All Posts Tagged: children’s mental health

woman using virtual reality headset

The Uses of Virtual Reality in Social Anxiety Treatment

Dr. Rosen and Dr. Spinner recently presented a session on The Uses of Virtual Reality in Social Anxiety Treatment for the National Social Anxiety Center.

View the presentation on The Uses of Virtual Reality in Social Anxiety Treatment.

We Can Help

If you are worried about your child’s social anxiety, discuss your concerns with our clinicians, who specializes in childhood anxiety. For more information, contact us or call us today at 561-223-6568.

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overweight boy eating pizza while focused on a laptop

The Mounting Crisis of Childhood Obesity

Growing up in the United States, we remember our childhoods as filled with fun and games – tag on the playground, sports competitions with friends – a seemingly endless well of energy. Unfortunately, too many kids today are facing a different reality; they’re falling victim to a crisis that’s been mounting for years – childhood obesity.

It’s no secret that junk food and technology are taking over our kid’s lives. At the same time, physical activity has become a thing of the past, leading to a public health crisis that is only getting worse as each year passes. If we don’t take action now, future generations will be faced with even more detrimental effects from the growing childhood obesity epidemic. We can’t afford to wait any longer – it’s time to step up and make a change!

Childhood Obesity Statistics

2022 was the final year of available statistics related to childhood obesity, and the numbers are staggering – it’s a crisis that needs attention. This crisis affects children all around the world, and it’s clear that we need to do something to stop this problem before it gets any worse.

  1. According to the World Health Organization (WHO), a staggering 39 million children under 5 were overweight or obese in 2020. This issue is no longer limited to higher-income countries; it’s now affecting middle and lower-income nations too. Even more concerning is that being overweight or obese is now linked to more deaths across the world than being underweight!
  2. The prevalence of obesity among preschoolers has grown nearly three-fold since 1975, jumping from 5% up to more than 18%.
  3. The Centers For Disease Control And Prevention (CDC) reported that, in the United from 2017 to 2020, an estimated 14.7 million American children – nearly one-fifth of our nation’s kids – between the ages of 2 and 19 were classified as obese.
  4. Obese children are at a significantly higher risk of developing medical issues related to their weight than those who have a healthy weight. In fact, they may be up to five times more likely to have at least one significant health issue by the time they reach 12 years old.
  5. Studies show that obese children often face increased risks for cardiovascular diseases, type 2 diabetes and certain types of cancer into adulthood. There are also psychological effects associated with being overweight, such as depression, anxiety and lower self-esteem.
  6. Additionally, obese children are more likely to become obese adults, which can lead to even more serious medical conditions, like stroke, heart disease, fractures, and other chronic diseases later in life.
  7. It is projected that there will be over 70 million obese children worldwide by the end of 2023, if current trends continue unchecked. This number would represent a 70% increase since 2012.

One of the most important ways parents and caregivers can help children stay at a healthy weight is by teaching them good habits early on. It’s also beneficial if healthcare providers give kids and their parents support and guidance.

Why Is Childhood Obesity Becoming A Crisis?

As with anything, there isn’t just one answer for today’s childhood obesity crisis. Among the contributing factors are:

Unhealthy Eating Habits: Poor eating habits, such as not eating breakfast, skipping meals, consuming too much sugar, and snacking on unhealthy foods throughout the day can all cause weight gain in children.

Lack Of Exercise: Today’s kids are much more sedentary than a generation ago. This is due to increased technology use and it means that children often miss out on important physical activity opportunities that help keep them fit and healthy. If calorie intake isn’t balanced with physical activity, it can lead to weight gain and a higher chance of developing chronic health problems.

Stress: Stressful life situations can cause children to overeat or engage in other unhealthy behaviors that lead to weight gain. They can also create other physical and mental health issues. Without healthy coping strategies, kids may manage their stress by resorting to unhealthy behaviors.

Genetics: Due to genetics, some young people may be more prone to storing more fat than the average person, leading to an increased risk of being overweight or obese.

Not Enough Sleep: Some studies have shown that not getting enough sleep might make kids more likely to be obese.

Medications: Certain medications have been linked to weight gain in children. Be sure to speak with your child’s doctor or a pharmacist about any potential side effects of any prescribed medications and ask whether any lifestyle changes may be necessary while the child is taking them.

How Can We Prevent Childhood Obesity?

Fortunately, it’s not too late to take steps to reverse the obesity trend. To be sure, preventing childhood obesity is a group effort, but it starts in the home.

To reduce the chances of their children becoming obese, parents can take the following steps. They should also check in with their pediatrician regularly to make sure their child’s weight is healthy.

These steps include:

  • Reducing and limiting screen time
  • Regular physical activity, ideally modeled by physically active parents
  • Encouraging the child to drink more water instead of fruit juices and sugary drinks
  • Healthy snack and food choices at home, such as fresh fruits and vegetables
  • Limiting access to unhealthy food options, like high-fat or sugary foods and beverages
  • Creating a positive environment where children feel supported and encouraged to make good nutritional choices
  • Setting bedtime schedules so the child gets enough sleep
  • Talking to kids about nutrition and weight issues in a way that fosters body confidence and self-esteem instead of reinforcing negative attitudes toward weight or size

Pediatricians should screen their patients for risk factors for obesity and provide nutrition education to parents. They should also refer to community resources as needed. In addition, pediatric doctors must counsel parents on creating a supportive home environment and encouraging healthy behaviors in their children.

Schools can also help kids stay healthy by creating and enforcing policies promoting physical activity and healthy eating habits. Nutrition education programs can teach their students the importance of making nutritious food choices and maintaining a healthy weight.

The key to reversing childhood obesity is to get kids involved in their own health from an early age and empower them with knowledge about the benefits of good nutrition and regular physical activity.

If we make small changes in our lifestyles and provide proper guidance and tools at home and in the schools, we can break the cycle of childhood obesity and our children can grow into happy, healthy adults.

We Can Help

If you are worried about your child’s weight and health, discuss your concerns with our pediatric psychologist, who specializes in childhood obesity. For more information, contact us or call us today at 561-223-6568.

