Private Practice Psychology

Resilience is something that most people need to bounce back from whatever life throws at them. Everyone experiences difficulties in life, and some people will even experience traumatic events that create an upheaval in their lives. Resilience is the process by which people adapt to changes or crises, like death, divorce, tragedy, the loss of a job, or financial problems. Resilience is not a character trait - it can be learned by anyone, but learning resilience does require time and effort.

Several factors involved in resilience include having a loving support system, the ability to make plans and follow through with them, communication and problem-solving skills, having a positive view of yourself and your abilities, and the capability to manage your feelings and impulses. Building resilience is a different process for everyone, and what works for one person may not work for another. Each person should determine what works for them and do that.

It may be helpful to imagine resilience as a mountain climb to Mount Kinabalu for example. It is best to take that trip with someone else, particularly someone you love and trust. Having a plan in mind for how to navigate the trail is a good idea. Trusting your own instincts and abilities will help guide you along the way. Lastly, stopping along the trail to rest can be a great idea, but you will have to get back on and continue your journey in order to finish the trip.

Building resilience can be a challenging process. Here are a few tips for developing and strengthening resilience:

*Maintain good relationships with your family and friends, and accept their help in times of stress. Also, getting involved in community groups or faith-based organizations may help give you social support when you need it.

*Try to look at the big picture of life, and avoid viewing difficult times as insurmountable. Take small steps toward your goals and take one day at a time.

*Accept that change is a part of life and learn to embrace the circumstances that you cannot change.

*Keep working toward your goals every day, and ask yourself “What can I do today to move in the direction I need to go?”

*Keep a positive view of yourself and your ability to solve issues and challenges.

*Maintain a positive view of life and visualize what you want.

*Notice how you have changed after a tragedy or crisis. Many people report having more confidence in themselves after a crisis and some even have a deeper appreciation for life. Get what you can out of these tough times.

*Take care of yourself! Get enough food, sleep, and exercise to keep yourself healthy. This is especially important during times of stress.

*Lastly, seek professional help if you feel that the situation is too hard for you to handle on your own. A licensed mental health professional, such as a counselor or psychologist, can help you develop a strategy for moving forward in your life.

Definition
Just as the field of treatment for substance use and mental disorders has evolved to become more precise, so too has the terminology used to describe people with both substance use and mental disorders. The term co-occurring disorders replaces the terms dual disorder or dual diagnosis. These latter terms, though used commonly to refer to the combination of substance use and mental disorders, are confusing in that they also refer to other combinations of disorders (such as mental disorders and mental retardation).

Furthermore, the terms suggest that there are only two disorders occurring at the same time, when in fact there may be more. Clients with co-occurring disorders (COD) have one or more disorders relating to the use of alcohol and/or other drugs of abuse as well as one or more mental disorders. A diagnosis of co-occurring disorders occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder.

Although co-occurring disorder is the most current term used professionally, for the purposes of this article, dual disorders will be used interchangeably.

The acronym MICA, which represents the phrase Mentally Ill Chemical Abusers, is occasionally used to designate people who have a COD and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms include: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), SAMI (substance abuse and mental illness), MISU (mentally ill substance using), MICD (mentally ill chemically dependent) and ICOPSD (individuals with co-occurring psychiatric and substance disorders).

Common examples of co-occurring disorders include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and polydrug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse. Although the focus of this is on dual disorders, some patients have more than two disorders. The principles that apply to dual disorders generally apply also to multiple disorders.

The combinations of COD problems and psychiatric disorders vary along important dimensions, such as severity, chronicity, disability, and degree of impairment in functioning. For example, the two disorders may each be severe or mild, or one may be more severe than the other. Indeed, the severity of both disorders may change over time. Levels of disability and impairment in functioning may also vary.

Thus, there is no single combination of dual disorders; in fact, there is great variability among them. However, patients with similar combinations of dual disorders are often encountered in certain treatment settings.

More than half of all adults with severe mental illness are further impaired by substance use disorders (abuse or dependence related to alcohol or other drugs).

Compared to patients who have a mental health disorder or a COD use problem alone, patients with dual disorders often experience more severe and chronic medical, social, and emotional problems. Because they have two disorders, they are vulnerable to both COD relapse and a worsening of the psychiatric disorder. Further, addiction relapse often leads to psychiatric decompensation, and worsening of psychiatric problems often leads to addiction relapse. Thus, relapse prevention must be specially designed for patients with dual disorders. Compared with patients who have a single disorder, patients with dual disorders often require longer treatment, have more crises, and progress more gradually in treatment.

Psychiatric disorders most prevalent among dually diagnosed patients include mood disorders, anxiety disorders, personality disorders, and psychotic disorders.

Symptoms The symptoms of co-occurring disorder include those associated with substance abuse along with those of psychiatric disorders mentioned previously.

Substance abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. Individuals who abuse substances may experience such harmful consequences of substance use as repeated failure to fulfill roles for which they are responsible, legal difficulties, or social and interpersonal problems. It is important to note that the chronic use of an illicit drug still constitutes a significant issue for treatment even when it does not meet the criteria for substance abuse.

For individuals with more severe or disabling mental disorders, as well as for those with developmental disabilities and traumatic brain injuries, even the threshold of substance use that might be harmful (and therefore defined as abuse) may be significantly lower than for individuals without such disorders. Furthermore, the more severe the disability, the lower the amount of substance use that might be harmful.

People with dual disorders are at high risk for many additional problems such as symptomatic relapses, hospitalizations, financial problems, social isolation, family problems, homelessness, suicide, violence, sexual and physical victimization, incarceration, serious medical illnesses, such as HIV and hepatitis B and C, and early death. Any one of these problems complicates the treatment of co-occurring disorder.

