Tag Archives: human

Emotional Impact of the Separation of Children and Parents at the US Border

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On June 20, 2018, the American Psychiatric Association (of which I am an Assembly Member) and 17 other mental health organizations joined forces in a letter to the Departments of Justice, of Homeland Security and of Health and Human Services, urging the administration of President Donald Trump to end its policy of separation of children from their parents at the United States border.

The letter states that “children are dependent on their parents for safety and support. Any forced separation is highly stressful for children and can cause lifelong trauma, as well as an increased risk of other mental illnesses, such as depression, anxiety, and posttraumatic stress disorder (PTSD). In addition, the longer that children and parents are separated, the greater the reported symptoms of anxiety and depression for the children.”1

The separation and detention of minors is a human rights crisis

The United Nations Convention on the Rights of the Child emphasizes the importance of considering “the best interests of the child.”2 These interests include:

  • Protection against discrimination
  • Safety
  • Wellbeing
  • Health
  • Ensuring to the maximum extent possible the child’s survival and development
  • Preservation of the child’s identity
  • Family integrity
  • Protection against the separation from parents against the child’s will
  • Free expression of ideas
  • Freedom
  • Education

The separation of children from their families and their detention under inhumane and deplorable conditions are in direct opposition to all these interests.

The emotional impact of the separation

The negative effects, both physical and emotional, on the children separated from their parents may not be apparent for many years and some may be irreversible.

The short-term emotional effects include:

  • Post-traumatic stress disorder
  • Anxiety
  • Depression
  • Low self-esteem
  • Feelings of helplessness and hopelessness
  • Behavioral problems
  • Irritability
  • Sleeping problems
  • Changes in appetite
  • Loss of interest in pleasurable activities
  • Poor self-care
  • Feelings of guilt
  • Suicidal thoughts or behaviors

The long-term emotional sequelae can be reflected in:

  • Developmental delay
  • Poor psychological adjustment
  • Poor school performance
  • Regressive behavior
  • Aggression
  • Increased vulnerability to physical illness
  • Alcohol and drug use

Studies show that no matter how brief the detention, it may cause severe and long-term psychological trauma and increase the risk of mental disorders.3

Parents may also be affected due to the uncertainty of what may be happening to their child, which may manifest itself in:

  • Increase in physical and emotional problems
  • Anxiety
  • Depression
  • Post-traumatic stress disorder
  • Difficulty in their relationships
  • Suicidal thoughts or behaviors

What is Attachment?

Attachment is the bond between the child and his parents, which plays a fundamental role in the social and emotional development of the child. Adequate attachment fosters feelings of security in the child. Poor attachment can make the child grow insecure, with separation anxiety, self-esteem problems, trust issues, behavioral problems, and even extreme dependence on others.

The relationship between parents and children can continue to be affected even after being reunited, which may be manifested in:

  • Attachment problems
  • Reduction in parental authority
  • Poor parent-child relationship
  • Difficulties in child rearing

How can we prevent these negative effects?

  • Putting a stop to the separation of families and to the inhumane conditions in the detention centers. The separation of a parent from a child should never occur, unless there are concerns for the safety of the child at the hands of his/her parent.
  • Early detection of symptoms through mental health assessments and periodic reevaluations (especially when symptoms may arise later as the separation or detention persists).
  • Coordination of services:
      o Physical health
      o Mental health
      o Legal
      o Interpretation in the child’s primary language
  • Psychotherapy and counseling can help the children and their parents to deal with their feelings or negative thoughts, identify stressors, and strengthen coping skills. Therapy can assist in processing emotions and offer support and hope.
  • Psychiatric medications may also control symptoms of depression, anxiety, post-traumatic stress disorder, or any other mental health condition.
  • Finally, there should be no shame in seeking help, which can improve the lives of the child and his/her family.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

References:

1American Psychiatric Association. (2018, June 20). Mental health organizations urge administration to halt policy separating children and parents at U.S. border. Retrieved from https://www.psychiatry.org/newsroom/news-releases/mental-health-organizations-urge-administration-to-halt-policy-separating-children-and-parents-at-u-s-border/

2United Nations. Convention on the Rights of the Child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx/

3Linton, J.M., Griffin, M., Shapiro, A.J. (2017, March). Detention of immigrant children. American Academy of Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/early/2017/03/09/peds.2017-0483.full.pdf

Simply Irresistible? – Impulse Control Disorders

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Luis Suárez, soccer player with the Uruguay National Team representing his country at the 2014 FIFA World Cup in Brazil, has recently gained some notoriety. Not so much for his abilities as a soccer player but for the bite seen around the world. And this is reportedly the third time in his career when he has bitten an opponent on the field. The unsportsmanlike behavior has left many soccer enthusiasts wondering, what is wrong with Suárez?

