Posted by: faithful | October 23, 2014

prodromal treatment of schizophrenia

October 20, 2014 
Meghan, 23, began experiencing hallucinations at 19. "Driving home, cars' headlights turned into eyes. The grills on the cars turned into mouths and none of them looked happy. It would scare the crap out of me," Meghan says.

Meghan, 23, began experiencing hallucinations at 19. “Driving home, cars’ headlights turned into eyes. The grills on the cars turned into mouths and none of them looked happy. It would scare the crap out of me,” Meghan says.

Marvi Lacar for NPR

The important thing is that Meghan knew something was wrong.

When I met her, she was 23, a smart, wry young woman living with her mother and stepdad in Simi Valley, about an hour north of Los Angeles.

Meghan had just started a training program to become a respiratory therapist. Concerned about future job prospects, she asked NPR not to use her full name.

Five years ago, Meghan’s prospects weren’t nearly so bright. At 19, she had been severely depressed, on and off, for years. During the bad times, she’d hide out in her room making thin, neat cuts with a razor on her upper arm.

“I didn’t do much of anything,” Meghan recalls. “It required too much brain power.”

“Her depression just sucked the life out of you,” Kathy, Meghan’s mother, recalls. “I had no idea what to do or where to go with it.”

One night in 2010, Meghan’s mental state took an ominous turn. Driving home from her job at McDonald’s, she found herself fascinated by the headlights of an oncoming car.

“I had the weird thought of, you know, I’ve never noticed this, but their headlights really look like eyes.”

To Meghan, the car seemed malicious. It wanted to hurt her.

Kathy tried to reason with her.

“Honey, you know it’s a car, right? You know those are headlights,” she recalls pressing her daughter. “You understand that this makes no sense, right?”

“I know,” Meghan answered. “But this is what I see, and it’s scaring me.”

In other words, Meghan had insight, defined in psychiatry as the ability to understand that one’s unusual experiences are attributable to a mental illness.

What Meghan saw did not fit with what she believed. She knew she was hallucinating.

Meghan keeps a photo of her cat, Boo, on the wall in her bedroom. "She would stay in her room and keep to herself," Kathy, Meghan's mother, says. "Sometimes that was a good thing because her depression just sucked the life out of you."

Meghan keeps a photo of her cat, Boo, on the wall in her bedroom. “She would stay in her room and keep to herself,” Kathy, Meghan’s mother, says. “Sometimes that was a good thing because her depression just sucked the life out of you.”

It’s the loss of insight that signals a psychotic break. This can lead to several different diagnoses, but in people ultimately diagnosed with schizophrenia, the break signals the formal onset of the disease. Typically, a first psychotic break occurs in a person’s late teens or early 20s. In men, the range is 15 to 24; in women, 25 to 34.

That first psychotic break can lead to a series of disasters: social isolation, hospitalization, medications with sometimes disabling side effects, and future psychotic episodes.

So, what if you could intervene earlier, before any of that? Could you stop the process from snowballing?

At 19, Meghan hadn’t had a psychotic break. She still had insight. That made her eligible for a new type of program taking shape in California that aims to prevent schizophrenia before it officially begins.

The program draws on research suggesting that schizophrenia unfolds much more slowly than might be obvious, even to families.

“You start to see a decline in their functioning,” says Dr. Daniel Mathalon, who studies brain development in the early stages of psychosis at the University of California, San Francisco.

“They were doing better in school, now they’re doing worse,” he says. “Maybe they had friends but they’re starting to be more isolated.”

Eventually, these subtle behavioral shifts may take on a surreal quality. A young person may hear faint whispers or hissing, or see flashes of light or shadows on the periphery.

“They lack delusional conviction,” explains Mathalon. “They’re experiencing these things; maybe they’re suspicious. But they’re not sure.”

"I valued my ability to think and learn," Meghan says. "To know that the one thing I valued so highly was dissolving away, that I was losing chunks of my sanity with every hallucination. ... That was more terrifying than the monsters that I saw could ever be."

“I valued my ability to think and learn,” Meghan says. “To know that the one thing I valued so highly was dissolving away, that I was losing chunks of my sanity with every hallucination. … That was more terrifying than the monsters that I saw could ever be.”

Psychiatrists have a word for this early stage: prodromal.

Meghan took a screening test developed at Yale University Medical School that identified her as possibly within the prodromal stage of psychosis. That is, her symptoms could be indicative of early psychosis, but weren’t predictive.

She was referred to a clinic in an office park about an hour from her house calledVentura Early Intervention Prevention Services, or VIPS, operated by Alameda-based Telecare Corp.

VIPS is one of a handful of programs that have sprung up in California in recent years, based on a model developed in Maine by psychiatrist Dr. Bill McFarlane.

McFarlane believes that psychosis can be prevented with a range of surprisingly low-tech interventions, almost all of which are designed to reduce stress in the family of the young person who is starting to show symptoms.

McFarlane cites research done at UCLA suggesting that certain kinds of family dynamics — families that don’t communicate well, or are overly critical — can make things worse for a young person at risk of schizophrenia.

Meghan’s family credits the VIPS program for her transformation. “She’s not the broken little girl that she was three years ago,” Meghan’s stepfather, Charlie, says.

“Our theory,” says McFarlane, “was that if you could identify these young people early enough, you could alter some of those family patterns. Then you could work with the family to start behaving not just normally, but in a way that was smarter.”

McFarlane’s programs bring families in for twice-monthly multifamily group therapy sessions, where participants take a nuts-and-bolts approach to resolving disputes at home and softening their responses to what the young person is going through.

“We assume parents can’t figure this out alone,” says McFarlane.

In some cases, participants are also prescribed antipsychotic drugs, especially one called Abilify, which McFarlane and others believe can stem hallucinations.

McFarlane himself is careful about recommending antipsychotic medications.

The drugs, he says, should be used cautiously, at lower doses than would be prescribed for full psychosis, and even then only in young people who aren’t responding to other treatments.

But in programs inspired by his model, the drugs appear to be widely prescribed, including in clients as young as 10 or 13. This fact has become a flashpoint in the conversation around schizophrenia prevention.

“No one is harder to diagnose than a child or a teenager,” says Dr. Allen Frances, a former chair of the psychiatry department at Duke University and chair of the task force that produced the fourth revision of the Diagnostic and Statistical Manual, or DSM-IV, the standard reference for psychiatric diagnoses.

“There are rapid developmental changes from visit to visit,” he says. “The tendency to overdiagnose is particularly problematic in teenagers.”

Frances points to studies showing that if you take three kids, all experiencing those surreal early symptoms, only one will get schizophrenia.

So what about the other two?

Frances says these kids are wrongly labeled and stigmatized. Their parents are terrified. And in many cases, they will be prescribed antipsychotic drugs, which can have serious side effects and haven’t been studied well in children.

“We have to be careful of any new fad in psychiatry,” says Frances. “The field has been filled with fads in the past, and often we learn in retrospect that they’ve done much more harm than good.”

But what Frances calls a fad is to others a model for mental health care.

To see these programs in action, the best place to go is California, where over the past few years a handful of programs have sprung up based on McFarlane’s PIER model.

One, in San Diego, is called Kickstart. Like the others, it’s paid for by a state tax on millionaires, passed by voters in 2004, that funds mental health. Services — everything from homework help to family therapy and outings such as kite-flying expeditions — are offered for free.

Joseph Edwards, Kickstart’s assistant program director, says for teenagers who might be developing schizophrenia, just being outside, with friends, is a kind of therapy.

“They’ll want to isolate,” says Edwards. “There’s sensitivity to a lot of stimulation. And a lot times we’ll see what we call day/night reversal, where they’ll stay up all night and go to sleep in the daytime.”

Edwards says if a teenager is really isolating, a Kickstart worker will drive to his or her house and cajole the person out. Anything, he says, to keep them engaged, with friends in school or at work.

Tony, 13, spends an afternoon at an arcade with Ashley Wood, his occupational therapist in the Kickstart program in San Diego.

Tony, 13, spends an afternoon at an arcade with Ashley Wood, his occupational therapist in the Kickstart program in San Diego.

At an arcade in a strip mall, we meet Ashley Wood, one of Kickstart’s occupational therapists. Wood brought her client, 13-year-old Tony, here as a reward for being cooperative in therapy.

We aren’t using Tony’s full name because he’s a minor, at the request of his parents.

Wood has an easy laugh and teases Tony gently to pull him out of his shell.

“When we first met, he was so quiet,” she says, laughing. “He’s like, ‘Who is this chick?’ “

“Nah,” says Tony, smiling shyly. “I was being a jerk.”

Tony had been getting in fights. He was angry at his mom, angry in school. And there was something else.

“I used to see stuff and hear [stuff],” he tells me.

“Like what?” I ask him. “Like … weird objects,” he responds. When I press him for more details, he shakes his head.

Are Tony’s symptoms the beginning of schizophrenia? Or just the routine weirdness of a teenage brain taking shape?

No one — not Wood, not his therapists — can say for sure.

Wood says what she’s teaching him will be helpful either way: “When he’s frustrated at school or at home, instead of immediately responding, kind of finding a way to communicate. So we’re trying to work on the impulse control as well.”

Impulsive, unruly, prone to angry outbursts, Tony sounds like a lot of 13-year-old kids.

That’s one reason that last year, the American Psychiatric Association opted to exclude the idea of “psychosis risk syndrome” from the DSM-5, the latest version of the manual of mental disorders. The screening test is generally considered to be only 30 percent accurate.

