eNewsletter - November 2022

Dispelling misconceptions about PTSD and readiness for treatment
By: Jerome T. Kaul, Psy. D | Lead Clinical Therapist - PTSD Program

More than 12 million Americans over the age of 18 are believed to have posttraumatic stress disorder (PTSD) each year, according to the National Center for PTSD.

The condition can be difficult to identify for a person suffering from it, and for medical and clinical professionals who are a part of their treatment team. People experiencing PTSD often dismiss their own trauma, experience intense shame, avoid talking about their trauma, and/or believe that they cannot handle the consequences of thinking about their trauma. As a result, many professionals who work with these individuals may not be aware of their trauma history.

PTSD can also be easily confused with other conditions that deal with emotional dysregulation, such as bipolar disorder, borderline personality disorder, and obsessive-compulsive disorder.

Common PTSD myths. Because of the shame and avoidance that often surrounds PTSD, it remains confusing to the public and many myths exist. Some of the most common are:

1. Only military vets have PTSD. Injury, abuse, accidents, complicated grief, natural disasters, or assaults can cause PTSD as well.
2. If you don’t experience immediate symptoms, you can’t have PTSD. While it’s common for symptoms to begin within three months, sometimes they don’t surface until much later.
3. In time, PTSD will go away on its own. Most studies show if symptoms persist for more than a year, they will not subside without treatment that specifically treats PTSD.
4. PTSD symptoms look the same for everyone. Symptoms vary from person to person. Some people don’t experience flashbacks or nightmares.
5. There are no effective treatments for PTSD. Currently, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy have been listed as strongly recommended by the American Psychological Association for PTSD. Other treatment options, such as eye movement desensitization and reprocessing (EMDR), have been proven effective in some populations.

Misconceptions about PTSD treatment. Many professionals have misconceptions about what trauma-specific therapy is and when it is appropriate to refer an individual to trauma-specific treatment. Due to these misconceptions, professionals with the best intentions to help their patient inadvertently reinforce that individual’s own misconceptions and avoidance of treatment for PTSD.

Please keep the following common misconceptions in mind when considering an individual’s readiness for trauma treatment:

1. Trauma-focused treatments are not suitable for complex/multiple traumas. Conversely, traumatic experiences often overlap with one another and working on one of them can help alleviate the painful impact of the others.
2. Stabilization is always needed before memory work. If a person is appropriate for inpatient, residential or partial hospital-level of care, then determining whether stabilization is needed should happen on a case-by-case basis. If a person is appropriate for outpatient-level of care, research suggests that trauma-specific therapy is remarkably unlikely to “destabilize” a person.
3. Talking about trauma memories is retraumatizing. While working through traumatic memories, the patient should remain in control of the process and be supported by the therapist, minimizing any retraumatizing impact. That does not mean the process won’t be painful. However, painful experiences are not the same thing as traumatic experiences.
4. Some traumas shouldn’t be relived. Trauma-specific treatment teaches an individual how to think through their worst experiences in a way that helps them remember them as opposed to relive them. This process helps a person move on so that their worst moments don’t have to define their life experiences.
5. Dissociation interferes with working on trauma memories. Even for patients prone to dissociation, trauma-focused memory work is helpful and effective, as long as a patient does not dissociate for prolonged periods of time and has some capacity to know where they are. If this isn’t the case, brief therapeutic interventions can take place to help that person learn how to do this.
6. PTSD is about fear. Evidence shows only about half of the negative emotions related to traumatic events involve fear. Other emotions include guilt, shame, anger, humiliation, betrayal, disgust, helplessness, hopelessness and more.

Other considerations. In addition to the misconceptions above, individuals may have issues with commitment level, coping skills or thoughts of suicide. It’s important for an individual to be committed to treatment and personally want to work on their PTSD at this time. Coping skills to manage stress, anxiety, cravings, and other factors are also an important part of being ready for PTSD treatment. If an individual has tried to die by suicide within the last two months, that person may need to engage in immediate treatment that helps them more effectively manage emotional health stressors in their life before starting PTSD treatment.

Finding more support. Linden Oaks Behavioral Health is available to discuss treatment options for any level of behavioral healthcare. If you know someone who would benefit from talking about their treatment options related to PTSD or another concern, please encourage them to contact our 24/7 Help Line at 630-305-5027 or complete our Assessment Request Form and one of our staff will contact them to assist.

Eating Disorders in College Students
By: Joseph Pepitone, MD 

College is a time of unprecedented freedom and transition in a young person’s life. It can be a time full of excitement, but also of new challenges. Coping skills that worked in the past may not have the same level of success, and the ability to feel in control of new surroundings may seem out of reach. For some, the college years can open the door for eating disorders to develop, return or worsen.

