Dr. Henry Paul, MD

Psychiatrist, Author and Educator

UNDERSTANDING ANGER IN TEENAGERS

January 31st, 2015

There are two main sources of anger in children and teens: one is the danger that occurs as a result of facing new daily challenges, and the other is interpersonal relations.

First, for teenagers facing new challenges, anger is part of the process. New challenges include dealing with the bodily changes of puberty, sexuality and increasing independence from parents. They can also include new social situations that are baffling and demanding, school and peer pressures, college anxiety, and all the other awkward and anxiety-provoking challenges that the passage through adolescence entails.

Second, anger resulting from interpersonal relationships — primarily, the relationship between teens and parents and social stresses with peers – is usually because a teenager feels a sense of being unwanted or being treated unfairly. Neglect, broken promises, inconsistency, hypocrisy, double messages, being over-protective, teasing, and the arbitrary exercise of power are just some examples of what can lead to these feelings.

The degree of a teenager’s anger also varies according to his or her makeup and other things such as age and temperament and his or her ability to tolerate stress and situations that are around them. Their gender also plays a role. While most males tend to act out their anger aggressively, females – although more willing now to express anger outwardly than in the past – tend to subsume it in other feelings such as depression.

Because parents tend to misunderstand teenage anger; they frequently mishandle it. Mishandling it may include denying that the teen is angry at all, ignoring it, attempting to eradicate it by abuse of punishment, complying with it, resorting to bribery, or refusing to set limits. All of those responses result in impeding anger from serving its function; to communicate to the parent what’s bothering the teen. Understanding your teenager’s anger is the first step in dealing with it. Understanding your own anger is the second step.

Parents need to understand their own motives and styles of anger management. Questions parents should ask themselves: Are you confused about your anger? Are you trying to exercise excessive control over your teenager? Do you feel an unconscious identification with your child that interferes with good judgment? Are you afraid of your teenager’s anger, or applying a standard of “perfection” in which anger is not permissible? Dependency, egocentricity, martyrdom, vengefulness – these are all personality traits that parents need to address in themselves before they can clear the way to reacting to their teenager’s anger more productively.

Thus, while most anger is normal, when parents mishandle their teen’s anger because of their own non-comprehension of it, they can cause problems that otherwise would not ensue; they affect what I call an anger metamorphosis, in which the child begins to see his anger as a bad, threatening, and disruptive feeling and therefore goes to great lengths to repress it. When anger is repressed, it evolves into symptoms that we especially see in teenage years. It can become the fuel for generalized anxiety states, depression, school failure, conduct disorder and other behavior disorders; criminal-type behavior, drug addiction, and a host of other problems. These legacies of mishandled anger will only grow if parents don’t realize that the original anger was healthy to begin with – that it carries a message of need that must and can be addressed directly, without fear.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT TO DO ABOUT AN ANGRY TEEN

January 30th, 2015

Dealing with your teenager when they are angry or having a violent “anger emergency” is not easy. Here are some steps to take when an explosive situation turns towards violence.

If your teenager gets so angry that you feel threatened by an “anger emergency,” do all you can to stay with your child and restrain him whatever way possible. In this situation, try not to criticize, although you should employ whatever means necessary to protect yourself and any others present. When you feel threatened, you may need to call in extra help, such as another parent, or, in rare cases, the police. Remember, you do your teenager no good by allowing him to rant and rave uncontrollably, especially if he is physically violent. Restrain him but do not berate him.

Fortunately, most teenagers do not reach the “anger emergency” point. With most teenagers, the aim should be to understand what message the teen’s anger seeks to convey. Understanding cannot be achieved by lecturing, chastising, or intimidating, but rather by compassionate listening and questioning. You want to find out what is troubling your teenager and to locate the trigger for the anger. Some teens can tell you why they’re angry while others cannot. You may need to play detective, trying to piece together what you know from your child’s actions, activities, and friends. Try to come up with a working theory to present to your child about why he might be angry. Observing, listening, and questioning your child are key.

Your primary goal should be to relieve the teenager, to ease whatever situation has induced the anger in the first place. You might suggest a solution to his problem or offer direct assistance. You might have to look at your behavior and how you might be able to keep from triggering your teen yourself. You may have to intervene at school or with local clubs to mediate the situation.
Lastly, if your teenager’s anger just does not go away despite your hard work in trying to detect the cause and ameliorate the underlying causes, then professional consultation is warranted.

