Research studies have shown that children raised by a depressed parent are at increased risk for academic and behavioral problems, as well as developing major depression themselves. These risks emanate from both a child’s genetic predisposition for developing depression, as well as their stressful environmental upbringing, says Michelle Sherman, PhD, a clinical associate professor of psychology at the University of Oklahoma Health Sciences Center in Oklahoma City and the author of I’m Not Alone: A Teen’s Guide to Living with a Parent Who Has a Mental Illness. “Children often assume blame or responsibility for their parents when things go wrong, like in depression or divorce” adds Sherman.

Parents suffering from untreated major depression are typically pessimistic and uninterested in life and social activities; they also frequently have low energy, and irritability- all of which make even the basic tasks of parenthood overwhelming. When mothers are depressed, they tend to be less organized, less responsive, more likely to express negative emotions, and less likely to be engaged with their children compared to non-depressed mothers, says Kate Fogarty, assistant professor of youth development at the University of Florida. For many children, this experience forces them to learn to care for themselves prematurely, and may place them inappropriately in the role of parental caretaker. Other children are less capable, and develop dysfunctional patterns of behavior and emotional disturbance as a result of ongoing parental neglect.

A study of 244 formerly depressed adolescents revealed that those whose mothers had a history of major depression were more likely to experience a recurrence of depression between the ages of 19 and 24, and had more frequent and severe depressive episodes. Depressed mothers had more of an impact on the adolescents’ mental health than depressed fathers, according to this 2005 study by researchers at the Oregon Research Institute in Eugene, Ore., although the sons of depressed fathers were found to be more likely to consider and attempt suicide. The effects of having a father with depression has not been studied to the extent of depressed mothers, says Fogarty, but she suspects that the effect would be similar for any primary caretaker. “If this was the father and he was depressed, I would suspect there would be similar results. Researchers look at maternal depression mainly because mothers are traditionally the primary caretaker, but that’s changing” she adds.

How to support children with a depressed parent, and decrease their mental health risks.
“Depressed parents and their families should know that there is much one can do to reduce a child’s risk for becoming depressed. Just one adult who’s available and willing to help support the child can make a big difference in a child’s life when a parent is depressed,” says Sherman. Additional emotional support can come from relatives in the family, a child psychologist, school teachers, church members, or other role models in community groups. Spouses of depressed parents also need support, since parental duties often fall disproportionately upon them much of the time. Couples and family therapy are also great resources that teach healthy communication, as well as how to build coping resources and resiliency in all family members.

Grandparents can also be a great resource in mitigating the negative effects of parental depression upon a child. “Frequent contact between a child and his or her grandparents, especially if the relationship is warm and nurturing, lessens the likelihood the child will develop depression later in life” according to Fogarty. “It is important for children to have a strong adult who is consistent in his or her life” adds Fogarty.

Adults hoping to help should provide a structured environment whenever possible, most importantly, one that encourages a child to express their emotions. “That can be as simple as maintaining a dialogue with the children, keeping the lines of communication open. It can also be showing sensitivity to the child’s needs,” says Fogarty. Children with a depressed parent need adults who can detect their emotional state, since they often struggle to notice their own feelings and mood. As children, they’ve learned to focus on the emotional states of others, as a way to anticipate the shifting moods of their depressed parent. “If a child comes home after a bad day and is visibly upset, a depressed caregiver might not be available to help them through that process,” says Fogarty.

Is there hope for children raised by a depressed parent?

Some of these children show incredible resiliency, in spite of the challenges they’ve faced being raised by a depressed parent. These tend to be children with higher than average intelligence, who learn early on how to utilize an array of outside resources for guidance and support. They are often capable of socially complex problem solving, appearing ‘wise beyond their years.’ Further, they are usually comfortable with stressful situations, making them well suited to careers that require them to anticipate and read others’ emotions. They tend to be independent and self-sufficient, and are often ‘the workhorse’ and conflict facilitator in groups. As adults, they are usually sensitive and understanding of others with mental health issues. While children raised by a depressed parent remain vulnerable to depression themselves due to the aforementioned reasons, this experience does not mean they are doomed to repeating the life of their depressed parent. With sufficient support and early intervention, children raised by a depressed parent can go on to lead normal, healthy lives.

