Childhood Trauma Leaves Mark On DNA of Some Victims: Gene-Environment Interaction Causes Lifelong Dysregulation of Stress Hormones

How we live and what happens to us changes our genes. Trauma in early childhood can change DNA and lead to PTSD, anxiety and depression.

Dec. 2, 2012 from Sciencedaily.com— Abused children are at high risk of anxiety and mood disorders, as traumatic experience induces lasting changes to their gene regulation. Scientists from the Max Planck Institute of Psychiatry in Munich have now documented for the first time that genetic variants of the FKBP5 gene can influence epigenetic alterations in this gene induced by early trauma.

In individuals with a genetic predisposition, trauma causes long-term changes in DNA methylation leading to a lasting dysregulation of the stress hormone system. As a result, those affected find themselves less able to cope with stressful situations throughout their lives, frequently leading to depression, post-traumatic stress disorder or anxiety disorders in adulthood. Doctors and scientists hope these discoveries will yield new treatment strategies tailored to individual patients, as well as increased public awareness of the importance of protecting children from trauma and its consequences.

Many human illnesses arise from the interaction of individual genes and environmental influences. Traumatic events, especially in childhood, constitute high risk factors for the emergence of psychiatric illnesses in later life. However, whether early stress actually leads to a psychiatric disorder depends largely on his or her genetic predisposition.

Research Group Leader Elisabeth Binder of the Max Planck Institute of Psychiatry examined the DNA of almost 2000 Afro-Americans who had been repeatedly and severely traumatised as adults or in childhood. One-third of trauma victims had become ill and was now suffering from post-traumatic stress disorder. The risk of developing post-traumatic stress disorder rose with increasing severity of abuse only in the carriers of a specific genetic variant in the FKBP5 gene. FKPB5 determines how effectively the organism can react to stress, and by this regulates the entire stress hormone system. The scientists hoped to cast light on the mechanisms of this gene-environment interaction by comparing modifications of the DNA sequence of victims who had not become ill with that of those who had.

The Munich-based Max Planck scientists were then able to demonstrate that the genetic FKBP5 variant does make a physiological difference to those affected, also in nerve cells. Extreme stress and the associated high concentrations of stress hormones bring about what is called an epigenetic change. A methyl group is broken off the DNA at this point, causing a marked increase in FKBP5 activity. This lasting epigenetic change is generated primarily through childhood traumatisation. Consequently, no disease-related demethylation of the FKBP5 gene was detected in participants who were traumatised in adulthood only.

Torsten Klengel, a scientist at the Max Planck Institute of Psychiatry, explains the findings of the study as follows: "Depending on genetic predisposition, childhood trauma can leave permanent epigenetic marks on the DNA, further de-repressing FKBP5 transcription. The consequence is a permanent dysregulation of the victim's stress hormone system, which can ultimately lead to psychiatric illness. Decisive for victims of childhood abuse, however, is that the stress-induced epigenetic changes can only occur if their DNA has a specific sequence."

This recent study improves our understanding of psychiatric illnesses which arise from the interaction of environmental and genetic factors. The results will help tailor treatment particularly for patients who were exposed to trauma in early childhood, thereby greatly increasing their risk of illness.

Story Source:

The above story is reprinted from materials provided by Max-Planck-Gesellschaft (2012, December 2). Childhood trauma leaves mark on DNA of some victims: Gene-environment interaction causes lifelong dysregulation of stress hormones. ScienceDaily. Retrieved December 10, 2012, from http://www.sciencedaily.com­ /releases/2012/12/121202164057.htm

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El Huracán Sandy: Como Lidiar con las Secuelas Emocionales

Por Nerina Garcia,-Arcement Ph.D. Traducción por Carla Saad, B.A.

Los desastres naturales, como el Huracán Sandy, nos recuerdan que tan vulnerables somos.  Entre más cercano haya sido la experiencia de uno con el huracán, la reacción que uno sentirá después podrá ser más intensa.  Al sobrevivir un desastre natural como el Huracán Sandy, uno puede sentir estrés, ansiedad, depresión y síntomas del trastorno de estrés postraumático.  Si usted ha sufrido de problemas emocionales en el pasado, el enfrentarse con un evento estresante, como el Huracán Sandy, puede exacerbar éstas condiciones pre-existentes.

Algunas de las reacciones emocionales típicas que uno puede sentir tras vivir un desastre natural incluyen sentimientos de incredulidad, sentirse confundido o indefenso, irritabilidad, tristeza, miedo, dificultad para concentrarse y para tomar decisiones, sentirse preocupado y pensar constantemente acerca de lo que paso durante/después de la tormenta, sentir preocupación por consecuencias negativas que puedan llegar a ocurrir, y sentir que uno está volviendo a vivir los eventos del desastre.  Algunas de las reacciones físicas comunes que uno puede tener incluyen: dificultad para dormir, tener pesadillas, sentirse nervioso y sobresaltarse con facilidad, latidos rápidos del corazón, problemas para respirar, dolor de cabeza y sentirse tembloroso.

Hay varias cosas que usted puede hacer para sentirse mejor si ha notado que está teniendo éstos problemas:

1. No se aísle: Busque apoyo de gente querida, amigos y vecinos que entiendan lo que usted está viviendo. Esto le ayudará a darse cuenta que no está solo, y no es el único que siente éste dolor.
2. Hable con amigos y gente querida acerca de como se siente: El expresar sus preocupaciones, miedos, ansiedades, tristeza, sentimientos de incredulidad y confusión puede ser un proceso curativo y catártico.
3. Limite ver noticieros: Ver las imágenes de destrucción únicamente recuerdan la experiencia traumática y reafirman los sentimientos de miedo y vulnerabilidad.
4. Participe en actividades de recursos de socorro: El ser voluntario y donar su tiempo en esfuerzos de ayuda humanitaria le ayudará a sentir mayor control y sentir que puede causar un impacto positivo. Ayudar a otras personas a sentir menos dolor, le puede ayudar a aliviar su propio dolor.
5. Participe en pasatiempos o en actividades positivas: El participar en actividades que uno disfruta le ayuda a distraerse y en no pensar en su aflicción, y le recordará que aún existe belleza y creatividad en el mundo, y no solamente destrucción.
6. 6.      Manténgase activo: Haga ejercicio, o salga a dar caminatas. Estas actividades le ayudarán a no pensar en sus problemas. El mantener el cuerpo activo le ayuda a liberar hormonas que reducen el estrés.

