Parentification Resources

by Band Back Together | Aug 30, 2018

What Is Parentification?

Parents are the guardians and caretakers of children – they care for the emotional and physical needs of a child to ensure that the child’s needs are met. However, for some, the traditional roles of parent and child are not followed.

Parentification may be defined as a role-reversal between parent and child. A child’s needs are sacrificed to take care of the needs of one or both of his or her parents. In very extreme cases, the parentified child may be used to fill the void of the parent’s emotional life. Parentification is a form of child abuse.

During the process of parentification, a child may give up his or her needs of attention, comfort, and parental guidance to care for the needs and care of logistical and emotional needs of his or her parents.

The parent, in the case of parentification, does not do what he or she should do to take care of the child or children as a parent and instead, gives up parental responsibilities to one or more of his or her children. Thereby the children are “parentified.” During parentification, the child becomes “the parental child.”

What Happens During Parentification?

Parents who have certain personality disorders are more at risk for transferring the responsibility of parenthood – the physical and emotional needs of the rest of the family – in an active or passive fashion.

There is an expectation of parentified children to forgo playing, making friends, school work, and/or sleep to better meet the needs of the rest of the family members.

In a family with more than one child, the eldest or most mature child is usually the child prone to be parentified.

In certain cases, a child of the opposite sex is chosen to meet the emotional needs of the parent and become a “surrogate spouse.” It may also lead to emotional incest.

Most children are anxious to make their parents happy, so a child undergoing parentification, often takes his or her new responsibilities seriously. It may even feel as though it’s a huge honor to have such responsibility given to them.

In the long term, however, parentification means that the child’s emotional needs are not met. This can lead to many, greater problems down the road.

There are subtle ways that parents can make the mistake of parentifying their kids. This term means to reverse roles, causing the child to parent the adult. There are two forms of parentification: instrumental and emotional. Instrumental refers to the child actually doing physical tasks that a parent should do, such as taking care of younger siblings or even an adult relative, maintaining the household, or paying the bills. Emotional parentification happens when the child becomes the emotional support for the parent and takes on the burden of being a confidant or friend.

Why is parentification bad for a child?

1. It can take away their childhood. Childhood is the only opportunity a person has to allow others to care for them all the time and enjoy not having to be responsible and facing the world’s many troubles. Having a happy childhood sets the stage for the rest of a person’s life and identity. Being confused as a child about the role one is supposed to have can cause problems in the future.
2. Anger, resentment and mistrust can emerge. Parentified children may recognize as they look around them at other children their age that these kids are not expected to do as much as they are, or that their parents don’t talk to them about certain things that the parentified child’s does. As they get older they may also realize that what they were expected to do was unfair, and feel anger and resentment towards their parents. They may not trust others due to these bad past experiences.
3. It may hinder future relationships. A child’s relationship with their parents is the first and most fundamental relationship a person experiences. Children are supposed to be able to rely on their parent to take care of and protect them. A parentified child realizes that they cannot depend on their parent, and instead, that the parent relies on them. This feeling of only being able to rely on oneself may extend into future relationships for a parentified child.
4. The child may feel guilty about leaving home. After having been the caretaker of the parent or the family for so long, a parentified child may worry about what will happen to the family once they grow up and leave home. This may hinder the child from wanting to leave and engage in the individuation process that young adults go through of trying to determine who they are and what they want to do with their lives.

How parents can avoid parentifying their child:

1. Give age-appropriate responsibilities. It is good for kids to have responsibilities such as chores around the house or babysitting for a younger sibling. Responsibilities should increase when a child becomes a teenager to prepare them for being on their own eventually. However, when a young child is responsible for going to the store for groceries, paying the electricity bill, or raising a younger sibling, that is when problems arise.
2. Maintain the hierarchy of the family. Know that as the parent, you are in charge. Caretaking, family decisions, and managing through hard times are all on you. It is important to be able to convey a sense of control and security to your child so that they can have a solid foundation in life.
3. Remember that your child is not your friend. This means it is not appropriate to talk to your child about certain things, even if they are older. Emotional parentification often happens during divorces- one or both parents may talk to the child about what is going on between them to an extent that is not appropriate or bad-mouths the other parent. Your child needs to see you as someone who can take care of oneself emotionally in order to be able to confide in you about feelings.
4. Allow your child to be independent. Emotional parentification can have the effect of enmeshing you and your child so that you depend so much on each other that it is unthinkable to break away. Do and say things that support your child becoming their own person, and do not say things that make your child feel guilty for wanting to leave home or do something different.

Parentification is usually totally unintentional and parents do not realize that it is occurring. Educate yourself so that you can see the signs and make sure your child gets to be young and carefree.

How Do I Know If I Was Parentified As A Child?

If you’re unsure if you were parentified as a child, ask yourself the following questions:

Were you made to feel responsible for your parents welfare, well-being, and feelings?

Was your parent indifferent or did he or she ignore your feelings most of the time?

Were you often blamed, criticized, devalued and demeaned by your parents?

When your parent was upset, were you often the target of those negative feelings?

Did you feel like you were always trying to please your parent – without ever succeeding?

Did you feel like your parent took all the credit for your successes?

If you answered yes to any of the above, you may have been the victim of parentification.

If those questions sounded familiar to you, ask yourself the following:

Did your parents ever say anything like…

• “Don’t you want me to feel good?”
• “You make me feel like a failure when you…”
• “You should care about me.”
• “If you cared about me, you’d do what I want you to.”

What Type Of Parents “Parentify” Their Children?

Parentification is often defined as a type of role reversal, boundary distortion, and inverted hierarchy between parents and other family members in which children or adolescents assume developmentally inappropriate levels of responsibility in the family of origin that go unrecognized, unsupported, and unrewarded. In the parentification phenomenon, the overarching role of the parentified youth can be described as that of caregiver – caring for others at the expense of caring for self. It is often clinically observed and empirically examined along two dimensions: instrumental parentification and emotional parentification.

Parentification is often observed in families where the parent or caregiver has experienced a serious medical condition or mental health disorder. Parental alcohol use and abuse is also common in families where parentification exists. More recently, parentification is often evidenced in families where children must serve as a translator (e.g., language broker) for parents and family members.

Many other circumstances can engender inappropriate levels of parentification (e.g., temporal or continuous familial financial hardship, divorce, and cultural settings which promote early childhood responsibility and autonomy). Excessive levels of parentification in the family of origin, often, but not always result in negative outcomes. More recently, empirical literature is beginning to accumulate on differential outcomes, negative and positive, related to parentification.

While all parents may run the risk of parentifying his or her child, there are a few types of parents who run a higher risk of emotionally damaging their child through parentification. These include:

Parents who suffer personality disorders, including narcissistic personality disorder, antisocial personality disorder, histrionic personality disorder, borderline personality disorder, and dependent personality disorder.

Parents who are alcoholics or drug addicts.

Parents who have a serious, chronic illness.

Parents who have other mental illnesses.

The Narcissistic Parent and Parentification:

Lacking a moral compass or the ability to act selflessly, narcissist parents create devastating havoc and damage in the lives of their kids. Unlike emotionally mature parents whose priority is to meet their children’s needs, support their healthy development, and respect and nurture their individual identities, narcissist parents put their own needs first and do not recognize their children as separate individuals.

In the narcissistic family, although spouses often suffer excruciatingly, children are most vulnerable to the narcissist’s abuse because they

1. are relatively helpless;
2. are reliant on the narcissist parent for caregiving;
3. are especially susceptible to the narcissist parent’s opinions; and
4. are easy and manipulable targets.