Causes The common wisdom among mental health and medical professionals is that both disorders are biologically based and related to the brain. Sometimes the mental problem occurs first. This can lead people to use alcohol or drugs that make them feel better temporarily. Sometimes the substance abuse occurs first. Over time, that can lead to emotional and mental problems.

Mental disorders and addiction are each a dynamic process, with fluctuations in severity, rate of progression, and symptom manifestation and with differences in the speed of onset. Both disorders are greatly influenced by several factors, including genetic susceptibility, environment, and pharmacologic influences. Certain people have a high risk for these disorders (genetic risk); some situations can evoke or help to sustain these disorders (environmental risk); and some drugs are more likely than others to cause psychiatric or substance use disorder problems (pharmacologic risk).

Treatment To provide appropriate treatment for this complex diagnosis, the Substance Abuse and Mental Health Services Administration (SAMHSA) of the US Department of Health and Human Services recommends integrated treatment of people with COD based on current research that supports the efficacy of this treatment. Integrated treatment is a means of coordinating substance abuse and mental health interventions to treat the whole person more effectively in the context of a primary treatment relationship or service setting.

Integrated Dual Disorders Treatment occurs when a person receives combined treatment for mental illness and substance use from the same clinician or treatment team. It helps people develop hope, knowledge, skills, and the support they need to manage their problems and to pursue meaningful life goals. A person is receiving integrated treatment because their clinician or treatment team will do several things at the same time, including:

• Help the person think about the role that alcohol and other drugs play in their life. This should be done confidentially, without any negative consequences. People feel free to discuss these issues when the discussion is confidential, nonjudgmental, and not tied to legal consequences.
• Offer the person a chance to learn more about alcohol and drugs, to learn about how they interact with mental illnesses and with medications, and to discuss their own use of alcohol and drugs.
• Help the person become involved with supported employment and other services that may help the process of recovery.
• Help the person identify and develop recovery goals. If the person decides that the use of alcohol or drugs may be a problem, a counselor trained in integrated dual disorders treatment can help the person identify and develop personalized recovery goals. This process includes learning about steps toward recovery from both illnesses.
• Provide special counseling specifically designed for people with dual disorders. If the person decides that the use of alcohol or drugs may be a problem, a trained counselor can provide special counseling specifically designed for people with dual disorders. This can be done individually, with a group of peers, with family members, or with a combination of these.

Successful strategies with important implications for clients with COD include interventions based on addiction work in contingency management, cognitive-behavioral therapy (CBT), relapse prevention, and motivational interviewing.

The Mental Health System

Most states have an assortment of public mental health centers that have a wide range of services. Mental health services are provided by a variety of mental health professionals including psychiatrists; psychologists; clinical social workers; clinical nurse specialists; certified substance abuse counselors (CSACs); other therapists and counselors including marriage, family, and child counselors; and paraprofessionals.

These mental health personnel work in a variety of settings, using a variety of theories about the treatment of specific psychiatric disorders. Different types of mental health professionals (for example, social workers and MFCCs) have differing perspectives; moreover, practitioners within a given group often use different approaches.

A major strength of the mental health system is the comprehensive array of services offered, including counseling, case management, partial hospitalization, inpatient treatment, vocational rehabilitation, and a variety of residential programs. The mental health system has a relatively large variety of treatment settings. These settings are designed to provide treatment services for patients with acute, subacute, and long-term symptoms. Acute services are provided by personnel in emergency rooms and hospital units of several types and by crisis—line personnel, outreach teams, and mental health law commitment specialists. Hospitals, day treatment programs, mental health center programs, and several types of individual practitioners provide sub-acute. Long-term settings include mental health centers, residential units, and practitioners’ offices. Clinicians vary with regard to academic degrees, styles, expertise, and training.

The Addiction Treatment System

Individuals with COD are found in all addiction treatment settings, at every level of care. Although some of these individuals have serious mental illness and/or are unstable or disabled, many of them have relatively stable disorders of mild to moderate severity. As substance abuse treatment programs serve the increasing number of clients with COD, the essential program elements required to meet their needs must be defined clearly and set in place.

Essential components of treatment for substance abuse agencies with COD clients:

1. Screening, assessment, and referral
2. Mental and physical health consultation
3. The use of a prescribing onsite psychiatrist
4. Medication and medication monitoring
5. Psychoeducational classes
6. Onsite double trouble groups
7. Offsite dual recovery mutual self-help groups. These elements are applicable in both residential and outpatient programs.

Screening, Assessment, and Referral

All substance abuse treatment programs should have in place appropriate procedures for screening, assessing, and referring clients with COD. It is the responsibility of each provider to identify clients with both mental—and substance—use disorders, and assure that they have access to the care needed for each disorder.

Screening is a formal process of testing to determine whether a client does or does not warrant further attention at the current time in regard to a particular disorder and, in this context, the possibility of a co-occurring substance use or mental disorder. The screening process for COD seeks to answer a “yes” or “no” question: Does the substance abuse (or mental health) client being screened show signs of a possible mental health (or substance abuse) problem?

Assessment is a process for defining the nature of that problem and developing specific treatment recommendations for addressing the problem. A basic assessment consists of gathering key information and engaging in a process with the client that enables the counselor to understand the client’s readiness for change, problem areas, COD diagnoses, disabilities, and strengths. This typically involves a clinical examination of the functioning and well-being of the client and includes a number of tests and written and oral exercises. The COD diagnosis is established by referral to a psychiatrist, clinical psychologist, or other qualified healthcare professional. Assessment of the client with COD is an ongoing process that should be repeated over time to capture the changing nature of the client’s status.