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Dr Andrew Rosen

Andrew Rosen, PhD, ABPP, FAACP – The Dangers Of The Media And Outside Influencers

For our October Consult The Expert interview, we spoke with Dr. Andrew Rosen, the founder of The Center for Treatment of Anxiety and Mood Disorders and The Children’s Center for Psychiatry, Psychology, And Related Services. Dr. Rosen has been a practicing clinician for over forty years. As you might expect, he is well-versed in the changes that have taken place regarding mental health challenges over the past four decades. This month, he wanted to discuss something a little different – the breakdown of family and tradition in a culture of influential media and news coverage, along with how this has affected people’s values, mindset, and beliefs.

Dr. Rosen, you talk about a breakdown of family and traditions by the media and the news. What is the media doing to cause this?

After so many years of seeing our clients here at The Center and the Children’s Center, I feel it’s important for people to think about the changes that are happening in our world, especially in the last ten to fifteen years. During this time, there has been a tremendous increase in mental health problems both here at home and across the globe. More people are suffering now than ever.

In psychology, we learn about the biopsychosocial model. This concept says that three aspects – our psychological health, our physical biology, and the social influences around us – are connected. An unbalance in any one of these aspects can affect our health or illness. In my opinion, the social aspect began a dramatic shift in the 1960s and this started the skyrocketing mental health problems we are seeing in our clinic now.

The role of authority figures changed in the 1960s. At the same time roles within the family changed. Until then, dad was out working and mom was home overseeing the house and the children, but that all stopped during the 60s. Suddenly mom was at work, too. Kids became latchkey children and the family stopped connecting.

We have now reached the point where there is an absence of family authority and communication. However, we need authority figures to keep structure and calm in place. If there is no organizing body to oversee us, we experience more personal anarchy and dysfunction.

Additionally, twenty-first century families no longer sit down together or connect with each other at the end of the day. Children no longer get the parental time they need because everyone is so busy. When we relax, we’re on our devices instead of talking with each other.

The result is that parents are no longer passing their values or beliefs onto their children because it is being left up to outside sources. Parents often have no idea what is happening with their children and the kids feel the lack of parental time. This is a huge element of today’s mental health concerns.

When we turn to the media and the internet for answers and information, we may have access to tons of information, but it may not be accurate information. Many times the information we consume has been heavily influenced by the content producer’s opinion and geared to trending buzzwords. In many ways, this information has become a combination of brainwashing and propaganda. And, people are unaware that they are being shaped by it!

We don’t realize how much we are influenced by what we are told or not told, both on a personal and a social level. Rather than having an internal family voice (mom and dad), we now have an external voice (media, internet, teachers) that is forming our beliefs. The voice that guides us isn’t the parent’s; the voice is that of social media influencers, celebrities, sports figures, and other externals. “Home” is no longer the role model; instead it is the “cause of the day” and the voices that are out there in the media and on social media. The end result of this is that we have a greater incidence of mental illness in the world.

For years, we have been told that it would be a better world if we stopped listening to authority and were open and frank in talking about various social topics, yet this hasn’t worked. Every day in our clinic, we see children at risk of suicide, or being admitted to the hospital for attempting it – and at earlier ages than ever before – often at ages 9 or 10!

How do these influences affect family values and beliefs?

As I said, today’s influencers are not mom and dad – they are TikTok and the other types of people and platforms I mentioned. But, really, who are these people? Why do you believe they know so much? Where did they learn what they are teaching? To illustrate: if a celebrity endorses a certain idea and tells everyone that it is the correct way to think, people don’t question where this person got their knowledge or why they are qualified to tell you that they are right and you should listen to them. Why is that?

Part of the problem is that people don’t understand how much their beliefs, core values, and lifestyles are shaped and affected by the things they read about, watch, or listen to. Instead of thinking for themselves and questioning what they are told, they are walking around like robots, parroting back what these influencers have told them.

Furthermore, many views are skewed to a political agenda. For example, the clinicians at our Children’s Center have seen a noticeable increase in children who are coming in to us, confused about their gender orientation or whether they might be gay. Although the gay population is a small percentage of the total population, here in Florida there has been so much news coverage about the legislation surrounding certain laws that the constant media coverage has begun to influence how kids see themselves.

And, this influence isn’t just limited to children. The heightened amount of media coverage over this law has also influenced adults. Since the relentless coverage of this controversial law, we have seen a huge increase in HOCD patients in our treatment center (people who have always identified as straight, but who are now afraid they might be gay). While there is no question that we need to have forward movement and social growth within our culture, taking a topic and talking incessantly about it plants seeds of anxiety in people.

If you look within your own, personal world since the pandemic, I am sure you can see this happening within yourself.

Before covid came on the scene, most of us had no problem with someone coughing nearby or shaking hands with someone without fear. After the unrelenting coverage of the pandemic in the past two years, I’m willing to bet that you have at least some degree of health anxiety. Most likely, you now scrutinize every sniffle or analyze every headache in case you might be coming down with covid. This summer was calmer and news coverage was reduced, so you might have been able to lessen your internal concerns, but with cold and flu season right around the corner, many of us will return to a heightened level of anxiety once again.

Dr. Rosen, what can we do to stop or change this outside influence?

We are being indoctrinated by celebrities, politicians, and other people who have an ax to grind. I am not sure it can be stopped – I think all we can do is be aware of it and try to compensate.

Families must make an effort to talk to their children about how they can be influenced by outside forces. Tell them, “let’s have our own thoughts and discuss our own beliefs.” Ask your kids to talk to you and other family members they are close to about their concerns instead of looking outside the family. Don’t allow yourself or your children to obsessively watch or listen to influencers.

Is there a takeaway or anything else you would like our readers to know?

The takeaway from this is to be aware that this is happening. Please don’t minimize these influences, because this is very serious. The essential thing for parents is to make your voice heard and make efforts to shrink the voice of these external forces.  This isn’t as simple as just putting controls on a computer – you must step up and say, “We are your parents and this is what we want.”

I want parents to understand that they are also vulnerable to this outside influence. Whenever you watch a news broadcast, read a report online, watch YouTube or TikTok, or listen to politicians or others who are pushing their agendas, keep in mind that it’s all about money and clickbait. Stories and videos have to be shocking or entertaining in order to get you to click on them. The more sensational, the more power the media company or influencer gains and the more money they earn. But, as we see daily in our clinic, we pay the price for their power and success with the erosion of our mental health.

We Can Help

If you or someone you love has questions or would like further information about a mental health concern, the professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-223-6568.

