There are many more complications that a geriatric individual misusing alcohol may have to deal with than their younger counterparts. Even though studies suggest that the amount of alcohol used by the elderly is not considerable, research suggests that the amount of alcohol a geriatric individual consumes is not a reliable measure of alcoholism because they can drink less frequently with smaller amounts and still experience the same effect and desired mood-state as young alcoholics (Beullens et al., 2004). Since this population has a higher sensitivity to alcohol and tends to have higher blood levels of ethanol at lower consumption amounts, the tolerance criterion is suggested to be inapplicable (Menninger, 2002). Therefore, the geriatric population is suggested to have a biological vulnerability towards the effects of alcohol on their system. The increasing number of chronic diseases they suffer from, along with slower hepatic metabolism and the greater amount of medications that may interact with alcohol, lead this population to have different biological reactions and stronger effects with alcohol use (Aira et al., 2005; Byles, Young, Furuya, & Parkinson, 2006).

As someone ages, their amount of adipose tissue increases while lean tissue lessens (Beullens et al., 2004). As this occurs, the amount of water in the body is decreasing and the proportion of body fat increases, which results in lower volume of distribution where blood ethanol concentrations become higher (Beullens et al., 2004; Menninger, 2002). Since the older population is more sensitive to alcohol’s effects because of these biological changes, lower amounts of alcohol consumption may not fulfill the criterion regarding amount of time they spend in activities related to substance use (Menninger, 2002).

The biological vulnerability also means that these older individuals may experience the unfavorable health effects related to alcohol at low levels of consumption because of their age-related physiological changes (Fink et al., 2005). An example of these health effects is a decline in the number of brain cells in the basal ganglion, neocortex, reticular activating system, and hippocampus, which may increase the risk of delirium (Menninger, 2002). In addition, because of the higher prevalence of neurological disorders in this population, their sensitivity to the ethanol effects on the central nervous system are heightened (Menninger, 2002).

Alcohol use and abuse may increase mental and physical problems as the individual ages (Beullens et al., 2004). A history of heavy drinking in men 65 and older for five years during a period of time in their past has almost a six-fold risk of suffering from a psychiatric disorder (Beullens et al., 2004). The risk of depression is suggested to be approximately four times as high and dementia almost five times in these men (Beullens et al., 2004). Alcohol use may also result in a greater susceptibility for self-neglect, falls/injuries, other types of accidents, and malnutrition (Byles et al., 2006; Sarfraz, 2003; Menninger, 2002). When there is a history of problem drinking, then there is a greater risk of falls later on in life, even when the individual abstains or consumes minimal alcohol (Cawthon, Harrison, Barrett-Connor, Fink, Cauley, Lewis, Orwoll, & Cummings, 2006). Common signs and symptoms in the geriatric population include amnestic periods while drinking, using alcohol daily, altered cognitive abilities, liver abnormalities, and anemia (Menninger, 2002).

Many serious side effects that occur with the use of alcohol in the geriatric population have to do with concurrent administration of prescribed medications. Many prescribed and over-the-counter medications have potential negative interactions when taken with the use of alcohol (Aira et al., 2005). Many of these adverse effects are related to this combination of medication and alcohol rather than the amount of alcohol they are consuming (Aira et al., 2005).

Nonsteroidal analgesics, antihistamines, nitrates, aspirin (in doses exceeding 650mg daily), non-steroidal anti-inflammatory agents, sedatives, anti-hypertensives, and benzodiazepiens have potential adverse interaction effects when combined with alcohol (Aira et al., 2005; Fink et al., 2005). One study suggests that approximately 40% of antidepressant, benzodiazepine, sleeping pills and opiate users, along with approximately half of nitrate users, consume alcohol (Aira et al., 2005), even though there may be serious consequences from this combination. Examples of these adverse effects include a potential risk of gastric bleeding when alcohol is used with analgesics (Aira et al., 2005). One study suggests that 46% of non-steroidal anti-inflammatory drug users and 40% of anticoagulant users may be at risk of a hemorrhage because of their concurrent consumption of alcohol (Aira et al., 2005).

Along with these interaction effects, alcohol use and abuse in the geriatric population increases the possibility of these individuals of developing serious internal problems. Considerable damage may occur to several of the body’s organs, including the brain, gastrointestinal tract, heart, and liver (Menninger, 2002). Global cognitive impairment with cerebral atrophy may occur and gastrointestinal disturbances may include gastritis and peptic ulcer disease (Menninger, 2002). Alcohol misuse may also cause liver disease, alcoholic bowel disease, and could exacerbate many medical illnesses including cardiovascular disorders, diabetes mellitus, depression, fractures, and hypertension (Fink et al., 2005; Menninger, 2002; Sarfraz, 2003). In addition, rates of all types of dementia, excluding Alzheimer ’s disease, are higher in individuals with alcohol abuse, and abstinence from alcohol is recommended for individuals with diabetes, congestive heart failure, and other related chronic conditions (Menninger, 2002).

There are several possible toxic and/or fatal effects of using alcohol, which include acute pancreatitis, perforated peptic ulcer, cardiomyopathy, increased risk of breast cancer, oral cavity cancer, and lung cancer (Fink et al., 2005; Menninger, 2002). Arrhythmias also may occur after an alcohol binge and alcohol-related alterations in the immune system could lead to higher susceptibility to bacterial pneumonia, infectious diseases, and reactivated tuberculosis (Menninger, 2002).

Even though there are a number of factors that contribute to a decrease in alcohol consumption among this population, such as increased change of organ damage and comorbid conditions, there are several factors and characteristics that may make a geriatric individual more susceptible to late onset alcoholism as well. The primary risk factors regarding alcoholism that are suggested in the elderly include losses or bereavements, major life changes, and the male gender (Menninger, 2002). Although older women are suggested to be less likely to drink, they are more likely than men to start drinking heavily later in life (Menninger, 2002). Major life changes may include stressors such as bereavements, deterioration of health, decline in economic status, and chronic loneliness (Menninger, 2002).

Next up: Part Two of this series will discuss how to more accurately identify alcohol abuse and dependence in the geriatric population.

References

Aira, M., Hartikainen, S., & Sulkava, R. (2005). Community prevalence of alcohol use and concomitant use of medication—a source of possible risk in the elderly aged 75 and older? International Journal of Geriatric Psychiatry, 20, 680-685.

Beullens, J., & Aertgeerts, B. (2004). Screening for alcohol abuse and dependence in older people using DSM criteria: A review. Aging & Mental Health, 8(1), 76-82.

Byles, J., Young, A., Furuya, H., & Parkinson, L. (2006). A drink to healthy aging: The association between older women’s use of alcohol and their health-related quality of life. Journal of the American Geriatrics Society, 54, 1341-1347.

Cawthon, P., Fink, H., Barrett-Connor, E., Cauley, J., Dam, T., Lewis, C., Marshall, L., Orwoll, E., & Cummings, S. (2007). Alcohol use, physical performance, and functional limitations in older men. Journal of the American Geriatrics Society, 55, 212-220.