Some intake information includes:

• Background: family, trauma history, history of domestic violence (either as a batterer or as a battered person), marital status, legal involvement and financial situation, health, education, housing status, strengths and resources, and employment.
• Substance use: age of first use, primary drugs used (including alcohol, patterns of drug use, and treatment episodes), and family history of substance use problems.
• Mental health problems: family history of mental health problems, client history of mental health problems including diagnosis, hospitalization and other treatment, current symptoms and mental status, medications, and medication adherence.

A comprehensive assessment serves as the basis for an individualized treatment plan. Appropriate treatment plans and treatment interventions can be quite complex, depending on what might be discovered in each domain. This leads to another fundamental principle: There is no single, correct intervention or program for individuals with COD. Rather, the appropriate treatment plan must be matched to individual needs according to these multiple considerations.

Mental and Physical Health Consultation

A physical and mental health consultation serves individuals with COD by determining the physical and mental health challenges and incorporates the necessary treatment(s) into patient services.

Prescribing an Onsite Psychiatrist

An onsite addiction treatment psychiatrist can improve treatment retention and decrease substance use among patients. The onsite psychiatrist brings diagnostic, medication, and psychiatric counseling services directly to the location clients are based at for the major part of their treatment. This approach often is the most effective way to overcome barriers presented by offsite referral, including distance and travel limitations, the inconvenience of enrolling in another agency and of the separation of clinical services (more “red tape”), fears of being seen as “mentally ill” (if referred to a mental health agency), cost, and the difficulty of becoming comfortable with different staff.

Medication and Medication Monitoring

Many clients with COD require medication to control their psychiatric symptoms and to stabilize their psychiatric status.

Pharmacological advances over the past decade have produced antipsychotic, antidepressant, anticonvulsant, and other medications with greater effectiveness and fewer side effects. With the support available from better medication regimens, many people who once would have been too unstable for substance abuse treatment, or institutionalized with a poor prognosis, have been able to lead more functional lives.

Psychoeducational Classes

Psychoeducational classes on mental and substance use disorders are important elements in basic COD programs. These classes typically focus on the signs and symptoms of mental disorders, medication, and the effects of mental disorders on substance abuse problems. Psychoeducational classes of this kind increase client awareness of their specific problems and do so in a safe and positive context.

Relapse prevention education presents strategies designed to help clients become aware of cues or “triggers” that make them more likely to abuse substances and help them develop alternative coping responses to those cues. Some providers suggest the use of “mood logs” that clients can use to increase their consciousness of the situational factors that underlie the urge to use or drink.

Onsite Double Trouble Groups

Onsite groups such as “Double Trouble” provide a forum for discussion of the interrelated problems of mental disorders and substance abuse, helping participants to identify triggers for relapse. Clients describe their psychiatric symptoms (such as hearing voices) and their urges to use drugs. They are encouraged to discuss, rather than to act on, these impulses. Double Trouble groups also can be used to monitor medication adherence, psychiatric symptoms, substance use, and adherence to scheduled activities. Double Trouble provides a constant framework for assessment, analysis, and planning. Through participation, the individual with COD develops perspective on the interrelated nature of mental disorders and substance abuse and becomes better able to view his or her behavior within this framework.

Dual Recovery Mutual Self-Help Groups (Offsite)

These offsite self-help groups exist in many communities. Substance abuse treatment programs can refer clients to dual recovery mutual self-help groups, which are tailored to the special needs of a variety of people with COD. These groups provide a safe forum for discussion about medication, mental health, and substance abuse issues in an understanding, supportive environment wherein coping skills can be shared.

The dual recovery mutual self-help movement is emerging from two cultures: the 12-Step fellowship recovery movement and, more recently, the culture of the mental health consumer movement. In keeping with traditional 12-Step principles and traditions, dual recovery 12-Step fellowships do not provide specific clinical or counseling interventions, classes on psychiatric symptoms, or any services similar to case management. Dual recovery fellowships maintain a primary purpose of members helping one another achieve and maintain dual recovery, prevent relapse, and carry the message of recovery to others who experience dual disorders. Dual recovery 12-Step members who take turns chairing their meetings are members of their fellowship as a whole.

Substance abuse groups include the 12-step program of Alcoholics Anonymous (AA); Narcotics Anonymous (NA), Cocaine Anonymous (CA), and so on, can provide needed support and encouragement for patients in treatment. More importantly, these services are widespread nationally and internationally. While self-help programs are not considered treatment per se, they are integral adjuncts to professional treatment services.

Outpatient Substance Abuse Treatment Programs for Clients with COD

Treatment for substance abuse occurs most frequently in outpatient settings—a term that includes a wide variety of disparate programs. Some offer several hours of treatment each week, which can include mental health and other support services as well as individual and group counseling for substance abuse; others provide minimal services, such as only one or two brief sessions to give clients information and refer them elsewhere. Some agencies offer intensive outpatient programs that provide services several hours per day and several days per week. Typically, treatment includes individual and group counseling, with referrals to appropriate community services.

Screening and assessment are used to make two essential decisions—about the stability of the individual with COD to remain in an inpatient, outpatient or appropriate alternative treatment setting and the needed mental health services. A centralized intake team is a useful approach to screening and assessment, providing a common point of entry for many clients entering treatment.

Once admitted to treatment, clients need regular reassessment as reductions in acute symptoms of mental distress and substance abuse may precipitate other changes. Periodic assessment will provide measures of client change and enable the provider to adjust service plans as the client progresses through treatment. Then careful assessment will help to identify those clients who require more secure inpatient treatment settings (such as clients who are actively suicidal or homicidal), as well as those who require 24-hour medical monitoring, those who need detoxification, and those with serious substance use disorders who may require a period of abstinence or reduced use before they can engage actively in all treatment components.

