Tuesday, May 7, 2013

Happy 14 year old but angry outbursts

Hello Dr. Dave,

I luckily just found your blog after days of research:  My daughter sounds JUST  like the post from Sept. 12 ….  I’m going to buy your books today !  I think she’s always had “Anger Overload”.

I am desperate to get her more help and trying to figure out where to bring her, etc (If you happened to have any recommendations in the Los Angeles area,  they would be GREATLY appreciated … ?

I have a 14 year old daughter living with angry outbursts most of her life but otherwise happy.   She sounds SO  similar to the Sept post …. On the outside she does really well; school, social, sports, friends and looks like she has it all and never acts up or get angry at school, etc – she does get quite moody with friends on occasion.  (She’s always been very spoiled materially by her father and perhaps I’ve  over-nurtured her but I say no a lot to stuff! so to speak)  By chance I’ve been a stay-at-home mom,  I also have a 16 year old son who’s just been diagnosed with ADD – he’s a good  even-tempered boy who’s always been a little “absent minded” but he’s bright, easygoing and does well in school -  They used to get along really well as kids but now basically can’t be in the same room, and this hurts her.

The family is still living under one roof  but basically they know the parents aren’t on the same page (not even the same book!).  We do need to fix the living situation and make changes soon – it so not fair to the kids and not the way I’d ever expected to live.   Their dad has always been very hot-headed and impulsive and childlike, etc (never diagnosed but difficult) , it’s not a good situation but no fighting just underlying bitterness and lack of communication.   I’m inclined to nag and be the peacekeeper – always the sensible one and I give in to things just to keep the peace )

Anyway – back to my daughter;  she can be the sweetest, caring, empathic person.  She’s very humble, being surrounded by teenage bragging etc – She is very sensitive and has been isolating herself recently .   She is seeing a therapist who I find out she’s not that comfortable/truthful  with – we are doing a DBT workshop together but that doesn’t seem to help …. I think she needs to be assessed again and don’t know where to start?

She’s a high achiever at school and stresses over the smallest thing, very conscientious and can be a teen “drama queen”  – last week she had a big speech to write – well she had just watched “Silver Lining Playbook” – she choose to write about “Bipolar Disorder”;   She then  had a lot of anger last week, and has just  told me she’s had a recurring dream about being in a mental hospital and she has  diagnosed herself as Bipolar. 

She did rage at me the other night and hit me … She has hit in the past but it’s been a very long time ….   And sadly she’s always been prone to throwing things when she’s angry …. (lack of sleep was an issue last week – something I’m generally careful with)

I’m trying to find a psychologist to have her assessed and going for a “biological” check up with the pediatrician .

I’m sure she’s depressed and therefore rages more etc …. I know she’s hurting and want to help.   I’m worried about her being misdiagnosed.   Any suggestions would be greatly appreciated.  Thank you.

Hi, I don't know specific psychologists in the L.A. area; maybe start with your pediatrician for suggestions, or a major medical center like UCLA, or check with the California Psychological Association.  Most states have psychological associations that can give you a short list of people in your area who work with  teens and families.  Then you'd want to ask the psychologist whether he/she works with anger issues, and whether he/she works with teens as well as parents.  I find in most cases it is helpful to work on strategies with parents and the teenager.  Parents and teens each may have ideas about possible anger triggers.  In addition, many of the strategies involve parents and teens working together.  The second half of my workbook on anger overload explains how to work together, for example, teaching your teen about other points of view, and how to use catch phrases to help your teen think before acting out her anger.  Most teens cannot develop these skills alone.

Individual therapy can be helpful though when there are underlying problems, such as worries about family, friends, or school.  Teens may want to address these concerns without you in the room.  So ideally the therapist is able to assess the problem in the first couple of sessions, and then work with the family and/or the teenager. 

The two diagnoses that are sometimes mistakenly used for teens who get angry are oppositional defiant disorder and bipolar disorder.  Many teens who have anger overload are not usually defiant.  They just have difficulty when they get really angry.  Further, they do not usually have a mood disorder.  For bipolar disorder there would be many other mood related symptoms besides anger overload.  By the way it is not unusual that your daughter might think she has bipolar disorder after reading about it.  Any of us may think we have a disorder when we first learn about it; we call this "medical students' disease" because when medical students are first learning about diseases they think they have them.  When they get more experience they realize they don't!

All the best, Dr. Dave Gottlieb

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