Cawthon, P., Harrison, S., Barrett-Connor, E., Fink, H., Cauley, J., Lewis, C., Orwoll, E., & Cummings, S. (2006). Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men. Journal of the American Geriatrics Society, 54, 1649-1657.

Fink, A., Elliott, M., Tsai, M., & Beck, J. (2005). An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. Journal of the Geriatrics Society, 53, 1937-1943.

Menninger, J. (2002). Assessment and treatment of alcoholism and substance-related disorders in the elderly. Bulletin of the Menninger Clinic, 66(2), 166-183.

Sarfraz, M. (2003). Alcohol misuse among elderly psychiatric patients: A pilot study. Substance Use & Misuse, 38, 1883-1889.

 Dr. Ruth G. Anderson is a postdoctoral psychology fellow in the Adult Outpatient Clinic at Jackson Behavioral Health Blog.

When something as shocking as this happens, the nation, and even the world longs to understand and make sense of something that just doesn’t seem to make any sense.  Despite the preponderance of other national tragedies, it appears that many Americans still have the idea that “it will never happen here.”  History has proven that this is just not the case.  According the United States Justice Department, 2,185 children are reported as missing every day, and 797,500 missing persons reports are filed each year.  209,900 are reported as being kidnapped by family members, or as in the case of the women in Cleveland, more than 58,200 being kidnapped by non-family members.  As related to the non-family member abductions, unfortunately, the outcome is often tragic, as statistics indicate that if a missing child has not been located within 3-6 hours, the likelihood of the family actually being reunited with the child is significantly low, and decreases with each passing hour, day, week, month and year.  Thankfully, this was not the case for Michelle Knight, Amanda Berry and Georgina DeJesus in Cleveland, Ohio.  On May 6, 2013, these women were rescued by a citizen who heard the call for help and, giving no thought to the potentially harmful consequence of his own actions, worked to free the four captives of Ariel Castro.  Which brings us back to the question: How did this happen?

As was the case with Knight, Berry and DeJesus in Cleveland, one of the most salient factors of this case is that these women were not kidnapped and held captive for weeks; their imprisonment lasted over ten years for some of them. Kidnapping is terrifying enough, but to be held prisoner, sexually assaulted and psychologically tortured adds a different dimension to the case.  News media and the public are clamoring for information about how such a monstrous crime was able to go unnoticed or unreported for such an extended period of time.  Different media sources are even postulating the potential of the “Stockholm Syndrome,” a term which was coined by Nils Bejerot in 1973 after a robbery in Stockholm Sweden that involved a 6 day hostage situation.  These captives began developing empathy and positive feelings for their captors, even raising money for their legal team and defending them during their prosecution.  A similar phenomenon occurred the following year with one of the most publicized and controversial abduction stories in American history, in the case of Patty Hearst.  Hearst was abducted from her home, held for ransom, tortured physically, sexually and psychologically, and later resurfaced under a new name, having identified with the cause of her captors.  In our attempts to understand the factors involved in the abduction and perpetuation of such unconscionable crimes, we have to be careful with using terms like the “Stockholm Syndrome.”  The “Stockholm Syndrome” involves an almost mental conversion of the captors in positively identifying and empathizing with their captors, thus seemingly “allowing” their captivity to progress.  Based on the information we have at present, we don’t know enough about this case to determine if the “Stockholm Syndrome” was indeed a part of the bigger picture or not.  In fact, it appears, as people tend to do, that we are looking for someone to blame.  Obviously, Ariel Castro is being identified as the “villain” in this story, however, why does it also appear that we are trying to blame the victims, as is often the case in society.  As with the case of victims of rape and sexual assault, a misogynistic perspective attempts to vilify the victim of the assault by attempting to find factors that influenced or even contributed to their own victimization.  Sure, we all think kidnapping is a horrible crime, but when we heard that this occurred over a span of ten years, it seems to become an incomprehensible notion.  On multiple occasions, I have heard people ask the same questions, “how did this happen for so long,” “there were three of them and only one of him, why didn’t they just break out?”  The suggestion of complicity is not only insulting, but an outrage to women and survivors of abduction, sexual assault and torture the world over, and evidence that misogyny is alive and kicking in the American mind.

Kidnappings involving children appear to garner more support and compassion for the victims most likely due to the perceived powerless nature of children and perhaps because they touch the heart strings of parents and grandparents everywhere, as they fear such a thing could happen to their own children.  The choice of whether to blame the kidnapping victims is not as prevalent with child abductees as it is with some of the adult victims.  In recent years, we learned of the case of Elizabeth Smart, who gained media attention after her escape from her captors in Utah, having lived in their home for nine months.  In January, 2007 the world learned of the rescue of 13-year-old William Benjamin Ownby, missing for four days and 16-year-old Shawn Hornbeck, missing for four-and-a-half years, after being abducted by a pizza restaurant manager in Missouri.  Unlike the abducted women in Cleveland, Hearst, Smart, Ownby and Hornbeck had been in captivity for a significantly less amount of time, but were nonetheless tortured into a semblance of obedience as they adjusted to their roles of the abducted.  “Going along with it,” or complying with the wishes and instructions of their captors became something akin to a survival mechanism for each of these young people.  As in Seligman’s theory of learned helplessness, after mental, physical and sexual torture, some kidnapping victims seemingly adopt the role of victim, losing hope that things will change, believing that they cannot survive the situation in any other way than to just “accept the reality of the situation” of their enslavement.  This could perhaps have been the case with Georgina DeJesus and Amanda Berry as they were reported to behave similarly to Seligman’s test subjects who were fearful of leaving the captivity situation, after Michelle Knight was able to get free and their reluctance prevented them from leaving.  This behavior and cognitive distortions can be seen in victims of domestic violence, incest, sexual abuse and a multitude of other societal problems which are epidemic in the United States today.  In some cases, phenomena such as Anna Freud’s identification with the aggressor may explain some of the abductees attitudes, as the use of this coping mechanism involves reducing fear and anxiety by working to actively reject the passive role of victim and become more like the aggressor or abductor, to psychologically and physically survive the trauma inherent in the abduction and the torture that follows.  Similar to this is reaction formation, which serves by the victim adopting ideals and actions that are diametrically opposite from their own core values, as a mechanism of survival, and an attempt to make sense of, and gain a sense of mastery over their situation.