Very few studies have examined the long term health consequences for people who divorce.
According to Dr. Gerald F. Jacobson, director of the Didi Hirsch Community Mental Health Center in Culver City, Calif., author of ‘The Multiple Crises of Marital Separation and Divorce “there has been a ‘disproportionate emphasis on the impact of divorce on children, and not enough attention to how divorce affects the former spouses.” Celebrities like Hollywood actress Eva Longoria and NBA player Tony Parker, who have recently made international news by filing for divorce after 7 years together, are not immune to the long term health consequences of divorce, as seen below. Erin Barry, San Antonio Spurs former player Brent Barry‘s wife has also recently filed for divorce, and has admitted to sexting with Tony Parker for months, perhaps leading to the demise of both marriages.

Both Dr. Gerald F. Jacobson and Dr. James J. Lynch, a psychologist at the University of Maryland, author of ”The Broken Heart: The Medical Consequences of Loneliness”, suggest that people’s reaction to divorce is similar to experiencing the death of a spouse. Feelings of anger, guilt and depression often become overwhelming. However unlike in bereavement, the former spouse continues on with their life, making it difficult to gain closure following a divorce.

Scientific research has long established the biological connection between emotional stress, and the development of physical illness. Untreated stress can lead to abnormal immunological functioning in those who have divorced, making them more vulnerable to all kinds of illnesses, including cancer. A study examining the health effects of divorce reveal that after a diagnosis of cancer, married people are most likely to recover, while the divorced are least likely to recover, indicating that the emotional trauma of divorce has a long-term impact on the physical health of the body.

Dr. Robert Segraves, a psychiatrist and marriage and divorce counselor at the University of Chicago Medical Center, points out that divorced people not only have higher suicide rates, but also higher rates of admission to psychiatric hospitals and outpatient clinics, more visits to non-psychiatric physicians than people who were married, single or widowed. Dr. Segraves points out ”There’s a lot of evidence that divorce is an overwhelming stress for most people, even if they are getting divorced for the right reasons. There’s tremendous internal and external reorganization required after a divorce. And the effects are not just short-term. We see a lot of people years later who are having trouble reconnecting with the opposite sex. Men, for instance, often have problems with impotence four or five years later because they’re scared to death to be reconnected.”

In a study of 79 men and 159 women who were separated or divorced and who went to a psychiatric crisis clinic, Dr. Jacobson found that time did not necessarily heal the wounds of divorce. While depression peaks immediately after the initial separation and then subsides, Dr. Jacobson found that those who are separated 14 months or more, whether or not they have filed for divorce, ”do not tend to improve further and may even worsen.” He also found that while women were most disturbed just before separation, ”men tend to be more depressed, anxious and suicidal after separation.”

Should you remain ‘friends with your ex” when no children are involved, such as in the marriage of Eva Longoria & Tony Parker?

While many mental health professionals purport that divorced spouses can continue to be valuable resources for one another, Dr. Jacobson found that ”more often than not, continued reliance may not be associated with better levels of mental health, particularly in women.” Results from this study suggest that ”disturbance will be less when there is a moderate amount of contact between the spouses and when emotional reliance is acknowledged when it exists.”

In spite of the negative impact divorce can have upon one’s health, divorce can also be an opportunity for positive growth. By learning and growing from the divorce experience, you will be better equipped to develop a healthy romantic relationship in the future. For more advice on how to move on and manage stress following a divorce, visit this article featured on Dr. Phil.com

For most American college students, the influx of new social opportunities, academic demands, pulling all nighters, and the ubiquitous college party scene can lead to high levels of stress. But students with bipolar disorder or other mental health problems, and students with a family history of mental health disorders, are especially vulnerable in a college environment.

The pressure of academic performance, social demands, and irregular sleep patterns are all triggers of depression as well as mania, the euphoric, revved-up state characteristic of bipolar disorder. In fact, college is one of the most common places people experience their first bout of depression or mania. According to Russell Federman, Ph.D, the director of Counseling and Psychological Services at the University of Virginia student health center, the desire to fit in and conform to the college lifestyle can cause students with mental health problems to abandon healthy behaviors, even their medications. Without the right treatment and support, bipolar college students face higher dropout rates, drug and alcohol abuse, and even suicide.