ANGER IS NORMAL – VIOLENCE IS NOT

January 29th, 2015

Young people can be downright frightening when angry. But many teens can become violent particularly if they are suffering from a conduct disorder or a psychotic disorder with paranoid delusions. Drugs and alcohol can often cause dyscontrol (the inability to control one’s behavior) that leads to violence.

While anger itself is a perfectly normal emotion, violence is not. No parent should ever tolerate violence coming from their child. It is dangerous for everyone including the child. Immediate emergency measures include calling 911, restraint if safe and possible or even escape if necessary. Make no bones about it a violent child is dangerous and should be evaluated by a professional immediately. Don’t be fooled into thinking that if the episode passes that reasoning and processing alone is enough. You need a professional’s opinion. Emergency room personnel has training for dealing with these types of emergencies and is a good place to start if you’re in a crisis.

Anger, in general, is a difficult emotion for parents to understand. Should it be expressed, repressed, or displaced into other areas? Part of why it is so baffling is that most parents themselves do not understand their own anger – what it means, and how to handle it effectively. They don’t know how to make sense of the confusing messages in the media that bombard them about kids and anger. Parents worry that angry teens might hurt somebody, hurt themselves, join gangs, deteriorate academically and socially, and end up in prison.

First, some reassurance: although a majority of teenagers commit at least one anti-social act during adolescence, it is rare that they become criminals later in life. More fundamentally reassuring: anger is a perfectly normal feeling. Defined as a sense of displeasure or distress caused by feelings of powerlessness and helplessness, it runs the gamut from mild annoyance and crankiness to actual rage and fury, all of which can be normal reactions. Along with guilt, love, passion, joy, sorrow and excitement, feeling and expressing anger are part of being human. Without the ability to express anger, children and teenagers would be badly endangered. Anger is a great communicator. It signals parents to know when and how to help their child. Angry feelings are reactions to frustration, helplessness, and vulnerability – an alarm that the child needs aid.

The most important thing to remember about anger is that it is a response to feeling helpless. It usually can be understood if parents take the time to try. Anger usually disappears when the sense of helplessness underlying it resolves. Anger leaves no damage when it passes. Since feelings of helplessness are usually temporary and anger, freely expressed, can elicit help, parents are best advised to see it as a constructive feeling, even a helpful and life enhancing one.

WHEN YOU CAN’T DO IT ON YOUR OWN

January 26th, 2015

For nearly any disorder, stress, or issue that your teenager faces, the first line of intervention should be made by parents at home. Compassion and understanding comprise the most beneficial approach you can take to helping your teen. However, sometimes mustering up compassion and understanding is difficult because teenagers’ issues can reverberate in us and cause great anxiety, anguish, and anger.

Parents who are usually well-tempered adults can lose their tempers quite easily when dealing with adolescent moods, behaviors, and provocative discussions. Reflecting before blowing up – understanding that there are always reasons for your teens’ misbehavior or mood variation that may not readily be apparent – is sometimes difficult but is always the most rewarding tactic you can employ in helping your teenager.

Parental help is not always enough. It is important to follow your instincts. When you believe help is necessary, you need to act. Figuring out who to turn to once you realize that your teenager needs help can be overwhelming. Consulting your teenager’s doctor, teachers, school counselors, religious counselors, local mental-health associations, hospitals or outpatient services are reliable ways to find a trained mental-health professional to help.

The first step in getting help for your teenager usually involves a mental-health evaluation. Mental-health evaluations can be carried out by nearly all mental-health professionals. These include adolescent psychiatrists who specialize in the problems of teenagers, psychologists, social workers, mental health counselors and psychiatric nurses.

Adolescent psychiatrists are the most broadly trained of mental-health professionals; they have gone to medical school and pursued advanced training in adult and child/adolescent psychiatry during residency programs. The adolescent psychiatrist can prescribe medication and do psychotherapy.

The psychologist has received an advanced doctoral degree in psychology and often has done an internship prior to getting a license. Psychologists are trained not only in doing therapy but also in doing various types of testing, which helps in the evaluation of many aspects of a teen’s life.