Some people will suggest that perhaps instead of demonizing the victims in the case, answers may lie in the people surrounding the case.  At this time, it is reported that many of Ariel Castro’s neighbors had no knowledge of anything unusual going on in the house.  Some people are beginning to come forth now, but these people are relatively few in number, given the breadth and scope of this crime which encompasses a span of ten years.  I can’t speak for everyone, but in most of the places I have lived, there has always been one or two of those “nosey neighbors;” the Gladys Kravitz’s (from the television show Bewitched) of the world that make it a point to let you know what time they saw you coming home from work, when there was a car parked in your driveway that they did not recognize, or that your dog barks a little too loud on Sunday mornings.  Where was Mrs. Kravitz when these women were being held captive?  As we learned in the case of Catherine “Kitty” Genovese, who was being brutally murdered in New York City, and for whom the term “the bystander effect” was created, sometimes people hear and see things in their own backyard and “do not want to get involved.”  This only serves to perpetuate violence and criminal activity.  What about Castro’s brothers?  Could it be that they really knew “nothing?”  Was Ariel Castro intimidating or threatening violence to them to ensure their cooperation and silence, as it is reported he did to his former wife?  As is intrinsic to situations like these, an abductor is in a position of supreme power and dominance over the abductee, and as Baron John Emerich Edward Dalberg Acton pointed out in a letter to a colleague in 1887, “absolute power corrupts absolutely.”  This idea was exemplified in social psychologist Stanley Milgram’s obedience experiments, in which subjects administered increasing levels of electric shocks to (what they believed were) other subjects in the presence of an authority figure.   Philip Zimbardo’s Stanford Prison Experiment also exemplified a similar ideal with college students being split into groups acting in the role of prisoners and prison guards, in which the prison guards (those with inherently higher levels of power and freedom) lorded over the prisoners (those who lost their freedom and were disempowered by their lower status).  Zimbardo’s experiment yielded results similar to Milgram, in which those in positions of power (the guards) abused their authority and those without power (prisoners) accepted their loss of power, a factor of situational attribution of their behavior, indicating that the situation of being imprisoned and victimized foments a position of disempowerment and compliance.

Whatever the case may be, speculation will continue to run rampant through the American media and in the hearts and minds of the world, as more facts are revealed of the horrors these women endured.  Irrespective of who is indirectly to blame for such a heinous crime, the facts remain that these women are physically free, although their psychological freedom is one road which will prove to be daunting and arduous as they begin the process of healing.  As a society, we strive to have an understanding of this case, hopefully not out of some morbid fascination with victims of crime, but in the hopes that by shedding light on the situation, we won’t be too quick to judge, we can learn the causes, and somehow prevent such a horrible thing from happening again.  After all, aren’t “those who do not learn from their mistakes, doomed to repeat them?”  May 25^th is National Missing Children’s Day.

Let’s keep in mind, and light a candle for the children (and their families) who have not come home yet, and for the ones who will never return home.

^ Fitzpatrick, Laura (August 31, 2009). “Stockholm Syndrome”. Time.

^ Nils Bejerot: The six day war in Stockholm New Scientist 1974, volume 61, number 886, page 486-487

Per Andrea J. Sedlak, David Finkelhor, Heather Hammer, and Dana J. Schultz. U.S. Department of Justice. “National Estimates of Missing Children: An Overview” in National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice, October 2002, page 5.

 Guest blogger Dr. Alex Dryden is a postdoctoral fellow in Child and Adolescent Service at Jackson Behavioral Health Hospital. 

Research suggests that children of homosexual couples show no higher levels of maladjustment than do the children of heterosexual couples (Gartrell & Bos, 2010).  In fact, this particular study which followed children for over 10 years, showed that 17-year-old daughters and sons of lesbian mothers were rated significantly higher in social, school/academic, and total competence and significantly lower in social problems, rule-breaking, aggressive, and externalizing problem behavior than their age-matched counterparts in the general population (Gartrell & Bos, 2010).  Of interest is that this study looked particularly at children whose same-sex parents raised them together from birth, as might occur in a traditional heterosexual nuclear family.

Other studies indicate that the sexual orientation of parents is relatively unimportant compared to other factors that are much more salient in a child’s adjustment and development.  These other factors include having parental compatibility, parents sharing responsibility, parents’ ability to provide financial stability, and the ability of parents to have healthy interpersonal connections (Perrin, 2002).   A report that examined the overall psychosocial adjustment of teens raised by same-sex parents versus teens raised by heterosexual parents found no significant differences in terms of peer relations, academic performance, risk-taking behaviors or personal adjustment (Wainright, Russel & Patterson, 2004).

Perhaps as important as scientific research in this regard is a discussion of the possible individual effects of legalized same sex marriage.  Perhaps increased acceptance and integration into society may lead to children who feel less marginalized, and who therefore may be less likely to internalize feelings of shame and guilt over either their own sexuality or the sexuality of their parents.  Additionally, a formalized acceptance of gay families may increase one’s feeling that they can eventually start their own family and prosper. That is— the American dream—a dream that LGBT individuals may currently feel shut out from, due to the fact that many jurisdictions have an actual ban on their unions.  As a clinician, it seems important to recognize the possibly deleterious effects of being told that one may not marry (even if they desire), and as an implication of that law, that one’s relationships are seen as invalid or not good enough to be recognized by the legal system of their society.  Perhaps the high levels of systemic level marginalization that LGBT individuals face contributes to their higher levels of depression and other related psychosocial difficulties.

Only time will tell what will happen with the decisions of these court cases.  However in terms of psychological research, it is important to underscore the numerous studies that have not shown significant problems with children raised by same-sex parents.  Finally, it is always important to recognize the effects public policy on the psyche of minorities.  Hopefully, in the future we may continue to use such psychological literature to shape brighter futures for all individuals.

Guest blogger Zeyad Layous, Ph.D., is a postdoctoral fellow at the Adult Outpatient Clinic at Jackson Behavioral Health Hospital.

References

Gartrell, N. & Bos, H. (2010).  US national longitudinal lesbian family study: Psychological adjustment of 17-year-old adolescents.  Pediatrics 126(1), 28-36

Perrin, E.C. (2002), Technical Report:  Coparent or second-parent adoption by same-sex parents.  American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health.  Pediatrics, 109(2), 341-344  

Wainright, J.L., Russel, S.T. & Patterson, C.J. (2004) Psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents.  Child Development, 76(6), 1886-1898.

On April 15^th, during the 117^th Boston Marathon, two bombs exploded near the finish line, killing 3 and injuring over 150 people, turning this happy day into one of fear and loss. Of those who were injured, many sustained severe injuries, requiring the amputation of limbs.  Amputation is a life altering and often traumatic event, in which individuals must make both physical and psychological adaptations. For these individuals, not only are they faced with the psychological trauma of coping with this tragedy, but they are also faced with personal adjustment to loss of function, loss of sensation, and loss of body image (Racy, 1989). Unfortunately, many individuals have previously befallen similar injuries. The good news is many have paved the path for life after loss and have embraced it head on with pride and resilience. One important step in the recovery process is setting goals to increase motivation needed to engage in rehabilitation and improve quality of life. The psychological reactions to amputation are highly diverse and individualized based on the person’s premorbid experiences, personality, coping style and goals.

