A Guide to Chronic Sinusitis

Cold & Flu Center

Sinusitis is the inflammation of the air-filled spaces (sinuses) behind the forehead, cheeks, and eyes. Allergies and infections are the most common causes. When sinusitis keeps coming back or continues for a long period of time, it is considered chronic.

Causes of chronic sinusitis includeA deviated nasal septum or other blockage of the nose, which can trap fluid in a sinus. Dental infections such as a tooth abscess, which may spread into a sinus. An allergy to the Aspergillus fungus, which appears to cause a form of chronic sinusitis that's particularly difficult to treat.

Symptoms

Symptoms may last for three months or more. They include headache, facial pain around the eyes or in the forehead or cheeks, pain in the roof of the mouth or teeth, nasal drainage (yellow or yellow-green and thick), and cough.

Treatment

The goal of treatment is to cure the infection and make the symptoms go away. A three- to four-week course of antibiotics may be given if bacteria caused the infection. Oral decongestants are sometimes used, as are nasal sprays (topical steroids) that may help relieve allergy-related chronic sinusitis. Over-the-counter painkillers can control pain.
For some, surgery to clean and drain the sinuses may be needed. Surgical repair of a deviated septum or nasal obstruction may prevent chronic sinusitis from recurring.
PreventionUsing decongestants when you have an upper respiratory infection may reduce your risk of developing sinusitis. However, decongestant nasal sprays should only be used for short periods of time because they can make congestion worse.

5 Cold Symptoms and How to Treat Them

Cold & Flu Center

When you have a cold, it's very important to choose the right medicines for your symptoms. Here are five common cold symptoms and the recommended over-the-counter remedies:


For a stuffy nose: Use a nasal decongestant.


To quiet a cough: Use a cough suppressant.


To loosen mucus so you can cough it up: Use an expectorant.


To stop a runny nose and sneezing: Use an antihistamine.


To ease fever, headache, and minor aches and pains: Use a pain reliever such as acetaminophen or ibuprofen.


A reminder when treating children's colds: Do not give aspirin or other salicylates to children or teenagers with symptoms of a cold or flu. If you aren't sure whether a product contains salicylates, ask your doctor or pharmacist. Young people can get sick or die from a rare condition called Reye's syndrome if they take such medicines while they have these symptoms. If you are unsure which medication is best for you or your child, consult your physician.

8 Unmistakable Signs of the Flu

Cold & Flu Center


The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications. For this reason, it's important to know the symptoms so you can get treatment fast, both for your own sake and so you don't pass the disease on to others.

The telltale signs include:

Fever (usually high)

Headache

Extreme tiredness/fatigue

Dry cough

Sore throat

Runny or stuffy nose

Muscle aches

Stomach symptoms, such as nausea, vomiting, and diarrhea, can also occur but are more common in children than adults.


If you develop flulike symptoms and are concerned about your illness, consult your health care provider. This is especially important for those at high risk for complications from the flu virus, including people 65 and older, those with chronic medical conditions, pregnant women, and young children.

The 3 Best Ways to Avoid the Flu

Cold & Flu Center

There are three primary actions you can take to protect yourself and others from the flu:


Vaccination

This is your best defense against the flu. There are two types of vaccines: the "flu shot," an inactivated vaccine (containing killed virus) that is administered by needle, and the nasal-spray flu vaccine, made with live, weakened flu viruses that do not cause the flu.


Good Health Hygiene

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick. This includes staying home from work, school, and errands. When coughing or sneezing, cover your mouth and nose with a tissue. Washing your hands often will help protect you from spreading germs on your hands to your eyes, nose, and mouth. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.


Antiviral Drugs

Four antiviral drugs (amantadine, rimantadine, zanamavir, and oseltamivir) are approved for use in preventing the flu. Because the flu virus changes each year, your doctor will know which medication is recommended for fighting this year's bug. Antivirals are effective only if taken within two days after becoming sick. When used in this manner, these medications can reduce influenza symptoms and may shorten your illness by one or two days. They may also make you less contagious.

Steer Clear of the Common Cold

Cold & Flu Center

With due diligence and proper hygiene, you can stay sniffle-free this cold season. Here are eight ways to keep yourself from getting a cold or passing one on to others:


Hands off: Because cold germs can easily enter through your eyes and nose, keep your hands away from those parts of your body.


Stay away: If possible, avoid being around people who have colds.


Stand back: If you have a cold, avoid being close to other people.


Be polite: If you sneeze or cough, cover your nose or mouth.


Soap up: Washing your hands with soap and water is the simplest and one of the most effective ways to prevent the spread of colds. When water isn't available, the Centers for Disease Control and Prevention recommends using alcohol-based hand-sanitizing products.


Clean up: Cold-causing rhinoviruses can live up to three hours on your skin and on such objects as telephones and stair railings. Using a virus-killing disinfectant to wipe down these objects may help prevent the spread of infection.


Try a supplement: Some people use the herbal remedy echinacea to treat their colds. Researchers, however, have found that while the herb may help treat your colds if taken in the early stages, it will not help prevent them.


Hit the OJ: Many people are convinced that taking large quantities of vitamin C will prevent colds or relieve symptoms. To test this theory, several large-scale controlled studies involving children and adults have been conducted. To date, no conclusive data have shown that large doses of vitamin C prevent colds; large doses may, however, reduce the severity and duration of symptoms.

A Cold or Worse? 11 Signs of Sinusitis

Cold & Flu Center

Though sinusitis simply means your sinuses are infected or inflamed, the term gives little indication of the misery and pain this condition can cause. Health experts estimate that 37 million Americans are affected by sinusitis every year. Here are 11 ways to know whether you're one of them:
Headache when you wake in the morning


Pain when touching your forehead over the frontal sinuses


Achiness in the upper jaw and teeth; your cheeks also become tender to the touch


Swelling of the eyelids and tissues around your eyes, and pain between your eyes


Earaches, neck pain, and deep aching at the top of your head


Fever


Weakness


Tiredness


A cough that may be more severe at night


Nasal congestion


A sore throat caused by postnasal drip down the back of your throat


After diagnosing sinusitis and identifying a possible cause, your health care provider will probably suggest treatments such as decongestants, antibiotics, and pain relievers to reduce the inflammation and relieve your symptoms.

