Eating Disorders

Many kids — particularly adolescents — are concerned about how they look and can feel self-conscious about their bodies. This can be especially true when they are going through puberty, and undergo dramatic physical changes and face new social pressures.

Unfortunately, for a number of kids and teens, that concern can lead to an obsession that can become an eating disorder. Eating disorders such as anorexia nervosa or bulimia nervosa cause dramatic weight fluctuation, interfere with normal daily life, and can permanently affect their health.

Parents can help prevent kids from developing an eating disorder by building their self-esteem and encouraging healthy attitudes about nutrition and appearance. If you become worried that your son or daughter might be developing an eating disorder, it’s important to step in and seek proper medical care.

About Eating Disorders

Generally, eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habits that disrupt normal body function and daily activities.

While more common among girls, eating disorders can affect boys, too. They’re so common in the U.S. that 1 or 2 out of every 100 kids will struggle with one, most commonly anorexia or bulimia. Unfortunately, many kids and teens successfully hide eating disorders from their families for months or even years.

People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape. As a result, they strive to maintain a very low body weight. Some restrict their food intake by dieting, fasting, or excessive exercise. People with anorexia try to eat as little as possible, and take in as few calories as they can, frequently obsessing over food intake.

Bulimia is characterized by habitual binge eating and purging. Someone with bulimia may undergo weight fluctuations, but rarely experiences the low weight associated with anorexia. Both disorders can involve compulsive exercise or other forms of purging food eaten, such as by self-induced vomiting or laxative use.

Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight but those with bulimia may be a normal weight or even overweight.

Binge eating disorders, food phobia, and body image disorders are also becoming increasingly common in adolescence.

It’s important to remember that eating disorders can easily get out of hand and are difficult habits to break. Eating disorders are serious clinical problems that require professional treatment by doctors, therapists, and nutritionists.

Causes of Eating Disorders

The causes of eating disorders aren’t entirely clear. However, a combination of psychological, genetic, social, and family factors are thought to be involved.

For kids with eating disorders, there may be a difference between the way they see themselves and how they actually look. People with anorexia or bulimia often have an intense fear of gaining weight or being overweight and think they look bigger than they actually are. Also, certain sports and activities (like cheerleading, gymnastics, ballet, ice skating, and wrestling) that emphasize certain weight classes may put some kids or teens at greater risk for eating disorders.

There is also an increased incidence of other problems among kids and teens with eating disorders, like anxiety disorders and obsessive-compulsive disorder. Sometimes, problems at home can put kids at higher risk of problem eating behaviors.

Some research suggests that media images contribute to the rise in the incidence of eating disorders. Most celebrities in advertising, movies, TV, and sports programs are very thin, and this may lead girls to think that the ideal of beauty is extreme thinness. Boys, too, may try to emulate a media ideal by drastically restricting their eating and compulsively exercising to build muscle mass.

Concerns about eating disorders are also beginning at an alarmingly young age. Research shows that 42% of first- to third-grade girls want to be thinner, and 81% of 10-year-olds are afraid of being fat. In fact, most kids with eating disorders began their disordered eating between the ages of 11 and 13.

Many kids who develop an eating disorder have low self-esteem and their focus on weight can be an attempt to gain a sense of control at a time when their lives feel more out-of-control.

The Effects of Eating Disorders

While eating disorders can result from serious mental and behavioral health conditions, as well as trauma (for example, sexual abuse), they can lead to very serious physical health problems. Anorexia or bulimia may cause dehydration and other medical complications like heart problems or kidney failure. In extreme cases, eating disorders can lead to severe malnutrition and even death.

With anorexia, the body goes into starvation mode and the lack of nutrition can affect the body in many ways:

  • a drop in blood pressure, pulse, and breathing rate
  • hair loss and fingernail breakage
  • loss of periods
  • lanugo hair, a soft hair that can grow all over the skin
  • lightheadedness and inability to concentrate
  • anemia
  • swollen joints
  • brittle bones

With bulimia, frequent vomiting and lack of nutrients can cause:

  • constant stomach pain
  • damage to the stomach and kidneys
  • tooth decay (from exposure to stomach acids)
  • “chipmunk cheeks,” when the salivary glands permanently expand from throwing up so often
  • loss of periods
  • loss of the mineral potassium (this can contribute to heart problems and even death)

Warning Signs

It can be a challenge for parents to tell the difference between kids’ normal self-image concerns and warning signs of an eating disorder.

While many kids and teens — girls in particular — are self-conscious, compare themselves with others, and talk about dieting, this doesn’t necessarily mean they have eating disorders. Kids with eating disorders show serious problems with their eating and often have physical signs.

Someone with anorexia might:

  • become very thin, frail, or emaciated
  • be obsessed with eating, food, and weight control
  • weigh herself or himself repeatedly
  • count or portion food carefully
  • only eat certain foods, avoid foods like dairy, meat, wheat, etc. (of course, lots of people who are allergic to a particular food or are vegetarians avoid certain foods)
  • exercise excessively
  • feel fat
  • withdraw from social activities, especially meals and celebrations involving food
  • be depressed, lethargic (lacking in energy), and feel cold a lot

Someone with bulimia might:

  • fear weight gain
  • be intensely unhappy with body size, shape, and weight
  • make excuses to go to the bathroom immediately after meals
  • only eat diet or low-fat foods (except during binges)
  • regularly buy laxatives, diuretics, or enemas
  • spend a lot of time working out or trying to work off calories
  • withdraw from social activities, especially meals and celebrations involving food

If You Suspect an Eating Disorder

If you suspect your son or daughter has an eating disorder, it’s important to intervene and help your child get diagnosed and treated.

Kids with eating disorders often react defensively and angrily when confronted for the first time. Many have trouble admitting, even to themselves, that they have a problem. Sometimes getting a family member or friend who has been treated for an eating disorder can help encourage someone to get help. A fear of being fat or overweight is a core problem for anyone with an eating disorder. So it’s understandable that kids with eating disorders don’t want to go to a clinic and “get fat.”

Trying to help when someone doesn’t think he or she needs it can be hard. Still, getting the professional assistance needed, even if your child resists, is essential. Enlist help from friends and family that your son or daughter trusts and loves — people known to have your child’s best interests at heart.

Your child may be more receptive to a conversation if you focus on your own concerns and use “I” statements rather than “you” statements. For example, steer clear of statements like “you have an eating disorder” or “you’re too thin,” which may only prompt anger and denial. Instead, try “I’m worried that you have lost so much weight so quickly.” Cite specific things your child has said or done that have made you worry, and explain that you will be scheduling a doctor’s appointment to put your own mind at ease.

If you still encounter resistance, talk with your doctor or a mental health care professional about other approaches.

Treating Eating Disorders

Treatment focuses on helping kids cope with their disordered eating behaviors and establish new patterns of thinking about and approaching food. This can involve medical supervision, nutritional counseling, and therapy. The professionals will address a child’s perception about body size, shape, eating, and food.

Kids who are severely malnourished may require hospitalization and ongoing care after their medical condition stabilizes.

Generally, the earlier the intervention (ideally, before malnutrition or a continual binge-purge cycle starts), the shorter the treatment required.

Preventing Eating Disorders

You can play a powerful role in your child’s development of healthy attitudes about food and nutrition. Your own body image can influence your kids. If you constantly say “I’m fat,” complain about exercise, and practice “yo-yo” dieting, your kids might feel that a distorted body image is normal and acceptable.

At a time of great societal concern about obesity, it can be tricky for parents to talk with their kids about their eating habits. It’s best to emphasize health, rather than weight. Make sure your kids know you love them for who they are, not how they look.

It’s OK to appreciate attractiveness in celebrities — if your kids (and you!) feel fine about how they look, it won’t prompt them to try to change to be like someone else. Getting the message that they’re great as they are and that their bodies are healthy and strong is a wonderful gift that parents can give their kids.

Try to avoid power struggles regarding food — if your teen wants to “go vegetarian,” be supportive even if you’re an avid meat-eater. Teens frequently go through trendy eating periods, so try to set good limits, encourage healthy eating, and avoid fighting over food issues. Kids can catch on pretty quickly if their parents panic over one skipped meal. Try to gain perspective and talk to your kids about what’s going on if they don’t want to eat with the family.

Finally, take an active role in creating a healthy lifestyle for your family. Involve your kids in the preparation of healthy, nutritious meals. Let them know that it’s OK to eat when hungry and refuse food when they’re not. Also, make exercise a fun, rewarding, and regular family activity.

