WRCH - Dr. Elaine Ducharme's Blog

Posted: Thursday, 25 February 2010 10:07AM

Dr. Elaine Ducharme's Blog

Dr. Ducharme’s Blog June 30, 2008

Feeding your Child

Parents are often concerned about what their children, especially their toddlers, eat. I frequently hear parents worried that their young child has relatively limited foods they will tolerate. This is not unusual for young children. However, parents often engage in behaviors that make the situation worse. Worried that their child will starve or be poorly nourished, they begin offering the child a variety of foods at every meal and snacks throughout the day… ”so they won’t starve!” I have had parents tell me that they routinely make their children their favorite sandwich at 11 or 12 o’clock at night because they are such picky eaters. Honestly, unless we have a child with an eating disorder, kids rarely will starve themselves. However, they will try to push you to give them what they like best, just as they push you to buy them their favorite toy or let them stay up late at night. But research is very clear that when children are offered a variety of healthy foods without the option of lots of junk, they will choose a balanced diet. Our bodies really do know what they need. Need and want are very different. So often meal time becomes a battle ground for kids and parents. How often have you said to your child: “eat three more bites and then you can have dessert”? Do you feel like a short order cook? Or do you tell your child he must sit at the table until his plate is clean? Do any of you have memories of sitting at the table for hours until you managed to gag down whatever your parents felt you should be eating? How would you feel today if someone told you to clean your plate and you hated what was on it? Kids are no different. If you set up a power struggle over food when they are young, you may be setting the stage for a full blown eating disorder later on. Or, power struggles may emerge elsewhere. Young children are trying to learn about control. And two things they ultimately control for themselves are what goes in and what comes out. Here are a few ideas to help you and your child enjoy meal times.

1. Provide a balanced diet with a variety of fruits, vegetables and whole grains and dairy products.

2. Try to eat as a family every night. This is not always possible if one or both parents get home from work very late. But kids can be given their meal at an earlier time and then have their dessert with you or even just sit with you for some family “talking time”.

3. Kids generally will eat whatever they need in 20 minutes. The problem of kids getting out of their seats and wandering around the house generally disappears if they know their food will be gone after 20 minutes. For toddlers who don’t want to sit in their seat it is often helpful to set a timer. Do not leave their plates lying around in case they are hungry a little later. When kids are really hungry they eat, just as adults will do.

4. If they do not eat much at one meal, don’t worry. They will eat at the next one. Or they may go for a few days and seem to eat very little. But, if they have not been filled with lots of junk food, they will be far more likely to eat the healthy foods offered when they are hungry. We just don’t see eating disorders in places where there is not enough food to eat. Many young kids do better on 5 or 6 small meals throughout the day. But walking around with juice, cereal or other snacks all day is really unhealthy. Of course they won’t eat at mealtime if they have snacked all day long. Kids that are demanding snacks all day long are rarely hungry. They are often bored, overtired, lonesome or looking for attention. Try distracting them with a fun activity. When they are busy, the demands for snacks generally decrease dramatically.

5. In this hot summer weather, be sure your child drinks plenty of liquid. This does not, however, mean lots of fruit juice. Encourage your child to drink water. Many young children like having a special water bottle. They may be more likely to drink water out of a Spider Man or Dora bottle, especially if they see you carrying around your own water bottle. If you let your toddler drink from a regular water bottle, please be careful of the cap. Many young kids try to put them in their mouths…a definite choking hazard.

6. Set a good example by eating well yourself.

7. If you have concerns about your child’s nutritional health check with your pediatrician who can assess your child’s particular needs.

8. Consulting with a psychologist or other qualified mental health professional can often help to eliminate mealtime stress and leave you and your child with positive and healthy feelings and attitudes about food.

Summertime Challenges
6/23/08

Summer is here and schools are letting out. Children, so happy to be free are shouting with joy. Parents, on the other hand, may just find themselves shouting. Holidays and vacations bring special challenges to families, especially when parents must still go to work. Keeping your cool during these times can be difficult. Some simple tips can help you enjoy the summer vacation.

1. Try to maintain some structure. While many parents are relieved to be done with carpools for all their kids formal activities (sports, Brownies, Boy Scouts etc.) too many parties, company and late night activities can leave children overtired, cranky and even sick.

2. Have some flexibility…an occasional late night won’t hurt anyone. Try to plan quiet time or a nap before or the day after a late night.

3. Keep a sense of humor. This is the # 1 rule for parents in most situations.

4. Consider summer camp for your child. Day camps, privately operated or run by your town are great for younger children. Camp gives children wonderful opportunities to try new activities, make new friends and develop new coping skills. It also encourages children to problem solve on their own and utilize other adults (besides you) to help them with difficult situations. I remember thinking how lucky I was to be able to go to overnight camp every summer. While I still know this is true, it was only after I became a parent that I realized what a great break my parents were also getting,

5. Time outs can be for parents too. Make sure your children are safe, trade off with a neighbor or put toddlers in their cribs and you take your own time out. 15-30 minutes of peace and quiet can really help you keep your cool. It is also a great way to role model “stress management” for your kids.

6. 6. Be creative. With the cost of gas so high, many families can’t afford to take vacations or drive long distances every day to entertain the kids. Remember that most kids love to bake, paint, do crafts, have lemonade stands and play games. Let the kids wash your car. Don’t worry how clean the car actually gets. Give the kids hoses, sponges and soap and you can sit back with a cool drink while your kids play in the water. You will probably all be wet. But, really, you will dry off. Think about building a fort, either inside (blankets over a card table are just fine) or out and let the kids have snacks or read stories in the fort. Take advantage of your town parks, pools and libraries. Many of the town libraries offer free passes to families to a variety of attractions around the state. These really help to make day trips more affordable.