4 Ways to Stay Healthy at Work

Cold & Flu Center

Viruses that infect the nose, throat, and lungs cause the flu and the common cold. These germs usually spread from one person to another when an infected person coughs or sneezes. Here are four ways to stop this cycle:


- Cover your mouth and nose when you sneeze or cough. Use a tissue or cover your mouth with your hands. Then clean your hands, and do so every time you cough or sneeze.

- Clean your hands often. For 15 to 20 seconds, rub your hands vigorously together and scrub all surfaces with soap and warm water. It is the soap, combined with the scrubbing action, that helps dislodge and remove germs. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. If using a gel, rub it on your hands until they are dry.

- Avoid touching your eyes, nose, and mouth. Germs are often spread when a person touches a contaminated surface and then touches his or her eyes, nose, or mouth. Germs can live for up to two hours or more on surfaces such as doorknobs, desks, and tables.

- Stay home when you are sick. Also, see a health care provider if necessary. Your employer may need a doctor's note for an excused absence.

Steps to Address Domestic Violence

Psych Central


Break the Silence

Victims should talk to family, friends, neighbors or co-workers about the domestic violence they experience. It may be helpful to call a domestic violence hotline for information, referrals and support.

Develop a Safety Plan

When domestic violence occurs, it is helpful to have a plan to deal with an emergency or crisis. It is important for individuals to think about ways to provide a safer environment, both for themselves and their children. Victims should plan how to get out of their home quickly and safely, so they may do so if violence begins. This plan should consider very fine details such as where to keep keys, a purse and an extra set of clothes for a rapid departure.

People may want to discuss code words for children or friends so they can call the police for help. It is important that children know how to use the phone to call the police or fire department. Figuring out where to go after leaving the home and how to obtain the greatest safety at work or school is also important. Refer below for a sample safety plan.


Safety During a Violent Situation

Victims cannot always avoid violence. To increase safety, it is important to plan what action to take during a violent situation. What will you do?


· If I have to communicate with my partner and suspect that we may have an argument, I will try to move to a space that is lowest risk, such as ________________________. (Try to avoid arguments in rooms without an access to the outside or in rooms where injury is more likely such as the bathroom, the kitchen or on the stairs.)

· I will use __________ as my code word with my children/family/friends so they can call for help should violence ensue.

· I will tell the following people about my situation and request they call the police if they hear suspicious noises coming from my home.

1. _____________

2. _____________

3. _____________

4. _____________

· In a situation where I need to exit quickly, I will leave by using ______________ (the back door, stair well, elevator or window).

· I will keep my purse and car keys ready and put them________________ so that I can leave quickly.

· When I leave my home, I will go______________________________________.


Safety When Preparing to Leave


Safety is extremely important when preparing to leave the abuser. Leaving home must be done with a careful plan to increase safety. What will you do if you decide to leave home?

· I will leave copies of important documents, an extra set of keys, money and extra clothes with ____________________, so that I can leave quickly.

· I will have the following important phone numbers accessible to myself and children:

· Contact Number__________________ ______________________________ ______________________________ ______________________________ ____________

· I will check with ____________________ and____________________ to see if I could stay with them in an emergency situation.

· I will seek shelter by calling my local domestic violence program at (___)____________.

· When I leave, I will need to take:— identification (driver’s license)— Social Security cards for all family members— birth certificates for all family members— school and vaccination records for children— medication— medical records— divorce/custody papers— work permits/green cards/passports— money/check book/ATM card— house and/or car keys— lease/rental agreement— other items: ____________________ ____________________


Safety in My Home


Safety is important even if the abuser does not live with you. What will you do to ensure your own safety and your children’s safety?

· I will change the locks on the following doors as soon as possible:_______________, _______________ _______________.

· I will install a security system.

· I will install an outside lighting system that lights up when a person is coming close to my home.

· I will change my phone number to an unlisted number.

· I will teach my children to _____________________________ when I am not home.

· I will inform ____________________ and ____________________ that my partner no longer resides with me and they should call the police if he/she is observed near my home.


Call for Help


It may be necessary for victims as well as friends, relatives or neighbors of victims to call the police for help. People should not be afraid to ask for immediate help; domestic violence is a crime. Sometimes calling the police may be enough to make the abuser think twice before using violence in the future. When someone calls the police, they are asking for immediate protection to stop the abuse. The police will investigate the call and may arrest the batterer, make a written report of the abuse and provide the victim with referral information for domestic violence services in the area.


Seek Medical Treatment


Many injuries require medical treatment. Victims who have been physically or sexually abused should see a physician for complete medical evaluation. A detailed medical report that documents the victim’s injuries may be helpful in a legal situation. If possible, the physician should take color photographs of the injuries and place them in a sealed envelope.


Seek Community Help


There are many services available to help families struggling with domestic violence. There are various domestic violence hotlines and programs in the community. Such resources offer counseling, emergency shelter and referrals. Victims may seek support through their church, local police department or domestic violence agencies. The phone book provides the numbers of the state or local domestic violence agencies. For hotline numbers, one may refer to the “Organizations and Resources” section.

Domestic Violence: Where to Seek Help

Psych Central

By Toby D. Goldsmith, MD

If you think you are in an abusive relationship, you can go to a number of people for help. Be careful, however, to keep your search a secret from your abuser. If your abuser learns that you are reaching out, he may try to stop you, be angered and abuse you even more.

People who can help you include:

· Family and friends

· Medical and mental health professionals—First, they can treat the physical and emotional injuries you have already suffered. They also can recommend programs specially designed to help victims of domestic violence. Counselors can help to heal your emotional wounds.

