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A nomadic expat life can be stressful on kids!

A nomadic expat life can be stressful on kids!

Expat life and moving around the world places a great deal of stress on children. DR REBECCA GIESS and DR MARK TOH from Promises Healthcare share how parents can help them adapt to new environments and people.

What issues do children deal with when adjusting to expat life?

Rebecca: They suffer mostly from homesickness, and grief from losing friends, extended family and familiar places. In a new country, they find it difficult to fit in and feel a sense of belonging. They have a fear of missing out (FOMO) on life back home.

Mark: They perceive a threat in relocating. Extended family and friends represent the emotional resources the child depended on, and the disruption in daily routine affects their emotional security and stability. This is an important and largely overlooked stressor. How children experience this, and how prepared they are for the change, is based on their relationship with their parents.

DR REBECCA GIESS

What are the red flags?

Rebecca: It can be difficult for children to know how they are feeling or how to express it. They may exhibit anti-social behaviours by breaking the rules or defying expectations. Tune into your child to uncover the underlying emotional triggers, and what they might need emotionally from you.

Mark: For children under the age of eight, there may be more crying, moodiness and irritability, complaining about school, expressing worry, or becoming withdrawn and clingy. There may also be regressions such as thumb-sucking, temper tantrums or toilet accidents, despite being potty-trained.

Children aged seven to 10 may worry about their health or family and express anger and irritability. They may also pin negative labels on themselves. Some of these behaviours may manifest at school more than at home.

Preteens may be more reactive to the demands and stress of the new school, complaining about the different system or classmates. They could become withdrawn, have more incompleted homework, or have declining grades.

DR MARK TOH

How can we help teenagers adjust?

Mark: Teenagers will miss their friends, prom, graduation and sports pursuits – the rites of passage – and they may feel their sense of identity being stripped away. They may display depression, anxiety, irritability, apathy and withdrawal, which increases their sense of isolation.

Those who feel ready to be independent may feel trapped with their family. They blame their feelings on the relocation and start to resent the family for it.

If the teenager is close to completing Grade 12, consider allowing them to graduate before they relocate.

How can parents navigate their child’s emotions?

Rebecca: Create space and guidance for their emotional experiences. Parents can validate and normalise their emotions by saying things like: “It makes sense.” Or: “It’s normal to feel sad or stressed.”

Don’t place any expectations on how your child “should be feeling”. They feel what they feel. Parents can help them label their emotions and work out how best to manage them.

Talk to your child about becoming a “third culture kid” – someone who spends a portion of their developmental years in another country. There are several benefits and challenges worth understanding and planning for.

I recommend parents read Third Culture Kids: The Experience Of Growing Up Among Worlds (Pollock, Van Reken & Pollock 2017).

What is most important to the child?

Mark: Children are looking for safety and security. With younger children especially, this depends on how close they are to their parents. Pay more attention to any work or social activity that might threaten this bond. Parents must remain accessible to the child, meeting regularly, exploring and discovering the country together and having fun in the process.

They should also assess how they themselves are coping, and if they might be unintentionally neglecting their child’s needs.

What can parents do at home?

Mark: Help children to set up their room. They are more likely to embrace their new home when they know that their needs are being met predictably. Parents should be ready to share their personal feelings and discoveries to encourage their children to communicate as well.

Create routines that bring everyone together. Playing games encourages bonding. Team games, where discoveries can be made individually and shared collectively, are particularly useful. In the process, the family learns about each member together.

How can a therapist help?

Rebecca: Therapists are trained to work with children experiencing anxiety and depressive symptoms due to adjustment difficulties. Children are rarely completely open with their parents and may do better in a non-judgmental safe space.

Mark: A therapist looks at both the child and family’s wellbeing. How is each person in the family coping? If there are individual or collective difficulties uncovered, the therapist could help them get unstuck.