Social workers who are licensed have also attended graduate school to receive their Master’s Degree in social work. Like psychologists and psychiatrists, they are also psychotherapists but have more training in dealing with family issues, cultural issues, and system theory.

Mental health counselors are also licensed mental health professionals who are also broadly trained in most areas of mental health and do psychotherapy and school counseling.

Psychiatric nurses, especially those with a Master’s Degree in Psychiatry, are often trained similarly to a psychiatrist but not as extensively. The nurse will often have a strong background in medical sciences but also an expertise in psychiatric diagnosis, like the psychiatrist. Psychiatric nurses also do psychotherapy.

As you can see all five of the major professions provide psychotherapy, while psychiatrists and specially trained psychiatric nurses can also prescribe psychotropic medication. Any of the aforementioned mental-health professionals can go on for advanced psychotherapy and/or psychoanalytic training. Without such training, many therapies get bogged down in more superficial approaches that don’t take into consideration unconscious psychological issues, family influences, and a host of inner conflicts that cause anxiety and symptoms in our teenagers. It should be emphasized that work with teenagers requires training in the area of adolescent problems specifically, and while many in the field of mental health are adequately trained it is mostly in work with adults. Make sure that the mental-health professional you choose has specific training and experience working with teenagers.

NUMBER OF DRUG ADDICTED BABIES BORN IN THE U.S. IS ON THE RISE

January 25th, 2015

In June of 2014, I wrote about the growing number of drug-dependent babies being born to drug-addicted mothers. At that time, the state of Tennessee was monitoring its growing epidemic since the beginning of 2013. Now, a new study in Friday’s issue of the CDC Journal Morbidity and Mortality Weekly Report, is saying the abuse of, and addiction to, Opioids (prescription painkillers) has skyrocketed leading to an epidemic of drug-dependent babies.

On Thursday, U.S. Health officials said in a statement to WebMD News from HealthDay, “Too many women of childbearing age take narcotic painkillers, putting any unborn babies at risk.”

The narcotic painkillers most commonly prescribed are hydrocodone, oxycodone and codeine, also known as Vicodin, Demerol, OxyContin and Percocet. The study says that most of the mothers are prescribed pain medication to treat moderate to severe pain from a surgery.

“Using narcotic painkillers in early pregnancy can increase the risk for certain birth defects, including spina bifida (a defect of the spine), gastroschisis (a defect of the abdominal wall) and heart defects,” said CDC epidemiologist Jennifer Lind in a statement to WebMD News from HealthDay.

Babies born drug addicted have to go through an excruciating drug withdrawal, known as neonatal abstinence syndrome (NAS). These babies can have seizures, brain damage and in later years school difficulties and behavior problems. It is heart-breaking to watch them go through this!

The complicated issue here is that the mothers are victims, too. Many are prescribed these addictive medications by a doctor to treat their pain. These women not only become addicted to the pain medications, but they also become pregnant. Once pregnant they become fearful of discussing their addiction with their doctor, family or friends. What needs to be understood is that there are two victims who need treatment – mother and child. This is a very heart-wrenching time for both and so compassion and understanding are necessary. Also, necessary are laws that make women feel safe so they can seek help for their addiction, and not fear losing their babies.

If you suspect that a friend or loved one is addicted to pain medications and pregnant you should talk about it with her, suggest she speak with her doctor, not be judgmental and help her to find the correct treatment.

TALKING STDS TO YOUR KIDS

January 21st, 2015

The Center for Disease Control (CDC) reported in 2013 that statistics are showing that more than half of the 19 million people infected each year with a sexually transmitted disease (STD) are between the ages of 15 -24. They are diagnosed with either HIV or other STDs making this a serious concern for parents, educators and the medical community.

STDs are dangerous and affect both males and females. They are caused by both bacteria and viruses and are worse for females because they are often asymptomatic, which means the diagnosis is often made after the disease has spread to the uterus and fallopian tubes. STDs can cause pelvic inflammatory disease which can lead to infertility. Studies are also showing that STDs can cause cervical cancer and genital warts.