Parentifying: The Upside-Down Parent-Child Relationship

Consistent, appropriate caretaking and unconditional love are beyond the narcissist’s scope. Rather than seeing those things as his responsibilities (and privileges) as a parent, the narcissist expects such treatment from his kids, often turning the adult-child relationship upside down.

In the narcissistic family, it is common for adults to parentify their children, expecting them to meet their emotional and even physical needs and fulfill roles beyond their maturity level or rightful responsibility. The parentified child may be placed in the role of therapist, confidante, or even surrogate spouse. That child, or others in the family, also may be burdened with excessive chores, caretaking siblings, managing finances, or earning money for the household.

Parentified children may feel flattered to be given adult responsibilities and honored to play the role of “special helper.” It may feel as though they are getting attention from their parent, which they can’t get any other way. But parentification is an extreme violation of boundaries, and the parentified child is being used at her own expense to meet the needs of the person whose job it is to meet hers. As they mature, parentified children are likely to struggle with healthy boundaries, fall into caretaking roles, and believe they can only “earn” love and approval by “working” for it.

What Are The Types Of Parentification?

Two types of parentification exist that may or may not occur together. These types of parentification are “emotional” and “instrumental” parentification.

1) Physical or Instrumental Parentification: In this type of parentification, a child takes up the role of the parent to meet the physical needs of the family and relieves the anxiety of a non-functioning parent. Instrumental parentification primarily involves completing physical tasks for the family such as taking care of relatives with serious medical conditions, grocery shopping, paying bills, and/or ensuring that a younger sibling attends and does well in school.

The child usually takes over the needs of the household, by cooking, cleaning, shopping for groceries, paying bills, managing the budget, getting his or her siblings ready for school, and caring for his or her siblings.

This differs from teaching a child to manage assigned chores and tasks, which is healthy for child development. The parent forces the child to become caretaker, dumping more and more responsibilities upon their child, whether or not the child is developmentally ready for such tasks. This leaves the physically parentified child without opportunity to behave as a child and engage in normal childhood behaviors. The child feels like a surrogate parent to his or her siblings as well as his or her parents.

2) Emotional Parentification: In this type of parentification, a child is forced to meet the emotional needs of his or her parents and siblings. This often involves a child or adolescent taking on the role and responsibilities of confidant, secret keeper, or emotional healer for family members Emotional parentification is the most destructive type of parentification as it robs the child of his or her ability to have a childhood. Emotional parentification also sets up the child for a series of dysfunctions that may incapacitate the child as he or she grows into an adult.

In the role the child is forced to try and meet the emotional and psychological needs of his or her parent. The child may become the parent’s confidant. Every child feels the desire to please his or her parent, even if it means not having his or her emotional needs met. This comes at a high cost – the child cannot develop normally or learn what an emotionally healthy bond is, which can lead to many problems in intimate relationships down the road.

Emotional incest is a type of Emotional Parentification that may occur if a parent selects a child of the opposite sex to confide in, openly discuss the problems and issues facing the parent as the parent uses the child as a surrogate spouse or surrogate therapist. Children should never, ever be treated as adults and exposed to adult problems in such a way.

How Do Parentified Children Respond To Parentification?

There are two major responses that children who have been parentified exhibit. These responses are the compliant response and the siege response and are discussed in greater detail below:

Compliant Response to Being Parentified: this behavior is a continuation of how you behaved as a child caring for his or her parents.

• Spend much time caring for others.
• Very conforming
• Hyper-vigilant about acting to in a manner that pleases others.
• Feel responsible for care, welfare and feelings of others.
• May be self-deprecating.
• Seldom get their own needs met.
• Rushes to maintain peace and soothe hurt feelings of others.

Siege Response to Being Parentified: a continuation of the behavior as a child who was parentified and rebelled by attempting to fight to be separate and independent.

• Work hard at preventing others from manipulating you.
• Withdrawn and seemingly insensitive to others.
• Work to avoid being involved by the demands of others.
• Assume responsibility for the welfare of others and feel diminished when you don’t meet their expectations.

What Are The Future Problems For Victims Of Parentification?

There is a difference between giving your child responsibility and parentifying them

Growing up parenting your parent, having your childhood taken away, never getting the opportunity to be a child, can lead to a number of bigger problems down the road. The two main problem facing parentified children as adults include anger and difficulty with interpersonal relationships and attachments.

With regard to potential outcomes, research that has examined the experiences of parentified children during childhood reveals that these individuals report a vast array of adverse effects in response to adopting the parentified role.

Extreme Anger – parentified children can grow to become extremely angry. They may have a love/hate relationship with their parent, but they may not understand why. Some adults who were parentified children may not understand the seemingly endless chasm of anger at others, including friends, partners and children. These people may explode with anger if the emotional wounds of their childhood are triggered.

Difficulty Forming Attachments With Other Adults: an adult parentified child may have a difficult time connecting with others. This difficulty can be closely tied to growing up without understanding healthy versus unhealthy attachments. This may lead to problems forming a healthy intimacy in relationships.

Other Problems Facing An Adult Who Was A Parentified Child:

If left unresolved, these symptoms of maladjustment can continue into adulthood, causing further dysfunction throughout the parentified individual’s lifespan instead, the majority of research conducted has focused solely on the effects of childhood parentification on individual characteristics in adulthood. Specifically, parentification has been shown to impede identity development and personality formation and to affect interpersonal relationships, including those with one’s own children. It has also been foundto be associated with later attachment issues, mental illness, psychological distress, masochistic and narcissistic personality disorders, substance abuse, and one’s academic and career choices.

However, researchers have speculated that in some instances, emotional and instrumental parentification may prove beneficial for individuals in adulthood. Specifically, parentification can lead to greater interpersonal competence and stronger family
cohesion, as well as higher levels of individuation, differentiation from family, and self-mastery and autonomy when the child experiences a low level of parentification and when the efforts of the child are recognized and rewarded by adult figures

There’s not a question that becoming the parent of your own parent can lead to some pretty heavy burdens. Losing your childhood, your innocence, turning into “little adults” far too young leads to many problems later in life. These problems can include the following:

• Low or poor self-esteem
• These children are more likely to report internalizing problems such as depressive symptoms and anxiety, as well as somatic symptoms like headaches and stomachaches
• Depression
• Feeling of disconnect from their real self.
• Shame
• Furthermore, parentification is also linked to social difficulties, particularly lower competency in interpersonal relationships as well as academic problems such as high absenteeism and poor grades
• Parentified  children are also more likely to exhibit externalizing behaviors such as aggressiveness and disruptive behavior, substance use, self-harm, and attention-deficit/hyperactivity disorder
• Fears that he or she may not properly meet his or her own demands and expectations.
• Anxiety disorders
• Feeling incompetent
• Feelings of being unable to cope with adulthood
• Underestimation of his or her own intelligence
• Overestimation of the importance of others
• Codependency in relationships
• Becoming a caregiver
• Becoming a workaholic

Breaking the Cycle of Parentification:

Parentification occurs when a child feels obligated to act as the parent to their parent, whether it is in the practical way, like taking care of siblings, making dinner, or cleaning the house, or emotionally, when the child has to provide emotional support for the parent. This can occur for many reasons, but if a child is somehow forced into a parental role when they should have the freedom to behave like a child, it can delay their development and affect them through adulthood. Parentification can cause underlying anger, difficulty forming connection in relationships, and people-pleasing behavior. It can impact self-worth and the ability to form one’s own identity.

In learning about parentification, we can begin to identify and accept our own experience with it, building the foundation for healing and growth. But how can we then move forward in our lives and break the cycle so our children do not experience the same?