7. When possible, see if grandparents would like to have the children for a few days or weeks. Our grandchildren look forward to “Grandma Camp” every summer. Their parents stay home and they get to spend special time with grandparents, Aunts and Uncles

8. Most of all, enjoy the time you have with your children. They grow up so fast. Take lots of pictures and let the kids make an album of their summer vacation. You will all enjoy “remembering” these moments over the years.

Dr. Elaine Ducharme blog 6/12/08

Parenting: High Expectations, Dads and Stress

I sent this article to Allan last year and he put it up on his first blog. Since then the world has become even more stressful for most of us. So, I thought it might be helpful to put this information on my blog before Father’s Day to remind Dad’s to take care of themselves.

Parenting is difficult in today’s fast-paced and demanding world, and it can take a toll on one’s physical and emotional well-being. With equal sharing of parenting duties increasingly becoming the norm, many men (as well as women) are experiencing the pressure of being both a breadwinner and an active care giver. Father’s Day is right around the corner—it is important to recognize the challenges dads face and figure out how dads can deal with the resulting stress.

According to a 2006 APA survey, forty-three percent of men are concerned about stress. Balancing both work and family life can leave many men feeling as if they’re drowning in a sea of work, bills, and the responsibilities of being a father. “Men in particular respond to stress by feeling irritable, angry, and having trouble sleeping,” says psychologist Ron Palomares, Ph.D. “This stress is, unfortunately, often dealt with in unhealthy ways, such as by smoking, drinking, and overeating.”

Moreover, since fathers and mothers serve as role models for children, it is important to set a good example. “Children mold their behavior after that of their parents,” says Palomares. “Thus, developing healthy responses to stress will be good for you, and, ultimately, good for your children.”

APA offers these few strategies to help fathers manage stress:

• Identify — How do you know when you are stressed? What events or situations trigger stressful feelings? Are they related to your children, family health, financial decisions, work, relationships, or something else?

• Recognize — Determine if you are using unhealthy behaviors to cope with work or life stress. Are you a restless sleeper or do you become easily upset and annoyed over trivial things? Is this a routine behavior, or is it specific to certain events or situations?

• Manage — Unhealthy reactions to stress are like taking the easy way out: consider healthy, stress-reducing activities like exercising or playing sports. Focus on the quality of time spent, not the quantity. Keep in mind that unhealthy behaviors develop over time and can be difficult to change. Put everything in perspective, think before you act or speak, and make time for what’s really important.

• Support — Accepting help from supportive friends and family can improve your ability to persevere during stressful times. If you continue to feel overwhelmed by stress, you may want to talk to a psychologist who can help you manage stress and change entrenched, unproductive behaviors.

“No one expects you to be the perfect father. It is essential to maintain balance among what is “Superdad” fantasy and what are realistic and attainable aspects of fatherhood,” Palomares asserts. “Stress management is not a race to the finish line—don’t take on more than you can handle. Instead, set goals and focus on changing one behavior at a time.”

Documents from apahelpcenter.org may be reprinted in their entirety with credit given to the American Psychological Association. Any exceptions to this, including requests to excerpt or paraphrase documents from apahelpcenter.org, must be presented in writing to helping@apa.org and will be considered on a case-by-case basis. Permission for exceptions will be given on a one-time-only basis and must be sought for each additional use of the document.

Summertime Challenges

2. Have some flexibility…an occasional late night won’t hurt anyone. Try to plan quiet time or a nap before or the day after a late night.

3. Keep a sense of humor. This is the # 1 rule for parents in most situations.

Blog June 2, 2008

I spent this past Saturday working at the Glastonbury Wellness Fair. It was a great event and very well attended. There were so many opportunities to learn about living a healthier lifestyle. They even had cooking demonstrations, massages, oxygen therapy, ballroom dancing, music and had a room set up for people to play Wii. My job was to man the booth for the Connecticut Psychological Association. Several of my colleagues and I had a wonderful opportunity to give out literature, do screenings for depression and anxiety and talk to over 100 individuals about mental health issues. People really seemed to welcome the opportunity to chat about stress management techniques, experiences with depression and anxiety and mental health issues, in general. There were a few very interesting issues that came to our attention. A number of individuals, over 55 said how excited they were to see mental health issues being addressed so openly. They eagerly took literature and said they wished this information had been available to them as they struggled with depression and anxiety. Sometimes we forget that so many people suffered for so long, afraid to talk about their feelings and therefore unable to get treatment. The reality is, some people are still afraid to ask for help. Several people refused to take the screening test stating that they were “afraid to find out” or that they already knew what the results would be. But they all took information and were receptive to reviewing information on becoming more resilient. It is so important that people understand that anxiety, depression and most other forms of mental illness generally respond extremely well to treatment. Sometimes talk therapy is enough. Sometimes a combination of psychotherapy and medication works best. It is important that a client feel comfortable with their therapist. If someone feels unsafe, unheard or put down in therapy, it is critical that they raise this issue in treatment. A good therapist should be willing to discuss any of these issues and work to help you understand what is going on. Most of the time, these issues get resolved. Occasionally both patient and therapist decide a second opinion or change in therapist is a good idea. And sometimes, the client should find another therapist with whom they feel better connected. One women at the fair said her therapist regularly chided her because she had no insurance and was on a sliding scale fee. He told her to please get insurance so he could make some money on her. Several years ago, a patient of mine told me her previous therapist often fell asleep during sessions. She felt badly for the therapist, assuming she must be working very hard, so she kept going back. Clearly, these are the exceptions. And if you are already experiencing low self-esteem, it may be hard to stand up for yourself. When we are in emotional pain, we often don’t feel strong enough or worthy enough to stand up for ourselves. But, please try. There are so many wonderful psychologists and other psychotherapists available.