About Andrew Rosen, PhD, ABPP, FAACP

Dr. Andrew Rosen received his doctoral degree in clinical psychology from Hofstra University in New York in 1975 and completed an additional six years of psychotherapeutic and psychoanalytic training at the Gordon Derner Institute in New York, where he earned his certification as a psychoanalyst in 1983. In 1984, Dr. Rosen founded the Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, where he continues to serve as Director and to work as a board-certified, licensed psychologist providing in-person and telehealth treatment options. With an impressive clinical career spanning over four decades, Dr. Rosen has helped countless individuals with a wide variety of mental health issues in both inpatient and outpatient settings to reach an improved overall quality of life, to manage daily life stresses, and to restore their relationships with partners, families, and friends. Coupling his psychoanalytic background with more modern schools of psychology, he brings a unique understanding and perspective to the patient’s situation, which results in more comprehensive and thorough treatment planning. In addition to his clinical successes, he has written numerous articles and books and appeared as a professional authority on several television radio shows concerning anxiety and personality disorders and substance-related issues and addiction.

Dr. Rosen is Board Certified by the American Board of Professional Psychology (ABPP). He is also a Clinical Fellow of the Anxiety and Depression Association of America (ADAA) and a Diplomate and Fellow in the American Academy of Clinical Psychology (FAACP). He is an active member of the American Psychological Association (APA), the National Register of Health Service Providers in Psychology, the Florida Psychological Association (FPA), and the Adelphi Society for Psychoanalysis and Psychotherapy. Dr. Rosen was appointed a Clinical Affiliate Assistant Professor at the FAU College of Medicine in November, 2021. He is a Board Member of the National Social Anxiety Center. He has previously served as president of both the Palm Beach County Psychological Society and the Anxiety Disorders Association of Florida.

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Brittany Schulman

Brittany Schulman, Psy.D – Consult The Expert On ADHD

For this month’s Consult The Expert interview, I spoke with Brittany Schulman, Psy.D. She is a licensed clinical psychologist here at the Center and has a special interest in the diagnosis and treatment of Attention Deficit/Hyperactivity Disorder (ADHD).

Most of us have heard about ADHD, but may have only a vague understanding of the condition, so I asked Dr. Schulman to tell us what ADHD encompasses.

“ADHD is a neurodevelopmental disorder that first occurs in childhood,” she answered. “Research has shown that there is a difference in the brain chemistry of people with ADHD, with one of the main brain areas affected being the frontal lobe and specifically, the prefrontal cortex. The prefrontal cortex controls our executive functioning which includes impulsivity, planning, problem solving, and emotional flexibility and regulation. “

“A good analogy for understanding what happens in those with weaknesses in executive functioning is to imagine the prefrontal cortex as the conductor in an orchestra. If the conductor is off on the directions they give to the musicians, the orchestra suffers and doesn’t work in sync. In the same way, a child can have high cognitive skills, but if the prefrontal cortex isn’t regulating these other areas, the result is frustration and behavioral challenges.”

“ADHD is very genetic and we know it runs in families,” she continued. “In fact, between 20 – 35 percent of diagnosed children also have a parent with the disorder. ADHD is more common in boys and is typically first seen in elementary school, when it is often identified as inattention. Difficulty sitting still becomes less visible in ‘tweens and teens, but then we tend to see more restlessness or inability to control impulses.”

So, Is It ADD Or ADHD?

I asked if ADHD is the same as ADD and also why we don’t hear much about ADD anymore.

“Years ago, we had Attention Deficit Disorder (ADD) and there was also ADHD,” she said. “As research has evolved, the most recent version of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) categorized the two diagnoses under the same umbrella, but with different presenting characteristics. As a result, they’ve been combined and are officially recognized as ADHD today, but with three subtypes. These subtypes are ADHD with predominantly inattentive presentation, ADHD with predominantly hyperactive/impulsive presentation, and ADHD, with a combined presentation.”

Dr. Schulman acknowledges that these similar-yet-distinct terms can seem confusing at first, so she broke down the subtypes a little further. “For a child to be diagnosed with predominantly inattentive ADHD, they must meet six criteria in the inattentive category, which includes behaviors like being forgetful, losing things, or frequently wandering off-task. Maybe they fail to pay attention or to sustain it. They may have trouble organizing tasks or may avoid tasks that require a more sustained mental effort.”

“On the other hand, if a child falls into the hyperactive/impulsive category, they must meet at least six criteria from that subtype, such as being restless or squirming a lot, often leaving their seat in class, talking excessively or blurting out answers, interrupting frequently or having trouble engaging in quiet activities. Adults must meet five of the symptoms instead of six to be diagnosed, and children who are diagnosed with a combined presentation must have at least six symptoms each from both categories.”

How Is ADHD Diagnosed?

I asked her what steps are taken to make a diagnosis.

“First, the individual must have displayed some of the ADHD indicators before age 12. Symptoms typically start in the toddler years,” she explained, “but some criteria aren’t generally recognized until age 7 and above – in the early elementary school years when the child is less attentive in class.”

“To be diagnosed, the symptoms have to have lasted at least 6 months and have to have occurred in more than one setting – for example, both at home and at school. This is because being in different settings can change the child’s responses.”

As for the process of diagnosis, Dr. Schulman told me that a comprehensive evaluation is vital.

“Diagnosis is based on a thorough history and observation of the child, plus information obtained from parents, teachers, and others. We observe the child in various settings because kids can often pay better attention in a one-to-one setting or with peers or in play, but may have a hard time in school where more concentration is required. By watching how the child acts in a structured versus unstructured setting, the psychologist can see behavior differences. Another important factor in the assessment of ADHD is looking at the individual’s executive functioning skills, as those diagnosed with ADHD typically have difficulties in executive functioning.”

Is It ADHD Or Something Else?

I asked Dr. Schulman if ADHD can mimic other conditions. “On a surface level, yes,” she answered. “Bipolar disorder, for example, can have impulsive activity, as well as poor concentration and poor impulse control. So, we tend to look at the person’s mood episodes, when they occur, and how long they typically last. For the most part, we do not see the level of mood instability seen in mood disorders in young children with ADHD. Furthermore, the onset of bipolar disorders is typically later than the onset of ADHD.

