Understanding a BPD Diagnosis

Borderline Personality Disorder (known as BPD) is a little-known mental health condition that affects approximately 1% of people in the UK. Sufferers feel emotions more intensely than those around them, and can swing from feeling dependent to feeling smothered. They are also very likely to self-harm or attempt suicide as a way of coping with these emotions. People newly diagnosed with BPD can find the condition confusing, as there is comparatively little information available online, and it isn’t regularly discussed by the media.

However, BPD is treatable and is mainly managed with a specific type of talking therapy called Dialectical Behaviour Therapy, which teaches more robust and healthy coping skills and behaviour management, either in a group setting or individually.

Symptoms of BPD

Inability to regulate your emotions
Frequent self-harm and suicidal ideation, often leading to suicide attempts
Intense relationships with friends, family, colleagues and partners; a fear of being abandoned by them even for short periods, driving you to co-dependent behaviour, but also a fear of being smothered or controlled by them, driving you to confrontation. These contrasts are commonly referred to as ‘go away/please don’t go’
Emotional outbursts and uncontrollable anger (sometimes leading to physical violence)
Mood swings across several hours
Feelings of emptiness
Low self-esteem and poor self-image
Risk-taking behaviour, such as substance abuse, gambling or unsafe sex
Disturbed thought patterns, like hallucinations, or a feeling you don’t exist

BPD isn’t usually diagnosed in childhood, but its symptoms can appear in or be traced back to teenage years or early adulthood.

The symptoms may affect your life in many different ways: for example, you might have trouble holding down jobs or relationships, or you might become driven to use alcohol and drugs to conceal low self-esteem and feeling chronically empty.

Dialectical Behaviour Therapy: The Main Treatment for BPD

Dialectical Behaviour Therapy is a long-term commitment, but a very effective strategy for managing BPD. You will learn to analyse your behaviour and reset your goals, moving away from feelings of anger, low mood and emptiness to be able to survive and then thrive again.

DBT can involve ‘homework’, so it can’t be entered into lightly, but every bit of work you put in will lead you towards a sustainable way of life, where you feel in control of your emotions and your life decisions. It will add much-needed stability after months or years of turbulence. For more on DBT and how it works, click here.

Other approaches like Cognitive Analytical Therapy (CAT), schema therapy and psychodynamic psychotherapy can also be used where appropriate.

Marsha Linehan, PhD: BPD Patient and the Godmother of Dialectical Behaviour Therapy (DBT)

Though the doctor who invented Dialectical Behaviour Therapy has personally experienced Borderline Personality Disorder, she didn’t publicly reveal this connection until 2011. Aged just 17, Marsha Linehan was admitted to a mental health hospital, the Institute of Living, in 1961, due to ‘social withdrawal’. She spent over two years as an inpatient, often on the secure ward, having been misdiagnosed with schizophrenia (there was no BPD diagnosis in those days); she was even given electroconvulsive therapy (ECT).

Once back in the community, Linehan struggled to deal with the outside world but simultaneously trained in psychology, determined to help others like her. She noticed that patients with chronic suicidal ideation and self-harm history often disengaged from traditional Cognitive Behavioural Therapy (CBT). They became angry and defensive, particularly when asked to make major life changes, or they became too dependent on their therapist.

Linehan was determined not to invalidate her patients’ feelings, but to lead them to a state of acceptance that the life they envisaged was not the life they had; this conflict between hopes and plans versus reality was often resulting in low mood and the urge to self-harm.

Her pioneering work to develop DBT has helped countless patients around the world, as DBT is now recognised as the best option for someone diagnosed with BPD. If you’d like to discuss DBT treatment with Christine Tizzard Psychology, get in touch today.

Written by guest contributor Vikram Das for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

Syrian Refugee Crisis: How We Can Help

It is now three long years since three-year-old Alan Kurdi drowned in the Mediterranean – just one victim of many in the ongoing Syrian refugee crisis, but the image of his little body made headlines around the world. Alan died alongside his mother and older brother; his father was the only family member who survived the tragedy of their boat capsizing as they made the dangerous crossing to Europe. 5.6 million Syrians have so far fled the country in fear of their lives.

The photograph of Alan has come to define the refugee crisis, and it drove a sharp uptake in donate to charities helping refugees, but the momentum has died down for fundraisers and there are still hundreds of thousands of Syrian citizens left in refugee camps. From Jordan to Lebanon and Greece to Turkey, they wait and wait and wait; some 80,000 people are crammed into in Jordan’s Za’atari camp and cannot leave without a permit. Unfortunately, people smugglers can still do a lucrative trade, as desperation is so high after seven and a half years of conflict (see CNN’s Syrian civil war timeline for details).

