Adoption

Caz knew she'd been adopted as a baby, and she'd always felt loved and special. Although she didn't know the names of her birth parents or the details of her adoption, she'd never really thought about it that much. So she was surprised to find herself thinking more about her adoption as her fifteenth birthday approached. Although Caz knew a lot of things about her adoptive family, she realized that she knew nothing about the people whose genes she shared.

More than 127,000 kids are adopted in the United States each year. Adopted children are loved and cared for just like other kids. But it's natural for people who are adopted to wonder about their birth families (also called biological families) and where they came from. This curiosity often becomes more intense as part of the process of self-discovery that happens during the teenage years.

What Is Adoption?

Adoption is the creation of a new, permanent relationship between an adoptive parent and child. Once this happens, there is no legal difference between a child who is adopted and a child who is born into a family.

Birth parents have many different reasons for putting children up for adoption. Some decide that they want better lives for their kids than they feel they can provide. Some feel their child would do better living in another country. Sometimes parents just can't take good care of a child because of illness or other difficulties. Many birth parents say that having their child placed for adoption with another family is the most difficult thing in the world, but that sometimes it is truly in the child's best interests.

Every adoption is different. Families of all kinds adopt kids of all kinds, from babies to teens. Kids may be adopted by a relative, foster parent, or a completely new family. An adoptive family might be a single parent, a couple, or a family with kids.

Adoptions can be arranged by adoption agencies or handled independently (where the parties involved work through an adoption attorney or private center). An increasing number of adoptions are taking place internationally, with people adopting kids from a different country.

Adoptions are subject to the laws of different states and countries. Some adoptions are confidential (also called closed adoptions), which means that neither the birth nor adoptive parents know the others' identities. Other adoptions are handled more openly. Open adoptions, where both parties have some level of contact with each other, are becoming more common.

As views about adoption change, the secrecy and confidentiality surrounding adoption is giving way to openness in which birth parents are more likely to be involved in the process. This can mean anything from choosing the family they want to adopt their child to keeping in touch with that family as the child grows up.

Emotional Aspects of Adoption

It's natural for any adopted person, child or adult, to have complex feelings about being adopted.

Most of us (whether adopted or not) go through a process of self-discovery and identity development in our teens — figuring out who we are and the kinds of adults we want to be. Being adopted can make that process more complicated. For example, family members may look different from the adopted person or come from different cultures.

It's common for kids who've been adopted to want to know more about their birth history. Usually a big question is why the birth parents placed their child for adoption. And, now that we know the role genes play in many diseases, lots of people want to know about their health history.

When people are curious about their birth family, it doesn't mean they don't love their adoptive family or feel close to them. This curiosity, which can feel quite intense, is a normal part of development. It's common for people to just want to figure out more about themselves by meeting their birth families.

It may take a while for some people to feel they can talk about the different emotions relating to their adoption. Finding a trusted person to talk to — a family member, friend, or counselor — can help when it comes to figuring things out. It can also help to talk to others who were adopted or to join a local or online support group.

The National Adoption Information Clearinghouse has a section that provides advice on searching for birth families in both the United States and some other countries.

Teens who decide to take this step might worry that searching for their birth families may hurt or insult their adoptive parents. But many adoptive parents will be understanding about this natural curiosity, even if they feel unsure about a potential reunion. Many parents want to help their kids find answers to their questions, even if it's difficult for the parents themselves.

Emotionally, this can be a challenging time. It's important to prepare yourself and your family for any and all possibilities. Finding out about birth families has both advantages and disadvantages. But lots of people feel it's better to know than not know, even if what they discover is not what they expected.

Abuse

Amy's finger was so swollen that she couldn't get her ring off. She didn't think her finger was broken because she could still bend it. It had been a week since her dad shoved her into the wall, but her finger still hurt a lot.

Amy hated the way her dad called her names and accused her of all sorts of things she didn't do, especially after he had been drinking. It was the worst feeling and she just kept hoping he would stop.

What Is Abuse?

Abuse can be physical, sexual, emotional, verbal, or a combination of any or all of those. Neglect — when parents or guardians don't take care of the basic needs of the children who depend on them — can also be a form of abuse.

Physical abuse is often the most easily spotted form of abuse. It may be any kind of hitting, shaking, burning, pinching, biting, choking, throwing, beating, and other actions that cause physical injury, leave marks, or produce significant physical pain.

Sexual abuse is any type of sexual contact between an adult and anyone younger than 18, or between a significantly older child and a younger child. If a family member sexually abuses another family member, this is called incest.

Emotional abuse can be difficult to pin down because there may not be physical signs. Emotional abuse happens when yelling and anger go too far or when parents constantly criticize, threaten, or dismiss kids or teens until their self-esteem and feelings of self-worth are damaged. Emotional abuse can hurt and cause damage just as physical abuse does.

Neglect is probably the hardest type of abuse to define. Neglect occurs when a child or teen doesn't have adequate food, housing, clothes, medical care, or supervision. Emotional neglect happens when a parent doesn't provide enough emotional support or deliberately and consistently pays very little or no attention to a child. But it's not neglect if a parent doesn't give a kid something he or she wants, like a new computer or a cell phone.

Family violence can affect anyone. It can happen in any kind of family. Sometimes parents abuse each other, which can be hard for a child to witness. Some parents abuse their kids by using physical or verbal cruelty as a way of discipline.

Abuse doesn't just happen in families, of course. Bullying is a form of abusive behavior. Bullying someone through intimidation, threats, or humiliation can be just as abusive as beating someone up. People who bully others may have been abused themselves. This is also true of people who abuse someone they're dating. But being abused is no excuse for abusing someone else.

Abuse can also take the form of hate crimes directed at people just because of their race, religion, abilities, gender, or sexual orientation.

Recognizing Abuse

It may sound strange, but people sometimes have trouble recognizing that they are being abused. Recognizing abuse may be especially difficult for someone who has lived with it for many years. A person might think that it's just the way things are and that there's nothing that can be done. People who are abused might mistakenly think they bring it on themselves by not acting right or by not living up to someone's expectations.

Someone growing up in a family where there is violence or abuse may not know that there are other ways for family members to treat each other. A person who has only known an abusive relationship may mistakenly think that hitting, beating, pushing, shoving, or angry name-calling are perfectly normal ways to treat someone when you're mad. Seeing parents treat each other in abusive ways might lead a child to think that's a normal relationship. But abuse is not a normal or healthy way to treat people.

If you're not sure you are being abused, or if you suspect a friend is, it's always OK to ask a trusted adult or friend.

Why Does It Happen?

If you're one of the thousands of people living in an abusive situation, it can help to understand why some people abuse — and to realize that the violence is not your fault. Sometimes abusers manipulate the people they are abusing by telling them they did something wrong or "asked for it" in some way. But that's not true.

There is no single reason why people abuse others. But some factors seem to make it more likely that a person may become abusive.

Growing up in an abusive family is one factor. Other people become abusive because they're not able to manage their feelings properly. For example, someone who is unable to control anger or can't cope with stressful personal situations (like the loss of a job or marriage problems) may lash out at others inappropriately. Alcohol or drug use also can make it difficult for some people to control their actions.

Certain types of personality disorders or mental illness might also interfere with a person's ability to relate to others in healthy ways or cause people to have problems with aggression or self-control. Of course, not everyone with a personality disorder or mental illness becomes abusive.

Fortunately, abuse can always be corrected. Everyone can learn how to stop.

What Are the Effects of Abuse?

When people are abused, it can affect every aspect of their lives, especially self-esteem. How much abuse harms a person depends on the situation and sometimes on how severe the abuse is. Sometimes a seemingly minor thing can trigger a big reaction. Being touched inappropriately by a family member, for example, can be very confusing and traumatic.

Every family has arguments. In fact, it's rare when a family doesn't have some rough times, disagreements, and anger. Punishments and discipline — like removing privileges, grounding, or being sent to your room — are normal. Yelling and anger are normal in parent–teen relationships too — although it can feel pretty bad to have an argument with a parent or friend. But if punishments, arguments, or yelling go too far or last too long it can lead to stress and other serious problems.

Teens who are abused (or have been in the past) often have trouble sleeping, eating, and concentrating. They may not do well at school because they are angry or frightened, or because they can't concentrate or don't care.

Many people who are abused distrust others. They may feel a lot of anger toward other people and themselves, and it can be hard to make friends. Abuse is a significant cause of depression in young people. Some teens may engage in self-destructive behavior, such as cutting or abusing drugs or alcohol. They may even attempt suicide.

It's normal for people who have been abused to feel upset, angry, and confused about what happened to them. They may feel guilty and embarrassed and blame themselves. But abuse is never the fault of the person who is being abused, no matter how much the abuser tries to blame others.

Abusers may manipulate a person into keeping quiet by saying stuff like: "This is a secret between you and me," or "If you ever tell anybody, I'll hurt you or your mom," or "You're going to get in trouble if you tell. No one will believe you and you'll go to jail for lying." This is the abuser's way of making a person feel like nothing can be done so he or she won't report the abuse.

People who are abused may have trouble getting help because it means they'd be reporting on someone they love — someone who may be wonderful much of the time and awful to them only some of the time. A person might be afraid of the consequences of reporting, either because they fear the abuser or the family is financially dependent on that person. For reasons like these, abuse often goes unreported.