One of the mental health diagnoses being thrown around by sports commentators, and even mental health experts, has been that of impulse control disorder. While displaying aggression at the height of a stressful event, like biting another human being, may be characteristic of a lack of impulse control, making a diagnosis without evaluating a person, whether a public figure or not, is neither responsible nor ethical. But since the topic has been on the news, I think it is important to have a discussion about impulse control disorders, how they manifest, and how to treat them.

First of all, impulse control disorder is not an actual diagnosis recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Together with disruptive and conduct disorders, they describe a set of different diagnoses characterized by “problems in the self-control of emotions and behaviors,”1 which include oppositional defiant disorder, intermittent explosive disorder, conduct disorder, antisocial personality disorder, pyromania, and kleptomania. These disorders involve the violation of the rights of others and/or “bring the individual into significant conflict with societal norms or authority figures.”2 They tend to be more common in males than females, initially manifest in childhood or early teenage years, and are generally rare.

Here is a brief overview of these disorders, all of which must cause distress in the individual or impairment in his/her level of functioning:

Oppositional Defiant Disorder

Usually begins in preschool years.

How common: About 3.3%.3

Signs/Symptoms: Frequent loss of temper, anger/resentfulness, arguments with authority figures, defiance of rules, blaming others for mistakes/misbehavior, vindictiveness.

Intermittent Explosive Disorder

Usually begins in late childhood or adolescence.

How common: About 2.7%.4

Signs/Symptoms: Behavioral outbursts characterized by a failure to control aggressive impulses and manifested through verbal aggression, damage/destruction of property, or physical injury against others/animals. The outbursts cannot be premeditated and are grossly out of proportion to any provocation or stressor.

Conduct Disorder

Usually begins in mid-childhood to mid-adolescence.

How common: About 4%.5

Signs/Symptoms: Violation of the rights of others or society norms/rules manifested by bullying/intimidation of others, use of a weapon that can cause serious harm, physical cruelty towards people or animals, destruction of property, deceitfulness, theft, and serious violations of rules.

Antisocial Personality Disorder

Never diagnosed before age 18 but symptoms of conduct disorder must be present before age 15.

How common: 0.2 to 3.3%.6

Signs/Symptoms: “Pervasive pattern of disregard for and violation of the rights of others”7 manifested by unlawful behavior, deceitfulness, impulsivity, irritability/aggressiveness, reckless disregard for safety, consistent irresponsibility, and lack of remorse.

Pyromania

Insufficient data to determine when it usually begins.

How common: Not known.

Signs/Symptoms: Deliberate fire-setting; tension before the act followed by pleasure, gratification or relief once a fire is set; and fascination/attraction to fire.

Kleptomania

Variable age of onset.

How common: 0.3 to 0.6%8; females outnumber males 3 to 1.

Signs/Symptoms: Failure to resist impulses to steal things that are not needed for personal use or for their value; tension before the act followed by pleasure, gratification or relief once the theft is committed.

Other Disruptive, Impulse-Control and Conduct Disorders

Presentations in which symptoms of emotional or behavioral dysregulation cause clinically significant distress or impairment to the individual but that do not meet full criteria for any of the disorders above.

How are these disorders treated?

Impulse control disorders may be treated with therapy and/or medications. Early detection and intervention are important, especially when some of these disorders may bring the person in contact with the legal system. A mental health expert may evaluate the individual’s history and current presentation to determine the presence of a disorder and to establish the best treatment plan. There are different behavioral therapies that have proven effective for the management of these disorders and which should only be performed by a licensed provider.

We may not know what, if anything, is wrong with Suárez, but at least his behavior has given us the opportunity to talk about these important topics while the world is watching.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix