What sort of issues are particularly important with girls?

The teen years can be a tough time for both teens and their families. Your daughter is going through many changes and her emotions may change from one minute to the next. It can be hard to know if what your daughter is going through is normal or if it is a mental health problem. The resources in this section cover many of the mental health issues that teens face, including depression, suicide, cutting, and weight and body image issues. Your daughter, also, might want to use the tools in this section to learn more about the different mental health issues, or to learn how to better express her feelings or deal with stress.

The following topics are covered on this web page:

Parenting girls
ADHD and girls
Sexual harassment
Unhealthy relationships
Domestic violence
Teenage pregnancy
Binge eating
Compulsive exercise
Stress and girls
Major disasters or terror attacks
Running away
Other considerations

There are a number of issues that matter specifically to girls, which follow below. You'll notice, for the purposes of reference, questions broken down according to how parents might ask. This list of questions is extensive but not exhaustive; contact Ward Halverson personally, using this web site, to ask more specific questions or request further information on mental health issues with girls.

It is useful to know some facts about mental health and girls:

" Girls are seven times more likely than boys to be depressed and twice as likely to attempt suicide. " Girls are three times more likely than boys to have a negative body image (often reflected in eating disorders such as anorexia and bulimia). " One in five girls in the U.S. between the ages of 12 and 17 drink alcohol and smoke cigarettes. " Girls who develop positive interpersonal and social skills decrease their risk of substance abuse. " Girls who have an interest and ability in areas such as academics, the arts, sports, and community activities are more likely to develop confidence and may be less likely to use drugs. " On the other hand, this also is a time when girls may make decisions to try risky behaviors, including drinking, smoking, and using drugs

What can parents do for girls, in general?

Parents and other caregivers are responsible for children's physical safety and emotional well-being. Parenting styles vary; there is no one right way to raise a child. Clear and consistent expectations for each child, by all caregivers, are important. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills. The following suggestions are not meant to be complete:

  • Do your best to provide a safe home and community for your child, as well as nutritious meals, regular health check-ups, immunizations, and exercise.
  • Be aware of stages in child development so you don't expect too much or too little from your child.
  • Encourage your child to express her feelings; respect those feelings. Let your child know that everyone experiences pain, fear, anger, and anxiety.
  • Try to learn the source of these feelings. Help your child express anger positively, without resorting to violence.
  • Promote mutual respect and trust. Keep your voice level down-even when you don't agree. Keep communication channels open.
  • Listen to your child. Use words and examples your child can understand. Encourage questions.
  • Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.
  • Look at your own problem-solving and coping skills. Do you turn to alcohol or drugs? Are you setting a good example? Seek help if you are overwhelmed by your child's feelings or behaviors or if you are unable to control your own frustration or anger.
  • Encourage your child's talents and accept limitations.
  • Set goals based on the child's abilities and interests-not someone else's expectations. Celebrate accomplishments. Don't compare your child's abilities to those of other children; appreciate the uniqueness of your child. Spend time regularly with your child.
  • Foster your child's independence and self-worth.
  • Help your child deal with life's ups and downs. Show confidence in your child's ability to handle problems and tackle new experiences.
  • Discipline constructively, fairly, and consistently. Keep in mind that discipline is a form of teaching, not physical punishment. All children and families are different; learn what is effective for your child. Show approval for positive behaviors. Help your child learn from her mistakes.
  • Love your daughter unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job.

What about PMS, or Premenstrual Syndrome?

Premenstrual Syndrome (PMS) refers to uncomfortable physical and mental symptoms that occur before the onset of the woman's menstrual period. Estimates of affected women range from 40 to 80%. About 5% of women experience symptoms that cause them severe impairment. PMS may start at any time during the years that a woman menstruates. The peak occurrence is in the 20s and 30s, but plenty of younger girls are affected as well. Once PMS begins, the symptoms often continue until menopause.

About 150 separate symptoms have been documented, but it is unlikely that any one woman will have all of them:

Increased emotional reactivity
Changes in sexual desire
Exacerbation of existing psychiatric condition
Changes in Attention
Difficulty staying on task
Prone to accidents
Physical Changes
Breast tenderness
Feeling bloated
Swelling in arms and legs
Back pain
Difficulty sleeping
Changes in energy level

How is PMS treated?

There are a variety of approaches, beginning with lifestyle changes: Many women find that healthy lifestyle changes decrease symptoms of PMS. Exercise, three to five days per week, improves mood, and increases physical tone. Women who exercise regularly have fewer PMS symptoms. Eating less salt may minimize bloating and swelling. Also helpful is a healthy diet, rich in complex carbohydrates and low in simple sugar. Decreasing caffeine and alcohol intake may help irritability and mood swings. Relaxation techniques, such as meditation or yoga, decrease physical discomfort and stress.

Another approach is self knowledge: Girls with mild PMS are able to accept and adjust to their monthly changes in energy and mood. Although parts of the experience are unpleasant, she discovers that it helps her to view things from a different perspective. If she is impulsive or irritable before her menses, she may decide to defer important decisions for a few days. If she feels angry at a friend, she may write down the anger. If, after a few days, it still bothers her, she then responds to the anger. Some women learn this on their own. Others may seek counseling to help reduce stress and to learn ways to actively cope with the PMS.

Social support can be important: Supportive parents or roommates can be a great help during low energy days or periods of irritability. Some girls can take turns helping each other during vulnerable times. However, girls who live or work closely together often go into synch: they have their menses at the same time. Depending on the situation, this can either be a support or a difficult time for the entire group.

Vitamins and minerals can be helpful. There is some evidence that Calcium may decrease many PMS symptoms. Moderate doses of Magnesium and Vitamin E may also be helpful. Controlled trials have failed to show nay benefit from high dose Vitamin B6. Additionally, high doses of B6 can cause peripheral nerve damage. If lifestyle and dietary changes are not effective, there are other treatments. Diuretics help reduce fluid buildup and decrease bloating. Some women find that oral contraceptives decrease symptoms of PMS. This varies, depending on the dosage and mix of hormones in the particular pill. Non-steroidal anti-inflammatory drugs, such as Ibuprofen, are helpful for PMS-associated pain.

Is PMS a mental illness?

Marked mood changes are called Premenstrual Dysphoric Disorder. The symptoms of PMDD resemble major depression. A girl or woman with PMDD has her mood swings only in the one to two weeks before her menses. AS a clinician, when Ward suspects PMDD, he often ask the woman or girl to chart her moods for three months. This helps determine whether the mood shifts are confined to the premenstrual days. If depression or other mood shifts also occur in other phases of the cycle, it's treat as any depression, anxiety or bipolar disorder, using psychotherapy and/or medication. If charting reveals that depression occurs only before menses, we can choose to treat with medication all month or we may decide to use medication only during the days before menses. The girl or woman should be an active participant in making this decision. Full-cycle treatment is easier to remember. It does not require the same degree of charting and calendar watching. However, if the girl or woman experiences medication side effects, or simply wants to minimize medication use, she can take an antidepressant during the 10-14 days before her menses. The SSRIs (Prozac, Paxil, Zoloft and others) are the first-line antidepressants for premenstrual depression or irritability. They seem to work more rapidly for PMS mood symptoms than for regular major depression. If a woman has significant manic symptoms before her menses, she may need to take a mood stabilizer such as Lithium or Depakote during her entire cycle. Interestingly, some females find that when the most severe symptoms, mood, or physical symptoms, are addressed, the other symptoms are less intense. Thus, a woman who is successfully treated for premenstrual depression may experience fewer physical symptoms. Other women need active treatment for both kinds of symptoms. Premenstrual-type symptoms may temporarily become worse in the perimenopausal period (the years just before menstruation ceases). However, true menopause often brings the end of premenstrual symptoms.