Si después de intentar éstos consejos usted todavía se siento afligido, considere hablar con un experto en problemas de salud mental o con un consejero espiritual.  El sobrevivir un desastre natural puede tener impactos negativos y duraderos en la manera en que nos sentimos y en la que vemos el mundo.  El enfrentar el dolor emocional lo antes posible reduce las probabilidades de que los síntomas de estrés, ansiedad, depresión y del trastorno de estrés postraumático sean duraderos, y persistan en los años por venir.

Managing and supporting grieving employees

I was quoted in this article discussing the benefits of supporting employees through their grief. By www.hrmonline

Losing a close friend or family member, a child or spouse, is a nightmare for all of us and when it happens to a co-worker or employer then we can struggle to know how to support. While there are policies in place for grievance leave, what do you do when the affect is felt for weeks or months

Licensed therapist Steve Havertz knows from experience the difference between having a supportive manager, and management that seems to view your struggle as a cost to them.

Havertz lost his wife in 2003, but leave constraints meant he had to return to work after just 10 days. Despite the quick turnaround the positive relationship he had with his manager made it easier to manage a return to work.

“I had a great relationship with my boss and she was always asking how I was doing. That made a huge difference. I felt supported and she was understanding and supportive,” he said. “I thought I was an expert on grief and loss until I actually experienced it two times. Now I really am an expert personally and professionally.”

A few years later Havertz’ young daughter was diagnosed with cancer. He worked hard to balance full-time work with her cancer treatments, but while his direct supervisor was supportive he received emails from the “uppers” querying why he needed the leave.

“It left a very bad taste in my mouth,” he said. “Then when Emmalee died [in 2009], my boss has changed and the ‘uppers’ were the same and both not supportive. I was did not dare talk about any of my feelings and even let them know I was struggling.”

With further conflict over the next six to 12 months, Havertz ended up leaving the company. The difference wasn’t in how much leave he got, but in how caring his company was.

“It make all the difference if the EE feels support and is asked how they are doing for months after the loss. Talk to them weekly to see how they are carrying to load of work, emotions, family and personal health. I don't think the amount of time off is the issue, it is the amount of concern felt and support given.”

It’s a sentiment echoed by New York clinical psychologist Nerina Garcia-Arcement, who said supporting employees is economically, as well as morally responsible. Grieving employees often feel emotionally and cognitively impaired and are less productive.

“They will likely not be as productive, as their attention, memory and concentration will be impacted by their emotional response to their loss,” Garcia-Arcement said. “This is a time when employers can show sensitivity and as a by-product gain increased loyalty and appreciation from an employee.

That employee is likely to return to work feeling grateful for the support they received from their employer and "give" back to their employers through increase productivity, Garcia-Arcement added.

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8 Ways Kids Can Give Thanks

Appreciating our blessings and taking time to notice what we are grateful for helps us feel happier and reduces depression. This is a great article about how to instill gratitude in children. These helpful tips are appropriate for all ages, whether children or adults. By nurturing a sense of gratitude from an early age, your children will learn to appreciate big and small blessings.

By Ansley Roan

Teaching kids to be thankful doesn't involve guilt trips or lectures on the less fortunate, and the benefits will last longer than the turkey sandwiches. Grateful children may grow into happier adults, according to Christine Carter, Ph.D., author of Raising Happiness and director of the Greater Good Parents program at the University of California at Berkeley. "Pioneering social scientists think that 40 percent of our happiness comes from intentional, chosen activities throughout the day. Thankfulness is not a fixed trait. It's a skill that can be cultivated, like kicking a soccer ball or speaking French," Dr. Carter says. Because Thanksgiving is high season for gratitude, it's an ideal time to talk to your children about remembering the blessings. Try these easy and interesting tips to teach your children to develop a habit of thankfulness.

Shop, Buy, and Share

Trips to the grocery store, drugstore, or toy store can be opportunities to think of others. Next time you're stocking up, encourage your children to pick one or two canned goods to donate to a Thanksgiving food drive or a food bank. Shelters also need donations of personal care items (soap, toothpaste, diapers) or new clothing (warm socks, jackets). Check with local shelters to see what they need, and have kids choose the supplies. They'll learn to think of others and start to appreciate the necessities they ordinarily take for granted. National toy drives, like Toys for Tots, provide new gifts for children. Ask your kids to imagine what children their age might want, and then help them buy it. The item could be something on their wish list or even something they already have and love, like a cherished teddy bear.

De-clutter and Donate

Encourage your children to donate toys they no longer use or clothes they've outgrown. Let them know that some things they don't need might be useful for another child. Suggest that they consider a short list of items to donate, and then bring them to a drop-off place such as the Salvation Army. Involve them in considering what they don't want anymore so they will have new appreciation for their toys and clothes. Just remember not to force it: If they're not ready to give something away, that's okay. Avoid warning the kids that they won't get something new to replace what they give away; they may associate sacrifice with loss or punishment. Instead, find other ways to cultivate a sense of gratitude and helping others.

