Understanding Adolescent Pain Providing essential pieces for dealing with issues of an adolescent with depression.

Understanding Adolescent PainUnderstanding Adolescent PainProviding essential pieces for dealing with issues of an adolescent with depressionProviding essential pieces for dealing with issues of an adolescent with depression

Key understandingsKey understandingsAll kids are goodKids are trying to do the best they can

They want to fit in/be acceptedThey want to be liked and lovedThey want to please othersThey are stressed They are scared about the futureThey don’t feel that anyone understandsThey want to feel secure and in controlThey want to feel good

All kids are goodKids are trying to do the best they can

They want to fit in/be acceptedThey want to be liked and lovedThey want to please othersThey are stressed They are scared about the futureThey don’t feel that anyone understandsThey want to feel secure and in controlThey want to feel good

They want to be…They want to be…

LOVEDUNDERSTOODACCEPTED

LOVEDUNDERSTOODACCEPTED

DEPRESSIONDEPRESSION

Anger turned inward Anger turned inward

What to look for: Warning Signs

What to look for: Warning Signs

Unexplainable changes in…FriendsGradesBehaviorHabitsHobbiesActivitiesBody appearance

Unexplainable changes in…FriendsGradesBehaviorHabitsHobbiesActivitiesBody appearance

Unsure?Unsure?

At this point, If you’re unsure if an adolescent in your life is depressed or just “being a teenager,” consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self.

dramatic, long-lasting changes in personality, mood, or behavior are red flags of a deeper problem. 2-3 weeks… More often than not.

Duration-Severity-Real Change

At this point, If you’re unsure if an adolescent in your life is depressed or just “being a teenager,” consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self.

dramatic, long-lasting changes in personality, mood, or behavior are red flags of a deeper problem. 2-3 weeks… More often than not.

Duration-Severity-Real Change

Key UnderstandingKey Understanding

If a teenager can identify the causes of there depression then it normally isn’t clinical depression

Name it, Claim it, and Tame it!Depression will not just go awayDepression needs interventionDepression is hard to understand

If a teenager can identify the causes of there depression then it normally isn’t clinical depression

Name it, Claim it, and Tame it!Depression will not just go awayDepression needs interventionDepression is hard to understand

Major DepressionMajor Depression

Considered a Mood DisorderCan be episodic or recurrentPsychological and physical

componentsHighly treatableOften misunderstood and

undiagnosed especially in teenagers

Considered a Mood DisorderCan be episodic or recurrentPsychological and physical

componentsHighly treatableOften misunderstood and

undiagnosed especially in teenagers

Major DepressionMajor Depression

A combination of symptoms that interfere with ability to work, study, sleep, eat and enjoy once pleasurable activities and which may occur only once or several times

A combination of symptoms that interfere with ability to work, study, sleep, eat and enjoy once pleasurable activities and which may occur only once or several times

Symptoms: DepressionSymptoms: Depression

Major Depressive Disorder requires two or more major depressive episodes.

Diagnostic criteria: Depressed mood and/or loss of interest or

pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day

Major Depressive Disorder requires two or more major depressive episodes.

Diagnostic criteria: Depressed mood and/or loss of interest or

pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day

At least 5…At least 5… 1.Depressed mood most of the day. 2.Diminished interest or pleasure in all or

most activities. (Quit) 3.Significant unintentional weight loss or

gain. 4.Insomnia or sleeping too much. 5.Agitation or psychomotor retardation

noticed by others. 6.Fatigue or loss of energy. 7.Feelings of worthlessness or excessive

guilt. 8.Diminished ability to think or concentrate,

or indecisiveness. 9.Recurrent thoughts of death (APA, 2000, p. 356).

1.Depressed mood most of the day. 2.Diminished interest or pleasure in all or

most activities. (Quit) 3.Significant unintentional weight loss or

gain. 4.Insomnia or sleeping too much. 5.Agitation or psychomotor retardation

noticed by others. 6.Fatigue or loss of energy. 7.Feelings of worthlessness or excessive

guilt. 8.Diminished ability to think or concentrate,

or indecisiveness. 9.Recurrent thoughts of death (APA, 2000, p. 356).

Teen specific…Teen specific…

The difference between teenage and adult depression Irritable or angry mood – As noted above, irritability, rather

than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.

Unexplained aches and pains - Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.

Extreme sensitivity to criticism - Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.”

Withdrawing from some, but not all people - While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

The difference between teenage and adult depression Irritable or angry mood – As noted above, irritability, rather

than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.

Unexplained aches and pains - Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.

Extreme sensitivity to criticism - Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.”

Withdrawing from some, but not all people - While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

Untreated Depression Can Lead to…

Untreated Depression Can Lead to…

Problems at school -Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.

Running away - Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.

Substance abuse - Teens may use alcohol or drugs in an attempt to “self-medicate” their depression. Unfortunately, substance abuse only makes things worse.

Low self-esteem - Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.