· Police—If you are in immediate danger and need emergency help, call 911. The police can arrest your abuser, help you get a restraining order, take you a battered women’s shelter or take you for emergency medical care. Courts can issue a restraining or protective order to keep your abuser away from where you live and work. The order becomes effective as soon as it is issued. It can be extended or made permanent if necessary.

People who violate restraining orders are in contempt of court and may be arrested and taken to jail. The violation of a restraining order usually results in a criminal charge and the violator may serve time in jail.

The Physical and Emotional Injuries of Domestic Violence

Psych Central

By Toby D. Goldsmith, MD


All victims of domestic violence can be physically and emotionally injured. However, because of general strength differences between men and women, women are six to seven times more likely to receive serious physical injuries than are men.

Physical InjuriesThere are some startling statistics about the frequency of physical injuries to women.

· Domestic violence is the most frequent cause of injuries in women. The incidence of injuries from domestic violence is greater than the combined causes of all other injuries to women.

· In 1991 the U.S. Department of Health and Human Services reported that more than 1 million women seek treatment for injuries caused by battering each year.

· One study reported that 28 percent of the battered women who came to one large city’s emergency room required inpatient hospitalization for their injuries and 13 percent required major medical treatment. This study found that 40 percent of the sample’s 218 women had received medical care for abuse injuries in the past.

Emotional InjuriesEmotional abuse does not produce cuts and bruises like physical abuse, so its scars are more difficult to recognize and treat. However, emotional abuse can leave deep scars on the psychological well-being of the victim. Also, emotional abuse often leads to substance abuse, low self-esteem, feelings of powerlessness, isolation, alienation, anxiety and depression, and post-traumatic stress disorder.

Because women are so often the victims, more is known about their psychological injuries. Psychologist Lenore Walker studied female victims and described a “battered woman syndrome.” She found that women who repeatedly experience physical, sexual or serious emotional abuse tend to be affected in common ways, and begin to show similar behavior. These battered women:

· Minimize and deny the abuse.

· Block the abuse incidents from their memory.

· Have anxiety, fearfulness or panic because of constant stress.

· Numb themselves to avoid dealing with the situation.

· Have recurrent flashbacks of battering episodes.

· Have specific fears and are continually watching out for signs of further harm.

Studies have documented that many battered women suffer from post-traumatic stress

disorder, or PTSD. The likelihood of a PTSD diagnosis and severe PTSD symptoms is correlated with more severe domestic violence experiences.

Understanding Domestic Violence

Psych Central

Domestic violence, or violence in the family unit, with women and children as primary victims, is a major public health problem.

Domestic violence constitutes a pattern of abusive behavior that includes the use or threat of violence and intimidation for the purpose of gaining power and control over another person. A violent event is seldomly an isolated incident, but part of a pattern which increases in both frequency and severity over time.

Abusive behavior can be defined as physical abuse, psychological and emotional abuse, sexual abuse or economic coercion.

· Physical Abuse—Any act of violence that is designed to control, hurt, harm or physically assault a partner. This includes pushing, punching, kicking, grabbing, pulling hair, choking, slapping, damaging property or valued items, the use of weapons and refusing to help a sick partner.

· Sexual Abuse—Any action forcing the partner to perform sexual acts against her or his will. This includes pursuing sexual activity with a partner that is not fully conscious, uninvited touching, unwanted sexual intercourse and coercing a partner to have sex without protection against pregnancy or sexually transmitted diseases.

· Psychological or Emotional Abuse—Any action intended to degrade, humiliate or demean, both in public or private. This includes verbal threats, yelling, intimidation, harassment, criticism, lying, withholding information and isolation from family or friends. Psychological abuse may precede or accompany physical violence as a means of control.

· Economic Coercion—Any action forcing the partner to become dependent on the abuser for money and survival. This includes withholding money, a car or other resources; sabotaging attempts to make money independently; or controlling all family finances.


The Scope of the Problem


Domestic violence is a major worldwide epidemic. This section will focus on the scope of the problem in the United States.

Battering is the No. 1 cause of injuries to women—more common as a source of injury than rapes, muggings and automobile accidents combined. Although it is difficult to obtain accurate statistics concerning the incidence of domestic violence, it is estimated that at least 3 million to 4 million women are beaten by their husbands or partners annually.

A woman is more likely to be assaulted, injured, raped or killed by a male partner than by any other type of assailant. About half of all marital relationships involve some form of domestic violence. Of males that beat their wives or partners, 47 percent do so three or more times a year. More than one-half of the female homicide victims in this country are killed by their male partners. In Massachusetts alone, a battered woman is killed once every nine days.

To put the information in perspective, during the Vietnam War, there were 58,000 American soldiers killed in Southeast Asia; during the same period of time, 51,000 women were murdered by their partners in America.


Who Is at Risk?


Domestic violence threatens the lives of millions of Americans each year and crosses all ethnic, racial, sexual orientation, religious and socioeconomic lines. The majority, an estimated 90 percent to 95 percent, of domestic violence victims in heterosexual relationships are women.
There are various factors that appear to place certain women at a somewhat greater risk for abuse.

· Age—Women between the ages of 19 and 29 are at greater risk. This age group reported more violence by intimate partners than any other age group.

· Marital Status—Separated or divorced women were 14 times more likely than married women to report having been a victim of domestic violence. It is, however, possible in some situations that separation or divorce directly resulted from the violence.

· Pregnancy—Medical sources suggest that about 37 percent of obstetric patients are physically abused while pregnant. About 21 percent of women who were previously abused report an increase in the abuse during pregnancy. Pregnant women who were already victims of domestic violence face the risk of more severe violence. Advanced stages of pregnancy leave a woman less mobile and less able to avoid a physical attack; therefore, the risk for injuries to the woman and her fetus increases.

· Possessive Partner—Women in a relationship with an excessively jealous or possessive partner are at a greater risk.

· Substance Abuse—Women who abuse alcohol or other drugs or have a relationship with someone who abuses alcohol or drugs are at a greater risk.

· History of Abuse—Children raised in families in which domestic violence was present are more likely to be the victim or perpetrator of domestic violence in adulthood. Men who have witnessed domestic violence between their parents are three times more likely to abuse their own wives than children of nonviolent parents.

