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Danceband On The Titanic

by | Sep 4, 2018 | Addiction, Addiction Recovery, Adult Bullying, Adult Children of Addicts, Agoraphobia, Anger, Anxiety, Anxiety Disorders, Bacterial Infectious Diseases, Child Neglect, Cognitive Distortions, Coping With Depression, Coping With Divorce, Denial, Depression, Dissociative Amnesia, Divorce, Emotional Boundaries, Emotional Regulation, Estrangement, Fear, Guilt, How To Help With Low Self-Esteem, Hypoparathyroidism, Infectious Diseases, Invisible Illness, Jealousy, Loneliness, Major Depressive Disorder, Marriage Problems, Medical Mystery Tour, Mental Illness Stigma, Pain And Pain Disorders, Poverty, Economic Struggles and Hardship, Sadness, Self-Esteem, Shame, Stress, Substance Abuse, Substance Abuse Relapse, Trauma, Trust | 43 comments

There is a picture of me, somewhere out there, probably still on my dad’s phone unless they’ve turned into Christmas Card people, in which case, the picture is most definitely out there in the world for all to see.

I hope it is not.

I didn’t see the picture until I was 5 months sober, staying in the unfinished basement at my parents house, grateful that I was no longer homeless, while I hunted for a job. Before this, I’d been staying there after a stint at a ramshackle, rundown motel, the kind of place you probably could dismantle a dead body, leave the head on the pillow, and no one would think anything of it. But it was my room, and despite the lice they gifted me, I loved it. Until money dried up and suddenly I was, once again, homeless. I’d moved in there after I was discharged from the inpatient psych ward, in which I was able to successfully detox after a suicide attempt. Got some free ECT to boot.

(WINNING)

Despite what you see on the After School Special’s of our childhood, I didn’t take a single Vicodin, fall into a stupor, and become insta-addict – just add narcotics! No, my entry into addiction was a slow and steady downward spiral of which I am deeply ashamed. It’s left my brain full of wreckage and ruin, fragmented bits of my life that don’t follow a single pattern. Between the opiates, the Ketamine, and the ECT, I cannot even be certain that what I am telling you is the truth; what I’ve gathered are bits and pieces of the addict I so desperately hate from other people who are around, fuzzy recollections, and my own social media posts.

About a year and a half before I moved from my yellow house to the apartments by the river, Dave and I had separated; he’d told me that while he cared for me, he no longer loved me. While we lived in the same house, we’d had completely separate lives for years, so he moved to the basement while I stayed upstairs. I’d been miserable before his confession and after? I was nearly broken. Using the Vicodin, then Norco, I was able to numb my pain and get out of my head, which, while remarkably stupid, was effective. For awhile.

Let me stop you, Dear Reader, and ask you to keep what I am about to say in mind as you read through this massive tome. I’m simply trying to make certain that you understand several key things about my addiction and subsequent recovery. I alone was the one who chose to take the drugs. No one forced me to abuse opiates, and even later, (SPOILER ALERT) Ketamine. This isn’t a post about blaming others for my misdoings, rejecting any accountability, nor making any excuses for the stupid, awful things I’ve done. I alone fucked up. My addiction was my own fault. However, in the same vein, no one “saved” me but myself. There was no cheeky interventionist. No room full of people who loved me weeping stoically, telling me how my addiction hurt them. No letters. Nothing. It was just me. I was alone, and I chose to get – and remain – sober.

The delusions started when I moved out, sitting in my empty apartment alone, paralyzed by the thought of getting off the couch to go to the bathroom. Always a night-owl, I’d wake at some ungodly hour of the morning, shaking. It wasn’t withdrawal, no, it was pure unfettered anxiety.

It was the aftermath of using so many pills, all the fun you think you’re having comes back to bite you with crippling anxiety and depression.

Which is why I’d do more.

Yes, opiates are powerful, and yes, I abused them, but things really didn’t become dire until I added Ketamine to my life.

