In a previous essay (The Four Questions), I suggested that the four questions - "Who am I? Do I have any value? Why doesn't anybody see or hear me? Why should I live?"---were answered by young children on the basis of the subtext of the parent - child relationship. Children are adept at reading between the lines. Consider this situation: a mother comes home from work, says "I love you," to her young children, tells them to watch television, then goes into her bedroom for an hour and shuts her door. She then comes out makes dinner for the kids, doesn't sit with them, but asks how school was ("fine" they say) - and an hour later makes dinner for herself and her husband. After the couple's dinner, she helps the children into their pajamas, sits on each of their beds for thirty seconds, kisses them, says how much she loves them, and then closes the door. If you asked the mother, she might say she felt good about the interaction with her children - after all, she said she loved them twice, cooked dinner for them, and sat on each of their beds. This is what good parents do, she thinks.

And yet, the subtext is quite different. The message the children receive is: "You are not worth spending time with. There is nothing of value inside of you." Children want to share their experience of the world, and to know that this experience matters, but in this case they are stymied. They do not consciously think about or ask the four questions - but they secretly absorb the answers, and the answers shape their sense of who they are and deeply influences how they interact with others. Damage can be done no matter how many times they hear the words: "I love you," or see other token displays of affection. Of course this kind of parent-child interaction may be a one-time affair: perhaps the mother was sick, or had a terrible day at work - these things happen. But often, this level of interaction is habitual and consistent - and may start the day the child is born. The message: "You don't matter" is deeply embedded in the child's psyche, and may even predate the child's capacity for speech. For children, subtext, which they perceive as genuine, is always far more important than text. In fact, if the subtext is affirming, words hardly matter. (My 15 year old daughter Micaela and I have always shared a "I hate you" before going to bed because we know the words are the furthest thing from the truth--irony and word play is part of our very special relationship--see the essay "What is a Wookah?")

What do young children do with these hidden messages about their worthlessness? They have no way of expressing their feelings directly, and no one who can validate their existence. As a result, they have to defend themselves in any way possible: escape, act out, bully other children, or try to become the perfect child (the chosen method is probably a matter of temperament). Rather than feeling the freedom of being their own unique self, their life becomes a quest to become someone, and to find a place in the world. When they don't succeed, they experience shame, guilt, and worthlessness. Relationships serve the purpose of finding a place and validation rather than experiencing the pleasure of another person's company.

Inadequate answers to the four questions are not resolved when a child reaches adulthood. The goal remains the same: prove anyway possible that "I am someone of substance and value." If a person finds success in career and relationships, the questions can temporarily be put aside. But failures bring them out, once again, in full force. I have seen many deep, long-lasting depressions resulting from inadequate answers to the four questions, triggered by the loss of a relationship or a job. For many people there is no overt childhood abuse or neglect - instead, powerful hidden messages or subtext that placed the child-turned-adult in the position of having to defend their very existence. They were simply neither seen nor heard, but had to enter their parent's lives on terms other than their own. This is a condition, described elsewhere in these essays, called "voicelessness."

Therapy for the "voiceless" involves addressing the original wound. In the therapeutic relationship, the client learns they are indeed worth spending time with. The therapist facilitates this by encouraging the client to reveal as much as they can, by valuing the client's voice, and finding what is special and unique in them. However, the popular notion of therapy as an intellectual process is an oversimplification - over time a benevolent therapist must find his or her way into the client's emotional space. Often, after some months, the client is surprised to find the therapist with him or her during the day (when therapist and client are not literally together). Some clients will hold conversations in their head with their temporarily absent therapist and receive comfort in anticipation of being heard. Only then does the client realize how alone he or she has always been, and the missing parent (and the hole in the client's life) is fully revealed. Slowly and silently, the internal wound begins to heal, and the client finds, in relationship to the therapist, a secure place in the world and a new sense of value and meaning.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Adult Children of Narcissistic Parents: Is Love Enough?

Find out which antidepressants are safer during pregnancy and how taking antidepressants during pregnancy impacts the baby.

The standard of care when it comes to antidepressant medication treatment during pregnancy is for the doctor to weigh the risks to the mother vs. the risks to the baby. If you are depressed and pregnant, there's a concern you may not have the energy or desire to take care of yourself properly; putting not only yourself at risk, but also the health of your baby.

Research shows that while pregnancy doesn't make depression worse, hormonal changes can trigger emotions that make it more difficult to deal effectively with depression. Pregnant women with depression may not eat right, or they'll smoke cigarettes, drink or use drugs as a way or coping with the depression. This can lead to having a premature baby, developmental problems in the baby and a higher risk of postpartum depression.

Are Antidepressants Safe During Pregnancy?

For many women with depression, antidepressants help relieve depression symptoms, but there are special concerns about taking antidepressants during pregnancy. First you should know that when it comes to taking antidepressant medications during pregnancy, just like any other time, there are no guarantees that it will be risk-free. But current research does show there's a very low risk of birth defects, along with other potential problems for babies of mothers taking antidepressants during pregnancy.

Here's a list of antidepressants and their potential problems if taken during pregnancy:

SSRIs

• Celexa, Prozac (Serafem), : are considered by doctors to be a good option. If taken during the last half of pregnancy, they are all associated with a rare but serious condition called Persistent Pulmonary Hypertension of the Newborn (PPHN), which effects a newborn's lungs.
• Paxil should be avoided during pregnancy as it's been associated with fetal heart defects if taken during the first 3 months of pregnancy.

Tricyclic Antidepressants

• Amitriptyline and Nortriptyline (Pamelor) are considered by doctors to be a good option. Early studies showed risk of limb malformation, but the risk was never confirmed in later studies.

Other Antidepressants

• MAOIs should be avoided during pregnancy.
• Wellbutrin is also considered a good option as research hasn't revealed any risks if taken during pregnancy.