Who Are the Victims of Domestic Violence?

psych central

By Toby D. Goldsmith, MD

Domestic violence can happen in any relationship, regardless of ethnic group, income level, religion, education or sexual orientation. Abuse may occur between a married people, or between an unmarried people living together or in a dating relationship. It happens in heterosexual, gay and lesbian relationships.

However, researchers have found that some people are more likely to become the victims of domestic violence. A likely victim:


· Has poor self-image.

· Puts up with abusive behavior.

· Is economically and emotionally dependent on the abuser.

· Is uncertain of his or her own needs.

· Has low self-esteem.

· Has unrealistic belief that he or she can change the abuser.

· Feels powerless to stop violence.

· Believes that jealousy is proof of love.

While abuse can happen to anyone, women are by far the most frequent victims and men are the most frequent abusers. The U.S. Department of Justice estimates that 95 percent of the assaults on partners or spouses is committed by men against women.


Again, the victims often have some common characteristics. Women who are victims of domestic violence often:

· Abuse alcohol or other substances.

· Have been previously abused.

· Are pregnant.

· Are poor and have limited support.

· Have partners who abuse alcohol or other substances.

· Have left their abuser.

· Have requested a restraining order against the abuser.

· Are members of ethnic minority or immigrant groups.

· Have traditional beliefs that women should be submissive to men.

· Do not speak English.

Taking Action with Domestic Violence

Psych Central Staff

When spouses, intimate partners or dates use physical violence, threats, emotional abuse, harassment or stalking to control the behavior of their partners, they are committing domestic violence.

The first step is for the victim to understand that she or he is not responsible for the abuse. One does not deserve to be abused no matter what the circumstances may be.
It is important for victims to admit to themselves that they are being abused or that they are in an abusive relationship. Even if a battered person is not ready to leave the abuser, recognition and validation of the situation are important steps.

The next step is to decide what action to take in order to be safe.

Symptoms of Domestic Violence

psych central

By Toby D. Goldsmith, MD

Abusive relationships have a powerful psychological impact on the victims. Victims of an abusive relationship may experience some of the following emotions and behaviors:


· Agitation, anxiety and chronic apprehension

· Constant state of alertness that makes it difficult for them to relax or sleep

· A sense of hopelessness, helplessness or despair because the victim believes they will never escape the control of their abuser

· Fear that one cannot protect oneself or one’s children. This person will turn down the assistance offered by relatives, friends or professionals.

· Feeling paralyzed by fear to make decisions or protect oneself

· A belief that one deserves the abuse

· A belief that one is responsible for the abuse

· Flashbacks, recurrent thoughts and memories of the violence and nightmares of the violence
· Emotional reactions to reminders of domestic violence



Physical SymptomsVictims of domestic violence can also have physical symptoms that aren’t directly caused by physical abuse. These symptoms are instead caused by the constant stress and tension of living in an abusive relationship. These symptoms include:



· Headaches

· Asthma

· Gastrointestinal symptoms

· Chronic pain

· Restless sleep or inability to sleep

· Genital soreness

· Pelvic pain

· Back pain

What Is Domestic Violence?

psych central

By Toby D. Goldsmith, MD

Domestic violence is when one partner in an intimate relationship abuses the other. The abuse can be physical, sexual, emotional or a combination of all three.

Physical abuse can include very aggressive acts, such as beatings and forced sexual activity including intercourse, or it can take the form of less severe acts like throwing, shoving and slapping.

In emotional abuse, the abuser constantly humiliates and puts down the victim. The weapons of emotional abuse include verbal insults, threats, control of physical activity, unfounded accusations of infidelity, control of economic decisions and social isolation.

Depending on the relationship, the physical or emotional abuse may happen very often or not as often. Either way, it will usually continue and get worse over time. No matter how often the abuse happens, the victim of domestic violence suffers constant terror and stress, living in fear of the next episode.

While women are most commonly the victims of their male partners, domestic violence can happen between all sorts of people and in all sorts of relationships. It happens between people who are married and between people who aren’t living together. It can be abuse by a man against a woman, or by a woman against a man. It can occur in gay or lesbian couples.
Domestic violence is a common reality in our society. It occurs in all social classes, ethnic groups, cultures and religions. Most people don’t realize how common it is, because very often victims of abuse keep quiet.

These two studies show just how strongly victims feel the need to keep quiet:

· A study of women treated by medical practitioners reported that 92 percent of the women whose partner had physically abused them did not reveal the abuse to their physicians, and 52 percent had not discussed the abuse with anyone. (Social Problems, 34 (1), 1987)

· The National Crime Survey found that 48 percent of all domestic violence incidents against women were not reported to law enforcement. (New York: The Commonwealth Fund, July 14, 1993)

Despite these facts, a number of studies have attempted to show how often domestic violence occurs:

· Seven percent of women who were married or living with a partner were physically abused, and their spouse or partner verbally or emotionally abused 37 percent or them. (New York: The Commonwealth Fund, July 14, 1993)

· Between 3 million and 4 million adult women in the United States are abused yearly by an intimate partner. About one in four women is likely to be abused by a partner in her lifetime. (Journal of the American Medical Association, 267:3184-3189, 1992)

· A study conducted in emergency rooms and walk-in clinics reported that 54 percent of a sample of women treated in emergency departments had been threatened or physically injured by a partner. (Journal of the American Medical Association, 273:1763-1767, 1995)

There is some disagreement as to how often men are abused by their female partners and who initiates the incidents of abuse.

Self Quiz: Am I in an Abusive Relationship?

psych central

By Toby D. Goldsmith, MD

Below are some questions and checklists to help you determine if you are in an abusive relationship. Answer the questions honestly. If you answer “yes” to any of the following questions, you may be a victim of abuse.lie to your family, friends and doctor about your bruises, cuts and scratches?

In addition to those questions, consider the following two checklists. The first list includes signs of emotional abuse. You are probably the victim of emotional abuse if your partner:

· Repeatedly gives you destructive criticism, verbal threats and browbeating.

