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Month: August 2012

High School, High Anxiety: How to support teens with anxiety disorders

Last week’s inspiring post by Jane Caro on overcoming an anxiety disorder struck a chord with many readers who have been through the same thing. Many of our girls are facing this issue, too. In fact, 15% of people aged 16-24 are affected by an anxiety disorder. So this week, we’re taking a look at the causes and symptoms of anxiety — and most importantly, what we can do to support girls who are dealing with it.

What is anxiety disorder?

We have all experienced anxiety. For you, the pounding heartbeat, flushed face, dry mouth, sweatiness and feeling of dread might hit before you have to give a speech. Or perhaps it’s going to a job interview or sitting for an exam that makes you feel shaky, short of breath and queasy.

This is a normal reaction to stress. It’s your body’s fight or flight response, and humans have been experiencing it since we lived in caves: in the face of a threat, adrenaline is released, ramping up your body to either defend yourself or run. Since then the threats have changed from sabre-toothed tigers to things like impending deadlines and public speaking engagements, but our body’s reaction is the same. And this isn’t necessarily a bad thing. According to Youth BeyondBlue, “a certain amount of anxiety is good for us, as it gets us hyped up to perform at our best.”

It becomes a problem, though, when that feeling remains long after the stressful situation has passed. For a girl with anxiety disorder, it pervades her whole life and continues for weeks, months or longer. The anxious feelings tend to be a more intense and overwhelming. The anxiety may interfere with her daily life, as she avoids situations that are likely to trigger her anxiety. Vanessa, who had an anxiety disorder for several years during high school and overcame it at age 17, describes her experience this way:

I would be standing on the bus coming home from school, and boom, my heart would start racing so fast that I was convinced I was about to have a heart attack and die. Obviously that didn’t happen — but instead of being relieved, I thought that this must be how insanity starts. I was worried I would just slip away and lose all grip on reality. Some days it was too hard to go to school, because I thought everyone could tell I was going crazy. It was a vicious cycle, because those thoughts only fed the anxiety.

Anxiety can take several forms:

  • Generalised Anxiety Disorder — continual worrying about aspects of everyday life such as school, work, relationships and health
  • Social Anxiety — crippling fear of being judged by others in social situations
  • Obsessive Compulsive Disorder — obsessive fears leading the continual repetition of an action or ritual — e.g., a fear of germs leading to the frequent washing of hands
  • Panic Disorder — periods of intense fear and anxiety lasting from a few minutes up to half an hour
  • Phobia — fear and avoidance of a particular thing or situation — e.g., heights, enclosed spaces, dogs, etc.
  • Post-Traumatic Stress Disorder — periods of anxiety, flashbacks or bad dreams related to a traumatic experience

What causes anxiety?

Stressful situations such as parents breaking up, family conflicts, being bullied or abused, or going through a relationship breakup can  trigger an anxiety disorder. And genes can play a role, so girls may be more prone if other people in the family have gone through it.

Perfectionism also seems to be a common thread for many people with an anxiety disorder. Adelaide psychologist Dr Michele Murphy said in July’s edition of Madison, “Of course perfection is impossible, so anxiety may result from a sense of failure and the exhaustion of attempting to attain unrealistic standards.” Hmm…attempting to attain unrealistic standards, now doesn’t that sound familiar? Given the constant barrage of media, pop culture and social messages telling girls that they aren’t thin enough, or hot or pretty or popular enough, or they aren’t achieving enough, it’s  little wonder that so many of them feel overwhelmed and anxious. (And their mothers, too!)

Bella, who is 20 and had anxiety throughout her teens, always performed well academically, and this became a major focus of her anxiety:

In the subjects I got my best marks in, I was a wreck for weeks before exams. I couldn’t sleep and I had this dread of what would happen if I didn’t get the mark everyone was expecting me to. It was like my life was going to come to an end. Now I know that fear was out of all proportion — but at the time, I couldn’t think about anything else.