Eating disorders - Anorexia, bulimia, binge eating, and yo-yo dieting are often signs of unrecognized depression.

Problems at school -Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.

Running away - Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.

Substance abuse - Teens may use alcohol or drugs in an attempt to “self-medicate” their depression. Unfortunately, substance abuse only makes things worse.

Low self-esteem - Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.

Eating disorders - Anorexia, bulimia, binge eating, and yo-yo dieting are often signs of unrecognized depression.

Cont.Cont. Internet addiction - Teens may go online to escape from their

problems. But excessive computer use only increases their isolation and makes them more depressed. Cyberbullying and harrassment. Falsifying identity on Social networks like Twitter and Facebook.

Self-injury - Cutting, burning, and other kinds of self-mutilation are almost always associated with depression. (Piercings and Tattoos)

Reckless behavior - Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, out-of-control drinking, and unsafe sex.

Illegal behaviors – Shoplifting and Theft (Chemical High) Violence - Some depressed teens (usually boys who are the

victims of bullying) become violent. As in the case of the Columbine school massacre, self-hatred and a wish to die can erupt into violence and homicidal rage.

Suicide - Teens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. Suicidal thoughts or behaviors should always be taken very seriously.

Internet addiction - Teens may go online to escape from their problems. But excessive computer use only increases their isolation and makes them more depressed. Cyberbullying and harrassment. Falsifying identity on Social networks like Twitter and Facebook.

Self-injury - Cutting, burning, and other kinds of self-mutilation are almost always associated with depression. (Piercings and Tattoos)

Reckless behavior - Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, out-of-control drinking, and unsafe sex.

Illegal behaviors – Shoplifting and Theft (Chemical High) Violence - Some depressed teens (usually boys who are the

victims of bullying) become violent. As in the case of the Columbine school massacre, self-hatred and a wish to die can erupt into violence and homicidal rage.

Suicide - Teens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. Suicidal thoughts or behaviors should always be taken very seriously.

Talking or joking about committing suicide Saying things like, “I’d be better off dead,” “I wish I could

disappear forever,” or “There’s no way out.” Speaking positively about death or romanticizing dying

(“If I died, people might love me more”) Writing stories and poems about death, dying, or suicide Engaging in reckless behavior or having a lot of accidents

resulting in injury Giving away prized possessions Saying goodbye to friends and family as if for the last time Seeking out weapons, pills, or other ways to kill

themselves

These are serious issues…they are scary…any serious illness is!

Talking or joking about committing suicide Saying things like, “I’d be better off dead,” “I wish I could

disappear forever,” or “There’s no way out.” Speaking positively about death or romanticizing dying

(“If I died, people might love me more”) Writing stories and poems about death, dying, or suicide Engaging in reckless behavior or having a lot of accidents

resulting in injury Giving away prized possessions Saying goodbye to friends and family as if for the last time Seeking out weapons, pills, or other ways to kill

themselves

These are serious issues…they are scary…any serious illness is!

Suicide warning signs

Suicide is a game changerSuicide is a game changer

Ask the tough questions?Do you want to kill yourself?How will you do it?Do you have the means?Help before the sun goes down!

Get an assessment…Call 911 or ER!

Do not leave alone!

Ask the tough questions?Do you want to kill yourself?How will you do it?Do you have the means?Help before the sun goes down!

Get an assessment…Call 911 or ER!

Do not leave alone!

Realize this…Realize this…

Depression effects 20% of teens2x as many girls as boys

Experts say only one in five depressed teens receive help.

1 in 5…Why? Very treatable illness

take them to a doctor!

Depression effects 20% of teens2x as many girls as boys

Experts say only one in five depressed teens receive help.

1 in 5…Why? Very treatable illness

take them to a doctor!

If not depression, then what is it?

If not depression, then what is it?

Terminology is EssentialTerminology is Essential

Depression – clinical sadness often linked to Serotonin and other unknown reasons -DISTRACT or RUMINATE

Persistent Depressive Disorder (Dysthemia) Seasonal Affective Disorder General Anxiety Disorder Worrier Grief or Bereavement Sadness Unhappiness Stressed out Blahs

Depression – clinical sadness often linked to Serotonin and other unknown reasons -DISTRACT or RUMINATE

Persistent Depressive Disorder (Dysthemia) Seasonal Affective Disorder General Anxiety Disorder Worrier Grief or Bereavement Sadness Unhappiness Stressed out Blahs

StressStress

What is stress: physiological response to a psychological or physical stimuliUltimately, energy to respond

Eustress v. DistressEustress: positive energy to respondDistress: negative amount of energy

What is stress: physiological response to a psychological or physical stimuliUltimately, energy to respond

Eustress v. DistressEustress: positive energy to respondDistress: negative amount of energy

Analogy of the BucketAnalogy of the Bucket

Puppies must be walked…OR ELSE!

The Bucket must be either…

Emptied or Made Larger

Puppies must be walked…OR ELSE!

The Bucket must be either…

Emptied or Made Larger

Unhappiness: Why?Unhappiness: Why?