· Always claims to be right.

· Excludes you from making decisions and claims to be the head of the household.

· Abuses your trust by lying, hiding important information and papers, cheating or being inappropriately jealous.

· Minimizes or denies abusive behavior.

· Constantly shows disrespect, puts you down or embarrasses you in front of others.

· Harasses you by following you or checking up on you.

· Prevents you from seeing your relatives or friends or insists on going everywhere with you.

· Monitors your phone calls.



The next list includes signs of physical abuse. You are a victim of physical abuse if your partner:


· Intimidates you through angry or threatening gestures.

· Destroys your belongings or household items.

· Coerces you to have sex or perform sexual acts against your will.

· Kicks, bites, stabs, pushes, burns or chokes you.

· Uses weapons to threaten or harm you or others you love.

If you answered “yes” to one or more of these questions, or experience these forms of emotional and physical abuse in your relationship, you should seek help. Abuse is not acceptable behavior and is not something you should just learn to live with.

Don’t be a victim that keeps this a silent disease. Seek help from relatives, friends, law enforcement or community resources. With their help, you may be able to stop the abuse or, if necessary, leave the relationship. Realize that once the abuse has started, it will nearly always get worse.

Types of Abuse

by psych central staff

Abuse refers to harmful or injurious treatment of another human being that may include physical, sexual, verbal, psychological/emotional, intellectual, or spiritual maltreatment. Abuse may coexist with neglect, which is defined as failure to meet a dependent person’s basic physical and medical needs, emotional deprivation, and/or desertion. Neglect is sometimes described as passive abuse.



Physical Abuse


Physical abuse refers to striking or beating another person with the hands or an object, but may include assault with a knife, gun, or other weapon. Physical abuse also includes such behaviors as locking someone in a closet or other small space, depriving someone of sleep, burning, gagging, or tying them up, etc. Physical abuse of infants may include shaking them, dropping them on the floor, or throwing them against the wall or other hard object.


Sexual Abuse


Sexual abuse refers to inappropriate sexual contact between a child or an adult and someone who has some kind of family or professional authority over them. Sexual abuse may include verbal remarks, fondling or kissing, or attempted or completed intercourse. Sexual contact between a child and a biological relative is known as incest, although some therapists extend the term to cover sexual contact between a child and any trusted caregiver, including relatives by marriage. Girls are more likely than boys to be abused sexually; according to a conservative estimate, 38% of girls and 16% of boys are sexually abused before their eighteenth birthday.



Verbal Abuse


Verbal abuse refers to regular and consistent belittling, name-calling, labeling, or ridicule of a person; but it may also include spoken threats. It is one of the most difficult forms of abuse to prove because it does not leave physical scars or other evidence, but it is nonetheless hurtful. Verbal abuse may occur in schools or workplaces as well as in families.



Emotional or Psychological Abuse


Emotional or psychological abuse covers a variety of behaviors that hurt or injure others even though no physical contact may be involved. In fact, emotional abuse is a stronger predictor than physical abuse of the likelihood of suicide attempts in later life. One form of emotional abuse involves the destruction of someone’s pet or valued possession in order to cause pain. Another abusive behavior is emotional blackmail, such as threatening to commit suicide unless the other person does what is wanted. Other behaviors in this category include the silent treatment, shaming or humiliating someone in front of others, or punishing them for receiving an award or honor.



Intellectual or Spiritual Abuse


Intellectual or spiritual abuse refers to such behaviors as punishing someone for having different intellectual interests or religious beliefs from others in the family, preventing them from attending worship services, ridiculing their opinions, and the like.

Neglect: The Quieter Child Abuse

by psychcentral

By Marie Hartwell-Walker, Ed.D.



It’s a silent problem. While newspapers and TV news shows regularly highlight stories of child physical and sexual abuse, the companion problem, child neglect, hardly gets a mention. Neglect, unless accompanied by pictures of squalor or emaciated kids, is much harder to capture in a headline or sound bites. Abuse is active and often characterized by violence and exploitation. Neglect is passive and often characterized by depression and resignation. Abuse makes a better news story.

But neglect is the bigger problem. In 2005, almost 900,000 children were victims of maltreatment. More than half — 63 percent — were victims of neglect. Less than 12 percent of substantiated cases involved child sexual abuse. Further, while child abuse steadily declined from 1990 to 2005, the incidence of neglect didn’t go down at all. Sadly, it is the youngest children who are most likely to be neglected.

Linda grew up as the oldest of eight kids in rural Connecticut. “My mother needed the kind of love that babies give. Once a kid started to be at all independent, she was done with him. Looking back, I know she was mentally ill. But at the time, I just thought that babies were mom’s job and everyone else was mine. I give my dad some credit. At least he worked steady and supported us but he was either working or drinking so he was no help at home.”
Although her parents brought home bags of groceries now and then, Linda and her siblings never had a meal prepared for them. They foraged in the cupboards. Mom did do some laundry but Linda can’t remember ever having clean sheets or a clean house. While their mother rocked the current baby, the other kids were left on their own. The kids did what they wanted when they wanted. “It’s a wonder we didn’t get hurt more often,” says Linda. “It was only when we all regularly showed up at school with head lice that protective services finally got involved.”
I’ve been seeing Linda for therapy for several years. Never having had order or structure or basic necessities, she finds it difficult to organize her things, manage a schedule or maintain a healthy lifestyle. Never having had love or support from her parents, she finds it difficult to love, to trust, or to reciprocate in relationships.

Neglect is the failure of caregivers to provide needed age-appropriate care. In a family like Linda’s, there is often both physical and psychological neglect. Physical neglect is the failure to provide the basic necessities of food, shelter and clothing. It also includes the failure to provide needed medical care or adequate supervision. As a result, the kids are at risk for malnutrition, illness, and physical harm. Having never experienced good care, they may become adults who often don’t know how to care for themselves or others.

