Therapy That Works...

Growing Kids Strong - Childhood Depression - By Chris Gearing

Monday, March 11, 2013

Watch Dr. Sylvia describe childhood depression and how it can affect your child's future success - click here.

Childhood depression can be an overwhelming concern for parents and educators who witness young children retreating into depressive, anxious behaviors.

Often our children are stuck in full clinical depression before we really understand what is happening. Even though we may have experienced depression ourselves or had a friend or family member that was depressed, it is painful and confusing to see our child developing a full scale mood disorder. Unfortunately, children cannot always articulate their thoughts and feelings. They are unable to tell us why they are so sad. It’s important that you educate yourself on the signs of childhood depression to prevent it from damaging your child’s life.

There are several reasons why childhood depression needs to be taken so seriously:

Life-Long Beliefs:

In childhood, most of us are learning how to interpret our environment and to be as accurate as possible. During this critical point in life, kids are creating belief systems and coping skills based on what they are experiencing in the moment. If life is regularly tumultuous, if there is severe anxiety due to trauma or loss, or if there is an underlying endogenous depression that goes unaddressed, the child may not accurately develop the explanatory view. Such inaccurate beliefs can last a lifetime and cause tremendous heartache.

Misinterpreted Behaviors:

With an underlying endogenous depression, a young child can be overwhelmed with their crushing negative beliefs. Many adults who developed depression as kids report that the world turned dark and gray at an early age. Parents can misinterpret such suffering as normal shyness or withdrawal. Depression robs a child of the chance to develop better coping skills and to face developmental challenges.

Social and Academic Withdrawal:

Children with depression often feel tired and depleted, and they are reluctant to engage with their peers socially. School avoidance is another common problem for kids with depression. If your brain is sad, it is difficult to focus and deal with all of the social and academic pressures of the classroom.

Permanent Labels:

Kids are already quick to label their peers, and depressed children tend to act grumpy and avoidant. Unfortunately, labels can become self-fulfilling prophecies as the child struggles with depression and how they feel about themselves. The negative labels become a familiar identity and children are prone to increasingly shut out their peers in an effort to avoid further criticism.

Now if you are concerned about a child, here are some signs to watch out for:

  • Feeling persistently sad
  • Talking about suicide or being better off dead
  • Rapid mood swings such as becoming irritable all of a sudden
  • Showing a marked deterioration in academics or home life
  • Attempting to avoid school by making up illnesses or visiting the school nurse too regularly
  • Stopping previously fun activities or no longer seeing friends
  • Drug or alcohol abuse

Childhood and adolescent depression are very serious. If you are worried about you or someone you know, please seek the assistance of a clinical psychologist.

Sources:

"The Optimistic Child" by Dr. Martin Seligman

The National Alliance on Mental Illness website (www.nami.org)

How Gearing Up Treats Eating Disorders - By Chris Gearing

Wednesday, March 06, 2013

Watch Dr. Sylvia Gearing describe how Gearing Up treats eating disorders and some of the most effective therapies for eating disorders - click here.

Eating disorders affect millions of people every year and despite valiant efforts, many patients remain mired in unhealthy eating habits. At Gearing Up, we are committed to coaching our patients to maximum success.

We believe in evidence based treatments and utilize well executed approaches to eating disorders including:

Cognitive Behavioral Therapy:

This approach focuses on the relationship between core beliefs and thoughts, and negative emotions and behavior. By evaluating and challenging negative thinking, we can achieve an improved accuracy that leads to healthier eating and more effective living. CBT helps people with eating disorders to correct larger misperceptions about their body and their unhealthy lifestyle.

Dialectical Behavior Therapy:

This approach emphasizes skills building in the face of strong, negative emotions. Managing strong emotions often requires a set of skills to distract, sooth, and tolerate emotional distress. Developed by Dr. Marsha Linehan, DBT teaches clients that dysfunctional behaviors must be replaced by more effective skills. Since many eating disorders thrive with impulsivity and distressed minds, DBT can be a critical intervention to stop unhealthy eating cycles.

Maudsley Based Family Treatment:

This treatment approach recognizes the parents’ central role in guiding and leading their child back to health and is one of the most effective therapies for eating disorders. In addition to intensive individual therapy, we work closely with parents in family therapy and in nutritional counseling to plan and support their child’s recovery. Hopefully, interventions throughout the home and family will create an atmosphere for recovery and healing.

