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  • Comprehensive Overview of Mental Health Disorders

    Dr. Mary Williams, RN, DC

    About the author

    Dr. Mary
    Williams, RN, DC

    Dr. Mary Williams, R.N., D.C is a Doctor of Chiropractic with an extensive background as a Registered Nurse. She is a NVC Psychiatric Technician Instructor teaching psychiatric mental health nursing at Napa State College. She has over 30 years of hands-on medical and instructional experience.


    A Comprehensive Overview of Mental Health Disorders

    Resources for Patients, Families and Healthcare Providers

    Mental health disorders can have a seismic effect on the lives of individuals as well as families, friends, loved ones, and the community at large. The need for guidance can be overwhelming, and while there are many great resources available, there is also a lot of misinformation—about every type of disorder.

    This guide aims to provide a comprehensive resource of trustworthy information to individuals with mental health diagnoses, their loved ones, and medical professionals looking to gain a more complete understanding of various disorders.

    It provides links to nationwide organizations that offer information, resources, in-person and online support groups, helplines, and more to sufferers and their families. Use this guide to explore what is available to you—both nationally and at the local level.

    Alcoholism / Drug Abuse (Teens, Adults, Elderly)

    Drug and alcohol abuse are more than social problems. Most addictive substances actively change the brain to make the user feel compelled to use. As it progresses, addiction becomes a medical problem—one that’s still often seen in our society as a personal or moral failing. This can make even the act of admitting to a problem—let alone committing to recovery—very difficult for those struggling with addiction.

    However, addiction can be successfully treated. Here’s an overview of how addiction works, what to look for, what to do if you suspect addiction, and common treatments.

    What is it?
    Addiction can be described as a brain disease. While different substances have varying effects, they all change the basic chemistry and structure of the brain. These changes can wreak havoc, both in the addict’s own life and the lives of those who love them.

    Effective treatments for addiction usually combine medication and behavioral therapy. Often, the most effective treatments are personally tailored—because each addict’s situation, dependency, and reinforcing social factors are unique. Even so, recovery can be a long road and relapses are very common.

    How it works
    Drugs and alcohol affect the brain on the most fundamental level—disrupting the way it receives, sends, and understands information. Some drugs, such as heroin and marijuana, imitate the brain’s neurotransmitters; others, like cocaine and meth, stimulate the brain to release overwhelming amounts of dopamine, creating an intensely euphoric feeling.

    As the addiction progresses, the addict’s brain slowly adapts to the floods of dopamine—producing less natural dopamine of its own. The addict needs more and more of the substance just to feel normal, let alone achieve the intense highs of the beginning.

    Drug and alcohol addicts also experience other negative changes to their brains over time, including damages to the parts that control memory, behavior, learning, and judgment. This makes it easier for compulsive behavior to take root.

    What are the symptoms?
    Different substances have different symptoms of addiction. However, there are a few behavioral signs that are classic across different types of addictions, from illegal street drugs to medically necessary painkillers. These include:

    1. Dangerous behaviors. The addict may engage in increasingly risky behaviors revolving around their drug habit. These might include unsafe sex, violent crime, lying and stealing, or selling drugs themselves.
    2. Financial issues. Addicts sometimes spend every cent in their bank accounts, skip on paying bills and rent, and rack up debt in order to buy drugs. Complete financial collapse can be linked to a drug addiction problem.
    3. Dropped responsibilities. Some addicts are “high-functioning,” and manage to keep their other life responsibilities going for years while managing an addiction. However, a sudden inability to meet basic personal or work obligations is also a very common sign.
    4. Isolation. Some drug users and alcoholics cut off close relationships with friends and family in order to hide their addiction problems.
    5. New, questionable friendships. It isn’t uncommon for addicts to befriend other addicts—people they don’t have to hide their problem from. Often, these new friends encourage risky behaviors, and may be drastically different than the type of people the addict sought out before the issue started.

    In addition to these, the following links will give you more specific signs and symptoms of various substances.

    What to do
    If you suspect someone you love has an addiction, you have a challenge in front of you. Some addicts fiercely deny they have a problem—sometimes for years—because of the shame and stigma. Others may resist treatment for numerous reasons. The bottom line is that the addict must have a clear desire to recover before treatment works.

    First things first: You may think you’re overreacting to various signs if you’re not seeing the person actually drinking or using drugs—and you may not, as it isn’t uncommon for users to hide these behaviors. If you suspect a loved one has an addiction problem, watch them carefully and take note of the symptoms that concern you. Then contact a substance abuse professional.

    Here are a few hotlines and organizations that can help you today.

    Over time: There are usually many complex contributors affecting addiction—including the substance itself and a variety of social and mental health factors. As a result, there is no one best course of action.

    A substance abuse professional can help you determine your plan—whether the right thing to do is enlist other family members for help, talk to the addict directly, try to stage an intervention, or continue to look for signs or symptoms. It is also essential to determine whether there is a safety threat to you or other family members, and develop a plan to deal with that if necessary.

    Addiction can be notoriously difficult to treat, and even if the addict is dedicated to recovery, relapses are common. Often, the best thing you can do is take care of yourself. Joining an organization or support group that supports family members of addicts can help you immeasurably.

    • Adult Children of Alcoholics: This group uses the same philosophy as most twelve-step programs. The meetings can be in person, over the phone, or even online—so they’re easy to attend.
    • Al-Anon: Al-Anon has groups specifically for different family members of alcoholics, including children, grandparents, parents, siblings, and spouses.
    • Nar-Anon: Founded as an umbrella group of Al-Anon, these programs are specifically for the family members of drug addicts. The groups and events are nationwide, with an active online community as well.
    • Co-Dependents Anonymous: It is extremely common for an addict’s loved ones to unintentionally enable the addiction—often while attempting to help. This group helps family members understand how to avoid that trap and maintain mental health while supporting the addict as much as possible.
    • Dual Recovery Anonymous: This is a support group for addicts who are also suffering from mental health issues that contribute to addiction, as well as their loved ones.

    Many of these are nationwide organizations with chapters in states and cities throughout the country; some have online and phone-based counseling options as well, so you should be able to find support no matter where you live. Many communities have locally-based organizations that provide addiction support counseling as well.

    Treatment options
    Once the addict is ready to recover, there are two major options: inpatient and outpatient treatment.

    Inpatient treatment involves living at a treatment facility seven days a week, for as long as the treatment takes. This can be a good option for people who want to remove themselves from contributing aspects of their lives that feed into the addiction—such as damaging friendships or an unhealthy home life. It also removes all distractions from recovery, and provides round-the-clock medical care.

    The detox process—which can be dangerous to do alone, depending on the drug—is medically supervised. In addition, most inpatient treatment programs include group and individual therapy, family therapy, and even activities such as exercise and meditation. Some inpatient treatment programs are quite luxurious.

    Outpatient treatment doesn’t require an overnight stay. Patients sleep and live at home, and can undergo treatment while managing work, school, family, and other responsibilities. While the process varies depending on the treatment philosophy and the type of substance, there are a few common features of most programs. These include medically-supervised detox, medication, group and individual therapy, relapse prevention, and continuing support.

    Depression (Teens, Adults, Elderly)

    Depression is a disease that causes feelings of deep sadness, apathy, numbness, and disconnection. Approximately 1 in 15 adults will become clinically depressed at some point in their lives. The disease usually begins in the late teens or early 20s, and women become depressed at higher rates than men. In some studies, it’s suggested that as many as one in three women will become depressed at some point.

    What it is
    Depression is an illness that attacks mood. While depressed people may feel sad, they also feel irritable, angry, detached, numb, or indifferent. Feelings of worthlessness are also very common. The disease affects every aspect of the sufferer’s life, and robs every moment of joy.

    Normal feelings of grief are usually a result of something happening—a divorce or breakup, the death of a loved one, or the loss of a job, for instance. Depression is not necessarily triggered by an outside event. In many cases, the depression sufferer has a great life on the outside—something that makes their condition even more difficult to explain to friends and family.

    That said, grief over a loss can also co-exist with depression—and there can be considerable overlap. Depression makes normal grief much more severe and long-lasting.

    How it works
    Scientists aren’t sure what causes depression. It is an extremely complex disease with a number of triggering factors. Some of the potential red flags include:

    • A history of abuse. People who have been sexually, physically, or emotionally abused are at heightened risk of depression, either during the abuse or years later.
    • Certain medications. Medications known to increase the risk of depression include interferon-alpha, an antiviral drug; and isotretinoin, an anti-acne medication. A more comprehensive list can be found here http://www.aarp.org/health/drugs-supplements/info-02-2012/medications-that-can-cause-depression.html.
    • Grief or loss. While depression is not the same as grief or sadness, the loss of a loved one can trigger depression and intensify the grief.
    • Genetics. Depression can run in families. Experts believe that it isn’t caused by a single gene so much as a multitude of genes that contribute to risk.
    • A major life event. Even positive events can trigger depression in some. Post-partum depression, for instance, specifically occurs in women after giving birth.
    • Serious illness. Both mental and physical illness can cause depression. The depression may be directly triggered by the other condition, or by a related issue such as isolation.
    • Chronic pain. People in chronic pain have a high rate of clinical depression, as ongoing pain can completely upend lives.
    • Addiction. Those suffering from addiction are also very likely to be depressed. Approximately 30% of substance abusers suffer from clinical or major depression.

    Common symptoms
    To be formally diagnosed with depression, a sufferer needs to experience at least five of the items on the following list for a minimum of two weeks. This list is meant to be used only as a guideline and not a tool for diagnosis.

    1. A consistently negative or irritable mood.
    2. Loss of interest in activities the person used to love.
    3. Abnormal weight gain or loss, or changes in appetite.
    4. Insomnia or abnormally frequent sleep.
    5. Feeling tired, sluggish, or restless.
    6. Feelings of low self esteem or worthlessness.
    7. An inability to focus or make decisions.
    8. Suicidal thoughts.

    In addition to these criteria for clinical diagnosis, people with depression frequently exhibit symptoms such as these:

    1. Social isolation; withdrawing from friends and family.
    2. Canceling on social plans and foregoing social activities.
    3. Feelings of hopelessness or helplessness.
    4. Physical symptoms such as stomach issues, headaches, or back pain.
    5. Increased tendency to drink or self-medicate, such as taking sleeping pills and painkillers.

    What to do
    Loved ones often try to improve a depressed person’s mood, but these efforts are usually not successful. Depression is a bigger issue than one person can fix alone, no matter how much you love the depressed person.

    That said, there are a number of things you can do to be supportive.

    First things first: Talk to the person and let them know that you are here to support them. Being a patient, non-judgmental listener is key. However, it’s important to keep your expectations in check and know that a single conversation—or any number of conversations—may not solve this.

    Being supportive to a depressed person often means listening without judgment, being kind and persistent, and trying to meet the person where they are.