“Autism is another condition that can co-occur with ADHD, however, a child on the spectrum will often have social differences, in that they may prefer to play alone or have trouble making eye contact. The child with ADHD may misbehave because of impulsivity, but an autistic child may misbehave because there were changes in the expected plan for the day, which is unrelated to an impulsive response.”

“That said, ADHD can also occur in conjunction with other disorders,” she continued. “So, when we are diagnosing a child, it’s important to be extremely thorough with our evaluations and observations to be sure that it is ADHD and not another comorbidity.”

Has Covid Affected ADHD Diagnoses?

I was surprised when Dr. Schulman mentioned that the Covid pandemic has increased the number of children who show signs of ADHD.

“We have had many, many kids come in to our clinic recently, who never had symptoms before the pandemic, but do now. In children, the symptoms of anxiety and depression can look similar to ADHD. A child may be inattentive because they are depressed or because they are worried and ruminating, so we definitely take a deep look to decide which condition is causing the problem.”

“A simplistic way of distinguishing between the two is by understanding that a child with ADHD-related inattentiveness is more easily distracted by new things. In depression, the inattentiveness shows up as having more difficulty concentrating.”

What Happens After An ADHD Diagnosis?

“Depending on what we feel will benefit the child most, they may go on medication after diagnosis. We now have not only the traditional stimulant medications, but also two non-stimulant medications for children who do not have optimal results on stimulants or for those who have side effects due to the stimulants. Medications alone don’t usually help the child entirely, though,” she said.

“Typically they must undergo some form of behavior therapy, as well. Depending on their challenge areas, the child might get executive function coaching, or behavior therapy teaching certain skills. Another important piece is implementing school interventions and putting accommodations in place so the school day is less challenging for them.”

“We will also likely recommend parent training,” Dr. Schulman said. “This is so the parent learns why the child acts the way they do, along with how to work with the child more successfully and to gain more effective ways to help the child’s behavior. For example, most kids don’t want to act defiantly, but sometimes they can only hold it together long enough to get through the school day and then lose it at home, so parent training teaches the parent how to redirect the child’s behavior.”

I asked if a child could be treated for ADHD without the use of medications. “It’s possible, depending on the case and the child,” she answered. “Some kids can possibly do better with just behavior modification. Some people can do better just by learning the skills they need to be successful.”

I had read that an ADHD diagnosis in a child is only valid for five years, so I asked Dr. Schulman why that is. “Actually, we try to have a client come back within two to three years to get an updated diagnosis for school requirements,” she answered. “Also, symptoms can manifest in different ways as a child ages and matures, so this requested intervention can help to reduce any concerns these changes bring up.”

Final Thoughts

When asked if there was one final thing she would like people to understand about ADHD, Dr. Schulman was quick to emphasize that a professional diagnosis is needed before someone labels themselves as having the disorder.

“A lot goes into an ADHD diagnosis and it’s important to have a complete evaluation. You cannot diagnose yourself!” she emphasized. “Some social media laypersons have become popular lately by taking one or two pieces or symptoms and telling you that you may have ADHD, but that is a simplistic way to see the condition. If you are concerned about the possibility of having ADHD, you owe it to yourself to go through an in-depth evaluation to be sure.”

Need More Information?

If you or someone you love has questions or would like further information about ADHD or other mental health concerns, the professionals at The Children’s Center for Psychiatry, Psychology, & Related Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-223-6568.

About Brittany Schulman, Psy.D.

Dr. Brittany Schulman is a licensed clinical psychologist who provides assessment and therapy services to children, adolescents, and adults. Although she specializes in providing evaluations for individuals presenting with an array of concerns, she has a keen interest in anxiety and anxiety-related disorders. During her clinical training, she completed a rotation providing therapy services to individuals with a variety of anxiety disorders including generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, hoarding disorder and specific phobias. Dr. Brittany is known for her ability to be personable, warm, and empathetic towards her clients while creating an environment where they feel comfortable expressing their challenges. In therapy, Dr. Brittany generally works from a cognitive behavioral approach, incorporating mindfulness and ACT techniques into her practice, but tailors each therapy session to every client’s individual needs.

Dr. Brittany completed her doctoral degree in Clinical Psychology at Nova Southeastern University in 2019. She received double bachelor’s degrees with honors in Psychology and Sociology from Florida State University. Dr. Brittany completed her doctoral internship at NSU’s Psychology Services Center specializing in school-related comprehensive psychological evaluations. During her training, Dr. Brittany provided services for individuals presenting with a variety of developmental, behavioral, and emotional challenges including attention and executive functioning, anxiety, depression, and autism spectrum disorders. She has worked in both outpatient and private practice settings. Dr. Brittany completed her post-doctoral residency at Child Provider Specialists in Weston, FL, conducting comprehensive psychoeducational and psychological evaluations.

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Eric Spinner

Eric Spinner, Psy.D – Consult The Expert On Eating Disorders

This month, we talked with Eric Spinner, Psy.D. Beginning in September, he will be working at The Center for Anxiety and Mood Disorders as a Post Doctoral resident.

For the past two years, Dr. Spinner has worked at a residential facility for women, where he treated adolescents to older adults with eating disorders. As a result of this experience, this area of treatment is of special interest to him. “I feel like eating disorders do not get the attention they deserve,” he said.

He pointed out that there are several misconceptions surrounding disordered eating. “Culturally, when we think of eating disorders, we might think of certain body types. For example, one common myth is that people with eating disorders are always very thin. The reality is that an eating disorder is not solely diagnosed based on body type or weight. Someone of average weight, or even above average weight, could be struggling with an eating disorder.”

He’s concerned that this body type misconception could allow the condition to go unnoticed by family or friends – or even by the person themselves. He told me, “The fact is, anorexia nervosa accounts for the smallest percentage of those diagnosed with an eating disorder, whereas OSFED (other specified feeding or eating disorders) and binge eating disorder account for the two highest.”

“When considering an eating disorder diagnosis, it is important to look beyond a person’s weight or body type. Instead, look for the behaviors that cause medical issues. These can be things like extreme dieting and losing a lot of weight in a short amount of time, missed menstrual cycles, and low heart rates.”

What Is OSFED?

Many people have a vague notion of what bulimia nervosa, anorexia nervosa, or binge eating disorder consist of, but what comprises the other specified feeding or eating disorder (OSFED) diagnosis that Dr. Spinner mentioned? “OSFED is basically an umbrella term,” he explained. “It is meant to capture individuals whose eating disorder presentation does not meet the diagnostic criteria for any other eating disorders.”