Ketamine, if you’re unaware, is a club drug, a horse tranquilizer, and a date rape drug. You use too much? You may wake up at some hipster coffee bar, trying to sing “You’re Having My Baby” to the dude in the front row who may or may not actually exist. In other words, it’s the best way to forget how fucked you are.

The delusions worsen as time passed. I could see into the future. I could read your mind. I was going to be famous. I was super fucking rich. In this fucked-up world, I could even forget about me, and the life that I’d so carelessly shattered. I remember sitting in Divorce Class at the courthouse, something required of all divorces in Kane County, weeping at all that I’d thrown away – using a total of three boxes of the low-quality, government tissues. I left with a shiny pink face and completely chapped nose and eyes that appeared to be making a break from their sockets. I went home, took some pills, took some Ketamine, and passed out.

I retreated ever-inward. I didn’t talk to many people. I didn’t share my struggles. I was alone, and it was my fault.

The hallucinations started soon after Divorce Class ended and my ex and I split up. He’d left my house in a rage after a fight and went to live with his sister. I got scared. His temper, magnified by the drugs, the hallucinations, and the delusions, grew increasingly frightening. Once he’d moved out, the attacks began. I’d wake up naked in my bedroom, my body sore and bruised, and my brain put the two unrelated events together as one – he was attacking me. It happened every few days, these “attacks,” until I found myself at the police station, reporting them. I was dangerously sick and I had no idea.

My friends on the Internet (those whom I had left), sent me money for surveillance cameras. I bought them, installed them – trying to capture the culprit – and when I saw what I saw, I immediately called the police and told them the culprit.

The videos in my bedroom captured an incredibly stoned, dead-eyed, version of myself, violently attacking myself, brutally tearing at my flesh. In particular, THAT me liked to beat my face with one of my prized possessions – a candlestick set from our wedding, take another pill or hit up some Ketamine, then violating myself with the candlestick. It lasted hours. I’d wake up with no memory of events, sore and tired and unsure of how I’d gotten there.

I’d never engaged in self-injury before – not once – so the very idea that I’d hurt myself was unbelievable, but right there, on my grainy old laptop, was proof of how unhinged I’d become. Charged with filing a false report, I plead guilty.

In early September of 2015, I decided to get fixed, and made arrangements with work to take a few weeks off to do an inpatient detox, and, for the first time in a long time, I woke up happily, rather than cursing the gods that I was still alive.

It was to be short-lived.

Several days later, sober, I was idly chatting with my neighbor about her upcoming vacation (funny the things your brain remembers and what it does not), standing by my screen door, when karma came calling. It sounded like the shucking noise of an ear of corn, or maybe the sound that a huge thing of broccoli makes when you rip it apart – hard. It felt like a bullet to the femur. I crumpled on top of my neighbor and began screaming wildly about calling an ambulance, yelling over and over like some perverse, yet truthful, Chicken Little:  “my leg is broken, my LEG is broken!”

I don’t remember much after that. I woke up in (physical rehab) and learned that my femur (hereafter to be called my “Blasfemur,”) had broken, fairly high up on the bone, where the biggest, strongest bone in your body is at its peak of strength. Whaaaa?

The doctors and nurses shrugged it off my questions, with a flippant “It just happens” and sent me home, armed with a Norco prescription, in November, to heal. I added the Ketamine, just to make sure.

A couple of weeks later at the end of November, I was putting up the Christmas tree with the kids and my mother. It was all merry and fucking bright until I sat down on the couch and felt that familiar crunch. Screams came out of me I didn’t know were possible, but I’d lost my actual words. My mother stood over me yelling “what’s wrong? what’s wrong?” and I couldn’t find the words. I overheard her telling my babies that I was “probably just faking it” as she walked out the door, my screams fading into an ice cold silence. They left me alone in that apartment where I screamed and cried and screamed. Finally, I managed to call 911 and when they asked me questions, all I could scream was my address.