It’s easy for us to remark on the ongoing crisis from our comfy homes and from behind our screens on social media, and to say something should be done, but it is far harder to improve the situation. Society has become driven by virtue-signalling – appearing charitable or caring to the outside world, without taking any concrete action such as donating time or money to the cause. We can get caught up in movements like the Ice Bucket Challenge (for Motor Neurone Disease awareness) then quickly move onto the next public stunt or social media post.

The UK has so far accepted 10,000 Syrian refugees, and will accept 10,000 more by 2020. At Christine Tizzard Psychology we actively offer psychological support to refugee children; they will have witnessed scenes no child should ever see, and they are processing the trauma of being separated from their home, friends and country. Many will have lost family members in Syria or on the journey to safety, and younger children won’t remember a time before the war.

It’s crucial these children have psychological interventions once they arrive here and begin to cope with life thousands of miles from home: a new environment, learning or improving English, going to school, making friends, adjusting to the similarities and differences between their new home and the one they left behind.

The whole process will stir up a range of emotions, from anger to anxiety, and no child adjusts overnight. However, with the right support, these children can flourish and their distress will diminish over time, especially if their new community is welcoming and they have a support network around them. Just look at 19-year-old refugee Muzoon Almellehan, who fled Syria in 2013 and started a new life in Newcastle two years later. She is now UNICEF’s youngest ever goodwill ambassador, honouring her campaigns to give refugee children an education.

What Can You Do to Help Syrian Refugees?

Support a charity to improve their living conditions – Help Refugees, War Child and Unicef are just some of the charities actively involved on the ground.
Get involved in Cities of Sanctuary, a website that lists local groups welcoming refugees in different ways, such as involving them in community gardens, joining a mentoring project, or leading arts activities.
Lobby your local council or MP to do more for refugees nearby.
Refugee Action has many more ideas for dynamic ways to help.

However you choose to help, even if your action feels small, it goes some way to helping people who have been through unimaginable trauma.

Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

Safeguarding Children Inside and Outside School

Schools across the UK started implementing newly updated statutory guidance this week to safeguard children, but what does this update mean for your child’s wellbeing?

The Department of Education’s Keeping children safe in education document now heavily draws on guidelines from Working together to safeguard children, published in July 2018.

There are many reasons for updating the guidance – the first is to ensure schools offer more support for bullied children. Though bullying is an age-old problem for any school, the way they approach the issue can vary dramatically. Adding robust policies will help parents and governors hold schools to account. It will also highlight the need to support the bullies themselves; when a child becomes a bully, they act out to disguise their own mental distress. They may be repeating behaviour they’ve seen in or out of school, or they may lash out at others as a misguided coping mechanism.

Last year, The Psychologist published a major feature that explored anti-bullying studies across Europe. It suggested there needs to be more of a focus on reducing prejudice in general to reduce the likelihood of bullying. It will be interesting to see how many schools choose to strongly tackle prejudice in their strategies.

Protecting Children from Sexual Violence and Harassment

Meanwhile, growing awareness of sexual violence and harassment between students has meant there is now extensive risk assessment guidance for staff, with directions on how to handle a report and support the victim. The 2017 Girlguiding Girls’ Attitudes survey found that 64% of girls aged 13-21 have experienced sexual harassment at school in the past year.

Additionally, young people face peer pressure to get involved in sexting, which can then lead to harassment and humiliation. The issue of consent is interlinked with this, and educating children about consent is vital. The government’s separate advice document for schools about child-on-child sexual violence and harassment states that every school must clearly communicate its sexual violence and harassment policies to parents. If you don’t feel your child’s school has been clear on this, you may want to raise the issue.

Child hiding from outside world safeguarding safety and security inside box

Unfortunately, children with additional needs can face bullying and prejudice from classmates.

Groups at Risk

The report also acknowledges the increased risk of bullying, isolation and communication issues faced by children with special educational needs, such as autism. It can be noticeably harder for children with additional needs to explain how they have been bullied, or for them to understand if a bully has exploited or manipulated them whilst pretending to be their friend.

Children from other vulnerable groups, such as young carers, should also be given earlier interventions to help tackle problems at school, as the report states. By letting problems escalate, schools perpetuate distress for pupils and create a bigger issue for parents, guardians and the school itself to deal with.

Taking Action Against FGM

One major new addition is a mandatory regulation to report cases of Female Genital Mutilation (FGM). When a teacher suspects FGM may have taken place, or may be a prospect for a child, they should speak to the school’s designated safety lead. If they are certain the child is a victim of FGM, they have a legal obligation to report this to the police.

Between April 2017 and March 2018, nearly 4,500 new cases of women and girls with FGM were reported in the UK. If a victim has undergone FGM as a baby or toddler, they may not be aware of it until decades later, which can cause trauma and distress. If the victim is over five years old at the time of FGM, they are most at risk of developing Post-Traumatic Stress Disorder (PTSD). At any age, an FGM victim faces a range of physical complications besides the mental processing of the incident, which is often perpetrated by family members or family friends.