What about girls who struggle with ADHD?

Interestingly, girls and women are under diagnosed. The DSM-IV - the book of all mental health disorders - estimates that the ratio of boys with ADHD to girls is 4:1. For those in actual treatment in clinics, the ratio is 9:1. Clinicians who treat a girls with ADHD feel that many girls have been overlooked. Why is this?

Simple: The Squeaky Wheel Gets the Grease. Boys with ADHD are more likely to be disruptive in class and at home. Parents and teachers notice this and refer them for treatment. Girls with ADHD can be physically hyperactive, but are more likely to be quietly inattentive and disorganized. Adults are more likely than children to refer themselves for treatment. Thus, women are often diagnosed in adulthood. Sometimes Ward Halverson sees adult women who brings their children in for treatment. While evaluating the child, a thorough family history is taken. As the mother tells her own story, she realizes that some of her difficulties are similar to her son's. Whether she was hyperactive or just inattentive, the diagnosis was missed.

OK - what are the signs of ADHD in girls?

Girls can manifest their ADHD in vastly different ways. Active girls may act like tomboys. They may socialize with boys. They are active, and may engage in impulsive escapades. Another group of girls shows their ADHD by talkativeness and excessive socializing. They too may become involved in risky behavior. Some girls with ADHD seem to fade into the background. They are shy and inattentive. They may have few friends and are more likely to be depressed. The last group often escapes diagnosis until adolescence or adulthood. These are the very smart girls who have the ability to put in an extraordinary effort to hyperfocus. Adults see them as achievers but are often unaware of the anxiety and extreme effort the such girls use in order to compensate for their inattentiveness. Such girls are often anxious and self-critical.

Girls and women with ADHD (particularly if undiagnosed) are at higher risk for anxiety, depression, drug abuse and unplanned pregnancy. This makes treatment more complicated. Early diagnosis is important. The unique concerns of girls with ADHD often respond well to treatment. Understanding one's own ADHD symptom set is therapeutic in itself. Effective treatments include medication, psychotherapy, support groups and coaching.

What is sexual harassment and how can girls deal with it?

Sexual harassment can range from a suggestive statement to aggressive sexual assault. In many cases, males are the aggressors, but women and girls can be sexually aggressive too. When girls let people make sexually harassing comments to them, it may give the message that it is OK for people to treat her this way. These types of comments are mean and disrespectful. Ward asks, would you want someone to say that sort of thing to your little sister? Teens and younger kids hear these comments regularly, unfortunately. As a teen, it is important to be liked, to be part of the crowd. The pressure to fit in is stressful. Teens may think, "If I ignore it or laugh, maybe they will back off." However, that may not occur. Girls don't want to be identified as someone who doesn't mind sexual harassment. It's important for girls to stand up for themselves, to make it clear that you expect others to respect your personal space. Make it clear that harassing comments to you or toward others are not funny or flattering.

Some harassing statements may include: Are you wearing a bra? Nice butt! Suggestive noises, or If you don't do it with me, I'll tell everyone that you did.

Internal boundaries are feelings and thoughts about the way you feel and think. Ward suggests that girls ask themselves, "Does this feel right or wrong?" and to determine whether you like what the other person is saying (or doing) to you, or if you just like the attention. External boundaries, on the other hand, define the relationship between a girl's body and the bodies of others. Girls have the right to decide whether it is OK for someone to touch them. They do well exploring their personal boundaries of safety. To girls, Ward often asks: how close you feel comfortable standing to a friend-a sibling-a stranger? Be aware of your environment: Is this a risky situation? Are there friends nearby who can help if something happens?

On that note, girls should be extremely careful if drinking. If you are "out of it" you may not realize that someone is about to take advantage of you. Some people don't take your "no" as seriously if you are drunk. If a boyfriend pressures a girl for sex, she should look him in the eye and say, "no" firmly. If words don't work, push him away-as hard as necessary. If a girl is alone with a boy who is pressuring, Ward advises to say you have to go to the bathroom or that you are having your period. Give yourself time to think clearly-do you truly want to have sex with this boy at this moment? Girls may need to call a parent or a friend to bring them home. Have an advance agreement with someone - ideally a parent - who can take you home without questions. If a girls feels harassed or violated, tell someone! At any point in a sexual encounter, every woman has the right to stop. No woman should not allow another to victimize her.

What about domestic violence?

In America, police reports indicate that children are present in the home in 40 to 50 percent of cases involving domestic violence calls. Research indicates that between 3.3 and 10 million children are exposed to domestic violence in the United States every year. Children are significantly affected by this exposure to domestic violence in a number of ways. The most common are that they observe violent acts, they incur injury to themselves, and they suffer neglect by their caretakers.

Children who observe domestic violence react in many ways. External behaviors may include aggressive behavior and conduct problems in home and in school, fighting, cursing, and name calling. Internal behaviors that may also occur include anxiety, depression, low self esteem, guilt, crying; decreased intellectual and academic functioning including inability to concentrate; difficulty with school work, school truancy and failure; and developmental delay. Domestic violence can also affect children's social development, causing them to become isolated and withdrawn from friends and family and demonstrate low levels of empathy. Children affected by domestic violence may also exhibit negative physical health, developing somatic - physical - symptoms, poor sleeping and eating habits, headaches, stomachaches, and self-destructive behaviors such as suicide attempts and self-mutilation. A 1998 study shoed that between 45 and 70 per cent of children exposed to domestic violence are also victims of physical abuse. Children in homes with domestic violence are at higher risk of sexual abuse than children in nonviolent homes.

At every stage of a child's life the impact of exposure to violence in the home is evident. Infants or very young children are vulnerable to injury when adults handle them roughly in a moment of violence, but children are also subject to injury when flying objects are thrown or smashed or when weapons are used. They also may be ripped from their caretakers' arms or hurt when the person holding them falls or is knocked down. The victim of domestic violence may neglect the child in an attempt to appease the abuser or in fear that the child might be harmed further if concern is shown. Effects of this neglect can be seen in infants or young children through eating or sleeping disturbances (particularly if the abuse routinely occurs during meal times or after the child has gone to sleep), listlessness, developmental delays (due to lack of stimulation), and failure to thrive (due to lack of nurturing). Exposure to violence interferes with children's ability to develop trust in adults charged with their care. These children commonly exhibit excessive irritability, fear of being left alone, regression in toileting and language skills, and other delays in learning.

School-age children between the ages of five and twelve may exhibit more significant behaviors as a result of observing domestic violence. These children may be aggressive toward other children, exhibit low self-esteem, feel insecure, run away, use drugs, or have problems in school. As the child enters the teen years, he or she may exhibit more of the behaviors associated with the abuser or the victim. The child who identifies with the victim may come to accept violence as part of an intimate relationship. The child who identifies with the perpetrator learns to use violence to control relationships. Teens may also feel compelled to intervene on behalf of the victim and be injured, or be coerced into participating in the violence. Teens commonly experience shame about what is going on in their home and seek to remove themselves from the situation by running away or attempting suicide. When a victim seeks to remove herself and her children from an abusive situation, the children are frequently separated from their communities, friends, and schools. This puts additional stress on the child.

Given the serious consequence of domestic violence on children, some professionals argue that exposure to domestic violence constitutes a form of child maltreatment. But others argue that not all children are affected in the same way and that, in fact, many children learn to cope with the violence. Thus, witnessing abuse should be viewed as a potential risk factor for child maltreatment rather than conclusive evidence.

What about domestic violence in Herkimer County?