Psychological Testing:

We often utilize personality testing to evaluate psychological resources at a deeper level including cognitive style, emotional and informational processing approaches, affective features, self-control and willpower, the ability to tolerate stress, tendencies toward impulsivity, and self-sabotaging behaviors. Testing gives us a kind of psychological x-ray so we can pinpoint the issues that we need to address and direct treatment effectively.

Coordinated Care:

To effectively address an eating disorder, we coordinate with other professionals including a nutritionist and a physician to round out our understanding of diet, nutrition, and physical health. With every professional coordinating treatment, we have the best chance at effectively treating the eating disorder.

Sources:

The New Maudsley Approach (http://thenewmaudsleyapproach.co.uk/Home_Page.php)

The National Institute of Mental Health (www.nimh.nih.gov)

The work of Dr. Marsha Linehan

Eating Disorders: Not Otherwise Specified - By Chris Gearing

Monday, March 04, 2013

Watch Dr. Sylvia Gearing discuss the "Not Otherwise Specified" diagnosis for eating disorders and what they mean - click here.

Anorexia nervosa, bulimia, and binge eating disorder are the best-known eating disorders and among the most lethal. However, Eating Disorder, Not Otherwise Specified is also a dangerous, persistent eating disorder that can disrupt an otherwise successful life.

This eating disorder diagnosis is reserved for those patients who do not meet all the criteria of the previously mentioned eating disorders. For example, a patient may severely restrict her diet but not to the point where she experiences an absence of menstruation.

According to some experts, approximately 70% of eating disorders fall under the “Not Otherwise Specified” diagnosis.

The presence of this type of eating disorder suggests several important points:

Progressive & Evolving:

Eating disorders are dynamic illnesses and do not always follow one, strict course of development. For example, a young girl may begin her eating disorder by restricting food and then move on to bulimia in which she regularly binges and then purges. The “Eating Disorder, Not Otherwise Specified” diagnosis indicates that the eating disorder is responsive to the environment and to the developmental and life changes that often come during adolescence and early adulthood.

Fluid Symptoms:

This type of eating disorder also demonstrates how difficult it is to classify this illness within one static category. The fundamental problem in eating disorders is the effective management of the self, both emotionally and cognitively. While the symptoms may vary, the basic problem often remains the same.

Processing Issues:

Since eating disorders can be such stubborn mental health issues, psychologists and neuroscientists are beginning to explore the neurological aspects of eating disorders. For instance, people with eating disorders tend to have difficulty with more abstract thinking and executive functioning – they tend to notice the details and miss the greater picture. At other times, they may be show a lack of cognitive flexibility which means that they struggle to be less rigid and adaptable in handling food and how they feel about themselves.

Eating disorders are very serious conditions, and they can even be lethal. If you think you or someone you know may have an eating disorder, please seek the assistance of a clinical psychologist.

Sources:

http://thenewmaudsleyapproach.co.uk/Home_Page.php

The work of Dr. John Lock

The National Institute of Mental Health (www.nimh.nih.gov)

Eating Disorders: Binge Eating - By Chris Gearing

Friday, March 01, 2013

Watch Dr. Sylvia Gearing describe what Binge Eating is, what it looks like, and signs of when it's time to get help - click here.

Eating disorders are serious emotional and behavioral mental health conditions that disrupt the individual’s ability to handle food appropriately.

Food becomes an “emotional thermostat” and is used by the individual to control emotions and to lower stress. Routine eating disorder habits include food restriction, excessive consumption of food, purging of food usually by laxatives or vomiting, and compulsive overeating in a short amount of time.

The most common of all eating disorders, binge eating disorder can be a chronic and painful problem.

It affects women more than men and it can last hidden for years by a veil of shame, secrecy, and stress. Since this eating disorder does not involve purging behaviors or excessive exercise, the people suffering with the disorder present with either average weight or are overweight. As with other eating disorders, binge eating involves a central focus on food and the power of food to modulate stress and adversity.

Binge eating disordered patients tend to have higher levels of depression.