A 2006 study in the Journal of Affective Disorders compared a group of bipolar adults with a group of healthy adults who had similar IQs and social backgrounds. More than 60 percent of both groups entered college, but their achievements differed greatly: Nearly half of the control group received a college degree, compared to just 16 percent of the bipolar group.

Students with bipolar disorder or other mental health problems can succeed in college, but doing so requires dedication to a plan. The following points are ALL crucial and can make the difference between achieving your college success goals and dropping out or worse, losing control of your mental health.

* Taking the proper medications, and ensuring they are easily accessible for refills
* arranging for the appropriate counseling and medical care on campus in addition to outside support
* avoiding drugs and alcohol and even caffeine, as they can render medications ineffective
* maintaining a steady sleep and study schedule
* finding sources of peer support

In his 2010 book, “Facing Bipolar: The Young Adult’s Guide to Dealing With Bipolar Disorder”, Federman outlines what he calls the “four S’s of bipolar stability”: structure, stress management, sleep management, and self-monitoring. This framework includes sticking to a regular schedule of studying and sleep, and learning to recognize the signs that you are beginning to drift into mania or hypomania.

An organization called Active Minds is trying to open the dialogue about mental illness on college campuses. Founded by Alison Malmon in 2001, following the suicide of her older brother, the organization now has more than 200 chapters nationwide. Active Minds organizes events such as National Day Without Stigma and has partnered with the Depression and Bipolar Support Alliance to create peer support groups on college campuses.

Bipolar disorder, also known as manic-depressive illness, has become a commonly used term by the public, with many of us becoming familiar with it as a result of celebrities such as Bobby Brown, Ben Stiller, Britney Spears, and Jim Carey exhibiting symptoms or identifying themselves as having been diagnosed with this disorder. But what exactly IS Bipolar disorder, and how can you tell the difference between someone who meets the criteria for the disorder from someone who is just ‘moody’ or chooses to live an extreme lifestyle?

Bipolar is a brain disorder, or chemical imbalance that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. The symptoms of bipolar disorder are severe, and the criteria for receiving a diagnosis are quite specific. They are different from the normal ups and downs that everyone goes through from time to time, as well as more extreme mood shifts you might observe in others.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies Bipolar Disorder by the occurrence of one or more manic or mixed episode (also known as agitated depression) often accompanied by depressive episodes. So even if you’re depressed 99 percent of the time, experiencing just one manic episode qualifies you for a diagnosis of bipolar disorder according to this definition – but that still leaves most of us confused about who fits the criteria for a diagnosis, aside from the fact that the DSM-IV also differentiates between Bipolar I, Bipolar II, Hypomania, and Cyclothymia (all diagnoses that can be referred to as ‘manic depressive’.)

This article aims to explain the differences amongst these disorders in the simplest terms. Bipolar disorder is an illness that impacts a person’s thoughts, feelings, perceptions (both mental and physical), and behavior. It’s likely caused by electrical and chemical elements in the brain that are not functioning properly, with research suggesting that people are genetically vulnerable to inheriting the disease when their families have a history of its occurrence.

Typically, a person with manic-depression experiences moods that shift from high to low and back again, with varying degrees of severity. To receive a diagnosis of bipolar, these symptoms CANNOT be a direct result of alcohol or drug use. The symptoms are severe enough to lead to impairment in work, social, or academic functioning, and may lead to involuntary hospitalization to prevent harm to self or others. Note: to receive a diagnosis of a manic or depressive episode, a specific type, duration and number of symptoms MUST be present; refer to a mental or medical health professional or the DSM-IV for more details on this.)

A depressive episode can be identified by:

Mood Changes:

A long period of feeling sad, hopeless, worried, guilty or tearful
Loss of interest in activities once enjoyed, including sex.

Behavioral Changes:

Feeling tired, or ‘slowed down’
Having problems concentrating, remembering, and making decisions
Being restless or irritable
Changing eating, sleeping, or other habits
Thinking of death or suicide, or attempting suicide

May include psychotic or catatonic features as well.