Discharge planning is important to maintain gains achieved through outpatient care. Clients with COD leaving an outpatient substance abuse treatment program have a number of continuing care options. These options include mutual self-help groups, relapse prevention groups, continued individual counseling, mental health services (especially important for people who will continue to require medication), as well as intensive case management monitoring and supports. A carefully developed discharge plan, produced in collaboration with the person with COD, will identify and match their needs with community resources, providing the supports needed to sustain the progress achieved in outpatient treatment.

Individuals with COD often need a range of services besides substance abuse treatment and mental health services. Generally, prominent needs include housing and case management services to establish access to community health and social services. These can be essential to the successful recovery of the person with COD.

It is imperative that discharge planning for the client with COD ensures continuity of psychiatric assessment and medication management, without which client stability and recovery will be severely compromised. Relapse prevention interventions after outpatient treatment need to be modified so that the client can recognize symptoms of psychiatric or substance abuse relapse on her own and can call on a learned repertoire of symptom management techniques (such as self-monitoring, reporting to a “buddy,” and group monitoring). This also includes the ability to access assessment services rapidly, since the return of psychiatric symptoms can often trigger substance abuse relapse.

The Medical System

Although not substance abuse treatment settings per se, acute care and other medical settings are included here because important substance abuse and mental health treatment do occur in medical units. Acute care refers to short-term care provided in intensive care units, brief hospital stays, and emergency rooms (ERs). Providers in acute care settings usually are not concerned with treating substance use disorders beyond detoxification, stabilization, and/or referral.

In other medical settings, such as primary care offices, providers generally lack the resources to provide any kind of extensive substance abuse treatment, but may be able to provide brief interventions and treatment referrals.

Primary health-care providers (physicians and nurses) have historically been the largest single point of contact for patients seeking help with psychiatric and COD use disorders. Physicians and nurses are uniquely qualified to manage life-threatening crises and to treat medical problems related and unrelated to psychiatric and substance use disorders. And because they are in contact with such large numbers of patients, they have an exceptional opportunity to screen and identify patients with psychiatric and COD disorders. At that point, the person with COD can be referred for appropriate services in the proper setting.

Sources:

• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
• Office for Treatment Improvement, Alcohol, Drug Abuse, and Mental Health Administration
• Substance Abuse and Mental Health Services Administration (2005)
• Hospital and Community Psychiatry
• Dual Diagnosis of Major Mental Illness and Substance Disorder
• Journal of the American Medical Association
• Journal of Addictive Diseases
• Archives of General Psychiatry
• Center for Substance Abuse Treatment
• Charney DA, Paraherakis AM, Gill KJ. Integrated treatment of comorbid depression and substance use disorders. Journal of Clinical Psychiatry. 62((9)):672-677; 2001.
• Saxon AJ, Calsyn DA. Effects of psychiatric care for dual diagnosis patients treated in a drug dependence clinic. American Journal of Drug and Alcohol Abuse. 21((3)):303-313; 1995.
• Etheridge RM, Hubbard RL, Anderson J, Craddock SG, Flynn PM. Treatment structure and program services in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behavior. 11((4)):244-260; 1997.
• Simpson DD, Joe GW, Rowan-Szal GA. Drug abuse treatment retention and process effects on follow-up outcomes. Drug and Alcohol Dependence. 47((3)):227-235; 1997b.

The Internet is unlike anything we have ever seen before. It is a socially connecting device that is socially isolating at the same time. With the increasing number of users and the social problems that people are finger pointing at, it is not surprising that there is an uprising concern about the use of Internet.

However, no research has yet established that there is a disorder of Internet addiction that is separable from problems such as loneliness or pathological gambling, or that a passion for using the Internet is long-lasting.

Much of the original research was based upon the weakest type of research methodology, namely exploratory surveys with no clear hypothesis or rationale backing them. Therefore, we cannot establish causal relationships between specific behaviors and their cause.

Years have gone by and there are more than a few studies out there looking at Internet addiction. Yet none of them agree on a single definition for this problem, and all of them vary widely in their reported results of how much time an “addict” spends online. If they cannot even get these basics down, it is not surprising the research quality still suffers.

For now, this and other questions about Internet use will remain unanswered until more controlled studies are done.

Do some people have problems spending too much time online?

Sure they do. Some people also spend too much time reading, watching television, and working, and ignore family, friendships, and social activities. That does not suggest they have a TV addiction disorder, book addiction, and work addiction that is legitimate mental disorders in the same category as schizophrenia and depression. It is the tendency of some mental health professionals and researchers to want to label everything they see as potentially harmful with a new diagnostic category. Unfortunately, this causes more harm than it helps people.

Some people online who think they are addicted could possibly be suffering from desires not to want to deal with other problems in their lives. These problems could include a mental disorder (depression, anxiety, etc.), a serious health problem or disability, or a relationship problem. In this case, it is no different than turning on the TV so you won’t have to talk to your spouse, or going “out with the boys” for a few drinks so you don’t have to spend time at home. Nothing is different except the modality.

On the other hand, some people who spend time online without any other problems present may suffer from compulsive over-use. Compulsive behaviours, however, are already covered by existing diagnostic categories and treatment would be similar. It is not the technology (whether it be the Internet, a book, the telephone, or the television) that is important or addicting – it is the behavior. And behaviors are easily treatable by cognitive-behavioural techniques in psychotherapy.

Is it possible for people to become addicted to chat rooms?

As explained above, I will now use the word addiction in a different manner.

Time alone cannot be an indicator of being addicted or engaging in compulsive behavior. Time must be taken in context with other factors, such as whether you are a college student (who, as a whole, proportionally spend a greater amount of time online), whether it is a part of your job, whether you have any pre-existing conditions (such as another mental disorder), whether you have problems or issues in your life which may be causing you to spend more time online (e.g., using it to “get away” from life’s problems, a bad marriage, difficult social relations), etc. So talking about whether you spend too much time online without this important context is useless.