Signs of an anxiety disorder

It’s normal for everyone to experience a certain amount of anxiety surrounding stressful events, but if a girl shows these signs and they are impacting her everyday life and activities, she may have an anxiety disorder:

  • fast heartbeat
  • pain or a tight feeling in the chest
  • shortness of breath or hyperventilation
  • tingling sensation or pins and needles
  • feeling light-headed or dizzy
  • trembling, shaking or being easily startled
  • sweating
  • nausea
  • insomnia and tiredness
  • constant worrying, about big or small concerns
  • fear or avoidance of certain places, situations or things
  • compulsive actions such as hand washing

What you can do to help

If you believe that your child may have anxiety, the first step is to speak to her about her feelings. Yes, you might meet resistance or even anger. Embarrassed by the thoughts that are going through her head, a girl may try to suffer in silence. Or she may have trouble finding the words to describe the feeling of dread that’s hanging over her. Here are some pointers to get the conversation started and keep it going (adapted from Youth Beyondblue‘s advice for parents and caregivers):

  • Try to stay calm and  relaxed.
  • Set aside a good time to chat quietly without distractions, and give her all of your attention.
  • Ask open-ended questions that can’t be answered with a simple “yes” or “no”.
  • Resist the urge to jump in with advice straightaway. Instead, focus on acknowledging her feelings.
  • Avoid making judgments or saying things like “Snap out of it” or “That’s silly”, as this only shames and doesn’t help solve the problem.
  • Try not to take it personally if she can’t fully open up to you about her anxious feelings, as some girls find it easier to talk with a neutral professional.
Treatments
These suggestions made by psychologists for curbing anxiety may sound almost ridiculously simple, but they really can be effective:
  • Eat a balanced, healthy diet.
  • Get a good night’s sleep.
  • Exercise regularly.
  • Try relaxing activities such as yoga, tai chi or meditation.

Also seek advice from a professional, because if it is left untreated, anxiety may escalate rather than subside. Your family doctor is a good starting point, and he or she may suggest a specialist or a counsellor. There are a range of treatments, including medication, relaxation techniques and cognitive behavioural therapy (CBT), which equips girls to challenge unrealistic, negative thoughts and fears and replace them with a more realistic and positive outlook.

In Vanessa’s case, a rapid heart rate and shortness of breath meant she saw multiple doctors and was even admitted to the cardiac ward of a hospital before a switched-on doctor set aside her medical chart and instead asked her about her thoughts and feelings, and diagnosed an anxiety disorder:

It was the hugest relief that someone had put a name to what I was feeling and to know I wasn’t going crazy. He got me in to see a psychiatrist, who taught me breathing and relaxation techniques and CBT. As an adult, in times of stress I have the skills to manage anxiety so that it doesn’t take hold. Having an anxiety disorder was awful — but I don’t regret it, because I think that learning to take charge of it has made me a stronger person today.
Resources
  • Youth BeyondBlue has fact sheets; advice for parents, caregivers and kids; and a comprehensive checklist of anxiety symptoms. Their helpline in Australia is 1300 22 4636.
  • Reachout provides great articles and resources on anxiety in young people.
  • Lifeline Australia’s number is 13 11 14. Lifeline New Zealand is 0800 543 354.
  • Kids Help Line Australia is 1800 55 1800.

Amazing Grace: One woman’s story of overcoming anxiety

I am fortunate to regularly be a panelist on Channel 9’s Mornings with Jane Caro, self-described novelist (Just a Girl), author (The Stupid Country, The F Word), writer, feminist, atheist, Gruen Chick, speaker, media tart, wife, mother and stirrer. I recently spent time with her at the Byron Bay Writer’s Festival, where she took part in two particularly inspiring and stand-out panels on public schooling and feminism.

I joked with her afterwards that she should get a T-shirt made up: “Jane Caro, challenging bullshit since 1957”. I think her considered, and occasionally fierce, approach to challenging issues is exactly what we need in this age of subtext and hidden agendas. She and I have had some really powerful discussions on the role the media  plays in shaping our self-perception and on whether or not real confidence can, in fact, be taught. I enjoy our ongoing debates, as they are always mutually respectful and stretch me enormously.

At another session at the writer’s festival, Women of Letters, Jane read a piece she had written on her experiences overcoming an anxiety disorder. I loved her honestly in revealing her struggles. When we share our struggles, we have enormous capacity to inspire others to face and overcome their own issues. That’s why I share my struggles with body image and alcohol in my books. Many girls thank me and say things like “I thought I was the only one who struggled” or “I felt so alone.” Girls (and women!) can’t be what they can’t see — imagine how liberating it would be if more female leaders revealed their vulnerable sides and spoke of their own trials. The truly powerful show all of themselves.

I’m excited to feature Jane’s moving and inspiring account of overcoming anxiety here on the blog this week. This is a special exclusive for Enlighten Amazons, as it is the first time this story has been published. Next week, we’ll be following up this feature with a look at the causes and treatments for anxiety, which affects 15% of people aged 16-24 and 5% of Australians of all ages.