In 2011, a review of prodrome intervention programs called the idea of intervention in pre-schizophrenia “inconclusive.”

“This is an experiment far before its time,” says Allen Frances.

McFarlane believes the benefits of these programs are borne out in the work done at his clinic and others based on his model. In July, he published the results of a two-year study of two groups of young people at risk for, or in the early stage of, schizophrenia, which showed better functional outcomes for those who went through treatment.

He and other proponents say schizophrenia’s early window may be too precious to miss.

“We’re running up against the limits of what we can do for patients who develop schizophrenia, once it goes to chronic stages,” UCSF’s Mathalon says. “I think this is a direction we have to go in, but we have to do it carefully.”

When you talk to people who have been through these programs and ask them what helped them, it is not the drugs, not the diagnosis. It’s the lasting, one-on-one relationships with adults who listen, like Ashley Wood.

Tiffany Martinez, an early client of Bill McFarlane’s in Maine, chokes up when asked to describe what she thinks helped her climb out of an incipient mental health crisis that began when she was in college.

“To share such personal intimate details, you know? To have these people working so hard on it and so devoted and invested in the work,” Martinez, now age 26, says, “it’s like getting a chance. Just the program, what the program stands for alone, is hope.”

That same relief is palpable when you talk to Meghan’s mom, Kathy, and stepfather, Charlie.

“I thought we were going to have to take care of her for the rest of her life,” says Kathy. “I thought she’d forever be marginal, forever be medicated. I thought we’d just have to get used to it.”

Today Meghan is off all her medications. She’s animated, playing board games with her family, excited about being back in school.

Her family credits the VIPS program.

“We were blessed to have this for her,” Charlie says. “We really were. It saved her life.”

Posted by: faithful | October 7, 2014

how to help your children through a parental divorce

What Children Need Most When Their Parents Divorce

Posted: 10/06/2014 1:49 am 

When parents go through a divorce, children’s psychological needs greatly increase as they live in the middle of an emotional (and perhaps economic) roller coaster filled with guilt, fear and confusion. In Family First: Your Step-by-Step Plan for Creating a Phenomenal Family, Dr. Phil explains the most profound needs of children during this challenging time:

This will be a child’s greatest need because their self-concept is very likely in a fragile and formative stage, especially if they are at a young age. They will try to gain approval because their sense of belonging to the family has been shattered. Children also tend to personalize things and blame themselves, which is another reason they need acceptance. Let them know that they are important, that they are a priority.

Assurance of safety
Parents need to go beyond normal efforts to assure their children that although the family has fragmented, their protection is solid. The key is to maintain a normal pace, boundaries and routines. They need to know that their world is predictable and that it’s not going to change on them.

Freedom from guilt or blame for the divorce

Children often shoulder the blame for the dissolution of a marriage. They personalize their part in the divorce, so they might think: “If only I didn’t make so much noise. If only I didn’t ask for new shoes …” They may think it’s their fault or that somehow they are being punished for their parents’ breakup. Be conscious of this and assure your children they’re blameless.

With the loss of a family leader from the home, children will check and test for structure, so be sure to give it to them. They need structure more than any other time in their lives, because this is when things seem to be falling apart for them. Enforce discipline consistently and with the right currency for good behavior. They need to see that the world keeps going, and they’re still an integral part of what’s going on.

A stable parent who has the strength to conduct business
Whether or not you feel brave and strong, you have to appear to be the best for your children. They’re worried about you and about your partner, especially if there’s an apparent crisis. Do everything possible to assure them of your strength, and in doing so, you make it possible for them to relax. Show yourself to be a person of strength and resilience.

Let kids be kids
Children should not be given the job of healing your pain. Too often, children serve either as armor or as saviors for their parents in crisis. They don’t need to be dealing with adult issues, and should not know too much about what’s going on between you and your ex-spouse.

There are two primary rules to follow, especially during times of crisis and instability in your family:

1. Do not burden your children with situations they cannot control. Children should not bear such a responsibility. It will promote feelings of helplessness and insecurity, causing them to question their own strengths and abilities.

2. Do not ask your children to deal with adult issues. Children are not equipped to understand adult problems. Their focus should be on navigating the various child development stages they go through.


How To Make Your Divorce Less Tough on Your Kids

Posted: 08/26/2014 2:36 pm 

Making the decision to divorce your partner is not something that should be done lightly, especially when there are children involved. On the other hand, unhappy couples should not stay together solely for the sake of the children. If you and your spouse have exhausted all efforts to rehabilitate your relationship and decided that divorce is the right choice for you, Dr. Phil has this advice:

Put your children’s needs first.
You have a responsibility to your children to do everything you can to ensure that the divorce doesn’t leave permanent scars. Children don’t have the voice and ability to tell you what they think, so it is important to make their best interest your best interest. Take an honest look at yourself and what you’re doing to impact your children. Tell them that they are priority number one: “You’re the most important. You are first in everything we think and do, and we’re going to take care of you.”

Create a new relationship with your ex-spouse.
Don’t think of the divorce as ending the relationship with your ex-husband or ex-wife. Instead, think of it as starting a new one. Your new relationship as divorced parents involves being co-allies, nurturers and protectors of your children. Consider going to post-marital counseling, where you can create a parenting plan and resolve your differences, so you can clearly see what is in the best interest of your children. Find a way to make your children feel that everywhere they turn they see love, support and appreciation.

Communicate clearly with your children.
If communication is vague, children fill in the blanks to the detriment of themselves. They will blame themselves and think that it’s their fault that things have happened. Children can take anything and personalize it. For example, they’ll hear Mom and Dad fighting about money, and they’ll go in their room and say, “Oh, my gosh, I needed $20 yesterday for the school lunches. And if I didn’t eat all the time, maybe they wouldn’t be fighting.”

Don’t put your kids in the middle.
Resolve that there is not going to be a tug- of-war. Don’t put the children in between you and your ex and start pulling on them for their allegiance. Don’t use your children as pawns to find out about the other person or get back at your ex.

Fight in private.
Parents must stop the right-fighting and make a plan to help their children make it through the transition with as little trauma as possible. The kids don’t care who’s right; They want you to shut up! If parents are filled with bitterness and angst and resentment, then their children are going to get pulled back and forth, and that’s not right or fair to them.

Never undermine the other parent.
Don’t attack or criticize your ex in front of the children. Take the high ground and put the children above all of your personal wants and needs. If you behave in such a way as to alienate your child’s mother or father from them, they will resent you for it. The day will come when they will say, “You ran your own agenda and it cost us our mother/father.” You may feel like you might win at the time, but in the long term, they will resent you.

Communicate with your ex regarding child rearing decisions.
Make joint decisions about your children’s wellbeing. Don’t let the children divide you even further by manipulating the parent who is more lenient, etc.

Decide that your children will not come from a broken home; they are just going to have two homes.
Each parent should set up a home in which the children have a bedroom, toys to play with and space to be kids. Make sure the children feel at home in both places.


Dr. Phil’s Dos and Dont’s for Co-Parenting with Your Ex

Posted: 08/29/2014 4:24 pm 

No matter how much you hate your ex, if you’ve got kids together then you need to find a way to get along as co-parents.

“You have a lot of divorces that get acrimony and finger-pointing back and forth, but at some point you hope that the parents become fiduciaries and put the child’s best interest above their own agenda,” Dr. Phil tells his guests, Shawn and Kayla, who are in the middle of a heated custody battle.

Dr. Phil shares these co-parenting dos and don’ts:


• Remember that the only person you control is you. Take the high road; there’s a lot less traffic up there.
• Think about the effects your actions have on your children.
• Set boundaries with your ex.
• Sit down with your ex and make an affirmative plan that sets aside any differences you may have so you can focus instead on meeting the needs of your children.
• Agree with your ex that you absolutely won’t disparage each other to your children. Further, forbid your children from speaking disrespectfully about the other parent, even though it may be music to your ears.
• Negotiate how you can best handle sharing the children for visitation, holidays, or events.
• Compare notes with your ex before jumping to conclusions or condemning one another about what may have happened.
• Although it may be emotionally painful, make sure that you and your ex keep each other informed about changes in your life circumstances so that the children are never, ever the primary source of information.

• Never sabotage your children’s relationship with the other parent.
• Never use your children as pawns to get back at or hurt your ex, or as tools to gain information and manipulate your ex.
• Never transfer hurt feelings and frustrations toward your ex onto your child.
• Never force your children to choose a side when there’s a conflict in scheduling or another planning challenge.
• Never convert guilt into overindulgence when it comes to satisfying your children’s material desires.



Posted by: faithful | September 19, 2014

what bipolar disorder really feels like

What Bipolar Disorder Really Feels Like

Posted: 09/18/2014 

About 2.6 percent of American adults — nearly 6 million people — have bipolar disorder, according to the National Institute of Mental Health (NIMH). But the disease, characterized by significant and severe mood changes, is still dangerously misunderstood.

Bipolar disorder is vastly different from the normal ups and downs of everyday life, but many have co-opted the term to refer to any old change in thoughts or feelings. The mood swings in someone with bipolar disorder, sometimes also called manic depression, can damage relationships and hurt job performance. It has been estimated that anywhere from 25 to 50 percent of people with bipolar disorder attempt suicide at least once.

Artist Ellen Forney detailed her diagnosis with bipolar disorder in the graphic memoir Marbles: Mania, Depression, Michelangelo, and Me. Forney previously shared her story with us, specifically detailing how her bipolar disorder has affected her creative work.

Below are some poignant pages from the memoir, along with unique commentary into how these panels came to be and what they mean to Forney, in her own words.


