Teens and Co-Occurring Issues with Eating Disorders

At Rosewood, our specialty is the treatment of eating disorders(link is external).  However, very rarely does someone present with just an eating disorder.  It is common that comorbid issues are also present.  Dr. Nicole Garber, Rosewood’s Chief of Pediatric and AdolescentEating Disorders, shares her expertise on teens and self-injurious behavior – a common co-occurring issue with teens and eating disorders.  

Typical Scenario

Maria comes into the office with her mother. Maria looks tired and will not make eye contact as she sits down. Before the door is even closed, her mother says in almost hysteric tones, “Show her, show her what you have been doing!” Hesitantly Maria pushes up the sleeve of her shirt to reveal several linear, superficial cuts that were self-inflicted. Her mother sits down looking frustrated and says “I just don’t understand, how she can be hurting herself”.

The above is a scene that clinicians deal with on a daily basis. Self-injury, or more formally Non-suicidal Self-injury (NSSI), is common in teenagers with anywhere from 8-61% of the population engaging in self-injurious behaviors. The 8% estimate is from community estimates, and the higher end of the spectrum is from patients seeking mental health services. The average age of onset for self-injury is between 14 and 15 years old and earlier in adolescents.  Girls self-injure more than boys, but the rates become more equal through the later adolescence period.

What is NSSI?

NSSI is defined as “Direct and deliberate destruction of body tissue in the absence of any observable intent to die”. (Nock) One must ask about the intent of the injury and not assume on way or the other.

Why do young people self-injure?

Often in the popular press, self-injury will be presented as a means that a young person gains attention. At times, self-injury may be used as a cry for help, but more commonly it is used to regulate emotions. A young person may self-injure when they are experiencing very intense emotions and they do not know how to self soothe in a more adaptive manner. It is known when someone self-injures there are endogenous opiates that are released that can cause the person to feel better which is part of the reason that a young person continues the behavior despite other negative consequences. Often time young people with trauma will feel numb or dissociated and will self-injure in order to ground themselves and feel something. 

What are some warning signs that my teenager may be self-injuring? 

One may notice blood stains on clothes, towels, or tissues. Often there will be frequent unexplained wounds or an increase in “accidents”. One may also notice always wearing long sleeves or pants, even if not appropriate for situations or weather. Most young people self-injure in private, so there may be more time spent alone and irritability prior to them being able to go someplace private if they are having the urge to self-harm.

What to do if my teenager is self–injuring?

If you discover your child is self-injuring, take a deep breath and take a few moments (or hours) to collect yourself. Ask your child about what you are noticing and try to take a curious and non-judgmental stance. Let them know that you realize that they must be experiencing significant pain if they are self-injuring, and that you are there for them and want to get them help. Then book an appointment with a mental health practitioner, therapist or psychiatrist, for an evaluation. Over 90% of teenagers that self-injure meet criteria for one or more psychiatric diagnosis such as depression, anxiety disorder, or conduct disorders. It is also known that self-injury in adolescents increases the risk of a suicide attempt and completing suicide.

Treatment of Self-injury:

The mental health practitioner will work with the teenager and family members to develop a treatment plan that will address the self-injury and any co-occurring disorders. Specific therapies have been developed to treat NSSI in teenagers including dialectical behavioral therapy (DBT) and mentalization based treatment (MBT). Both DBT and MBT have a coherent model to understand self-injurious behaviors, employ an active therapist, balance validation with change, make a connection between thoughts, feelings, and behaviors, and encourage agency amongst the adolescents. 

In summary, self-injury is common in adolescents and is most often used to as a means to regulate their emotions. If you suspect your child is self-injuring, please seek an evaluation with a qualified mental health practitioner as there are effective treatments that exist.

Dena Cabrera Psy.D., CEDSSitting at the Kids Table

Profit with Passion Summit - Day 2

The Profit with Passion Summit kicked off today (Friday) and I'm so excited. There are 30+ speakers and each one has something special to share.  Registration to attend is FREE -- click here -- to be taken to the registration page.

Check out the line up for Saturday, January 30, 2016 to see which speakers you'd like to visit.

West coast folks -- the times are ET not PT so please remember to make the time change for your calendar.

Again, visit my link http://profitwithpassionsummit.com/?ap_id=drangela to register for FREE. Enjoy!