Rural domestic violence victims are in more isolated locations and may have difficulty accessing health care and other services due to lack of transportation or poor weather and road conditions. Emergency response time is often slower in rural areas like ours. In addition, some rural homes do not have telephone service to request emergency assistance. Herkimer is a relatively poor area, and rural poverty is a particular concern regarding domestic violence. Studies have shown that poverty and domestic violence are related. Poverty greatly contributes to family and relationship stress and limits victims' ability to leave abusive partners or family members. Non-metropolitan poverty rates are higher than those in metropolitan regions for many demographic groups. Rural family violence survivors who live in poverty and lack transportation may be unable to travel to family members' or friends' homes for shelter.

Domestic violence survivors may be in need of legal assistance for protection orders, divorces, child custody proceedings and other legal matters that are a consequence of abuse or violence. In rural areas, it can be more difficult to find an affordable lawyer or legal aid. Law enforcement and the courts in rural communities may be less familiar with issues of domestic violence and appropriate responses.

What can we do in our community to address domestic violence?

Herkimer County has worked for years to develop a coordinated community response, or CCR, in which health care providers, community groups, criminal justice, and social service agencies work together. Such a response is considered one of the best approaches to addressing domestic violence. Some of the characteristics of CCR programs include a shared philosophical approach, understanding of the each group's role, and a plan to work together to improve the community's response to violence against women. The CCR approach provides a more unified response to victim needs while holding offenders accountable for their actions.

What are the signs that a girl is in an abusive or unhealthy relationship?

Your friend or the person you are going out with:

  • " Gets angry when you talk or hang out with other friends or other dating partners
  • bosses you around
  • Often gets in fights with other people or loses his or her temper
  • Pressures you to have sex or to do something sexual that you don't want to do
  • Uses drugs and alcohol, and tries to pressure you into doing the same thing
  • Swears at you or uses mean language
  • Blames you for his or her problems or tells you that it is your fault that he or she hurt you
  • Insults or tries to embarrass you in front of other people
  • Has physically hurt you on purpose
  • Makes you feel scared of their reactions to things
  • Always wants to know where you are going and who you are with

Some people think that their relationship isn't abusive unless there is physical fighting. There are other types of abuse, though. Below is a list of different types of abuse.

" Physical abuse is when a person touches your body in an unwanted or violent way. This may include: hitting, kicking, pulling hair, pushing, biting, choking, or using a weapon or other item to hurt you. " Verbal or emotional abuse is when a person says something or does something that makes you afraid or feel bad about yourself. This may include yelling, name-calling, saying mean things about your family and friends, embarrassing you on purpose, telling you what to do, or threatening to hurt you or hurt themselves. Pressuring you to use drugs or alcohol is also abuse, as is keeping you from spending time with your friends and family. " Sexual abuse is any sexual contact that you do not want. You may have said "no" or may be unable to say no because the abuser has threatened you, stopped you from getting out of the situation, or has physically stopped you from leaving. This may include unwanted touching or kissing or forcing you to have sex. Sexual abuse includes date rape.

Why do some girls stay in unhealthy or violent relationships?

Sometimes it may be hard to get out of an abusive relationship, because violent relationships often go in cycles. After a person is violent, he or she may apologize and promise never to hurt you again. They may even say that they will work on the relationship, and it may be awhile before that person acts violently again. These ups and downs can make it hard to leave a relationship. Also, it's also hard to leave someone you care about. You may be scared or ashamed to admit that you are in an abusive relationship, or you may be simply scared to be alone without that person. You may be afraid that no one will believe you, or that your friend or partner will hurt you more if you tell someone. Whatever the reasons, leaving an unhealthy relationship is hard but it is something you should do.

What can a girl do to get out of it?

Abusive relationships are very unhealthy for you. You can have trouble sleeping or have headaches or stomachaches. You might feel depressed, sad, anxious or nervous, and you may even lose or gain weight. You may also blame yourself, feel guilty, and have trouble trusting other people in your life. Staying in an abusive relationship can hurt your self-esteem and make it hard for you to believe in yourself. If you are being physically abused, you can be in pain and may suffer permanent damage. You should definitely leave the relationship if you are getting hurt, or if you are being threatened with physical harm in any way. The most important reason to leave an unhealthy relationship is because you deserve to be in a relationship that is healthy and fun. Here's how to get out:

First, if you think that you are in an unhealthy relationship, you should talk to a parent/guardian, friend, counselor, doctor, teacher, coach or other trusted person about your relationship. Tell them why you think the relationship is unhealthy and exactly what the other person has done (hit, pressured you to have sex, tried to control you). If need be, this trusted adult can help you contact your parent/guardian, counselors, school security, or even the police about the violence. With help, you can get out of an unhealthy relationship. Sometimes, leaving an abusive relationship can be dangerous, so it is very important for you to make a safety plan. Leaving the relationship will be a lot easier and safer if you have a plan. Here are some tips on making your safety plan:

  • Go to your doctor or hospital for treatment if you have been injured.
  • Tell a trusted adult like a parent/guardian, counselor, doctor, teacher, or spiritual or community leader.
  • Tell the person who is abusing you over the phone that you do not want to see him or her so they cannot touch you. Do this when a parent or guardian is home so you know you will be safe in your house.
  • Use a diary to keep track of the date the violence happened, where you were, exactly what the person you are dating did, and exactly what effects it caused (such as bruises). This will be important if you need the police to order the person to stay away from you.
  • Avoid contact with the person.
  • Spend time with your other friends, and avoid walking by yourself.
  • Think of safe places to go in case of an emergency, like a police station or a public place like a restaurant or mall.
  • Carry a cell phone, phone card, or money for a call in case you need to call for help. Use code words on the phone that you and your family decide on ahead of time. If you are in trouble, say the code word on the phone so that your family member knows you can't talk openly and need help right away.
  • Call 911 right away if you are ever afraid that the person is following you or is going to hurt you.
  • Keep domestic violence hotline numbers with you in a safe place or program them into your cell phone. The 24-hour National Domestic Violence Hotline is 1-800-799-SAFE (7233) or 1-800-787-3224 (TDD). Herkimer County's number is 866-0458.

What can I do, as a parent?

The best thing you can do is protect your daughter. If she's under the age of 18, you have to - follow the safety plan described above. If she's over 18, work with her to understand the risks she may be taking and be as supportive as you can. You may consider providing the police with information, although if she refuses to seek help, there may be little you can do directly. Call Ward V. Halverson for more information or ideas.

How about the risks of teen pregnancy?

Teenage pregnancy, without a doubt, carries high costs in terms of both the social and economic health of mothers and their children. Teenage mothers are less likely to receive prenatal care, and their children are more likely to be born before term, to have low birth weights, and to have developmental delays. Teenage mothers are also less likely to complete their education than moms over twenty years of age.

After rising steadily from 1987 to 1991, the birthrate for teens aged 15-19 declined for 10 straight years, from a high of 62.1 per 1,000 teens aged 15-19 in 1991 to a record low of 45.9 in 2001. The birthrate for young teenagers aged 15-17 fell 8 percent from 2000 to 2001, reaching 25.3 births per 1,000 teenagers. All 50 states had a decline in their teen birthrates between 1991 and 2000, with 10 states recording declines of more than 20 percent during this period. Recent declines in both birth and abortion rates indicate that teen pregnancy rates are continuing to fall. Overall teen pregnancy rates have dropped 19 percent since 1991. However, still about 900,000 pregnancies occur each year among American teenagers aged 15-19. Most of these pregnancies are unintended. Almost 190,000 teens aged 17 and younger have children. Their babies are often of low birth weight and have disproportionately high infant mortality rates. They are also far more likely to be poor.

So, what can a parent do to avoid teen pregnancy?

