I haven’t very often suffered from significant chronic pain in my life; a fact that I am quite grateful for as I’ve worked with many patients who have faced this condition. I always had considerable empathy for their plights, but never fully understood how incapacitating it can be. And the anxiety of such pain continuing for a prolonged time doesn’t help matters much either.

So, the other day, after sitting through two and a half days of faculty retreat meetings on miserable, inflexible steel framed chairs, I felt a crushing pinch in my neck that radiated pain starting at the neck which traveled down beneath my scapula. Ouch. Over the next few days, the pain only intensified, reaching a level of about 8 on a 10 point scale. You know what? It gets rather hard to concentrate on teaching, reading, or much of anything else when your body radiates those kinds of exquisite sensations. Sleep doesn’t come all night and one’s mood deteriorates faster than a spoiled banana.

So it took me about four days to connect with the thought that calling my doctor might be a good idea even though I was out of town. I did so and he called right back. He told me (and later confirmed) that I probably had a nerve compression at C4/5 which was causing the whole thing. He said we should jump right on it and perhaps we could get things to settle down. Well, not jump in the literal sense, but fill me up with an armamentarium  of medications to reduce the inflammation/pain cycle that had set in. Without getting into the actual details, he gave me scripts for serious inflammation, pain, and muscle relaxants.

Wow. What a help. Immediately relief came to me although I could tell there was still some trouble with inflammation. After another week or ten days or so, I’m tapering off these things and so far it’s working out pretty well. It’s getting a bit less likely that we’ll have to …

Chuck and I are going to get professional pictures for our web site in order to show our readers how much older we’ve become. So, already, I’m a bit worried about my smile. I don’t think I ever worried about the way I looked in pictures until I started to notice pictures of myself in my early 20’s. I hated them all. It must have been genetic because my grandmother who was born in 1882 or so carefully scratched all of her faces off her pictures before she died at age 92. No wonder I am a psychologist.

Scientists have looked into smiles. They measure the muscles in the face and call one smile– that involves two facial muscle movements the Ducheene Smile. For those of you who care, the zygomaiticus muscle pulls the corner of the lips up and the orbicularis oculi pars lateralis muscle lifts the cheeks, narrows the eyes and causes crow feet. The Ducheene smile is associated with real pleasure or amusement.  The fake smile, sometimes called the polite smile, only uses the muscles in the mouth region. When people aren’t feeling happy or don’t have a natural talent to bring forth instantaneous joy, they often produce the social or polite smile. In fact one treatment for people with Borderline Personality Disorder developed by Dr. Marsha Lineham suggests that patients practice half smiles in order to control their underline feelings of unhappiness or anger.

When I am unselfconscious, in a dark comedy, feeling silly, or with kids, I usually don’t think about my smiles. However, when I am in front of a photographer, my cheeks and crows’ feet are paralyzed. I must admit, as the wrinkles in my face are overtaking my youth, I’m a bit less self-conscious than I used to be. So that’s good.

But, it brings me to a study that colleague Ken Pope reported on last week.  In this study, one group of participants was given Botox (injections that paralyze muscles). This injection was given in the area that paralyzes the muscles that cause frowning. The subjects were then asked …

There are many potential challenges to attachment. When children are born prematurely or have serious health issues, they may be hospitalized and separated from their parents. Modern medical practices encourage parents to spend as much time as possible at the bedside with sick children to maintain bonding. Mothers who have serious physical or mental health issues following the birth of their babies can also cause delays in attachment. Divorce, death, abuse, or trauma can damage or prevent the development of secure attachment. However, most believe that evolution pushes attachment so despite challenges, most babies become attached to their primary caregivers.

Different attachment patterns have been recognized and seem to be consistent in young children. These patterns may be related to emotional well being in later childhood and even adulthood. Attachment styles are either secure or insecure. Researcher Mary Ainsworth developed a way to study attachment behavior in young children through an experiment called the Strange Situation Protocol. Basically, babies and their mothers were taken to a playroom and watched through a one-way mirror. The mother leaves the child in the room with a stranger and then returns. The behavior of the child is then observed carefully. This research found three major attachment styles–secure (marked by being easily comforted by the mother), avoidant (demonstrated by little distress when the mom leaves and ignoring or turning away from her upon return), and ambivalent/resistant (seen when the child shows anxiety and distress when the mother reunites). Later research by Dr. Mary Main found a fourth style (disorganized, which appears to be a mix of both avoidant and ambivalent styles).

