teenage sex

Does thinking about gay sex make you gay? What about experimenting with same-sex sex?

Your sexual orientation is a reflection of your sexual and emotional feelings toward people of the same or opposite gender. Although some people know early on that they are homosexual, others go through a confusing period where they wonder: Am I different? Could I be gay? Are my feelings just a passing phase?

The answer is there is no single answer. Your sexual orientation will emerge over time, probably little by little. You shouldn't label yourself as gay just because you've had homosexual feelings or even homosexual encounters. These experiences are very common among people your age. Or, you may realize over time that you're only attracted to people of your own gender. Or maybe you'll find that you're into both guys and girls - that you're bisexual.

Right now the best thing you can do is give it time and explore and experience your sexual feelings with an open mind. If it turns out you're gay, you'll probably face some unique challenges but you'll also get a lot of support along the way. The world's come a long way. It's still not perfect, but these days most people know that it's okay to be gay, and homosexuals have more social freedoms and legal protections than ever before.

You may have wondered what causes homosexuality. Why are some people gay and some people aren't? Truth is, nobody really knows for sure. Researchers used to believe that homosexuality stemmed from improper parenting (some people still believe this), but this just isn't the case. As best we know, what "causes" homosexuality is the same as what causes heterosexuality: the roll of the biological dice.

Today, sex researchers and doctors view homosexuality not as a sexual problem but as a normal sexual difference, much like green is a normal - if fairly unusual - eye color.

What all this means is that homosexuals are no more responsible for their homosexuality than heterosexuals are for their heterosexuality. It is not a "lifestyle" you choose for yourself as much as something you discover in yourself. Which is not to say it's an easy discovery. Even if you know that homosexuality isn't a disorder or a flaw, you may fear that your family and friends won't accept you if you come out to them.

Visit HealthyPlace.com Gender Community for comprehensive GLBT information.

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Describing Depression Among African-Amarican Women by Nikki Giovanni, Introspection

because she didn't know any better
she stayed alive
among the tired and lonely
not waiting always wanting
needing a good night's rest

Defining the Roots of Depression Among African-American Women

Clinical depression is often a vague disorder for African- American women. It may produce an abundance of "depressions" in the lives of the women who experience its ongoing, relentless symptoms. The old adage of "being sick and tired of being sick and tired" is quite relevant for these women, since they often suffer from persistent, untreated physical and emotional symptoms. If these women consult health professionals, they are frequently told that they are hypertensive, run down, or tense and nervous. They may be prescribed antihypertensives, vitamins, or mood elevating pills; or they may be informed to lose weight, learn to relax, get a change of scenery, or get more exercise. The root of their symptoms frequently is not explored; and these women continue to complain of being tired, weary, empty, lonely, sad. Other women friends and family members may say, "We all feel this way sometimes, it's just the way it is for us Black women."

I remember one of my clients, a woman who had been brought into the emergency mental health center because she had slashed her wrists while at work. During my assessment of her, she told me she felt like she was "dragging a weight around all the time." She said, "I've had all these tests done and they tell me physically everything is fine but I know it's not. Maybe I'm going crazy! Something is terribly wrong with me, but I don't have time for it. I've got a family who depends on me to be strong. I'm the one that everyone turns to." This woman, more conerned about her family than herself, said she "[felt] guilty spending so much time on [her]self." When I asked her if she had anyone she could talk to, she responded, "I don't want to bother my family and my closest friend is having her own problems right now." Her comments reflect and mirror the sentiments of other depressed African-American women I have seen in my practice: They're alive, but barely, and are continually tired, lonely, and wanting.

Statistics regarding depression in African-American women are either non-existent or uncertain. Part of this confusion is because past published clinical research on depression in African-American women has been scarce (Barbee, 1992; Carrington, 1980; McGrath et al., 1992; Oakley, 1986; Tomes et al., 1990). This scarcity is, in part, due to the fact that African-American women may not seek treatment for their depression, may be misdiagnosed, or may withdraw from treatment because their ethnic, cultural, and/or gender needs have not been met (Cannon, Higginbotham, Guy, 1989; Warren, 1994a). I also have found that African-American women may be reticent to participate in research studies because they are uncertain as to how research data will be disseminated or are afraid that data will be misinterpreted. In addition, there are few available culturally competent researchers who are knowledgeable regarding the phenomenon of depression in African-American women. Subsequently, African-American women may not be available to participate in depression research studies. Available published statistics concur with what I have seen in my practice: that African-American women report more depressive symptoms than African-American men or European-American women or men, and that these women have a depression rate twice that of European-American women (Brown, 1990; Kessler et al., 1994).

African-American women have a triple jeopardy status which places us at risk for developing depression (Boykin, 1985; Carrington, 1980; Taylor, 1992). We live in a majority-dominated society that frequently devalues our ethnicity, culture, and gender. In addition, we may find ourselves at the lower spectrum of the American political and economic continuum. Often we are involved in multiple roles as we attempt to survive economically and advance ourselves and our families through mainstream society. All of these factors intensify the amount of stress within our lives which can erode our self-esteem, social support systems, and health (Warren, 1994b).