I woke up in January in a nursing home. When I woke up, I found myself sitting at a table in a vast dining room, full of old people. For weeks to come, I thought that I’d died and gone…wherever it is that you go.

This time, I learned, my (blas)femur and it’s associated hardware had become infected after the first surgery, which weakened the bone, causing it to snap like a tree. They put me all back together like the bionic woman, but the surgery had introduced the wee colony of Strep D in the bone into my bloodstream, creating an infection on meth. I’d been in a coma for weeks. Once again, I learned to walk, and once again, I was sent home in late January with another Norco prescription. The nursing home really wanted me to have someone stay with me to help out, but I insisted that I was fine alone. In truth, I had nobody to help me out, but was far too ashamed to tell them.

The picture I referenced above was taken some time in May, as far as my fuzzy memory allows me to remember, after my third femur fracture in March. This time, I’d been so high that I fell asleep on the toilet and rolled off. Glamorous, no? Just like Fat Elvis. Luckily, my eldest son was there and he called 911 and my parents to whisk him away. I remember my father on the phone, telling Ben that I was a liar and I was faking it. I was swept away in the ambulance for even more hardware, and finally? A diagnosis:

HypoPARAthyroidism.

It’s an autoimmune disease that leaches calcium from the bones, resulting in brittle bones. It is managed, not treated. There is no cure.

But, I had the answer. Finally.

After my third fracture, I once again was sent to the nursing home, and quickly discharged with even higher doses of Norco, when my insurance balked, I’d used up all my rehab days for the year. By this time, I’d lost my apartment, my stuff was in storage (except the things that we’re thrown away, which my father gloated about while I was flat on my back) and my parents let me stay with them, which was about the only option I had. They couldn’t really kick me out if my leg was only freshly attached. I feel deeper into a depression, self-loathing, and drug abuse as I realized what a mess I’d made with my life. How many bad choices I’d made. How many people I’d hurt. How much I’d hurt myself. How much I loathed myself. How I once had a life that in no way resembled sleeping in my parents dining room. How I’d been a home owner. How I’d been married. How lucky I’d been. How I threw it all away. My life turned into a series of “once did” and “used to.”

The only one who hated me more was my father.

While we were once close confidants, in the years after my marriage to Dave, his disdain had become palpable. My uncle had to intervene one Christmas, after my father mocked me incessantly for taking a temp job filling out gift cards while I was pregnant with Alex. It may seem normal to some of you, this behavior, but in THEIR house, NO ONE was EVER SAD and NOTHING was EVER WRONG. WASPs to the core, my family is.

When I moved back in, broken, dejected, and high, our fights became epic. For the first time in my life, I stood UP to one of my parents. Then, I was promptly kicked out.

Guess I’m not so WASPy after all.

I want to say that the picture was taken around May of 2016, but my estimate may be thoroughly skewed, so if you’re counting on dates being correct and cohesive, you’ve got the wrong girl.

This is a picture of me, though you probably wouldn’t recognize me. I am wearing the blue scrubs that you associate with a hospital: not exactly sky blue, not teal, not navy, just generic blue hospital scrubs. These are, I remember, the only clothes I have to my name. I was given them in both the hospital and the nursing home, a gift, I suppose, of being a frequent flier, tinged with a bit of pity – this girl has no clothes, we can help. Whomever gave them to me, know that you gave me a bit of dignity, which I will never forget. Thank you.

I am wearing scrubs, the light of the refrigerator is slowly bleaching out half of my now-enormous body, as opposed to the darkness outside. There is a tube of fat around my neck, nearly destroying any evidence of my face, but if you look closely, you can make out my glasses, my nostrils, my hair cascading down. My neck is stretched back at nearly a 90 degree angle from my body, my head listlessly resting on the back of my wheelchair. My mouth gaped wide, which, should I been engaging in fly catching, would have netted far more than the average Venus flytrap. I am clearly, unmistakably, and without a single shred of doubt, passed the fuck out.