Another issue that was brought up is one I hear about often. A woman told me a close family member had died about one year ago. She also had several other stressors that she was dealing with and felt she just couldn’t get over this loss. Her friends were telling her it was time to move on…let it go. After all, it had been over a year. It is important to know that grief, particularly after the death of a loved one or even a divorce, can take up to three years to resolve. We don’t spend every day crying hysterically. But even very healthy, well adjusted individuals will continue to have rough days. They may find themselves crying while driving alone in their car or feeling particularly lonely during the holidays. The problem is, your friends may get tired of talking about the loss after awhile. And, frankly, it is better for you to try to have fun and enjoy time out with your friends. But, if you find the feelings of sadness and loss overwhelming, it is probably a good idea to seek out professional help. A psychologist can help determine if what you are experiencing is part of the normal grief process or a more serious delayed grief reaction. Sometimes just knowing that your on and off feelings of sadness are normal is enough to help you cope and feel better.

We still have a ways to go helping some people to feel comfortable discussing mental health issues. But we have certainly come a long way. For more information on a variety of mental health topics, please go to www.apahelpcenter.org .

Blog May 26, 2008

Memorial Day week-end. I am sitting at my computer thinking about what I should write for this week’s blog. The windows are open and I can smell the wonderful aromas of my herb garden and flowers blooming on my patio. When I look up, I am thrilled to see the iridescent humming bird who has perched himself on a feeder while enjoying a long drink of sugar water. Yesterday I was able to enjoy two young deer staring at me while I looked in awe at them. With all the bad news in the media, it is sometimes easy to forget the wonders that await us if we only take time to look and listen. We can try to come up with all kinds of tricks/devices to help us relax. We can spend money on expensive vacations. But sometimes, all we really have to do is slow down and smell the roses…and I mean literally. With the cost of gasoline so high right now, I hope you will all turn off your engines, turn on your grills, and enjoy the free gifts of nature.
elaine.ducharme@yahoo.com

Blog May 19, 2008

Let’s talk about intimacy. People use this word all the time. Women routinely say that want more intimacy with their spouses and lovers. What is an intimate friendship? Does intimacy always imply sex? Actually, intimacy is really about sharing very personal feelings and thoughts. It is about letting another human being into your inner self. It is shared and must be reciprocal in order for true intimacy to exist. So many people think intimacy is just about having sex. But sexual behavior without communication is just sex. Don’t get me wrong. Sometimes sex itself is just great. No real talking involved. But, I am talking about an ongoing relationship. I speak to so many adolescents who are sexually active. And yet, when I ask them about whether they have told their boyfriends what they really like, or discussed birth control or how often they want sex…the answer is generally “no”. They report that they would be embarrassed to talk about these things. I personally feel that so many of these kids are just too young to really get intimacy. Girls, in particular, are often “doing it” just to please their boyfriends. But, what about adults? Why are we so afraid to share our thoughts and feelings about this topic with our lovers? It is often related to fears of refusal or rejection. Sometimes we feel guilty or that we don’t deserve to have our needs met. And sometimes it is based on messages we received during our childhoods that sex is something “icky” that you are supposed to “just do” to keep your partner (usually husband) happy. There are three common beliefs that also limit communication about sex. The first is that you shouldn’t have to talk about sex with your partner because sex will naturally take care of itself. Second, your partner should be sensitive and considerate enough to know how to sexually satisfy you. And third you should avoid conflict at all costs. These beliefs lead to a lot of trouble in the bedroom. Humans are complex beings. And sex is even more complicated. How can we possibly expect it to take care of itself? Does childrearing just take care of itself? Do our jobs just happen? Of course not. And how can our spouses know what really makes us feel good, especially if sometimes we are just pretending or “doing it” just to please them. And finally, what is wrong with conflict? Actually, nothing. Without conflict, we would probably never have interesting change. Life would be really boring. It is not the conflict that is the problem. It is how we resolve the conflict. If we simply blame the other person, become angry and shut down, we will become resentful and the situation will just get worse. If we use conflict as an opportunity to grow and change we learn that conflict can be embraced rather than avoided at all costs. Here are some guidelines to help you and your spouse begin a conversation. These guidelines are based on recommendations in the book Messages by McKay, Davis and Fanning.

1. Prepare yourself. Be clear about what you think, feel and want in your sexual relationship.

2. Ask your partner if this is a good time to talk about something important. If not, schedule a time.

3. Be positive. Tell your partner what you like about your sex life in general. Phrase what you don’t like in a more positive style. Instead of saying, don’t rub me so hard, say; I would like it even more if you would touch me more gently.

4. Use I messages. Take responsibility for your thoughts, feelings and ideas. Remember, it is not just your husband’s job to bring you to orgasm. It is a joint responsibility. He can’t help you to enjoy yourself if you don’t know what you like or if you don’t let him know. This is often called the feedback loop. Most of us really enjoy being able to please our partner. It is really no different asking your partner what would please them in bed tonight than what they might like for dinner. Our tastes may change a bit from time to time. We may like chocolate ice cream. But after awhile we might want something else. On the other hand, we may never want strawberry ice cream.

5. Avoid accusations. The statement, “You never make time for me” is accusatory. However,” I miss spending alone time with you. Can we talk about finding time to be alone together?” will be far more likely to end in a positive resolution. You can then say, “if you would help me bathe the kids at night and make the lunches, we would have time to snuggle before I am too tired.”

6. Be specific. Let your spouse know exactly what you mean. Don’t say…”you never pay attention to me”. Rather, say, “I really need a hug before we go to sleep. It makes me feel close to you”.

7. Be sure you and your spouse are actively listening to each other. Ask your partner what he heard you say that you need. If he or she didn’t get it, repeat it and try again until you are both sure you are hearing each other correctly.