“individuals with OSFED may present with many of the symptoms of other eating disorders like anorexia nervosa, bulimia nervosa, or binge eating disorder, but will not meet the full criteria for diagnosis of these disorders. This, however, doesn’t mean that the eating disorder is any less serious or dangerous.”

A diagnosis of OSFED can be further specified using some of the following terms:

  • Atypical anorexia nervosa (all of the criteria are met for anorexia nervosa except that, despite significant weight loss, the individual’s weight is within or above the normal range)
  • Bulimia nervosa of low frequency and/or limited duration (all of the criteria for bulimia nervosa are met, except that binge eating and compensatory behaviors occur, on average, less than once a week and/or for less than three months)
  • Binge eating disorder of low frequency and/or limited duration (all of the criteria for binge eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than three months)
  • And purging disorder (recurrent purging behavior to influence weight or in the absence of binge eating).

Dr. Spinner warned that having lesser known diagnosis ,like OSFED, instead of a more defined “label,” such as anorexia or bulimia, can sometimes cause the person to feel they somehow don’t belong or they aren’t really that sick. Conversely, if the person receives an OSFED diagnosis, it can help to ease their anxiety to know that the most common eating disorder is OSFED.

“Don’t get hung up on the diagnosis, though,” he cautioned. “It isn’t always important, for the individual struggling with an eating disorder, or their loved ones, to know the exact diagnostic box that they fall into. What is important is being able to identify that they are struggling in a way that is negatively impacting their daily functioning, along with getting them the help they need.”

No matter which eating disorder diagnosis an individual is given, Dr. Spinner said they will get the correct treatment. “Most of the prominent treatments used with individuals diagnosed with an eating disorder are transdiagnostic, meaning the underlying concepts of the treatment are similar across the various types of eating disorder diagnoses.”

General Eating Disorders Signs To Watch For

When I asked Dr. Spinner what someone should look for if they are concerned a loved one may have an eating disorder, he was quick to respond. “Caregivers should be on the lookout for dramatic behavioral changes, like increased food intake or restriction, extreme dieting, or excessive laxative or diuretic use. A change in the duration or intensity of exercise behavior and increased mirror checking can also indicate a concern.”

“Sometimes an individual might engage in food rituals,” he continued. “This could involve playing with their food, cutting it into very small pieces, or pushing it around on the plate so it looks like they are eating, although they really aren’t. Caregivers should also watch to see if the activity [exercise, food preoccupation, and so forth] is a big topic of conversation or if the person talks in ways that indicate they have a poor body image.”

“Eating disorders are seen as emotional disorders,” he said. “The behavior helps the person avoid or escape the unwanted emotions or situations they don’t want to engage in. These individuals often have more frequent or intense experiences than others, which can be scary. An eating disorder can give them a feeling of control and help them avoid those emotions.”

Because these disorders are so closely linked with emotions, Dr. Spinner said a parent who suspects an eating disorder in their child can begin by asking about the child’s emotional state. “They can say something like, “I notice you seem down or anxious lately,” which can help the child understand the parents are open to talking.”

Treatment For Eating Disorders

Because there are many variables that therapists need to consider, it can be difficult to apply a particular treatment strategy to a particular eating disorder. ”The thing to target may be different from one person to another, so we focus on the different thoughts and behaviors specific to each individual, and treat those. A particular diagnosis can help us know what to focus on, but may not change the person’s treatment exponentially.”

Cognitive behavioral therapy (CBT) is generally used along with other treatment modalities. CBT helps the patient become aware of their unreasonable thoughts and beliefs so they can view the situation more realistically and react in a healthier way. In addition, therapists might use any other therapy that works to address thought change.

Specific Support Strategies For Parents (Emotional Distress Strategies And Meal/Post Meal Strategies)

Dr. Spinner listed some strategies that can be used to help support someone who is going through therapy for an eating disorder, both in general and during and after meals.

Emotional distress strategies (when trying to support a loved one during times of emotional distress):

  • Notice the person’s cues, both verbal and nonverbal. You know them and their characteristics, so you’ll know that being short with you means they are angry or depressed, sighing means they are frustrated, and so on.
  • Help them to label and express their emotions. “You can ask, “How are you feeling? Put it into words.” If they can’t verbalize their feelings, then try saying, “It seems you are feeling like…” or “I thought you might be having…” This can help them identify their emotions.
  • Validate their emotions. Caregivers are encouraged to put themselves in the shoes of their loved ones struggling with an eating disorder to better understand and validate their loved ones’ distressing emotional experiences.
  • Meet their emotional needs and give empathy, support, and comfort.
  • Fix or problem solve. If your loved one can’t resolve the issue on their own, don’t collude with the disorder or try to avoid it. For example, don’t give them one piece of chicken if their recovery meal plan says they should have two, because you send the message that it is okay to disregard the plan or not follow it exactly.

Meal/post meal strategies for someone who is struggling with an eating disorder:

  • People who have eating disorders have intense emotions, so if they get distressed, remain calm to help them calm down.
  • Show compassion and concern and don’t confront them or argue about their eating.
  • Be consistent and confident with the nutrition meal plan given by the therapist or nutritionist (“I know you can do this, it will get easier.”).
  • Refrain from talking about calories or food. Instead, keep mealtime light and enjoyable. Talk about a class the person likes in school or the job or hobby they love.
  • Refrain from talking about a stressor, such as an upcoming exam.
  • Also, it may not be helpful to engage in distracting activities like watching television during meals as it allows them to avoid dealing with the emotions that may come up during the meal, which serves to further perpetuate avoidance behaviors.
  • After each meal, engage in relational activities to get them out of their head. Plan a structured activity for the first 45 minutes to 1 hour (work on arts/crafts, look at photos, do scrapbooking, play games, or work on hands-on projects).  Again, it may not be helpful to engage in distracting activities like watching television after meals as it encourages emotional avoidance.

Final Thoughts

At the end of our conversation, I asked Dr. Spinner if he had one takeaway that he wanted to be sure our readers understood.

“Be aware that an eating disorder can affect anyone – of any size or gender,” he responded. “If the person’s perceived self-worth is tied into weight, size or body image, and it is interfering with their daily life, please encourage them to talk to someone. It is possible for someone to have an eating disorder and not realize they have one.”

