Most personality disorders begin as problems in personal development and character which peak during adolescence and then are defined as personality disorders. 

Personality disorders are not illnesses in a strict sense as they do not disrupt emotional, intellectual, or perceptual functioning.  However, those with personality disorders suffer a life that is not positive, proactive, or fulfilling.  Not surprisingly, personality disorders are also  associated with failures to reach potential.

The Diagnostic and Statistical Manual of Mental Health Disorders DSM-IV-TR, published by the American Psychiatric Association, defines a personality disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

 Currently, there are 10 distinct personality disorders identified in the DSM-IV:

• Antisocial Personality Disorder:  Lack of regard for the moral or legal standards in the local culture, marked inability to get along with others or abide by societal rules.  Sometimes called psychopaths or sociopaths.  Known as conduct disorder for persons under age 18.
• Avoidant Personality Disorder:  Marked social inhibition, feelings of inadequacy, and extremely sensitive to criticism.
• Borderline Personality Disorder:  Lack of one’s own identity, with rapid changes in mood, intense unstable interpersonal relationships, marked impulsively, instability in affect and in self image.
• Dependent Personality Disorder:  Extreme need of other people, to a point where the person is unable to make any decisions or take an independent stand on his or her own. Fear of separation and submissive behavior. Marked lack of decisiveness and self-confidence.
• Histrionic Personality Disorder:  Exaggerated and often inappropriate displays of emotional reactions, approaching theatricality, in everyday behavior. Sudden and rapidly shifting emotion expressions.
• Narcissistic Personality Disorder:  Behavior or a fantasy of grandiosity, a lack of empathy, a need to be admired by others, an inability to see the viewpoints of others, and hypersensitive to the opinions of others.
• Obsessive-Compulsive Personality Disorder:  Characterized by perfectionism and inflexibility; preoccupation with uncontrollable patterns of thought and action.
• Paranoid Personality Disorder:  Marked distrust of others, including the belief, without reason, that others are exploiting, harming, or trying to deceive him or her; lack of trust; belief of others’ betrayal; belief in hidden meanings; unforgiving and grudge holding.
• Schizoid Personality Disorder:  Primarily characterized by a very limited range of emotion, both in expression of and experiencing; indifferent to social relationships.
• Schizotypal Personality Disorder:   Peculiarities of thinking, odd beliefs, and eccentricities of appearance,  behavior, interpersonal style, and thought (e.g., belief in psychic phenomena and having magical powers).

According to Dr. Sam Vaknin, self-proclaimed narcissist and author of Malignant Self Love – Narcissism Revisited, individuals with personality disorders have many things in common:

• Self-centeredness that manifests itself through a me-first, self-preoccupied attitude
• Lack of individual accountability that results in a victim mentality and blaming others, society and the universe for their problems
• Lack of perspective-taking and empathy
• Manipulative and exploitative behavior
• Unhappiness, suffering from depression and other mood and anxiety disorders
• Vulnerability to other mental disorders, such as obsessive-compulsive tendencies and panic attacks
• Distorted or superficial understanding of self and others’ perceptions, being unable to see his or her objectionable, unacceptable, disagreeable, or self-destructive behaviors or the issues that may have contributed to the personality disorder
• Socially maladaptive, changing the rules of the game, introducing new variables, or otherwise influencing the external world to conform to their own needs
• No hallucinations, delusions or thought disorders (except for the brief psychotic episodes of Borderline Personality Disorder)

Vaknin does not propose a unified theory of psychopathology as there is still much to learn about the workings of the world and our place in it.  Each personality disorder shows its own unique manifestations through a story or narrative (see Metaphors of the Mind), but we do not have enough information or verifying capability to determine whether they spring from a common psychodynamic source.

It is important to note that some people diagnosed with borderline, antisocial, schizoid, and obsessive-compulsive personality disorders may be suffering from an underlying biological disturbance (anatomical, electrical, or neurochemical).  A strong genetic link has been found in antisocial and borderline personality disorders (see Genetics and Mental Disorders, The Chemistry of Personality and The Biology of Borderline Personality Disorder).