There are evidence that suggests that the time people spend chatting online is phasic and can be explained in terms of three phases:

Stage I: Enchantment (Obsession)
Stage II: Disillusionment (Avoidance)
Stage III: Balance (Normal)

That is to say that people first are enchanted by the activity (characterized by some as obsession) especially when they are new users, followed by disillusionment with chatting and a decline in usage, and then a balance was reached where the level of chat activity normalized.

What can lead to such an addiction?

How do people get caught up in the Internet? For one thing, human beings are curious. People like to see more and do more. People like to feel competent and in control. Online, they can act in ways that are exciting and they can do so without leaving their chair of being with a real person. Especially in chat rooms and a virtual society - accountability, supervision and social consequences are almost non-existent.

People also like to feel better and they don’t like to feel bad. We like to do things that feel good and avoid things that feel worse. We especially like doing pleasurable things more and more.

On the Internet, people do not have to go out and find real people and have an honest relationship. They can stay in their own chair and explore endless activities. They can walk away and come right back. There is always something happening.

People will even miss you and ask you to come back.

The seduction and addictive nature of the chat rooms can be understood primarily in terms of a behavior modification process called a variable reinforcement schedule. That means you don’t know how much of a reward you will get and when for your behavior (ie. praises, expressions of longing, admiration, intimacy, true friendships, etc). And a variable reinforcement schedule is the most addictive reward system.

Being on the Internet is not necessarily about having a good time. Being on-line might make you feel better but it might just change how you feel. It can be an escape from reality that isn’t necessarily better for you.

Prolonged chats on-line and mouse clicking on the Internet will produce a dissociative state whereby Internet users can separate from reality and enter cyber reality. Anyone with children has seen how children can watch television for countless hours. Children and even adults watching television long enough will enter a “hypnotic trance.” They “meld” into the television and disconnect from reality.

People can disappear into a good book or a movie, but there is always an end to a book or a movie. The Internet is especially addictive because it is endless, interactive, social and exploding with never ending images and information. The Internet offers exciting relationships 24 hours a day all over the world.

Limited use is a form or healthy recreation or escape. Prolonged and repeated use can create problems.

What do you think is the pull or the attraction for many young people today to communicate and express themselves and make friends via chat rooms as opposed to meeting people the old fashioned way?

Nearly 20% of the people going on-line will encounter one or more of the following problems.

    * Personal neglect
* Social anxiety
* Lack self esteem and self confidence
* Compulsive checking and “clicking”
* Isolation and avoidance from people
* Depression
* Relationship problems
* Academic failure

Apart from that, meeting real people and developing friendships takes a longer time and much more effort and in this century, I see young people having heavier schedules than the average adult! Piano lessons, tuition classes for all subjects, competitive sports, you name it.

Meeting people online also seems to be more convenient and cost effective for young people. They don’t have to negotiate with their parents for money, transportation and curfew time.

To a certain extend, meeting real people means taking a risk. A risk of getting hurt, embarrassed, humiliated and many more. And if that happens online, you can just change your name, age and marital status and just start over.

The reasons why young people choose online chat rooms instead of real life interactions are varied and endless.

Furthermore, some people do have serious challenges in real life social interactions such as social anxiety disorders, depression, shyness, lack self esteem and many more. The most important to bear in mind is to seek professional treatment for it. Help is readily available without needing to create all these hoopla about a new diagnosis.

Nearly any well-trained mental health professional will be able to help to slowly curve the time spent online, and address the problems or concerns that may have contributed to online overuse.

Finally, prevention is more likely to be assured if you maintain balance in your life. People go on-line looking for something missing in their life or they become involved in content and relationships on-line that begin to interfere with important routines, responsibilities and relationships. Making a conscious effort and commitment to a balanced life in crucial.

Definition
Anorexia nervosa is an eating disorder characterized by refusal to stay at even the minimum body weight considered normal for the person’s age and height. Other symptoms of the disorder include distorted body image and an intense fear of weight gain. Inadequate eating or excessive exercising results in severe weight loss. Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood. Anorexia nervosa is one of the two major types of eating disorders; the other is bulimia.

People with anorexia see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession to them. Unusual eating habits develop, such as avoiding what they perceive as high caloric food and meals, picking out a few foods and eating only these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight and many engage in other techniques to control their weight, such as intense and compulsive exercise or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.

Eating disorders frequently co-occur with other psychiatric disorders, such as depression, substance abuse, and anxiety disorders. In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure, that may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Symptoms An estimated 0.5 percent to 3.7 percent of females and 0.1 percent to 0.2 percent of males suffer from anorexia nervosa in their lifetime. Symptoms of anorexia nervosa include:

• Refusal to maintaining body weight at or above a minimally normal weight for one’s age and height
• Intense fear of gaining weight or becoming fat, even though one is underweight
• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of low body weight
• Infrequent or absent menstrual periods (in females who have reached puberty)

Causes Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own.

Dieting to a body weight leaner than required for health is highly promoted by current fashion trends, by sales campaigns for special foods, and in some activities and professions. Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, move beyond control for some people and develop into eating disorders.

Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity; in time, their findings may to lead to new pharmacologic treatments for eating disorders. Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses.

Treatment Eating disorders can be treated, and a healthy weight can be restored. The sooner these disorders are diagnosed and treated, the better the outcome is likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling, and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.

Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost to severe dieting and purging, (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts, and (3) achieving either long-term remission and rehabilitation or full recovery. Early diagnosis and treatment increases the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

The acute management of severe weight loss is usually provided in an inpatient hospital setting, where feeding plans address the person’s medical and nutritional needs. In some cases intravenous feeding is recommended. Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapeutic process.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting into and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long-term.

Sources:

• American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised. Washington, D.C.: American Psychiatric Association, 2000.
• American Psychiatric Association Work Group on Eating Disorders (APAWG). Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 2000; 157(1 Suppl): 1-39.
• Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of MedicineAmerican Journal of Psychiatry, 1999; 340(14): 1092-8.
• National Institutes of Health, National Library of Medicine, MedlinePlus, 2006. Anorexia nervosa. http://www.nlm.nih.gov/medlineplus/ency/article/000362.htm
• The National Institute of Mental Health

Eating disorders happen as a result of severe disturbances in eating behavior, such as unhealthy reduction of food intake or extreme overeating. These patterns can be caused by feelings of distress or concern about body shape or weight and they harm normal body composition and function. A person with an eating disorder may have started out just eating smaller or larger amounts of food than usual, but at some point, the urge to eat less or more spirals out of control. Eating disorders are very complex, and despite scientific research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive. Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood. Many adolescents are able to hide these behaviors from their family for months or years.

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa. A person with anorexia nervosa starves himself or herself to be thin, experiencing extreme weight-loss. An estimated .5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime. Bulimia nervosa is binge eating followed by purging (vomiting). An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime. A third disorder, binge-eating disorder, is characterized by frequent episodes of out-of-control eating. A cycle develops due to feelings of shame and disgust caused by obesity brought on by the overeating and leading to bingeing again. Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a six-month period. This illness has only been suggested but has not yet been approved as a formal psychiatric diagnosis.

Eating disorders frequently occur together with other psychiatric illness such as depression, substance abuse, or anxiety disorders. In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure, which may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorders are male.

Symptoms Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior. Some people with anorexia lose weight by dieting and exercising excessively; others lose weight by self-induced vomiting, or misusing laxatives, diuretics or enemas. More characteristics of anorexia nervosa include:

• Significant weight loss
• Continual dieting
• Intense fear of gaining weight or becoming fat, even if underweight
• Undue influence of body weight or shape on self-evaluation
• Preoccupation with food calories or nutrition
• Preference to eat alone
• Compulsive exercise
• Bingeing and purging
• Brittle hair or nails
• Depression
• Infrequent or absent menstrual periods (in females who have reached puberty)
• Growth of fine hair over body
• Mild anemia, and muscle weakness and loss
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy

Many people with anorexia also have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development.

Bulimia Nervosa

Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (binge-eating), and feeling a lack of control over the eating. This is followed by some type of behavior that compensates for the binge, such as purging (vomiting, excessive use of laxatives or diuretics), fasting and/or excessive exercise. Usually, bulimic behavior is done secretly. Additional symptoms include:

• Recurrent episodes of binge eating
• Purging by strict dieting, fasting, vigorous exercise or vomiting
• Abuse of laxatives or diuretics to lose weight
• Frequent use of bathroom after meals
• Reddened fingers
• Swollen cheeks
• Self-evaluation is unduly influenced by body shape and weight
• Depression or mood swings
• Irregular menstrual periods
• Dental problems, like tooth decay
• Heartburn or bloating
• Intestinal distress and irritation from laxative abuse
• Kidney problems from diuretic abuse
• Severe dehydration from purging of fluids

Binge-Eating Disorder

Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over her eating. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder often are overweight or obese. Characteristics include:

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts of food when not hungry
• Eating alone because of embarrassment caused by how much is eaten
• Marked distress about the binge-eating behavior
• Binge-eating occurs, on average, at least 2 days a week for 6 months
• Binge-eating not associated with regular use of compensatory behaviors (purging, fasting, excessive exercise)

Causes Researchers are unsure of the underlying causes and nature of eating disorders. Unlike a neurological disorder, which generally can be pinpointed to a specific lesion on the brain, an eating disorder likely involves abnormal activity distributed across brain systems. With increased recognition that mental disorders are brain disorders, more researchers are using tools from both modern neuroscience and modern psychology to better understand eating disorders. Additionally, eating disorders appear to run in families so research on genetic factors continues.

Other factors—psychological, interpersonal and social—can play roles in eating disorders. Psychological factors that can contribute to eating disorders include low self-esteem, feelings of inadequacy or lack of control in life, depression, anxiety, anger, or loneliness.

Interpersonal Factors include troubled family and personal relationships, difficulty expressing emotions and feelings, a history of being teased or ridiculed based on size or weight or a history of physical or sexual abuse. Social factors that can contribute include cultural pressures that glorify “thinness” and place value on obtaining the “perfect body”, narrow societal definitions of beauty that include only women and men of specific body weights and shapes or cultural norms that value people on the basis of physical appearance and not inner qualities and strengths.

People with anorexia nervosa see themselves as overweight even though they are dangerously thin. In bulimia nervosa, despite sufferers usually weighing within the normal range for their age and height, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. Many with binge-eating disorders are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge-eating.

Treatment Eating disorders can be treated and a healthy weight can be restored. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, professional interventions, nutritional counseling and, when appropriate, medication management.

Treatment of anorexia calls for a specific program that involves three main phases: restoring the person to a healthy weight lost to severe dieting and purging; treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.

Some research suggests that the use of medications, such as antidepressants, antipsychotics or mood stabilizers, may be modestly effective in treating patients with anorexia by helping to resolve mood and anxiety symptoms that often co-exist with anorexia. Recent studies, however, have suggested that antidepressants may not be effective in preventing some patients with anorexia from relapsing. In addition, no medication has shown to be effective during the critical first phase of restoring a patient to healthy weight. Overall, it is unclear if and how medications can help patients conquer anorexia, but research is ongoing.

