Age/Gender Differences

• Age differences exist for age of onset of clinically defined conduct disorder, with boys being largely over-represented in the early onset group, and girls predominantly demonstrating conduct difficulties in adolescence

• Late‑onset conduct difficulties were thought to be less serious; that is, adolescent‑onset conduct difficulties tend to result in less serious offenses (i.e., they involve property rather than interpersonal violence) and showed a higher rate of desistance (i.e., remission of problems)

• In general, boys have more difficulties with cooperation and tend to be more aggressive, especially in early childhood

• However, girls may engage in different types of aggression (e.g., interpersonal or covert aggressive acts, such as gossip and ostracism) in later childhood/adolescence

• There is some evidence that parental conflict has more severe implications for boys, leading to more significant behavioral difficulties

• Whereas rates of overt aggression (e.g., physical confrontations) generally decrease with age, highly aggressive children often escalate in their "acting‑out" behaviors, and broadened their scope of antisocial behaviors (i.e., become involved with theft, vandalism, fire‑setting, truancy, substance use, etc.)

 

 

• Inadequate parental supervision is highly predictive of behavioral difficulties in adolescence, and represents an important precursor of involvement with a “deviant peer group” (i.e., classmates known as “trouble makers”, who are identified as a social clique by peers).

Treatment of CD includes a variety of approaches, appropriateness/effectiveness of which depends of the nature of the child’s difficulties and his/her developmental level.

            Toddler/Preschool period:

• During the toddler/preschool period the treatment efforts are generally geared towards changing the dynamics of the parent-child interaction

• Informing parents about the temperament tendencies of the child, recognizing the ones that make the interactions challenging, often leads to increases in parental sensitivity and responsiveness, important in interaction with younger children

• Working with the parents on increasing attention to, and rewards of, positive and appropriate child behavior, along with using ignoring or consistent/appropriate punishment (e.g., time-out) in instances of significant noncompliance or misbehavior, lead to positive changes in child behavior and parent-child interactions

School-age period:

• Parent-child interaction factors need to be addressed, with the emphasis on the parent’s ability to gain the child’s cooperation

• Rewarding positive/appropriate behavior and ignoring/punishing noncompliance and misbehavior remains important, but the methods change because of the child’s growing capacity for participation

*Rewards tend to be distributed on the basis of point charts, that provide points (stars for younger children) for appropriate/positive behaviors, and these points are later exchanged for more tangible rewards, such as playing games, movies, etc. 

*Punishment can still involve time-out, especially for younger children, but the loss-of-privilege approach becomes more important

*If a child is on the point system, s/he would lose points for noncompliance and/or misbehavior

*If the point chart is not being used, parents can remove privileges such as late bed time and access to the TV, when the child’s cooperation is lacking, or significant misbehavior occurs

Adolescence:

• The greatest variety of approaches can be applied during this period, because the conduct difficulties tend to be more severe and diversified, and often include criminal behavior, substance use, and significant academic problems

• Inpatient/residential care may be needed in instance of severe disturbance (e.g., when there is evidence of significant danger to self and/or others)

• Criminal behavior often results in the involvement of the Juvenile Justice System, which utilized a variety of interventions, such incarceration, probation, mandatory mental health services and/or substance abuse treatment

• Therapeutic foster care treatment has also been successfully utilized in the treatment of male and female adolescents with conduct disorder and a record of delinquency

• Parents continue to be important participants in the treatment process, and are often taught to increase their level of supervision of child activities, use discipline more effectively, and provide the child with appropriate opportunities for the development of amore positive approaches to interactions

• Adolescents can be successfully engaged in individual and group treatment, focusing on the strategies for avoiding rule-breaking behaviors, and the associated negative consequences

• Other therapeutic techniques, such as family treatment aimed at improving parent-child problem solving, can be utilized when the circumstances make these relevant (e.g., when parents and children are having difficulties in negotiating around rules/expectations)

 

Parenting Difficult Children and Adolescents

Parenting can be a challenge, especially when children and adolescents refuse to comply with parental requests, break rules, behave defiantly and oppose what adults ask of them. However, there are steps a parent may take to help decrease unwanted behavior and increase healthy behavior in their children. By beginning with some basic parenting behaviors, parents can help their children develop healthy and adaptive behaviors from infancy through adolescence.