What Should Someone Who's Being Abused Do?

People who are being abused need to get help. Keeping the abuse a secret doesn't protect anyone from being abused — it only makes it more likely that the abuse will continue.

If you or anyone you know is being abused, talk to someone you or your friend can trust — a family member, a trusted teacher, a doctor, or a school or religious youth counselor. Many teachers and counselors have training in how to recognize and report abuse.

Telephone directories list local child abuse and family violence hotline numbers that you can call for help. There's also Childhelp USA at (800) 4-A-CHILD ([800] 422-4453).

Sometimes people who are being abused by someone in their own home need to find a safe place to live temporarily. It is never easy to have to leave home, but it's sometimes necessary to be protected from further abuse. People who need to leave home to stay safe can find local shelters listed in the phone book or they can contact an abuse helpline. Sometimes a person can stay with a relative or friend.

People who are being abused often feel afraid, numb, or lonely. Getting help and support is an important first step toward changing the situation.

Many teens who have experienced abuse find that painful emotions may linger even after the abuse stops. Working with a therapist is one way to sort through the complicated feelings and reactions that being abused creates, and the process can help to rebuild feelings of safety, confidence, and self-esteem.

Am I in a Healthy Relationship?

Sometimes it feels impossible to find someone who's right for you — and who thinks you're right for him or her! So when it happens, you're usually so psyched that you don't even mind when your little brother finishes all the ice cream or your English teacher chooses the one day when you didn't do your reading to give you a pop quiz.

It's totally normal to look at the world through rose-colored glasses in the early stages of a relationship. But for some people, those rose-colored glasses turn into blinders that keep them from seeing that a relationship isn't as healthy as it should be.

What Makes a Healthy Relationship?

Hopefully, you and your significant other are treating each other well. Not sure if that's the case? Take a step back from the dizzying sensation of being swept off your feet and think about whether your relationship has these qualities:

• Mutual respect. Does he or she get how cool you are and why? (Watch out if the answer to the first part is yes but only because you're acting like someone you're not!) The key is that your BF or GF is into you for who you are — for your great sense of humor, your love of reality TV, etc. Does your partner listen when you say you're not comfortable doing something and then back off right away? Respect in a relationship means that each person values who the other is and understands — and would never challenge — the other person's boundaries.
• Trust. You're talking with a guy from French class and your boyfriend walks by. Does he completely lose his cool or keep walking because he knows you'd never cheat on him? It's OK to get a little jealous sometimes — jealousy is a natural emotion. But how a person reacts when feeling jealous is what matters. There's no way you can have a healthy relationship if you don't trust each other.
• Honesty. This one goes hand-in-hand with trust because it's tough to trust someone when one of you isn't being honest. Have you ever caught your girlfriend in a major lie? Like she told you that she had to work on Friday night but it turned out she was at the movies with her friends? The next time she says she has to work, you'll have a lot more trouble believing her and the trust will be on shaky ground.
• Support. It's not just in bad times that your partner should support you. Some people are great when your whole world is falling apart but can't take being there when things are going right (and vice versa). In a healthy relationship, your significant other is there with a shoulder to cry on when you find out your parents are getting divorced and to celebrate with you when you get the lead in a play.
• Fairness/equality. You need to have give-and-take in your relationship, too. Do you take turns choosing which new movie to see? As a couple, do you hang out with your partner's friends as often as you hang out with yours? It's not like you have to keep a running count and make sure things are exactly even, of course. But you'll know if it isn't a pretty fair balance. Things get bad really fast when a relationship turns into a power struggle, with one person fighting to get his or her way all the time.
• Separate identities. In a healthy relationship, everyone needs to make compromises. But that doesn't mean you should feel like you're losing out on being yourself. When you started going out, you both had your own lives (families, friends, interests, hobbies, etc.) and that shouldn't change. Neither of you should have to pretend to like something you don't, or give up seeing your friends, or drop out of activities you love. And you also should feel free to keep developing new talents or interests, making new friends, and moving forward.
• Good communication. You've probably heard lots of stuff about how men and women don't seem to speak the same language. We all know how many different meanings the little phrase "no, nothing's wrong" can have, depending on who's saying it! But what's important is to ask if you're not sure what he or she means, and speak honestly and openly so that the miscommunication is avoided in the first place. Never keep a feeling bottled up because you're afraid it's not what your BF or GF wants to hear or because you worry about sounding silly. And if you need some time to think something through before you're ready to talk about it, the right person will give you some space to do that if you ask for it.

What's an Unhealthy Relationship?

A relationship is unhealthy when it involves mean, disrespectful, controlling, or abusive behavior. Some people live in homes with parents who fight a lot or abuse each other — emotionally, verbally, or physically. For some people who have grown up around this kind of behavior it can almost seem normal or OK. It's not! Many of us learn from watching and imitating the people close to us. So someone who has lived around violent or disrespectful behavior may not have learned how to treat others with kindness and respect or how to expect the same treatment.

Qualities like kindness and respect are absolute requirements for a healthy relationship. Someone who doesn't yet have this part down may need to work on it with a trained therapist before he or she is ready for a relationship. Meanwhile, even though you might feel bad or feel for someone who's been mistreated, you need to take care of yourself — it's not healthy to stay in a relationship that involves abusive behavior of any kind.

Warning Signs

When a boyfriend or girlfriend uses verbal insults, mean language, nasty putdowns, gets physical by hitting or slapping, or forces someone into sexual activity, it's an important warning sign of verbal, emotional, or physical abuse.

Ask yourself, does my boyfriend or girlfriend:

• get angry when I don't drop everything for him or her?
• criticize the way I look or dress, and say I'll never be able to find anyone else who would date me?
• keep me from seeing friends or from talking to any other guys or girls?
• want me to quit an activity, even though I love it?
• ever raise a hand when angry, like he or she is about to hit me?
• try to force me to go further sexually than I want to?

These aren't the only questions you can ask yourself. If you can think of any way in which your boyfriend or girlfriend is trying to control you, make you feel bad about yourself, isolate you from the rest of your world, or — this is a big one — harm you physically or sexually, then it's time to get out, fast. Let a trusted friend or family member know what's going on and make sure you're safe.

It can be tempting to make excuses or misinterpret violence, possessiveness, or anger as an expression of love. But even if you know that the person hurting you loves you, it is not healthy. No one deserves to be hit, shoved, or forced into anything he or she doesn't want to do.

Why Are Some Relationships So Difficult?

Ever heard about how it's hard for someone to love you when you don't love yourself? It's a big relationship roadblock when one or both people struggle with self-esteem problems. Your girlfriend or boyfriend isn't there to make you feel good about yourself if you can't do that on your own. Focus on being happy with yourself, and don't take on the responsibility of worrying about someone else's happiness.

What if you feel that your girlfriend or boyfriend needs too much from you? If the relationship feels like a burden or a drag instead of a joy, it might be time to think about whether it's a healthy match for you. Someone who's not happy or secure may have trouble being a healthy relationship partner.

Also, intense relationships can be hard for some teenagers. Some are so focused on their own developing feelings and responsibilities that they don't have the emotional energy it takes to respond to someone else's feelings and needs in a close relationship. Don't worry if you're just not ready yet. You will be, and you can take all the time you need.

Ever notice that some teen relationships don't last very long? It's no wonder — you're still growing and changing every day, and it can be tough to put two people together whose identities are both still in the process of forming. You two might seem perfect for each other at first, but that can change. If you try to hold on to the relationship anyway, there's a good chance it will turn sour. Better to part as friends than to stay in something that you've outgrown or that no longer feels right for one or both of you. And before you go looking for amour from that hottie from French class, respect your current beau by breaking things off before you make your move.

Relationships can be one of the best — and most challenging — parts of your world. They can be full of fun, romance, excitement, intense feelings, and occasional heartache, too. Whether you're single or in a relationship, remember that it's good to be choosy about who you get close to. If you're still waiting, take your time and get to know plenty of people.

Think about the qualities you value in a friendship and see how they match up with the ingredients of a healthy relationship. Work on developing those good qualities in yourself — they make you a lot more attractive to others. And if you're already part of a pair, make sure the relationship you're in brings out the best in both of you.

Abusive Relationships

When Brian and Sarah began dating, all of her friends were envious. Brian was smart, sensitive, funny, athletic, and good-looking.

For the first couple of months, Sarah seemed happy. She started to miss her friends and family, though, because she was spending more time with Brian and less time with everyone else. That seemed easier than dealing with Brian's endless questions. He worried about what she was doing at every moment of the day.

Sarah's friends became concerned when her behavior started to change. She lost interest in the things she once enjoyed, like swim meets and going to the mall. She became secretive and moody. When her friends asked Sarah if she was having trouble with Brian, she denied that anything was wrong. What was going on?

Read this article to find out how to tell if you or a friend is being abused and what you can do about it.

What Is Abuse?

Everyone has heard the songs about how much love can hurt. But that doesn't mean physical harm: Someone who loves you should never abuse you. Healthy relationships involve respect, trust, and consideration for the other person.

Sadly, though, lots of relationships turn abusive. In fact, 1 in 11 high school students report being physically hurt by a date.