    Over time: Depression makes people want to withdraw. You may need to be gently and lovingly persistent with the depressed person—keep contacting them and inviting them to things, even if you don’t hear from them for a while. Don’t wait for them to initiate.

    There are a few other things you can do over time besides being a good listener. These include:

    • Suggest a medical check-up. It might be easier to get the depressed person to agree to see a doctor than a psychologist, and this has an additional benefit: it gives the opportunity to see if the depression has a medical cause. Some cases do; and if that’s not the case, the patient can get a referral to see a mental health professional.
    • Offer to help find a therapist. Depressed people are often low on energy and motivation—so having someone willing to make calls and do the research to find a therapist can be hugely helpful.
    • Take your loved one out of the house. Go see a movie, go shopping, have dinner, go for a walk or a run, or do something else active and fun. Exercise in particular is known to alleviate depression.
    • Help keep your loved one on track. Depressed people often need help making and sticking to appointments, getting to therapists’ offices, researching different types of treatment, and remembering medications. The depressed person may or may not accept an intense level of help; do what you can and don’t put pressure on the person.
    • Help with chores. Even small household chores can sometimes feel overwhelming to a depressed person. Help them do laundry, cook them a meal, take their pet to the vet, and perform other household tasks for them.
    • Stay positive. It’s essential to take care of yourself during this process. Treating depression is a marathon, not a sprint, and you’ll need endurance. This could mean setting boundaries about the type of help you’re willing to give, taking time for yourself, or seeing a therapist on your own.

    If the person has mentioned suicide, take it seriously. Here are a few numbers to call if you are worried your loved one might have suicidal thoughts.

    Treatment options
    As intractable as it may seem, depression is treatable. Treatment can alleviate depression in about 80-90% of cases. Generally, medical causes should be ruled out before going the therapeutic route.

    Medication can be enormously helpful. Antidepressants are not like stimulants or sedatives; they are also not addictive. Most take a while to kick in—from several weeks to two or three months.

    The patient’s psychiatrist should be closely involved in observing the effects of the medication and adjusting the dosage. It may take several tries to find the medication and dosage that works best. Patients may take the medication for six months or more after their depression alleviates, or they may stay on the meds long term.

    Psychotherapy. Talk therapy can be very effective on its own for milder cases of depression; for more severe cases, it is usually used in addition to medication. Cognitive behavioral therapy is particularly effective in helping people with depression; it’s a form of talk therapy that focuses on changing the patient’s patterns of thinking, rather than dwelling on incidents in the past.

    Electroconvulsive therapy is generally only used for people with extremely severe depression who have unsuccessfully tried other treatments. With this type of therapy, the patient is put under anesthesia and electrical stimulation is applied to the brain.

    Bipolar Disorder (Teens, Adults)

    Bipolar disorder is a mental illness characterized by extreme highs and lows—both manic and depressive episodes that are often severe enough to interfere with jobs, relationships, academic performance, and daily life.

    What is it?
    About 2.9% of people in the US suffer from bipolar disorder. It usually starts from an early age—between 15 and 25 about half of the time.

    Bipolar disorder is characterized by extreme mood swings—but these are nothing like the mood swings most people experience as a normal part of life. Bipolar disorder can be debilitating, but it is also very treatable both with therapy and medication.

    There are generally thought to be three types of bipolar disorder:

    Bipolar I Disorder: This is the most serious form of the disease. The patient has suffered at least one manic episode and at least one depressive episode.

    Bipolar II Disorder: The patient is more high-functioning than those suffering from Bipolar I. This type of bipolar disorder is characterized by at least one depressive and one hypomanic episode—still manic, but less severe than true mania.

    Cyclothymia: The patient is generally stable, but suffers from milder instances of depression along with hypomania.

    How it works
    The experts aren’t sure what causes bipolar disorder, but there are a number of contributing factors. These include:

    • Genetics. Studies have determined that those who have a relative with bipolar disorder are more likely to suffer from it as well.
    • Chemical imbalances in the brain. This contributes to a number of mood disorders, including bipolar disorder.
    • Hormonal imbalances. This may also be a contributing cause, although exactly how isn’t clear.
    • Stress factors. Stress, abuse, and trauma may either trigger bipolar disorder or raise the likelihood for those already at heightened risk of developing it.

    What are the symptoms?
    There are two stages to bipolar disorder: manic and depressive episodes. They have distinct sets of symptoms, including:

    Symptoms of mania

    • Feelings of exhilaration and euphoria
    • Delusions of grandeur or extreme overconfidence
    • Impaired judgment
    • Racing thoughts and bizarre ideas, often acted upon
    • Noticeably rapid talking
    • Oversharing and dramatic confessions
    • Risky behavior, such as promiscuity, drug use, and physically dangerous activities
    • Spending binges
    • Lessened ability to focus
    • Skipping school, work, and other obligations.

    Symptoms of depression

    • Feelings of despair, grief, and hopelessness
    • Insomnia or extreme exhaustion
    • Lack of interest in activities they usually enjoy
    • Severe guilt
    • Anxiety about small issues
    • Noticeable weight loss or gain
    • Changes in eating patterns—either under-eating or over-eating
    • Inability to focus
    • A low threshold for irritation, lost temper, and moodiness
    • Skipping school, work, and other obligations
    • Suicidal thoughts

    What to do
    It might seem clear to you that a loved one has bipolar disorder, but a mental health professional should be the one to make a definitive diagnosis. It can be very difficult to talk to a loved one about getting diagnosed for a mental illness, because of the stigma and shame involved. That said, here are a few guidelines.

    First things first: Talk to the person. Ask them how they’re feeling in a non-judgmental way. Avoid being confrontational or trying to force a particular outcome—the person may not be ready to seek treatment, and until they are, they cannot be forced to.

    The next step is to encourage the person to seek professional help—as they cannot start to solve the problem until they have a diagnosis. Avoid blame or sounding judgmental. Some helpful phrases include:

    • “Bipolar disorder is a medical illness and it is not your fault.”
    • “It takes courage to seek help; there’s nothing wrong with getting therapy or taking meds.”
    • “Bipolar disorder is treatable. You can get help for this.”
    • “Talking to a professional can make a huge difference.”

    Even once the sufferer decides to seek treatment, it isn’t always easy to find a doctor or sort out insurance issues. You can help with research, and once the sufferer has an appointment, you can offer to drive, look after children if needed, or accompany the person and provide moral support.

    Over time: Being subject to the ups and downs of bipolar disorder can be extremely wearing on friends and loved ones. You will have to take care of yourself as well as being a source of support to them. Do your best not to take the things a bipolar person says during mood swings personally.

    There are a number of resources for bipolar disorder sufferers that you can share with your loved one. These include:

    Apps. There are a range of applications that help bipolar disorder sufferers track and manage their moods. These can be very helpful, both in managing the disease and collecting valuable information to provide to doctors and therapists. A few include:

    • Bipolar Disorder Guide. This app provides a thorough, chapter-based guide to bipolar disorder, including coping methods, support resources, treatment, and other key info.
    • BrainWave Tuner. This app uses audible brainwave frequencies to help people control their moods, reduce stress, concentrate better, meditate, and sleep—among many other things.
    • Breathe2Relax. This is a simple app that helps people regulate their breathing to control mood and relax. It’s ideal for those suffering from stress and anxiety as a result of mood disorders.
    • DBSA Wellness Tracker. This app is designed to carefully track moods, activities, and medications—giving users a central place to monitor triggers and patterns.
    • DBT Diary Card and Skills Coach. This app provides a form of dialectical behavior therapy—a method found to be effective in treating bipolar disorder—to help sufferers track behaviors, monitor moods, and self-treat.

    Support groups. Even if the sufferer isn’t ready to start seeing a doctor, there are a number of support groups out there—often free, with no appointment necessary. Here are a few resources:

    • The DBSA Alliance. This organization offers both online and in-person support groups nationwide, focused on both depression and bipolar disorder.
    • The National Alliance on Mental Illness. In addition to nationwide support groups and chapters, this organization offers an emergency helpline for those suffering from mental illness, including bipolar disorder.
    • www.7cups.com. This website provides online therapy from trained listeners who are educated to help people with a variety of issues, including bipolar disorder.
    • The Anxiety and Depression Association of America. This group provides support for a variety of anxiety-related disorders, including bipolar disorder.

    In addition to helping your loved one, it is essential to take care of yourself. There are a number of support organizations targeted especially toward caregivers of people with bipolar disorder. A few include:

    • Bipolar Significant Others Mailing List. This organization provides a wealth of useful information for caregivers, as well as putting you in touch with others who are helping loved ones manage their bipolar disorder.
    • Families for Depression Awareness. This organization is focused on providing online support groups, advocacy, support, and resources for caregivers of people with depression.
    • National Alliance for Mental Illness. In addition to support for bipolar sufferers themselves, this organization offers a family education program targeting those with a loved one suffering from mental illness, including bipolar disorder.
    • International Bipolar Foundation. In addition to a wealth of resources and information, this website provides forums for caregivers and lists of support groups.

    Treatment options
    Usually, the goal of treatment is to reduce the intensity and frequency of manic and depressive episodes. Many patients start to improve within three to four months of treatment, although results vary. The mood swings will still occur, and relapses are not uncommon—but with the help of qualified professionals, the disease often gets less severe over time.

    Generally, the options include a combination of things, such as:

    Medication. The most common drug used to treat bipolar disorder is lithium carbonate. It is usually taken for a minimum of six months, and it’s crucial to keep taking it consistently. Some patients may be prescribed anticonvulsants, antipsychotics, or a valproate-lithium combination instead.

    Psychotherapy. This type of therapy helps the patient identify the triggers for mood swings, improve their relationships, understand negative patterns, and keep a healthy mindset to stay functional and happy.

    Cognitive behavioral therapy. This helps in particular with depressive episodes, and focuses on present behaviors rather than incidents in the past.

    Anxiety (Children, Teens, Adults, Elderly)

    The term “anxiety” can apply to a number of mental disorders that cause a person to feel fear and worry. These feelings can be relatively mild, or so serious that they impair the sufferer’s life.

    Some amount of anxiety is normal in everyone’s life, but these feelings become disordered when the anxious reaction is more severe than the situation warrants—and it negatively impacts the person’s ability to function.

    What is it?

    There are a number of different types of anxiety disorders. Some include:

    • Generalized Anxiety Disorder (GAD): This chronic disorder involves an outsized level of generalized anxiety. The feeling may be tied to some outside issue or event—a job, money, family, or health, for example—but it may not be.
    • Panic Disorder: People with this diagnosis experience sudden, intense attacks of fear—resulting in a physical reaction that can include dizziness, nausea, trembling, mental confusion, and difficulty breathing. These attacks may last only a few minutes or several hours.
    • Social Anxiety Disorder: People with this disorder are nervous about interacting with others. The anxiety may manifest in different ways—the sufferer may have a phobia about intimate relationships, crowds or parties, public speaking, or other situations. It isn’t unusual for those with this disorder to avoid going out in public to the point where their daily life is profoundly affected.
    • Separation Anxiety Disorder: Those with this disorder become extremely anxious when separated from a place or person that provides them with security. It is often experienced in toddlers and young children.

