Mental & Emotional Health

Definition

Depression is an illness that makes people feels sad and miserable over a long time. Depression isn't just an adult state of mind - children suffer from the condition, too. Depression is an overwhelming feeling of hopelessness, sadness and lack of self-worth. Many people feel sad occasionally, but when someone is depressed, the sadness or feeling low are so extreme or persistent that they get in the way of normal activities. Depression is a serious condition that can impact every area of your life. It can affect your social life, your family relationships, your career, and your sense of self-worth and purpose.

Depression can make one’s feel:
• Hopeless
• Worthless
• Unmotivated
• Exhausted

Causes of Depression
There are many possible causes for depression, some include:
Psychological factors
• Unresolved, repressed traumatic experiences from childhood or later life may surface when a senior slows down.
• Previous history of depression.
• Damage to body image (from amputation, cancer surgery, or heart attack) fear of death.
• Frustration with memory loss.
• Difficulty adjusting to stressful or changing conditions (i.e., housing and living conditions, loss of loved ones or friends, loss of capabilities, etc.)
• Substance abuse
Environmental factors
• Loneliness, isolation.
• Retirement (whether the individual has chosen to stop working, been laid off, or been forced to stop because of chronic health problems or a disability).
• Being unmarried (especially if widowed)
• Recent bereavement.
• Lack of a supportive social network.
• Decreased mobility due to illness or loss of driving privileges.
Physical factors, including genetics
• Inherited tendencies toward depression.
• Co-occurring illness (such as Parkinson's, Alzheimer's, cancer, diabetes or stroke).
• Vascular changes in the brain.
• A vitamin B-12 deficiency (as yet unclear if this is caused by poor eating habits or a result of depression).
• Chronic or severe pain
Personality characteristics
• low self-esteem
• extreme dependency
• pessimism
Symptoms
Depression is associated with many symptoms. Common symptoms include:
• feeling low, sad or miserable
• persistent tearfulness
• not enjoying or getting pleasure from life
• loss of interest in life, even in favorite hobbies or sports
• sleep disturbance - most typical is waking unusually early and not being able to get back to sleep, or roaming around all night and day unable to sleep at all, or never getting out of bed
• appetite disturbance - either increased or decreased, including either weight gain or weight loss
• feeling useless, hopeless or helpless
• tiredness and fatigue
• low self-esteem/confidence
• feeling anxious, agitated or tetchy
• extreme placidity, which may go as far as physical slowing down
• poor libido
• over-sensitivity
• poor concentration, memory and motivation
• constant physical problems with no return to feeling well despite treatment
• suicidal thoughts and ideas
• stop eating or drinking
• Suffer from delusions or hallucinations.
Why Do People Become Depressed?
Depression is believed to be caused by disturbances in body chemistry. This physical change can be triggered by disease and illness, by traumatic, stressful events such as bereavement, illness and retirement, or by work, relationship and financial problems.
Types of Depression
Following are the types of the depression
• Simple Depression
• Manic Depression or Bipolar Disorder)
• Seasonal Affective Disorder (SAD)
• Clinically Diagnosed Depression
• Post-Natal Depression
• Post Partum Depression
• Dysthymia
• Atypical Depression
Major Depression - Major depression is characterized by a persistent sad mood and/or an inability to experience pleasure. These symptoms are constant, interfering with the ability to lead a productive and enjoyable life. Left untreated, a major depressive episode typically lasts for about six months. Some people may experience just a single episode of depression in their lifetime, but more commonly, major depression is a recurring disorder.
Atypical Depression - Atypical depression is a common subtype of major depression. It features a specific symptom pattern, including a temporary mood lift in response to positive events. You may feel better after receiving good news or while out with friends. However, this boost in mood is fleeting. Other symptoms of atypical depression include weight gain or significant increase in appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection.
Dysthymia - Dysthymia, or dysthymic disorder, is a type of “low-grade” depression that lasts for at least two years. Dysthymia is less severe than major depression, but the chronic symptoms prevent one from leading life to the fullest. If you have dysthymic disorder, you are mildly to moderately depressed on more days than not, although you may have brief periods of normal mood. Many people with dysthymia also experience major depressive episodes, a condition known as “double depression”.
Bipolar Disorder or Manic Depression - Bipolar disorder, also known as manic depression, is characterized by cycling mood changes, with episodes of depression alternating with episodes of mania. Typically, the switch from one mood extreme to the other is gradual, with each manic or depressive episode lasting for at least several weeks. When depressed, a person with bipolar disorder exhibits the usual symptoms of major depression. In the manic phase, symptoms include hyperactivity, rapid speech, and impulsive behavior. It is also marked by is marked by extreme mood swings, between highs when a person experiences excessive energy and optimism and lows when they may feel total despair and lack of energy.
Seasonal Affective Disorder (SAD) - Some people who experience recurring episodes of depression show a seasonal pattern known as seasonal affective disorder (SAD). SAD is a major depression that occurs in the fall or winter when the amount of sunlight is limited. In SAD, the depression goes away once the seasons turn again in the spring. SAD is more common in northern climates and in younger people.
Postpartum Depression - Many new mothers suffer from some fleeting form of the “baby blues.” Postpartum depression, in contrast, is a longer lasting and more serious depression thought to be triggered by hormonal changes associated with having a baby. Postpartum depression usually develops soon after delivery, but any depression that occurs within six months of childbirth may be postpartum depression.
Post-natal depression - can occur from about two weeks after the birth of a child to two years after and differs from the mood swings suffered by many in the first few days after the child is born.
Genetic factors of Depression
Depression is the result of an interaction of genes and environment (this is called a multifactor disease). The interaction is complex but some people appear more vulnerable to the effects of stressful life events, perhaps because of their genetic make-up.
Combating Depression
Although it's often not possible to prevent depression, many people find that an understanding of their disease and its possible triggers can help to keep their depression at bay. Strengthening emotional wellbeing can help. This is done by:
• getting enough rest and learning how to relax
• using therapies such as yoga and massage
• exercising regularly s
• avoiding too much alcohol, smoking and illegal drugs
• eating a balanced healthy diet
• talking about feelings, problems and concerns with a trusted friend
• Exercise


How common is it?
Seven to 12 percent of men suffer from diagnosable depression, and 20 to 25 per cent of women. There are many theories as to why the figure is higher for women. The incidence of postnatal depression certainly contributes to the higher figure.
Differentiation of signs and symptoms of depression in special groups
Depression is expressed differently according to one's age, sex, and culture. For example, a teenager is unlikely to exhibit the same signs of depression as an elderly person would. An awareness of these differences helps ensure that the problem is recognized and treated.

• Teen Depression
Depression in children and adolescents can look quite distinct from that of adults. Irritability—rather than depression—is frequently the predominant mood. A depressed child or teenager may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains, such as headaches and stomachaches, is also a common symptom of depression in children and teens. Other signs include pretending to be sick, refusing to go to school, getting into trouble, clinging to a parent or worrying that the parent may die.
• Depression in Women
Rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphonic disorder (PMDD), postpartum depression and per menopausal depression. When it comes to symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.
• Depression in Men
Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Other symptoms of depression in men include anger, aggression and violence, reckless behavior, and substance abuse. Men may also try to cope with their depression by throwing themselves into their work.
• Depression in Older Adults and the Elderly
The difficult changes that many older adults face—such as bereavement, loss of independence, and health problems—can lead to depression, especially in those without a strong support system. However, depression is not a normal part of aging. Older adults tend to complain more about the physical rather than the emotional symptoms of depression, and so their mood disorder often goes unrecognized. But depression in the elderly is associated with poor health, a high mortality rate, and an increased risk of suicide, so diagnosis and treatment are extremely important.


Risk Factors for Depression
Risk Factors for Depression
Lack of social support Social support serves as a protective factor against depression. People who are isolated and have few friends or family members to turn to in times of stress are more likely to develop depression.
Recent stressful life experience When people are going through stressful experiences that overwhelm their coping skills, depression often results. Relationship, family, and career difficulties
Previous history of depression If you’ve had an episode of major depression before, you are at increased risk of having another episode. The probability of having a recurrence increases with each major depressive episode.
Family history of depression If depression runs in your family, your risk for depression is higher. Your risk is particularly high if one of your close relatives, such as parent or sibling, has depression.
Lower socioeconomic status Research has shown that low socioeconomic status is associated with increased rates of depression. People with lower levels of income, education, and occupational status face many obstacles and stressors that likely contribute to this risk.
Underlying emotional or personality disorder People with pervasive emotional difficulties or personality disorders are vulnerable to depression.
Chronic medical condition Ongoing medical problems or chronic pain can lead to depression.
Female sex Women are twice as likely to experience depression as men.
Advanced age People over the age of 65 are more vulnerable to depression.

Treatment for Depression
There are many different treatment options for depression. The most common approach involves some type of psychotherapy, antidepressant medication, or a combination of the two.
• Psychotherapy
• Antidepressant Medication
A variety of medications are used in the treatment of depression. SSRI (selective serotonin reuptake inhibitor) antidepressants such as Prozac are the most commonly prescribed type. Antidepressants typically take up to 4-6 weeks to reach their full effectiveness. Drug treatment may cause unwanted side effects, so educating yourself about your medication and its risks is important.
Who's affected?
Depression is a complicated problem, which is often hidden behind physical illness. This can be confusing because, for example, chronic pain can cause depression and depression can cause chronic pain. Often depression has no obvious cause. It can affect anyone at any time in their life, even during childhood, although it's more common in mid-life. Depression can affect any person of any age at nay stage of life. That is why Children, teenagers and old age person may be victim of Depression. Women are twice as likely as men to be diagnosed with depression. Although many now believe that equal numbers of men and women are likely to experience depression.
Depression in Children
In the early 1980s, many psychiatrists believed children were incapable of experiencing depression because they lacked the emotional maturity to feel despondent. However, most children feel down at times.
At least two per cent of children under 12 struggles with significant depression, and by teenage years this has risen to five per cent - that's at least one depressed child in every classroom.
More than half of the adults who develop depression say they can pinpoint early symptoms before the age of 20.
Symptoms of Children Depression
There are many symptoms related to depression, which can make it difficult to spot. Common symptoms in children include:
• simply appearing unhappy much of the time
• headaches, stomach aches, tiredness and other vague physical complaints which appear to have no obvious cause
• spending a lot of time in bed but sleeping badly and waking early in the morning
• doing badly at school
• major changes in weight
• being unusually irritable, sulky or becoming quiet and introverted
• losing interest in favorite hobbies
• having poor self-esteem or recurrent feelings of worthlessness
• contemplating suicide
Depression in teenager

Occasional melancholy, bad moods and short periods of feeling down are common in adolescence. Major depression, however, limits an adolescent's ability to function normally. Depression in teenagers is characterized by a persistent sad mood, irritability, feelings of hopelessness or the inability to feel pleasure or happiness for an extended period of time—weeks, months or years.
Symptoms of Teenage Depression

Early symptoms of adolescent depression can be difficult to diagnose because they appear to be a normal part of the difficulties adolescents face. Depression may be indicated if an adolescent experiences an unusual degree of the following symptoms:


• changes in eating and sleeping habits (eating and sleeping too much or too little)
• significant weight gain or loss
• missed school, poor school performance and/or a sudden decline in grades
• withdrawal from friends and family
• no longer enjoying activities that were once pleasurable
• indecision, lack of concentration, or forgetfulness
• feelings of worthlessness or guilt
• overreaction to criticism, irritability
• feeling that nothing is worth the effort
• frequent health complaints when no physical ailment exists
• anger, rage, anxiety
• lack of enthusiasm and motivation
• drug/alcohol abuse, thoughts of death or suicide
• Symptoms such as insomnia, panic attacks, delusions or hallucinations can indicate extreme depression, with particular risk for suicide.
Causes of Depression in Teenagers
• Significant events such as the death of a loved one, parents’ divorce, moving to a new area, or breaking up with a girlfriend or boyfriend can prompt symptoms. Adolescent depression can occur from neglect, prolonged absence from someone who is a source of care and nurturance, abuse and bullying, damage to self-esteem, or too many life changes occurring too quickly. In some teenagers, any major change may provoke depression.
• Earlier traumatic experiences such as abuse or incest often emerge and cause great distress as the child becomes a teen. This is because as a young child the victim did not have the life experience or language to process these painful experiences, or to protest. When such memories emerge in adolescence, the distress can be compounded if adults deny or discount the information.
• Stress, especially if the adolescent lacks emotional support.
• Hormonal/physical changes that occur during puberty also cause new and unexpected emotions. Moodiness and melancholy are often experienced and labeled as depression.
• Medical conditions such as hypothyroidism can affect hormone balance and mood. Chronic physical illness also can cause depression. When a medical condition is diagnosed and treated by a doctor, the depression usually disappears.
• Substance abuse can cause changes in brain chemistry.
• Allergies to foods such as wheat, sugar, and milk cause or exacerbate symptoms of depression.
• Nutritional deficiencies may be caused by an amino acid imbalance or vitamin deficiency.
• Genetics can predispose a teen to depression when the illness runs in the family.
Affects of depression in teenagers
Many teen behaviors or attitudes that are annoying to adults are actually indications of depression:
• Drug and alcohol use – depressed teens often use substances in an attempt to self-medicate their symptoms
• Low self-esteem – depression can intensify feelings of ugliness and unworthiness
• Eating disorders – anorexia, bulimia, binge eating, or yo-yo dieting are often signs of unrecognized depression
• Self injury – cutting, burning, head banging, or other kinds of self-mutilation are almost always associated with depression
• Acting out – depression in teenagers may appear as agitation, aggression, or high risk behaviors rather than—or in addition to—gloominess
• Suicidal thoughts or attempts – teens who are seriously depressed or despondent often think, speak, or make "attention-getting" attempts at suicide, which should be taken seriously.
Treatment of Depression in Teenagers
Depression is commonly treated with therapy or with therapy and medication. A combination of approaches is usually most effective:
• Cognitive-behavioral therapy focuses on the causes of the depression and helps change negative thought patterns.
• Group therapy is often very helpful for teens, because it breaks down the feelings of isolation that many adolescents experience (sometimes it helps just to know that "I'm not the only one who feels this way").
• Family therapy as an adjunct to individual therapy can address patterns of communication and ways the family can restructure itself to support each member, and can help the teenager feel like others share the responsibility for what happens in the family.
• Physical exercise is helpful in lifting depression, as it causes the brain's chemistry to create more endorphins and serotonin, which change mood.
• Creative expression through drama, art or music is often a positive outlet for the strong emotions of adolescents.
• Volunteer work is sometimes helpful for adolescents. Helping someone else whose problems are greater than one's own offers a perspective and also an opportunity to be helpful, which can increase one's sense of purpose and meaning.
• Medication for depression should be used with great caution, and only under careful supervision. Recent studies by both the UK government and the FDA have led to warnings that not all psychiatric drugs may be appropriate for teenagers and children. Seek a physician who works specifically with teenagers.
• Hospitalization may be necessary in situations where a teen needs constant observation and care to prevent self-destructive behavior. Hospital adolescent treatment programs usually include individual, group and family counseling as well as medications.
• Special schools, wilderness challenges, or "boot camps" are sometimes recommended for troubled teens. These alternatives are intended to help adolescents learn coping skills, develop confidence, learn to trust and work with others, improve academics and/or deal with negative behaviors. Whether or not they are good options largely depends on the staff running the program. In many cases, they are not trained mental health professionals and may use confrontation, humiliation and punitive measures designed to break down resistance rather than build up internal strengths. Sometimes these programs do more harm than good, and can even result in worse outcomes for adolescents. Before considering such alternatives, do careful research on their philosophy, methods, and the background of their employees.
Depression in Old Age
The Biology of Depression
Older people are more likely to blame their depression on events or social circumstances. But while the death of a partner or friends, or coping with a chronic illness are all important contributory factors, there are real biological changes that account for depression.
In depression the brain circuits responsible for regulating mood, thinking, sleep, appetite and behavior all fail to work properly. The chemicals that brain cells use to communicate with each other, called neurotransmitters, become out of balance. This happens in young and old alike and is always abnormal.
Treatment of depression in Old Age
Many people think that:
• depression will go away by itself
• they're too old to get help
• Getting help is a sign of weakness.
Such views are simply wrong. Depression is a treatable psychological problem. Even the most seriously depressed person who feels hopeless and helpless can be treated successfully, often in a matter of weeks, and return to a happier and more fulfilling life.
Treatment can greatly reduce the symptoms of depression. The most common treatments for depression in the elderly are:
• treatment of underlying medical conditions
• counseling
• psychotherapy
• trauma-focused therapy
• a combination of antidepressants and therapy
• frequently monitored, low dose antidepressant medications
• ECT (electroconvulsive therapy) to "jump-start" the electrical activity in the brain
• hormone replacement therapy (now under investigation for the treatment of elderly depression)
• A change in prescription or dosage to alleviate some symptoms -- if the depression is a side effect of a medication taken for another condition.
Counseling and Psychotherapy
Counseling and psychotherapy can be particularly helpful in treating depression. There are several different modes of treatment:
• Supportive counseling includes religious and peer counseling. It can help ease the pain of loneliness and address the hopelessness of depression. Both peer counseling and pastoral counseling usually are provided at no cost.
• Cognitive Behavioral Therapy (CBT) helps people distinguish between problems that can and cannot be resolved, and develop better coping skills.
• Interpersonal psychotherapy can assist in resolving personal and relationship conflicts.
• Somatic or Trauma Psychotherapy with a professional who is an expert in early life trauma can help bring about the resolution of traumatic experiences.
Treatment depends on the cause and severity of the depression and, to some extent, on personal preference. In mild or moderate depression, psychotherapy is often the most appropriate treatment. But incapacitating depression may require medication for a limited time along with psychotherapy. In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy enables the patient to learn more effective ways of handling his problems.
As in old age people are more caring about their health so there are certain also many self-help activities that can help elevate the mood of seniors. Having a "glass half-full" rather than "half-empty" attitude is useful. Adding that state of mind to any of the following may “fire-up” your imagination and take your mind off of your troubles:
• mild exercise (walking or even chair exercise)
• music (listening, sing-alongs)
• pets (stroking animals has been shown to elevate mood
• gardening or other hobbies
• reminiscing, either with other elders or with younger people
• visiting with family members and friends
• humor (such as telling jokes, emailing funny stories, watching old comedy shows)
• social interventions to help with isolation and loneliness such as: group outings, regular visits from concerned people, participation in a support group
• maintaining a healthy diet enhanced by a multivitamin
• volunteering to help others
• joining a religious or spiritual community
Preventive Measures
Although it may seem like a great many seniors suffer from depression, the majority handle the challenges of aging with at least philosophical acceptance. They enjoy being grandparents, find new activities to replace those they can no longer do, and remain relatively content with their lives. They may be saddened by their losses, but they are not depressed. Most seniors continue to feel happiness, joy, contentment, and other positive emotions.
Some ways to prevent depression include:
• Social interaction such as support groups that deal with losses and changes
• Staying in contact with family, friends, and neighbors
• Participating in absorbing activities
• Volunteering to help others
• Learning a new skill, such as emailing, cooking, or gardening
• Sharing jokes and humorous stories (there are even humor classes for seniors)
• Maintaining a healthy diet
• Exercise, exercise, exercise!
Depression in Women
Women are two times more likely than men to suffer from depression, and the way women experience depression is often different than it is for men.