Abuse can sometimes be mistaken for intense feelings of caring or concern. It can even seem flattering. Think of a friend whose boyfriend or girlfriend is insanely jealous: Maybe it seems like your friend's partner really cares about him or her. But actually, excessive jealousy and controlling behavior are not signs of affection at all. Love involves respect and trust; it doesn't mean constantly worrying about the possible end of the relationship.

Abuse can be physical, emotional, or sexual. Slapping, hitting, and kicking are forms of physical abuse that can occur in both romances and friendships.

Emotional abuse (stuff like teasing, bullying, and humiliating others) can be difficult to recognize because it doesn't leave any visible scars. Threats, intimidation, putdowns, and betrayal are all harmful forms of emotional abuse that can really hurt — not just during the time it's happening, but long after too.

Sexual abuse can happen to anyone, guy or girl. It's never right to be forced into any type of sexual experience that you don't want.

The first step in getting out of an abusive relationship is to realize that you have the right to be treated with respect and not be physically or emotionally harmed by another person.

Signs of an Abusive Relationships

Important warning signs that you may be involved in an abusive relationship include when someone:

• harms you physically in any way, including slapping, pushing, grabbing, shaking, smacking, kicking, and punching
• tries to control different aspects of your life, such as how you dress, who you hang out with, and what you say
• frequently humiliates you or making you feel unworthy (for example, if a partner puts you down but tells you that he or she loves you)
• coerces or threatens to harm you, or self-harm, if you leave the relationship
• twists the truth to make you feel you are to blame for your partner's actions
• demands to know where you are at all times
• constantly becomes jealous or angry when you want to spend time with your friends

Unwanted sexual advances that make you uncomfortable are also red flags that the relationship needs to focus more on respect. When someone says stuff like "If you loved me, you would . . . " that's also a warning of possible abuse. A statement like this is controlling and is used by people who are only concerned about getting what they want — not caring about what you want. Trust your intuition. If something doesn't feel right, it probably isn't.

Signs That a Friend Is Being Abused

In addition to the signs listed above, here are some signs a friend might be being abused by a partner:

• unexplained bruises, broken bones, sprains, or marks
• excessive guilt or shame for no apparent reason
• secrecy or withdrawal from friends and family
• avoidance of school or social events with excuses that don't seem to make any sense

A person who is being abused needs someone to hear and believe him or her. Maybe your friend is afraid to tell a parent because that will bring pressure to end the relationship. People who are abused often feel like it's their fault — that they "asked for it" or that they don't deserve any better. But abuse is never deserved. Help your friend understand that it is not his or her fault. Your friend is not a bad person. The person who is being abusive has a serious problem and needs professional help.

A friend who is being abused needs your patience, love, and understanding. Your friend also needs your encouragement to get help immediately from an adult, such as a parent or guidance counselor. Most of all, your friend needs you to listen without judging. It takes a lot of courage to admit being abused; let your friend know that you're offering your full support.

How You Can Help Yourself

What should you do if you are suffering from any type of abuse? If you think you love someone but often feel afraid, it's time to get out of the relationship — fast. You're worth being treated with respect and you can get help.

First, make sure you're safe. A trusted adult can help. If the person has physically attacked you, don't wait to get medical attention or to call the police. Assault is illegal, and so is rape — even if it's done by someone you are dating.

Avoid the tendency to isolate yourself from your friends and family. You might feel like you have nowhere to turn, or you might be embarrassed about what's been going on, but this is when you need support most. People like counselors, doctors, teachers, coaches, and friends will want to help you, so let them.

Don't rely on yourself alone to get out of the situation. Friends and family who love and care about you can help you break away. It's important to know that asking for help isn't a sign of weakness. It actually shows that you have a lot of courage and are willing to stand up for yourself.

Where to Get Help

Ending abuse and violence in teen relationships is a community effort with plenty of people ready to help. Your local phone book will list crisis centers, teen help lines, and abuse hotlines. These organizations have professionally trained staff to listen, understand, and help. In addition, religious leaders, school nurses, teachers, school counselors, doctors, and other health professionals can be sources of support and information.

You can also get involved at a school or community level as an advocate to help prevent future dating abuse. One example of a school-based program is Safe Dates. Talk to your school guidance counselor about starting a group or other ways to get involved in making sure dating abuse doesn’t happen to people in your school.

Body Dysmorphic Disorder

Most of us spend time in front of the mirror checking our appearance. Some people spend more time than others, but taking care of our bodies and being interested in our appearance is natural.

How we feel about our appearance is part of our body image and self-image. Lots of people have some kind of dissatisfaction with their bodies. This can be especially true during the teen years when our bodies and appearance go through lots of changes.

Although many people feel dissatisfied with some aspect of their appearance, these concerns usually don't constantly occupy their thoughts or cause them to feel tormented. But for some people, concerns about appearance become quite extreme and upsetting.

Some people become so focused on imagined or minor imperfections in their looks that they can't seem to stop checking or obsessing about their appearance. Being constantly preoccupied and upset about body imperfections or appearance flaws is called body dysmorphic disorder.

What Is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a condition that involves obsessions, which are distressing thoughts that repeatedly intrude into a person's awareness. With BDD, the distressing thoughts are about perceived appearance flaws.

People with BDD might focus on what they think is a facial flaw, but they can also worry about other body parts, such as short legs, breast size, or body shape. Just as people with eating disorders obsess about their weight, people with BDD become obsessed over an aspect of their appearance. People with BDD may worry their hair is thin, their face is scarred, their eyes aren't exactly the same size, their nose is too big, or their lips are too thin.

BDD has been called "imagined ugliness" because the appearance issues the person is obsessing about usually are so small that others don't even notice them. Or, if others do notice them, they consider them minor. But for a person with BDD, the concerns feel very real, because the obsessive thoughts distort and magnify any tiny imperfection.

Because of the distorted body image caused by BDD, a person might believe that he or she is too horribly ugly or disfigured to be seen.

Besides obsessions, BDD also involves compulsions and avoidance behaviors.

A compulsion is something a person does to try to relieve the tension caused by the obsessive thoughts. For example, someone with obsessive thoughts that her nose is horribly ugly might check her appearance in the mirror, apply makeup, or ask someone many times a day whether her nose looks ugly. These types of checking, fixing, and asking are compulsions.

A person with obsessions usually feels a strong or irresistible urge to do compulsions because they can provide temporary relief from the terrible distress. To someone with obsessions, compulsions seem like the only way to escape bad feelings caused by bad thoughts. Compulsive actions often are repeated many times a day, taking up lots of a person's time and energy.

Avoidance behaviors are also a part of BDD. A person might stay home or cover up to avoid being seen by others. Avoidance behaviors also include things like not participating in class or socializing, or avoiding mirrors.

With BDD, a pattern of obsessive thoughts, compulsive actions, and avoidance sets in. Even though the checking, fixing, asking, and avoiding seem to relieve terrible feelings, the relief is just temporary. In reality, the more a person performs compulsions or avoids things, the stronger the pattern of obsessions, compulsions, and avoidance becomes.

After a while, it takes more and more compulsions to relieve the distress caused by the bad thoughts. A person with BDD doesn't want to be preoccupied with these thoughts and behaviors, but with BDD it can seem impossible to break the pattern.

What Causes BDD?

Although the exact cause of BDD is still unclear, experts believe it is related to problems with serotonin, one of the brain's chemical neurotransmitters. Poor regulation of serotonin also plays a role in obsessive compulsive disorder (OCD) and other anxiety disorders, as well as depression.

Some people may be more prone to problems with serotonin balance, including those with family members who have problems with anxiety or depression. This may help explain why some people develop BDD but others don't.

Cultural messages can also play a role in BDD by reinforcing a person's concerns about appearance. Critical messages or unkind teasing about appearance as someone is growing up may also contribute to a person's sensitivity to BDD. But while cultural messages, criticism, and teasing might harm somebody's body image, these things alone usually do not result in BDD.

It's hard to know exactly how common BDD is because not many people with BDD are willing to talk about their concerns or seek help. But compared with people who feel somewhat dissatisfied with their appearance, very few people have true BDD. BDD usually begins in the teen years, and if it's not treated, can continue into adulthood.

How BDD Can Affect a Person's Life

Sometimes people with BDD feel ashamed and keep their concerns secret. They may think that others will consider them vain or superficial.

Sometimes other people become annoyed or irritated with somebody's obsessions and compulsions about appearance. They don't understand BDD or what the person is going through. As a result, people with BDD may feel misunderstood, unfairly judged, or alone. Because they avoid contact with others, they may have few friends or activities to enjoy.

It's extremely upsetting to be tormented by thoughts about appearance imperfections. These thoughts intrude into a person's awareness throughout the day and are hard to ignore. People with mild to moderate symptoms of BDD usually spend a great deal of time grooming themselves in the morning. Throughout the day, they may frequently check their appearance in mirrors or windows. In addition, they may repeatedly seek reassurance from people around them that they look OK.

Although people with mild BDD usually continue to go to school, the obsessions can interfere with their daily lives. For example, someone might measure or examine the "flawed" body part repeatedly or spend large sums of money and time on makeup to cover the problem. Some people with BDD hide from others, and avoid going places because of fear of being seen. Spending so much time and energy on appearance concerns robs a person of pleasure and happiness, and of opportunities for fun and socializing.