Clinically, depression is described as a mood disorder with a collection of symptoms persisting over a two-week time. These symptoms must not be attributed to the direct physical effects of alcohol or drug abuse or other medication usage. However, clinical depression may occur in conjunction with these conditions as well as other emotional and physical disorders such as hormonal, blood pressure, kidney, or heart conditions (American Psychiatric Association [APA], 1994). To be diagnosed with clinical depression, an African-American woman must have either depressed mood or loss of interest or pleasure as well as four of the following symptoms:

1. Depressed or irritable mood throughout the day (often everyday)
2. Lack of pleasure in life activities
3. Significant (more than 5%) weight loss or gain over a month
4. Sleep disruptions (increased or decreased sleeping)
5. Unusual, increased, agitated or decreased physical activity (generally everyday)
6. Daily fatigue or lack of energy
7. Daily feelings of worthlessness or guilt
8. Inability to concentrate or make decisions
9. Recurring thoughts of death or suicidal thoughts (APA, 1994).

The Meaning of Contextual Depression Theory

In the past, causal theories of depression have been used across all populations. These theories have utilized biological, psychosocial, and sociological weaknesses and changes to explain the occurrence and development of depression. However, I think that a contextual depression theory provides a more meaningful explanation for the occurrence of depression within African- American women. This contextual focus incorporates the neurochemical, genetic perspectives of biological theory; the impact of losses, stressors, and control/coping strategies of psychosocial theory; the conditioning patterns, social support systems, and social, political, and economic perspectives of sociological theory; and the ethnic and cultural influences which affect the physical and psychological development and health of African-American women (Abramson, Seligman, & Teasdale, 1978; Beck, Rush, Shaw, & Emery, 1979; Carrington, 1979, 1980; Cockerman, 1992; Collins, 1991; Coner-Edwards & Edwards, 1988; Freud, 1957; Klerman, 1989; Taylor, 1992; Warren, 1994b). Another important aspect of the contextual depression theory is that it incorporates an examination of the strengths of African- American women and the cultural competency of mental health professionals. Past depression theories traditionally have ignored these factors. Understanding these factors is important because depressed African-American women's assessment and treatment process is impacted not only by the women's attitudes but also by the attitudes of the health care professionals who provide services for them.

African-American women have strengths; we are survivors and innovators who historically have been involved in the development of family and group survival strategies (Giddings, 1992; Hooks, 1989). However, women may experience increased stress, guilt, and depressive symptoms when they have role conflicts between their family's survival and their own developmental needs (Carrington, 1980; Outlaw, 1993). It is this cumulative stress which takes a toll on the strengths of African-American women and can produce an erosion of emotional and physical health (Warren, 1994b).

Choosing a Treatment Path

Treatment strategies for depressed African-American women need to be based on contextual depression theory because it addresses women's total health status. African-American women's psychological and physiological health cannot be separated from their ethnic and cultural values. Mental health professionals, when culturally competent, acknowledge and understand African-American women's cultural strengths and values in order to successfully counsel them. Cultural competence involves a mental health professional's use of cultural awareness (sensitivity when interacting with other cultures), cultural knowledge (educational basis of other cultures' world views), cultural skill (the ability to conduct a cultural assessment), and cultural encounter (the ability to engage meaningfully in interactions with persons from different cultural arenas) (Campinha-Bacote, 1994; Capers, 1994).

Initially, I advise a woman to have a complete history and physical done to help determine the cause of her depression. I take a cultural assessment in conjunction with this history and physical. This assessment allows me to find out what is important for the woman in the areas of her ethnic, racial, and cultural background. I must complete this assessment before I can institute any interventions for the woman. Then I can spend time with her discussing her attitude toward her depression, what she thinks created her symptoms, and what the causes of depression are. This is important because depressed African-American women need to understand that depression is not a weakness, but an illness often resulting from a combination of causes. It is true that treating neurochemical imbalances or physical disorders may alleviate the depression; however, surgeries or certain heart, hormonal, blood pressure, or kidney medications actually may induce one. Consequently, it is important to provide a woman with information regarding this possibility and perhaps to alter or change any medications that she is taking.

I also like to screen women for their level of depression using either the Beck Depression Inventory or the Zung Self- Rating Scale. Both of these instruments are quick and easy to complete and have excellent reliability and validity. Antidepressants may provide relief for women by restoring neurochemical balances. However, African-American women may be more sensitive to certain antidepressants and may require smaller dosages than traditional treatment advises (McGrath et al., 1992). I like to provide women with information on the different types of antidepressant medications and their effects and to monitor their progress on medication(s). Women also should be given information regarding the symptoms of depression so they may recognize changes within their current condition and any future recurrence of depressive symptoms. Information regarding light, nutrition, exercise, and electroshock therapies may be included. An excellent booklet that I use, which is available for free through local mental health centers or agencies, is Depression Is a Treatable Illness: A Patient's Guide, Publication #AHCPR 93- 0553 (U.S. Department of Health and Human Services, 1993).

I also advise that women participate in some form of individual or group therapeutic discussion sessions with either myself or another trained therapist. These sessions can help them to understand their depression and their treatment choices, enhance their self-esteem, and develop alternative strategies in order to handle their stress and conflicting roles appropriately. I advise these women to learn relaxation techniques and develop alternative coping and crisis management strategies. Group sessions may be more supportive for some women and may facilitate the development of a wider selection of lifestyle choices and changes. Self-help groups, such as the National Black Women's Health Project, also may provide social support for depressed African-American women as well as enhance the work women accomplish with their therapeutic sessions. Finally, women need to monitor their ongoing emotional and physical health as they progress through life and "rise," as Maya Angelou writes, "into a day break that's wondrously clear . . . bringing the gifts that my ancestors gave" (1994, p. 164).

Barbara Jones Warren, R.N., M.S., Ph.D., is a psychiatric mental health nurse consultant. Formerly an American Nurses Foundation Ethnic/Racial Minority Fellow, she has joined the faculty of The Ohio State University.