Volunteer Your Time

Look for opportunities to volunteer as a family. Friends and neighbors may know of a group that can use the help. Serve food at nearby shelters or put together care packages for senior citizens or soldiers oversees. Show how giving time, not just money or objects, is another way of helping others and acknowledging gratitude for what you already have. Or devote time to neighbors or other family members by scheduling a group project to rake leaves for an elderly relative or cook a meal for someone who's under the weather.

Showcase History

Even young kids draw turkeys or learn about the Pilgrims in classrooms. Ask your child (or the teacher) about the lesson plans and build on those at home. Have little ones imagine what the Pilgrims might have been grateful for that first Thanksgiving in Plymouth. They may have been grateful to be with each other or to be living in a new country. The more advanced the lesson, the more possibilities. Kids can also imagine what the Pilgrims might appreciate in your house today. They might enjoy good food and the time with family, as well as modern conveniences like heat and hot water.

Write Notes of Appreciation

Ask your kids to write a handwritten note to someone they're thankful for; if kids are too young to write, have them a draw picture instead. Ask them to consider who makes their lives better or brighter. Is it the babysitter? A favorite aunt? A family friend who always remembers birthdays? When children reflect on who they want to write to, they learn to value people in their lives who have touched them. No doubt the recipient will appreciate a note from the heart, too. Plus, you can spread the blessings by composing more than one note!

Don't Forget Family

Many parents teach their children to say thank you when they receive a gift, but family members often forget to thank each other for everyday favors. "I think we lack ways to talk about gratitude," Dr. Carter says. "My kids have picked up notions of what romantic love is from Disney movies, but they probably couldn't say a word about how Cinderella feels thankful for all that her fairy godmother has given her. We don't talk much about good things that come from other people's efforts." Set an example by thanking your children and your spouse. Saying "Thank you for cleaning your room" or "Thank you for sharing with your brother," not only lets children know that their efforts (like folding laundry or running errands) are appreciated, it also instills the idea that "thank you" is not reserved for the birthday bonanza. Children see gratitude in action, and it's good for household harmony too.

Appreciate Small Moments

Take time to appreciate the good things with your kids. Use travel time in the car as an opportunity to share something positive, perhaps by saying, "Look at the pretty leaves on that tree" or "Wasn't it fun to make that drawing in class today?" These simple conversation starters encourage children to contemplate and appreciate the blessings around them. When you tuck them into bed, ask what they're grateful for that particular day. Gradually weave these observations and questions into your time together to cultivate thankfulness.

Keep Gratitude Going

Long after the turkey is eaten and football season ends, continue to practice thankfulness throughout the year. In the summer, donate your time when charities and food banks need extra help because regular volunteers are on vacation. One of the most practical ways to inspire gratitude is also the simplest. You don't have to be involved in big projects all the time. Set aside time to name one or two things every person in the family is grateful for each day. "Researchers have found that people who practice gratitude feel considerably happier (25 percent) than those in a control group," Dr. Carter says. "They are more joyful, enthusiastic, interested, and determined. Grateful people are more likely to be both kind and helpful." Raising children with those traits would be enough to make any parent thankful.

Copyright © 2011 Meredith Corporation.

Ansley Roan is a freelance writer and editor in New York City. She writes about faith and spirituality, health, and parenting. Her work has appeared in The Washington Post, Chicago Tribune, Glamour, and Teen People.

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Hurricane Sandy: Coping with the Emotional Aftermath

By Nerina Garcia-Arcement, Ph.D. Natural disasters, such as Hurricane Sandy, remind us of our vulnerability. The closer the impact of the hurricane to you the more intense your reaction can be. Surviving a natural disaster such as Hurricane Sandy can bring about stress, anxiety, depression and post traumatic stress symptoms. If you have experienced emotional distress in the past, then a major stressor such as Hurricane Sandy is likely to exacerbate a pre-existing condition.

Typical emotional reactions include disbelief, feeling confused or helpless, irritability, sadness, fear, difficulty focusing and making decisions, feeling preoccupied and ruminating about what happened during/after the storm, worrying about what future negative things could occur, and re-experiencing events from the disaster. Common physical reactions are sleep problems, nightmares, feeling jumpy and being easily startled, racing heart, trouble breathing, headaches and trembling.

If you notice you are experiencing these problems there are actions you can take to feel better:

1. Do not isolate yourself: Seek out support from loved ones, friends and neighbors that know what you are going through.  This will help you realize you are not alone in your pain.
2. Talk to friends and loved ones about how you are feeling: Expressing your worries, fears, anxieties, sadness, disbelief and confusion can be healing and cathartic.
3. Limit your news watching: Seeing the images of destruction simply reminds you of your traumatic experience and reinforces your feelings of fear and vulnerability.
4. Donate or volunteer your time through relief efforts: This will help you feel more in control and that you can make a difference. Aiding others through their pain helps reduce your own.
5. Engage in hobbies or life affirming activities: Doing things you enjoy will help distract you from your distress and remind you that there is beauty and creativity in the world, not just destruction.
6. Stay Active: Exercise or go outside for walks. These activities will get your mind off of your problems.  Getting your body moving will help release hormones that relieve stress.

If you find you are still distressed after trying these suggestions, consider talking to a mental health professional or a faith based adviser. Surviving a natural disaster can have a lasting negative impact on how you see the world and how you feel. Addressing your emotional pain now can reduce the chances of your stress, anxiety, depression or PTSD symptoms lasting for years into the future.

Naming the Shame that Can Cripple

I was quoted on the causes of shame, how to cope and treatment options. By Marcia G. Yerman

When Amy Ferris asked me to contribute an essay to Dancing at the Shame Prom: Sharing the Stories That Kept Us Small, I wasn't sure that I had any shame. Then, when I thought about it, I realized that I did. I just hadn't framed it that way. I agreed to participate. After I handed in my essay, I heard back from co-editor Hollye Dexter. "I think you are holding back," she said. "Can you go a little deeper?" So I did. Along with twenty-six other women, I wrote openly about issues that had impacted my life.