Although most of the changes occur in a gradual continuum, a division into four stages allows for conceptualization of what is typically experienced at each point in time. The four stages are:

• Preoperative Stage
• Immediate Postoperative Stage
• In-Hospital Rehabilitation
• At-Home Rehabilitation

During the Preoperative Stage, individuals begin the process of acceptance, and for those who have a chance to prepare, over a third recognize the surgery as a new beginning and the start of the healing process. Common anxieties during this time include practical issues such as pain and the loss of function, as well as symbolic concerns such as change in appearance and threats to one’s personal identity. During the Immediate Postoperative Stage, concerns shift to one’s safety, as well as fears of complications and pain. The In-Hospital rehabilitation stage is the most challenging phase, which calls for flexibility as an individual’s needs progress. Finally, during the At-Home Rehabilitation stage, the full impact of one’s loss is realized. However, those individuals who are able to resume productive daily functioning, engage in social support, and develop an acceptance of their new life with a prosthetic limb tend to have the best psychosocial response.

Despite all of the obstacles of living as an amputee, there are innumerable accounts of renewed vigor and demonstrations of resilience. For instance, Rick Ball is one of the many individuals who lost his leg, in this case due to a motorcycle accident, and was able to turn a challenging situation into one of inspiration. When his leg was first amputated, he felt devastated and “felt [his] life was over.” However, after working hard in physical therapy and adjusting to life after trauma, he renewed his interest in running. He demonstrated perseverance and ran in the Boston Marathon in 2009, beating his personal best. He discovered that “a marathon is not where you go to duel something out; it’s more about personal goals.”

Trauma and loss shatters and fragments the self.  Besides the physical ramifications of trauma, the psychological sequela is extremely powerful, having the potential to scar an individual for life.  We have heard of the enormous pain and grief that many are suffering in our country due to this unpredictable and traumatic event.  However, we have also heard many of our citizens respond with resilience and determination to heal and grow from these inexplicable events.  This is the time for support and healing that we must continue to offer each other, particularly during times of mind-shattering experiences.  It is a time to become closer and appreciate our families and loved ones in order to promote the healing process.

If you or a loved one is experiencing a sense of profound grief or anxiety related to trauma, amputation or other physical or psychological injury, please contact your healthcare provider for psychological services and group support, which can be offered at Jackson Behavioral Health Hospital.

Guest bloggers Kendra Ellway, M.A. and Rachel Lerner, M.S. are psychology interns in Medical Psychology/Consultation Liaison at Jackson Behavioral Health Hospital.

I take a step back and think “Am I in the wrong room?” I introduce myself to the patient and check. I ask her what brought her in to the hospital, and she calmly relays her story of how she was hit by a truck. She is so peaceful; the whole situation feels surreal, like we are talking about someone else—someone who isn’t in the room. As a psychology intern, I assess for acute stress, denial, dissociation, and emotional numbing. None of these apply. I ask this woman how she has been coping with everything since the accident, and with a light in her eyes, she says she has immense faith in God. Her mother, the woman at her bedside is “[her] own saint,” and she has many friends from her house of worship, who have come to visit her. I spoke with this woman for just a little while longer and continued on with a very busy day. Later, my mind came back to that sense of calm I had felt earlier in the woman’s room. I wondered, how is it possible for someone to be so at peace and coping so well just days after a horrific accident? Particularly, when she is facing so much uncertainty! This woman does not even know if she will be able to walk again, and she was so at peace, so calm.

This led me to wonder about and research the impact of religiosity and spirituality in coping with trauma. I found that regardless of the type of trauma—physical or sexual assault, political torture, or suffering an unexpected and life threatening medical illness—individuals who are able to build on their already present strengths are best able to cope. These strengths may include religiosity, spirituality, social support, or other factors that foster healthy coping and well-being.  Within the literature, religiosity is often defined as an outward expression of spiritual beliefs through participation in organized religion. This may involve attendance of religious services, adherence to doctrinal teachings, and prayer (Yick, 2008). Spirituality is often defined as one’s belief in the existence of a higher being, a divine order, or of a life force that transcends space and time. Such faith is used to make meaning from life experiences and to achieve a greater sense of self-awareness (Bryant-Davis, 2005). Adebimpe (2004) found that a sense of connectedness to a higher being has an important role in one’s ability to exhibit healthy functioning in the face of adverse life experiences. He found a particularly strong relationship between religiosity and healthy coping in African American trauma survivors, and he explained that this is likely because an adherence to religious traditions and values is an essential component of African American culture. Therefore, in this case, religious coping is building on a pre-morbid strength. Importantly, a distinction needs to be made between positive and negative religious coping. Positive religious coping includes seeking spiritual support, compassionate religious reappraisals, and religious forgiveness. Negative religious coping includes demonic religious reappraisals, spiritual discontent, and punitive religious reappraisals. Positive religious coping has been correlated with posttraumatic growth (PTG), i.e., personal growth following a traumatic event. PTG involves the development of more adaptive interpretations of the self, relationships with others, and the world. It often involves new and adaptive views regarding one’s philosophy of life, spirituality, and new possibilities (Tedeschi & Calhoun, 1996). Negative religious coping, on the other hand, has been correlated with symptoms of posttraumatic stress (Gerber, Boals, & Scheuttler, 2011). In fact, Leaman and Gee (2011) found negative religious coping to be associated with symptoms of both posttraumatic stress and depression in African torture survivors. This distinction between positive and negative religious coping is a likely explanation for Bryant-Davis and colleague’s (2011) finding that African American sexual assault survivors who endorsed greater use of religious coping also reported more symptoms of depression and posttraumatic stress disorder.

Importantly, religious coping was not beneficial in individuals who did not have a strong pre-trauma religious belief system. In a group of women with breast cancer, women who struggled with their religious beliefs reported lower emotional well-being and higher emotional distress. Similarly, women who looked to religion to help reframe their lives or as a distraction from their worries following a cancer diagnosis reported lower emotional well-being (Schreiber & Brockopp, 2011). This demonstrates the importance of building on an individual’s pre-morbid coping strategies, rather than imposing a particular coping mechanism simply because it is beneficial for others.

Other potential strategies for coping with trauma include fostering a sense of spirituality/meaning in life or social support.  Schreiber and Brockopp (2011) share findings that breast cancer survivors with children had a significantly higher sense of meaning in life and lower psychological stress/distress than breast cancer survivors without children. In addition, a longitudinal study found that a sense of meaning and peace in life predicted a modest decrease in depressive symptoms in women with breast cancer. Importantly, meaning and peace in life was the only significant predictor of depression at 12 months in women with high meaning and peace at baseline.

In terms of social support, Bryant-Davis and colleagues (2011) found evidence supporting prior research that social support is a major protective factor for trauma survivors. In this study, African American women sexual assault survivors who perceived more access to and utilization of social support reported less depression and posttraumatic stress than women with less support  (Bryant-Davis, Ullman, Tsong, & Gobin, 2011). The authors suggest the beneficial effects of social support may also be attributed to sociocultural roots including collectivistic cultural principles. The authors further theorize that sexual assault is an interpersonal or social offense, and social support is thus an integral aspect of repairing that violation. Social support may be a key aspect of reducing any felt shame, enhancing a sense of value/self-worth, and re-establishing a sense of safety. Importantly, social support may be one of the beneficial aspects of religious coping, given the strong social component of group prayer and membership in a congregation, which may foster a sense of belonging.