 

At the Byron Bay Writer’s Festival (from left): Jane Caro, Dannielle Miller and feminist and author Susan Johnson, whose three-part article on teens and body image recently appeared on our blog

A letter to the person I’d have been if I had stayed in “that relationship” with anxiety

Are you still waiting for that sword to fall? Are you still facing the world with your eyes wide open (I have the wrinkles your hyper-vigilant state of alert etched into my forehead with me still), eyebrows lifted as you scan the world for the danger that you are sure is there – just there, round the next corner, crouched like a lion ready to pounce, in the very next second?

The fangs and claws you feared was madness. It wasn’t what was outside you that terrified you, it was what you carried within.

Do you still have pins and needles in your wrists and hands? That sense of being eternally tensed and ready to fend off danger, to protect yourself or turn and flee? Poised, on tiptoes, ready for fight or flight. How exhausted you must be, how ground down – or maybe, finally, you have managed to do what you always most feared and have driven yourself mad. I used to think it might be a relief to give in, to stop fighting and let the demons take over.

Do you still drive past pedestrians, convinced that only by dint of great effort have you defeated the impulse to run them down and that next time – the mental anguish of this thought always nauseated you – you may not be so lucky? Do you still hate edges? Edges of train platforms, cliffs, open windows on upper floors? Remember how you had to crawl past that long, low window in the hotel room in Rome, sick to your stomach? You never knew if you had the mental strength to resist the twin urges that overwhelmed you whenever you came to an edge – especially unexpectedly – to either push someone else over or plunge over yourself. And, truly, I know well, you would have preferred the latter. I remember thinking – when I was still you – that I could always commit suicide and that the thought was a comfort. And we were so young, back then, and so afraid.

So many things nauseated you – sharp knives, little children, boiling water – you became convinced you carried a monster around inside you. A monster you had to control.

Have you still not realized that was what it was all about – control? That you were casting magic spells with fate, trying to make a bargain with gods you didn’t actually believe in? You felt that you could (had to?) control the monsters by anticipating them and remaining on high alert. Have you still not understood that you had neither the power to defeat danger by imagining it in advance nor – as you always deeply feared – make it happen by simply conjuring it up in your mind?

Are you still trapped in the vicious circle of worrying about worrying about things? It was egotistical, in a way, that belief in your own importance and power – your imaginary dangerousness. This may astonish you, but in the end, I believe it was humility that defeated the fear.

But before I get to that, I have so many things to thank you for and now is my chance to give my ten years of anxiety their due. You taught me so much that I do not believe I could have learned any other way. You taught me not to rush to judgment, ever. To understand what struggling with mental anguish and the demons in the depths of your own mind is like. I cannot condemn the murderer, the evildoer, even the pedophile as others seem able to do. I thought I was a monster; I felt overwhelmed with terrifying, dark thoughts. I know their power and their terror. Who am I to judge? Thank you for that; it was worth every nauseating minute to learn that lesson in humanity, not simply intellectually but viscerally. The only hymn I love is “Amazing Grace”, because I feel as if I understand it. When I read of someone the world is vilifying and whose deeds are dark, there is still a part of me that reminds me “There but for the grace of God go I.” Thank you, thank you, thank you for that. Compassion and humility are very great gifts.

You made me a writer. Novelists, in particular, must be able to understand and value all their characters, even the worst of them. We must be able to fully occupy their inner world to make them real to our readers, to make them live. Suffering informs the imagination, broadens it, hones it, softens it.

You forced me to seek help. Now I understand that my anxiety was the healthiest part of me at that time. You would not let me go until I had dealt with the patterns of thinking that were no longer working for me. You were inexorable. I had to face you, and you would not leave me until I did. It was you who forced me to reach out to psychologists, psychiatrists and, finally, most successfully, a counsellor. All of them taught me many things about being alive and what it is to be human. They could not cure me – in the end, I had to do that for myself – but they gave me the tools, the information, the commonsense and the wisdom that, when I was finally ready, I picked up and used. I use them all still. And when I need it, I remain happy to seek help knowing that I will find it. I have passed on many of the skills and wisdom I learnt, particularly to my daughters, neither of whom seem to suffer with the anxiety that so bedevilled my own youth.