    How it works
    There are a wide range of contributors to anxiety disorders. These include:

    • Stress and trauma. Abuse, the death of a loved one, the loss of a job, problems at school, a traumatic event such as a car accident or medical diagnosis—all of these can result in an anxiety disorder.
    • Medical issues. Anxiety is a side effect of some medications. In addition, a physical anxiety response can result from a lack of oxygen—making it a symptom of conditions such as emphysema or pulmonary embolism.
    • Substance abuse. Some drugs, such as cocaine and amphetamines, cause anxiety during general use. It can also be triggered during withdrawal from drugs such as heroin, barbiturates, or Vicodin.
    • Genetics. If someone you’re related to has anxiety, chances are you’re at heightened risk as well. Scientists aren’t sure exactly which genes contribute to anxiety, however.
    • Brain chemistry. Research indicates that people with nonstandard amounts of specific neurotransmitters in the brain are more at risk of anxiety.

    What are the symptoms?
    The symptoms of anxiety can be both physical and mental. They may vary depending on the disorder, but some of the more common symptoms include:

    Physical symptoms

    • Shaking or trembling.
    • Upset stomach or nausea.
    • Headaches.
    • Shortness of breath.
    • Heart palpitations or heightened heart rate.
    • Numbness in the extremities.
    • Overheating and excessive sweating.
    • A feeling of restlessness.
    • Exhaustion or difficulty sleeping.
    • A hair-trigger startle response.
    • Frequent urination.
    • Tense muscles.
    • Chest pains.
    • A feeling of choking.

    Mental symptoms

    • Feelings of fear or terror out of proportion to the stimulation.
    • Feelings of extreme apprehension or worry.
    • Obsessive thoughts.
    • Irritability.
    • Inability to concentrate.
    • A strong aversion to the anxiety trigger.

    Doctors diagnose generalized anxiety disorder using the following criteria. Please note that this list is intended as a guide only, and a qualified professional should perform a diagnosis:

    • Excessive worry for most days of the week, for a period of six months or more.
    • Difficulty or inability to control feelings of apprehension.
    • At least three of these symptoms (in adults) or one (in children): sleep issues, tense muscles, irritability, fatigue, restlessness, or trouble concentrating.
    • Feelings of worry that interfere with daily life, or cause extreme distress.
    • Generalized feelings of anxiety unrelated to other mental health conditions.

    What to do
    It isn’t unusual for people with these disorders to suffer from sudden anxiety attacks, which can be terrifying—both for the sufferer and anyone present. We’ll cover what to do in case of a sudden attack, as well as tips for supporting an anxiety sufferer over the long term.

    First things first: A person suffering an anxiety attack might suddenly feel very fearful and unsettled, restless and jittery, or strangely frozen. They might think they’re having a stroke or heart attack—some anxiety attacks feel that severe. But with an anxiety attack, the feeling will reach peak intensity after about ten minutes.

    If you’re with someone having an anxiety attack, stay calm. Help the person focus on keeping their breathing slow, even, and deep. Don’t let the panic worry you; instead, help the person get to a safe, quiet area. A few other things you can do include:

    • Ask the person what you can do to help—don’t assume.
    • Bring the person their medicine if they usually take it for panic attacks.
    • Use short, concise sentences.
    • Keep your behavior predictable; don’t surprise the person.
    • Help the person by breathing slowly with them, or by slowly counting with them to ten.
    • Engage the person in some light physical activity, such as a walk or yoga. This will help them focus on sensations other than their panic.

    Over time: If your loved one suffers from anxiety, there are a number of things you can do to help over the long term. These include:

    • Learn about anxiety. Educate yourself about the type of anxiety your loved one has, its triggers and symptoms, and common forms of treatment.
    • Be an activity partner. Exercise, yoga, meditation, and breathing exercises can all help anxiety immensely. They are also easier to stick to when done with a partner.
    • Help your loved one spot and stop avoidant behavior. Many sufferers avoid the things that make them anxious. These can include making phone calls, beginning a difficult task, asking someone for something, or fixing a mistake.

    You can help the person tackle things they’ve been avoiding by making a list of small, doable tasks that will get them closer to being done; helping or accompanying them in doing some tasks; and working through the steps.

    • Know the signs of reassurance-seeking. Anxious people often need a great deal of reassurance—sometimes an endless amount—to assuage their anxiety. You may find yourself on the receiving end of endless anxious questions, ranging from “are you sure I won’t have a heart attack?” to “are you sure you’re not mad at me?” depending on the anxious person’s source of fear.

    These reassurance-seeking behaviors can become bigger and more demanding over time. Discuss the issue with the sufferer and their therapist—when the sufferer is not experiencing severe anxiety. The therapist can help develop a plan to disrupt the pattern.

    • Encourage your loved one to get help. A therapist can help immensely. Often, finding the right therapist, making the appointment, and keeping it can be a challenge for anxiety sufferers. You can help with research, make calls, help your loved one sort out insurance issues, give them a ride or offer to watch their kids while they go.

    Support groups and organizations. There are a number of free support groups, both online and in person—as well as organizations that provide information and resources. Local organizations often provide services like these, and nationwide organizations are a good place to start looking as well. A few include:

    • The Anxiety and Depression Association of America (ADAA): This nationwide nonprofit provides support group listings as well as information on treatment, anxiety management techniques, information specific to people of different ages an genders, and more.
    • Anxiety Social Net: This is an online meeting space for anxiety sufferers. It’s free to join, and visitors can participate in online support groups, live chats, and Q&A sessions.
    • The Child Anxiety Network: This website is designed for children and adolescents who suffer from anxiety and their caregivers. The coping methods, symptoms, and resources are all geared to young anxiety sufferers. It also offers classes and resources for parents and caregivers, and assistance in finding a therapist.
    • Anxiety.org: This organization was developed by medical professionals at the UCLA Anxiety Disorders Research Center. It provides a directory of healthcare providers specializing in anxiety treatment, as well as research-based information and resources designed for consumers.

    Helpful apps. There are a number of apps that can help people deal with their anxiety, alleviate panic attacks, and track their moods. Some useful ones include:

    • Anxiety Free: This app teaches users self-hypnosis techniques to reduce stress through a series of 90-minuite guided lessons.
    • Free Relaxing Sounds of Nature: Relaxing sounds can be extremely helpful in controlling generalized anxiety, sleeping better, and calming panic attacks. This app lets users build a custom soundtrack.
    • Headspace: This app teaches users to meditate and use mindfulness strategies to manage anxiety. It offers a series of 10-minute guided meditations, with a tracking and reward system to encourage progress.
    • HelloMind: This app provides guided relaxation sessions that focus on building confidence and addressing anxiety. There’s a point system to encourage progress and a journaling feature to help users track their moods.
    • Stop Panic and Anxiety Self Help: This app uses cognitive behavioral therapy to help users reduce the instance and severity of panic attacks.

    Treatment options
    There are a number of ways to treat anxiety. Usually, treatment includes behavioral therapy, medication, and psychotherapy—or some combination of these. Some anxiety sufferers learn to self-treat, or get better with the help of a support group.

    Some anxiety sufferers have additional issues, such as depression, substance abuse, or medical problems that must also be addressed in order to reduce their anxiety.

    Independent treatment options. Some anxiety sufferers can treat themselves. This is usually only true for those with less severe anxiety, or anxiousness tied to a specific cause that can be eliminated. Stress management, deep breathing, meditation, exercise, and relaxation techniques can help enormously.

    Cognitive-behavioral therapy (CBT). This type of therapy focuses on present behaviors and thought patterns. It helps the patient identify negative thoughts that trigger anxiety, and interrupt harmful patterns. It can also involve exposure therapies, where patients confront the source of their fears in a safe, supervised environment and become desensitized.

    Psychotherapy. Psychotherapy involves discussing past issues, relationships, and other environmental factors that contribute to the sufferer’s anxiety. The counselor will also help the patient develop coping mechanisms.

    Medications. There are a number of medications that have proven effective in treating the physical causes of anxiety, including beta-blockers, antidepressants, and tricyclics.

    Suicidal Thoughts (Teens, Adults, Elderly)

    Suicidal thoughts—also referred to as “suicidal ideation”—are thoughts about how to take one’s own life.

    Approximately 30,000 people commit suicide each year in the United States; there are about twice as many suicides as homicides. Men are more likely than women to commit suicide, at a rate of about four out of five, and suicide is the most common among the young—it is the third leading cause of death among those aged 15 to 24.

    What is it?

    Suicidal thoughts can range from fleeting ideas to solid, deliberate plans that are acted upon. The large majority of people who have suicidal thoughts do not follow through, but some do; most people who follow through on suicidal thoughts also suffer from a mental illness.

    How it works

    There are many different reasons people have suicidal thoughts. These include:

    • Mental illness. Suicidal thoughts are not unusual among those who suffer from depression, PTSD, bipolar disorder, eating disorders, and other mental issues.
    • Genetics. Some mental illnesses that lead to suicidal thoughts have a genetic component. Suicidal tendencies may also be inheritable on their own.
    • Outside events. Sometimes, a devastating event—such as the death of a loved one, a financial loss, or a divorce—can trigger thoughts of suicide.
    • Substance abuse. Those with substance abuse problems are more likely to have suicidal thoughts.
    • A history of abuse. Those who have suffered sexual, physical, or emotional abuse—or who have a family history of it—may be at heightened risk.
    • Social isolation. People who are socially isolated can be at increased risk of suicidal thoughts as well. This is particularly true for the single and elderly.
    • A serious medical diagnosis. Some people experience suicidal thoughts after suffering a debilitating injury or illness, or getting a difficult diagnosis.
    • Exposure to suicide. Studies suggest those who know someone who committed suicide are at increased risk themselves. This is especially true for teens.

    What are the symptoms?
    It isn’t uncommon for people who are experiencing suicidal thoughts to keep those thoughts to themselves—so as not to worry those around them. But those who are the most serious about these thoughts will usually exhibit some signs and symptoms. Some of the typical warning signs include:

    • Talking or writing about death, dying, or harming oneself.
    • Seeking out medications or weapons that could be used to take one’s own life.
    • Feelings of bleakness or hopelessness about the future; feelings that the person is trapped or that things will never improve.
    • Extreme mood swings or personality changes.
    • Feelings of worthlessness, shame or gilt; worry about being a burden to others.
    • Taking concrete steps to “get affairs in order,” such as writing a will or giving prized possessions away.
    • Saying goodbye to loved ones as if it were the last time they plan to talk to them.
    • Withdrawal and social isolation.
    • Taking reckless risks; using or over-using drugs or alcohol, having unprotected sex, or acting like they have a death wish.
    • A sudden, overriding sense of calm.
    • Physical agitation—pacing, hand-wringing, compulsively taking off or putting on clothing, and other anxious behaviors.

