Teenage Mental Health, Eating Disorders and Gender Diversity

Teenage Mental Health, Eating Disorders and Gender Diversity

is a series of health talks that imc are doing to educate and help people maybe with a bit more information this is the last talk in our uh then series um this is the last talk in our series it’s teenage mental health eating disorders and gender diversity this is something i think we can all learn about more about as parents um and it’s it’s presented today by dr jacqueline dickino she graduated from sydney and has practiced in australia and in shanghai in her most recent practice her main areas of focus were women’s health long-term management of mental health and aged and palliative care she also saw a lot of teenagers in that practice and she’s got a particular interest in gender dysmorphia and domestic family issues dr jacqueline also has four teenagers herself so she’s right in the middle of parenting stage perhaps that gives her an understanding that some people might not so that’s great to have that experience as well um at the end of the presentation we will have time for questions uh so if you would like to ask a question at any time you can email you can sorry use the chat function to contact me at imc as my username all questions will be anonymous so um and also uh dr jacqueline has done quite a lot of research into resources for these issues so she will we put together a very comprehensive resource sheet which we will email to you at the end of the presentation so we might just wait maybe a couple more minutes before we get started just to make sure everyone’s here and arrived oh sorry i’ve just been corrected it’s gender dysphoria not gender warfare so thank you very much for that correction okay continued the part of it’s on one screen oh good well actually my brain kinda likes that matches my personal i can’t even right now we all hear now i don’t hear anything but i did bring my coffee the most important part what is happening look at that face oh i don’t want to do that computer audio hello all right i think we are i think we are ready to get started so i will hand over now to dr jacqueline morning everyone hi i’m jacqueline as andrea said andrea said i’ve um yeah i’ve got four children and um four teenagers and i have worked in australia and shanghai most recently i was working in brisbane and i focused a lot on women’s health and mental health and i did see a lot of teenagers in my practice there i have only been working at imc for three months so i haven’t haven’t seen a lot of teenage patients here yet but i i do see teenagers who come in for um their school medicals or for adolescent screening and i talked you know and talked to me about their family dynamics and talked to me about what’s happening with their teenagers as well so i do have some experience with what’s going on with teenagers in singapore as well um so today i’m going to talk about kind of a broad topics about teenage mental health i’m going to start off with a little bit of an introduction about um you know got my schoolism nation zoom presentation i’ve already managed to make a few mistakes with clicking on the wrong things so hopefully the rest of it goes smoothly um yeah and i hope that you guys learned something as well okay so that’s just an overview of what i’m hoping to cover today so yeah look at um teenage mental health and look at mental well-being um and sort of look at the you know ways that we can approach improving our mental wellbeing improve helping improve our teens mental well-being um i am going to talk a little bit about mental health and covert i i must admit i haven’t really prepared notes about that i was going to see how i felt today myself and see what i wanted to talk about on that it’s you know if we’re still living the reality of code and a lot of the information is going to be more information is going to be coming through about how covert affects mental health but i will touch on that um and i want to talk a bit about eating disorders and sexual identity and gender identity so we’ll start off with what is adolescence adolescence is a it’s a transitional stage it’s a stage where things are changing physically emotionally cognitively it occurs in girls earlier than boys so it’s usually defined by starting before the onset of puberty and ending somewhere in adulthood um so some some definitions have it ending sort of at 25 some extend that a bit further so for girls we’re kind of looking out from the age of eight and boys at the age of 11. there’s rapid changes through this period as i work through as you know as young people work through different parts of who are they and what’s their role and what you know what are they doing um and it can be a really confusing time for young people it has lots of challenges as their body changes as they you know as their thinking changes as their emotions kind of go all over the place and it’s a time when they’re building their own identity and finding the people that they you know they deal with um it’s a time when they’re taking risks and pushing boundaries and and finding you know their own independence away from their parents and making new connections with um in social groups and with adults and um and mentors it can also be a confusing and challenging time for you know the parents and the adults who support these children as they’re going through all these changes just outlines the um the physical changes that occur in puberty and um i guess it’s just interesting to see the reason i put this slide up is it’s interesting to see that you know there are um the changes occur can occur over a long period of time so over a number of years but also there’s a range of ages that you um for the start of puberty and um and when things change for different people i really like this slide this gives us a i guess having four teenagers myself um you know you go through the the experience of the grunting teenage boy and um the emotional teenage daughter um but it’s kind of nice to see that you know there are reasons why they’re behaving the way they’re behaving or saying the things they’re saying and it’s because things are changing physiologically things are changing in our teenagers brains that are you know affecting their ability to modulate their emotions or you know affecting their ability to have impulse control so um as you can see there a lot of these areas are developing um and you know in the teenagers they’re still immature and i guess the one that’s sort of most important in this slide the the two area sorry the most important are the prefrontal cortex so in an adult that area is fully developed and that’s the area that we use for planning and reasoning um and in and in adolescence that area is still growing and it grows until about the age of 25 so that’s why sometimes teenagers behaviors seems unreasonable and immature and more impulsive the area that does kind of control that you know adolescents rely on more is amygdala which is sort of a more an area that’s in the brain that’s responsible for emotions and um and adults tend to rely less on that area they use a prefrontal cortex more but for teenagers this area is more active and that’s why they’re more impulsive and passionate and um yeah i can and can explain some of their behaviors so i’ve just covered a little bit of this in that last slide but um yeah i think my major part of adolescence is learning how to how to assess risks and you know what are consequences for their behaviors and how to how to have a reasoned and reasonable approach to things and not just an emotional approach and obviously as their brain grows that becomes easier but i think as part of you know fitting in with school and society and family life they need to learn some skills to try and um you know try not to be impulsive all the time try not to be emotional all the time and this is just some of the teenage characteristics and i guess anyone out there with um teenagers will recognize some of these things but um yeah you