“I’ve heard from a lot of readers that the carousel metaphor has really clarified the different mood states for them. It’s really satisfying when you’re trying to explain something, and a metaphor that makes sense to you also works for someone else. I was originally going to draw a swing — you know, “mood swings” — but side-to-side didn’t work, I needed up-and-down.”




“A lot of readers have pointed to this page as one they identify with personally. I drew the scene very simply because I wanted it to not be set in time, or even space — it wasn’t what my bed looked like, or my couch, it was just a bed and a couch. It doesn’t even depict me, specifically, it’s mostly about the feeling of weariness and dread, with a tiny, sad bit of hope despite the feeling that all is futile. I do think this scene of having trouble getting out of bed is a common experience on the surface though, too.”


“It was really satisfying to draw that, to pin it down on paper like a butterfly and examine it; to externalize things that are so confusing if they stay inside. I don’t know if it’s because I’m a swimmer or because I just love the water, but I actually pictured that specifically, that I was feeling “unmoored.” I suppose it’s the flip side of depression’s feeling like drowning.

You can see in that cloud that mania isn’t all euphoric or happy, it’s mostly that everything is punched up. I’m getting swept into that state of mind — the cloud is a thought balloon.”




“What meds work or don’t work for any one person is just so hit-or-miss right now. I remember a bipolar friend telling me with a certain backhanded pride that she’d been put on so many meds that she had a whole drawer full of bottles. I wanted to make the most of the absurdity of our victim-pride, so I imagined something like a Benny Hill soundtrack, and just rattled off my failed meds in cartoony, fast-moving panels. The merit badges were both serious — because this is hard, and we deserve some kind of Purple Hearts — and a nod to victim one-upmanship (“How many meds have you been on?” i.e., what are your battle scars?). In my head, this series of pages was really cinematic, like an old silent movie with slapstick in fast motion and tinkly music. That’s the kind of energy I was going after.”




“This is one of my favorite pages. I’ve been a swimmer my whole life; with this page, I can just smell the chlorine, which is a comforting smell to me. I so clearly remember leaning my head against the cool side of the shower and crying and feeling like a weight had lifted. I finally had a sign that things were going to be okay. This page is like a cool drink of water to me — it’s not that the drink makes everything better, because the reason it feels so amazing is because you felt like you were dying of thirst. It’s a resetting.”


“It was satisfying to wrestle something unwieldy like mania into categories and tidy descriptions. I was also hoping to remind other bipolars who miss their manias — especially if they’re tempted to go off their meds — that mania can be terrible, too. It’s hard to describe, and my impression is that there’s a lot of misunderstanding of what mania is.”


“Telling people is hard. But so many people have mental disorders. We have so much company. I wish I could tell everyone that it’d be okay to talk to other people about their illness. In my experience, more often than not, they will share their own personal experience — if not for that person, then their friend or family member. I’m serious: more often than not. Who knew? It’s something I’m privileged now to know, after coming out and talking about my bipolar disorder so openly because of Marbles.

A lot of people came out after Robin Williams’s death, and in general there’s a lot more awareness about mental illness, but for the most part people still don’t feel safe talking abut their personal experiences. I think that the more people come out, the more the stigma will lift, but it’s not easy. I will say for myself, though, that coming out has made me feel infinitely stronger and more resilient.

People sometimes ask me what they might do for a friend of theirs who is either manic or depressed or otherwise having a tough time and is kind of unreachable. My mom played a big role in keeping me afloat — she made it clear that she loved me. Even in my haze of self-negation, there was some deep nut in me that knew she loved me, and I needed to carry on, if not for me then for her. My friends were patient and were there for me when I was ready. Sometimes that’s about what you can do.”


All image reprints courtesy of Gotham Books, an imprint of Penguin Random House.

Posted by: faithful | September 19, 2014

long-term health outcomes of childhood sexual abuse

Long Term Health Outcomes of Childhood Sexual Abuse

October 2012

Author: and Mariesa R. Severson, MSN, RN, WHNP, ICCE

Psychological consequences of trauma were first seen in veterans of war and described in the literature as shell shock. By 1980, the diagnosis of post-traumatic stress disorder (PTSD) was listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which guides healthcare practitioners with diagnosis, treatment, and reimbursement. For years we have been studying thepsychological changes that are the sequelae of childhood trauma. These long-term consequences include a higher incidence of depression, intrusive flashback memories, hypervigilance, maladaptive coping skills, dysfunctional social skills, and an overactive stress response. Research examining the more holistic effect of trauma has exploded due to recent events, such as 9/11, terrorism, and traumatized troops returning from war.

As holistic nurses, we understand that even when the effect seems to be psychological, social or biology is also influenced. The mind and body interact on every level. The ripple effect of early childhood trauma has more than psychological effects. Biology of the brain and immune function are influenced. The child is forever changed. Here we examine the influence of childhood sexual abuse on the long-term health and the nursing care of adult survivors.


Walter Cannon first described the fight-or-flight response in 1914 as the complex physiological response that prepares the body for fighting or fleeing. The sympathetic nervous system responds to a stressor, suppressing the calming effects of the parasympathetic system. The hypothalamus in the brain secretes hormones that in turn influence the kidneys and the brain. The cascade of chemicals has a ripple effect on many systems, including the respiratory, gastric, cardiovascular, endocrine, renal, and immune. A major part of the brain/hormone/immune interaction, the hypothalamic-pituitary-adrenal axis, becomes involved and further influences physical and psychological functioning.

Adrenocorticotropic hormone is released from the brain and anti-inflammatory steroids such as cortisol suppress the immune system. Ability for healing and even normal cell maintenance is reduced. With altered immune cell levels, the body has increased inflammation, susceptibility to infection, allergic response, and cell mutation. Natural killer cells, for example, whose job it is to correct the cell mutation of cancer, diminish in number. The effect is cumulative: The longer the stress is perceived, the greater the severity of imbalance.

Early trauma changes the brain

When trauma and stress happen early in life, the effects are far more profound and long-lasting. Biological brain development is influenced by genetics, nutrition, social interaction, and experiences. Almost no new brain neurons are formed after birth. There is, instead, a constant rewiring of the existing neurons. New connections are made and old connections are disconnected. This understanding of the plasticity of the brain is what drives rehabilitation after a stroke.

Trauma and early negative experiences affect the development and even structure of the brain. Women who were sexually abused as children show significantly diminished brain volume on brain scans. The structure and function of the hippocampus (responsible for learning and memory), for example, are different when compared to individuals who weren’t traumatized. The medial prefrontal cortex, amygdala, and other neural circuitry of the brain are also changed. The brain shows a sustained and pervasive stress response as the child grows, and this has a long-term effect on immune function. Brain wave patterns change. The brain’s response to inflammation and healing is altered. Neurotransmitter levels adapt to these new abnormal levels. The biological changes in the brain are even more profound if the abuse was early, pervasive, or severe.

Long-term health issues for survivors of childhood sexual abuse

The range of potential adverse health outcomes is extensive and childhood sexual abuse can be seen as a risk factor for many diseases. Those who experienced childhood sexual abuse are one and a half times more likely to report serious health problems.

The figure below shows common long-term sequelae of childhood sexual abuse. Because of the holistic nature, it’s difficult to categorize the conditions into traditional systems or paradigms.

Psychological issues for this population often include anxiety, poor self-esteem, dysfunctional relationships, eating disorders, and PTSD. PTSD results from a threat to self or others accompanied by “intense fear, horror, or helplessness,” according to the Veteran’s Administration National Center for PTSD. Maladaptive coping such as denial is overused. Those with a history of childhood sexual abuse have increased reports of fear, anxiety, insomnia, headaches, aggression, anger, hostility, poor self-esteem, and suicide attempts. Higher rates of depression are reported. Depression has also been shown to be associated with impaired immune functioning. Increased cytokines (inflammation) and cortisol (stress) have been identified as mechanisms by which immune system function is impaired and related to depression. Incidences of dysfunctional relationships, intimate partner violence, and self-destructive behavior are higher.

Higher rates of some physical diseases, such as sexually transmitted diseases, hepatitis, or pelvic inflammatory disease, can be attributed to the common behavioral issues for this population that include promiscuity, substance abuse, and/or sexual dysfunction. But for those traumatized early in life, there exists a clear and increased risk of lung disease, ulcers, cardiac disease, diabetes, and cardiac disorders. The high incidence of inflammatory disorders, such as rheumatoid arthritis and allergies, is an example of the imbalanced immune system’s overreaction. Prolonged stress and exposure to cortisol, for instance, cause wounds to heal slowly, indicating an underreacting immune system.

Autoimmune disease

The role of childhood sexual abuse in the development of autoimmune disease is worthy of special attention. Trauma in early childhood predisposes the individual to autoimmune diseases in later life. Some of the strongest evidence linking autoimmune disease to childhood trauma is a retrospective study of over 15,000 adults who were enrolled in the Adverse Childhood Experiences study. Autoimmune disease processes commonly seen in this population are fibromyalgia, Crohn’s disease, irritable bowel syndrome, type 1 diabetes, and rheumatoid arthritis. Patients with a history of childhood sexual abuse may develop fibromyalgia and use outpatient health services and analgesics more frequently. Adult survivors of childhood sexual abuse also report increased pain associated with other medical conditions. Cardiovascular diseases, such as arteriosclerosis and ischemic heart disease, are directly related to maladaptive immune function and inflammation and occur in higher rates in adult survivors of childhood sexual abuse. It’s important to remember that any of these disease processes can occur in people who weren’t sexually abused as children.

