emotional dysregulation/bent out of shape

Discussion in 'General Parenting' started by pepperidge, Jun 15, 2011.

  1. pepperidge

    pepperidge New Member

    Does anyone have any ideas for dealing with difficult child 2 who gets so bent out shape when he doesn't get what he wants. Friends aren't available to come over, he wants something now, somebody didn't get something at the store, he wants to do something, something doesn't go his way, he gets bummed out --sulks, angry no rages, though some less than nice language. Takes it out on us the parents. Out of proportion and a pain to live with.

    He is not in the most rational place, he says angry things he isn't even totally aware of or in control of, just nasty. We his parents get it the worst but we see it with others too. We don't think punishment is the answer, as this is one of those lagging skills Ross Greene's talks about. but we are also not willing to tolerate too much abuse either. It is difficult to reason with him when he is in a foul mood. Wwat I do more often than not is just absent myself, stop talking , go away, leave him alone. Eventually it passes. often will be in this state for a better part of day unless something major good comes along.

    This capacity to emotionally regulate is such an important thing. Anyone had a plan for dealing with this? We've never found therapists to be particularly helpful.
     
  2. gcvmom

    gcvmom Here we go again!

    We had a therapist who was very good at helping difficult child 1 deal with this same kind of emotional reaction. Granted, he was much more receptive to this stuff when we got his medications right. The therapist gave me this chart (I'll have to see if I can find it) that he would talk difficult child 1 through, beginning with the trigger and the thoughts that it generates, and then he analyzes those negative thoughts and difficult child 1 was able to see how illogical, self undermining, even ridiculous those negative thought processes were.

    For example, difficult child 1 was angry with me for something that happened that he blamed me for. As if I PURPOSELY sabotaged him. The therapist asked him questions that got him thinking about his relationship with me -- how I am the one who is ALWAYS there for him, who ALWAYS tries to get him help for what he needs, who looks out for him, cares for him, LOVES him. Then he asked him if he really thought that if all those things about me were TRUE, would I REALLY do what he's imagining I had done to hurt him? I guess what he was doing was taking an irrational thought process and breaking it down rationally to expose it for what it truly is. That really helped turn his thinking around -- but like I said about the medications, if they weren't right he would NOT be very receptive to any of that type of therapy. At one point, he refused to even get out of the car to go in to the appointment (we were still tweaking medications at that point). SO the therapist went out to the car with me and we sat in the front seat with a pouting/sulking difficult child 1 in the back seat. And we did the therapy with him listening. :D The next week went much better!
     
  3. crazymama30

    crazymama30 Active Member

    Pepper, I wish I had an answer, for our difficult child son has the same issues. I really think that removing yourself from the equation would be the best thing to do, and maybe (I have not been able to try this as it goes on so long and I end up losing my temper) trying to go back over the situation when he is calmer? Seeing if he can realize why you don't have control over it, and maybe trying to work on him being more flexible?

    Not as easy as it sounds, I know..............
     
  4. keista

    keista New Member

    Gvcmom said almost exactly what I was going to say. Although, I didn't have a therapist talking DD1 though, I did it on my own. No chart, either. But really it did absolutely no good unless she was stable on medications which made her receptive.
     
  5. compassion

    compassion Member

    I stay calm and do not react or try to reason with her. She is much more reasonable now that she has 31 days off of substances. I have also foudn reinfocing the positve, watching for triggers helps. Totally azgree though that medication stabilization is the first and most important. Just today, I tried Occupational Therapist (OT) communicate with her, she was intractable. I stayed calm. We are reinforcing prosocial beahviors with pleasuable acitivities. I do not express anger/dissopaintment to her directly. I find that helps a lot. I aslo calmly say I do not want to be extorted/blackmailed/manipulated. She calms down much faster now.
     
  6. pepperidge

    pepperidge New Member

    Thanks for the responses. I think he is about as well medicated as he can be so I don't think we are going to make much progress. He just gets so flooded wiith anger or frustration it is like he goes into brain freeze. You can't reason or have a civil conversation and and his capacity to deal with disappointment or inability to delay gratification is limited. I don't think he is even aware really at some level of the things he says when he is in that mode. Then the emotional brain freeze ends. Definitely inaccessible to logic in those times.

    I have my doubts about therapy --I really don't know if talking about it when things are calm really helps him to process better when disappointed. We have spent so much time in therapy etc that I just don't want to go there unless it is really really worth it.
     