8. Stay focused. Don’t start talking about all the things you may be upset or worried about. This is a sure fire way to end up in an argument.

9. Try to agree on some change for a short period of time. Don’t be afraid to experiment. But never do something that makes you feel really uncomfortable or unsafe. Then talk about it. Give your partner feedback.

10. Let your partner know how good it is to be able to talk about your sexual relationship.

These ideas really can help open up conversation about your sexual relationship. And, just talking about it in a non-defensive way can lead to greater intimacy. If, however, you and your spouse can’t get beyond the blaming stage or if you are just too uncomfortable to begin the conversation, you might want to consult with a psychologist or other mental health provider who is experienced in dealing with issues of sexuality. They can either help you gain the emotional tools to begin the dialogue with your spouse or facilitate that discussion with the two of you.

elaine.ducharme@yahoo.com

My husband’s father died in his 50’s, before his retirement and before he could complete many of his dreams. I know this has had a profound impact on my husband and the way he lives his life. So, I asked myself the following questions…If I had to vanish tomorrow, what would I want to leave as my legacy? What would I want my loved ones to have known about me? And what do I want to have accomplished? I know that I would want my family to know how much they are loved and that they are my most precious gifts. I try to tell them this often. I would want my patients to know that I am so very grateful to have the opportunity to share in their own growth. To be allowed into the inner sanctums of another human being as they deal with the pain of early trauma and current life stressors, is indeed a privilege. Reading The LastLecture has emphasized for me that every day really matters. My time is like nuggets of gold and I want to use them wisely. When my mother died fairly quickly of cancer, I was comforted by the fact that shortly before her death she sat with our family and said that, other than dying before she was ready to leave us, she had no regrets about how she had lived her life. What an amazing thing to be able to say. As a result, I try to live my life so that I, too, may one day be able to make the same statement. Of course we all make mistakes. But, it is the entire pattern of our lives, like the beautiful weavings of an oriental rug that really matters. In the end, I want my rug to be beautiful, even with the irregularities found in all these works of art. I truly believe that dreams can come true. I have been able to accomplish many of my dreams. This has not always been easy. But, going after and working towards our dreams is half the fun. So think about what you want your legacy to be and begin living it now. And don’t forget to share it with those you love the most.
elaine.ducharme@yahoo.com

Blog May 12th 2008

I started reading The Last Lecture the other day. It is a small book by Randy Pausch, a professor at Carnegie Mellon, who develops pancreatic cancer. Although he is determined to beat this disease, ultimately he discovers that the cancer has spread and he has only a few months to live. Saddened at the thought that he will have such a short amount of time to be with his wife he also faces the fact that his three young children will have few if any real memories of their father. During this time, he is invited to give a talk at Carnegie Mellon called the Last Lecture…a discussion of what wisdom he would impart to the world if he knew it was his last chance. Ultimately, he decides to give and videotape his lecture as a gift to his family, especially his children, so that someday they might really “know” their Dad and what made him unique.

Dr. Elaine Ducharme Blog 5/5/08

Hi from sunny south Florida.

Many of you know that I lived and worked in the Palm Beach area for 15 years. I still maintain a small practice there. I utilize technology…phone and videoconferencing to speak with my Florida patients and travel to Florida every few months for “live” sessions. This has actually worked out well for all of us. A real bonus for me is visiting with family and friends on a regular basis. Each May, an event called “Sunfest”, a mixture of wonderful music and art is held along the intracoastal in West Palm Beach. I was fortunate enough to be able to attend this year. It is always wonderful to see a community come together and celebrate the good things in life. As we look around us, flowers are blooming, trees are turning green, days are longer and many of us are feeling a sense of renewed energy and spirit. We may not all be able to be in the tropical paradise of Florida, but we certainly can take time to come together with friends and family. We are all so busy. We often tell ourselves that we will call our friends tomorrow or make plans with family for another day. To renew and enrich your own life, pick up the phone today and call someone with whom you have not spoken in a long time. Make plans and get together with a friend or family member that you have not seen in a long time. Because, in the end, it is relationships that really matter and renew our souls.
elaine.ducharme@yahoo.com

Dr. Ducharme’s Blog April 28, 2008

I just finished reading the Sunday morning Courant. Two articles in the Life section really struck me as being incredibly important for both children and young adults. The first was an article by Susan Campbell entitled “Drawing a line on Cellphones”. The article discusses the fact that so many of our very young children starting at age 8 own their own cellphones. The second article is actually a column by Dr. Sandra Scantling, entitled “Risqué Pictures Evidence of Youthful Desperation”. Dr Scantling talks about a 17 year old girl who is so desperate to get back together with her boyfriend that she sends him (via cellphone) a naked video of herself, fondling her own body. The boyfriend does not want her back. And then she loses her cellphone in a taxi. Needless to say, she is distraught and terrified of who might find her cellphone and post these pictures on the internet. And she should be!

Ms. Campbell stated that last year a New York Research Company found that 38% of 12-13 year olds had their own cellphone. I do not know who did the study, the size of the sample or the validity of the study. But, I can certainly confirm that I am seeing many young children carrying their own phones. The reasons vary. “I wanted one”, (I want a lot of things) “my parents need to know where I am all the time”, (tell where you are going and be there when they check on you) “for emergencies” (where is the adult) “my divorced parent wants to be able to reach me without having to deal with my other parent” (put in a separate line) are typical responses. How often are our children in situations that are so dangerous that they would truly be in trouble if they did not have a cellphone. Are there no adults around them? Are they out in the wilderness and unable to find help? No…I am sorry. Kids are using cellphones so they may be in constant contact with their friends. They want instant gratification and we are allowing it. We support this lack of impulse control. We get mad at our kids when we get huge cellphone bills. But do we really ever take them away…for a long time? Sometimes parents say they make their kids pay the bill. But, really, how is 10 year old going to pay? Parents could make them work it off. But, most of the time, a warning is given. That is it. Then we discover that the children are using their phones to send answers to tests to each other in class. I know. Cell phones generally aren’t allowed in many schools. But they are there, just as kids are listening to ipods through headsets covered by long hair and have alcohol in water bottles. Kids are also sending inappropriate photos to each other and using this technology as a form of bullying. They text message impulsively, rarely thinking of the consequences of having something they don’t want circulated in writing or in pictures.