While bacterial STDs can be treated and cured with antibiotics, the viral infections can only be prevented and treated (to some degree) but NOT cured.
Most sexually transmitted diseases can be treated if diagnosed early. For this reason, it is important that parents, medical professionals, and educators make sure to educate teenagers about prevention, diagnosis, and treatment of STDs.
STDs you get by having sex; genital intercourse or oral or anal intercourse with someone who already has a STD. There are two ways in which STDs are transmitted:

The “discharge diseases” are transmitted by infected semen of vaginal fluids that contact mucosal surfaces such as the urethra, vagina or cervix. These STDs include HIV, as well as gonorrhea, chlamydia, and trichomoniasis.
The genital “ulcer diseases” are transmitted through contact with infected skin or mucosal surfaces, and these include genital herpes, syphilis, chancroid, and the human papilloma virus (HPV). HPV now has a vaccine.

What to do to prevent STDs:

Any teenager, who is sexually active, should have regular check-ups for STDs, even if there are no symptoms.
Parents and teenagers should know the symptoms of STDs.
Talk with your teenager. Tell them that anal intercourse should be avoided, but the use of a condom is important if it is practiced.
Douching should be avoided. It may increase the risk of getting some STDs because it removes protective bacteria that live in the vagina and are necessary for good health.
STDs can be transmitted to a fetus, so treatment is necessary.
A teenager, who has a STD, should notify all sexual partners and sexual activity should be avoided while being treated for any STD.

Talk to your teenager about practicing safe sex! Basic prevention includes using a condom, getting vaccinations (i.e. Hepatitis A & B, HPV), and understanding how infection is spread. Most importantly, have an open line of communication with your teenager. Make sure your sons or daughters know that they can talk with you about such personal issues and that you will be there to help.

For more information, check out the Sexual Risk Behavior Guidelines & Strategies provided by the CDC.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

MY CHILD IS GAY! WHAT SHOULD I DO?

January 15th, 2015

Most parents love their children! That love is what will help parents to survive the initial shock of hearing that their son or daughter is gay. After a period of disbelief or denial, most parents can be counted on to be supportive. Here are some guidelines for parents to deal with their child’s homosexuality.

If your teen is gay or lesbian you should provide emotional support, despite the fact that you may have trouble accepting it.
Counseling and/or psychotherapy are suggested for teenagers who are uncomfortable with or uncertain about their sexual orientation. Therapy can help with adjusting to society in general. Make no mistake, sending a child for conversion therapy to change their sexual orientation has not been shown to work.
There are many local and national gay support groups (see list below) that can help a homosexual teenager to overcome some of the stigmatization and negative feedback that he or she gets.
It is extremely important that ALL teenagers understand the information about the risk for sexually transmitted diseases. Homosexual transmission of HIV is common and knowing the importance of condoms and other protection against such transmissions is essential.
A very large percentage, up to 95 percent, of LGBT teenagers report that they are often called names or threatened. As a result, they often skip school because they feel unsafe. LGBT teenagers are three-times more likely to be assaulted than their heterosexual peers. In addition, they are threatened and injured more by weapons. Additionally, lesbian and bisexual teenagers are more likely than heterosexual girls to be victims of rape or attempted rape.
Take care of yourself, too. Parents should make sure that they seek support, as well. Groups like PFLAG are available to answer questions and offer help. The most important thing for parents is to gain knowledge, be understanding, and most importantly be supportive.

In my next blog, I will discuss the STDs and Safe Sex for teenagers.

DISCLAIMER

HOMOSEXUAL TEENS “COMING OUT”

January 14th, 2015

In our culture, homosexual youths have to deal with a number of mental health issues. Ongoing discrimination fuels anxiety, depression and other stress-related mental health problems among LGBT people. In our culture homosexual youths have a higher suicide/mortality rate than heterosexuals. It is estimated that 30 percent of all youth suicides are gay youths.

Many gay youths feel guilty about their sexuality and painfully different from their peers; they worry about the response from their families, are often teased and bullied, worry about HIV infection and other STDs, feel discrimination when joining various clubs and other activities, and often are rejected and harassed by other teenagers. This leads to isolation and withdrawal, low self-esteem, depression, and sometimes trouble concentrating. An added distress for gay youths is telling their parents and the fear of rejection. (See my next blog about support for parents).