Antidepressant Withdrawl in Newborn Baby

There is evidence that babies born to mothers who take antidepressants during pregnancy often experience symptoms of drug withdrawal shortly after birth. In a 2006 study, about one out of three newborn infants exposed to antidepressants in the womb showed signs of neonatal drug withdrawal, which included high-pitched crying, tremors, and disturbed sleep. It's important to keep in mind though that these symptoms are temporary and disappear once the antidepressants are out of the baby's system.

What may be more important is another major study that came out about the same time as the one above. It showed that pregnant women who stop taking antidepressants run a high risk of relapsing into depression. In fact, they were five times more likely to experience a depression relapse than were pregnant women who continued taking the drugs.

The Decision to Use Antidepressants During Pregnancy...

...is not an easy one. About 10% of women are affected by depression during pregnancy and doctors say that antidepressants are an effective depression treatment option. The American College of Obstetricians and Gynecologists advised doctors in late 2006 to use SSRIs if needed during pregnancy; if the drugs are discontinued and the depression worsens.

If you are suffering from mild depression, therapy, a support group or other self-help measures may help you manage depression symptoms. But if have severe depression or a history of depression, then the risk of relapse may be greater than they risk of taking antidepressants. It's important to speak with your doctor about any concerns you may have.

Sources: The American College of Obstetricians and Gynecologists Committee Opinion: "Treatment with Selective Serotonin Reuptake Inhibitors During Pregnancy," December 2006. Louik, C. The New England Journal of Medicine, June 28, 2007; vol 356: pp 2675-2683. Greene, M. The New England Journal of Medicine, June 28, 2007; vol 356: pp 2732-2734. Alwan, S. The New England Journal of Medicine, June 28, 2007: vol 356: pp 2684-2692.

Instructions to Patients to be Read Before the Patient Leaves His Office
Joseph H. Talley, M.D.

IMPORTANT: These are sample directions (below) given out by one doctor and to be used accordingly. These do not apply to your specific situation or health. Please contact your personal healthcare provider for information on your health, any treatments or medications you may be taking.

Please read the following directions until you are certain that you understand them thoroughly, but call if there are any questions about your medications.

1. The name of your antidepressant medication is circled below. The bold italized names are the chemical names for the brand names listed under them:

1. Antidepressants must be taken regularly, not just when you feel like you need them. In other words, never stop taking the medications because you feel better and think you no longer need them. Stop them only when I tell you. Your treatment with antidepressants will last a minimum of four months.

2. Take your medication all in one dose, and take them about four hours before you intend to go to bed. That will put some of your side effects such as drowsiness while you sleep. There are two exceptions: Trazodone (Desyrel) should be taken right at bedtime with a snack. Fluoxetine (Prozac) should be taken after arising.

3. Most of the good effects of this antidepressant medication will not show themselves for about two-four weeks. Some of the medications will help you sleep right away, but all of the other beneficial effects will be delayed for two-four weeks or sometimes longer. When the medication does begin to work your headaches or other pain will go away. Your tendencies to cry and feel irritable will go away; in other words, you will feel like you are back to normal.

4. When you do begin to feel back to normal, do not stop taking the antidepressant medication. If you do, within three or four days you will feel worse again.

5. It is extremely important that I see you again after the first two weeks of treatment in order to evaluate whether the diagnosis and treatment is correct. Whatever you do, do not stop taking the antidepressant medication until you see me.

6. If anything troublesome happens which you think may be due to the medication, call and let me know what is happening. Many times the problems will have nothing to do with the medication at all. However, it is true that with a few people there may be such reactions as constipation, blurring of vision, delay of urination. or a lot of perspiration. Such side effects are usually temporary and can be controlled other ways.

7. You should be able to work, drive, and carry out your usual activities while taking the medicine. When first beginning the antidepressant, you should use some caution about driving or engaging in other hazardous activity until you see how the medicine will affect you. Usually you can do anything you wish, especially after the first two or three days. If you are too sleepy after that, or cannot sleep, it usually means that we need to change the type of antidepressant to one that gives more or less drowsiness, and I can easily do that by phone. Call if there is any problem.

8. You should be aware that the safety of these antidepressant medications lies in the fact that you cannot hide from troublesome life situations with them. If, for example, you do not have the true medical disease of depression, but instead are only working too hard, you will receive no "energy" from these pills. If you do not have a depression, but instead are simply unhappy with a life situation that would make anyone unhappy, then the pills will give no happiness. If your headache or stomach ache are due to some other disease, the pills won't help. They only work when the disease depression is present, and in that situation they usually give dramatic and gratifying relief to all of the symptoms. Thus you can see the basic difference between these medications and such drugs as alcohol, "uppers", "nerve pills", sleeping pills and the like. These medications cannot be used as an escape from life's problems. and are not habit forming. The antidepressants cannot be used in that way, and that is their greatest safety feature.

Important: This is a sample set of directions handed out by a specific doctor to a specific patient. You are advised to follow your doctor's specific directions and ask your doctor any questions before making any changes in your medications or the way you take them.

next: Assertiveness, Non-Assertiveness, and Assertive Techniques
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Getting through the days, the nights, the meals, the snack times without overeating or starving is a challenge for people with eating disorders.

Often people write or call me to say, "Yes, I keep my journal. I see my therapist. I go to 12 step meetings. I'm learning to be kind and compassionate with myself. But what can I do about the food? Please help me."

What people specifically mean by this plea varies with each individual. But they clearly express their bewilderment and anguish as they attempt to find and develop new attitudes and behaviors toward daily eating.

A long time ago the Buddhists developed a contemplative practice for eating which may be just what these callers are looking for.

Here is my edited version of the five contemplations for eating. I suggest that people with and without eating disorders print them out and read them before eating anything at any time.

Being fully present for ourselves, being fully aware of what we consume and being fully aware of our intention in the moment can help us develop the attitudes and behaviors we need for our well being.

These ancient contemplations may be very helpful in eating disorder recovery. What's more, they may open our awareness to other aspects of our lives that also need healing.

These contemplations were originally written for all of us.

