1. PreparedandPresentedBy
GlenChristie,MS,EdS,ThD,LPC,CASAC
FaithBibleCollege
CrisisCounseling II

2. I am the center of the
Universe!Starting at about the age of eleven or
twelve, adolescents develop the ability to
think at a higher, more abstract level than
they did as children…These new mental
abilities bring about a Copernican
revolution in the way young people think
and feel about themselves, others, and
the world in general”

3. Family History
Golden age
 Nuclear family
 two parent family
 romantic love
 maternal love
 Adolescents perceived
as immature
 Protective
environment
Postmodern age
 Permeable family
 Single parent, etc.
 consensual love
 shared parenting
 Adolescents
perceived as
socially
sophisticated
 Exposure to many
destructive images

4. Two pathways to identity
formation
 Differentiation and integration
separating out concepts, feelings, and
emotions and putting those parts
together into a higher ordered whole
 Substitution
replacing one set of concepts, feelings,
and emotions for another

5. Identity construction by:
 Differentiation
 strong sense of
self
 inner directed
 future oriented
 ability to postpone
gratification
 Substitution
 patchwork self
 other directed
 present oriented
 less able to
postpone
gratification

6. Body Image
 Important ingredient of self-concept
 Whether we accept or reject ourselves
 Whether we feel confident in social
relationships
 Whether we have an idealized or realistic
idea of attractiveness, strength, skills and
sex appeal.

7. Body Image
Perceptual
Evaluation of size of one’s body
1
2
Affective or cognitive
Evaluation of abilities

8. Body Image – Self-Esteem
 Comparing with peers – developing a
feeling of inferiority
 Interfere with day to day functioning and
studies
 Problems in relationships with peers and
family, jealousy, arguments and other
negative expressions

9. Teenage Reactions to Postmodern Stressors
 Eating disorders
Anorexia nervosa
Bulimia
 Alcohol and drug use
 Alcohol accounts
for 80% of teenage
deaths
 45-50% violent
teenage deaths
 400,000 teenage
alcoholics
 Depression
 Repression/ Denial
PTSD
 Teenage suicide
 Violence
 High rates of
teenage pregnancy
 High rates of STD’s
 Stress and Anxiety

10. Puberty
and the
Emotional Lightning Rod
 Adolescents tend to focus all of their
developmental anxieties on one feature
 Interesting fact- Adolescent girls are most
satisfied with their body image when they are
slightly underweight
 It is estimated that 75% of girls have at least
one symptom of an eating disorder, most
often, fad dieting

11. Predisposing Factors
 Negative self-esteem
 Hypersensitivity to rejection
 Suppressed anger and sadness
 Chronic anxiety
 Relationship problems
 Poor functioning in school, home or work
 More common in females than males
 Typical onset is at puberty
 History of physical and/or sexual abuse

12. Predisposing Factors
 Average to high intelligence
 Middle to upper-class background
 Feels “empty” and isolated
 Drug or alcohol abuse
 Early history of medical illness or surgical
procedures requiring hospitalization
 Imprisonment or institutionalization in drug
treatment centers
 Inability to express or tolerate negative
feelings
 Poor academic performance or truancy
 Has a background of emotional neglect

13. Bulimia

14. What is Bolimia?
Bulimia nervosa is an eating disorder characterized
by frequent episodes of binge eating, followed by
frantic efforts to avoid gaining weight. It affects
women and men of all ages.
When you’re struggling with bulimia, life is a
constant battle between the desire to lose weight or
stay thin and the overwhelming compulsion to binge
eat.
You don’t want to binge—you know you’ll feel guilty
and ashamed afterwards—but time and again you
give in. During an average binge, you may consume
from 3,000 to 5,000 calories in one short hour.

15. What is Bolimia?
After it ends, panic sets in and you turn to
drastic measures to “undo” the binge, such as
taking ex-lax, inducing vomiting, or going for a
ten-mile run. And all the while, you feel
increasingly out of control.
It’s important to note that bulimia doesn’t
necessarily involve purging—physically
eliminating the food from your body by
throwing up or using laxatives, enemas, or
diuretics. If you make up for your binges by
fasting, exercising to excess, or going on crash
diets, this also qualifies as bulimia.

16. Anorexia

17. Anorexia
What is anorexia nervosa?
Anorexia nervosa is a complex eating disorder with
three key features:
 refusal to maintain a healthy body weight
 an intense fear of gaining weight
 a distorted body image
 Because of your dread of becoming fat or
disgusted with how your body looks, eating and
mealtimes may be very stressful. And yet, what
you can and can’t eat is practically all you can think
about.