In one study, researchers found that these patients had about twice the risk of depression over their lifetime. In addition, these patients struggle with feelings of inadequacy interpersonally, often due to the distress about their body and their disordered eating. Many sufferers reported the disorder affecting their work and impairing their regular activities. It is difficult to be your best when healthy eating is a challenge.

Rapid Consumption:

Frequently, rituals of food consumption are built into daily schedules. The food is most often purchased, either through an impulsive or scheduled visit to the store or fast food outlet and is consumed rapidly in a short amount of time. Rapidity of consumption is usually one of the main clues to this disorder.

Emotional Seesaw:

Following the binge, the individual often experiences an uptick in mood. The food is calming and soothing in the short run. There are usually momentary feelings of control or satisfaction. However, they are soon followed by feelings of shame, self loathing, and depression as they begin to deal with the realities of overeating. Clothes don’t fit, bodies are bloated, energy is sluggish, and any possible weight goals are compromised or eliminated.

Here are some other signs to watch out for:

  • Excessive eating when they don’t feel hungry
  • Eating until there is discomfort
  • Eating rituals that emphasize isolation, secrecy, and control
  • Anger and resentment if any eating ritual is interrupted
  • Depression, negative mood, and feelings of being out of control following the binge cycle
  • Ineffective dieting caused by the caloric overload of binging

Eating disorders are very serious conditions, and they can even be lethal. If you think you or someone you know may have an eating disorder, please seek the assistance of a clinical psychologist.

Sources:

"Dialectical Behavior Therapy for Binge Eating and Bulimia" by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen

The National Institute of Mental Health (www.nimh.nih.gov)

How Parents Can Overcome The Empty Nest - By Chris Gearing

Friday, March 01, 2013

Watch Dr. Sylvia Gearing on CBS 11 discuss how parents can cope with the empty nest - click here.

Eating Disorders: Bulimia Nervosa - By Chris Gearing

Wednesday, February 27, 2013

Watch Dr. Sylvia Gearing describe what Bulimia Nervosa is and how it begins - click here.

Bulimia nervosa is an insidious mental health disorder that can cause extraordinary pain and suffering.

Women are more likely than men to develop Bulimia and sufferers tend to start the cycle of Bulimia in late adolescence or early adulthood.

Bulimia begins with eating an unusually large amount of food, often in an impulsive but ritualized manner. During the binge eating, it’s almost as if another consciousness takes hold and the food is their total focus. Afterward, they’re often consumed with overwhelming feelings of self-loathing and remorse. Binging is often followed by getting rid of any evidence of the binge and then different behaviors to curb any weight gain – like extreme amounts of exercise, harsh food restriction, use of laxatives, or even purging the food from their system by vomiting.

These post-binge behaviors come from a need to reverse the damage they have done to their body and to lower their soaring anxiety. Ironically, these efforts often end up causing more damage to their bodies and increasing their anxiety instead of helping to resolve the problem.

Similar to other eating disorders, people with bulimia often are highly self-critical, scrutinize their bodies, and hold themselves to an impossible standard. There can be considerable distortion about what they look like and they may be extremely inaccurate about their appearance. Relentless cognitive self-criticism can easily lead to destructive eating habits that are not only bad for their physical health but are emotionally addictive. The binging and purging become a coping mechanism that temporarily allows them to feel less anxious, in control, and even euphoric in some cases.

Eating disorders such as bulimia are difficult to beat even under the best of circumstances.

According to some studies, people with bulimia have higher levels of depression, anger, and shifting moods. Since they primarily involve problems in emotional regulation, cognitive behavioral therapy and dialectical behavioral therapy are extremely effective and have high rates of success.

Eating disorders are very serious conditions, and they can even be lethal. If you think you or someone you know may have an eating disorder, please seek the assistance of a clinical psychologist.

Sources:

"Dialectical Behavior Therapy for Binge Eating and Bulimia" by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen

The National Institute of Mental Health (www.nimh.nih.gov)

The National Alliance on Mental Illness (www.nami.org)

Eating Disorders: Anorexia Nervosa - By Chris Gearing

Monday, February 25, 2013

Although all eating disorders are extremely damaging for your physical and psychological health, anorexia is also the most lethal.