It is both me and not me.

High as i was, I don’t remember a thing about the photo being taken. But there I was, in all my pixelated glory.

By the time I saw the photo, I was once again in my “will do” and “can do” space. I’d kicked drugs in September 2016 and had found a job that I enjoyed. I stayed with my parents while I began to sort out my medical debt and save toward a new car and an apartment of my own. My spirits were high, my depression finally abated to the background, and I was tentatively happy. I’d apologized until my throat was sore, but my fragmented memory saved me from the worst of it, but I was not forgiven. I don’t think I ever expected to be. And now, I never will.

It’s okay. I can’t expect this. I know I fucked up.

My father, who’d actually grown increasingly disdainful of me, the more sober and well I became, confronted me when I came home one day after work, preparing to do my AFTER work, work.

My mother shuffled along behind him, Ben, the caboose. All three of them were in hysterics, tears rolling down their cheeks as I sat down in my normal spot on the couch. After showing them a video of two turtles humping a couple of days before, I eagerly waited to see what they were showing me.

What it was was that picture. Of the not me, me.

They could hardly contain their laughter, my father happier than ever, braying, “Isn’t this the best picture of you?” and “You PASSED OUT, (heave, heave) IN FRONT OF THE FRIDGE!” punctuated, with “I’m going to frame this picture!” The tears welled in my eyes while my teeth clenched, they laughed even harder at my reaction.

Like I said, if they’ve become Christmas Card sending people, this will be the picture of me they show, expecting others to laugh uproariously. Before I moved out, in fact, my father made certain to show the picture to anyone who came over. “Wanna see something hilarious?” he’d ask. Expecting memes or a funny cat playing the piano, they’d agree. I could see it when they saw it, my dad chortling with laughter, nearly choking on his giggles, the looks on their faces: a mixture of confusion and pity. Even in my drug-hazed “glory,” I’d never felt so low.

Maybe that picture is splashed all over the internet, in the dark recesses I don’t explore, and maybe it’s not. Maybe it’s hung on their wall, replacing all of the other pictures. Maybe it’s not.

Maybe we’ll meet again.

Maybe not.

Infertility.

by | Sep 3, 2018 | Family, Guilt, Hope, How To Help A Friend With Infertility, In Vitro Fertilization, Infertility, IUI, Love, Male Factor Infertility, Secondary Infertility | 0 comments

Infertility can be an isolating, awful experience.

This is her story:

My name is Gen and I’ve always loved children. I love being their entertainer, their caregiver, their snuggle buddy. Having one of my own was on my bucket list but having one ON my own wasn’t.

I was 28 when I met Sam, the man who was to be my husband. In less than 4 years we were ready to give parenthood a try. I went off the pill and we were as busy as bunnies. After 8 months without results, I consulted a gynecologist.  He took a history, did a pelvic exam and recommended that Sam provide a sample for analysis.

The results were mixed. I appeared healthy. Sam’s sperm count was low and had low motility. But there was a supplement that showed promise.

3 months later Sam’s sample didn’t show any improvement. We consulted a fertility specialist. This time, the same history the same pelvic exam and the same semen analysis. The only way we would get pregnant would be with IVF with ICSI, that is, in vitro with intracytoplasmic sperm injection.

No, we really didn’t know what we were getting into. And no, we hadn’t talked about adoption.

Next step was to start on birth control and then the follicle stimulating hormones. The process involves needles. Lots of needles. And did I mention the hormones? Lots of hormones.

To cut to the chase, the first cycle failed. The second failed and third and fourth cycles never made it to the transfer stage. My body did not respond well to the hormones. I suffered months of migraines and my uterine lining refused to thicken with the treatment. I took a month off. I tried acupuncture, took a few more yoga classes. I relaxed.

August came and the migraines were far enough behind me that I was willing to try another cycle. My uterine lining barely responded to the hormones but there was just enough there for the doctor to approve proceeding with the cycle.