Causes of depression in women
Depression in Women: Biological Factors
Premenstrual Problems Hormonal fluctuations during the menstrual cycle can cause the familiar symptoms of premenstrual syndrome (PMS), such as bloating, irritability, fatigue, and emotional reactivity. For many women, PMS is mild. But for some women, symptoms are severe enough to disrupt their lives and a diagnosis of premenstrual dysphoric disorder (PMDD) is made.
Pregnancy & Infertility The many hormonal changes that occur during pregnancy can contribute to depression, particularly in women already at high risk. Other issues relating to pregnancy such as miscarriage, unwanted pregnancy, and infertility can also play a role in depression.
Postpartum Depression Many new mothers experience the “baby blues.” This is a normal reaction that tends to subside within a few weeks. However, some women experience severe, lasting depression. This condition is known as postpartum depression. Postpartum depression is believed to be influenced, at least in part, by hormonal fluctuations.

Per menopause & Menopause Women may be at increased risk for depression during per menopause, the stage leading to menopause when reproductive hormones rapidly fluctuate. Women with past histories of depression are at an increased risk of depression during menopause as well.
Depression in Women: Social & Cultural Factors
Role Strain Women often suffer from role strain over conflicting and overwhelming responsibilities in their life. The more roles a woman is expected to play (mother, wife, working woman), the more vulnerable she is to role strain and subsequent stress and depression. Depression is more common in women who receive little help with housework and child care. Single mothers are particularly at risk. Research indicates that single mothers are three times more likely than married mothers to experience an episode of major depression.
Unequal Power & Status Women’s relative lack of power and status in our society may lead to feelings of helplessness. This sense of helplessness puts women at greater risk for depression. These feelings may be provoked by discrimination in the workplace leading to underemployment or unemployment. Low socioeconomic status is a risk factor for major depression. Another contributing factor is society’s emphasis on youth, beauty, and thinness in women, traits which to a large extent are out of their control.
Sexual & Physical Abuse Sexual and physical abuse may play a role in depression in women. Girls are much more likely to be sexually abused than boys, and researchers have found that sexual abuse in childhood puts one at increased risk for depression in adulthood. Higher rates of depression are also found among victims of rape, a crime almost exclusively committed against women. Other common forms of abuse, including physical abuse and sexual harassment, may also contribute to depression.
Relationship
Dissatisfaction While rates of depression are lower for the married than for the single and divorced, the benefits of marriage and its general contribution to well-being are greater for men than for women. Furthermore, the benefits disappear entirely for women whose marital satisfaction is low. Lack of intimacy and marital strife are linked to depression in women.
Poverty Poverty is more common among women than men. Single mothers have the highest rates of poverty across all demographic groups. Poverty is a severe, chronic stressor than can lead to depression.
Depression in Women: Psychological Factors
Coping Mechanisms Women are more likely to ruminate when they are depressed. This includes crying to relieve emotional tension, trying to figure out why you’re depressed, and talking to your friends about your depression. However, rumination has been found to maintain depression and even make it worse. Men, on the other hand, tend to distract themselves when they are depressed. Unlike rumination, distraction can reduce depression.
Stress Response According to Psychology Today, women are more likely than men to develop depression under lower levels of stress. Furthermore, the female physiological response to stress is different. Women produce more stress hormones than men do, and the female sex hormone progesterone prevents the stress hormone system from turning itself off as it does in men.
Puberty & Body Image The gender difference in depression begins in adolescence. The emergence of sex differences during puberty likely plays a role. Some researchers point to body dissatisfaction, which increases in girls during the sexual development of puberty. Body image is closely linked to self-esteem in women, and low self-esteem is a risk factor for depression. For more on how depression affects teenage girls.

Symptoms of Depression in Women
The symptoms of depression in women are the same as those for major depression. Common complaints include:
• Depressed mood
• Loss of interest or pleasure in activities you used to enjoy
• Feelings of guilt, hopelessness and worthlessness
• Suicidal thoughts or recurrent thoughts of death
• Sleep disturbance (sleeping more or sleeping less)
• Appetite and weight changes
• Difficulty concentrating
• Lack of energy and fatigue

Risk Factors for Depression in Women
• Family history of mood disorders
• Personal past history of mood disorders in early reproductive years
• Loss of a parent before the age of 10 years
• Childhood history of physical or sexual abuse
• Use of an oral contraceptive, especially one with a high progesterone content
• Use of gonadotropin stimulants as part of infertility treatment
• Persistent psychosocial stressors (e.g., loss of job)
• Loss of social support system or the threat of such a loss



Treatments for depression in women
For the most part, women suffering from depression receive the same types of treatment as everyone else. The main treatment approaches are psychotherapy and antidepressant therapy. However, there are some special treatment considerations for depression in women.
Depression and the Reproductive Cycle
Hormone fluctuations related to the reproductive cycle can have a profound influence on a woman’s mood. In light of this possibility, you and your doctor should always look for connections between your depressive symptoms and the female reproductive cycle. Is your depression connected to your menstrual period and a possible effect of PMS? Are you pregnant and struggling with complications and concerns related to the vast changes you and your body are undergoing? Are you struggling with the baby blues after recently giving birth? Or are you approaching menopause and dealing with hormonal and emotional fluctuations? All of these milestones in the reproductive cycle can influence or trigger depression. It’s also important to consider mood-related side effects from birth control medication or hormone replacement therapy.
Relationship Issues and Role Strain
Because of the special role that interpersonal issues and role strain plays in female depression, psychotherapy should address them directly. Interpersonal therapy and cognitive-behavior therapy are both effective in teaching new problem solving skills, improving interpersonal relationships, and reducing negative thinking and ineffective coping techniques.
Treatment Modifications
Specific aspects of treatment must often be modified for women. Because of female biological differences, women should generally be started on lower doses of antidepressants than men. Women are also more likely to experience side effects, so any medication use should be closely monitored. Finally, in addition to antidepressant treatment, women are more likely than men to require simultaneous treatment for other conditions such as anxiety disorders and eating disorders.
Depression Self-Help
Depression has been called a “Catch 22” because the steps that a depressed person must take to recover are made difficult by the very symptoms of depression, which include loss of energy and feelings of hopelessness.
However, while recovery from depression is certainly difficult, it is by no means impossible—and it is essential for the depressed person to remember this distinction.
According to an article from Psychology Today, recovery from depression, “involves a series of hard choices over a long period of time—five months, on average.” To recover from depression, these choices must include:
• choosing to get out of bed
• choosing to eat breakfast
• choosing to shift attention from negative thoughts to at least neutral ones
• choosing to stop ruminating
• choosing to be with people who make you feel cared for and supported
While trying the many activities suggested below, allow you to be guided and comforted by the following general reminders from NIMH in regard to depression recovery:
• Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
• Set priorities and do what you can when you can.
• Expect your mood to improve gradually, not immediately. Feeling better takes time.
• People rarely “snap out of” a depression. But they can feel a little better day-by-day.
• Positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
• Let others help you.
Tips for activities you can do alone to avoid or reduce depression
• Sweat exercise: Do any form of aerobic exercise—such as brisk walking, biking, or running in place—until you work up a healthy sweat.
• Turn on your favorite music and dance, dance, dance—until you work up a sweat.
• Sing in the shower.
• Instead of listening to the radio or talking on your cell phone, roll up the car windows and sing loudly.
• Get a dog or other pet—or simply visit a pet store to boost your spirits.
• Plant and tend a garden—an herb garden takes up very little space.
• Rub or body massage.
• Take a hot bubble bath with candles and music in the room. If you are really upset, take a brisk walk and focus exclusively on the physical and emotional sensations you experience in your body. Stay out of your head—no thoughts allowed!
• Rent funny videos or see funny movies and plays.
• Go to the store and read all the humorous greeting cards.
• Treat your self to a great cup of coffee—if you take half-decaf and half regular, you can have two cups a day (too much caffeine can bring you down, but one cup is safe enough).
• Let nature bring you up—walk by the ocean or other waterways, hike the hills and forests.
• Draw, paint, or write.
• Avoid foods that zap your energy—for most people, sugar and pasta can be downers.
• Give yourself a hand or foot massage, or go get a back
Tips for activities you can do with others to avoid or reduce depression
• Strike up conversations with strangers—in line at the market, walking in your neighborhood, at the Local Park, etc.
• Pet the animals or volunteer to walk the dogs at a local animal shelter.
• Become a “big brother” or “big sister” to a lonely child.
• Having lunch with friends.
• Ask your friends to turn off their cell phones when they are with you, and do the same for them.
• Volunteer at a soup kitchen.
• Set up at least three dates with friends or acquaintances at the beginning of each week.
• Take acting, singing, or dancing class—even if you have no talent whatsoever!
• Avoid people that make you feel bad.
• Improve your intimate relationships.
Tips to improve your environment to avoid or reduce depression
• Cut and arrange flowers or bring a live plant into your office or living space.
• Clean up your room (or start with one small shelf, drawer, or corner).
• Wash your clothes.
• Paint your walls a shade of yellow or another color that cheers you up.
• Try different kinds of music in your home—peppy, mellow, country, opera, pop, etc.
• Try aromatherapy—use different scents of candles, incense, or oils. Choose fragrances that remind you of a happy place or time or those that are known for their uplifting qualities.
• Move the furniture around to create a different feeling in a room.
• Change the lighting—try opening windows or curtains; if necessary, get full-spectrum light tubes.
Tips for coping with “holiday blues” and depression
For many people, the holidays are filled with happiness and family gatherings. But for others, holidays are a time of sadness and loneliness. Seniors particularly feel depressed during these times.
Many factors can cause the “holiday blues”: stress, fatigue, unrealistic expectations, financial constraints, inability to be with one’s family and friends, or memories of better times. The demands of shopping, parties, family reunions, and houseguests only compound the feelings of tension. The holiday blues syndrome sometimes also affects people who are usually not prone to depression and may cause other stress responses, such as headaches, irritability, and difficulty sleeping.
The following are some suggestions for coping with seasonal anxiety and depression:
• Set realistic expectations for the season, especially regarding what you can and cannot do.
• Pace yourself. Do not take on more responsibilities than you can handle.
• Make a list and prioritize the important activities. This can help make holiday tasks more manageable.
• Live and enjoy the present. Try not to get caught up in memories of better times.
• If you are lonely, try volunteering some time to help others.
• Do not put all your energy into just one day; the holiday cheer can be spread from one holiday event to the next.
• Find holiday activities that are free, such as looking at holiday decorations, going window shopping without buying, and watching the winter weather.
• Understand that anxiety and depression are natural reactions to the stress and fatigue of the season—and they will pass.
• Remember that excessive drinking will only increase feelings of depression.
• Try something new. Celebrate the holidays in a new way.
• Spend time with supportive and caring people.
• Make time for yourself!
Tips for surviving living with a depressed person
People who are depressed are not behaving this way intentionally. They did not cause the problem, nor can they just “snap out of it,” any more than someone can just stop having cancer or stop being in a cast with a broken leg. They are not trying to do anything to their family or loved ones, but that does not mean it is easy to live with a depressed person.
Normally, partners are sources of understanding, fun and intellectual stimulation, and support with difficulties. In a love relationship, they are also your partner in sexual intimacy. But when your loved one is depressed, he or she is not available to provide you with these usual resources. You still have these needs, and for a time may have to find other appropriate sources for fun, support and stimulation: time with family, friends or colleagues; enjoyable hobbies or activities; and perhaps counseling for you.
There are several things you can do to help a depressed friend or family member, and there are also things you can do to take care of yourself in the process. Keeping yourself mentally healthy is not selfish—it is essential for your own safety and for you to continue to be helpful to your loved one. Here are some tips for survival.
Things one can do to help the depressed person
• Learn about the disorder so you will have a better understanding of what is happening.
• Try to be supportive, loving and empathic.
• Offer kindness and attention, even if it is not reciprocated.
• Keep reaching out, calling, and letting the person know you care—even if he/she does not respond to your invitations.
• Don’t be hostile or sarcastic when the person makes meager attempts to be responsive—accept their efforts as the best they have to offer at that time.
• Offer assistance with chores.
• Don’t make promises you can’t keep.
• Don’t take over things that the other person CAN handle, as this will further erode self-confidence.
• Focus on the positive aspects of the other person and the relationship.
• Listen non-judgmentally.
• Don’t push the other person’s buttons.
• Don’t abandon him/her if you can find ways to help without creating your own health issues.
• Remind the person that this is an illness, that he/she is not to blame for feeling “down.”
• Don’t lie or make excuses for his/her behavior—this may only delay getting assistance.
• Insist that the person get a complete medical exam to rule out any organic source of depression (such as a thyroid or endocrine imbalance).
• Encourage the person to get professional assistance—for both of your sakes.
• Accompany the person to a doctor’s appointment as a way of facilitating getting professional help. Take notes, as the person’s concentration and recall are likely to be affected by depression.
• Be patient—treatment for depression takes time.
• At a time when he/she is less depressed, try to reach agreement with the depressed person to outline ways you can be helpful when depression sets in.
• Take suicidal comments seriously and call for emergency help, if needed.
• Continue to offer reassurance that things will get better with time and help.
Things one can do to help the children of a depressed person
• Reassure children that they did not cause their parent’s depressive illness.
• Give children extra attention and kindness, as they are likely to be missing that from a depressed parent.
• Encourage children to have activities with other family members and friends so their emotional state is not totally dependent upon their parent’s mood.
• Find one of the many children’s books devoted to helping young readers understand mental illness.
• Seek family counseling to help all individuals to better understand and support each other.
Things one can do to help yourself if your loved one is depressed
• Don’t take the other person’s actions personally—they are not directed toward you, even if it feels like they are.
• Do your best not to feel guilty. You didn’t cause the other person’s depression and you can’t “cure” it.
• Don’t try to “rescue” or “save” the other person.
• Know that your feelings of guilt, frustration, anger, and exhaustion are completely normal and understandable.
• Express your feelings without blaming or shaming the other person.
• Let go of your anger—frustration is very understandable but is not helpful to anyone.
• Don’t read rejection into your partner’s sexual unavailability—even though it feels bad, it’s not a reflection on you.
• Find other ways to express loving feelings when sexual contact is limited or non-existent.
• Don’t look outside the relationship for sexual intimacy—you risk destroying the chance of the relationship recovering when your partner’s condition improves.
• Choose healthy lifestyles—get enough rest, eat balanced meals, exercise regularly, and keep up your own social network.
• Talk regularly with someone who will listen without giving advice unless you ask for it—this could be a trusted friend, clergy, or therapist.
• Share the care-giving responsibilities with other family members.
• Don’t be a martyr—give freely and without resentment while also taking time for your own needs.
• Give yourself time alone and with friends to socialize and have fun.
• Identify your own needs and boundaries and express them clearly.
• Remember that depression is a treatable condition and that, with time and assistance, your loved one will improve.