The Strange (But Effective) Way I Stick to Hard Goals

There’s a saying that you should never trust a skinny chef. By that logic, you should never trust an out of shape behavioral designer(link is external).

Over the past four years, I’ve discovered many incredible ways to hack my habits and improve my life. I have taught myself to love running, dramatically improved my diet and found the focus to write a bestselling book(link is external). Understanding how the mind works and using it to affect my daily behaviors has yielded tremendous dividends.

However, there is one goal that’s nagged at me for years that despite my best efforts, I’ve never been able to achieve—going to the gym consistently. I hate lifting weights. Hate it. I disdain the strain, the sweat, the smells—all of it. The only thing I like about working out are the results. Unfortunately, there’s no way to enjoy the benefits of going to the gym without, you know, actually going to the gym.

That’s not to say building muscle is all that important. Diet has a much greater impact(link is external) on body weight and health than exercise. But given that I’ve already hacked my diet and no longer struggle with eating right, I wanted to finally get to the bottom of this stubborn challenge.

Why was this one goal so hard to achieve? If I could figure out a way to overcome this challenge, perhaps it would provide insights into how to tackle other difficult to achieve goals.

Habits vs. Routines—There is a Difference

Recently, it seems habits are everywhere. A slew of new books, not to mention countless blog posts and apps, guarantee a whole new you by harnessing the power of habits. However, almost all of these well intentioned authors promise too much. Many over-prescribe habits as a solution to problems they just can’t fix.

So what are habits, really? According to Dr. Benjamin Gardner, a psychologist focusing on habit research at King’s College London, “habit works by generating an impulse to do a behavior with little or no conscious thought.” Habits are simply how the brain learns to do things without deliberation. These impulses can be put to good use, but only certain behaviors can become habits.

Building a habit is relatively simple—just harness the impulse. For new habits to take hold, provide a clear trigger, make the behavior easy to do, and ensure it occurs frequently. For example, by completely removing unhealthy food from my home and eating the same thing every morning, my diet became a healthy habit. I extracted the decision making process out of what I eat at home.

However, if the behavior requires a high degree of intentionality, effort, or deliberation, it is not a habit. Although proponents of habits tout them as miracle cures for doing things we’d rather not do, I’m sorry to say that’s snake oil. All sorts of tasks aren’t habits and never will be. By definition, doing things that are effortful aren’t habits.

Unfortunately, this means behaviors that require hard work and deliberate practice aren’t good candidates for habit-formation. For example, although I make time for it every day, writing is not a habit. Writing is hard work. If I waited for an “impulse” to write, I’d never do it. To get better at writing requires concentration and directed effort to make sense of the words as they go from the research to my head and then to the screen. Similarly, lifting weights isn’t a habit because getting stronger requires working harder.

So if these type of behaviors aren’t habits, what are they? They’re routines. A routine is a series of behaviors regularly practiced. Routines don’t care if you feel an urge or not, they just need to get done. When I finally realized I would never succeed at making going to the gym a habit, I began looking for how to establish a routine instead.

Burn or Burn

A word of warning. Before I share one technique I used to finally get myself to go to the gym regularly, I need to share a few disclaimers.

First, this technique, as effective as it is, can be dangerous. It is a very good way to get you to do a routine but provides no safeguards against doing the wrong thing again and again. If you’re doing something counterproductive, this technique will only get you to do more of it. For example, doing tons of sit-ups won’t help you (and may actually hurt you) if you’re also drinking sugary sodas every day.

Second, this method is not good for getting other people to do things. This is for personal use only so don’t try and force it on people who have to do what you tell them, like employees or your kids.

Finally, this isn’t the only method you can use and admittedly this is a rather brute force strain of behavior change. If learning to love a behavior is an option, I recommend trying a different technique. For example, I’ve written about finding your MEA – your Minimum Enjoyable Action(link is external). The MEA method is great for simple behaviors you enjoy doing. I learned to love running because I always enjoyed going on walks. Finding my MEA proved very effective at slowly improving my stamina until running replaced walking as an enjoyable pastime.

However, there are certain things we just don’t like doing, but we must do anyway. These behaviors require diligence, grit, hard work and consistency. This is where what I call the “burn or burn” technique comes in.