And we were successful. We did it. Nine months later, Chloe made her appearance.

But we weren’t satisfied. Chloe was a delight. Being a mom was the most wonderful experience of my life and I couldn’t wait to try again. 10 months after her birth, we went back to our fertility doctor and asked for another. We had several embryos cryopreserved.

We had been through the process we knew what we were getting ourselves into.

I weened Chloe and started the hormones again. Fortunately my body responded. My uterine lining thickened nicely and we scheduled the transfer.

We took our first pregnancy test and wow, we were pregnant. That was easy, right?

Wrong. Sadly it was a chemical pregnancy.

We tried again. This time nothing.

We had one embryo left. We tried again and again.

Nothing.

Finally our fertility doctor suggested testing me for hydrosalpinx, a blocked and fluid filled fallopian tube. Turns out this is a pretty standard test for women having difficulty conceiving a child naturally. And I had it.

We went through a procedure to correct the situation, essentially a sterilization. Yes, it was surreal.

By now we had used all of our frozen embryos. We were going to have to go through a fresh cycle again. Great, more hormones and a LOT more needles.

We completed the cycle, the transfer, the pregnancy tests. We were pregnant, finally. And then we weren’t.

Our fertility clinic provided ultrasounds for the first 8 weeks of the pregnancy. The initial ultrasound showed one live embryo. The second ultrasound showed a slow heartbeat, but a heartbeat nonetheless. The third showed progress, not excited, not reassuring but enough to qualify as growth. I was released and sent on to my regular OB.

At 9 weeks, I went to my OB, without Sam, for my first appointment. She did an ultrasound and there was no heartbeat. She checked a few times but nothing. I left her office with an appointment for a D&C.

I was in shock when I left, I was in shock when I had the procedure and I was in shock for at least another 2 weeks. I didn’t cry, I didn’t talk about it, I felt nothing.

This effort to have another child has been harder than trying to have the first….because I know what I’m missing.

And yet, I’m still trying.

Eight Tips For Battling Depression

by | Aug 31, 2018 | Anger, Anxiety, Baby Loss, Coping With Baby Loss, Coping With Depression, Faith, Fear, Forgiveness, Grief, Guilt, Help For Grief And Grieving, Hope, Loneliness, Loss, Love, Major Depressive Disorder, Mental Illness Stigma, Mood Disorder, Sadness, Self Loathing, Shame, Stress, Trauma | 3 comments

We’ve all seen the commercials:

“Depression hurts.”

“Do you have trouble concentrating or making decisions? ___ [drug] can help.”

“Depression can make you feel like you have to wind yourself up to get through the day.”

“Depression can take so much out of you.”

I have to say that all of that is true. I hate to use the word depression (I think most people do), but things have been rough since my daughter died. I’ve scraped for words to express the isolation, pain, persistent sadness, discouragement, lethargy, roller coaster days, rage, sullenness, futility… but every time those words fall short.

Over the last few years, I’ve learned  a lot of things not to do, and a few things to try.

Most important is that a quick fix is a myth. So often I’ve woken up feeling OK, moved through the day’s activities relatively well, actually enjoyed some of the day’s moments, and thought to myself, “Hurray! I’m better!” Only I woke up the next day back in the swamp, feeling worse than before because I was wrong. I hadn’t actually left it behind.

Here are a few ways that have helped me, along with a few things I recommend avoiding.

If you are struggling with depression:

1. If you are a spiritual person, pray and tell God about how you feel and ask for help. Don’t shut God off just because you don’t feel God’s presence anymore. Feelings are fickle things, affected by lack of sleep, poor eating habits, hormones, illness, grief, and more.

I found that praying in the shower was a good place because

1) I could usually count on not being interrupted by my children, and

2) if I cried my heart out, the water washed my tears and snot away (I’m not a pretty cryer.)

