Tuesday, March 21, 2017

Therapy recommended for self harm behaviors

Hello Dr. Dave,

My 9-year-old daughter suffers from anger overload and her episodes have gotten more frequent and pretty scary. My husband  and I are wondering if we should follow the course you recommend in your book on our own, or seek professional help. Some background…

We can trace E’s angry outbursts back to when she was a newborn and would get so mad when we would put her in her carseat that she would hold her breath and turn purple. As a toddler, she was more volatile than my older daughter, but we figured her behavior was in the range of normal for her age. Between the ages of 5 and 7, she had several over-the-top reactions to seemingly small disappointments or when she would not get her way. The summer after she turned 7, things got worse. Practically every day, something would set her off and she would scream at the top of her lungs, cry, say nasty things to her parents and sister, and throw stuff around. Once she pulled out a clump of hair and once she banged her head on the floor, before realizing it wasn’t a great idea. In desperation, I searched the Internet and came across your book, “Anger Overload in Children: A Parents’ Manual”. I ordered it and quickly read through the introduction. Your description of anger overload fit E to a tee. Before i could get farther into the book, the summer ended, school started, and the horrible episodes disappeared. I filed the book away, hopeful that we didn’t need it after all.

During the winter of 2nd grade, E had a struggle with anxiety, and we ended up seeing a LCPC, who helped us identify the problem, label it, and taught E some basic skills to deal with it. E has not had to deal with anxiety interfering with her life since then.

E continued to have infrequent anger episodes, though few stand out in my mind, as I reflect back on that time. Fast forward to February 2017. E is now 9-1/2. Without warning, she began to have more frequent and more intense episodes. The triggers are different - once she was struggling with homework, another time she received a piece of modestly disappointing news. The reactions are often fierce. She screams, cries, throws hurtful words at her family, and is modestly destructive. Of most concern, she has hurt herself by pulling out her hair and hitting herself in the head. She says that she wants to kill herself or wishes we would kill her. After the episode passes, E acknowledges that she does not want to hurt herself and is generally a sweet, happy kid.

We went back to the therapist she had seen for anxiety, but I realized that the therapist was not equipped for this type of problem and it was no longer a good fit. I also met with a psychologist, who E is supposed to see for the first time later this week. However, the psychologist didn’t seem to have any experience with behavior like this and I am a little concerned that she will take the wrong path. E does not want to see anyone.

In the midst of all this, I remembered your book and once again read through the introduction. I am certain that anger overload is descriptive of E’s condition. I am unsure, though, if we should handle this on our own, following the recommendations of the book, or if we should be working with a professional, given the threats of self harm. 

Hi, Yes, given the self harm behaviors, I would recommend you consult with a mental health professional who works with children and their parents.  Many of the strategies in my parent's manual may be helpful and woven into the course of therapy.  Continue to record what some of your daughter's triggers are.  That will help you and the therapist anticipate some of her outbursts and devise the best strategies to help.  

In reading your e-mail, I wonder if your daughter expects too much of herself.  You wrote that she experiences anger overload when she struggles with homework or gets modestly disappointing news.  I would recommend cuing her before she starts homework that some of it will be hard, and that it's good she does not know some answers.  If homework were too easy, she would not be learning anything new.  You could shorten this into a catchy mantra that your daughter helps to create.  An example would be "mistakes are good. It means I'm learning new stuff."  Or "everyone makes mistakes."  This would be practiced daily, until it gets internalized (i.e. until your daughter can deal better with disappointments, like homework difficulties).

Beyond the mantra, the parent's manual has other strategies to help her with self control. In addition, therapy can help identify further the source of her upsets, and help your daughter feel better about herself.  Therapy helps with underlying issues as well as helps a child develop self control strategies.  

Best, Dr. Dave Gottlieb

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