People with severe symptoms may drop out of school, quit their jobs, or refuse to leave their homes. Many people with BDD also develop depression. People with the most severe BDD may even consider or attempt suicide.

Many people with BDD seek the help of a dermatologist or cosmetic surgeon to try to correct appearance flaws. But dermatology treatments or plastic surgery don't change the BDD. People with BDD who find cosmetic surgeons willing to perform surgery are often not satisfied with the results. They may find that even though their appearance has changes, the obsessive thinking is still present, and they begin to focus on some other imperfection.

Getting Help for BDD

If you or someone you know has BDD, the first step is recognizing what might be causing the distress. Many times, people with BDD are so focused on their appearance that they believe the answer lies in correcting how they look, not with their thoughts.

The real problem with BDD lies in the obsessions and compulsions, which are distorting a person's body image, making that person feel ugly. Because people with BDD believe what they are perceiving is true and accurate, sometimes the most challenging part of overcoming the disorder is being open to new ideas about what might help.

BDD can be treated by an experienced mental health professional. Usually, the treatment involves a type of talk therapy called cognitive-behavioral therapy. This approach helps to correct the pattern that's causing the body image distortion and the extreme distress.

In cognitive behavioral therapy, a therapist helps a person to examine and change faulty beliefs, resist compulsive behaviors, and face stressful situations that trigger appearance concerns. Sometimes doctors prescribe medication along with the talk therapy.

Treatment for BDD takes time, hard work, and patience. It helps if a person has the support of a friend or loved one. If someone with BDD is also dealing with depression, anxiety, feeling isolated or alone, or other life situations, the therapy can address those issues, too.

Body dysmorphic disorder, like other obsessions, can interfere with a person's life, robbing it of pleasure and draining energy. An experienced psychologist or psychiatrist who is knowledgeable about BDD can help break the grip of the disorder so that a person can fully enjoy life.

A Guy's Guide to Body Image

Al's friend Rachel invited him to go to the lake for the day with her family. Rachel thought Al was fun to be around — plus he was cute. Rachel really hoped he'd say yes.

Al turned Rachel down. He liked Rachel, too, but was self-conscious about taking off his T-shirt. He worried that her family and others at the lake would see what he saw when he looked in the mirror — a scrawny excuse for a man. Al hadn't gone to the pool in more than a year because he was so self-conscious about his appearance.

The Truth About Guys

Many people think of guys as being carefree when it comes to their appearance. But the reality is that a lot of guys spend plenty of time in front of the mirror. It's a fact — some guys care just as much as girls do about their appearance.

You may hear a lot about being a tough guy, but how often do you hear that being a guy is tough? Guys might think that they shouldn't worry about how they look, but body image can be a real problem for them. Unlike girls, guys are less likely to talk to friends and relatives about their bodies and how they're developing. Without support from friends and family, they may develop a negative self-image. The good news is that self-image and body image can be changed.

Why Is Body Image Important?

Body image is a person's opinions, thoughts, and feelings about his or her own body and physical appearance. Having a positive body image means feeling pretty satisfied with the way you look, appreciating your body for its capabilities and accepting its imperfections. Body image is part of someone's total self-image. So how a guy feels about his body can affect how he feels about himself. If he gets too focused on not liking the way he looks, a guy's self-esteem can take a hit and his confidence can slide. (The same thing can happen to girls, too.)

How Puberty Affects Body Image

Although body image is just one part of our self-image, during the teen years, and especially during puberty, it can be easy for a guy's whole self-image to be based on how his body looks. That's because our bodies are changing so much during this time that they can become the main focus of our attention.

A change in your body can be tough to deal with emotionally — mainly because, well, your body is yours and you have become used to it.

Some guys don't feel comfortable in their changing bodies and can feel as if they don't know who they are anymore. Being the only guy whose voice is changing or who's growing body hair (or the only guy who isn't) can also make some guys feel self-conscious for a while.

Some guys go into puberty not feeling too satisfied with their body or appearance to begin with. They may have wrestled with body image even before puberty started (for example, battles with weight or dissatisfaction with height). For them, puberty may add to their insecurities.

It Could Be in Your Genes

It can be tough to balance what you expect to happen to your body with what actually does happen. Lots of guys can have high expectations for puberty, thinking they'll develop quickly or in a certain way.

The best way to approach your own growth and development is to not assume you'll be a certain way. Look at everyone in your family — uncles, grandfathers, and even female relatives — to get an idea of the kinds of options your genes may have in store for you.

When Everyone Else Seems Bigger

Not everyone's body changes at the same time or even at the same pace. It can be tough if all of your friends have already matured physically and are taller and more muscular. Most guys eventually catch up in terms of growth, although some will always be taller or more muscular than others — it's in their genes.

It's natural to observe friends and classmates and notice the different ways they're growing and developing. Guys often compare themselves with other guys in certain settings, and one of the most common is the locker room. Whether at a local gym or getting ready for a game at school, time in the locker room can be daunting for any guy.

Try to keep in mind in these situations that you aren't alone if you feel you don't "measure up." Many guys feel exactly the same way about their own bodies — even those whose physiques you envy. Just knowing that almost everyone else will go through the same thing can make all the difference.

You could try talking to a trusted male adult — maybe a coach, a doctor, a teacher, or your dad. Chances are they went through similar experiences and had some of the same feelings and apprehensions when their bodies were changing.

Picture Perfect?

Guys put enough pressure on themselves, but what about the pressure society puts on them to be perfect?

It used to be that only girls felt the pressure of picture-perfect images, but these days the media emphasis on men's looks creates a sense of pressure for guys, too. And sometimes (actually many times) that "as advertised" body is just not attainable. The men you see in those pictures may not even be real. Magazines and ad agencies often alter photographs of models, either by airbrushing the facial and muscular features, or by putting a good-looking face on someone else's buff body.

Building a Better Body Image

So in the face of all the pressure society places on guys — and guys place on themselves — what can you do to fuel a positive body image? Here are some ideas:

• Recognize your strengths. Different physical attributes and body types are good for different things — and sometimes the things you did well as a kid can change during puberty. What does your body do well? Maybe your speed, flexibility, strength, or coordination leads you to excel at a certain sport. Or perhaps you have non-sports skills, like drawing, painting, singing, playing a musical instrument, writing, or acting. Just exploring talents that you feel good about can help your self-esteem and how you think of yourself.
  
  
• A good body doesn't always translate into athletic success. Too often, the way guys see their body image is closely associated with their performance on a sports field or in the gym. The upside to this is that if you're good at a team sport, you might have a pretty good view of your body. But what if you don't like team sports or you got cut from a team you really wanted to make? In these cases, it helps to look at individual accomplishments.
  
  If you don't like team sports, that's OK. Try finding another form of physical activity that really gets you going. Depending on your interests and where you live, that may be mountain biking, rock climbing, dancing, yoga, or even jogging. This will help you stay in shape and help you to appreciate skills may not have realized you had in a team environment.
  
  If you like team sports but didn't make a particular team, don't let it get you down. Use this as an opportunity to discover what you're good at, not to lament what you aren't best at. Maybe try out for another team — so soccer wasn't for you, but maybe cross-country running will be.
  
  If none of these appeal to you, continue to practice the sport you were cut from and try again next year. The people around you probably won't remember that you didn't make the team — not being picked was a much bigger deal to you than it was to them.
  
  
• Look into starting a strength training program. Exercise can help you look good and feel good about yourself. Good physiques don't just happen — they take hard work, regular workouts, and a healthy diet. There's no need to work out obsessively. A healthy routine can be as simple as exercising 20 minutes to 1 hour three days a week. Another benefit to working out properly is that it can boost your mood — lifting weights can lift your spirits.
  
  
• Don't trash your body, respect it! To help improve your view of your body, take care of it. Smoking and other things you know to be harmful will take a toll after a while. Treating yourself well over time results in a healthier, stronger body — and that contributes to a better body image. Practicing good grooming habits — regular showering; taking care of your teeth, hair, and skin; wearing clean clothes, etc. — also can help you build a positive body image.
  
  
• Be yourself. Your body is just one part of who you are — along with your talent for comedy, a quick wit, or all the other things that make you unique. Your talents, skills, and beliefs are just as much a part of you as the casing they come in. So try not to let minor imperfections take over.

While it's important to have a positive body image, getting too focused on body image and appearance can cause a guy to overlook the other positive parts of himself. If you're like most guys who take care of their bodies and wear clothes that look good, you probably look great to others. You just might not be aware of that if you're too busy being self-critical.

5 Ways to Shake Shyness

Having a shy style isn't necessarily a problem. It's perfectly OK to take time to warm up to new people and situations. But shyness blocks some people from being as comfortable or sociable as they'd like to be.