Now that the book is out, I have taken off my memoirist hat and am writing as health journalist. Reading the stories that encompassed familial alcoholism, sexual abuse, parental suicide, distorted body images, hoarding, alienation, and racial identity anxiety - I wanted to get to the psychological root of how shame shapes who we are and how we live our lives.

I interviewed four practitioners who shared insights that were both clinical and revelatory. We focused on how shame specifically impacts girls and women. Many of their observations and verbiage overlapped. To a person, they all began the conversation by drawing a distinction between shame and guilt.

Shame is a feeling or belief that screams, "I am bad." Guilt is evidenced as, "I did something bad." Shame is feeling worthless. Guilt is external; you can fix it. Specifically, shame is, "I am damaged."

Amber Lewter, EdS., LAPC, whose background includes working as a survivor advocate at a rape crisis center, told me, "When women define themselves as being bad, it creates low self-esteem and a poor sense of self-worth." Treating those who have experienced childhood sexual trauma, Lewter sees women coming in for counseling with a lot of "shoulds" ("I should have told someone.").

She conducts an exploration of shame through expanding awareness of external factors, pointing out that what happened "was beyond the control" of the patient. She believes that shame is more of an issue for women because they are "relationship-centric" and therefore bring childhood shame and a "less than" mindset into their adult relationships.

Ph.D. and Licensed Clinical Psychologist, Nerina Garcia-Arcement, qualifies shame as "an insidious emotion, often at the root of mental health problems like depression and anxiety." She sees shame as creating "a sense of isolation which poisons an individual's self-esteem."

She told me, "My patients feel silenced due to their shame. Often, they can't even speak out loud what they feel ashamed about." Garcia-Arcement defines shame as a reflection of a "core value." Therefore, what results is a need to cover up what we feel ashamed about.

She related, "The power of shame is that it silences us and creates internal negative dialogue, such as, 'I wasn't good enough. I deserved it.' So we want to stay invisible. We don't want to feel vulnerable. This stunts our ability to grow." Garcia-Arcement explained how the fallout of shame translates into a "fear of takings risks."

"A silent killer," is how Lori Freson, Licensed Marriage and Family Therapist, describes shame. Her practice specializes in women's issues and self-esteem.

"Women don't always acknowledge shame as a presenting problem," she said. "Women can have body image problems and not realize it is shame."

She spelled out, "Shame about our bodies can lead to isolation, depression, and eating disorders." Shame about sexual abuse can lead to "avoidance of intimacy, relationships, sexual problems, and self-harm." Shame about an addiction "can delay or sabotage" efforts to recover.

Finally, she added the key observation, "Shame is connected to self-perception and how you think people perceive you."

Founder of the Critical Therapy Center, Silvia M. Dutchevici, spoke at length about how our culture "plays into our perceptions." Her philosophy embraces a holistic approach. "Psychology is not in a vacuum," she emphasized. She referenced the issue of race, class, gender, ideology, and economic status. Her point of view is that "society has issues as well," forcing people to "adapt to a false criteria rather than challenging that criteria."

Dutchevici was crystal clear in her assessment. "For women in particular, depending on the trauma, feelings of shame may arise from our culture's imposition of gender roles and the way women have been socially conditioned regarding their view of themselves. The more a society demands perfectionism," Dutchevici continued, "the more we have shame."

Both Freson and Garcia-Arcement addressed this element as well.

"A lot of shame comes from external societal factors," Freson said. "People want to be accepted. People are afraid of being different. Shame among women and girls is more prevalent because of cultural standards."

Freson pointed to celebrity media and fashion magazines. "People shut shame down because they want to have the perfect image." Her message about shame to young girls is, "You don't have to be perfect. Be your best self."

"The core expectation for women," said Garcia-Arcement, "is that we can do it all. Be beautiful and be everything to everybody." When girls and women buy into cultural norms they "learn to hate their bodies and themselves." It all comes back to not being "good enough." Garcia-Arcement illustrated shame from the ground level of family dynamics, up and outward toward group identification.

"Our family is a reflection of who we are," she said. "So if there is a family behavior [alcoholism, suicide, sexual abuse, domestic violence], it's still a part of us." Treatment by Garcia-Arcement entails the challenges faced by people of color. She identified that if a person from a minority community does something that the rest of the group is not proud of - it is seen as a "personal reflection on who they are."

In tandem, Dutchevici - a political refugee from Romania - touched on the use of shame as a tool of control in promoting a specific ideology. Shame also operates by keeping group memberships and affiliations intact.

So what can be done? All four women I spoke with communicated the need to explore an individual's experience through expanding consciousness.

Lewter articulated about introducing an awareness of "external factors." Freson, who maintains that if "shame is not exposed and dealt with it can destroy your relationships and your life," believes the more exposure the topic gets the more taboos are broken down.

Applauding the premise of the book, Freson sees it functioning as a tool for dialogue while enabling readers to discover, "Oh. It's not just me. I'm not the only one."

Dutchevici agreed. "The more people come out and talk about shame, the less power it has." She reiterated that it was important to "name the emotion."

"The first step is to realize that you are not alone," Garcia-Arcement reiterated. She uses a combination of talk therapy, cognitive behavior therapy, and insight-oriented work. She suggested mindfulness exercises, trying to connect the mind and body, sitting with your feelings, and being in the moment. Garcia-Arcement stressed the power of stories, advising the importance of sharing one's story.

"Empathy is essential to healing. If you can't say it out loud yet, write it down. Excise it from yourself. Writing is a useful tool, as there is no witness to the shame." An important element of eventually sharing the narrative is that it helps individuals "normalize their experience," through a realization that they are not alone and not to blame.

(The Shame Prom has a Tumblr blog where anyone can post a shame narrative, either with her name or anonymously).