Treatment of Personality Disorders

Dr. David B. Adams of Atlanta Medical Psychology says that therapists have the most difficulties with those suffering from personality disorders. They are difficult to please, block effective communication, avoid development of a trusting relationship, [and] cannot be relied upon for accurate history regarding problems or how problems arose (The Psychological Letter, February 2000).

According to the Surgeon General, mental disorders are treatable.  An armamentarium of efficacious treatments is available to ameliorate symptoms . . . Most treatments fall under two general categories, psychosocial and pharmacological.  Moreover, the combination of the two — known as multimodal therapy — can sometimes be even more effective than each individually. (See Mental Health: A Report of the Surgeon General)

By reading the DSM-IV’s definition of personality disorders, it seems that these conditions are not treatable.  However, when individuals choose to be in control of their lives and are committed to changing their lives, healing is possible.  Therapy and medication may help, but it is the individual’s decision to take accountability for his or her own life that makes the difference.

To heal, individuals must first have the desire to change in order to break through that enduring pattern of a personality disorder.  Individuals need to want to gain insight into and face their inner experience and behavior.  (These issues may concern severe or repeated trauma during childhood, such as abuse.)

This involves changing their thinking – about themselves, their relationships, and the world.  This also involves changing their behavior, as action reflects the learned internal changes.

Then, with a support system (e.g., therapy, self-help groups, friends, family), they can free themselves from their imprisoned life.

by Linda Lebelle

Research suggests that problems are more likely to occur during a transitional year, such as moving from elementary to middle school, or middle school to high school.

Some adolescents are able to get through this time with minimal assistance from their parents or teachers.  It may be enough for a parent to be available simply to listen and suggest coping strategies, provide a supportive home environment, and encourage the child’s participation in school activities. 

However, when the difficulties last longer than a single grading period, or are linked to a long-term pattern of poor school performance or behavior problems, parents and teachers need to intervene.

Identifying Adolescents Who Are At Risk for Failure

Some “at-risk” indicators, such as those listed here, may represent persistent problems from the early elementary school years for some children.  Other students may overcome early difficulties but begin to experience related problems during middle school or high school.  For others, some of these indicators may become noticeable only in early adolescence.

To intervene effectively, parents and teachers can be aware of some common indicators of an adolescent at risk for school failure, including:

• Attention problems as a young child – the student has a school history of attention issues or disruptive behavior.

• Multiple retentions in grade – the student has been retained one or more years.

• Poor grades – the student consistently performs at barely average or below average levels.

• Absenteeism – the student is absent five or more days per term.

• Lack of connection with the school – the student is not involved in sports, music, or other school-related extracurricular activities.

• Behavior problems – the student may be frequently disciplined or show a sudden change in school behavior, such as withdrawing from class discussions.

• Lack of confidence – the student believes that success is linked to native intelligence rather than hard work, and believes that his or her own ability is insufficient, and nothing can be done to change the situation.

• Limited goals for the future – the student seems unaware of available career options or how to attain those goals.

When more than one of these attributes characterizes an adolescent, the student will likely need assistance from both parents and teachers to complete his or her educational experience successfully.  Girls, and students from culturally or linguistically diverse groups, may be especially at risk for academic failure if they exhibit these behaviors.  Stepping back and letting these students “figure it out” or “take responsibility for their own learning” may lead to a deeper cycle of failure within the school environment.

Teens Want To Feel Connected to Their Family and Their School

In a recent survey, when students were asked to evaluate their transitional years, they indicated interest in connecting to their new school and requested more information about extracurricular activities, careers, class schedules, and study skills.  Schools that develop programs that ease transitions for students and increase communication between schools may be able to reduce student failure rates.

The Role of Parenting Style

Parenting style may have an impact on the child’s school behavior.  Many experts distinguish among permissive, authoritarian, and authoritative parenting styles.  These parenting styles are associated with different combinations of warmth, support, and limit-setting and supervision for children.

The permissive style tends to emphasize warmth and neglect limit-setting and supervision; the authoritarian style tends to emphasize the latter and not the former; while the authoritative style is one in which parents offer warmth and support, and limit-setting and supervision.  When the authoritative parenting style is used, the adolescent may be more likely to experience academic success.

It is important to remember that adolescents need their parents not only to set appropriate expectations and boundaries, but also to advocate for them.