know teenagers we all have mood swings but i guess in teenagers they become a little bit more obvious um as hormones start to kick in with puberty and yeah as um interactions with friends and family may not go their way during this time teenagers can form quite intense relationships with friends of both sexes and these relationships can you know come and go and that can create issues and um and emotional problems for teenagers as well around about the age of 14 or 15 particularly in girls um the whole friendship relationship thing can be quite tricky and difficult and it’s not uncommon to see girls at this stage having fallings out with friends and finding new friends and um yeah so that’s something to think about as well with teenagers that this is a difficult time in terms of finding their place in social circles and also adolescence this is a time when they start to value their privacy and time for themselves and um and their independence as well so the you know the teenage boy in the closed bedroom with his door closed for hours on end and you know that i think that’s reasonable that teenagers do have a degree of privacy but we also do need to encourage social interaction and family interaction and during this time as well teenagers going through amazing growth in cognition and starting to learn more about their world and um starting to have views on political and um religious or public health things as well so it is a it is an exciting time as well also during this time they have they’ve got more interest in their own activities and less interest in probably their parents activities so there may be less interaction with their parents as well and i guess one of the things that you know people worry about with teenagers is risk-taking behavior and i guess it’s our role as parents is to try and encourage our teenagers to be safe try and encourage you know model behavior in our families about um you know safe behavior and encouraging our teenagers to talk to us that’s the best way to keep them safe okay so i’m going to talk a little bit about mental health so so as i said i have been working in imc for just over three months now and and during that time i i have seen quite a lot of patients for mental health issues not so much teenagers but i have seen parents who have shared about their concerns with teenagers and um and i guess the yeah the one of the issues with um teenagers in mental health is that a lot of mental health disorders commonly start during the adolescent years so depression and anxiety predominantly start in adolescent the adolescence period um and interestingly there was a study done in australia that looked at year 12 students and it showed that over 40 of those students reported symptoms of depression and stress so they these children may not these adolescents may not have had diagnoses of mental health disorders but they’re reporting symptoms so it’s quite a common finding in adolescence i guess one of the important messages i wanted to sort of highlight for adolescents and mental health is that if you are worried about your child then the best thing is to try and get help early um getting help early means that you know the symptoms are likely to be less severe if it does progress to a mental health disorder it’s likely to be less be less severe and and potentially not as long lasting as well um yeah so if you are worried then you know talking to your child or seeking professional help is really a worthwhile thing to do um this is a mental health literacy pyramid from the sources from the mental health literacy website and this is actually this website i’ve actually put on the resource list has some fantastic information for both parents and teenagers so it really is worth having a look at so the um the with this pyramid so that we’ve got the mental health um aspect on the sides there so and that should have our wrists both go both going up and down so that’s looking at the overall overall mental health and um and there’s different stratifications for mental health within that pyramid now this isn’t a step progression so it doesn’t necessarily mean you go from one you know the green section to the pink sections of the blue section to the yellow section you can have all of these things going on at once [Music] so i’ll just explain it a little bit so the so i guess for most people most of the time we sit in that green area where our mental health is going well we don’t have any distress we don’t have any problems there are no disorders and we’re thoughtful we’re coping we’re using resilience we’re using coping skills we’re showing resilience the next level of mental distress is when things are causing stress for us or things that have upset us or made us sad or disappointed so i guess examples for adolescents would be um you know stress about an upcoming exam or stress about an assignment or worrying about um their friendship group or feeling sad that they missed out on getting into the basketball team sort of things like that and then the next level is um mental health problems and this is so this is more um it’s more symptomatic than with the mental distress so this is when people feel have feelings of heartbreak or sorrow or grief so i guess good examples would be bereavement um moving country it’s for a teenager moving school um and i guess also in these times you know dealing with covert and the effects that it’s having so in terms of you know restrictions and being separated from family yes that could fit in that mental health problem but also maybe the mental distress just i guess depending on how people are coping and you know what resilience they have and then the top of the pyramid is what we call mental disorders and illness so these are you know diagnosable dsm-5 category mental health disorders so depression anxiety disorder schizophrenia i just find this um this pyramid quite helpful as a way of thinking about you know where people are at where their emotions are at and as i said someone could have um could be on all four of those levels so they you know you could have someone with depression who is grieving the loss of a parent who is stressed about their upcoming year 12 exams but there may be times during the day when they are feeling that they are coping and um so they could be on all four levels for that okay so one of the um most common mental health disorders that we see is depression and it is the top cause of illness and disability mental mental illness and disability among adolescents about 20 of all teens experience depression before they reach adulthood and interestingly a significant number do not undergo treatment um i have seen quite a range of figures for what that significant number is so for some studies it says 30 some studies say 67 i didn’t put those statistics in because i guess it really depends on you know what level of um depression studies are looking at but needless to say it’s a significant number and as i mentioned earlier you know the it is important that if you are worried about your teenager’s mental health that seeking treatment early is the best um the best way to try and get on top of things and hopefully to try and shorten the duration of symptoms and i guess some of the reasons for not undergoing or not seeking treatment are that you know sometimes people don’t sometimes adolescents don’t recognize or accept that they that something is going on that they have a problem um they may not realize that how they’re feeling is not um a normal way of dealing with stresses or what’s going on in their life and some people aren’t willing to talk about how they’re feeling some people don’t feel confident to talk to teachers or counselors or may feel worried about talking to their parents they may feel worried about upsetting their parents sometimes people believe that you know no one can help me or there’s nothing anyone can do so why do i do anything at all um and sometimes there are factors such as you know availability for services or costs that may affect um access