In summary, to survive living with a depressed person, remember the airlines’ advice to put on your own oxygen mask before you try to help another—you will be unable to help your loved one if you collapse under the burden of helping. Don’t get dragged down by the other person’s depression—take care of yourself. This is not an act of selfishness, especially if it allows you to continue to love and care for the other person.

STRESS

Signs Symptoms, Causes and Effects of Stress

What is stress?

The stress response of the body is meant to protect and support us. To maintain stability or homeostasis, the body is constantly adjusting to its surroundings. This process is often referred to as the "fight or flight response." We prepare for physical action in order to confront or flee a threat.
Stress is often associated with situations that you find difficult to handle. How you view things also affects your stress level. If you have very high expectations, chances are you'll experience more than your fair share of stress.
Your stress response can also have a positive effect, spurring motivation and awareness, providing the stimulation to cope with challenging situations.
Take some time to think about the things that cause you stress. Your stress may be linked to external factors such as:
• the state of the world, the country, or any community to which you belong
• unpredictable events
• the environment in which you live or work
• work itself attitudes and feelings
• unrealistic expectations
• family
• perfectionism

Sign and symptoms of stress
Stress affects mind, body, and behavior in many ways; the signs and symptoms of stress vary from person to person, but all have the potential to harm your health, emotional well-being, and relationships with others. Below are partial lists of signs and symptoms of stress that a person undergoing stress might experience.
Intellectual symptoms:
How stress can affect your mind Physical symptoms:
How stress can affect your body
• problems with memory
• difficulty making decisions
• inability to concentrate, shortened attention span
• confusion
• repetitive or continual thoughts
• misunderstanding of what others tell you
• poor judgment
• thoughts of escaping, running away
• inability to slow down thought process
• headaches
• digestive disorders
• muscle tension and pain
• sleep disturbances
• fatigue
• chest pain, irregular heartbeat
• high blood pressure
• weight gain or loss
• hair loss
• asthma or shortness of breath
• skin problems
• periodontal disease, jaw pain
Emotional symptoms:
What stress can make you feel Behavioral symptoms:
What stress can make you do
• less interest in hobbies or fun
• sudden shifts in mood
• frequent uneasiness, restlessness
• frustration
• anger, resentment
• unwarranted jealousy
• quick irritability with others
• oversensitivity
• overreaction to unexpected situations or events
• sense of being overwhelmed or swamped
• anxiety
• increased fear of failure
• inadequacy, reduced confidence
• depression • eat more or less
• sleep too much or too little
• isolate yourself from others, including people close to you
• stay home from work or stay at work extended hours
• increase use of tobacco, alcohol, drugs, caffeine
• have sex more or less
• engage in nervous habits such as nail biting, hair twisting, pacing
• grind your teeth
• laugh or cry at inappropriate times
• overdo activities such as exercising or shopping
• become bossy or inflexible with others

Your stress response can also have a positive effect, spurring motivation and awareness, providing the stimulation to cope with challenging situations.
Take some time to think about the things that cause you stress. Your stress may be linked to external factors such as:
• the state of the world, the country, or any community to which you belong
• unpredictable events
• the environment in which you live or work
• work itself attitudes and feelings
• unrealistic expectation
• family
• perfectionism


Different types and causes of stress

Acute stress: is the most common and most recognizable form of stress, the kind in which you know exactly why you’re stressed: you were just in a car accident; the school nurse just called; a bear just ambled onto your campsite. Or it can something scary but thrilling, such as a parachute jump. It’s the kind of sudden jolt that triggers the hormonal and physiological effects listed above. Along with obvious the Episodic acute stress.
Chronic Stress The APA Help Center describes chronic stress as “unrelenting demands and pressures for seemingly interminable periods of time.” Chronic stress is stress that wears you down day after day and year after year, with no visible escape. It grinds away at both mental and physical health, leading to breakdown and even death.
Common causes of chronic stress include:
• poverty and financial worries
• long-term unemployment
• dysfunctional family relationships
• caring for a chronically ill family member
• feeling trapped in unhealthy relationships or career choices
• living in an area besieged by war, ethnic rivalry, or criminal violence
• bullying or harassment
• perfectionism

Long-Term Effects of Stress
It’s important to pay attention to stress symptoms and learn to identify what causes them, because if they persist, you’re at risk for serious health problems. Recent research suggests that anywhere from two-thirds to 90 percent of illness is stress-related. Fifty-five percent of Americans report being stressed at work, and 25 percent of U.S. workers miss 16 days of work each year because of stress. . Stress is a contributor to very serious physical and psychological conditions, including:
• heart disease
• cancer
• diabetes
• depression
• obesity
• anorexia nervosa • substance abuse
• ulcers
• irritable bowel syndrome
• memory loss
• child, elder, and sexual abuse
COPING WITH STRESS
Management, Prevention and Reduction





What is stress management?
Stress is a normal physical reaction that occurs when you feel threatened or overwhelmed. The perception of a threat is as stressful as a real threat. You perceive a situation as threatening or feel overwhelmed because you are dealing with an unusually large number of everyday responsibilities. With increasing demands of home and work life, many people are under enormous stress.
Controlling your life means balancing various aspects of it — work, relationships and leisure — as well as the physical, intellectual and emotional parts. People who effectively manage stress consider life a challenge rather than a series of irritations, and they feel they have control over their lives, even in the face of setbacks.
Ways to manage stress better?
• Get enough sleep: Adequate sleep fuels your mind, as well as your body. Feeling tired Connect with others: Develop a support system and share your feelings. Perhaps a friend, family member, teacher, clergy person or counselor can help you see your problem in a different light. Talking with someone else can help clear your mind of confusion so that you can focus on problem solving.
• Exercise regularly: Find at least 30 minutes, three times per week to do something physical. Nothing beats aerobic exercise to dissipate the excess energy. Physical activity plays a key role in reducing and preventing the effects of stress. During times of high stress, choose things you like to do will increase your stress because it may cause you to
• Don’t self-medicate with alcohol or drugs: While consuming alcohol or drugs may appear to alleviate stress, it is only temporary. When sober, the problems and stress will still be there. Don’t mask the issue at hand; deal with it head on and with a clear mind irrationally.

Change in thinking and emotional responses to handle stress better
• Have realistic expectations: Know your limits. Whether personally or professionally, be realistic about how much you can do. Set limits for yourself and learn to say “no” to more work and commitments.
• Reframe problems: See problems as opportunities. As a result of positive thinking, you will be able to handle whatever is causing your stress. Refute negative thoughts and try to see the glass as half full. It is easy to fall into the rut of seeing only the negative when you are stressed. Your thoughts can become like a pair of dark glasses, allowing little light or joy into your life.
• Don’t try to control events or other people: Many circumstances in life are beyond your control, particularly the behavior of others. Consider that we live in an imperfect world. Learn to accept what is, for now, until the time comes when perhaps you can change things.
REDUCTION IN STRESS
Job Stress Management / Workplace Stress

What is job stress?
A survey by St. Paul Fire and Marine Insurance Co. found that problems at work are more strongly associated with health complaints than are any other life stressor—more so than even financial or family problems. While challenges are a normal and satisfying part of work life, stress is not a necessary evil in the workplace. However, for many people stress has become synonymous with work.
According to The National Institute for Occupational Safety and Health (NIOSH), early warning signs of job stress include:
• headache
• sleep disturbances
• difficulty in concentrating
• short temper • upset stomach
• job
• dissatisfaction
• low morale
The National Institute for Occupational Safety and Health (NIOSH) is the federal agency responsible for conducting research and making recommendations for the prevention of work. The NIOSH report states that job stress results from both the characteristics of a worker and the working conditions, but that there are differing views as to which set of circumstances is the primary cause of job stress:
• Individual characteristics – According to one school of thought, differences in personality and coping style of the worker are most important in predicting job stress. Thus, what is stressful for one person may not be a problem for someone else? This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.
• Working conditions – Scientific evidence suggests that certain working conditions are stressful to most people. Evidence from recent studies argues for a greater emphasis on working conditions as the key source of job stress and for job redesign as a primary prevention strategy.
Both viewpoints suggest ways to prevent stress at work, but NIOSH “favors the view that working conditions play a primary role in causing job stress.” The report cites the following job conditions that may lead to stress:
• The design of tasks – heavy workload; infrequent rest breaks; long hours; and routine tasks that do not utilize workers' skills
• Management style – poor communication in the organization and a lack of family-friendly policies
• Interpersonal relationships – an unsupportive social environment
• Work roles – conflicting or uncertain job expectations; too much responsibility
• Career concerns – job insecurity; lack of opportunity for advancement or promotion
• Environmental conditions – unpleasant or dangerous physical conditions such as crowding, noise, air pollution, or ergonomic problems

What Can Managers or Employers Do To Reduce Stress At Work?
To reduce stress at work, an individual should try to maintain a balance between work and family or personal life, a supportive network of friends and coworkers, and a relaxed and positive outlook. But it is also important that the workplace is a “healthy” organization. There are several ways to reduce stress in the workplace. While the employee may not have control over whether the workplace entirely supports a more stress-free lifestyle, possible changes can be made, or individuals can make an educated decision as to whether the workplace is right for him or her.
An understanding of the relationship between individual and organizational health
Recent research suggests that policies benefiting worker health actually benefit the bottom line. A healthy organization—one that has low rates of illness, injury, and disability in its workforce—is competitive in the marketplace. NIOSH research has found the following organizational characteristics to be associated with both healthy, low-stress work and high levels of productivity:


• establishment of recognition of employees for good work performance
• opportunities for career development
• an organizational culture that values the individual worker
• management actions consistent with organizational values

DISASTERS
Natural, War, Rape, and Other Traumas


Whether or not something is a disaster will depend on our perception of our helplessness. The less overwhelmed we feel, the more able we are to act or reach out in some way and become more resilient in the face of a grave threat.
There are common known reaction patterns that people have in disaster settings, although individuals may vary. In considering reactions to disaster, it helps to acknowledge these are normal reactions to extraordinary circumstances and to acknowledge that they will pass in time:
Emotional Physical and Behavioral
• anger
• irritability
• terror
• shock / disbelief
• agitation
• despair
• sadness
• guilt
• numbness, difficulty feeling happy or experiencing loving feelings
• helplessness
• anxiety
• worry
• desire to find reason/blame • decreased energy
• muscle tension
• problems sleeping
• increased stomach/intestinal problems
• headaches
• short of breath
• lowered or increased sex drive
• feeling “jumpy” (startling easily)
• isolating yourself from others
• risky behavior
• heroism
• headaches
• vulnerability to illness
Cognitive Interpersonal
• impaired concentration
• impaired decision making ability
• memory impairment
• disbelief
• confusion
• nightmares
• decreased self-esteem
• decreased self-efficacy
• self-blame
• intrusive thoughts/memories
• worry
• dissociation (e.g., tunnel vision, dreamlike or "spacey" feeling) • increased relational conflict
• social withdrawal
• reduced relational intimacy
• alienation
• impaired work performance
• impaired school performance
• decreased satisfaction
• distrust
• externalization of blame
• externalization of vulnerability
• feeling abandoned/rejected
• being overprotective of you and your family’s safety