How it Works

1. Pick your routine. For me, my routine was hitting the gym.
2. Book your time. Make time in your schedule for the routine. If you don’t reserve the time as you would booking an appointment or important meeting, the routine won’t happen.
3. Find a crisp $100 bill. Other denominations will work too but it has to be an amount you’d hate to lose.
4. Find a lighter.
5. Buy a wall calendar and place it somewhere you’ll see every day. My calendar is in my closet and it’s the first thing I see when I get dressed in the morning.
6. Tape the $100 bill to today’s date in the calendar and place the lighter somewhere visible near the wall calendar.

Now you have a choice to make. Everyday, when the time comes to do your routine, you can chose either option A and do the routine, which in my case was to feel the “burn” in the gym, or option B and literally burn your money. You can’t give the money to someone or buy something with it, you have to set it aflame.

Yes, I know it’s technically illegal to destroy government tender but the reason this technique works is that you should never have to actually burn the money. Instead, the threat of watching your money go up in smoke makes this technique work. I’ve been on “burn or burn” for six months now and I haven’t burned a bill yet.

Why it Works

As radical as “burn or burn” sounds, there’s good science to support why it’s so effective. For one, it’s no surprise we hate losing money. But why not pay yourself for doing the routine instead of taking money away? Social scientists tell us humans feel the psychological pain of loss twice as powerfully as the satisfaction of a gain—a phenomenon known as “loss aversion.”

Furthermore, people are notoriously awful at predicting their future actions. “Sure, I’ll go to the gym tomorrow,” I’d say, but when tomorrow came, I’d find an excuse. The theory of hyperbolic discounting helps explain why what we say we will do in the future is not what we do when the time comes to actually do it. We are “present-biased,” meaning we fail to properly value benefits we won’t realize for some time. These psychological tendencies conspire to keep us from doing the things we know we should.

The “burn or burn” technique works by binding us to a financially painful contract so we can’t weasel out of it when the task needs to get done. In fact, a similar technique was shown to be amazingly effective at helping smokers kick their addiction to cigarettes. The study, published in the New England Journal of Medicine(link is external), found that when smokers were asked to risk their own money, they were much more likely to quit.

Unfortunately, the researchers in the smoking study found that very few smokers would agree to risk their money. Perhaps these test subjects knew that if they wagered their own cash, they’d have to actually stop smoking, something they likely did not want to do.

I too struggled with starting “burn or burn” because I knew it meant I’d have to actually do the uncomfortable work. Then, I finally realized how ridiculous this line of thinking was. Why would I resist a technique that virtually guaranteed I would accomplish my goal?

If I wasn’t ready to commit, then I should forget the goal altogether. But if I really wanted it, I should gladly put money on the line to make sure I’d do the heavy lifting. After several weeks of difficult deliberation, I finally made my decision. I nailed the calendar to my wall, taped my money to the date, and put my lighter on the shelf where it still sits today and every day.

Nir EyalAutomatic You

Living a Fulfilled Life

What does it mean to live a fulfilled life? Many will say look at the material items accumulated, others look to the number of friends, while others yet, contend it is simply how happy your family is at any given time. There are certain actions one can take to insure that no matter the algorithm used you will end up on the happier side of life.

Join me as we look at five tips for living a more fulfilled life.

BONUS INTERVIEW: Eleze "Lisa" Thomas-McMillan author of Living Fulfilled The Infectious Joy of Serving Others
SHOW SPONSOR: Inspirational Productions
 MUSIC SPONSOR: Triumph by JaneliaSoul also available on Amazon

Should I Stay Up Late Being Productive or Just Go to Bed?

Source: CollegeDegrees360/Flickr

It’s every student’s dilemma. Should you keep studying and delay your bedtime, or shut the books and hit the hay?

In college, I regularly stayed up until midnight or 1 a.m. studying and writing lab reports, even though my alarm went off at 5 a.m. each morning for rowing practice. It was always so tempting to stay up late when there was just so much work to be done. So much work, all the time.

Although running on four or five hours of sleep in college let me finish a lot of work and studying, I was sleepy. I found myself nodding off during class, eating more food to keep myself awake, and I became more susceptible to catching colds. I found it harder to study because I hadn’t paid attention well in class. On occasion, I didn’t do as well on tests as I would have liked to. Sometimes I even found myself being short-tempered toward my friends.