Healing is possible

Healing from childhood sexual abuse is possible at any point in life. Nurses should be familiar with local providers for counseling, stress-management training, and holistic care of these survivors. Nurses should take an active role in advocating for the client in the referral process when the history of childhood sexual abuse is identified. The human cost of healing survivors of childhood sexual abuse is still far greater than the cost of preventing childhood sexual abuse from occurring in the first place. Being sexually abused as a child has a lifelong impact on health. Once again we are reminded that an awareness of the holistic perspective is vital for competent nursing care of victims of childhood sexual abuse.

Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. Cumulative childhood stress and autoimmune diseases in adults. Psychosom Med. 2009:71(2):243-250. doi: 10.1097/PSY.0b013e3181907888.Bremner JD. Effects of traumatic stress on brain structure and function: relevance to early responses to trauma. J Trauma Dissociation. 2005;6(2):51-68. doi:10.1300/J229v06n02_06.

Goodwin RD, Stein MB. Association between childhood trauma and physical disorders among adults in the United States. Psychol Med 2004;34:509–520.

Sachs-Ericsson N, Blazer D, Plant EA, Arnow B. Childhood sexual and physical abuse and the 1-year prevalence of medical problems in the National Comorbidity Survey. Health Psychol. 2005;24(1):32-40.

U.S. Department of Veterans Affairs. (2011). National Center for PTSD. Accessed September 20, 2012.

Wilson DR. Health Consequences of childhood sexual abuse. Perspect Psychiatr Care. 2010;46(1):56-64. doi: 10.1177/0123456789123456.

Wilson DR, Warise L. Cytokines and their role in depression. Perspect Psychiatr Care. 2008;44(4):285-289. doi: 10.1111/j.1744-6163.2008.00188.x.

Posted by: faithful | September 4, 2014

narcissistic family tree: the legacy of distorted love

The Legacy of Distorted Love

Recognizing, understanding and overcoming the debilitating impact of maternal narcissism

The Narcissistic Family Tree

It can be pretty and decaying at the same time.


Clinical experience and research show that adult children of narcissists have a difficult time putting their finger on what is wrong, because denial is rampant in the narcissistic family system:

“The typical adult from a narcissistic family is filled with unacknowledged anger, feels like a hollow person, feels inadequate and defective, suffers from periodic anxiety and depression, and has no clue about how he or she got that way.”—Pressman and Pressman, The Narcissistic Family

It is common for adult children of narcissists to enter treatment with emotional symptoms or relationship issues, but simultaneously display a lack of awareness of the deeper etiology or cause.

You know them—they’re all around us. They think they’re exceptional, and they’re just waiting for you to realize how superior they are. To meet a narcissist is to like one; but to know them over time is to seriously sour on them.

The narcissistic family hides profound pain.

Such families tend to operate according to an unspoken set of rules. Children learn to live with those rules, but never stop being confused and pained by them, for these rules block their emotional access to theirparents. They basically become invisible—neither heard, seen, or nurtured. Conversely, and tragically, this set of rules allows the parents to have no boundaries with the children and to use (or abuse) them as they see fit.

The following are some common dynamics of this profoundly dysfunctional intergenerational system. (Keep in mind there are always degrees of dysfunction on a spectrum depending on the level ofnarcissism in the parents.)

  1. Secrets. The family secret is that the parents are not meeting the children’s emotional needs, or that they are abusive in some way. This is the norm in the narcissistic family. The message to the children: “Don’t tell the outside world—pretend everything is fine.”
  2. Image. The narcissistic family is all about image. The message is: “We are bigger, better, have no problems, and must put on the face of perfection.” Children get the messages: “What would the neighbors think?” “What would the relatives think?” What would our friends think?” These are common fears in the family: “Always put a smile on that pretty little face.”
  3. Negative Messages. Children are given spoken and unspoken messages that get internalized, typically: “You’re not good enough”; “You don’t measure up”; “You are valued for what you do rather than for who you are.”
  4. Lack of Parental Hierarchy. In healthy families, there is a strong parental hierarchy in which the parents are in charge and shining love, light, guidance, and direction down to the children. In narcissistic families, this hierarchy is non-existent; the children are there to serve parental needs.
  5. Lack of Emotional Tune-In. Narcissistic parents lack the ability to emotionally tune in to their kids. They cannot feel and showempathy or unconditional love. They are typically critical and judgmental.
  6. Lack of Effective Communication. The most common means of communication in narcissistic families is triangulation. Information is not direct. It is told through one party about another in hopes it will get back to the other party. Family members talk about each other to other members of the family, but don’t confront each other directly. This creates passive-aggressive behavior, tension, and mistrust. When communication is direct, it is often in the form of anger or rage.
  7. Unclear Boundaries. There are few boundaries in the narcissistic family. Children’s feelings are not considered important. Private diaries are read, physical boundaries are not kept, and emotional boundaries are not respected. The right to privacy is not typically a part of the family history.
  8. One Parent Narcissistic, the Other Orbiting. If one parent is narcissistic, it is common for the other parent to have to revolve around the narcissist to keep the marriage intact. Often, this other parent has redeeming qualities to offer the children, but is tied up meeting the needs of the narcissistic spouse, leaving the children’s needs unmet. Who is there for them?
  9. Siblings Not Encouraged to Be Close. In healthy families, we encourage our children to be loving and close to each other. In narcissistic families, children are pitted against each other and taught competition. There is a constant comparison of who is doing better and who is not. Some are favored or seen as “the golden child,” and others become the scapegoat for a parent’s projected negative feelings. Siblings in narcissistic families rarely grow up feeling emotionally connected to each other.
  10. Feelings. Feelings are denied and not discussed. Children are not taught to embrace their emotions and process them in realistic ways. They are taught to stuff and repress them, and are told their feelings don’t matter. Narcissistic parents are typically not in touch with their own feelings and therefore project them onto others. This causes a lack of accountability and honesty, not to mention other psychological disorders. If we don’t process feelings, they do leak out in other unhealthy ways.
  11. “Not Good Enough” Messages. These messages come across loud and clear in the narcissistic family. Some parents actually speak this message in various ways; others just model it to the children. Even if they display arrogant and boastful behavior, under the veneer of a narcissist is a self-loathing psyche—that gets passed to the child.
  12. Dysfunction—Obvious or Covert. In narcissist families, the dynamics can be seen or disguised. The dysfunction displayed in violent and abusive homes is usually obvious, but emotional and psychological abuse, as well as neglectful parenting, are often hidden. While the drama is not displayed as openly to the outside world, it is just as, if not, more damaging to the children.

Reviewing these dynamics, one can see how this kind of family can look pretty but be decaying at the same time. If you recognize your family in this description, know that there is hope and recovery. We can’t change the past, but we can take control of the now. We do not have to be defined by the wounds in our family systems. As Mark Twain defines the optimist, I see the recovering adult child: “A person who travels on nothing from nowhere to happiness.”

We can create new life that will flow through us to the future and stop the legacy of distorted love learned in the narcissistic family. If we choose recovery, we can defy intergenerational statistics.

We Can!


Additional resources for recovery


Posted by: faithful | August 16, 2014

abusive narcissists: how they do it…

Five Powerful Ways Abusive Narcissists Get Inside Your Head

July 21, 2014

In popular culture, the term “narcissistic” is thrown about quite loosely, usually referring to vanity and self-absorption. This reduces narcissism to a common quality that everyone possesses and downplays the symptoms demonstrated by people with the actual disorder. While narcissism does exist on a spectrum, narcissism as a full-fledged personality disorder is quite different.

People who meet the criteria for Narcissistic Personality Disorder or those who have traits of Antisocial Personality Disorder can operate in extremely manipulative ways within the context of intimate relationships due to their deceitfulness, lack of empathy and their tendency to be interpersonally exploitative. Although I will be focusing on narcissistic abusers in this post, due to the overlap of symptoms in these two disorders, this post can potentially apply to interactions with those who have ASPD to an extent.

It’s important in any kind of relationship that we learn to identify the red flags when interacting with people who display malignant narcissism and/or antisocial traits, so we can better protect ourselves from exploitation and abuse, set boundaries, and make informed decisions about who we keep in our lives. Understanding the nature of these toxic interactions and how they affect us has an enormous impact on our ability to engage in self-care.

Watch out for the following covert manipulation tactics when you’re dating someone or in a relationship.

1. The Idealization-Devaluation-Discard Phase

Narcissists and those with antisocial traits tend to subject romantic partners through three phases within a relationship. The idealization phase (which often happens most strongly during the early stages of dating or a relationship) consists of putting you on a pedestal, making you the center of his/her world, being in contact with you frequently, and showering you with flattery and praise. You are convinced that the narcissist can’t live without you and that you’ve met your soulmate. Be wary of: constant texting, shallow flattery and wanting to be around you at all times. This is a technique known as “lovebombing” and it is how most victims get sucked in: they are tired of the “games” people play with each other in communication and are flattered by the constant attention they get from the narcissist. You may be fooled into thinking that this means a narcissist is truly interested in you, when in fact, he or she is interested in making you dependent on their constant praise and attention.

The devaluation phase is subsequent to this idealization phase, and this is when you’re left wondering why you were so abruptly thrust off the pedestal. The narcissist will suddenly start to blow hot and cold, criticizing you, covertly and overtly putting you down, comparing you to others, emotionally withdrawing from you and giving you the silent treatment when you’ve failed to meet their “standards.” Since the “hot” aspect of this phase relies on intermittent reinforcement in which the narcissist gives you inconsistent spurts of the idealization phase throughout, you become convinced that perhaps you are at fault and you can “control” the narcissist’s reactions.