Steps Taken to Reduce Trauma

Trauma is the perception of life-threatening experience combined with an overwhelming sense of helplessness to do anything about it. The nervous system becomes so stressed that it stops functioning normally and doesn’t return to a normal state of balance; instead, we stay frozen, anxious or stuck in some debilitating way that diminishes our ability to act feel or to think.
• Create an emergency contact list. Ask several relatives or friends who live outside your immediate area to serve as contacts to relay information to your friends and relatives after a disaster. This will help to reduce calling into and out of the affected area once the phones are working. Also, it is often easier to place an out-of-state long distance call from a disaster area, than to call within the area. Ensure that all of your family members know to call the contact person to report their location and condition.
• Develop an emergency plan. Develop a variety of contingent emergency plans—plans for when disaster strikes while you are driving, when you are at home, at work or at school. Establish a chain of command – what each member’s role might be in a disaster – to help things run smoothly. Knowing how to get out of your home, where family/friends are to meet up, how to reach each other, all help decrease anxieties about missing loved ones.
• Keep informed. Having a radio, understanding where to get news, and which sources are reliable helps one stay informed of how to proceed during an emergency. It is important to understand that instructions and news can change as new information comes in, and if reports contradict each other not to worry.
What kinds of stress reactions require medical attention?
Suicidal, homicidal or psychotic symptoms (hearing voices, seeing visions, severe paranoia, or severe disorganization) are not common reactions to disaster-related stress and require immediate medical intervention. Other extreme reactions to disasters that require medical assistance may include:
• Severe dissociation (feeling as if the world is unreal, not feeling connected to one's own body, losing one's sense of identity or taking on a new identity, amnesia)
• Severe intrusive re-experiencing (flashbacks, terrifying screen memories or nightmares, repetitive automatic reenactment)
• Extreme avoidance (agoraphobic-like social or vocational withdrawal, compulsive avoidance)
• Severe hyper-arousal (panic episodes, terrifying nightmares, difficulty controlling violent impulses, inability to concentrate)
• Debilitating anxiety (ruminative worry, severe phobias, unshakeable obsessions, paralyzing nervousness, fear of losing control/going crazy)
• Severe depression (lack of pleasure in life, feelings of worthlessness, self-blame, dependency, early wakening)
• Problematic substance use (abuse or dependency, self-medication)
Ways to cope after a disaster
• Talk about your feelings. Sharing common experiences with family, friends and neighbors will help you and others cope with and overcome feelings of anxiety, grief, and helplessness. Communicate your experience in whatever ways feel comfortable to you - such as by talking with family or friends, or writing in a diary.
• Get back into daily routines as soon as you can. Eat well-balanced meals and get plenty of rest. Do some physical exercise every day. Avoid alcohol and drugs.
• Reassure children that they are safe. Encourage them to talk about their fears and experiences. Hold and hug them often. Children are particularly vulnerable to emotional stress after a disaster. Signs of stress often include an excessive fear of the dark, crying, fear of being alone, aggression, withdrawal and constant worry.
• Give yourself time to heal. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced. Try to be patient with changes in your emotional state and avoid major life decisions such as switching careers or jobs if possible because these activities tend to be highly stressful.
Ways to help children cope with disaster
Devastating events can be frightening experiences for children and adults. As a parent or caretaker, it’s important for you to be aware that your children are learning from your reactions and will develop their own coping mechanisms based on what they see and understand. It is frightening for traumatized children to sense that the people caring for them are responding in a disorganized, confused and/or anxious manner.
If you feel yourself becoming overwhelmed, irritable or anxious, it is best to simply help the child understand why. Communicate what you are feeling, that these reactions are normal, and will pass.
• Talk. Provide children with age-appropriate information. Speak about your thoughts and feelings. Honesty and openness will help the child develop trust.
• Listen. Listening (while being careful not to avoid or over-react) and providing comfort will have a critical, long-lasting positive effect on the child.
• Discuss. Encourage children to speak with you, and with one another, about their thoughts and feelings. This helps reduce their confusion and anxiety related to the trauma. Respond to questions in terms they can comprehend.
• Provide a consistent, predictable pattern as much as possible. It is helpful to try and keep regular schedules for activities such as eating, playing and going to bed to help restore a sense of security and normalcy for children. Make sure the child knows the pattern. When the day includes new or different activities, tell the child beforehand and explain why this day's pattern is different.
• Provide play experiences to help relieve tension. Younger children in particular may find it easier to share their ideas and feelings about the event through non-verbal activities such as drawing.

POST-TRAUMATIC STRESS DISORDER (PTSD)
Symptoms, Types and Treatment
What are the symptoms of PTSD?
There are four main types of PTSD symptoms. A diagnosis of PTSD requires the presence of all categories of symptomatic responses:
• Re-experiencing the trauma: flashbacks, nightmares, intrusive memories and exaggerated emotional and physical reactions to triggers that remind the person of the trauma.
• Emotional numbing: feeling detached, lack of emotions (especially positive ones), loss of interest in activities
• Avoidance: avoiding activities, people, or places that remind the person of the trauma.
Consequences of PTSD?
PTSD can have severe and long lasting effects on people's lives. Examples of outcomes of PTSD are:
Physiological outcomes
• Neurobiological changes (alterations in brainwave activity, in size of brain structures, and in functioning of processes such as memory and fear response)
• Psycho physiological changes (hyper-arousal of the sympathetic nervous system, increased startle, sleep disturbances, increased neurohormonal changes that result in heightened stress and increased depression)
• physical complaints that are often treated symptomatically, rather than as indications of PTSD (headaches, stomach or digestive problems, immune system problems, asthma or breathing problems, dizziness, chest pain, chronic pain or fibromyalgia)
Psychological outcomes
• depression (major depressive episodes, or pervasive depression)
• other anxiety disorders (such as phobias, panic, and social anxiety)
• conduct disorders
• dissociation ("splitting off" from the present, and into parts of the self)
• eating disorders
Social outcomes
• interpersonal problems
• low self esteem
• alcohol and substance use
• employment problems
• homelessness
• trouble with the law
Self-destructive behaviors
• substance abuse
• suicidal attempts
• risky sexual behaviors leading to unplanned pregnancy or STDs, including HIV
• reckless driving
• self-injury

What is Complex PTSD?
Prolonged, extreme traumatic circumstances — such as childhood sexual abuse, prisoner of war camps, or long-term domestic violence — can cause a form of PTSD called Complex PTSD. As in PTSD, ordinary, healthy persons under severe circumstances can experience changes in how they adapt to stress and how they view themselves. A mental health diagnosis called Borderline Personality Disorder is also highly indicative of a history of trauma, and is increasingly viewed as a type of Complex PTSD.
Possible symptoms of Complex PTSD are:
• severe behavioral difficulties (such as alcohol/drug abuse, aggression, eating disorders)
• difficulty in controlling intense emotions (such as anger, panic, or depression)
• other mental difficulties (such as amnesia or dissociation — a serious condition called Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, which is characterized by "splitting off" parts of oneself).
How PTSD is diagnosed?
A diagnosis of PTSD is made when symptoms in the main clusters (re-experiencing, numbing, avoidance, and arousal) are present for an extended period and are interfering with normal life. The first step in getting treatment is getting a diagnosis. This can be difficult for a number of reasons:
• symptoms may occur months or years after the traumatic event and may not be recognized as being related to the trauma
• beliefs that people "should be able to get over it" or "shouldn't have such a reaction" or "should solve their own problems" may delay treatment being sought
• guilt, blame, embarrassment or pain may interfere with a person seeking help
• Avoidance of anything associated with the trauma may result in an inability to recognize the need for treatment.


Emotional and Psychological Trauma
Causes, Symptoms and Effects

Emotional or Psychological Trauma
The ability to recognize emotional trauma has changed radically over the course of history. Until rather recently psychological trauma was noted only in men after catastrophic wars. The women's movement in the sixties broadened the definition of emotional trauma to include physically and sexually abused women and children. Now because of the discoveries made in the nineties, known as the decade of the brain, psychological trauma has further broadened its definition.
Recent research has revealed that emotional trauma can result from such common occurrences as an auto accident, the breakup of a significant relationship, a humiliating or deeply disappointing experience, the discovery of a life-threatening illness or disabling condition, or other similar situations. Traumatizing events can take a serious emotional toll on those involved, even if the event did not cause physical damage.
Regardless of its source, an emotional trauma contains three common elements:
• it was unexpected
• the person was unprepared
• there was nothing the person could do to prevent it from happening
It is not the event that determines whether something is traumatic to someone, but the individual's experience of the event. And it is not predictable how a given person will react to a particular event. For someone who is used to being in control of emotions and events, it may be surprising – even embarrassing – to discover that something like an accident or job loss can be so debilitating.
What causes emotional or psychological trauma?
Our brains are structured into three main parts, long observed in autopsies:
• the cortex (the outer surface, where higher thinking skills arise; includes the frontal cortex, the most recently evolved portion of the brain)
• the limbic system (the center of the brain, where emotions evolve)
• the brain stem (the reptilian brain that controls basic survival functions)
Because of the development of brain scan technology, scientists can now observe the brain in action, without waiting for an autopsy. These scans reveal that trauma actually changes the structure and function of the brain, at the point where the frontal cortex, the emotional brain and the survival brain converge. A significant finding is that brain scans of people with relationship or developmental problems, learning problems, and social problems related to emotional intelligence reveal similar structural and functional irregularities to those resulting from PTSD.
Symptoms of Emotional Trauma
There are common effects or conditions that may occur following a traumatic event. Sometimes these responses can be delayed, for months or even years after the event. Often people do not initially associate their symptoms with the precipitating trauma. The following are symptoms that may result from a more commonplace, unresolved trauma, especially if there were earlier, overwhelming life experiences:
Physical
• Eating disturbances (more or less than usual)
• Sleep disturbances (more or less than usual)
• Sexual dysfunction
• Low energy
• Chronic, unexplained pain
Emotional
• Depression, spontaneous crying, despair and hopelessness
• Anxiety
• Panic attacks
• Fearfulness
• Compulsive and obsessive behaviors
• Feeling out of control
• Irritability, angry and resentment
• Emotional numbness
• Withdrawal from normal routine and relationships
Cognitive
• Memory lapses, especially about the trauma
• Difficulty making decisions
• Decreased ability to concentrate
• Feeling distracted
The following additional symptoms of emotional trauma are commonly associated with a severe precipitating event, such as a natural disaster, exposure to war, rape, assault, violent crime, major car or airplane crashes, or child abuse. Extreme symptoms can also occur as a delayed reaction to the traumatic event.
Re-experiencing the trauma
• intrusive thoughts
• flashbacks or nightmares
• sudden floods of emotions or images related to the traumatic event
Emotional numbing and avoidance
• amnesia
• avoidance of situations that resemble the initial event
• detachment
• depression
• guilt feelings
• grief reactions
• an altered sense of time
Increased arousal
• hyper-vigilance, jumpiness, an extreme sense of being "on guard"
• overreactions, including sudden unprovoked anger
• general anxiety
• insomnia
What are the possible effects of emotional trauma?
Even when unrecognized, emotional trauma can create lasting difficulties in an individual's life. One way to determine whether an emotional or psychological trauma has occurred, perhaps even early in life before language or conscious awareness were in place, is to look at the kinds of recurring problems one might be experiencing. These can serve as clues to an earlier situation that caused a deregulations in the structure or function of the brain.

Common personal and behavioral effects of emotional trauma:
• substance abuse
• compulsive behavior patterns
• self-destructive and impulsive behavior
• uncontrollable reactive thoughts
• inability to make healthy professional or lifestyle choices
• dissociative symptoms ("splitting off" parts of the self)
• feelings of ineffectiveness, shame, despair, hopelessness
• feeling permanently damaged
• a loss of previously sustained beliefs
Common effects of emotional trauma on interpersonal relationships:
• inability to maintain close relationships or choose appropriate friends and mates
• sexual problems
• hostility
• arguments with family members, employers or co-workers
• social withdraw
• feeling constantly threatened


EMOTIONAL FIRST AID

Tips for Coping with a Traumatic Event




Steps Taken
• Don’t be isolated. Get together with family and friends and support each other. The understanding and support of our loved ones help us cope with tragedy much faster. It is crucial to validate the feelings of fear and helplessness of others even if we are reacting and coping better than them. People have different ways of responding to shocking events. There is no right or wrong reaction.
• Seek professional help if your reaction feels too strong to handle on your own or with your friends. It doesn’t mean you are crazy or weak.
• Keep busy and as structured a schedule as possible.
• Organize and meet in community groups in neighborhoods, YMCAs and religious centers.
• It is crucial to refocus on your resources, anything that helps you feel calmer, stronger and more grounded. Refocus on all your support systems, whether people, activities or places. Do things that keep your mind occupied, such as watching a movie, knitting, and gardening, cooking, playing with children or pets or going in nature.
Psychological Response
People can have many different reactions to the tragedy or feel all of them in sequence. Often we feel first shock, then denial, anger and depression before we move to grief and acceptance.
• Some will be in shock, stunned and dissociated for a while. They may feel disoriented in time, and place, and sometimes in person. They may feel numb and cut off from the terror and pain.
• People may feel fear and deep sorrow, uncertainty and helplessness. These feelings are normal too and will pass.
• People may feel confused, not able to think well, concentrate, remember things or problem-solve. They may feel depressed, exhausted unable to rest and wanting to withdraw.
Physiological Response
It is natural to have a physical reaction to this stress, so don’t let these scare you. It is good to recognize signs of 'activation’ and not to be scared by them:
• heart beating faster
• difficulty breathing
• blood pressure going up
• stomach tightening, knot in the throat
• skin cold and racy thoughts

STRESS RELIEF
Yoga, Meditation, and Other Relaxation Techniques

Whenever we encounter a stressful event, our bodies undergo a series of hormonal and biochemical changes that put as in ‘alarm mode.’ Our heart rate increases, adrenaline rushes through our blood stream, and our digestive and immune systems temporarily shut down. If the stressors continue and we stay on high alert for a prolonged period of time, we experience exhaustion and burn out.
Yoga
Yoga is a broad term for a series of practices that were developed over several millennia to bring practitioners into a state of wholeness and completeness. The Sanskrit word yoga, which literally means ‘to unite,’ has many branches, including Hatha Yoga. Hatha Yoga consists of concentration techniques, breathing exercises, dietary guidelines, and a series of stationary or moving poses—also called asanas. These body movements are what we commonly refer to today when we use the word ‘yoga.’
The health benefits of yoga are tremendous. Feeling better physically counters the effects of stress. Yoga produces the following physical health benefits:

• improves flexibility and muscle joint mobility
• strengthens and tones muscles
• increases stamina
• relief from back pain
• increases vitality and improves brain function
• improves digestion and elimination
• decreases cholesterol and blood sugar levels
• increases circulation
Meditation
The history of meditation goes back even further than that of Hatha Yoga, with its origins beginning around 3,000 B.C.E. Meditation evolved as a way for the ancient spiritual seers—known in India as Rishis—to gain direct knowledge of the nature of the Ultimate Reality. Today, meditation is recognized for its myriad health benefits, and is widely practiced as a way to counteract stress. Meditation brings together all the energies of the mind and focuses them on a chosen point: a word, a sound, a symbol, an image that evokes comfort or one’s own breathing. It is typically practiced in a quiet, clean environment in a seated posture with the eyes closed.
Some other activities that Relieve Stress
Sleep – While there are many things you can do to reduce stress, the first line of defense against stress is to make sure you are getting enough sleep. Sleep restores the body systems and provides rejuvenation.
Cardiovascular exercise – Exercise is good for the mind, not just the body. Exercise can help with stress relief because it provides a way for the body to release tension and pent-up frustration. It can also help stave off the depression that can set in when stress levels become too high by raising the output of endorphins, one of the ‘feel good’ chemicals in the brain. Any form of exercise can combat stress, but it is important that the activity be enjoyable, vigorous enough to discharge energy, and have a relaxing effect when u r finished.
Spending time in nature – Psychologists today recognize the mental health benefits of spending time in to bring greater body awareness as a way to let go of mental stress. From taking walks in your neighborhood, to observing animals in the wild, to planting the garden.
Massage Therapy – A professional massage from a trained therapist can provide soothing, deep relaxation and can improve physiological processes such as circulation. A stress-relieving massage targets specific muscles that may be tense and painful. As the tense muscles relax, so does your entire body as well as your overstressed mind.