During an episode of a now-classic 70s television program, a mother is worried about how to broach the subject of sex with her pre-teen daughter. The mother finally gets up the courage to start the conversation and says, "I want to talk to you about the birds and the bees." With a straight face, the daughter replies, "OK, what do you want to know?" Ward Halverson finds this hilarious, but the topic is deadly serious. Your children may not be as matter of fact as that young TV character, but you may still be surprised at what they already know, or perhaps don't know about sex.

Here are some useful tips for parents:

  • Be clear about your own sexual values and attitudes. Talking to your children about love, sex and relationships will be more successful when you're clear about how you feel about them.
  • Talk early and often with your children about sex. Forget about "The Talk." Kids need more than a one-time lecture.
  • Look out for teachable moments: use TV, movies, magazines and real-life situations to discuss sex, love and relationships.
  • Get to know your children.
  • Don't assume that if your child asks questions about sex, he or she is necessarily thinking about having sex.
  • Set a good example.
  • It's not just the birds and the bees. Don't limit the conversation to just sex. Talk about abstinence, the male and female reproductive systems, pregnancy, birth control, love and the emotional consequences of having sex.
  • Leave age-appropriate articles or books about teenage sexuality around your home.
  • Don't wait for your child to start the conversation.
  • Reassure your child that not everyone is having sex.
  • Don't rely solely on the schools for providing your child's sex education.
  • If the signs are there, take your daughter to Planned Parenthood

If you don't believe your children are exposed to sexual concepts, you may want to rethink your perceptions. Here are a few possible clues: Your nine-year-old son gets caught at school with your Victoria Secret catalog. Your three-year-old daughter is walking around singing "Shake Your Laffy Taffy" and she's not referring to the candy. Your 13-year-old wants to spend her allowance on a present for her friend's baby. Still not ready to use the "s- word"? Consider the alternative: What children don't learn about sex from a parent, they learn mostly from friends. Remember the one about how a girl can't get pregnant the first time? Ultimately, parents must make the decisions about sex education that are right for their own kids, but research shows that uniformed children are at greater risk for early sexual activity, pregnancy, sexually transmitted diseases and abuse.

OK, what are some useful books on the subject of teen pregnancy and sex?

  • The Real Truth about Teens and Sex: From Hooking Up to Friends with Benefits: What Teens Are Thinking, Doing, and Talking About, and How to Help Them Make Smart Choices by Sabrina Weill.
  • Beyond the Big Talk: Every Parents Guide to Raising Sexually Healthy Teens from Middle School to High School and Beyond by Debra Heffner.
  • Flight of the Story: What Children Think (and When) about Sex and Family Building by Anne C. Bernstein.
  • But How'd I Get There in the First Place?: Talking to Your Young Child about Sex by Debra Roffman.
  • Raising a Child Responsibly in a Sexually Permissive World by Sol and Judith Gordon

Although the rate for teen pregnancies have dipped since the early 1990s, the United States still has the dubious distinction of having the highest rate of teen pregnancy among other countries of similar status. So if you are parent of a teenager, be cautious and be prepared to make some hard choices, or you're going to be a grandparent earlier than expected.

OK, what about food - when is an issue with food a serious problem?

Kids are always rooting around in the kitchen, especially during the teen years. They grab a handful of cookies here, a bag of chips there. They're growing like weeds, of course, so you figure all that eating is OK. Most of the time, it is. But sometimes, heavy snacking isn't what it seems to be. If kids eat unusually large amounts of food - and feel guilty or secretive about it - they could be struggling with a common eating disorder called binge eating disorder.

So what is "binge eating disorder"?

Lots of people find comfort in food. After all, it's often at the heart of our happiest celebrations. Birthdays mean cake with friends, and Thanksgiving means turkey and stuffing with family. Most people will sometimes eat much more than they normally do on special occasions. But people with binge eating disorder have a different relationship with food - they feel like they've lost all control over how much they're eating, like they can't stop.

For people with binge eating disorder, at first food may provide sustenance or comfort, but later it's the focus of incredible guilt and distress. They eat unusually large amounts of food quickly and feel completely out of control as they do it, and they binge not just from time to time, but fairly regularly. These behaviors become a pattern of eating and can alternate with dieting. Binge eating disorder is more common with girls who are obese, but it affects people with healthy weights as well. However, there's little information on how many children and teens are affected by the disorder because the condition has only recently been recognized, and many people may be too embarrassed to seek help for it. Adults in treatment often say their problems started in childhood or adolescence. Still, it's believed that 2% of adult Americans - roughly 1 million to 2 million people - have the disorder. And although the majority of people with other eating disorders are female, it's estimated that more than a third of individuals with binge eating disorder are male.

What are the signs and symptoms of a binge eating disorder?

Children and teens who sometimes eat a lot don't necessarily have binge eating disorder. Kids can have huge appetites, especially during growth spurts, when they need more nutrients to fuel their growing bodies. So, it can be difficult to determine whether a child has binge eating disorder. But several signs distinguish someone who binge eats from someone with a "healthy appetite." Parents may first suspect a problem when they discover large amounts of food are missing from the pantry or the refrigerator, though it's hard to imagine one child could have eaten so much.

Other signs of a problem include:

  • A girl eating a lot of food quickly
  • A pattern of eating in response to emotional stress, such as family conflict, peer rejection, or poor academic performance
  • A girl feeling ashamed or disgusted by the amount she eats
  • Finding food containers hidden in a girl's room
  • An increasingly irregular eating pattern, such as skipping meals, eating lots of junk food, and eating at unusual times (like late at night)

People who binge eat may also experience feelings that are common to many eating disorders, such as depression, anxiety, guilt, or shame. They may avoid school, work, or socializing with friends because they're ashamed of their binge eating problem.

What causes binge eating? How is it different from other eating disorders?

The cause of binge eating disorder is unknown, although the National Institutes of Health report that up to half of all people who have it also have a history of depression. It remains unclear, however, whether binge eating brings on depression, or whether people with depression are prone to the disorder. Many people who binge eat say that episodes can be triggered by feelings of anger, sadness, boredom, or anxiety. Scientists are also examining how brain function and body metabolism (the way the body uses energy) may affect binge eating. It's important to distinguish binge eating disorder from other eating disorders, such as bulimia nervosa and anorexia nervosa. People with bulimia nervosa (sometimes called binge-purge syndrome) binge on food and then vomit or use laxatives to avoid gaining weight. They may also fast (stop eating for a while) or compulsively exercise after an eating binge. Like people who suffer from binge eating disorder, those with bulimia nervosa repeatedly eat excessive amounts of food and feel guilty or ashamed about it. Unlike bulimia, however, individuals with binge eating disorder do not purge and are, therefore, frequently overweight.

Anorexia nervosa, another eating disorder, also involves feelings of guilt about eating. Whereas people with binge eating disorder consistently overeat, people with anorexia starve themselves, causing potentially life-threatening damage to their bodies. They may also compulsively exercise to achieve weight loss, a condition becoming known as anorexia athletica.

OK, how is it diagnosed and treated?

Doctors and mental health professionals use the criteria in the Diagnostic and Statistical Manual IV (DSM-IV) when they identify binge eating disorder. These include:

  • Binge eating more food than most people could consume in short periods of time
  • Feelings of distress about eating behaviors
  • Binge eating that occurs, on average, at least 2 days a week for 6 months
  • Binge eating that isn't associated with regular purging with laxatives or by vomiting
  • Binge episodes associated with: eating more rapidly than usual, eating until uncomfortably full, eating when not hungry, or eating alone because of embarrassment about how much food is consumed
  • Feelings of disgust, depression, or guilt
  • Also, a binge has to be accompanied by a loss of control over eating.