In conclusion, an assessment of a trauma survivor’s belief system in relation to his or her recovery and well-being will be essential in providing effective psychological services. A belief system is the backbone from which individuals interpret life events. Whether religious, spiritual, or secular, these belief systems will impact how survivors view their trauma, their current situation, and their future (Schreiber & Brockopp, 2011). Therefore, it is vital that healthcare providers develop an understanding of their survivor patient’s belief systems and pre-morbid coping strategies, in order to build on these strengths and foster recovery and well-being in a way that is validating and reinforces that individual’s identity and self-worth.

For comments and questions regarding the evaluation and treatment of post-traumatic stress or depression at the Jackson Behavioral Health Hospital, please contact us at mentalhealthinfo@jhsmiami.org.

Guest blogger Rachel S. Lerner, M.S., is a psychology intern for Medical Psychology CL Service at Jackson Behavioral Health Hospital.

In the decade of 80’s, HIV/AIDS was classified as a terminal disease due to ineffective medical treatments in which most people diagnosed with this disease died promptly. Over the years, scientists have developed different and very effective treatments for people diagnosed with HIV/AIDS. Although at this time scientists do not have the cure of this disease, treatments permit people with HIV/AIDS to have a better quality of life and live longer. The current life expectancy of a person diagnosed with HIV in United States is approximately 70 years (Tong, 2012). For these reasons, HIV/AIDS is no longer considered a terminal disease; HIV/AIDS is currently classified as a chronic medical condition. Individuals diagnosed with HIV in 2013 have an even greater life expectancy than those diagnosed in the 80’s. Moreover, we now have strong evidence about how HIV is transmitted. Despite these facts, however, we still see stereotypes and misconceptions about this medical condition.

Some common misconceptions that society has about HIV/AIDS:

•  “HIV is the same as AIDS”

Fact: A person with HIV usually has a CD4 (white blood cells) count of between 600 and 1,200. When the CD4 count drops below 200, a person’s immune system is severely weakened, and that person is then diagnosed with AIDS because he/she has more propensity towards developing opportunistic infections (Citron, Brouillette & Beckett, 2005). If the person is adherent to his/her antiretroviral treatment, CD4 count should remain in the appropriate range.

• “HIV/AIDS is a medical condition associated with the gay community”

Fact: Although at the beginning of the HIV/AIDS epidemic this condition was associated with the gay community, at the present time it is known that HIV/AIDS does not discriminate. Everyone is at risk regardless of age, race, sexual orientation, class, income or religion. In fact, in some countries such as Puerto Rico, the population most infected with HIV/AIDS in 2003 to 2007 was men-intravenous drug users (Health Department of Puerto Rico, 2012).

• “HIV is a terminal disease”

Fact: At the beginning of HIV/AIDS epidemic, to be diagnosed with HIV was a “death sentence”. However, throughout time scientists have developed effective treatments. In June 1989, Samuel Broder, then head of the National Cancer Institute, declared in a speech at the international AIDS meeting in Montreal, Quebec, that AIDS was a chronic illness (Scandlyn, 2000)

• “HIV is transmitted by using the same cutlery, by a mosquito, or kissing a person with HIV”

Fact: HIV can be acquired only by sexual intercourse, drug use with in infected needle and maternal-fetal transmission (Citron, Brouillette & Beckett, 2005).

• “If the viral load is undetectable that means that the person does not have HIV”

Fact: Having an undetectable viral load tells us that the antiretroviral medications are working. An undetectable viral load doesn’t mean the HIV virus has been eradicated from the body. Even though the virus is undetectable in the blood, it is still hidden in other parts of the body, such as the brain, reproductive organs, and lymph nodes (Citron, Brouillette & Beckett, 2005).

Why is it important that mental health providers know this information?

• Stereotypes and misconceptions about HIV provoke social stigma. Social stigma is closely related with some psychiatric disorders such as depression and anxiety among the HIV/AIDS population (Vyavaharkar et al., 2010).
• By knowing accurate information we can challenge and help the patient to modify dysfunctional thoughts about HIV/AIDS that trigger depression and/or anxiety.
• In some cases, patients’ families reject them because they ignore accurate information about HIV. By educating patients’ families we can facilitate family support and ensure that that patient is understood by his/her primary support group. Lack of social support and depression are factors associated with poor adherence to the HIV medical treatment. (Vyavaharkar et al., 2007).
• When a patient with HIV knows the correct information about his/her medical condition, the patient feels empowered and can help other people to break stereotypes.

References:

Citron, K., Brouillete, M. & Beckett, A. (2005). HIV and Psychiatry. Cambridge: Cambridge University Press.

Health Department of Puerto Rico (2012). Perfil Epidemiológico Integrado para la Prevención del VIH en Puerto Rico, 2003 – 2009. Retrieved January 10, 201 from: http://www.salud.gov.pr/unidadesdeapoyo/Documents/PE%202003-2009.pdf.

Scandlyn J. (2000) When AIDS became a chronic disease. West J Med.;172:130–133.

Tong, W. (2012). Life Expectancy Increases for North Americans Living With HIV. Retrieved January 9, 2012 from http://www.thebodypro.com/content/66391/life-
expectancy-increases-for-north-americans-livi.html.

Vyavaharkar M, Moneyham L, Corwin S, Saunders R, Annang L, Tavakoli A. (2010). Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. J Assoc Nurses AIDS Care. 21(2):144-52. doi: 10.1016/j.jana.2009.07.008. Epub 2009 Oct 30.

Vyavaharkar M, Moneyham L, Tavakoli A, Phillips KD, Murdaugh C, Jackson K, Meding G (2007). Social support, coping, and medication adherence among HIVpositive women with depression living in rural areas of the southeastern United States. AIDS Patient Care STDS. 21(9):667-80.

Guest blogger  Dr. Luis J. Laboy-Albert, Psy.D. is a psychology fellow in Behavioral Medicine (The Healing Place) at Jackson Behavioral Health Hospital.

In 2011, 1,545 children died from child abuse or neglect.  And almost 82% of those were younger than four-years-old.  The consequences of continuous child maltreatment can be devastating.  Abuse and neglect can result in both physical and psychological changes that are undesirable.  It has been found that the brain of a child who has suffered abuse or neglect is underdeveloped when compared to their non-maltreated peers.  Children who have been maltreated have higher incidences of chronic illnesses such as diabetes and cancer.  And lastly, the long term psychological sequelae can be devastating where the development of a healthy personality can be altered, the child’s ability to have fulfilling relationships can be reduced, and the child’s ability to regulate mood states and tolerate frustrations can be negatively impacted.  All of this culminates in an 80% increase in the likelihood that the child will be diagnosed with one or more mental illnesses in the future.