    What to do
    If you believe a loved one may be considering suicide, it is very important to take it seriously. It’s far better to be wrong and a little embarrassed than to be right and for your loved one to hurt themselves or die.

    First things first: Talk to the person. Showing you care can often be hugely meaningful to the other person—even if you feel it is trivial.

    When talking to a suicidal person, there are a few things to keep in mind. These include:

    • Don’t worry about finding the right words. It’s enough for the person to know you care and that they aren’t alone.
    • Listen without being judgmental. Allow the person to discuss their own feelings of despair, anger, and depression. Even if they’re talking about negative things, they’re talking—and that’s positive.
    • Be a source of hope. Suicidal thoughts can be prevented, and most underlying mental illnesses are treatable. Reassure the person that this won’t last forever—even if they don’t believe it.
    • Take the issue seriously. Don’t dismiss the person’s pain or try to minimize it by telling them things aren’t that bad. That will only make the person feel unheard.
    • Don’t fight with the person. Don’t try to persuade them that they have a lot to live for or that their family and friends will suffer if they die. Don’t tell them to be optimistic.
    • Don’t let the person swear you to secrecy. Some suicidal people might ask this of you, but you must be able to tell others and get help if needed. Don’t promise to keep suicidal secrets.

    If you suspect there is an immediate risk for suicide, it’s essential to take immediate action. The threat is imminent if the person has:

    • A plan to commit suicide.
    • The means to take their own life (such as a gun, a knife, or medication).
    • A time set for when this will happen.
    • The intention to commit suicide.

    The general risk scale is as follows:

    • Low risk: The person has some passing thoughts of suicide, but no concrete plan. They say they don’t intend to kill themselves.
    • Moderate risk: The person has suicidal thoughts, and a vague plan that isn’t very well thought out. They say they don’t intend to follow through.
    • High risk: The person has suicidal thoughts, and a specific plan that would be effective. The person says they won’t commit suicide.
    • Severe risk: The person has suicidal thoughts, a lethal and well-thought-out plan, and says they intend to follow through.

    Do not leave a suicidal person alone. Remove all access to guns, medication, or other lethal implements. Call 911, take them to a local emergency room, or call a crisis hotline, such as one of these:

    Over time: People with suicidal tendencies may need a lot of support in order to find help and start improving. Here are a few things you can do:

    • Help them get help. Call a crisis line and have someone experienced help you develop an action plan. Call therapists’ offices and make appointments. Help the person sort out insurance issues. Offer to go with them to appointments, give them a ride or watch their kids while they go.
    • Help them with follow-up. Did the doctor prescribe medication? If so, be sure the person takes their meds. Help them monitor side effects. Did the therapist suggest coping mechanisms? Help the person follow through with those too.
    • Take action. Don’t tell a suicidal person to call you if they need anything. Chances are they won’t reach out. Instead, take the initiative to call them or stop by on your own.
    • Model healthy behavior. If you want the person to change their behavior, you may need to be the change you want to see. Eat a healthy diet, stay away from drugs and alcohol, get enough sleep, exercise, and undertake other healthy lifestyle changes. This will give the person a solid example to follow.
    • Develop a crisis plan. Help your loved one create a series of actions to take in a crisis—or during a triggering event such as a painful anniversary. Make sure their therapist’s or doctor’s contact information is easily on hand. Get friends and family on board to be emergency contacts.
    • Get lethal objects out of the house. Be sure the person does not have access to knives or razors, deadly medication, guns, or other potential weapons.
    • Don’t give up. Even after a crisis has passed, be sure to stay in the person’s life. Check on them periodically, drop by, or give them a call.

    Treatment options
    There are as many options for treatment of suicidal thoughts as there are underlying causes. Many suicidal people also suffer from mental illnesses, and treating the suicidal thoughts requires treating the mental illness. This can be done through a range of different medications and therapies.

    Some people feel suicidal because of physical illness, chronic pain, or other medical problems. In addition, some medications actually cause suicidal thoughts as a side effect. If the suicidal person isn’t already seeing a doctor or specialist, they need to.

    If there is no diagnosed mental or physical illness causing the suicidal thoughts, seeing a doctor can still be a good place to start. If no physical issue is found, the doctor can refer the person to a therapist.

    Generally, treatment for suicidal thoughts often includes any or all of these elements:

    • Psychotherapy. This type of therapy, sometimes called “talk therapy,” involves exploring different personal issues, discussing the events and causes that trigger hopeless feelings, and developing strategies to manage those feelings.
    • Medications. A psychiatrist or doctor may prescribe anti-anxiety meds, antidepressants, antipsychotics, or other types of medication to lessen suicidal tendencies and treat underlying mental conditions.
    • Treatment for addiction. Many people with suicidal tendencies also struggle with addiction problems. Both in-patient and out-patient detox programs have ben shown to be helpful.
    • Family therapy. Families and loved ones can be enormously helpful in getting a suicidal person through their crisis. Often, family members have the opportunity to be involved in treatment.
    • Self-coping strategies. There are many activities that can help lessen suicidal thoughts and improve mood—everything from exercise, meditation, healthy eating, and getting enough sleep to learning which negative triggers to avoid. Self-coping strategies can be developed with help from a therapist.

    Physical & Abuse (Teens, Adults, Elderly)

    Abuse can take many different forms. It can be physical, emotional, or sexual; it can also involve neglect. Abusers can be parents or guardians, schoolmates, partners, co-workers, caretakers, and many others. The signs of abuse can sometimes be obvious, but are often difficult to spot as abusers often take care to hide the symptoms.

    What is it?

    There are four major types of abuse. These include:

    Physical abuse. This can include any physical assault, such as choking, punching, kicking, shaking, beating, burning, and other actions.

    Sexual abuse. Sexual abuse can involve an adult coercing or forcing a child into sexual contact; or unwanted or forced sexual contact between two people of any age.

    Emotional abuse. This type of abuse can be more difficult to spot, as it doesn’t leave physical signs. However, it can be just as damaging as physical abuse. Emotional abuse often involves constant threats, criticism, put-downs, and other behaviors that can severely damage the victim’s self-worth.

    Neglect. Physical neglect occurs when the victim does not have access to food, housing, medical care, clothes, or supervision. Emotional neglect usually involves a parent paying little or no attention to a child or withholding emotional support. Usually, victims of neglect are dependents—frequently children, but they can also be disabled or elderly adults who rely on caretakers.

    How it works

    Many people abuse others as a way of exerting control over them. Some were raised in abusive families themselves, and learned the behavior from parents. Others suffer from mental disorders or substance abuse problems. Whatever the reason, abuse is never justified.

    Some victims of abuse have no choice but to stay. They are children, or adult dependents living with a caretaker. But some seem to be able to walk away and don’t. This is often the most baffling question to people on the outside—why a victim of abuse chooses to stay.

    There are many different, complex reasons. Some victims are afraid to leave; they may fear what the abuser will do if they go. In some cases, abusers threaten friends and family. Others may have low self esteem and believe that abusive treatment is normal. Still others may truly love the abuser, and believe that they can be redeemed.

    In some cases, the victim is monetarily dependent on the abuser. Some abusers take control of the family finances in order to exert control over the victim. There may be children involved, making it much more difficult to leave. Some victims feel they have nowhere else to go.

    Still others are stuck in cultural or social situations that make it difficult to leave. In cultures and religions that emphasize traditional gender roles, there may be outside pressure for a couple to stay together regardless of an abusive dynamic. Undocumented immigrants and those who don’t speak the predominant language may face particular challenges in leaving. In some communities, distrust of police means that many instances of abuse go unreported.

    What are the symptoms?

    There are many different symptoms depending on the type of abuse. However, some common physical and emotional signs include:

    Physical abuse

    • Bruises—both new and old, centered on one part of the body, or around the upper arms.
    • Burns, including cigarette burns.
    • Scars or cuts.
    • Imprint injuries—marks shaped like thumbs or hands, belts, sticks, or fingers.
    • Missing teeth.
    • Bald spots, from pulled hair.
    • Black eyes or detached retinas.
    • Sprains or broken bones.
    • Bleeding from the ears, nose, or mouth.
    • Frequent sore throats.
    • Problems walking or sitting.
    • Sudden psychosomatic symptoms (stomach aches are more common in men; headaches are more common in women).

    Sexual abuse

    • Vaginal or rectal pain.
    • Frequent yeast or urinary tract infections.
    • Painful urination.
    • Trouble using the restroom.
    • Chronic pelvic pain.
    • Problems walking or sitting.
    • Tears, cuts, redness, or swelling around the genitals or anus.
    • Sudden incontinence.


    • Poor hygiene or grooming: overgrown fingernails, unkempt hair, unshaven facial hair, visibly dirty skin, etc..
    • Dehydration.
    • Malnourishment or weight loss.
    • A smell of urine or feces.
    • Skin conditions: rashes, bedsores, open wounds.
    • Fleas or lice.
    • Improper management of medication; no access to necessary aids such as glasses or hearing aids.

    Behavioral symptoms

    • Fear of being touched.
    • Unusual or inappropriate ways of showing affection.
    • Nightmares or insomnia.
    • Regression to childlike behaviors, such as thumb-sucking or bed-wetting.
    • Inappropriate knowledge of sexual activity (in children); frequent masturbation.
    • Fear of bathing or using the restroom.
    • Fear of a certain place or person, or generalized fear of a type of place or person.
    • Cruelty to animals.
    • Depression or social withdrawal.
    • Sudden mood swings.
    • Aggressive behavior.
    • Other sudden changes in behavior and mood.

    What to do
    There are some differences between talking to a child you suspect is being abused, and bringing it up with an adult. This section will be broken up into appropriate responses and an overview of the process for both adults and children.

    For children

    First things first:

    • Talk to the child. Be non-judgmental. Choose a comfortable place or let the child pick the place to talk. Be sure the suspected abuser is not within earshot.
    • Use a casual tone. A more serious tone may frighten the child into being less forthcoming. Keep the tone casual and relaxed, even if you don’t feel that way.
    • Be reassuring. Make sure the child knows they aren’t going to get in trouble—you are only asking because you are worried about them.
    • Be gentle and patient. In many cases, the abuser will make threats to keep the child from talking to adults like you. Be gentle and reassuring; don’t get angry.

    Once you’ve determined that the child is being abused, you can report it—and you may be required to by law. In 18 states, everyone who suspects a child is being abused is required to file a report. In other states, people such as medical professionals, social workers, teachers, police officers, and psychiatrists are required to report.

    A comprehensive overview of who is required to report child abuse can be found here.

    How to report child abuse

    The process for reporting child abuse varies by state. Most states have a toll-free number that will put you in touch with agencies that specialize in investigating cases of child abuse. A nationwide list can be found here.