Attachment styles can change over life, but that takes time, effort, and/or therapy. If someone suffers from …

All children worry and are frightened from time to time. However, between 3 and 6 percent of children worry almost all of the time. They have a condition called generalized anxiety disorder (GAD). Many professionals consider GAD the common cold of anxiety and it’s prevalence among adults is even higher (lifetime prevalence up to 25%). Kids with GAD worry about things that might happen, or things that probably won’t happen, or things that absolutely won’t happen. Basically, they worry about everything.

GAD is serious in children because it interferes with their ability to enjoy life, make friends, and concentrate in school. Kids with GAD often suffer headaches, stomach aches, fatigue, or muscle tension. They may have difficulty sleeping, be irritable, or feel restless and agitated.

Like other emotional problems, GAD is caused by some combination of genetics, biology, learning, and/or experience. Lots of kids from very normal, happy families have GAD. So, if your child has GAD, don’t blame yourself; just make sure to get help.

The earthquake and tragedy in Haiti can have a very powerful effect on your child, with or without an anxiety disorder. All children are afraid of losing a parent, being lost and unable to get out, or getting hurt. The news coverage of this disaster lets kids know that this can happen. So, here are some tips in terms of handling this incident with your child.

• Do not sit and watch television coverage of Haiti for extended periods of time with your children (actually, that’s pretty good advice even if you don’t have kids!). Very young children can be affected by seeing suffering or violence on the television even when they don’t understand what’s happening.
• Do talk to your kids about their fears and concerns. What you say and do will depend on the age and interest of your child. You probably won’t be talking about earthquakes with your 3 year old. Many school aged children will have worries and some won’t bring it up. You can start a conversation by asking what they know about the situation.
• Have a family plan in case of …
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Like millions of human beings, I’ve found myself riveted to the horrors of Haiti. While watching the news at half attention this morning, President Obama’s speech on putting a tax on the companies that took part in the bailout seemed a bit jarring at first. But then I realized that the Haitian situation fits rather well with the economic message.

President Obama called the banks recent round of bonuses “obscene.” I like that word. The average Haitian lives on less than $2 dollars a day. That makes the math pretty easy-about $730 a year. I confess, I can get lost on searching the Internet. Today I did as I went looking for what obscene might mean. Just how much did the financial institutions, too big to fail, pay out in executive bonuses? The New York Times reported (01/10/10) that numbers, “six, seven, and even eight-figure sums for some chief executive and top producers…” Then I found another story on CNN that the average compensation of the CEO’s who took bailout money in 2007 was 11.1 million. Hmm, 11.1 million divided by 365 means that those poor guys have to get by on a little over $30,000 a day. Just think about that. Obscene.

The contrast is amazing. I can only hope that Americans can respond to the overwhelming human suffering in Haiti with a fraction of our financial institutions’ response to the insatiable desires of their top executives. I guess it’s too much to expect Goldman Sachs et al. to demonstrate similar compassion and generosity to the natives of Haiti.

So, what does our blog have to do with all of this? When you see pictures of people digging with their hands through concrete to reach thin limbs and muffled moans, we urge you all to take some time to count your blessings and help those less fortunate. Donate directly to an organization and watch out for scams. Partners in Health has been recommended by Tracy Kidder, author of Mountains Beyond Mountains, in an Op-Ed in NYT and our son who traveled to Haiti a few weeks ago …

When I meet new people, they often tell me about someone they know that has some sort of emotional problem. Many people give me a synopsis of symptoms and ask whether or not a person has obsessive compulsive disorder, anxiety, attention deficit disorder, depression, or borderline personality disorder. I’m pretty quick to say that I don’t ever make a diagnosis without seeing a person, but can talk about some qualities that might suggest this or that. I almost always point out that emotional problems are different than physical ailments; they tend to be more dimensional and less categorical. At this point, most people are stifling a yawn and moving on to the next topic (or in your case blog).