We need to learn to be out of touch…to be quiet and at peace with ourselves. As parents it is our job to protect our kids. The argument that these phones are really protecting young children is rather weak. Perhaps if we were supervising our kid’s activities, knew the families whose homes our children were at and taught our kids what to do in an emergency we could still feel that our children were safe. We could check to make sure the adults with our kids had cell phones. It is important to know where our kids are. But calling them on their cellphones doesn’t do that. Unless you have put a tracking device on the phone they can tell us they are one place but be somewhere else. And frankly, do your children really need to be able to reach you 24-7? I don’t think so. We all managed to survive without having our parents on call 24 hours a day. We sometimes had to wait to speak to them. If they were unavailable, we had to wait…or go to the school office to call home…or say no to going somewhere with a friend because we hadn’t confirmed it with a parent. I am seeing a lot more children with anxiety disorders than ever before in my practice. Some kids, terrified of being away from a parent, won’t go to school. Parents, afraid of frustrating their kids, insist their phones have to be on during their own therapy sessions. We discuss this as a therapeutic issue. I encourage them to tell their children that they are in a private meeting and are not to be disturbed. They can even tell them where they are so that in a true emergency, an adult could contact them. I ask you all to take a hard look at your kid”s cellphone use. Without supervision, kids got into a lot of trouble on the internet. Phone technology has its own set of dangers. Please think about limiting your kid’s use of phones. If they have to have them so you feel better, set boundaries, time limits and talk about the dangers. Don’t expect an impulsive child to use much restraint on their phone.They call each other and text message all day and late into the night, because they can. Think about your young teen daughters. Their lives are filled with high drama. The immediate gratification of their impulses does little to help them to deal with problems or relationships in a calm and thoughtful way. They can cause chaos in their own lives and the lives of their friends by immediately sending their thoughts out to their “network”. Cellphones are a wonderful invention. But, as is the case with most technology, it can backfire. They need to be used with caution and discretion. Another time, I will talk about how “texting” is having a negative impact on adult relationships.
elaine.ducharme@yahoo.com

Dr. Ducharme’s Blog April 21st, 2008

Anorexia Nervosa

Dying to be Thin

   Last week, French lawmakers, adopted a groundbreaking bill that would make it illegal for anyone-including fashion magazines, advertisers and websites- to promote extreme thinness. Under the proposed law, judges would have the power to imprison and fine offenders up to $47,000 if found guilty of inciting others to deprive themselves of food to an excessive degree. The bill goes to the Senate in a few weeks. French lawmakers and fashion industry members signed a nonbinding charter last week on promoting healthier body images. Spain, in 2007, banned ultra-thin models from catwalks. It is impossible to know how and if this will be enforced. But it is a big step.

   Anorexia Nervosa is a disorder in which the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight and exhibits a significant disturbance in the perception of the shape or size of his or her body. The name anorexia is a misnomer, because loss of appetite is rare. Anorexics are preoccupied with food. Anorexia Nervosa appears to be far more prevalent in industrialized societies in which there is an abundance of food and in which, especially for females, being considered attractive is linked to being thin.

   Anorexics usually strive for perfection. They set very high standards for themselves and feel they always have to prove their competence. They usually put the needs of others ahead of their own. A person with anorexia may also feel that the only control they have in their lives is in the area of food and weight. If they can’t control what is happening around them they can control their weight. Each morning, or even numerous times per day, the number on their scale tells them whether they have succeeded or failed at their goal for thinness. Focus on calories helps them to avoid facing the real issues of concern. Most anorexics have very low self-esteem and some may even feel they don’t deserve to eat. They may be resistant to therapy as they feel they will be forced to eat. In their attempts to get thinner, they will avoid food and taking in calories at all costs. Anorexia nervosa has the highest premature death rate of any psychiatric disorder. Death is often from heart arrhythmias or electrolyte imbalance.

Signs and symptoms of anorexia include:

  Noticeable weight loss

  Becoming withdrawn

Excessive exercise

Wearing baggy clothes to hide weight loss

Difficulty eating in public

  Fatigue, muscle weakness

Perfectionist attitude

Feelings of self worth determined by what is or is not eaten

Always being cold

Obsessions with food and calories

Guilt or shame about eating

Vomiting after eating or excessive use of laxatives and diuretics

Abuse of diet pills

Frequent bouts of dizziness or headaches

  Secretiveness about eating

  Irregular or loss of menstruation

No known physical illness that would explain weight loss

Complications include, but are not limited to:

  Fatigue

  Irregular heartbeat

  Dehydration

  Constipation

  Bloating

  Depression

  Infertility

  Hair loss

  Loss of bone mass

  Development of lanugo (fine body hair)

  Electrolyte imbalance

  Kidney and liver damage

  Depression

  Low potassium (most common cause of nocturnal cardiac arrest)

  Cardiac arrest and death

   Clearly, this is a terribly serious problem. We have developed a society that shouts to us all from billboards, television screens, movie theatres, magazines and just about everywhere we look, that happiness comes only with being thin. The old saying that “you can’t be too thin or too rich” is just not true.