Developing your own healthy attitudes about food and exercise will set an excellent example for your kids.

Reviewed by: Michelle J. New, PhD
Date reviewed: November 2011

Developing Your Child’s Self-Esteem

Healthy self-esteem is like a child’s armor against the challenges of the world. Kids who know their strengths and weaknesses and feel good about themselves seem to have an easier time handling conflicts and resisting negative pressures. They tend to smile more readily and enjoy life. These kids are realistic and generally optimistic.

In contrast, kids with low self-esteem can find challenges to be sources of major anxiety and frustration. Those who think poorly of themselves have a hard time finding solutions to problems. If given to self-critical thoughts such as “I’m no good” or “I can’t do anything right,” they may become passive, withdrawn, or depressed. Faced with a new challenge, their immediate response might be “I can’t.”

What Is Self-Esteem?

Self-esteem is similar to self-worth (how much a person values himself or herself). This can change from day to day or from year to year, but overall self-esteem tends to develop from infancy and keep going until we are adults.

Self-esteem also can be defined as feeling capable while also feeling loved. A child who is happy with an achievement but does not feel loved may eventually experience low self-esteem. Likewise, a child who feels loved but is hesitant about his or her own abilities can also develop low self-esteem. Healthy self-esteem comes when a good balance is maintained.

Patterns of self-esteem start very early in life. The concept of success following effort and persistence starts early. Once people reach adulthood, it’s harder to make changes to how they see and define themselves.

So, it’s wise to think about developing and promoting self-esteem during childhood. As kids try, fail, try again, fail again, and then finally succeed, they develop ideas about their own capabilities. At the same time, they’re creating a self-concept based on interactions with other people. This is why parental involvement is key to helping kids form accurate, healthy self-perceptions.

Parents and caregivers can promote healthy self-esteem by showing encouragement and enjoyment in many areas. Avoid focusing on one specific area; for example, success on a spelling test, which can lead to kids feeling that they’re only as valuable as their test scores.

Signs of Unhealthy and Healthy Self-Esteem

Self-esteem fluctuates as kids grow. It’s frequently changed and fine-tuned, because it is affected by a child’s experiences and new perceptions. So it helps to be aware of the signs of both healthy and unhealthy self-esteem.

Kids with low self-esteem may not want to try new things and may speak negatively about themselves: “I’m stupid,” “I’ll never learn how to do this,” or “What’s the point? Nobody cares about me anyway.” They may exhibit a low tolerance for frustration, giving up easily or waiting for somebody else to take over. They tend to be overly critical of and easily disappointed in themselves.

Kids with low self-esteem see temporary setbacks as permanent, intolerable conditions, and a sense of pessimism prevails. This can place kids at risk for stress and mental health problems, as well as real difficulties solving different kinds of problems and challenges they encounter.

Kids with healthy self-esteem tend to enjoy interacting with others. They’re comfortable in social settings and enjoys group activities as well as independent pursuits. When challenges arise, they can work toward finding solutions and voice discontent without belittling themselves or others. For example, rather than saying, “I’m an idiot,” a child with healthy self-esteem says, “I don’t understand this.” They know their strengths and weaknesses, and accept them. A sense of optimism prevails.

How Parents Can Help

How can a parent help to foster healthy self-esteem in a child? These tips can make a big difference:

  • Be careful what you say. Kids can be sensitive to parents’ and others’ words. Remember to praise your child not only for a job well done, but also for effort. But be truthful. For example, if your child doesn’t make the soccer team, avoid saying something like, “Well, next time you’ll work harder and make it.” Instead, try “Well, you didn’t make the team, but I’m really proud of the effort you put into it.” Reward effort and completion instead of outcome.

    Sometimes, a child’s skill level is just not there — so helping kids overcome disappointments can really help them learn what they’re good at and what they’re not so good at. As adults, it’s OK to say “I can’t carry a tune” or “I couldn’t kick a ball to save my life,” so use warmth and humor to help your kids learn about themselves and to appreciate what makes them unique.

  • Be a positive role model. If you’re excessively harsh on yourself, pessimistic, or unrealistic about your abilities and limitations, your kids might eventually mirror you. Nurture your own self-esteem and they’ll have a great role model.
  • Identify and redirect inaccurate beliefs. It’s important for parents to identify kids’ irrational beliefs about themselves, whether they’re about perfection, attractiveness, ability, or anything else. Helping kids set more accurate standards and be more realistic in evaluating themselves will help them have a healthy self-concept.

    Inaccurate perceptions of self can take root and become reality to kids. For example, a child who does very well in school but struggles with math may say, “I can’t do math. I’m a bad student.” Not only is this a false generalization, it’s also a belief that can set a child up for failure. Encourage kids to see a situation in a more objective way. A helpful response might be: “You are a good student. You do great in school. Math is a subject that you need to spend more time on. We’ll work on it together.”

  • Be spontaneous and affectionate. Your love will help boost your child’s self-esteem. Give hugs and tell kids you’re proud of them when you can see them putting effort toward something or trying something at which they previously failed. Put notes in your child’s lunchbox with messages like “I think you’re terrific!”

    Give praise often and honestly, but without overdoing it. Having an inflated sense of self can lead kids and teens to put others down or feel that they’re better than everyone else, which can be socially isolating.

  • Give positive, accurate feedback. Comments like “You always work yourself up into such a frenzy!” will make kids feel like they have no control over their outbursts. A better statement is, “I can see you were very angry with your brother, but it was nice that you were able to talk about it instead of yelling or hitting.” This acknowledges a child’s feelings, rewards the choice made, and encourages the child to make the right choice again next time.
  • Create a safe, loving home environment. Kids who don’t feel safe or are abused at home are at greatest risk for developing poor self-esteem. A child who is exposed to parents who fight and argue repeatedly may feel they have no control over their environment and become helpless or depressed.

    Also watch for signs of abuse by others, problems in school, trouble with peers, and other factors that may affect kids’ self-esteem. Encourage your kids to talk to you or other trusted adults about solving problems that are too big to solve by themselves.

  • Help kids become involved in constructive experiences. Activities that encourage cooperation rather than competition are especially helpful in fostering self-esteem. For example, mentoring programs in which an older child helps a younger one learn to read can do wonders for both kids. Volunteering and contributing to your local community can have positive effects on self-esteem for everyone involved.

When promoting healthy self-esteem, it’s important to not have too much or too little but “just enough.” Make sure your kids don’t end up feeling that if they’re average or normal at something, it’s the same as not being good or special.

Finding Professional Help

If you suspect your child has low self-esteem, consider getting professional help. Child and adolescent therapists and counselors can help identify coping strategies to help deal with problems at school or home in ways that help kids feel better about themselves.

Therapy can help kids learn to view themselves and the world more realistically and help with problem-solving. Developing the confidence to understand when you can deal with a problem and when to ask for help is vital to positive self esteem.

Taking responsibility and pride in who you are is a sure sign of healthy self-esteem and the greatest gift parents can give to their child.

Reviewed by: Michelle J. New, PhD
Date reviewed: March 2012


Bullies and mean girls have been around forever, but technology now gives them a whole new platform for their actions. The old “sticks and stones” saying is no longer true — both real-world and online name-calling can have serious emotional consequences for our kids and teens.

It’s not always easy to know how and when to step in as a parent. For starters, most kids use technology differently than we do. They’re playing games online and sending texts on their phones at an early age, and most teens have devices that keep them constantly connected to the Internet. Many are logged on to Facebook or Tumblr and chatting or texting all day. Even sending email or leaving a voicemail can seem old-school to them. Their knowledge of the digital world can be intimidating to parents.

But staying involved in kids’ cyber world, just as in their real world, can help parents protect them from its dangers. As awareness of cyberbullying has grown, parents have learned more about how to deal with it. Here are some suggestions on what to do if this modern type of bullying has become part of your child’s life.

What Is Cyberbullying?

Cyberbullying is the use of technology to harass, threaten, embarrass, or target another person. By definition, it occurs among young people. When an adult is involved, it may meet the definition of cyber-harassment or cyberstalking, a crime that can have legal consequences and involve jail time.

Sometimes cyberbullying can be easy to spot — for example, if your child shows you a text, tweet, or response to a status update on Facebook that is harsh, mean, or cruel. Other acts are less obvious, like impersonating a victim online or posting personal information, photos, or videos designed to hurt or embarrass another person. Some kids report that a fake account, webpage, or online persona has been created with the sole intention to harass and bully.

