It is important to note, however, that having strong reactions to trauma is normal. What’s more, there is a range (spectrum) of expected reactions depending on a person’s prior exposure to trauma and even on hereditary (genetic) factors. Most importantly, you should understand that there are efficient and effective treatments for PTSD.

What are the symptoms of PTSD?

In general, posttraumatic stress disorder can be seen as an overwhelming of the body’s normal psychological defenses against stress. Thus, after the trauma, there is abnormal function (dysfunction) of the normal defense systems, which results in certain symptoms. The symptoms are produced in three different ways:

1. Re-experiencing the trauma
2. Persistent avoidance
3. Increased arousal

First, symptoms can be produced by re-experiencing the trauma, whereby the individual can have distressing recollections of the trauma. For example, the person may relive the experience as terrible dreams or nightmares or as daytime flashbacks of the event. Furthermore, external cues in the environment may remind the patient of the event. As a result, the psychological distress of the exposure to trauma is reactivated (brought back) by internal thoughts, memories, and even fantasies. Persons also can experience physical reactions to stress, such as sweating and rapid heart rate. (These reactions are similar to the “fight or flight” responses to emergencies. The patient’s posttraumatic symptoms can be identical to those symptoms experienced when the actual trauma was occurring.

The second way that symptoms are produced is by persistent avoidance. The avoidance refers to the person’s efforts to avoid trauma-related thoughts or feelings and activities or situations that may trigger memories of the trauma. This so-called psychogenic (emotionally caused) amnesia (loss of memory) for the event can lead to a variety of reactions. For example, the patient may develop a diminished interest in activities that used to give pleasure, detachment from other people, restricted range of feelings, and a sad affect that leads to the view that the future will be shortened.

The third way that symptoms are produced is by an increased state of arousal of the affected person. These arousal symptoms include sleep disturbances, irritability, outbursts of anger, difficulty concentrating, increased vigilance, and an exaggerated startle response when shocked.

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When you look in the mirror each day, what do you see? Is it the real you or a perception of you? It’s not what we see, but how we see that matters. If you see yourself as bad, inadequate or a failure what do you think the consequences will be?

We can change that negative self-image to one that’s positive and filled with confidence, aware of your own unique qualities, capabilities and capacities, as well as enhancing general coping abilities, and minimize anxiety and worrying, thus increasing confidence, self-esteem and self-efficacy. Just imagine what that would be like for you!

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• The death of someone you love.
• Your parents or other important people splitting up or getting divorced.
• Separation from a parent, both parents and your family.
• Separation from friends or your community.
• Moving away from home or leaving your country.
• Loss of your childhood.
• Splitting up with your partner.
• Having a miscarriage.
• Being forced to give up something you don’t want to (like your job, child, or home).
• Losing your job.
• Leaving school or university.
• Losing or not having the ability to have children.
• Losing the ability to do some things through disability.
• Having an abortion.
• Becoming really sick or seeing someone else become really sick.
• Even when we experience change that is positive to us such as leaving school and starting work we can also experience some feelings of grief for what we’ve left behind.

When we have a loss in our life we go through reactions of grief. These reactions and feelings are different for everyone.

Here are some tips.