   What can you as a parent do when you see a child struggling with these issues? First, you can consistently and throughout your child’s life encourage independent thinking and have open discussions about healthy life-styles. Be aware of your own problems and concerns about weight and eating. Be wary of sports or dance coaches that encourage your child to lose just a few more pounds. Because most eating disorders begin while patients are in their teens or early 20’s be particularly aware of excessive exercise patterns and unusual restriction of caloric intake. Be aware of distortions of body image, signs of depression and low self-esteem. Many teens struggle with identity issues and in today’s highly competitive world, many achieving kids feel they should still be doing more. Help your child set realistic goals for themselves and strive to keep open lines of communication. If they frequently appear upset, and most teenagers do have down periods, ask them if they are just having a bad day or if they have been feeling depressed for a long time. And, if you suspect an eating disorder is developing, consult with your child’s physician or a mental health professional that has experience working with eating disorders. Once an individual admits they have a problem and are willing to seek help, they can be treated effectively through a combination of psychological, nutritional and medical care.
elaine.ducharme@yahoo.com

Dr. Ducharme’s Blog April 14, 2008

Child and Adolescent Depression

With the recent news of the suicides of two 8^th grade boys in West Hartford, I felt an article on depression in children and adolescents was important. For years people questioned whether or not children could experience true clinical depression. They often wonder why a child could be depressed. After all, they have no bills to pay, family to support, jobs to deal with or many of the everyday stressors that effect adults. We now understand that childhood depression, like depression in adults is a mental illness that alters a child’s mood. Like depression in adults, childhood depression can result in feelings of sadness and hopelessness, low self-esteem, lack of energy and loss of enjoyment. Unlike adults, kids often show depression though behavior changes and the development of physical symptoms. The American Academy of Child and Adolescent Psychiatry reports that about 5 percent of children and adolescents in the general population suffer from depression at any given point in time. The number of suicides among young people has risen nationally. The Centers for Disease Control and Prevention reported last year that the suicide rate among 10-24 year olds had increased 8 percent from 2003-2004, the most recent year for which statistics were available. Children under stress, who experience loss, have attention difficulties, learning, conduct or anxiety disorders are at increased risk for depression. With the divorce rate of first marriages at about 50%, many kids experience sadness and depression as they cope with the losses and often traumatic issues that are often associated with divorce. Depression is often biologically based (chemical imbalance) and tends to run in families. All children have episodes of sadness, irritability and even regressive behaviors. During the normal course of development, kids will encounter disappointment, frustration and at times real heartbreak. The key to diagnosing true depressive illness lies in the length of time and intensity when these symptoms are present. Depressed kids feel bad/sad the majority of the time. Although they can be distracted, laugh or seem engaged in a particular activity, they have lost their ability to feel real joy for extended periods of time, generally more than two weeks. With depression, symptoms return regularly or the child expresses suicidal ideation.

Early diagnosis is very important in treating childhood depression.

Warning signs of suicide or other forms of self-harm

1.     Previous suicide attempt

2.     Family history of suicide attempt or completion

3.     Sudden mood change…negative or positive

4.     Change in eating or sleeping habits

5.     Feelings of hopelessness or helplessness

6.     Poor control over behavior/impulsive aggressive behavior

7.     Drop in quality of schoolwork

8.     Lack of interest in usual activities

9.     A need to be perfect

10.                        Giving away important possessions

11.                        Hints at not being around in the future or saying good-bye

12.                        Use of drugs or alcohol

13.                        Writing poems about death

14.                        Sexual acting out

15.                        Recent break-up with a boyfriend or girlfriend

Please do not ignore these signs. Don’t be afraid that if you ask about thoughts of suicide you will make them think about and maybe act on the thought Do not leave medicines that can be used to overdose unlocked. And be sure to remove deadly weapon, especially guns from your home.

A physical examination by your child’s pediatrician can help to rule out any medical causes for the child’s mood change. Meeting with a psychologist or other mental health clinician is very important in making a proper diagnosis and conducting therapy. Treatment may include individual play or talk therapy, family therapy, exercise and relaxation techniques, and, when necessary, medication. A lot of parents are very hesitant about using medication. All medications can have side effects and potential risks. However, if a child is not responding to therapy, the risks of not using medication can be serious. Certain medications seem to quite safe for children. New research suggests that with the recent use of the black box warning and decline in the use of antidepressants in children, there has been a significant rise in suicides in this population. Suicide is the third leading cause of death for 15-24 year olds and the sixth leading cause of death in 5-15 year olds. The goal is to use medications only when necessary and in the minimal amount needed to achieve the maximum effect. The bottom line is that if medication is being considered; speak with a trusted medical practitioner who has a lot of experience administering anti-depressants to children. Kids taking medication need to be monitored regularly. Good communication between parents, the child’s therapist and the prescribing physician, and often your child’s school teacher is critical in ensuring that your child recovers as quickly as possible and is able to enjoy life.
elaine.ducharme@yahoo.com

Dr Elaine Ducharme Blog April 8 2008

My husband and I just returned from a wonderful vacation in Italy and France. We both love to travel. But this was a particularly special trip because we were able to go back to the small town in Italy, San Gimignano, where my mother –in-law was born 94 years ago. It is a small village in Tuscany. We have been hearing about this little village for so many years. Sometimes the images don’t live up to expectations. But, in this case, the reality far exceeded the expectations. Total strangers helped us find the house where my mother-in-law was born. They then directed us to the antique shop our cousins still own. Although the cousins knew who we were, we had never met. Within a few minutes, a phone call was made and we were being escorted home to “Mama” for an incredible lunch! Another day found us visiting with more relatives…being treated to wonderful food and wine as we sat around a table on a hillside in Tuscany, surrounded by gardens, vineyards and speaking a combination of Italian and English. The warm feelings needed no translation. Although I speak reasonable French, I had begun to study Italian for about a year before the trip. Clearly, it was a challenge. But it was fun and we managed well. We will return to visit again and I know that several of our cousins will visit us here in America.