Who commits the majority of crimes against children?  More than 80% are the parent(s) of the child, and more than half of those perpetrators are women.

So how do we protect our children from maltreatment?  As parents, we need to focus on self-care.  Oftentimes parents can mistreat their children, not because they are “bad” or “evil” people, but simply because they are overwhelmed and lack the skills and resources required to raise a child, particularly when that child has a difficult temperament, a disability or a mental illness.  Research shows that children with special needs are maltreated at a significantly higher rate than typically developing children.  This suggests that the caretaking needs of these children induce higher levels of stress and burden in the primary caregiver.  In order to take care of a child, you need to care for yourself first!  And when you need help, just ask!  It can feel marginalizing to ask for help raising your child, or feeling as though you do not possess the qualities of a “good” parent.  But there is no perfect parent and everyone needs assistance at one point or another in their life!

What can you do?

Ten Ways to Help Prevent Child Maltreatment as outlined by Prevent Child Abuse America

1. Be a nurturing parent – children need to know that they are special, loved and capable of following their dreams
2. Help a friend, neighbor or relative – being a parent isn’t easy!  Offer a helping hand to take care of the children, so the parent(s) can rest or spend time together
3. Help yourself – when the big and little problems of your everyday life pile up to the point you feel overwhelmed and out of control-take time out.  Don’t take it out on your kid.
4. If your baby cries – it can be frustrating to hear your baby cry.  Learn what to do if your baby won’t stop crying.  Never shake a baby – shaking a child may result in severe injury or death
5. Get Involved – ask your community leaders, clergy, library and schools to develop services to meet the needs of healthy children and families
6. Help to develop parenting resources at your local library
7. Promote programs in school – teaching children, parents and teachers prevention strategies can help to keep children safe
8. Monitor your child’s television and video viewing – watching violent films and TV programs can harm young children
9. Volunteer at local child abuse prevention program – For information about volunteer opportunities call 1.800.CHILDREN
10. Report suspected abuse or neglect – if you have reason to believe a child has been or may be harmed, call your local department of children and families services (1.800.96ABUSE in Florida) or your local police department.

There are many resources available to parents through organizations and partnerships across the country.  For information, resources, and referrals please call the National Parent Helpline at 1.855.4.A.PARENT or visit the website at www.nationalparenthelpline.org

For general information, please visit the U.S. Department of Health and Human Services Administration for Children and Families at www.childwelfare.gov

For comments and questions regarding parenting skills and groups at the Jackson Behavioral Health Hospital, please contact us at mentalhealthinfo@jhsmiami.org

 Guest blogger Dr. Claudia Ranaldo is a postdoctoral fellow for Child and Adolescent Service at Jackson Behavioral Health Hospital.

References

Fuller-Thomson, E., Baker, T.M., & Brennenstuhl, S. (2012). Evidence supporting an independent association between childhood physical abuse and lifetime suicidal ideation. Suicide and Life-Threatening Behavior, 42(3), 279-291.

Teicher, M.H., Anderson, C.M., & Polcari, A. (2012). Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum. PNAS Proceedings of the National Academy of Sciences of the United States of America, 109(9), 563-572.

 The home environment, and family support more specifically, play a critical role in the development of an adolescent’s identity.   Parents, as well as other family members and close caregivers play an influential role in the health and well-being of adolescents and it is not surprising that their negative, unsupportive, and even punitive, reactions can play a significantly negative role in their children’s outcomes later in life (Ryan, Huebner, Diaz, & Sanchez, 2009).  Revealing same-sex attractions, identity, or behavior to parents or caregivers is anxiety provoking and apprehension-filled for many youth due to fear of rejection, disappointment, or other negative consequences (Savin-Williams, 2001).  Because of this, coming out to parents is often described as one of the most challenging parts of being a same-sex attracted youth (Willoughby, Malik, & Lindahl, 2006).  A study of 164 LGB youth by Savin-Williams and Ream (2003) found 68% of mothers with gay sons and 55% of mothers with lesbian daughters were perceived to have responded to their child’s disclosure with disbelief, denial, intolerance, rejection, or no response at all, while 59% of fathers with both gay sons and lesbian daughters were perceived to have reacted in a non-supportive way.  Additionally, D’Augelli and Hershberger (1993) found that youth reported 55% of their mothers were accepting upon disclosure, 25% were tolerant, 8% were intolerant but not rejecting, and 12% were rejecting.  In the same study, 37% of fathers were perceived as accepting, 36% as tolerant, 10% as intolerant but not rejecting, and 18% as rejecting.  These numbers lend some understanding for why a significant amount of LGBT youth may choose to hide their sexual orientation from their family, especially towards the beginning of their identity exploration.  Doty, Willoughby, Lindahl, and Malik (2010), found that 34% of the young adults in their study had family members who were not aware of their LGB identity.

 Research has shown that when there is little or no support from family members there is an increased risk of poorer health outcomes (Rosario, Hunter, Maguen, Gwadz, & Smith, 2001), including poor self esteem, internalized homophobia, academic difficulties, depression, conduct problems, and struggles with interpersonal relationships (Hale, Van Der Valk, Engles, & Meeus, 2005).  A study by Ryan et al. (2009) reported that LGB young adults who retrospectively reported greater amounts of family rejection during adolescence were 8.4 times more likely to have ever attempted suicide, 5.9 times more likely to experience high levels of depression currently, 3.4 times more likely to have used illegal drugs within the past 6 months, and 3.4 times more likely to have engaged in unprotected sexual intercourse in the last 6 months than LBG young adults who did not experience any, or very little, family rejection.  These results paint a picture of how influential a families’ negative reaction may be in the long term for an adolescent.

It remains unclear as to why some parents react with acceptance and support when they learn of their child’s same-sex attractions, identity, or behavior, while other parents may immediately reject or deny their child.  Theorists and researchers in this area have recently moved away from a grief and mourning perspective when trying to understand parental reactions to their child’s disclosure to a family stress perspective (Willoughby, Doty, & Malik, 2008).  From this perspective, the child’s disclosure is considered a stressor and a family’s reactions are dependent on 1) how readily available resources are for the family to manage stress (e.g., support system, coping skills), 2) what the stressor means to the family or how it affects the family (e.g., do they believe sexual orientation is biologically based or something that can be controlled, does this stressor signal a life of struggle to them, is this against their religious or political beliefs), and 3) how many other stressors the family is concurrently dealing with (i.e., pileup).  Learning about your child’s same-sex attractions, identity, or behavior has the potential to challenge the stability of a family system- family roles and boundaries may change, beliefs about sexuality, religion, and politics maybe become a source of internal or external conflict, fears about being judged for having a gay child may come to the surface, views of who makes up a family system may need to be modified, relationships with the family may be strained (Crosbie-Burnett, Foster, Murray, & Bowen, 1996).