• Accept your own feelings – No-one will feel what you do, in the same way or with the same power. Understand what you are feeling as natural. Let yourself cry, talk about the loss or have a laugh. Check out the stages of grief. Let yourself feel what you are feeling. The feeling will pass.
• Express your feelings – Talk to someone you trust. Write a letter, poetry or a journal. Paint, draw or sing. Express what you are feeling, your fear, your hurt and your loss. Talk about what you have gained by knowing the person or having the experience you have had. Talk about the good and not so good times. Send it, keep it, hang it up, give it to someone, discard it or show it to someone you trust.
• Ceremonies – Funerals, ceremonies or memorials can be important. They are an opportunity to share your grief with other people or help accept an ending in your life. This is an ending of one phase in your life and the beginning of a new one.
• Take each step at a time – Live each day as it comes. Experience what you are experiencing in your own time. Understand and accept disruption in your life. Take control of things you can. Remind yourself of the things you have little or no control over. Give yourself permission to grieve.
• Relax – Exercise, take a warm bath (with some aromatherapy oils and incense), meditate, have a massage or spa. Listen to soothing music. Do things you like doing and that help you to relax.
• Move forward – What have you learned from that person, place or experience? What memories do you have? How have they become part of your life? How might you carry these on? How might you share them with children or others? What place might these skills, attributes, stories or knowledge hold in your future?
• Support – Support is essential. Talk to a friend, family or someone you trust. Sometimes it might feel people “don’t understand” or “get sick of your grieving”. It can be useful to check out a counselor or have a network of supports in your life.
• Have a laugh – Your sense of humour can be a great tool in at any hard time. It is OK to laugh at things you would usually laugh at. Advantages of laughter are that it gives you just a little break from the pain and that it releases healthy, healing chemicals into your body.
• Celebrate your memory – Plant something as a living memorial. Carry or wear something that reminds you of the person who died or the thing you have lost. Create a memory book or journal with photo’s, stories, pictures or poems. Put up a photo or something else that reminds you of that person (something they made, a trophy or gave to you). Spend time at a place or doing things that you used to do.
• Explore your spirituality – Pray, meditate or spend some time with nature. Use your own personal spirituality to explore what death or loss means to you and your spiritual self.
• Change – Be open to new ways of doing things. When it feels right, start something new. Don’t feel guilty about this, it is part of healing and you will never lose what your relationship with the person you have lost has given you.
• Be aware – It is natural to become more dependent on others immediately after a loss. It is not useful to keep this going for a long time. Keep an eye out for signs you are not gradually feeling better. Give yourself a pat on the back when you do things for yourself.
• Reward yourself – Be kind to yourself. Do things you like doing. Treat yourself to things that make you happy. When you feel ready, do something to help someone else. Soak up the enjoyment as much as you can!
• Write down the things you have learned – What have you noticed about yourself in this time? What have you found hardest? How did you over-come the hard things? What did you find easiest? What does this tell you about yourself? What have you learnt about your life? What beliefs have you gained, let go of or are new to you? How might you use this knowledge in your future?  If you write it down you will see how you are gradually feeling better.

Note: It is not usually a good idea to make major life changing decisions in the first few months after the loss. It is often better to wait until your life is back in balance again.

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• Inattention or poor persistence on many tasks, particularly those that are tedious, boring, and long.
The individual becomes bored rapidly during repetitive tasks, shifts from one uncompleted activity to another, frequently loses concentration during tasks, and fails to complete assignments.

• Impulsivity or difficulty delaying gratification.
Difficulty being able to stop and think before acting; difficulty waiting his or her turn; not being able to work for larger, longer-term rewards; and not being able to inhibit behavior, as a situation demands.
• Excessive irrelevant activity or poorly regulated activity to situational demands.
Individuals with ADHD are often excessively fidgety, restless, and “on the go.” They display movement that is not needed to complete a task, such as wriggling feet and legs, tapping things, rocking, or shifting position while performing relatively boring tasks. Trouble sitting still or inhibiting movement as a situation demands is often seen in younger children.

ADD without Hyperactivity: Individuals who exhibit attention problems but do not display excessive activity levels are considered to have ADHD, Predominately Inattentive, (formerly called Undifferentiated Attention Deficit Disorder). This disorder appears less likely to be associated with aggression or conduct problems and may have a greater association with learning disabilities and with a personal or family history of anxiety. Also, this subtype is less likely to have early onset and may not be noticeable until academic demands requiring attention increase.

Other Characteristics
1. Early onset. Many ADHD individuals begin to show problems in early childhood, often at 3 to 4 years of age, and most have had their difficulties since the age of 7. However, it is believed that those with the mostly inattentive subtype (without prominent hyperactivity) of ADHD may not have shown noticeable symptoms at an early age.

2. Inconsistent performance of repeated tasks. ADHD individuals show wide swings in the quality, correctness, and speed with which they perform work. This may be seen in highly variable school or work performance. This variability is seen less in one-to-one activities with others, particularly if they are with their fathers or other authority figures. They also do better when the activities they are doing are new, highly interesting, or involve an immediate consequence for completing them. Group situations or relatively repetitive, familiar, and uninteresting activities are likely to cause the most problems for them.