Parents — and teachers — can assist teens by:

• Making the time to listen to and try to understand the teen’s fears or concerns

• Setting appropriate boundaries for behavior that are consistently enforced

• Encouraging the teen to participate in one or more school activities

• Attending school functions, such as sports, and plays

• Meeting as a team, including parents, teachers, and school counselor, asking how they can support the teen’s learning environment, and sharing their expectations for the child’s future

• Arranging tutoring or study group support for the teen from the school or the community through organizations such as the local YMCA or a local college or university

• Providing a supportive home and school environment that clearly values education

• Helping the teen think about career options by arranging for visits to local companies and colleges, picking up information on careers and courses, and encouraging an internship or career-oriented part-time job

• Encouraging the teen to volunteer in the community or to participate in community groups such as the YMCA, Scouting, 4-H, religious organizations, or other service-oriented groups to provide an out-of-school support system

• Emphasizing the importance of study skills, hard work, and follow-through

Don’t Give Up on Your Child

Understanding the factors that may put an adolescent at-risk for academic failure will help parents determine if their teen is in need of extra support.  Above all, parents need to persevere.  The teen years do pass, and most adolescents survive them, in spite of bumps along the way.

Being aware of common problems can help parents know when it is important to reach out and ask for help before a difficult time develops into a more serious situation.

Is this the true meaning of love, bonding, coupling?

Do we simply get used to other human beings, pets, or objects?

Habit-forming in humans is reflexive.  We change ourselves and our environment in order to attain maximum comfort and well being.  It is the effort that goes into these adaptive processes that forms a habit.  The habit is intended to prevent us from constant experimenting and risk taking.  The greater our well being, the better we function and the longer we survive.

Actually, when we get used to something or to someone – we get used to ourselves.  In the object of the habit we see a part of our history, all the time and effort that we put into it.  It is an encapsulated version of our acts, intentions, emotions and reactions.  It is a mirror reflecting back at us that part in us, which formed the habit.  Hence, the feeling of comfort:  we really feel comfortable with our own selves through the agency of the object of our habit.

Because of this, we tend to confuse habits with identity.  If asked WHO they are, most people will resort to describing their habits.  They will relate to their work, their loved ones, their pets, their hobbies, or their material possessions.  Yet, all of these cannot constitute part of an identity because their removal does not change the identity that we are seeking to establish when we enquire WHO someone is.  They are habits and they make the respondent comfortable and relaxed.  But they are not part of identity in the truest, deepest sense.

Still, it is this simple mechanism of deception that binds people together.  A mother feels that her offspring are part of her identity because she is so used to them that her well being depends on their existence and availability.  Thus, any threat to her children is interpreted to mean a threat on her Self.  Her reaction is, therefore, strong and enduring and can be recurrently elicited.

The truth, of course, is that her children are a part of her identity in a superficial manner.  Removing them will make her a different person, but only in the shallow, phenomenological sense of the word.  Her deep-set, true identity will not change as a result.  Children do die at times and their mother does go on living, essentially unchanged.

But what is this kernel of identity that I am referring to?  This immutable entity which is the definition of who we are and what we are and which, ostensibly, is not influenced by the death of our loved ones?  What is so strong as to resist the breaking of habits that die hard?

It is our personality.  This elusive, loosely interconnected, interacting, pattern of reactions to our changing environment.  Like the Brain, it is difficult to define or to capture.  Like the Soul, many believe that it does not exist, that it is a fictitious convention.  Yet, we know that we do have a personality.  We feel it, we experience it.  It sometimes encourages us to do things – at other times, as much as prevents us from doing them.  It can be supple or rigid, benign or malignant, open or closed.  Its power lies in its looseness.  It is able to combine, recombine and permute in hundreds of unforeseeable ways.  It metamorphizes and the constancy of its rate and kind of change is what gives us a sense of identity.

Actually, when the personality is rigid to the point of being unable to change in reaction to changing circumstances, we say that it is disordered.  A personality disorderis the ultimate misidentification.  The individual mistakes his habits for his identity.  He identifies himself with his environment, taking behavioral, emotional, and cognitive cues exclusively from it.  His inner world is, so to speak, vacated, inhabited, as it were, by the apparition of his True Self.