Practical Considerations

Behind the scenes, school staff must deal with the impact of GDPR and treat your data carefully. The guidelines also suggest a school should have more than one emergency contact number for your child which, in this day and age with most of us having mobiles, work phones and landlines, makes perfect sense.

Your child doesn’t need to be wrapped up in cotton wool to thrive, but knowing this statutory guidance is in place can reassure you that there are strategies in place should something happen.

Papal Visit: Praying for Forgiveness Falls Short

As a consultant psychologist, I am stunned to see the Holy Father Pope Francis asking for God’s forgiveness for the atrocities that the Catholic Church has carried out through countless decades.

Forgiveness comes, so religious scripture tells us, from repentance. Repentance is about making good the harm that has been done. More important repentance means ensuring this harm never ever happens again.

It is hard to see how any making good has occurred or, moreover, how that harm will never happen again. Harm still continues. Our clients’ anguished stories tell it all – the abuse still goes on.

As a young teenager, I can clearly remember visiting the Magdalene Laundry in Waterford with my long-deceased mother, a devout but good and honest Catholic. We were, for some reason, taking laundry to be washed after an elderly relative had died. I knew nothing at the time about the infamous Magdalene Laundries, nor of the trauma the nuns had inflicted on women of all ages. However, I was struck by the austere, gut-wrenching oppressiveness of the place; the omnipresent nastiness of the building. Words failed me then and words, they fail me now.

A few years later, in 1979, I was a young married mother having her first child in Ireland. The young woman in the next bed was also 19 but unmarried. I witnessed the nuns come into the ward and try to persuade her forcefully to give up her son. She was told she couldn’t give him a good life without a husband. I spent the night consoling her and telling her to go home to England and seek out her family and not to give up her son.

Fast forward 40 years and now, more recently, we have the scandal at Tuam and the ritual silencing of it.

Breaking the Cycle of Clerical Abuse

Surely it’s not sufficient for His Holiness to pray for God’s forgiveness; dedicated reparative action is needed. Abuse and brutality have to be rooted out and eradicated once and for all.

When we consider the cycle of change, it is accepted that lasting change only occurs when we fully acknowledge and contemplate our past wrongful behaviours. It is impossible to move towards change without this. Praying for forgiveness without contemplative action can’t lead to new ways and change. It is merely pre-contemplation or a flight of fantasy.

It is time to for the church to compensate these victims and their families. It is clear to say that the abuse carried out by priests and nuns doesn’t stop with or die with the victim. Clerical abuse continues to be an awful blight on the church and has in many cases caused a trans-generational pattern of misery. Its time for the church to acknowledge this and then, perhaps, it can move forward.

Written by Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

The Dangers of Parental Alienation

Child custody is an emotive and significant issue for separating parents. It can be complicated by conflicting work schedules and shift patterns, making it difficult to spend time with children in the time you are allocated; it can further be complicated by house moves and introducing new partners into the mix.

Yet parental separation can sometimes lead to parental alienation, when one parent tries to keep the other from seeing the children as a revenge tactic (but the alienated parent doesn’t pose a welfare risk to the child). This can lead to years of estrangement, with the child believing their absent mother or father is bad or irresponsible and may not love them at all.

Since October 2014, parental involvement has been implemented in the Children and Families Act, promoting both parents’ valuable roles in a child’s life (except in cases where one or both parents pose a risk to the child). At the time, Justice Minister Simon Hughes said: “No parent should be excluded from their child’s life for no good reason.”

Signs of Parental Alienation

Marking a parent as toxic, uncaring or irresponsible can take many forms, but may include:

Suggesting a parent isn’t around because they don’t want to see their children any more, or don’t love them.
Saying Mummy or Daddy is building a ‘new family’ with their new partner and won’t have time for their existing children.
Telling children not to engage with a parent or accept presents from them.
Hiding communication from the parent to the child, such as letters, text messages or phone calls (this is more common with younger children, whose parents may monitor their mobile phones and limit usage).
Encouraging children to report back from their visits to the other parent and record evidence of the parent’s behaviour.
Exaggerating reports of the other parent’s behaviour to influence a child’s perception of them: a car crash (which wasn’t the parent’s fault) morphs into ‘Mummy’s dangerous driving’; infrequent take-away meals as treats become a complaint that ‘Daddy only feeds us junk food’.
Regularly changing times and locations of arranged visits at short notice, knowing the other parent won’t be able to accommodate them.

This can even extend to alienating grandparents, other relatives and close friends on that side of the family, damaging children’s relationships with even more people they once happily spent time with. When a child is struggling to cope with their parents being apart, it is cruel to cut off healthy pre-existing relationships, as this creates further instability and anxiety.

Of course, if a parent feels their children are genuinely unsafe or at risk in the other parent’s care, such as in cases of domestic violence, neglect or severe addiction, caution is justified and social services should be involved. They may also wish to seek help from charities such as Women’s Aid or Al Anon.