References for article:

Abramson, L. Y., Seligman, M. E. P., & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87, 49-74. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorder-IV [DSM-IV]. (4th ed.) Washington, DC: Author. Angelou, M. (1994). And still I rise. In M. Angelou (Ed.), The complete collected poems of Maya Angelou (pp. 163-164). New York: Random House. Barbee, E. L. (1992). African-American women and depression: A review and critique of the literature. Archives of Psychiatric Nursing, 6(5), 257-265. Beck, A. T., Rush, A. J., Shaw, B. E., and Emery, G. (1979). Cognitive therapy of depression. New York: Guilford. Brown, D. R. (1990). Depression among Blacks: An epidemiological perspective. In D. S. Ruiz and J. P. Comer (Eds.), Handbook of mental health and mental disorder among Black Americans (pp. 71-93). New York: Greenwood Press. Campinha-Bacote, J. (1994). Cultural competence in psychiatric mental health nursing: A conceptual model. Nursing Clinics of North America, 29(1), 1-8. Cannon, L. W., Higgenbotham, E., & Guy, R. F. (1989). Depression among women: Exploring the effects of race, class, and gender. Memphis, TN: Center for Research on Women, Memphis State University. Capers, C. F. (1994). Mental health issues and African-Americans. Nursing Clinics of North America, 29(1), 57-64. Carrington, C. H. (1979). A comparison of cognitive and analytically oriented brief treatment approaches to depression in Black women. Unpublished doctoral dissertation, University of Maryland, Baltimore. Carrington, C. H. (1980). Depression in Black women: A theoretical perspective. In L. Rodgers-Rose (Ed.), The Black woman (pp. 265-271). Beverly Hills, CA: Sage Publications. Cockerman, W. C. (1992). Sociology of mental disorder. (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall. Collins, P. H. (1991). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. (2nd ed.). New York: Routledge. Coner-Edwards, A. F., & Edwards, H. E. (1988). The Black middle class: Definition and demographics. In A.F. Coner-Edwards & J. Spurlock (Eds.), Black families in crisis: The middle class (pp. 1-13). New York: Brunner Mazel. Freud, S. (1957). Mourning and melancholia. (Standard ed., vol. 14). London: Hogarth Press. Giddings, P. (1992). The last taboo. In T. Morrison (Ed.), Race-ing justice, en-gendering power (pp. 441-465). New York: Pantheon Books. Giovanni, N. (1980). Poems by Nikki Giovanni: Cotton candy on a rainy day. New York: Morrow. Hooks, B. (1989). Talking back: Thinking feminist, thinking black. Boston, MA: South End Press. Kessler, R. C., McGongle, K. A., Zhao, S., Nelson, C. B., Hughes, H., Eshelman, S., Wittchen, H., & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the U.S. Archives of General Psychiatry, 51, 8-19. Klerman, G. L. (1989). The interperson model. In J. J. Mann (Ed.), Models of depressive disorders (pp. 45-77). New York: Plenum. McGrath, E., Keita, G. P., Strickland, B. R., & Russo, N. F. (1992). Women and depression: Risk factors and treatment issues. (3rd printing). Washington, DC: American Psychological Association. Oakley, L. D. (1986). Marital status, gender role attitude, and women's report of depression. Journal of the National Black Nurses Association, 1(1), 41-51. Outlaw, F. H. (1993). Stress and coping: The influence of racism on the cognitive appraisal processing of African Americans. Issues in Mental Health Nursing, 14, 399-409. Taylor, S. E. (1992). The mental health status of Black Americans: An overview. In R. L. Braithwate & S. E. Taylor (Eds.), Health issues in the Black community (pp. 20-34). San Francisco, CA: Jossey-Bass Publishers. Tomes, E. K., Brown, A., Semenya, K., & Simpson, J. (1990). Depression in Black women of low socioeconomic status: Psychological factors and nursing diagnosis. The Journal of The National Black Nurses Association, 4(2), 37-46. Warren, B. J. (1994a). Depression in African-American women. Journal of Psychosocial Nursing, 32(3), 29-33. Warren, B. J. (1994b). The experience of depression for African-American women. In B. J. McElmurry & R. S. Parker (Eds.), Second annual review of women's health. New York:National League for Nursing Press. Woods, N. F., Lentz, M., Mitchell, E., & Oakley, L. D. (1994). Depressed mood and self-esteem in young Asian, Black, and White women in America. Health Care for Women International, 15, 243-262.

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The bipolar (also called the manic-depressive) illness, caused by as yet unknown imbalances of neurotransmitters in the brain, is know to wreak havoc with countless lives in this country and all over the world. My interest in the illness stems from the fact that my father (now deceased) had it (the illness first manifested itself when I was around fourteen or fifteen). Needless to say, it placed significant emotional burden on me and my family. In retrospect however, I realize that a lot of the pain and suffering (for us anyway) was due simply to misinformation and/or lack of information about the illness. Although things are improving, especially in the U.S. and in the western hemisphere at least, I feel that the bipolar illness (unfortunately) still remains taboo and a cause of much unnecessary suffering for the patient and for the family/caregivers involved. This website is my minuscule effort to correct this situation.