Some people want to feel less shy so they can have more fun socializing and being themselves around others. Here are some tips for overcoming shy feelings:

1. Start small with people you know. Practice social behaviors like eye contact, confident body language, introductions, small talk, asking questions, and invitations with the people you feel most comfortable around. Smile. Build your confidence this way. Then branch out to do this with new friends, too.
2. Think of some conversation starters. Often, the hardest part of talking to someone new is getting started. Think of conversation openers, like introducing yourself ("Hi, I'm Chris, we're in the same English class"), giving a compliment ("That jacket looks great on you"), or asking a question ("Do you know when our report is due?"). Being ready with a conversation starter (or a few) makes it easier to approach someone.
3. Rehearse what to say. When you're ready to try something you've been avoiding because of shyness — like a phone call or a conversation — write down what you want to say beforehand. Rehearse it out loud, maybe even in front of the mirror. Then just do it. Don't worry if it's not exactly like you practiced or if it's not perfect. Few of the things more confident-seeming people do are perfect either. Be proud that you gave it a go. Next time, it'll be even better because it will be easier.
4. Give yourself a chance. Find group activities where you can be with people who share your interests. Give yourself a chance to practice socializing with these new people, and get to know them slowly. People who are shy often worry about failing or how others will judge them. Worries and feelings like these can keep you from trying. If self-criticism plays a role for you, ask yourself whether you'd be this critical of your best friend. Chances are you'd be much more accepting. So treat yourself like your own best friend. Encourage yourself instead of expecting to fail.
5. Develop your assertiveness. Because shy people can be overly concerned with other peoples' reactions, they don't want to rock the boat. That doesn't mean they're wimpy or cowardly. But it can mean they are less likely to be assertive. Being assertive means speaking up for yourself when you should, asking for what you want or need, or telling other people when they're stepping on your toes.

Most of all, be yourself. It's OK to try out different conversational approaches you see others using. But say and do what fits your style. Being the real you — and daring to let yourself be noticed — is what attracts friends.

5 Ways to Deal With Anxiety

Everyone has feelings of anxiety, nervousness, tension, and stress from time to time. Here are 5 ways to help manage them.

Note: When anxiety or worry feels extreme, it may be a sign of an anxiety disorders. For someone who has an anxiety disorder, getting proper care from a heath professional is important. The tips below can help too, of course. But professional treatment is the only way to shake an anxiety disorder.

1. Become a relaxation expert. We all think we know how to relax. But chilling out in front of the TV or computer isn't true relaxation. (Depending on what you're watching or doing, it could even make you more tense.) The same is true for alcohol, drugs, or tobacco. They may seem to relieve anxiety or stress, but it's a false state of relaxation that's only temporary. What the body really needs is a relaxation technique — like deep breathing, tai chi, or yoga — that has a physical effect on the mind. For example, deep breathing helps to relax a major nerve that runs from the diaphragm to the brain, sending a message to the entire body to let go and loosen up.
   
2. Get enough sleep, nourishment, and exercise. Want your mind and body to feel peaceful and strong enough to handle life's ups and downs? Get the right amount of sleep for your needs — not too much or too little. Eat well: Choose fruit, vegetables, lean proteins, and whole grains for long-term energy (instead of the short bursts that come from too much sugar or caffeine). And exercise to send oxygen to every cell in the body so your brain and body can operate at their best.
3. Connect with others. Spend time with friends or family. Organized activities are great, but just hanging out works too. Doing things with those we feel close to deepens our bonds, allowing us to feel supported and secure. And the fun and sharing that go with it allow us to feel happier and less upset about things. If you feel worried or nervous about something, talking about it with someone who listens and cares can help you feel more understood and better able to cope. You'll be reminded that everyone has these feelings sometimes. You're not alone.
4. Connect with nature. Heading out for a walk in the park or a hike in the woods can help anyone feel peaceful and grounded. (Choose somewhere you feel safe so you can relax and enjoy your surroundings.) Walking, hiking, trail biking, or snowshoeing offer the additional benefit of exercise. Invite a friend or two — or a family member — along and enjoy feeling connected to people as well.
5. Think positive. A great way to keep our minds off the worry track is to focus our thoughts on things that are good, beautiful, and positive. Allow yourself to dream, wish, and imagine the best that could happen.

Anxiety Disorders

Liam had always looked out for his younger brother Sam. But whenever Sam took the late bus after soccer practice, Liam worried about him so much he couldn't concentrate on his homework. Liam watched the clock, worrying and imagining the worst — picturing bus accidents and fearing, for no particular reason, that Sam might be injured or dead. Only when Sam arrived home safe could Liam finally relax.

It's completely normal to worry when things get hectic and complicated. But if worries become overwhelming, you may feel that they're running your life. If you spend an excessive amount of time feeling worried or nervous, or you have difficulty sleeping because of your anxiety, pay attention to your thoughts and feelings. They may be symptoms of an anxiety problem or disorder.

What Is Anxiety?

Anxiety is a natural human reaction that involves mind and body. It serves an important basic survival function: Anxiety is an alarm system that is activated whenever a person perceives danger or threat.

When the body and mind react to danger or threat, a person feels physical sensations of anxiety — things like a faster heartbeat and breathing, tense muscles, sweaty palms, a queasy stomach, and trembling hands or legs. These sensations are part of the body's fight-flight response. They are caused by a rush of adrenaline and other chemicals that prepare the body to make a quick getaway from danger. They can be mild or extreme.

The fight-flight response happens instantly when a person senses a threat. It takes a few seconds longer for the thinking part of the brain (the cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. If the cortex sends the all-clear signal, the fight-flight response is deactivated and the nervous system can relax.

If the mind reasons that a threat might last, feelings of anxiety might linger, keeping the person alert. Physical sensations such as rapid, shallow breathing; a pounding heart; tense muscles; and sweaty palms might continue, too.

Normal Anxiety

Everyone experiences feelings of anxiety from time to time. Anxiety can be described as a sense of uneasiness, nervousness, worry, fear, or dread of what's about to happen or what might happen. While fear is the emotion we feel in the presence of threat, anxiety is a sense of anticipated danger, trouble, or threat.

Feelings of anxiety can be mild or intense (or anywhere in between), depending on the person and the situation. Mild anxiety can feel like a sense of uneasiness or nervousness. More intense anxiety can feel like fear, dread, or panic. Worrying and feelings of tension and stress are forms of anxiety. So are stage fright and the shyness that can come with meeting new people.

It's natural for new, unfamiliar, or challenging situations to prompt feelings of anxiety or nervousness. Facing an important test, a big date, or a major class presentation can trigger normal anxiety. Although these situations don't actually threaten a person's safety, they can cause someone to feel "threatened" by potential embarrassment, worry about making a mistake, fitting in, stumbling over words, being accepted or rejected, or losing pride. Physical sensations — such as a pounding heart, sweaty hands, or a nervous stomach — can be part of normal anxiety, too.

Because anxiety makes a person alert, focused, and ready to head off potential problems, a little anxiety can help us do our best in situations that involve performance. But anxiety that's too strong can interfere with doing our best. Too much anxiety can cause a person to feel overwhelmed, tongue-tied, or unable to do what they need to do.

Anxiety Disorders

Anxiety disorders are mental health conditions that involve excessive amounts of anxiety, fear, nervousness, worry, or dread. Anxiety that is too constant or too intense can cause a person to feel preoccupied, distracted, tense, and always on alert.

Anxiety disorders are among the most common mental health conditions. They affect people of all ages — including adults, children, and people in their teens. There are many different types of anxiety disorders, with different symptoms. They all have one thing in common, though: Anxiety occurs too often, is too strong, is out of proportion to the present situation, and affects a person's daily life and happiness.

Symptoms of an anxiety disorder can come on suddenly, or they can build gradually and linger until a person begins to realize that something is wrong. Sometimes anxiety creates a sense of doom and foreboding that seems to come out of nowhere. It's common for those with an anxiety disorder to not know what's causing the emotions, worries, and sensations they have.

Different anxiety disorders are named to reflect their specific symptoms.

• Generalized anxiety. With this common anxiety disorder, a person worries excessively about many things. Someone with generalized anxiety may worry excessively about school, the health or safety of family members, and the future. They may always think of the worst that could happen.
  
  Along with the worry and dread, people with generalized anxiety have physical symptoms, such as chest pain, headache, tiredness, tight muscles, stomachaches, or vomiting. Generalized anxiety can lead a person to miss school or avoid social activities. With generalized anxiety, worries can feel like a burden, making life feel overwhelming or out of control.
• Obsessive compulsive disorder (OCD). For a person with OCD, anxiety takes the form of obsessions (bad thoughts) and compulsions (actions that try to relieve anxiety).
• Phobias. These are intense fears of specific situations or things that are not actually dangerous, such as heights, dogs, or flying in an airplane. Phobias usually cause people to avoid the things they are afraid of.
• Social phobia (social anxiety). This intense anxiety is triggered by social situations or speaking in front of others. An extreme form called selective mutism causes some kids and teens to be too fearful to talk at all in certain situations.
• Panic attacks. These episodes of anxiety can occur for no apparent reason. With a panic attack, a person has sudden and intense physical symptoms that can include a pounding heart, shortness of breath, dizziness, numbness, or tingling feelings causes by overactivity of the body's normal fear response. Agoraphobia is an intense fear of panic attacks that causes a person to avoid going anywhere a panic attack could possibly occur.
• Posttraumatic stress disorder (PTSD). This type of anxiety disorder results from a traumatic or terrifying past experience. Symptoms include flashbacks, nightmares, or constant fear after the fact.