However, if a parent knows deep down that their behaviour is a way to get back at an ex-partner, and punish them by gaining full custody, it is time to stop and think about the life-long consequences of these actions. No game-playing or point-scoring scheme can be worth manipulating your children over and damaging their perception of a parent for years to come.

Resolution, a family law organisation, has drawn up a Parenting Charter that you can go through with your children. The charter emphasises the importance of safe contact with all parents and siblings where possible.

Marriage contract cut up with orange scissors and broken flower laid on top, symbolising separation and divorce

Your relationship is over, but why cut your ex-partner out of your child’s life unless their safety is endangered?

Mediation to Deal with Parental Alienation

Many parents resort to mediation during a separation or divorce where they can barely face to be in the same room as each other, and both parties are fighting for child custody. These days, we all know families shouldn’t stay together for the sake of appearances; when parents can no longer live in the same house for whatever reason, it is healthier for the family to be split than to subject children to endless arguments and upset. However, when one or both parents cannot be civil or adult about family matters, it is crucial to bring in external parties who can mediate and ensure the situation doesn’t deteriorate further.

There is a vast difference between a mother or father’s negative attitude to their ex-partner, such as not trusting them after an affair, and a mother or father’s belief that their ex-partner is a bad or dangerous influence on their child. You may not want to spend time with your ex-partner, but do you really want your child to be largely estranged from them?

Mediation will give both parents a mature and considered way to state their case and their ideal resolution. It is suitable for many divorcing or separating partners, except when the relationship has involved violence or major welfare concerns for partners or children. The discussions from mediation are not reported to the courts unless they become police matters.

Family Court

If you do have to go to court, HM Courts and Tribunals Service has a guide on family court cases when parents are separated. It covers three main orders that the courts may be involved in:

Child arrangements orders state where the child will be living and when they will visit each parent – for example, regular weekend visits for one partner, instead of sporadic contact.
Specific issue orders are just that – relating to a particular childcare or child lifestyle issue you cannot agree on, such as private or state school education, religion, or health treatment.
Prohibited steps orders ban a parent from certain actions unless they have the court’s permission, such as taking the child overseas or removing them from school.

In difficult circumstances, some people face going to court on their own and representing themselves. The Personal Support Unit, a charity based around England and Wales, can help navigate the legal system.

During divorce and separation, you may find talking therapy helpful, either for you or your children. Whilst many schools now have counsellors on hand, and your GP can provide a counselling referral, waiting lists can be long, and on-site school counselling may not feel enough for you, especially with breaks for the school holidays. Instead, a child psychologist is specially trained to work with children using a range of talking therapies; they can fit appointments around your child’s schooling and other commitments throughout the year.

Your own schedule of talking therapy gives you a safe and nurturing environment to talk about the relationship breakdown, your children’s wellbeing and any related issues, such as parental alienation, with professional help to develop solutions that work.

De-bunking the Myths About Seeing a Psychologist

Deciding to see a psychologist is a positive step forward for your wellbeing and mental health, but it may take you a while to make that initial contact. That’s because there are so many popular myths about what a psychologist is like, how their sessions will work, and what you will get out of seeing a psychologist.

We’ve decided to bust some of the biggest myths about seeing a psychologist, and what it means to sign up for talking therapy.

You Have to Lie on a Couch

One of the biggest myths of seeing a psychologist and having psychotherapy centres around Sigmund Freud. Because Freud is often portrayed as conducting sessions from a chair, with his client laying on a chaise longue or couch facing away, this set-up has become the go-to representation of therapy in cartoons, comedy sketches and more; it’s a well-established TV trope. You can even visit the real-life couch, pictured above, in London.

Over the years at Christine Tizzard Psychology, we have had chairs and sofas in the room, but there is no suggestion you should lie back on a sofa and expect Freudian psychotherapy as you stare at the ceiling or close your eyes. Freud believed patients would be more open when led down and not making eye contact with their therapist, and his interest in hypnotism led him to use a hypnotist’s couch. Freudian psychoanalysis involves the patient doing most of the talking; this leads to prolonged silences if necessary, where patients fill the gaps and probe deeper into their own thoughts.

However, we believe in establishing face-to-face contact and building a trust-based relationship with clients, where dialogue is key. Some therapists around the world do still use a couch, but it’s much more common to sit down facing each other.

Only Stereotypically ‘Damaged’ People Have Psychotherapy

Television shows tend to use therapy scenes for characters who have experienced severe trauma, such as the death of someone close, or witnessing a crime or accident. Inpatient group therapy scenes tend to rely on the initial reluctance of a lead character to open up to the group, followed by their gradual disclosure of addiction or childhood trauma. This can lead to the false perception that you must have deep-seated trauma to justify attending therapy.

Alternatively, characters with marital issues are seen struggling through couples’ therapy in comedy shows, where their dysfunctional relationship or the behaviour of a bad therapist is the punchline. In reality, couples’ therapy is a constructive and smart step forward for people who want to improve their relationship.