But our blog readers tend to be persistent, so let me continue. In the medical model, which psychology too often tries to emulate, a person has a disease and that disease can, in most cases, be verified by a medical test. For example, your biopsy reveals cancerous tissue or your blood test suggests that you have been invaded by parasites. Or the sore throat, fever, and a positive culture are consistent with a diagnosis of strep throat. Good medical diagnosis then hopefully leads to specific, specialized treatment.

The diagnosis of mental disorders is not so black and white. You don’t catch depression. And the symptoms of depression can look very different among people. Some with depression sleep too much or eat too much. Some toss and turn all night and lose their appetite. Some weep; others rage. There’s no blood test or MRI for assessing a diagnosis of depression. And unlike pregnancy, you can be just a little anxious or depressed.

The same diagnostic issue is even truer for what are known as the personality disorders. For example, the diagnosis of Obsessive Compulsive Personality Disorder (which is different than the more commonly known, Obsessive Compulsive Disorder) requires a person to demonstrate four of the following eight symptoms (according to the DSM IV TR):

• Preoccupation with details, rules, and lists
• Perfectionism that interferes with finishing projects
• Unable to throw away worthless objects
• Unable to …
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In the past several decades, we’ve watched the treatment of Borderline Personality Disorder (BPD) evolve from a virtually hopeless status with no clear answers as to what may work, to a far more sophisticated and hopeful array of possibilities (see our earlier blog on Increasing Hope for the Treatment of Borderline Personality Disorder). Have you ever wondered or worried that you might have BPD? The actual, current approach to diagnosing BPD is quite complex, but the four components that most folks with BPD demonstrate include:

• Mood instability: A person with BPD may flip from feelings of joy to despair, sadness to profound anxiety, or affection to rage within minutes or hours. Sometimes these shifts occur many times throughout a given day. People with Bipolar Disorder, on the other hand, tend to have somewhat longer lasting moods though they also may demonstrate frequent shifts in mood.
• Impulsivity: People with BPD tend to do things without thinking about the consequences first. Perhaps not surprisingly, this tendency often lands them in trouble. People with BPD also speak without thinking. They may lie to get out of trouble, exaggerate reality, or to lash out at others.
• Disturbances in Thinking: We’re not talking about psychosis here although people with BPD do sometimes experience fleeting departures from reality. Rather, the more common disturbances in thinking that they have involve tendencies to see things in all or not, black and white terms with no shades of gray. Sometimes they are also inclined to having somewhat paranoid thoughts and see other people as maliciously motivated (though this “paranoia” does not reach psychotic levels very often).
• Unstable Relationships: People with BPD are notorious for having struggles with interpersonal relationships. They get drawn into conflicts with other people and feel exquisitely hyper-sensitive to criticism or rejection.

If this description seems to fit you, please see a licensed mental health professional for a diagnosis. Although we see the mental health diagnostic system as highly flawed, there’s enough value in understanding the nature of your problems that we do recommend you get yourself checked out.

But if you discover that you have …

Sam, a 5th grader, hates school. He cries and complains to his mother, pretends that he’s sick, and if forced to go to school is simply miserable. It seems to be getting worse every day. When he does go to school, Sam rarely finishes his work. His teacher threatens loss of recess and he doesn’t respond. On the playground, he’s usually in some far off corner with a baseball cap pulled down across his face.

Sam’s mother and teacher talk frequently. They have tried giving him rewards for going to school without complaining and for finishing his assignments at school. They’ve asked him repeatedly why he is behaving the way he is. The teacher and mom are puzzled that he loves to read and learn at home but shuts down completely at school. And Sam’s first years in school were great; he seemed happy and kept up without problems. Now, nothing seems to motivate him. Worried that he may be developing some sort of school phobia, his mother makes an appointment with a counselor to get to the bottom of Sam’s troubles.