And my terror made me feel alive – painfully so – but very aware of myself, the world and my place in it. I struggled and I grew. Sometimes I miss that. I am happier now but also more complacent and a little bit less present. Even self-confidence has its price.

But how did it end? How did we break up and how did I manage to leave you behind, now for almost a quarter of a century?

I experienced real, rather than imaginary, danger and did not go mad.

My first baby was born prematurely and caught an infection in the hospital: RSV and bronchiolitis, still the biggest single killer of babies under one. After a few harrowing days in the crowded babies ward, she stopped breathing in my arms and had to be resuscitated. She stopped breathing two more times that night and ended up being intubated in the last available intensive care neo-natal bed in NSW. She was officially the sickest child in the state.

The next morning, convinced she would die (I remember clearly thinking, “I have only known her for 13 days but if she dies, so will I”), I did what I had learnt to do – thanks to you – and reached out for help. Dr Peter Barr, neo-natologist and grief counsellor, met me in the coffee shop of the hospital. There he said these words to me that, 25 years later, I can still quote verbatim.

“There is nothing special about you,” he said. “There is nothing special about Polly. Terrible things can happen and they can happen to anyone. Safety is an illusion. Danger is reality.”

Invisible bricks fell from my shoulders as he spoke, as I realized that I had to deal with what was and not what might be. There was nothing special about me; I had no power over my fate or even my child’s. Terrible things could and might happen but I would only worry about them when they did. I gave up control.

I have been frightened since, but never anxious.

I still don’t much like edges, though.

 

Jane Caro is the author of:

Just a Girla young adult historical fiction told from the perspective of Elizabeth, daughter of King Henry VIII and Anne Boleyn, who on the cusp of her coronation wonders, “How do you find the courage to become queen even though you are just a girl?”

The Stupid Country: How Australia is dismantling public education (with Chris Bonnor), which aims to “show how government, anxious parents, the church and ideology are combining to undermine public schools”.

The F Word: How we learned to swear by feminism (with Catherine Fox), which challenges “the pervasive idea that women will never be able to effectively combine work or interests outside the home with marriage, a social life and parenting” by telling the stories of a range of women and providing “practical suggestions for forgiving ourselves, having fun and not giving up while holding it all together”.

On “targeting” little girls who wear shorts as “trampy”

Do short shorts = trampy? Does a short skirt = slutty?

The American Psychological Association (APA) defines “sexualisation” as  occurring when a person’s value is believed to come only from their sexual appeal; their sexiness is judged according to a narrow ideal of physical attractiveness; or they are sexually objectified (that is, seen simply as an object for others’ sexual use). This may have a serious impact on a child’s cognitive functioning, physical and mental health, and on their sexuality.

As a parent and educator, this has concerned me enough to compel me to act.

Back in 2002, I founded a company, Enlighten Education, which now works with over 20,000 girls a year in schools. We encourage girls to be discerning consumers and critical thinkers and to find their own voice and power in a complex world. I’ve taken to the streets to protest against child beauty pageants. I’ve backed boycotts of stores that market Playboy-branded merchandise to kids. Back in 2007, when 60 Minutes did a feature story in response to the Senate’s inquiry into this issue, I was presented as the “poster girl” for parents who were concerned that our culture imposes pressures on girls to be too sexy, too soon. Hell, I have even written two books aimed at supporting parents, and girls, to claim their own power.

So why am I not thrilled at the latest online furor over the mother’s Facebook message to clothing store Target that slammed them for encouraging girls to look “trampy”? After all, over 57,000 people agreed with her. Why too aren’t I elated by the subsequent media storm this has initiated, which has seen two different pairs of denim shorts held up as shocking examples of sexualized clothing we should all be morally outraged by?

A pair of shorts presented by the media as evidence of the sexualisation of girls.

Because short shorts are not evidence of the sexualisation of our children, nor should children ever be labeled as “trampy”. And the really important and valid discussions around the sexualisation of children we need to be having at the moment seem to be being hijacked by those that would have this issue used as an excuse to shame girls and women based on their clothing choices.

This diversion may have serious consequences. History shows us that the natural progression in making moral judgements about an individual based solely on their clothing is to then begin blaming victims for sexual assaults based on what they were wearing at the time. I have already seen a number of comments and posts on Facebook that suggest if little girls are attacked by predators, it would be reasonable for us to then question what they were wearing at the time of the assault. Not only is such thinking deeply offensive, it is misinformed and dangerous. All the research shows that those who would harm girls and women pick targets they perceive as vulnerable; as easy targets. They don’t go around measuring short lengths or skirt hems.