You are much less likely to see a character talk about their anxiety, OCD or bipolar in a TV show if this condition doesn’t add to the on-screen drama. You won’t see everyday discussions about managing OCD triggers in the supermarket, or coping with anxiety during your commute, yet these outwardly simple scenarios can cause intense distress. Therapy helps you develop coping strategies and new techniques to face all kinds of challenging situations.

Getting Family Therapy Means You Have Failed as a Parent

Acknowledging you need family therapy is an important first step, but it takes guts – that’s because many mums or dads are worried they will be labelled ‘bad parents’, so they don’t come forward. In truth, a psychologist isn’t there to play the blame game.

Becoming a parent doesn’t require qualifications or a certain skillset, and nobody gives you a manual, though plenty of parenting gurus may have tried to make you pay for their wisdom. Whatever your background, income or personal situation, family issues can arise that need to be resolved with everyone’s input.

Family therapy is about finding the stumbling blocks in your relationships with each other, which you can’t always spot in your own family. Sessions don’t always involve the entire family, and the whole therapy programme is tailored to your individual needs. What’s important is that everyone has a voice and is willing to make or accept changes to improve family life.

If You Don’t Have a Rapport with Your Psychologist, You’re Not Trying Hard Enough

The relationship between a psychologist and their client is important, but it cannot be forced. Not all psychologists have the same way of working – they follow different types of psychological theory, for example, or may structure their sessions around tasks and games rather than a session-long rolling discussion.

Though psychotherapy is about the client, not the therapist, you will inevitably pick up on aspects of your psychologist’s personality: their dress sense, their turn of phrase, how chatty or matter-of-fact they are. There is no one-size-fits-all therapist, so you are perfectly entitled to move on if you don’t strike up a rapport.

It is crucial that you feel comfortable enough to share during your therapy, and the wrong therapist may leave you reluctant to open up. At Christine Tizzard Psychology, our therapists have a range of specialisms, so you can be assured there is a therapist for you with years of experience treating similar issues.

Image credit: Robert Huffstutter, via Flickr (flickr.com/photos/huffstutterrobertl).

University Mental Health Provision: Safeguard Our Students

Young people’s mental health is in the spotlight with good reason, and the last few years has seen a particular focus on mental health at university. The late teens and early 20s are a transformative period of any young person’s life, let alone when they live away from home and study to improve their career prospects whilst finding out who they are and developing their independence. But if we know student mental health is fragile, why have some UK universities outsourced mental health services?

We were shocked to read about several UK universities outsourcing student mental health support, rather than providing it in-house. Instead, they are providing students with support from a vaguely-titled ‘wellbeing officer’, pushing the focus away from mental health to the cosier and less stigmatised wellbeing label: a subtle but intentional shift of direction that is a red flag for psychologists.

As Metro.co.uk pointed out, ‘the softer focus on “wellbeing” could put students with more serious mental health problems at risk’, particularly as wellbeing staff act to signpost external services, not to intervene directly. At the University of Essex, ‘wellbeing assessors’ do not require qualifications in counselling, psychology or psychotherapy. Such assessors may be good-intentioned, but how informed and safe will their assessments be? This all comes just months after Universities UK collaborated with NHS leaders to improve care coordination for students dealing with mental health issues, so to have less proactive intervention from universities feels especially misguided.

University graduate looking upwards in black graduating gown with red trim, standing in front of building and grass

University is a formative experience for young people.

Mental Health Issues at University

Students can be faced with various difficulties when living with and around their peers – for example, eating disorders and dependency on alcohol or drugs may evolve over time, and can be easily camouflaged or enabled by the stereotypical student lifestyle of ‘lazy’ cooking, irregular hours, endless parties and lie-ins. Peer pressure and academic pressure will simply add fuel to the fire for vulnerable young adults.

Toxic relationships with friends or partners can come to the fore, and old friendships may be lost along the way. Many students may question their gender identity or sexual orientation and can face anxiety and depression as a result, especially if their family and friends do not accept their new identity. Besides this, living away from home can also involve hard lessons about money management, motivation and self-care. It is hardly surprising that mental health issues may be prevalent for these young people, but getting help must be more straightforward and less stigmatised if we are to avoid students spiralling into mental health crisis.

Student Suicide

Figures on student suicide are another concern. In late June, the Office for National Statistics revealed the number of university students who died by suicide – the first time this kind of data has been revealed. From July 2016 – July 2017, there were 95 student suicides recorded. Meanwhile, the media has highlighted a higher than average rate of student suicide at the University of Bristol which, at its height, tragically saw three student deaths in one month. Hundreds of fellow students took to the streets in May to demand more mental health support, and the Guardian published a widely shared article with insight from students and staff.