How Anxiety Disorders Affect People

For people dealing with anxiety disorders, symptoms can feel strange and confusing at first. For some, the physical sensations can be strong and upsetting. For others, feelings of doom or fear that can happen for no apparent reason can make them feel scared, unprotected, and on guard. Constant worries can make a person feel overwhelmed by every little thing. All this can affect someone's concentration, confidence, sleep, appetite, and outlook.

People with anxiety disorders might avoid talking about their worries, thinking that others might not understand. They may fear being unfairly judged, or considered weak or scared. Although anxiety disorders are common, people who have them may feel misunderstood or alone.

Some people with anxiety disorders might blame themselves. They may feel embarrassed or ashamed, or mistakenly think that anxiety is a weakness or a personal failing. Anxiety can keep people from going places or doing things they enjoy.

The good news is, doctors today understand anxiety disorders better than ever before and, with treatment, a person can feel better.

What Causes Anxiety Disorders?

Experts don't know exactly what causes anxiety disorders. Several things seem to play a role, including genetics, brain biochemistry, an overactive fight-flight response, stressful life circumstances, and learned behavior.

Someone with a family member who has an anxiety disorder has a greater chance of developing one, too. This may be related to genes that can affect brain chemistry and the regulation of chemicals called neurotransmitters. But not everyone with a family member who has an anxiety disorder will develop problems with anxiety.

Things that happen in a person's life can also set the stage for anxiety disorders. Frightening traumatic events that can lead to PTSD are a good example.

Growing up in a family where others are fearful or anxious can "teach" a child to view the world as a dangerous place. Likewise, if a person grows up in an environment that is actually dangerous (if there is violence in the child's family or community, for example), he or she may learn to be fearful or expect the worst.

Although everyone experiences normal anxiety in certain situations, most people — even those who experience traumatic situations — don't develop anxiety disorders. And people who develop anxiety disorders can get relief with proper treatment and care. They can learn ways to manage anxiety and to feel more relaxed and at peace.

How Are Anxiety Disorders Treated?

Anxiety disorders can be treated by mental health professionals, or therapists. A therapist can look at the symptoms someone is dealing with, diagnose the specific anxiety disorder, and create a plan to help the person get relief.

A particular type of talk therapy called cognitive-behavior therapy (CBT) is often used. In CBT, a person learns new ways to think and act in situations that can cause anxiety, and to manage and deal with stress. The therapist provides support and guidance and teaches new coping skills, such as relaxation techniques or breathing exercises. Sometimes, but not always, medication is used as part of the treatment for anxiety.

What to Do

Getting the problem treated can help a person feel like himself or herself again — relaxed and ready for the good things in life. Someone who might be dealing with an anxiety disorder should:

• Tell a parent or other adult about physical sensations, worries, or fears. Because anxiety disorders don't go away unless they are treated, it's important to tell someone who can help. If a parent doesn't seem to understand right away, talk to a school counselor, religious leader, or other trusted adult.
• Get a checkup. See a doctor to make sure there are no physical conditions that could be causing symptoms.
• Work with a mental health professional. Ask a doctor, nurse, or school counselor for a referral to someone who treats anxiety problems. Finding out what's causing the symptoms can be a great relief.
• Get regular exercise, good nutrition, and sleep. These provide your body and brain with the right fuel and time to recharge.

Try to stay patient and positive. It can take time to feel better, and courage to face fears. But letting go of worry allows space for more happiness and fun.

5 Facts About Goal Setting

These practical tips on goal setting can help make it easier to set and reach goals:

1. Specific, realistic goals work best. When it comes to making a change, the people who succeed are those who set realistic, specific goals. "I'm going to recycle all my plastic bottles, soda cans, and magazines" is a much more doable goal than "I'm going to do more for the environment." And that makes it easier to stick with.
2. It takes time for a change to become an established habit. It will probably take a couple of months before any changes — like getting up half an hour early to exercise — become a routine part of your life. That's because your brain needs time to get used to the idea that this new thing you're doing is part of your regular routine.
3. Repeating a goal makes it stick. Say your goal out loud each morning to remind yourself of what you want and what you're working for. (Writing it down works too.) Every time you remind yourself of your goal, you're training your brain to make it happen.
4. Pleasing other people doesn't work. The key to making any change is to find the desire within yourself — you have to do it because you want it, not because a girlfriend, boyfriend, coach, parent, or someone else wants you to. It will be harder to stay on track and motivated if you're doing something out of obligation to another person.
5. Roadblocks don't mean failure. Slip-ups are actually part of the learning process as you retrain your brain into a new way of thinking. It may take a few tries to reach a goal. But that's OK — it's normal to mess up or give up a few times when trying to make a change. So remember that everyone slips up and don't beat yourself up about it. Just remind yourself to get back on track.

Bipolar Disorder

Bipolar disorders are one of several medical conditions called depressive disorders. Depressive disorders affect the way a person's brain functions.

Depressive disorders are widespread. In the United States alone, it's estimated that more than 17.4 million adults have a depressive disorder each year. That works out to about 1 out of every 7 people, so there's a good chance that you or someone you know is dealing with a depressive disorder.

What Is Bipolar Disorder?

Bipolar disorder goes by many names: manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder are medical terms for the same condition.

Bipolar disorder is classified into four different types: Bipolar I, Bipolar II, Cyclothymic Disorder, or Bipolar Disorder Not Otherwise Specified. Mental health experts separate the condition into these four types because the symptoms of bipolar disorder show up differently in different people. When doctors know what type someone has, they can tailor treatment to that person's specific needs.

Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: It often shows up in adolescence, and even children can have the disorder.

Recent research suggests that kids and teens with bipolar disorder don't always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.

Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just "snap out of it," as if a person who is sick can become well simply by wanting to. Bipolar disorder isn't a sign of weakness or a character flaw; it's a serious medical condition that requires treatment, just like any other condition.

What Are the Signs and Symptoms?

A person with bipolar disorder will go through episodes of mania (highs) and at other times experience episodes of depression (lows). These aren't the normal periods of happiness and sadness that everyone experiences from time to time. Instead, the episodes are intense or severe mood swings, like a pendulum that keeps arcing higher and higher.

Symptoms of mania include:

• racing speech and thoughts
• increased energy
• decreased need for sleep
• elevated mood and exaggerated optimism
• increased physical and mental activity
• excessive irritability, aggressive behavior, and impatience
• poor judgment
• reckless behavior, like excessive spending, making rash decisions, and erratic driving
• difficulty concentrating
• inflated sense of self-importance

Symptoms of depression include:

• loss of interest in usual activities
• prolonged sad or irritable mood
• loss of energy or fatigue
• feelings of guilt or worthlessness
• sleeping too much or inability to sleep
• drop in grades and inability to concentrate
• inability to experience pleasure
• appetite loss or overeating
• anger, worry, and anxiety
• thoughts of death or suicide
  

In adults, episodes of mania or depression usually last for weeks or months, although they can be shorter in length. In children and adolescents, though, these episodes can be much shorter, and a kid or teen can even go back and forth between mania and depression throughout the day. Episodes of mania or depression may happen irregularly and follow an unpredictable pattern or they may be linked, with a manic episode always following a period of depression, or vice versa. Sometimes episodes have a seasonal pattern. Mania in the spring, for example, may be followed by depression in the winter.

Between episodes, a person with bipolar disorder usually returns to normal (or near-normal) functioning. For some people, though, there is little or no "break period" between their cycles. These mood swing cycles can change slowly or rapidly, with rapid cycling between mania and depression being much more common in women, children, and adolescents.

Some people with bipolar disorder turn to alcohol and drugs because they feel temporarily better when they're high. But using alcohol and drugs can have disastrous results for people with bipolar disorder. Substance abuse can actually make the symptoms worse, as well as making the condition hard for doctors to diagnose.

What Causes Bipolar Disorder?

Doctors and scientists don't know the exact cause of bipolar disorder, but they think that biochemical, genetic, and environmental factors may all be involved. It's believed this condition is caused by imbalances in certain brain chemicals called neurotransmitters. If the neurotransmitters aren't in balance, the brain's mood-regulating system won't work the way it should.

Genes also play a role. If a close relative has bipolar disorder, a person's risk of developing the condition is higher. This doesn't mean, though, that if you have a relative with bipolar disorder you will automatically develop it! Even in studies involving identical twins raised in the same home, one twin sometimes had bipolar disorder whereas the other did not. Researchers are now working on identifying the gene or genes involved in bipolar disorder.

Environmental factors may play a role in bipolar disorder. For some teens, stresses such as a death in the family, their parents' divorce, or other traumatic events could trigger a first episode of mania or depression. Sometimes, going through the changes of puberty can set off an episode. In girls, symptoms can be tied to their monthly menstrual cycle.

How Is Bipolar Disorder Diagnosed?

Most people with bipolar disorder can be helped — but a psychiatrist or psychologist must first diagnose the disorder. Sadly, many people with the condition are never diagnosed or are not diagnosed properly. Without proper diagnosis and treatment, the disorder can become worse. Some teens with undiagnosed bipolar disorder can end up in a psychiatric hospital or residential treatment center, in the juvenile justice system, abusing drugs, or committing suicide.