About Dr Giess & Dr Toh

Dr Giess has extensive experience in working with teenagers and parents. She also helps adults address severe and chronic mental and physical health issues, and is trained in couples relationship counselling.

Dr Toh treats troubled children and their families and helps them to address their challenges. Helping parents to parent well is also a concern for him. He also works with couples and individual adults, as well as individuals with personality disorders.

Promises Healthcare is at #09-22/23 Novena Medical Center, 10 Sinaran Drive. Contact the team at 6397 7309.

*This article first appeared online on Expat Living Magazine’s website. Anna Murphy, an editor at Expat Living Magazine, wrote this article.


 

Being Too Critical of Your Body? Exploring Body Dysmorphic Disorder

Being Too Critical of Your Body? Exploring Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD), in simple terms, is a condition involving an obsessive focus on one or more perceived flaws or defects in appearance. While the perceived flaw may be minor and inconspicuous, individuals struggling with this disorder are inclined to spend a large proportion of their waking hours worrying and finding means to fix these flaws. This includes seeking dermatological or cosmetic procedures and exercising excessively to fix their appearance. Depending on its severity, BDD can be disabling – the emotional distress it causes can affect one’s functioning at social events, work and in the public eye. 

BDD is estimated to affect approximately 2 percent of the adolescent and adult population worldwide, and preliminary studies in Singapore have also noted a similar proportion. This figure is, however, likely to be underreported due to the nature of the disorder, where affected individuals are unable to recognise the symptoms of the disorder. Coupled with the lack of awareness of BDD, people associate these BDD symptoms with the “physical flaw” itself. 

While there is no definitive cause, there are risk factors that can contribute to the onset of BDD. These can include bullying or abuse, perfectionism, constant competition with others, genetics, and other mental health conditions such as depression, anxiety or obsessive-compulsive disorder (OCD). With the prevalence of social media, this condition is further exacerbated as it perpetuates body image comparison and the image of an “idealised body”. This can trigger such compulsive behaviour in vulnerable individuals, especially if they struggle with low self-esteem. Chemical imbalances can also trigger the onset of BDD in the brain or the use of certain drugs such as ecstasy in susceptible people. 

 

What is the diagnostic criteria for BDD?

For a BDD diagnosis, there is a set of criteria that the individual must meet. According to the Diagnostic Statistical Manual of Mental Disorders (DSM V), they are:

  1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
  2. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
  3. The preoccupation causes clinically significant distress or impairment in social, occupational or other areas of functioning.
  4. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

 

In addition, the individual would need to be assessed on their degree of insight regarding body dysmorphic disorder beliefs. In other words, how convinced are they that their bodies look “deformed” or “ugly”? A person with good or fair insight recognises that these beliefs are definitely or probably false. A person with poor insight would think that these beliefs are probably true. In the worst-case scenario, a person with absent insight or delusional beliefs would be completely convinced that their body dysmorphic beliefs are true.

 

What forms of treatment are available for BDD?

A combination of psychotherapy and pharmacotherapy is often implemented in the treatment plan for BDD. Cognitive Behavioural Therapy (CBT) is a psychotherapeutic method which aims to help one recognise maladaptive thought and behaviour patterns, and teach self-help coping strategies that can improve one’s quality of life. CBT has been proven to be an essential form of treatment for other mental health conditions as well, including depression and anxiety disorders. CBT for body dysmorphia would focus on helping the patient build self-esteem, and learn to tolerate the distress of “exposing” their perceived defects to others. It helps them manage their concerns with healthier coping mechanisms instead of taking extreme measures to fix their appearance. This includes training them to cope with symptoms of anxiety.

Medication is sometimes used in combination with CBT for maximum efficacy. One common medication used to relieve BDD symptoms include antidepressant medications. Selective Serotonin Inhibitors (SSRIs) in particular, can ease and reduce compulsivity, as well as overwhelming symptoms of anxiety or depression. 

