Author: Grace Ogren

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Dissociative Identity Disorder and Trauma: Coping and Healing

Have you ever driven home lost in thought, unaware of what you experienced during your drive? Not even sure if all the lights you passed were green? People often chalk that up as dissociation, which is true. It can feel a little freaky or odd, but it’s been normalized as something that happens to everyone. Someone living with dissociative identity disorder (DID) experiences a much different reality—severe dissociation, gaps in their memory, and new identities that develop.

Trauma can cause DID. Many experts have explored this connection, including Athena Phillips, who we spoke to in our recent podcast episode. You can listen to that here. 

What Is Dissociative Identity Disorder (DID)?

Dissociative identity disorder, once known as multiple personality disorder, describes someone with two or more separate, independent identities1 or ‘alters.’ People can have dozens of alters with their own habits, memories, and even genders. DID is one of several dissociative disorders1 marked by derealization, memory loss, distorted self-identity, and disruptions in consciousness. 

Each identity has their own view of the world and makes their own decisions2. Someone with DID may know about all their alters or just a few, especially ones that come out more often. Patients typically experience memory loss when various identities take over—alters aren’t usually aware of what the others are doing, and memory loss occurs as a result. For example, if an alter brings home a new vase, someone with DID may not recognize it later or know where it came from.

Each alter has their own first-person experience and forms memories based on what they see, feel, and think. Other alters and the true self aren’t usually able to retrieve these memories2, though many clinicians propose they could if they didn’t strongly believe they can’t. Believing they can access an alter’s memories could allow the true self or other alters to retrieve them.

Causes of DID

DID most often occurs as a response to trauma1, typically physical, sexual, or emotional abuse in childhood. The post-traumatic model of DID2 proposes that “​​dissociative identities are the primary results of early trauma and the relational, cognitive, emotional, and neurobiological consequences of it.” Children may unconsciously resort to dissociation and numerous personalities to both avoid and cope with traumatic memories.

Each alter develops as a disconnected, separate, autonomous subset of the self. Picture islands separated by deep waters instead of one town. The true self may travel to different islands depending on what their situation demands and memories that arise, often memories of severe trauma. Once the true self goes to an island, it becomes their whole reality and remains closed off from the other islands.

Clinicians and researchers have found trauma to be the leading and primarily identifiable cause of DID2, though some genetic dispositions, social influences, and personality traits could contribute to dissociation and someone’s inability to cope with stress. Someone who’s more likely to experience dissociation and struggle to deal with stress could be more likely to develop DID.

Diagnosing DID

Most people with DID don’t get an accurate diagnosis until later in life1 because DID has similar symptoms to other personality disorders, including amnesia, dissociation, and losing consciousness. Particularly, borderline personality disorder (BDP) shares similar symptoms, and like DID, patients often present as suicidal and engaging in self-harm. BPD patients also struggle with emotional regulation and dissociation. To meet diagnostic criteria for DID, experts say patients must present with these 4 factors1:

  1. The ability to dissociate
  2. Intense, overwhelming traumatic experiences 
  3. Alters with unique personalities, names, and memories
  4. Homelife instability

Children may cope with unstable homes and overwhelming trauma by self-soothing through dissociation and developing alters. Someone with DID also has altered brain structures3, usually the hippocampus and amygdala, which can affect memory and overall functioning. Looking at the brain can help doctors accurately diagnose DID and rule out other diagnoses. Observing patients also clues doctors into the personality shifts related to DID, as a few key physical signs often occur:

  • Eyes rolling
  • Fading into a trance-like state
  • Blinking or twitching eyes
  • Sudden posture changes

History of DID

Until 1994, DID was known as multiple personality disorder and not well understood3 or sympathized by the medical community. Its strong connection to trauma has recently become better known and understood, helping patients get the diagnosis and help they need.

Before it was recognized as a mental health condition, DID was thought to be the work of demonic possession1. Cultures outside North America were more likely to attribute symptoms to possession, while schizophrenia or psychosis incorrectly explained many symptoms in other cultures. Internal voices from other alters were explained as schizophrenia, which can have similarities.

How Trauma Can Lead to Dissociative Identity Disorder

Children or adults who experience more trauma and stress than they’re capable of dealing with can develop DID as a coping mechanism1. Their experience goes beyond what their mind can process and articulate, leading to dissociation as a way to escape and alternate identities to process a fractured sense of self. 

Certain alters may be more capable of dealing with the traumas experienced and come out when situations mimic the original trauma, or memories of the trauma arise. For example, a tough male alter may take over when a female with a history of assault feels uncomfortable around certain men. He comes out to protect her and deal with a situation she cannot. 

Dissociation as a Predictor of DID

Intense trauma can cause dissociation1, as seen in some cases of post-traumatic stress disorder. An out-of-body experience during an assault can be the brain’s effort at protection. Children who suffer repeated abuse or instability in their homes may regularly dissociate to protect themselves. Alters can eventually present during dissociation and take over general consciousness, leading to amnesia. 

Small Social Cues Can Trigger Shifts in Identity

Social cues can prompt small behavioral changes, triggering an alter to take over2 in someone with DID. As an example, picture a formal event. This requires professionalism and different social etiquette. Someone without DID could adapt to the situation by speaking more formally, standing straighter, and carrying themselves differently. But someone with DID may unknowingly shift to an alter identity that’s more poised and professional. Their true self may not remember the event or what they talked about if the alter takes over.

Treatment for DID and Trauma

Effective treatment addresses the symptoms of DID and its underlying trauma1. Clinicians often use cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR) to treat DID, similar to other personality disorders. For DID patients specifically, hypnosis has been an effective option to reach alters and discuss their memories, views on the world, and life experiences. 

Therapy teaches patients with DID more about their condition, how to regulate their emotions, manage stress, and function in day-to-day life with their unique symptoms. Therapists work with the patient to glean memories from different alters and piece together underlying trauma so the true self and their alters can begin processing. As therapy brings more memories to light, they can become more readily accessed by different alters and the true self. 

Finally, therapy works to reunite the self1 and help patients with DID become more aware of their unified self and its relationship to the world they interact with. Reunifying their sense of self can reduce the number of alters, though therapeutic interventions often can’t merge them all. But with fewer alters, patients are more likely to remain as their true selves throughout various situations and potential triggers. 

EMDR and Hypnosis

Patients with DID respond well to hypnotherapy1 as they’re more receptive to hypnosis. In their hypnotized state, therapists may be able to talk to alters that traditionally stay hidden. These alters can be crucial to the healing process and help the therapist learn more about their patient, giving access to memories and experiences the true self and other alters may not know about.

EMDR uses guided eye movements to help patients process trauma4. Tracking an object back and forth offers a distraction and can make traumatic memories feel less intense, helping patients discuss and process them without shifting to an alter identity or becoming too uncomfortable. Not every patient with DID will feel comfortable accessing memories through EMDR, but for those who are, it can help unify their sense of self and manage symptoms.

Medications

Some medications, like antipsychotics and antidepressants, can manage symptoms of DID like suicidality, mood dysregulation, and improve self-harm behaviors. However, clinicians haven’t yet found a medication or combination of medications to treat DID1. More options may become available as they study and develop new medications. 

Optimized Care for DID Patients

A safe therapeutic environment and collaborative, compassionate care can help DID patients1 find the best treatment outcomes and stay in treatment. Therapists should also recognize and stay aware of alters not communicating what patients learn or discover in sessions. They’ll likely need to bring each alter forward to ensure they talk with them and identify their unique personalities. Building rapport and comfort also encourages alters to come out and speak with their therapist.

Life-Long Care

Patients with DID often stay in treatment their whole lives1 to receive ongoing grounding in their unified self, process trauma, and navigate stressors as they arise. In some cases, it can take years for the therapist to meet and identify each alter. A positive relationship between the patient and their therapist (and treatment team as a whole) is crucial in keeping them in treatment and creating a comfortable environment.

Identifying Alters

Therapists can aim to identify all alters, helping patients become more aware of them, their personalities, and what triggers them to arise. Once patients and their therapist know who’s all there, they can work on identifying their backgrounds and merging alters into one self identity. Therapists can bring alters ‘to the front’ using hypnosis or, if appropriate, mimicking a situation that would bring out a suspected alter. 

Compassionate, Personalized Care

Ultimately, therapists should adapt treatment to their patient by recognizing their comfort levels, assessing their trauma responses, and building a positive therapeutic relationship. Identifying alters and processing trauma shouldn’t come at the patient’s harm. The therapeutic relationship can determine which treatments may be most effective and comfortable for each patient, encouraging them to engage and participate throughout the course of treatment.