3. Trouble following rules. ADHD individuals often have difficulty following through on instructions or assignments. This is not due to poor language comprehension, defiance, or memory impairment. Instructions do not guide behavior as well.

Frequently Associated Conditions
Persons with ADHD are more likely than others to have the following conditions:

1. Academic underachievement and learning disabilities. The vast majority of individuals with ADHD often perform below their expected levels of achievement in school relative to their tested intellectual and academic abilities. As many as 30% may also have reading disorders, while an additional 10 to 15% may have other academic disabilities, such as difficulties in math or writing.

2. Aggression or conduct problems. Studies suggest that up to 65% of individuals with ADHD have a co-existing condition known as Oppositional Defiant Disorder or aggression. This is shown by defiance toward adults or other authorities, stubbornness or disobedience of instructions, temper outbursts, destructiveness, and verbal or physical aggression toward others.

3. Emotional Immaturity. A pattern of exaggerated emotional expressions may be observed, particularly in children with ADHD, in which the individual tend to overreact emotionally to frustrating, provocative, or stressful situations. These individuals may be described as having a lower frustration tolerance and as being more moody or emotionally sensitive than others. A quickness to display anger, sadness, elation, and other normal emotions occurs frequently in ADHD children. Low self-esteem is common by late childhood or early adolescence.

4. Social skills deficits. At least 50% of ADHD individuals have problems with social relationships. They may be described as self-centered, demanding, intrusive, insensitive to the feelings of others, and unappreciative of assistance from others.

Frequency
ADHD occurs in approximately 3 to 5% of the population. It is more common in individuals with a history of aggression, delinquency, substance abuse, truancy, learning, tics, or Tourette’s Syndrome and Obsessive Compulsive (OCD).

Causes
ADHD appears to have a strong biological basis, and may run in families. In a few cases, it may be connected with greater-than-normal pregnancy or birth complications. In even fewer cases, it comes as a direct result of disease or trauma to the central nervous system.

Research has not supported the view that ADHD is frequently due to the consumption of food additives, preservatives, or sugar. While in a few individuals their allergies can contribute to a worsening of ADHD, these allergies are not viewed as the cause of ADHD. Individuals with seizures or anticonvulsant drugs may develop ADHD as a side effect of their medication or may find their pre-existing ADHD features made worse by these medications. Although ADHD itself is believed to be a neurologically based disorder, many studies have shown that attention, concentration, and oppositional behavior are adversely affected by turmoil, conflict and instability in an individual’s life. This is true whether someone has ADHD.

Adult Outcome
It has been estimated that between 15 and 30% of children with ADHD ultimately “outgrow” their problems. Most individuals will continue to display their characteristics into young adulthood. Children with ADHD who begin to exhibit serious aggressiveness, defiance, and lying/stealing during the elementary school years are most likely to be at serious risk for later antisocial behavior problems. Yet some well-behaved ADHD children may also be at risk.

Evaluation / Diagnosis
There is no single medical or psychological test that diagnoses ADHD. A quality evaluation is one that is: conducted by a licensed health care professional with explicit training and experience in evaluating ADHD; comprehensive collection of information from multiple sources including family, educators, and the individual; able to “rule-in” the symptoms that make up this syndrome; and complete enough to “rule-out” other disorders that might co-exist with ADHD or that might explain ADHD.

Psychologists and other mental health professionals often integrate data collected from parents and teachers who complete rating scales about a child. Results of such tests can provide important clues as to whether a child’s difficulties are related to ADHD and/or other problems with learning, behavior, or emotional adjustment. Such scales offer measurable, information about the child, thus providing a way to compare a child’s behavior to others of the same sex and age. Psychological and educational tests of cognition, perception, attention span, visual-motor skills, memory, achievement, and social/emotional adjustment are often part of a valid and comprehensive evaluation.