A manic episode can be identified by:

Feeling like you can do anything, even something unsafe or illegal

extreme displays of emotion- including jubilant or euphoric expressions, rage, paranoia, agitation
Decreased need for sleep, yet never feeling tired

Inflated self esteem or grandiosity

highly talkative, or pressured speech

distractability, or being too easily drawn to unimportant or irrelevant stimuli
Dressing flamboyantly, spending money extravagantly, living recklessly
Having increased sexual desires, or indulging in risky sexual behaviors
Thoughts of suicide or other morbid/destructive behaviors

May include psychotic, or catatonic features

Bipolar I is defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes (typically lasting at least two weeks) but depression is NOT necessary for receiving a Bipolar I diagnosis, however the symptoms of mania or depression must be a major change from the person’s normal behavior.

Bipolar Disorder II is differentiated from Bipolar 1 in that it involves symptoms of hypomania (less extreme symptoms and for shorter duration compared to full-blown mania), as well as the presence of a depressive episode. This diagnosis is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

Cyclothymia is a “bipolar-like” illness. People with cyclothymic disorder have milder symptoms than in full-blown bipolar disorder.

Bipolar disorder, if left untreated, can wreak havoc on the personal lives of people with the disorder. Unstable moods frequently disrupt or even destroy personal and work relationships. People may have difficulty finding a life partner, instead moving through a series of passionate, short-lived romances. Impulsive behavior can be self-destructive and lead to serious legal problems. At it’s worst, bipolar disorder can be lethal, leading to suicide or death of others. People with bipolar are also more likely to abuse drugs and alcohol. As many as 50% of people with bipolar may also have a problem with substance abuse, in an attempt to alleviate or enhance their symptoms. But bipolar disorder can be treated, and people with this illness can lead full and productive lives with the appropriate medical and emotional support. If you or someone you know is suspected of experiencing symptoms associated with Bipolar disorder, seek the help of a medical and/or mental health professional as soon as possible.

Sources: DSM-IV, webmd.com

Most of us typically associate attention deficit disorder (ADHD) as a childhood problem. However between 30 and 70 percent of people who meet the criteria for ADHD in childhood continue to struggle with the symptoms into adulthood.

The first research studies on adult attention deficit disorder were done in the late 1970’s. Individuals were retrospectively diagnosed in their childhood through assessment by interview. As a result, standardized criteria were created to help mental health professionals diagnose ADHD in adults, called the Utah Criteria. These, and other newer tools such as the Conners Rating Scale and the Brown Attention Deficit Disorder Scale, combine data on personal history and current symptoms.

ADHD Diagnosis in Adults

Quite often, adults with symptoms consistent with ADHD do not believe they have this condition- it may take a specific event to trigger their suspicions. For example if their child is being assessed for or has been diagnosed with ADHD, or if they seek out medical attention for other problems such as anxiety, depression or addiction. While on staff at Kaiser Permanente hospital, I served in the adult ADHD clinic for diagnosis and treatment, and it was quite common for people to spend years feeling like something was ‘different’ but never understanding why they struggled with various aspects of their life.

Take the adult ADHD screening quiz now to find out if you may have this disorder and should seek professional help.

Diagnostic criteria. Individuals must have symptoms that coincide with ADHD beginning in childhood and are ongoing up to the present. These may include distractibility, impulsivity and restlessness. Diagnosis is best undertaken by an expert in adult ADHD. It will include taking a personal history and often involve gathering information from one or more of the individual’s close relatives, friends or colleagues. Your specialist should also check for other undiagnosed conditions (such as learning disabilities, anxiety, or affective disorders). A physical examination is also an important part of understanding other medical issues that might be contributing to the presence of symptoms.

Treatment. Medical treatment for adult ADHD can be similar to that for children — many of the same stimulant drugs can be of benefit, including the newer drug Strattera (atomoxetine).

Other common drugs used for treating adults with ADHD are the antidepressants, either alongside or instead of stimulants. Antidepressants which target the brain chemicals dopamine and norepinephrine are the most effective. These include the older form of antidepressant known as the tricyclics. In addition, the newer antidepressant drug Venlafaxine (Effexor) may be helpful. The antidepressant Bupropion (Wellbutrin) has been found useful in trials of adult ADHD, and may also help reduce nicotine cravings.