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Debunking the Rock Bottom Myth: A New Perspective on Addiction Recovery

The “rock bottom” myth suggests someone must hit a catastrophic low point before they recover from addiction. While pain and negative consequences can motivate change, it can be misguided and even dangerous to require this of everyone with an addiction. Many recover or start treatment without hitting their rock bottom. Staying connected to loved ones, work, and daily life often supports recovery.

Rock bottom is considered the ultimate low in someone’s life, like losing loved ones, money, status, freedom, and possessions. It can be a singular event of cumulation of consequences. Everyone will have a different rock bottom, which makes the myth even less defined—one person may consider becoming homeless and unemployed rock bottom, another may consider getting divorced to be their rock bottom.

Viewing “rock bottom” as the only entry point into treatment can harm a person with addiction and their loved ones. Instead of waiting to reach rock bottom, they can take agency over their treatment journey and seek help whenever they feel it’s necessary.

What Is The Rock Bottom Myth?

The rock bottom myth views hitting “rock bottom” as a requirement1 for addiction recovery. It sees pain, grief, and negative consequences as motivators for going to and engaging in treatment. While this can be true and often is, not everyone needs to hit a breaking point to get treatment or want help. You certainly don’t need to reach rock bottom to deserve help. 

The rock bottom myth originated in the 12-Steps2 of Alcoholics Anonymous (AA), where hitting rock bottom was once a sign participants were ready to practice and commit to the 12 Steps (and recovery). Rock bottom was portrayed as a launching pad into recovery. If participants didn’t reach this point, they weren’t seen as being able to commit to recovery and/or recover fully.

More recently, the rock bottom myth has faded to make room for unique recovery journeys, motivations, and underlying causes of addiction.

The Dangers of the Rock Bottom Myth

Waiting to hit rock bottom and going through it as a prerequisite for recovery poses several dangers. The components of rock bottom can be dangerous in themselves, like homelessness or committing a crime. 

The rock bottom myth can also keep someone from getting treatment and continuing in their addiction, which harms their mind and body. Waiting for a flip to switch, an epiphany, or acute realization of being at rock bottom delays treatment and can contribute to denial.

Someone may hesitate to pursue treatment if they’ve not hit a clear breaking point. They may worry treatment professionals won’t take them or their needs seriously if they don’t have evidence of hitting rock bottom. This can delay treatment, cause shame, and deepen hopelessness. These feelings can even build into a crisis point.

Rethinking Recovery: Early Intervention and Support

Early intervention is found to be the most effective preventative measure2 against addiction and its consequences. It can prevent addiction from worsening to a breaking point, and the harms that come with that. Knowing you can get treatment at any point, not just at the end of your rope, can encourage people to seek treatment sooner. 

Recognizing signs of addiction can help you get treatment early. For example, you may notice you’re drinking every night and feel uncomfortable or ill when you try to stop. Even though it hasn’t affected your relationships, work, or finances, you still feel like something’s wrong. Getting treatment once you realize that can stop its progression and hitting rock bottom.  

Alternatives to the Rock Bottom Approach

Many avenues to recovery don’t rely on hitting rock bottom or anything close to it. You can find the motivation to heal and treat underlying symptoms through therapy, supportive relationships, and various community resources.

Therapies like cognitive behavioral therapy (CBT) and motivational interviewing can disrupt unhealthy thought patterns and teach healthy coping mechanisms. Exploring past events and trauma can also help you identify triggers, connect them to substance or behavioral addictions, and find new ways to cope.

Connecting to peer support and community resources prevents the isolation and loneliness that can feed into substance use. Stay close to friends and loved ones, and try joining an in-person or online group focused on recovery. Twelve-Step groups may be a good option for you, or you could attend non-12-Step groups like SMART recovery. You could also join non-recovery focused communities, like clubs or sport teams, to meet new people and grow your support network. 

These communities and support networks can jumpstart your recovery by offering a subjective view of your situation. For example, an honest conversation with a friend or family member may open your eyes to your need for treatment, before you start experiencing consequences. Listening to their concerns and ideas can inspire you to begin treatment with their support. 

Shifting Societal Perceptions on Addiction and Recovery

Addiction and mental health conditions aren’t fully understood by the public—unless it happens to them or someone they love. This misunderstanding can lead to prejudice and stigma, which can make it hard for anyone to admit to struggling with a mental health condition or addiction. This can hinder early intervention and land people at their rock bottom.

Awareness on addiction, mental health, and the realities of recovery can change how the public views these conditions. Rather than seeing it as something that must reach a certain drastic point for treatment, addiction can instead be seen as something you treat as soon as you notice symptoms, much like most illnesses or wounds. If addiction or mental health conditions were seen in this light, more and more people might feel willing to admit their struggles and seek treatment before it becomes consuming.

Thankfully, many efforts and organizations are actively working on making the public aware of the realities of addiction and mental health—and reducing stigma along the way.

  • To Write Love On Her Arms raises awareness for depression, suicide, self-injury, and addiction. They offer a message of hope and unity and donate to treatment efforts by selling merchandise. 
  • The Herren Project helps individuals and families find treatment with personalized support and scholarships to cover treatment costs. They’re founded by former NBA player Chris Herren, who recovered from addiction and seeks to reduce the stigma surrounding recovery, bring awareness, and provide hope.
  • Red Ribbon focuses on youth and drug use prevention in schools. They advocate for drug use prevention and recovery, hosting events to spread awareness and help more and more people commit to drug-free lives.
  • The Pan American Health Organization (PAHO) runs a mental health awareness campaign addressing stigma and discrimination. They encourage countries and people to #DoYourShare in reducing stigma and making treatment more accessible.
  • CALM’s “Suicidal doesn’t always look suicidal” campaign uses photos and videos of people before the took their own life to bring awareness to suicide, encourage treatment, and start much-needed conversations without shame or judgment.
  • State campaigns are often run by state governments and aim to bring awareness to addiction and help people connect to treatment. Search the internet for local campaigns or check community centers, libraries, and churches in your town or city.

How to Seek Help Without Hitting Rock Bottom

You don’t have to hit rock bottom to heal. If you’re experiencing symptoms of addiction or a mental illness and notice they have an effect on your life, ask yourself, “Do I want to keep living like this?” The answer can inform what you do next.

If you answer no, you can begin seeking treatment or implementing changes into your daily life. You can set up an appointment with your primary care physician, bring your concerns to them, and see what they recommend. Keep questions like these in mind to get a full understanding of your condition and treatment options:

  1. Do my symptoms and experiences fall under a diagnosis? If so, which one(s)? (This can help insurance cover the costs of treatment.)
  2. What lifestyle changes or new habits would you recommend to improve my symptoms?
  3. Do you recommend I start medication to manage my symptoms? If so, which one, and what are its side effects?
  4. What type of treatment or level of care would you recommend?
  5. Will I need a referral for my next steps in treatment?

Use Recovery.com to find treatment centers for your condition and preferences, filtering by insurance coverage, amenities, and location. 

Helping Someone Else

An open and non-judgemental conversation with a friend or loved one could save them from the life-altering effects of hitting rock bottom—and even save their life. 

You may notice a friend or family member acting differently; seeming ‘off.’ They may drink more often or get drunk more regularly. They may seem sad and view life through a suddenly cloudy lens. If you notice signs like these or just intuitively know something’s wrong, voice your concerns calmly, non-judgmentally. Here’s how that could look:

  • “I’ve noticed you seem down lately. Would you like to talk to me or someone else about it?” 
  • “I see you’ve been drinking more and more often. Do you think you might need help to stop?”
  • “I feel like you’ve been acting differently lately—you seem sad. Can I help you, or help you find help?”

Together, you can look into treatment options, just talk, or both. Your support and care can make all the difference. 

Bridging Rock Bottom With Early Intervention

You don’t have to hit your breaking point to heal. Though the rock bottom myth holds truths about motivation to change, it’s not necessary for successful recovery. Getting help as soon as you notice signs in yourself or someone else can be key to early intervention and healthy living.
Browse Recovery.com to find a treatment center that fits your needs.

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Rural Recovery: Challenges and Hope

Rural areas offer great benefits, like a slower pace of life, open fields, and close-knit communities. But what happens when they can’t provide the resources someone vitally needs, like addiction and mental health treatment? Lacking what many urban dwellers take for granted—access to resources—can endanger the billions of people living in rural communities worldwide. 

Thankfully, technology has opened new doors for rural areas. With just a phone or laptop and internet access, people can attend therapy online and even virtual rehab. Increased mental health awareness in small communities may also create new and improved resources for areas in desperate need.

To learn more about the healthcare challenges in rural areas and how providers navigate them, listen to our recent podcast episode featuring Dr. Jonathan Rosenthal!

Behavioral Health Challenges in Rural Areas

About 1/5th of rural Americans have a diagnosed mental health condition1. Urbanites make up close to the same. However, those in rural areas have more trouble accessing care and finding clinicians, as opposed to urban cities with multiple clinics and practices to choose from. 

Over 60% of rural Americans live in ‘mental health provider shortage’ areas1, with 65% of rural counties without psychiatrists. Waiting lists for therapy or more intensive care can extend for months. Limited mental health knowledge and stigma often prevent rural residents from seeking treatment at all. If they do, low availability often means they must choose the first provider they can get, whether they’re a knowledgeable fit or not. Personalized care can become more of a luxury than a necessity.

Primary care physicians (PCPs) often become the first and only line of defense for mental health conditions and substance use. While PCPs can prescribe medications and recommend next steps, they often don’t have the specialized training in mental health or addiction to educate and support patients properly.

A Top Challenge: Growing Suicide Rates in Rural Communities

Rural residents are twice as likely to die by suicide than urban residents1. Isolation, stigma, poverty, and an inability to access care contribute to the steadily growing rate of rural suicides. Timely access to care, crisis services, and increased awareness of mental health could lower the risk of suicide among rural residents, particularly veterans and young adults. 

Boundaries to Effective Care in Rural Communities

People in rural areas face several prevalent barriers to care, including limited availability of resources, long travel times to get to treatment, and stigma. 

Lack of Access

Here’s a story highlighting a common treatment scenario in rural communities, where the necessary treatment simply isn’t available:

  • Rosie has been struggling with severe depression and loneliness. After months of waiting, she finally got into therapy. Rosie thinks group therapy would help her feel less alone and stigmatized. Her therapist agrees, but tells Rosie they don’t have any groups in town. Rosie keeps going to individual therapy but misses out on an aspect of treatment she feels is crucial.

Not having access to is the biggest bar to effective care1. Often, those in rural communities simply don’t have clear or easy access to treatment (or any access at all) and thus don’t receive it. And when they do seek treatment, overwhelmed medical providers can only refer to whatever resources they have and hope availability opens up.

Rosie’s story is a poignant illustration of the challenges faced by those seeking mental health care in rural areas. After enduring a prolonged wait to receive therapy, she encounters another hurdle: the absence of group therapy options in her area, which she and her therapist agree could be vital for her recovery. This scenario highlights the disparity in mental health resources available in less populated regions and the significant impact it can have on those in need of comprehensive care.

Long Wait Times

Waiting time poses another barrier to care. Here’s a second scenario highlighting this:

  • Darren has a paralyzing fear of socializing and talking in groups. He feels something isn’t right and seeks out therapy, but hears he’ll have to wait at least five months to get in. To manage his symptoms in the meantime, Darren starts bringing alcohol with him to work and getting tipsy to deal with his social anxiety. 

With these long wait times, symptoms can worsen; patients could lose motivation and back out. Being unable to access care could lead to substance use as a way to cope with conditions like depression, trauma, or anxiety. 

Darren’s situation underscores the pressing challenges that arise from the lack of timely access to mental health services. Suffering from a paralyzing fear of socializing and speaking in groups, Darren recognizes the need for professional help and reaches out for therapy. However, he bumps into a discouraging five-month wait. In a desperate attempt to manage his escalating anxiety, Darren resorts to bringing alcohol to work, using it to lessen his discomfort in social situations. This scenario highlights the detrimental effects that can occur when immediate mental health support is unavailable.

Behavioral Health Illiteracy

People in rural communities may not know how to identify behavioral health issues1 or how to get treatment. Bigger cities and communities often have more programs and initiatives highlighting behavioral health treatment and broadening awareness.

Stigma

Without adequate knowledge of behavioral health conditions, stigma can make mental health challenges and addiction seem unimportant or weak, discouraging rural residents from seeking help. Living where everybody knows everybody, they may worry they’ll be judged if they try to get help or admit to a problem. 

Travel Times

Rural residents often have long drives to get to a treatment facility or clinic that meets their needs. Juggling the time spent on the road, work, and other personal obligations can delay care2 or keep them from seeking it altogether. Here’s a predicament a farmer may face when trying to get treatment:

  • Bill seeks out treatment for his alcohol use disorder and needs a psychiatrist to go to once a week. The closest psychiatrist to him practices an hour and a half away, which means he’ll be gone for almost four hours each time. But Bill runs his own cattle farm, and he needs to milk his cows every morning and ensure they’re fed. Leaving for 4 hours feels out of the question; he cancels his appointments and decides to deal with his symptoms alone. 

Solutions for Better Access and Support

Rural areas need more general physicians, therapists, and specialists to meet the rising demand for behavioral health services. Incentive programs in some states encourage new physicians to practice in rural areas1, which could steadily grow their workforce and improve access to care. Other solutions, many already in play, include:

Virtual Care

Virtual care uses the internet3 to connect patients and care providers virtually. Since COVID-19, virtual care has become more commonplace and can serve as a vital connection for rural residents and treatment providers. You only need a phone or laptop and an internet connection to access virtual care. You’ll use a secure online platform to conveniently meet with a doctor, therapist, psychiatrist, or other healthcare provider.

With virtual care, you don’t have to live in a certain city or near a therapist’s office. You can even attend residential rehab online and outpatient levels of care. And with a larger pool of providers and specialists to choose from, you can get into treatment faster and find care specialized to your needs. 

Incentives for Rural Providers

Some state governments have incentivized more healthcare providers1 to practice in rural communities. If they practice for a set number of years, they receive additional financial compensation. If every state had the funding for this initiative, it could repopulate the rural workforce with eager health and mental health providers.

Increased Behavioral Health Training

Additional training would benefit current rural providers1 and help them make better-informed decisions on patient care. Primary care physicians would understand all the available options, including virtual care and local crisis services for mental health and addiction. Some programs have started training non-professionals to provide peer support, which has had success in the rural Native Alaskan community.

Known and Accessible Suicide Prevention Strategies

Death by suicide occurs more commonly in rural populations1, especially in kids, young adults, and older adults. Social isolation and not knowing what support they have can lead to untreated crises. Many programs and crisis services do exist and specifically serve rural populations, like local crisis teams, but residents don’t often know they’re there.

Educating community members on their available crisis services and support programs could save lives. Community leaders could make their crisis services more prominent and accessible by posting them in daily newspapers and highlighting crisis hotlines like 988 (National Suicide Prevention Hotline). Schools, churches, and businesses could also spread the word to destigmatize mental health and inform residents of their resources.

Better Support for Physicians

Physicians and mental health professionals face burnout in all settings, but rural providers can end up shouldering high caseloads and pressure to treat more people than they reasonably can. Compassion fatigue and discouragement can drive providers to areas with better support, so providing support in rural settings could help them stay. Financial incentives could bring more practitioners to rural areas, also lightening the load for current practitioners. 

Psychological care, peer support, and financial benefits can help providers retain their well-being and compassion, essentially helping them help others.  

Future Goals and Ideas

In an ideal world, rural populations would have the same access to and knowledge of mental health and addiction care as urbanites. Virtual health would fill in the gaps, with more better-trained and better-supported providers meeting the high need and demand for behavioral healthcare. Awareness and education on behavioral health would reduce stigma and help people feel more comfortable asking for help. 

Low-Cost Clinics

Low-cost clinics, funded by grants or donations, could offer the affordable care many rural residents in poverty need. Staff at these clinics could educate patients on good mental and physical health, with free resources for improving their diet and creating healthier habits.

Funding Local Resources

Funding for local programs could strengthen community services, too, helping them offer more robust non-clinical services. For example, funds to a local crisis support unit could go towards hiring full-time staff with specific crisis training.

In rural areas and beyond, everyone who needs treatment should have a clear path to it and support along the way, whether from their doctor, family, other community members, or all three. 

Learn more about future goals and ideas in improving rural healthcare by listening to our recent podcast episode here!

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Beyond Paradise: Exploring The Realities of Rural Healthcare in Hawaii

We were thrilled to talk with Dr. Jonathan Rosenthal, a hospitalist from Kauai, Hawaii, about his 23+ years as a hospitalist and his unique experiences practicing in rural Hawaii. In our newest episode, Dr. Jonathan Rosenthal talks with hosts Dr. Malasri Chaudrey-Malgeri, Editor-in-Chief, and Cliff McDonald, Chief Growth Officer.

Listen to Dr. Rosenthal’s episode and hear from our previous guests here!

Finding a Fit as a Hospitalist

Dr. Rosenthal is a hospitalist in an intensive care unit (ICU). He sees people in the emergency room and admits them into hospital care, working with his patients daily until they’re ready to leave treatment. Dr. Rosenthal has been working as a hospitalist in the remote town of Kauai for almost 13 years, starting his career in urban Seattle.

Dr. Rosenthal came to Kauai seeking a better quality of life and settled in, now living on the island with his wife. Kauai’s rural setting means Dr. Rosenthal works at the only major hospital on the island. He and his other 5-7 coworkers balance the needs of the island’s hospitalized patients. 