Treatment
No treatments have been found to “cure” this disability, but many exist that have shown effectiveness in reducing either the level of symptoms or the degree to which they impair adjustment. The most substantiated treatment is the use of medications. However, most experts agree that medication alone is never the treatment of choice. Most medications used with ADHD to help first thing in the morning or at the end of the day. Medication does not teach the child anything they have failed to learn adequately (e.g. study skills & social skills). Medications often do not return the child to “normal.” Also, medications are not effective with 100% of the people who take them.

It is often recommended that other treatments be used first or in conjunction with the stimulant medications. These other treatments include training the parents of ADHD children in more effective child-management skills, modifying teachers’ classroom behavior-management methods, adjusting the length and number of assignments given to ADHD children at one time, and providing special educational services to those ADHD children with more serious degrees of the disorder.
Other treatments that show promise are social skills training, training in self-control methods (i.e., acquiring better problem-solving skills, learning to use self-directed instructions, anger control, and questions to slow down impulsive thinking).

For ADHD adults, educating them in practical methods of coping with their disability and enlisting the assistance of others in helping to better organize and structure ADHD individuals’ work-related activities may prove helpful. Also, the impact of ADHD on relationships may need to be addressed in individual or couples therapy. Stimulant medications may be effective.

Treatments with little or no or very limited scientifically valid evidence for their effectiveness in treating the core symptoms of ADHD including elimination of sugar or food additives, high doses of vitamins, chiropractic treatment, or sensory-integration therapy.

The treatment of ADHD requires education of the individuals or their caregivers as to the nature of the disorder and the methods proven to assist with its management. Treatment is likely to be multi-disciplinary, requiring the assistance of the mental health, educational, and medical professions at various points in its course. Treatment may be needed periodically over long intervals to assist ADHD individuals in coping with their behavioral disability.

Comprehensive Services

ADHD Child / Adolescent / Adult Evaluation
A comprehensive and valid assessment of symptoms of ADHD to evaluate and rule-out disorders which may co-exist with ADHD or which may explain its symptoms. Information is obtained from parents, spouses, educators, and the individual child or adult. A doctoral-level psychologist conducts this evaluation. Conclusions guide medical management, educational therapy and other interventions.

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What is anger?

Anger is a natural human emotion, just like happiness, sadness and grief. Emotions are simply the feelings you get when something happens to you. Anger is the emotion you get when you think you have been treated unfairly for example.

When you get angry, your body releases a whole load of chemicals into your brain and they change the way your body is working. These changes can be:

• making your heart pump faster
• short ‘panting’ breathing
• higher body temperature and ‘sweating’
• shaking or trembling.

These changes are your body’s way of preparing you for ‘fight or flight’. They give you extra strength and alertness so you can protect yourself by either running away, or standing up to fight for your rights or personal safety, which is what people had to do in the past. Now, when something goes wrong for you, you still have those body changes but most times it isn’t a situation where you can either physically fight or run away so you have all those changes and no easy way to get rid of the feelings.

Anger is closely related to other emotions like fear and hurt or disappointment or frustration, but is sometimes the only emotion you choose to show (sometimes you don’t even realize you have the others). For example, imagine an iceberg. Above the water there is one small part of the iceberg that shows, this could be seen as anger. Most of the iceberg is actually under the water and these are the other emotions linked to anger like fear, hurt, embarrassment, sadness etc. Next time you are angry, stop and ask yourself some things like: Why you are really angry? Is it because you fear something? Do you feel you have been treated unfairly? Did someone say or do something that embarrassed you? Did something hurt your feelings? Did you feel a lack of respect for you and your needs? Does it remind you of another experience where you were hurt? Does that scare you?

Who experiences anger?

Everybody, young and old, male and female, feels angry at some time or another.

Many people think that men, especially young men, get angry more often than women. This is a myth. This belief may have come about because men and women tend to express their anger in different ways.

• Men and boys are given messages that they “should” be ‘tough’ and that it is unmanly to express feelings such as fear, hurt, rejection and other ‘painful’ emotions.
• Women and girls are generally taught that getting angry is ‘unladylike’ or unfeminine. This can mean that women are more likely to bottle up their anger or ignore it, while men lose their temper and let people know they feel angry.

Expressing anger – helpful

In spite of the way anger is often viewed it can be a helpful emotion in our lives. Anger can help you by:

• driving you to reach your goals, handle emergencies and solve problems
• helping you express stress and tension
• communicating to others what you are feeling
• motivating change towards social justice.