Garcia-Arcement said definitively, "Everyone has shame. We just don't want to look at it."

In her essay, Elizabeth Geitz wrote, "I've learned letting go of shame is one of the most freeing things I've ever done. I've learned that I don't have to dance at the Shame Prom forever. The dress, the shoes, the long-wilted corsage are now gone.

"The music has finally stopped."

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Maternal Depression Can Impact Children's Health

Maternal depression is a topic that is difficult to discuss out loud. Mothers often feel shame as they struggle to cope with the demands of motherhood.  In this article I am quoted on the impact depression has on mothers and their children. I share helpful coping strategies and treatment options.

By Rheyanne Weaver HERWriter September 20, 2012 - 7:25am

Maternal depression is not only an ongoing struggle for mothers, but research suggests children of depressed mothers can be impacted in multiple ways.

For example, a recent study published in the Journal of Affective Disorders noted that mothers who are depressed have a reduced responsiveness toward infant distress, which can lead to harmful effects on the child.

However, the small pilot study stated that women who received cognitive behavioral therapy treatment had a reduction in their depression and as a result, were also more responsive toward infant distress.

Another study published in the journal Pediatrics found that children ages 4 and 5 were more likely to be short for their age if their mothers were depressed starting around nine months after the child was born.

An article about the study on Medpage Today stated that children of depressed mothers could have an “increased stress response,” which could lead to higher cortisol levels and lower levels of growth hormones. This could lead to a shorter height.

Mothers with depression might practice “poor parenting behaviors and feeding practices” as well, and children might form an insecure attachment with depressed mothers.

The article added that stunted growth at a young age is associated with various negative outcomes, such as poor development, reduced scholastic performance, smaller body size as an adult, and higher levels of death.

Nerina Garcia-Arcement, a licensed clinical psychologist, said in an email that there are many negative health outcomes for children of depressed mothers. For example, children of depressed mothers tend to visit the emergency room more often, and they might even develop depression in their teens.

“A depressed mother often is less responsive to their child's needs (i.e., when distressed, hungry) and does not have the emotional and physical energy to play and cuddle with their child,” Garcia-Arcement said.

“This can be disruptive to forming a secure and healthy emotional bond with each other. When a child does not feel safe and secure they can go on to become isolated, have difficulties making friends and develop anxiety and depression.”

Mothers suffering from depression need to make treatment a priority for their own health as well as their children’s.

“A parent is modeling for a child how to cope with challenges,” Garcia-Arcement said.

“The best example a mother could set for her child is that when you don't feel well, you don't ignore it. Instead you prioritize your well-being and you seek out help. Things they can do includes speaking to a mental health professional, reaching out to friends and family for social support, attending mom groups in person or participating online.”

She suggested that mothers make a point of getting out of the house every day for 15 minutes minimum. It is best to exercise, but mothers can even take their children for a walk or saunter in the neighborhood or at the mall with their babies in a stroller.

“Mothers should ask for child care assistance from their partner, family or friends in order to have time to do things alone,” Garcia-Arcement said.

“Moms need time [to] rest and catch up on sleep (sleep deprivation makes depression worse). They must do something kind for themselves, such as taking a hot bath, reading a book, getting a massage, engaging in a neglected hobby, and watching a comedy that will make them laugh. Reach out and meet up with a supportive friend.”

She also suggested spending bonding time with children for at least 10 minutes a day, which can lead to a greater connection, and children can also feel more safe and secure.

Ramani Durvasula, a psychology professor at California State University, said in an email that since mothers tend to be primary caregivers, children can suffer in many aspects of life if their mothers are depressed.

For example, children might not receive the nutrition they need and might have reduced sleep. They could also develop anxiety, depression and social withdrawal.

Mothers need to eat healthy, sleep and exercise consistently. Especially for women who have a history of depression, it’s important to make a plan for increased support once the baby comes.

“Many mothers try to be superwoman/supermom - and maternal depression is not part of that plan,” Durvasula said.

“Lots of times people write it off to fatigue and stress, and untreated depression can get worse and worse. Depression is a treatable disorder, and when there are children involved it is critical that it be managed to ensure the health of mother and children.”

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Organizing Your Life

I was recently on the Colin Lively Show, discussing how to declutter your mind.  The entire show was filled with helpful tips on how to better organize your home, office and mind. The description for the show is below:

Oh lord, if this show wasn’t sent from on-high, than it was Hildamae’s dying wish coming true: get Colin to clean his room! So, there it is, the cat is out of my Birkin bag: I can be rather messy. But aren’t we all? Whether it be in mind, life, schedule, desk, purse, closet, or your inbox, somewhere you are a little messy; and a little messy can lead to a great deal of stress. It is, as Dawn Falcone put it, “stuck energy.” For me, Consuelo un-sticks my stuck energy four times a week, but that doesn’t cover all my bases: I still need to go to Dr. Feldheim, my therapist, and Dr. Koplowitz, my psychiatrist, to get my mind in order.

I was stunned to learn that our outer world is very much a reflection of our inner world. For instance, a messy desk can be a sign of a stressful work environment or chronic work overload. It is important to create systems that keep our lives orderly and neat. We do not need to be neat freaks, but organization is one of the keys to happiness. Growing up, we polished the silver under the iron fist of Hildamae, she said the harder we scrubbed the more we would feel her love. Boy was she right! Three hours of polishing spoons made my wrist feel so loved that they were practically stuck in an arthritic state until my mid-40s. “Sheets tight enough on which to bounce a quarter,” she would demand. By the time I went to college, I had had enough Old Dutch Cleanser, Clorox and Bon-Ami running through my blood that I vowed never to clean again. And I have not touched a mop since!

This week I will be speaking with three personal organizers and a psychologist, and we are going see how we can change our state of mind with a Swiffer, or two, or forty-seven.