18. Anorexia
What is anorexia nervosa?
 Thoughts about dieting, food, and your body may
take up most of your day—leaving little time for
friends, family, and other activities you used to
enjoy. Life becomes a relentless pursuit of thinness
and going to extremes to lose weight.
 But no matter how skinny you become, it’s never
enough.
 While people with anorexia often deny having a
problem, the truth is that anorexia is a serious and
potentially deadly eating disorder.

19. Drugs and alcohol are hijackers…
 They are chemicals that jump in to the
communication system of the brain and disrupt
the messages
 They also cause ‘incorrect’ messages
 For example, because drugs
fool the ‘pleasure’
center of the brain, the
brain will think it has
plenty of the chemicals
that normally make you
feel good, so the brain will
make less of those chemicals!

20. The teen brain is wired for learning….
 Basically anything you do, or ‘practice’, your
brain will learn to do much faster than if an adult
does the same thing
 Because of this, teens develop
addictions much faster than
adults. Exposure to alcohol or
drugs is ‘teaching’ your brain
to form an addiction

21. Alcohol-Related Disorders
 Alcohol abuse and dependence.
 Alcohol withdrawal
 Alcohol induced dementia.
 Alcohol induced amnestic disorders.
 Alcohol induced psychotic disorders
 Alcohol related mood disorder.

22. Alcohol Withdrawal
 The classic signs of alcohol withdrawal are due
to sympathetic over activity and tendency to
develop epileptic convulsions.
 Symptoms include tremulousness, sweating,
restlessness and even excitement.
 They may include psychotic symptoms (such as
delusions and hallucinations).
 Seizures and symptoms of delirium tremens
may eventually develop.
 Treatment is Benzodiazepines.

23. Hallucinogens
Agents that induce a state of marked perceptual
alterations.
They are CNS stimulants.
Examples are:
 Lysergic acid diethylamide (LSD) and
amphetamines.
 Mushrooms
 They have both an antagonist and an agonist
effect on serotonergic systems.

24. Hazards of hallucinogen use
 A drug precipitated psychosis may continue
following the cessation of hallucinogen use.
 Flashbacks are brief spontaneous recurrences
of perceptual changes, such as experienced
while using hallucinogens.
 They have been reported days, months or
years after drug use.

25. Cocaine
 Cocaine is one of the most addictive of
commonly abused substances and one of the
most dangerous.
 Cocaine, variously referred to as crack, snow,
cock, girl and lady,
 It is a white powder that is inhaled, smoked
or injected.
 Psychological
dependence
can develop
after a single
use.

26. Withdrawal symptoms of cocaine
Withdrawal symptoms are mild compared to
those of opioids.
They include depressed mood, dysphoria,
fatigue, hypersomnolence.
Suicidal ideations may occur.
Symptoms persist for a few days up to one week.
Craving is very strong.

27. Benzodiazepines (BDZ)
 Benzodiazepines are psychoactive depressant
drugs that are used to control anxiety and
epilepsy and in induction of anesthesia.
 Tolerance to benzodiazepines is common.
 Benzodiazepines are widely used in combination
with heroin, cocaine, alcohol and stimulants.
 includes somnolence and behavioral disinhibition.
 In higher doses, they cause hypotension and
central respiratory depression, particularly if
taken with another depressant drug (e.g.,
alcohol).

28. Withdrawal of BDZ
 symptoms include rebound anxiety,
restlessness, agitation, hypertension, and
tachycardia.
 Epileptic seizure is a serious emergency and
may be fatal.
 Hospitalization and gradual withdrawal of
benzodiazepines are the main lines of
treatment of benzodiazepine addiction.
 Prevention of seizures by antiepileptics may be
needed.

29. Risk Factors For Teen Depression
 Hormonal changes
 Emotional changes
 Situational
stressors
 Social pressure
 Academic pressure
 Family history
 Abuse
 Illness
 Alcohol and/or drug
use

30. Signs of Depression
 Loss of all pleasure in life
 Sleep, energy, weight, or appetite changes
 Decreased interest in sex and
other pleasurable activities
 Feelings of helplessness and
hopelessness
 Inability to think clearly &
concentrate
 Social isolation and withdrawal
from others

31. Things to look for…
 Withdrawn
 Lack of interest is
previously enjoyed
activities
 Angry outbursts
 Sleep problems
 Changes in school
performance
 Moodiness
 Self-Injury

32. Adolescent Self-Harm
 Self-harm is defined as deliberate self-inflicted
physical harm severe enough to cause tissue
damage or markings that last for a minimum of
several hours, done without suicidal intent or
intent to attain sexual pleasure.
 Spiritual ritual, ornamentation body markings
(tattoos), and/or modifications (body piercing)
are not generally considered self-injury unless
this is undertaken with the intention to harm
the body.