  7. keista

    keista New Member

    Don't know what you've tried before or how long he's been on his current rx, but if he's still being that difficult, it's worth another chat with the psychiatrist. There's always stuff to add and/or change.

    DD1 used to be so quick to point out other ppl's poor behavior - she really did know what's acceptable and what's not - but when she lost control, she was INCAPABLE of taking control. Each time when we adjusted medications, it would get better, and then backslide again. Now with 'so far, so good', medications she recognizes when she's loosing it, and can adjust herself.
     
  8. DammitJanet

    DammitJanet Well-Known Member Staff Member

    With me, emotional dysregulation is defined by me like having my emotional "skin" removed or burned off. All of the emotions are raw and exposed so anything that is said or heard or touches those emotions, basically sets me off. Just like with a burn, I would feel pain and might not be able to exactly tell which nerve ending was being brushed against at that exact moment, emotionally I can go off with anger or irritability or sadness or other emotions. Does that make any sort of sense?

    With time, I have learned to slow down my reactions and know that I am this way and I can see that the world really isnt trying to attack my raw skin. This is just my way of thinking about things. I think I read this somewhere and it made sense to me. Made it easier for me to learn to put band-aids up or even aloe on...lol. Just something to protect my feelings if I am not having such a good day.

    Maybe you could try and explain this to him when he is calmer and he would understand it somewhat?
     
  9. pepperidge

    pepperidge New Member

    Janet,

    It makes sense. I think your notion of a metaphor is great. We could try the skin analogy or maybe there is a metaphor that would be even more visual for a 14 year boy. Have to work on that one.

    He knows he has been hurtful and apologizes afterwards much of the time the next morning or later on; I need to try to find some way of reaching him then. when you get upset, you get a brain freeze, the filter goes off, you say stuff and make yourself and everyone miserable, and what you are doing is slowly eroding people's capacity--ie. your mother-- to want to do things for you. I am sure there is a better way to say that, but that's what I would like to say. Anybody have any good scripts or can point me to a book?

    Still not sure about the medications. He definitely is no BiPolar (BP), some ADHD. We have tried: Adderall, focalin, ritalin, concerta, tenex (total disaster, twice), strattera, prozac (not good) zoloft (total disaster), Lamictal (didn't do anything), Topamax (made him sleepy), Abilify (helped for a while, but side effects were very worrying), Risperdal (now on currently, weight gain issues but helped with aggressiveness.

    So I don't know where to go with medications now, since we are max on concerta, and I would rather ditch Risperdal than increase it.

    Thanks for the responses. I am going to study them and see what i can try.

    difficult child 2 is pretty typical Fetal Alcohol Effects (FAE) kid--not totally impacted but definitely impulsive. They are hard to medicate.
     
  10. exhausted

    exhausted Active Member

    P,
    I don't know if you will find this helpful or not-my daughter is learning DBT skills at this time (has trouble with distress tolerance as well-manifests in different way). One of the skills is distress tolerance. I have found this site helpful to me. There is a whole section on this- I would look at the explainations and maybe in a peaceful time you culd share this information and use CPS to negotiate how he will handle his frustrations?? http://www.dbtselfhelp.com/html/dbt_skills__defined_.html
     
  11. Star*

    Star* call 911........call 911

    At ANY age? I highly recommened ANGER management therapy where he learns HOW to deal with his own anger. The techniques he will learn will benefit him for life. It's not a bad idea that if you don't know what he's learning that you get a few therapy sessions as well so YOU know HOW to ALLOW him to deal with his anger. Some people are not good at ALLOWING people to deal. I was one of them. I didn't know how to just let Dude walk away. When he would blow up? I wanted to FIX it - NOT what you should do. You need to let them work it out, walk away, do their exercises and there are several. Go for a walk - and by that I don't mean huffing out the door into the night, slamming the door with NO warning or word of where they are going. There is protocal. He also had stress induced (by self) tensionoin then relieving body muscle and relaxation exercises that we both learned that I promise I could teach you here - and if you do them when you are angry? Then try to get up? You won't be able to lol. Dude uses that one a lot when he thinks he's going to go hurt someone.

    Also - I read a fantastic book called How to talk to teens so they will listen and how to listen to teens so they will talk. It is a phenominal book on Effective communication - and HIGHLY worth every cent you pay to learn how and what to say and when - It was literally worth it's weight in gold in communication with difficult child.
     
  12. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hi there.

    If I repeat anything, I'm sorry. I just got home and I'm tired.