Keep in mind too that sexual assault is a very real issue in our society and when we make statements that are in effect rape-apologist in nature, or that shame women based on clothing choice, the victims of these assaults hear that we think somehow it was their fault. That they asked for it. Their shorts were an invitation to judge them / insult them / harm them.

Truly, where do we think this policing of the length of a pair of shorts might end? Should girls and women be ashamed of their flesh? Do we want to keep them covered up from head to toe?

I absolutely agree that there are many marketers who are selling out on our children by pushing a product that does enforce an artificial, adult version of sexuality upon them. Should the shorts have been brandished with “Flirt”, “Playboy”, “Porn Star” or pouting lips (and make no mistake, I have seen products aimed at children bearing all these slogans) then yes, this would clearly be evidence of sexualisation.

And whilst I support any individual who wishes to speak back to corporates and demand more for children, I know that a path which invites the shaming of girls and women based on clothing choice, and that views garments that seem only to be guilty of perhaps “showing too much leg,” is not a path we should be going down.

* This post was first published by The Hoopla, 15/8/12.

Smart and Witty vs Fake and Pretty: The new “compare and despair” game

I have noticed a trend in the quest to promote positive body image that I really think needs to be critiqued and nipped in the bud. Fast. It is typified by the slogan on this T-shirt, which is being marketed by an organisation that otherwise does positive work in the field:

I am sure the intention is good – to break down our culture’s obsession with beauty.  The problem? Pitting two types of women against each other and implying that only one type – women with intelligence – has value. Couldn’t a woman be both smart and pretty? Isn’t it possible that a witty woman may also have moments of insincerity? This seems “pretty” limited and alienating to women who may, either through genetic luck or the use of beauty products, just so happen to fit society’s notion of what is beautiful.

It’s not the only example of this “compare and despair” game that has reached prominence of late. A graphic comparing the Victoria’s Secret “Love My Body”  campaign to that of Dove’s “Real Beauty” campaign did the rounds too. The message? The lingerie models aren’t real women. What are they then, androids? The models may be Photoshopped and represent a body image ideal that few can attain – but does reducing women to two types and implying that one is better or more real actually help promote healthy body image and body acceptance?

We don’t need to see women reduced to stereotypes, no matter how “good” or “bad” those stereotypes supposedly are. What we need to see, and what our girls need to see, are women being celebrated for who they are, and for the brilliant, beautiful, complicated mix of qualities that makes each of us utterly unique.

Rage and despair: Positive, helpful ways to support girls in crisis

Trigger warning: This blog post contains references to suicide. If you or anyone you know has suicidal thoughts or behaviour, seek help immediately. These help lines are open 24 hours a day:
Australia
Lifeline: 13 11 14
Kids Help Line: 1800 55 1800
Salvation Army 24-hour Care Line: 1300 36 36 22
New Zealand
Lifeline: 0800 543 354

All of us at Enlighten have been heartbroken to see a number of media reports recently of teens taking their own lives. Cath Manning, one of Enlighten’s Victoria workshop presenters, is concerned about the high rates of depression and suicide in her area. Interviewed along with Steve Biddulph this week by her local media, Cath made this great point:

I think we sometimes forget that teen girls are going through the same things we went through when we were growing up, however, today there is even more pressure on them due to the relentless media images and messages they are bombarded with, and the added complications with social media. Of course, social media is here to stay, and there really are great benefits that come with that, but young girls just need to be given the tools to engage with the medium in a positive, helpful way.

Positive — that’s the key. There are positive things we can all do to help our kids cope. We can listen and look for the signs that all may not be well in their world, and we can offer our support. Due to the recent media coverage of teen suicides, a lot of parents and teachers have been asking my advice, so this seems a good time to share an excerpt from my book for parents, The Butterfly Effect, on how to identify and help teen girls in crisis. For the teen girls in your life, I have also written a version of the book specifically for them, The Girl with the Butterfly Tattoo. Both are available for purchase here.

Rage and Despair: Suicide

What many people who try to take their lives share is a sense of being trapped in a stressful or painful situation, a situation that they are powerless to change. Having depression or a mental illness raises a person’s risk of suicide. Stressful life events or ongoing stressful situations may fuel feelings of desperation or depression that can lead to suicide attempts. Examples of these stresses include the death of a loved one, divorce or a relationship breakup, a child custody dispute, settling in to a blended family, financial trouble, or a serious illness or accident. Any kind of abuse – physical, verbal or sexual – increases the risk. Substance abuse by any member of a family affects the other members of the family and can lead to suicidal feelings either directly or indirectly, through the loss of income and social networks or trouble with the law.