Cyberbullying also can happen accidentally. The impersonal nature of text messages, IMs, and emails make it very hard to detect the sender’s tone — one person’s joke could be another’s hurtful insult. Nevertheless, a repeated pattern of emails, texts, and online posts is rarely accidental.

Because many kids are reluctant to report being bullied, even to their parents, it’s impossible to know just how many are affected. But recent studies about cyberbullying rates have found that about 1 in 4 teens have been the victims of cyberbullying, and about 1 in 6 admit to having cyberbullied someone. In some studies, more than half of the teens surveyed said that they’ve experienced abuse through social and digital media.

Effects of Cyberbullying

No longer limited to schoolyards or street corners, modern-day bullying can happen at home as well as at school — essentially 24 hours a day. Picked-on kids can feel like they’re getting blasted nonstop and that there is no escape. As long as kids have access to a phone, computer, or other device (including tablets), they are at risk.

Severe, long-term, or frequent cyberbullying can leave both victims and bullies at greater risk for anxiety, depression, and other stress-related disorders. In some rare but highly publicized cases, some kids have turned to suicide. Experts say that kids who are bullied — and the bullies themselves — are at a higher risk for suicidal thoughts, attempts, and completed suicides.

The punishment for cyberbullies can include being suspended from school or kicked off of sports teams. Certain types of cyberbullying can be considered crimes.

Signs of Cyberbullying

Many kids and teens who are cyberbullied don’t want to tell a teacher or parent, often because they feel ashamed of the social stigma or fear that their computer privileges will be taken away at home.

Signs of cyberbullying vary, but may include:

  • being emotionally upset during or after using the Internet or the phone
  • being very secretive or protective of one’s digital life
  • withdrawal from family members, friends, and activities
  • avoiding school or group gatherings
  • slipping grades and “acting out” in anger at home
  • changes in mood, behavior, sleep, or appetite
  • wanting to stop using the computer or cellphone
  • being nervous or jumpy when getting an instant message, text, or email
  • avoiding discussions about computer or cellphone activities

How Parents Can Help

If you discover that your child is being cyberbullied, offer comfort and support. Talking about any bullying experiences you had in your childhood might help your child feel less alone.

Let your child know that it’s not his or her fault, and that bullying says more about the bully than the victim. Praise your child for doing the right thing by talking to you about it. Remind your child that he or she isn’t alone — a lot of people get bullied at some point. Reassure your child that you will figure out what to do about it together.

Let someone at school (the principal, school nurse, or a counselor or teacher) know about the situation.Many schools, school districts, and after-school clubs have protocols for responding to cyberbullying; these vary by district and state. But before reporting the problem, let your child know that you plan to do so, so that you can work out a plan that makes you both feel comfortable.

Encourage your child not to respond to cyberbullying, because doing so just fuels the fire and makes the situation worse. But do keep the threatening messages, pictures, and texts, as these can be used as evidence with the bully’s parents, school, employer, or even the police. You may want to take, save, and print screenshots of these to have for the future.

Other measures to try:

  • Block the bully. Most devices have settings that allow you to electronically block emails, IMs, or texts from specific people.
  • Limit access to technology. Although it’s hurtful, many kids who are bullied can’t resist the temptation to check websites or phones to see if there are new messages. Keep the computer in a public place in the house (no laptops in children’s bedrooms, for example) and put limits on the use of cellphones and games. Some companies allow you to turn off text messaging services during certain hours. And most websites and smartphones include parental control options that give parents access to their kids’ messages and online life.
  • Know your kids’ online world. Ask to “friend” or “follow” your child on social media sites, but do not abuse this privilege by commenting or posting anything to your child’s profile. Check their postings and the sites kids visit, and be aware of how they spend their time online. Talk to them about the importance of privacy and why it’s a bad idea to share personal information online, even with friends. Write up cellphone and social media contracts that you are willing to enforce.
  • Learn about ways to keep your kids safe online. Encourage them to safeguard passwords and to never post their address or whereabouts when out and about.

If your son or daughter agrees, you may also arrange for mediation with a therapist or counselor at school who can work with your child and/or the bully.

When Your Child Is the Bully

Finding out that your kid is the one who is behaving badly can be upsetting and heartbreaking. It’s important to address the problem head on and not wait for it to go away.

Talk to your child firmly about his or her actions and explain the negative impact it has on others. Joking and teasing might seem harmless to one person, but it can be hurtful to another. Bullying in any form is unacceptable; there can be serious (and sometimes permanent) consequences at home, school, and in the community if it continues.

Remind your child that the use of cellphones and computers is a privilege. Sometimes it helps to restrict the use of these devices until behavior improves. If you feel your child should have a cellphone for safety reasons, make sure it is a phone that can be used only for emergencies. Set strict parental controls on all devices.

To get to the heart of the matter, talking to teachers, guidance counselors, and other school officials can help identify situations that lead a kid to bully others. If your child has trouble managing anger, talk to a therapist about helping your son or daughter learn to cope with anger, hurt, frustration, and other strong emotions in a healthy way. Professional counseling also can help improve kids’ confidence and social skills, which in turn can reduce the risk of bullying.

And don’t forget to set a good example yourself — model good online habits to help your kids understand the benefits and the dangers of life in the digital world.

Reviewed by: Larissa Hirsch, MD
Date reviewed: June 2014


Cutting isn’t new, but this form of self-injury (SI) has been out in the open more in recent years, portrayed in movies and on TV — even talked about by celebrities who have admitted to cutting themselves at some point.

Cutting is a serious issue that affects many teens. Even if you haven’t heard about cutting, chances are good that your teen has and might even know someone who does it. Like other risky behaviors, cutting can be dangerous and habit-forming. In most cases, it is also a sign of deeper emotional distress. In some cases, peers can influence teens to experiment with cutting.

The topic of cutting can be troubling for parents. It can be hard to understand why a teen would deliberately self-injure, and worrisome to think your teen — or one of your teen’s friends — could be at risk.

But parents who are aware of this important issue and understand the emotional pain it can signal are in a position to help.

What Is Cutting?

Someone who cuts uses a sharp object to make marks, cuts, or scratches on the body on purpose — enough to break the skin and cause bleeding. People typically cut themselves on their wrists, forearms, thighs, or belly. They might use a razorblade, knife, scissors, a metal tab from a soda can, the end of a paper clip, a nail file, or a pen. Some people burn their skin with the end of a cigarette or lighted match.

Most people who self-injure are girls, but guys do it too. It usually starts during the teen years and can continue into adulthood. In some cases, there’s a family history of cutting.

A sense of shame and secrecy often goes along with cutting. Most teens who cut hide the marks and if they’re noticed, make up excuses about them. Some teens don’t try to hide cuts and might even call attention to them.

Cutting often begins as an impulse. But many teens discover that once they start to cut, they do it more and more, and can have trouble stopping. Many teens who self-injure report that cutting provides a sense of relief from deep painful emotions. Because of this, cutting is a behavior that tends to reinforce itself.

Cutting can become a teen’s habitual way to respond to pressures and unbearable feelings. Many say they feel “addicted” to the behavior. Some would like to stop but don’t know how or feel they can’t. Other teens don’t want to stop cutting.

Most of the time, cutting is not a suicide attempt. But sadly, people often underestimate the potential to get seriously sick or hurt through bleeding or infections that go along with cutting.

Why Do Teens Cut?

Teens cut for many different reasons:

Powerful overwhelming emotions. Most teens who cut are struggling with powerful emotions. To them, cutting might seem like the only way to express or interrupt feelings that seem too intense to endure. Emotional pain over rejection, lost or broken relationships, or deep grief can be overwhelming for some teens.

And many times they’re dealing with emotional pain or difficult situations that no one knows about. Pressure to be perfect or to live up to impossible standards — their own or someone else’s — can cause some teens unbearable pain. Some teens who cut have been deeply hurt by harsh treatment or by situations that have left them feeling unsupported, powerless, unworthy, or unloved.

Some teens have experienced trauma, which can cause waves of emotional numbness called dissociation. For them, cutting can be a way of testing whether they can still “feel” pain. Others describe cutting as a way of “waking up” from that emotional numbness.

Self-inflicted physical pain is specific and visible. For some, the physical pain of cutting can seem preferable to emotional pain. Emotional pain can feel vague and hard to pinpoint, talk about, or soothe.

When they cut, teens say there is a sense of control and relief to see and know where the specific pain is coming from and a sense of soothing when it stops. Cutting can symbolize inner pain that might not have been verbalized, confided, acknowledged, or healed. And because it’s self-inflicted, it is pain the teen controls.