Psychological neglect, though less obvious, is just as serious. Children who are constantly ignored, rejected, threatened, or belittled grow up without the inner resources that everyone needs to cope with difficult times. When children get little or no affection and physical comfort, they are vulnerable to anyone who will give them attention. Often they become sitting ducks for people who exploit them.

Brett is trying to break a drug habit. “When did you start using?” I ask. “Oh, I think I was about eight,” he replies.

“Eight?” After 35 years in this business, it takes a lot to surprise me but I still internally register some shock when I hear this kind of story.

“Yeah. My folks never looked out for us kids. They didn’t like us much. We were expected to stay out of the house and out of their sight as long as it was light. The older guys in the neighborhood thought it was funny to get the younger kids stoned. We thought being included by the big guys was cool.”

Brett is now 30 and trying to get his life together. Having been stoned for over 20 years, he lacks basic social skills, has low self-esteem, and can’t shake a chronic depression. In many ways, his psychological development stopped at age 8.

The effects of childhood neglect can be devastating and long-term. Neglected kids have poor social skills and may fall into substance abuse. Lacking true friendships, they settle for being drinking or drugging buddies. Even more often, they develop serious psychological problems including depression, post traumatic stress disorder, social anxiety, and personality disorders. Sadly, Brett is not at all unusual in his response to early neglect. At 30, he now has to learn how to give himself the parenting he never had.

It’s often school professionals who first notice neglected kids. They come to school dirty, tired, hungry, and inappropriately clothed. They sometimes become a regular fixture in the nurse’s office, complaining of vague stomachaches and headaches. They often can’t concentrate in school and don’t do well. Some are withdrawn and depressed. Others are very, very angry and rebellious. Sometimes they substitute attitude for confidence. Frequently absent, they have little chance of keeping up with the curriculum. Unable to succeed, they stay away more and more. When the school calls the parents for a meeting, the parents seldom show up. When they do show up, they may be overwhelmed and incapable or defensive and angry.

Jordan’s teacher knows she should be more sympathetic. She admits with some shame that she’s relieved when he doesn’t come to school. When he does show up, he is usually dirty and oddly dressed. He smells. The other kids avoid him. Although he is 12, he is still in the fourth grade. Frequent absences mean he probably won’t get promoted this year either. Notes and calls to his parents get no response. Jordan is neglected.

Jenny, on the other hand, always has the latest clothes and the latest technology. Her teachers are very concerned because she is sexually provocative with peers and even with her male teachers. Her guidance counselor was able to have one briefly unguarded conversation with her. Hungry for love and attention, Jenny acknowledged that she goes after sex as a route to some kind of love. The counselor has called Jenny’s mother repeatedly to request a meeting. Mother says she is much too busy. “I put off my own life long enough,” says the mother. “She’s 15 now and she can take care of herself.” Jenny is neglected too.

Neglect is found at all levels of the economic spectrum. While some kids, like Jordan, suffer the dual burden of neglect and poverty, other children, like Jenny, have parents who have plenty of material resources. They are willing and able to provide material things but not enough care and concern.

Neglected children often are undetected both because they are less obviously hurting and because America has a tradition of respecting family privacy. Sadly, the end result is that neglected children are protected neither by their parents or their community.

If you suspect neglect is occurring to a child you know, it’s important to get involved. Report it to your local child protective services. Most will allow you to do so anonymously if you prefer. Generally, a report is followed up with an investigation. Despite the impression created by high-profile cases, it is rare that children are removed from their home. That only occurs in the most severe cases, when the child is at significant risk for harm. Even in those cases, removal is usually temporary, with placement with extended family being preferred to foster care.

Sometimes the best efforts to preserve the family fail and children are placed with foster families to keep them safe and to give them a chance for a better life. Whenever possible, though, the approach in most communities and states is to educate and support the parents and to monitor the children in the hope that their own family can become a safe and healthy one. Once provided with adequate services, many parents do improve.

Recovering from Childhood Neglect

from psychcentral

By Marie Hartwell-Walker, Ed.D.

The longterm effects of childhood neglect are many and serious. Have you fallen in and out of love with people who can’t love you back? Do you believe that you are essentially unlovable? If you never felt loved by your parents, you may not know what it really means to love and be loved. Are you unable to adequately take care of yourself or people you love? Maybe you were never taught how to take care of a home, prepare healthy meals, or manage your money. Are your easily frustrated by your kids and uncertain how to parent? If your parents never took care of you, you may feel clueless about how to take care of your own children. Do you find it difficult to empathize with others’ pain? Do others accuse you of being selfish and unfeeling? When a child has never had enough, be it food, or attention, or love, it’s hard for the adult he becomes to ever feel he has enough to share.

If you were neglected as a child, you are not doomed. You don’t have to accept your early training that you are not worth someone’s love. You don’t have to become an overly dependent partner or an inadequate parent. You don’t have to repeat the pattern of neglect that may have been in your family for generations. By taking steps to understand yourself, love yourself, and learn new skills, you can turn the negative effects of neglect around.

The first step is to stop blaming yourself for being somehow inadequate and other people for letting you down. You have been caught up in a very old pattern. Having been neglected as a child, you continue to neglect yourself. Having been ignored or worse, you continue to find people who ignore and mistreat you. It’s time to get some reparenting to compensate for the parenting you never had. As an adult you can take charge of your life and make your future better than your past.

You can make up for the years when nobody cared. Just as you can put yourself on a physical fitness program to strengthen your body, you can create an “anti-neglect” program to strengthen your self-esteem and improve your relationships with others. Consider these resources, create a plan, and write it down. Be as specific as you know how. Writing it down will make your commitment to yourself more real. Keeping a journal or diary of your progress will help keep you on track.


Reparenting Resources

· Individual psychotherapy can help you learn to love and care for yourself. The adult you are now can learn how to “parent” the needy and neglected child that you carry within. Your therapist can provide you with an adult witness and can guide your growth, becoming for a time the “good parent” to your neglected child. As therapy winds down, the relationship will change to one that is adult to adult.