Five Contemplations When Taking A Meal

1. I consider the work required in producing this food. I am grateful for its source.
2. I evaluate my virtues and examine any spiritual defects. The ratio between my virtues and defects determine how much I shall deserve this offering.
3. I guard my heart cautiously from faults, particularly greed.
4. To strengthen and cure my weakening body, I consume this food as medicine.
5. As I continue on the spiritual path I accept this offering with appreciation and gratitude.

Note: Periodically I receive questions about contemplation two and less often about contemplation three. As always, questions and comments inspire me to think, research and write more. Here is my latest thinking on the contemplations. Please feel free to write me with your perspective.

I found these contemplations written on the dining room wall in a Chinese Buddhist temple, Hsi Lai , in Hacienda Heights, California. So some of the phrasing and word choices may relate to translation from Chinese to English challenges and different meanings given to words based on cultural values.

However, here is a way of thinking that may help you understand what the contemplations are getting at.

First, they are contemplations, not rules. They are not meant to be followed like laws. They are meant to be contemplated, at best over a lifetime and at least, over the course of a meal. Different levels of meaning will occur to us over time if we continue to contemplate the words and what thoughts and feelings come up within us over time.

Second, evaluating one's one virtues and spiritual defects is a mighty challenge. When 12-steppers get to the stage of writing their personal inventory they understand how challenging this is. Often when we begin the process of exploring our own defects we can't think of a single one! And just as often, when we try to look deeply into the truth of who we are, we can't think of a single virtue either!

But at least we are looking. We are beginning to examine ourselves.

Later, perhaps in a week or year or more, when we inventory ourselves again, we discover defects and virtues that were invisible to us before.

In this way we become open to the possibility of learning something about ourselves. That openness is what allows us to see what we couldn't see, understand what we couldn't understand, forgive what we didn't know, care about who we are and appreciate the consequences of our actions and attitudes over a lifetime. This contemplation process allows us to open our hearts and minds to the people around us and who were around us in the past and who will come into our lives in the future. We have an opportunity to become free as imperfect beings in an imperfect world where we are surrounded by imperfect others and nonetheless can recognize, give and receive love and respect.

If we think about this deeply, isn't the act of eating a behavior that embodies the giving and receiving of love and respect from one life form to another in order to maintain life force on this planet? This question, if contemplated, may lead us to issues of deep spirituality about which we have been oblivious and yet which concern us every moment of our lives.

So how do we begin to look at our defects and virtues if we don't know how and probably wouldn't recognize them if we did see them?

Because I was a visiting professional guest at the Sierra Tucson Treatment Center in Arizona, I started receiving their Alumni Newsletter, "Afterwords." In their 2002-2003 Reunion issue I came across an article by David Anderson, Ph.D. In his article, "The Eight Deadly Defects of Character," Dr. Anderson addresses the issues you and I are exploring together in this article.

Dr. Anderson made a list combining the seven or eight deadly sins with ten personality disorders and came up with what he calls the Eight Deadly Defects of Character:

1. Dishonesty/lack of authenticity/wearing a "mask".
2. Pride/vanity/need for things to be "my way/need to always be "in control"
3. Pessimism/gloomy disposition/being stuck in a "victim role" (this is closely associated with anger, bitterness and resentment).
4. Social, emotional and spiritual isolation
5. Sloth/laziness/passivity/living the unexamined life
6. Gluttony/unwillingness to self-discipline/need for the "quick fix"
7. Self-debasement/excessive self-denial and self-sacrifice
8. Greed/lust/envy/materialism

We can use his list as a starting place to think about what may apply to us (in different degrees at different times, of course). Contemplation two invites us to think about what virtues and defects are in ascendance in the moment. Any "defects" on the list above will influence how we plan to eat, what we eat, where we eat, how we relate to ourselves and others while we eat, how we feel, think and communicate before, during and after we eat.

Possible considerations:

One way of eating involves receiving with grace, humility, respect and gratitude an offering of life from life forms on the planet that nourish our body and soul.

We may eat well, thoughtfully and with care because we are preparing for a physically or emotionally stressful time and need extra resources in our body.

We may eat well with particular care and consume particular various nutrients even if we don't feel like eating them because we are nursing a child and want to give our baby the most nourishing milk our bodies can produce.

We may eat thoughtfully and with care because we want to keep ourselves well and healthy for our own pleasure and delight and for the pleasure and delight of the people who love us and count on us to be a stable and reliable presence in the world.

Another way of eating involves using food, thinking of it as a device to manipulate feelings (ours or someone else's), to act out feelings or control feelings or change feelings and completely disregard all the value and meaning of the food we are using: e.g. the life that is being offered up, the people and animals who worked to bring the food to us, earth and sky and rain and sun that helped the food come into being, etc.

Another way of eating involves mindless bingeing that could relate to many of the character defects on Dr. Anderson's list, including flight from all of them.

Yet another way of eating is non-eating, using self-sacrificial means to control others and to make up for lack of control in other areas of life. It's using food by wasting it to waste away a body. It's attempting to create a body that is desired because of almost all of the defects listed above. Plus, non-eating is a way to disregard the gifts of life supporting life including the life within one's own physicality.

When a person is bingeing mindlessly does he or she "deserve" the offering from the earth? These are the kinds of thoughts and questions we develop when we contemplate the contemplations.

Contrary to what people seem to believe when they write me about this article, contemplations are designed to remove guilt. Guilt arrives when a person with an eating disorder thinks he or she is doing something wrong and must stop, should stop, could stop but can't stop.

Instead, the philosophy expressed here involves contemplating our behavior and internal experience. The willingness to contemplate, the generosity of spirit that allows room to contemplate, can open our minds, hearts and bodies so that positive changes occur, not from self punishing acts of control, but naturally, organically and at the pace that is just right for individual healing.