You may wonder why we don’t proceed with cosmetic or surgical procedures to correct their perceived flaws, especially if they seek such measures. As mentioned, BDD often involves flawed beliefs surrounding an inconspicuous or minor flaw in appearance. We must acknowledge that any medical or surgical procedure carries health risks, regardless of the extent of the surgery. Any unnecessary alterations or body modifications may not only lead to undesirable health effects but may also lead to dissatisfaction with the results. Should the surgical procedure not turn out as expected, this could worsen the patient’s BDD.

If you believe a loved one may be showing signs of BDD, do encourage them to consult one of our mental health professionals at Promises Healthcare. 

 


 

References:

  1. https://www.channelnewsasia.com/commentary/body-dysmorphia-vanity-obsession-mental-health-treatment-1883421 (Accessed 25/07/2022)
  2. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t19/ (Accessed 25/07/2022)
  3. https://www.mind.org.uk/information-support/types-of-mental-health-problems/body-dysmorphic-disorder-bdd/causes/ (Accessed 25/07/2022)
Straits Times Interviews Juliana Pang about the rise of gaming addiction amid the pandemic

Straits Times Interviews Juliana Pang about the rise of gaming addiction amid the pandemic

The Straits Times interviewed Juliana Pang, Addictions Therapist at Visions by Promises* to weigh in on her thoughts on the rise in Gaming Addiction among children in Singapore.

She shared that gaming addictions often develop in the context of underlying issues, such as struggles with schoolwork, bullying, or tensions at home. Children hence turn to gaming as a coping mechanism, she added.

*Visions by Promises is the addiction treatment arm of Promises Healthcare. This interview was done before its formation.

Follow the link to read the full article: https://www.straitstimes.com/singapore/community/gaming-addiction-on-the-rise-among-children-amid-pandemic-counsellors


Photo by Glenn Carstens-Peters on Unsplash

Anxiety and anxiety disorders in children: Time to talk about it

Anxiety and anxiety disorders in children: Time to talk about it

Anxiety and anxiety disorders are not an ‘adult-only’ thing – children are capable of experiencing these too, and we shouldn’t dismiss or trivialise their feelings.

Anxiety is a common feeling for many of us. It’s that uneasy feeling of nervousness, worry, dread, and fear that we experience in certain situations. You might have felt it before a job interview, while you’re in the labour room (even if you’re not the birthing parent!) and probably on your child’s first day of school. The occasional anxious feeling isn’t exactly a bad thing – in fact, it’s perfectly normal and beneficial to a certain extent. Healthy levels of anxiety function as a warning signal during dangerous situations, prompting us to react or flee to protect ourselves.

However, some people may experience overwhelming levels of anxiety to the point where it interferes with their daily life and relationship with others. In this case, professional help is highly recommended as intense and prolonged feelings of distress aren’t great for anyone and may be attributed to an anxiety disorder. And we’re not just talking adults – anxiety disorders may also develop in children.

Senior Clinical Psychologist, S C Anbarasu & Senior Psychologist Jane Low, share their thoughts about this with Honeykids Asia. Follow the link to read on:

https://honeykidsasia.com/anxiety-in-children/

Henny Tan Shares With The Straits Times About The Sensitivities Of Speaking With Someone With Eating Disorders

Henny Tan Shares With The Straits Times About The Sensitivities Of Speaking With Someone With Eating Disorders

Henny was interviewed by the Straits Times for her views on “What to say – and not to say – to someone with a suspected eating disorder”.

Here’s a snippet from her quotes:

a patient may misinterpret comments like “You look well” or “You look healthy” to mean “You look fat”. She explains that patients are often plagued with critical thoughts about themselves, viewing the world through an eating disorder lens or filter.

To read her full quotes and read the the full article, follow this link: https://www.straitstimes.com/life/what-to-say-and-not-to-say-to-someone-with-a-suspected-eating-disorder

 


Photo by Trung Thanh on Unsplash