During graduate school in the late eighties, I had the privilege of meeting Dimitri Mihalas, then a distinguished professor of astronomy at the University of Illinois at Urbana-Champaign (and a member of the National Academy of Sciences). Though he suffers from the illness, he feels that he has actually "gained" instead of "losing" to it. He has also been a pioneer in attempts to increase public awareness of (and therefore decreasing the stigma associated with) the bipolar illness by the act of being completely open about it. Soon after a major, life-threatening episode of depression (which was treated successfully with medication), he set upon himself the task of composing a primer on manic-depression. Because of his openness, the primer is quite personal and many have thus found it to be useful in gauging their own experience with the illness. It also contains a great deal of useful information, particularly about the spiritual aspects of recovery, and contains a bibliography for those who want to learn more. Someone who read it described it as a "life saver" for her.

Anurag Shankar, Bloomington, Indiana, 2003

Contents in A Manic Depression Primer:

• Depression and Spiritual Growth: Introduction
• A Manic Depression Primer: Preface
• Mood Disorders as Physical Illnesses
• Treatment of Depression and Bipolar Disorder
• Suicide and Bipolar Disorder - Part II
• Impact of Mood Disorders on Victim, Family, and Friends
• Grace
• Purpose and Meaning
• Background and History: Anurag Shankar
• Love and Major Depression
• Mental Illness and Public Policy
• A Spiritual Model of Healing and Wellness
• Stigma of Having A Mental Illness
• The Role of Mystical Experience
• Why This Pamphlet?
• About the Author Dimitri Mihalas

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Whites Are Far More Likely to Be Prescribed Antidepressant Drugs

Although depression is a common and troubling problem among the elderly, a July 2000 study suggests that its symptoms are being overlooked in many older black people. Elderly white people, the study found, are more than three times as likely to be prescribed anti-depressant drugs as elderly blacks.

In the July 2000 issue of the American Journal of Psychiatry, study author Dan Blazer, MD, PhD and colleagues from Duke University Medical Center in Durham, N.C., report the results of a 10 year survey of more than 4,000 people age 65 and older.

• One researcher says that part of the problem may be a reluctance on the part of black people to take antidepressants, to understand depressive symptoms, or to admit to having depression.
• Another expert says depression is often overlooked by patients and their doctors, and the symptoms are instead attributed to age-related medical conditions.

"Misconceptions of clinical depression as a weakness of character or a normal [part] of aging, rather than a treatable illness, are common," says George S. Zubenko, MD, PhD. Zubenko is a professor of psychiatry and biological sciences at the University of Pittsburgh School of Medicine.

A study that Zubenko conducted a few years ago suggested that older, depressed blacks responded better to antidepressants than whites. But further investigation found that, unlike whites with depression, the majority of blacks were never even treated for their depression until they required hospitalization.

Zubenko says that both patients and doctors may attribute signs of depression -- such as decreases in mood, interest, energy, sleep, and concentration -- to age-related medical conditions. "This contributes to the underdiagnosis of depression," he says.

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It's a hidden crisis and it's killing more young black men then ever. Suicide is a taboo subject among many cultures, but the denial of mental health disorders runs rampant among African Americans. Between 1980 and 1995, the suicide rate of black males doubled to about eight deaths per 100,000 people. The authors of a new book are uncovering an unspoken crisis in the African American community.

It was 1979 but Amy Alexander remembers the day like it was yesterday.

 "He was just very wonderful," recalls Amy Alexander, author of Lay My Burden Down" I looked up to him. I admired him."

She was just a teenager when her brother Carl took his own life. Still reeling from the tragedy, Amy teamed up with renowned Harvard psychiatrist Alvin Poussaint to dispel the myths of suicide among the black community.

"It is very much a misperception that black people don't commit suicide and that comes in part from a need the very real and legitimate need for black people for many years to be very strong," says Alexander.

"They see mental disorder and depression as a sign of personal weakness or moral failure," says psychiatrist Alvin Poussaint, M.D. of the Harvard Medical School.

The suicide rate among black men has doubled since 1980 making suicide the third leading cause of death for black men between the ages 15 and 24. Poussaint calls his own brother's death from heroin abuse a slow form of suicide.

"Psychologists and psychiatrists have to pay attention to those types of behaviors and look at them in a context in the same way they would look at someone who, in fact, was depressed or maybe suicidal," says Poussaint.

Like others, African Americans may display depression through physical symptoms like headaches and stomachaches and may complain of an aching misery.

"There must be an increased awareness about the unique aspects of mental health in black Americans."

Doctor Poussaint says one reason African-Americans may not seek out professional help is because only about 2.3% of all psychiatrists in the United States are African American. Amy feels it's important that culturally sensitive training become a part of the standard mental healthcare education process. She emphasizes mental health problems are often physically related and can be treated through talk therapy or through medication.

STARTLING STATISTICS:
Between 1980 and 1995, the suicide rate among black men doubled to nearly 8 deaths per 100,000 people. Suicide is now the third leading cause of death among black men between the ages of 15 and 24.

SILENT SITUATION:
Despite this increase in numbers, the topic of suicide is still considered "taboo". While this is true nationwide among all groups, Alvin Poussaint, M.D., a Harvard psychiatrist, says the stigma is even stronger in the black community. One problem, he says, is the stigma associated with depression itself. More than 60 percent of black individuals don't see depression as a mental illness, which makes it unlikely they will seek help for it.

Dr. Poussaint says it goes back to the days when blues music was invented as a way to sing about pain and distress. He says blacks just consider it part of life. He also says blacks pride themselves on being strong after surviving 250 years of slavery and years of segregation and discrimination. Depression, then, is seen as a sign of weakness.