Drug treatment alone is not enough to manage this life long problem. Adults with ADHD can benefit from psychotherapy aimed at managing the cognitive and behavioral symptoms of this disorder. Therapy can also help people see the benefit of having the high energy levels, spontaneity and enthusiasm typical of ADHD, and use these characteristics to their advantage. Therapy should also include developing personalized techniques that address problems directly affected by the disorder, such as relationships, work life, and self care. Organizational plans should include simple calendars, charts, to-do lists, notes, and designated locations for everyday items such as keys, wallets, glasses, etc. Computer/online systems can help reduce the potential confusion of bills and other vital documents and correspondence. Such routines will give a sense of order and achievement.

With proper assessment and treatment, adults with ADHD can live happy and fulfilling lives free of chaos and disorder. For more information on this disorder visit http://www.psychcentral.com

This article (part 3 of 3), outlines essential criteria for insomnia and may help you decide if you need professional help with treating your sleep problems. According to the United States Department of Health and Human Services in the year 2007, approximately 64 million Americans regularly suffer from insomnia each year. Insomnia is 41% more common in women than in men. (source: wikipedia)

“Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:

* Difficulty falling asleep
* Waking up often during the night and having trouble going back to sleep
* Waking up too early in the morning
* Feeling tired upon waking

Types of Insomnia

There are two types of insomnia: primary insomnia and secondary insomnia.

* Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.

* Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).

Acute vs. Chronic Insomnia

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

Causes of Insomnia

Causes of acute insomnia can include:

* Significant life stress (job loss or change, death of a loved one, divorce, moving).
* Illness.
* Emotional or physical discomfort.
* Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep.
* Some medications (for example those used to treat colds, allergies, depression, high blood pressure, and asthma) may interfere with sleep.
* Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for example).

Causes of chronic insomnia include:

* Depression and/or anxiety.
* Chronic stress.
* Pain or discomfort at night.

Symptoms of Insomnia

* Sleepiness during the day.
* General tiredness.
* Irritability.
* Problems with concentration or memory.

Diagnosing Insomnia

If you think you have insomnia, talk to a professional- start with your primary care physician. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.

Treatment for Insomnia

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see part 2 of 3 of this series). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting medications can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia since they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.” (source: Webmd.com)

Nothing is more frustrating than not being able to sleep. Tossing and turning, even though your body is exhausted, your mind remains active and you’re painfully aware of how soon you’ll need to awaken for the next day. Or maybe you’re plagued by daytime sleepiness, such that at any given time you are fighting the urge to close your eyes and doze off. An earlier article (part 1 of this series on Sleep habits) reviews how much sleep people need based on age. If you haven’t already, take this two minute, 10 question Sleep Hygiene Test to determine the quality of your sleep habits.

Are you suffering from sleep deprivation? Sleep experts say that if you feel drowsy during the day, even during boring activities, you likely haven’t had enough sleep. If you regularly fall asleep within 5 minutes of lying down or closing your eyes, you are probably suffering from severe sleep deprivation, or possibly a sleep disorder. Another marker of sleep deprivation is when a person begins experiencing microsleeps, (3-14 seconds of sleep in an awake person) because the body is desperate for rest. More often than not this person is not aware they are experiencing these episodes of microsleep.

Aside from chronic sleepiness, how is my health affected by poor sleep habits? Sleep deprivation can have serious effects on your health in the form of physical and mental impairments. Regularly not getting enough sleep impairs our ability to think clearly, effectively manage stress and moderate our emotions, maintain a healthy immune system/fight diseases and disrupt hormonal levels such that your body feels increased hunger without satiety, which leads to weight gain regardless of diet and exercise.

How can people begin improving their sleep habits? Sleep hygiene tips from the American Sleep Association.

Maintain a regular sleep routine

* Go to bed at the same time. Wake up at the same time. Ideally, your schedule will remain the same (+/- 20 minutes) every night of the week.