Even though the narcissist can be quite possessive and jealous over you, since he or she views you as an object and a source of narcissistic supply, the narcissist is prone to projecting this same behavior onto you. The narcissist makes you seem like the needy one as you react to his or her withdrawal and withholding patterns even though the expectations of frequent contact were established early on in the relationship by the narcissist himself.

You are mislead into thinking that if you just learn not to be so “needy,” “clingy,” or “jealous,” the narcissist will reward you with the loving behavior he or she demonstrated in the beginning. The narcissist may use these and other similar words to gaslight victims when they react normally to being provoked. It’s a way to maintain control over your legitimate emotional reactions to their stonewalling, emotional withdrawal and inconsistency.

Unfortunately, it is during the devaluation phase that a narcissist’s true self shows itself. You have to understand that the man or woman in the beginning of the relationship never truly existed. The true colors are only now beginning to show, so it will be a struggle as you attempt to reconcile the image that the narcissist presented to you with his or her current behavior.

During the discard phase, the narcissist abandons his or her victim in the most horrific, demeaning way possible to convince the victim that he or she is worthless. This could range from: leaving the victim for another lover, humiliating the victim in public, being physically aggressive and a whole range of other demeaning behaviors to communicate to the victim that he or she is no longer important.

2. Gaslighting.

Most abusive relationships contain a certain amount of gaslighting, a technique narcissists use to convince you that your perception of the abuse is inaccurate. During the devaluation and discard phases, the narcissist will often remark upon your emotional instability, your “issues,” and displace blame of his/her abuse as your fault. Frequent use of phrases such as “You provoked me,” “You’re too sensitive,” “I never said that,” or “You’re taking things too seriously” after the narcissists’ abusive outbursts are common and are used to gaslight you into thinking that the abuse is indeed your fault or that it never even took place.

Narcissists are masters of making you doubt yourself and the abuse. This is why victims so often suffer from ruminations after the ending of a relationship with a narcissist, because the emotional invalidation they received from the narcissist made them feel powerless in their agency and perceptions. This self-doubt enables them to stay within abusive relationships even when it’s clear that the relationship is a toxic one, because they are led to mistrust their own instincts and interpretations of events.

3. Smear campaigns.

Narcissists keep harems because they love to have their egos stroked and they need constant validation from the outside world to feed their need for excessive admiration and confirm their grandiose sense of self-importance. They are clever chameleons who are also people-pleasers, morphing into whatever personality suits them in situations with different types of people. It is no surprise, then, that the narcissist begins a smear campaign against you not too long after the discard phase, in order to paint you as the unstable one, and that this is usually successful with the narcissist’s support network which also tends to consist of other narcissists, people-pleasers, empaths, as well as people who are easily charmed.

This smear campaign accomplishes three things: 1) it depicts you as the abuser or unstable person and deflects your accusations of abuse, 2) it provokes you, thus proving your instability to others when trying to argue his or her depiction of you, and 3) serves as a hoovering technique in which the narcissist seeks to pull you back into the trauma of the relationship as you struggle to reconcile the rumors about you with who you actually are by speaking out against the accusations. The only way to not get pulled into this tactic is by going full No Contact with both the narcissist and his or her harem.

4. Triangulation.

Healthy relationships thrive on security; unhealthy ones are filled with provocation, uncertainty and infidelity. Narcissists like to manufacture love triangles and bring in the opinions of others to validate their point of view. They do this to an excessive extent in order to play puppeteer to your emotions. In the book Psychopath Free by Peace, the method of triangulation is discussed as a popular way the narcissist maintains control over your emotions. Triangulation consists of bringing the presence of another person into the dynamic of the relationship, whether it be an ex-lover, a current mistress, a relative, or a complete stranger.

This triangulation can take place over social media, in person, or even through the narcissist’s own verbal accounts of the other woman or man. The narcissist relies on jealousy as a powerful emotion that can cause you to compete for his or her affections, so provocative statements like “I wish you’d be more like her,” or “He wants me back into his life, I don’t know what to do” are designed to trigger the abuse victim into competing and feeling insecure about his or her position in the narcissist’s life.

Unlike healthy relationships where jealousy is communicated and dealt with in a productive manner, the narcissist will belittle your feelings and continue inappropriate flirtations and affairs without a second thought. Triangulation is the way the narcissist maintains control and keeps you in check – you’re so busy competing for his or her attention that you’re less likely to be focusing on the red flags within the relationship or looking for ways to get out of the relationship.

5. The false self and the true self.

The narcissist hides behind the armor of a “false self,” a construct of qualities and traits that he or she usually presents to the outside world. Due to this armor, you are unlikely to comprehend the full extent of a narcissist’s inhumanity and lack of empathy until you are in the discard phase. This can make it difficult to pinpoint who the narcissistic abuser truly is – the sweet, charming and seemingly remorseful person that appears shortly after the abuse, or the abusive partner who ridicules, invalidates and belittles you on a daily basis? You suffer a great deal of cognitive dissonance trying to reconcile the illusion the narcissist first presented to you with the tormenting behaviors he or she subjects you to. In order to cope with this cognitive dissonance, you might blame yourself for his or her abusive behavior and attempt to “improve” yourself when you have done nothing wrong, just to uphold your belief in the narcissist’s false self during the devaluation phase.

During the discard phase, the narcissist reveals the true self – the ugly, abusive and abrasive monster rears its head and you get a glimpse of the evil that was lurking within all along. You bear witness to his or her cold, callous indifference as you are discarded. You might think this is only a momentary lapse into evil, but actually, it is as close you will ever get to seeing the narcissist’s true self.

The manipulative, conniving charm that existed in the beginning is no more – instead, it is replaced by the genuine contempt that the narcissist felt for you all along. See, narcissists don’t truly feel empathy or love for others – so during the discard phase, they feel absolutely nothing for you except the excitement of having exhausted another source of supply. You were just another source of supply, so do not fool yourself into thinking that the magical connection that existed in the beginning was in any way real. It was an illusion, much like the identity of the narcissist was an illusion.

It is time to pick up the pieces, go No Contact, heal, and move forward. You were not only a victim of narcissistic abuse, but a survivor. Owning this dual status as both victim and survivor permits you to own your agency after the abuse and to live the life you were meant to lead – one filled with self-care, self-love, respect, and compassion.

Posted by: faithful | July 30, 2014

successful people with mental illnesses

These Wildly Successful People Will Prompt You To Rethink What It Means To Have A Mental Illness
The Huffington Post | By Lindsay Holmes

Posted: 07/30/2014

Approximately one in four American adults suffers from a diagnosable mental disorder in a given year. This staggering statistic goes to show that mental illness can touch anyone — from entrepreneurs to presidents to celebrities.

Given the stigma attached to mental illness, despite its prevalence, many people suffer quietly instead of reaching out for the support they may need. But as the wildly accomplished individuals below prove, just because you’re battling a mental disorder doesn’t mean you should feel alone — or incapable of accomplishing your goals.

It’s also worth noting that the conversation around these disorders used to be much quieter. And while many prominent people have publicly revealed their diagnoses, there is a whole host of luminaries who historians suspect suffered from one disorder or another: Renowned, innovative creative-types like Steve Jobs, Charles Dickens and Charles Lindbergh as well as gifted politicians like Abraham Lincoln and Thomas Jefferson.

Catherine Zeta-Jones

The Academy Award-winning actress, who is the picture of poised on the red carpet, revealed in 2011 that she was diagnosed with Bipolar II disorder. Zeta-Jones said the condition, which causes a series of deep, depressive lows with extreme manic highs that don’t reach full-blown mania, has had a huge impact on her personal life as well as her professional career. Zeta-Jones has been open about her battle and remains optimistic about treating the illness (last year she checked back into a health care facility for additional treatment). “This is a disorder that affects millions of people and I am one of them,” she told PEOPLE magazine. “If my revelation of having bipolar II has encouraged one person to seek help, then it is worth it. There is no need to suffer silently and there is no shame in seeking help.”

Jessie Close
The upcoming author and sister of acclaimed actress Glenn Close was diagnosed with Bipolar I disorder at the age of 47 after struggling with it most of her life. “When I was finally diagnosed, I went through a long period of grief, because I had so many instances where I was manic and not in my right mind,” she told CNN earlier this year. “It’s a difficult thing to look back on a life when you’re already 50 years old.” After receiving an official diagnosis, Close joined Glenn in launching Bring Change 2 Mind, a foundation working to end the stigma and discrimination of mental illness.

Howie Mandel
The “America’s Got Talent” host is one of more than 2 million people who suffer from OCD. The condition, which is associated with repetitive thoughts and impulses, affected Mandel for most of his life before he finally sought help as an adult. “We take care of our dental health,” he told CNN in February. “We don’t take care of our mental health … I think the solution to making this world better is if we would just be healthy, mentally.”

Adam Levine

The Maroon 5 crooner has struggled with Attention Deficit Hyperactivity Disorder for most of his life, and created a public service announcement earlier this year about how he’s still dealing with the condition. Since filming the PSA, he’s been open about his battle — even admitting that it sometimes affects him in the recording studio — and hopes his public status can help someone who may be suffering from the same disorder. “ADHD isn’t a bad thing, and you shouldn’t feel different from those without ADHD,” Levine wrote in ADDitude magazine. “Remember that you are not alone. There are others going through the same thing.”