people accessing treatment and i guess also one of the other issues is that um you know if parents or close friends or teachers don’t notice the symptoms they may not advocate for the child to try and seek professional support and i wanted to just highlight you know depression is um it is a mental health disorder and it’s when people have low mood but how do we determine you know is is someone depressed or are they feeling sad or are they are they moody um and the three characteristics that help define depression are how long it’s lasted so you know anything over two weeks so a low mood depressed mood for over two weeks um is concerning and would make us wonder if if it is actually depression that we’re dealing with how strong the feelings are how pervasive they are how persis persistent they are so if it’s um you know if someone’s for teenagers feeling down and sad all day um that makes it less likely to be a feeling of sadness or an intimate moodiness and how much it affects their life so how does it affect their social interaction how does it affect their academics how is it affecting their family life so all of those things help us to differentiate if someone is sad or depressed and these are some of the symptoms we look for for depression sorry some of the signs um so things like feeling tired having sleep affected changes in appetite social withdrawal changes in school performance or changes in school attendance and and the presence of school refusal changes in moods so being angry or disruptive self-harming behaviors can be a sign of depression um and changes in the way that um people look after you know teenagers look after themselves for being less attentive to their personal hygiene or appearance there can be changes noted in you know the way teenagers talk the way they think their thoughts their they may present as agitated or restless and they may they may present with a whole lot of physical elements that you know don’t seem specific so sometimes mental illnesses can present as physical symptoms and also of course sometimes teenagers present with suicidal thoughts and and suicidal attempts and so that’s what i’m going to be talking about next is suicide and there is a high risk in adolescence of um who have um underlying mental health conditions of um of suicidal ideation so that’s suicidal thoughts and part of that is because of their cognitive immaturity and they increase impulsivity last year in suicide oh sorry sorry last year in singapore suicide had it uh i said it again last year in singapore um that was the highest suicide statistics uh this was a report put out by samaritans of singapore um the actual figures for that were all aged so this that um wasn’t for adolescents as such but it um in 2019 in uh there were 71 suicides in people in the in their 20s um and it is the leading cause of death for adolescents in singapore and the samaritans singapore did report that in 2020 that they had the um highest number of calls to their um their call line and their um their email and um messaging groups as well for people who are in distress and people have had suicidal thoughts and just on that that aspect um suicidal thoughts it isn’t an uncommon thing for teenagers to report so up to 50 of teenagers report that at some time they have thoughts of suicide and that may be a sign of mental distress um and you know a sign of impulsivity rather than a sign of underlying suicidal intent but for some adolescents it is a sign of underlying suicidal attempts so that means that you know they are making plans or they have made an attempt so i guess with um you know one of the things to think about is you know if your child does come to you with thought saying that they’ve had thoughts of suicide or death what should you as a parent do at that stage and if you think your child is in immediate danger you should call 995 for an argument so that’s a number in singapore um or you should take them to an emergency department you need to make sure that your child is safe if they’ve come to you expressing suicidal thoughts i guess there are some teenagers who are more at risk of suicidal thoughts and suicidal plans so people who have had previous attempts of suicide someone who know if a teenager knows someone else who has died by suicide children adolescents with underlying mental illnesses so depression or anxiety or eating disorders if there’s been a family history of suicide that does increase the risk children who are socially isolated are at more risk and also children who misuse drugs like alcohol and children and adolescents who have experienced stigmatization or abuse or bullying or adolescents who are exploring their gender or sexuality are also at increased risk and i think some of the it’s important to you know think about what sort of warning signs would you act on and obviously suicidal signs so um that’s something that you need to take urgent action on so if your child or adolescent comes to you talking about feelings of hopelessness or despair talking a lot about death saying goodbye in a way that seems permanent or um writing suicide notes or collecting things that could be used for a suicide attempt so pills or knives um then you know that’s something that needs to um needs to be added on urgently either if you feel that your child is unsafe as i said call an ambulance or take them to emergency department or if you feel they’re safe at that time arranging an appointment with a general practitioner and then the other things too the other warning signs are behavioral changes so if there’s been an abrupt change in their social activities if they’re running away skewer school refusal drop-in academic performance or drug and alcohol use and also emotional changes can be part of the warning signs so if your child has become very agitated it’s having marked mood swings it’s quite aggressive or showing signs of psychosis so hallucinations or um erratic thoughts or behaviors they’re warning signs as well and and they should seek professional help in that case if your child has come to you and expressed some concerns about suicide or their thoughts um then it’s important to talk to them about it to take them seriously to um you know if you’re worried if you see behaviors that you’re worried about to ask them have they had any thoughts about death or suicide and obviously as a parent that’s a really difficult conversation to have it’s a really important conversation to have if you are worried and some teenagers will be really relieved that mum or dad has recognized and i’m struggling and yes i am having these thoughts and i was scared to talk to them about it and you know i’m happy that you’ve come to me mum or dad too and i’ve been interested in how i’m feeling i guess at this stage it’s important to also address and to highlight that you know something as teenagers don’t show any warning signs that they’re having these thoughts and so um so that can be difficult for both healthcare workers and parents if um if an adolescent does undergo a suicide attempt if there haven’t been any warning signs about that um so if your child does come to you with suicidal thoughts it’s really important that you stay with your child that you don’t leave them alone that you know if you can’t be with them have another adult who’s responsible be with them to make sure that they’re safe that they’re in an environment where they’re not going to be potentially at risk or to remove any objects that may cause harm and to it’s important to tell your child that you care about them that you care about how they’re feeling and to tell them that if you think their life is in danger that you’re going to be seeking professional help urgently but also that you’re going to be seeking professional help at some stage because they’ve come to you to talk about it it’s also important to tell them that if they ever have any thoughts like this again that you know that you want them to promise you to that they’ll come to you or to another adult to talk about how