OVERCOMING THE PROBLEM:
Dr. Poussaint says the first step to help is public awareness. He says, "You can't prevent illness or suicide if you don't talk about it and gain some knowledge about it." Along with this, he says education about the warning signs of suicide is needed. These signs include:

• Irritability
• Changes in appetite
• Changes in sleep habits
• Headaches, stomach aches, pain all over
• Chronic fatigue - not wanting to get up in the morning
• Sadness that continues for up to a month - spontaneous crying
• Social withdrawal - a loss of interest in activities and things once considered enjoyable

SLOW SUICIDE
Dr. Poussaint also talks about what he calls "slow suicide." This is other self- destructive behavior that can accompany depression. This includes drug addiction, alcohol addiction, gang involvement, and other high-risk behaviors.

GET HELP
Dr. Poussaint says if these characteristics describe you or anyone you know, get help. Don't deny the problem. He says, "It is not a moral weakness, and it doesn't mean you are less of a person because you reach out for help."

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Or for a crisis center in your area, go here.

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Your daughter's seemingly healthy eating habits could be masking a deadly eating disorder

At her cousin's wedding, Melissa, 14, looked around at the female guests and imagined what the kids at school would say: What a bunch of porkers. "Right there," says Melissa, who was teased for being slightly overweight in junior high school, "I decided I was going to be different."

As she entered high school, Melissa became a vegetarian to cut the calories and fat her family's meat and fried food diet was heavy on. People praised her slimmer appearance as well as her self-discipline in following such an apparently strict diet. Melissa continued to lose weight, believing that the slimmer she became, the more she would impress people. But by the following spring, it was obvious to everyone but Melissa that she had crossed a line and become anorexic.

This is not to say that every girl who decides to go veg is headed for an eating disorder. "For most teens, becoming vegetarian is a healthy choice," says Judy Krizmanic, author of Teen's Vegetarian Cookbook (Viking, 1999). But as with any significant change a child makes, the parents must be sure she's doing it correctly--and with the right motivation. "Wanting to be healthy, being concerned about the environment or animals are all good reasons," says Nancy Logue, Ph.D., director of the Renfrew Center, an eating disorder clinic in Philadelphia. "But when a lifestyle is pursued to extremes, or extreme behavior becomes attached to it, there's potential for a serious problem."

Anorexia, a pathological fear of weight gain that leads to excessive weight loss, often manifests itself with an obsessive-compulsive personality. Vegetarianism is not simply a lifestyle choice for an anorexic girl. What and how she eats become the daily yardstick by which she measures her worth. Common beliefs among anorexics include, "If I'm a good person, I can have five extra bites at dinner" and "I'm a strong person because I can eat less than other People. Everyone else is weak."

A report in the Archives of Pediatric Adolescent Medicine (August, 1997) analyzed how teens hide eating disorders behind the healthy facade of vegetarianism. The study found that while veg teens ate more fruits and vegetables than their omnivorous peers, they were also twice as likely to diet frequently, four times as likely to diet intensively and eight times as likely to abuse laxatives--all behaviors associated with eating disorders.

The National Association of Anorexia and Associated Disorders estimates that more than 8 million Americans suffer from full-blown eating disorders and that 86 percent of them develop the problem before age 20. While anorexia is relatively rare, occurring in just 3 percent of women, its eating disorder health problems and complications can be dire. "It has the highest mortality rate among eating disorders," says Monika Woolsey, M.S., R.D., editor of the After the Diet Newsletter (www.afterthediet.com) and author of American Dietetic Association book Eating Disorders: Putting It All Together.

One reason eating disorders begin in adolescence is because those years are a time of intense pressure--from friends, parents, teachers and society. A key developmental issue for teens is identity, and they begin to struggle with questions like Who am I? and Where do I fit in? According to Amy Tuttle, R.D., L.S.W., director of nutrition services at the Renfrew Center, "Young girls are looking outside of themselves for the first time for guidance on identity, and what do they see? That they are supposed to be thin. That women are supposed to have petite needs." To have a strong appetite--for food, competition or recognition--is still largely considered unfeminine in our culture. For girls, the external pressure to be thin and popular combines with an internal drive to excel and be perfect and makes them especially vulnerable to anorexia. (Not surprisingly, 90 percent of all anorexics are female.) According to the Renfrew Center, 53 percent of American 13-year-old girls are already unhappy with their bodies. And researchers have found negative body images among girls as young as 9.

Growing Needs

Teenage girls usually don't shoot up six inches over a summer the way boys often do, but they still need nearly as much food to fuel their growing bodies. And they need the right mix of calories, notes Tuttle. In general, girls aged 11 to 18 need 2,200 calories a day--more if they're physically active. Of that, 40 to 50 percent should come from carbohydrates, 20 to 30 percent from protein and no more than 30 percent from the good fats found in olive oil, avocados and nuts. "Teenage girls should also get plenty of calcium, iron, zinc and vitamins D and [B.sub.12]," says Tuttle. Here's what the National Academy of Sciences recommends your daughter take in every day:

Calcium 1,200 to 1,500 milligrams (mg.)

Nondairy sources include broccoli, legumes, seeds, leafy greens like kale, collards, mustard and bok choy, and calcium-fortified foods.

Iron 15 to 18 mg.

The best sources are from the dried bean family, which includes lentils, lima and kidney beans. To enhance absorption, include vitamin C-rich foods like cantaloupe, broccoli and tomatoes with your meals.

Vitamin D 800 international units (IU)

Getting 15 minutes of sun exposure without sunscreen, two to three times a week, will allow the body to make enough on its own.

Vitamin [B.sub.12] 3 micrograms (mcg.)