Carrie Fisher
Best known for her role as the captivating Princess Leia in the “Star Wars” franchise, Fisher has received several accolades for her activism for the mental health community. In an interview with the Sarasota Herald-Tribune, she explains that people with mental illness shouldn’t feel like they have to give up their dreams just because of a disorder. “Stay afraid, but do it anyway,” she advised. “What’s important is the action. You don’t have to wait to be confident. Just do it and eventually the confidence will follow.” Fisher had the confidence to not let bipolar disorder define her when she publicly announced her diagnosis on 2000. “People say ‘mental illness’ like it’s not a part of the body,” she told Forbes in 2011. “It’s nothing to be ashamed of.”

Drew Barrymore

The goofy, lovable actress wasn’t always the picture of happy that she is today. Barrymore struggled with addiction to drugs and alcohol, which ultimately led to severe depression and a suicide attempt. In an interview with Teen Ink, Barrymore offered advice for teens who are struggling with similar demons: “Persevere and find people who are safe and honest and who will give you tough love and will guide you through the times,” she said. “You really can’t do everything on your own. You need love and support around you. Believe that you will get past these times. You will overcome. Things will get better. Life is a series of ups and downs and the good news, when you’re in a low, is that it will go up again. And things will become safe and clear and beautiful.”

Michael Phelps
The most-decorated Olympian of all time also faced ADHD growing up, Everyday Health reported. His inability to focus was concerning for his family — but they noticed that while he lacked discipline in the classroom, he was able to cultivate it elsewhere: the pool. “Michael has a mental toughness. He’s very intense, but he never used to be able to focus,” his mother Debbie Phelps told Everyday Health. “But even at ages 9 and 10, at swim meets he would be focused for four hours — even though he’d only be swimming himself for three to four minutes — because swimming is his passion.”

Sinead O’Connor
The pop star has been diagnosed with bipolar disorder and depression, Everyday Health reported. O’Connor has been public about her battle with mental illness, and spoke out about her advocacy to end the stigma against mental disorders with TIME magazine in 2013: “Unfortunately there’s such a stigma about mental illness or perceived mental illness that people are bullied and treated like sh*t and the illnesses are used as something with which to beat people, and in a manner than a physical illness wouldn’t be,” she said.

Ludwig van Beethoven

It’s possible the musical genius also suffered from a bipolar disorder, which may have even influenced his creativity. According to François Martin Mai, author of Diagnosing Genius: The Life and Death of Beethoven, the composer showed signs of depression and episodes of mania, some of which was even reflected in his own works. In a review of Mai’s book, the New England Journal of Medicine points out some of the author’s logic, citing that Beethoven was still able to channel creative energy:

Mai thoughtfully analyzes the ways in which Beethoven’s chronic illnesses and psychopathology may have contributed to his creativity. But it is also important to acknowledge that Beethoven had an inner impulse that demanded expression — even in the face of many obstacles.

Posted by: faithful | July 30, 2014

genetic markers in mental illness

Spark for a Stagnant Search

JULY 21, 2014


“You’re talking to a guy who went from psychotic to normal with some pills,” said Jonathan Stanley, who was found to have bipolar disorder in the 1980s. The donation of a foundation started by his father is one of the largest private gifts ever for scientific research. Credit

One day in 1988, a college dropout named Jonathan Stanley was visiting New York City when he became convinced that government agents were closing in on him.

He bolted, and for three days and nights raced through the city streets and subway tunnels. His flight ended in a deli, where he climbed a plastic crate and stripped off his clothes. The police took him to a hospital, and he finally received effective treatment two years after getting a diagnosis of bipolar disorder.

“My son’s life was saved,” his father, Ted Stanley, said recently. When he himself was in college, he added, “those drugs didn’t exist; I would have had a nonfunctioning brain all the rest of my life.”

The older Mr. Stanley, 84, who earned a fortune selling collectibles, created a foundation to support psychiatric research. “I would like to purchase that happy ending for other people,” he said.

Late on Monday, the Broad Institute, a biomedical research center, announced a $650 million donation for psychiatric research from the Stanley Family Foundation — one of the largest private gifts ever for scientific research.


Psychiatric Research Revival, Second Thoughts About Consciousness, Take-Home Sleep Tests 25:05
A family pledges one of the largest private gifts ever for scientific research; why we may never have all the pieces necessary for a theory of everything; sleep apnea tests can now be taken from the comfort of your bed. David Corcoran, Michael Mason and Joshua A. Krisch
It comes at a time when basic research into mental illness is sputtering, and many drug makers have all but abandoned the search for new treatments.

Despite decades of costly research, experts have learned virtually nothing about the causes of psychiatric disorders and have developed no truly novel drug treatments in more than a quarter century.

Broad Institute officials hope that Mr. Stanley’s donation will change that, and they timed their announcement to coincide with the publication of the largest analysis to date on the genetics of schizophrenia.

The analysis, reported by the journal Nature on Monday, identified more than 100 regions of DNA associated with the disease. Many of them contain genes involved in just a few biological functions, like pumping calcium into neurons, that could help guide the search for treatments.

“For the first time, there’s a clear path forward,” said Eric Lander, the president of the Broad Institute.

Experts not affiliated with the institute or the new paper agreed that the news on both fronts was good, but characterized the research as a first step in a long process. “The signals they found are real signals, period, and that is encouraging,” said David B. Goldstein, a Duke University geneticist who has been critical of previous large-scale projects. “But at the same time, they give us no mechanistic insight, no targets for drug development. That will take a lot more work.”

Jonathan Stanley, now 48, cannot explain why he suddenly developed bipolar disorder at 19. All he knows is that his brain responded well to lithium. He was eventually able to return to college, complete law school and become a lawyer. “You’re talking to a guy who went from psychotic to normal with some pills,” he said.

When scientists began to discover psychiatric drugs like lithium in the mid-20th century, they did so mostly by accident, not out of an understanding of the biology of the diseases they hoped to cure. For many years, they worked backward, hoping that by figuring out the action of the drugs, they could understand the causes of the diseases. But they came up empty.

Continue reading the main story
Some researchers argued that a better strategy would be to find the genes involved in psychiatric disorders. This approach would give them new molecular targets for drugs they could test.

Yet the staggering complexity of the brain has yielded few secrets. More than 80 percent of the roughly 20,000 genes in human DNA are active in the brain.

In the 1990s, many scientists argued that the best approach to find “mood genes” was top-down. They would identify promising genes based on their biological properties and then survey their variants in people with and without a diagnosis.

But this approach was something like trying to find a thief in a crowd, based on a hunch of what he or she might look like. The research was “pretty much completely useless,” Dr. Lander said. “It turns out we are terrible guessers.”

By the early 2000s, the ability to decode human DNA had vastly improved, and scientists could look across our complete complement of genetic material, known as the genome, comparing samples from ever-larger groups of people. Ted Stanley’s first donation to the Broad Institute — $100 million in 2007, to found the Stanley Center for Psychiatric Research — went to support precisely such research.

Yet these studies were disappointing, too, and many researchers thought they were a dead end. “We were saying, ‘Maybe it isn’t the right way to go,’ ” Dr. Lander said.

Soon, the Broad Institute joined forces with scores of other research groups to form a consortium that could pool tens of thousands of subjects for analysis. In 2011, the consortium reported five genetic markers associated with schizophrenia. The group added more people to its studies and found even more genetic links.

The new paper in Nature is a culmination of the effort to date. The consortium analyzed 37,000 people who had schizophrenia and 114,000 who did not. It found 83 regions of the genome linked to the disorder that had not been previously flagged, and confirmed 25 previously identified ones, bringing the total to 108.

Dr. Lander cautioned that each variant accounts for only a tiny portion of the risk of developing schizophrenia. “It shouldn’t be used for a risk predictor,” he said.

Still, Dr. Samuel Barondes, a professor of neurobiology and psychiatry at the University of California, San Francisco, who was not involved in the study, called the findings encouraging. Even though schizophrenia is a “diverse disorder, with a horribly complicated genetic basis,” he said, “it is possible to pick up a reliable genetic signal if you have enough people.”

Other research teams are making progress on other conditions, such as bipolar disorder and autism, and finding that some mutations are rare while others are common variants.

On Sunday, an international team of scientists reported a study in Nature Genetics in which they compared 466 autistic people to 2,580 others. They found that most of the genetic risk of autism involved common mutations.

But these studies of brain disorders are also revealing a deep complexity that could pose an obstacle to rapid progress to effective drugs.

For example, recent research has found that mutations in the very same gene can cause a wide range of brain disorders, including autism, schizophrenia and epilepsy. “We are implicating the exact same genes across really different neuropsychiatric disorders,” Dr. Goldstein said. “We have no idea at all about why that is, and the only way to find out is to do some hard biology — to find out not only which genes matter, but what about them matters.”

That will take time and will probably produce plenty of reversals and spurious predictions. “Expect no grand-slam home runs,” said Dr. Allen Frances, professor emeritus of psychiatry at Duke and author of “Saving Normal,” a critique of psychiatric diagnosis. “There will be lots of strikeouts and only occasional singles.” The new study in Nature found that many risk variants clustered around specific body functions, like the immune system and calcium transmission in brain cells.

To understand their underlying biology, Broad researchers plan to grow neurons with mutations in the genes they have discovered, to see how they differ from normal cells. They will engineer mice with some of the mutations to see how their brains are affected. The scientists hope these experiments will lead them to hypotheses about the biology underlying psychiatric disorders — which they will test by giving mice drugs that target specific molecules in the brain.

These studies will be expensive, which is where the Stanley foundation comes in. Last year, after the death of his wife, Vada, Mr. Stanley, the founder of MBI, began considering what he would do with his fortune. He decided that his first gift to Broad Institute was not enough.

“After I’m gone,” he said, “I just want the money to flow to them as it would if I was still alive.”

Posted by: faithful | July 22, 2014

mood and food and bipolar disorder

Internationally recognized health expert, physician, scientist, and New York Times best-selling author. Known as ‘the doc who walks the talk’.



Mood, Food and Bipolar Disorder: A New Prescription


If you’re one of the estimated 5.7 million U.S. adults dealing with bipolar disorder, you know the potent control it can have on your moods, energy and emotions. What you may not know is how much power you have to control it.

Thanks to an emerging science called epigenetics, researchers have learned that DNA is no longer destiny and that each of us has the ability to influence how our genes express themselves to the rest of the body. With healthy lifestyle choices and environmental changes, we can actually alter our own destiny.

For those with bipolar disorder, it’s an empowering message: No longer are you a prisoner of your genetics, thought to play a key role in the disorder. And through healthier lifestyle choices, you may be able to decrease your reliance on medication to manage your illness, although this remains a critical part of the overall treatment equation. By taking a holistic and integrative lifestyle approach that includes the practice of mindfulness and stress reduction, using nutrition based on whole foods, and adding a more active lifestyle — what I like to call my Mind, Mouth and Muscle blueprint — you can reduce the effects of the bipolar condition and improve the quality of your life.

This isn’t just theory. I work directly with those with mood disorders and have seen firsthand the benefits that can result from choosing the apple over the doughnut, meditating rather than obsessing and ruminating over a life stress, and going for a walk instead of sitting for hours watching mindless TV. With each healthy choice that’s made, you’re influencing the proteins that switch genes on and off and affecting the messages that are delivered throughout the body. Consistently good choices translate into a better reading of your genetic script. You’re also carving neural highways that lay down a foundation for new lifestyle habits.

This attention to Mind, Mouth and Muscle can also help with a condition highly associated with the diagnosis of bipolar disorder: weight gain. A 2011 review found that 68 percent of those who seek help for bipolar disorder are overweight or obese. The medications are partly to blame for the extra pounds, but the psychobiology of the disorder itself also plays a significant role as well. Those with bipolar disorder are believed to have lower levels of the chemical messenger serotonin, which can spark a craving for carbs and sweets.

Bipolar disorder also goes hand in hand with stress, which can cause a buildup of the hormone cortisol. When cortisol levels rise, our appetite for sweetness intensifies. And top that with new research that indicates that brain circuits involved with reward are more strongly activated in people with bipolar disorder. If reward is perceived, a tsunami of the pleasure neurotransmitter, dopamine, is secreted by the brain’s reward center. The good news is that this dopamine-driven push for reward helps people with bipolar disorder become high achievers. The bad news is that they can also become side-tracked by short-term, pleasurable rewards like overeating. Not surprisingly, the foods that are over-consumed are the “hyperpalatables” — sugary, fatty, salty food combinations. One result of these psychobiological interplays is that the self-soothing and rewarding behaviors can contribute to strong, addictive-like eating behaviors that may become destructive to mental and physical health and well-being.


Planning Your Menu

Here’s what science says about what should be in and out of your daily nutrition in order to help control your weight and moods, as well as manage those cravings while reining in addictive-like eating behaviors. As you plan to integrate these tips, remember to practice mindfulness, being present and aware of your daily nutrition, and taking the time to savor each bite:

Omega-3 essential fatty acids — A mountain of studies confirms it: Omega-3 fats, such as those found in fatty fish like wild Alaskan salmon, are not only great for general health, they can also help lower the incidence of depression. In fact, the more fish the population of any country eats, the less depression. If you need more proof of their power, consider this: At least one study has found that bipolar disorder is the No. 1 illness associated with lack of omega-3s. These are other fatty fish with high levels of omega-3 fats: arctic char, Atlantic mackerel, sardines, black cod, anchovies, oysters, rainbow trout, albacore tuna, mussels and Pacific halibut.

Refined sugar — You are already on a mood roller coaster with bipolar disorder. Refined sugar throws your ride into further chaos. Processed refined sugar sends insulin levels soaring, which in turn sparks a roaring craving for more sweet stuff. Sweet begets sweet. When you don’t get your sugar fix, a crash follows. Instead, satisfy yourself with moderate servings of the natural sugars in fruits and vegetables. A warning about artificial sweeteners: Ditch the Splenda and agave; they affect insulin levels in exactly the same way as processed sugar. Instead, use stevia, an herb that provides sweetness with no effect on insulin levels.

Magnesium — Magnesium has been found to function similarly to lithium, which is often prescribed for bipolar disorder as a mood stabilizer. Adding magnesium to your diet may help to decrease the symptoms of mania or rapid cycling. Magnesium also supports good sleep, another problem spot for those with bipolar disorder. Top sources for magnesium include pumpkin seeds, spinach, swiss chard, soybeans, cashews, black beans and sunflower seeds.

Vitamins — Vitamin deficiencies, especially of vitamins C, D and the B vitamins, are common in those with bipolar disorder. Vitamin B9, also known as folic acid, is especially crucial. A deficiency of vitamin B9 can increase levels of homocysteine, and higher levels of homocysteine are linked to depression. Low levels of vitamin D are also associated with mood disorders and depression. Here’s another reason to make sure you get your full requirement of vitamin D: Research shows it may help prevent some cancers such as ovarian, colon and breast. Look for vitamin C in citrus and other fruits; vitamin D in fatty fish, beef liver, cheese, egg yolks and from sunshine; and vitamin B9 in foods such as beans, spinach, asparagus, mango and whole wheat bread.

Carbs — Carbohydrate cravings come with the territory in bipolar disorder. The goal is to ditch the processed, refined carbs, usually found in manufactured foods, and stick with whole foods like vegetables, fruits and whole grains such as quinoa, barley and oats. Go for long-acting complex carbohydrates such as those found in sweet potatoes and whole grains. Try this tip for cutting carb cravings: Mix a serving of lean protein with fiber. Some examples are slices of apple and peanut butter, hummus and carrots, low-fat cottage cheese with berries, a peach and low-fat string cheese, and vegetables and salmon or chicken.

Alcohol — Drinking alcohol is a bad idea on multiple levels for those with bipolar disorder. For one, the alcohol-drug interaction can make you very sick. For another, alcohol can disrupt sleep, and so many people with bipolar disorder already have sleep problems. Finally, alcohol can affect mood swings, sending them spiraling even further out of control. If you’re socializing, opt for a glass of sparkling water with a twist of lemon or lime.

Caffeine — Any kind of stimulant can precipitate mania, so it’s best to pass on the coffee, Red Bull or any heavily caffeinated beverage. Tea, which has about one-fourth the caffeine as coffee, is a better choice than that $20 venti-size triple shot mocha. Top of the better option charts, though, are non-caffeinated herbal teas and refreshing water. If you want to jazz up your H20, buy an inexpensive infuser and add fruits, vegetables or herbs to your water. Infused water is not only delicious, it provides plant nutrients to help you kick sugar and caffeine cravings.

Fat — Healthy fats, such as those found in avocados, fish, low-fat dairy and nuts, provide vitamins and minerals and are so satisfying you won’t want to overeat.

Putting It All Together

Experts agree that bipolar disorder has no cure. However, we now know that simple lifestyle choices like opting for whole food nutrition can make a significant impact on the daily management of mood, energy and sleep. Combine that with improved stress coping abilities, along with regular physical activity and the result is a more optimized, effective and long-term treatment plan. There’s no need to feel helpless, hopeless and defeated as so many with bipolar disorder do. You can make a significant difference in improving the quality of your life. And it all starts with being mindful of every mouthful.

Pamela Peeke, MD, MPH, FACP, is a Pew Scholar in nutrition and metabolism, assistant professor of medicine at the University of Maryland, and a fellow of the American College of Physicians. She is a New York Times bestselling author, including her latest book, The Hunger Fix: The Three Stage Detox and Recovery Plan for Overeating and Food Addiction. As Senior Science Adviser for Elements Behavioral Health, Dr. Peeke has created integrative nutrition and holistic lifestyle programs at Malibu Vista women’s mental health center in Malibu, California, and Lucida Treatment Center in West Palm Beach, Florida.

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MORE: Moods Bipolar Disorder Vitamins Epigenetics Mental Health Health Nutrition Diet

Posted by: faithful | July 22, 2014

altering cortisol levels

Six Tips To Lowering Your Cortisol Production:

Cherniske and Talbott both emphasize the importance of increasing our “anabolic” metabolism, the rebuild, repair and rejuvenate cycle of cell life, to reverse the consequences of elevated stress hormones and aging. Cherniske likens the anabolic/catabolic metabolic model to a seesaw. You want to have the anabolic side of the seesaw up in the air and the catabolic, or breakdown and degeneration, side down as low as it can go.

Here are 6 tips that give you their top recommendations to decrease cortisol levels and thus catabolic metabolism while you increase anabolic metabolism and experience optimal health.

     1. Eliminate caffeine from your diet. It’s the quickest way to reduce cortisol production and elevate the production of DHEA, the leading anabolic youth hormone. 200 mg of caffeine (one 12 oz mug of coffee) increases blood cortisol levels by 30% in one hour! Cortisol can remain elevated for up to 18 hours in the blood. This is the easiest step to decrease your catabolic metabolism and increase your anabolic metabolism.