Such a person is incapable of loving and of living.  He is incapable of loving because to love (at least according to this model) is to equate and collate two distinct entities: one’s Self and one’s habits.  The personality disordered sees no distinction.  He is his habits and, therefore, by definition, can only rarely and with an incredible amount of exertion, change them.

And, in the long term, he is incapable of living because life is a struggle towards, a striving, a drive at something.  In other words:  Life is Change.  The person who cannot change, cannot live.

by Dr. Sam Vaknin,

author of Malignant Self Love – Narcissism Revisited

An important outcome is emotional growth whether or not it is intentionally built into the program structure.  Outdoor programs have helped teens improve in

• self-concept

• social skills

• academic achievement

• classroom behavior

• group cohesion

• relationships with family and peers

Summer Camps

The goals of summer camps and other recreation programs are fun, enjoyment, and recreation.  Through these goals, camp participants can learn social skills, become more socially comfortable, more open to trying new things, learn empathy and cooperation, and different ways of responding to new and challenging situations.

It is at camp where the underachieving teen suddenly takes a leadership role on an overnight hike; the shy child assumes the lead role in a dramatic production; a clumsy child learns she excels in art.  All of these experiences build character and develop leadership skills.

Although parents will often see dramatic changes in their teen’s attitude, behavior, and motivation, summer camps are a good choice for teens who are not having major behavior problems.  Fun activities, connecting with new peers and enjoying some structured independence are all benefits of summer camping for teens.

Special needs camps can positively affect teens with issues such as ADHD, Asperger Syndrome, obesity, learning differences, or behavioral problems.  By nature of their focus, there is usually more emphasis on staff training and support.  Administrative staff will have a background in the field and counselors will either be professionals or college students aspiring to work in the helping professions.

A summer camp is a good choice for teens

• with no behavior problems or emotional issues

• during the critical middle-school years when enriching and empowering experiences are crucial

• when the teen needs respite from difficult family situations, such as divorce and separation or when a sibling is having behavior problems

• that have special needs and would benefit from a camp experience

Wilderness Programs

Wilderness programs are not designed as therapy, but are intended to have a positive impact on emotional growth, character development, and general psychological well-being.  The challenges faced in the outdoors bring about a greater understanding of self, others, and the natural world. 

Many wilderness programs incorporate an element of perceived risk which encourages teens to move beyond their comfort zones and face their issues and fears.  Moving out of the usual environment helps to reduce defensiveness and change relationships with adult leaders. 

Wilderness programs are also relatively free from external forces — peers, school, family, TV, other societal influences — and so provide the opportunity to explore new responses and develop new patterns of thought and behavior.

These programs provide teens an opportunity to go beyond their self-imposed limitations.  Groups engage in a series of activities that promote individual abilities, teamwork, good communication, and leadership skills. Individual and group success is achieved through peer support and encouragement, not physical strength.  There is no place for blame, denial, excuses, and other defense mechanisms.

Most wilderness programs use a small-group format and encourage interdependence and cooperation among group members.  In expedition programs, where teens and counselors venture out into natural settings for extended periods of time, the 24-hour-a-day group experience becomes very powerful.

In general, wilderness programs build self-esteem, leadership, academics, personality, and interpersonal relations, with self-esteem change being most significant.

Adventure Therapy Programs

Adventure therapy programs use the outdoors as a part of therapy, or use an adventure activity — such as wilderness expeditions — to guide towards therapeutic goals.  Real or perceived risk, uncertainty of outcome, and personal decision-making help bring about behavioral change and personal growth.

For treating teens with emotional, behavioral, and substance abuse disorders, adventure therapy, with its hands-on approach, can be an effective treatment choice.  Adventure therapy focuses on creating personal change through learning by doing.  It presents opportunities for trust and personal growth to help teens experience feelings of self-worth, to assume responsibility for their own actions, and to internalize new coping skills.

Choosing an Outdoor Program

Choosing an outdoor program is difficult for any parent, but the search can seem overwhelming when your child has behavior problems, attention disorders, or learning differences.

Parents need to make some decisions concerning the type of program that is most appropriate and then gather some basic information about programs offering this type of experience.