    You can also call the Childhelp National Child Abuse Hotline. This organization has a team of trained volunteer crisis counselors on call 24/7, and can provide you with resources, emergency contacts, and social services on a nationwide basis. The volunteers can guide you through the process of filling out the report.

    Before you report, make sure the child is in a safe place away from the abuser. Tell the authorities when you fill out your report if you are concerned for the child’s safety. If the parents are not the abusers, you may also talk to them before filling out the report.

    Over time: The investigation may not occur right away. You may be able to call and follow up in a few days, depending on the agency’s rules and your relationship to the victim. If possible, stay in the child’s life—continue to play the role you’ve always played. In some cases, that may not be possible.

    It is important to take care of yourself during this time, as abuse can be hard on those who care for the victims as well. This article provides some general guidelines for taking care of yourself as a friend of a child victim of abuse.

    For adults
    If you believe an adult is being abused, don’t stay quiet. Expressing your concern could have a huge impact on the victim’s life—and may help save it.

    • Talk to the person. Let them know you’re worried, and tell them why. Tell them you’re available whenever they’re ready to talk.
    • Reassure the person. Be sure they know that you’ll keep anything they say confidential.
    • Avoid blame or judgment. Don’t tell the person that they just need to leave. Don’t put pressure on them or hint that they’re to blame for the abuse in any way.
    • Don’t give advice. This can be seen as putting pressure on the person or being judgmental if they don’t follow the advice.
    • Offer help and support. This might include creating an escape plan, giving them a place to stay, or other forms of help. Don’t put conditions on your help.

    The victim may need a place to stay or financial assistance in getting out. They may need a place to keep their possessions, or someone to help them make and follow through on an escape plan. Decide what you can help with, and make the offer.

    In some cases, the victim is not ready to leave. If that is the case, don’t stop being the victim’s friend. Don’t set conditions on your relationship or judge the person for choosing to stay. However, be sure to communicate that the victim doesn’t deserve this abuse and that it is not a normal part of a relationship. There may be underlying reasons for abuse, but there are no justifiable excuses.

    Many communities have local resources for victims of abuse. A few of those that operate on a national level include:

    Treatment options

    Whether or not they’ve left the abusive relationship behind, victims of abuse often need counseling medical help.

    Medical help. Victims of abuse may have injuries that need treatment—as well as psychosomatic symptoms such as headaches or stomach aches. If abuse is suspected, a medical professional can help you determine whether an injury is a possible sign of abuse.

    Psychiatric help. Former and current victims of abuse can often benefit enormously from therapy.

    Medication. Depression, anxiety, PTSD, bipolar disorder, eating disorders, and other forms of mental illness are common side effects of abuse. These problems are often treated with various combinations of therapy and medication. A psychiatrist can diagnose the patient, prescribe medications, and monitor their progress to find the right combination of treatments.

    Bullying (Children, Teens)

    Bullying is aggressive behavior that usually takes place among school-aged children. A real or perceived power imbalance is usually at play—the bully may be physically larger or stronger, have a higher social status than the victim, or both. Bullying was often dismissed historically as “kids being kids,” but being bullied can have serious mental health ramifications that continue throughout a person’s life.

    What is it?
    Bullying can include physical assault, verbal attacks and put-downs, name-calling, exclusion from friend groups, cyber-bullying, and spreading hurtful rumors, among other things. It does not have to be physical, although it can be. Cyber-bullying has become particularly common in recent years, with abusive behavior occurring over social media, text, IM, and email.

    Bullies are often larger and stronger, have a higher social status, or have access to embarrassing “dirt” on the victim—such as compromising photos. The bullying usually occurs on multiple occasions; it is not just a one-time thing.

    Verbal bullying may include the following, either in writing or in speech:

    • Teasing or name-calling.
    • Calling attention to the child in public, in an embarrassing way.
    • Making sexually suggestive comments.
    • Threatening bodily harm.

    Social bullying typically focuses on ruining the victim’s social status. It includes:

    • Abandoning a victim on purpose.
    • Telling other children to avoid, exclude, or not be friends with the victim.
    • Embarrassing the child in public.
    • Spreading rumors or releasing embarrassing or inappropriate photos online.

    Physical bullying escalates to physical assault. It includes:

    • Punching, kicking, hitting, or spitting.
    • Trips and pushing.
    • “Jumping” or fighting.
    • Stealing or breaking the victim’s possessions.
    • Ripping the victim’s clothes.
    • Hair-pulling and pinching.

    How it works
    Bullies take out their frustrations on the children they perceive as “weaker” or “different” for a number of reasons. These may include:

    • Feeling hurt or anger about a difficult home life.
    • Feeling a lack of attention from parents, teachers, or friends.
    • As a way to increase their social status.
    • Because they learned it from an older sibling or abusive parent.
    • Because they have been victims of bullying themselves.
    • Untreated mental health problems.
    • Untreated learning disabilities, leading to frustration.
    • Feeling personally or socially insecure.

    What are the symptoms?

    Children experience both physical and mental symptoms of bullying. These include:

    • Unexplained bruises, cuts, or other injuries.
    • Psychosomatic problems, such as headaches or stomach aches.
    • Lost or destroyed belongings such as books, clothes, phones, or jewelry.
    • Coming home from school hungry because of skipped meals at school.
    • Insomnia and nightmares.
    • Sudden loss of interest in school.
    • Declining grades.
    • Loss of friends or avoidance of social activities.
    • Dropping out of after-school activities.
    • Decreased confidence and self esteem.
    • Nervousness when receiving texts or instant messages.
    • Faked illnesses to avoid going to school.
    • Anger, depression, or lashing out.
    • Loss of appetite; unexplained weight loss or gain.
    • Panic or anxiety about going to school.
    • Self-destructive behaviors, such as drug use or unsafe sex (in teens).

    In addition to serious physical injury, the most serious consequences of bullying can include suicidal thoughts and tendencies; use of drugs, engagement in unsafe sex or other self-destructive behaviors; or running away.

    What to do

    Children will often not confide in their parents and other adults about bullying because they feel ashamed. Victims often believe that if they were tougher, more popular, more attractive, or weren’t so awkward and nerdy, they wouldn’t have been a victim of bullying. They might also worry that the bullying might get worse if they tell an adult.

    First things first. If you believe your child might be being bullied, here are some steps to take.

    • Listen without judgment. Ask directly but gently how your child is doing. Don’t judge the answer.
    • Stay calm. Don’t get angry or reactive, and don’t rail against the other child.
    • Reassure your child. Tell them they did the right thing by coming to you. Tell them that many people get bullied. If you have personal experience, share it.
    • Don’t tell your child to fight back. This encourages violence and could result in your child putting themselves in a dangerous situation.
    • Develop a plan. Talk to your child before reaching out for help—and develop a plan that you are both on board with.
    • Block the bully online. You may need to limit access to technology in order to protect the child from cyber bullying. This should ideally be done with the child’s support; you are not punishing the child, but protecting them.

    Tell the authorities at school—such as teachers, counselors, the school nurse, or the principal. They are often in the best place to take concrete steps to stop the bullying. Most schools have processes in place to respond to different kinds of bullying, and some states have laws that guide the process.

    Over time. You may need to educate yourself on the laws surrounding bullying in your area. A comprehensive list of anti-bullying laws by state can be found here.

    If your child’s school takes no action about the bullying, you may need to take it to the next level. There are a number of actions you can take, including:

    • Talk to other parents. It’s possible that your child isn’t this bully’s only victim. Reach out to other parents and enlist their help. The school may be able to ignore the complaints of one parent, but not a unified group.
    • Document the problem. Have your child tell you about each instance of bullying and write down the date, time, location, participants, and a description of events. Document the school’s responses as well—who you talked to, when, and what they said. Write down any agreed outcomes when you meet with a school counselor or teacher, and have everyone sign the document. Keep written track of the actual outcome.
    • Know the school’s policies. Many schools have published policies on anti-bullying. If your school is not responding to your complaints, they may be in violation of their own policy.
    • Fill out a Notice of Harassment form. If you’ve complained and spoken to everyone in the school’s chain of command and the harassment has continued, fill out a Notice of Harassment document. The child’s teachers and principal should receive a copy.
    • Escalate. You may need to take the issue to the board of education, the superintendent of schools, or even law enforcement if the bullying is bad enough.

    There are a range of online resources for bullying victims and their parents, providing information on state and local laws, strategies to take, and support groups for victims. These include:

    Treatment options
    Bullying can have long-lasting effects on a child’s self-esteem. In serious cases, mental disorders such as depression, anxiety, and PTSD can be triggered by sustained bullying. Those targeted by bullies can also develop a victim mentality and feelings of low self-worth that can affect them well into adulthood.

    Therapy can help the victim process feelings of shame, anger, and anxiety over their experience; repair their self esteem; and learn coping mechanisms for dealing with difficult relationships as well as their own feelings. Medications may be required in the most serious circumstances, when additional mental disorders have been diagnosed.

    Eating Disorders (Children, Teens, Adults)

    Eating disorders are a cluster of mental illnesses centered around food and eating habits. People of all ages, genders, and races can have eating disorders. They take different forms, but often include extreme behaviors, attitudes, and emotions surrounding food. Eating disorders are physically and mentally debilitating; in some cases, they can be fatal.

    What is it?
    There are a number of different kinds of eating disorders, some relatively well publicized, and some more obscure. These include:

    Anorexia nervosa. People with this disorder starve themselves to lose as much weight as possible. It is often accompanied by an intense fear of weight gain. In the most severe cases, anorexia sufferers can starve themselves to death.

    Bulimia nervosa. This disorder is characterized by cycles of bingeing and purging. Bulimia sufferers often eat large amounts of food in secret, then vomit, take enemas or laxatives, or over-exercise to rid themselves of the calories.

    Binge eating disorder. This is compulsive overeating; sufferers typically binge excessively without the cycle of purging. These binges are often accompanied by feelings of shame and low self-esteem, as well as periodic dieting attempts. Sufferers are often obese.

    Night-eating syndrome. Sufferers typically binge-eat at night, accompanied by nighttime agitation and insomnia. Studies have shown that this type of behavior is characterized by abnormal hormone levels.

    Orthorexia. This disorder involves an obsession with healthy eating. It is often characterized by an intensely pleasurable, almost spiritual feeling accompanying healthy eating, as well as social isolation and obsessive thoughts about food.

    There are also instances of eating disorders that fit none of these diagnoses neatly, or involve the symptoms of several different disorders.

    How it works
    There are a number of contributing factors that influence whether or not a person will develop an eating disorder. While these factors vary depending on the disorder, most people who develop problematic eating habits also experience body dysmorphia. This involves seeing your body differently than it actually is—for example, an anorexia sufferer might see her body as much larger than it is in real life.

    Some contributing factors to eating disorders include:

    The media. In many societies, the media promotes unrealistic standards of beauty that are unattainably thin for most people. These images may not trigger eating disorders in everyone, but prolonged exposure most likely has this effect on those who are already vulnerable to it.