Avoid naps if possible

* Naps decrease the ‘Sleep Debt’ that is so necessary for easy sleep onset.
* Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that.
* When we take naps, it decreases the amount of sleep that we need the next night – which may cause sleep fragmentation and diffulty initiating sleep, and may lead to insomnia.

Don’t stay in bed awake for more than 5-10 minutes.

* If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Do your mind racing in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired.

* If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.

Don’t watch TV or read in bed.

* When you watch TV or read in bed, you associate the bed with wakefulness.
* The bed is reserved for two things – sleep and hanky panky.

Do not drink caffeine inappropriately

* The effects of caffeine may last for several hours after ingestion. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, use it only before noon.
* Remember that soda and tea contain caffeine as well.

Avoid inappropriate substances that interfere with sleep

* Cigarettes, alcohol, and over-the-counter medications may cause fragmented sleep.

Exercise regularly

* Exercise before 2 pm every day. Exercise promotes continuous sleep.
* Avoid rigorous exercise before bedtime. Rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.

Have a quiet, comfortable bedroom

* Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer.
* Turn off the TV and other extraneous noise that may disrupt sleep. Background ‘white noise’ like a fan is OK.
* If your pets awaken you, keep them outside the bedroom.
* Your bedroom should be dark. Turn off bright lights.

If you are a ‘clock watcher’ at night, hide the clock.

Have a comfortable pre-bedtime routine

* A warm bath, shower
* Meditation, or quiet time

References: American Sleep Association., webmd.com, psychologytoday.com

For most of us, the words ‘sleep deprived’ describes virtually everyone we know. Sleep deprivation is so common these days it’s essentially become part of American culture, from youth to middle and late adulthood. Demanding academic and/or work schedules, caring for loved ones, social plans that carry on late into the night, and early morning exercise regimes keep us barely alert without an end in sight. It’s become the new normal to live with the effects of poor sleep habits, but how is it affecting our health and well-being in the long run? This series of articles aim to help people:

1. determine the quality of your sleep habits with a 2 minute, 10 question Sleep Hygiene Test (for the record, I scored a 69, so I hope to improve my sleep habits right along with you!)
2. discover how much sleep you should be getting, on average for your age (part 1)
3. learn how to identify key signs that you are suffering from sleep deprivation (part 2)
4. learn helpful tips for improving your sleep hygiene (part 2)
5. how to determine if you’re suffering from a sleep disorder such as insomnia (part 3)

How much sleep do we really need? The amount of sleep we need varies. Infants generally need about 16 hours a day, while adolescents need about 9 hours on average, to function optimally. Adults generally need about 7 to 8 hours a night of sleep. A very small segment of people can function normally with as few as 5 hours, though others may need 10 hours of sleep each day. Women in the first 3 months of pregnancy often need several more hours of sleep than what is normal for them. People tend to sleep more lightly and for shorter time periods as they age, although they generally need about the same amount of sleep as they needed in early adulthood. About half of all people over 65 report having sleep problems, such as insomnia, and deep sleep stages in many elderly people often become very short or stop completely. This change may be a normal part of aging, or it may be the result of medical problems common in elderly people, and/or from the medications and treatments for those problems.

Parts 2 and 3 of this article will be published soon, so please stay tuned to learn how your sleep habits are affecting you, and how to make healthy changes in your sleeping routine.

Do other people describe you as a ‘pack rat’? Do your friends and family repeatedly comment on your inability to get rid of things, or show concern about the cluttered state of your office, home or car? Or perhaps you collect vast volumes of digital files on your computer beyond the point of usefulness, and feel incapable of deleting anything. If so, this article may help you clarify whether you have a pathological problem with hoarding.

What is Compulsive Hoarding? It is a mental disorder marked by an obsessive need to acquire (and failure to use or discard) a significant amount of possessions, even if the items are worthless, hazardous, or unsanitary. Compulsive hoarding causes significant clutter and impairment to basic living activities, including mobility, cooking, cleaning, showering, and sleeping.” (Wikipedia)

How to diagnose. Hoarding in the latest DSM-IV-TR appears only in the description of obsessive-compulsive personality disorder (OCD), and is not included in as an independent clinical disorder. Under the OCD differential diagnosis ‘hoarding’ should be diagnosed when it is categorically “extreme.” Therefore clinicians should diagnose “extreme” hoarding as OCD, and less than “extreme” hoarding may be a part of a different diagnosis, such as obsessive-compulsive personality disorder.