According to some estimates, up to 10% of patients suffering from anorexia will die from the disease. While both genders can die from metabolic complications and starvation, anorexia is also highly correlated with suicide.

According to the National Institute of Mental Health, anorexia is characterized by the following symptoms:

  • The presence of extreme thinness or emaciation
  • Highly restricted eating
  • An obsession with being thin and a fervent opposition to gaining and maintaining any new weight
  • There is often a constant self-loathing of their body
  • Low body weight is redefined to be commendable
  • Sufferers often have extreme denial about the physical emaciation and any health risks

Anorexics engage in two types of approaches to food:

1.) Severe food restriction that is rigid and systematized. There is an unforgiving stance toward eating food and there is a refusal to face the problem with eating.

2.) Binge-eating followed by purging, the possible use of laxatives, extreme food restriction, and high amounts of exercise to keep the body slender.

Anorexia, as with other eating disorders, can often co-exist with other serious mental health disorders. Depression, anxiety, post traumatic stress disorder and obsessive compulsive disorder commonly co-occur with eating disorders.

Eating disorders are very serious conditions, and they can even be lethal. If you think you or someone you know may have an eating disorder, please seek the assistance of a clinical psychologist.

Sources:

Arcelus J, et al. “Mortality rates in patients with anorexia nervosa and other eating disorders.” Archives of General Psychiatry, 68(7):724-731.


Hudson JI, Hiripi E, Pope HG, Kessler RC. “The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.” Biological Psychiatry. 2007; 61:348-58.


Zhao, Y., and Encinosa, W. “Hospitalizations for Eating Disorders” from 1999 to 2006. HCUP Statistical Brief #70. April 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb70.pdf


Lock J and Le Grange D. “Family-based treatment of eating disorders.” International Journal of Eating Disorders. 2005;37 Suppl:S64-7.


Lock J et al. “Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.” Archives of General Psychiatry. 2010 Oct. 67(10):1025-1032.

The National Institute of Mental Health

Detecting Eating Disorders - By Chris Gearing

Friday, February 22, 2013

Watch Dr Sylvia Gearing describe a few ways you can detect an eating disorder - click here.

Eating disorders affect millions of Americans every year.

Not only are they painful and disruptive to productive lives, they are very difficult to overcome, especially without professional help.

But part of what makes eating disorders so challenging they are to define, especially when they are just beginning. They are on a continuum and the early symptoms are usually intermittent. It is very confusing to really understand when the disorder cross the line into something more serious.

Here are some tips to guide you in knowing when to reach out to professional help:

Unintentional:

First of all, no one who develops an eating disorder really intends to do so. At some point, there is a psychological shift that causes us to use these behaviors to manage food and to deal with stress. We often do not fully realize the impact of our behavior until we are fully involved in the eating disorder.

Progressive Slide Down:

It is usually a progressive disorder and most of us back into them using the behaviors occasionally at first. Once it becomes a habit, the slide downhill into a full blown eating disorder is difficult to stop.

Planning My Life Around Food

Since eating disorders are so addictive, they often begin to interfere with our planning of food, time, and even our social interactions. Our lives and our schedules are often built around food, and they begin to change their lifestyle to center around the eating disorder.

Justified Reasons:

Those of us who develop eating disorders are great at creating justification for our maladaptive habits, and we find it difficult to think of ourselves as unreasonable. After all, everyone says we look great! We excuse and permit ourselves to return to these behaviors repeatedly, reinforcing their presence in our lives.

Emotional Seesaw:

Many of us with eating disorders vacillate between self loathing and denial. Our emotions shift back and forth as our devotion to the eating disorder increases. Depression may become a part of our daily life as we descend into the world of the eating disorder.

Eating disorders are very serious conditions, and they can even be lethal. If you think you or someone you know may have an eating disorder, please seek the assistance of a clinical psychologist.

Sources:

National Institute of Mental Health (www.nimh.nih.gov)

The work of Dr Christopher Fairburn

How Eating Disorders Begin - By Chris Gearing

Wednesday, February 20, 2013

Watch Dr. Sylvia Gearing describe how eating disorders begin and what you should watch out for - click here.

Eating disorders are a tenacious mental health disorder that can be highly lethal if left unaddressed.