Challenges Faced in Rural Populations

Dr. Rosenthal’s community faces distinct challenges, like not having access to care, poverty, health illiteracy, and unhealthy eating. He frequently encounters metabolic disorders like diabetes, obesity, and hypertension as residents don’t have the means or access to healthy foods. Meth use also runs rampant:

“​​I was blown away that, like how frequently, you would come across people who are using methamphetamine. It’s really rampant. It often leads to problems that I need to see them for.”

Dr. Rosenthal notes his community has no public resources for the issue of meth use, making awareness and treatment difficult. Finding affordable care also poses a challenge for impoverished residents. 

For the physicians, they face discouragement from a lack of resources and support. Compassion fatigue, burnout, and the grief of being unable to help everyone pose significant challenges for providers in Kauai and other rural areas.

Encountering Wide-Spread Addiction and Mental Health Concerns

Of patients Dr. Rosenthal sees from the ER, he estimates:

“Almost every single time if you have to be hospitalized and you’re under 40, maybe 90 percent of the time, you have some sort of substance abuse and/or mental health, usually both, problem accompanying whatever else is going on.”

As the first line of defense, the emergency room takes the primary load of cases involving addiction and severe mental health concerns. Dr. Rosenthal highlights the inadequacy of emergency treatment for long-term recovery, as patients receive treatment for symptoms but not underlying issues.

Ideas and Solutions for All Rural Communities

Dr. Rosenthal notes Kauai actually has one of the highest life expectancies in America, but a large subset of the population are “still quite unhealthy” and don’t have access to healthy foods, as most of Kauai’s wealthier residents do. Nutrition education could go a long way in re-shaping eating habits and lowering the high rate of metabolic disorders.  

As for the addiction concerns his community faces, Dr. Rosenthal says, 

“We need to come up with some sort of public health system that will incentivize people to get clean and stay clean. And to be healthy in general.”

Dr. Rosenthal dreams of opening a low-cost clinic for impoverished residents to get affordable care and pick up fresh fruits and vegetables. Healthy food in his hospital’s cafeteria would also improve access to healthy foods. Showing residents what healthy foods they could buy with constrained budgets and providing cooking classes would educate residents and encourage healthier eating. 

Virtual addiction and mental health services can also make care more accessible for rural patients, as they’d only need a device and internet access to get treatment. Services like these could lighten the burden for Kauai’s emergency rooms and providers like Dr. Rosenthal. Making these resources known through community outreach plays a vital role in patient education and people using their resources.

Listen to Dr. Rosenthal’s episode on The Recovery.com Podcast to hear about his inspiring work and ideas. 

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The Untold Power of Compassionate Care: Addressing Stigma with Dr. Ishant Rana

In our recent podcast episode, Recovery.com was thrilled to talk with Dr. Ishant Rana, Clinical Director at Alpha Healing Center. We explored the weight of stigma in India and how rehabs like Alpha Healing Center actively shift from punitive approaches to compassionate, personalized care. Dr. Ishant describes the impact he sees and ways the behavioral healthcare system could improve even further. 

Listen to Dr. Ishant Rana’s podcast episode here. 

Building Experience and Understanding

Dr. Ishant Rana has practiced clinical psychology in India for over 13 years. He graduated from the National Institute of Mental Health and Neurosciences in Bangalore, India. He’s worked across a variety of focuses, including addiction, personality disorders, psychosis, depression, and anxiety. Dr. Rana joined Alpha Healing Center as Clinical Director, impressed with their multifaceted programs and respectful, non-stigmatized approach to care.

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Alpha Healing Center combines medical and psychological care, helping clients safely detox and receive the mental healthcare they need. They use advanced services like neurofeedback and repeated transcranial magnetic stimulation (rTMS) to heal addiction’s underlying causes, all while providing comfortable living spaces and an atmosphere of support and camaraderie.

Making a Difference with Personalized Treatment And Education

Dr. Rana’s work at Alpha Healing Center leverages multiple forms of therapy, medical services, and holistic practices to create personalized care plans for each patient. Alpha Healing Center treats both addiction and underlying mental health concerns, helping Dr. Rana and his colleagues provide the comprehensive care needed. 

Dr. Rana believes everyone needs and deserves help, especially people with substance dependence who may otherwise be seen as “too difficult.” His work at Alpha Healing Center allows him to provide the compassionate care needed to overcome stigma and impose the empowering possibility of recovery. He’s found psychoeducation to be a particularly powerful tool in disputing stigmas around addiction, including myths like:

  • Addiction is caused by a lack of willpower; enough willpower treats addiction
  • Relapses mean treatment failed
  • Someone with an addiction must also have a personality disorder

Science-backed truths educate patients and their loved ones, helping them heal as a unit.

Future Directions and Hope for Communities

As Dr. Rana outlines in his podcast episode, accurate addiction education can benefit both the person suffering and their loved ones. Psychoeducation teaches the truths about addiction and mental health conditions, helping communities view those with addiction in a more helpful light. Rather than being shunned or disgraced, those with addiction could instead receive support and encouragement to attend treatment. 

Fortunately, this is already happening in India and worldwide, especially as younger generations set the standard for mental health awareness and non-stigmatized care. As families and individuals learn more about addiction, they become more equipped to support their loved ones and pursue treatment with hope compassionately. Dr. Rana says,

“So people are getting better, they’re learning more, but I think we have to go a long way,” says Ishant.

Like recovery itself, education and awareness are journeys. Practitioners like Ishant Rana and Alpha Healing Center combat stigma and change viewpoints in hundreds of lives through their caring, evidence-based care, creating an approach that leaves a lasting impact.

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What Are Eating Disorders? Types, Symptoms, and Treatment

Eating disorders are illnesses defined by disturbances in eating patterns1 and food intake. They also include a preoccupation with body image, calories, and weight. People of any age, sex, gender, and background can develop an eating disorder. Someone with an eating disorder (also called ED) may avoid certain foods or restrict their diet, exercise excessively, use laxatives, or vomit after eating. 

Eating disorders are often an expression of the emotional pains in conditions like depression, trauma, and anxiety. Someone may develop an ED as a way to punish or gain control over themselves. Eating disorders can also develop due to genetic predispositions and social factors. Someone with an ED runs a higher risk of physical health complications, mental health decline, death, and suicide. 

A blend of therapy, weight restoration, and nutritional counseling can not only treat symptoms of an eating disorder, but heal its underlying causes for life-long recovery.

Listen to our podcast to learn more about eating disorder and addiction recovery from Recovery.com’s Chief of Staff, Amanda Uphoff. 

What Are The Causes of Eating Disorders?

Multiple factors can cause eating disorders1, including genetic predispositions, peer influence, mental health conditions, and bullying. Behaviors and personality dispositions can also lead to an eating disorder and affect what types of eating disorders may develop.

Types of Eating Disorders

Eating disorders take many forms, from restricting diets, purging, and a blend of both. Healing exists for each kind of eating disorder and its potential health complications.

Anorexia Nervosa

Anorexia nervosa causes someone to restrict their food intake2, exercise compulsively, and intensely fear weight gain. Someone with anorexia will often have a distorted body image, leading them to feel constantly overweight and in a pursuit of thinness. Anorexia has a very high mortality rate compared to other mental illnesses due to the health effects of emaciation (extreme thinness) and risk for suicide.

Anorexia is more common in females2 and occurs most often in adolescence or early adulthood. Someone with anorexia often won’t recognize their low weight, which can make it difficult for them to understand the severity of their condition and agree to treatment. As they progressively lose weight, severe health complications and other symptoms can arise, including:

  • Feeling cold all the time
  • Irregular periods or no periods at all, which can lead to infertility
  • Constipation
  • Tiredness and fatigue
  • Low and irregular heart rate
  • Shallow breathing or feeling out of breath
  • Dry skin and brittle nails
  • Bone thinning
  • Organ failure
  • Heart and brain damage

Co-occurring conditions like depression and anxiety often contribute to the development of anorexia2, as does growing up overweight, having parents or blood relatives with anorexia, and being body shamed by peers or loved ones. Suicide is the second leading cause of death for people with anorexia1, following death from health complications caused by undereating and excessive exercise.

Early intervention, weight restoration, and therapy can reverse the effects of anorexia and teach the coping tools needed for long-term recovery, helping patients navigate day-to-day stressors and heal their relationships with food—and themselves.

Bulimia Nervosa

Bulimia nervosa is defined as a pattern of binge eating and purging3. Binge eating involves eating large meals or many high-calorie foods in one sitting, often with the inability to stop. Purging is used to compensate for the binge and prevent weight gain. Someone may purge through self-induced vomiting, using laxatives, excessive exercise, or fasting. Binge-purging can quickly become a self-feeding cycle.

Bulimia nervosa occurs most commonly in young women1. It can develop due to brain abnormalities, social influence, and mental health conditions. Bulimia can lead to weight loss and symptoms like:

  • Irregular periods
  • Throat and mouth pain from the stomach acid in vomit
  • Tooth damage and erosion, also from stomach acid
  • Stomach pain and bloating
  • Fatigue
  • Dehydration from purging
  • Imbalanced electrolytes

Unlike anorexia, someone with bulimia may not appear underweight; they can even look overweight. That’s why clinical evaluations and examinations are important for diagnosis and treatment of bulimia. A doctor will check their patient’s vital signs, ask questions related to binge or purging behaviors, and check for inflammation in the mouth and throat to diagnose bulimia nervosa and start treatment.

Therapy can address the underlying causes of bulimia and teach skills to manage binge-eating, while weight restoration and nutritional care can improve physical health.

Binge-Eating Disorder

Someone with binge-eating disorder will binge on food, but not purge afterwards1. Binge-eating often includes a lack of control and inability to stop eating, which can cause someone to eat large meals. They may feel sick after binging and gain weight over time, potentially becoming obese. 

Binge-eating disorder can affect men and women of all ages. It can lead to extreme weight gain, shame, and secretive habits to conceal binging behaviors. Other symptoms include:

  • Eating very quickly
  • Eating despite feeling full or not hungry
  • Stomach pain due to overeating
  • Eating alone or in a secret location to hide eating habits
  • Lying about eating habits
  • Frequent dieting to try to control weight gain
  • Bloating

Therapy can help someone with binge-eating disorder learn to control binging and find comfort in other activities. Personalized eating plans and exercise regimes can also reduce weight at a safe, comfortable pace.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID causes avoidant or restrictive eating habits4. Someone with ARFID may avoid certain food groups, like carbs, or specific foods, like ice cream. They may also restrict their eating and not meet their required calorie intake. ARFID differs from other eating disorders in that body image and fear of weight gain don’t contribute to food habits; rather, someone may avoid or restrict food simply because they don’t like it.

ARFID was commonly thought of as a childhood disorder, like a more severe version of picky eating. But physicians saw adults experiencing symptoms too, and moved to shift the diagnosis to both children and adults. 

Symptoms of ARFID include:

  • Avoiding food groups or types of food suddenly and dramatically
  • Eating much less than usual
  • Eating fewer and fewer foods because they no longer sound appetizing
  • Weight loss
  • Reduced interest in food and meal times
  • Low/no appetite
  • Stomach and digestive problems

Treatment for ARFID often includes therapy to work through food avoidance and identify foods someone will enjoy eating. Weight restoration and nutritional care may be needed, but not always. 

Other Specified Eating or Feeding Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED)

You can think of OSFED as a mix of eating disorder symptoms5 that don’t fall under anorexia nervosa, bulimia nervosa, or binge-eating disorder. A patient with this diagnosis may partially meet the requirement for one or more ED diagnoses. OSFED recognizes disordered behaviors and negative relationships with food as a hindrance on daily living, mental health, and physical health.

Similarly, UFED encapsulates eating disorder behaviors and symptoms that may not have a distinct classification. Some scholars and physicians debate the helpfulness of UFED and OSFED5, and instead suggest a singular term of ‘mixed eating disorders’. This term could offer more clarification for those diagnosed with it.

The symptoms of OSFED and UFED can vary widely, but typically include:

  • Restrictive diets; not eating certain foods
  • Purging behaviors (vomiting, excessive exercise, using laxatives)
  • An obsession with size and weight
  • Body dysmorphia

Therapy and possible weight restoration can help someone with OSFED or UFED heal short and long-term.

Pica

Pica is defined as eating non-food items or substances6, like mud or chalk. To diagnose, the person must be older than 2 and eating non-foods outside of cultural or societal norms. Pica can accompany disorders like schizophrenia, obsessive compulsive disorder (OCD), or trichotillomania (compulsively pulling out hair). It commonly occurs in intellectually impaired patients, children, and pregnant women. One study found 28% of pregnant women experienced pica6 during their pregnancy. 

Pica doesn’t have a direct cause6, though it’s been theorized that iron and zinc deficiencies can cause cravings for non-foods7. Pica can also be fueled by curiosity—most people may wonder about eating non-foods or want to, but they realize they shouldn’t. Intellectually impaired people and children may lack this reasoning and eat non-foods regularly. Children may also resort to non-foods to survive in neglectful or abusive environments.

Common pica ‘foods’ include:

  • Dirt and clay
  • Ice
  • Charcoal
  • Coffee grounds
  • Eggshells
  • Paper
  • Flaking paint (which can lead to lead poisoning)
  • Rocks, bricks, and cement
  • Plastic (plastic bags, containers, chunks)

Rumination

Rumination syndrome describes habitually regurgitating food8 and swallowing it or spitting it out. It usually happens 10-15 minutes after eating and can last up to two hours. Unintentional stomach and diaphragm tension can cause regurgitation. It happens without nausea and retching, but can cause stomach pain. Once someone learns how to do it, it can become habitual, like burping.

Symptoms of rumination syndrome include:

  • Weight loss
  • Malnutrition
  • Teeth erosion
  • Electrolyte imbalances
  • Abdominal pain

Rumination can co-occur with conditions like depression, anxiety, obsessive compulsive disorder (OCD). It can be a symptom of an eating disorder or occur alongside one. Treatment often includes breathing exercises to relax the diaphragm, behavioral therapies, and other relaxation methods to practice after meals. Staying relaxed can prevent the over-tightening of the stomach and diaphragm that allows rumination.

Treatment for Eating Disorders

Eating disorder treatment1 often includes a blend of behavioral therapies, nutritional counseling, medically supervised weight restoration, and medications. Treatment aims to address the ED’s symptoms and underlying causes, like anxiety, stress, depression, or trauma. Therapists work in 1:1, group, and family settings to help patients heal their relationship with food, navigate co-occurring conditions, and develop a relapse prevention plan.

Behavioral Therapies for Eating Disorders

Cognitive behavioral therapy (CBT) for eating disorders1 addresses binging, purging, and restrictive behaviors. It teaches coping tools and helps patients identify and change untrue beliefs about food, their body, and self-image.

Dialectical behavioral therapy (DBT) helps in similar ways, but focuses more on accepting thoughts and emotions and living with their potential discomfort—without restricting, binging, or purging. It centers on mindfulness, helping patients experience emotions without trying to change or limit them.

Behavioral therapies often occur alongside medications (like antidepressants or antipsychotics), medical care, and nutritional counseling.

Medical Care and Monitoring

Medical care may take place in an inpatient or outpatient setting, depending on each patient’s presentation and how underweight they may be. Weight restoration aims to safely restore weight until patients reach a healthy base weight. It focuses on physical health and safety, but restoring weight can also restore cognitive functioning.

Weight restoration9 can be done via feeding tube, nutritional supplements, and meal monitoring to ensure patients eat full meals. Other medical services may include heart monitoring, medications, and potential life-saving measures in the case of heart failure or other organ failures.

In an inpatient setting, patients receive 24/7 care and monitoring. This may be necessary for severely underweight patients and/or those who refuse to eat due to an eating disorder. Nurses and clinical staff monitor vital signs and track weight. In an outpatient setting, care and monitoring may be available, but not 24/7. This can fit the needs of someone at a stable weight, but needing ongoing therapeutic care and monitoring.

Nutritional Counseling

In nutritional counseling, a certified nutrition counselor assesses current eating habits10 and identifies dietary changes. They help create meal plans, educate on the importance and effects of good nutrition, and help patients with eating disorders change how they view food. For example, they may explain the benefits of feared food groups and “fear foods” to lower the fear and negative associations someone may have.

Nutritional counseling can disprove untrue beliefs or fears about food and help patients feel more comfortable eating new/more foods, complementing behavioral therapies and  weight restoration.

What to Expect When Seeking Treatment

What happens when you seek treatment for an eating disorder? It varies for everyone, but you can expect your appointments with therapists and medical providers to follow general structures.

Medical Providers

You’ll typically meet with your primary care physician (PCP) first to start the treatment process, then see specialists at their referral. In this initial appointment, you and your doctor will discuss what you’ve been experiencing and struggling with. Based on your discussion, you can ask questions like:

  • Do my symptoms meet the diagnostic criteria for an eating disorder?
  • What treatment do you recommend?
  • What level of care do you recommend for my symptoms and their effect on my life?
  • What can I do to take care of myself at home?
  • Will I be put on medication? Which one, and what are its side effects?

Your doctor will likely provide physical evaluations, checking your mouth, throat, stomach, and your heart rate, among other vital signs. These evaluations can reveal and confirm health concerns, potentially leading to additional lab testing or other functional tests. Your doctor will use the results of their evaluations to determine the best next steps for you.