We Can Help

If you or someone you love has questions or would like further information about eating disorders or other mental health concerns, the professionals at The Children’s Center For Psychiatry, Psychology, And Related Services in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-223-6568.

About Eric Spinner, Psy.D.

Dr. Eric Spinner is a postdoctoral resident specializing in individual therapy, partner and family therapy, and group therapy across the lifespan. His primary focus is on the treatment of eating disorders, anxiety, and depression. Utilizing a collaborative approach, Dr. Spinner focuses on each client’s strengths, life experiences, and cultural background to address their individual needs, while providing a safe, open, and judgment-free therapeutic environment. He incorporates a variety of treatment modalities, including cognitive-behavioral therapy, acceptance and commitment therapy, dialectical-behavioral therapy, and rational emotive behavioral therapy.

During his APA-accredited Clinical Psychology Doctoral Internship, Dr. Spinner provided treatment at the Renfrew Center for Eating Disorders in Coconut Creek, Florida. There, he obtained extensive experience in treating primary eating disorder diagnoses, including working with individuals, families, and groups, and within various levels of residential, day, and intensive outpatient care. Additionally, Dr. Spinner provided comprehensive treatment of his client’s co-occurring mental health challenges, including anxiety, depression, substance use, trauma, and personality disorders, as well as facilitating numerous group therapy sessions, process groups, and manualized skill-based groups. 

Dr. Spinner earned both his Master’s and Doctor of Psychology degrees in Clinical Psychology from Nova Southeastern University. He graduated from the University of Central Florida with a Bachelor’s degree in Psychology. He holds a certificate in Rational Emotive Behavior Therapy and conducted research into the treatment of specific phobia for older adults during his doctoral training. Dr. Spinner also has clinical experience working at both the Intensive Psychodynamic Psychotherapy Clinic and the Adult Services Clinic at the Psychology Services Center at Nova Southeastern University.


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Darbi Miller, MS, LMFT – Consult The Expert About Increasing Relational Self-Awareness

In this month’s Consult The Expert interview, we spoke with Darbi Miller, MS, LMFT. She is one of the marriage and family therapists here at The Center For Treatment Of Mood And Anxiety Disorders. Although she likes working with all ages, she enjoys the dynamic surrounding family and relationships.

“One of my favorite things to work with is increasing clients’ relational self-awareness,” she said. “I also enjoy exploring peoples’ Families of Origin, which is connected to self-awareness from my perspective.”

What Is Relational Self-Awareness?

What does she mean by “relational self-awareness”? “Family of Origin and self-awareness are related,” she answered. “In any experience with another person, relational self-awareness can look like asking ourselves, “What is mine? What is yours? What is ours?”

“We each have our own stories, beliefs, and experiences,” she said. “Relational self-awareness looks at what each person brings to the table and how this affects the interaction between us. If we are self-aware, we have a compass for ourselves which translates into tolerance. We are able to share our personal values and beliefs and hear the other person’s.”

“If we are not self-aware, our interactions are based in fear. We begin looking for approval or we get defensive because we may feel we will “lose” in some way if we are vulnerable with the other person. When you have self-awareness, however, you can be vulnerable and can create more intimacy in all of your relationships.”

Ms. Miller talked about a Harvard study that has been following certain individuals over an 80-year period. One of the surprising things it has found is that the quality of our relationships has a higher impact on our health than even our cholesterol levels. “It turns out that surrounding ourselves with positive, close relationships creates a better sense of community within ourselves, which in turn, has a better health impact,” she reported.

So, how does relational self-awareness help with anxiety treatment? “With anxiety, behind that is usually fear on a basic level. Our thoughts are powerful. If you can get to the core and understand the fear (how can I feel more connection with myself?), connecting to your body and grounding yourself, allows this to be part of the healing process.”

How Does Family Of Origin Fit Into Mood Disorder Therapy?

Ms. Miller explained how Family of Origin can impact the treatment of anxiety and other mood disorders. “We come from our own system that was learned in childhood. This is the Family of Origin,” she explained. “This system has patterns, beliefs, and values that we can sometimes see, but sometimes aren’t aware of. We all have a family role – maybe we’re the funny one, the responsible one, or the nurturing one. This role can carry into our adult lives and play out between couples.”

“Sometimes people go into a relationship expecting it to heal their Family of Origin wounds,” she said. “Although it can happen that a new relationship can be good and healing, if we enter it expecting our partner to instinctively know what we need to heal, that may not be the case and we’re disappointed. If you are expecting your partner to heal you, where is this coming from? The answer leads back to relational self-awareness.”

How Can We Use These Concepts To Improve Mood Disorders?

We discussed how knowing what we bring with us from our Family of Origin can be used to help when dealing with mood disorders.

“Knowing what you have “inherited” and what you can change can be very empowering,” Ms. Miller told me. “You don’t have to operate out of same system you inherited. You have control. The realization that you don’t have to follow the same patterns – and you get to decide – can help with anxiety and trauma.”

“I mainly use this work for people who feel stuck in their life, work, and relationships,” she continued. “During therapy, my approach is always to start at the top. We begin with something action-focused, like behavior organization, and getting back into routines that can have a positive effect on the person’s mood and decrease anxiety.”

“I also use cognitive behavioral therapy to challenge negative thoughts. Taken together, these give people some relief. But if they are still looking for more, this is when we explore other things like Family of Origin and relational self-awareness.”

“When we look into Family of Origin, we can choose to do the work for ourselves and also within the family roles, with siblings and parents,” she said. “I typically go three levels up within the family to look at the generational dynamic. Doing this work can uncover patterns that influence a person’s mood, narratives, and the core beliefs that influence mood, which can be healing.”

“People want to explore these concepts, but in a safe space,” Ms. Miller said. “So, we balance a safe space with these tools, allowing them to go deeper to uncover the aspects that may be underlying their anxiety, depression, or trauma.”