Giving thoughtful and regular attention to the ancient contemplations can help us release ourselves from stray remnants of our character defects. When we can maintain a healthy and personal alert awareness of what nourishes life we can we appreciate how we are part of all life and how, by living our lives well, we in turn nourish others. Then we can get through our days, nights, meals, snack times not only with strength and serenity, but also with grace and a vibrant internal joy.

next: Guided Imagery and Eating Disorder Treatment
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I have been a psychotherapist in private practice in Los Angeles, CA since 1980. Many of my patients have struggled with eating disorders, including overeating. Some are brave adults on a particularly challenging healing path as they explore not only their own inner world but also how their way of life may have contributed to the creation of eating disorders in their children.

I'm of the traumatology school, where the eating disorder is viewed not as an illness but as a symptom. The people who find me and stay to do the deep work are often grateful and relieved that we focus on:

• their identity;
• perspectives which influence their decision making and their actions; developing an ability to be clear and functioning in the world while understanding the forces around them.

This focus helps equip them to care for themselves in ways that are far more effective than an eating disorder.

Guided imagery was my first specialty. This study still teaches me about symbols and how we can use a disguised language to work through problems we will not let ourselves know concretely. Dream analysis became part of this study.

This led me to 12 step programs and psychoanalysis simultaneously as I studied the grip of addiction and the power of memory, distorted memory and lack of memory.

Gradually, I began to more fully appreciate the joy and useful personal development opportunities the creative arts and various body awareness practices contribute to emotional healing.

My experiences with patients continually shows me the value and need of speaking directly and to the point concerning specific thoughts, actions and the consequences of both. Studying the cognitive behavioral approach brings a practical and concrete aspect to the day-to-day work of healing.

Recovery from an eating disorder is a complex process. Part of the process is about becoming aware of a more broad perspective and appreciation of the physical, emotional and psychological environment in which we live. I began studying systems theory, boundary issues and the psychological effect of the group on the individual and the individual on the group. This has been helpful in understanding various family dynamics that can contribute to individual suffering and individual healing.

I began a serious and ongoing study of eating disorders, compulsive overeating and bulimia in 1983. This study continues.

I wish you every success in your healing, your research or your attempt to understand and help someone you love. I hope you find your way to your own personal Triumphant Journey.

Joanna Poppink, MFT, licensed psychotherapist, specializing in eating disorders
10573 West Pico Bl. #20, Los Angeles, CA.
(310) 474-4165
email: joanna@poppink.com
website: www.eatingdisorderrecovery.com
blog: www.eatingdisorderrecovery.com

Professional Affiliations Joanna Poppink, M.F.T.

Academy for Eating Disorders (AED)
http://www.aedweb.org/

American Anorexia and Bulimia Association (AABA)

American Association for Marriage and Family Therapy (AAMFT)
http://www.aamft.org

California Association of Marriage and Family Therapists (CAMFT)
http://www.camft.org

International Association of Eating Disorders Professionals (IAEDP)
http://www.iaedp.com/

International Society for the Study of Dissociation
http://www.issd.org

International Society for Traumatic Stress Studies
http://www.istss.org

Sidran Foundation
http://www.sidran.org

Joanna Poppink, MFT, licensed psychotherapist, specializing in eating disorders 10573 West Pico Bl. #20, Los Angeles, CA, (310) 474-4165

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In psychiatric circles, it is known as 'muscle dysmorphia' (an obsession about being muscular) but to the layman it's Bigorexia. (BIG.uh.rek.see.uh) is a mental disorder in which patients - typically men and typically bodybuilders - view themselves through a distorted lens and become obsessed about what they perceive as their physical inadequacies. It's the big brother disease to anorexia nervosa, except that bigorexia is to "huge" what anorexia is to "thin." This is an under-diagnosed condition because, for men, being big is acceptable. It isn't surprising that bigorexia is a growing disorder in gyms and health clubs given the hype about six packs, impressive pecs and large lats. Their muscles may be sculptured, bulging and rippling, yet no amount of persuasion will convince them their body is big enough. Rather than their bodies being thought of as functional machines, they become the objects of hate, resentment, fear and loathing.

No longer are body dissatisfaction and breast implants the domain of women. In a study of over 1000 men, over 50% were unhappy with their bodies and 40% said they would consider chest implants in order to achieve bigger pectorals. When asked to draw their ideal body, the body ideal was so muscular it could only be achieved by taking the risks associated with using anabolic steroids. When fevered by muscle mania, men may use steroids for nine or ten years - sometimes refusing to even take a break from them. 1993 study for the Department of Health looked at 1,300 men in a range of UK gyms and found that 9% were on steroids and GP surveys revealed that one in three doctors had seen steroid takers (i.e. takers that they knew of). Steroid use has long-term risks - potentially damaging changes to the liver, heart and muscles, raised cholesterol levels, possible dependence, mood swings, acne, breasts and "'roid rage". However the common (mis)perception is that, properly taken, they are safe.

At its most extreme muscle dysmorphia can have a devastating effect on men's relationships, careers and social lives.

Do this simple test to see if you suffer from Bigorexia:

• How often do you look at your body in the mirror? (One study found that men with this condition check themselves in the mirror an average of 9.2 times a day with the most extreme checking their reflection more than 50 times).
• Do you think your body needs to be leaner and more muscular? And does it drive you crazy thinking you are too small?
• Do you find yourself reading up on new training methods, diets and supplements?
• Do you eat special high protein or low fat diets or use food supplements to improve your muscularity or to help you bulk up?
• Do you disbelieve people who comment on how big you and find fault with your musculature?
• Do you ever wear baggy clothes because you wish to hide the body you feel is too small? Or do you avoid situations where your body might be seen such as the beach because you think you are not muscular enough?
• Do you still train and work out even when injured because you fear losing muscle mass?
• Do you find it difficult to cut back on the hours spent working out and training?
• Do you compare yourself to other men and feel envious when you see someone bigger than you and find yourself pre-occupied with this for sometime afterwards?
• Do you ever perceive that others are snickering at your puniness?
• Would you rather spend time and energy going to the gym than having sex and/or has your libido taken a dive?
• Have you turned down social events, taken time off work (or passed up on a higher-paying job), had relationship problems or skipped family responsibilities because of your need to work out? *typically men who have bigorexia will say yes to three or more questions

So before any big guys or health clubs get hot under the collar. I'm not saying there is necessarily anything wrong with working out regularly, or being an exercise enthusiast or even a body-builder. But looking in the mirror at 110kg and seeing a weedy weakling and being so consumed with your pursuit of muscle gain that it interferes with your every day life is something totally different. Sadly bigorexic tendencies are exacerbated, not alleviated, by more sessions at the gym. Wanting to be bigger is like running on a road to nowhere, because obsession breeds dissatisfaction. There will always be someone bigger and better.