Because children and teens with bipolar disorder do not usually show the same patterns of behavior as adults who have the condition, a mental health professional will observe a teen's behavior carefully before making a diagnosis. This includes getting a complete history of a person's past and present experiences. Family members and friends can also provide helpful insights into the person's behavior. The doctor may also want a teen to have a medical exam to rule out other conditions.

Diagnosing bipolar disorder can be difficult. As yet, there aren't any laboratory tests like a brain scan or blood test that will diagnose it. In teens, bipolar disorder can sometimes be mistaken for illnesses like schizophrenia and posttraumatic stress disorder, attention deficit hyperactivity disorder (ADHD), and other depressive disorders. That's why a complete, detailed history is so important.

How Do Doctors Treat It?

Although there's no cure for bipolar disorder, treatment can help stabilize a person's moods and help the person manage and control symptoms. Like other teens with long-lasting medical conditions (such as asthma, diabetes, or epilepsy), teens with bipolar disorder need to work closely with their doctors and other medical professionals to treat it.

This team of medical professionals, together with the teen and family, develop what is called a treatment plan. Teens with bipolar disorder will probably receive medication, such as a mood stabilizer, from a psychiatrist or other medical doctor. A psychologist or other type of counselor will provide counseling or psychotherapy for the teen and his or her family. Doctors will watch the symptoms closely and offer additional treatment advice if necessary.

Living With Bipolar Disorder

Teens normally face ups and downs with school, family, work, and friends. Dealing with bipolar disorder at the same time is a very difficult challenge. One 16-year-old reader who was diagnosed with bipolar disorder at 14 wrote to us about the experience:

"I had mood swings that were the worst anyone could have ever seen. My poor parents thought I hated them, but really I was sick and didn't even realize it. But now I am on medications for my disorder and I live a pretty normal life. My family and friends support me, and they, along with my therapist, have helped me get to the point where I am today. I just want other teens to know that even though it is hard at times to be bipolar, things will get better."

If you've been diagnosed with bipolar disorder, taking your medications as prescribed, reporting any changes in how you feel or function, and participating in therapy will be key to living a successful life. In addition to treatment, making a few lifestyle changes, such as reducing stress, eating well, and getting enough sleep and exercise can help someone who is living with the condition. And many teens find it helps to join a support network such as a local support group for people with bipolar disorder.

5 Ways to Fight Depression

If you feel depressed, it's best to do something about it — depression doesn't just go away on its own. In addition to getting help from a doctor or therapist, here are 5 things you can do to feel better.

1. Exercise. Take a 15- to 30-minute brisk walk every day — or dance, jog, or bike if you prefer. People who are depressed may not feel much like being active. But make yourself do it anyway (ask a friend to exercise with you if you need to be motivated). Once you get in the exercise habit, it won't take long to notice a difference in your mood.
   
   In addition to getting aerobic exercise, some yoga poses can help relieve feelings of depression. Try downward-facing dog or legs-up-the-wall pose (you can find these poses on yoga websites). Two other aspects of yoga — breathing exercises and meditation — can also help people with depression feel better.
2. Nurture yourself with good nutrition. Depression can affect appetite. One person may not feel like eating at all, but another might overeat. If depression has affected your eating, you'll need to be extra mindful of getting the right nourishment. Proper nutrition can influence a person's mood and energy. So eat plenty of fruits and vegetables and get regular meals (even if you don't feel hungry, try to eat something light, like a piece of fruit, to keep you going).
3. Identify troubles, but don't dwell on them. Try to identify any situations that have contributed to your depression. When you know what's got you feeling blue and why, talk about it with a caring friend. Talking is a way to release the feelings and to receive some understanding. If there's no one to tell, pouring your heart out to a journal works just as well.
   
   Once you air out these thoughts and feelings, turn your attention to something positive. Take action to solve problems. Ask for help if you need it. Feeling connected to friends and family can help relieve depression. (It may also help them feel there's something they can do instead of just watching you hurt.)
4. Express yourself. With depression, a person's creativity and sense of fun may seem blocked. By exercising your imagination (painting, drawing, doodling, sewing, writing, dancing, composing music, etc.) you not only get those creative juices flowing, you also loosen up some positive emotions. Take time to play with a friend or a pet, or do something fun for yourself. Find something to laugh about — a funny movie, perhaps. Laughter helps lighten your mood.
5. Look on the bright side. Depression affects a person's thoughts, making everything seem dismal, negative, and hopeless. If depression has you noticing only the negative, make an effort to notice the good things in life. Try to notice one thing, then try to think of one more. Consider your strengths, gifts, or blessings. Most of all, don't forget to be patient with yourself. Depression takes time to heal.

Stepparents

Shelly just knew. When her father took her to their favorite coffee shop for what he called a "very important talk," Shelly's instincts told her that her dad was getting married again. After he broke the news to her, though, Shelly's father surprised her by asking how she felt about having a stepmother.

Shelly didn't have an immediate answer. Her father's announcement triggered a range of emotions — a little jealousy about her father's new wife, lingering sadness over her parents' divorce 3 years before, and feelings of insecurity over just where she fit into her dad's new life. Shelly realized she hadn't really thought about the day-to-day realities of having a stepmom — or being a stepdaughter, for that matter.

Lots of Shelly's ninth-grade friends have stepparents. After all, statistics show that one third of all children are likely to spend some time in a stepfamily while growing up. Like anyone with a TV, Shelly had seen her share of pop culture stereotypes, ranging from to the disinterested, self-absorbed stepmother to the overeager one who tries too hard. She wondered how it would be for her.

When a Stepparent Enters the Picture

In some families, new adults and kids seem to slip in effortlessly, as though they have been there all along. Everyone gets along well — one big happy family, just like on "The Brady Bunch."

But some families brought together through marriage can be so different that the best everyone can do is grit their teeth and work extremely hard to get through a weekend together.

Building a relationship with a stepparent can be quite different from building other new relationships. After all, when you meet a new friend or love interest, you are the one deciding if that person will have a role in your life. You get to introduce these new people into your life gradually, taking time to decide how they fit and how you really feel about them.

A stepparent is different; he or she is someone your mom or dad has invited into the family. Sometimes a stepparent can feel like a stranger who is suddenly inserted into the most personal aspects of your life. The pressure to get along can be intense.

Because everyone's situation is different, there are no easy answers to accepting a stepparent. Some people find themselves with new stepparents after a parent has died, others after parents have divorced. Some parents take years to meet and marry other people; some remarry almost immediately.

When a parent remarries, you may find yourself with an instant family of stepsiblings or, after a few years, with younger half brothers or sisters.

Although every family is different, there are some things that can help you deal with a new stepparent.

Dealing With Feelings

One of the most important things you can do for yourself is to recognize that you'll have plenty of feelings about your new situation, and some of these may conflict. For example, even when someone likes a new stepparent, it's natural to feel some pangs that this new person is "replacing" a beloved parent in some way.

Change — good or bad — is difficult. Even if you don't have negative feelings about the new person in your family, you may have very strong feelings about the changes a stepparent is creating.

At some point, you're probably going to feel confused, conflicted about your loyalties, angry, and possibly sad. Here are a couple of things to try that may help put your feelings into focus:

• Keep a journal. Write down how you feel about the changes in your life. Make a list of pros and cons to see how they compare. Then check back in 6 months and do the list again. This can help you track how things may have changed. Sometimes, when time has passed, you can see a situation in a different way.
• Seek support from a friend. Some of your close, trusted friends may have their own stepparent experiences that can help you feel you're not alone. Friends also can share tips on what they did in situations similar to yours — everything from sharing a room with a new stepsibling to juggling computer time. Even if your friends' situations are different (just because your best friend doesn't get along with his or her stepparents, that's not a hard and fast rule for anyone else), it always helps to have a sympathetic ear.
• Talk to your parent or another trusted adult about how you're feeling. It's important to share your fears, feelings, and frustrations with an adult you trust — no matter how crazy you may think these feelings are. Don't be afraid that something you say will cause hurt feelings or make you seem like a problem. An adult who loves you will want to help.

If your parent is too wrapped up in the new relationship to help you work through your feelings (yes, parents can be selfish sometimes), then look for a group at school or in your community where you can vent. Or talk to a teacher or a guidance counselor about what's going on in your life. Mental health professionals, such as social workers or therapists, are trained to help people sort out the conflicting mix of feelings that can accompany a parent's remarriage.

Entering a stepparent situation can be particularly challenging for teens. Feeling like your family life has been disrupted can be especially difficult because of all the other changes that take place during the teenage years — everything from the emotional growth involved in becoming an adult to the hormonal changes triggered by puberty. If you find that your new situation has left you feeling sad most of the time, or you just can't shake the blues, you may want to talk to a doctor or therapist.

Facing the Realities

So what can you do to adjust to the daily realities of living with a stepparent? Instead of worrying about the "what ifs" and the inevitable changes, talk to your mom or dad about what to expect before your new stepparent joins the family. That way, you can be prepared for, rather than mortified by, what lies ahead. For example, figure out ahead of time what to call your stepparent. Ask about holiday plans and who's giving presents to whom. If your house is about to explode with new people, find out how this affects you and that spare room where you listen to music.