Friends, relatives, or neighbors may have recommendations based on their experiences.  If you’re looking for a religious program, talk with your clergy and find out if your church organization sponsors any camps, or knows of a related religious organization that runs a camp.  Your local Y, Scouts, Camp Fire Boys and Girls, the school system, or recreation department may also sponsor outdoor programs.

Camp fairs, which take place in many locations around the country, are an excellent place to pick up literature, talk to staff, and ask questions.  Camp fairs are usually advertised in newspapers, magazines, and other local media.

Consult with your child’s therapist on therapeutic outdoor programs if adventure therapy has been recommended.  Your child’s home therapist will have some level of involvement during your child’s residential stay and after-care.

Research any program thoroughly.  Learn the program’s philosophy and ask the program to describe its goals and mission.  Find out how long the program has been operating.  Ask about the admission criteria.  Don’t hesitate to ask questions.

Talk directly to the staff at the outdoor program and not independent marketers who often misrepresent themselves and give misleading information. You should be able to speak directly with the program director, counseling supervisor, clinical director, and medical staff.

Ask about the education and certification of the director and other program staff.  Find out the ages of the counselors and how they are screened, chosen, and trained.  Find out if there are any current lawsuits against the program, and if any staff member has ever been charged with physical or sexual misconduct against a child.  Find out about the staff turnover rate.

Ask about the qualifications, training and licensure of the program’s medical staff.  Most programs have an on-site infirmary staffed by a nurse or other qualified medical personnel.  In addition to treating cuts, insect bites and other injuries, infirmary staff are responsible for storing and administering medications and monitoring children with special medical needs.

Check on how the program is licensed and/or accredited.  Most states require licensure although this varies from state to state. The program director can tell you how to contact the state licensing agency to check the program’s compliance history — this is a matter of public record.

Accreditation is voluntary and the standards for accreditation by the American Camping Association are more stringent than what the state requires.  Ask to see a copy of the last accreditation report or their last safety report.

Other accrediting agencies such as the Council on Accreditation (COA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredit some programs.

Be sure to ask for references, the names of parents and teens who attended the program and who would be willing to talk with you and your child about their experiences.

Other important information to know includes:

• Health and safety procedures, including accident and emergency procedures

• Number of participants and their ages

• Rules and consequences policy

• Family involvement, including progress reports, communication with staff, and communication with your child

• Health insurance coverage

An important factor in finding the right outdoor program is the trust and comfort level between parents and staff.  However, trust must be backed up by facts.  The more parents and the program believe in each other and are working toward the same goals, the better the teen’s chance of a positive, enriching, and empowering experience.

Helping Others Cope With Grief

It’s part of life.  Someone special died today.  Someone’s father or mother, husband or wife, son or daughter.  A family, a lifetime of memories and a lot of pain are left behind.  And, for the survivors, the pain is just beginning.  Working through that pain and sadness is often a long and grueling process called mourning.

Almost everyone worries about what to say to the survivors.  You don’t want to hurt their feelings or upset them.  But more important than knowing what to say is knowing how to listen.  You cannot take away the pain that friends or co-workers are suffering from the loss of a loved one, but you can listen to their stories.  Storytelling is a very common and effective way for the grieving person to keep the memory of a loved one alive.  The biggest fear for someone in mourning is that those around them will forget the loved one now that they are gone.

It is helpful to allow the survivors to “tell the story” about how their loved one died.  At first, they will recount minute details, but with each retelling, the story typically gets shorter.  Each time they tell it, it becomes part of acknowledging and accepting the reality of the death.

If the subject of death makes you uncomfortable, understand that most people feel the same way.  But realize that there is a real need for the survivor to talk.  Don’t worry about being conversational.  It is simply more important to listen.

Let those who are grieving know that you are thinking of them and of the loved one that has passed away.  Let them know that you are praying for them and their families.  A card can let someone know you are thinking of him or her.  A visit or a phone call to listen would even be a better idea.

Some people listen best over a plate of cookies, a glass of tea or milk, and some time set aside to concentrate one-on-one with the person who is grieving.  Whatever your style, by simply listening, we can help others cope with their grief.