Considering 75% of mental health issues are evident by the age of 24, and a typical three or four-year degree (coupled with a possible gap year) may mean graduating at the age of 21-23, universities must do more to safeguard students at this crucial time in their lives. You cannot educate someone, charge them substantial fees and seemingly prepare them for their future whilst ignoring their very real feelings of hopelessness, confusion and low self-esteem.

The most vulnerable young people may wrongly believe they have no future at all; that’s why we call on all universities to invest in robust mental health support programmes with properly trained and qualified staff.

Please note: If you are supporting a young person with a mental health issue and you believe they may have suicidal thoughts, please see our blog post on preventing suicide in a mental health crisis. We recommend you accompany them to their GP for an urgent psychiatric referral, consider a private consultation, visit A&E, call NHS 111 or, in the threat of violent behaviour towards themselves or others, call 999.

Helicopter Parenting and How to Avoid It

Recent research published in the journal Developmental Psychology has fuelled the argument that helicopter parenting – metaphorically hovering above your child, over-protecting them and exerting excessive control over their life – is damaging children’s wellbeing.

The findings come from a study of 422 children when aged two, five and 10. By the age of five, children with more controlling helicopter parents struggled to regulate their own emotions and impulses. At 10, these children were more likely to have poor social skills, lower academic performance and a more negative attitude to school.

The term ‘helicopter parenting’ was coined in 1969 by psychotherapist Dr. Haim Ginott, in his bestselling book, Between Parent and Teenager. Though this term can often be used tongue-in-cheek by the media, perhaps to suggest that little Johnny doesn’t need you to micro-manage his playdates aged 13, the recent study shows there is lasting damage from imposing too much control on your children.

At Christine Tizzard Psychology, we are always keen to emphasise that children need freedom as they grow: freedom to make mistakes, or tumble over and dust themselves off. Though parents can be over-protective out of love, wrapping a child in cotton wool or over-indulging them is not something any psychologist would advise. Of course, children need boundaries and routine, but they thrive by making decisions, taking responsibility and gaining independence as they get older.

Helicopter parents might argue that their attitude is far better than letting children run riot, and better than the other extreme of imposing strict Victorian values where children are treated coldly. Yet these parents probably don’t recall the benefits of their own childhood, when they could climb trees, make mess and maybe even fail an exam, all of which they have learned from.

How to Avoid Being a Helicopter Parent

If your child has been upset by a friend or classmate, don’t go in all guns blazing and demand to meet the friend’s parents or your child’s teacher. Children fall out with each other all the time, and slights can be quickly forgotten in a day or two. Think how often you fell out with friends at their age! You should intervene if a real rift is developing, or you see signs of long-term bullying, but let smaller incidents lie. It’s part of growing up.
Accept that your child’s homework is there to test them and recall what they have learned during the day; it is not a collaborative project between parents and children. Check they are completing their homework but resist the urge to tweak it (or pass off your own work as theirs). If they are really floundering over the task – for example, they cannot grasp fractions – gently explain where they are going wrong, then let them try again by themselves.
Don’t volunteer to be a parent helper at every school trip. Parents should take it in turns to help out: these trips are not an excuse to keep an eye on your child, who will just want to be with their friends.
Don’t pay your child for achieving certain grades or doing chores. They shouldn’t need a rewards system to try hard or be helpful. Besides, does anyone pay you for completing a work assessment or washing the car?
Keep after-school and weekend activities to a reasonable level and tailored to the child’s interests, not your own agenda. Resist the urge to hover poolside or become a Brownie leader; instead, catch up with a friend, read a book or get through your own ‘to do’ list.
In competitive activities like school sports day or a poetry competition, don’t demand prizes for all. Coming fourth means there is no shiny medal or certificate, but it is part of life. Yes, there may be tears and tantrums, but there is always next time.

If you struggle to avoid being a helicopter parent, and you feel these instincts are deep-seated, you may want to try Solution-Focused Therapy. This is a short-term intervention, taking just three to five sessions on average, to develop goals and make changes in your life. It can be delivered as family therapy or one-on-one.

Gaming Disorder: Genuine Addiction or Media Hype?

When the World Health Organisation added gaming disorder to the latest edition of its International Classification of Diseases (ICD-11), widespread media coverage and an outcry from the gaming industry made it the issue of the moment. The classification applies to people with 12 months of low control over their gaming habits, escalating to the extent that they neglect other activities or basic functions, even when it puts them at risk.

But is gaming disorder a sign of genuine addiction, or is it pathologizing the behaviour of a small minorities of gamers in a multi-billion-pound industry?

Is ‘Gaming Disorder’ Real, or Are We Overreacting?

Gaming disorder might sound far-fetched on paper: being glued to a video game for hours on end is practically a rite of passage for many teenagers these days. Furthermore, many teens see the gaming industry as a career option, where jobs can range from designing and making games to entering tournaments and video blogging your own achievements on YouTube. The power and hype of the gaming industry means your child may have a valid excuse when they head to their console or computer for another session, particularly if they join multi-player online games with their friends, but there is a dark side to consider.