Consequences (how the caregiver responds to the child’s actions) can shape a child’s behavior from a young age and provide the foundation for a variety of behaviors children will learn throughout their development. Consequences may be divided into three categories:

•  If a child’s behavior is rewarded, it is being positively reinforced and its frequency will increase. Rewards may take the form of praise, privileges or tokens.

• If the response to a child’s behavior is nagging or yelling, the behavior is being negatively reinforced. Both positive and negative reinforcement increase the future occurrence of the behavior they follow.

• Decreasing the occurrence of an undesirable behavior is brought about through punishment.

Punishment may take the form of yelling and spanking (negative punishment) or by removing privileges, logical and natural consequences, and time out by isolation (positive punishment).
Parents often reinforce unwanted behavior by giving positive attention to behaviors such as tantrums, or giving the child what they want when the child is being disrespectful or aggressive. While accommodating the child seems to calm them and thus decrease parental stress, the parent begins to reinforce and increase the frequency of behaviors such as tantrums and aggressiveness. The challenge for parents is to reinforce positive, not negative behaviors.

Effective parenting of children can be difficult due to parental stress and the tendency to react to a child’s behavior out of frustration. However, doing so reinforces unwanted behavior and creates a cycle of negative interactions between the child and parent. So, how does a parent encourage and motivate their child to behave in ways that lead to healthy, responsible, respectful and positive interpersonal interactions?

Children begin to explore and respond to consequences in their environment during toddler hood. This means that as they explore their surroundings, some of the child’s behaviors are dangerous to themselves or others. The ability of parents to shape their child’s behavior begins to take on more importance. At this age, children respond to limit setting, which is typically done to ensure their safety.

For example, it is important to focus on the child’s behavior because this is what you want to change. It is equally important to use effective commands and positive language. Rather than using words like “stop” or “don’t,” which are negative in tone, use positive language such as “It’s time to sit down,” or “As soon as you show me calm, you can have…” Give the child 3-5 seconds after the request to respond and avoid talking further or engaging in other activities. If they don’t respond after 3-5 seconds, repeat the request. A slight variation in wording of the second command may be helpful to let the child know that this is their last chance to choose to respond positively before consequences occur. Including such words as “need” or “now” in the repeat command lets the child know that they need to make a decision within the next 3-5 seconds.

 If after the second request they do not respond, consequences are applied such as time out (response cost, or removal from a reinforcing environment). The most effective consequences are usually response cost (removing something the child considers valuable), and letting them know that as soon as they decide to follow the command they will have access to the valued object or activity.
There are other aspects to giving commands that may increase their effectiveness. Tell the child what you want them to start doing, rather than what you want them to stop doing. Make sure they establish eye contact and are within three feet of you, because they need to be attending to you in order to receive your message. Make sure your voice is firm and confident yet concerned and caring. It is critical if you are feeling frustrated that you remain calm; otherwise there is a chance of increasing your child’s resistance.

The command should be specific to what you want the child to do. For example, “You need to play calmly with your brother now,” rather than “Stop hitting your brother.” If the child does not comply or begins to argue, it is important not to engage in arguing with him. Simply let them know that as soon as they show you they can do the behavior requested, they will receive the valued object or participate in the desired activity. Of course, if you believe the desired object or activity is not healthy for them you may communicate your thoughts, but avoid arguing with them. Once the child engages in the positive behavior, it is critical that you give them praise for doing so.

If the child only does a portion of the desired behavior, give them positive comments, while also encouraging them to do more. For example: “I really like the way you’re sharing toys with your brother, and I know you can do it without hitting him, too.” If the child does not comply with the command, do not threaten her. Rather, consistently apply mild consequences and let them know what they need to do in order to regain what they want. For instance, “I’m taking this toy from you now, but as soon as you can show me you can share with your brother without hitting him, you can have it back.” Consistency is essential in helping your child develop behavioral, emotional and social skills to effectively adjust to interpersonal relationships, and to function independently through responsible decision making.