This week I will be speaking with three personal organizers and a psychologist, and we are going see how we can change our state of mind with a Swiffer, or two, or forty-seven.

Dawn Falcone is not only passionate about organization, she knows it has a HUGE impact on personal sanity, success, and overall stress level. She emphasizes the point that reducing clutter and chaos will ultimately bring reward in the form of clarity, serenity, and time. She works closely with her clients to design spaces that reflect their personality and spirit. Dawn is a proud member of the (National Association of Professional Organizers) and is a certified interior environmental coach. Her work has appeared in many publications including: Real Simple, Woman’s World, Home And Garden Television, and Apartment Therapy.

Bonnie Joy Dewkett is the founder of The Joyful Organizer and is an organizing expert, author, motivational speaker, and radio personality – oh and she is an expert in time management! Boy oh boy does she know how to block-out a day!

Andrea Brundage of Simple Organized Solutions (S.O.S.) offers personalized hands-on organizational solutions to help small-to-medium sized business owners and homeowners function in efficient and organized environments. In partnership with its clients, S.O.S. creates “sensible solutions for your organizational needs.”

Dr. Nerina Garcia-Arcement is a licensed Clinical Psychologist and a Clinical Assistant Professor, in the Dept. of Psychiatry, at NYU School of Medicine. She specializes in challenges associated with life transitions, stress, anxiety, and depression.She provides a holistic therapeutic session by using a combination of Cognitive Behavioral Therapy and insight oriented/psychodynamic techniques to identify current problems, develop individualized strategies to ease stress, and gain insight into understanding one’s patterns in behavior. Dr. Garcia strongly advocates the act of self exploration, which helps us understand the way we think and act, it will also help shed light on our behaviors that worked in the past but are not effective any longer.

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Organizing Your Life

Mental Health Issues to Be Aware of in Your 20s

I was quoted in this article regarding typical mental health issues for people in their 20s. I discuss the impact of stressful transitions and how to cope. by Rheyanne Weaver |

People in their 20s seem to have it all: youth, energy, health, and looks. But they are also still figuring themselves out, and this time of change can bring certain mental health concerns as well. Experts have information on these issues that tend to impact people in their 20s, and provide some solutions for addressing and coping with these problems.

Clinical psychologist Dean Haddock, a marriage, family, and child counselor and the executive director and founder of Community Counseling and Psychological Services, points to a fairly common activity of 20-somethings that can lead to mental health issues if it’s not checked: alcohol and drug use.

“The first problem that leads to many others is alcohol and chemical abuse, which often leads to dependency,” Haddock said in an email. “The mental disorders that follow are often depression, anxiety, and brain injury. Of course, self-esteem and body-image problems often lead to eating disorders.”

Haddock gives three tips to help people in their 20s prevent and get through some common mental health concerns:

1. Know your genetic history of mental disorders. Knowing is half the battle to avoid those disorders in yourself.
2. Be choosey about your friends, as they will influence your decisions. Healthy friends lead to healthier decisions.
3. Self-esteem is often the result of the people who matter to you. If they do not esteem you, then you will not esteem yourself.

Nerina Garcia-Arcement, a clinical psychologist and clinical assistant professor at NYU School of Medicine, suggests that the many life changes people experience in their 20s can cause mental health issues at times.

“Your 20s are filled with life transitions that can be stressful,” Garcia-Arcement said. “This is a time when young adults are solidifying their personalities, developing their independence from family, starting or finishing college, beginning new jobs, developing a career, forming romantic relationships, and learning to manage their existing family relationships and friendships within these context.”

“Individuals in their 20s don’t have a lifetime of experience to draw on when managing multiple life transitions at once,” she added. “When someone experiences these transitions, anxiety and depressive disorders can occur.”

Here are six of Garcia-Arcement’s tips to help people in their 20s cope with mental health issues more common to that age group:

1. Seek out and form strong support networks.
2. Seek out others who are going through similar experiences and share your feelings, whether you are feeling worried, nervous, scared, sad, confused, or excited.
3. Know that you are not alone in your confusion about your career and relationships.
4. Seek out mentors who have achieved their goals, and ask for advice.
5. If you are feeling stress, sadness, or anxiety, engage in activities that will help you manage those feelings such as yoga, meditation, exercise, hobbies, social activities, relaxation exercises, and deep breathing.
6. If you feel you are not getting the necessary support and feel overwhelmed or depressed, seek out mental health professionals who can help you manage the feelings related to your life transitions.

Stephanie Sarkis, a licensed mental health counselor, said in an email that anxiety and depression are some of the main mental health issues 20-somethings face.

“We have seen an increase in these issues due to the lagging economy and difficulties finding employment,” Sarkis said. “Many people in their 20s have moved back in with their parents, which can trigger feelings of failure and frustration.”

Dr. Maiysha Clairborne, a family physician and wellness and stress management coach, added in an email that eating disorders associated with body dysmorphic disorder and body-image issues are also common for people in their 20s. She has three overall tips for people in this age group:

1. Talk to someone. The worst thing that a person can do when they are feeling depressed, anxious, or alone is to isolate more. Many times when we talk with someone we trust about what’s going on, we come to realize that we are not the only ones experiencing it and then we can get support.
2. Get active. Staying physically active not only helps to keep the body fit but also helps release endorphins and serotonin in the brain, which help keep the mood elevated. Physical activity is also a good release for stress and anxiety.
3. Minimize sugar and junk food. Sugar and processed junk foods can worsen the emotions of stress, anxiety, and depression because they cause erratic changes in your body’s blood sugars. This can disrupt the normal release of hormones in the brain that keep your moods stable.

Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said there are many issues specific to people in their 20s, including problems associated with medication use.