    Genetic predisposition. Some studies suggest that susceptibility to disordered eating is an inherited trait, although the processes involved are complex and not well understood.

    Psychological predisposition. Some people have additional mental disorders that may make them more likely to develop an eating disorder. While the causality hasn’t been fully established, studies suggest that depression, substance abuse, attention deficit disorders, anxiety, and obsessive-compulsive disorders may contribute to disordered eating habits.

    Medical issues. Some physical diseases, such as food allergies, Celiac disease, and irritable bowel syndrome can result in disordered eating patterns. These usually start out as an attempt to control the physical disease, but become more pronounced as time goes on.

    Abuse. Child abuse can often result in eating disorders, either in adolescence or later in life.

    Parental influence. Parents are often unwittingly instrumental in triggering disordered eating in children. The factors here are complex, and may include restricting children’s food choices in certain ways, making comments about a child’s weight, or modeling unhealthy eating habits or attitudes toward food.

    Peer influence. Some studies have shown a clear connection between a child’s peer group, especially in adolescence and early adulthood, and the development of eating disorders.

    Professional influence. Certain athletic professions put a premium on certain types of builds and encourage disordered eating. Some of these have specific weight classes that require athletes to weigh a under certain amount to compete, or base career success on a certain “look.” High-risk professions include dancers, gymnasts, bodybuilders, wrestlers, jockeys, and fashion models.

    What are the symptoms?
    Symptoms vary depending on the type of eating disorder. However, a general list of symptoms include:

    • Dramatic weight loss or weight gain.
    • Obsessive thinking or talking about food.
    • Making excuses to avoid mealtimes or eating around people.
    • Reduced libido.
    • Weakness and fatigue.
    • Sensitivity to cold.
    • Reduced beard growth (in men) and stopped periods (in women).
    • Refusing to eat in public.
    • Cooking food for others and never eating it.
    • Obsessively counting calories and reading food labels.
    • Taking diet pills or prescribed stimulants, such as Adderall.
    • Extreme concern with the body’s appearance; frequent weighing.

    Some more specific symptoms aligned with different types of eating disorders are as follows:

    What to do
    People with eating disorders will often go to great lengths in order to hide their disorder. If you believe a loved one has an eating disorder, however, it can be crucial to start a conversation. Eating disorders are treatable, but they often get worse if left untreated.

    First things first. Talk to the person. Here are a few guidelines for starting a conversation:

    • Pick the right place and time. Don’t start the conversation where there might be distractions or time constraints.
    • Explain your concerns. Don’t criticize or lecture the person. Instead, give specific reasons why you’re worried, and troubling behaviors you’ve noticed. Express that you’re worried, you love them, and you want to help.
    • Be ready for resistance. The person may get angry or become defensive. These conversations can feel threatening. Stay calm and don’t take it personally.
    • Don’t comment on the person’s appearance. Stay away from mentioning that the person is over- or underweight.
    • Don’t issue an ultimatum. You can’t force someone to get treatment unless they’re underage—and even then, you can’t force them to cooperate.
    • Stay away from simple suggestions. Don’t offer platitudes for the person to eat more or love their body.

    Over time. Your loved one may not want to discuss their eating disorder with you initially. It is important to stay connected, make it clear that you care, and don’t judge them.

    Ultimately, the best course of action is to encourage your loved one to get help. The longer disordered eating continues, the more havoc it can wreak on the body. The process often starts with a physician, who can screen for any medical issues, diagnose the problem, and refer the patient to a therapist if needed.

    Support groups can provide tremendous help and support to those suffering from eating disorders. There are often support groups and local organizations in locations nationwide. A few resources include:

    For parents
    Having a child with an eating disorder can be heartbreaking and terrifying. There are, however, a few steps you can take to deal with the situation in the home.

    Be a positive role model. Eat nutritious foods, but avoid dieting. Be aware of how you talk about your body and your relationship to food. Avoid saying negative things about your own body or appearance, or those of others.

    Make mealtime a positive experience. Family mealtimes should be fun and positive—avoid bringing up negative things. Don’t put pressure on the child if they refuse to eat; instead, encourage them to join in and become part of the conversation.

    Don’t try to force the child to change their habits. Stay away from trying to force your child to do anything. This may only drive your child’s disordered eating habits further underground. Hold the child accountable and set limits without constantly monitoring the child’s food intake.

    Help your child develop healthy self esteem. Emphasize your child’s many positive qualities that aren’t centered around looks or weight.

    Don’t bring up problem topics. Avoid mentioning food, eating, or weight around your child—but do eat healthy foods and portions in front of them.

    Treatment options
    Treatment procedures can vary depending on the disorder, the patient, and the situation. Usually, however, effective treatment involves addressing both the physical and mental aspects of the issue. This often requires a team of professionals, including a doctor, nutritionist, and psychologist or therapist.

    Medical intervention. The first step is to make sure the patient is physically stable and resolve any medical issues. Some people with eating disorders become seriously malnourished or have other medical complications, and many are initially resistant to treatment. The person may need to be hospitalized for a period of time to ensure they get the treatment they need. When they are physically stable and cooperative, they can be treated on an outpatient basis.

    Nutritional help. A nutritionist can be of great benefit in helping the patient improve their relationship to food. The nutritionist will help determine a balanced meal plan, establish healthy diet goals, and keep a healthy weight. They can also provide counseling and guidance on healthy eating.

    Therapy. There are many different types of therapy that explore the underlying emotional and mental issues the patient has surrounding food. These may include individual, family, and group therapy. The patient may undergo multiple kinds during treatment.

    ADHD (Children, Teens, Adults)

    ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder. People diagnosed with this disease have trouble focusing and controlling their behavior; they may be hyperactive. Usually, symptoms start to show between ages six and twelve. About a third to half of children diagnosed with ADHD continue to show symptoms as adults.

    What is it?
    Children and teens with ADHD have trouble controlling their impulses or paying attention in school. Often, their behaviors are disruptive and inappropriate, and interfere with school and family life.

    Some people have ADHD into adulthood. As adults, ADHD patients often have trouble with time management, staying organized, sticking to goals, or staying employed. ADHD can also affect their relationships and impulse control.

    How it works
    Scientists aren’t sure why some people contract ADHD. However, there are some factors that appear to put some children more at risk. They include:

    Intelligence level. Studies have linked ADHD with lower scores on IQ tests. However, this may not be because people with ADHD are less intelligent per se, but that they have particular trouble with the IQ test due to their attention deficit issues.

    Contributing disorders. Children with ADHD may also have other mental disabilities, such as Tourette’s syndrome, learning disabilities, obsessive-compulsive disorder, anxiety issues, depression, or bipolar disorder.

    Genetics. Studies suggest that in about 75% of cases, children with ADHD inherited the disorder from one or more parents. Children with siblings who have ADHD are about three or four times more likely to be diagnosed with it as well.

    Environmental factors. Babies exposed to certain substances in the womb, such as alcohol, cigarette smoke, or lead, may be at added risk of developing ADHD. Premature birth, low birth weight, and significant neglect and abuse have also been linked to ADHD.

    Medical factors. Some studies indicate that exposure to certain viruses and diseases in early childhood, such as rubella, measles, varicella zoster encephalitis, can boost the risk of developing ADHD. Approximately a third of children who suffer traumatic brain injuries are also diagnosed with the disorder.

    Relationship and family factors. Dysfunctional family dynamics may play a role in prompting ADHD development. Those who have experienced abuse are particularly at risk.

    Brain impairments. Some studies suggest that ADHD arises as a result of problems with the brain’s neurotransmitter system, especially the ones relevant to the dopamine and norepinephrine pathways; abnormalities in brain structure; brain chemical imbalances; and deficiencies in various cognitive processes related to executive function.

    What are the symptoms?
    Symptoms vary depending on the child, but in general there are two broad categories of ADHD. These include:

    Inattentive ADHD.
    A child with inattentive ADHD will show the following symptoms:

    • Becomes distracted easily; doesn’t pay attention.
    • Has trouble following directions.
    • Seems not to be listening.
    • Makes thoughtless mistakes.
    • Is very disorganized.
    • Has trouble sitting still.
    • Daydreams frequently.
    • Loses things often.

    Hyperactive ADHD.
    A child with hyperactive ADHD disorder will have these symptoms:

    • Has trouble sitting still; often fidgets, squirms, or bounces.
    • Struggles to play quietly.
    • Is constantly in motion.
    • Appears to have excess energy.
    • Talks frequently and loudly.
    • Has trouble waiting in lines or waiting to be called on.

    Adult ADHD.
    Some adults experience symptoms of ADHD as well; these tend to present differently than in childhood. Some of these include:

    • Anxiety, impulsiveness, depression, or low self-esteem.
    • Frequent lateness.
    • Trouble holding down a job.
    • Anger management issues.
    • Impulse control issues.
    • Addictive tendencies; possible substance abuse.
    • Easily bored or frustrated.
    • Trouble concentrating.
    • Highly disorganized.

    What to do

    First things first: If you suspect your child may have ADHD, the first thing to do is speak to the child’s pediatrician. Ask if the doctor has experience in seeing patients with ADHD; this is a somewhat specialized field. If they don’t have the expertise themselves, your pediatrician should refer you to a psychiatrist, psychologist, or other mental health professional with experience in this area.

    Over time: Parenting a child with ADHD can be challenging. Children with ADHD can have learning deficits, trouble with impulse control, and frequent disruptive outbursts. It can require a great deal of patience and calm on the part of parents.

    The best place to start is to understand more about the disorder. Start by learning about ADHD—its symptoms, potential causes, and likely effects on your child throughout all phases of life. In addition, it can also be extremely helpful to join a support group or making contact with other parents of children with ADHD.

    There are often local groups and resources in specific communities—but there are also nationwide organizations that can provide resources, list support groups, and help you find a community. These include:

    Treatment options
    ADHD can be managed, usually with a combination of medication and therapy. Typical treatments include:

    Behavioral therapy. This is usually the first treatment prescribed, especially for young children and those with less severe symptoms. Cognitive behavioral therapy, which keeps the focus on behaviors and controlling negative thoughts rather than deep-seated issues from the patient’s past, is considered particularly effective. Neurofeedback, which effectively “retrains’ the brain using real-time displays of brainwaves on an EEG machine, may also be effective.

    Family therapy. Often, the entire family becomes part of the counseling session. Parents may receive separate counseling on adopting effective strategies to help the child manage their ADHD.

    Exercise. Regular exercise is shown to be beneficial to both adults and children with ADHD in conjunction with medication and therapy. In addition to being good for overall physical fitness, exercise may help stimulant medication affect the brain’s executive function.

    Medications. There are a number of medications commonly prescribed for ADHD. Perhaps the most common is Ritalin; others include Adderall, Dexedrine, and amphetamines. Most medications prescribed for ADHD are stimulants. Non-stimulants are usually prescribed for those over six years of age only; these include Conodine, Guanfacine, and Atomoxetine.