Bullying needs to be taken seriously as it has been known to make teens try to take their own life. Also, teens are right in the middle of forming their own individual identities and a major component of that is their sexuality. For a teenager who is questioning their sexual preference or gender, the pressure to be like everyone else, the taunting they receive because they clearly are not, or their own guilt and confusion can become unbearable. A relationship breakup can be a trigger for suicide in some teens. As adults, we have the ability to look at the bigger picture and know that in years to come, a teenage breakup will not seem anywhere near as important as it does at the time. A teenage girl, on the other hand, may not yet have the maturity to see beyond the immediate pain. If she seems unduly distressed about a breakup, pay attention. Another trigger for teen suicide is the recent suicide of someone close to them, or the anniversary of a suicide or death of someone close to them, so these are times when girls may need extra support.

Suicide is hard to talk about. It is almost taboo, simply too painful to touch on. But silence can be deadly. Often the parents of a teen girl at risk of suicide do not ask her the tough question of whether she is planning to take her own life. In part they may be in a state of denial, which is only human – after all, no parent wants to imagine that their daughter feels suicidal. They may also have a fear that seems to be ingrained in our culture: that if they mention suicide to their depressed or distressed daughter, they will be putting the idea in her head. But experts in adolescent mental health agree that it is more than okay to speak directly to your daughter about suicide. ‘Parents are often worried that by asking they may make matters worse. Well, I have never known a child to suicide because someone asked whether they were thinking about it,’ says child and adolescent psychiatrist Dr Brent Waters.

Another unhelpful myth about suicide is that a teen who talks about suicide is simply seeking attention and won’t actually take her life. In fact, four out of five young people who commit suicide tell someone of their intentions beforehand. Besides, I have never understood the point of making a distinction between attention seeking, a cry for help or a genuine intention to commit suicide. Even if a teen is not actually going to go through with a plan to take her life, if she is distressed enough to cry out for help, her voice needs to be heard and she needs our support.

What you can do

Number one: if anyone – child, adolescent or adult – says something like ‘I want to kill myself’ or ‘I’m going to kill myself’, seek help straightaway. Remove anything they might be tempted to use to kill themselves with and stay with them. Dial 000 in Australia or 111 in New Zealand or a crisis line. The following phone counselling services are available 24 hours a day:

Australia

  • Lifeline: 13 11 14
  • Kids Help Line: 1800 55 1800
  • Salvation Army 24-hour Care Line: 1300 36 36 22

New Zealand

  • Lifeline: 0800 543 354

Another valuable thing you can do to help someone you fear is having suicidal thoughts is to listen. These pointers are adapted from the Victorian Government’s excellent ‘Youth suicide prevention – the warning signs’ on www.betterhealth.vic.gov.au:

  • Listen and encourage her to talk
  • Tell her you care
  • Acknowledge her feelings
  • Reassure her
  • Gently point out the consequences of her suicide, for her and the people she leaves behind
  • Stay calm; try not to panic or get angry
  • Try not to interrupt her
  • Try not to judge her
  • Don’t overwhelm her with too much advice or stories about your own experiences

Suicide warning signs

  • Loss of interest in activities she used to enjoy
  • Giving away her prized possessions
  • Thoroughly cleaning her room and throwing out important things
  • Violent or rebellious behaviour
  • Running away from home
  • Substance abuse
  • Taking no interest in her clothes or appearance
  • A sudden, marked personality change
  • Withdrawal from friends, family and her usual activities
  • A seeming increase in her accident proneness, or signs of self-harm
  • A change in eating and sleeping patterns
  • A drop in school performance, due to decreased concentration and feelings of boredom
  •  Frequent complaints about stomach aches, headaches, tiredness and other symptoms that may be linked to emotional upsets
  • Rejection of praise or rewards
  • Verbal hints such as ‘I won’t be a problem for you much longer’ or ‘Nothing matters anyway’
  • Suddenly becoming cheerful after a period of being down, which may indicate she has made a resolution to take her life

 
(Heart image by Seyed Mostafa Zamani, licensed under the Creative Commons Attribution 2.0 Generic license.)

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