Sound familiar?

These days, after working in a sleep research laboratory for the past four years and becoming intimately acquainted with what the research says about sleep curtailment, I am much more inclined to shut the books, close my laptop, and crawl into bed.

In short, there are literally no benefits—none, zip, zero, nada—to depriving oneself of necessary sleep.

What does sleep deprivation do to my body?

• Just one all-nighter alters your immune system’s functioning, similar to the waystress does. The peak concentration of white blood cells’ diurnal rhythm issignificantly reduced after one night of sleep deprivation(link is external), making us more vulnerable to illness and infection. 
• A single night of sleep deprivation results in increased blood pressure(link is external), and even a half-night of sleep loss can have the same effect for individuals who are hypertensive or prehypertensive, suggesting activation of the sympathetic system. 
• Our body experiences many unique endocrine changes during sleep related to growth and thermoregulation, which become disrupted when sleep is curtailed.Satiety hormones, like leptin and ghrelin, are also altered(link is external), which may result in increased hunger and weight gain. 
• One week of mild sleep restriction (six hours per night—a pretty typical schedule for most people, right?) causes increased secretion of proinflammatory cytokines(link is external), which can contribute to cardiovascular and neurocognitive dysfunction. Recovery sleep on the weekends lowers these inflammation levels. 
• One week of six hours per night is associated with a change in the transcription ofover 700 genes(link is external), many of which are implicated in the body’s circadian rhythms, oxidative stress, and metabolism. 

What does sleep deprivation do to my brain?

• One night of total sleep deprivation reduces the coordination and speed of our ability to eye-track(link is external), as assessed in a study that simulated driving ability after insufficient sleep. 
• In the same study above that found an increase in cytokines with modest sleep restriction for one week, it was found that three nights of recovery sleep (10 hours per night in bed) was not sufficient to reverse deficits(link is external) in attention and reaction time, as measured by a simple computer task. 
• Taken together, many studies have concluded that chronic sleep loss is associated with deficits(link is external) in both short- and long-term memory, memory formation, decision-making, and attention/vigilance. 

How can I tell if I’m getting enough sleep?

This is a test called the Epworth Sleepiness Scale(link is external). If you add your total score (out of a maximum of 24 points), you can get a sense for how sleepy you are, subjectively. For reference, the average person scores around four or five.

There’s also an objective test of daytime sleepiness in which an individual is given several 20-minute nap opportunities throughout the day. The lower the sleep latency, the greater the “sleep need.”

But sometimes you DON’T feel like you could actually fall asleep during the day, yet it’s still clear you aren’t getting enough sleep. Do you find it difficult to get out of bed in the morning? Feel you need coffee to start your day? Find yourself yawning frequently? Feel sluggish, unmotivated, inattentive, or foggy-headed? Find yourself getting sick more often, or unable to perform as well in the gym? You’re probably running on too little sleep.

I have a test the next day, and I’m too stressed to fall asleep. What can I do?

• If you absolutely must study in the hours before bed, make sure that you’re not studying in bright light. Light, especially in the blue wavelength, suppresses the secretion of melatonin, a hormone synthesized by the pineal gland that prepares your body for sleep. Computer, tablet, and phone screens are the worst culprits for blue light exposure onto the retina. Consider downloading the program f.lux(link is external), which automatically softens your computer screen’s brightness at sunset. You can also try donning a pair of orange glasses to filter out blue light (and read about the experiment I did on myself here!) Try to limit bright light exposure at least one hour before bed.
• Consider deep breathing and mindfulness techniques to relax. I keep a meditationMP3 and a pair of earbuds by my bed every night, just in case. Even on my most stressful nights, following along with the voice’s commands is extremely helpful in relaxing me.
• Associate your bed with sleeping only. Don’t study in bed. If you’re lying in bed paralyzed with stress and can’t fall asleep, get out of bed and find a quiet activity until you’re ready to try again. Associating your bed with insomnia will only make you dread bedtime even more each night.
• If your insomnia is chronic (more than three times per week for at least three months), consider seeing a sleep specialist. They may prescribe you a medication that can suppress your body’s stress system, or refer you to a cognitive-behavior therapy specialist for treatment.