My husband and I enjoyed Florence, though it was incredibly crowded. Rome is unbelievable. It is impossible to describe the feelings I had while standing in the Colosseum. Looking at the Forum and imagining what life was like in Imperial times was amazing.I will say, that although the Romans invented plumbing, they have a long way to go to begin to catch up with the convenience of our public restrooms. Guidebooks are not kidding when they tell you not to drink too much coffee during the day. Bathrooms are few and far between. They are often coed. Sometimes a hole in the floor. The food, especially the pasta, gelato and all the chocolate and wine were phenomenal. And what can I say about Paris. It is always enchanting…even in the rain. Yes, it was raining a lot while we were there. But in the end, it was the time spent with the family we enjoyed most. I am posting pictures so I can share some of the beauty with you. Enjoy!

elaine.ducharme@yahoo.com

Ducharme’s Blog

3/31/2008

Bedtime Blues

One of the most frequent questions I am asked by parents concerns getting their young children to go to sleep and stay in their own beds throughout the night. It is not about the child who likes to climb into their parent’s bed on the week-end mornings for snuggle time. It is not about the child who asks for one more story and then goes to sleep. The primary problems are children who manipulate so much at bedtime that they are often still awake and running around one and two hours after they were put into their bed. Or, they have worn their parents down so much they are spending the entire night in their parents’ bed.

Getting your child to go to sleep is often a matter of consistent routine. Children need structure. From early infancy parents should establish bedtime rituals. I often recommend a bath, rocking during a last feeding, a lullaby and then bed for infants. The toddler still enjoys bath time, brushing his or her teeth and a story or two. A nightlight in the room helps children who are afraid of the dark. When a child tries to prolong bedtime with incessant requests for just another drink of water or pleas of hunger etc., it is important for the parent to be loving but firm and say “no”. Some children have particular difficulty with the transition from waking state to sleep. For these children consistency is even more important. Lying down next to your child for a few minutes can be helpful. Even young children can learn relaxation techniques and games to help them settle down. Just be careful that you, the tired parent, doesn’t fall asleep and spend most of every night sleeping with your child. Another technique that works well with willful children looking for some control is to let them read a book or two on their own and turn their own light off when a timer rings or when they can read certain numbers on a digital clock.

There are few topics I am more adamant about than having children learn to sleep in their own beds. This is because children need to learn to calm themselves and have their own space. Many parents continue to let their children sleep with them because they are too tired to get up and deal with a crying child. The longer your child stays in your bed the harder it will be to get him out. Some couples let this habit continue as a way of avoiding intimacy with each other. Others let the behavior continue because it is just easier than trying to fix the problem. Often, people don’t realize that children can experience premature sexual stimulation from sleeping with adults.

Getting your child to sleep in his or her own bed requires persistence, determination and approximately two weeks. Let your child know that they will be sleeping in their own bed from now on. It is fine for you to stay in their room for a while until they fall asleep. But you must leave at some point (generally within 15-30 minutes). If your child wakes up crying and/or comes to your room simply return them to their bed. Do not give in to their cries by taking them into your bed, no matter how tired you are. If you give in to their cries they will simply learn that all they have to do is cry longer and harder to get their way. Small rewards such as an extra bedtime story, a piece of sugarless gum or a sticker can be given for each successful night. A larger reward such as a trip to the video store can be given when the child has successfully stayed in their room for several nights. Hang in there. This really does work! And after two weeks you and your child will be very proud. You will also have reinforced for your child that he/she can do hard things.
elaine.ducharme@yahoo.com
3/25/08
Handling Stress

The Mind Body Connection

Dr. Elaine Ducharme Reporting:
The American Psychological Association has launched a major campaign to help people understand the mind /body connection Mind/ body health is the effective balance of physical and psychological health so that each works to support the other. Poor mental health or poor emotional well-being can have a negative effect on your physical health. And, poor physical health can affect a person’s mental health.

Stress is generally defined as overwhelming feelings of lack of control over our environment and an inability to change things. According to the Academy of Stress, stress tends to be more pervasive, persistent and insidious because it stems primarily from psychological rather than physical threats. It is associated with ingrained and immediate reactions over which we have no control that were originally designed to be beneficial. For example:

·        Heart rate and blood pressure rise to increase the flow of blood to the brain to improve decision making.

·        Blood sugar rises to furnish more fuel for energy as the result of the breakdown of glycogen, fat and protein stores.

·        Blood is moved away from the stomach, where it is not immediately needed for purposes of digestion, to the large muscles of the arms and legs to provide more strength in combat or greater speed in getting away from potential danger.

·        Even our blood tends to clot more quickly to prevent loss from lacerations or internal hemorrhages.

However, when we are not in great danger but maintain high levels of anxiety and stress, there can be very negative consequences. High blood pressure can lead to heart attacks and strokes. High blood sugar can lead to diabetes and blood being shunted away from the gut can lead to many digestive problems.

Stress is a normal part of life and is sometimes necessary for optimal performance. However, stress becomes a problem when it interferes with a person’s ability to do daily life tasks over a period of a few weeks or impacts your health in a dangerous way.

More and more children are showing signs of chronic stress. We are seeing more cases of juvenile diabetes, high blood pressure and obesity in our kids. We may not be able to eliminate all of the stress in our lives or the lives of our children, but we can certainly help our kids develop better ways of coping with stress. One of the most common methods of handling stress is overeating and/or unhealthy eating. How often have we tried to sooth ourselves or our children by serving something “special”? This is usually something comforting and high in fat and calories. This is only a temporary fix. Although we might feel immediate relief, we frequently then feel worse as our blood sugar plummets after eating foods high in carbohydrates. Then we feel hungry, eat some more, gain weight, feel sluggish and may develop other serious physical symptoms.