The disorder usually begins in adolescence and can last a lifetime. Current researchers recognize that the earlier the eating disorder develops, the more serious and stubborn the condition.

Society’s Message of Perfection:

One of the chief reasons that eating disorders persist is that our society continues to value being thin as a desirable characteristic, for women especially. Others who view the decreased weight as a sign of self-discipline or ambition tend to reward very thin people, often unintentionally. When the social environment is so reinforcing, the young man or woman learns to focus on external approval of appearance rather than creating a more mature, internally derived sense of self.

At a Young Age:

Another reason that eating disorders persist is that they often occur at such a young age. According to authors, Dr. James Lock and Dr. Daniel Le Grange, most cases of anorexia begin between the ages of 13 and 14 but can occur as young as 8 years old. The authors emphasize that the eating disorder usually begins casually with dieting. The progressive elimination of foods leads to pronounced weight loss and social approval, which reinforces the potentially malignant eating habits. Once firmly entrenched, the eating disorder can begin to disrupt a young person’s life with stress. Over the years, it will come and go at times of peak anxiety and challenge.

Thin Equals Power:

Tragically, weight becomes a scorecard of adequacy and many women equate being excessively thin with being in control and powerful in their own lives. The eating disorder is likely to linger into young adulthood especially if there has not been a strategic intervention by parents and psychologists. During this pivotal time, stressors that should be handled with healthy coping skills are dealt with through weight and rigid eating habits. Young men and women do not learn the coping skills required for handling food competently and for living a mature life. Instead, they are defeating stress and adversity through the eating disorder. Developmentally, they are not progressing as their same age peers and may continue to act out with food for years.

Older Women Also Affected:

Eating disorders are not only an affliction of the young. Current estimates of eating disorders in older women indicate that it is on the rise with up to 13% of older women reporting an eating disorder. The International Journal of Eating Disorders reports that 13% of women ages 50 and older stuggle with the problem and that the eating disorder may be a new phenomenon in older women. According to the author, Dr. Cindy Bulik, 79% of the women polled reported that their shape and weight affected how they viewed themselves.

Eating disorders are very serious conditions, and they can even be lethal. If you think you or someone you know may have an eating disorder, please seek the assistance of a clinical psychologist.

Sources:

National Institute of Mental Health (www.nimh.nih.gov)

The work of Dr Christopher Fairburn

What Is An Eating Disorder? - By Chris Gearing

Monday, February 18, 2013

Watch Dr. Sylvia Gearing explain what eating disorders are and when you should get professional help - click here.

Eating disorders affect millions of people every year.

They happen to people across all socioeconomic levels, all ages, to both genders, and they can vary in intensity and duration. Fundamental to all eating disorders is the presence of unhealthy eating habits that are disruptive to a person’s health.

Eating disorders take over peoples’ lives and become central to how they define themselves. They’re often difficult to detect since they start with small changes that become large problems, and they are usually well hidden – particularly when they start. The chief reason that eating disorders begin and flourish is heavy doses of denial. They come out of nowhere and can become very serious, very quickly.

From my clinical practice, I’ve learned that patients develop their eating issues for a variety of reasons including the following:

Trauma Disorders:

Eating disorders can be triggered by a trauma like the loss of a loved one, the loss of a stable life style (like the divorce of parents or the loss of income), or an event or series of events that threatened their safety or even their lives.

Perfectionism:

The psychological need to be perfect can be overwhelming. These individuals are excessively dependent on the opinions and the approval of others. In their own minds, they are only as good as their last success.

In Control:

Some people have a relentless need to be admired and an entitlement to being the center of attention. Controlling their weight is a method of controlling others.

Affective Disorder:

In some cases, affective disorders like depression and anxiety are the basis of the eating disorder. An underlying depression can cause abnormalities in many areas of life including eating and self-regulation.

Family System:

Certain families emphasize performance and weight can become a central focus, especially in females. Issues of adequacy emerge and the eating disorder becomes a defining way to control anxiety.

Eating disorders are very serious conditions, and they can even be lethal. If you think you or someone you know may have an eating disorder, please seek the assistance of a clinical psychologist.

Sources:

National Institute of Mental Health (www.nimh.nih.gov)

The work of Dr Christopher Fairburn


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