As a child develops they begin to show signs of independence. They want to make decisions for themselves and may rebel when their parents attempt to place limits on them. Especially during adolescence, after having a broader experience through social interaction and media influence, challenging the authority of parents becomes more frequent. Although there are no “hard and fast rules” in dealing successfully with this normal developmental process, there are parental behaviors that can increase the likelihood of the child and adolescent negotiating this period of their life by learning healthy skills they can continue to use as independent and responsible adults.

It is important that adolescents have a sense that they are respected, trusted, heard, and loved. Although they are exploring new behaviors, they continue to need a safe and nurturing environment to which they can turn and feel accepted. Parents can let children know at an early age (when they start to show signs of independence) what is expected of them in order for the family to “work.” This means they will have to consider their decisions based on the context of how it will affect others in their family and take responsibility in their actions. Let your teen know what the values of your family are. For example: “ Amy, in order for our family to work well, your mother and I are going to need your help. We value respect for each other and responsibility for our actions, and we want you to show us you can handle the responsibility of making healthy decisions for yourself and the family. We think you can do this and we respect your desire for freedom, but you also need to show us you are capable of handling these responsibilities.”

Once “core values” are expressed and expectations are made clear, adolescents have a better understanding of why limits are set and how they can gain more independence by consistently showing their parents they can make healthy, responsible decisions. Allowing your teen to be part of decision making for family matters will also let them know they are valued and their opinion counts. This will help instill a sense of competency in their ability to make responsible decisions for themselves and others. The amount of freedom they have will be based on how their behavior reflects the “core values” of the family and how it contributes to their healthy development. Consequences become more “logical” as the child enters adolescence. For example, being able to think realistically about the consequences of their actions and how they “fit into” the family values is important.

Additionally, adolescents need to have a sense that they are heard and understood by their caregivers. This can sometimes be challenging because, oftentimes, teens can seem distant and not want to talk. However, it is important that a balance be found between allowing your teen time alone and maintaining consistent and quality communication with them. For example, let them know that you expect them to eat dinner with the family every night, and even participate in its preparation. These are examples of “golden opportunities” during which you can talk with your teen. They will be collaborating with you in contributing to the welfare of the family by preparing dinner, which gives them the opportunity to learn skills in self-care and communication that will serve them well as independent adults.

It is important to encourage your adolescent when they make mistakes and don’t meet expectations. Let them know they can do better and ask them what they will do differently next time given a similar situation. Let them know you want them to succeed and that you believe in their ability to do so.

Effective parenting involves skills that are learned and practiced on a daily basis. Unfortunately, parenting is not always easy or enjoyable, but nonetheless it can be one of the most rewarding experiences you can have. The natural challenges of parenting increase with children and adolescents considered “difficult,” but it is also important to know that how a parent responds to such children is critical to the child’s emotional and psychological development. The response of parents to such children is also important because the children learn how to interact with others, especially when coping with and effectively resolving difficult interpersonal situations in a healthy way.

The following is a summary of some basic skills that increase the effectiveness of parents, especially those who have children or adolescents who are “difficult”

•  “I love you AND…” when setting rules, limits and boundaries.

• Develop two categories: Explicit and implicit.

• The explicit category should be small and include the core values that can be generalized across situations (e.g., be respectful) and phrased in a positive manner (e.g., “You will” vs. “Don’t”)

•  “Slow down” and talk yourself through this. This is a useful statement for both parents and children to learn to use in stressful or conflictual situations.

• Catch your children doing something good and reward them. This is critical especially with “difficult” children because oftentimes parents “get in a rut” of giving attention only for misbehavior.

• Logical punishments related to and appropriate to the situation. Remember, rewards for good behavior are much more effective than punishment for misbehavior, and response cost is often the most effective means of decreasing unwanted behavior.

• Natural consequences are the most effective (e.g., If the child breaks curfew, they will not be allowed out after school for a specified amount of days, and then they will slowly regain full privileges as they show ability to handle this responsibility).

• Focus on behavior because behavior is what you want to see changed. Using gentle but firm commands tell your child to “show me…” and encourage them by letting them know you believe they can do it.

• Collaborate with your child/adolescent. Include them in problem solving when both of you are clam, and try this solution for a limited time to check if you need to readjust your approach in order to increase its effectiveness.