Anxiety

We all know what it’s like to feel anxious. Most of us experience anxiety when we’re faced with stressful situations or traumatic events. Our heart may pound before a big presentation
We worry and fret over family problems or feel jittery at the prospect of asking our boss for a raise. Anxiety is part of our natural “fight-or-flight” response. It’s our body’s way of warning us of danger ahead. And for the most part, anxiety is adaptive. It gears us up for life’s challenges and spurs us to action when we’re faced with a threat. However, if anxiety is preventing you from living your life the way you’d like to, you may be suffering from an anxiety disorder.
Anxiety attack
Anxiety attacks, also called panic attacks, are unexpected episodes of intense terror or fear. Anxiety attacks usually come without warning, and although the fear is generally irrational, the perceived danger is very real. A person experiencing an anxiety attack will often feel as if they are about to die or pass out.
Symptoms of an anxiety attack include:
• Shortness of breath
• Palpitations or pounding heart
• Chest pain or discomfort
• Trembling or shaking
• Dizziness
• Nausea or stomach distress
• Fear of losing control or going crazy
Anxiety disorder
According to the National Institute of Mental Health, anxiety disorders are the most common type of mental illness in the U.S., with approximately 40 million people over the age of 18 affected each year. Anxiety disorders can take many forms. You may experience free-floating anxiety without knowing exactly why you’re feeling that way. You may suffer from sudden, intense panic attacks that strike without warning. Your anxiety may come in the form of extreme social inhibition or in unwanted obsessions and compulsions. Or you may have a phobia of an object or situation that doesn’t seem to bother other people.
Symptoms of anxiety disorders
The primary symptoms of anxiety disorders are fear and worry. However, anxiety disorders are also characterized by additional emotional and physical symptoms.
Emotional/Psychological Symptoms
• Apprehension, uneasiness, and dread
• Impaired concentration or selective attention
• Feeling restless or on edge
• Avoidance
• Hyper vigilance
How is anxiety disorders diagnosed?
If you’ve experienced intense anxiety or worry for six months or more, you may be suffering from an anxiety disorder. Worry that interferes with your work, relationships, and activities is also a red flag that you’ve crossed from normal worrying into the territory of anxiety disorders. If your anxiety and fears have become so great that they are causing extreme distress or disrupting your daily routine, it is important to seek out help.
First, you should consult with a doctor to rule out possible medical conditions. Some medications or diseases create anxiety-like symptoms such as rapid heartbeat, dizziness, nausea, and nervousness. A change in medication or the correct diagnosis of a medical illness may take care of your anxiety problem. Your doctor will give you a physical examination and may also run some laboratory tests.
Medication
A variety of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs, antidepressants, and beta-blockers. Medication is sometimes used in the short-term to alleviate severe symptoms so that other forms of therapy can be pursued. Anxiety medications can be habit forming and may have unwanted side effects, so be sure to research your options. Read about the types of medications prescribed for anxiety disorders, along with an in-depth look at the risks and benefits in Medications for Anxiety.

Medical Conditions Which Can Mimic or Cause Anxiety
• Thyroid Disorders
• Diabetes
• Hypoglycemia
• Asthma
• Sleep Disorders • Adrenal Disorders
• Epilepsy
• Certain heart conditions
• Migraines
• Other psychiatric illness
What is Obsessive-compulsive disorder?
Obsessions are intrusive, irrational thoughts -- unwanted ideas or impulses that repeatedly well up in a person's mind. Again and again, the person experiences disturbing thoughts, such as "My hands must be contaminated; I must wash them"; "I may have left the gas stove on"; "I am going to injure my child." On one level, the sufferer knows these obsessive thoughts are irrational. But on another level, he or she fears these thoughts might be true. Trying to avoid such thoughts creates great anxiety.
Compulsions are repetitive rituals such as hand washing, counting, checking, hoarding, or arranging. An individual repeats these actions, perhaps feeling momentary relief, but without feeling satisfaction or a sense of completion. People with OCD feel they must perform these compulsive rituals or something bad will happen.
Most people at one time or another experience obsessive thoughts or compulsive behaviors. Obsessive-compulsive disorder occurs when an individual experiences obsessions and compulsions for more than an hour each day, in a way that interferes with his or her life.
What are other examples of behaviors typical of people who suffer from OCD?
People who do the following may have OCD:
• Repeatedly check things, perhaps dozens of times, before feeling secure enough to go to sleep or leave the house. Is the stove off? Is the door locked? Is the alarm set?
• Fear they will harm others. Example: A man's car hits a pothole on a city street and he fears it was actually a body.
• Feel dirty and contaminated. Example: A woman is fearful of touching her baby because she might contaminate the child.
• Constantly arrange and order things. Example: A child can't go to sleep unless he lines up all his shoes correctly.
Is heredity a factor in OCD?
Yes. Heredity appears to be a strong factor. If you have OCD, there's a 25-percent chance that one of your immediate family members will have it. It definitely seems to run in families.
Can OCD be effectively treated?
Yes, with medication and behavior therapy. Both affect brain chemistry, which in turn affects behavior. Medication can regulate serotonin, reducing obsessive thoughts and compulsive behaviors.
Panic Attack
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reach a peak within 10 minutes:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. Fear of losing control or going crazy
11. Fear of dying
12. Parasthesia (numbness or tingling sensation)

What causes Panic attacks?
Most researchers have found that they are caused by an abnormality in the part of the brain which tells the brain how much Carbon Dioxide (CO2) is in the blood. If your brain finds there is getting to be too much CO2, it usually means that you are not breathing fast enough, or there is too much CO2 in the air (for example, in a room with no ventilation or a cave). So your body sends all sorts of signals to increase breathing and a rush of adrenaline to help you get out of wherever you are in a hurry. This is a great thing if you are in a fire.

It is thought that in Panic attacks this Carbon Dioxide sensor is too sensitive, and tells the brain there is not enough Carbon Dioxide when there is just plenty. So a person could be just sitting quietly and then BOOM, this rush of adrenaline and fast breathing appears out of nowhere. Since there is no reason outside the body to be worried, most people will start thinking there is something horribly wrong with their own body.
Phobias
Phobias – A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the thing you fear.
Separation Anxiety Disorder
Agoraphobia and Panic attacks often go together. More recently it has been discovered that Panic attacks and agoraphobia are much more common in children who currently have Separation Anxiety Disorder or had it in the past. What is Separation Anxiety Disorder?
It is a worry about being away from home or about being away from parents which is way out of line for that child's age, culture, and life.
So if a child worries about being away from his mother while at preschool at age 4 for a few weeks, that isn't Separation Anxiety Disorder.
If a child is very concerned about their mother and is calling her at home. That is unusual, but if the mother just got out of cancer treatment the week before, that is not Separation Anxiety Disorder.


Signs of Separation Anxiety Disorder
• Getting nervous if the parent is going to leave, even if they haven't left yet.
• Examples would be a young child having a tantrum when the mother starts to get her work clothes on or an older child noticing that in two hours the mother is leaving and starting to have panic symptoms.
• Worrying that something bad is going to happen to a parent.
For example, a young child goes in at night to make sure parents are still breathing in their beds. A child calls all relatives in the area because the mom is 10 minutes late. A teenager has to stay home from school to watch mom because the mother is slightly ill.
• An older child still sleeping with parents. A child wants to sleep with sibling or will not sleep at all. A teenager wanting room right next to parents.
• All the signs of Panic attacks occurring when parent is leaving or child are forced to leave.
• Common ones are severe headaches, nausea, vomiting, shortness of breath and diarrhea right before school or before parent goes to work.
Social anxiety and social phobia
If you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia.



Abuse and Neglect

What is Abuse?

There are three definitions used to describe abuse
• Physical Abuse -- an unexplainable, non-accidental injury to the child.
• Emotional Abuse -- continual scapegoat or rejection of a child by parents which results in disturbed behavior.
• Sexual Abuse -- any sexually oriented act, practice, contact, or interaction in which the child has been used for sexual stimulation of an adult.

What is Neglect?
Neglect is typically defined in two ways.
Emotional Neglect
This is when the child is suffering severe negative emotional effects to a parent's failure to provide opportunities for normal experience that produce feelings of being loved, wanted, secure, and worthy.
Physical Neglect
This is when a parent fails to provide basic needs or a safe and sanitary
Living environment for the child. Examples include, but are not limited to:
• Not providing adequate food or clothing,
• Not following medical recommendations,
• Lack of supervision that places a child at risk, or
• No heat in the winter.



Types of Abuse
• CHILD ABUSE
• ELDER ABUSE
• DOMESTIC ABUSE

Child Abuse
Child abuse is both shocking and commonplace. Child abusers inflict physical, sexual, and emotional trauma on defenseless children every day. The scars can be deep and long-lasting. Unfortunately, the more subtle forms of child abuse such as neglect and emotional abuse can be even more traumatizing than violent physical abuse.
What is Child Abuse?

Child abuse consists of any act, or failure to act, that endangers a child's physical or emotional health and development. Someone is abusive if he she fails to nurture the child, physically injures the child, or relates sexually to the child.

Types of Child Abuse

The four major types of child abuse are:

• Physical abuse
• Sexual abuse
• Emotional abuse
• Neglect
Physical Abuse
Physical child abuse is an injury resulting from physical aggression. Even if the injury was not intended, the act is considered physical abuse.
The injury from physical child abuse may be the result of:
• Beating, slapping, or hitting
• Pushing, shaking, kicking, or throwing
• Pinching, biting, choking, or hair-pulling
• Burning with cigarettes, scalding water, or other hot objects
• Severe physical punishment.
Signs of Physical child Abuse
• Burns, bite marks, cuts, bruises, or welts in the shape of an object
• Resistance to going home
• Fear of adults

Sexual Child Abuse
Sexual abuse of a child is any sexual act between an adult and a child. This includes:
• Fondling: touching or kissing a child's genitals; or making a child fondle adult's genitals
• Violations of bodily privacy: forcing the child to undress, spying on a child in the bathroom or bedroom
• Child pornography: using a child in the production of pornography, such as a film or magazine
• Exposing children to pornography (movies, magazines, or websites) or enticing children to pornographic sites on the Internet
• Luring a child for sexual liaisons, through the Internet or by any other means
• Exposing children to adult sexuality in any form (showing sex organs to a child, forced observation of sexual acts, telling "dirty" stories, group sex)
• Child prostitution or sexual exploitation (using a child to perform sex with others)
• Sexual acts with a child: penetration, intercourse, incest, rape, oral sex, sodomy
Regardless of the child's behavior or reactions, it is the responsibility of the adult not to engage in sexual acts with children. Sexual abuse is never the child's fault.
Sexual child abusers can be:
• mothers, fathers, siblings, or other relatives
• childcare professionals or babysitters
• clergy, teachers, or athletic coaches
• foster parents or host families of foreign-exchange students
• neighbors or friends
Some signs of sexual child abuse
• Inappropriate interest in or knowledge of sexual acts.
• seductiveness
• Avoidance of things related to sexuality, or rejection of own genitals or body.
• Either over compliance or excessive aggression.
• Fear of a particular person or family member.
Emotional Child Abuse
Emotional child abuse is another person’s attitude, behavior, or failure to act that interferes with a child's mental health or social development. Surprisingly, emotional abuse can have more long-lasting negative psychiatric effects than either physical abuse or sexual abuse.
Other names for emotional abuse are:
• Verbal abuse
• Mental abuse
• Psychological maltreatment or psychological abuse
Emotional abuse can range from a simple verbal insult to an extreme form of punishment. The following are examples of emotional child abuse:
• Ignoring, withdrawal of attention, or rejection lack of physical affection such as hugs
• Lack of positive reinforcement, such as praise or saying "I love you"
• Yelling or screaming
• Threatening or frightening
• Negative comparisons to others
• Belittling; telling the child he or she is "no good," "worthless," "bad," or "a mistake"
• Shaming, humiliating, or name-calling
• Habitual blaming
• Using extreme forms of punishment, such as confinement to a closet or dark room, tying to a chair for long periods of time, or terrorizing a child
• Child exploitation, such as child labor
• Witnessing the physical abuse of others
• Child kidnapping
• Parental child abduction or child stealing Emotional abuse is almost always present when another form of abuse is found. (Some overlap exists between the definitions of emotional abuse and emotional neglect.)
Emotional child abuse can come from adults or from other children:
• parents or caregivers
• teachers or athletic coaches
• siblings
• bullies at school or elsewhere
• middle- and high-school girls in social cliques
Some signs of emotional child abuse
• Apathy, depression
• Hostility
• Difficulty concentrating

Neglect and Children
“More children suffer from neglect...than from physical and sexual abuse combined.”
Neglect is a very common type of child abuse, yet victims are not often identified, primarily because neglect is a type of child abuse that is an act of omission, of not doing something.
Neglect is a pattern of failing to provide for a child's basic needs. A single act of neglect might not be considered child abuse, but repeated neglect is definitely child abuse.
The types of neglect are:
• physical neglect,
• educational neglect, and
• Emotional neglect.
Physical neglect
Physical neglect is not providing for a child's physical needs, which are:
• food
• clothing appropriate for the weather
• supervision
• a home that is hygienic and safe
• medical care, as needed
Educational neglect
Educational neglect is the failure to enroll a school-age child in school or to provide necessary special education. This includes allowing excessive absences from school.
Emotional (psychological) Neglect
Emotional neglect is not providing emotional support and love, which is:
• affection
• attending to the child’s emotional needs
• psychological care, as needed
Some signs of neglect of a child
• clothing unsuited to the weather
• being dirty or un bathed
• extreme hunger
• apparent lack of supervision

Results of Child Abuse
Child abuse can have dire consequences, during both childhood and adulthood. Child abuse may result in:
• impaired social behavior, antisocial behavior, and difficulty establishing intimate personal relationships
• alienation and withdrawal
• depression, anxiety, low self-esteem, feelings of worthlessness, self-injury,
• suicidal tendencies
• substance abuse and high levels of medical illness
• eating disorders or drastic changes in appetite
• problems in school or work
• impaired psychological development; personality disorders
• abusive parenting or care giving
• prostitution (in the case of sexual abuse)
• cognitive disorders
• a distorted view of sex, and difficulty relating to others except on sexual terms (in the case of sexual abuse)
• nightmares and bed wetting
• death of a child; or death of the abuser, if the child eventually fights back

Prevention or Stopping Child Abuse
Mental health professionals and others can prevent child abuse by:
• Establishing educational programs to teach caregivers good parenting and coping skills.
• Making people aware of alternatives to abusive behaviors so that they seek help for their own abusive tendencies.
• Educating the public about abuse so that people report abuse early enough for intervention.
• Establishing relationships of trust with children so that they feel comfortable disclosing abuse.