We Are Here For You

If you are concerned that your child is struggling emotionally or showing signs of anxiety or depression, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

About Darbi Miller, MS, LMFT

Darbi Miller is a Licensed registered Marriage and Family Therapist. She has extensive training in Integrative Systemic Therapy however, does not believe one model fits all. Her approach is strength-based, collaborative, holistic, and geared to meet her client’s specific needs and goals. She works to truly understand each client and the systems that surround them. She believes therapy is a courageous step and feels privileged to bear witness to their journey. Through her authenticity, empathy, and compassion, she provides a safe space for exploration. Darbi works to integrate her knowledge into meaningful and collaborative sessions with individuals, couples, and families. Her areas of interest include walk/talk therapy, the mind/body connection, increasing relational self-awareness, high-conflict couples, and full family work. 

She holds a Bachelor of Arts in Psychology from Michigan State University and a Master of Science in Marriage and Family Therapy from Northwestern University, where she received academic distinction. She is also certified as an Eating Psychology Coach and a Prepare/Enrich Facilitator. Darbi has worked in a variety of settings including schools, hospitals, university clinics, and in-home. She also published an article in the Encyclopedia of Couple and Family Therapy on conjoint sex therapy.

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Lonette Belizaire

Lonette Belizaire, Ph.D. – Consult The Expert On Cognitive Behavioral Therapy (CBT) And Self-Care

Dr. Lonette Belizaire works with children, teens, and young adults in our Children’s Center. Her primary treatment approach utilizes cognitive behavioral therapy (CBT), a modality which helps people recognize and change their negative thoughts and behaviors. CBT has been shown to be effective in treating many mental health conditions, including anxiety and depression.

How do negative thoughts and behaviors contribute to anxiety? “The brain has plasticity,” Dr. Belizaire explains. “Anxiety, trauma, and distressing life experiences actually create structural changes within the brain.”

When we encounter something that scares us, worries us, or puts us on guard, the amygdala – a small structure within the brain – responds with a nearly instant message to our hypothalamus. The result is the activation of stress hormones and heightened physical responses, along with the building of new neural pathways.

This is designed to keep us safe by getting us out of imminent danger, such as out of the path of a speeding car. “The fight or flight response is protective and good,” Dr. Belizaire says, “but at times we apply this response when we’re not in danger.”

“For example, someone who is anxious and facing an exam in school may have the thought “I’m going to fail this test,” she explains. “The distress response from this negative thought can lead to the person avoiding the test altogether. However, with cognitive behavioral therapy, this person would learn how to challenge their negative thought and replace it with a more positive one, such as “I can study for the test and do my best.”

Exploring Thinking Patterns

The longer we focus on and worry about a stressor, the more robust those neural pathways become and the stronger we respond. This is involuntary on our part, but it means the key to calming anxiety is breaking those pathways and building more positive channels. In turn, the positive emotions support the building of new neural responses that suppress the old, negative responses.

“I begin by having my clients look at their thinking patterns. I want them to explore how they see themselves, others, and how they operate within the world,” Dr. Belizaire says. “Part of our work together involves identifying these patterns and working to challenge those distortions.”

“When working with adults, we may explore how early childhood responses to early attachment figures may still be operating in adult relationships,” she explains. “Are those messages still in place? How do these responses show up across relationships, in both the past and present?”

The answers to these questions can be enlightening. “Sometimes this is the first time the person has thought of it this way,” she says.

Incorporating Self-Care

Along with traditional CBT, Dr. Belizaire often integrates self-care into her therapy sessions. Mindfulness exercises and grounding techniques help to refocus anxious responses and build positive brain pathways. “These techniques are aimed at the amygdala,” she explains.

“We know that self-care and self-regulating activities engage the physical to help the mental and emotional responses, so I try to find out what the client likes to do. What are their interests? Once I know, we incorporate regular self-care strategies in our work.”

For example, Dr. Belizaire may encourage yoga, diaphragmatic breathing exercises, meditation, or progressive muscle-relaxing exercises. When using visual imagery, “I may incorporate breathing exercises with visual imagery and have the client visualize breathing in calming white light or a calming word, phrase, or memory filling their body, and then exhaling black smoke, for example…or stress, anxiety and visualize it escaping their body with every breath.”

At times, she also gives “homework,” but it’s the kind that clients want to complete. “I’m not giving out actual homework,” she chuckles. “Along with self-care homework, I may ask them to monitor their cognitive distortions between now and our next session, or implement a new sleep hygiene, or reward themselves after achieving a step towards their treatment goal.”

This homework doesn’t have to be time-consuming either. “Something as simple as a gratitude journal can help reframe your thinking more positively,” she says.

Just as with school-based homework or working out at the gym, Dr. Belizaire says that engaging in daily self-care exercises brings results. “If you can learn to do them when you aren’t anxious, the habit kicks in when you are fearful, which helps ease your stress response. After all, when you are in those anxious moments, you are in fight or flight activated mode and you may not readily recall the strategies that will help reduce your stress response.”

In addition, a big step in reducing stress comes from being prepared for it. “If you can anticipate a trigger, such as an upcoming anniversary, exam, or anxiety-producing situation, you can prepare for it in advance, which can help reduce the stress during the actual event.”

We Are Here For You

Dr. Belizaire is primarily seeing clients through teletherapy right now. “There are advantages to telehealth, which includes scheduling,” she says.

One caveat: “Teletherapy may not be appropriate for everyone and for every presenting concern,” she cautions, “but many people do benefit. Young children tend to do better with in-person interaction, but tweens, teens, and adults all do well with teletherapy.”

If you are concerned that your child or teen is struggling emotionally or showing signs of anxiety or depression, we can help. To schedule an appointment with Dr. Belizaire or our other clinical team members, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

About Dr. Lonette Belizaire, Ph.D.

Dr. Lonette Belizaire is a licensed psychologist with over 15 years of clinical experience working in a variety of treatment settings. She has worked with the gifted and talented child and adolescent school population, in college counseling centers, city hospitals and in private practice. She specializes in the treatment of anxiety, adjustment issues, interpersonal concerns, stress management, and bicultural identity. Dr. Belizaire’s approach is grounded in evidence-based treatment. She utilizes an integrative model that draws upon cognitive behavioral therapy and mindfulness-based interventions tailored to meet the client’s needs. She has found that building an awareness of the neurological basis of anxiety, how it is created and maintained in the brain, has also been particularly transformative for clients.

Dr. Belizaire earned her doctoral degree in Counseling Psychology from Fordham University, Master’s Degree in Mental Health Counseling from the University of Miami, and her Bachelor’s degree in Psychology from Stony Brook University. She has worked in some of the top institutions in the New York area including the Hunter College Campus Schools, Cornell University, and Pratt Institute. She is licensed in both Florida and New York.