“Many people were on stimulants/meds for their ADHD when they were younger, but they thought it was okay to stop their meds when they were done with school,” Carroll said. “Now they are struggling at work and don’t know why. I’ve also seen young adults stop all kinds of meds like their thyroid meds because they didn’t know why they were even on it, and then they have all kinds of problems.”

Bad habits involving drug and alcohol use can start to become a major substance abuse issue when people are in their 20s, and other mental health issues start coming to the forefront at this time in peoples’ lives. Examples include bipolar disorder and schizophrenia. Also, panic attacks can start for people who have a genetic predisposition and who have higher amounts of stress associated with newfound adulthood.

“The 20s are an important time of social/emotional development,” Carroll said. “Unlike previous generations, identity formation often takes the entire 20s due to the complexity of modern society. It could be said that adolescence lasts until the early 30s in today’s society due to [prolonged] periods of education (grad school, law school, med school, etc.), lack of stable job options, and delays in getting married and starting families.”

Carroll, who is also an assistant professor at the University of New Mexico School of Medicine, suggests that when it comes to serious relationships and marriage, people in their 20s should consider how their choices could eventually affect their mental health and how their brain plays a part in their decision.

“Many 20-somethings are tempted to get married, but it is generally a bad idea because the brain in not done developing until about 25 [years old] … which leaves young adults vulnerable to having their rational mind be overwhelmed by their feelings or stress,” Carroll said. “Relationship choices often dramatically change from the early 20s to the late 20s, so many people find that the person that was perfect at 22 is a disaster at 27.  This can be an incredibly hard transition, to have to break up with your former soul mate that you thought you’d love for life because you’ve changed so much over the last several years.”

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Domestic violence and mental health: How are they intertwined?

Domestic violence leads to complicated emotional reactions. In this article I share information that sheds light on typical reactions to trauma and why it is difficult for the abused to leave.

By Rheyanne Weaver |

The United States still has a lot of work to do in regard to addressing the prevalence of domestic violence.

In fact, an in-depth story from the Arizona Republic has pointed to the fact that in the last several years, the number of deaths from domestic violence has stayed fairly consistent in Arizona.

While this means there hasn’t really been an increase in deaths, there certainly hasn’t been a decrease either.

Fortunately, researchers are seeking more information about domestic violence and specifically about domestic violence that ends in death. Not surprisingly, much of the research has a mental health aspect.

For example, the article mentioned how substance abuse, depression and estrangement are just some of many risk factors that could increase a battered woman’s chance of eventually being killed by her partner.

Later, the article explained that generally before a battered woman’s life ends at the hands of her partner, there are warning signs. For example, the partner usually engages in a specific kind of abusive behavior called “intimate partner terrorism” or “coercive control.”

“Coercive control is almost exclusively the domain of men,” according to the article. “It is long-term and tyrannical abuse that includes, often in addition to physical violence, attacks on a woman's self-worth, degrading remarks and obsessive monitoring of her whereabouts and her contact with other people.”

The abuser often has mental health issues like depression or substance abuse, and struggles with obsessive and possessive behavior. In some cases, abusers cope with massive self-shame by severely abusing or killing their partners.

Mental health experts have more insight into how domestic violence can impact mental health, and what issues sometimes predispose people to being in relationships that involve domestic violence.

Nerina Garcia-Arcement, a licensed clinical psychology and a clinical assistant professor at the NYU School of Medicine, said in an email that there is a gradual process that leads from “normal” relationships to relationships involving domestic violence.

“Women don't enter violent relationships where they are being hit from day one,” Garcia-Arcement said. “They date men that pay attention to them, are possessive and slowly begin to limit their behavior and social interactions (i.e., the woman can't talk to friends or family as much or at all, or she can't wear certain things). Often this controlling behavior is couched as ‘loving them.’"

Then comes the act of lowering the victim's self-esteem.

“Once they are socially isolated, they (abusers) begin to erode their self-esteem by insulting them or calling them names, telling them that no one else would want them, etc.,” Garcia-Arcement said. “Once the (victim’s) self esteem is fragile, they often begin the physical abuse.”

“This is why women don't just leave,” she added. “By the time they are being hit, they are socially isolated, feel stupid and undesirable, doubt their self-worth and fear the consequences of leaving. If they are not staying out of fear, they are staying because they have come to believe they deserve this treatment, that they are at fault for being hit, for ‘being stupid/saying the wrong thing,’ etc."

Women in abusive relationships tend to suffer from mental health issues like anxiety, depression and post-traumatic stress disorder as a result, she said.

“Many women who are in abusive relationships grew up in households where they witnessed abuse,” Garcia-Arcement said. “This normalizes it. Confuses love and violence. This is a pattern that is familiar. For other women (who) don't grow up in abusive households, the typical cycle of abuse prepares them. Their self-esteem gets eroded until the abuse makes sense.”

David M. Reiss, a psychiatrist and previous interim medical director for Providence Behavioral Health Hospital, just spoke at the 35th annual convention of the International Psychohistorical Association about child abuse and trauma, and their impact on individuals, communities and society. He said in an email that relationships with domestic violence are characterized by dysfunction and pathology.

“No relationship can maintain appropriate intimacy and trust if there is violence occurring,” Reiss said.

Some women also try to rationalize that it’s better for the children if they stay with their abusive partner.

“Staying ‘for the children’ is misguided, as children need role models who do not let themselves be abused,” Reiss added.

Freda Emmons, the author of “Flame of Healing: A Daily Journey of Healing From Abuse and Trauma,” said in an email that she grew up with abuse throughout her childhood.

Her mother was a victim of abuse by her father, and the mother also contributed to some child abuse along with the father.

“I asked her once why she stayed and she said it was because of us kids; she didn't believe that she could provide for us,” Emmons said. “I told her it would have been better to get assistance or whatever she could do to spare us the horrible years of pain.”