Elder Abuse
Elder abuse has reached epidemic proportions in the United States. Elderly people may be more vulnerable to abuse than others because of social isolation and mental impairment. Abuse of the elderly can occur in the elder's home, in a nursing home, or in public. The elder, just like the young child, may not know how to stop the abuse and will therefore have to suffer relentlessly.
Definition of Elder Abuse
Elder abuse is the intentional or unintentional hurting, either physical or emotional, of a person who is age sixty or older.
Types of Elder Abuse
Elder abuse usually occurs in one of two locations:
• domestic elder abuse (in the elder's home)
• institutional elder abuse (in a nursing home or other long-term-care facility)

The types of senior abuse are:
• Physical abuse of the elderly
• Emotional abuse of the elderly (psychological or verbal)
• Neglect or abandonment of elders by caregivers
• Self-neglect by elders
• Sexual abuse of the elderly
• Financial exploitation of seniors (elder financial abuse)
• Healthcare fraud or healthcare abuse of the elderly
Nursing Home Elder Abuse
Most elder abuse occurs at home. However, a significant proportion of elder abuse occurs in long-term-care facilities, such as in nursing homes, out of sight of the general public. Nursing home abuse can take any form: physical abuse, emotional abuse, sexual abuse, neglect, financial exploitation, or healthcare abuse. Elder abuse in nursing homes has recently gained media attention, and a federal program has been established to help prevent and resolve such abuse of the elderly.
Physical Abuse of the Elderly
Physical abuse is
• physical force that results in injury, impairment, or physical pain, or
• the threat of such physical force
Physical violence against an elder in the home is a form of domestic violence. The injury from physical abuse may be from physical punishment of any kind, such as:
• beating, whipping, hitting (with or without an object), paddling, slapping, or punching
• pushing, shoving, shaking, choking, or throwing
• kicking, pinching, biting, or scratching
The practice of physically restraining elders in a nursing home is particularly troublesome and controversial. Physical restraint may sometimes seem necessary if the elder wants to get up and move around, but is unable to walk without falling. Where staffing is low, the elder cannot be left alone, so the staff uses physical restraints to keep the person in bed or in a chair. If the senior resists the physical restraints, the staff medicates them so that they are more compliant with the restraints.

Signs of physical abuse
Symmetric injuries on two sides of the body.
• unexplained bruises, pressure marks, black eyes, welts, lacerations, cuts, or burns
• bone fractures or broken bones
• sprains or dislocations
• internal injuries or bleeding
• bite marks
• broken eyeglasses or frames
• signs of being restrained, such as rope marks

Emotional Neglect (Psychological Neglect) Of The Elderly
Emotional neglect is a lack of basic emotional support, respect, and love, such as:
• not attending to the elder; ignoring moans, calls for help, or hospital call bells
• inattention to the elder's need for affection
• failure to provide necessary psychological care to the senior, such as therapy or medications for depression
• isolation of the elder from the outer world, including restriction of phone calls, mail, visitors, and outings
• lack of assistance in doing interesting activities, such as watching preferred television programs or going out for cultural or intellectual activities
Signs or symptoms of emotional abuse
• apathy, withdrawal, depression, non-communication
• sucking, biting, or rocking (behaviors usually attributed to dementia)
• caregiver behaviors such as belittling, threats, or other powerful or controlling behavior




Elder Self-Neglect
Elders can neglect themselves by not caring about their own health or safety. Elder self-neglect can lead to illness or injury. The senior may deny themselves or ignore the need for:
• food or water
• bathing or other personal hygiene
• proper clothing for the weather
• shelter, adequate safety, or clean surroundings
• essential medications or medical attention for serious illness
In addition, self-neglectful elders may have the following behaviors:
• hoarding
• leaving a stove on, but unattended
• confusion
Signs and symptoms of elderly self-neglect
• dehydration or malnutrition
• physical weakness
• foul body odor, poor personal hygiene
• foul household odor
• human or animal feces and urine in the house
• medical conditions left untreated
• lack of medical aids such as hearing aids, glasses, or dentures
• homelessness

Sexual Abuse of the Elderly
Elder sexual abuse is sexual contact with an elder without that person's consent. This includes:
• coerced nudity
• fondling, touching, or kissing, particularly the genitals
• making the elderly person fondle someone else's genitals
• forcing the elder to observe sexual acts
• photographing the elder in sexually explicit ways
• sexual assault of any type (coercion to perform sexual acts), including rape or sodomy
Signs and symptoms of sexual abuse
• bruises around the breasts or genitals
• unexplained venereal disease or genital infections
• unexplained vaginal or anal bleeding
• torn, stained, or bloody underclothing
Financial Exploitation of the Elderly
Financial or material exploitation of an elder is when someone illegally or improperly uses an elder's assets, funds, or property. Because elderly people are sometimes unable to hear or see well or to be as forceful physically or verbally as they used to be, they are easy targets for exploitation. The financial abuser may take, misuse, or conceal the elder's belongings or money. The financial abuser can be a family member; a caregiver or caretaker; a professional, such as an accountant, lawyer, doctor, or banker; a new boyfriend, girlfriend, spouse; or partner; or a stranger.

A caregiver who financially exploits an elder takes control of the elder's world. The caregiver might isolate the senior from the outside world, handle all financial matters, withhold food and medicine to weaken the elder, and psychologically abuse the elder so that’s/he is afraid of doing anything about the situation.
Signs and symptoms of financial or material exploitation of seniors
• elder's withdrawal of a large sum of money from the bank when accompanied by another person
• numerous withdrawals from the elder's bank account, particularly in round amounts, such as $100 or $500
• large checks written to unusual recipients
• names being added to the senior's bank account signature card
• objects or money missing from the senior's household
• withdrawals from investments in spite of penalties for early withdrawal
• abrupt changes in wills, trusts, contracts, the power of attorney, the durable power of attorney, property titles, deeds, or mortgages
Healthcare Abuse of the Elderly
Healthcare fraud or abuse is less visible than some other forms of elder abuse. Healthcare abuse includes:
• not providing healthcare, but charging for it
• overcharging or double-billing for medical care or services
• getting kick-backs for referrals to other providers or for prescribing certain drugs
• patient abuse or neglect in a hospital, at home, or in a residential care setting
• overmedicating or under medicating
• recommending fraudulent remedies for illnesses or other medical conditions
Signs and symptoms of healthcare abuse
Duplicate billings for a medical service or device
• the count of pills left in a container is either under or over the expected amount for the period of time for which they were prescribed
• lack of or inadequate medical care, even though bills are being paid
• in the elder's living space, a huge number of remedies for various medical conditions, including many non-prescription remedies
Causes of Elder Abuse
Sometimes those who care for elders are not suited to the requirements of the job, and they allow themselves to vent their impatience, frustration, and anger on the elder whom they are supposed to be protecting and nurturing.
In nursing homes, in particular, staff may be prone to elder abuse because of:
• insufficient staffing
• lack of training
• stressful working conditions
• staff burnout

Taking care of the elderly, whether at home or in an institution, can be very stressful. The incidence of depression is very high among caregivers. Caregivers habitually lack exercise and outdoor time, have inadequate nutrition, and need more sleep. Many people with dementia have trouble sleeping, so caregivers are kept up caring for them. Caregivers have a high level of anxiety. Because stress affects the heart and cardiovascular system, the stresses of care giving can even lead to death in the caregiver.
The amount of stress that the caregiver experiences depend upon:
• the elder's type of disease or dementia
• the progression of the elder's requirements for care: at first, care may have been mundane errands or financial management, but the needs may have progressed to helping to eat, bathe, and toilet
• how the caregiver perceives the responsibility of caring for the elder (burdensome or not)
• what the elder thinks about the caregiver
• how close the elder and caregiver were before and how close they are now
• how the caregiver copes with stress, in general (resilience)
• whether others help with the care giving

Who abuses the elderly?
Most elder abuse occurs in the elder's home, and the abuser is usually a family member. Most commonly, the perpetrators of elderly abuse are spouses or partners of elders. Next most frequent abusers are the adult children of elders.
Abusers can be men or women. Men ages thirty-six to fifty are the most common perpetrators.
In nursing homes and other long-term-care facilities, the abusers may be employees, outside visitors, or intruders.
Anyone associated with an elder may abuse them: friends, relatives, doctors, lawyers, bankers, accountants, clergy, caregivers, or strangers.
Results of elder abuse
Elder abuse can have a host of resultant conditions:
• inability to move (immobility)
• incontinence
• longer time to heal
• pressure sores or bed sores
• dehydration, malnutrition, or starvation
• depression
• loss of dignity or self-esteem
• loss of friendships and companionship
• loss of assets, poverty, homelessness
• criminal attack (due to lack of precautionary measures)
• worsening or irremediable medical conditions
• death
Tips to Prevent Elderly Abuse

Elders themselves are unlikely to be on the forefront of prevention of elder abuse. Elders are most often silent in their suffering because they may be physically unable to speak out and because society does not listen well. One of the ironies of elder abuse is that younger people may be too busy to listen or act..
Prevention is especially important because the majority of elder abuse cases go unreported. We cannot even count how many elderly abuse cases we prevent by making changes that stop abuse. Through prevention, we can make elders' last years more pleasant, and we can save elders' lives.
Key elements in the prevention of elder abuse are:
• Educate
• Enforce
• Intervene
The public can help to prevent elder abuse by helping to educate seniors, professionals, caregivers, and others about elder abuse. If you cannot directly help, you can volunteer or donate money to the cause of educating people about elder abuse. Encourage law enforcement agencies to prosecute elder abuse when they find it. Mental health professionals, social workers, nurses, and lawyers can step up interventions.
Caretakers can prevent abusing their elderly charges by doing the following:
• Stay healthy and get medical care for yourself when necessary.
• Get professional help for drug or alcohol abuse, which can lead to elder abuse.
• Seek counseling for depression, which can lead to elder abuse.
• Make contact with domestic violence prevention services.
• Find a support group for spouses, partners, or grown children caring for the elderly.
Family members and friends who are not caregivers of the elder can help to prevent abuse:
• Watch for warning signs that might indicate elder abuse.
• Make sure that the elderly person is eating properly and taking required medications. A weakened elder cannot think clearly about the care being given.
• Scan bank accounts and credit card statements for unauthorized transactions, if you can get access permission from the elder. Watch for possible financial exploitation.
• Call and visit as frequently as you are able. Keep the lines of communication open so that the elder feels comfortable talking about abusive behaviors?
• Gain trust so that the elder allows you more oversight in financial and caretaking matters.


Domestic Abuse


Domestic abuse between spouses or intimate partners is when one person in the relationship tries to control the other person. The perpetrator uses fear and intimidation and may threaten to or actually use physical violence. Domestic abuse that includes physical violence is called domestic violence.

The victim of domestic abuse or domestic violence may be a man or a woman. Domestic abuse occurs in traditional heterosexual marriages, as well as in same-sex partnerships. The abuse may occur during a relationship, while the couple is breaking up, or after the relationship has ended.
The key elements of domestic abuse are:
• Intimidation
• Humiliation
• Physical injury
Types of Domestic Abuse
The types of domestic abuse are:
• Physical abuse (domestic violence)
• Verbal or nonverbal abuse (psychological, mental, or emotional abuse)
• Sexual abuse
• Stalking or cyber-stalking
• Economic abuse or financial abuse
• Spiritual abuse
The divisions between these types of domestic abuse are somewhat fluid, but there is a strong differentiation between the various forms of physical abuse and the various types of verbal and nonverbal abuse.
Physical Abuse of a Spouse or Intimate Partner
When someone talks of domestic violence, they are often referring to physical abuse of a spouse or intimate partner. Physical abuse is the use of physical force against another in a way that ends up injuring that person or putting him or her at risk of being injured. Physical abuse ranges from physical restraint to murder. Physical assault or physical battering is a crime, whether it occurs inside or outside the family.
• Pushing, throwing, and tripping.
• Slapping, hitting, punching, and kicking.
• Grabbing, choking, and shaking.
• Pinching, biting.
• Holding, restraining, confinement.
• Assault with a weapon.
• Burning or freezing.
• Throwing things.

Emotional Abuse or Verbal Abuse of a Spouse or Intimate Partner
Mental, psychological, or emotional abuse can be verbal or nonverbal. Verbal or nonverbal abuse of a spouse or intimate partner consists of more subtle actions or behaviors than physical abuse. While physical abuse might seem worse, the scars of verbal and emotional abuse are deep.
Sexual Abuse or Sexual Exploitation of a Spouse or Intimate Partner
Sexual abuse often is linked to physical abuse. According to the National Coalition against Domestic Violence, abusers who are physically violent toward their intimate partners are often sexually violent as well. Furthermore, women who are both physically and sexually abused are at a higher risk of being seriously injured or killed.
Sexual abuse includes:
• Sexual assault – Forcing someone to participate in unwanted, unsafe, or degrading sexual activity.
• Sexual harassment – Using unwanted sexual advances to gain power over someone.
• Sexual exploitation – Examples include forcing someone to look at pornography or participate in pornographic filmmaking.
Economic or Financial Abuse of a Spouse or Domestic Partner
• Withholding economic resources such as money or credit cards.
• Stealing from or defrauding a partner of money or assets.
• Exploiting the intimate partner’s resources for personal gain.
• Withholding physical resources such as food, clothes, necessary medications, or shelter.
• Preventing the spouse or intimate partner from working or choosing an occupation.
Spiritual Abuse of a Spouse or Intimate Partner
• Using the spouse’s or intimate partner’s religious or spiritual beliefs to manipulate them.
• Preventing the partner from practicing their religious or spiritual beliefs.
• Ridiculing the other person’s religious or spiritual beliefs.
Causes of Domestic Abuse or Domestic Violence
An individual who was abused as a child or exposed to domestic violence in the household while growing up is at an increased risk of becoming either an abuser or the abused in his or her adult relationships. In this way, domestic violence and abuse is transmitted from one generation to the next. This cycle of domestic violence is difficult to break because parents have presented abuse as the norm. Other factors that can lead to domestic abuse include:

• Stress
• Economic hardship
• Depression
• Jealousy
• Mental illness
Effects of Domestic Violence or Abuse
The adverse effects of domestic violence or abuse can be very long-lasting. People who have been abused by a spouse or intimate partner often suffer from:
• Depression
• Anxiety attacks
• Low self-esteem
• Lack of trust in others
• Feelings of abandonment
• Anger
• Sensitivity to rejection
• Chronic health problems
• Sleeping problems
Effect of Domestic Violence on Children
Children who witness domestic violence may develop serious emotional, behavioral, developmental, or academic problems. As children, they may become violent themselves, or withdraw. Some act out at home or school; others try to be the perfect child. Children from violent homes may become depressed and have low self-esteem.
As they develop, children and teens that grow up with domestic violence in the household are more likely to:
• Exhibit violent and aggressive behavior.
• Attempt suicide.
• Use and abuse drugs.
• Commit crimes, especially sexual assault.
• Become abusers in their own relationships later



Alcohol Abuse and Alcoholism




Difference between Alcohol Abuse and Alcoholism
Alcohol abuse, also called “problem drinking,” is a pattern of excessive drinking that result in adverse health and social consequences to the drinker, and often to those around the drinker. In cases of alcohol abuse, the person using alcohol in a destructive way has the ability to change his or her drinking habits. Alcoholism, or alcohol dependence, is characterized by an addiction to alcohol that is out of the drinker’s control—he or she cannot stop using alcohol despite the severe physical, mental, emotional, and spiritual consequences. Alcoholism is a chronic, progressive disease that can be fatal if left untreated.
People with an alcohol abuse problem:
• Use alcohol to help them change the way they feel about themselves and/or some aspect of their lives.
• Experience some problems associated with their alcohol use but use those experiences to set appropriate limits on how much and how often they drink.


People who are addicted to alcohol:
• Experience negative consequences associated with drinking but continue to drink despite those consequences.
• Set limits on how much or how often they will drink but unexpectedly exceed those limits.
• Promise themselves and/or other people that they will drink in moderation but break those promises.
• Feel guilty or remorseful about their drinking but still fail to permanently alter the way they drink.


