Lepage Associates Newsletter
Mental Health Matters
February 2009
Lepage Associates
Call: (919) 572-0000
In This Issue
Collateral Damage
Your Love Language
Wasting Away
Please click on each group for a flier with complete information to include description,
Collateral Damage: Children of Alcoholics
Alcoholism is a large problem in our society.  It is estimated that one in five children are exposed to substance abuse within their home.  Children who grow up with parents who are alcoholics are at greater risk for developing behavioral and emotional difficulties.  These children are also more likely to experience abuse or neglect in the home.  Children respond to dysfunction in the home in many different ways. 
Difficulties can include anxiety, depression, anger, guilt, embarrassment, and failure to form friendships.  The child will often try to keep problems at home a secret from other adults and peers.  Some behaviors to watch for include, but are not limited to, truancy or failures at school, withdrawal from friends, risky or delinquent behavior, aggression, depression, and substance use. 
Some children of alcoholics may show no difficulties while others become the "parent" in the home.  They may look out for the well being of themselves and others in the home, including their parents, and be very successful at school to compensate for the difficulties at home. 
These children often live in fear of their parents and of what may happen to them if others discover their parent's alcoholism.  They may also feel guilty that they are unable to change their parent's behavior.  Although these children may present well, they tend to have poor self image and are insecure in relationships.

It can be difficult to intervene effectively in this situation for many reasons.  The problems associated with alcoholism are often kept "secret" from others.  The child may feel that they are betraying their parent if they seek out assistance for themselves.  The parent may be in denial of the problem or have no desire to change their behavior. 
It is best when the whole family enters treatment and begins the recovery process; however when this is not possible, provide children with support and help them in building meaningful relationships with others. 
It is important for these children to understand that they did not cause their parent's alcoholism and they are not responsible for curing it.  In addition to help in these areas, professionals can also treat disorders that commonly occur in children of alcoholics such as anxiety and depression. 
Older children may benefit from participation in groups such as Alateen which focuses on social connectedness and community involvement.

Often times the emotional impact that alcoholism had in the child's life will surface during adulthood.  Adult children of alcoholics often have difficulty maintaining relationships, overreact to change, seek constant approval from others, have difficulty following through with tasks, are very hard on themselves, and have poor problem solving skills. 
It is important for adult children of alcoholics who are having difficulties to seek the assistance of a professional when having difficulty achieving success, developing healthy social and romantic relationships, or having difficulty coping with life's stresses. 
Psychologists can help these individual's process their traumatic past and build skills for a more successful present and future.  


Monthly Reader
Each month we will recommend a book that someone at our practice has found useful. This month's books are:
The Marriage-Work Connection: A Couple's Guide to Balancing Your Life Together

Dr. Joel D. Block

Wasted: A Memoir of Anorexia
and Bulimia
 by Marya Hornbacher 

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We have articles on a variety of topics this month. February 8th-14th is Children of Alcoholics Week and February 22nd - 28th is National Eating Disorders Awareness Week. Of course, we can't ignore that February 14th is Valentine's Day
We hope you find our newsletter helpful and always look forward to your feedback.
 Your Love Language

Oh how I love thee, but how should I show you the ways?
Valentine's Day is fast approaching and the explosion of red and pink everywhere you turn makes the topic of love hard to ignore. One of the love hot topics that I've seen when working with couples is partners feeling at a loss about how to demonstrate their love in a meaningful way to their partner. For example, have you ever gone out of your way to cook a special meal for your partner and been less then impressed with their appreciation (or lack there of)? Or maybe you tell your partner you love him or her frequently but they still seem unsure of your feelings for them?
According to Gary Chapman, author of The Five Love Languages, this is because we often show our partners how we feel about them in our own "love language" and not theirs. Growing up, we learned to show love in ways our families did. For example, some families are very verbally expressive with compliments and others are physically touchy-feely giving hugs and kisses frequently. Just as some families speak French and others speak Spanish, we learn to express our love in a language we have learned. So when two people come together who were raised speaking different "languages," they find, in order to effectively communicate love, it's time to learn a second language! So if you feel your partner hasn't quite gotten the message of how much you love them, read on to figure out other languages you can use.
1. Words of Affirmation: These can include compliments ("Great dinner honey!" or "I really appreciate you taking out the garbage."), encouraging words for something your partner has set as a goal ("I bet you'd write a great book!"), kind words (this can include forgiving your partner for a wrongdoing), and humble words (this can include making requests "I'd love it if you could paint the bathroom this weekend" instead of demands "Do you ever think you'll paint the bathroom?!?).

2. Quality Time: Give each other your undivided attention. Go for a walk, turn off the T.V. for 20 minutes, go to dinner and look at each other and talk, or any other activity that, now that you're thinking about it, your partner has asked you to do with him or her.

3. Receiving Gifts: Gifts can be bought, found, or made. It can be a tangible item or the gift of yourself, standing next to your partner in a time of need. According to Chapman, this is the easiest second language to learn.

4. Acts of Service: This language includes doing things your partner wants you to do. Examples include mowing the lawn, doing laundry, bathing the kids, making dinner. When any of these are done with a smile and not out of fear, guilt, or resentment, they are expressions of love.