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Jerome Siegmeister MD

Jerome Siegmeister, MD, MaED – Consult The Expert On How Virtual Schooling Is Affecting Children

Dr. Jerome Siegmeister, the Center’s newest clinician, is an expert on the psychiatric concerns of children and adolescents. A former high school teacher, he is in a unique position to help children through mental health resources that are tailored specifically for kids or teens in need.

Since the pandemic, parents and children have had to adapt quickly as schools shut down for periods of time. Virtual classes have become routine. An online learning environment can be difficult enough for kids, without being isolated from their peers. “Covid has really devastated these kids,” Dr. Siegmeister says. “Though some children can do well in this environment, virtual learning causes an issue for most.”

“The virtual learning modality is basically a lecture modality,” he continues. “What do you and I do when listening to a lecture? If we are honest, most of us listen to it in the background while doing other things, so we miss a lot of the information.”

“Children are no different,” he says. “From a developmental standpoint, it is clearly better for kids to attend in-person schooling, but the unfortunate reality is that we need to be worried about public health, as well. In many cases, virtual learning is all we have right now, but this isn’t workable for many kids.”

Aside from the loss of knowledge, the pandemic has affected our children’s social interactions. “Virtual classes have their place because kids need to be learning, one way or another, but it comes at a price,” he explains. “It is very obvious that our children’s socialization has been affected and will be for a long time to come.”

“At this point, we have lost at least eighteen months of socialization,” he says. “Society pushes the idea that we need others to validate us, so kids rely on social acceptance for much of their self-worth. Covid took away much of that.”

Even older teenagers are being tested by this new normal. “The pandemic has been very hard for kids who are transitioning to college,” he notes. “Life is drastically different for them, especially if they are having to do their first year of college virtually. They are missing out on the social aspects that help them adjust to college life.”

Nevertheless, Dr. Siegmeister is optimistic. For most kids who are struggling, “it isn’t too hard to stabilize them and they can do really well,” he says. “Counseling and working one on one with kids will make things better in the majority of cases.”

When it comes to mental health concerns, Dr. Siegmeister believes in treating the whole person. He often uses a team approach and commonly involves the child’s parents, teachers, or college faculty. He also may combine two or more treatment methods for children whose needs that are not being met by one single approach. For example, he may use cognitive behavior therapy along with medical treatments if the child has an underlying psychiatric concern.

And, although a pandemic silver lining would seem unlikely, Dr. Siegmester says there is one. “Mental health is often swept under the rug,” he says, “but depression is now pretty pervasive in both children and adults and people recognize this. In fact, many so called “sick days” happen because the person is depressed and really needs to take a mental health day. The positive outcome from covid is that people are now much more aware of anxiety and depression because they’ve experienced it themselves. This means it has become much more acceptable to seek help.”

About Jerome Siegmesiter, MD, MaED. (Child And Adolescent Psychiatry / General Psychiatry)

Jerome Siegmeister, MD, MaED, is a South Florida Native. He has worked with clients of all ages, and believes that the whole person needs to be treated. Consequently, he evaluates all aspects of the situation, from medical to situational, to determine the best initial course. He has a background in both individual and group therapies, employing supportive, behavioral, and insight oriented approaches, as appropriate to best fit his client’s needs, as well as comfort with medical treatment of any underlying conditions that might manifest psychiatrically. He has significant experience in all forms of psychiatric issues, including mood symptoms, thought disorders, anxiety, phobias, attention deficits, behavioral issues, insomnia, compulsive disorders, emotional lability, substance abuse, and trauma.

Dr. Siegmeister graduated with his Bachelor’s from Florida International University, after which he spent a number of years teaching, and obtained a Masters from the University of South Florida in Career and Technical Education/Adult Education. Upon deciding to pursue medicine, he initially completed a Post Baccalaureate Pre-Medical Certificate program at the University of Miami, and then obtained his MD from the University of Miami Miller School of Medicine, staying there afterwards for his specialty training in Psychiatry, followed by a fellowship in Child and Adolescent Psychiatry, where he served as Chief Fellow, and was awarded with a Research Distinction. After training, he has worked providing Emergency care, with additional work in inpatient settings, both in mental health and as a consultant to medical units at multiple hospitals. He is currently Board Certified by the American Board of Psychiatry and Neurology in both general Psychiatry, and Child and Adolescent Psychiatry, and by the National Board of Physicians and Surgeons in Psychiatry.

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Psychological evaluations

Psychological Evalutations

The Children’s Center for Psychiatry, Psychology and Related Services is pleased to again offer psychological evaluations to the community. To best serve the need of our clients we will be offering both in person appointments or remote video conferencing to get a better understanding of your child, their strengths and weaknesses, and what accommodations and interventions they would benefit from.

We are able provide our typical in person evaluations with procedures and materials to ensure safety during COVID-19 concerns. Additionally, while the evaluation process is typically a hands-on experience and the assessment tools require face-to-face interactions, we have also made adaptations to provide remote evaluations via video appointments.

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COVID paradox

The COVID Paradox

Never before in modern memory has the human race been faced with such a stressful and anxiety provoking foe. The novel coronavirus or COVI-19 has resulted in untold emotional unrest and fear among all nations and peoples of our world. There has been a lot of talk about the “invisible enemy,” an RNA based complex protein that looks like a World War 2 anti-ship mine with spikes sticking out of its surface. We are informed daily by the media that young and old victims of this virus are ending up on ventilators for weeks at a time if they survive. To “flatten the curve” and avoid overwhelming our hospitals we have had to become socially isolated, settle in place in our residences, wear masks when going out and remembering to wash our hands and not touch our faces. And after three months of dealing with this enemy of grown ups we are now being informed that children who we believed were not at risk of being made seriously ill have suffered as cases of a strange multi system inflammatory syndrome much like Kawasaki disease began to appear at hospitals.

The reality of this plague is bad enough to fathom by any rational person. The facts we are presented with certainly evoke fear and apprehension. Our frontline healthcare providers who are by their profession somewhat desensitized to run-of-the-mill suffering as they treat patients with terminal illness, heart attacks, metastatic cancer or debilitating strokes, find themselves traumatized by the COVID crisis.

So what is generating this degree of emotional suffering?

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