For some of us just staying alive is a full time job, anger has had an important part to play in survival. When people see their safety being threatened by enemies, anger releases a flood of chemicals into the brain. These chemicals provide extra strength to:

• run away
• to stand and fight off attackers
• help focus during battle
• reduce the ability to feel pain.

These reactions are part of the way your body reacts to protect itself and help to react to dangerous or threatening situations.

Anger is also useful to:

• notice you have been treated unfairly or been emotionally attacked by others
• help you protect your emotional well being
• allow you to stand up for yourself and your rights
• show disapproval when someone breaks social rules or ‘norms’. Anger communicates a message that some behavior is not OK, eg, you might get angry at when Joe “beats up his girlfriend” because you see violence in this manner as not OK
• lead to changes in the way our society runs. When a group of people get angry over the same things, they will often join together to change the situation, eg, marches against racism or protests against war.

Note: Your anger can be useful but only if you express it in a useful way.  It is important that you don’t hurt yourself or other people or damage property.

Expressing anger – hurtful

Some people believe anger always leads to an explosion. This can result in frequent rages of violence or even child abuse. Other people believe they “should” cover up their anger because it is an “unacceptable” emotion to show. Anger used in these ways can become negative, destructive and can harm yourself, other important people or important things in your life.

If you frequently lose your temper you may find it can:

• be hard to keep friends, partners, family or employment
• end up making both yourself and other people miserable
• hurt yourself or others (often loved ones)
• lead to loneliness and unhappiness.
• lead to violence – this is illegal, you may be charged with assault, or other crimes.

Anger can take over your life!

If you feel low or have little control in your life, you sometimes use anger to manipulate or make others afraid of you. This can give you a sense of strength, power and control over the people around you. Using anger this way can hurt other people and yourself. It makes it difficult to keep friends or other relationships and can lead to feelings of guilt or shame. These feelings can lead to low self-esteem, and increased anger and loneliness. It becomes a vicious circle! It is never OK to use anger to hurt people in any way!

On the other hand, when people ignore their anger, it has nowhere else to go, and can often turn upon its owner.

When you bottle up your anger you may:

• find this method only works for a short period of time
• have depression, low self-esteem or anxiety
• use drugs and alcohol to “cover it up”
• feel ugly, horrible and hate yourself
• hurt or punish yourself
• explode – often over little things that wouldn’t normally worry you
• aim it at people who had nothing to do with the original cause of the anger
• let anger take over your life!

These strategies don’t allow anger to be dealt with in a healthy or useful way. This means anger continues to lurk like an emotional monster, waiting for opportunities to hurt you or someone else.

Physical health problems

When you stay angry for a long time, the chemical changes in your body keep going, placing strain on your body and can cause a range of health problems.

Short-term problems may be:

• headaches
• stomach aches
• insomnia (trouble getting to sleep, or waking up many times during the night)
• increased stress levels and feelings of anxiety
• injury caused by fighting or doing things like punching walls or windows, etc.

Long-term health problems may be:

• stroke
• heart attack
• depression, even possibly leading to suicide attempts
• using alcohol and smoking to ‘get you through’ and all the health problems they cause.

Some of these conditions could kill you, but any of them would affect your ability to have a happy, healthy lifestyle.

Releasing anger

Things happen every day that make us feel angry. You can’t avoid feeling angry but you can make choices about how you are going to express your anger. Remember that abuse toward yourself or others is never an OK way of dealing with anger. Healthy choices are those that help you resolve a problem, or let you deal with your anger. What you do with your anger is your choice only – it is never anyone else’s fault.

Three steps that may help you deal with anger in a healthy way.

1. Feel the anger.

• Recognize that it is a normal emotion you are feeling because you believe you have been treated unfairly or that you are being threatened in some way.

2. Work out the actual cause of the anger.

• Who, why or what happened to make you feel angry? Identify when you first became angry. Was it because you are scared of something or your feelings were hurt?
• Are you feeling angry partly because of something that happened a long time ago (ex. childhood)?