2. Talk yourself through the day. I don’t mean talk out loud to yourself – that’s the fast-lane to crazytown. What I mean is this: if you catch yourself possibly over-reacting or taking the actions or words of another person personally, try to stop long enough to remind yourself that you are predisposed to assume the worst right now. Tell yourself, “I need to take my own emotional/mental/physical state into account when I’m reading other people and cut everyone, including this jerkwad, some slack.”

When I remind myself of this, I’m more likely to step back and wait to see if what I am jumping to conclusions and being paranoid (and usually I am). This helps preserve those relationships, and heaven knows we need as many healthy relationships as we can get.

3. Talk to someone about your struggle. Be selective. Keep your circle small, at least at first. Look for someone who is strong because they have struggled through some hard things themselves (not because he or she is a know-it-all). Find someone you can trust. Don’t talk to that girl who starts every story with, “Don’t tell anyone else, but so-and-so told me …” If they tell stories about other people, don’t give them any dirt on you. The right person will listen well, try to understand you, and give realistic counsel. They will be flexible but also persistent, drawing you out even when you withdraw or hide what’s inside.

4. Remain engaged with your family and friends. Make yourself go to birthday parties, cook-outs, ball games… whatever it is that you and your friends and family do together. Go even when every cell in your body wants to hole up in bed. We need people, and you have never experienced encouragement quite like spending time with people who care about you and who love to have fun.

I am so thankful for my husband and friends who have dragged me out of the house. No matter how many times it happens, I’m always surprised at how much better I feel when I go, even when it’s The Last Thing I want to do that day.

5. Give yourself time. This one has been hard for me. I want to be done with this depression. I want to move on, move forward, leave it behind, get better. I’m tired of dragging it around every day. But my counsellor keeps reminding me that there is no timetable on grieving. And if I try to stuff it all away and hide it, that actually makes the whole process longer. I need to feel those feelings and work through my grief, not run away from it.

6. Go see your doctor. Ask him or her to check for any physical problems and talk about how you are doing. It is very common for an illness or untreated condition to affect every part of you, including your energy level and outlook on life in general. They will collect some labs to look for things like low iron, an out-of-whack thyroid, or abnormally high white cell count (indicates that your body is fighting an infection somewhere). The doctor should be able to work with you to identify ways for you to improve your physical health, and present some options for improving your emotional and mental health.

7. Do your homework before trying supplements and/or prescription medications. Talk with your doctor about this. They will help you select the best things to try and often have non-prescription options as well. Taking a pill, whether it is an antidepressant or an herbal remedy, is not going to make you happy. These treatments are designed to give enough of a boost to do the hard work of recovery.

Be sure to ask your doctor and pharmacy about how various things interact. Tell them everything you are taking, including herbals and home remedies, because some things are very dangerous when combined. And if you think you need to change something because it isn’t working, don’t just stop cold-turkey! Call your doctor or pharmacist to see if you need to wean yourself off or if it is safe to just stop.

The best advice I was given about trying meds? Try one thing at a time, and give it at least a month before changing anything. Otherwise you won’t know what helped and what didn’t.

8. Build in some cushion. During the worst of my depression, I realized that my weeks were so tightly-scheduled that I had no slack at all for bad days. You know the kind: it’s all you can do to get the kids fed, dressed, and to school, and when you finish that, you collapse. Forget work, laundry, paying bills, washing dishes, cleaning house, grocery shopping. I got radical, backing out of commitments, canceling activities, and taking a leave of absence from work to build in some slack. It gave me the time I needed to rest and recover.

I hope these tips are helpful. I offer them up as ideas picked up along my own struggle in hopes that they encourage you to keep going, keep trying, and most importantly, get help.

Parentification Resources

by | 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.”

When occurring to a pathological degree, parentification is considered by some a form of child neglect as it impedes development through the denial of basic childhood necessities and experiences.

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

Mood Disorders Resources

by | 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:

Many people who have mood disorders try, before approaching a doctor, to self-medicate themselves. That means that they use alcohol and other drugs to make themselves feel better.

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.