A child will be diagnosed with a binge eating disorder only after her doctor or therapist discusses family dynamics, patterns of eating, and emotional issues with her. The treating doctor will also perform a complete physical and may order lab tests to assess some complications of obesity and nutritional adequacy. As with any eating disorder, it's also important that the child receives therapy, which may be ongoing. Different types of therapy can help treat binge eating disorder. For example, family therapy and cognitive behavioral therapy teach people techniques to monitor and change their eating habits and the way they respond to stress. Family therapy includes the whole family in the process of helping the individual. Cognitive-behavioral therapy combines the approach of helping the individual change their self-defeating thoughts with changing their behavior. Counseling also helps patients look at relationships they have with others and helps them work on areas that cause them anxiety. In some cases, doctors may prescribe antidepressant medication to be used in conjunction with therapy. However, it's important to understand there's no quick fix for any eating disorder. Treatment can take several months or longer while the child learns how to have a healthier approach to food. Although weight-control programs are helpful for some people affected by binge eating disorder, children and teens should not begin a diet or weight-control program without the advice and supervision of a doctor.

What if my daughter is exercising all the time, even to the point of hurting herself?

Compulsive exercise (also called obligatory exercise or anorexia athletica) is best defined by an exercise addict's frame of mind: He or she no longer chooses to exercise but feels compelled to do so and struggles with guilt and anxiety if he or she doesn't work out. Injury, illness, an outing with friends, bad weather - none of these will deter those who compulsively exercise. In a sense, exercising takes over a compulsive exerciser's life because he or she plans life around it. Of course, it's nearly impossible to draw a clear line dividing a healthy amount of exercise from too much. The government's 2005 dietary guidelines, published by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS), recommend at least 60 minutes of physical activity for kids and teens on most - if not all - days of the week.

Experts say that repeatedly exercising beyond the requirements for good health is an indicator of compulsive behavior, but because different amounts of exercise are appropriate for different people, this definition covers a range of activity levels. However, several workouts a day, every day, is overdoing it for almost anyone.

Much like with eating disorders, many people who engage in compulsive exercise do so to feel more in control of their lives, and the majority of them are female. They often define their self-worth through their athletic performance and try to deal with emotions like anger or depression by pushing their bodies to the limit. In sticking to a rigorous workout schedule, they seek a sense of power to help them cope with low self-esteem.

Although compulsive exercising doesn't have to accompany an eating disorder, the two often go hand in hand. In anorexia nervosa, the excessive workouts usually begin as a means to control weight and become more and more extreme. As the person's rate of activity increases, the amount he or she eats may also decrease. A person with bulimia may also use exercise as a way to compensate for binge eating.

Compulsive exercise behavior can also grow out of student athletes' demanding practice schedules and their quest to excel. Pressure, both external (from coaches, peers, or parents) and internal, can drive the athlete to go too far to be the best. She ends up believing that just one more workout will make the difference between first and second place . . . then keeps adding more workouts. Eventually, compulsive exercising can breed other compulsive behavior, from strict dieting to obsessive thoughts about perceived flaws. Exercise addicts may keep detailed journals about their exercise schedules and obsess about improving themselves. Unfortunately, these behaviors often compound each other, trapping the person in a downward spiral of negative thinking and low self-esteem.

We all know that regular exercise is an important part of a healthy lifestyle. But few people realize that too much can cause physical and psychological harm: Excessive exercise can damage tendons, ligaments, bones, cartilage, and joints, and when minor injuries aren't allowed to heal, they often result in long-term damage. Instead of building muscle, too much exercise actually destroys muscle mass, especially if the body isn't getting enough nutrition, forcing it to break down muscle for energy. Girls who exercise compulsively may disrupt the balance of hormones in their bodies. This can change their menstrual cycles (some girls lose their periods altogether, a condition known as amenorrhea) and increase the risk of premature bone loss (a condition known as osteoporosis). And of course, working their bodies so hard leads to exhaustion and constant fatigue.

An even more serious risk is the stress that excessive exercise can place on the heart, particularly when someone is also limiting how much he or she eats. In extreme cases, the combination of anorexia and compulsive exercise can be fatal.

Psychologically, exercise addicts are often plagued by anxiety and depression. They may have a negative image of themselves and feel worthless. Their social and academic lives may suffer as they withdraw from friends and family to fixate on exercise. Even if they want to succeed in school or in relationships, working out always comes first, so they end up skipping homework or missing out on time spent with friends.

How do I know if my daughter is over-exercising?

If you're concerned that your child may be exercising compulsively, look for these warning signs. There could be a problem if he or she:

  • Won't skip a workout, even if tired, sick, or injured
  • Doesn't enjoy exercise sessions, but feels obligated to do them
  • Seems anxious or guilty when missing even one workout
  • Does miss one workout and exercises twice as long the next time
  • Is constantly preoccupied with his or her weight and exercise routine
  • Doesn't like to sit still or relax because of worry that not enough calories are being burnt
  • Has lost a significant amount of weight
  • Exercises more after eating more
  • Skips seeing friends, gives up activities, and abandons responsibilities to make more time for exercise
  • Seems to base self-worth on the number of workouts completed and the effort put into training
  • Is never satisfied with his or her own physical achievements

It's important, also, to recognize the types of athletes who are more prone to compulsive exercise because their sports place a particular emphasis on being thin. Ice skaters, gymnasts, wrestlers, and dancers can feel even more pressure than most athletes to keep their weight down and their body toned. Runners also frequently fall into a cycle of obsessive workouts.

So what can I do to get my daughter some help?

If you recognize two or more warning signs of compulsive exercise in your child, call your child's doctor to discuss your concerns. After evaluating your child, the doctor may recommend medical treatment and, hopefully, other therapy. Because compulsive exercise is so often linked to an eating disorder, a community agency that focuses on treating these disorders might be able to offer advice or referrals. Extreme cases may require hospitalization to get the child's weight back up to a safe range. Treating a compulsion to exercise is never a quick-fix process - it may take several months or even years. But with time and effort, your child can get back on the road to good health. Psychotherapy can help improve self-esteem and body image, as well as teach your child how to deal with emotions instead of sweating them out. Sessions with a nutritionist can help your child develop healthy eating habits. Once your daughter knows what to watch out for, she will be better equipped to steer clear of unsafe exercise and eating patterns. At home, you can do a lot to help your child overcome a compulsion to exercise:

  • Involve your child in preparing nutritious meals.
  • Combine activity and fun by going for a hike or a bike ride together as a family.
  • Be a good body-image role model. In other words, don't fixate on your own physical flaws, as that just teaches your child that it's normal to dislike what he or she sees in the mirror.
  • Never criticize another family member's weight or body shape, even if you're just kidding around. Such remarks may seem harmless, but they can leave a lasting impression on kids or teens struggling to define and accept themselves.
  • Examine whether you're putting too much pressure on your child to excel, particularly in a sport (because some teens turn to exercise to cope with pressure). Take a look at where your child may be feeling too much pressure. Help your child put it in perspective and help him or her find other ways to cope.
  • Most importantly, just be there with constant support. Point out all of your child's great qualities that have nothing to do with how much he or she works out - small daily doses of encouragement and praise can help improve your child's self-esteem. If you teach kids to be proud of the challenges they've faced, and not just the first-place ribbons they've won, they will likely be much happier and healthier children now and in the long run.

What if my daughter is unusually anxious or fearful?