Too High or Too Low of expectations from self or others – never good enough or always successful but no fulfillment

Missing or Broken tile syndrome – Christmas tree lights- one out…all out!

Comparison to others: the Uberperson

Too High or Too Low of expectations from self or others – never good enough or always successful but no fulfillment

Missing or Broken tile syndrome – Christmas tree lights- one out…all out!

Comparison to others: the Uberperson

Is this what you want?Is this what you want?

master-photoshopper merging Catherine Zeta-Jones, Charlize Theron, Angelina Jolie and Keira Knightly.

master-photoshopper merging Catherine Zeta-Jones, Charlize Theron, Angelina Jolie and Keira Knightly.

The negative symptoms dart board

The negative symptoms dart board

Adolescence tend to go from one symptom to another searching for help and relief Drinking and Drugs Cutting Sex/ bad relationships Stealing Lying Escape – Internet and Video gaming Change of behaviors – anger and acting out

Adolescence tend to go from one symptom to another searching for help and relief Drinking and Drugs Cutting Sex/ bad relationships Stealing Lying Escape – Internet and Video gaming Change of behaviors – anger and acting out

When to act?When to act?

When symptoms persist or get worse persistent sad, anxious, or “empty” mood feelings of hopelessness, pessimism feelings of guilt, worthlessness, helplessness, loss of interest or pleasure in hobbies or activities once

enjoyed decreased energy, fatigue, being “slowed down” difficulty concentrating, remembering, making decisions insomnia, early morning awakening or oversleeping appetite and/or weight loss or overeating and weight gain thoughts of death or suicide, attempts of suicide restlessness and irritability persistent physical symptoms which do not respond to

treatment headaches, digestive disorders, chronic pain...

When symptoms persist or get worse persistent sad, anxious, or “empty” mood feelings of hopelessness, pessimism feelings of guilt, worthlessness, helplessness, loss of interest or pleasure in hobbies or activities once

enjoyed decreased energy, fatigue, being “slowed down” difficulty concentrating, remembering, making decisions insomnia, early morning awakening or oversleeping appetite and/or weight loss or overeating and weight gain thoughts of death or suicide, attempts of suicide restlessness and irritability persistent physical symptoms which do not respond to

treatment headaches, digestive disorders, chronic pain...

Helping a depressed teenager

Helping a depressed teenager

Talk to your teenAsk the school for guidanceVisit your family doctorCall your insurance companySeek out a specialist

Explore the treatment options Talk Therapy, Medication, Family support services,

Educational Classes, Behavior Management techniques, as well as Family therapy

Talk to your teenAsk the school for guidanceVisit your family doctorCall your insurance companySeek out a specialist

Explore the treatment options Talk Therapy, Medication, Family support services,

Educational Classes, Behavior Management techniques, as well as Family therapy

TIPS FOR TALKING TO A DEPRESSED TEEN

TIPS FOR TALKING TO A DEPRESSED TEEN

Offer SupportBe gentle but persistent

Listen without lecturing

Validate feelings

Offer SupportBe gentle but persistent

Listen without lecturing

Validate feelings

The positive dartboardThe positive dartboardGiven the opportunity and training,

teens will opt for healthy responses tooExercise and sportsAppropriate emotional expressionPositive social interactionsPrayerPlayingRelaxationTalking

What to do…What to do…

The most important thing we can do is have a consistent relationship with our children.

THIS INCLUDES: providing them limits, providing guidance and support in decision-making, providing them discipline being aware of what's happening in their lives daily

AND Seeking advice and help when needed

The most important thing we can do is have a consistent relationship with our children.

THIS INCLUDES: providing them limits, providing guidance and support in decision-making, providing them discipline being aware of what's happening in their lives daily

AND Seeking advice and help when needed

Remember…Remember…

…the peer group is important to young adolescents, and there’s nothing wrong with that. Parents are often just as important, however. Don’t give up on the idea that you make a difference.

…the peer group is important to young adolescents, and there’s nothing wrong with that. Parents are often just as important, however. Don’t give up on the idea that you make a difference.

Final Thoughts…Final Thoughts…

Step back; Put the puzzle together Learn to be awareOnce you start seeing these symptoms Talk about it (Saying it doesn’t make

it)Seek Help (MUCH EASIER EARLY, than LATER)

If you suspect that a teenager in your life is suffering from depression, speak up right away and do something.

Step back; Put the puzzle together Learn to be awareOnce you start seeing these symptoms Talk about it (Saying it doesn’t make

it)Seek Help (MUCH EASIER EARLY, than LATER)

If you suspect that a teenager in your life is suffering from depression, speak up right away and do something.

resourcesresources

Cuyahoga County Board of Mental Health

Helpguide .org National Institute of Mental

Health

http://www.nimh.nih.gov

Cuyahoga County Board of Mental Health

Helpguide .org National Institute of Mental

Health

http://www.nimh.nih.gov