A sense of relief. Many teens who cut describe the sense of relief they feel as they’re cutting, which is common with compulsive behaviors. Some people believe that endorphins might add to the relief teens describe when they cut. Endorphins are the “feel-good” hormones released during intense physical exertion. And they can be released during an injury.

Others believe the relief is simply a result of being distracted from painful emotions by intense physical pain and the dramatic sight of blood. Some teens say they don’t feel the pain when they cut, but feel relieved because the visible SI “shows” emotional pain they feel.

Feeling “addicted.” Cutting can be habit forming. Though it only provides temporary relief from emotional distress, the more a person cuts, the more he or she feels the need to do it. As with other compulsive behaviors, the brain starts to connect a momentary sense of relief from bad feelings with the act of cutting.

Whenever the tension builds, the brain craves that relief and drives the teen to seek relief again by cutting. So cutting can become a habit someone feels powerless to stop. The urge to cut — to get relief — can seem too hard to resist when emotional pressure is high.

Other mental health conditions. Cutting is often linked to — or part of — another mental health condition. Some teens who cut are also struggling with other urges, obsessions, or compulsive behaviors. For some, depression or bipolar disorder can contribute to overwhelming moods that might be difficult for a teen to regulate. For others, mental health conditions that affect personality can cause relationships to feel intense and consuming, but unsteady. For these teens, intense positive attachments can suddenly become terribly disappointing and leave them feeling hurt, anger, or despair too strong to cope with.

Other teens struggle with personality traits that attract them to the dangerous excitement of risky behavior or self-destructive acts. Some are prone to dramatic ways of getting reassurance that they are loved and cared about. For others, posttraumatic stress has had an effect on their ability to cope. Or they’re struggling with alcohol or substance problems.

Peer pressure. Some teens are influenced to start cutting by another person who does it. For example, a teen girl might try cutting because her boyfriend cuts. Group peer pressure can play a role too. Some teens cut in groups and might pressure others to cut. A teen might give in to group pressure to try cutting as a way to seem cool or bold, to belong, or to avoid social bullying.

Any of these factors may help to explain why a particular teen cuts. But each teen also has unique feelings and experiences that play a role. Some who cut might not be able to explain why they do it.

Regardless of the factors that may lead a teen to self-injure, cutting isn’t a healthy way to deal with even the most extreme emotions or pressures.

Confronting Cutting

Some teens call attention to their self-injury. Or if the SI requires medical attention, that might be a way others find out. But many teens cut for a long time before anyone else knows. Some teens eventually tell someone about their self-injury — because they want help and want to stop, or because they just want someone to understand what they’re going through.

It can take courage and trust to reach out. Many teens hesitate to tell others because they fear being misunderstood or worry that someone might be angry, upset, disappointed, shocked, or judgmental. Some teens confide in friends, but ask them not to tell. This can create burden and worry for a friend who knows.

If confronted about the cutting, teens can respond in different ways, depending partly on the teen and partly on the how they were approached by it. Some might deny the cutting, while others might admit to it, but deny that it’s a problem. Some might get angry and upset or reject efforts to help. Some teens are relieved that someone knows, cares, and wants to help.

Bringing a Halt to Cutting

Whether or not anyone else knows or has tried to help, some teens cut for a long time before they try to stop. Teens whose cutting is part of another mental health condition usually need professional help. Sometimes cutting or another symptom leads to a teen’s admission to a mental health hospital or clinic. Some teens have more than one hospital stay for self-injury before they feel ready to accept help for cutting or other problems.

Some teens find a way to stop cutting on their own. This might happen if a teen finds a powerful reason to stop (such as realizing how much it hurts a friend), gets needed support, or finds ways to resist the powerful urge to cut. To stop cutting, a person also needs to find new ways to deal with problem situations and regulate emotions that feel overwhelming. This can take time and often requires the help of a mental health professional.

It can be difficult to stop cutting and a teen might not succeed at first. Some people stop for a while and then start cutting again. It takes determination, courage, strength — as well as support from others who understand and care — to break this powerful habit.

Reviewed by: D’Arcy Lyness, PhD
Date reviewed: July 2015

Competitive Sports: Helping Kids Play it Cool

Sports are a great way for kids to have fun, stay fit, improve skills, and make friends.

But it’s not always fun and games out on the field or court. The pressure to succeed can be overwhelming — and that can lead to a lot of frustration and tears.

In some cases, sports pressure is self-inflicted. Some kids are natural perfectionists and are just too hard on themselves when things don’t go their way. But more often than not, the pressure is external: Kids try to satisfy the demands of a parent, coach, or other authority figure and end up feeling like winning is the only way to gain the approval of the adults they respect.

Either way, how kids learn to cope with sports pressure — and what the adults in their lives teach them about it, either directly or indirectly — not only affects their performance and enjoyment of the sport, but can have a lasting impact on how they deal with similar challenges throughout life.

How Stress Affects Performance

Sometimes sports-related stress is good — it prepares the body to rise to a challenge with focus, strength, stamina, and heightened alertness. On the other hand, too much of it can exhaust a kid’s energy and drive, leading to sports burnout.

Events that cause stress are called stressors, and they can be positive (such as trying to impress a college scout out on the sidelines) or negative (such as struggling to keep up with schoolwork).

  • Positive stress comes from taking part in something that’s enjoyable yet challenging. This type of stress provides energy and pumps kids up and keeps them on their toes, providing a healthy spark for the tasks they undertake.
  • Negative stress is different. If your child had a fight with a close friend, missed the bus, and forgot his or her homework, it can be pretty hard to get in the right frame of mind for the afternoon tennis match.

How to Help

Parents can probably spot the difference between their child’s good and bad stress simply by noticing kids’ game-time interactions. For example, is your child focused and ready for action or is nervous energy getting the best of him or her? How does your child handle mistakes? Is he or she a good sport or do emotions get out of control? Of course, some of this has to do with your child’s personality. Like adults, some kids are naturally able to stay calm under pressure.

What may be a little harder to spot, though, is the role you and other adults might play in your child’s handling of stressful situations. For example, parents who place a lot of weight on their kids’ sports accomplishments run the risk of adding to a child’s stress.

Of course it’s good for your kids to see you taking an interest in their activities, but there’s a fine line between encouraging kids and pushing too hard. Overzealous parents tend to overreact to mistakes, game losses, and skipped practices, which often causes kids to do the same. And when kids beat themselves up over mistakes, they’re missing an important opportunity to learn how to correct problems and develop resiliency.

Similarly, check your sideline behaviors. Words have incredible power, so use them carefully, especially when you disagree with coaches and umpires. Praise specific good efforts by your child and other players, even after a loss, and offer criticism constructively and not in the heat of the moment. Make sure your child knows you understand that a game is just a game.

Playing sports can teach many wonderful life lessons — valuing teamwork, overcoming challenges, controlling emotions, taking pride in accomplishments — but only if you stay out of the way and let your kids learn them. In fact, by taking a step back, you’re showing your kids that you trust them to handle situations on their own.

Kid-Friendly Stress Management

Teach kids to use these relaxation techniques when the demands of competition start to heat up:

  • Deep breathing: Find a quiet place to sit down and inhale slowly through the nose, drawing air deep into the lungs. Hold the breath there for about 5 seconds, then release it slowly. Repeat the exercise five times.
  • Muscle relaxation: Contract (flex) a group of muscles tightly. Keep them tensed for about 5 seconds, then release. Repeat the exercise five times, selecting different muscle groups.
  • Visualization: Eyes closed, picture a peaceful place or event. While recalling the beautiful sights and happy sounds, imagine stress flowing away from the body.

    Or visualize success. People who advise competitive players often recommend that they imagine themselves completing a pass, making a shot, or scoring a goal over and over. On game day, recalling those stored images can help calm nerves and boost self-confidence.

  • Mindfulness: Focus on the present instead of worrying about the future, and stop negative thinking by focusing on the positives. Whether preparing for a competition or coping with a defeat, repeat positive affirmations: “I learn from my mistakes!” “I’m in control of my feelings!” “I can make this goal!”

Other things kids can do to keep stress in check:

  • Do a body good. It’s important to eat well and get a good night’s sleep, especially before games where the pressure’s on.
  • Do something fun. Encourage kids to engage in some type of activity other than the sports they’re involved in. Suggest taking a walk, riding a bike, seeing a movie, or hanging with friends to get completely away from the sport that’s causing stress.
  • Avoid perfectionist thinking. Don’t try to be perfect — and don’t expect it in teammates either. Everyone flubs a shot or messes up from time to time. Teach kids to forgive themselves and move on.