One of the ways to avoid this cycle is to teach your children more positive and longer term methods for dealing with stress. First, help them identify what they are upset about. Encourage them to talk about their feelings and a few solutions to the problem. Then, help them to engage in activities that really will reduce their stress levels. I like to refer to these behaviors as “stress busters”. Any form of physical activity is generally helpful For example, taking a walk, going for a bike ride, using exercise equipment and even doing jumping jacks are all stress busters. Learning how to relax with self hypnosis or progressive relaxation is also a wonderful way to let go of stress. Doing anything that produces laughter also helps. Read a funny book with your child or play a silly game. And if you or your child are hungry, be sure to eat well balanced meals and snacks that are low in fat and higher in protein to maintain more even levels of your blood sugar. As you and your children incorporate these healthy “stress busters” into your lives, you will be rewarded with increased levels of energy and better physical and emotional health.
elaine.ducharme@yahoo.com

3/17/2008
A Matter of Time

By

Elaine Ducharme Ph.D

Recently I was asked to speak to a group of young mothers. One of the major concerns was about having enough time for everything and everyone. First time parents wonder how and if they will ever find time to actually take a shower in the morning and eat their own meals. Sleep is another issue altogether. Parents of 3 and 4 children worry they are not giving their children enough individual time. Trying to fit in naps for the younger children, meals, baths, sports and homework for the older kids can leave everyone feeling frustrated and inadequate. I haven’t even mentioned doing the laundry, baking cookies for school parties, going on field trips and helping out at your child’s school. Oh, and I forgot…some parents actually have another job outside of the home. While I am at it, I had better mention the issue of finding time to be intimate with your spouse. It is enough to push anyone over the edge. What are we doing to ourselves and our children? If we as adults are feeling exhausted, the chances are that our kids are even more worn out. My daughter was telling me how much she loves the quiet time she and her 3 year old spend snuggling and reading books each night before he goes to bed. How many of you have had to give up that snuggle time with your kids just to get “everything” done? How many of you have given up intimate times with your spouse because you were just too tired?

Parents seem to feel they are not doing their job if they are not personally controlling every aspect of their child’s life. Parents do need to know what is happening in their kids’ lives. But they don’t need to micromanage everything. Many of us feel that we have to intervene to make sure every aspect of our kid’s day runs perfectly. Quick reality check...Not only is this impossible, but it is counterproductive. Kids need to learn to deal with problems. They need to be involved in figuring things out. One mother recently told me that her daughter was insistent on playing two different sports. Many of the practices occurred on the same day several miles apart. The family also had two other children. Finally the mother told the child to sit down with a calendar scheduled by the hour and work out how she was going to accomplish all she needed to do, arrange the transportation, have time for dinner and homework and hang out with friends. Fairly quickly the child came to the mother and said she felt it would be overwhelming for her and the entire family and gave up one sport.

With these ideas in mind, I am asking you to consider the following points if you are feeling overwhelmed.

Prioritize. Think about what you really want for you and your family. Are you trying to raise a sports fanatic or a well balanced child?

Consider your own capacities and time constraints. If you are exhausted and screaming, your children will not be happy.

Involve your children in realistically planning their schedules. This should include homework and playtime.

Schedule time for you and your husband to be alone. Even if it is for one hour a week. Watch a movie together, go out to dinner or take a shower together. It doesn’t have to be expensive. If you are short on money, try to trade kids with another family for an evening or an hour or two during the week or on the week-end. Keeping your marriage as strong as possible is critical in raising happy and healthy children.

Schedule alone time with each child. In a larger family this obviously may happen less frequently. Every week is great. But, even if special time is only once a month it is worth it. Letting your child know that he or she is special by developing traditions that you do just with them goes a long way towards building self-esteem and strengthening your bond. This is important for mothers and fathers.

Eat dinner together. I have said this before. Children who eat dinner on a regular basis with their families have fewer problems with drugs and alcohol than children who do not.

When you are really feeling overwhelmed, cancel all outside activities for the day and recharge your battery. Tell the kids you are all taking a rest. Let them play with their toys, lie around on the couch, read books, eat leftovers or order a pizza. Some religious families take the Sabbath as a day of rest. With the soccer and basketball schedules of today the day of rest is often cancelled. So, religious or not, consider adding a day of rest to your weekly (if not monthly) schedule. You will not be sorry. elaine.ducharme@yahoo.com

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Dr Ducharme's Blog 3/10/08
Teen Depression

Teen depression affects as many as one in every eight adolescents, according to the National Institute of Mental Health. Many teens appear sad occasionally. Most teens experience mood swings as part of their normal development. However, clinical depression goes beyond this. Depressed teens experience persistent negative emotions that interfere with their daily functioning. They may have occasional moments or short periods of time where they appear to be feeling OK, but their general mood is down. Many parents remember having feelings of sadness and isolation as a teen. They may even tell themselves that they are now fine and never got treatment. So they assume their teen will also be fine. This may or may not be the case. Suicide is the third leading cause of death among teens. Approximately 5000 young people between the ages of 15-24 commit suicide every year according to the National Center for Health Statistics. If you are concerned about your teen seek the advice of a professional. They can help you and your child determine if any intervention is necessary. Depression can be treated with psychotherapy, medication or a combination of the two.

Warning signs that your child may be depressed include:

Social withdrawal
Feelings of despair, rage, worthlessness, excessive guilt
Feelings of hopelessness and or worthlessness
Frequent episodes of agitation
Persistent lack of enthusiasm or motivation
Significant weight loss or gain
Chronic fatigue
Insomnia (not just the adolescent habit of staying up late and then sleeping very late in the morning)
Preoccupation wi