So…should I stay up an extra hour studying, or give myself an extra hour of sleep?

I don’t think this question needs answering anymore! Physical effects aside, sleep loss makes it difficult to learn, pay attention, and memorize information. Studying late at night, to a degree, becomes counterproductive; delaying sleep cuts into our precious slow-wave sleep stage, which is associated with reduced cortisol levels and memory consolidation.

You get one body and one brain in life. Give them enough sleep—it’s the single best thing you can do to perform and feel your best every day.

Jordan Gaines LewisBrain Babble

The Link Between Introversion and Loneliness

Introverts love solitude. As a full-fledged introvert myself, I relish my time alone and completely understand the desire to forego socializing. Socializing is draining for introverts and, frankly, a lot of it feels like pointless chit-chat.

Solitude is like the air that introverts breathe.

But this deep need for solitude—a legitimate need, by the way—does have the potential to turn into harmful social isolation. It’s a balancing act that all introverts face: How much time alone is too much time alone? How do I know when I’ve crossed the line from delightful alone-ness to fretful loneliness?

As someone who’s been through this journey, I’d like to share my advice for maintaining your precious alone time, while successfully staving off painful loneliness.

1. Pay attention to how your alone-ness is making you feel.

This, in my opinion, is the #1 piece of advice you can receive on this topic. The amount of time one can spend alone while still feeling perfectly happy varies from person to person, and for introverts, this amount of time can be substantial.

Monitoring your own individual feelings about the amount of time you’re spending alone is the best way to know when you’ve crossed the line from tranquil to lonely.

If you choose to be diligent about this effort, keep a regular log of how your alone-ness is making you feel. Once a day, on a scale of one to ten, rate how happy you feel with the amount of alone-ness you’ve experienced that day.

2. Focus on hanging out one-on-one or in small groups.

The average introvert strongly prefers socializing with just one other person or in small groups. Introverts tend to dislike a lot of stimulation, so when they attend a gathering where large numbers of people buzz around them, they’re likely to leave the gathering feeling more distressed than when they arrived.

One-on-one or small group interactions are excellent for staving off introvert loneliness because they provide all the benefits of socializing without the overstimulation.

3. If attending a large gathering, set expectations about when you will leave.

It’s a bit of an introvert’s nightmare to go to a large social gathering (especially if you don’t know anyone) without any end-point in sight.

As I discussed in my previous article, How Your Flaky Friend May Have Gotten That Way, some people feel an anticipatory anxiety around social gatherings that make them prone to flake out—not because they don’t want to be included, but because they’re genuinely anxious.

One of the best ways to mitigate anxiety around large gatherings is to make clear— both to yourself and to whomever else might be invested—what time you need to leave. Not only will this prevent you from ghosting inappropriately early in the night, your host will appreciate that you came for as long as you could.

4. Keep to a weekly quota of social interaction.

Some introverts have wiped social interaction off their calendars altogether, while others feel overwhelmed by the amount of social gatherings they’re expected to attend. A good way to strike a balance between solitude and socializing—no matter which end of the spectrum you’re on—is to set a weekly quota for social interaction.

Let’s say you decide to hold yourself to two social interactions per week. If you currently have no interactions scheduled, this will prompt you to reach out and start inviting people into your life. If you receive many invitations per week, this gives you permission to attend only the two you’re most excited about… and turn down the rest.

5. Stay smart about your online socializing.

When you find real-life interaction draining, as most introverts do, it can be tempting to turn over your whole social world to the Internet. The Internet allows you to chat with people when you feel like it, yet disengage at any moment. It creates the feeling that you have social support even when you’re alone. There’s no doubt that this is an intriguing prospect to the introverts among us.

But don’t rely too heavily on the Internet (or your phone) to fulfill your desire for togetherness. It’s profoundly difficult to get to know another real person through a device. And if, at any point, the person you thought you knew turns out to be a fraud, you’ll likely end up lonelier than you were before you met them.

Keep these tips in mind, fellow introverts! We have special gifts to share with the world, so don’t let our propensity for loneliness get in your way.

Kira AsatryanThe Art of Closeness

The Cooling Breeze of Janelia

I'm excited to have Janelia as a sponsor on 2 upcoming episodes of Modern Living with Dr. Angela on January 19th and 26th.  The vibe of the music is just breathtaking. 