It is estimated that probably 10% of the men in any hard-core gym have muscle dysmorphia, ranging from mild to crippling and that this figure could be three times as high if sub-clinical statistics were added. The hidden message is that your confidence, your desirability, your sense of being in control and your sex life will improve instantly when you get bigger muscles. However, just as anorexics lose control, so to do bigorexics and paradoxically, women interviewed liked toned muscles, but were put off by huge muscles. Huge muscles reek of self-absorption. Research shows that men's perception of the ideal body is typically around 8 kg more muscular than the stated female preference.

Standards for male beauty are changing, because we are bombarded with imagery in movies and television that portray men as larger than life. Action toys give the message that being mortal just isn't enough. Having super power and super strength is what counts. The muscle definition of chest and biceps measurements of 'GI Joe' and 'Star Wars' male action figures has sky-rocketed. For insecure children picked on and bullied at school, the supposed power exuded by these figurines can be alluring.

Men are catching up on the levels of body dissatisfaction that used to be the monopoly of the fairer sex. Ideas that men shouldn't care how they look have gone. It's no longer acceptable for a man to stand around the braai with a beer belly. What stands out is that what used to be women-talk is now man talk: "I constantly think I'm overweight and go into cycles of eating hardly anything and exercising like crazy. I can't eat sweets or cakes; I go to the gym every day. It takes willpower." Men are buying into the beauty myth, except that instead of being thin - Å“ it's BIG.

next: Eating Disorders: Muscle Dysmorphia
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Pedophiles on the web put your children in danger

Info on internet pedophiles that parents should be aware of

Submitted by request to the
Internet Online Summit:Focus on Children
Washington DC December 1, 1997
by Debbie Mahoney, Founder and Board President,
and Dr. Nancy Faulkner, CEO,
Safeguarding Our Children -- United Mothers

The Internet Allows Pedophiles:

• Instant access to other sexual predators worldwide;
• Open discussion of their sexual desires;
• Shared ideas about ways to lure victims;
• Mutual support of their adult-child sex philosophies;
• Instant access to potential child victims worldwide;
• Disguised identities for approaching children, even to the point of presenting as a member of teen groups;
• Ready access to "teen chat rooms" to find out how and who to target as potential victims;
• Means to identify and track down home contact information;
• Ability to build a long-term "Internet" relationship with a potential victim, prior to attempting to engage the child in physical contact.

Computer technology and the Internet enables pedophiles to locate and interact with other pedophiles more readily than ever before. Although pedophiles luring kids on the Internet is a horrifying problem, the long-term organizational aspects are more terrifying.

The common gathering place and the resultant support child predators are providing each other is probably their most significant advantage, -- and the most troublesome for a concerned public. The computer, a common household fixture, is now a place where pedophiles can go to hear others say, "You're okay and what you're doing is okay; don't listen to the rest of the world, just listen to us."

The ability to receive and offer comfort within the support of their like-minded group reinforces pedophiles with the belief that their attraction to children and adult-child sex are an acceptable way of life.

Child predators are forming an online community and bond that is unparalleled in history. They are openly uniting against legal authorities and discussing ways to influence public thinking and legislation on child exploitation. A group of admitted pedophiles has even developed their creed, "The BoyLove Manifesto."

While pedophile websites are being tracked down and removed from Internet servers in countries all over the world, they are still easily finding ways to post websites, webrings, forums and chat rooms. Recent online topics have even focused on fundraising efforts and plans to purchase a dedicated server for their websites.

It is easy to find and read messages between pedophiles supporting adult-child sex. It is also increasingly common to observe pedophiles in chat rooms promoting one another to move forward with advances on new victims and their families, -- in what they define as "loving relationships."

The advancement of Internet technology allows pedophiles to exchange information about children in an organized forum. They are able to meet in "online chat rooms" and educate each other. These online discussions include sharing schemes about how to meet, attract, and exploit children, -- and how to lure the parents of their victims into a false sense of security about their presence within the sanctity of the family structure. It has become an online "How To" seminar in pedophilia activities.

Pedophile chat rooms, forums, irc-chat, and newsgroups are filled with information on "their" boys and girls and the "safety tips" that allow the abuse to remain hidden. Some of their Websites have information posted telling children that it is okay to be sexual with adults. It is in direct opposition to the messages advocates, teachers, and parents have been trying instill in our country's children.

The larger the sense of community and support that is offered, the bolder pedophiles have become in their graphic descriptions of sex with and exploitation of children. The added comfort of anonymous email addresses and anonymous surfing is helping pedophiles literally "hide in the open"! They appear to be feeling safe enough in their nicknames to openly relate (and brag about) their stories of child sexual exploitation.

Organized Pedophile Groups

The largest organized pedophile group on the Internet is the Man/Boy Love. That is not to say they are the only ones, just that they indeed do have the largest community. Their website community is entitled "Free Spirits."

Within the "Free Spirits" Internet community are pages of links to other Websites, that include:

• Personal Pedophile Web Pages
• BL IRC Channels
• Pedophile Organizations
• Pedophile Web Forums
• Pedophilia History
• Documents that support the pedophile viewpoint.

"Free Spirits" also provides links to non-pedophile children's organizations and child protection Websites, like:

• Adoption
• Boys and Girl Organizations
• Boy and Girl Fan Clubs
• Child Sites, and many more.

NOTE:
None of these pedophile pages are blocked by current software.