    Emotional dysregulation in somebody over 18 is often referred to as borderline personality disorder (an inability to regulate emotions). Unlike bipolar, which causes mania and depression and some normal times usually for periods longer than ten minutes, this emotional dysregulation is constant and can happen in the middle of one sentence or one thought. Thus the person appears very unstable and irrational and needs a new type of therapy (VERY effective...I LOVE it) called Dialectal Behavioral Therapy. I wish they'd had this years ago. Although it was geared toward borderline personality disorder originally, I know of people using it for many types of problems. It is very comforting and makes a lot of sense...I like it better than cognitive behavioral therapy, which is also good. This, by the way, would be VERY effective for anger management.

    Here is a good explanation of dialectal behavioral therapy. It does require a commitment on the patient's part or it won't work. But NOTHING will work if the patient is not willing to try hard:

    http://bipolar.about.com/cs/menu_treat/a/aa031016.htm
     
  13. gcvmom

    gcvmom Here we go again!

    There are ALWAYS other options for medication, so don't feel like you're at a dead end with his treatment. You might want to ask your psychiatrist about taking him OFF the stimulant medication and try something like Intuniv. It's a non-stimulant medication for ADHD and it has helped my BiPolar (BP)/ADHD kiddo very well. And FWIW, Adderall caused a lot of aggression/anger problems in both my difficult child's, and even before we had the BiPolar (BP) diagnosis in difficult child 2.

    Another option for replacing the Risperdal is Seroquel. Same class of medications but it has a side effect profile that's a little better (at least it has been for us -- not nearly the weight gain issues, and NO dystonic reactions like we had with Abilify, Zyprexa and Risperdal).

    Lamictal is known to be good for BiPolar (BP)'ers with depressive features, which it sounds like your difficult child tends toward. I don't know off-hand what the dosing is for it, but it might be worth a conversation with your psychiatrist to determine if he's at a high enough dosage. Kids grow, and that can affect body mass and how much medication they need.
     
  14. gcvmom

    gcvmom Here we go again!

    Also wanted to add that both my difficult child 1 and my husband were practically feral in their angry meltdowns -- you could see a change in their eyes: dilated pupils, shallow, fast breathing -- almost like a switch was flipped. The Dr. Jekyll, Mr. Hyde syndrome. I can laugh now, but it's not funny when you're dealing with it. Things are MUCH different now that we've got the medications sorted out. They still lose their tempers, but they can calm themselves down and I can diffuse and redirect much more easily.
     
  15. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I was going to mention that my emotional dysregulation is caused by the borderline.

    Not going to go into except to say that there are two new atypical AP's on the market. Might want to ask the doctor about them at next appointment. One is one that is dissolved in the mouth and the other, well, I cant say anything about because my insurance wouldnt pay for me to try. Supposedly these two are easier on the body both weight wise and the one that dissolves doesnt go through the liver so it doesnt cause increases in cholesterol.
     
  16. InsaneCdn

    InsaneCdn Well-Known Member

    If your sig is accurate and you're maxed out at 56 mg on Concerta, then either your difficult child 2 is a really scrawny runt, or someone is giving you the run-around... At 14, with the major growth spurt - we've had to up the Concerta big-time - now at 72 (2x 36 tabs), and they tell us we can go to 90 if we need to (54 + 36). K1 isn't small (tall genes), and he's filling out (muscle, not flab) - add that to the hormones and the Concerta was getting "watered down".
     
  17. ML

    ML Guest

    This is a very helpful thread, one I will definitely refer back to. Manster and I are currently disussing ways to deal with frustration. Our ideas range from physical exercise and deep breathing to visualization techniques. What happens is he reacts without thinking which sets off husband and then husband's anger exacerbates things even more. It helps to have the adults educated because the wrong kind of parenting can make things go down hill even faster.
     
  18. seriously

    seriously New Member

    In our case, this exact same behavior occurs when my son (bipolar) is unstable. He is out of touch with reality and is having ideas of reference - in other words he is unable to be rational due to his mood disorder symptoms. You cannot reason with him or get him to see things from another person's point of view. To attempt to do so only increases his agitation and fuels his intrusive and abusive behaviors. He is convinced that you are victimizing him, opposing him out of spite or trying to sabotage his happiness. He will harass us for hours and often peaks into a rage followed by a plunge into despair.

    Our son's problems are complicated by language processing issues. It is very difficult for him to accurately interpret what is being said to him and to accurately communicate with others or recognize when his communication has not been effective. when his mood symptoms are unstable, the consequences of this disability are that he is triggered by any attempts to clarify instructions/understanding or to see things from another person's point of view.