News reports of gamers dying during marathon gaming sessions are rare enough to be shocking, and they show the extreme side of video gaming that can affect a minority of users.

Games involve many different levels or stages, and the pressure to complete them intensifies when you join an online team or community: there’s a genuine fear of letting others down if you don’t complete a level, put the hours in or play to a high standard.

The WHO’s actions haven’t come out of the blue, either: in May 2013, the American Psychiatric Association added ‘internet gaming disorder’ to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the main point of reference for psychiatrists.

What is Addictive Behaviour?

It can be helpful to compare gaming disorder to other well-known addictive behaviours, such as gambling or drinking. There are many people who enjoy gambling as a hobby, perhaps playing poker, going to the casinos of Las Vegas or placing bets at the races; there are others whose gambling is out of control and has taken over their entire lives. Similarly, there are people who readily enjoy drinking and can manage their intake, but others find themselves dependent on alcohol and struggle to live without it.

Gaming triggers specific parts of your brain – the area we often refer to as the ‘reward centre’. Dopamine is released when the brain registers pleasure from any activity, whether from winning a prize, buying new shoes or having a lovely meal, so in gaming it may be because the player has completed a level, beaten an opponent or started the latest must-have game. Memories and stimulus responses are also created in the brain’s ‘reward centre’, so the player can relive that moment of triumph and respond to the same stimulus in the same way, knowing a reward of a temporary high may be due.

As a gaming compulsion or disorder develops, the player’s brain gets a more intense rush of dopamine, but they need more of the activity to feel good because they have developed a tolerance. They may begin taking risks and spending time and money beyond their means to keep feeding the addiction. When they can’t relieve the cravings, or the feeling of satisfaction wears off, they feel low and empty, often to the point of distraction.

Symptoms of any addictive behaviour, including gaming disorder, can include:

Tiredness
Changes in performance and timekeeping at school or work
Paying little attention to their physical appearance and hygiene
Lack of interest in hobbies they previously enjoyed
Weight loss and changes in appetite
Mood swings and irritability
Sudden secrecy and dishonesty, especially when confronted

Remember the addiction, in this case to gaming, needs to continue for at least 12 months to meet the WHO’s criteria. The difficulty is that teenagers and young adults experience huge biological and hormonal changes and can exhibit some of the symptoms above as part of normal ‘growing pains’; scientists have found teenagers’ body clocks shift, so it’s unsurprising they seem tired. Some young people also go through phases of seemingly neglecting their personal appearance, changing eating patterns and being secretive, especially as their bodies change so dramatically. This makes it harder for parents, teachers and GPs to spot the signs of addiction, which may just be labelled as typical teenage behaviour, so it’s important to sit down and talk to your child face to face.

If it does emerge that gaming has become an issue, or part of larger behavioural patterns, such as withdrawal or self-neglect, talking therapy can be helpful. Family therapy or individual CBT (Cognitive Behavioural Therapy), if your child or teenager is willing, can break down barriers and explore the root cause of these issues. A psychologist then develops strategies with the family or individual to help change their habits. Whilst being addicted to gaming is rare, it is treatable.

Talking to Your Child About Gaming

Aside from thinking about those symptoms, try to keep an eye on your child’s gaming habits: how many hours do they spend on their console or computer? Are they on multi-player games with friends only, or do they join in games with strangers from around the world? Where possible, limit children’s time alone in their room on a device; build up a routine they can stick to, with gaming as a post-homework treat rather than an automatic right. You could try getting involved as a family, too – gaming systems with multiple controls allow friends and family to play against each other in the same room.

Virtual friendships can quickly build up through gaming, and children can rely on these relationships despite having no face-to-face contact with their online friends. People who befriend young gamers don’t necessarily have sinister motives, but a young and impressionable gamer may struggle if they lack real life friendships.

Balance virtual experiences with related experiences in the real world: if your child enjoys football games, get them outside playing or watching matches; if they prefer war-themed games, visit a real-life battlefield, try archery or go paintballing; for sci-fi fans, a trip to an escape room or sci-fi related convention is perfect.

You should also be mindful of prejudice across the gaming industry: female-identifying workers and players are often subjected to offensive comments, either criticising them (particularly during the 2014 #Gamergate controversy) or making unwanted sexual advances. Even male gamers using female avatars, usernames or character identities have found themselves facing more harassment than when they present as male.

The gaming industry is still notoriously biased towards white heterosexual middle-class men, making other groups feel under-represented; it isn’t a racially diverse or gender diverse environment, and prominent YouTube gamers like PewDiePie have openly made racist comments whilst retaining their fan-base and earning millions. You can encourage tolerance at a young age with this list of positive female role models in gaming for ages 5+, 10+ and beyond, and look at organisations like BAME in Games for older teens.