It’s possible that some anxiety stems only from uncertainty. Encourage your child to meet privately with the coach or instructor and ask for clarification if expectations seem vague or inconsistent. Most instructors do a good job of building athletes’ physical and mental development, but some might need to work on it. And sometimes kids might need to be the ones to open the lines of communication.

Stress Overload: What to Do

A child who is so nervous that he or she feels physically unwell before a game or begins to have trouble sleeping at night or concentrating at school may be over-stressed. This can lead to health problems, so it’s important to discuss it and find ways to help. Simply sharing these feelings can ease anxiety. When talking, let your child know that you won’t pass judgment or look down on him or her for revealing these feelings.

Sometimes kids don’t want to play a sport but don’t know how to tell their parents. So ask if your child really wants to play or is just doing it to please you or someone else. Remember, while things like college scholarships are a nice reward for hard work, they may not be worth the risk of physical injury or long-term stress on kids.

If your child wants to continue playing, perhaps a hectic schedule is part of the problem. Many kids are involved in so many teams and activities that there’s no time left over for schoolwork, hobbies, or just kicking back with friends. Exhaustion can sap enthusiasm, even for a sport a child seems to love.

If a too-full plate is the problem, discuss the options together. Perhaps it’s time to let a sport go or to choose one that’s less demanding. When looking for something new, encourage your child to try a variety of activities and choose the one that is the most enjoyable.

Once a decision is made, respect it and give your child credit for recognizing the need to steer out of a stressful situation. This is a sign of courage, wisdom, and maturity.

Sports are about enhancing self-esteem, building social skills, and developing a sense of community. And above all, whether kids play on the varsity team or at a weekend pick-up game, the point is to have fun. By keeping that as the priority, you can help your child learn to ride the highs and lows that are a natural part of competition.

Reviewed by: Mary L. Gavin, MD
Date reviewed: November 2014

Childhood Stress

As providers and caretakers, adults tend to view the world of children as happy and carefree. After all, kids don’t have jobs to keep or bills to pay, so what could they possibly have to worry about?

Plenty! Even very young children have worries and feel stress to some degree.

Sources of Stress

Stress is a function of the demands placed on us and our ability to meet them. These demands often come from outside sources, such as family, jobs, friends, or school. But it also can come from within, often related to what we think we should be doing versus what we’re actually able to do.

So stress can affect anyone who feels overwhelmed — even kids. In preschoolers, separation from parents can cause anxiety. As kids get older, academic and social pressures (especially from trying to fit in) create stress.

Many kids are too busy to have time to play creatively or relax after school. Kids who complain about all their activities or who refuse to go to them might be overscheduled. Talk with your kids about how they feel about extracurricular activities. If they complain, discuss the pros and cons of stopping one activity. If stopping isn’t an option, explore ways to help manage your child’s time and responsibilities to lessen the anxiety.

Kids’ stress may be intensified by more than just what’s happening in their own lives. Do your kids hear you talking about troubles at work, worrying about a relative’s illness, or arguing with your spouse about financial matters? Parents should watch how they discuss such issues when their kids are near because children will pick up on their parents’ anxieties and start to worry themselves.

World news can cause stress. Kids who see disturbing images on TV or hear talk of natural disasters, war, and terrorism may worry about their own safety and that of the people they love. Talk to your kids about what they see and hear, and monitor what they watch on TV so that you can help them understand what’s going on.

Also, be aware of complicating factors, such as an illness, death of a loved one, or a divorce. When these are added to the everyday pressures kids face, the stress is magnified. Even the most amicable divorce can be tough for kids because their basic security system — their family — is undergoing a big change. Separated or divorced parents should never put kids in a position of having to choose sides or expose them to negative comments about the other spouse.

Also realize that some things that aren’t a big deal to adults can cause significant stress for kids. Let your kids know that you understand they’re stressed and don’t dismiss their feelings as inappropriate.

Signs and Symptoms

While it’s not always easy to recognize when kids are stressed out, short-term behavioral changes — such as mood swings, acting out, changes in sleep patterns, or bedwetting — can be indications. Some kids have physical effects, including stomachaches and headaches. Others have trouble concentrating or completing schoolwork. Still others become withdrawn or spend a lot of time alone.

Younger children may pick up new habits like thumb sucking, hair twirling, or nose picking; older kids may begin to lie, bully, or defy authority. A child who is stressed also may overreact to minor problems, have nightmares, become clingy, or have drastic changes in academic performance.

Reducing Stress

How can you help kids cope with stress? Proper rest and good nutrition can boost coping skills, as can good parenting. Make time for your kids each day. Whether they need to talk or just be in the same room with you, make yourself available. Don’t try to make them talk, even if you know what they’re worried about. Sometimes kids just feel better when you spend time with them on fun activities.

Even as kids get older, quality time is important. It’s really hard for some people to come home after work, get down on the floor, and play with their kids or just talk to them about their day — especially if they’ve had a stressful day themselves. But expressing interest shows your kids that they’re important to you.

Help your child cope with stress by talking about what may be causing it. Together, you can come up with a few solutions like cutting back on after-school activities, spending more time talking with parents or teachers, developing an exercise regimen, or keeping a journal.

You also can help by anticipating potentially stressful situations and preparing kids for them. For example, let your son or daughter know ahead of time that a doctor’s appointment is coming up and talk about what will happen there. Tailor the information to your child’s age — younger kids won’t need as much advance preparation or details as older kids or teens.

Remember that some level of stress is normal; let your kids know that it’s OK to feel angry, scared, lonely, or anxious and that other people share those feelings. Reassurance is important, so remind them that you’re confident that they can handle the situation.

Helping Your Child Cope

When kids can’t or won’t discuss their stressful issues, try talking about your own. This shows that you’re willing to tackle tough topics and are available to talk with when they’re ready. If a child shows symptoms that concern you and is unwilling to talk, consult a therapist or other mental health specialist.

Books can help young kids identify with characters in stressful situations and learn how they cope. Check out Alexander and the Terrible, Horrible, No Good, Very Bad Day by Judith Viorst; Tear Soup by Pat Schweibert, Chuck DeKlyen, and Taylor Bills; and Dinosaurs Divorce by Marc Brown and Laurene Krasny Brown.

Most parents have the skills to deal with their child’s stress. The time to seek professional attention is when any change in behavior persists, when stress is causing serious anxiety, or when the behavior causes significant problems at school or at home.

If you need help finding resources for your child, consult your doctor or the counselors and teachers at school.

Reviewed by: Steven Dowshen, MD
Date reviewed: February 2015

Body Dysmorphic Disorder

Kids and Self-Image

We all spend time in front of the mirror — dressing, grooming, or checking our appearance. This is especially true for teens, who are undergoing rapid growth and appearance changes, and taking new interest in the way they look. How they feel about their appearance is important, since body image can be such a big part of self-esteem during the teen years.

As a parent, you want to teach that there’s much more to people than appearance. You want your teen’s self-image to include personality, character, abilities, and unique strengths and interests. Parents want their teens to appreciate and care for their bodies, and to take pride in how they look.

But feeling satisfied isn’t always easy. Many kids who have positive body images become self-conscious or self-critical as they enter the teen years. It’s common for teens to express dissatisfaction about their appearance or to compare themselves with their friends, celebrities, or others in the media. Ads for everything from makeup and clothing to hair products and toothpaste send messages that a person needs to look a certain way to be happy. It’s hard not to be influenced by that.

While many teens feel dissatisfied with some aspect of their appearance, usually these concerns aren’t consuming and don’t cause extreme distress. They don’t constantly occupy their thoughts or torment them and keep them from thinking about other things.

But for some teens, concerns about appearance become quite extreme and upsetting. They become so focused on imagined or minor imperfections that they can’t seem to stop checking or obsessing about their appearance.

If your teen is constantly preoccupied and upset about body imperfections or appearance flaws, it may be a sign of body dysmorphic disorder.

About Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a condition that involves obsessions, which are distressing thoughts that repeatedly intrude into a person’s awareness. With BDD, the distressing thoughts are about appearance flaws. Teens who have BDD might focus on what they perceive as a facial flaw, but they can also worry about other body parts, such as short legs or breast size or body shape.

Just as people with eating disorders obsess about their weight, teens who have BDD worry about an aspect of their appearance. They may worry that their hair is thin, their face is scarred, their eyes aren’t exactly the same size, their nose is too big, or their lips are too thin.