Sources include fortified breakfast cereals, soy milk, veggie burgers, eggs and dairy products. Although seaweed, algae, spirulina and fermented products (like tempeh) contain [B.sub.12], it is a form that is not easily assimilated into the body. Supplements are another good source.

Zinc 15 mg.

Found in whole grains and whole-grain breads. Grains lose zinc when processed to make refined (white) flour.

A Healthy Start

It's just as important to provide your daughter with a supportive environment as it is to educate her on good nutrition.

* Be a good role model. Becoming a vegetarian should be enjoyable. Emphasize that a balanced diet has room for treats and that there's no need to deprive oneself.

* Be aware of your own prejudices toward overweight or thin people that may fuel her insecurity. "One of the most effective things we can do is to stop judging people by what they eat and what they look like," says Woolsey.

* If other family members eat meat, create vegetarian nights for everyone. Let your daughter decide what the menu will be and let her help you cook it. This will connect her to healthful food and teach her to be responsible for her new lifestyle.

* Compliment her on her skills and attributes, not her size or weight.

* Don't compare her with others, whether it's about appearance or schoolwork.

Warning Signs

People often lose some weight when they go veg because they're still learning how to eat healthfully. If you notice some of the following symptoms, however, your daughter may have a problem.

* Continued weight loss after the first two or three months of being vegetarian.

* Distorted body image. She repeatedly comments that she's fat or still needs to lose weight, even if she's thin or of a healthy weight.

* Regularly skipping meals or denying she's hungry.

* Complaints about feeling bloated or nauseated when she eats normal portions.

* Elimination of other foods besides meat, especially those that contain fat, like peanut butter, tofu, soy meat substitutes, breads, pasta and other nutritious foods.

* Ritualistic behavior. "Anorexics typically eat their food in a specific way, whether it's eating in a circle around the plate or cutting everything into several tiny pieces to make the food last," says Woolsey. "Or they may refuse to eat if food isn't served exactly on time."

* Compulsive calorie- and fat-gram counting. "It's hard to tell the difference between someone who's trying to educate herself and someone who's become obsessive," says Woolsey. But sometimes it's Obvious. "One of my patients spent over an hour choosing a salad dressing because she had to read every single bottle in the store."

* Obsessive and/or compulsive behavior. Teem are known for being passionate about whatever interests them at the moment, but it's not normal to spend hours rearranging canned food, setting aside the number of beans she can have that night or brushing her teeth five times a day.

* Frequently weighing herself.

* Thinning hair. She may also grow a layer of downy body hair.

The Right Course

If you think your daughter may be anorexic, the last thing you want to do is broach the subject in an accusatory way. "Focus on the specific behavior that can't be debated and how it makes you, as the parent, feel," advises Woolsey. For example, you might say, "When you only eat a banana and an apple for dinner, I'm scared that you aren't getting the important nutrients you need."

Many teens find that vegetarianism is a safe and appropriate way to assert their own identity. Because an anorexic's identity is pathologically connected to her diet, you need to show her that you respect her. Otherwise, she will only hear blame and criticism and shut you out.

What else you can do:

* Learn everything you can about eating disorders (see "Resources"). Anorexics often go through phases of bulimia (bingeing and purging), so it's essential to know the warning signs for both.

* Pick a good time and place to discuss your concerns. Make sure it's just the two of you and that there are no distractions (such as a ringing telephone) or lingering tensions from a recent argument.

* Offer her the opportunity to talk with a nutritional therapist, one who understands the emotional aspects of eating. Tell her that you want to make sure she has all the right information, so you'd like to hire an expert to work with her. If teens first build trust with a nutritional therapist, they're usually more receptive when the therapist feels it's time to bring in a doctor and/or a psychiatrist.

* The longer anorexia lasts, the more difficult the recovery. Don't be embarrassed to take your daughter to a physician sooner rather than later. A doctor can determine whether she's developing an eating disorder by checking, among other things, her progress on the growth chart and whether her periods have become irregular.

For the most part, becoming a vegetarian is a great way for teens to explore new foods and gain new experiences. As for Melissa, she got the treatment she needed and today is still a vegetarian. However, she continues to struggle against social pressures to be thin and in control of at least one thing--her body. "It's tempting to become alarmed when you hear the facts," says Krizmanic. "But as long as you talk to your teens and provide them with the skills and the resources they need, becoming a vegetarian should be a positive experience."

next: Women, Food and Eating Disorders
~ eating disorders library
~ all articles on eating disorders

Lately, I've had a growing emptiness within me. Not a negative kind of emptiness, but a positive, satisfying, clean emptiness. More like the emptiness of a desert, or a mountain top, or being out at sea, beyond the sight of land. This emptiness comes from a beneficial, healing place—not from loneliness, self-pity, futility, or isolation—but from the spiritual, refining fire of experience.

My life is finally ready to be filled with good stuff—positive relationships, healthy communication, being alive and aware in every moment. I'm like an cup or water jar, empty and clean, anticipating cool, clear, refreshing water. For the first time in my life, I feel like I'm really living and being, rather than just existing and doing, doing, doing.

This sense of emptiness makes me realize how much recovery has helped me unlearn. Learning that pain has purpose. That hurt holds a healing paradox. That suffering is never meaningless. That my ego can finally surrender and deflate and simply accept, waiting silently to see what God wills to do with this life.

Like that line from Psalm 23, "my cup runneth over . . ." I first had to be emptied of ego and self, before I could be filled.

Thank you, God, for the clean, emptying grace of recovery.

next:Letting Go of Perfectionism

Made a decision to turn our will and our lives over to the care of God as we understood God.