    PTSD (Teens, Adults)

    PTSD, or Post-Traumatic Stress Disorder, is a mental disorder that occurs as a result of trauma. The cause could be a single event, or prolonged exposure to trauma over time. PTSD can occur in people with normal, healthy mental states before the traumatic event—it is not a sign of weakness.

    What is it?
    It is normal to have disturbing memories, suffer from insomnia, or struggle with anxious feelings after a traumatic event. However, PTSD lasts longer than three months after the event and is severe enough to intrude on daily life. PTSD sufferers can have trouble holding down jobs and maintaining relationships; in some cases, they can enact violent behavior on others.

    How it works

    PTSD commonly manifests after witnessing or experiencing a traumatic event. The event usually involves a feeling of intense fear, the death of a person involved, or serious injury to the sufferer or someone else.

    Studies suggest that a traumatic event causes an outsized adrenaline response, which makes a very strong impression on the brain—making changes to neurological patterns and biochemical processes that can last for decades after the event. This makes the patient extremely responsive to perceived threats in their environment.

    Those most at risk include:

    • Members of the military.
    • People in certain non-military jobs, such as emergency service workers and medical service providers, police officers, firefighters, and journalists.
    • Survivors of natural disasters.
    • Accident victims.
    • Children in foster care.
    • Victims of violent crime, such as sexual or physical assault.

    While PTSD is overwhelmingly caused by a traumatic event or series of events, there are a few additional factors that make some people more at risk of developing it. These include the size of the hippocampus—a smaller hippocampus has been linked to susceptibility—as well as genetic factors.

    What are the symptoms?
    There are four general ways PTSD manifests. These include:

    Re-experiencing. Re-living the traumatic event is common. PTSD sufferers may experience intense flashbacks, often because of things they see, hear, smell, or feel that remind them of the event. For instance, the sound of a backfiring car is a common flashback trigger for military veterans, who often associate it with gunfire.

    Avoiding certain situations. PTSD sufferers often avoid situations, thoughts, or people that remind them of the event. For instance, a person who survived an earthquake may avoid going into certain buildings that seem like they might be unsafe, or a car accident victim might avoid driving. In addition, PTSD sufferers may keep very busy or engage in substance abuse to block out thoughts about the event.

    Negative thought patterns and changes in emotion. Some people suffer from amnesia around the event, while still experiencing flashbacks—a combination of symptoms that can be extremely disturbing. Others have difficulty maintaining positive relationships with others, or experience intense paranoia or anger.

    Hyper-vigilance. This symptom involves always being alert to danger, as well as feeling jittery or on-edge. People with this symptom often have difficulty sleeping or maintaining concentration, and are easily startled. Some maintain certain obsessive habits, such as insisting on always sitting facing the door in restaurants.

    What to do
    PTSD can be very tough on relationships of all kinds. Your loved one may be less affectionate than before the event, and may experience anger or violent mood swings. For family, living with someone with PTSD can feel like walking on eggshells.

    It is important for family members to realize that their loved one’s volatility is not their fault. The victim’s brain is caught in a state of constant hyper-awareness, flooding them with feelings of fear, vulnerability, and mistrust. They are always on edge to an extreme degree, and may not have control over their actions.

    The support of friends and family can be tremendously effective in helping the PTSD sufferer feel safe again. Steps you can take include:

    First things first. It can be difficult not to start with a conversation, but talking about their feelings may initially make the sufferer feel worse.

    Let the person know you are willing to listen, without judgment, whenever they are ready to talk. They might not be ready yet—and that’s okay, too. The important thing is for them to feel safe and accepted by their loved ones; so spend time hanging out and relaxing with the person. Draw them into activities you both enjoy.

    In the meantime, learn as much about PTSD as you can. Join a support group for people who have loved ones with PTSD. There may be some local active groups in your community; a few places to start looking for support and resources include:

    Over time. It is crucial to help your loved one regain a sense of safety. Reassure them that you’re in it for the long haul—and you’re here to help them through this. Listen without judgment if they want to talk, and if they don’t, don’t pressure them. Meanwhile, you can help them manage triggers and model a sense of calm.

    PTSD sufferers are often angry and volatile. This is one of the most difficult parts of dealing with this disorder. If your loved one is having an angry outburst, stay calm and don’t take it personally. Ask the person what you can do to help—but be prepared to give them space if needed.

    Always put safety first. Some PTSD sufferers become violent. If you are concerned for your safety or that of others in the house, you may have to leave or lock yourself in a room. Call 911 if you believe your loved one might harm you or themselves.

    Over the long haul, it is crucial to take care of yourself. Be sure you’re getting enough sleep, exercising often, eating healthy food, and dealing with stress. See a therapist yourself if needed—this can be tremendously helpful. Don’t hesitate to lean on family members or other loved ones, and set boundaries as you need to—one person can’t do everything for another, and you cannot love a PTSD sufferer back to health.

    Treatment options
    PTSD can get better with treatment. Often, this involves a combination of medications and therapy. Every sufferer is different, and every case requires a different course of treatment.

    Cognitive-behavioral therapy is often used to treat PTSD. Some types and techniques include:

    Exposure therapy. This type of therapy exposes the sufferer to a facsimile of the trauma they faced, in a safe and medically supervised way. The person may be asked to perform visualization exercise, write about the event, or visit the place where the trauma occurred.

    Stress inoculation training: This therapy helps sufferers deal with traumatic memories and reduce anxiety.

    Cognitive restructuring: This technique helps patients change the way they see and experience their disturbing memories to reduce feelings of guilt, shame, and fear.

    Virtual reality treatment. This is a new but promising type of treatment. Sufferers experience a virtual environment specially built to gradually expose them to triggers. The therapist has total control over the environment through a computer, allowing them to determine the exact timing and content of what the sufferer experiences.

    In addition to therapy, a psychiatrist or doctor may prescribe medications such as SSRIs and SNRIs. Common medications include Zoloft, Prozac, Paxil, and Effexor.

    Dementia (Elderly)

    The word “dementia” does not refer to a single disorder. It’s a large umbrella term that is typically used to talk about a number of mental illnesses related to memory problems and cognitive degeneration. Some of these conditions are reversible, and some of them are not, although symptoms can often be managed with a variety of medications and therapies.

    What is it?
    Some of the more common types of dementia include:

    Alzheimer’s disease. Approximately 60-80% of dementia cases are Alzheimer’s disease. The cause is not well known, but people with Alzheimer’s disease typically have a buildup of amyloid plaques and proteins in the brain. It is incurable and progressive, but symptoms can be alleviated with treatment.

    Vascular dementia. This is the second most common type of dementia, and it typically occurs after a stroke—when bleeding in the brain causes extended brain damage. Like Alzheimer’s disease, there is no cure, but the underlying cause can be treated to ensure it doesn’t get worse—and the symptoms can be managed with therapy and medication.

    Lewy Body dementia. This type of dementia is the third most common. Its symptoms include sleep problems, hallucinations and noticeable changes in alertness, as well as memory loss. There is no cure, but as with vascular dementia and Alzheimer’s disease, the symptoms can be managed.

    Frontotemporal dementia. This is a more rare form of dementia, and one whose symptoms include major changes in behavior and emotion rather than cognitive and memory problems. It is caused by damage to the frontal or temporal lobes of the brain. Many people with this type of dementia do not experience memory problems, although they may experience reduced inhibition, compulsive behaviors, lack of empathy, problems with motivation, and dementia.

    In addition to these, dementia can also have other root causes. People with Huntington’s, Parkinson’s, and Creutzfeldt-Jacob disease may exhibit symptoms of dementia. Severe alcoholism and drug abuse can also result in major cognitive impairment.

    Reversible dementias. Some people experience dementia-like symptoms for a variety of reasons, but the condition is sometimes reversible. Causes of possibly-reversible dementias include:

    • Medications.
    • Deficiencies in folate or Vitamins A, B-12, and C.
    • Thyroid imbalances.
    • Metabolic problems, such as severe dehydration or kidney failure.
    • Brain tumors.
    • Exposure to environmental toxins.

    How it works
    Different types of dementia have different causes. However, the common thread is that they are all caused by damage to brain cells. This damage impairs the cells’ ability to communicate, and can have a broad effect on cognitive ability, memory, and behavior. Which set of symptoms is most prominent depends on the region of the brain most affected.

    Some more specific information about the causes of various types of dementia are as follows:

    What are the symptoms?
    The symptoms people experience can vary widely. However, the patient must have severe impairment in at least two of these areas to be diagnosed with dementia:

    • Language and communication
    • Reasoning and judgment
    • Ability to focus
    • Communication and language
    • Visual perception

    In everyday life, it isn’t unusual for dementia sufferers to struggle with everyday tasks; to constantly misplace things; to have difficulty planning meals; to frequently miss appointments and forget about plans; and to become lost in familiar environments. It is not uncommon for the symptoms to look like run-of-the-mill forgetfulness at first; most dementias are progressive and get worse over time.

    Some more specific symptoms of common dementias include:

    What to do
    Dealing with dementia in a loved one can be a grueling and heartbreaking experience. It can also be difficult to discern whether your loved one really has dementia, because increased forgetfulness is also a normal part of aging. However, if you’re fairly sure, here are a few tips for moving forward.

    First things first: The first thing to do is get your loved one to a doctor. Some dementias are reversible. Your doctor can provide a diagnosis that will help you and your loved one move forward and manage symptoms.

    There is no definitive test for dementia. Usually, a diagnosis involves a careful evaluation of different factors, including medical and family history, laboratory tests, and a physical and mental examination. In some cases, doctors have difficulty discerning between different types of dementia, as the symptoms are very similar; if you get a vague diagnosis of “dementia” without a specific kind, you may need to see a specialist.

    However, broaching the topic with your loved one before you get them to the doctor isn’t always easy. Frequently, older adults are in denial about their early symptoms, and may try to hide them from family members. Here are a few suggestions for making the conversation easier:

    • Pick a familiar, comfortable environment as a setting for the conversation.
    • Avoid language that places blame. For instance, instead of saying “you couldn’t microwave a cup of soup yesterday,” say “you seemed to have trouble making a cup of soup.”
    • Ask the person how they’re feeling about their memory and what things they’ve noticed lately. Emphasize that you are asking because you care.
    • Get the person’s help in deciding which steps to take next.

    Over time: It’s challenging to care for someone with dementia. The disease gets worse over time but is rarely fatal. While every dementia sufferer is different, following is a list of some of the most challenging symptoms caregivers deal with—and tips for managing them.

    Wandering. Some people with dementia walk for long periods of time—often with no clear purpose. They may be trying to get a physical need met—such as hunger, thirst, the need to use the restroom, or a need for exercise. They also may be experiencing side effects from medication. This can be a worrying activity, because the wanderer may leave the house, get lost, or unwittingly put themselves in danger.