First and foremost, we must find a way to heal our own emotional wounds – likely through individual or group therapy. Even if we can identify the behaviors of our parents and the ways in which those behaviors affected us, it can take time to process the feelings of hurt and loss that accompany the realization that we were never given the care we as children deserved.

Sometimes we have to grieve never having a safe childhood in which we could be ourselves, make messes, and play irresponsibly. Sometimes we have to accept our anger and forgive our parents for not providing the stable foundation we so desperately needed. Working through the effects of parentification may take time, but we are able to take the first step of breaking the cycle.

As you move through your healing process, try to recall the ways in which you experienced parentification. For some, parentification is instrumental, meaning that as a child one was required to tend to many or most household chores and responsibilities, especially in the absence of one or both parents. Often these duties end up being asked of the eldest child in the family, simply because the eldest child is often the most “qualified” to be able to handle the household responsibilities.

If you experienced instrumental parentification, ask yourself, “How can I expect my children to complete chores in order to teach responsibility without placing too much burden on them?” Maybe you limit a child’s chores to one or two duties per week, so that the child has plenty of playtime and homework time to tend to their own needs. Another approach might be that you are actively mindful of not relying on your child to complete household tasks and instead asking them to help out only occasionally.

For others, parentification may have been emotional, meaning that as a child one was required to tend to one or both parents’ emotional needs. Often one parent relies on a child for emotional support and friendship, blurring the relationship boundary. Children who take on the role of mediator between fighting parents can also find themselves emotionally parentified, because they feel responsible for being “the glue that holds the family together.”

To break the cycle of emotional parentification, as parents we must be very mindful of the boundary between parent and child as well as our children’s need to feel that we are a secure place that they can return when scared, upset, or hurt. It’s important to show a child that even if he misbehaves, his parents will not stop loving him. Or, that if she establishes independence by playing with other children on the playground, parents will still be there waiting for her when she’s done.

Consider whether you received the kind of love and care you needed as a child. Sometimes it can be difficult to admit that our parents might have fallen short, even if they did the best they could. Just because they weren’t perfect doesn’t mean we don’t love them. But loving our parents doesn’t negate our needs and doesn’t mean that we aren’t entitled to feel sad or angry with them because of something we longed for but never received.

Acknowledging and accepting our experiences can help us break the cycle and move forward to give our children more our parents gave us.

Page last audited 8/2018

Pain Management Resources

by Band Back Together | Aug 29, 2018

What Is Pain?

Pain is so universal that it barely needs a definition to be understood.

What follows is a discussion of physical pain, not emotional pain.

The International Association for the Study of Pain (IASP) defines pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

According to the IASP, pain is the most frequent reason for emergency department (ED) visits, accounting for over 70% of visits. In the US, more than 115 million ED visits occur each year with acute headache alone accounting for 2.1 million of these visits. Acute pain is also a common reason for visits to family practice, sports medicine, and internal medicine health care practitioners.

Recent Center for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS) data suggest substantial rates of pain from various causes and that most people in chronic pain experience pain in multiple areas of the body. For U.S. adults reporting pain, causes include: severe headache or migraine (16.1%), low back pain (28.1%), neck pain (15.1%), knee pain (19.5%), shoulder pain (9.0%), finger pain (7.6%), and hip pain (7.1%).

The American Academy of Pain Medicine (AAPM), in its report with the Institute of Medicine of the National Academies, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, estimates that at least 100 million adults in the US have common chronic pain conditions.

Pain helps us to remove ourselves from damaging situations, protect an injury while it heals and learn to avoid similar situations in the future. Generally, pain resolves when the painful stimulus is removed and the body has healed, but sometimes pain may persist. Pain may also arise in the absence of painful stimuli, damage or disease.

Types of Pain:

It’s safe to say most of us are not big fans of pain. Nevertheless, it is one of the body’s most important communication tools. Imagine what would happen if you felt nothing when you put your hand on a hot stove. Pain is one way the body tells you something’s wrong and needs attention.

But pain — whether it comes from a bee sting, a broken bone, or a long-term illness — is also an unpleasant sensory and emotional experience. It has multiple causes, and people respond to it in multiple and individual ways. The pain that you push your way through might be incapacitating to someone else.

Even though the experience of pain varies from one person to the next, it is possible to categorize the different types of pain. Here’s an overview of the different types of pain and what distinguishes them from one another.

There are several ways to categorize pain. One is to separate it into acute pain and chronic pain

Acute Pain: Typically results from injury, disease or inflammation of the tissues. Acute pain is usually confined to a given amount of time and severity and can be diagnosed and treated. Acute pain comes on suddenly and is accompanied by anxiety and emotional distress. Acute pain typically comes on suddenly and has a limited duration. It’s frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress.

Rarely, it can become chronic pain.

Break-Through Pain (also known as Flare-Up Pain) is transient and excruciating pain beyond the normal pain baseline. Breakthrough pain goes above and beyond the medication taken to prevent and treat persistent pain. It may be caused by changes in treatment or in the underlying disease or physical actions – sneezing or standing up. Breakthrough pain may be caused by stress, worry or anxiety.

About 70% of people with chronic pain treated with pain medication experience episodes of what’s called breakthrough pain. Breakthrough pain refers to flares of pain that occur even when pain medication is being used regularly. Sometimes it can be spontaneous or set off by a seemingly insignificant event such as rolling over in bed. And sometimes it may be the result of pain medication wearing off before it’s time for the next dose.

Chronic Pain: pain that persists over a longer period of time and is resistant to most medical treatments. Chronic pain is widely believed to represent disease itself. It can and often does cause problems for people who live with it. Chronic Pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It’s usually associated with a long-term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, it’s one of the defining characteristic of the disease. Chronic pain can be the result of damaged tissue, but very often is attributed to nerve damage.

Both acute and chronic pain can be debilitating, and both can affect and be affected by a person’s state of mind. But the nature of chronic pain — the fact that it’s ongoing and in some cases seems almost constant — makes the person who has it more susceptible to psychological consequences such as depression and anxiety.

At the same time, psychological distress can amplify the pain.

Why Do People Experience Pain Differently?

Pain is real and it’s physical — there’s no mistaking that. But pain is measured and specific to one person based on that person’s perception of the pain, and that’s why everyone’s pain is different.

What the brain perceives is indisputably modifiable by emotions. That means that people who are fearful of pain, depressed, or anxious may experience pain differently, and perhaps more severely, than someone who has pain but isn’t experiencing those other emotions.

Classification for Chronic Pain:

Pain is most often classified by the kind of damage that causes it. The two main categories are pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A third category is psychogenic pain, which is pain that is affected by psychological factors. Psychogenic pain most often has a physical origin either in tissue damage or nerve damage, but the pain caused by that damage is increased or prolonged by such factors as fear, depression, stress, or anxiety. In some cases, pain originates from a psychological condition.

Pain is also classified by the type of tissue that’s involved or by the part of the body that’s affected. For example, pain may be referred to as muscular pain or joint pain.

Chronic pain is classified by the functional changes associated with the disease or injury.

Neuropathic pain is caused by damage to the brain, spinal cord or peripheral nerves. It is typically described as burning, tingling, shooting, stabbing, stinging or “pins and needles.”

Phantom Pain – pain from a part of the body that has been lost, or from an area from which the brain no longer receives signals. This type of pain is common in amputees.

Psychogenic Pain – (also called psychalgia or somatoform pain) is pain that is caused by, increased, or prolonged by emotional, mental or behavioral patterns.