Step Three was a long, heavy sigh. The weight of a dead man lifted off my heart and my mind. My life began fresh, clean, and new. I experienced what some would probably describe as a religious conversion. But I like to say a spiritual awakening, using the words of the program.

My life was a wreck. With the help of my therapist, I discovered and took responsibility for the choices that brought me to that low point. This is what recovering people call hitting bottom.

What had I done? You name it. I'd managed to exile from my life everyone who mattered to me most. My wife, my children, my parents, my in-laws, my co-workers.

How did I do it?

By advising them how to run their lives. By shaming them. By ripping off their masks and betraying their vulnerabilities. In a thousand ways, I emotionally and psychologically hurt and devalued those closest to me in the name of love and care. I was a pro at chasing people out of my life. I couldn't understand why no one appreciated my efforts to help them see "reality" as I saw it. So I ranted and raved. And of course, my perspective was 20/20, perfect, right, and everyone else's was myopic, misguided, immature, etc. There was absolutely no tolerance for any perspective but mine. There was absolutely no questioning the infallability of my own thinking.

All this was my way of denying my feelings. Of avoiding pain and loneliness. Of avoiding fear and risk. Of seeking to make everyone dependent on me so I would never be abandoned.

The result? I found myself utterly alone, out of work, out of money, out of the house, separated from my wife of 12 years, and out of the church.

For the first time, I was face-to-face with my feelings. Fully conscious of my pain. Totally alone. Full of self-pity, anger and rage. Scared and frightened of being completely on my own. Aware that no one was dependent upon me for anything; they all wanted independence from the tyrant I'd become in their lives. Everyone gladly abandoned me in favor of positive, encouraging, uplifting family and friends.

I wanted out of my body, out of my life, out of my head.

By God's grace, I realized (and am still realizing) all the damage I'd done. When there was absolutely no one left in my life, I was left only with my unknown self. And I was miserable. Even I couldn't stand me. I'd denied the real, inner me for so long, I had no idea who I was. I was a shell of a person, a being created from my own insane thinking and acting.

Fortunately, I had been brought up to believe in God. I was in therapy at the time, and my therapist, also a "believer" was just as exasperated with me. He could not break through my defenses, so he suggested I try a CoDA meeting. I went to a particular meeting for about two months, but then it disbanded. I tried another. This one opened my eyes. Step One and Two followed soon thereafter.

God brought me to the point of despair for my own good. When there was no one else to whom I could turn, the only decision I could make was Step Three.

I decided to abandon my way and my will in favor of God's way and God's will. After all, I was convinced that 33 years was enough time to prove whether I was right, and I was now convinced of how wrong I had been. I was ready to honestly admit: "My way does not work. I am ready to try another way. I am ready to be shown the way. I am willing to relinquish the fantasy-control of my life and be a follower. I am ready to let go of my self and my way."

In that moment, a self-directed life became a God-directed life.

next: The Twelve Steps of Co-Dependents Anonymous Step Four

Rachel and her cheerleading team practice three to five times a week. Rachel feels a lot of pressure to keep her weight down - as head cheerleader, she wants to set an example to the team. So she adds extra daily workouts to her regimen. But lately, Rachel has been feeling worn out, and she has a hard time just making it through a regular team practice.

You may think you can't get too much of a good thing, but in the case of exercise, a healthy activity can sometimes turn into an unhealthy compulsion. Rachel is a good example of how an overemphasis on physical fitness or weight control can become unhealthy. Read on to find out more about compulsive exercise and its effects.

Too Much of a Good Thing?

We all know the benefits of exercise, and it seems that everywhere we turn, we hear that we should exercise more. The right kind of exercise does many great things for your body and soul: It can strengthen your heart and muscles, lower your body fat, and reduce your risk of many diseases.

Many teens who play sports have higher self-esteem than their less active pals, and exercise can even help keep the blues at bay because of the endorphin rush it can cause. Endorphins are naturally produced chemicals that affect your sensory perception. These chemicals are released in your body during and after a workout and they go a long way in helping to control stress.

So how can something with so many benefits have the potential to cause harm?

Lots of people start working out because it's fun or it makes them feel good, but exercise can become a compulsive habit when it is done for the wrong reasons.

Some people start exercising with weight loss as their main goal. Although exercise is part of a safe and healthy way to control weight, many people may have unrealistic expectations. We are bombarded with images from advertisers of the ideal body: young and thin for women; strong and muscular for men. To try to reach these unreasonable ideals, people may turn to diets, and for some, this may develop into eating disorders such as anorexia nervosa and bulimia nervosa. And some people who grow frustrated with the results from diets alone may overexercise to speed up weight loss.

Some athletes may also think that repeated exercise will help them to win an important game. Like Rachel, they add extra workouts to those regularly scheduled with their teams without consulting their coaches or trainers. The pressure to succeed may also lead these people to exercise more than is healthy. The body needs activity but it also needs rest. Overexercising can lead to injuries like fractures and muscle strains.

Are You a Healthy Exerciser?

Fitness experts recommend that teens do some kind of physical activity every day. In addition, you should take part in at least 20 minutes of vigorous exercise (that's the heart pumping, breathing hard, sweaty kind of workout) 3 days a week. Most young people exercise much less than this recommended amount (which can be a problem for different reasons), but some - such as athletes - do much more. Working out more than once a day is often a warning sign of compulsive exercise.