Teens who are having serious problems with grief and loss may show one or more of these signs:

• an extended period of depression in which the teen loses interest in daily activities and events

• inability to sleep, loss of appetite, prolonged fear of being alone

• acting much younger for an extended period

• excessively imitating the dead person

• repeated statements of wanting to join the dead person

• withdrawal from friends

• sharp drop in school performance or refusal to attend school

• lack of concentration

• declining grades

• over-activity, acting too busy

• drug and/or alcohol use

• risk-taking behavior

• promiscuity

• self-destructive, antisocial, or criminal behavior

• suicidal thoughts

These warning signs indicate that professional help may be needed.  Child and adolescent therapists can help youth accept the death and assist the survivors in helping through the mourning process.

by Sharon Strouse, Family and Consumer Sciences, Ohio State University

Peer Influence & Peer Relationships

Teens want to be with people their own age — their peers.  During adolescence, teens spend more time with their peers and without parental supervision.  With peers, teens can be both connected and independent, as they break away from their parents’ images of them and develop identities of their own.

While many families help teens in feeling proud and confident of their unique traits, backgrounds, and abilities, peers are often more accepting of the feelings, thoughts, and actions associated with the teen’s search for self-identity. 

Positive Peer Pressure

The ability to develop healthy friendships and peer relationships depends on a teen’s self-identity, self-esteem, and self-reliance.

At its best, peer pressure can mobilize your teen’s energy, motivate for success, and encourage your teen to conform to healthy behavior.  Peers can and do act as positive role models.  Peers can and do demonstrate appropriate social behaviors.  Peers often listen to, accept, and understand the frustrations, challenges, and concerns associated with being a teenager.

Negative Peer Pressure

The need for acceptance, approval, and belonging is vital during the teen years. Teens who feel isolated or rejected by their peers  — or in their family — are more likely to engage in risky behaviors in order to fit in with a group.  In such situations, peer pressure can impair good judgment and fuel risk-taking behavior, drawing a teen away from the family and positive influences and luring into dangerous activities.

For example, teens with ADHD, learning differences or disabilities are often rejected due to their age-inappropriate behavior, and thus are more likely to associate with other rejected and/or delinquent peers.  Some experts believe that teenage girls frequently enter into sexual relationships when what they are seeking is acceptance, approval, and love.

A powerful negative peer influence can motivate a teen to make choices and engage in behavior that his or her values might otherwise reject.  Some teens will risk being grounded, losing their parents’ trust, or even facing jail time, just to try and fit in or feel like they have a group of friends they can identify with and who accept them.  Sometimes, teens will change the way they dress, their friends, give up their values or create new ones, depending on the people they hang around with.

Some teens harbor secret lives governed by the influence of their peers.  Some — including those who appear to be well-behaved, high-achieving teens when they are with adults — engage in negative, even dangerous behavior when with their peers. 

Once influenced, teens may continue the slide into problems with the law, substance abuse, school problems, authority defiance, gang involvement, etc.

If your teen associates with people who are using drugs or displaying self-destructive behaviors, then your child is probably doing the same.

Encourage Healthy and Positive Relationships

It is important to encourage friendships among teens.  We all want our children to be with persons who will have a positive influence, and stay away from persons who will encourage or  engage in harmful, destructive, immoral, or illegal activities.

Parents can support positive peer relationships by giving their teenagers their love, time, boundaries, and encouragement to think for themselves.

Specifically, parents can show support by:

• Having a positive relationship with your teen.  When parent-teen interactions are characterized by warmth, kindness, consistency, respect, and love, the relationship will flourish, as will the teen’s self-esteem, mental health, spirituality, and social skills.

• Being genuinely interested in your teen’s activities.  This allows parents to know their teen’s friends and to monitor behavior, which is crucial in keeping teens out of trouble.  When misbehavior does occur, parents who have involved their children in setting family rules and consequences can expect less flack from their children as they calmly enforce the rules.  Parents who, together with their children, set firm boundaries and high expectations may find that their children’s abilities to live up to those expectations grow.

• Encouraging independent thought and expression.  In this way, teens can develop a healthy sense of self and an enhanced ability to resist peer pressure.

When Parents Don’t Approve

You may not be comfortable about your son or daughter’s choice of friends or peer group.  This may be because of their image, negative attitudes, or serious behaviors (such as alcohol use, drug use, truancy, violence, sexual behaviors).