Sam does not talk much with the counselor during the first few sessions. The counselor patiently waits for Sam to begin to trust him and spends the time in session talking about Sam’s interests in geology especially volcanoes. As Sam begins to relax and enjoy his sessions, the counselor gently probes for information about Sam’s days at school.

What the counselor finds out does not surprise him. Sam has been the victim of sly bullying since the beginning of the school year. He has been repeatedly punched, had his school work ripped up, and been called names. He’s shut down and suffering. Sam was afraid to tell his teacher or mother because the bullies told Sam that they would beat him up if he told.

About half of all school children are bullied at one time or another. Bullying can lead to anxiety, depression, and even suicide. If your child or someone you care about shows signs of being unhappy at school, has falling grades, or becomes …

The way you interpret an event makes a difference in the way you end up feeling. People with OCD may make great progress with treatment yet sometimes they experience setbacks. The way you deal with that initial return of symptoms can determine whether your lapse turns into a relapse.

The following story about Jerry and Tim illustrates how two differing perspectives on a re-emergence of an obsession led to a big setback for Tim, but had relatively little impact on Jerry.

Jerry suffers from contamination OCD. He was first referred for help when his doc noticed that his hands were raw and bleeding. Jerry confesses that he often spends an hour in his shower and washes his hands hundreds of times most every day. After 10 sessions of exposure and response prevention (ERP), Jerry’s symptoms are under control. Yet, Jerry continues to have times he worries about getting contaminated. He recalls that his treatment included how to handle these occasional thoughts. He tells himself that the obsessions are normal and to be expected. He purposely waits until the thought passes and does not engage in compulsive washing. He knows that if the thoughts get worse, that he can always return to therapy for a few booster sessions. Most days Jerry feels that he is leaving OCD behind him despite his occasional lapses.

Tim also has contamination OCD. He too washes compulsively and avoids public places. His washing takes up hours of his day. Tim visits his primary care doctor to see if he can suggest something to help him. The doc talks to Tim about different kinds of treatment. Tim chooses to go on an antidepressant to see if that will help him. Tim’s doctor reminds him that the medication can take a long time to have an effect. Tim is relieved he may get better. After about 8 weeks, his symptoms seem to lesson. He doesn’t always think about contamination and has reduced his washing.

An early flu season hits and Tim comes down with the flu. He finds himself obsessing about …

The other day, our grandchildren came in from playing outside all afternoon–dirt and mud covering every inch of their feet, legs, trunks, hands, arms, faces, and even their hair. They were smiling and giggling with no concern for their hygiene or appearance. Obviously, a bath was in order for all.

This incident triggered a memory of one of the “Parts of Ten” chapters from our book Obsessive Compulsive Disorder For Dummies. We were inspired to write that chapter because those with OCD so often worry about becoming ill from the slightest contact with dirt. At the same time, few people know very much about dirt, whether they have OCD or not.

Here’s five items (from out book chapter) that you may not know about dirt:

• Dirt generally evokes negative connotations such as disgusting, filthy, unsanitary, corruption, or obscene. Yet soil, which is also dirt, has a positive meaning. Soil consists of hummus and bits of disintegrated rock and most crops need it to grow. So in spite of all of those negative connotations, we need dirt to survive.
• Dirt isn’t dead. Dirt is teeming with life. Sometimes as many as 100,000 worms live in a single square yard of dirt. But you can also find fungi, bacteria, algae, protozoa, and other forms of life in dirt.
• A little dirt is probably good for you. Kids who grow up in unusually sanitary, pristine environments actually have a higher risk of allergies, autoimmune diseases, and asthma than kids who have pets, large families, and attend daycare. Of course, we’re not recommending squalid conditions, but maybe knowing this information can help ease up on having a spotless home all of the time.
• Dirt isn’t what it used to be. Humans have systematically leached nutrients out of soil without replacing them. The effects on agriculture, especially in poor countries haven’t been good.
  Kids eat a little dirt with almost no ill effects. You know that kids stuff almost anything into their mouths. Toddlers manage to consume about 500 mg of dirt quite frequently. Assuming the dirt isn’t laced with pesticides, lead, gasoline, and such, they do so …
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