Talk to your child’s school: is internet safety being covered in IT or PSHE lessons and, if so, do they talk about online friendships, virtual identities, sexism and the pitfalls of gaming? Schools shouldn’t ignore these issues when they directly affect a child’s behaviour and performance.

Gaming disorder is a valid concern for parents, teachers and psychologists, but fortunately it affects a minority of users. However, even if a child doesn’t show signs of addictive behaviour, there’s no reason not to establish healthy boundaries and rules around gaming – after all, this should be a hobby, not an all-consuming habit.

How to Combat Impostor Syndrome

Impostor syndrome is not a recognised psychiatric disorder in its own right, but is acknowledged by psychologists and psychiatrists as a legitimate issue for many people – sometimes (but not always) contributing to a mental health condition such as anxiety.

When someone says they ‘feel like a fraud’, or their attitude suggests they feel that way, they essentially feel like an impostor in the role they inhabit, whether that’s in work, in relationships, recreationally, or at home.

Here are some examples of impostor syndrome in everyday life:

You’ve just earned a promotion, but you wonder why you were chosen over other candidates, and whether you’re truly up to the job. You’re afraid of letting your boss down, and you wonder when you will be demoted.
There’s a local baking competition that your friends tell you to enter. You’re known for making great cakes, but what if your success has all been down to good luck so far? You don’t really deserve to win against genuinely talented bakers. If you do win, you’ll have to give the award back before someone finds you out.
Several people pay you a compliment on your outfit at a high-profile event. You can’t believe they are being sincere – they’re just being polite, surely. You don’t feel attractive or special compared to other attendees, and you question why you were even invited to be in the same room. Maybe the invite was sent by mistake?

Though no-one is immune from impostor syndrome, Scientific American has reported it is more likely to affect women and minorities. People marked as high-achievers are also at risk; the American Psychological Association links it with perfectionist traits. The term ‘impostor syndrome’ was coined in 1978 by psychologists Pauline R. Clance and Suzanne A. Imes, when studying high-achieving women who consistently put their success down to luck instead of their own talent.

Impostor syndrome might also be fuelled by childhood experiences: teachers being overly critical, or parents consistently helping you to win games or pass assignments, could undermine your sense of personal achievement.

Tips to Combat Impostor Syndrome

Write down the evidence for and against you falling short of expectations. Are you dwelling on worst-case scenarios, or using past failures to assume your future goals won’t be reached?
Keep a list of your major achievements and how you made them happen – you’ll see it’s not just down to luck or someone else’s help. You really can rely on yourself.
Ask friends and family what they think. Make a note of their comments to read back during low moments or ask to record their comments as a soundbite on your phone if you’d prefer. Listen back to feel like you’re having a pep talk with them.
Remember that people of all levels make mistakes and start out ignorant. Their progress develops by taking risks, trying new things out, and learning from everything along the way. Nobody’s perfect.
Go into meetings and appraisals with details of your achievements and learning curves. Try and quantify them where possible, demonstrating factual evidence of the value you provide to your company.
Challenge hints of other people’s impostor syndrome. If a friend says they don’t deserve their new boyfriend, or a colleague tries not to take credit for the major project they created, remind them why they are good enough.
Mindfulness and meditation are useful ways to shift your thought patterns and tackle stress when you’re feeling self-critical. Take five minutes out of your day to try them.

I Am Enough phrase written on fingernails of person's hands to show self-esteem and positive mental health, challenging impostor syndrome

Does your self-worth take a battering sometimes, or is it part of a wider mental health issue?

Mental Health and Impostor Syndrome

Whilst we can all experience impostor syndrome at one time or another, it can become chronic for some people, and can come hand in hand with mental health issues. CBT (Cognitive Behavioural Therapy) is an excellent option for persistent impostor syndrome that sits at the heart of anxiety, depression or OCD (Obsessive Compulsive Disorder). All of these mental health conditions can involve patients feeling unworthy, incompetent and unproductive, despite any evidence to the contrary.

Negative automatic thoughts can build up, making the patient question their own abilities and achievements; with anxiety and OCD, these thoughts can be persistent and extreme, but sometimes implausible to anyone without a mental health condition. Cognitive distortions can occur, and the patient’s beliefs (such as ‘My science exam must have been marked wrong, as I can’t have done that well’) become removed from the facts at hand (‘I scored 90% in my science exam’). Because of this, sufferers often bottle up their worries and compulsions, leaving them unchallenged but also heightened over time.

With OCD, the obsessive thoughts may become further removed from reality (‘Someone must have bribed the examiner to give me a good mark’, ‘Maybe I cheated on the exam and blanked it out because I’m so ashamed’). For patients with depression, impostor syndrome can increase feelings of self-loathing and lethargy, and it may potentially fuel suicidal ideation in someone already vulnerable or in crisis.

Impostor syndrome is an understandable and fleeting experience for most of us, but when it’s truly engrained – or part of a larger mental health pattern – talking therapy can be invaluable to rid you of the self-doubt.