33. Self-Harm Basic Information
 Cutting is most common form: knives,
paperclips, razors, keys, glass, pins, etc.
 Over 16 documented forms.
 Any individual may use from 1 to over 10 forms.
 Any part of the body may be harmed - most
often hands, wrists, stomach and thighs
(hidden).
 Severity covers a broad continuum from
superficial wounds to permanent
disfigurement.
 Most people report little or no pain during the

34. Other Forms of Self-Harm
 Using an eraser or
friction to burn skin
 Burning with heat,
chemicals or cigarettes
 Bruising oneself
 Pulling off fingernails
and toenails
 Refusing to take needed
medications
 Hitting self
 Banging one’s head
 Ingesting sharp or toxic
objects
 Tooth-pulling
 Picking scabs or keeping
wounds from healing
 Deep scratching or
pulling patches of skin
 Inserting objects into
body openings
 Inserting needles or
sharp objects under the
skin
 Some forms of hair-
pulling
 Bone-breaking
 "Carving" symbols,
names or other images
into the skin

35. Reasons Behind Self-Harming Behavior
 Distraction from emotional pain
 Distraction from painful thoughts or memories
 Distraction from other environmental problems
 Self-punishment (believe they deserve punishment
for having good feelings or being an "evil" person
or hope that self-punishment will avert worse
punishment from some outside source)
 Reflection of self-hatred or guilt
 Maintaining control
 Feeling control over their minds and bodies

36. Common Myths
 Self-harm is usually a failed suicide attempt.
 Self-injury is often a means of avoiding suicide
 Typically a suicide attempt is by completely
different method than preferred form of self-harm
 Majority of persons with self-harm history (60%)
report no suicide thoughts
 Non-suicidal self-injury best understood as a
symptom of serious psychological distress
 Left untreated, self-harm could lead to suicide
behavior
 Differentiate between a self-injurious act and a
suicide attempt - require different treatments

37. Common Myths
 People who self-injure are crazy and should be
locked up.
 People who deliberately self-harm are not
psychotic.
 Self-harm is a coping mechanism like
alcoholism, drug abuse, overeating, smoking
cigarettes, etc.
 The vast majority of self-inflicted wounds are
neither life threatening nor require medical
treatment.
 Caution should be used when assessing a
client’s level of threat to self or others.

38. Common Myths
 People who self-harm are trying to get
attention.
 Everyone needs attention; this is not bad.
 When distress is expressed by self-harm,
something is definitely wrong. Help is
needed, not judgment.
 Most people who self-injure go to great
lengths to hide their wounds and scars.
 Many consider their self-harm to be a deeply
shameful secret and dread discovery.

39. Common Myths
 If the wounds aren’t “bad enough,” self-harm
isn’t serious.
 Severity has little to do with level of
emotional distress.
 Different people use different methods.
 People have varying pain tolerances.
 To know a client’s distress level - ask.
 Never assume; check it out with the person.

40. Common Myths
 Only teen-aged girls self-injure.
 All people and SES are represented.
 Male or female; gay, straight, or bi; Ph.D.s or
high-school dropouts; rich or poor; and live in
any country in the world.
 Some people manage to function effectively in
demanding jobs: therapists, lawyers, engineers.
 Some are on disability. Some are highly
achieving high-school students.
 Age typically ranges from early teens to early
60s, although may be older or younger.

41. Self-Harm
 Self-harm can begin early in life.
 Early onset is common around 7 years of age.
 Frequently, onset is middle adolescence (12-15)
and can last for weeks, months, or years.
 Many times self-harm is cyclical rather than
linear.
 Do not assume that self-harm is a fleeting
adolescent phenomenon.
 Has some addictive qualities and may serve as a
form of self-medication for some individuals.

42. Self-Harm Risk Factors
 High levels of perceived loneliness
 Less dense social networks
 Less affectionate relationships with their
parents
 History of emotional and/or sexual abuse
 Suffer from diminished self-esteem
 Feelings of invisibility and shame
 Feelings of being unreal and inauthentic
 Never learned appropriate ways of expressing
emotion
 Learned that emotions are bad and to be

43. Self-Harm Indicators
 Repeatedly and deliberately cuts or harms self
 Displays tension immediately prior to the act
 Displays relaxation, gratification, pleasure or
numbness during and immediately after the act
 Displays shame or fear of social stigma
 Attempts to hide scars, blood or other evidence
 Conversely, may display injuries in an attempt
to gain attention or sympathy
 Typically uses multiple methods of harm
 Describes self-harm as addictive