Fear is a normal human emotional reaction - it is a built-in survival mechanism with which we are all equipped. Even as babies, we possess the survival instincts necessary to respond when we sense danger. Fear is a reaction to danger that involves the mind and body. Fear serves a protective purpose - signaling us of danger and preparing us to deal with it. A fear reaction happens whenever we sense danger or when we're confronted with something new or unknown that seems potentially dangerous. Fear can be brief - like the startled reaction you have if a balloon unexpectedly pops or if you are surprised by something you didn't expect. This is often over in seconds, as soon as the brain gets enough data to realize there's no danger. If the brain doesn't receive the "all clear" signal, fear can last longer and feel more intense.

Most people tend to avoid the things they feel afraid of. There are, of course, exceptions - some people seek out the thrill of extreme sports, for example, or amusement park rides, because the rush of fear can be exciting. We all experience fear slightly differently and with more or less intensity. Some people even like it and find it exciting. During the scariest moments of the roller-coaster ride you may be telling yourself, "I'll never get on this thing again - that is, if I make it out alive!" Meanwhile, the friend sitting next to you may think, "This is awesome! As soon as it's over, I'm getting back on!"

Girls tend to have more fears than adults because so much of what they experience is new and unfamiliar. Older children tend to have different fears than younger children, but it's normal for kids to have at least a handful of things that are scary to them. Whereas young children tend to fear things like the dark, monsters, loud thunder and lightning, getting lost, or big dogs, older kids are more likely to fear things like being bullied or getting hurt.

Teenage girls have certain common fears, too. Most teens have some social fears like the fear of being embarrassed or rejected or fear of failing. They may also have personal fears, such as a fear of becoming ill or injured. Some may feel afraid of heights, dogs, snakes, or insects or of performing or public speaking. Because teens think about and care about the larger world community, they may also have global fears such as a fear of war or violence. Some normal fears seem pretty much like a worry, or something they feel generally afraid of or uneasy about. Other times, fear comes as a sudden reaction to a sudden confrontation with danger. It's that sudden fear response that triggers the body's survival mechanism, known as the fight or flight reaction. The fear reaction is known as "fight or flight" because that is exactly what the body is preparing itself to do - to fight off the danger or to run like crazy to get away.

What's happening to my daughter physically when she's afraid?

The brain triggers a response that causes the heart rate to increase, blood to pump to large muscle groups to prepare for physical action (such as running or fighting), blood pressure to increase, skin to sweat to keep the body cool, and so forth. The body stays this way until the brain signals that it's safe to relax.

Everybody knows what it's like to feel anxious: the butterflies in your stomach before a first date, the tension you feel when your boss is angry, the way your heart pounds if you're in danger. Anxiety rouses you to action. It gears you up to face a threatening situation. It makes you study harder for that exam, and keeps you on your toes when you're making a speech. In general, it helps you cope.

Anxiety disorders, however, are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason. Young people with anxiety disorders experience excessive fear, worry, or uneasiness that interferes with their daily lives. These disorders aren't just a case of "nerves." They are illnesses, often related to the biological makeup and life experiences of the individual, and they frequently run in families. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual's quality of life. Ward Halverson suggests you go to the Anxiety section of this web site for much more information, almost all of which applies directly to girls in general as well.

Is my daughter at risk of suicide, or hurting herself?

Now that you're a parent, you might not remember how it felt to be a teen, caught in that gray area between childhood and adulthood. Sure, it's a time of great possibility but it can also be a period of great confusion and anxiety. There's pressure to fit in socially, to perform academically, and to act responsibly. There's the awakening of sexual feelings, a growing self-identity, and a need for autonomy that often conflicts with the rules and expectations set by others.

A teen with an adequate support network of friends, family, religious affiliations, peer groups, or extracurricular activities may have an outlet to deal with his or her everyday frustrations. But many teens don't feel like they have that, and they feel disconnected and isolated from family and friends. These teens are at increased risk for suicide.

Factors that increase the risk of suicide among teens include:

  • The presence of a psychological disorder, especially depression, bipolar disorder, and alcohol and substance use (In fact, approximately 95% of people who die by suicide have a psychological disorder at the time of death.)
  • Feelings of distress, irritability, or agitation
  • Feelings of hopelessness and worthlessness that often accompany depression. A teen, for example, who experiences repeated failures at school, who is overwhelmed by violence at home, or who is isolated from peers is likely to experience such feelings.
  • A previous suicide attempt. This is a major factor to consider.
  • A family history of depression or suicide. Depressive illnesses may have a genetic component, so some teens may be predisposed to suffer major depression.
  • Having suffered physical abuse or sexual abuse
  • Lack of a support network, poor relationships with parents or peers, and feelings of social isolation
  • Dealing with homosexuality in an unsupportive family or community or hostile school environment

OK, what are the warning signs of possible suicidal thinking?

Suicide among teens often occurs following a stressful life event, such as a perceived failure at school, a breakup with a boyfriend or girlfriend, the death of a loved one, a divorce, or a major family conflict. A teen who is thinking about suicide may:

  • Talk about suicide or death in general 
  • Talk about "going away"
  • Talk about feeling hopeless or feeling guilty
  • Pull away from friends or family
  • Lose the desire to take part in favorite things or activities
  • Have trouble concentrating or thinking clearly
  • Experience changes in eating or sleeping habits
  • Show self-destructive behavior (drinking alcohol, taking drugs, or driving too fast, for example)
  • Give away items of personal value

What can a parent do?

Most kids who commit or attempt suicide have given some type of warning to loved ones ahead of time. So, as a parent, it's important that you are aware of some of the warning signs that your child may be suicidal, so that you can get your child the help that he or she needs.

Watch and listen. If your child seems depressed and withdrawn, it's a good idea to watch him or her carefully. Poor grades, for example, may signal that your teen is withdrawing at school. It's important that you keep the lines of communication open and express your concern, support, and love. If your child confides his or her concerns, it's important to show your child that you take those concerns seriously. Your child's fight with a friend may not seem like a big deal to you in the larger scheme of things, but for a teen, a situation like that can seem immense and consuming. It's important not to minimize or discount what your child is going through. This may increase his or her sense of hopelessness. Most people who attempt suicide have given some type of warning to loved ones.

If your child will not speak to you about how he or she is feeling, it's a good idea to suggest that your child talk to someone else who he or she feels comfortable confiding in. If your teen doesn't feel comfortable talking with you, you may want to suggest a more neutral person, such as another relative, a clergy member, a coach, a school counselor, or your child's doctor. It's smart to ask questions. Some parents are reluctant to ask teens if they have been thinking about suicide or hurting themselves. Some parents fear that if they ask, they will plant the idea of suicide in their child's head.

It's always a good idea to ask. Asking a person if he or she is having thoughts about suicide can be difficult. Sometimes it helps to let the person know why you are asking. For instance, you might say: "I've noticed that you've been talking a lot about wanting to be dead. Have you been having thoughts about trying to kill yourself?"

Finally, get help. If you learn that your child is thinking about suicide, get help immediately. Your child's doctor can refer you to a psychologist, psychiatrist, or social worker, or your local hospital's department of psychiatry can provide a list of professionals in your area. Your local mental health association or county medical society can also provide references. In an emergency, you can call (800) SUICIDE or (800) 999-9999. Herkimer County Mental Health can be reached at 867-1465.

If your child is in an emergency situation, your local emergency room can conduct a comprehensive psychiatric evaluation and refer you to the appropriate resources. In this area, Little Falls Hospital is a good resource, although most emergency psychiatric assessments are done at St. Luke's Hospital in Utica. If you are unsure about whether you should bring your child to the emergency room, you can contact your clinician or call MCAT for help. Their number is 732-6228.

If you've scheduled an appointment for your child with a mental health professional, make sure to keep the appointment, even if your child says he or she is feeling better. Suicidal thoughts do tend to come and go; however, it is important that your child get help developing the skills necessary to decrease the likelihood that suicidal thoughts and behaviors will emerge again if a crisis arises in the future. If your child refuses to go to the appointment, discuss this with the mental health professional - you may consider attending the session and working with the clinician to make sure your child has access to the help he or she may need. The clinician might also be able to help you devise strategies to help your child want to get help.