Nociceptive Pain – pain due to an ongoing tissue injury. Nociceptive pain is often divided into two categories:

1. Somatic Pain – pain caused by activation of the pain receptors in the musculoskeletal tissues or the body’s surface. It may be described as dull or aching.
2. Visceral Pain – pain caused by damaged or injured internal organs. Usually described as vague, unlocalized pain that may feel like pressure, deep squeezing, dull and diffuse.

Chronic Pain Caused by Tissue Damage (Nocioceptive Pain)

Most pain comes from tissue damage. The pain stems from an injury to the body’s tissues. The injury can be to bone, soft tissue, or organs. The injury to body tissue can come from a disease such as cancer. Or it can come from physical injury such as a cut or a broken bone.

The pain you experience may be an ache, a sharp stabbing, or a throbbing. It could come and go, or it could be constant. You may feel the pain worsen when you move or laugh. Sometimes, breathing deeply can intensify it.

Pain from tissue damage can be acute. For example, sports injuries like a sprained ankle often the result of damage to soft tissue. Or it can be chronic, such as arthritis or chronic headaches. And certain medical treatments, such as radiation for cancer, can also cause tissue damage that results in pain.

Pain Caused by Nerve Damage (Neuropathic Pain)

Nerves function like electric cables transmitting signals, including pain signals, to and from the brain. Damage to nerves can interfere with the way those signals are transmitted and cause pain signals that are abnormal. For instance, you may feel a burning sensation even though no heat is being applied to the area that burns.

Nerves can be damaged by diseases such as diabetes, or they can be damaged by trauma. Certain chemotherapy drugs may cause nerve damage. Nerves can also be damaged as a result of stroke or an HIV infection, among other causes. The pain that comes from nerve damage could be the result of damage to the central nervous system (CNS), which includes the brain and spinal cord. Or it could result from damage to peripheral nerves, those nerves in the rest of the body that send signals to the CNS.

The pain caused by nerve damage, neuropathic pain, is often described as burning or prickling. Some people describe it as an electrical shock. Others describe it as pins and needles or as a stabbing sensation. Some people with nerve damage are often hypersensitive to temperature and to touch. Just a light touch, such as the touch of a bed sheet, can set off the pain.

Much neuropathic pain is chronic. Examples of pain caused by damaged nerves include:

Central pain syndrome. This syndrome is marked by chronic pain that stems from damage to the central nervous system. The damage can be caused by stroke, MS, tumors, and several other conditions. The pain, which is typically constant and may be severe, can affect a large part of the body or be confined to smaller areas such as the hands or feet. The pain often can be made worse by movement, touch, emotions, and temperature changes.

Complex regional pain syndrome. This is a chronic pain syndrome that can follow a serious injury. It’s described as persistent burning. Certain abnormalities such as abnormal sweating, changes in skin color, or swelling may be noticed in the area of the pain.

Diabetic peripheral neuropathic pain. This pain comes from nerve damage in the feet, legs, hands, or arms caused by diabetes. Individuals with diabetic neuropathy experience various kinds of pain including burning, stabbing, and tingling.

Shingles and postherpetic neuralgia. Shingles is a localized infection caused by the same virus that causes chickenpox. The rash and associated pain, which can be debilitating, occurs on one side of the body along the path of a nerve. Postherpetic neuralgia is a common complication in which the pain from shingles lasts more than a month.

Trigeminal neuralgia. This condition causes pain as a result of inflammation of a facial nerve. The pain is described as intense and lightning like, and it can occur in the lips, scalp, forehead,eye, nose, gums, cheek, and chin on one side of the face. The pain can be set off by touching a trigger area or by slight motion.

How Pain Affects Daily Life:

Pain is pervasive. According to the American Pain Foundation, 26 percent of Americans have experienced pain that persisted for more than 24 hours at one point or another, and a third of them describe their pain as disabling.

Chronic pain is strongly linked to a greatly increased risk of major mental conditions including depression, anxiety, and post-traumatic stress disorder.

A body in chronic pain continually sends stress signals to the brain, leading to a heightened perception of not only the pain itself but also the perceived level of threat.

Pain can greatly impact quality of life and functioning for those affected by it.

Chronic pain actually changes the way the brain processes emotion and the pain itself. Patients with chronic pain are more likely to experience depression because the pain acts on the sense-data areas of the brain that regulate not only emotion but also sleep. When sleep becomes unsatisfying (too long, too short, poor quality, etc.), feelings of depression, anxiety, and pain become more intense. The brain also begins to anticipate pain, leading to anxiety and a hypervigilance that is normally associated with post-traumatic stress disorder.

Just as chronic pain can lead to depression, depression itself can lead to chronic pain. This is a vicious cycle that can be very difficult to break.

For those without chronic pain, there are a good many things taken for granted. Tying shoelaces, making breakfast, walking the dog, balancing the checkbook: there is a seemingly endless supply of time, energy, and attention (TEA) for these tasks.

With chronic pain, time, energy, and attention are often in limited supply. This means that decisions must be made and priorities set daily depending on the level of pain. This is often described using spoon theory. “Spoonies” are people with chronic pain who have a limited amount of TEA for daily tasks, represented by a number of spoons. Getting dressed in the morning might take up two of that day’s ten spoons, making the rest of the day instantly problematic.

Considering the prevalence and extent of chronic pain, it’s understandable that a wide range of coping mechanisms may be part of your pain management plan. However, you might be doing yourself more harm than good, especially if you rely on tactics such as smoking, drinking, overeating, or using drugs.

Chronic pain touches every aspect of daily life, arguably none more powerfully so than in the area of relationships. Family and friends alike can be greatly affected by a loved one’s chronic pain in ways that can last long after the pain is diagnosed and treatment begins.

For chronic pain sufferers with a partner, chronic pain can be the cause of frustration with things like daily parenting and household chores. Partners of people in pain may resent the fact that they are often the primary breadwinner, main caretaker (or children and the pain patient), and head of household chores.

Financial strain is often the cause of conflict in any relationship, and chronic pain patients may incur more than their share of medical bills. Sexuality and intimacy may suffer as well, due to the pain itself and the frustrations experienced due to unequal distribution of responsibilities.

Parenting with chronic pain can be even more of a struggle, as young children don’t always understand a “boo-boo” that isn’t visible and doesn’t go away. Pain patients may not be as patient with their children as they would like. These difficult relationships with children can lead to feelings of inadequacy as a parent, which can then turn into depression or deep sadness or low self-esteem as a person and a parent.

At work, it can be difficult to feel comfortable in a setting where colleagues may resent frequent absences or what is perceived as special treatment for an invisible illness. When just getting to the job every day is a nearly insurmountable task, this resentment at work can make a chronic pain patient want to quit.

People who experience both acute and chronic pain also see impairments in working memory, attention span, mental flexibility, information processing speed, and problem solving.

Coping With Acute and Chronic Pain:

Remind yourself that you can cope with your pain

Try your best to remain calm – remind yourself of the ways you can help yourself, you could take medication designed for flare-ups

Get help with housekeeping and other chores.

Remind yourself that if you need it, you can go to the ER.

Pain can disrupt sleep on a nightly basis, and chronic pain sufferers have been known to make major lifestyle adjustments, including taking disability leave from work, changing jobs, getting assistance with activities of daily living, and even moving to a home that is more user-friendly in order to help cope with their pain.

In addition, acute and chronic pain are associated with anxiety, depression, anger and fear.

Pain medication can be a double-edged sword.

Uncontrolled pain is a stressful experience and as the stress generates, perpetuates, and amplifies your pain. Using pain medication can both feel better and make you more likely to recover quickly.