Signs and symptoms of alcohol abuse and alcoholism

The Mayo Clinic provides a list of signs and symptoms that indicate that an abusive relationship to alcohol exists:
• Drinking alone or in secret
• Not remembering conversations or commitments—sometimes referred to as "blacking out"
• Making a ritual of having drinks before, with or after dinner and becoming annoyed when this ritual is disturbed or questioned
• Losing interest in activities and hobbies that used to bring pleasure
• Irritability as usual drinking time nears, especially if alcohol isn't available
• Keeping alcohol in unlikely places at home, at work or in the car
• Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel "normal"
According to The National Institute on Alcohol Abuse and Alcoholism, the following four additional symptoms indicate that an alcohol abuse problem has developed into an addiction to alcohol:
• Craving – A strong need, or urge, to drink
• Loss of control – Not being able to stop drinking once drinking has begun
• Physical dependence – Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking
• Tolerance – The need to drink greater amounts of alcohol to get "high."
Causes or of alcoholism
Alcoholism is a disease with multiple causes that combine uniquely for every drinker who eventually becomes alcoholic. One or more of these causes may predominate, but in each case the risk factors are well known:
• Brain chemistry imbalance – As a person engages in a regular habit of drinking, chemical changes in the brain take place. Alcohol consumption depletes gamma-amino butyric acid (GABA), the chemical responsible for inhibiting impulsiveness, and it increases the production of glutamate (which excites the nervous system) and more epinephrine (a stress-producing hormone).
• Genetics – It is estimated that half of all cases of alcoholism are primarily caused by genetics. One study showed that the amygdale—the area of the brain thought to play a role in emotional craving—was smaller in individuals with a family history of alcoholism.
• Mental and emotional stress – Since alcohol blocks emotional pain, it is frequently resorted to as a “cover up” during times of temporary or ongoing stress or grief such as that experienced with the loss of a loved one or relationship, unresolved family tensions, and chronic work stress.
• Psychological factors – Low self-esteem and depression make one more vulnerable to excessive drinking and alcoholism.
• Social and cultural pressures – The media and popular culture are filled with messages and images that legitimize or even glamorize frequent or excessive drinking. Also, associating with people who are able to drink socially, and encourage the same behavior in those around them, is dangerous to the alcoholic trying to abstain from drinking.

Health effects of alcohol abuse
While some studies have shown that low to moderate alcohol consumption is beneficial for certain conditions, such as heart disease, regular and prolonged use of alcohol leads to a host of health problems, such as:
• Impaired mental functioning – Loss of verbal memory and slower reaction times are associated with drinking, as are mild neurological impairments such as headaches and insomnia.
• Liver disorders – About 10% to 35% of heavy drinkers develop alcoholic hepatitis (damaging inflammation in the liver). And, between 10% to 20% of these individuals develop cirrhosis, a progressive scarring of the liver that can eventually be fatal.
• Gastrointestinal problems – Violent vomiting can produce tears in the junction between the stomach and esophagus. Alcoholism poses a high risk for diarrhea, hemorrhoids, and increases the risk for ulcers
• Heart disease and stroke – Heavy drinking is associated with abnormal blood clotting factors, high blood pressure, and increased risk for stroke, irregular heart beats, and an enlarged heart.
• Lung disorders – Acute alcoholism is strongly associated with very serious pneumonia, and has also been shown as a strong contributing factor in acute respiratory distress syndrome (ARDS), a type of potentially fatal lung failure.
• Cancer – Alcoholics have a rate of carcinoma 10 times higher than that of the general population. Sustained heavy drinking has been implicated in upper digestive system and upper airway cancers, breast cancer (even with moderate intake), esophageal cancer, and vaginal and cervical cancers.
• Skin, muscle, and bone disorders – Severe alcoholism is associated with osteoporosis (loss of bone density), muscular deterioration, skin sores, and itching.

Self-injury
Self-injury (SI) – also known as self-harm or self-mutilation – is defined as any intentional injury to one's own body. It usually either leaves marks or causes tissue damage. It is hard for most people to understand why someone would want to cut or burn himself/herself). The mere idea of intentionally inflicting wounds to oneself makes people cringe. Yet there are growing numbers of young people who do intentionally hurt themselves. Understanding the phenomenon is the first step in changing it.



This behavior is not limited by gender, race, education, age, sexual orientation, socio-economics, or religion. However, there are some commonly seen factors:
• Self-injury more commonly occurs in adolescent females.
• Many self-injurers have a history of physical, emotional or sexual abuse.
• Many self-injurers have co-existing problems of substance abuse, obsessive-compulsive disorder (or compulsive alone), or eating disorders.
• Self-injuring individuals were often raised in families that discouraged expression of anger, and tend to lack skills to express their emotions.


Types of Self-Injury
The most common ways that people self-injure are:
• cutting
• burning (or “branding” with hot objects)
• picking at skin or re-opening wounds
• hair-pulling (trichotillomania)
• hitting (with hammer or other object)
• bone-breaking
• head-banging (more often seen in autistic, severely retarded or psychotic people)
• multiple piercing or multiple tattooing

People Engage In Self-Injury
Even though there is the possibility that a self-inflicted injury may result in life-threatening damage, self injury is not suicidal behavior. Although the person may not recognize the connection, SI usually occurs when facing what seems like overwhelming or distressing feelings. The reasons self-injurers give for this behavior vary:
• self-injury temporarily relieves intense feelings, pressure or anxiety
• self-injury provides a sense of being real, being alive – of feeling something
• injuring oneself is a way to externalize emotional internal pain – to feel pain on the outside instead of the inside
• self-injury is a way to control and manage pain – unlike the pain experienced through physical or sexual abuse
• self-injury is a way to break emotional numbness (the self-anesthesia that allows someone to cut without feeling pain)
• self-abuse is self-soothing behavior for someone who does not have other means to calm intense emotions

Relationship between Self-Injury and Suicide
Self-injury is not suicidal behavior. In fact, it may be a way to reduce the tension that, left unattended, could result in an actual suicide attempt. Self-injury is the best way the individual knows to self-sooth. It may represent the best attempt the person has at creating the least damage. However, self-injury is highly linked to poor sense of self-worth, and over time, that depressed feeling can evolve into suicidal attempts. And sometimes self-harm may accidentally go farther than intended, and a life-threatening injury may result.

How Self-Injuring Person Stop This Behavior
Self-injury is a behavior that becomes compulsive and addictive. Like any other addiction, even though other people think the person should stop, most addicts have a hard time just saying no to their behavior – even while realizing it is unhealthy.
There are several things to do to help you:
• Acknowledge that this IS a problem, that you are hurting on the inside, and that you need professional assistance to stop injuring yourself.
• Realize that this is not about being bad or stupid – this is about recognizing that a behavior that somehow was helping you handle your feelings has become as big a problem as the one it was trying to solve in the first place.
• Find one person you trust – maybe a friend, teacher, minister, counselor, or relative – and say that you need to talk about something serious that is bothering you.
• Get help in identifying what “triggers” your self-harming behaviors and ask for help in developing ways to either avoid or address those triggers
• Recognize that self-injury is an attempt to self-sooth, and that you need to develop other, better ways to calm and sooth yourself.


What is Addiction?
An addiction is a complex illness with physical and psychological symptoms, affecting not only the patient, but their family, friends and social environment too.
If you ask anyone what an addiction is, they'll probably say it's being unable to stop using a substance, for example an illegal drug such as heroin, or maybe alcohol.
Perhaps the best example is cigarette smoking. Anyone who has ever smoked will recognize the strong sense of compulsion to light up, particularly in situations where this is not allowed, such as in an aero plane.
These aspects of addiction have a physiological basis related to how the substance acts on the brain and a psychological aspect relating to the reasons for taking the substance (such as smoking to improve concentration).
There are some people who use substances on a fairly regular basis and over a prolonged period and experience few, if any, problems as a result. For others, however, the capacity to control how often and how much is used seems to erode quickly and a more powerful state of attachment or preoccupation with taking the substance develops.
Stages of Addiction

Most addictions take time to develop and almost no one deliberately sets out to become addicted to a substance. What happen are a person's consumption progresses through several stages?

A person may go on to use the substance again, and perhaps begin to use on an occasional then regular basis. Meanwhile, the amount that's consumed may also begin to increase. For some substances, the body rapidly becomes tolerant of a dose taken and the user will increase the amount to achieve a desired effect.

Addictions and addictive behaviors

Popular conceptions of addiction do not stop at drugs and alcohol. People can become overly attached to gambling, chocolate, computer games - even using the internet. These non-drug addictive behaviors are similar in that the person has a lack of control over their behavior.

There are popular and professional definitions of addiction. In everyday language, we think of someone who is addicted to something as having what could be called an unhealthy habit.

How does addiction start?

People take drugs, for instance, because of their physical effects. They've a marked effect on the body and mind. If there were no effect, people would be unlikely to repeat the experience. No one sets out to become addicted.

Crucially, substances and certain behaviors change the way we feel. If they make us feel better, relax us, make us feel powerful, excite us, let us escape and so on, we tend to go back to them.

What are the risk factors?

There are cultural and social factors that put people at greater risk. For instance, you're less likely to become alcohol dependent growing up in a country where alcohol consumption is unacceptable than where it's a normal part of everyday life. Growing up in a family where there's alcohol or drug abuse increases the risk. This is also the case for people who suffer childhood trauma, abuse and neglect.

Poverty, a lack of education and unemployment can also increase the risks. If your environment is stressful and you feel unable to change it, you may turn to substances for relief. Significant life events may contribute. If your inner world is in turmoil, you may turn to substances as medication to feel better.

Types of Addiction

1. Addicted to heroin

Heroin is extracted from opium poppies and 90% of the illicit heroin that reaches the UK comes from Afghanistan and Burma.

2. Addicted to Alcohol

Alcohol has been an important component of many societies for thousands of years. Of all the drugs available in the UK, alcohol is responsible for more damage and homicides than all the other drugs put together.

3. Nicotine addiction

Nicotine is a stimulant drug and the active ingredient in tobacco, which is a leafy plant grown in many areas of the world.


Effects of Addiction
The effects of addictions are devastating. Not only do they damage your physical and mental health, but they also affect your family and friends.

1. Psychological Effects
2. Physical Effects
3. Effects on Families

1. Psychological Effects
Addiction tends to be so consuming that it affects an addict's thoughts, their feelings and behaviors.
This leads to a feeling of isolation. He may also feel ashamed of feeling unable to cope, and of the addiction that's causing this. To deal with the feeling, he takes more of the drug. His relationship with the drug excludes people, so people avoid him. The result is increased isolation - a vicious circle.
It's important to realize that the psychological effects of addiction aren't only experienced by the person who misuses alcohol and/or drugs, but also by those who are personally involved with them, such as families, friends, and colleagues.
Some, like shame and guilt, come from finding you behaving in ways that are at odds with your personal values and beliefs.

2. Physical Effects
Physical Effects concentrate on the physical consequences of chemical abuse; there are many other equally devastating effects on other aspects of a person's health.

Alcohol
Alcohol contributes to innumerable deaths on the road. The cumulative effects of excessive alcohol consumption, especially when associated with a poor diet, affect every part of the body. The two main sites of damage are the liver and the nervous system.

Cocaine
Its intense psychological addictive properties have led to a phenomenal explosion in use. Cocaine is obtained from the juice of the coca plant. Its leaves have been chewed for centuries by the local people as a tonic. Cocaine raises blood pressure and also constricts blood vessels.
Nicotine
Nicotine, is used the world over by millions of people for its tranquillizing and mildly mood-elevating properties. It's strongly addictive, and its prolonged withdrawal symptoms of anxiety, mood swings and craving make the habit hard to break.
Opiates
The most commonly abused opiate is heroin, a partially modified version of the drug morphine, which is derived from the juice of the opium poppy. The harm to the body from the method of using heroin is enormous. Smoking heroin often causes an asthma-like condition and a severe cough.
By sharing injecting equipment with other individuals who've been infected, or through prostitution, injecting heroin users are prone to serious liver disease - hepatitis B and hepatitis C - and HIV (AIDS).

Tranquillizers
Addiction to prescription tranquillizers is becoming increasingly common, both from legitimately prescribed and illegal sources of supply. They produce little in the way of physical harm, but with long-term use can lead to a variety of psychiatric problems; withdrawal may lead to severe anxiety reactions, nightmares, panic attacks, seizures, hallucinations and other frightening symptoms that can last many weeks, months or even years.




Effects on Families
The degree of distress experienced by families trying to cope with addiction is severely underestimated.

Socially
Through embarrassment and shame, families may decline invitations, stop inviting friends round, hobbies are ignored and the family becomes gradually more isolated - they're unable to tell anyone what's happening.

Mentally
When someone's been laid to many times, when they're searching for evidence to support their suspicions, when they're the focus of someone else's abuse, they start to wonder if they're going crazy.

Emotionally
Living with a drinking or using addict is like being on a roller coaster - with feelings of anger, frustration, helplessness, confusion, hopelessness, desperation, guilt and shame.

Physically
The stress of being on edge all the time, constantly worrying what the next phone call will bring or what you'll find when you open the door, eventually takes its toll on the body. Family members have more than the average degree of health conditions, such as anxiety, depression, headaches, migraines, digestive disorders and heart problems, often resulting in them having to take medication. It's not unusual to find relatives admitting to occasionally having suicidal feelings.

Mental Illness


A Mental illness, as defined in psychiatry and other mental health professions, is an abnormal mental condition or disorder associated with significant distress and/or disfunction. This can involve cognitive, emotional, behavioral and interpersonal impairments, such as suicide and self harm. With the appropriate care and treatment, improvement and/or recovery can happen.

Suicide

Suicide is defined as the act of deliberately taking one's own life. It occurs most often in response to a crisis .During a crisis people experience a wide range of feelings, and each person's response to crisis is different. It is normal to feel frightened or anxious or depressed.
Sometimes problematic circumstances, such as divorce, substance abuse, domestic violence or sexual abuse, complicate and worsen these "growing pains." Dealing with adolescence is difficult enough by itself. When other such problems are added into the mix, life can seem unbearable to the teenager, resulting in feelings of depression, destructive behavior like suicide. If a person feels overwhelmed or unable to cope, he or she may try to commit suicide.
Suicide is a cluster concept, which could not be treated separately from the social and psychological factors compelling a person to contemplate this act.


Causes
Suicide is not caused by any one factor, but likely by a combination of them. Suicide is often a result of depression, loss of self-esteem, and inability to see a positive future. Some factors that influence the attitudes and behaviors of people include:
• Decline in physical, mental and emotional health
• Reduced mobility
• Fear of disability
• Economic and environmental limitations
• Change in relationships, particularly marital status (divorce or death of a spouse)
• Life situations; retirement
• Social isolation
• Substance abuse, especially alcohol
• Prior psychiatric illness, especially clinical depression
Any combination of these factors may lead a person to consider suicide as a solution to a problem or crisis that causes much emotional pain.
When Someone Feels Suicidal

We are born with the ability to take our own lives. Each year a million people make that choice. Even in societies where suicide is illegal or taboo, people still kill themselves.
For many people who feel suicidal, there seems to be no other way out. Death describes their world at that moment and the strength of their suicidal feelings should not be underestimated – they are real and powerful and immediate. There are no magic cures. But it is also true that: Suicide is often a permanent solution to a temporary problem.
When we are depressed, we tend to see things through the very narrow perspective of the present moment. A week or a month later, things may look completely different.
Most people who once thought about killing themselves are now glad to be alive. They say they didn’t want to end their lives – they just wanted to stop the pain.
“Suicide is not chosen; it happens
when pain exceeds
resources for coping with pain.”