What about afterward?

Remember that any ongoing conflicts between a parent and child can fuel the fire for a teen who is feeling isolated, misunderstood, devalued, or suicidal. Get help to air family problems and resolve them in a constructive way. Also, let the mental health professional know if there is a history of depression, substance abuse, family violence, or other stresses at home, such as an ongoing environment of criticism.

What if my daughter knows someone who's committed or attempted suicide?

What should you do if someone your child knows, perhaps a friend or a classmate, has attempted or committed suicide? First, acknowledge your child's many emotions. Some teens say they feel guilty - especially those who felt they could have interpreted their friend's actions and words better. Others say they feel angry with the person who committed or attempted suicide for having done something so selfish. Still others say they feel no strong emotions. All of these emotions are appropriate; stress to your child that there is no right or wrong way to feel.

When someone attempts suicide and survives, people may be afraid of or uncomfortable about talking with him or her about it. Tell your child to resist this urge; this is a time when a person absolutely needs to feel connected to others. Many schools address a student's suicide by calling in special counselors to talk with the students and help them deal with their feelings. If your child is having difficulty dealing with a friend or classmate's suicide, it's best for him or her to make use of these resources or to talk to you or another trusted adult.

My daughter's self-esteem is in the toilet. Is that normal?

Part of being a teen - especially a teenage girl - is having thoughts and feelings about different parts of your life, such as how you feel about:

  • Your friends and other kids your age
  • How you are doing in school and in other activities
  • Your parents
  • The way you look

While having these new feelings, many changes are also taking place in your body. It is normal to feel self-conscious or shy about the changes in your body and emotions but there are also changes to celebrate. Some cultures even have celebrations to recognize these changes. For example, the Western Apaches have the Sunrise Dance or "Na'ii'ees" and the Jewish community has the Bat Mitzvah - both mark a girl's passage to becoming a woman. Even though it might seem tough sometimes, remember that you are absolutely great!

Having a healthy or high self-esteem can help you to think positively, deal better with stress, and boost your drive to work hard. Having low self-esteem can cause you to feel uneasy and may get in the way of doing things you might enjoy. For some, low self-esteem can contribute to serious problems such as depression, drug and alcohol use, and eating disorders.

What can a girl do to boost her self-esteem?

For girls: self-confidence is also an important part of feeling good about yourself. Self-confidence is that little voice inside of you that tells you that you are okay, that you are a good person, and that you know how to deal with things in good times and in bad. You are not born confident - confidence is learned. As a baby, you started to learn self-confidence from knowing your family loved you. As you learned to walk, play and talk, you also learned self-confidence. Now as a young woman, you are learning to be more self-confident in school, playing sports and in other social settings, but sometimes it's not easy. Participating in class, talking to new teachers or students, or trying out for an after-school activity may make you feel stressed or anxious...but that is normal. The good news is, as you try these new things, you are gaining confidence in spite of your fears. In fact, that is what real self-confidence is - your belief that you can do things well even when you have doubts.

Try these steps to boost your self-esteem:

  • Tell yourself that it is okay not to be the best at everything.
  • Help out by doing chores around the house and volunteering in your community.
  • Do things that you enjoy, or learn about new things you would like to try.
  • Understand that there will be times when you will feel disappointed in yourself and other people. No one is perfect!
  • If you are angry, try talking it over with an adult you trust, such as parents/guardians, relatives or a school counselor.
  • Think positively about yourself and the things you can do. Think: "I will try!"
  • If you still find that you are not feeling good about yourself, talk to your parents/guardian, a school counselor, a clinician, or your doctor because you may be at risk for depression. You can also ask the school nurse for help through tough times. Most schools in this area offer counseling
  • Learn more about depression and other health issues that can affect your mind.

Try these steps to boost your self-confidence:

  • Think positive thoughts about yourself! Focus on your strengths - not your weaknesses. Realize that you are better at some things than others.
  • Set realistic goals. This means not setting goals too high or too low, but at a level you know you can reach. Then, you can always strive to do better than your goal.
  • Give yourself credit when you reach a goal and praise yourself when you have done well.
  • Do more of anything that you're good at. Activities or sports that make you feel positive about yourself will also make you feel better about other parts of your life.
  • Learn to be assertive - express your thoughts, opinions, needs, and feelings openly - but without abusing others' rights.
  • Don't compare yourself to others - remember, you're just fine the way you are!
  • Practice positive body language. Walk tall, don't slump. When your body says "I can" everyone will believe you can.

Is my daughter suffering from problems with stress?

Stress is what you feel when you react to pressure from others or from yourself. Pressure can come from anywhere, including school, work, activities, friends, and family members. You can also feel stress from the pressure of wanting to get good grades or wanting to feel like you belong. Stress comes in many forms and everyone feels stress.

Interestingly, the body has a built-in response to handle stress. When something stressful happens, you may experience sweaty palms, dry mouth, or knots in your stomach. This is totally normal and means that your body is working exactly as it should. Other signs of stress include emotional signs, such as feeling sad or worried, behavioral signs such as not feeling up to doing things, and mental signs such as not being able to concentrate or focus.

OK, so what causes stress among girls?

Lots of everyday things, as well as new things in life or unexpected changes:

  • School work
  • Not feeling good about yourself
  • Changes in your body or weight
  • Body shape or size
  • Problems with friends, boyfriends, or other kids at school
  • Living in a dangerous neighborhood
  • Peer pressure from friends to dress or act a certain way, or smoke, drink, or use drugs
  • Not fitting in or being part of a group
  • Moving or friends moving away
  • Separation or divorce of parents
  • A family member who is ill
  • Death of a loved one
  • Changing schools
  • Taking on too many activities at once
  • Not getting along with your parents or having problems at home
  • Feeling lonely
  • Really, just being a teen can be stressful - there is so much going on and so many changes that are happening all at once

Is stress always a bad thing?

No - on the contrary, a little bit of stress can work in a positive way. For instance, during a sports competition, stress might push you to perform better. Also, without the stress of deadlines, you might not be able to finish schoolwork or get to where you need to be on time. Stress is more of a concern when it starts to interfere with a person's daily functioning, like in school, at home, or in the community.

What are some signs that there's too much stress?

  • Feeling down, edgy, guilty or tired
  • Headaches or stomachaches
  • Trouble sleeping
  • Laughing or crying for no reason
  • Blaming others for bad things that happen to you
  • Wanting to be alone all the time (withdrawal).
  • Not being able to see the positive side of a situation
  • Not enjoying activities that you used to enjoy
  • Feeling resentful of people or things you have to do
  • Feeling like you have too many things you have to do

Why are teenage girls so often stressed about their bodies?

During adolescence, a girl's body is going through many changes that are happening at a fast pace. These changes might make her feel unsure of yourself at times, or stressed. They might make her worry about her size while wanting to fit in with the rest of the crowd. That's a powerful emotion and can be very difficult for teenage girls to handle. During puberty, of course, not only will she get taller, she will also see other changes in her body such as wider hips, bottoms, and thighs. Because her body is starting to produce new hormones, her weight may change and her body, which has both muscle and fat, will also start to have more fat compared to muscle than it did before. Changes in estrogen levels can also cause mood swings - especially around her period, which includes the stress of her first period.

Ward advises girls and their parents to try not to worry. Each woman changes at her own pace and all of these new changes are normal. While you are experiencing these changes, keep your self- confidence up by taking good care of yourself, eating healthy foods and getting regular exercise. Remember…you are unique and beautiful…just as you are.