Often when teenagers become aware of homosexual stirrings they feel great confusion and attempt to deny and repress them. This leads to anxiety, sometimes causing a teen to “run” for treatment to get the problem fixed. They sometimes even make religious commitments to overcome the homosexual feelings thought to be bad or sinful.

“Coming out” is a popular term used when someone chooses to make their sexual preference known. In most cases, teenagers will “come out” when asked about their sexual preference. Over time, increased socialization with other gays tends to solidify the sexual identity of a homosexual teenager. This decreases the sense of loneliness and isolation. Some pride in being gay begins to develop. Eventually, positive relationships with other gays and lesbians result in positive self-identification and ultimate integration and acceptance. This encourages teens to be open about their sexual orientations without defensiveness. Increased awareness of homosexuality, and gay teens’ own growing self-acceptance and self-expression, hopefully will continue to reduce social prejudice against being gay.

Talking about your sexual preference or “coming out” is an uncomfortable issue for anyone. For homosexuals it is also controversial. Just look at the gay athletes who in the past couple of years have come out in the NFL and NBA. How has it changed their lives; particularly their careers? Homosexual teenagers see this and try to relate it to their own lives. Who should they tell – friends, parents, siblings their doctor or coach? The bottom line is that homosexual teenagers have to decide when and whom they are going to tell and how they are going to tell them based on their particular and unique families, friendships, and social adaptation.

It is not easy for teenagers to express their feelings, but in 2011, 183 teenagers provided their feelings to The New York Times “Coming Out” project. Click on the link to read their stories. You will come away with a much better understanding of what teenagers face and how they feel about “coming out” as homosexual Here is also a link to the May 2011 NY Times article that outlines the project; “‘Coming Out’ – Gay teenagers in their own words” by Sarah Kramer.

“COMING OUT” IS NEVER EASY

January 8th, 2015

Despite increased societal acceptance of homosexuality, coming out for gay and lesbian teens is rarely an easy task. Many gay and lesbian youths first become aware of being homosexual during adolescence. The American Academy of Pediatrics defines homosexuality as the persistent sexual and emotional attraction to one’s gender and is part of the continuum of sexual expression. While the American Psychiatric Association for many years considered homosexuality an illness, it changed its position in 1973 and re-classified homosexuality as a psychologically viable sexual orientation/expression.

There has been much discussion about the genesis of homosexuality, but it remains unclear how and why sexual orientation evolves. Not all homosexual behavior, especially in early adolescence, is a predictor of future homosexuality. It is common for adult heterosexual males and females to report having had homosexual contact during their adolescent years. The exact percentage of adolescents, who are homosexual, is not known. Many people view homosexuality as a choice, while others feel it is not. This debate rages on.

In August 2014, Daniel Pierce came out to his parents and grandparents. Sadly, the outcome was not good. Pierce decided to start filming the interaction with his family, which quickly turned verbally abusive and physically violent. The five-minute video posted to YouTube went viral garnering nearly four million views. Later Pierce appeared on Dr. Drew to discuss his situation (click here to watch the interview).

One thing, I want to make clear, is that when a child does come out it affects the entire family. A lot of support, love and understanding is needed for all involved. When a person decides to “come out” it is important to know what resources are available for support for all. It is important to remember that when a child “comes out” there is a process that parents need to go through, too. They often are perplexed, shocked, angry and scared and can’t understand it. They need their support. All parents want to love their children and support them but often anxiety interferes. With the proper understanding of their particular child and homosexuality, they can do just that. There are groups like PFLAG that can help. PFLAG’s vision and mission are as follows:

Our Vision. PFLAG envisions a world where diversity is celebrated and all people are respected, valued, and affirmed inclusive of their sexual orientation, gender identity, and gender expression.

Our Mission. By meeting people where they are and collaborating with others, PFLAG realizes its vision through:

Support for families, allies and people who are LGBTQ
Education for ourselves and others about the unique issues and challenges facing people who are LGBTQ
Advocacy in our communities to change attitudes and create policies and laws that achieve full equality for people who are LGBTQ

In our culture, homosexual youths have to deal with a number of mental health issues. The ongoing discrimination fuels anxiety, depression and other stress-related mental health problems among LGB people. My next blog will specifically look at some of these issues.