When pain exceeds pain-coping resources, suicidal feelings are the result. Suicide is neither wrong nor right; it is not a defect of character; it is morally neutral. It is simply an imbalance of pain versus coping resources.
One can survive suicidal feelings if you do either of two things:
(1) Reduce your pain,
(2) Mental IllnessFind a way to increase your coping resources. Both are possible.
The most important step is to talk to someone. People who feel suicidal should not try to cope alone. They should seek help. Talk to family or friends. Just talking to a family member or a friend or a colleague can bring huge relief.
Talk to a doctor. If someone is going through a longer period of feeling low or suicidal, he or she may be suffering from clinical depression.
Suicide plan
The possibility of suicide is most serious when a person has a plan for committing suicide that includes:
• Having the means, such as weapons or medications, available to commit suicide or do harm to another person. Nearly 3 out of every 5 suicides is committed with a firearm.
• Having set a time and place to commit suicide.
• Thinking there is no other way to solve the problem or end the pain.
People who are considering suicide often are undecided about choosing life or death. With compassionate help, they may choose to live.

Thoughts and Emotions of suicide
• Loneliness – lack of support from family and friends
• Deep sadness or guilt
• Unable to see beyond a narrow focus
• Daydreaming
• Anxiety and stress
• Helplessness
• Los of self-worth
Warning Signs
Suicide is rarely a spur of the moment decision. In the days and hours before people kill themselves, there are usually clues and warning signs. The strongest and most disturbing signs are verbal – ‘I can’t go on,’ ‘Nothing matters any more’ or even ‘I’m thinking of ending it all.’ Such remarks should always be taken seriously. Of course, in most cases these situations do not lead to suicide. But, generally, the more signs a person displays, the higher the risk of suicide.

Situations
• Suffering a major loss or life change
• Family history of suicide or violence
• Sexual or physical abuse
• Death of a close friend or family member
• Divorce or separation, ending a relationship
• Failing academic performance, impending exams, exam results
Behaviors
• Showing a marked change in behavior, attitudes or appearance
• Crying
• Fighting
• Behaving recklessly
• Impulsiveness
• Abusing drugs or alcohol
• Self-mutilation
• Extremes of behavior
Physical Changes
• Lack of energy
• Disturbed sleep patterns – sleeping too much or too little
• Loss of appetite
• Becoming depressed
• Sudden weight gain or loss
• Increase in minor illnesses
• Change of sexual interest
• Lack of interest in appearance

Male Suicide Rates Increase than women
"Far more women suffer from depression that men do, so it seems odd that women would commit suicide at only one-fourth the rate of men. The key difference between the two sexes may be that women talk out their problems. George E. Murphy, an Emeritus professor of psychiatry at Washington University School of Medicine in St. Louis, says that women may be protected because they are more likely to consider the consequences of suicide on family members or others. Women also approach personal problems differently than men and more often seek help long before they reach the point of considering suicide. 'As a result, women get better treatment for their depressions. It's important for people with suicidal feelings to let them be assisted in overcoming deep depression. It's also a good idea to talk about your feelings with friends. No man is an island and there's nothing wrong with leaning on people who love you in times of need.
Youth and elderly suicides are on the increase, Young men commit suicide successfully at a higher rate than women. The ratio between men and women was 4.1:1 while in young people 15-24 the average ratio is 5.5:1 and the ratio increases with age within this group. In white males over 85, the suicide rate was 73.6/100,000 in 1999.

Divorce Doubles Suicide Risk in Men
Divorced or separated men are more than twice as likely to commit suicide as men who remain married. Between 1979 and 1989, 545 of such individual men committed suicide. But divorce and separation do not appear to affect suicide risk in women
'Men were nearly 4.8 times as likely to commit suicide as women, and individuals with less household incomes are more likely to commit suicide than others. Suicide rates are also higher in older age groups, especially those aged 65 and older, and in residents of Western states.
Divorce or marital separation more than doubled the risk of suicide in men, whereas in women, marital status was unrelated to suicide, because women have better ways of communicating. They may have more social support networks, friends and relatives that they talk to, whereas men do not.
Among the Elderly
• Suicide rates are highest among aged 65+.
• Men accounted for 83% of suicides in this category.
• Firearms were the most common method of suicide by both men and women accounting for 77% of men and 33% of women suicides in that age group.
Suicide among the Young
• Persons under 25 account for 15% of all suicides.
• The incidence of suicide has nearly tripled in this age group since 1952.
• Suicide is the third leading cause of death for 15-24 year olds, behind unintentional injury and homicide.
• Among persons 15-19, firearm-related suicides accounted for 62% of the increase in the overall rate of suicide.
Although suicide among young children is a rare event, the dramatic increase in the rate among persons aged 10-14 underscores the urgent need for intensifying efforts to prevent suicide among persons in this age group.
Gays and Suicide
Gays are six times more likely to attempt suicide than their straight counterparts and the numbers increase exponentially. This story appears in the Dec/Jan 99 issue of Genre and examines the issues behind why they are taking their own lives, and offers some solutions. A report from P-FLAG (Parents and Friends of Lesbians and Gays) states that in a study of 5,000 gay men and women, 35 percent of gay men and 38 percent of lesbians have considered or attempted suicide. The statistics are even higher among gay teens: The Department of Health study indicates that gay youth are up to six times more likely to attempt suicide than straight teens, and gay teenagers account for up to 30 percent of all teenage suicides in the nation.
Suicide bombing
Suicide bombing is an explosive attack on people or property where the perpetrator knows they will kill themselves in the action. Attacking both military and civilian targets, the bombers random destruction of innocent lives on public transport, in cafés, markets and discotheques evokes horror and outrage.
The purpose of suicide terrorism is to inflict high casualties at 'low cost', disrupt transport and the economy, and create a climate of fear that pressurizes governments to change policy. Such attacks have a high media impact and demonstrate the victim’s vulnerability. Military historians see suicide bombings as a symptom of 'asymmetric warfare', where one side lacks the means to engage in conve Suicide plan national war but alters the balance of victims through unconventional tactics.

Suicide bombers
The tabloid media profile of a suicide bomber is a desperate, poor, psychotic young male, actively recruited by murderous organizations. He is brainwashed into undertaking a suicide act and lionized by his family and community.
Academics disagree. They describe young single adults aged 18-23, mostly, but not exclusively, male, well-educated, and often living more comfortably than many whose cause they represent. Most are volunteers; few have been long-term members of terror groups and very few have a violent or criminal past. Their families neither know nor approve.
Non-violent alternatives
The use of suicide terror methods compromises those seeking to redress genuine grievances. There are examples of effective non-violent alternatives for peoples and nations seeking freedom and dignity.




How to Help Someone Else

If someone is feeling depressed or suicidal, our first response is to try to help. We should share our own experiences, try to find solutions. We’d do better to be quiet and listen. People who feel suicidal don’t want answers or solutions. They want a safe place to express their fears and anxieties, to be themselves.
We must control the urge to say something – to make a comment, add to a story or offer advice. We need to listen not just to the facts that the person is telling us but to the feelings that lie behind them. We need to understand things from their perspective, not ours.
Help the person break down their problems into more manageable pieces. It is easier to deal with one problem at a time.
They want someone to listen. Someone who will take time to really listen to them. Someone who won’t judge, or give advice or opinions, but will give their undivided attention.
They want someone to trust. Someone who will respect them and won’t try to take charge. They wants someone to care. Someone who will make themselves available put the person at ease and speaks calmly. Someone who will reassure, accept and believe. Someone who will say, ‘I care.’
Suggest that the person see a doctor for a complete physical. Although there are many things that family and friends can do to help, there may be underlying medical problems that require professional intervention. Your doctor can also refer patients to a psychiatrist, if necessary.



World Health Organization
According to the WHO 786,000 people committed suicide around the world in 1999. This is an effective suicide rate of around 10.7 per 100,000 populations per year. To put this statistic in perspective, that is the equivalent of one suicide every forty seconds, somewhere in the world.
Suicide is the ninth leading cause of death in the Pakistan with 31,204 deaths recorded in 1995. This approximates to around one death every seventeen minutes. In Pakistan the upward trend has been very dramatic with almost 3,000 cases of suicide being reported in 2004 nationally. It was also well-known that for every suicide there were at least another 10 to 20 suicide attempts, which means there may be 30,000 to 60,000 cases of attempted suicide in Pakistan.

Suicide prevention grants
Through a competitive process, 14 grants were awarded by MDH to:
• provide education, outreach and advocacy services to populations who may be at risk for suicide;
• Educate family members, spiritual leaders, coaches, employers, school staff, students and others on how to prevent suicide by encouraging interventions and help-seeking.
• Educate populations at risk for suicide on the symptoms of depression and other psychiatric illnesses, the warning signs of suicide, skills for preventing suicides, and making or seeking referrals to mental health care.





Geographic Distribution of (Minnesota Development Health)
Suicide Prevention Grants

Self harm

Self-harm has traditionally been known as self-injury (SI), self-inflicted violence (SIV), self-injurious behavior (SIB), and self-mutilation. A broader definition can also include the phenomenon of those who inflict harm on their bodies by means of disordered eating, or compulsive tattooing or body piercing.

Who self harms?
Young people have the highest rate of self harm, with approximately three teenagers (13-19) harming every hour in the UK. One in ten people have harmed by the age of sixteen. It is thought to be the second highest reason for Hospital Accident and Emergency admissions. Figures suggest that four times more girls harm than boys.
Although these statistics are very up to date, it is very difficult to get a true figure as research definitions of self harm vary. Also the level of taboo around the subject is so high that most are very secret about it, and this normally omits them from any research.

How do people self harm?
There are countless ways that someone may self harm, with the most common being cutting, used by over two thirds of those who self harm.
Here are just a few examples: cutting, burning, punching, head banging, hair pulling, poisoning to cause discomfort or damage, excessive nail biting, scratching, bone breaking, picking wounds, tying ligatures around the neck etc, medication abuse, alcohol abuse, illegal drug use, smoking - some are socially acceptable. Starvation, binge-eating, vomiting. This list is endless - it's important to be aware that someone who stops self injuring may replace their harming behavior with a different type.
Why do people self harm?
People often harm themselves because they can find no other way to relieve a feeling of being overwhelmed by intense emotions.
These emotions commonly fall into five groups:
Anger and frustration : Feeling so wound up and annoyed that you want to scream and shout.
Low self esteem: Feeling so undervalued and low that you want to harm and feel you may even deserve it.
Dissociation: Feeling so overwhelmed by everything going on around, they want to escape or distract themselves by making a louder metaphorical noise.
Control and focus: Feeling that so much is out of your control that the only thing that you can control is the harm you inflict on yourself.
Self nurture: Feeling unreal and needing to harm to know you exist, or to help yourself heal.
Normally someone who is self harming will be able to identify at least one of these, if not more, as a reason for their behavior.

Why people continue self harming?
Once someone has found a way of coping, that both works and brings relief, it is a very daunting prospect to try relinquishing that way of coping in favor of another.
When someone cuts themselves, they send a rush of endorphins through the body that travel to the wound sight to help heal it. The experience of this is described as being similar to being walked up on from behind and startled, and then taking a sudden intake of breath to recover from the fright: the relief of that breath feels similar to the buzz felt by harmers. This feeling is addictive and is considered as a chemical addiction, underlining why it can be difficult to stop harming.

How to know if someone is self harming?
The short answer is you might not: it is a very secretive thing, and often purposefully hidden from others. A person is three times more likely to harm if they feel they lack emotional support, so those who are isolated, or feel isolated, may be more likely to harm. Those who find coping with the strains of life very difficult may also self harm.

Immediate risks are associated with self harming?
Someone who self harm's is a hundred times more likely to commit suicide, whether accidental or not. In other words, there is a risk of death, even though that is not the intention of the harming action.
Infection of wounds is also a significant risk. The cleanliness of implements used in cutting is a significant factor in whether infection occurs, as is treatment of wounds. Proper medical treatment for cuts and burns etc will give better healing prospects and reduced risk from infection.

Long term risks are associated with self harming?
If a person harms regularly over a period of time they are likely to weaken their body, depleting the essentials needed to maintain themselves. For example, the body's ability to clot blood may be reduced, immune systems could weaken and pulled hair may not grow back. These are but a few examples of many potential long-term effects on health. However the body is also surprisingly resilient, and is not impossible to have just scars as a indication of times spent harming.

Psychological models



Attempts to understand self-harm fall broadly into either attempts to interpret motives, or application of psychological models.
Motives for self-harm are often personal, often do not fit into medicalised models of behaviour and may seem incomprehensible to others, as demonstrated by this quote:
"My motivations for self-harming were diverse, but included examining the interior of my arms for hydraulic lines. This may sound strange."
Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances and information from the patient however the limited studies comparing professional and personal assessments show that these differ with professionals suggesting more manipulative or punitive motives.

The UK ONS study reported only two motives: “to draw attention” and “because of anger” Many people who self-harm state that self-injury is a way to "go away" or dissociate, separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing the pain felt at the time is caused by self-injury instead of the issues they were facing before: the physical pain therefore acts as a distraction from emotional pain.The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality, or as a means of punishing sexual organs that may be perceived as having responded in contravention to the persons well being.
To complement this theory, one can consider the need to 'stop' feeling emotional pain and mental agitation. "A person may be hyper-sensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings."
Those who engage in self-harm face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-injurers this relief is primarily psychological whilst for others this feeling of relief comes from the beta endorphins released in the brain. These act to reduce tension and emotional distress and may lead to a feeling of calm.
Often, people with disorders such as autism are unable to feel certain stimulation, such as temperature, hunger and pain, in the same way as someone without a processing disorder usually would.
A person with autism often displays behaviors to balance their sensory dysfunction. If, for example, a person was hypo-tactile, they may attempt to stimulate themselves by using methods that could be categorized as self-harm.
Alternatives to self harming
as a direct alternative to self harm, holding ice cubes in a hand and trying to crush them, has the same result, but without any long term physical effects. Another alternative can be having an elastic band on a wrist that is pinged onto the skin to give a short spurt of pain and a small rush - this however does need to be done in moderation, as overdoing it can bruise. One other form is to pluck hairs on legs or arms as a technique for weaning off cutting.
A lot of harming is done impulsively - so encouraging someone to wait five minutes each time they want to harm can help the urge to pass. If the person has identified the emotional groups they are harming out of, it can be very beneficial to explore different ways of expressing those feelings.
Treatment
Self-harm may be an indicator of depression or other psychological problems. Therapy and skills training can be very useful for those who self-harm. The therapy module used will vary depending on the person's diagnosis and their individual needs.


Self-harm awareness
It is very important for a self harmer to have consistent emotional support, where they can feel safe and respected. In terms of professional support an initial visit to a doctor will often lead to a referral to relevant mental health support in the local area.
There are many movements among the general self harm community to make self harm and treatment better known to mental health professionals as well as the general public. SIAD (Self Injury Awareness Day) which is set for March 1st of every year is the widest known movement. On this day some people choose to be more open about their own self harm, and awareness organizations make special efforts to raise awareness about self harm.