However, pain medication can also lead to rebound pain for some. Pain medication can also cover up pain enough that you “keep going” when what your body needs is some rest and recuperation.

You may end up needing to balance these pros and cons.

Use many methods to manage your pain rather than solely relying on pain medication such as heat/ice packs, meditation, yoga, breathing techniques, or whatever is recommended for your condition.

Live Your Life

It’s easy to feel social anxiety when you’re experiencing pain. Sometimes pain will make you cry or grimace at a social function which may make you feel ashamed. While highly unlikely, people worry that will pain will become so bad that you may not be able to drive home. This is a part of the thinking of people who have panic disorder or anxiety disorder and it’s all related to being scared that you’ll lose control of your body, or trapped and unable to escape a situation.

However, avoiding social situations makes these anxieties and fears worse. So, get out there!

Re-evaluate your priorities

Many people enjoy working hard and pushing beyond what’s truly necessary.  These may be self-imposed rules along the lines of “I have to get X done today.”

Break tasks into smaller tasks. Remember that many of the things you want to do are just that – wants, and just because you’d LIKE it to be done does not mean it must.

Focus upon the most basic needs and don’t feel guilty when you need help through these texts.

Experiment With What Works For You

Experiment with different types of coping to see what works for you  There might be particular kinds of self-talk you find useful. That might work for you, or it might backfire.  You’ll need to experiment for yourself.

Anything that involves a small amount of physical exertion and is methodical provides a helpful distraction, especially if it’s not mentally taxing.

Eating enough  is important  Pain makes many not hungry, but not eating is worse overall.

Enjoy lessened pain

You probably have periods when my pain was only mild rather than intense.  During these moments, relax into them and enjoy the relative calm.   This is a similar principle to relaxing between contractions when you’re in labor.  Make sure you notice when you’re feeling good, or at least less terrible.

If you find yourself catastrophizing, consider the opposite – your pain episode might be shorter than you’re expecting.  If you’re going to worry about worst case scenario, make sure to think of the best case scenario.

Pain In Different Age Groups:

Pain In The Elderly:

• Chronic pain is extremely prevalent in the elderly population.
• Addressing and treating pain in the elderly is a difficulty for health care professionals due to the following:
• The elderly are reluctant to report pain symptoms as they believe pain is a normal part of aging. The elderly may also be hesitant to “bother” their physician with complaints of pain.
• The elderly may be concerned by side effects of pain management as well as fear addiction to these drugs.
• Older adults have a higher likelihood of cognitive and sensory impairments.
• The elderly may be more concerned about the cost of treatment for pain management.

Common Pain-Inducing Conditions in Older Adults:

Nociceptive pain:

• Osteoarthritis
• Lower back pain
• Osteoporosis
• Prior bone fractures
• Rheumatoid arthritis
• Paget’s disease
• Polymyalgia rheumatic
• Coronary artery disease

Neuropathic Pain:

• Herpes zoster
• Peripheral neuropathies
• Trigeminal neuralgia
• Central post-stroke
• Nutritional neuropathies

Pain in Children:

Chronic pain is a significant problem for the pediatric population and their caregivers. The social and emotional consequences that result from pain and disabilities may be devastating. Financial costs of childhood pain may be significant in some families, as well as losing salary for time off to care for the sick child. Also, the physical and psychological issues with chronic pediatric pain can have an impact on health as well as predisposing the child for chronic pain in adulthood. 

Pain Management: Treating Mind and Body

Most pain specialists stress the importance of approaching pain both physically and emotionally and addressing “people as entire human beings.” So while chronic pain medication can be effective and important for pain management for many people, it isn’t the only tool available when it comes to pain treatment, and it shouldn’t be the only tool that’s used.

Medications. There are a lot of medications that are prescribed for pain and that opioids (narcotics) and benzodiazepines may not be the best options. Those treatments have their own problems, and there are no good studies on using opioids for long periods of time for the treatment of chronic pain.

The most common way that pain is treated is with the use of pain relievers. Pain relievers may be useful for certain patients in chronic pain; however, they are not universally effective. Pain relievers may, for certain individuals, worsen their condition or cause dangerous side effects.

Short-term use for pain medications is seldom concerning, although side effects are most problematic during the initial phase of treatment and tend to diminish after long-term use.

Long-term use – and misuse – of pain medications can lead to many adverse reactions.

Addiction should be distinguished from physical dependence. Any individual that takes sufficient doses of certain types of drugs for a significant length of time can have withdrawal symptoms if the drug is suddenly stopped or reversed by another medicine. This shows the presence of physical dependence but does not constitute addiction.

Therapy. Therapy can be aimed at both the mind and the body. Your pain management team should look at any of these therapies as not being purely physical or purely psychological — we are always a mixture of both of those things.

• Physical therapy is a very important part of any pain management program. Pain can be worsened by exercise that isn’t done correctly (or interpreted incorrectly as pain rather than overuse), and a physical therapist can tailor the right exercise regimen for you. Proper exercise slowly builds your tolerance and reduces your pain — you won’t end up overdoing it and giving up because it hurts.
• Cognitive-behavioral therapy allows people to learn and have a better understanding of what the pain is from, and what they can do about it, This therapy is really about understanding the role of pain in your life and what it actually means for you.

Each person should have an individualized care plan for managing chronic pain. With the help of a doctor, each medication – the pros and cons, the benefits, other medical problems and potential side effects – should be weighed before beginning any treatment plan.

Discuss all medications and treatments with your doctor before deciding on any treatment plan.

Managing Pain with Medications:

Over-The-Counter Pain Relievers:

Over-the-counter drugs are those that may be purchased without prescriptions. The two most common types of over-the-counter pain relievers are acetaminophen and non-steroidal anti-inflammatory drugs (also known as NSAIDs).

The most important thing for individuals to remember while purchasing over-the-counter drugs is to read the labels. People must be mindful and read the labels, understand what they are taking and how much of it.

Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Acetaminophen works on the parts of the brain that receive the “pain messages.” NSAIDs are also available in a prescription strength that can be prescribed by your physician.

Using NSAIDs increase the risk of heart attack or stroke and have also been known to cause stomach ulcers and bleeding. They can also cause kidney problems.

Safety And Over-The-Counter Medications:

When used sparingly, over-the-counter medications generally do not cause health problems. Occasionally, because they are drugs like any other, they are dangerous.

NSAIDs and acetaminophen are both used to prevent pain. Long-term use can lead to gastric bleeding, kidney failure, liver failure, as well as other conditions.

The most concerning over-the-counter pain medication is acetaminophen, which – even at fairly low doses – can be toxic to the liver, especially for those who have liver problems or are heavy drinkers.

Prescription Pain Killers

Chronic pain management is a public health concern with significant increases in the use of opioids for pain relief. There is a corresponding growth in the number of opioids prescribed in the U.S. and the overdose from those drugs. Family physicians and other primary care providers play a vital role in balancing patients’ pain management needs with the risk of drug misuse and abuse.

The American Academy of Family Physicians (AAFP) is dedicated to finding solutions to the crisis of pain management and opioid abuse. We recognize that long-acting and extended-release opioids are powerful drugs that require oversight, but these drugs can be controlled without unduly limiting their proper use. Creating additional prescribing barriers for primary care physicians would limit patient access when there is a legitimate need for pain relief.

What opioid medications do

Opioids are a broad group of pain-relieving drugs that work by interacting with opioid receptors in your cells. Opioids can be made from the poppy plant — for example, morphine (Kadian, Ms Contin, others) — or synthesized in a laboratory.