44. Detection
 Detecting / intervening - difficult because of secrecy
 Unexplained burns, cuts, scars, clusters of similar
markings
 Arms, fists, and forearms opposite dominant hand
 Inappropriate dress (long sleeves / pants in summer)
 Constant use of wrist bands / coverings
 Unwillingness to participate in events / activities
requiring less body coverage (swimming, gym class)
 Frequent bandages
 Odd / unexplainable paraphernalia (razor blades,
implements to cut or pound)
 Heightened signs of depression or anxiety
 Implausible stories to explain physical indicators

45. An Overview of Suicide

46. Facing the Facts
 In 2013, 46,035 people in the United States died by suicide.
About every 13 minutes someone in this country
intentionally ends his/her life.
 Over half of these suicides were by firearm
 We believe suicide is underreported by 5-25%
 40 to 100 times more non-fatal suicidal behavior
incidents (attempts)
 Individuals of all races, creeds, incomes and educational
levels die by suicide. There is no typical suicide victim.
 20% of us will have a suicide within our immediate family.
 60% of us will personally know someone who dies by
suicide.

47. Myths versus Facts
MYTH: People who talk about suicide don't complete
suicide.
FACT: Many people who die by suicide have given definite
warnings to family and friends of their intentions. Always
take any comment about suicide seriously.
MYTH: Suicide happens without warning.
FACT: Most suicidal people give clues and signs regarding
their suicidal intentions.
MYTH: Suicidal people are fully intent on dying.
FACT: Most suicidal people are undecided about living or
dying, which is called “suicidal ambivalence.” A part of them
wants to live; however, death seems like the only way out of
their pain and suffering. They may allow themselves to "gamble
with death," leaving it up to others to save them. This is
“Suicidal Ambivalence”.

48. Myths versus Facts
MYTH: Men are more likely to be suicidal.
FACT: Men are four times more likely to kill themselves than
women. Women attempt suicide three times more often than
men do.
MYTH: Suicide occurs in great numbers around holidays in
November and December.
FACT: Highest rates of suicide are in May or June, while the
lowest rates are in December.
Prevention may be a matter of a caring
person with the right knowledge being
available in the right place at the right time.

49. Teenage Pregnancy

50.  Education
 Less employment opportunities
 Lower income
 Welfare support
 Dependence upon other family members or their
community
 Infrequent long-lasting relationships.
 Domestic violence
 Likely/potential biological problems in the mother:
 increased risks of miscarriage
 premature labor
 blood pressure problems
 prenatal mortality
 Negative impacts on the child
Pregnancy implications generally not considered

51.  Teens who abuse their girlfriends or boyfriends
do the same things as adults who abuse their
partners.
 Teen dating violence is just as serious as adult
domestic violence.
 Domestic violence is the
same thing of teen violence,
but in this case happens
with adults.
 Women are more often the
victim.
Domestic Violence

52.  May start when one partner feels the need to
control and dominate the other;
 Low self-esteem;
 Alcohol;
 Abusers learn violent behavior from their family,
people in their community and other cultural
influences as they grow up;
 Extreme jealousy;
 Difficulties in regulating anger and other strong
emotions;
 Unemployment
Domestic Violence Causes:

53. Bullying

54.  Physical bullies use force
and body strength to
overpower their victims.
 Physical bullying can
include kicking, hitting,
punching, or other
physical attacks.
 This type of bullying is
easier to observe than
others.
Physical Bullying

55.  Verbal bullies intimidate
and harm their victims
using words.
 Verbal bullying includes
the use of relentless
insults and teasing and
may include making fun
of a peer’s lack of
physical capabilities,
appearance, etc.
 This type of bullying may
go unnoticed and
unreported for long
periods of time.
Verbal Bullying

56.  Relational bullies work to
damage a victim’s social
status and relationships.
 Relational bullying is
common among girls,
especially teen girls.
 Bullies who practice
relational bullying often do
it to increase their own
social standing or to
control others.
 This type of bullying may
go on for some time before
an adult notices.
 This is sometimes referred
to as “Mean Girls.”
Relational Bullying

57.  Reactive bullies coax
others into harming them.
It is often unclear who the
true bully is.
 A reactive bully incessantly
taunts a peer until the peer
snaps and reacts with
physical or verbal
aggression.
 Reactive bullying may be
the most difficult type of
bullying to identify. This is
because the reactive
bullies also tend to be
victims of bullying as well.
Reactive Bullying

58.  Cyberbullies use electronic
forums, such as email, cell
phones, and social
networking sites, to harass
their victims.
 Cyberbullying allows the
bully to remain
anonymous. It is easier to
bully in cyberspace than it
is to bully face to face.
 Over 25% of adolescents
and teens have been
bullied repeatedly through
their cell phones or the
Internet.
Cyberbullying