     2. Sleep deeper and longer. The average 50 year old has nighttime cortisol levels more than 30 times higher than the average 30 year old. Try taking melatonin, a natural hormone produced at night that helps regulate sleep/wake cycles, before going to sleep to boost your own melatonin production that also decreases with age. You may not need it every night, but if you are waking up in the middle of the night or too early in the morning, melatonin can help you sleep deeper and lengthen your sleep cycle. If you get sleepy during the day even though you had plenty of rest, back off the melatonin for a while. It’s a sign you are getting too much.

     3. Exercise regularly to build muscle mass and increase brain output of serotonin and dopamine, brain chemicals that reduce anxiety and depression. Cherniske recommends taking DHEA supplements to shorten the adaptation period when out-of-shape muscles and cardiovascular system discourage people from continuing to exercise before they get in shape. DHEA also accelerates the building of muscle mass and increases the feeling of being strong and energetic.

     4. Keep your blood sugar stable. Avoid sugar in the diet and refined carbohydrates to keep from spiking your insulin production. Eat frequent small meals balanced in protein, complex carbohydrates and good fats like olive oil and flax seed oil. Diets rich in complex carbohydrates keep cortisol levels lower than low carbohydrate diets. Keep well hydrated – dehydration puts the body in stress and raises cortisol levels. Keep pure water by your bed and drink it when you first wake up and before you go to sleep.

     5. Take anti-stress supplements like B vitamins, minerals like calcium, magnesium, chromium and zinc, and antioxidants like vitamin C, alpha lipoic acid, grapeseed extract, and Co Q 10. Adaptogen herbs like ginseng, astragalus, eleuthero, schizandra, Tulsi (holy basil) rhodiola and ashwagandha help the body cope with the side effects of stress and rebalance the metabolism. These supplement and herbs will not only lower cortisol levels but they will also help you decrease the effects of stress on the body by boosting the immune system.

     6. Meditate or listen to relaxation tapes that promote the production of alpha (focused alertness) and theta (relaxed) brain waves. Avoid jolting alarm clocks that take you from delta waves (deep sleep) to beta waves (agitated and anxious) and stimulants like caffeine that promote beta waves while suppressing alpha and theta waves.

For a deeper exploration of the role of cortisol and the consequences of long-term elevation of stress hormones in the body, read The Cortisol Connection by Shawn Talbott, Ph.D. and The Metabolic Plan by Stephen Cherniske, M.S.




Dark chocolate, Omega 3 fats found in salmon, walnuts etc., microgreens, citrus fruits,

zinc, basil, spinach, beans/barley.


By Dr. Joseph A. Debé

Exercising regularly and making healthful dietary choices takes discipline and dedication. Some people do it for their appearance – they want to build muscle and/or lose bodyfat. Others are motivated to improve their health and vitality. And then there are the competitive athletes. No matter what your fitness goals are, one of the main determinants of whether you will reach them is your hormonal status.

Although many hormones have an influence, two of the most important are cortisol and DHEA. These are the long-lasting stress hormones secreted by the adrenal glands. Cortisol has a general catabolic effect on the body. Catabolism refers to the breakdown of complex living tissue into simpler components, some of which are used as metabolic fuel. DHEA has largely opposite effects of cortisol, being an anabolic hormone. Anabolism is the process whereby food is converted into living tissue. Anabolism and catabolism are both essential processes. In order to achieve your fitness goals, cortisol and DHEA must be produced in the proper balance. Chronic stress results in imbalance, with increased cortisol and decreased DHEA production. This causes the body to shift into a catabolic state.

It is critically important to understand that mental-emotional strain is only one of many different things the body perceives as stress. Two of cortisol’s main functions are to raise blood sugar levels and to reduce inflammation. Thus, cortisol levels increase in response to drops in blood sugar and the presence of inflammation. Other types of stress include: chronic pain, chronic illness, chronic/severe allergies, trauma/injury, temperature extremes, surgery, toxic exposure, chronic or severe infections, late hours/insufficient sleep, light cycle disruption (as in working night shifts), and excessive exercise. That’s right. Excessive exercise results in elevated cortisol to DHEA ratios. Over enthusiasm about exercise can easily produce cortisol-DHEA imbalance. In addition to overtraining, the three most common stressors to be concerned about are mental-emotional stress, dysglycemia (blood sugar fluctuation), and inflammation.

How exactly does an elevated cortisol to DHEA ratio interfere with fitness goals? One way is by producing cellular amino acid deprivation. Amino acids are the building blocks of proteins, which are responsible for most of the cellular structure, and for enzymes which catalyze biochemical reactions. Under the influence of stress, (a high cortisol to DHEA ratio), protein synthesis slows and protein breakdown accelerates. The end result is reduced muscle mass. Proteins from the heart, bones and gastrointestinal mucosa (lining) are also targeted for breakdown. The amino acids released by the catabolism of these proteins are oxidized to produce carbon skeletons to be used for making glucose. Importantly, aging proceeds by this very process of cell protein degradation. Stress also results in the replacement of insulin-sensitive, slow oxidative type I muscle fibers by fast glycolytic type II-B muscle fibers, which impairs muscular endurance.

Elevated cortisol levels also interfere with energy production by decreasing glucose utilization. High cortisol to DHEA ratios result in fat deposition, especially around the midsection. It is possible to sometimes build muscle under stress (high cortisol : DHEA), but at the expense of the internal organs. What happens is that resistance exercise (weight training) makes the skeletal muscles the organ of demand so that protein is “stolen” from the internal organs to be used by the muscles. Bodybuilders in this condition have been found to have up to thirty percent shrinkage of the liver and catabolism of other organs, as their muscles grew. Obviously, this is detrimental to health. For those concerned about their appearance, stress strikes another blow. Elevated cortisol levels reduce skin regeneration and lead to accelerated wrinkling. The protein breakdown that occurs under stress can also accelerate osteoarthritis and bone loss, and prolong healing of injuries. Other conditions which people hope to prevent or improve by a healthy lifestyle are actually promoted by elevated cortisol to DHEA ratios. These include hypertension, ischemic heart disease depression and various cancers

Elevated cortisol: DHEA further impedes fitness goals by altering the levels and activities of other hormones. Thyroid stimulating hormone and triiodothyronine levels are reduced and reverse triiodothyronine levels increase. In other words, thyroid activity is diminished. This results in a slowing of the metabolic rate. Bodyfat becomes easier to store, more difficult to lose. Stress lowers levels of growth hormone, testosterone, and insulin-like growth factor I, all of which are muscle-building, fat-burning hormones. Stress increases levels of estrogen released from the ovaries and also increases conversion by fat cells of DHEA, androstenedione and testosterone to estrogen. The more bodyfat a person has, the more these hormones get converted to estrogen. Estrogen stimulates fat deposition, particularly around the thighs and hips. Stress is feminizing in men and women. Stress produces insulin insensitivity with subsequent elevation in insulin levels. This produces increased hunger with craving for carbohydrates. Elevated insulin levels increase fat cell proliferation and fat deposition. To sum it up, under stress, muscle is replaced by fat.

So, how does one know if they have elevated cortisol: DHEA? The best way to measure these hormones is with the Adrenal Stress Index test. This is a simple test the person performs at home. Four saliva samples are collected over the course of one day by rolling cotton swabs under the tongue and then placing them into test tubes. The kit is then mailed to the laboratory and the hormones are measured from the saliva. The testing laboratory furnishes the test kit, with all supplies needed.

Test results are sent to the ordering doctor within about two week’s time. Analysis of the test results, in combination with evaluation of the individual’s lifestyle, leads to therapies to help restore any hormonal imbalance. Scientifically proven techniques for mental-emotional stress reduction can be used. Dietary and nutritional supplement recommendations to balance blood sugar levels are often needed. Women trying to lose weight often eat too much carbohydrate. Bodybuilders often eat too much protein. Both of these situations can result in elevated cortisol to DHEA ratios, as can simply not eating enough. Sources of inflammation must be sought out and dealt with appropriately to lower cortisol output. Thorough understanding of the individual’s lifestyle can identify other sources of stress.

A nutritional supplement called phosphorylated serine is often useful in lowering elevated cortisol levels. It appears to work at the level of the brain and pituitary gland. DHEA supplementation is usually called for when levels are found to be low. In some cases, sublingual administration is preferred; in other cases, micronized capsule form is best. In cases of sex hormone related problems such as prostate or breast cancer, DHEA should not be supplemented before performing an additional test called a DHEA challenge test. This test measures the increase in testosterone and estrogen levels after supplementing DHEA for just a week. For those individuals who convert a lot of DHEA to testosterone or estrogen and have certain health conditions, DHEA can be dangerous. 7-keto DHEA is a supplement that apparently is not converted to sex hormones within the body and so can be used safely, although it will not provide all the benefits of DHEA.

An additional therapy to help lower cortisol levels is aerobic exercise. However, as was previously mentioned, excessive exercise can stress the body. There is a way to help determine if a given duration and intensity of exercise is stressing or de-stressing the body. Another test of cortisol levels is performed in relation to exercise. A saliva sample is taken five minutes before beginning exercise, five minutes after, one and three hours after finishing the exercise session. It is acceptable for cortisol levels to rise immediately after exercise. However, they should decrease by one hour after exercise. Three hours after exercise, cortisol levels should be equal to or lower than starting values. If they are, then the level of exercise is beneficial. If they are not, then this level of exercise is a stress to the body and is sabotaging fitness goals and undermining health. In this case, the type, intensity, and/or duration of exercise need to be adjusted. This test is particularly well suited for women who cannot lose weight even though they exercise aerobically and – inappropriately – eat a high carbohydrate diet and avoid weight training.

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