have achieved a very limited understanding of mental ailments, including symptom management and “cures”.
Anibal Torres PhD is an Assistant Professor of Marriage and Family Therapy at Fairfield University.