• Don’t say something you’re not willing to follow through with. Consequences are most effective if they are immediate, related to and appropriate to the situation, and consistent.

• Remember, harsh parenting and parenting with low expectations are both harmful to the healthy development of a child.

 

Obsessive-Compulsive Disorder (OCD)

For starters it is important to note that children with OCD are not alone.  There are approximately 1 million boys and girls in the United States alone that have this disorder.  There are many adults with the disorder as well; in fact, most adults with OCD will say that they begin to notice their problem when they were children or adolescents.  Today medical professionals know what OCD is and we know how to effectively treat it.

What is it?

Have you ever had a song in your head that you just could not get rid of?  No matter how much you want to get rid of it your brain will just keep playing it back.  For the most part this is normal occurrence.  However, can you imagine what it would be like if that song never went away?  What happens in children with OCD is very similar, in that, these children will often have bad thoughts or images which keep repeating in their head.  No matter how hard they try, these thoughts or images will not stop repeating. 

Worry is a key feature of OCD, and these children worry excessively! They typically worry about bad things happening.  Common worries include being contaminated with germs, or that something bad is going to happen to their mom or dad.  These children will often worry for hours at a time. 

Obviously, this extensive amount of worry can be very distressing for the child.  So to stop the worries and ensure that the bad things that the child is worrying about do not happen, the child engages in behaviors which shut down the worry thoughts. People with OCD hope to keep bad things they worry about from happening. They think that doing a certain behavior or ritual they will make a bad feeling go away, and they feel scared that if they don't do the ritual something bad will happen

  

What are the symptoms?

    OCD is characterized by two major components; obsessions (worries) and compulsions (behaviors children do get rid of the worries).

    Obsessions can be defined as being extremely strong worry thoughts. These thoughts produce a great deal anxiety for the child and appear uncontrollable and irrational to the child experiencing them.  The most common obsessions for children involve are repeated thoughts illness, injury, or dying.

    Compulsions are behaviors or acts that a child feels driven to perform over and over again in order to prevent whatever bad thoughts they may be having, from happening.  The child feels that by performing the behavior the bad feeling will go away and whatever bad thing they may be worrying about won’t happen.  Common compulsions include constant hand-washing, checking, and counting. 

How is OCD treated?

    Treatment for OCD typically involves two methods; medicine and a type of treatment called Cognitive-Behavior Therapy.  Medicines work on the chemical imbalances that children with OCD have in their brain.  Cognitive-Behavior Therapy involves changes children’s pattern of worries and helps them no longer engage in the behaviors needed to alleviate the worry.  Alone these two treatments have a great deal of success at fixing your child; however, when used together they are much more effective at getting kids back on the right track.

JUVENILE SEXUAL ABUSE

Definitions of Sexual Abuse 

Juvenile sexual offending includes a wide-range of behaviors that may or may not be illegal; may have differing penalties; depending on individual state differences, criminal investigative processes, and age-differences between the offender and victim; and likely has universal and specific clinical implications for victims of abuse and their loved ones.  The following definitions are provided for a general description of sexually abusive behavior (Kahn, 2001; Ryan & Lane, 1997): 

Rape.  Sexual intercourse against a person’s will.  May include penetration of any part of the victim’s body with any part of the offender’s body, as well as penetration with a foreign object.

Child Molestation.  Sexual contact with a child.  Sexual contact includes sexual intercourse, touching a child’s genitals or breasts with any offender body part, or masturbating onto the child.  In most states, there needs to be at least a three-year age difference between the offender and victim in order for the sexual misbehavior to be considered illegal.

Statutory Rape or Rape of a Child.  Sexual intercourse with a child under a state specified age (usually 16-years-old), when there is a significant age-discrepancy between the offender and the victim, which is somewhat dependent upon the ages of both parties (typically at least 3 years difference).

Incest.  Sexual contact with a blood-relative.

Indecent Exposure.  Exposing one’s genitals (penis, vagina, breasts, anus/bottom) to another person.

Voyeurism.  Commonly known as “peeping.”  A behavior that involves observing another person without their knowledge or consent.