they’re feeling i guess one thing to think about is you know if your child comes to you this is um this is a really upsetting situation for a parent and i guess it’s really important with how you how you approach the situation and it’s important to not trivialize how they’re feeling and to not make them feel that you’re being judgmental or blaming them and to not minimize what they’re going through as well so try to avoid things like saying things start saying things like now you’ve got everything to live for things would be worse or um this will all get better now your child is coming to you with um really serious thoughts and um and they need to they need to be acted on seriously and i guess it’s really important to help your child seek professional support as well so encourage them to come with you to see the gp or um yeah or as i said before that you know if you feel that you’re there um their life is in risk that you’ve told them that you will be seeking um support by going to the emergency department or calling an ambulance and so the next mental health disorder that i wanted to talk about was anxiety and so this is also a very common mental health disorder in adolescence and the study in the us has shown that nearly one in three adolescents will experience an anxiety disorder i guess the interesting thing with anxiety disorders is it actually covers a group of disorders it’s not just one um one mental health illness so it covers things like generalized anxiety disorder um panic disorder where people have panic attack some health anxiety disorder where people worry about their you know their body and um symptoms and do they have um do they have serious health issues like cancer or you know is that sore throat cancer is that i’m coughed that i have lung cancer and um but anxiety disorder also includes specific phobias so you know being scared of snakes or being scared of heights can come into anxiety disorder as well so it is normal for everybody to feel some feelings of anxiety or stress but how do we determine when it’s anxiety or stress versus when it’s an anxiety disorder and similar to when when i was talking about depression how do you determine if it’s depression versus sadness um so the the duration of the symptoms so if it’s um if it’s lasting lasting for weeks or months um the how much it affects and interferes with life so learning and socializing in everyday activities and how intense and severe the symptoms are um and as i as i’ve just uh pointed out that stress is a normal part of life for adolescents stress can come in a number of forms so having stress and worry about homeworks and exams um expectations and pressures to do well both academically and in sport and in other extracurricular activities stress can um stem from their social relationships and issues with their friendship groups um so yeah there’s there are a lot of things that adolescents go through um that can cause anxiety and stress for them and actually a research study done by mission australia found that 40 of 15 to 19 year olds are concerned about their ability to deal with stress sorry here we go um and so these are some of the signs of anxiety so as i pointed out with depression sometimes mental health disorders can present with somatic symptoms so physical symptoms um so things like rapid heartbeat palpitations dizziness feeling sweaty and trembling feeling upset in the tummy um chest pain and shortness of breath that are all common things that people can report with anxiety um often sleep is affected with anxiety and um and people quite often report insomnia and sometimes people feel like a sort of an overwhelming sense of dread an impending sense of doom feeling overwhelmed or feeling like they’re worrying about everything feeling terrible or feeling a loss of control and sometimes people feel like they’re going crazy and you know and sometimes people do worry am i dying is that chest pain and a heart attack okay i just wanted to talk a little bit about um if you are worried about how your child is um feeling and if you have you know if your child does come to you with symptoms of anxiety depression how do you as a parent manage that at home so if your child comes to you in an anxious moment so if they’re having a panic attack or if they’re if they’re feeling particularly anxious how can you as a parent help them at that time so i guess the first step is first step is for you to try and remain calm um but to help your child feel calm and to help them feel safe and and you can do this in a number of ways by sitting together with them by sitting close to them so that they feel like your physical presence there by doing some meditational mindfulness things with them so do some breathing exercises i guess one of the um so an example of a breathing exercise would be to to breathe in for a count of four to hold that for a count of three or four and then to breathe out for a count of six and you can do that with your child that’ll help keep you calm but it’ll help calm your child down as well and that’s a good skill for them to learn so that if this ever happens again they’ve got a tool for how to manage those symptoms another thing that you could try is doing some grounding exercises so um focusing on your senses so sitting calmly and quietly with your child and saying what five things can i see at the moment and getting them to list five things what four things can i hear at the moment and getting someone to list those things um so that gives them a way of focusing away from those feelings and away from the things that are triggered in the way they feel another time to tool to use would be talking to your child about a favorite memory or a safe or favorite favorable relaxing place and maybe visualizing that and talking them through that and also encouraging your child to do something that helps them helps them feel calm so listen to the music that helps them feel calm um or gone for a walk or something like that um yeah so the next slide is talking about how to help if your child is your adolescent comes to you and they’re feeling down or depressed so one of the important things is to look at lifestyle factors so that refers to sleep exercise and diet now i know sleep can be a difficult topic with adolescents um and the adolescents tend to have a change in their sleep rhythm and their circadian rhythm um they tend to want us if they tend to stay up later and they tend to sleep through to midday the next day if you let them but it’s really important that you know they aren’t getting enough good quality sleep and particularly during the school term actually it is important to try and keep a regular sleep pattern in part as as regular sleep pattern as possible even during school holidays but um yeah during school time it’s important that they get good quality sleep and so that would some of the factors that you could look at to improve that is making sure that there’s no screens the hour before they go to bed making sure they don’t have devices in their room or is it really accessible before they go to sleep another lifestyle factor to look at is exercise so encouraging your child to be active to move their body to be involved in sport at school to be involved in exercise with the family if possible and the other thing is diet so looking at making sure they have a good balanced diet of you know five fruit and veg a day and yeah making sure they’re fueling their body for the activities that they undertake during their day and so also with a you know teenager who comes to you with who’s feeling sad or down or depressed it’s important to show that you care about them that you know you love them that you’re supportive of them that you’re there for them if they want to talk to you um and yes encourage them to talk to you or another adult if things are getting worse or if they’re worried um let them know that you’re willing to you’re willing to listen um and sometimes that can be difficult with as i said before though you know the grunting teenage