3. Consider ways to deal with the cause of the anger.

• How could you try to explain or express why you are angry or upset?
• What sort of compromise could be made (recognizing your own and other’s rights)?
• Would it help to look at the situation from another person’s point of view?
• Make a list of your choices, and try to imagine what might happen if you tried them.
• Choose the one you think will be most beneficial for everyone involved.
• If you are angry because of something that happened a long time ago, or you can’t really work out why you are angry, you may find it useful to talk to a counselor.

It can be helpful to use assertiveness skills or learn about conflict resolution.

“Letting go”

• Physical exercise – let anger out bit by bit by running, aerobics or sport.
• Have a good cry or scream (in a safe environment) – let your anger out all at once. This can help express feelings of fear, hurt or grief.
• Write a letter. List the things you’re angry about. Destroy it if you want! If you want to send the letter, it can be a good idea to put it away for a few days before you put it in the mail.

Research shows a connection between stress and anger. If you are stressed out, you are likely to get angry more easily. If you are angry most of the time, you are more likely to feel stressed and anxious. Things you find relaxing can lower levels of stress and anger.

“Deep-relaxation”

• Taking deep even breaths – this tells the brain that the crisis is all over, and things can go back to normal!
• Count to ten – we’ve all heard this old favorite! It gives you time to get back in control of your feelings before you do or say something you regret. Whoops!
• Relaxation techniques like meditation and visualization Going for a walk or bike ride. Wander around and enjoy your surroundings.
• Take a warm relaxing bath.
• Listen to music you enjoy and find relaxing.

If anger has become a problem in your life, you may want to seek help.  A therapist can help you explore personal issues that help you to stay angry most of the time. Sometimes life experiences can hold you back from moving on with your life. Many people get help when they feel the things they’re trying on their own aren’t working!

Violence is a learned behavior

The way you express your anger is often learned from the people around you. If children are raised in a home where they see or experience violence, it is not surprising that children might grow up to think violence is the way to express anger.

The more you are around violence, the more likely you are to think it’s OK. If your friends are violent you might become used to it and think it’s alright. If you see lots of violence on things like TV or video games, you might see it as a way to let out your anger.

The good news is that any ‘learned’ behavior can be ‘unlearned’. If you want new ways of managing your angry feelings, practice them regularly and the new behaviors will soon become old habits.

Dealing with other people’s anger

If you are with a people who are angry and you think they may become violent, it is important to make sure that you are safe before the violence begins. This can mean leaving the situation or telling someone you trust and who can help you. You can’t change the way someone else uses his or her anger. Your safety is most important.

Some people may blame others for their anger. They might call you names or say things like “you make me so angry” or “you know I get angry when you do that”. You are not to blame for the other person’s anger. It is up to everyone to take responsibility for the way they choose to deal with their anger, and change the way they act. You can’t change a relationship by changing the things you do, or by hoping to change the other person.

It can be helpful to listen to what the angry person is saying and, where possible, agree that she has a right to feel angry about whatever it was that upset her. This strategy can establish some ‘common ground’ and, as long as you are safe, you can help the person who is angry to calm down and talk calmly about the problem.

If you are living with a violent partner, it is a good idea to have a ‘safety plan’ worked out. This might include having some money hidden away, some clothing packed in a suitcase (so you can leave quickly), or organizing somewhere to stay in an emergency situation. There are many crisis and domestic violence services that can give you advice and assistance.

If you are living in a situation of child abuse, it is important to tell someone you trust and who might be able to help. Remember you are not the cause of violence, it is not your fault.

There will be times when angry strangers confront you, possibly at work or even driving your car. If an angry person confronts you, it is important to stay calm. If you lose your temper as well, this can make things worse and anger can escalate. You may like to use some of the skills outlined in conflict resolution. If you are concerned about your safety contact your local police.

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Sexual abuse is the least frequently reported form of child abuse (6% of all cases). Experts believe that sexual abuse may be the most underreported type of child maltreatment because of the secrecy, the “conspiracy of silence” that so often surrounds these cases.

Sexual abuse includes fondling a child’s genitals, intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials.