The disorder has been called “imagined ugliness” because the appearance flaws usually are so small that others consider them minor or don’t even notice them. But for someone with BDD, the concerns feel very real because the obsessive thoughts distort and magnify any tiny imperfection. Because of the distorted body image caused by the disorder, a person may believe that he or she is too horribly ugly or disfigured to be seen.

Besides obsessions, BDD also involves compulsions. A compulsion is something a person does to try to relieve the tension caused by the obsessive thoughts. For example, a girl with obsessive thoughts that her nose is horribly ugly might constantly feel the need to check her appearance in the mirror, apply makeup, or ask someone many times a day whether her nose looks ugly.

Compulsions can provide temporary relief from the distress, so someone with BDD can feel a strong or irresistible urge to keep doing them. Someone might repeat compulsions almost constantly, and they can take up a lot of time and energy. They can feel like the only way to escape the bad feelings caused by the bad thoughts.

Some people who have BDD also might do things to avoid the bad thoughts, like trying not to seen by others, staying home, covering up, not participating in class, not socializing, or even refusing to look in mirrors.

With BDD, the pattern of obsessive thoughts, compulsive actions, and avoidance efforts gets so strong it feels impossible to control. Someone with BDD does not want to be preoccupied with the thoughts and behaviors, but might feel powerless to break the pattern.

Even though the checking, fixing, asking, and avoiding seem to relieve terrible feelings, the relief is just temporary. In reality, the more a person avoids things or performs compulsions, the stronger the obsessions, compulsions, and avoidance become. After a while, it takes more and more compulsive behavior to relieve the distress caused by the bad thoughts.

What Causes BDD?

Although the exact cause of BDD is unclear, it’s believed to be related to problems with serotonin, one of the brain’s chemical neurotransmitters. Poor serotonin regulation is also involved in other conditions, including obsessive-compulsive disorder (OCD), depression, and some eating disorders. If family members have had problems with OCD, anxiety or depression, or eating disorders, someone might be genetically prone to similar conditions.

Compulsive behaviors contribute to the problem, too, by creating learned “habits” that reinforce symptoms and can cause them to worsen over time.

Cultural messages also can contribute to BDD. They reinforce a person’s concerns about appearance. Criticism or teasing about appearance may also contribute to BDD. But while these might harm a person’s body image, alone they usually do not cause BDD.

How common is BDD? It’s hard to know because few people with BDD are willing to talk about their concerns or seek help. But while it’s very common for people to feel somewhat dissatisfied with their looks, true BDD, where it becomes a consuming part of everyday life, is rarer. It usually begins in the teen years and, if untreated, can continue into adulthood.

The Impact of BDD

Sometimes people with BDD feel ashamed and keep their concerns secret. They may think that others would consider them vain or superficial, or become annoyed or irritated with the obsessions and compulsions about appearance.

It can be difficult to understand what your teen is going through, so he or she may feel misunderstood, unfairly judged, or alone.

The obsessions of BDD can disrupt daily life. Someone struggling with BDD might seem tense and distressed about appearance almost all the time and find it hard to stay focused on other things. A teen with BDD may keep a hand over the face for the entire school year, trying to hide a flaw, or might measure or examine the “flawed” body part repeatedly or spend lots of money and time on makeup to cover the perceived problem.

A teen with has BDD may avoid going to school, quit a part-time job, or just stay at home all the time. BDD can lead to depression and, in severe cases, suicidal thoughts. A teen with BDD may ask to see a dermatologist or a plastic surgeon to correct a seeming appearance flaw. But with BDD, whatever the fix or treatment, obsession with appearance will continue.

Treating BDD

If you’re concerned that your son or daughter has BDD, talk to a doctor or mental health professional. A careful assessment can help to clarify what’s causing the distress and whether BDD is behind it. Many times, people with BDD are so focused on appearance that they (and those who love them) believe the answer is about correcting the appearance. If someone you love has BDD, you probably already know that no amount of reassurance seems to quiet the distress for long.

The problem with BDD lies in the obsessions and compulsions, which distort body image and make those who have it feel ugly. It’s hard for them to realize that, because they believe that what they perceive is truly there. Sometimes the most challenging part is helping someone accept a new idea of what might help.

BDD can be treated by an experienced mental health professional. Usually, treatment involves a particular type of talk therapy called cognitive-behavioral therapy, which focuses on the thoughts, feelings, and behaviors, and helps to correct the pattern behind the body image distortion and distress.

A therapist can help someone examine and change his or her faulty beliefs, resist compulsive behaviors, and face stressful situations that trigger appearance concerns. Sometimes, but not always, medication is used with the therapy. The treatment takes time, hard work, and patience. Support from family members can help a great deal.

It is often useful for parents to be involved in some aspects of the treatment, too, especially if a parent has been participating in the teen’s compulsions by providing repeated reassurance. Parents in this situation need to know how to best respond to their teen’s anxiety, distress, and requests for reassurance.

It’s also helpful to tell the therapist about any family members who have experienced other conditions that involve obsessions and compulsions, anxiety disorders, or depression. If a parent is dealing with BDD, OCD, depression, or another related condition, it’s important to mention this and for the parent to get treatment too. If a teen with BDD is also dealing with depression, anxiety, feeling isolated or alone, or dealing with difficult life situations, the therapy also can address those issues.

Getting Help for BDD

Body dysmorphic disorder, like other obsessions, can interfere with a teen’s life — robbing it of pleasure and draining his or her energy.

It’s not always easy to find the help you may need. Your doctor, health care network, or community mental health center can direct you to local resources. Your son or daughter might resist your offer to see a mental health professional, so be persistent.

Though living with someone who’s dealing with BDD can be frustrating and difficult, avoid blame, anger, or guilt. BDD is no one’s fault. But with help and time, relief is possible. An experienced psychologist or psychiatrist who is knowledgeable about BDD can help break the disorder’s grip.

Reviewed by: D’Arcy Lyness, PhD
Date reviewed: May 2013

Becoming a Stepparent

Becoming a parent by blending families or marrying someone with kids can be a rewarding and fulfilling experience. If you’ve never had kids, you’ll get the opportunity to share your life with a younger person and help to shape his or her character. If you have kids, you’ll offer them more opportunities to build relationships and establish a special bond that only siblings can have.

In some cases, your new family members may get along without a hitch (just like The Brady Bunch), but other times you can expect difficulties along the way. Figuring out your role as a parent — aside from the day-to-day responsibilities that come with it — also may lead to confusion or even conflict between you and your partner, your partner’s ex-wife or ex-husband, and their kids.

While there is no foolproof formula for creating the”perfect” family (every family has its own dynamics), it’s important to approach this new situation with patience and understanding for the feelings of those involved. Here’s how to make things easier as you adapt to your new role.

Start Slow

The initial role of a stepparent is that of another caring adult in a child’s life, similar to a loving family member or mentor. You may desire a closer bond right away, and might wonder what you’re doing wrong if your new stepchild doesn’t warm up to you or your kids as quickly as you’d like — but relationships need time to grow.

Start out slow and try not to rush into things. Let things develop naturally — kids can tell when adults are being fake or insincere. Over time, you can develop a deeper, more meaningful relationship with your stepchildren, which doesn’t necessarily have to resemble the one they share with their birth parents.

Factors That Affect Your Relationship

Children who are mourning the loss of a deceased parent or the separation or divorce of their birth parents may need time to heal before they can fully accept you as a new parent.

For those whose birth parents are still alive, remarriage may mean the end of hope that their parents will reunite. Even if it has been several years since the separation, kids (even grown ones!) often hang onto that hope for a long time. From the kids’ perspective, this reality can make them feel angry, hurt, and confused.

Other factors that may affect the transition into stepparenting:

  • How old the kids are. When it comes to adjusting and forming new relationships, younger kids generally have an easier time than older kids.
  • How long you’ve known them. Usually, the longer you know the kids, the better the relationship. There are exceptions (for example, if you were friends with the parents before they separated and are blamed for the break-up), but in most cases having a history together makes the transition a little smoother.
  • How long you dated the parent before marriage. Again, there are exceptions but typically if you don’t rush into the relationship with the adult, kids have a good sense that you are in this for the long haul.
  • How well the parent you marry gets along with the ex-spouse. This is a critical factor. Minimal conflict and open communication between ex-partners can make a big difference regarding how easily kids accept you as their stepparent. It’s much easier for kids to transition to new living arrangements when adults keep negative comments out of earshot.
  • How much time the kids spend with you. Trying to bond with kids every other weekend — when they want quality time with a birth parent they don’t see as often as they’d like — can be a difficult way to make friends with your new stepkids. Remember to put their needs first: If kids want time with their birth parent, they should get it. So sometimes making yourself scarce can help smooth the path to a better relationship in the long run.