boy but um you know finding those opportunities to have those little conversations with them sometimes they surprise you with you know how open they can be and um yeah and at times you may not expect like you know the drive in the car where well you’re not having that face-to-face kind of intense conversation children often open up a little bit more or going into their room late at night maybe trying to get them to go to bed and sitting on their bed and saying you know how things going adolescents often you know are willing to talk at that time um so yeah finding those opportunities to talk to your child we’re trying to engage them and keep them engaged in family routines so obviously meal times are an important one but you know pizza night friday or um sunday breakfast pancakes or something like that try and engage them in those routines that are special for your family and i put this slide in because it kind of fit in quite well with those um you know tools that i just talked about you know how to manage with um if your teenager is feeling anxious or depressed and and finding tools for helping them to cope with those and some of the pressures that teenagers will be um feeling are related to their social groups so to their peers and so it is good to have a think about how you um how you talk to your child about you know their peer group and their interactions with their friends to let them know if they if you’re concerned about um you know what’s happening in their social groups to let them know that you’re willing to you know talk to them and that you’re you know you’re an ear or a shoulder to cry on um talk to them about what what is a real friend and you know and what behaviors do not constitute real friendship and talk to them about ways of saying no or ways of keeping themselves safe and getting out of situations that they may not feel comfortable in and try not to to overreact if kids come to you and talk about what’s going on in their social group um or you know what they’re concerned about with their social interactions but i guess the other side of that is that you if you are concerned about your child’s safety or other children’s safety you wouldn’t need to act on that and um and i just thought this was really important to talk about as parents you know we um it’s it’s good to know about how to deal with my child if they come to me with anxious feelings or depression but what kind of things can i do to promote my child’s mental well-being what kind of things can i do to maybe help prevent them from feeling sad or anxious or stressed and um and so coping skills are really important these are behaviors that we um that we use to manage feelings of stress when we come across tough situations when we know when we’ve got exams or when we’ve got assignments or when we’ve got something to it at work as adults coping skills are what we use to deal with those feelings that we worry and stress and there are a number of kind of coping skills the positive coping skills help build resilience and well-being and help us to manage difficult situations in the future sometimes people resort to negative coping skills and these are skills that obviously don’t build resilience and um and those kind of coping skills like you know avoidance or um you know self-medicating with drugs and alcohol and things like that and so resilience is something that i think is really important to to try and promote to help our teenagers well mental welfare so resilience is being the ability to overcome difficult situations and to withstand tough situations and adversity and the sort of things the factors that help lead to resilience are having a positive attitude about things being able to regulate your emotions and as you remember from those slides that i showed you for the brain now that’s not an easy thing in teenagers but it’s something that we as parents can help um encourage our teenagers and to help regulate oops looks like i’m running out of time here um and yeah so i might just move on because i there are a few things that i do need to i really want to address with eating disorders and gender identity so i think with eating disorders the doctors at imc we we do see adolescents with eating disorders and um some of the other doctors i have seen patients with eating disorders and some of the other doctors have reported that certainly over the last 12 months they have seen um more with eating disorders i think some of the important things to um think about with eating disorders is it has the highest mortality rate of any mental disorder the mentality rate of a a lesson with um eating disorder is 12 times higher than those without an eating disorder and also it’s important to identify some of the myths about eating disorders it is eating disorders are a serious condition they’re not a lifestyle choice um dieting is not a normal part of life for an adolescent uh if an adolescent is undergoing a moderate diet they’re six more times more likely to develop um an eating disorder than someone who isn’t dieting and if they’re undergoing a severe diet so severely restricting or changing their diet um then they’re 18 times more likely to develop an eating disorder and eating disorders are not a cry for help or a phase they’re going through often two adolescents with eating disorders go to great lengths to hide um the fact that they’re um that they’re losing weight or that they have changed how they’re eating or that they’re restricting their foods or that they’re using pertinent behaviors and historically um the medical profession um you know try to um i guess explain why eating disorders concern um occurred and one of those um thoughts 20 to 30 years ago was that um it was something to do with the parents the parenting style or the mothers and and that’s not true parents often play our parents aren’t to blame for eating disorders yes sick is a genetic priest um propensity for eating disorders but it isn’t related to the parents parenting style and i guess another thing is that you can’t tell if someone has an editing disorder by looking at them there are some people with anorexia who um who have a normal bmi but they’re they have had marked weight loss and they have severely restrictive eating habits and that has physical and effects on their health and i guess and the other thing is that eating disorders don’t just affect white middle-class females who are adolescents it can affect boys and they can affect men it can affect any it can affect anyone so an important aspect in eating disorders is body image um and just given the fact that i’m running out of time i might might push through this slide but um body image is the way we think about ourselves so it’s it’s affected by our shape our size the way we think our body functions and how we think other people see us as well so there are four um therefore constructs to that so how you see your body how you feel your body how you think about your body and the way you um the way you behave as a result of all those factors body image can be affected by your relationship with your family or friends how other people um how you hear other people talking about their bodies um it can be affected by idealized or unrealistic body images that are presented in the media or social media and it can also be affected by pressure to look a certain way so i guess a common thing would be in this with certain sports so i guess for example gymnastics or dance or swimming um you know wanting to look a certain way or being expected to look a certain way just think about the next slide about some statistics i won’t talk a lot about this i have as i said i have tried to sort of steer a little bit away about statistics um for these slides but um i guess this is just kind of a little bit eye-opening about how adolescents feel about their body and and you know the ages of the young age that people are starting to worry about how they look and how um and what they eat and um and dieting behaviors so what are eating disorders they’re mental