The diagnosis, treatment and prevention of sexual child abuse are complex. Several points might be made here:

The diagnosis of sexual child abuse involves a thorough nonjudgmental history of the immediate events as well as a review of potential similar experiences often independently done by a physician, social worker, and the police department. A complete physical exam of the child which may include the taking of photographs to document sexual abuse is necessarily followed by x-rays and possible laboratory tests.

Pedophiles (people who sexually abuse children) often require intense psychological and pharmacological therapy prior to release into the community, because of the high rate of repeat offenders.

Children’s school programs regarding “good touch…bad touch” can provide parents and other caregivers with a forum in which to role-play and learn to avoid potentially harmful scenarios.

Parents should make sure that their child’s daycare center/preschool is licensed and has an open door policy regarding parental visitation.

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All people feel nervous from time to time.  However, sometimes fear or anxiety becomes so intense that it interferes with their ability to function at home, school, work, or in interpersonal relationships.  When an individual’s anxiety is consistently greater than normal for their age and the situation, seeking help may be beneficial.  There are several different types of anxiety disorders that affect children and adults.

Generalized Anxiety Disorder (GAD)

People with GAD experience excessive and uncontrollable worries and fears in a variety of areas.  The focus of worries often includes school or work performance, future events, and social activities.  People with this disorder also may be perfectionists and worry whether their performance meets unreasonably high standards.  Individuals with GAD also often report physical symptoms, such as headaches or stomachaches.

Phobias

A phobia is characterized by an intense fear of a specific circumstance or object that poses no real danger.  Simple phobias, such as fear of dogs or the dark, are extremely common among young children and tend to disappear with age.  However, when the fear causes the individual excessive fear and to actively avoid the feared object in such a way that it interferes with daily activities or interpersonal relationships, treatment may be beneficial.

Social phobia is characterized by excessive anxiety about, and avoidance of, social situations due to excessive concerns about negative evaluation or fears of rejection.  Situations that are often a concern include classroom presentations or speeches, parties, and dating.  When people are faced with a feared social or performance event, they often experience significant anxiety and physical symptoms (e.g., sweating, rapid heart rate, shaking, stomachaches, and dizziness).

Obsessive-Compulsive Disorder (OCD)

Obsessions are persistent, uncontrollable, and unwanted irrational thoughts or ideas.  People with OCD attempt to ignore, suppress, or neutralize the thoughts with some other thought or action.  Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words or numbers in their mind) that people with OCD feel “driven” to do in response to an obsession or rigid adherence to rules.  These compulsions are attempts at reducing distress or preventing a dreaded situation from occurring, even though the compulsive acts realistically cannot do so and often interfere with one’s life.  Obsessions and compulsions cause people marked anxiety or distress.  Although adults are aware that obsessions or compulsions are unreasonable or excessive, children with OCD may or may not be.

Separation Anxiety Disorder

Although anxiety over separation is a normal part of growing up, and most children react with unhappiness at being separated from their parents occasionally, this anxiety should decrease as children get older.  Separation anxiety disorder occurs when the distress upon routine separation from parents or the home environment is excessive and inappropriate for a child’s age.  This disorder can occur suddenly in a child who previously handled separation well.  Clinging, crying, panic, physical symptoms (e.g., stomachache, headache), and tantrums are common reactions of young children suffering from separation anxiety disorder.  In older children, unrealistic worry about harm to or abandonment by loved ones, reluctance to sleep alone, school refusal, and physical symptoms are signs of separation anxiety disorder.

Panic Disorder

Panic disorder is characterized by sudden, intense, and unprovoked feelings of fear or discomfort.  Common symptoms include difficulty breathing, a pounding heart, sweating, dizziness, and shaking.  Often, people worry about having another “panic attack” or avoid a variety of situations in an attempt to prevent it from happening again.  In agoraphobia, which is often comorbid with panic disorder, individuals may avoid public places or refuse to leave their homes at all.  Panic disorder is more common in adolescents and adults than in young children.