However, Emmons’ mother couldn’t take care of herself and was suffering from issues that are associated with abuse victims, so she was unable to protect her children from their father or herself.

“I think some women have been so battered, physically and emotionally, that they have lost their sense of personal value,” Emmons said. “They think that they are the cause of the problem, that if they would just be a better wife, mother, spouse, cook, cleaner, etc. that the abuse would stop. It never does.”

She hopes her book can help others find a way out of the despair she experienced.

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How Are Diabetes And Mental Health Connected?

I am quoted in a discussion of how Diabetes impact mental health and ways to cope. By Rheyanne Weaver |

Diabetes is a growing health condition that affects 25.8 million people of all ages in the United States, according to 2010 statistics from the Centers for Disease Control and Prevention website.

These most recent statistics also state that 8.3 percent of the U.S. population has diabetes. While the number of people with diabetes increases, there are not only concerns for how diabetes impacts physical health but also mental health.

The American Diabetes Association website suggests that some people living with diabetes can experience some mental health issues due to having diabetes. These can include anger toward having a diagnosis in the first place, denial toward the diagnosis, and in more severe cases depression can result.

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Living with diabetes can be stressful as well, according to the American Psychological Association website. For example, people with diabetes might stress over their eating options at restaurants, so it’s important to develop coping methods for stress and to make sure to plan ahead for some situation.

People with diabetes can also learn to recognize negative feelings they have toward diabetes, and then learn how they can treat their diabetes. Mental health professionals can help people with diabetes develop intervention and treatment plans, and they can help with coping strategies.

The American Psychological Association website also stated that according to different studies, diabetes can lead to mental health issues like depression and slow mental processing. People with depression may also in general be more prone to type 2 diabetes.

The website emphasizes that a very small percentage of people who are diagnosed with diabetes actually follow a treatment plan involving changes in diet, exercise and taking medication, suggesting that people with diabetes are having issues with lifestyle changes.

Another study found that people who did work with a mental health professional on behavior change along with making lifestyle changes decreased their chances of getting diabetes.

Some experts share even more information about the link between diabetes and mental health.

Sujatha Ramakrishna, a clinical psychiatrist, said in an email that people with mental illnesses can be more prone to diabetes and other health problems because they are more likely to make unhealthy choices related to overall health, such as poor eating and exercise habits.

People with mental illnesses who take medication can also unknowingly increase their risk of getting diabetes.

“Antipsychotic medications, also known as mood stabilizers, are associated with an increased risk of diabetes,” Ramakrishna said. “It's recommended that patients who take these medications have their weight and blood sugar levels checked regularly by their physician. Other psychotropic medications, including SSRIs such as Prozac, can also cause weight gain, which in turn increases the chance that patients might develop diabetes.”

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Nerina Garcia-Arcement, a licensed clinical psychologist and a clinical assistant professor at the NYU School of Medicine, said in an email that there are many mental health issues to consider that are connected to diabetes.

“If someone has diabetes, this impacts and limits their physical abilities and diet,” Garcia-Arcement said. “This often leads to people experiencing sadness, anxiety, frustration and loss. If there are [amputations] due to complications from the diabetes, this often negatively impacts mental health.”

There are also many contributing factors related to diabetes that can lead to depression.

“The stress related to managing a chronic illness, plus fear/worry about a negative prognosis are excellent causes for depression,” Garcia-Arcement added.

Taking diabetes medication can lead to mental health issues indirectly, in addition to psychiatric medication leading to diabetes in some cases.

“Having to monitor sugar levels and take insulin is stressful, limiting of everyday activities and can lead to worry, stress, anxiety and sadness,” Garcia-Arcement said.

In general, especially if you have a mental illness, it’s beneficial to talk to a mental health professional so they can help with motivation, behavior changes and understanding the link between mood and health so you can maintain good health, she said.

“Research has shown that people with mental illness have shorter life spans, often because they neglect their health,” Garcia-Arcement said.

“For example, if you are depressed, you are less motivated to engage in pleasurable activities, get out and socialize, eat healthy ... and exercise. Many don't take their medication as prescribed, often forget doctor’s appointments, or don't have the motivation to make appointments and keep them. This in turn worsens their diabetes. As they get sicker, they often get more anxious and depressed.”

Elizabeth Mwanga, who was diagnosed in 2007 with type 1.5 diabetes (latent autoimmune diabetes), used to be morbidly obese and was close to death due to her diabetes. However, she made major changes in her eating and fitness routines, and since 2009 she hasn’t needed to take medication for diabetes and has even kept off the 100 pounds that she lost.

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She definitely sees a connection between mental health and diabetes, especially because many diabetics have high and low blood sugar levels that tend to affect mood.

“Blood sugar lows and highs can cause mood swings, which can be very disruptive,” Mwanga said in an email.

She said low blood sugar levels can lead to anger and minimal energy, and sometimes hallucinations and delirium. With high blood sugar levels, depression and mood swings can be a result.

“Diabetes requires 24/7 self-care management,” Mwanga said. “Sometimes this can be frustrating, overwhelming and depressing.”

“Food and fitness is linked to better physical health and diabetes management, which in turn effects mental health,” Mwanga added.

“I find myself feeling a lot more energetic and happier when I eat a diet full of fresh fruit and vegetables. I have also begun doing research on foods that raise serotonin levels. For example, I drink green tea (for the energy boost/antioxidants) during the day, and chamomile at night (for the calming effect, also full of antioxidants and anti-inflammatory properties). I eat whole raw almonds a lot, and lean turkey.

All of these foods are low GI ([low] glycemic foods are best for diabetics) and studies have shown that all aid to the process of serotonin.”

There is never a better time to make health your priority. Proper exercise, healthy diet and sleep routines are all key to the best overall health, and at least paying special attention to these areas of life will most likely decrease your risk of developing diabetes, other physical and mental health issues.

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