Here are some suggestions:

• Get to know the friends of your teen.  Learn their names, invite them into your home so you can talk and listen to them, and introduce yourself to their parents.

• Do not attack your child’s friends.  Remember that criticizing your teen’s choice of friends is like a personal attack.

• Help your teen understand the difference between image (expressions of youth culture) and identity (who he or she is).

• Keep the lines of communication open and find out why these friends are important to your teenager.

• Check whether your concerns about their friends are real and important.

• If you believe your concerns are serious, talk to your teenager about behavior and choices — not the friends.

• Encourage your teen’s independence by supporting decision-making based on principles and not other people.

• Let your teen know of your concerns and feelings.

• Encourage reflective thinking by helping your teen think about his or her actions in advance and discussing immediate and long-term consequences of risky behavior.

• Remember that we all learn valuable lessons from mistakes.

No matter what kind of peer influence your teen faces, he or she must learn how to balance the value of going along with the crowd (connection) against the importance of making principle-based decisions (independence)

And you must ensure that your teen knows that he or she is loved and valued as an individual at home.

What Should I Know About My Teenager’s Emotional Health?

The teenage years are a time of transition from childhood into adulthood.  Teens often struggle with being dependent on their parents while having a strong desire to be independent.  Ideally, they are maturing from the one-sided self-centeredness of childhood to a self-identity that balances responsible self-interest with care and love for others.

What Are The Characteristics of Emotionally Healthy People?

People who are emotionally healthy view all that they do and say in light of how their words and actions affect others.  They do not manipulate, exploit, or abuse others.  They understand that the world does not revolve around them. They are not self-absorbed and they don’t feel entitled.  They recognize their self-centered nature but choose to value their relationship with God and others over their own self-interest.  Because of this, they are less likely to suffer from depression or anxiety.

Emotionally healthy people accept personal responsibility for their behavior and their choices.  There is no victim mentality, no blaming others, society and the universe for their problems or disappointments.  They realize that they are in charge of their lives — responsible for every action, word and thought, and accountable for the resulting consequences.

People who are emotionally healthy experience, acknowledge, identify, and accept their own emotions.  This means that they are open to their feelings and are aware of what they are actually feeling. They don’t distract themselves from their emotions through hiding or numbing themselves with obsessive behaviors (e.g., drug and alcohol use, sex, self-injury, gambling, work, hobbies, Internet use).  Those who are not in touch with their own feelings are not likely to have a sense of conscience.

Because emotionally healthy people are in touch with their feelings, they can identify with others’ feelings — they show empathy.  It’s necessary to not only “get into the shoes,” but get “into the heart and soul” of another.  To do that, the person must put the need for acknowledgement of his or her own emotions on hold.  Being able to correctly and comprehensively read another person’s emotional messages empowers them to intuitively identify with the person.  Emotionally healthy people are able to imaginatively insert themselves in other people’s situations and experience them intimately.  In turn, they are able to feel and make a compassionate response.

What Can I Do to Help My Teen?

Working on your own emotional health and communicating your love for your teen are the most important things you can do.  Children decide how they feel about themselves in large part by how their parents behave and react to them.  It’s also important to discuss your values and spiritual beliefs, and to set expectations and boundaries (e.g., honesty, self-control, respect for others), while still allowing teenagers to have their own space.

Parents of teens often find themselves noticing only the problems, and they may get in the habit of giving mostly negative feedback and criticism.  Although teens need feedback, they respond better when it is given positively and spoken with love.

Acknowledging and praising appropriate, responsible, and caring  behavior can help your teen feel a sense of accomplishment, enhance self-esteem, and reinforce your family’s values.

A child who reaches age 21 without

smoking, abusing alcohol or using drugs

is virtually certain never to do so.

- Joseph A. Califano, Jr., Chairman and President,

The National Center on Addiction and Substance Abuse at Columbia University

Alcohol abuse and alcohol dependence are not only adult problems — they also affect a significant number of adolescents and young adults between the ages of 12 and 20, even though drinking under the age of 21 is illegal.

The average age when youth first try alcohol is 11 years for boys and 13 years for girls.

By age 14, 41 percent of children have had least one drink.