disorders that are serious and potentially life-threatening they’re defined by um changes in behaviors and thoughts and attitudes to food and eating weight and body shape and they impact um on the individual’s life they have a negative impact on physical emotional um occupational and social aspects of their life they’re often associated with other mental health illnesses such as depression and anxiety and they can often be a way of dealing with an underlying personal um emotional or psychological difficulty and interestingly they can be experienced by the person who has the dc order as a way of helping them to function in the world a way of helping them to function um to deal with their emotions to provide distraction from how they’re feeling and to help them feel in control um this is a just a short um outline of some of the most common eating disorders in adolescence and i’m i’m sure most aware of the symptoms and signs for these so i won’t i just put a lot on that but anorexia nervosas is the most common um eating disorder in adolescence followed by bulimia um the risk factors for eating disorders uh as i said i pointed out before that there is a genetic predisposition there are psychological factors that can place an adolescent at risk so these are sort of personality traits so um and these can be present before during and after an eating disorder so personalities trace like perfectionism harm avoidance compulsive um obsessive personality traits i guess the one that is um is sort of most worrying and modifiable is um the social cultural influences and this is really how illness and beauty sorry thinness and beauty are presented in um in a cultural in certain cultures so how the media and social media depict thinness and beauty and i guess back when i was an adolescent you know to see images of models or of beauty yes you could see it on television but you sort of you know you had to go to the news agents and buy a magazine and that’s and these days you know teenagers have a phone where if you know one or two clicks they can see page after page photo of the photo of women who are presenting as a model of you know body image that is not um does not enhance a positive body image in adolescence so yeah the modifiable risk factors are um so low self-esteem body dysfunction dissatisfaction in an internalized internalization of sociocultural models um those risk factors can be modified by having a um enhancing a positive body image and i’ll talk a little bit about that on the next slide um extreme weight loss behaviors this is the single most important factor and an indicator of eating disorder so disturb patterns of eating also skipping meals fasting eliminating food groups and binging excess exercise and purging and yeah and dining behaviours as well you know the act of studying any diet in an adolescent boy or girl um increases the risk of an eating disorder by you know and also does increase the risk of um on measures looking at suicide risk by up to three times so how can we sorry how can we enhance a positive body image we can have we can be a positive role model for our teenagers so you know being positive about our own bodies and about other bodies not making um disparaging comments about how other people look or what their body does looking talking about our body is something that functions and talking about you know being proud of characteristics of our body that help us to be strong and healthy and being proud of things for our adolescents that don’t focus on how they look so being proud of their um you know the things that they have achieved and having zero tolerance for weight shaming or teasing or bullying about weight or body appearance and also avoiding things that create feelings of guilt about eating certain types of foods so i try not to label foods as bad or toxic or things like that it’s important to focus on your child as a whole person rather than you know what they look like and i guess the other thing is to focus on realistic depictions of bodies um so diversify your social media content so that you’re seeing things that um you know that make you feel positive and happy about your body not that you’re comparing yourself to a supermodel or an influencer and positive improving having a positive body you need to improve self-esteem and acceptance these are some of the warning signs for eating disorders so there are physical science and psychological science and behavioral science i’ll just talk a little bit about their behavioral signs because these are probably the ones that you you may notice but again as i said sometimes adolescents with eating disorders try to hide these so things to be worried about if you notice your child is diving if they’re refusing to eat with the family so if they’re eating in private if there’s evidence of binge eating so if you’re finding packets hidden under the packets from biscuits or sweets or whatever hidden under their bed if you’re you know if you feel that your teenager is vomiting or using diuretics or maximus and if they have rituals around food if food has to be placed in a certain way on their plate or if they have to eat in a certain pattern or cutting things into small pieces so management of eating disorders is um seek help as early as possible if you’re worried if you know if you’re worried that your child may have disordered eating or that they have an eating eating disorder yeah talk to your gp um bring the uh your adolescent for a consultation with the gp to see if there is something going on the management of eating disorders is a multidisciplinary team approach and i probably won’t talk a lot about this slide but other than to say that i guess one of the myths about eating disorder is that you know there’s no way of getting over and there is no recovery but but that’s not actually true they have there are some really um some really good evidence-based treatments and one of those for is family-based treatment which is used for adolescents with anorexia and the figures for um recovery for um adolescents are really good with family-based treatment and i guess in some cases children during the adolescence do need to be hospitalized to manage eating disorders and and when that is undertaken it’s for medical stabilization and nutritional rehabilitation because i’m running out of time i may not focus a lot on this other than to say that um you know we’ve all seen articles in newspapers both in singapore and i’m australian so obviously i look at australian newspapers there’s been articles in australian press and the u.s press about how adolescents have been affected um during covert 19 that over 90 pandemic how their mental health has been affected and there have been some studies unicef did a study where they looked at um eight and a half thousand children in latin america and the caribbean um and over the last seven days and you know quite a large proportion i think it was about 40 reported some symptoms of depression or anxiety in the last seven days i guess one of the i guess one of the sort of things that i was thinking about i was asking about what i was going to talk about today was that um we’re still living this um we we’re not we’re probably going to be seeing effects on our health our mental health and our children’s mental health over the next years but i guess one of the positive messages that i got out of looking at some research and information about this one step there was a study in norway that showed that um i think it was about three and a half thousand children and they there was a poll and it did show that yes the mental health effects were increased in some children but it was particularly children who had underlying mental health conditions that the great majority of children in this poll did show some um you know that they were coping that they were showing resilience skills and that you know i took that as a positive message that maybe our children will show um signs of adapting and resilience and learning to grow from this now it’s been