Knowing ahead of time what situations may become problematic as you bring new family members together can help you prepare so that, if complications arise, you can handle them with an extra dose of patience and grace.

Steps to Great Stepparenting

All parents face difficulties now and then. But when you’re a stepparent, those obstacles are compounded by the fact that you are not the birth parent — this can open up power struggles within the family, whether it’s from the kids, your partner’s ex, or even your partner.

When times get tough, however, putting kids’ needs first can help you make good decisions. Here’s how:

  • Put needs, not wants, first. Kids need love, affection, and consistent rules above all else. Giving them toys or treats, especially if they’re not earned with good grades or behavior, can lead to a situation where you feel like you’re trading gifts for love. Similarly, if you feel guilty for treating your biological kids differently from your stepchildren, don’t buy gifts to make up for it. Do you best to figure out how to treat them more equally.
  • House rules matter. Keep your house rules as consistent as possible for all kids, whether they’re your kids from a previous relationship, your partner’s kids from a previous relationship, or new children you have had together. Children and teens will have different rules, but they should be consistently applied at all times. This helps kids adjust to transitions, like moving to a new house or welcoming a new baby, and helps them feel that all kids in your home are treated equally. If kids are dealing with two very different sets of rules in each home, it may be time for an adults-only family meeting — otherwise kids can learn to “work the system” for short-term gain but long-term problems.
  • Create new family traditions. Find special activities to do with your stepkids, but be sure to get their feedback. Some new family traditions could include board game nights, bike riding together, cooking, doing crafts, or even playing quick word games in the car. The key is to have fun together, not to try to win their love kids are smart and will quickly figure out if you’re trying to force a relationship.
  • Respect all parents. When a partner’s ex is deceased, it’s important to be sensitive to and honor that person. If you and your partner share custody with the birth parent, try to be courteous and compassionate in your interactions with each other (no matter how hard that can be!). Never say negative things about the birth parent in front of the kids. Doing so often backfires and kids get angry with the parent making the remarks. No child likes to hear their parents criticized, even if he or she is complaining about them to you.
  • Don’t use kids as messengers or go-betweens. Try not to question kids about what’s happening in the other household — they’ll resent it when they feel that they’re being asked to “spy” on another parent. Wherever possible, communicate directly with the other parent about relevant matters, such as scheduling, visitation, health issues, or school problems. Online custody calendars make this process a little easier because parents can note visitation days and share this information with each other via the Internet.
  • Talk to your partner or spouse. Communication between you and your partner is important so that you can make parenting decisions together. This is especially crucial if you each have different notions on parenting and discipline. If you’re new to parenting as a stepparent, ask your partner what would be the best way to get to know the kids. Use resources to find out what kids of different ages are interested in — and don’t forget to ask them.

No matter what the circumstances of your new family, chances are there’ll be some bumps along the way. But don’t give up trying to make things work — even if things started off a little rocky, they still can (and probably will) improve as you and your new family members get to know each other better.

Reviewed by: D’Arcy Lyness, PhD
Date reviewed: September 2013

Anxiety, Fears, and Phobias

Everyone, from the youngest child to the oldest adult, experiences anxieties and fears at one time or another. Feeling anxious in a particularly uncomfortable situation never feels very good. However, with kids, such feelings are not only normal, they’re also necessary. Dealing with anxieties can prepare young people to handle the unsettling experiences and challenging situations of life.

Many Anxieties and Fears Are Normal

Anxiety is defined as “apprehension without apparent cause.” It usually occurs when there’s no immediate threat to a person’s safety or well-being, but the threat feels real.

Anxiety makes someone want to escape the situation — fast. The heart beats quickly, the body might begin to perspire, and “butterflies” in the stomach soon follow. However, a little bit of anxiety can actually help people stay alert and focused.

Having fears or anxieties about certain things can also be helpful because it makes kids behave in a safe way. For example, a kid with a fear of fire would avoid playing with matches.

The nature of anxieties and fears change as kids grow and develop:

  • Babies experience stranger anxiety, clinging to parents when confronted by people they don’t recognize.
  • Toddlers around 10 to 18 months old experience separation anxiety, becoming emotionally distressed when one or both parents leave.
  • Kids ages 4 through 6 have anxiety about things that aren’t based in reality, such as fears of monsters and ghosts.
  • Kids ages 7 through 12 often have fears that reflect real circumstances that may happen to them, such as bodily injury and natural disaster.

As kids grow, one fear may disappear or replace another. For example, a child who couldn’t sleep with the light off at age 5 may enjoy a ghost story at a slumber party years later. And some fears may extend only to one particular kind of stimulus. In other words, a child may want to pet a lion at the zoo but wouldn’t dream of going near the neighbor’s dog.

Signs of Anxiety

Typical childhood fears change with age. They include fear of strangers, heights, darkness, animals, blood, insects, and being left alone. Kids often learn to fear a specific object or situation after having an unpleasant experience, such as a dog bite or an accident.

Separation anxiety is common when young children are starting school, whereas adolescents may experience anxiety related to social acceptance and academic achievement.

If anxious feelings persist, they can take a toll on a child’s sense of well-being. The anxiety associated with social avoidance can have long-term effects. For example, a child with fear of being rejected can fail to learn important social skills, causing social isolation.

Many adults are tormented by fears that stem from childhood experiences. An adult’s fear of public speaking may be the result of embarrassment in front of peers many years before. It’s important for parents to recognize and identify the signs and symptoms of kids’ anxieties so that fears don’t get in the way of everyday life.

Some signs that a child may be anxious about something may include:

  • becoming clingy, impulsive, or distracted
  • nervous movements, such as temporary twitches
  • problems getting to sleep and/or staying asleep longer than usual
  • sweaty hands
  • accelerated heart rate and breathing
  • nausea
  • headaches
  • stomachaches

Apart from these signs, parents can usually tell when their child is feeling excessively uneasy about something. Lending a sympathetic ear is always helpful, and sometimes just talking about the fear can help a child move beyond it.

What’s a Phobia?

When anxieties and fears persist, problems can arise. As much as a parent hopes the child will grow out of it, sometimes the opposite occurs, and the cause of the anxiety looms larger and becomes more prevalent. The anxiety becomes a phobia, or a fear that’s extreme, severe, and persistent.

A phobia can be very difficult to tolerate, both for kids and those around them, especially if the anxiety-producing stimulus (whatever is causing the anxiety) is hard to avoid (e.g., thunderstorms).

“Real” phobias are one of the top reasons kids are referred to mental health professionals. But the good news is that unless the phobia hinders the everyday ability to function, the child sometimes won’t need treatment by a professional because, in time, the phobia will be resolved.

Focusing on Anxieties, Fears, or Phobias

Try to answer the following questions honestly:

Is your child’s fear and behavior related to it typical for your child’s age? If the answer to this question is yes, it’s a good bet that your child’s fears will resolve before they become a serious cause for concern. This isn’t to say that the anxiety should be discounted or ignored; rather, it should be considered as a factor in your child’s normal development.

Many kids experience age-appropriate fears, such as being afraid of the dark. Most, with some reassurance and perhaps a nightlight, will overcome or outgrow it. However, if they continue to have trouble or there’s anxiety about other things, the intervention may have to be more intensive.

What are the symptoms of the fear and how do they affect your child’s personal, social, and academic functioning? If symptoms can be identified and considered in light of your child’s everyday activities, adjustments can be made to alleviate some of the stress factors.

Does the fear seem unreasonable in relation to the reality of the situation; could it be a sign of a more serious problem? If your child’s fear seems out of proportion to the cause of the stress, this may signal the need to seek outside help, such as a counselor, psychiatrist, or psychologist.

Parents should look for patterns. If an isolated incident is resolved, don’t make it more significant than it is. But if a pattern emerges that’s persistent or pervasive, you should take action. If you don’t, the phobia is likely to continue to affect your child.

Contact your doctor and/or a mental health professional who has expertise in working with kids and adolescents.

Helping Your Child

Parents can help kids develop the skills and confidence to overcome fears so that they don’t evolve into phobic reactions.