Obscene Communication.  Offenses such as “Communicating with a Minor for Immoral Purposes,” which involves sexual talking or showing sexually explicit pictures to anyone under the age of 18-years-old.  This class of sexual misbehavior also includes acts such as obscene phone calls or verbal/written sexual harassment or degradation.

For all intents and purposes of this paper, any reference to sexual abuse will only include “hands-on” sexual offending such as rape and child molestation, unless noted otherwise. 

 

Incidence, Prevalence, and Other Important Defining Features

Regarding the epidemiological factors related to adolescent sexual offending, individuals under 18 years of age account for approximately 17% of all arrests for forcible rape and 18% of arrests for other sexual offenses, excluding prostitution (Federal Bureau of Investigation, 1997).  Moreover, juveniles continue to be responsible for approximately 30% of reports of child sexual abuse (Finkelhor, 1996), and self-reported sexual offenses to actual arrests for sexual offenses by juveniles are in the order of 25:1 (Elliott, Huizinga, & Morse, 1985).  In addition, as noted by Rubenstein, Yeager, Goodstein, & Lewis (1993), approximately half of adult sexual offenders commit their first offense during adolescence.  Another important finding is related to the number of victims that juvenile offenders have abused.  In general, it has been found that the average number of victims of juvenile offenders is 7, although many juvenile perpetrators report sexually abusing over 30 victims (Ryan & Lane, 1997).  With the above findings in mind, it is reasonable to conclude that juvenile sexual offending is a significant problem that accounts for a notable percent of sexual offending, severely affects the lives of many victims, and has various implications for the greater population.

 

Recidivism Data

Since the establishment of the first comprehensive treatment program for juvenile sexual offenders in 1975, there have been less than 15 published studies of criminal recidivism following specialized treatment.  As of the year 2000, when Worling and Curwen published their large-scaled and well-developed project, which examined juvenile sexual offender recidivism, they reported the presence of only 10 previously published studies related to this area of research.  Since that time, this author is aware of four subsequent projects that have been published on the examination of juvenile sexual offender recidivism (i.e., Borduin, Schaeffer, & Heiblum, 2000; Prentky, Harris, Frizzell, & Righthand, 2000; Seabloom, W., Seabloom, M.E., Seabloom, E., Barron, & Hendrickson, 2003; Worling & Curwen, 2000). 

In general, the overall findings from published studies geared toward evaluating juvenile sexual offender recidivism indicate a relatively low rate of sexual recidivism (i.e., less than 15%).  However, there are several weaknesses of most juvenile sexual offense recidivism research, a few of which will be described below.  First of all, the majority of the published recidivism studies (8 out of 14) did not include comparison groups.  Moreover, only 3 of the 14 projects involved a mean follow-up period beyond 4-years.  From the adult sexual offender research, it is apparent that treatment failure rates, including sexual recidivism, are generally low in the first 6 to 12 months after treatment is concluded, rise over time, double over 5 years, and then remain relatively stable for most offender populations, with men who rape being an exception (Maletzky & Steinhauser, 2002).  With that fact in mind, it is important to consider that several of the 14 published juvenile sex offender recidivism studies had follow-up periods less than 1 year.  Another notable criticism of most juvenile sexual offender recidivism research thus far has to do with the measure used in determining recidivism.  There is considerable variation in the type of measure used to determine recidivism, with several studies using criminal conviction as the measure examined.  As described in the previous section of this paper, the majority of sexual offenses are not reported, and therefore relying on official report as a measure of recidivism is overly conservative.  Based on the points described above, it appears prudent to consider the juvenile sexual offender recidivism data published to date with guarded skepticism. 

In addition to juvenile sexual offender recidivism, it is useful to briefly discuss non-sexual recidivism of juveniles that commit sexual offenses.  There is a good deal of research that documents a significantly higher rate of non-sexual than sexual recidivism for juvenile sexual offenders (Borduin, Henggeler, Blaske, & Stein, 1990; Borduin, Schaeffer, & Heiblum, 2000; Kahn & Chambers, 1991; Prentky et. al., 2000; Worling & Curwen, 2000).  After an evaluation of the 14 published studies related to juvenile sexual offender recidivism, the average rate of non-sexual recidivism for juvenile perpetrators who completed some form of specialized treatment was approximately 30%.  Moreover, there are some researchers and clinicians who posit that factors related to non-sexual recidivism such as general antisocial behavior, may be better predictors of sexual recidivism than factors related to sexuality such as deviant sexual arousal (Prentky et. al, 2000; Prescott, 2001). 