How do you know if your fitness routine is out of control? The main difference between a healthy exercise habit and people who are exercise dependent is how activity fits into your life. If you put workouts ahead of friends, homework, and other responsibilities, you may be developing a dependence on exercise.

If you are concerned about your own exercise habits or a friend's, ask yourself the following questions. Do you:

• force yourself to exercise, even if you don't feel well?
• prefer to exercise rather than being with friends?
• become very upset if you miss a workout?
• base the amount you exercise on how much you eat?
• have trouble sitting still because you think you're not burning calories?
• worry that you'll gain weight if you skip exercising for a day?

If the answer to any of these questions is yes, you or your friend may have a problem. What should you do?

How to Get Help

The first thing you should do if you suspect that you are a compulsive exerciser is get help. Talk to your parents, doctor, a teacher or counselor, a coach, or another trusted adult. Compulsive exercise, especially when it is combined with an eating disorder, can cause serious and permanent health problems, and in extreme cases, death.

Because compulsive exercise is closely related to eating disorders, help can be found at community agencies specifically set up to deal with anorexia, bulimia, and other eating problems. Your school's health or physical education department may also have support programs and nutrition advice available. Ask your teacher, coach, or counselor to recommend local organizations that may be able to help.

You should also schedule a checkup with a doctor. Because our bodies go through so many important developments during the teen years, guys and girls who have compulsive exercise problems need to see a doctor to make sure they are developing normally. This is especially true if the person also has an eating disorder. Female athlete triad, a condition that affects girls who overexercise and restrict their eating because of their sports, can cause a girl to stop having her period. Medical help is necessary to resolve the physical problems associated with overexercising before they cause long-term damage to the body.

Make a Positive Change

Changes in activity of any kind - eating or sleeping, for example - can often be a sign that something else is wrong in your life. Girls and guys who exercise compulsively may have a distorted body image and low self-esteem. They may see themselves as overweight or out of shape even when they are actually a healthy weight.

Compulsive exercisers need to get professional help for the reasons described above. But there are also some things that you can do to help you take charge again:

• Work on changing your daily self-talk. When you look in the mirror, make sure you find at least one good thing to say about yourself. Be more aware of your positive attributes.
• When you exercise, focus on the positive, mood-boosting qualities.
• Give yourself a break. Listen to your body and give yourself a day of rest after a hard workout.
• Control your weight by exercising and eating moderate portions of healthy foods. Don't try to change your body into an unrealistically lean shape. Talk with your doctor, dietitian, coach, athletic trainer, or other adult about what a healthy body weight is for you and how to develop healthy eating and exercise habits.

Exercise and sports are supposed to be fun and keep you healthy. Working out in moderation will do both.

next: Eating Disorders: 10 Tips for Dads of Daughters
~ eating disorders library
~ all articles on eating disorders

How to get help for yourself or a friend or classmate considering suicide. And how teens may deal with their own emotions after a friend's suicide.

If you have been thinking about suicide, get help right away, rather than simply hoping your mood might improve. When a person has been feeling down for so long, it's hard for him to understand that suicide isn't the answer - it's a permanent solution to a temporary problem. Talk to anyone you know as soon as you can - a friend, a coach, a relative, a school counselor, a religious leader, a teacher, or any trusted adult. Call your local emergency number or check in the front pages of your phone book for the number of a local suicide crisis line. These toll-free lines are staffed 24 hours a day, 7 days a week by trained professionals who can help you without ever knowing your name or seeing your face. All calls are confidential - nothing is written down and no one you know will ever find out that you've called. There is also a National Suicide Helpline - 1-800-SUICIDE.

If you have a friend or classmate who you think is considering suicide, get help right away rather than waiting to see if he will feel better. Even if your friend or classmate swears you to secrecy, you must get help as soon as possible - your friend's life could depend on it. A person who is seriously thinking about suicide is depressed - and isn't able to see that suicide is never the answer to his problems.

Although it is never your job to single-handedly prevent your friend from attempting suicide, you can help by first reassuring your friend, then going to a trusted adult as soon as possible. If necessary, you can call your local emergency number (911) or the toll-free number of the National Suicide Helpline - 1-800-SUICIDE. However you go about finding assistance for your friend, you must involve an adult - even if you think you can handle your friend on your own, this may not be the case.

After Suicide: How to Deal With Your Own Feelings

Sometimes even if you get help and adults intervene, a friend or classmate may attempt or commit suicide. When this happens, it's common to have many different emotions. Some teens say they feel guilty - especially if they felt they could have interpreted their friend's actions and words better. Others say they feel angry with the person who committed or attempted suicide for doing something so selfish. Still others say they feel nothing at all - they are too filled with grief. When someone attempts suicide, the people around him may feel afraid or uncomfortable about talking with him about it. Try to resist this urge; this is a time when a person absolutely needs to feel connected to others.

When someone commits suicide, the people around him may become very depressed and even think about suicide themselves. It's important to know that you should never blame yourself for someone's death - you could question yourself forever, which will only make you unhappy and won't bring your friend back. It's also good to know that any emotion you feel is appropriate; there is no right or wrong way to feel. Many schools will address the problem of a student's suicide head-on and call in special counselors to talk with students and help them deal with their feelings. If you are having difficulty dealing with a friend or classmate's suicide, it's best to make use of these resources or talk to an adult you trust. Feeling grief after a friend commits suicide is normal; it's when it begins to interfere with your everyday life that you may need to speak with someone about your feelings.

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Or for a crisis center in your area, go here.

next: How to Handle A Suicide Threat - For Teens
~ depression library articles
~ all articles on depression