Her music is available on her website or on Amazon. 

Check out her video (for a different song) below:

Ambassadors for Mashiach

The Eastern Gates presents 

"Ambassadors for Mashiach" 

"Ambassadors For Mashiach" is a documentary film that captures the biblical destiny of Israel, the Church and the One New Man. 

This is a must see film.

Dvd available for purchase online at: www.theeasterngates.org

Challenges with Dr. Angela Chester

Happy New Year!  We have some awesome things planned for everyone. We hope that you'll join us. Check out the video for more. See you there!

Home for the Holidays | Interview in the Long Beach Leader

Interview by Dianne Anderson  (Staff Writer)

Christmas is near.

The rush for gifts and hustle for toys, throw up the tree, hours over a hot stove, a fast six days till the New Year. Then, the moment is gone.

Local pastoral counselor, Dr. Angela Chester, thinks maybe this year, families can slow it down a bit and try to enjoy each other, and let the little things slide.

As often happens, at least some of the headaches around this time of year comes from long standing rivals hurling small insults across the table. She said a lot of it can be avoided if people can stay in a mindset of gratitude.

Her own recent close call, a car accident has left her bedridden for two weeks, gives her time to reflect on all the things that she is personally thankful for, despite extreme back pain.

In general, she said both the nation as a whole, and individuals in the community, are grieving from the latest of 355th mass shooting for this year alone. Stress at the individual level for African American families dealing with the loss of a loved one, either by gangs or wrongful death shootings by police, has a stronghold on the social psyche.    

There is a lot of violence to take in.

“It’s almost like a double whammy. Our nation is having an identity crisis, trying to put a band-aid on a wound that keeps getting ripped open,” she said. Part of coming to grips is understanding the five stages of grief -- denial, anger, bargaining, depression and finally acceptance -- which is a natural process for everyone.

“Whether it happened in San Bernardino, Boston Marathon, the children of Sandy Hook in Connecticut, in Columbine. Everyone is like, is this real, did that happen?” she said. “That’s a form of denial.”

At times, anger becomes, “how dare they do this?” leading to the bargaining stage, and trying to make sense or creating solutions. That often becomes a catalyst for action, such as mothers advocating through Mothers Against Drunk Drivers to stop the senseless loss of children.

Because of the grieving process, some laws are changed.

“Some schools now have more security cameras, metal detectors because kids were coming to school with guns. That idea came out of the bargaining stage of our grief. It was a good idea,” she said.

Through depression, both the community and individuals should do what they’ve been taught for maintaining emotional balance, turn to each other for support, she said. Others will cycle between depression and anger over a period of weeks, or months, depending on the loss.

“But we have to decide that we’re going to do something [in the healing process]. The same way that we can’t stay stuck in our depression, we can’t stay stuck in our anger,” she said.

More than likely, the recent events will be part of this family holiday conversation. But, it could also serve as a reminder to be thankful for family, not just playing lip service around turkey dinner holding hands.

For more information, see http://www.drangelachester.com

Prepping for the New Year

The New Year is just around the corner. If you haven't starting planning for 2016, they you're already behind the line.  Let's get you back on track and up to speed.

There's a few things you can do to start off 2016 -- one is get physically fit. Check out our video with AJ Joshi of Valens. We talk health, fitness, taking care of spirit, and more.

How to Spot Depression in Your College Student This Holiday

Observing these signs and symptoms?  You may need to take action.

 
The young adult who left for college in September was a predominantly vibrant, optimistic, albeit sometimes stubborn, 18-year-old heading off to a new life away from home.

Some four months later, the person who walked through the front door for the holidays has changed, though it’s difficult to articulate why.  

As social obligations mount in celebration of the season, a few observations, as well as likely explanations, are made. [READ MORE]

Dealing with the Holiday Blues

The joys of the Christmas season is upon us -- trees are going up, garland is being placed -- but what about those who see this time of year as not so festive?  Trying to prevent depression and anxiety during the holidays can be challenging.  


Find out what you can do to prevent the blues and learn how to help those who suffer. Listen now!

MUSIC SPONSOR: NOW featuring Tiffany Spencer
SHOW SPONSOR:   Wrapmamma24   FroButter