"A Brief Overview of Pedophiles on the Web"
is proprietary to D. Mahoney and Dr. N. Faulkner, © 1997.
Not to be copied or reprinted without express writen consent.

next:  The Relation Between Depression and Sexual Abuse, Violence, PTSD
~ all abuse library articles

A relationship breakup can produce intense feelings, but they are normal reactions to the end of a relationship.

The following are common, normal feelings often experienced when a relationship ends.   There is no right or wrong feeling to have - we each react to the end of a relationship in our own unique way.

• Denial. We can't believe that this is happening to us. We can't believe that the relationship is over.
• Anger. We are angry and often enraged at our partner or lover for shaking our world to its core.
• Fear. We are frightened by the intensity of our feelings. We are frightened that we may never love or be loved again. We are frightened that we may never survive our loss. But we will.
• Self-blame. We blame ourselves for what went wrong and replay our relationship over and over, saying to ourselves, "If only I had done this. If only I had done that".
• Sadness. We cry, sometimes for what seems an eternity, for we have suffered a great loss.
• Guilt. We feel guilty particularly if we choose to end a relationship. We don't want to hurt our partner. Yet we don't want to stay in a lifeless relationship.
• Disorientation and confusion. We don't know who or where we are anymore. Our familiar world has been shattered. We've lost our bearings.
• Hope. Initially we may fantasize that there will be a reconciliation, that the parting is only temporary, that our partner will come back to us. As we heal and accept the reality of the ending, we may dare to hope for a newer and better world for ourselves.
• Bargaining. We plead with our partner to give us a chance. "Don't go", we say. "I'll change this and I'll change that if only you'll stay".
• Relief. We can be relieved that there is an ending to the pain, the fighting, the torment, the lifelessness of the relationship.

While some of these feelings may seem overwhelming, they are all "normal" reactions and are necessary to the process of healing so that we can eventually move on and engage in other relationships. Be patient with yourself. It may also help to talk your feelings over with someone. Speaking with a counselor or therapist can often give us perspective.

For adults with ADHD, career choices may be based not only on skills but how a job fits with our ADHD symptoms. Here are some things to consider.

For Good Career Choices: Ask 20 Questions

Planning a career is serious business. Money, time, effort and self-esteem go into the process of finding that right career match. How can we maximize the probability of success and minimize the possibility of failure? It isn't by an instant, simple fix of stereotypic generalizations. We need to start with a complete collection of data, and in so doing, ask the following 20 questions:

1. What are my passions...those interests that really "light me up?"
2. What have been my accomplishments thus far?
3. What personality factors contribute to my ease of handling life?
4. What are the specifics that feel as natural and automatic as writing with my dominant hand?
5. What are my priority values that must be considered to feel good about myself?
6. What are my aptitude levels that maximize success?
7. What is my energy pattern throughout the day, week, month?
8. What are my dreams and how do they relate to the real world of work?
9. What are the pieces of jobs that always attracted me and how can those pieces be threaded together?
10. How realistic are my related options in terms of today's job market needs?
11. How much do I really know about the related options?
12. How can the options be tested out, rather than tried out, with the possibility of failure?
13. What special challenges do I have?
14. How do my challenges impact me?
15. How might my challenges impact on the work options?
16. How could the challenges be overcome by appropriate strategies and interventions?
17. How great is the degree of match between the option & the real me?
18. Can we test out the degree of match before pursuing the field?
19. How could I enter and sustain the work environment chosen?
20. What supports can be put in place to ensure long-term success?

Let's examine each of the questions, to see how the information they provide is valuable:

1. Interests:
   As we get older our interests broaden. We become exposed to more of life's experiences and select those that create a spark for us. Yet, most adolescents are asked at 17 to make a decision about what interests them enough to formulate a career! A career counselor can administer an interest inventory that will throw out dozens of options, but the secret to its helpfulness is in the interpretation of the results. There are clues to be gotten from an interest inventory...tiny clues that added to other clues, will weave a trend, an answer, a direction. Just handing someone a list of correlated jobs often "falls flat" in terms of helpfulness.
2. Accomplishments:
   We learn from our successes and from our failures. Accomplishments should be charted to see if there is a pattern that can lend support for a particular career route. Early accomplishments might be simple, yet still demonstrate a quality or talent that has grown with the individual.
3. Personality factors:
   When we are comfortable within our own skin, we do a better job at whatever we attempt. It's helpful to identify how personality factors impact on our day-to-day comfort, in an attempt to move toward those environments that nurture our comfort zones-and away from those that constantly threaten.
4. Natural & Automatic:
   Most people have a dominant hand preference. If we break our dominant hand, we can adjust--but it requires more focus and more energy. Most of us want a certain degree of challenge in our life's work. We want to feel as though we are growing. However, if 95% of our day-to-day tasks felt as unnatural as writing with our non-dominant hand, or if we had to focus with everything we have at every moment, we would likely feel threatened and burn out quickly. If we can feel natural and automatic with the majority of our job tasks, (even 51%) and still interject areas of challenge, then we have found a balance that could cultivate freshness, creativity and growth.
5. Priority Values:
   We want to feel proud when we speak of our life's work. It's important to consider those parts of life that have the greatest meaning and identify them to be incorporated into a career. While we can't always work at our greatest "heart's desire," we also wouldn't want a career that goes against our deepest convictions, values and beliefs.
6. Aptitude Levels:
   As in the discussion of personality factors, comfort is essential in a good career match. If we are working at a job that requires too high or too low an aptitude level for us, the match won't work out in the long run. Aptitude levels can be tested, or assumptions can be made using school achievement scores, aptitude levels and/or past performance in various subjects.