    When he is relatively stable, he continues to be difficult due to the language processing problems and a basic inflexibility of thinking but it is a matter of degree. You can often reason with him or get him to recognize that he has misunderstood you. He may get frustrated and act out a little but it doesn't trigger a rage or the intrusive and abusive behaviors unless it is a really major disagreement or he becomes unstable.

    It's hard to really compare symptoms between one difficult child and another online so I don't know where on that continuum your difficult child falls. But if he is completely unable to see your point of view or be reasoned with during these episodes then I would say that his mood disorder is NOT under good control and he needs additional or different medication.

    He also needs intervention when he is more stable to help him recognize and accept that he does this, that it is part of his mood disorder, and to recognize when it is starting so he can remove himself or otherwise manage his behavior rather staying engaged and slipping into a rage or abusive behavior.

    Just my 2 cents
     
  19. timer lady

    timer lady Queen of Hearts

    Teaching self regulation is one of the most trying aspects of parenting the tweedles. It's been a day in/day out struggle from day one.

    Saying that, wm has been in intense therapy for the last 5 years dealing with his anger. Just getting wm to stop & think before he explodes is one of the biggest goals in his treatment. At my last staffing for wm (this past Wed) there were tremendous signs of maturity in wm. When discussing wm's goals he no longer exploded when situations (bad choices, explosive outbursts, etc) of concern were discussed. wm admitted to doing the things being discussed albeit with many excuses as to why it was the right thing to do (we still have a ways to go). The fact that wm admitted it was huge.

    wm has also attended anger management at school. It's a wonderful program that has really helped him with-o the emotional demands a family & therapy will bring into the mix.

    pepperidge, whether it's medications, a combo of medications & his abilities (or lack thereof), I truly believe that with maturity you will see a difference. It may not be what you dream but a difference none the less.
     
  20. pepperidge

    pepperidge New Member

    Interesting responses, ladies, thank you.

    My oldest son had a period of raging about 5 years ago or so. Partially wrong medicine, partially not right medicines. Definitely wrong parenting. To try to get him out of it, I would try threats while he was in it. As someone mentioned above, kids in that state cannot be reasoned with. It is almost worth doing whatever it takes to get them out of it. And then addressing it when they are stable. There really was a feral quality about it as one poster said.

    My youngest (the one I wrote about) is not raging. I don't think he has a mood disorder probably. It is more like he is a four year old, he wants what he wants when he wants it and when he doesn't get he gets bummed out for a period of time. But it is overlaid with this almost adult nastiness. And when he gets in that state you can't have a rational conversation. He is not destructive or physically aggressive. Maybe like raging, but not with the intensity or destructiveness that I have seen with oldest. We have seen improvements, TL, so you are right, maturity is helping. Whoever on the board said to remember that these kids are 1/3 or 1/3 developmentally their chronological age was right.

    You have given me some great suggestions. Anger management--I will look into that. I also will look in the borderline personality therapy --DBT. There might be some concepts there that I can use. And the books that Star suggested.

    As for medications I will have another talk with psychiatrist. I am not going anywhere near Intuniv--that's the long-acting Tenex. difficult child had a paradoxical reaction to that twice--unbelievable levels of aggression. Last time we trialed SSRIs to deal with his tendency to perservate on other people's wrongdoings he was tying ropes to trees and seeing if he could jump off the roof. Not going there either. His psychiatrist said that up to age 14 higher levels of Concerta were not approved. but he is over 14. We might trial that when HS starts, but I am a bit nervous about raising the levels of Concerta. The level he is on seems to keep him focused sufficiently in school. Seroquel might be something.

    In any event, some of his behavior (impulsivity, low frustration tolerance) is classic fetal alcohol affects, and hard to medicate. Maturity will help. But I think he is also getting to the point where adults he respects can have some impact on his behavior. He is a very coachable kid. We might need to have another round of therapy, though frankly I have never seen great benefits from the talk therapy that either of my kids have had. I have come to believe that my kids benefit more from therapy in the moment rather than in the therapist's office. The right words of a coach or teacher or staff person close to some situation seems to have more of an impact. My oldest son was in wilderness last year--I think for him the experience was the major therapeutic change agent, not the words of the therapist as much. Though who knows, hard to sort it all out.

    i'm going to look into your suggestions. Thanks everyone.
     
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