A primary anxiety in hoarders occurs when they are threatened by forced clearing of their possessions. They literally feel unable to discard their collections, regardless of the harm or dysfunction their behavior has caused.

In its worst forms, compulsive hoarding can cause fires, unclean conditions (e.g. rat and roach infestations, injuries from tripping on clutter and other health and safety hazards, according to Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego. The hoarder may mistakenly believe that the hoarded items are very valuable, or the hoarder may know that the accumulated items are useless, or may attach a strong personal value to items that they recognize would have little or no value to others.

Levels of hoarding. Although not commonly used by clinical psychologists, criteria for five levels of hoarding have been set forth by the National Study Group on Chronic Disorganization (NSGCD) entitled the NGSCD Clutter Hoarding Scale. Using the perspective of a professional organizer, this scale distinguishes five levels of hoarding with Level I (Roman numeral one) being the least severe and Level V (Roman numeral 5) being the worst. Within each level there are four specific categories which define the severity of clutter and hoarding potential.

* Structure and zoning;
* Pets and rodents;
* Household functions; and
* Sanitation and cleanliness.

Level I Hoarder

Household is considered standard. No special knowledge in working with the Chronically Disorganized is necessary.
Level II Hoarder

Household requires professional organizers or related professionals to have additional knowledge and understanding of Chronic Disorganization.
Level III Hoarder

Household may require services in addition to those a professional organizer and related professional can provide. Professional organizers and related professionals working with Level III households should have significant training in Chronic Disorganization and have developed a helpful community network of resources, especially mental health providers.
Level IV Hoarder

Household needs the help of a professional organizer and a coordinated team of service providers. Psychological, medical issues or financial hardships are generally involved. Resources will be necessary to bring a household to a functional level. These services may include pest control services, “crime scene cleaners,” financial counseling and licensed contractors and handy persons.
Level V Hoarder

Household will require intervention from a wide range of agencies. Professional organizers should not venture directly into working solo with this type of household. The Level V household may be under the care of a conservator or be an inherited estate of a mentally ill individual. Assistance is needed from many sources. A team needs to be assembled. Members of the team should be identified before beginning additional work. These members may include social services and psychological/mental health representative (not applicable if inherited estate), conservator/trustee, building and zoning, fire and safety, landlord, legal aid and/or legal representatives. A written strategy needs to be outlined and contractual agreements made before proceeding.

Subtypes and related conditions

Book hoarding. Bibliomania is an obsessive–compulsive disorder involving the collecting or hoarding of books to the point where social relations or health are damaged. One of several psychological disorders associated with books, bibliomania is characterized by the collecting of books which have no use to the collector nor any great intrinsic value to a more conventional book collector. The purchase of multiple copies of the same book and edition and the accumulation of books beyond possible capacity of use or enjoyment are frequent symptoms of bibliomania.

Digital hoarding*. Digital hoarding involves collecting files on one’s computer beyond the point of usefulness. Often, files can be acquired through the Internet at no monetary cost, leading to extraordinarily large collections. Examples are music collections, often beyond what one enjoys or can listen to and television shows, movies and computer games. Hoarders, or “digital pack rats” often resort to buying optical media or new hard drives to store their collections, rather than deleting what they may never use.

Digital hoarders find it just as difficult to press delete as traditional hoarders find throwing items in the trash can or taking things to the dump. They have the same feeling of clutter and chaos, and feel that they might find the item useful “someday,” and similarly spend large amounts of time acquiring and organizing their collections. However, unlike physical clutter, automated systems exist to organize digital clutter. Scientific American remarked that humanity’s propensity for data collection is growing at a rate faster than their ability to store it.

*Digital hoarding is not a currently recognized subtype of compulsive hoarding by the DSM.