When opioid medications travel through your blood and attach to opioid receptors in your brain cells, the cells release signals that muffle your perception of pain and boost your feelings of pleasure.

When opioid medications are dangerous

What makes opioid medications effective for treating pain can also make them dangerous.

At lower doses, opioids may make you feel sleepy, but higher doses can slow your breathing and heart rate, which can lead to death. And the feelings of pleasure that result from taking an opioid can make you want to continue experiencing those feelings, which may lead to addiction.

You can reduce the risk of dangerous side effects by following your doctor’s instructions carefully and taking your medication exactly as prescribed. Make sure your doctor knows all of the other medications and supplements you’re taking.

People with chronic pain will often initially consult their family physician for treatment. Treatment may include subspecialists, but it is often the family physician’s role to coordinate and manage care, including the use of opioid pain relievers. The AAFP views the goal of pain management to be primarily improvement and maintenance of function. We urge family physicians to individualize treatment based on a review of a patient’s potential risks, benefits, side effects, and functional assessments, and to monitor ongoing therapy accordingly.

Invasive Pain Interventions:

Viscosupplementation – lubricating substances are injected into the knee joint in patients suffering from osteoarthritis of the knee. These substances restore lubrication of the joint and decrease pain while increasing motility.

Intra-Articular Steroid Injections – for those suffering osteoarthritis, steroid injections may be injected into the joint for short-term relief.

Spinal Cord Stimulation – a small device is implanted under the skin – usually in the abdomen or buttocks – to deliver mild electrical signals to an area near the spine. The electrical signals can be adjusted by the patient via remote control to provide optimal pain relief.

Epidural – a steroid is injected into the epidural space in the neck or lower back, with or without a numbing agent.

Nerve Blocks – combination of local anesthetic and steroids used diagnostically to identify pain generators. These can also therapeutically blog a painful condition, although only for the short-term.

Rhiztomy – a probe is inserted to destroy the nerve that supplies the facet joint (a small joint that connects the back of the spine and cause neck or back pain).

Intrathecal Drug Delivery Systems – also known as pain pumps, these implanted devices deliver prescribed amounts of pain medication directly to the spinal cord and nerve roots.

Non-Invasive Pain Interventions:

Acupuncture – thin, metallic needles are inserted along acupuncture sites on the body to restore balance. These needles are manipulated or stimulated electrically and has gained a wide following of chronic pain sufferers.

Hyperbaric Oxygen – oxygen is administered in a pressurized chamber to increase the oxygen delivery to the tissues, but its efficacy is still largely undetermined.

Passive Therapies – passive therapies, such as massage, ultrasound, heating pads, and wax treatment or traction, can be useful for managing short-term pain but have limited benefit in chronic pain conditions.

External Stimulation Devices – a common device used to treat chronic pain is transcutaneous electrotherapy (TENS), in which electrical stimulation is applied to the surface of the skin.

Trigger Point Injections – a short-term solution for those with myofascial pain syndrome.

Monotherapies to Manage Chronic Pain:

Education – Patient and family education should be the primary focus of treatment and management of chronic pain conditions. It is crucial that the healthcare team work in conjunction with the family to develop strategies to cope with and manage chronic pain.

Exercise – The treatment for chronic pain almost universally suggests that the patient with chronic pain be kept as active as possible. The overwhelming evidence suggests that exercise programs are beneficial to those who suffer chronic pain.

Psychological Approaches – While talking to someone trained in “talk therapy” will not cure chronic pain, it can aid in the development of coping strategies to manage and fully live life.

Mind-Body Approaches – There are many mind-body approaches to living with chronic pain, including meditation, relaxation, hypnosis, biofeedback and imagery.

In Summation:

Chronic pain, while a difficult and frustrating condition to manage, is something unique to each individual, which means that each person will respond uniquely to differing approaches to chronic pain. The most important things for those in pain is to advocate for themselves and not be afraid to stand up for a treatment that isn’t working.

Additional Pain Resources:

Clinical Trials for Pain may be utilized for certain individuals who meet the standards for participation.

Drug Interactions Checker – a handy way to determine the interactions between medications.

Drug Identification Checker – useful way to identify prescription medications.

FDA Website for safety information about prescription drugs.

Information about over-the-counter medications.

Physician’s Desk Reference – excellent source of drug information.

RX List – comprehensive internet drug index.

International Association For The Study of Pain (IASP) is a scientific organization open to all professionals  involved in the research, diagnosis or treatment of pain.

American Academy of Pain Medicine (AAPM) is a medical specialty society for physicians who practice in the field of pain medicine. The organization provides education, training, advocacy, and research in the specialty of pain medicine.

Page last updated 8/2018

Mood Disorders Resources

by Band Back Together | Aug 28, 2018

What Are Mood Disorders?

We all experience mood changes and mood swings. Sometimes we’re happy – maybe even euphoric – and other times we’re sad and feeling low. These changes in your mood are completely normal. For others, however, their mood swings are so pronounced and lingering that they begin to affect people in major ways – loss of work, marital strife, divorce. Sometimes these mood swings even cause people to lose touch with reality, and may even be life-threatening. Situations like these represent mood disorders.

Mood disorders are considered to be disturbances in emotional experiences that are strong enough to intrude on living.

Marked by changes in mood, depression and bipolar disorder (also known as manic depression) are both highly treatable, medical illnesses. Unfortunately, many people don’t get the help they need because of the misunderstanding surrounding the illnesses or the fear associated with stigma. The following are brief descriptions of depression and bipolar disorder.

According to the 2005 National Comorbidity Survey-Replication study, about 20.9 million American adults, or 9.5 percent of the population ages 18 and older, have mood disorders. These include major depressive disorder; dysthymic disorder (a chronic, mild depression); and bipolar disorder (also called manic depression). Major depressive disorder is, by itself, the leading cause of disability among Americans age 15 – 44, according to the World Health Organization.

Changes in mood that interfere with everyday life may indicate a mood disorder such as depression or bipolar disorder. Mood disorders are treatable medical conditions. With appropriate diagnosis, treatment, and support, most people struggling with mood disorders will get better.

If you have concerns about mood or behavior changes in yourself or someone you know, it’s important that you gain an understanding of how to recognize mood disorders like depression and bipolar disorder, and how to get appropriate diagnosis and treatment for them.

Symptoms of Mood Disorders:

Depending on age and the type of mood disorder, a person may have different symptoms of depression. The following are the most common symptoms of a mood disorder:

• Ongoing sad, anxious, or “empty” mood
• Feeling hopeless or helpless
• Having low self-esteem
• Feeling inadequate or worthless
• Excessive guilt
• Repeating thoughts of death or suicide, wishing to die, or attempting suicide (Note: People with this symptom should get treatment right away!)
• Loss of interest in usual activities or activities that were once enjoyed, including sex
• Relationship problems
• Trouble sleeping or sleeping too much
• Changes in appetite and/or weight
• Decreased energy
• Trouble concentrating
• A decrease in the ability to make decisions
• Frequent physical complaints (for example, headache, stomachache, or tiredness) that don’t get better with treatment
• Running away or threats of running away from home
• Very sensitive to failure or rejection
• Irritability, hostility, or aggression

In mood disorders, these feelings are more intense than what a person may normally feel from time to time. It’s also of concern if these feelings continue over time, or interfere with one’s interest in family, friends, community, or work. Any person who expresses thoughts of suicide should get medical help right away.

The symptoms of mood disorders may look like other conditions or mental health problems. Always talk with a healthcare provider for a diagnosis.

Who Is At Risk For A Mood Disorder?