At the end of your appointment, you’ll likely leave with referrals to specialists, therapists, or a plan to start intensive care in an inpatient or outpatient setting. In severe cases, a PCP may send you directly to an emergency room.

Therapists

Your first therapy session for eating disorder recovery often covers your history with eating disorders and general information about yourself. You’ll talk about what brought you into treatment, and depending on how much time you have, you may take assessments to help your therapist better understand your mental state and personality. Future sessions cover current and past issues more in depth, focusing on the thoughts and beliefs behind eating disorders, identifying triggers, and learning coping tools.

Overall, think of your first session as your therapist getting to know you, and you feeling comfortable with them. If you don’t find the right therapist on your first try, that’s okay. You’re encouraged to connect with new therapists if your current one doesn’t feel like the right fit. 

Lifestyle Strategies and Habits to Manage Eating Disorders

Lifestyle changes and new habits can help manage eating disorders. Remember to seek professional treatment as your first step in recovery, using new habits and lifestyle changes to complement your recovery and form your relapse prevention plan. 

Prioritize Good Sleep

Good sleep can help your mind and body work their best. This benefits your recovery and well-being as a whole. Try these tips to improve how long you sleep and your sleep quality:

  1. Create a nighttime routine that you enjoy and look forward to—purposefully wind down and prepare for sleep the same way each night to train your brain.
  2. Make sure your bedroom is a calm space focused on sleep. Don’t use it to work, eat, or scroll social media.
  3. Dim your lights an hour or longer before bed to trigger your natural circadian rhythm and make you feel sleepier.
  4. Get sunlight in the morning and evening, ideally the sunrise and sunset. You could take morning and evening walks, or sit outside on your porch to view and feel the sun. This can regulate your circadian rhythm.

Practice Stress-Reduction Strategies

Effective stress reduction strategies can vary person-to-person. You can identify what works for you in therapy, or you may already know from past experience. Keep one or two methods in mind to use as-needed, or work some of these examples into your weekly schedule: 

  • Drawing
  • Meditation
  • Talking to a friend or loved one
  • Journaling
  • Baking or cooking
  • Knitting, crocheting, or sewing
  • Taking a walk
  • Spending time in nature

Build and Connect With Support

Connect often with your support network as you undergo treatment, walk your recovery path, and live in long-term recovery. Your support network could include family, friends, and people at your work or place of worship. Keep them up-to-date on your treatment journey and how they can support you.

Friends and family can offer their support and keep you accountable. For example, they may catch or point out potential behaviors you’ve reverted back to, or new habits that could lead to an ED recurrence. 

Find Eating Disorder Treatment

Treatment for all types of eating disorders is an essential start in recovery. A personalized blend of therapy, nutritional counseling, and medical care can restore physical health and heal underlying causes and conditions. You can hear a first-account story of eating disorder recovery by listening to the episode with Amanda Uphoff on Recovery.com’s podcast.

To find eating disorder treatment, you can browse our list of treatment providers and compare services, pricing, and reviews to find the best center for your or a loved one’s needs. 

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Embracing Recovery: Amanda Uphoff’s Journey to Healing and Hope

We were delighted to speak with Amanda Uphoff, our Chief of Staff, in our recent Recovery.com Podcast episode. Amanda started with Recovery.com in 2022 as an Executive Administrator and has since excelled in the role of Chief of Staff. She owned and operated a yoga studio in Madison, WI and has made it her home. 

Amanda is a mother, a mentor, a certified yoga instructor, a certified recovery coach, and a woman in recovery from anorexia nervosa and alcohol use disorder. In our episode, we talk to Amanda about her recovery process, hurdles, and how she helps other women embrace recovery.

Listen to Amanda Uphoff’s podcast episode here.

Rosy Beginnings

Amanda grew up in Akron, Ohio as the oldest of 3 well-loved siblings. She entered into an unhealthy relationship with food in 8th grade, starting strict diets to lose weight. In college, social and interpersonal pressure bloomed her unhealthy relationship into an eating disorder. Amanda danced on her school’s dance team and received “really positive feedback” on her weight loss. Only when she went home for Christmas, saw a picture of herself, and was told she couldn’t return to college if she didn’t gain weight did Amanda realize the severity of her anorexia and the hold it had taken on her life. 

Love for her family and college dance group empowered Amanda to go to therapy, eat more to replenish weight and nutrients, and maintain her progress. 

Growing into Motherhood, Business Ownership, and Recovery—And Catching Thorns

Amanda had two children, crediting her pregnancies with healing her anorexia and how she felt about her body, saying, “It’s hard to hate something that does something so magical.” She soon opened her yoga studio, but Amanda quickly discovered she wasn’t fully suited to the small-business path. Disconnecting from work became a daily struggle, as did taking care of herself. Eventually catching just a few hours of sleep a night and wholly burnt out, Amanda again developed anorexia.

As that was happening, Amanda was introduced to wine and fell in love with how it “smoothed the edges, made everything feel just a bit better.” Drinking wine helped her fit in with the sophisticated small-business community in Madison. She gradually drank more and more, starting with a glass or two a night, and then a bottle a night by the time she was 35. Then she decided she wanted to stop.

Amanda figured her ability to stop something as crucial as eating would make quitting easy, but found she couldn’t stop—even though she wanted to for her own health, her children, and her marriage. 

When New Beginnings Bloom

Amanda walked through a divorce, the terrifyingly real prospect of losing custody of her two kids, and the lost hope of one “magic bullet” that could fix everything. She attended a residential program for her anorexia and alcohol use disorder but felt disconnected from treatment, leaving without feeling “healed”. Two years later, she attended residential treatment again and met a spiritual advisor. This person, and the facility’s spiritual program, appealed to her love of yoga and spiritual practices. 

Amanda retained sobriety after the second program, with her last relapse in January, 2020. Lockdowns during the Covid pandemic allowed Amanda to repair her relationships with her kids, primarily with her oldest daughter. 

Embracing Rigorous Honesty And Aggressive Authenticity

Amanda’s journey continues as a mentor and spokeswoman for honesty and authenticity as tools for recovery and relapse prevention. Amanda’s lived experience with addiction and recovery fuels this advice:

 “Community is everything. I recommend finding one person who you can be rigorously honest with, who you can tell everything—that can just be one person and then it can grow.”

Amanda is now a certified recovery coach and uses her experiences and wisdom to mentor women and help them find their path to recovery. She enjoys watching her children grow into capable, compassionate young adults and spending time with her partner, Wes, who works as a peer support specialist and is in recovery himself. 
To hear more of Amanda’s story, listen to her episode on The Recovery.com Podcast.

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Challenges in Education: COVID-19, Addiction, and Mental Health

Newer generations have had to hurdle many new challenges in their education—a global pandemic, a rise in school violence, and an unmet demand for mental health and addiction treatment. COVID-19, in particular, completely shifted how school and socializing worked, and many students still feel those effects. 

These challenges have brought a rise in mental health and addiction struggles in teens despite their resilience and desire for treatment. Fortunately, students and their families have many resources for healing. Dr. Dana Battaglia highlights some of these resources in our recent podcast episode; listen here.

Stats on Addiction in School-Age Kids

Kids and teens often experiment with substances like alcohol and tobacco. “Study drugs” like Adderall often pass hands1 during finals or other testing seasons. School can be an easy place to get and distribute vapes, marijuana, and “hard” drugs like cocaine. Alcohol is the most commonly used and abused substance2 among teens, followed by marijuana and tobacco products. Here are the stats at a glance:

  • 61.5% of teens have overused alcohol by their senior year
  • In 2022, 407,000 teens 12-17 years old met criteria for alcohol use disorder
  • 35.2% of teens smoked or vaped marijuana in 2022
  • 788,000 teens ages 12-17 met criteria for illicit drug use disorder in 2022 (1-in-8 teens)
  • Half of teens have misused a substance once or more

Between 2016 and 2020, the rate of 8th graders taking drugs went up 61%. One in 8 teens abuse drugs, making youth drug use a major public health concern2. Not only does substance use damage their health and well-being, but it can also impact their ability to do well academically and advance to college. 

Social acceptance and peer pressure could initiate substance use. For example, teens may feel pressured to drink at a party to fit in and not seem like a ‘downer.’ Drinking in these situations can progress into drinking in other situations, like casual hangouts with friends or even alone in their room. 

Similar to alcohol, vaping has been normalized among teens, leading to a reported 2.1 million teens using vapes in the U.S3. Well over half of teens want to quit but haven’t had successful attempts. Starting tobacco use as a teen often leads to continued use in adulthood.