Different forms of psychotherapy, including individual, group and family-based, can help address the psychological reasons for anorexia nervosa. Some studies suggest that family-based therapies in which parents assume responsibility for feeding their afflicted adolescent are the most effective in helping a person with anorexia gain weight and improve eating habits and moods. Others have noted that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia patients is more effective than just psychotherapy. But the effectiveness of a treatment depends on the person involved and her situation.

Hospital based care (including inpatient, partial hospitalization, intensive outpatient and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life-threatening, or when it is associated with severe psychological or behavioral problems.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some fluctuate between weight gain and relapse; and others chronically deteriorate over many years. The mortality rate among people with anorexia has been estimated at .56 percent per year which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

The primary goal of treatment for bulimia is to reduce or eliminate binge-eating and purging behavior. Nutritional rehabilitation, professional intervention and medication management are often employed. As with anorexia, treatment for bulimia often involves a combination of options and depends on the needs of the individual.

To reduce or eliminate binge and purge behavior, a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication. Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the FDA for treating bulimia, may help patients who also have depression and/or anxiety. It also appears to help reduce binge-eating and purging behavior, reduces the chance of relapse, and improves eating attitudes. CBT that has been tailored to treat bulimia also has shown to be effective in changing binging and purging behavior, and eating attitudes. Therapy may be individually oriented or group-based.

The treatment goals and strategies for binge-eating disorder are similar to those for bulimia. Fluoxetine and other antidepressants may reduce binge-eating episodes and help alleviate depression in some patients. Patients with binge-eating disorder also may be prescribed appetite suppressants. Psychotherapy, especially CBT, is also used to treat the underlying psychological issues associated with binge-eating, in an individual or group environment.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation.

Sources:

• American Psychiatric Association
• National Institutes of Health
• National Eating Disorders Association (2006)

Definition
Bulimia Nervosa is characterized by recurrent and frequent episodes of binge eating—i.e., unusually large amounts of food consumed in a short time—and a feeling that one lacks control over eating. A bulimic can consume as much as 3,400 calories in little more than an hour, and as much as 20,000 calories in eight hours. People with bulimia often know they have a problem and are afraid of their inability to stop eating. Binging is then followed by purging—namely, self-induced vomiting or the abuse of diuretics or laxatives. Binging and purging are often performed in secret, with feelings of shame alternating with relief.

Unlike anorexia, people with bulimia can maintain a normal weight for their age. But like people with anorexia, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape, which may explain why bulimic behavior often takes place in secret. The binging and purging cycle usually repeats several times a week. As with anorexia, people with bulimia often have coexisting psychological illnesses, such as depression and anxiety, and substance abuse problems. Many physical dysfunctions result from the purging, including electrolyte imbalances, gastrointestinal troubles, and dental problems.

An estimated 1 to 4 percent of females have bulimia nervosa during their lifetime. Most cases begin in the late teens and early 20s, but can go undetected until the 30s or 40s.

Symptoms

• Recurrent episodes of binge eating, characterized by eating within a discrete period of time—say, two hours—an amount of food substantially larger than most people would eat.
• A feeling that one cannot stop eating or control what or how much one eats.
• Recurrent compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; and excessive exercise.
• Self-evaluation unduly influenced by body shape and weight
• This disturbance doesn’t occur exclusively with anorexia nervosa.

Specific Types:

• Purging type: regularly induced vomiting or misused laxatives, diuretics, or enemas.
• Nonpurging type: other inappropriate compensatory behaviors, such as fasting or excessive exercise, but not self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

Other symptoms include:

• chronically inflamed and sore throat
• swollen glands in the neck and below the jaw
• worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids
• acid reflux disorder (gastroesophageal reflux disorder, or GERD)
• intestinal distress and irritation from laxative abuse
• kidney problems from diuretic abuse
• severe dehydration from purging of fluids.

Causes Bulimia is more than just a problem with food. A binge can be triggered by dieting, stress, or uncomfortable emotions such as anger or sadness. Purging and other actions to prevent weight gain are ways for people with bulimia to feel more in control of their lives and ease stress and anxiety. There is no single known cause of bulimia, but there are some factors that may play a part.

• Culture. Women in the U.S. are under constant pressure to fit a certain ideal of beauty. Images everywhere of flawless, thin females make it hard for women to feel good about their bodies. Increasingly, men are also feeling pressure to have a perfect body.
• Families. If you have a mother or sister with bulimia, you are more likely to have bulimia. Parents who think looks are important, diet themselves, or criticize their children’s bodies are more likely to have a child with bulimia.
• Life changes or stressful events. Traumatic events such as rape, as well as stressors such as starting a new job, can trigger bulimia.
• Personality traits. Someone with bulimia may have low self-esteem and feel hopeless. She or he may be very moody and have difficulty expressing anger or controlling impulsive behaviors.
• Biology. Genes, hormones, and brain chemicals may contribute to developing bulimia.

Treatment As with anorexia, treatment for bulimia often involves a combination of options and depends on individual needs.

To reduce or eliminate binging and purging, a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy, and be prescribed medication. Some antidepressants, such as fluoxetine (brand name, Prozac)—the only medication approved by the FDA for treating bulimia—may help patients who also suffer from depression and anxiety. It also appears to help reduce binge-eating and purging as well as the chance of relapse, and it can improve eating attitudes.

Cognitive behavioral therapy tailored to treat bulimia also has shown to be effective in changing binging and purging behavior and improving attitudes towards eating. Therapy may be done one on one or in a group.