Although it has been shown that juvenile sexual offenders who have a predilection for antisocial and impulsive behavior are at an increased risk for sexual reoffense, it is important to highlight the study by Worling and Curwen (2000) that came to a common discovery as the Hanson and Bussière (1998) research with adult sexual offenders, which found that sexual interest in children was a significant predictor of future sexual recidivism.  It is this author’s view that both antisocial/impulsive behavior, and sexually specific factors such as sexual interest in children, are equally important to consider when making decisions related to risk of reoffense.  Based on the above information, it appears plausible that general factors such as antisocial or impulsive tendencies may be essential predictors of sexual and non-sexual recidivism for many juveniles; however, whenever sexually specific factors are present such as a high degree of sexual fantasies of children, more child-victim grooming behaviors, and more intrusive sexual abuse activities (Worling & Curwen, 2000), these may be the best predictors of sexual recidivism.

 

How Do Youth Develop Sexual Behavior Problems

-  Abuse experiences – physical abuse = 70-90%, sexual abuse = 50-70%

-  Exposure to sexually explicit stimuli – Consider the stimulation factors, such as easy -  access to sexually explicit stimuli (television, cable, chat rooms, Internet, magazines, videos, pornography, etc.)

-  As a coping response to early neglect/trauma – Self-nurturing, self-stimulating.

-  Modeling of others – kids like sponges.

-  Impulsivity is a common contributing factor.  Impulsivity is a risk factor for sexual abuse and sexual behavior problems.  Consider recent research that finds that impulse control sections of the brain are the last to develop.

-  Lack of supervision/opportunity/social isolation.

-  Puberty?? Impulsivity + puberty = problems??

 

The Difference Between Healthy and Unhealthy Sexual Behavior (When is it a problem)

-  Making sexual sounds

-  Rubbing body against people or furniture in a sexual manner.

-  Talking about specific sexual acts.

-  Public masturbation.

-  Masturbation with an object.

-  Painful or irritating masturbation.

-  Insertion of objects into vagina or anus.

-  Putting mouth on sex parts.

-  Asking to touch genitals of others.

-  Asking others to have sex.

-  Exposing genitals to adults.

-  Attempts to undress others.

-  One of the children is +- two years of the other.

-  Acts include penetration, intercourse (actual), or oral sex.

-  One of the children coerces, threatens, bribes, or forces the other.

-  One of the children is angry or serious during the activity.

-  The behavior does not stop when one of the children asks to stop.

-  One of the children has been confronted previously, and does it again.

Generalization of the Aggressive Behavior Pattern

• As the child exhibits uncooperative and aggressive behaviors in the school setting, they serve to alienate classmates

• Parents who inadequately supervise their child's activities are less likely to discover their child's difficulties in the school setting (e.g., conflicts with peers and teachers) ~Insufficient monitoring of the youngster's activities could lead to greater opportunity for entering a “deviant peer group”, which in turn, rewards rule-breaking, avoiding responsibility, and an aggressive behavioral style, which are frequently the basis for affiliation

• Childhood aggression was highly predictive of delinquency, drug abuse, and early police arrests

• Proliferation of the oppositional/aggressive behavioral style to different settings (e.g., from home to school) tend to be associated with more severe, as well as more stable conduct disturbances

Depression:

Major Depressive Disorder is the clinical term for Depression.  It is a problem that affects 4.4% of the population.  That is 1 in every 25 people or about 9.4 million people in the U.S.

A common problem in identifying Depression is determining the Difference between sadness and Major Depressive Disorder.

How is depression different from sadness?

The biggest difference here is that while sadness is a relatively temporary change in emotion, depression is a chronic condition, which affects the emotional state of the person in most if not all contexts of their life.  Comparing sadness and depression is much like comparing the common cold to pneumonia.  The symptoms are very similar.  However, one is a condition that if left untreated the symptoms will disappear on their own; the other is a serious condition that if left untreated could lead to larger problems and possibly death.  In addition, Depression is a disorder that can affect people regardless of money, fame, athletic ability, success, popularity, etc…

What does Depression look like?