1. Energy Pattern:
   Charting an Energy Pattern is an enormously useful tool in assuring a good career match. While everyone tends to have times when they are more "tuned in" than others (i.e., "I'm a morning person," or "I do my best work in the wee small hours...") charting an Energy Patterns goes far beyond that. It includes charting one's degree of energy (rating on a scale of 1-10) 3 times a day for at least a month. The results can be surprisingly helpful to learning to harness energy when it's there--and plan more "automatic" tasks for when it is not there. Particularly with adults with ADD, gaining predictability is an essential part of the career development process.
2. Dreams:
   Our dreams need not be taken literally. If I dream of being a fireman, I may or may not find that a good career match. But, there are clues from our dreams that add to the process. If adventure and physical activity are both things I value and strive for, then I will keep that in mind as I continue to gather my facts.
3. Threading pieces:
   Rarely do we love or hate all aspects of a job. It's more often the case that there are pieces of jobs that we enjoy or wish to avoid. A very helpful process is going through previous jobs and identifying those pieces and then threading them together to see what type of bigger picture they indicate.
4. Realistic vs. Fantasy:
   If I truly want to be trained to be a circus clown, do I know if there currently is a market for them? If my talents lie in watercolor painting, am I aware of whether or not I can support myself doing that kind of work? I know for sure that I would want to go into something with my eyes open, and not with a fantasy shroud covering reality!
5. Knowing about options:
   Today, it is easy to access valuable labor-market information that can cut down on mistakes in career decision-making. It is estimated that a career can be read about in the library in about 12 minutes. An easy investment in one's future!
6. Testing out options:
   Once we've done the reading and still feel interested in a particular field, it's equally essential to do some testing of the option. We need to place ourselves, physically within the boundaries of where the work is being done. By observing, discussing, volunteering, interning, etc., we are gathering clues that would otherwise never be collected. This step separates the trial-and-error career seekers from those who wish to have more logic behind their final choice.
7. Special Challenges:
   Often in the testing of options, we discover that, while there may be many areas of match, there might also be areas of mismatch. It's important then to identify the mismatch, the degree of mismatch and what might be done to offset it! If it's a disability that results in the mismatch, we'll need to zero in on the extent to which extra support and/or modifications would be necessary. As in previous discussion, if the degree of mismatch is greater than the degree of match, the option is probably not going to prove to be a good one in the long run. Strategies and accommodations are available for consideration, providing the match is otherwise a good one, and the outcome can result in a marketable employee.
8. Individual Challenges:
   One person with ADHD may find that his/her symptoms manifest totally differently from another person with ADHD. Therefore, the next step would be to access the specific "gotcha" areas of the job that runs up against the individual challenge. Since we are all different, the strategy should match the specific person, and not be a stereotyping of someone else.
9. Challenges Vs. Career Options:
   By observing, volunteering, interning, etc., we can often get a good idea of the degree of challenge a disability might provide within a given career option. It might be this step that separates a really exciting career option from one that has the potential to be a constant source of frustration.
10. Strategies and interventions:
    There are dozens of wonderful books that highlight strategies and interventions used by others with similar challenges. These should be tried out in "safe" environments, long before the career match has been chosen, to see if they can provide enough offset power to eliminate the challenge as a barrier to the career option.
11. Degree of match:
    Once there are one or several career options before us, we want to do more than make a pro and con list, for good decision-making. We also want to decide on the degree of match for each option. If there are 23 essential tasks associated with a particular job, and 2 of them don't match with what we are all about, it becomes extremely important to assess the degree of mismatch. It can often be the case that if 23 tasks line up well, but only 1 doesn't...that the one that doesn't is so great a degree of mismatch that the career should not be considered. This step must be dealt with carefully and skillfully.
12. Test out:
    To begin with we stated that we want to minimize the possibility of failure and maximize the probability of success. This "test out" step cannot be skipped for that reason. Testing out can simply mean working as a volunteer in a place LIKE the one you'd like to work...just to see if it works. If all the other steps have already been done, the number of times that this step produces a surprise negative is very small...compared to not using a structured method of career decision-making.
13. Enter & sustain:
    If we have tested out the career option, we have also already made some contacts into the field. Therefore, entering the field becomes much easier than one who tries to "knock on doors from the outside." To help sustain employment, all areas of perceived mismatch should be identified, along with strategies, accommodations and modifications, if necessary. Remember to be sure that the majority of the job is a comfortable, non-threatening environment.
14. Supports:
    Today, more than ever before, career counselors, therapists, coaches and other professionals lend support for the career seeker to continue to grow within the field. There is no shame in seeking support. If talented basketball players require coaches to help them achieve their best, why not career-seekers? Such supportive interventions can be behind the scenes and no one else need know of it. It's the wise career person who identifies his/her needs and seeks them!

Planning a career is serious business. But it isn't a difficult business. It requires that we agree to as much effort put into it as we do in what we choose to wear! It requires that we find a process that works for us. It requires that we gather as much data about what makes "us tick" as we can gather in order to make the best decisions possible! Put the time in. You're worth it! For really good career choices, ask 20 questions.

Adapted from the book by Wilma Fellman. (2000). Finding A Career That Works For You. Specialty Press

next: Majority of Business Owners Exhibit ADHD Characteristics
~ adhd library articles
~ all add/adhd articles

Thorough discussion of treating depression in women, the different types of treatments, and treatment of depression during pregnancy and postpartum.

Although having depression has become more acceptable, many women still feel stigmatized by the disorder and do not seek treatment. Others don't recognize the symptoms of depression in themselves.

Symptoms of Depression in Women

• No interest or pleasure in things you used to enjoy
• Feeling sad or empty
• Crying easily or crying for no reason
• Feeling slowed down or feeling restless and unable to sit still
• Feeling worthless or guilty
• Weight gain or loss
• Thoughts of death or suicide
• Trouble thinking, recalling things, or focusing on what you're doing
• Trouble making everyday decisions
• Problems sleeping, especially in the early morning, or wanting to sleep all of the time
• Feeling tired all the time
• Feeling numb emotionally, perhaps even to the point of not being able to cry
• Persistent headaches, digestive disorders, chronic pain, or other physical symptoms

When seeing your doctor or mental health therapist for a diagnosis of depression, it is important for the specialist to try and identify any relationship between depression and menstruation, pregnancy, the postpartum period or the perimenopausal period. A possible relationship between depression and medications such as birth control pills or agents used in hormone replacement therapy must also be explored. If there is a link to any treatable cause of depression, it should be addressed first. If your depression does not respond to this intervention, further treatment is required.