To help your child deal with fears and anxieties:

  • Recognize that the fear is real. As trivial as a fear may seem, it feels real to your child and it’s causing him or her to feel anxious and afraid. Being able to talk about fears helps — words often take some of the power out of the negative feeling. If you talk about it, it can become less powerful.
  • Never belittle the fear as a way of forcing your child to overcome it. Saying, “Don’t be ridiculous! There are no monsters in your closet!” may get your child to go to bed, but it won’t make the fear go away.
  • Don’t cater to fears, though. If your child doesn’t like dogs, don’t cross the street deliberately to avoid one. This will just reinforce that dogs should be feared and avoided. Provide support and gentle care as you approach the feared object or situation with your child.
  • Teach kids how to rate fear. A child who can visualize the intensity of the fear on a scale of 1 to 10, with 10 being the strongest, may be able to “see” the fear as less intense than first imagined. Younger kids can think about how “full of fear” they are, with being full “up to my knees” as not so scared, “up to my stomach” as more frightened, and “up to my head” as truly petrified.
  • Teach coping strategies. Try these easy-to-implement techniques. Using you as “home base,” your child can venture out toward the feared object, and then return to you for safety before venturing out again. Kids also can learn some positive self-statements (such as “I can do this” and “I will be OK”) to say to themselves when feeling anxious. Relaxation techniques are helpful, including visualization (of floating on a cloud or lying on a beach, for example) and deep breathing (imagining that the lungs are balloons and letting them slowly deflate).

The key to resolving fears and anxieties is to overcome them. Using these suggestions, you can help your child better cope with life’s situations.

Reviewed by: D’Arcy Lyness, PhD
Date reviewed: July 2013

Anxiety Disorders

Ella was a worrier. Every morning, she worried that she wouldn’t make the bus on time, even though she hadn’t missed it once all year. And every afternoon, she worried that she wouldn’t get her favorite spot at the lunch table, or that she might have a pop quiz in science class and wouldn’t be prepared. At night, she worried about getting her homework done and whether her clothes would look right at school the next day.

Ella’s parents thought this behavior was a typical part of growing up. But when their daughter’s teacher said that Ella’s anxiety was starting to affect her grades in school and relationships with classmates, they decided it was time to talk to a doctor about finding ways to help Ella deal with her worries.

What Is Anxiety?

Anxiety is really just a form of stress. It can be experienced in many different ways — physically, emotionally, and in the way people view the world around them. Anxiety mainly relates to worry about what might happen — worrying about things going wrong or feeling like you’re in some kind of danger.

Anxiety is a natural human reaction, and it serves an important biological function: It’s an alarm system that’s activated whenever we perceive danger or a threat. When the body and mind react, we can feel physical sensations, like dizziness, a rapid heartbeat, difficulty breathing, and sweaty or shaky hands and feet. These sensations — called the fight–flight response — are caused by a rush of adrenaline and other stress hormones that prepare the body to make a quick getaway or “flight” from danger.

The fight–flight response happens instantly. But it usually takes a few seconds longer for the thinking part of the brain (the cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. When the cortex sends the all-clear signal, the fight–flight response is deactivated and the nervous system starts to calm down.

Normal Anxiety

Everyone experiences feelings of anxiety from time to time. These feelings can range from a mild sense of uneasiness to full-blown panic (or anywhere in between), depending on the person and the situation.

It’s natural for unfamiliar or challenging situations to prompt feelings of anxiety or nervousness in people of all ages. You may feel it when you have a big presentation at work, for example, or when life gets overly hectic.

Kids might feel it, too, in similar situations — when facing an important test or switching schools, for example. These experiences can trigger normal anxiety because they cause us to focus on the “what if’s”: What if I mess up? What if things don’t go as I planned?

Some amount of anxiety is normal and can even be motivating. It helps us stay alert, focused, and ready to do our best. But anxiety that’s too strong or happens a lot can become overwhelming. It can interfere with someone’s ability to get things done and, in severe cases, can start taking over the good and enjoyable parts of life.

Anxiety Disorders

Anxiety disorders are among the most common mental health conditions. That’s partly because everyone experiences stress and worry. There are many different types of anxiety disorders, with different symptoms. But they all share one common trait — prolonged, intense anxiety that is out of proportion to the present situation and affects a person’s daily life and happiness.

Symptoms of an anxiety disorder can come on suddenly or can build gradually and linger. Sometimes worry creates a sense of doom and foreboding that seems to come out of nowhere. Kids with anxiety problems may not even know what’s causing the emotions, worries, and sensations they have.

Disorders that kids can get include:

  • Generalized anxiety. With this common anxiety disorder, children worry excessively about many things, such as school, the health or safety of family members, or the future in general. They may always think of the worst that could happen. Along with the worry and dread, kids may have physical symptoms, such as headaches, stomachaches, muscle tension, or tiredness. Their worries might cause them to miss school or avoid social activities. With generalized anxiety, worries can feel like a burden, making life feel overwhelming or out of control.
  • Obsessive compulsive disorder (OCD). For a person with OCD, anxiety takes the form of obsessions (excessively preoccupying thoughts) and compulsions (repetitive actions to try to relieve anxiety).
  • Phobias. These are intense fears of specific things or situations that are not inherently dangerous, such as heights, dogs, or flying in an airplane. Phobias usually cause people to avoid the things they fear.
  • Social phobia (social anxiety). This anxiety is triggered by social situations or speaking in front of others. A less common form called selective mutism causes some kids and teens to be too fearful to talk at all in certain situations.
  • Panic attacks. These episodes of anxiety can occur for no apparent reason. During a panic attack, a child typically has sudden and intense physical symptoms that can include a pounding heart, shortness of breath, dizziness, numbness, or tingling feelings. Agoraphobia is an intense fear of panic attacks that causes a person to avoid going anywhere a panic attack could possibly occur.
  • Posttraumatic stress disorder (PTSD). This type of anxiety disorder results from a traumatic past experience. Symptoms include flashbacks, nightmares, fear, and avoidance of the traumatic event that caused the anxiety.


Experts don’t know exactly what causes anxiety disorders. Several things seem to play a role, including genetics, brain biochemistry, an overactive fight–flight response, stressful life circumstances, and learned behavior.

A child with a family member who has an anxiety disorder has a greater chance of developing one, too. This may be related to genes that can affect brain chemistry and the regulation of chemicals called neurotransmitters. But not everyone with a family member who has an anxiety disorder will develop problems with anxiety.

Things that happen in a child’s life can set the stage for anxiety disorders in childhood or later in life. Loss (like the death of a loved one or parents’ divorce) and major life transitions (like moving to a new town) are common triggers. Kids with a history of abuse are also more vulnerable to anxiety.

Growing up in a family where others are fearful or anxious also can “teach” a child to view the world as a dangerous place. Likewise, a child who grows up in an environment that is actually dangerous (if there is violence in the child’s family or community, for example) may learn to be fearful or expect the worst.

Signs & Symptoms

Although all kids experience anxiety in certain situations, most (even those who live through traumatic events) don’t develop anxiety disorders. Those who do, however, will seem anxious and have one or more of the following signs:

  • excessive worry most days of the week, for weeks on end
  • trouble sleeping at night or sleepiness during the day
  • restlessness or fatigue during waking hours
  • trouble concentrating
  • irritability

These problems can affect a child’s day-to-day functioning, especially when it comes to concentrating in school, sleeping, and eating.

And it’s common for kids to avoid talking about how they feel, because they’re worried that others (especially their parents) might not understand. They may fear being judged or considered weak, scared, or “babyish.” And although girls are more likely to express their anxiety, boys experience these feelings, too, and sometimes find it hard to talk about. This leads many kids to feel alone or misunderstood.

The good news is that doctors and therapists today understand anxiety disorders better than ever before and, with treatment, can help kids feel better.


A child’s anxiety disorder can be treated by a mental health professional. A therapist can look at the symptoms, diagnose the specific anxiety disorder, and create a plan to help a child cope.

A type of talk therapy called cognitive-behavior therapy (CBT) is often used. In CBT, kids try out new ways to think and act in situations that can cause anxiety, and to manage and deal with stress. The therapist provides support and guidance and teaches new coping skills, such as relaxation techniques or breathing exercises. Sometimes, but not always, medication is used as part of the treatment for anxiety.

Helping Your Child Cope

The best way to help your child is to acknowledge the problem in a supportive, nonjudgmental way. Talk openly about your child’s symptoms and really try to understand how they are affecting everyday life. It can also help to talk to other adults in your child’s life, such as teachers and coaches.

Be patient and positive as your child undergoes treatment and finds new ways to cope. Sometimes it helps to talk to your child about your own stresses and how you’ve been able to overcome them. Remind your child that letting go of worry allows space for more happiness and fun.

Rest assured that with the right care, your child can overcome anxiety and learn to face the future ready and relaxed.

Reviewed by: D’Arcy Lyness, PhD
Date reviewed: March 2014