When determining if someone has a Major Depressive Disorder you want to look for specific things.  Look for Changes in:

            Mood:  Sadness, Emptiness, Feelings of worry/ or being scared

Thought:  Problems concentrating, Thoughts of being worthless, Thoughts of being helpless, Thoughts of being hopelessness, being indecisive, Excessive thoughts about death

Behavior:  Lack of Hygiene, crying, low level of activity, very few social interactions, talking about or attempts at suicide

Physical Condition:  Appetite (eating too little, eating too much), Sleep (too much, very little), Low energy, Experiencing pain.
 

What causes Depression?

Depression can have different causes depending on the individual.  So it may be unclear what the specific cause is.  However, it is clear given the research that three components are involved in causing depression:

Thoughts:  The thought process in depressed individuals is different than those who arenot depressed.  We can categorize that thought process by the three “P’s.” 

Pervasive- Thoughts patterns in depressed individuals tend to be more constant

Permanent- In addition to being more constant thought patterns are also very resistant to change

Personal- Thoughts in a depressed individual tend to attribute negative outcomes exclusively to themselves.

Negative Thoughts- Thoughts of the depressed individual tend to begin from thinking that they are helpless.  Thoughts of helplessness in a depressed individual often lead to thoughts of hopelessness.  This helplessness and hopelessness leads to thinking along the lines of, “My life is crappy” “nothing will change” “Everybody hates me” “I can’t do anything right”…etc…

Behaviors:  Lower activity level is associated with depression.  Again it is unclear which comes

first, low activity or depression, but one thing that is certain is that because of lowered activity the person who is struggling with depression will often be supplied with evidence to back up their thoughts of helplessness and hopelessness.  For instance, I am a child struggling with depression, I assume that because I am helpless and everything is hopeless that I will fail my math exam.  Therefore, I do not adequately prepare for my math exam.  I fail my math exam.  I tell myself, “see I am stupid, I new I wouldn’t pass that test.”  The individual attributes the result to himself or herself not the situation that caused it.  Consequently, the behavior of that individual has provided them evidence for their negative thought.

Body Chemistry:  Certain Hormones and Brain Chemicals are associated with Depression as

well.  It is again important to note that the cause of depression is most likely different for different individuals.  In addition, like as mentioned above, affects in one area may affect another area.  For instance, low aerobic activity level can lower specific hormones know as endorphins which can help to battle depressive symptoms.  Negative thoughts can also greatly affect mood, which is determined by specific brain chemicals as well.  For instance if you start thinking about a very sad time in you life and continue to do so your mood will most likely change and you will begin to feel sad.  If on the other hand you think of a very happy time in you life and reminisce about good things your mood will most likely change to happier. 

Drug therapies:  Sometimes drug therapies are used in treating depression.  I will use the analogy of Diabetes here.  In both there is a biological component to the disorder.  Depression is also like Diabetes in that some individuals require only that they are more aware of their problem and are actively making changes to combat the negative effects of that disorder.  However, some people lack the chemicals necessary to produce desired effects in their treatment and require medication.  If you are considering medication for depression you should discuss this with both a physician and a mental health professional.

 

Gender Differences in Depression:

Before I mention Gender trends to be aware of I want to express that symptoms should be looked at on a case-by-case basis and people do not always have symptoms that fit these gender trends.  This is mentioned only to alert you to the fact that males have a tendency to exhibit different symptoms than do females, but both males and females can exhibit either symptom set.

Women are more likely to:  Cry and admit that they have symptoms

Men are more likely to:  Be angry rather than sad, deny their symptoms, and see depression as a weakness.

 

Bad News:  Only 1 in 3 people suffering with Depression seek treatment

            Reasons:           They see the disorder as a personal or emotional weakness

                                    They blame themselves

                                    They blame their situation

                                    Or they think they can just “tough it out.”

 

The Good News:         All of these reasons can be addressed by a mental health professional and

The research available on depression tells us that PEOPLE WHO GET HELP GET BETTER.  In addition, the earlier one gets help the better the outcome of treatment.

 

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