Anyone can feel sad or depressed at times. However, mood disorders are more intense and harder to manage than normal feelings of sadness. Children, teens, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder. However, life events and stress can expose or worsen feelings of sadness or depression. This makes the feelings harder to manage.

Sometimes, life’s problems can trigger depression. Being fired from a job, getting divorced, losing a loved one, death in the family, and financial trouble, to name a few, all can be difficult and coping with the pressure may be troublesome. These life events and stress can bring on feelings of sadness or depression or make a mood disorder harder to manage.

The risk of depression in women is nearly twice as high as it is for men. Once a person in the family has this diagnosis, their brothers, sisters, or children have a higher chance of the same diagnosis. In addition, relatives of people with depression are also at increased risk for bipolar disorder.

Medical Risk Factors For Mood Disorders Include:

Biochemical Factors

Depression is a type of mood disorder that some believe is triggered when neurotransmitters in the brain are out of balance. Neurotransmitters are chemical messengers that help the brain communicate with other parts of the body. These chemicals help regulate many physiological functions.

Low levels of neurotransmitters may play a role in why some people are more susceptible to depression, including the neurotransmitters:

• serotonin
• norepinephrine
• dopamine

Genetic Factors

Having an immediate family member with depression or a mood disorder can increase your risk for depression. The American Psychiatric Association (APA) states that if one identical twin is diagnosed with depression, the other twin has a 70 percent chance of developing it.

However, depression can occur in people with no family history, which is why some scientists believe it can be a product of both genes and life experiences.

Sleep disorders

Chronic sleep problems are associated with depression. Although experts don’t know if a lack of sleep causes depression, bouts of low mood do seem to follow periods of poor sleep.

Serious illness

The pain and stress that come with certain conditions can take a toll on a person’s mental state. Many chronic conditions are linked to higher rates of depression, including:

• chronic pain
• arthritis
• heart disease
• diabetes
• thyroid disease
• stroke
• cancer
• multiple sclerosis
• Alzheimer’s disease
• dementia
• Parkinson’s disease
• Huntington’s disease

Social Risk Factors for Depression:

Sometimes, our past and present experiences can trigger mood disorders, including depression.

Abuse:

People who were neglected or abused as children have a high risk for major depression. Such negative experiences can cause other mental disorders as well.

Gender:

Women are twice as likely to have depression as men, but this may be due to the fact that more women seek treatment for their symptoms than men. Some believe depression can be caused by hormonal changes throughout life. Women are particularly vulnerable to depression during pregnancy and after childbirth, which is called postpartum depression, as well as during menopause.

Lack of social support:

Prolonged social isolation and having few friends or supportive relationships is a common source of depression. Feelings of exclusion or loneliness can bring on an episode in people who are prone to mood disorders.

Major life events:

Even happy events, such as having a baby or landing a new job, can increase a person’s risk for depression. Other life events linked to depression include:

• losing a job
• buying a house
• getting a divorce
• moving
• retiring

The death of a loved one is certainly a major life event. Great sadness is a major part of the grieving process. Some people will feel better in a matter of months, but others experience more serious, long-term periods of depression. If your grieving symptoms last more than two months, you should see your doctor to be evaluated for depression.

Substance Risk Factors for Mood Disorders:

Substance abuse:

In many cases, substance abuse and depression go hand-in-hand. Drugs and alcohol may lead to chemical changes in the brain that raise the risk for depression. Self-medication with drugs and alcohol can also lead to depression.

Medications:

Certain medications have been linked to depression, including:

• blood pressure medication
• sleeping pills
• sedatives
• steroids
• prescription painkillers

If you are taking any such medications, speak to your doctor about your concerns. Never stop taking a medication without first consulting your physician.

What Are The Types of Mood Disorders?

Mood disorders describe a broad category of disorders in which a person’s mood is the primary underlying symptom.

If you have a mood disorder, your general emotional state or mood is distorted or inconsistent with your circumstances and interferes with your ability to function. You may be extremely sad, empty or irritable (depressed), or you may have periods of depression alternating with being excessively happy (mania).

Anxiety disorders can also affect your mood and often occur along with depression. Mood disorders may increase your risk of suicide.

Major Depressive (or Depression) Disorder:

Major Depressive Disorder requires two or more major depressive episodes. According to the National Institute of Mental Health (NIMH), major depression is one of the most common mental disorders in the United States.

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you’re having suicidal thoughts:

• Call your doctor or mental health professional.
• Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Use that same number and press “1” to reach the Veterans Crisis Line.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Diagnostic criteria:

Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning nearly every day:

• Depressed mood most of the day, almost every day.
• Lack of interest or pleasure in all or most activities
• Significant unintentional weight loss or gain
• Insomnia or sleeping too much.
• Agitation or psychomotor retardation noticed by others
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive guilt.
• Diminished ability to think or concentrate, or indecisivenesss
• Frequent thoughts of death, dying, or suicide

Treatment:

Major Depressive Disorder is generally treated with a combination of antidepressants, including SSRI’s, SNRI’s, and talk therapy. Also, those with depression should eat well, exercise often, and stick to a stress-free life.

Dysthymia and Persistent Depressive Disorder

This is a chronic, low-grade, depressed, or irritable mood that lasts for at least 2 years.

Persistent depressive disorder, also called dysthymia is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality, constantly complaining or incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.

Diagnostic criteria:

Depressed mood most of the day for more days than not, for at least 2 years, and the presence of two or more of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning:

• Poor appetite or overeating.
• Insomnia or sleeping too much
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions.
• Feelings of hopelessness\

Treatment:

Treatment includes antidepressants, talk therapy, as well as good self-care habits.

Bipolar Disorders:

Bipolar disorder is characterized by more than one bipolar episode.

There are three types of bipolar disorder:

Bipolar 1 Disorder, in which the primary symptom presentation is manic, or rapid (daily) cycling episodes of mania and depression. A manic episode is a period of abnormally elevated mood and high energy, accompanied by abnormal behavior that disrupts life. Most people with bipolar I disorder also suffer from episodes of depression. Often, there is a pattern of cycling between mania and depression. This is where the term “manic depression” comes from. In between episodes of mania and depression, many people with bipolar I disorder can live normal lives.

Bipolar 2 Disorder, in which the primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalization, but are sufficient to be observable by others). Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time.However, in bipolar II disorder, the “up” moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania.

A person affected by bipolar II disorder has had at least one hypomanic episode in his or her life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from. In between episodes of hypomania and depression, many people with bipolar II disorder typically live normal lives

Cyclothymic Disorder, a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder. Cyclothymia — or cyclothymic disorder — is a relatively mild mood disorder. In cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity or duration of major depressive or full mania episodes. People with cyclothymic disorder have milder symptoms than occur in full-blown bipolar disorder.

Manic episodes are characterized by:

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

Diagnostic Criteria:

During the period of mood disturbance, three (or more) of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

• increased self-esteem or grandiosity
• decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• more talkative than usual or pressure to keep talking
• flight of ideas or subjective experience that thoughts are racing
• distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
• increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Treatments:

Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition are sometimes controversial, antidepressants..

Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression, but its value seems greater against mania than depression; therefore, it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.

Seasonal Affective Disorder (SAD)

is a form of depression most often associated with fewer hours of daylight in the far northern and southern latitudes from late fall to early spring

Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons — SAD begins and ends at about the same times every year. If you’re like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer.

Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy.

Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

Common symptoms of SAD include fatigue, even with too much sleep, and weight gain associated with overeating and carbohydrate cravings. SAD symptoms can vary from mild to severe and can include many symptoms similar to major depression, such as:

• Feeling of sadness or depressed mood
• Marked loss of interest or pleasure in activities once enjoyed
• Changes in appetite; usually eating more, craving carbohydrates
• Change in sleep; usually sleeping too much
• Loss of energy or increased fatigue despite increased sleep hours
• Increase in restless activity (e.g., hand-wringing or pacing) or slowed movements and speech
• Feeling worthless or guilty
• Trouble concentrating or making decisions
• Thoughts of death or suicide or attempts at suicide

SAD may begin at any age, but it typically starts when a person is between ages 18 and 30.

Treatments:

Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Lifestyle changes and sometimes medicines can help manage symptoms.

Diagnosis:

In general, to diagnose PMDD the following symptoms must be present:

Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:

• Depressed mood
• Anger or irritability
• Trouble concentrating
• Lack of interest in activities once enjoyed
• Moodiness
• Increased appetite
• Insomnia or the need for more sleep
• Feeling overwhelmed or out of control
• Other physical symptoms, the most common being belly bloating, breast tenderness, and headache
• Symptoms that disturb your ability to function in social, work, or other situations
• Symptoms that are not related to, or exaggerated by, another medical condition

Treatment:

Two types of medication may help with PMDD: those that affect ovulation and those that impact the central nervous system (CMS).

Examples include the use of:

• SSRI antidepressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
• oral contraceptives that contain drospirenone and ethinyl estradiol
• gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel) and goserelin (Zoladex)
• danazol (Danocrine)

Cognitive therapy (CT) has been shown to help those with PMS. Combined with medication, CT may also help those with PMDD.

Disruptive Mood Dysregulation Disorder (Formerly Childhood Bipolar Disorder)

This is a disorder of chronic, severe and persistent irritability in children that often includes frequent temper outbursts that are inconsistent with the child’s developmental age.

The defining characteristic of disruptive mood dysregulation disorder (DMDD) in children is a chronic, severe, and persistent irritability. This irritability is often displayed by the child as a temper tantrum, or temper outburst, that occur frequently (3 or more times per week). When the child isn’t having a temper outburst, they appear to be in a persistently irritable or angry mood, present most of the day, nearly every day. As the DSM-5 Fact Sheet says, “Far beyond temper tantrums, DMDD is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.”

This disorder, which was new to the DSM-5 in 2013, was created in an effort to replace the diagnosis of childhood bipolar disorder. The prevalence of this disorder is not yet known, but is expected to be within the 2 to 5 percent range for children.

The onset of symptoms must be before age 10, and a diagnosis should not be made for the first time before age 6 or after age 18.

Diagnostic Criteria for Disruptive Mood Dysregulation Disorder:

• Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation
• The temper outbursts are inconsistent with developmental level (e.g., the child is older than you would expect to be having a temper tantrum).
•  The temper outbursts occur, on average, three or more times per week
• The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, friends).
• The above criteria have been present for 1 year or more, without a relief period of longer than 3 months. The above criteria must also be present in two or more settings (e.g., at home and school), and are severe in at least one of these settings
• The diagnosis should not be made for the first time before age 6 years or after age 18. Age of onset of these symptoms must be before 10 years old.
• There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
• The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder.

As with all child mental disorders, the symptoms also can not be attributable to the physiological effects of a substance or to another medical or neurological condition.

Treatment:

If you think your child has DMDD, it is important to seek treatment. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it hard to participate in activities or make friends. Having DMDD also increases the risk of developing depression or anxiety disorders in adulthood.

While researchers are still determining which treatments work best, two major types of treatment are currently used to treat DMDD symptoms:

• Medication
• Psychological treatments
  • Psychotherapy
  • Parent training
  • Computer based training

Psychological treatments should be considered first, with medication added later if necessary, or psychological treatments can be provided along with medication from the beginning.

It is important for parents or caregivers to work closely with the doctor to make a treatment decision that is best for their child.

Depression Related To Medical Illness

Is a persistent depressed mood and a significant loss of pleasure in most or all activities that’s directly related to the physical effects of another medical condition.

Depression associated with a chronic medical illness often aggravates the condition, especially if the illness causes pain and fatigue, or limits a person’s ability to interact with others. Depression can intensify pain, as well as fatigue and sluggishness. The combination of chronic illness and depression also can cause people to isolate themselves, which is likely to exacerbate the depression.

Research on chronic illnesses and depression indicates that depression rates are high among patients with chronic conditions:

• Heart attack: 40% to 65% experience depression
• HIV/AIDS
• Coronary artery disease (without heart attack): 18% to 20% experience depression
• Parkinson’s disease: 40% experience depression
• Multiple sclerosis: 40% experience depression
• Stroke: 10% to 27% experience depression
• Cancer: 25% experience depression
• Diabetes: 25% experience depression
• Chronic pain syndrome: 30% to 54% experience depression
• Hypothyroidism
• Lupus
• Huntington’s Chorea – depression is a hallmark of the beginning of the disease and the end of the disease

Depression Related To Substance Use And/Or Abuse:

It’s no secret that there is a strong connection between substance use and mental illness. In fact, substance abuse is nearly always linked to depression, this is called duel diagnosis, meaning that there are two closely related problems that need to be treated at the same time.

The National Bureau of Economic Research reports that people who have been diagnosed with a mental illness at some point in life consume 69 percent of the nation’s alcohol and 84 percent of the national’s cocaine. When a person struggles with substance abuse and a mental illness, this is known as a dual diagnosis or co-occurring disorder.

Depression is a mental illness frequently co-occurring with substance use. The relationship between the two disorders is bi-directional, meaning that people who abuse substances are more likely to suffer from depression, and vice versa. People who are depressed may drink or abuse drugs to lift their mood or escape from feelings of guilt or despair. But substances like alcohol, which is a depressant, can increase feelings of sadness or fatigue. Conversely, people can experience depression after the effects of drugs wear off or as they struggle to cope with how the addiction has impacted their life.

Depression is all too often a gateway into drug and alcohol use. It’s easy to see why. Those who experience feelings of depressions take alcohol and drugs in order to escape their negative emotions. But those who are clinically depressed are going to stay depressed if they do not seek treatment. And if these individuals are using drugs and alcohol on a regular basis, chances are their usage will soon turn into full-blown addiction as they continue in a vain attempt to self-medicate.

For some individuals who have depression and a substance use disorder, giving up drugs or alcohol can actually make depression worse. If you’ve been using alcohol for years to bury your depressive symptoms, you may find that your depression rises to the surface in sobriety. That’s why it’s so important to receive integrated treatment for both depression and substance abuse at the same time.

Without treating the depression that drives your addiction, or vice versa, you’re likely to go back to your addictive behaviors or to experience a return of your depressive symptoms as soon as you finish rehabilitation. In many cases, people who have depression and substance abuse drop out of conventional rehab programs because sobriety is too much to handle without the right level of therapeutic support.

How Are Mood Disorders Treated?

Mood disorders can often be treated with success. Treatment may include:

• Antidepressant and mood stabilizing medicines—especially when combined with psychotherapy have shown to work very well in the treatment of depression
• Psychotherapy—most often cognitive-behavioral and/or interpersonal therapy. This therapy is focused on changing the person’s distorted views of himself or herself and the environment around him or her. It also helps to improve interpersonal relationship skills, and identifying stressors in the environment and how to avoid them
• Family therapy
• Other therapies, such as electroconvulsive therapy and transcranial stimulation

Families play a vital supportive role in any treatment process. When correctly diagnosed and treated, people with mood disorders can live, stable, productive, healthy lives.