a difficult few years not just with not just with the pandemic but um you know with um climate change and geopolitical issues afghanistan situations politically in the us black life matters campaign adolescents have been you know have been exposed to these things and all of those things have impacted on their mental health and you know and also their ability to cope and um and adapt to the world so yeah i think i might leave it at that but you know i think we all need to think about trying to um yeah look after our own mental health in this time because that will help our adolescents to look after their mental health in this time as well and certainly i’ve seen a lot of adults who um you know finding the aspects to with the cover 19 pandemic difficult so and they’re showing signs of mental distress and um and my children and adolescents pick up on that as well so talking to your children trying not to focus too much on the you know the media trying to remove yourself from looking at the news every day finding out what case numbers are i think that will help our adolescents as well as they deal with this pandemic so hopefully i’ve got a bit of time to talk about um sexual identity and gender identity so sexual identity is how you perceive yourself and express yourself romantically and sexually i’ve just given a list of definitions and i i know most of us probably know what these things mean for lgbtqi but sometimes it’s good just to you know clarify what exactly they mean so um so for a lesbian it’s a woman whose physical romantic and emotional attraction is to other women gay is um a term that people used to describe their um attractions to people of the same sex bisexual um it’s for people who um have emotional attraction to people of the same gender or to those of the other gender and i think the interesting thing here is that bisexual people may need not to have had any specific sexual experience with um with one of those groups to actually identify as bisexual so you know your child may have an adolescent may have a boyfriend and may have never had any sexual experience with a female so sorry say it’s a female that we’re talking about here they may have a boyfriend may never have had a female sexual experience but they still may identify as bisexual um transgender is referring to people whose gender identity or gender expression differs to what they were typically associated with the sex they are assigned with at birth transgender identity isn’t dependent on physical appearance or medical procedures so someone can be transgender without making physical transition or surgical transition and queer is an adjective that people use to um to define a sexuality orientation that’s not exclusively heterosexual so sometimes people find that the other terms that we talked about don’t describe how they feel about their sexual identity so they may choose to identify as queer and the other cue in that um lgbtq is um questioning so some people some adolescents are genuinely unsure of their sexuality they’re still trying to work out you know who their what their physical or emotional attraction is some adolescents experience fluid trans um sorry fluid sexuality though so i can change over time it doesn’t have to be fixed um and as i as i just mentioned that some people prefer to identify as queer because it doesn’t restrict you to a specific category and some people don’t want to identify their sexuality at all oh and sorry some one thing i should say is that you know sexual identity and gender identity are not mental health issues so these aren’t mental health disorders but gender dysphoria is and i’m not about to but people who are you know dealing with issues with essential identity and gender identity are um more risk of having mental health disorders so um it’s quite common to have kind of border become more sorry comorbid mental health conditions so depression anxiety in people who are questioning their sexual identity or their gender identity and that can be a result of social um stigmatization of um of you know bullying or discrimination so um now to get to gender identity so gender identity is how you perceive your gender how you show your gender to others and how you want others to treat you so cisgender is when your um your gender identity is aligned with how your um your association sexist association at birth and gender eye diverse um points to a group of people whose gender identity does not associate with their um their sex as defined at birth so that can be transgender um non-binary whereas a person doesn’t identify as male or female or may i identify as a mixture of male or female and so as with um sexual identity gender identity can be fluid as well um and some and some adolescents may identify as being agent and so gender dysphoria is this as i just said it is a mental disorder so um the symptoms so being gender diverse in itself is not a mental health condition but gender dysphoria is a feeling of distress that can occur when a person’s biological sex doesn’t align with their gender identity gender dysphoria impairs functioning in everyday life the symptoms can present at different ages and different developmental stages and it’s often more debilitating in adolescence due to the development of secondary sexual characteristics in puberty and for the management of um if um the symptoms of gender dysphoria are treated then then that can be helpful in managing um yeah managing the gender dysphoria so some of the symptoms are sorry some of the treatments that can be undertaken are psychotherapy to help deal with symptoms such as stress but also to deal with any comorbid conditions such as depression or anxiety and psychotherapy can also help with support roles during transition so social transition and social transition is when some of his gender diverse may choose to dress as the sex that they identify with or may choose to you know behave in a certain way that identify fits in with their gen how they identify um another treatment for gender dysphoria is medical treatment and the medical treatments that are undertaken are period blockers and surgical treatment i may believe that if there’s anyone in the audience who wanted me to talk about that further you can bring that up in the questions um or um comments you know you can send us an email and i can talk about that a bit more but needless to say there are there are sort of you know a very strict guidelines about um access to those treatments and in particular access to those treatments in um in singapore oh sorry i said mental treatment and i meant to say for medical treatment it’s puberty blockers and hormonal treatments and then the other treatment is surgery and that’s gender reassignment treatment so as i did for depression and anxiety i wanted to touch on you know how parents can help their their child who may be having thoughts about their sexual identity or their gender identity or having gender dysphoria so i think it’s important to try and help your child to understand you know what their gender identity is or what their sexual identity is um it’s important to help them affirm those um those feelings and you know and if you are going to support them to support them in affirming that as well and to be their advocate as as well um and to seek help for the child if if that’s needed so that helped me be professional with a general practitioner or support groups and i have put quite a few support groups um on the resources um handout that you will um receive um but also you know there’s really good um a lot of the international schools in singapore school counsellors are fantastic and there’s often support and advocacy groups within the schools so um support groups for the parents and for the adolescents um and i guess one of the other things is that you know helping your child to find um their tribe i guess is a good way of putting it so finding other people who may be going through a similar experience to them or feeling the same way that they’re feeling someone