Don't be afraid to ask questions as they come to mind. Your parents and new stepparent may not have thought about the things you're asking either, so there's an opportunity to explore options together. And if there's something you absolutely don't want to change, try to negotiate. For example, if you and your dad always go fishing over Thanksgiving but your mom made plans for you to spend the holiday with her new husband's family, she may not realize how important the fishing trip is to you.

What about those times when you flat out disagree with a stepparent? You'll have a better chance of getting what you want if you disagree without disrespect.

Explain your feelings calmly and rationally. For example, if you have a new half-brother or -sister and you feel like you're constantly being expected to babysit at the last minute, talk it over with your stepparent before the situation gets to the stage where you feel taken advantage of. Present your side — maybe you have to study for a test or you already made plans with friends and they're relying on you. Then listen to the other person's perspective.

If you're particularly mad about something, it can feel hard not to lose control. But managing your anger and taking extra care to choose respectful language will help your stepparent see you for the mature person you are, not as a child.

Find a way to get to know the new stepparent in your life. Suggest a bike ride or go to a movie together. It may not be easy, but you can use the same relationship and communication skills you would use to make anyone feel welcome. It may help to remember that your stepparent is walking into a new situation, too. He or she could feel just as nervous and confused as you do.

Expect some rough spots. You know that establishing a good relationship takes time. Your new life won't always be smooth, so be ready to make some compromises. The good thing is, the ups and downs of adjusting to a new family situation can offer some really great life lessons. Many people look back on their experiences getting to know new family members and realize they learned some great relationship (and negotiating!) skills in the process.

Remind yourself that every situation is different. There's no real script for a new family that's being pulled together from all sorts of directions. Be open to lots of possibilities. And savor the good moments. Although change is often difficult, it can be good, too.

Three months after her dad remarried, Shelly was beginning to enjoy the time she spent with her father and stepmother. She couldn't help but see how happy her dad was — especially when the three of them did things together. And when she needed some alone time for just the two of them, she and her dad headed to the coffee shop. Despite all the changes in their lives, some things didn't change between Shelly and her dad — like the fact he thought there was way too much sugar and caffeine in the frozen mocha cappuccino and always made her pick something else.

Dealing With Divorce

For many people, their parents' divorce marks a turning point in their lives, whether the divorce happened many years ago or is taking place right now.

About half the marriages in the United States today end in divorce, so children of divorce are certainly not alone. But when it happens to you, you can feel very alone and unsure of what it all means. It may seem hard, but it is possible to cope with divorce — and have a good family life in spite of some changes divorce may bring.

Why Are My Parents Divorcing?

Parents divorce for many reasons. Usually divorce happens when couples feel they can no longer live together due to fighting and anger, or because the love they had when they married has changed. Divorce can also be because one parent falls in love with someone else, and sometimes it is due to a serious problem like drinking, abuse, or gambling.

It's common for teens to think that their parents' divorce is somehow their fault, but nothing could be further from the truth. Some teens may wonder if they could have helped to prevent the split. Others may wish they had prevented arguments by cooperating more within the family, doing better with their behavior, or getting better grades. But separation and divorce are a result of a couple's problems with each other, not with their kids. The decisions adults make about divorce are their own.

If your parents are divorcing, you may experience a lots of feelings. Your emotions may change frequently, too. You may feel angry, frustrated, upset, or sad. You might feel protective of one parent or blame one for the situation. You may feel abandoned, afraid, worried, or guilty. You may also feel relieved, especially if there has been a lot of tension at home. These feelings are normal and talking about them with a friend, family member or trusted adult can really help.

How Will Divorce Change My Life?

Depending on what happens in your family, you may have to adjust to many changes. These could include things like moving, changing schools, spending time with both parents separately, and perhaps dealing with parents' unpleasant feelings toward one another.

Your parents may go to court to determine custody arrangements. You may end up living with one parent most of the time and visiting the other, or your parents may split their time with you evenly.

Some teens have to travel between parents, and that may create challenges both socially and practically. But with time you can create a new routine that works. Often, it takes a while for custody arrangements to be finalized. This can give people time to adapt to these big changes and let families figure out what works best.

Money matters may change for your parents, too. A parent who didn't work during the marriage may need to find a job to pay for rent or a mortgage. This might be something a parent is excited about, but he or she may also feel nervous or pressured about finances. There are also expenses associated with divorce, from lawyers' fees to the cost of moving to a new place to live.

Your family may not be able to afford all the things you were used to before the divorce. This is one of the difficult changes often associated with divorce. There can be good changes too — but how you cope with the stressful changes depends on your situation, your personality, and your support network.

What Parents and Teens Can Do to Make Divorce Easier

Keep the peace. Dealing with divorce is easiest when parents get along. Teens find it especially hard when their parents fight and argue or act with bitterness toward each other. You can't do much to influence how your parents behave during a divorce, but you can ask them to do their best to call a truce to any bickering or unkind things they might be saying about each other. No matter what problems a couple may face, as parents they need to handle visiting arrangements peacefully to minimize the stress their kids may feel.

Be fair. Most teens say it's important that parents don't try to get them to "take sides." You need to feel free to relate to one parent without the other parent acting jealous, hurt, or mad. It's unfair for anyone to feel that relating to one parent is being disloyal to the other or that the burden of one parent's happiness is on your shoulders.

When parents find it hard to let go of bitterness or anger, or if they are depressed about the changes brought on by divorce, they can find help from a counselor or therapist. This can help parents get past the pain divorce may have created, to find personal happiness, and to lift any burdens from their kids. Kids and teens can also benefit from seeing a family therapist or someone who specializes in helping them get through the stress of a family breakup.

Keep in touch. Going back and forth between two homes can be tough, especially if parents live far apart. It can be a good idea to keep in touch with a parent you see less often because of distance. Even a quick email saying "I'm thinking of you" helps ease the feelings of missing each other. Making an effort to stay in touch when you're apart can keep both of you up to date on everyday activities and ideas.

Work it out. You may want both parents to come to special events, like games, meets, plays, or recitals. But sometimes a parent may find it awkward to attend if the other is present. It helps if parents can figure out a way to make this work, especially because you may need to feel the support and presence of both parents even more during divorce. You might be able to come up with an idea for a compromise or solution to this problem and suggest it to both parents.

Talk about the future. Lots of teens whose parents divorce worry that their own plans for the future could be affected. Some are concerned that the costs of divorce (like legal fees and expenses of two households) might mean there will be less money for college or other things.

Pick a good time to tell your parents about your concerns — when there's enough time to sit down with one or both parents to discuss how the divorce will affect you. Don't worry about putting added stress on your parents. It's better to bring your concerns into the open than to keep them to yourself and let worries or resentment build. There are solutions for most problems and counselors who can help teens and their parents find those solutions.

Figure out your strengths. How do you deal with stress? Do you get angry and take it out on siblings, friends, or yourself? Or are you someone who is a more of a pleaser who puts others first? Do you tend to avoid conflict altogether and just hope that problems will magically disappear? A life-changing event like a divorce can put people through some tough times, but it can also help them learn about their strengths, and put in place some new coping skills. For example, how can you cope if one parent bad-mouths another? Sometimes staying quiet until the anger has subsided and then discussing it calmly with your mom or dad can help. You may want to tell them you have a right to love both your parents, no matter what they are doing to each other.

If you need help figuring out your strengths or how to cope — like from a favorite aunt or from your school counselor — ask for it! And if you find it hard to confront your parents, try writing them a letter. Figure out what works for you.

Live your life. Sometimes during a divorce, parents may be so caught up in their own changes it can feel like your own life is on hold. In addition to staying focused on your own plans and dreams, make sure you participate in as many of your normal activities as possible. When things are changing at home, it can really help to keep some things, such as school activities and friends, the same. If things get too hard at home, see if you can stay with a friend or relative until things calm down. Take care of yourself by eating right and getting regular exercise — two great stress busters!

Let others support you. Talk about your feelings and reactions to the divorce with someone you trust. If you're feeling down or upset, let your friends and family members support you. These feelings usually pass. If they don't, and if you're feeling depressed or stressed out, or if it's hard to concentrate on your normal activities, let a counselor or therapist help you. Your parents, school counselor, or a doctor or other health professional can help you find one. Many communities and schools have support groups for kids and teens whose parents have divorced. It can really help to talk with other people your age who are going through similar experiences.

Bringing Out the Positive

There will be ups and downs in the process, but teens can cope successfully with their parents' divorce and the changes it brings. You may even discover some unexpected positives. Many teens find their parents are actually happier after the divorce or they may develop new and better ways of relating to both parents when they have separate time with each one.

Some teens learn compassion and caring skills when a younger brother or sister needs their support and care. Siblings who are closer in age may form tighter bonds, learning to count on each other more because they're facing the challenges of their parents' divorce together. Coping well with divorce also can bring out strength and maturity. Some become more responsible, better problem solvers, better listeners, or better friends. Looking back on the experience, lots of people say that they learned coping skills they never knew they had and feel stronger and more resilient as a result of what they went through.

Many movies have been made about divorce and stepfamilies — some with happy endings, some not. That's how it is in real life too. But most teens who go through a divorce learn (sometimes to their surprise) that they can make it through this difficult situation successfully. Giving it time, letting others support you along the way, and keeping an eye on the good things in your life can make all the difference.