Posttraumatic Stress Disorder (PTSD)

Individuals with PTSD have witnessed or experienced a seriously traumatic event that evoked intense fear, helplessness, or horror. Traumatic events can include physical or sexual abuse, natural disasters in which there was a threat to safety (e.g., hurricanes, tornadoes), and witnessing or experiencing domestic violence.  Following the trauma, individuals with PTSD often re-experience the event through uncontrollable thoughts, repetitive play in children, nightmares, or intense physical symptoms (e.g., rapid heart rate, sweating) when exposed to signs or cues that resemble part of the event.  People with PTSD may also persistently avoid things associated with the traumatic event and may appear “numb” or unresponsive.  Other symptoms include sleep problems, irritability or angry outbursts, difficulty concentrating, and an easy startle response.  In PTSD, symptoms indicate a change from prior functioning and cause significant distress or impairment.

A thorough evaluation and accurate diagnosis are necessary to guide intervention with anxiety disorders.  Extensive research has demonstration successful outcomes with the use of cognitive-behavior therapy in individual, family, or group formats.  Therapy focuses on helping an individual identify and change maladaptive patterns of thinking and behavior.

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It has many names: couples counseling, relationship counseling, marriage counseling, premarital counseling, re-marital counseling, and others.

The fact is that couples come to counseling for many reasons.

• Frequent arguments
• Loss of emotional or sexual spark
• Infidelity
• Feeling taken for granted
• Not feeling “heard” or respected
• Pre-marital counseling
• Maintaining civility in divorce

These and other common issues often respond well to couples counseling.

In addition to specific issues, most couples benefit from improved communication and conflict-management skills. Couples learn to shortcut arguments, to listen respectfully, to voice one’s real needs and to respect and appreciation. Skills like these break many dysfunctional patterns and change the dynamics that can save marriages and relationships.

It is also common that one person in a relationship wants counseling but believes “My partner would never agree to that.” Surely it is helpful to have both partners come to counseling for any relationship. But it only takes one to change the relationship or the marriage. Time and again a partner has been surprised to discover that far from being helpless, he or she actually had the power to change the whole relationship just by changing his or her own actions and reactions. It’s also common for a reluctant partner to refuse to come at first but later to decide that he or she doesn’t want to be “left out” of the counseling.

Couples counseling has the power to…

• End chronic arguments
• Recover intimacy
• Restore trust
• Rebuild respect and appreciation
• Get your needs met

Many people regard a healthy love relationship to be life’s most valuable asset. Few things are so important to long-term health and happiness. What else in our lives could be more deserving of the best we can give? Call it couples counseling, relationship counseling, marriage counseling, or anything else — sometimes counseling is the best thing we can give to our relationship or our marriage.

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Conduct disorders are behavioral problems that occur in children and adolescents. These young people have a hard time following rules and behaving in socially acceptable ways. Because they are often viewed as “bad” or “delinquent,” they receive a negative reaction from others and will often behave even worse. Causes of these conduct disorders are unknown but may include brain damage, child abuse, growth defects, negative family and social experiences, and failure in school. Some children with a conduct disorder also have an attention deficit disorder or depression.

Signs and Symptoms

Children with conduct disorders are often physically and verbally aggressive with other children and adults. They often bully, threaten and intimidate others, start fights, and are sometimes cruel to animals. They have a major problem with expressing anger appropriately. They often lie, steal, destroy property, violate rules, try to “con” others, and exhibit sexual misbehavior. The future of these youngsters is likely to be unhappy unless they and their families can receive early, ongoing and comprehensive treatment. Without treatment, many are unable to adapt to the demands of adulthood and continue to have problems with relationships and holding a job as they grow older. They will also often break the law and may continue to behave in an antisocial manner.

Recommended Course of Treatment

Treatment of children with conduct disorders is difficult because the illness is complex and each child is unique. An uncooperative attitude and fear and distrust of adults adds to the treatment challenge. Counseling oriented towards changing thinking patterns and behaviors is usually needed to help the child learn how to express and control anger more appropriately. Youngsters with learning disabilities may require remedial education, and parents may need expert assistance with special behavior management and education programs at home and at school. In some youngsters, medication treatment may be used, especially with those who have difficulty paying attention and controlling themselves or those with depression. Because new attitudes and behavior patterns take time, treatment is rarely brief. However, treatment does offer a good chance for improvement in the present and hope for a more successful and happy life in the future.

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