Mental Health Stats in School-Age Kids

Mental health conditions, especially untreated, can also impact students’ abilities to succeed in school and maintain their well-being. Mental health conditions can also lead to substance use4 as a coping mechanism, potentially leading to addiction. These are some stats on mental health conditions in students:

When mental health conditions affect a student’s ability to learn, they’re classified as having an “emotional disturbance.” Having an emotional disturbance makes students eligible for an individual education program6 (IEP), which offers more personalized education services and catered support services to help students succeed. However, few students get this important support. Many schools and teachers don’t have the resources to care for these students, leading to more suspensions and removals. 

Solutions center around seamless, integrated care—mental health support, educational support, and parental support all in one place: school. 

Impact of COVID-19 on Teen Education and Well-Being

Lockdowns during the COVID-19 pandemic changed how teens and children got their education, socialized, and learned. Many lost out on major milestones like graduation and prom. In-person classrooms became Zoom meetings on small Chromebook screens. As schools and educators adapted for virtual learning, new problems took root. 

A survey done by the Center for Disease Control7 reported these findings:

  • Of U.S. high school students, 67% felt like schoolwork got harder
  • 55% suffered emotional abuse at home
  • 11% suffered physical abuse
  • 24% didn’t have enough to eat during the pandemic

Adding in isolation and loneliness, these factors could strongly impact learning and teen mental health. Students also reported excessive homework and assignments8, lack of motivation, and difficulty with finding a balance between school and life. Those who needed extra help in the classroom lost access to the in-person, 1-1 attention required to help them stay on track. 

Students also lost the vital social interactions offered in a classroom. One student says9, 

“Learning without the social cues of a classroom was difficult. At in-person school, I took notes when I could see that everyone around me did. During Zoom, I didn’t know what I was supposed to be doing.” 


The National Center for Education Statistics found that in 2022, 9-year-olds scored lower in both reading and math10 compared to 2020. Reading scores saw their biggest drop in over 30 years, and math scores went down for the first time ever recorded. These changes happened because of COVID-19 disruptions like school closures and virtual learning. Despite these challenges, teachers, parents, and communities helped support students and prevented scores from falling even further. The same student from above echoes that, saying,

“People adapt and become stronger even with uncertainty. I can deal with it too.”

Preventative Measures and Available Resources for Healing

Students with mental health conditions, whether influenced by COVID or not, have multiple resources available for healing. But they often don’t know they’re there. 

Overwhelmed schools and staff can rarely provide the awareness many students need to know they have resources available, like access to school counselors, therapists, and state-funded mental health programs. Adequate awareness of these resources could help students access crucial mental health and addiction support before issues affect their learning and well-being. 

Students can also access resources outside of school, like therapy, intensive outpatient programs, or youth-focused crisis services. Many crisis services focus specifically on youths and certain demographics, like LGBTQ+ teens. Here are a few lines you can call or text:

  • TrevorLifeline: help for LGBTQ+ young adults needing support. Text 678678, call (866) 488-7386, or chat with them online.  
  • Hey Sam: peer support for people up to 24 years old. Text 439-726 from 9AM to 12AM ET and talk about anything on your mind.
  • Teen Line: support and resources for teens offered by highly trained volunteers. Call (800) 852-8336, text 839863, and chat online.

Future Goals and Ideas

Students showed resiliency through the COVID-19 pandemic and day-to-day struggles with mental health conditions and addiction. Gen Z takes an active stance in reducing their likelihood of addiction by drinking less11, up to 20% less than Millennials. Wellness trends, better awareness on mental health and addiction, and viewing mental health as important as physical health add up to make an inspiring impact.

Encouragement from schools, parents, and peers to maintain this momentum could reduce addiction and related mental health conditions in an entire generation. 

More mental health staff at schools could support this positive change and extend it to younger generations. For example, a school may employ a social worker for every grade who can provide in-the-moment crisis support, connect students to available care options, and educate parents on the support needed. 

Schools could also change or reduce punishments for substance use. As an example, catching a student vaping or drinking on-campus could automatically enroll them in an educational after-school program rather than a suspension. Mandatory education on drinking, drug use, and mental health conditions could also teach students the dangers of substance use and prevent addiction before it starts.

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The Necessity of Seamless Care in Improving Education: Insights from Dr. Dana Battaglia

We were honored to talk with speech-language pathologist, educator, and TEDx speaker Dr. Dana Battaglia on our recent podcast episode. Hosted by our Editor-in-Chief and clinical psychologist, Dr. Malasri Chaudhery-Malgeri, we discussed the special education system as a whole, where it can improve, and resources for parents.

Tune into this episode for a deep dive into adolescent mental health, how schools navigate their ever-increasing needs, and how seamless mental health and learning support can help students thrive.

Listen here on your favorite podcast platform.

Bringing Experience and Passion to Special Education

Dr. Dana Battaglia is a wife and mother passionate about effective communication and equal-opportunity learning. 

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To the special education system, she brings vast knowledge and experience with literacy disabilities, autism spectrum disorder, and communication. In her current work as Chair of the Committee on Special Education at the Westbury Union Free School District, she determines if students have a disability. To have a disability, students must fall under one or more of the 13 educational classifications, which include autism, emotional disorders, and speech impairments. Dr. Battaglia has worked as an Associate Professor and Clinical Coordinator at the Genesis/Eden II Programs.

Reactivity vs. Proactivity in Special Education

Dr. Battaglia outlines the need for proactive care, saying, “…by the time they get to me, a student is really in disarray if they truly do have a disability.” Students come to her only after they’ve experienced academic difficulties, which then gets treatment rolling.

However, Dr. Battaglia notes that the system has improved in the last twenty years. Mental health is recognized as an important aspect of student health, opening up doors to comprehensive treatment for both students and their parents. But by the time students have their needs recognized, their well-being and academic success have often already been affected.

Rising Mental Health Needs and Emotional Disabilities

Mental health conditions and diagnosed emotional disabilities have been on the rise, Dr. Battaglia notes. She sees literacy disorders leading to addiction as a means to cope with academic stress. COVID-19 has also created spotty, inconsistent education and classroom experiences, causing some students to fall behind socially and academically. 

Due to increased need, students who experienced sexual assault and abuse encounter long waiting lists for more intensive therapeutic environments. General mental health care often bumps into the same problem—unmet demand and wait times. 

Resources and Help Where Students Need It Most

Partnerships with clinics, psychiatrists, state programs, and community resources actively meet the needs of students with mental health conditions and learning disabilities. Though wait times and incongruent care can delay treatment, it is available and often highly effective. Asking for help is the first and most vital step. Dr. Battaglia says,

“What I have said to families is that in my 25-plus years of practice, I have never, ever seen a child die from an extra evaluation. Or getting extra therapy that maybe they didn’t need.”

Schools can offer help through on-site counseling and academic support, creating individualized education plans. They can also refer students to outside treatment to connect them to more effective and fast care. School staff and psychologists conduct home visits to ensure student safety, provide in-home instruction, and provide other forms of support to care for their students, including Parent Training and Consultation programs.

Support for Families

Parents have resources available to them, too. Parent Training and Consultations equip families with essential tools to support their children’s educational needs and treatment goals. Family groups connect parents and offer a space to share encouragement, which schools can connect parents to.

Solutions in a Dream World: Seamless Care 

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Dr. Dana Battaglia envisions seamless, integrated care in all schools and for all students. Each school would have psychologists, psychiatrists, social workers, speech pathologists, and special education instructors. Attentive care would identify mental health and learning challenges before they disrupt academics and a student’s overall well-being. Translators would be available for students of different cultures and countries, helping them assimilate into the classroom and new cultural expectations. Dr. Battaglia says,

“I would love to see a world where a teacher has opportunities to collaborate with a literacy specialist and a speech language pathologist, embedded in their day, with counseling support.”

Overall, students wouldn’t rely on a school’s limited resources and referrals to get treatment. Therapeutic treatment would instead take place where students already spend most of their time—at school. The first line of defense, though straggled now, would become more robust and capable of handling rising demands. 

With continued government support, this dream may soon become a reality, especially as educators and treatment professionals continue to advocate for their students’ well-being. 

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What Is ASMR?

Autonomous Sensory Meridian Response (ASMR) is a sensory response to specific audiovisual stimuli. Watching and listening to ASMR can cause relaxation1, reduce stress, and alleviate anxiety. Physically, ASMR can create tingling sensations in the brain and down your back and arms, which is why the ASMR experience is often called “getting tingles.”

Not everyone will experience ASMR, as its effect varies from person to person. Some people will only respond to specific “triggers,” like tapping, and not other sounds or stimuli. You can even become desensitized to ASMR, often called “tingle immunity.” New sounds or stimuli can restore its effect. 

ASMR can improve sleep, mental focus, and general relaxation. It’s become increasingly popular as a study tool or holistic sleep method. ASMR creators–or ASMRtists–upload videos on social media, including TikTok, Instagram, and YouTube to make their content easily accessible. Videos range from a few minutes to 10+ hours. 