Conversely, some adolescents are going to be fortunate enough to have parents and caregiver who are completely supportive and accepting of their disclosure.   A study completed by Rothman, Sullivan, Keyes, and Boehmer (2012), reported that within their 2002 Massachusetts population-based sample approximately two thirds of lesbian and bisexual women endorsed having received adequate social and emotional support from the parent to whom they first came out to.  Just as negative and rejecting family responses influence adolescent development, so do these positive parental reactions.  Adolescents from supportive and accepting families that react with little or no rejection of their children based on their sexual orientation disclosure have been found to be at much lower risk for poor psychological and behavioral outcomes than those from highly rejecting families such as fewer suicide attempts, less internalized homophobia, and fewer risk-taking behaviors (Ryan et al., 2009).  Additionally, parental acceptance has been associated with many positive outcomes, including relationship satisfaction, positive peer relationships, and prosocial behaviors (Rohner, Khaleque & Cournoyer, 2003).  Family support and acceptance may be demonstrated in a range of ways, including transportation to gay-identified social events, allowing other sexual minority friends to come to the house, freedom to speak about their friends, love-interests, or activities openly in the house, or even participation in LGBT research.  These seemingly minor gestures may be critical to helping these youth through this developmental period and potentially decreasing their likelihood for poor mental health outcomes.

Stay tuned for future blog posts that will explore additional contexts involved in the process of sexual identity development, such as friends and religion.  Additionally, where do researchers, educators, clinicians, and parents go from here?  What can we do to help foster healthy development and a strong sense of sexual identity and pride in the adolescents around us?

 Guest blogger Katherine Bedard, M.A. is a psychology intern in pediatric behavioral medicine at Jackson Behavioral Health Hospital.  

References

Crosbie-Burnett, M., Foster, T. L., Murray, C. I., & Bowen, G. L.  (1996).  Gays’ and lesbians’ families-of-origin: A social-cognitive-behavioral model of adjustment.  Family Relations: Journal of Applied Family and Child Studies, 45, 397-403.

D’Augelli, A. R., & Hershberger, S. L.  (1993).  Lesbian, gay, and bisexual youth in community settings: Personal challenges and mental health problems.  American Journal of Community Psychology, 21, 421-448.

Doty, N. D., Willoughby, B. L. B., Lindahl, K. M., & Malik, N. M.  (2010).  Sexuality related social support among lesbian, gay, and bisexual youth.  Journal of Youth and Adolescence, 39, 1134-1147.

Hale, W. W., Van Der Valk, I., Engles, R., & Meeus, W.  (2005).  Does perceived parental rejection make adolescents sad and mad?  The association of perceived parental rejection             with adolescents depression and aggression.  Journal of Adolescent Health, 36, 466-474.

Rohner, R. P., Khaleque, A.,  & Cournoyer, D. E.  (2003).  Cross-national perspectives on parental acceptance-rejection theory.  Marriage and Family Review, 35, 85-105.

Rosario, M., Hunter, J., Maguen, S., Gwadz, M., & Smith, R.  (2001).  The coming out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: Stipulation and exploration of a model.  American Journal of Community Psychology, 29, 133-160.

Rothman, E. F., Sullivan, M., Keyes, S., & Boehmer, U. (2012).  Parents supportive reactions to sexual orientation disclosure associated with better health: Results from a population-based survey of LGB adults in Massachusetts.  Journal of Homosexuality, 59(2), 186-200.

Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J.  (2009).  Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual youth adults.  Pediatrics, 123, 346-352.

Savin-Williams, R. C.  (1998).  The disclosure to families of same-sex attractions by lesbian, gay male, and bisexual youths: Associations with school problems, running away, substance abuse, prostitution, and suicide.  Journal of Counseling and Clinical Psychology, 62(2), 261-269.

Savin-Williams, R. C.  (2001).  Mom. Dad. I’m gay.  Washington, DC: American Psychological Association.

Savin-Williams, R. C., & Ream, G. L.  (1993).  Sex variations in the disclosure to parents of same-sex attractions.  Journal of Family Psychology, 17(3), 429-438.

Willoughby, B. L. B., Doty, N. D., & Malik, N. M.  (2008).  Parental reactions to their child’s sexual orientation disclosure: A family stress perspective.  Parenting: Science and Practice, 8, 70-91.

Willoughby, B. L. B., Malik, N. M., & Lindahl, K. M.  (2006).  Parental reactions to their sons’ sexual orientation disclosures: The roles of family cohesion, adaptability, and parenting style.  Psychology of Men & Masculinity, 7, 14-26.

Kliman (2010) describes a social matrix that we all live in.  Each and every one of us has a web of identifications that form us.  Layer upon layer, we embody those identities and experiences, and they form our identity and core sense of who we are.  Kliman (2010) likens the multiple aspects of identity and belonging to “kaleidoscopically” overlapping lenses.  In fact, she describes 33 domains of identity.  To make things even more complex is the idea that each of these domains lies on a spectrum of privilege and marginalization.  This therefore assumes that in every aspect of one’s identity, one may be privileged or marginalized, depending on the context.

Why does all of this matter?  Well, McGoldrick & Hardy (2008) discuss the importance of awareness of areas in which we are privileged because this may play out in our interactions with others on an unconscious level.  They describe how power differentials begin to play out in social-interpersonal domains as well as even in more public-professional domains.  How does the fact that I was able to achieve a decent level education (a privilege) play out in my interactions with friends and family?  How does my outward appearance as a Middle Eastern male affect the way people perceive me?  Two random people on the street may have very different attributions about me and my characteristics, simply based on my appearance as a minority.  Isn’t it interesting that I – a Middle Eastern male— have found myself consistently dressing as “normally” as possible and making sure to greet TSA agents with the clearest, most perfect English that I produce can whenever I go through security at an airport?  The messages we get from society about ourselves are seemingly impossible not to internalize on some level. The context from which we view world events inevitably shape how we interact with others every single day.

Interestingly, it could be argued that these domains of privilege and marginalization may shift on that spectrum, depending on who is viewing and analyzing the situation.  Take ethnicity for instance; I may think that someone of another ethnicity holds more social capital in the context of the United States.  They may feel the exact opposite, and it all depends on our experiences and perceptions of self and other.

In working with clients in an outpatient setting, I have found it extremely important to try and keep track of the ways in which I may hold privilege in relation to the clients that I work with.  How might they interpret my behavior based on the assumptions and beliefs they may have about me and my background?  How might I interpret their behavior given my inevitable assumptions about their backgrounds?  Although there are almost limitless scenarios in that regard, it is simply important to carry an awareness of our multiple identities in relation to others.

Although it seems almost impossible to hold 33 domains of identity in constant awareness, it is possible to hold two or three in awareness when discussing a particular issue with another person.  In doing so, we may be able to deconstruct assumptions and blind spots, and help move therapy out of a “stuck” place (Hardy & Laszloffy, 2002).  It is with a renewed awareness of our privileges that we can avoid continuing to play out eons of negative interactions based on racial, gender, class, sexual orientation, immigration status, age, appearance, occupation, marital status, and so on … And at the end of the day, it’s my belief that is one of the most fundamental aspects of interacting with others.