    Some tips for keeping your loved one safe include:

    • Installing locks that require a key, and putting them higher or lower than eye level.
    • Hanging a thick curtain over the door.
    • Hanging a sign that says “Do Not Enter” or “Stop” over the door.
    • Putting a black mat just outside the door. This may look like a deep hole to the dementia sufferer.
    • Installing child-safe covers over your doorknobs.
    • Installing a home security or monitoring system to monitor the person.
    • Giving the person a digital GPS tracker that can be attached to clothes or worn like a watch.
    • Putting away the person’s wallet, coat, purse, or other items they won’t leave the house without.
    • Sewing ID labels into the person’s clothes or giving them an ID bracelet to wear.
    • Keeping a current photo on hand to give to law enforcement in case the person gets lost.

    Loss of bowel and bladder control. This is a common symptom of advanced dementia. It can sometimes occur when the person can’t find the bathroom or forgets where it is. If the person experiences an accident, they will likely be humiliated, so be reassuring—and help the person maintain their dignity.

    A few tips include:

    • Develop a regular routine for using the restroom. Remind the person to go every two hours or so, and help if needed.
    • Keep the person hydrated on a regular basis. Help them avoid beer, sodas, tea, and coffee, as these can be diuretic.
    • Keep drinking before bedtime to a minimum.
    • Put up clear signs or night-lights leading to the bathroom.
    • Buy a commode for the bedroom.
    • Buy adult incontinence pads and other products to help control accidents.

    Agitated behavior. Dementia patients may display a range of difficult-to-deal-with behaviors that fall into this category, including sleepless tendencies and extreme irritability. In some cases, these can escalate into physical and verbal abuse. Fear, exhaustion, and environmental factors may contribute, but most dementia patients are primarily triggered by a loss of control.

    Some tips for handing this include:

    • Keep the area relaxing and uncluttered. Reduce noise and keep objects around that stimulate pleasant memories. Make sure no dangerous objects are within reach.
    • Keep a sense of structure, order, and routine. This can be calming to dementia patients.
    • Help the person avoid taking in sugar or caffeine.
    • During an agitation spell, stay soothing and reassuring. Play calming music.
    • Do not attempt to restrain an agitated dementia patient.
    • Try to let the patient keep as much independence as possible.
    • Distract the person with food or a fun activity. Do not confront the person; let them forget the incident.

    Repetitive behaviors. A person with dementia may frequently repeat certain words or activities. While this is usually not harmful to the patient, it can be irritating and worrying to caregivers. This behavior is often triggered by boredom or anxiety. Some tips for dealing with it include:

    • Distracting the person with food or a fun activity.
    • Being comforting. Use both words and touch.
    • Don’t remind the person that they just asked a certain question.
    • Don’t mention future plans until just before the event.

    Paranoid behavior. Some dementia patients become paranoid and suspicious. They may accuse you of stealing things from them, or cheating on them, or other crimes. Bear in mind that this is not them speaking; it’s the dementia—it’s crucial not to take it personally.

    Some tips include:

    • Start by helping the person search for a “missing” object; then distract them with food or a fun activity.
    • Find the person’s preferred hiding places. Some of their missing items might be there.
    • Don’t try to talk the person out of their delusion. Instead, provide gentle touch, a hug, or other nonverbal reassurance.

    Sundowning. Some dementia patients become agitated in the evening, and this behavior may continue all night. This can be exhausting for caregivers. A few tips include:

    • Avoid letting the person nap during the day. Make sure they’re kept busy so they are tired out at night.
    • Keep the person away from caffeine, sugar, and junk food. Keep nighttime meals small.
    • Keep the late afternoon and evening calm and quiet, but with structure; take a walk with the person, listen to music, or play a quiet game together, for instance.
    • Turn lights on and close curtains before the sun sets.
    • If the behavior is extremely severe, your doctor may be able to prescribe sedatives for use at night. However, these may have other difficult side effects.

    Caring for a person with dementia can be extremely wearing. It’s essential to get the support you need, and not try to take everything on yourself. Respite care is available, and there are a number of support groups that can help, both on a local and national level.

    The Alzheimer’s Association is a good place to start. This is a nationwide Alzheimer’s research association that provides an extensive network of support groups and resources for caregivers, led by both professionals and trained volunteers. You can find support groups by state, call their 24/7 hotline, or find a chapter in your area.

    Other resources include:

    Treatment options

    There is no cure or treatment that can stop the progression of most dementias. Unless your loved one has one of the regressible forms of the disease, most likely the symptoms will get worse over time.

    However, there are a number of therapies and medications that can temporarily alleviate symptoms. These include:

    Medications. There are a number of medications that can temporarily alleviate the symptoms of dementia. These include Memantine and cholinesterase inhibitors, a type of medication that increases levels of chemicals involved in the brains’ memory and judgment processes; these are sometimes prescribed together.

    Therapies. Non-drug interventions for dementia often rely on various forms of occupational therapy, wherein patients learn coping strategies for making the home safer, preventing falls and accidents, and managing behavior.

    Alternative medicines and therapies. Some therapies, herbal and other dietary supplements may be helpful for some dementia sufferers, although these should be handled with care; always talk to a doctor, as many of these options aren’t regulated and may interact with existing medications. A few include Omega-3 fatty acids, Ginkgo, music and pet therapy, art therapy, and massage.

    Schizophrenia (Teens and Adults)

    Schizophrenia is a chronic mental disorder that profoundly affects a sufferer’s thoughts, feelings, and behavior. It often includes a break with reality, and sufferers do and say things that appear bizarre and disturbing to loved ones. They may become extremely unresponsive or struggle to function in social situations.

    The symptoms typically intrude on daily life and make it difficult for sufferers to hold down jobs and maintain relationships; however, with the proper medications and therapies, they can be manageable.

    Schizophrenia usually manifests when the patient is young, between the ages of sixteen and thirty; it can be a lifelong disease.

    What is it?
    There are many misconceptions and stigmas surrounding schizophrenia. Most sufferers do not have multiple personalities, and most are not violent.

    Currently, doctors consider the word “schizophrenia” to refer to a group of different disorders with overlapping symptoms and causes that exist along a spectrum. All these disorders affect the sufferer’s perception of reality. No two schizophrenia patients are the same, and symptoms tend to overlap and vary; some sufferers may be diagnosed with different types of the disease at different stages.

    Different categories of schizophrenia include:

    Paranoid schizophrenia. This is the most common form of the disorder. The symptoms include hearing voices, having delusional thoughts, and believing in nonexistent conspiracies or feelings of persecution. These symptoms can be debilitating, but paranoid schizophrenics are often the most high-functioning.

    Disorganized schizophrenia. This form of the disorder is characterized by disorganized thoughts. Sufferers are less likely to experience hallucinations and delusions, although these may also occur. They may have trouble performing daily tasks such as bathing, dressing, and cooking; or they may have emotions that seem disconnected from or inappropriate to their triggers. Their speech may be disordered or incomprehensible.

    Catatonic schizophrenia. This type of schizophrenia affects movement. Sufferers may stay still for very long periods of time, or they might engage in frenetic motion. They may perform repetitive movements. When their bodies are arranged in a pose, some sufferers may hold that pose for a long period of time and resist being repositioned. They might assume strange facial expressions as well.

    In some cases, a patient’s symptoms do not fit neatly into one of these categories; they may receive a diagnosis of “undifferentiated” schizophrenia.

    Most people experience a waxing and waning of symptoms over their lifetimes. While some people require round-the-clock care, others may be high-functioning, with the ability to hold down jobs, maintain relationships, and lead relatively normal lives.

    How it works
    Researchers are still unclear as to what causes schizophrenia. Theories and studies suggest that some or all of the following might have an effect:

    • Genetics. Schizophrenia tends to run in families, although scientists are not clear on how various genes interact to produce schizophrenia.
    • Hormonal factors. Many people start showing symptoms in their teen years. It is possible that the hormonal shifts of puberty trigger schizophrenia in those who have a genetic predisposition.
    • Brain chemistry. There may be an imbalance of certain neurotransmitters in the brains of schizophrenics that can result in delusions and hallucinations.
    • Infections and immune disorders. People with some types of serious infections and children whose mothers had the flu during pregnancy are at heightened risk.

    What are the symptoms?
    Most people start exhibiting symptoms between the ages of 16 and 30. Some of the common symptoms include:

    • Hallucinations; hearing voices or seeing things that aren’t there.
    • Delusions; belief in persecution or conspiracies.
    • Dysfunctional thinking.
    • Disordered movement patterns.
    • “Flat affect,” or lack of expression in the face and voice.
    • Trouble starting and continuing activities.
    • Reduced ability to speak.
    • Trouble focusing.
    • Issues with short-term memory.
    • Problems with decision-making and executive function.
    • A withdrawn or lifeless demeanor.

    To be diagnosed with schizophrenia, the patient must experience at least two of the following symptoms for at least six months:

    • Hallucinations.
    • Delusions.
    • Disorganized speech.
    • A withdrawn or lifeless demeanor.
    • Disordered movement.

    One of the two must be delusions, hallucinations, or disorganized speech.

    What to do
    Caring for a loved one with schizophrenia can be a challenge. However, some people with the disease eventually learn to manage symptoms and live relatively normal lives.

    First things first: Encourage the person to see a doctor. Even if you may seem very sure that the person has schizophrenia, only a doctor can make a definitive diagnosis. Schizophrenics often have executive function issues and trouble focusing, so you can help a great deal in finding a doctor, sorting out insurance issues, and helping them get to appointments.

    Over time: People with schizophrenia can improve and live normal lives. It’s important to remember that, and remind your loved one. Over time, the best plan is often to learn all you can about the disease; help your loved one to develop strategies to cope with symptoms; and support them while they manage setbacks.

    Creating a supportive, structured environment can be extremely helpful, as stress can sometimes intensify schizophrenic symptoms. When you are with the schizophrenic person, keep an attitude of calm and keep activities soothing and structured.

    It’s important not to take away the person’s independence in the name of helping. Be supportive, but don’t take control of activities and tasks that they are capable of doing. Help the person develop self-care and self-help strategies as much as possible.

    It’s also crucial to take care of yourself. Get enough sleep, set boundaries, and find support. Some places to start looking for support groups and resources include:

    Treatment options
    The underlying causes of schizophrenia are still not clear; as a result, most treatments aim to make the symptoms manageable. Some of the common options include:

    Medications. Most schizophrenics are prescribed antipsychotics, which can be taken daily in liquid or pill form, or as a monthly or bimonthly injection. It can take several attempts to find the right combination of medications for individual patents.

    Therapy and psychosocial rehabilitation. This usually starts after the patient has found the right medication mix. After that, they begin therapy to learn coping skills, handle daily challenges, and work toward life goals.

    A combination of specialty care. Some experts recommend an integrated approach, incorporating medication, therapy, family counseling, education and employment services, and other support in order to help people suffering with schizophrenia both manage their symptoms and live a normal life.

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