The Science Behind ASMR

Emerging study results back the claims of ASMR fans who swear by its relaxing, comforting effects. 

Understanding the Physiological Response

One study on the effects of ASMR used functional magnetic resonance imaging (fMRI) to observe brain activity. The results showed ASMR triggers can decrease heart rate and increase skin conductance levels, a measure of the body’s response to stimuli. This suggests ASMR elicits a reaction similar to comforting interpersonal attention, which can create an overall sense of well-being, relaxation, and happiness—supporting the experiences of ASMR fans.

Benefits of ASMR

ASMR was found to reduce symptoms of depression and insomnia2 by relieving stress and promoting comfort. ASMR also offers a sense of personal connection3 and friendliness between the ASMRtist and the viewer, especially as viewers narrow their preferred style of ASMR and find their favorite ASMRtists. Some creators make specific videos tailored to personal attention and comfort, like simulated make-up applications, reassuring conversations, and repeated words of affirmation. 

Non-personal attention can also comfort the viewer, like watching someone get their back scratched, their hair combed or receive a soothing spa treatment. This relaxed environment and the viewer’s ability to put themselves in the subject’s shoes can almost feel as comforting as receiving the treatment themselves. 

The overall effects of ASMR can improve sleep and promote relaxation, calmness, and comfort. Viewers with mental health challenges, acute stress, and sleeping disorders often find ASMR particularly beneficial as a non-pharmaceutical, at-home remedy for their symptoms.

Common ASMR Triggers

ASMR triggers usually fall into these categories: sound-focused, visual-focused, and an intentional blend of both. 

Sound-Focused Triggers

A sound-focused video features a close-up view of an ASMRtist’s hands and their microphone. You’ll watch them manipulate, scratch, and tap items to make certain sounds, either holding them by the mic or placing them on a flat surface. The focus isn’t on ASMRtist’s hands, body, or movements; rather, the sounds the item makes. Here are a few common sound triggers:

  • Tapping
  • Whispering
  • Brushing the mic or object with a soft brush
  • Scratching
  • Using an item to tap/touch another item
  • Any triggers done ear-to-ear (binaural stimulation) with a special head-shaped mic

Visual-Focused Triggers

Visual-focused videos center on movement, sometimes without any sound at all (besides gentle background music, potentially). For example, an ASMRtist may move their hands and fingers in repetitive, flowing movements to stimulate ASMR. Visual-focused ASMR could also include painting, simple crafts, and eye-tracking ‘games’ hosted by the ASMRtist. Makeup destruction is also popular, as is organizing and cleaning.

Blended Triggers

Many ASMRtists blend visual and sound-focused triggers for a more comprehensive experience. For example, they may use rhythmic hand movements to comb someone’s hair, touch or tap an object, or whisper into their mic as they spin and pulse their hands. Some viewers strongly prefer the combination of visual and audio triggers and find them more effective.

An ASMRtist using blended triggers may also quietly narrate what they’re doing to help the viewer focus and connect. This is often called ‘whispered’, as in ‘whispered back scratch ASMR’. Some viewers prefer this, some find it distracting. ASMRtists often specify ‘non-whispered’ or ‘no talking’ on their video titles to help those viewers find the best ASMR for them.

Tactile Triggers

Though less common and accessible, some ASMR fans enjoy tactile triggers best. These include in-person touch, like hair playing or skin touches, that cause ASMR. Soft scratching or touching down the back and arms can cause the sensations of ASMR and its same positive effects. 

Experiencing ASMR

Knowing the benefits of ASMR, you may be more eager to experience it yourself. It’s okay if you don’t know where to begin—you can start in all sorts of ways. 

Finding Your ASMR Triggers

Start by watching ASMR videos. Try a variety, or begin with a compilation video of multiple (sometimes hundreds) of triggers in quick succession. This can help you find your preferences and discover new triggers even as a long-time ASMR fan. Your response to triggers should be immediate, so you’ll know right away what you prefer. Keep your mind open to new possibilities as you go, as what you like may surprise you.

You can peruse videos simply by typing ‘ASMR’ in the search bar on YouTube, which has longer videos. You can do the same on Tik Tok, Instagram, and other forms of social media to find snippets of longer videos. Once you know what kinds you like, your search could look like ‘slow tapping ASMR’, ‘back scratching ASMR’, or ‘unpredictable no talking ASMR’.

Many ASMRtists cater to deaf viewers or those with attention disorders. Read the title of each video or specify your search to find these types of videos. 

Creating an Ideal ASMR Environment

To get the benefits and effects of ASMR, your environment must align with rest and peace. For example, watching ASMR on a crowded subway likely won’t offer the same benefits as your environment would make it hard to stay focused and engaged with the content. 

Create a peaceful environment by dimming your lights, lighting a candle or incense, and getting comfortable. Ensure you won’t be disturbed by noises, people, or responsibilities. Your bedroom can be an ideal space to watch ASMR, especially for those who use it as part of their bedtime routine. Make yourself as comfortable as possible, and wear headphones if that gives you a better experience. Most ASMRtists recommend headphones for better sound quality and to experience binaural (ear-to-ear) audio.

ASMR for Relaxation and Sleep

ASMR can be highly effective in a sleep routine. Watching a video before bed can help you relax, process your day, and have a calmer mind before you shut your eyes with the intent to sleep.

To work ASMR into your nightly routine, start by watching a video every night. Set a timer for it to remind you, if needed. You could also pick out your videos for a whole week by saving them on YouTube. This can spare you the time and effort of picking a video each night, which can make it easier to integrate into your routine. 

If you have other nightly habits, like reading, you can watch ASMR after those activities. Try to do it right before you close your eyes to make sure your mind stays relaxed and calm as you shift into sleep. 

The ASMR Community 

ASMR has a large fanbase, especially as it continues to grow in popularity. YouTube hosts many ASMR videos and ASMRtists, as its long-form videos cater more to the length of ASMR videos. Many YouTube creators focus specifically on ASMR content and center on a niche, like tapping, back scratching, or organizing items. Some ASMRtists will show their face and talk to the camera during the video, commenting on the trigger, life updates, and more. ASMRtists like these can connect more personally with their audience and grow a unique following, though some viewers find conversation distracting and detracting from the experience.

ASMR fans often gravitate towards a handful of ASMRtists and join a community of others with the same preferences. Some ASMRtists have online groups for viewers to interact with them and other fans. You can even pay for specific ASMR videos that include your preferred triggers. Some fans also financially support their favorite ASMRtists with small monthly donations. 

The ASMR community as a whole provides a space of comfort and safety for many. ASMR’s focus on soothing, comforting, and healing touches every aspect of it, from its online communities to each unique video. Many ASMRtists with similar styles collaborate and create videos together, so you may see your favorites visit each other and make content.

Criticisms and Misconceptions of ASMR

Despite its growing popularity, ASMR faces skepticism. Some regard it as a sexual fetish due to the intimate nature of certain triggers, while others dismiss it as a pseudo-science4. However, for those who experience ASMR, it’s neither. It’s a personal, non-sexual, and subjective experience that varies person-to-person.

ASMR could also be seen as something only women can create and enjoy. But viewers and ASMRtists vary in all sorts of ways, from their age, race, gender, and sexuality. They live worldwide and represent unique cultures, languages, and demographics. 

Future of ASMR

ASMR could become even more of a buzzword and household practice in the coming years.

Research and Developments

As ASMR grows in popularity, more scientists and clinicians have begun publishing studies and reviewing its effects. This could broaden the medical community’s awareness of ASMR and make it more common practice to recommend it. For example, a particularly potent study could encourage doctors and mental health providers to recommend ASMR to their patients.

ASMR has been studied5 and likely will continue to be. As more studies and experiences reach the public, more people may try ASMR and incorporate it into their daily lives, similar to meditation and mindfulness. Apps and training courses now exist solely to help people meditate; the same could soon be true for ASMR.

Expanding ASMR Applications

Like other mindfulness practices, ASMR could be included in standard treatment plans for mental health conditions. For example, a therapy session could include watching an ASMR video to settle your mind before beginning. A therapist could also use it as a calming tool, similar to soothing music, during a session. 

Since ASMR can lower heart rates and improve mood5, it may become more mainstream in all types of treatment, from therapy to a calming pre-operation tool in the medical space. ASMR’s overall future and integration into the broad realm of healthcare seems promising.

ASMR’s Whispers of Hope

ASMR can be a highly beneficial tool for people with and without mental health conditions or sleep disorders. You can ask your friends and family if they watch ASMR and the types of benefits they feel. If you like ASMR, you’ll join a thriving community focused on comfort and healing. If you don’t, you’ll still have plenty of company. Try ASMR today to see how it can help you.