According to the National Eating Disorders Association, 10-20% of women in college, and 4-10% of men in college, struggle with an eating disorder—and it’s believed those percentages are increasing. But why? Beyond the stressors that come from this time of transition, other factors that may influence the development of eating disorders include:

• More independence
• Lack of access to affordable, healthy foods
• Lack of nutrition knowledge
• Fewer organized sporting activities, leading to less exercise
• Different food environment
• School and social stress
• Alcohol intake
• Social factors (e.g., what a person’s friends are eating)
• Busy schedules
• Lack of parental control/influence over diet

Additionally, studies show that college athletes are particularly at risk for eating disorders as they may be pressured to have lean bodies.

Identifying signs of eating disorders. The signs and symptoms of eating disorders may not be obvious or may be hidden in some cases. Some warning signs include:

Physical*

• Unusual and rapid weight fluctuations
• Fainting, fatigue, low energy, interrupted sleep
• GI discomfort, dysregulation, bloating
• Dry hands/hair or poor circulation
• Hair loss or development of lanugo (fine facial/body hair)
• Chest pain or heart palpitations
• For females, disruption in menstruation

Behavioral

• Dieting or chaotic food intake
• Preoccupation with food, weight, size and shape
• Excessive exercise
• Frequent trips to the bathroom
• Change in clothing style (sometimes to hide or flaunt the body)
• Eating in isolation

Emotional

• Severe mood swings
• Increased isolation, irritability, anhedonia (inability to feel pleasure)
• Low self-esteem, complaints about body
• Perfectionistic tendencies
• Sadness, comments about feelings of worthlessness
• Increased depression and/or anxiety

*The above list is shared from The Emily Program

How to help. It’s important to remember that eating disorders are not phases, but are serious conditions that require care and intervention for the best recovery and outcomes. If you have concerns about a patient, start the conversation early and if they’re willing to discuss their eating habits, follow up with additional questions.

The Emily Program recommends the following list to help assess a patient’s eating:

• Do you worry about your weight and body shape more than other people?
• Do you avoid certain foods for reasons other than allergies or religious reasons?
• Are you often on a diet?
• Do you feel your weight is an important aspect of your identity?
• Are you fearful of gaining weight?
• Do you often feel out of control when you eat?
• Do you regularly eat what others may consider to be a large quantity of food at one time?
• Do you regularly eat until feeling uncomfortably full?
• Do you hide what you eat from others, or eat in secret?
• Do you often feel fat?
• Do you feel guilty or depressed after eating?
• Do you ever make yourself vomit (throw up) after eating?
• Do you use your insulin in ways not prescribed to manage your weight?
• Do you take any medication or supplement to compensate for eating or to give yourself permission to eat?
• Do you exercise for the sole purpose of weight control?
• Have people expressed concern about your relationship with food or your body?

If a patient answers “yes” to two or more of the above questions, the presence of disordered eating is indicated.

Finding more support. Linden Oaks Behavioral Health is available to discuss treatment options for any level of behavioral healthcare, including the assessment and treatment of eating disorders. If you know someone who would benefit from talking with someone about treatment options related to eating disorders or another concern, please encourage them to contact our 24/7 Help Line at 630-305-5027 or complete our Assessment Request Form and one of our staff will contact them to assist.

Brain Inflammation and Depression

By: Sarah McMahon, LCSW | Behavioral Health Navigator

For years, a growing body of research has connected autoimmune disease and chronic or even mild inflammation in the brain to mood disorders like depression, anxiety or obsessive-compulsive disorder. 

While immunotherapies have been used for decades to treat illnesses such as cancers or inflammatory disorders, it’s now believed these therapies may be useful in treating inflammation-related mental health disorders. 

When examining brain inflammation and depression specifically, it’s important to understand the connection between the two conditions as it relates to treatment:

Depression is not an inflammatory disorder. Not every patient with depression has increased brain inflammation, and the amount of brain inflammation varies greatly in the depressed population. Patient risk factors are assessed based on medical history and testing, but it is not yet an exact science, and other psychiatric diseases can also present with brain inflammation.

Inflammation has specific effects on the brain and behavior. Research shows brain inflammation is very specific in how it impacts the brain and behavior of a person with depression or other mental health concerns. For instance, inflammation may affect areas of the brain associated with motivation and motor activity, arousal, anxiety and alarm. Additionally, inflammation can interfere with the transport of serotonin, dopamine and norepinephrine through the body. Finally, increased brain inflammation is also associated with poor response to conventional antidepressants. 

The role of immunology in inflammation and depression is just beginning to be understood. While treating depression and other mental illnesses with immunotherapy when brain inflammation is present may be therapeutic, studies are still in the early stages to determine what will be most effective. Innate immune responses and monocytes verses the adaptive immune response and T cells are the focus of much research in determining the best mechanism for targeting the immune system to treat depression.

Therapeutic implications are forthcoming. While there is still much to be learned about the relationship between brain inflammation and mental illness and the best therapeutic approach for patients, clinical trials are underway and individuals with high inflammation are currently being treated. Potential successes have been seen with nonsteroidal anti-inflammatory agents (NSAIDs), nutraceuticals and anticytokine treatments, but these treatments are still being studied and none are currently approved for depression by the Food and Drug Administration.

Finding more support. Linden Oaks Behavioral Health is available to discuss treatment options for any level of behavioral healthcare, including the assessment and treatment of depression and other mental health disorders. If you know someone who would benefit from talking about their treatment options related to depression or another concern, please encourage them to contact our 24/7 Help Line at 630-305-5027 or complete our Assessment Request Form and one of our staff will contact them to assist.

Getting Help for a Mental Health Illness

By: Lauren Campbell, LCSW | LOMG Lead Clinical Therapist

According to the National Alliance of Mental Illness (NAMI), one in five adults experience a mental health issue each year. Post-pandemic, that number is estimated to have increased to as high as one in three adults. 

Unfortunately, many people don’t get the help they need. I tell people to follow this rule of thumb: if you’ve tried reducing stress levels, getting more sleep and increasing activity level but still don’t feel better, it’s time to seek help. 

The following symptoms may also indicate a need for help. If you experience any of the following for more than two weeks, it’s a sign something isn’t right:

• Sleep changes – getting too much sleep, an inability to sleep or restless sleep 
• Appetite changes – eating too much or loss of appetite
• Weight loss or gain
• Increased substance use
• Mood changes – increased irritability or snapping at people 
• Personality changes
• Difficulty concentrating at work or at school 
• Withdrawal – being less engaged in interactions with loved ones or cancelling social engagements 

Pay special attention to red flag symptoms: thoughts of harming yourself, taking steps to harm yourself or losing touch with reality – such as hearing or seeing things that don’t exist. 

If you need help managing a mental health issue, your primary care provider is a good starting point. He or she will be able to provide resources and point you in the right direction. Talking with a trusted family member or friend about the situation may also help you get a referral to a provider. 

In the case of a mental health emergency, you need to seek urgent care. If you or a loved one has red flag symptoms, call 9-1-1 or go to your local emergency room. You might also try calling the National Suicide & Crisis Lifeline at 988. 

It’s important to seek help for mental health issues sooner rather than waiting. These conditions can significantly impact your life. Studies show that mental health illness can lead to compromised immunity, increased chronic pain and a higher risk of stroke, heart attack and obesity. You don’t have to suffer – and you don’t have to suffer alone. 

If one of your loved ones is suffering from a mental health illness, here are some tips to provide support:

• Know the signs. Many mental health conditions – such as depression – may be mistaken for laziness or self-sabotage. Recognizing the signs of mental health conditions can help you better understand when a loved one needs help. 
• Let them know you care. When dealing with a mental health condition, it’s easy to feel isolated and alone. It can make a world of a difference knowing someone cares and believes you can get better.
• Encourage them to seek help. There’s still stigma around talking to a therapist or seeking help for a mental health condition. Help remove the stigma and support your loved one in the decision to seek help.
• Help them find a provider and make an appointment.
• Offer to attend a support group with them. 
• Make plans. Be an accountability partner by scheduling regular meet-ups. For example, go on walks or make meals together. 
• Ask the tough questions. Don’t be afraid to ask your loved one if they’ve had thoughts of harming themselves. It’s important to know the degree of suffering to know how to best seek help. 
• Take care of yourself. It’s easy to get burned out or feel angry or helpless when you have a loved one dealing with a mental health condition. As you support your person, make sure your needs are also being met. 

Linden Oaks Behavioral Health is a great resource for those dealing with mental health conditions. We work with patients and families to tailor care and treatments to best meet their needs. We offer the full range of care with our multidisciplinary team. Our goal is to meet people where they are to help them successfully manage their conditions. 

To learn more about the Linden Oaks Behavioral Health or to schedule a confidential behavioral health assessment, visit us online or call 630-305-5027.

New Linden Oaks Provider: Lori Marek, Advanced Practice Nurse (APN)

Linden Oaks Behavioral Health welcomes our new provider Lori Marek, APN. Lori earned a bachelor’s in science of nursing from Northern Illinois University. She has extensive nursing experience in high-risk maternal fetal medicine, school nursing and psychiatry. Lori earned her master’s degree from University of St. Francis.  She completed her fellowship training in psychiatry at Linden Oaks Hospital.  Lori is board certified in psychiatry. 

While in her fellowship, Lori worked alongside the Medication-Assisted Treatment (MAT) team and learned the value of treating substance use disorders while promoting sustained recovery and prevention of overdose. She has witnessed the success of patients maintaining sobriety ranging from one month to 10 years.

Lori has a special interest in the area of women’s mental health, particularly reproductive issues such as pregnancy, infertility, perinatal loss and mood disorders. Lori also has experience working with school refusal and autism. Lori’s treatment approach is patient centered care utilizing both cognitive behavioral therapy and acceptance and commitment therapy. 

Schedule an Appointment 

Lori will treat patients in the outpatient setting.  For more information on treatment, call the Linden Oaks Help Line 24 hours a day at 630-305-5027 and one of our assessment professionals will assist.