For comments and questions regarding self-esteem and interpersonal relations at the Jackson Behavioral Health Hospital, please contact us at mentalhealthinfo@jhsmiami.org.

Guest blogger Zeyad Layous is a psychology fellow, AOPC, at Jackson Behavioral Health Hospital.

Hardy, K.V. & Laszloffy, T. (2002).  Couple therapy using a multicultural perspective.  In A.S. Gurman & N.              Jacobson (Eds.),  569-593.  New York:  Guilford Press

Kliman, J.  (2010).  Intersections of social privilege and marginalization:  A visual teaching tool.  AFTA  Monograph Series, Winter, 2010. 39-48.  Special Issue:  Expanding our social justice practices: Advances in theory and training.

McGoldrick, M. & Hardy, K. (2008).  Revisioning family therapy:  Race, gender and culture in clinical practice (2^nd ed.).  New York: Guilford Press

Many of us have either seen, engaged in, or been a target of bullying. Looking back at my years growing up, I can remember times when I was a target of a bully and how helpless and alone I felt. I also can remember times when I witnessed bullying incidents. The NASP website reported that between 15% and 30% of students are either bullies or victims. When discussing bullying with others, I often hear the comments stating that bullying is “not as common or harmful as people say it is”, or they say that it is a “normal” part of growing up or a “rite of passage” that can make us stronger as individuals. These feel like excuses to make us feel better about not supporting change. The NASP Center website suggested that 25% of teachers see nothing wrong with bullying or putdowns and intervene in about 4% of bullying incidents. This kind of thinking is extremely harmful. Research has demonstrated time and again that bullying is not a normal childhood activity, and instead has many damaging effects for the individuals who experience bullying. Research also suggests that bullying is very harmful in both the short and long-term impacts it can have on not only the target of bullying, but the bully themselves.

The target of bullying is said to have a “loss” experience because of the bullying. For some, this is a loss of safety, whereas others it is a loss of self-esteem. Other targets experience a loss of belonging or a loss of control over their own life. They are in continual fear of when the next attack will occur. In addition, there are many possible negative physical effects that bullying can have on the target. This may include stomach aches, weight loss or gain, a drop in their grades, substance use, sexual activity, physical aggression, suicidality, or homicidality. The National Education Association estimated that 160,000 children miss school every day due to fear of attack or intimidation by other students, and 15% of all school absenteeism is directly related to fears of being bullied at school. Emotional impacts that bullying can take include feeling of alienation, insecurity, depression, fear, low self-esteem, depression, feeling withdrawn, along with anger, aggression, or feeling vengeful. I have also heard the argument that the targets of bullying are at fault, and “they deserve it” for “being different.” It seems to me that everyone is different in one way or another, so what gives us the right to belittle and bully someone else because they seem to be “different” from us?

Bullying not only negatively impact the target, but the bully themselves can have major negative consequences for their actions. These individuals learn that using force and threats are the best ways to get what they want. Demonstrating more power and control over others is the means that they have learned to use to obtain things. This pattern of behavior can be detrimental to their future. Research has suggested that children who are identified as bullies by age 8 are six times more likely to be convicted of a crime by the age of 24, and 60% of 6^th to 9^th grade children identified as bullies have at least one criminal conviction by age 24 (referenced from Brewster & Railsback, 2001). The National Association of School Psychologists reported that bullies are five times more likely to end up with a serious criminal record by the age of 30. The National Crime Prevention Council suggests that these individuals are more often likely to smoke and drink alcohol as adolescents and do poorly in school (NCPC website).

Presented with the statistics, it is clear that bullying is very harmful to everyone involved. The question is, “What can I do? How can I help?” First and most importantly, talk with your child. Whether they are being bullied or they are the bully, talking with them is the first step towards changing the situation. For the child being bullied, let them know that you are open to discussing these issues, and that you are not going to belittle them and judge them like the bullies. They need to feel like they have a voice in how the situation is handled. If your child is the bully, don’t condone their behavior and discuss with them how their behavior is considered to be bullying. Encourage them in developing empathy toward others and review the consequences for their behaviors (discipline and relationship consequences). Demonstrate and reinforce behaviors that are respectful and help them express themselves in more positive ways.

Secondly, contact the school and set up a meeting either with your child’s teach or a counselor. During this meeting, if your child is being bullied it is important to develop a plan for keeping your child safe at the more vulnerable times, including class breaks, lunch, and recess. Find out the types of resources the school has that are available options for your child as well. If your child is engaging in bullying behavior, it is important to develop a plan for change during this meeting. School consequences may include verbal and/or written warnings, attending meetings for conflict resolution or problem solving skill development, filed into permanent record, suspension, or expulsion. It is important to intervene as early in this behavior as possible, before this behavior becomes normal for the child. The longer you wait, the harder it will be to change. If you suspect that bullying is occurring, investigate and help to make change. Our children rely on us to set the example, and we must step up to the plate. Be a good role-model for your children. Be their advocate when they need it and help them feel like they are not alone.

For comments and questions regarding related to the management of this issue at the Jackson Behavioral Health Hospital, please contact us at mentalhealthinfo@jhsmiami.org.

Guest blogger Ruth Anderson, Psy.D., is a psychology postdoctoral fellow at
Jackson Behavioral Health Hospital. 

Useful resources that can be used by parents, children, and professionals:

http://www.makebeatsnotbeatdowns.org -Information and statistics related to bullying

www.naspcenter.org/factsheets/bullying_fs.html -Information and statistics related to bullying

http://stopbullyingnow.com -Information and statistics related to bullying, and suggestions for bully-free programs

http://www.nea.org/home/neabullyfree.html -Information and statistics related to bullying, and suggestions for bully-free programs

http://www.wrightslaw.com/advoc/articles/prevention.of.bullying.pdf -School wide prevention of bullying suggestions

http://stopbullying.gov  - Has brief videos for kids, games, etc.

http://kidshealth.org -Information and activities for parents and children

http://pbskids.org - Has an interactive game about bullying and other issues that may arise for kids.

http://pbskids.org/itsmylife/friends/bullies/ - Has information, games, advice, and blogs on bullying and other issues that may arise for kids.

http://www.ncpc.org/topics/bullying/what-parents-can-do -National Crime Prevention Council

References:

Brewster, C., & Railsback, J. (2001) Supporting beginning teachers: How administrators, teachers, and policymakers can help new teachers succeed [PowerPoint slides]. Retrieved from http://www.wrightslaw.com/advoc/articles/prevention.of.bullying.pdf

National Crime Prevention Council. (2012). General format. Retrieved from http://www.ncpc.org/topics/bullying/what-parents-can-do

National Education Association. (2012). General format. Retrieved from http://www.nea.org/home/neabullyfree.html