The average age at which Americans begin drinking regularly is 15.9 years old.

Teens who begin drinking before age 15 are five times more likely to develop alcohol dependence than those who begin drinking at age 21.

An early age of drinking onset is also  associated with alcohol-related violence not only among persons under age 21 but among adults as well.

U.S. Department of Health and Human Services (HHS), The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking.  HHS, Office of the Surgeon General, 2007.

While drinking may be a singular problem behavior for some, research suggests that for others it may be an expression of general adolescent turmoil that includes other problem behaviors and that these behaviors are linked to unconventionality, impulsiveness, and sensation-seeking.

Binge drinking, often beginning around age 13, tends to increase during adolescence, peak in young adulthood (ages 18-22), then gradually decrease.  Individuals who increase their binge drinking from age 18 to 24 and those who consistently binge drink at least once a week during this period may have problems attaining the goals typical of the transition from adolescence to young adulthood (e.g., marriage, educational attainment, employment, and financial independence).

Dependence on alcohol and other drugs is also associated with several mental health problems,  such as:

• depression

• anxiety

• oppositional defiant disorder (ODD)

• antisocial personality disorder

Whether anxiety and depression lead to, or are consequences of, alcohol abuse is not known.

Alcohol use among adolescents has also been associated with considering, planning, attempting, and completing suicide.  Research does not indicate whether drinking causes suicidal behavior, only that the two behaviors are correlated.

Parents’ drinking behavior and favorable attitudes about drinking have been positively associated with adolescents’ initiating and continuing drinking.  Children who were warned about alcohol by their parents and children who reported being closer to their parents were less likely to start drinking.

Lack of parental support, monitoring, and communication have been significantly related to frequency of drinking, heavy drinking, and drunkenness among adolescents.  Harsh, inconsistent discipline and hostility or rejection toward children have also been found to significantly predict adolescent drinking and alcohol-related problems.

It has been estimated that over three million teenagers are out-and-out alcoholics.  Several million more have a serious drinking problem that they cannot manage on their own.

Annually, more than 5,000 deaths of people under age 21 are linked to underage drinking.

The three leading causes of death for 15- to 24-year-olds are automobile crashes, homicides and suicides — alcohol is a leading factor in all three.

Peer drinking and peer acceptance of drinking have also been associated with adolescent drinking.

The most common and effective way for an individual to combat his or her addictive behaviors is through a self-help support group, with advice and support from a health care professional.  Treatment should also involve family members because family history often plays a role in the origins of the problem and successful treatment cannot take place in isolation.

The National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), offering various resource information. Through this service you can speak directly to a representative concerning alcohol and other drugs, request printed material on alcohol or other drugs, or obtain local substance abuse treatment referral information in your State.

Information provided by the U.S. Department of Health and Human Services, Office of the Surgeon General and the National Clearinghouse for Alcohol and Drug Information.  To learn more about alcohol and other drugs of abuse, contact NCADI  at 1-800-729-6686.

There are so many concerns surrounding the diagnosis and treatment of ADD/ADHD that parents must be knowledgeable and cautious.  It is usually the school that approaches parents to have an assessment for ADD/ADHD and parents often feel pressured in having the traditional drug treatment to ‘correct’ their child’s behavior.

What should parents do if the school identifies a child with potentially having ADD/ADHD?

• Have the school put their concerns and directions in writing.  Hold them accountable.

• If the school tells you that your child needs medication to control his or her behavior, remind them that medical help does not necessarily mean taking medication.

• If you are told to sign a release for your child’s medical records, ask to see that law in writing.

• Whenever you have a school conference or go before a school review board, record that meeting on a tape recorder.  The recorder should be in plain sight.  If you are told that the meeting is confidential, remember that confidentiality is your child’s right — not the school’s right.

• Children who have an ADD/ADHD diagnosis normally have an above-average IQ.  Ask the school why it is so difficult for them to teach the smartest kids in school.

• The federal government allots over $2 billion to local school systems under the Individual Development Assistance Act of 1985.  Ask the school officials how much money their school and school system gets when a child is coded as needing special education services.

• Find out what percentage of students in the school system are taking ADD/ADHD medication.  The average number is between 3-5%.