5. Physical Touch: Examples include holding hands, kissing, embracing, massaging, and sex. It can be as simple as a quick peck out the door or sitting next to each other on the couch.
So when thinking of a gift for your loved one this year (and all year!), consider which one of the five love languages your partner speaks fluently. Choose an example from that category and they're sure to hear your message loud and clear.
Wasting Away
An eating disorder is characterized by extreme reduction or increase in food intake, or feelings of extreme distress or concern about body weight or shape. A person with an eating disorder may start out by eating smaller or larger amounts of food than normal but at some point takes it to an extreme. The two main types of eating disorders are anorexia nervosa and bulimia nervosa.
In her book, "Wasted: A Memoir of Anorexia and Bulimia," Marya Hornbacher, describes how her eating disorder started with bulimia.
"It was that simple: One minute I was your average nine-year-old, shorts and a T-shirt and long brown braids, sitting in the yellow kitchen, watching the Brady Brunch reruns, munching on a bag of Fritos, scratching the dog with my foot. The next minute I was walking, in a surreal haze I would later compare to the hum induced by speed, out of the kitchen, down the stairs, into the bathroom, shutting the door, putting the toilet seat up, pulling my braid back with one hand, sticking my two fingers down my throat, and throwing up until I spat blood. Flushing the toilet, washing my hands and face, smoothing my hair, walking back up the stairs of the sunny, empty house, sitting down in front of the television, picking up my bag of Fritos, scratching the dog with my foot."
Bulimia nervosa is characterized by recurrent and frequent patterns of eating unusually large amounts of food (binge-eating) followed by purging (e.g. vomiting, abuse of laxatives or diuretics), fasting and/or excessive exercise. People with bulimia believe that the act of purging compensates for the binge eating. Unlike those with anorexia, those with bulimia are often within the normal weight range for their age. However, they are still preoccupied by the desire to lose weight, are unhappy with their body shape and size and have an intense fear of gaining weight. Bulimic behavior is done secretly because it is usually accompanied by feelings of shame or disgust. In most cases, the binging and purging cycle is repeated several times a week. Bulimia is often comorbid with psychological disorders such as depression or anxiety and accompanied by physical health complications.
Marya Hornbacher also described how she became anorexic.
"Anorexia started slowly. It took time to work myself into the frenzy that the disease demands. There were an incredible number of painfully thin girls at Interlochen, dancers mostly. The obsession with weight seemed nearly universal. Whispers and longing stairs followed the ones who were visibly anorexic. We sat at our cafeteria tables, passionately discussed the calories of lettuce, celery, a dinner roll, rice. We moved between two worlds. When we pushed back our chairs and scattered to our departments, we transformed. I would watch girls who'd just been near tears in the door-room mirrors suddenly become rapt with life, fingers flying over a harp, a violin, bodies elastic with motion, voices strolling through Shakespeare's forest of words."
Anorexia nervosa is the inability or unwillingness to maintain a normal body weight for a person's age and height. A clinician will usually diagnose the disorder when a person fails to meet 85% of their normal or expected weight. Some symptoms include distorted body image and extreme fear of gaining weight, obsession with food and weight control, and extremely disturbed eating behavior. Girls and women may experience lack of menstruation. Some methods of weight loss used are excessive diet and exercise, self-induced vomiting and misuse of diuretics, laxatives or enemas. Other signs of anorexia include thinning of the bones, brittle hair and nails, dry and yellowish skin, and growth of fine hair all over the body. A person with anorexia may also experience mild anemia, muscle weakness and loss, severe constipation, low blood pressure, slow breathing and pulse, a drop in internal body temperature (feeling cold all the time), and feeling lethargic.

How to Get Help

A trained psychologist can be instrumental in treating eating disorders and helping the person recover. He or she can help identify the issues that need attention and develop a treatment plan, then helps the person replace destructive thoughts and behaviors with more positive ones. For example, a psychologist might work with the person to focus on health instead of weight, or ask the person to keep a food journal to become aware of what situations trigger disordered eating.
However, psychotherapy goes beyond just changing thoughts and behaviors. The psychologist must work with the person to uncover the psychological issues underlying the eating disorder, which sometimes involves improving personal relationships and going beyond the specific situations that triggered the disorder. Incorporating group therapy, family therapy, or marital therapy can be helpful for allowing family members to understand the disorder and how they can help.
Cognitive-behavioral therapy (CBT) is a common method of psychotherapy used to treat eating disorders. CBT therapists believe that people change because they learn how to think differently and then act on that learning. Therefore, an important part of the therapy is teaching self-counseling skills.
Treatments do not work instantly and many people may need long-term care. As with any medical or psychological disorder, the sooner treatment is sought, the better. The longer disordered eating continues, the more difficult it is to treat. The prospects for long-term recovery are good for those who seek help from qualified professionals. 
tlepaWe are offering two CLE opportunities in March on

Mental Illness, Substance Abuse, and Developmental Disabilities: A Primer for Lawyers
March 11th from 1-2:30 - Lunch will be included in the cost
March  19th from 5-6:30pm - heavy hor'dourves
will be included in the cost
Please call our office to register or email tlepage@lepageassociates.com

Our February Lunch and Learn Seminar is
 Loving Happily Ever After 
As much as we like to believe that love equals ease in relationships, the truth is relationships are hard work. But, even hard work can be fun! Come learn communication and other strategies to make your relationship a long-lasting, happy adventure.
Taxes Making You Jumpy?
Financial Planning Not Your Forte?
Presented by Guest Speaker Heather Linton, CPA
Getting your finances in order for tax season can increase levels of stress, anxiety, irritability, and depression. Come learn financial strategies to prepare yourself for tax season, as well as financial planning ideas to help next season feel less stressful.