Animal hoarding. Animal hoarding involves keeping larger than usual numbers of animals as pets without having the ability to properly house or care for them, while at the same time denying this inability. Compulsive animal hoarding can be characterized as a symptom of obsessive–compulsive disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached to their pets and find it extremely difficult to let the pets go. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for their pets. The American Society for the Prevention of Cruelty to Animals provides a “Hoarding Prevention Team,” which works with hoarders to help them attain a manageable and healthy number of pets.

Animal hoarders display symptoms of delusional disorder in that they have a “belief system out of touch with reality”. Virtually all hoarders lack insight into the extent of deterioration in their habitations and the health of their animals, refusing to acknowledge that anything is wrong. Delusional disorder is an effective model in that it offers an explanation of hoarder’s apparent blindness to the realities of their situations. Another model that has been suggested to explain animal hoarding is attachment disorder, which is primarily caused by poor parent-child relationships during childhood. As a result, those suffering from attachment disorder may turn to possessions, such as animals, to fill their need for a loving relationship. Interviews with animal hoarders have revealed that often hoarders experienced domestic trauma in childhood, providing evidence for this model. Perhaps the strongest psychological model put forward to explain animal hoarding is obsessive–compulsive disorder (OCD).

References

1. Saxena S, Brody AL, Maidment KM, Smith EC, Zohrabi N, Katz E, Baker SK, Baxter LR Jr: Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J Psychiatry 2004; 161:1038–1048
2. Wikipedia, the free online encyclopedia.
3. DSM-IV-TR
4. Cumpulsive hoarding and the meaning of things, by Randy Frost & Gail Steketee, Houghton Mifflin Harcourt.

Today’s cultural era of instant gratification has shaped our expectations of just about everything, including our personal relationships. The question of when to have sex in a new relationship continues to perplex many of us. Why? Most of us have learned the hard way, that sex has a way of complicating relationships, and never more so than when it is with a new person.

Joan Allen, a relationship expert and author of Celebrating Single and Getting Love Right: From Stalemate to Soulmate says “wait as long as you can.” Her rationale for this statement may seem like obvious and sound advice to some of us, but to others it may sound old-fashioned. It also seems the younger you are, the more likely you are to “go with the heat of the moment” by allowing physical attraction to be the leading factor in deciding when to have sex. Not surprisingly, as we gain age and experience many of us have had too-soon sexual encounters that have lead to undesirable consequences or unhealthy relationships. “You might find that you don’t even like the person,” says Allen. When sex occurs too soon “It becomes much more difficult to objectively see each other’s character traits” says Susanne Alexander, a relationship coach and author of Can We Dance? Learning the Steps for a Fulfilling Relationship. “Some couples then slide into engagement and marriage only to discover they have missed seeing major aspects of each other.”

Practically speaking, many people desire casual sexual relationships only, with no implied or intended commitment to their sexual partner. Regardless of the level of commitment, sexual partners can only benefit from talking about where they see their relationship going and how sex might change things — before they begin engaging in sexual acts with each other.

“There needs to be a conversation up front. The woman may assume sex implies a commitment; the man may not see it that way,” says Allen. “If you just want a one-night stand, you owe it to your partner to tell them ‘it’s just sex I’m after,'” says Cheryl McClary, PhD, JD, professor of women’s health at University of North Carolina-Asheville. A sexual partner may not be happy to hear this, but hopefully it will minimize the misunderstandings and conflicts that are inevitable without this conversation.

Just as important is an up-front conversation about sexually transmitted diseases (STDs). “The risks of STDS have got to be discussed and prevented from spreading,” says relationship expert Joan Allen. “I say definitely use condoms, even if you’re in a committed relationship,” she adds.

US HIV/AIDS statistics:

* Roughly one million people living with HIV/AIDS in the United States.
* Since the start of the AIDS epidemic, 1.5 million Americans have been infected with HIV and more than 524,000 have died of AIDS.
* At least 40,000 people are infected each year.
* African Americans account for 48% of new HIV infections.
* AIDS is the leading cause of death for African American women aged 25 to 34 and HIV rates among Hispanic women are increasing.
* The number of women living with HIV has tripled in the last two decades.
* At least half of all new infections are among people under the age of 25.
* Washington, DC has the highest HIV/AIDS prevalence rates in the United States – one in 20 people are living with HIV or AIDS.