Note: Despite the relative safety and popularity of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, some studies have suggested that they may have unintentional effects, especially on adolescents and young adults. In 2004, after a thorough review of data, the FDA adopted a black box warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking and attempts in children and adolescents. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A black box warning is the most serious type of warning on prescription drug labeling.

Current Research

Unlike a neurological disorder, which generally can be pinpointed to a specific lesion on the brain, an eating disorder likely involves abnormal activity distributed across brain systems. With increased recognition that mental disorders are brain disorders, more researchers are using tools from neuroscience, such as magnetic resonance imaging (MRI), to better understand eating disorders and how those with a disorder process information, whether they’ve recovered or are still in the throes of their illness.

Behavioral or psychological research on eating disorders is more complex and challenging. New studies are currently underway to remedy the lack of information about treatment. Researchers also are working to define the basic processes of the disorders, which should help identify better treatments.

These and other questions may be answered in the future as scientists and doctors think of eating disorders as medical illnesses with certain biological causes. Researchers are studying behavioral questions, along with genetic and brain systems information, to understand risk factors, identify biological markers and develop medications that can target specific pathways that affect eating behavior. Finally, neuroimaging and genetic studies may provide clues for individual responses to specific treatments.

Sources:

• National Institute of Mental Health
• Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised;
• American Psychiatric Association Work Group on Eating Disorders
• American Journal of Psychiatry
• U.S. Department of Health and Human Services

We all feel sad sometimes. Sadness is a normal emotion that can make life more interesting. Much art and poetry is inspired by sadness and melancholy. Sadness almost always accompanies loss. When we say goodbye to a loved one we usually feel sad. The sadness is even deeper if a close relationship has ended or a loved one has died.

Sadness also helps us appreciate happiness. When our mood eventually changes from sadness toward happiness the sense of contrast adds to the enjoyment of the mood.

Here are some ways to experience normal sadness in a healthy way and to allow this emotion to enrich your life:

• Allow yourself to be sad. Denying such feelings may force them underground, where they can do more damage with time. Cry if you feel like it. Notice if you feel relief after the tears stop.

• If you are feeling sad, plan a sadness day. Plan a day or evening just to be alone, listen to melancholy music, and to observe your thoughts and feelings.
  Planning time to be unhappy can be actually feel good. It can help you ultimately move into a more happy mood.

• Think about the context of the sad feelings. Are they related to a loss or an unhappy event? It is usually not as simple as discovering the “cause” of the sadness, but it may be possible to understand factors involved.

• Sadness can result from a change that you did not expect, or it can signal the need for a change in your life. Change is usually stressful, but it is necessary for growth.

• Know when sadness turns into depression. Get help if this happens rather than getting stuck in it.

Get help if you experience more than a couple of the following symptoms of depression:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Recent research has linked lack of sleep to a wide range of ailments, including memory problems and obesity. Learn more about some of the top reasons why you should get a good night’s sleep.

Sleep May Help You Learn More Effectively

Researchers have long believed that sleep plays an important role in memory, but recent evidence suggests that getting a good night’s sleep can improve learning. In one study, researchers found that depriving students of sleep after learning a new skill significantly decreased memory of that skill up to three days later (Winerman, 2006). Known as the memory consolidation theory of sleep, this notion proposes that sleep serves to process and retain information learned earlier while awake. While there is research both for and against the theory, many studies have shown that sleep can play an important role in certain types of memory.

Research Suggests Sleep Deprivation May Contribute to Obesity

In addition to affecting memory and learning, lack of sleep has been linked to body weight. In one 2005 study published in the Archives of Internal Medicine, overweight participants were found to sleep less than participants of a normal weight (Vorona et al., 2005). Brandon Peters, About.com’s Guide to Sleep Disorders, reports that poor sleep at age 30 months can predict obesity at age seven. While researchers do not yet understand exactly how sleep disruption impacts appetite and metabolism, getting a good night’s sleep certainly can’t hurt your weight loss or weight maintenance efforts.

Sleep is Important for Managing Stress

According to many experts, most people need between seven and eight hours of sleep each night. What happens when you don’t get enough sleep? Symptoms such as moodiness, anxiety, aggression and increased stress levels can result. About.com’s Guide to Stress Management, Elizabeth Scott, suggests taking “power naps” to combat drowsiness, reduce stress and increase productivity. While sleeping more certainly won’t eliminate all stress, it can help increase your readiness to cope with the stress of day-to-day life.

Sleep Can Help You Make Better Decisions

Have you ever found yourself struggling to make relatively simple decisions after a night of poor sleep? In addition to reducing such things as response time and accuracy, lack of sleep has also been linked to difficulty making good decisions. In one study published in the journal Sleep, researchers found that sleepiness has a serious impact on the ability to make effective decisions (Roehrs, 2004). Another study suggested that sleep impairs decision-making when gambling by increasing expectations of potential gains while minimizing losses. If you’re facing a challenging decision, make sure that you are well rested so that you will be at your best.

References

_{American Academy of Sleep Medicine (2007, May 5). Sleep Deprivation Can Threaten Competent Decision-making. ScienceDaily. National Sleep Foundation. (2008). Longer Work Days Leave Americans Nodding Off On the Job.}

_{Peters, B. (2008). Why so fat and tired?}

_{Roehrs, T., Greenwald, M., Roth T. (2004). Risk-taking behavior: effects of ethanol, caffeine, and basal sleepiness. Sleep, 27(5), 887-93.}

_{Vorona, R. et al. (2005, Jan. 10). Overweight and Obese Patients in a Primary Care Population Report Less Sleep Than Patients With a Normal Body Mass Index. Archives of Internal Medicine, 165, 25-30.}

_{Winerman, L. (2006). Let’s sleep on it: A good night’s sleep may be the key to effective learning, says recent research. Monitor on Psychology.}