How can I help my daughter handle this stress?

Different people are stressed by different things. For example:

  • She might get upset or stressed when she doesn't make good grades but her friends might not. " She might be able to handle doing homework and being involved in after-school activities but her sister or friend might feel they can't do both. " Her friend might see moving to a new house as a stress but she might view it as an adventure, or vice-versa.

There are no right or wrong things to stress over - there are just differences in what we consider to be stressful. No matter what stresses your daughter out, there are many things she can try to help her deal.

Before continuing, recovering from a major event follows the same approach.

Such as the stress following a terrorist attack or major disaster?

Yes. Sometimes we are part of, or have lived through, a very stressful event such as a hurricane, a serious car accident, or an assault, like date rape. These kind of scary events can cause a very strong stress reaction in the victims, but the reactions may be different for each person. Some become cranky or depressed; others can't sleep or have nightmares, some may keep reliving the experience, some might experience nervousness and their hearts might race, and some people put the event out of their minds. Feelings that lead to this type of stress include fear, a sense that your life is in danger, helplessness or horror. People don't have to be hurt to experience this type of stress, but can simply be a witness to the event or be threatened with physical harm to have this type of stressful reaction.

The first step is to recognize that it's normal to feel nervous about your own safety and wonder how you would react in an emergency. Here are some things you can do to handle this special kind of stress:

  • You may think it feels better to pretend the event did not happen, but it is best to be honest about how you are feeling. Ignoring or hiding your feelings can be worse for your health in the long run. It is okay to feel scared and uncertain.
  • Try to remember that, while you might feel like a changed person and everything seems off balance right now, your life will calm down and you will find a new normal groove.
  • Talk to a teacher, your parents, or a counselor about your sadness, anger, and other emotions. It can be tough to get started, but it is important to confide in someone you trust with your thoughts and feelings.
  • It is common to want to strike back at people who have caused you or those you love great pain. This feeling is normal, but it is important to understand that it is useless to respond with more violence. Nothing good can come from using hateful words or actions.
  • While you will always remember and feel changed by the event, the feelings will become less painful over time. In learning to cope with tragedy, you will become stronger and better at handling stressful situations. You may also find yourself appreciating life and the people you love even more.
  • Recognize when it's too much: Struggling with major stress and low self-esteem issues can contribute to more serious problems such as eating disorders, hurting yourself, depression, alcohol and drug abuse, and even suicide. Continued depression and thoughts about hurting or killing yourself are signs that it is time to seek help. Girls should to an adult they trust right away.

Are girls more at risk of homelessness?

It is estimated that on any given night, there are between five hundred and one thousand homeless youth on the streets of Seattle, Los Angeles, Las Vegas, and other major cities. Many of them are runaways - teens under the age of 18 who leave their home or place of legal residence without the permission of parents or a legal guardian. They come from every social class, race, and religion. And they are usually hungry, scared, desperate, and very vulnerable to crime.

What can you do?

If you think a girl you know is about to run away, ask her - in a non-confrontational, friendly way - these questions:

  • What else can you do to improve your home situation before you leave?
  • What would make you stay at home?
  • How will you survive?
  • What will you do for money?
  • Is running away safe?
  • Who can you count on for help?
  • Are you being realistic?
  • Have you given this enough thought?
  • What are your other options?
  • If you end up in trouble, who will you call?
  • When you return home, what will happen?
  • Why run away?

The most common reason that teens run away is family problems over such issues as curfew, behavior, dress code, grades, and the choice of friends. Teens also may choose to run away because of problems they are afraid to face, such as bullying at school, pregnancy, sexual orientation, or alcohol and drug problems. There are a number of teens that may choose life on the street because of emotional, physical, and sexual abuse in their home. The nature of ANY kind of abuse - the shame a girl may have, and the possible involvement of parents, stepparents, or other family members - may make it extremely difficult for her to tell someone about it. This is not a time for a girl to run away!

Here's what to do:

Encourage the girl to tell a teacher, counselor, babysitter, neighbor, clergy person, or her parents. Offer to go along with her to give her or him support. Let her know that being abused is not her or his fault. Be clear to her - nothing about what they say, the way they look, or how they behave gives ANYONE the right to use or hurt them!

What are the signs that a girl may run away?

  • She has sudden and dramatic mood swings that affect eating and socializing patterns
  • Her school grades, attendance, and behavior suddenly drop
  • She suddenly starts carrying large amounts of money and even asks you to keep some of it
  • She gives away clothing and other valuable items
  • She starts talking to you about running away. "Do you think anyone would miss me if I leave home?" Take these statements seriously!

If you are afraid that she may run away:

  • Let her know that running away will not solve anything! Rather, it will make things worse.
  • Ask her to get permission to stay with another family for a couple of days.
  • Encourage her to talk to her parents, grandparents, or teacher, or any trusted resource.
  • If she says she is being abused, tell a trusted adult or professional - including the police - immediately. Her life may depend on it.
  • Call the local runaway homeless center; in Herkimer, it's 866-1112, or nationally it's (800) 4-A-CHILD

Anything else to consider with my daughter?

It's also important to know that many children experience mental health problems that are real and painful and can be severe. Mental health problems affect at least one in every five young people, at any given time. At least 1 in 10 girls may have a serious emotional disturbance that severely disrupts her ability to function. Tragically, an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide.

A variety of signs may point to a possible mental health problem in a child or teenager. If you are concerned about a child or have any questions, seek help immediately. Talk to your doctor, a school counselor, or another mental health professional trained to assess whether your child has a mental health problem.

It's a concern when an adolescent girl is troubled by feeling:

  • Sad and hopeless for no reason, and these feelings do not go away.
  • Very angry most of the time and crying a lot or overreacting to things.
  • Worthless or guilty often.
  • Anxious or worried often.
  • Unable to get over a loss or death of someone important.
  • Extremely fearful or having unexplained fears.
  • Constantly concerned about physical problems or physical appearance.
  • Frightened that his or her mind either is controlled or is out of control.

It can be significant when a girl experiences big changes, such as:

  • Showing declining performance in school.
  • Losing interest in things once enjoyed.
  • Experiencing unexplained changes in sleeping or eating patterns.
  • Avoiding friends or family and wanting to be alone all the time.
  • Daydreaming too much and not completing tasks.
  • Feeling life is too hard to handle.
  • Hearing voices that cannot be explained.
  • Experiencing suicidal thoughts.

Other warning signs of a mental illness with a girl include:

  • Poor concentration and is unable to think straight or make up her mind.
  • An inability to sit still or focus attention.
  • Worry about being harmed, hurting others, or doing something "bad".
  • A need to wash, clean things, or perform certain routines hundreds of times a day, in order to avoid an unsubstantiated danger.
  • Racing thoughts that are almost too fast to follow.
  • Persistent nightmares.

Also, a girl might behave in a way that causes problems, such as:

  • Using alcohol or other drugs.
  • Eating large amounts of food and then purging, or abusing laxatives, to avoid weight gain.
  • Dieting and/or exercising obsessively.
  • Violating the rights of others or constantly breaking the law without regard for other people.
  • Setting fires.
  • Doing things that can be life threatening.
  • Killing animals.

Some children diagnosed with severe mental health disorders may be eligible for comprehensive and community-based services through systems of care, particularly in Herkimer County. Systems of care help children with serious emotional disturbances and their families cope with the challenges of difficult mental, emotional, or behavioral problems. Contact Herkimer County Mental Health at 867-1465 locally. To learn more about systems of care in other areas, call the National Mental Health Information Center at 1-800-789-2647, and request fact sheets on systems of care and serious emotional disturbances, or visit the Center's web site at