Treating Depression in Women

If you are depressed, it is important to seek treatment from your doctor other other mental health professional. There are many effective treatments for depression. The goals of the treatment of depression include treating the symptoms as well as addressing the psychological, social, and physical issues that may have contributed to its development.

The two most common approaches to treating depression are psychological treatments and antidepressant medications. If your depression is mild, psychological treatment alone may improve symptoms. However, in most cases a combination of therapy and antidepressant medication is recommended. Exercise and relaxation therapies, for example, yoga, Tai chi, and meditation will be also helpful in recovering from depression.

Psychological Therapy for Depression

There are various types of psychological treatments that your healthcare professional can discuss with you. The treatments will involve seeing a trained therapist for several sessions over a period of time. Some people may feel uncomfortable about this form of treatment as it involves revealing personal details to a healthcare professional and it carries a certain social stigma in our society. However, psychological treatments have been proven very beneficial in treating depression and reducing the risk of relapse.

The two most common types of psychological treatment for depression are:

Cognitive-behavioral therapy

Cognitive behavioral therapy involves seeing a therapist to understand how your thoughts and behaviors are linked. In cognitive behavioral therapy, techniques such as goal setting, problem solving, and keeping a diary of thoughts and emotions are used. Such techniques help you learn about your thought processes and how to change them as well as your response to them.

Interpersonal psychotherapy

This type of therapy involves seeing a trained psychotherapist in order to gain an increased understanding of your relationships and how they affect your life.

Antidepressant Medications

Medications to relieve symptoms of depression are called antidepressants. They work by altering levels of certain neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. A neurotransmitter is a brain chemical that enables messages to pass from nerve cell to nerve cell in the central nervous system. Many people with depression have low levels of one or more of these neurotransmitters and antidepressant medications help to boost levels.

Selective serotonin reuptake inhibitors are the most commonly prescribed medication in the U.S. for depression, because their side effects are more tolerable and they are safe if taken accidentally in excessive quantities. SSRIs include Prozac, Lexapro, , and Celexa.

Antidepressants sometimes cause mild side effects, some of which may be transient. Common antidepressants side effects include diarrhea, nausea, insomnia, headache, and feeling jittery. Often these side effects are temporary and will resolve within a few days of commencing treatment. One troublesome side effect is sexual problems, whereby people can experience a reduced libido. Bupropion (Wellbutrin XL/XR), which belongs to another class of antidepressants, has common side effects that include headache and an appetite-suppressing effect caused by a stimulant ingredient. It is much less likely to cause sexual dysfunction that selective serotonin reuptake inhibitors. Bupropion is not to be used in people with anorexia nervosa or bulimia.

See your healthcare professional to discuss any side effects you may experience or that interfere with your normal functioning, because stopping your antidepressant medication abruptly will worsen side effects.

Self-Help and Lifestyle Changes for Treatment of Depression

Taking care of yourself and making some lifestyle changes may be effective in reducing your symptoms of depression and helping you recover. Some suggested lifestyle and self-care approaches include:

• Eating a healthful balanced diet
• Exercising daily
• Meditation
• Breathing exercises to reduce stress
• Avoiding smoking, drugs and excessive alcohol
• Surrounding yourself with a supportive friends and family
• Making sure you get enough sleep
• Planning pleasant events into your day

Treatment for Depression During Pregnancy and Postpartum Depression

As with nonpregnant women, mild depression in pregnancy and postpartum can be treated with psychological therapies.

If antidepressant medication is required and a woman is pregnant, she should discuss this with her healthcare provider, as some medications carry a risk of affecting the fetus. In rare cases, some antidepressants have been associated with breathing and heart problems in newborns, as well as jitteriness after delivery. However, mothers who stop medications can be at increased risk for a relapse of their depression. This risk needs to be weighed against the risk of the mother's depression symptoms being untreated or getting worse.

Postpartum depression is usually treated with a mixed approach including psychological treatment, antidepresssant medication, and addressing specific issues in the postpartum period, such as sleep deprivation and family stressors. Psychological treatment can be given in group settings as well as individually. Education on looking after the newborn is useful, too.

When deciding on an antidepressant medication, it is important to remember that some medications can be secreted into breast milk and, therefore, may not be the first choice for a breastfeeding woman. However, a number of research studies indicate that certain antidepressants, such as some of the selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants for treating depression and anxiety disorders that includes medications such as Prozac, Celexa, and , have been used relatively safely during breast-feeding. You should discuss with your healthcare provider whether breast-feeding is an option or whether you should plan to feed your baby formula. Although breast-feeding has some advantages for your baby, most importantly, as a mother, you need to stay healthy so you can take care of your baby.

Dealing with Chronic Symptoms of Depression and Relapse

There are various factors that will influence how well a person with depression is treated will respond to treatment and what his or her chances of relapse. Generally, after one episode of depression there is a 50% chance of relapse.

The following factors are important in predicting how well someone will respond to antidepressant treatment.

• Ongoing life stressors as an adult such as relationship or marital difficulties will place an increased burden on the recovery process and will need to be addressed with psychological therapy.
• Major childhood stressors, such as experiences of child abuse, need to be addressed with psychological therapy at the same time as depression is treated with medication to help improve a child's coping abilities and recovery.
• Alcohol abuse and/or drug abuse may need to be treated separately from the symptoms of depression. This can be achieved by seeking specialized drug and alcohol counseling and treatment programs. Alcohol and/or drug abuse is a common comorbidity with depression and the prognosis of depression with this comorbidity is not good.
• Psychiatric comorbidities may be treated in addition to the symptoms of depression itself. Common comorbidities to depression are anxiety disorders, eating disorders, sleep disorders, personality disorders and substance abuse.

In closing, the most important thing for women with depression is to see your doctor for a thorough evaluation and diagnosis, which is then followed by treatment.

next: On Campus: The Doctors Are 'In'
~ depression library articles
~ all articles on depression