and they can talk to about that you know how to cope or um you know what sort of things um are available as support and um in in singapore um okay and so how can how can i as a doctor help you how can the other doctors at imc help you and your adolescents if you’re worried about their mental health so our role is to um to assess their lessons to screen them for risk of mental health disorders eating disorders and sometimes we may do this because you you’ve brought your child in because that’s something you’re concerned about but as i said you know sometimes we see adolescents for um for other things like school medicals or element adolescence health screening and you know there may be something that comes up that that we can explore further as doctors we you know we can look at what’s going on in your adolescence life and help formulate treatment plans it’s important to sometimes exclude physical causes for symptoms or signs it’s important to train for medical and health professionals to try and develop a relationship with um adolescents and i guess one of the things that that can help with that is doing a consultation allowing the child to have some time alone with the doctor or the psychologist or you know whichever health professional they’re seeing to um so that they can feel free to talk confidentially with um with the health professional so often i try and um manage my adolescent health consultations by spending time with both the parent and the adolescent and then spending offering to the adolescent to spend some time with them and asking mom and dad to sit in the waiting room while i talk to the adolescent um i guess it’s important to highlight that you know to your lessons that what we discuss as a as a doctor and a patient is confidential unless of course there are issues of concern with the adolescent safety or safety for um for other people i guess one of the other really important roles for the doctors here at inc is that you know we’re also here to support parents so sometimes sometimes the adolescent doesn’t actually come and see us it’s a parent who comes and sees us and um and you know they’re wanting help and guidance of whether they they should seek professional help or you know they’re struggling with dealing with an adolescent dealing with teenage behaviors and emotions um so yeah that’s a really important role for gps as well and i guess not as often but sometimes um we’re involved in prescribing medication and yeah and one other important thing is you know being a source of information um helping with pointing people in the right direction and finding more resources um and what kind of cycle i what kind of psychological health is available what support groups are available and yeah and i’ve as i said um i’ve i have put out a quite an extensive list of um resources obviously it doesn’t cover everything and it is a little bit um biased toward australian resources just obviously because i’m from australia and there are resources that i was familiar with um so the resource list that i have put together includes a lot of websites that i use to look up information for this talk and some of them are yeah some of them are really good like i recommend raising children network has fantastic resources for parents and teenagers um beyond blue and reach out also have really good resources as well so yeah have a look at some if you know if you’re concerned about your adolescent or you’re thinking about ways of helping around lessons i’ll have a look at some of those resources that i’ve listed on the list i did also put some singapore-based resources so um so the helpline so for adolescents samaritans in singapore have a call line and they also have a text in the email facility and for younger children so primary school aged children who are feeling distressed there is um a call line and i think it’s an online chat called tinkle friend so there are resources in singapore as well that you know that we should encourage parents and adolescents to use as well so i might wrap up there for some questions um andrea yeah thank you very much dr jacqueline that was great we’ve had one question come through about gender identity um how much of gender identity is due to nature versus nurture and what advice can we give our teen to discern the difference okay yes that’s a that is an interesting question um i think that i think over the last few years the um the understanding of gender identity has um has really changed so i think that the nature versus nurture approach was something we probably focused on a bit more maybe 20 or 10 or 20 years ago i think the important things to think about with gender identity and sexual identities it is actually how someone identifies um and so it isn’t necessarily something that we should be discounting um now on the other hand the you know the as i said i’ve got four teenagers so talking to them about the gender identity and sexual identity um you know they’ve opened up to me that you know it’s it’s quite well accepted among teenagers today that you know people identify as queer or bisexual or um [Music] okay or that they identify as gender um as non-binary whereas you know when i grew up that was not common um and so i guess some people may think is that a nature thing you know people saying that i’m non-binary because it’s more accepted to say that these days but i think that sort of i guess leads to a bit of a slippery slope of maybe discarding how a child is actually really feeling and how they’re identifying if we if we write it off as you know being their identity is a result of outside influences it is their identity so i’ve actually forgotten what that other second part of the question was there andrea can you help me with that what advice can we give our teens to discern the difference oh okay yes so i guess the advice is goes back to what i was talking about before is by helping them to um to talk through what they’re feeling what um you know why do they feel that they’re a certain way what do they feel inside themselves about who they are and what they want to be and how they want to present themselves to the world and you know how who they think they are um um so i think that’s probably the best way of approaching it is sitting down and talking it to your child about you know who do you see yourself as and why do you see yourself as that and i guess also you know maybe looking at you know what their influences are in their life like you know what are they looking at on social media um if they do feel a certain way is it because that is how they identify or is it because you know maybe that’s more socially acceptable now but yeah i guess it i guess it all comes down to having communication you know having a good communication with channel with your child and um and being willing to listen to them and you know if you are um if you’re you know if you’re not sure or if you feel you’re um teenagers not sure then you know seeking professional help coming to see a general practitioner maybe seeing a psychologist to work through those issues as well i think that would be the best way to approach that um thank you very much for that i think we’ll we’ll wrap it up there today dr dr jacqueline thank you very much for your time and for sharing your experiences with us today and your great tips um as i mentioned we’ve she’s dr jacqueline’s put together a very extensive resource sheet including organizations that can help in singapore which is often quite difficult to find local organizations so we will email that out to everyone and also there is we are going to put a copy of the presentation on youtube so if you think it would benefit other families or other parents you can direct that to the direct them to there and we’ll send out that link today as well so thank you all very much and we’ll sign off for imc thank you thank you
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Teenage Mental Health, Eating Disorders and Gender Diversity

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