· Group therapy can help you feel less alone in your problems and can help you develop empathy for others. You will get feedback about how others see you so that you can develop better social skills. By observing and interacting with other members of the group, you will get help in reversing old self-destructive patterns and support for establishing a healthier approach to life.

· Couples therapy can help you and your partner learn how to meet your own and each other’s needs. Some adult survivors of neglect repeat their relationship with their parents by finding partners who neglect them. Others find people like themselves who are well-intentioned but who don’t know how to nurture. Healthy relationships are reciprocal. Each person has times when they give, times when they receive.

· Parent education classes can help you learn the practical skills necessary to parent well so that you don’t repeat your parents’ mistakes. You may be horrified to find that you are repeating the kind of parenting your experienced, and hated, as a child. As much as you’ve promised yourself that you would do better; as much as you’ve worked to remember how much you resented being overlooked and mistreated, you are easily frustrated by your children and find yourself distancing from them.

Parent support groups such as Parents Anonymous can provide you with important support and practical help. Parenting programs like STEP (Systematic Training for Effective Parenting), PET (Parent Effectiveness Training), Triple-P or Positive Parenting Program, or any of a plethora of other parent education systems can provide you with skills you didn’t have a chance to learn while growing up. Check to see if your kids’ school, your church, or a local mental health agency offers classes.

· Find an older friend. No, I’m not suggesting you go looking for a new mother or father. But relationships with elders can have a parenting dimension. Think of the people you’ve met who are a generation older, who are happily partnered, and who seem to have positive, loving relationships with their adult children. Spend more time with them. Listen to their stories about their families. You’ll give yourself positive role models to counteract the one you had.

· Spiritual practice or religion can give you the all-loving, accepting parent you never had. Whether you look to God, the goddess, a loving spirit guide, or nature, one of the most powerful ways to experience an alternative parent is by belief in a presence who loves unconditionally and who takes a personal interest in your welfare. By becoming a child of god, however you define it, you can finally find parental love.

· Read. There are many books written by people who were parented badly and who determinedly made a better life. Their memoirs can serve as an inspiration and a guide. In another aisle of the bookstore are parenting books — lots of parenting books. Using more than one will overwhelm you and confuse your kids. Take an hour or two to browse. Find a philosophy and style that makes sense to you and buy just that one book. Read it and refer to it often. Use the techniques until they feel natural.

Sticking to your plan will be difficult. There will be times you will want to add yourself to the list of people who haven’t come through for you. The key to success is to give yourself lots of second chances. A slip-up isn’t failure. It is only another opportunity to reaffirm your own worth by getting back on the program. Do give yourself lots of credit for every time you manage to do things just a bit differently. With practice, taking care of yourself and the people you love will become second nature. Stay with it. You’re worth it.

How To Create a Healthy, Adult Relationship With Mom and Dad

Healthy relationship

By Maud Purcell, LCSW, CEAP

The problem is as old as time. It’s the stuff of which Greek myths, novels and screen plays are made. I’m referring to the love/hate relationship between parents and their adult daughters. Our Mistake: We continue to insist that our parents meet our emotional needs, while granting us our independence. Their Mistake: They unwittingly attempt to preserve the same relationship they had with us when we were little girls, yet can’t understand why we don’t just “grow up”!
The Good News: In the vast majority of cases, parent/adult daughter relationships can be greatly improved, and here’s how:

Step I: Get Your Own House in Order

· Acknowledge that you are different from your parents and that it is OK.
· If you haven’t already done so, begin to separate emotionally from your parents. Take the risk of defining yourself, and stop trying to win their approval.
· Accept that your parents aren’t perfect (and neither are you).
· Take responsibility for who you are today. Acknowledge what was troublesome about your growing up experience, accept it, and move on.
· Realize that your parents are a product of their own growing up and life experiences.
· Know that as an adult you are entitled to your own choices, opinions and decisions, even if they turn out to be mistakes. How else can you learn?
· Understand that today you have the power to influence your relationship with your parents, even though you’re still “the kid.”

Step II: Avoid the Same Old Traps: Do Something Different

· Stop trying to change your parents. Instead, think about how you can change your behavior so as to create better interactions with them.
· Although you can’t change Mom and Dad, you can establish limits with them. You can let them know if they have overstepped your boundaries. Be clear about what is acceptable or unacceptable when they are dealing with you in the future.
· Avoid old, toxic topics that are never resolved, and which only bring you pain.
· Gently remind your parents that you are an adult now, capable of making your own decisions — and sometimes those decisions may be wrong.
· Develop and enjoy interests and activities together, where you can participate as equals.
· When issues come between you, treat them as problems external to you both, not as character flaws or as a battle to be won.
· Do not expect Mom and Dad to do things for you, such as pick up your dry-cleaning or take care of the kids. This is part of the old parent/child relationship.
· Refrain from asking for their advice unless you really want it.
· Notice and acknowledge the good things they have done, and continue to do for you. Thank them for these things.
· Even if relations are strained, try to remain in contact, if only through notes, e-mail or voicemail.

And If the Best-Laid Plans Don’t Work

In rare cases even these steps won’t be enough. The pain you experience as a result of continued contact with your parents may be greater than any benefit you receive. In such instances it is OK to say enough is enough. No relationship is worth sacrificing your personal sense of well-being.
Ultimately it is to your advantage to work on developing a healthy relationship with your parents. Upbeat interactions with Mom and Dad can add a wonderful dimension to your life. And at the end of the day, it is rewarding to feel good about the kind of daughter you’ve been.

Grape Seed Extract Kills Leukemia Cells in Lab

from everyday health

More than three-quarters of laboratory leukemia cells exposed to an extract from grape seeds died within 24 hours, effectively killing themselves while leaving other cells unharmed, a new study shows.

University of Kentucky researchers say they found that the extract activates JNK, a protein that regulates the cell-signaling pathway the leads to cell death, or apoptosis.
The findings appear in the Jan. 1 issue of Clinical Cancer Research.
"These results could have implications for the incorporation of agents such as grape seed extract into prevention or treatment of hematological malignancies and possibly other cancers," study author Xianglin Shi, a professor in the Graduate Center for Toxicology at the University of Kentucky, said in a news release issued by the journal's publisher.

Shi cautioned that the research is still preliminary: "This is very promising research, but it is too early to say this is chemo-protective."

Previous studies have shown that eating vegetables and fruits helps prevent cancer development and that flavonoids and grape seed extract might cause cancer cell death and reduce certain tumors.

Shi treated the leukemia cells with a commercially available grape seed extract in different doses. The higher doses caused more apoptosis in the leukemia cells, yet did not affect normal, healthy cells.

The extract proved ineffective, though, when researchers added an agent to it that inhibited the JNK protein or used genetic engineering to shut down the JNK gene.

10 Things You Can Do Differently Today

from psychcentral

By John M. Grohol, Psy.D.


Every year at about this time, magazines, newspapers and websites (including ours!) publish their usual articles on how to keep your New Year’s resolutions. We all seem to forget that many people — perhaps even most of us — make such resolutions partly in jest, partly understanding that while our intentions are good, they are not meant to be hard and fast rules.
So this year, we thought we’d try and do something a little different. Instead of offering you 10 things you can do to help keep your resolutions, we’re going to share with you 10 things you can do differently today that will help change your life. None of these will blow your mind, but they will help make a positive impact.

1. Change your routine. Sometimes all we need in our lives is to alter something in our daily routines that hasn’t been working for a long time. We convince ourselves it would be too difficult to change, or that it would require something we don’t have. Making the commitment to change, however, often brings about insight — and resources — that we don’t always initially have.


2. Eat better. While not exactly a revolutionary suggestion, eating just a little better than you have in the past can have a significant impact in your life. We’re not saying do away with the fast food altogether or switch to eating nothing but bran flakes for the rest of your life. But make a commitment to everyday choices that are just a little healthier for you. For instance, opt for a smaller cheeseburger instead of the Big Mac. Eat two cookies instead of five. Eat one day at Subway instead of Burger King or McDonald’s. Don’t deny yourself the pleasures of eating, just try and make healthier decisions everyday when it comes to your food choices.


3. Have a real conversation. So much of our everyday activities are driven by things outside of our perceived control — going to school, work, or taking care of the kids. We seem to be pawns in a life not of our own making sometimes. One way to regain a little sense of control is to stop and have a real conversation with someone about something meaningful. Not every day. Not every conversation. Maybe just once a week, with a friend, a coworker, or your significant other. Talk about something important to you, something meaningful. You’d be surprised at having such regular, real conversations can help better ground you in your life and give it some meaning.


4. De-clutter. Nearly everyone has a clutter problem. While some people seem to have magical abilities removing clutter from their lives, the rest of us seem to live in a constant state of mostly manageable clutter levels. And that’s fine. Nobody should attempt to be Mary Poppins if their lives more often are akin to a tornado’s passing through a town. But if you make a conscious effort to reduce the amount of clutter, that can help you feel more in control of your life. For instance, deal with junk mail the minute you pick it up (don’t keep stacking it until it resembles the leaning tower of Pisa!). Have your children put their own things away once a week. Ask your significant other to help out with de-cluttering your life just a little bit.


5. Exercise. Yeah, yeah, we all know we should exercise more (unless you’re already hitting the gym 5 times a week!), and we all vow we will. But did you know a simple 15 minute walk every day will help significantly improve your long-term health? You don’t need a gym membership to stay a little more fit than you are today. Sometimes people feel the only way they can do something is if they do it 110%. But the easier solution is to find that 15 minutes a day to do something simpler and more likely to happen.


6. Listen more. We all think we listen when others talk to us, and most of the time, we do. But in this fast-paced, multitasking world, we often don’t really listen when someone speaks to us. The closer the person is to us, the more we often don’t really listen to what they’re saying. You can’t just stop not listening, because it’s something most of us have inadvertently learned to do over the years. We pretend (even to ourselves) that we’re listening, but we’re actually doing something on the computer, watching TV, or reading an article or book. Be a little more aware of when you’re doing this, and stop yourself from doing it once in awhile. Listen. While you may think that what you’re doing is more important than what the other person is saying, you may also find that the other person’s words have meaning… If for no other reason than because they are coming from someone you care about.


7. Have some fun. Some of us are very good about having fun, and doing it regularly. But some of us, especially as we get older, forget to have fun. We think we’re having fun watching TV or playing a video game — and some of us really are — but many times we use these activities as stand-ins for actual pleasure. There’s nothing wrong with that. It’s just that you should also make room in your life for real fun too! While there’s a time and place for taking life seriously, there’s an equal time and place for forgetting your troubles for a few hours a week and really enjoying yourself.


8. Enjoy the journey. Many of us are so focused on getting to where we’re going or where we think we should be going that we forget that the journey is often just as important (and fun!). Life is a full-time, 100% learning experience. Even when we think we’re in the midst of the most mind-numbing, repetitive and boring experience, life is trying to teach us something. The problem is that a lot of the time we don’t realize this. We negate the experience, and in the process, we negate a part of our lives. Embrace the journey, even if it’s just once in awhile, and understand that everything is a part of living a full and meaningful life.


9. Read an entire article. The Internet has been a wonderful boon to our lives, opening up doors and breaking down barriers that have plagued our society in so many different areas. But in one area, it has dealt us a bit of a setback — reading skills. The Internet values the interconnections (or “surfing”) one makes back and forth, all over the world, from website to website. But it doesn’t value sitting there and reading a full-length article from start to finish. Whether you do it online or in a local newspaper or magazine, sit and read an entire article, from start to finish. It teaches us to value good writing (rather than what passes for writing on so much of the Internet), appreciate the nuances of a well-told story and a very good writer, and often challenges us to think outside of our comfort zone. Skimming articles – what most people do online – gives us the gist of the information with none of the nuance or character of careful reading.


10. Try another stress relief. Like all patterns of behavior, we often adopt behaviors over time without giving them much thought. If it comes naturally, it must be okay. How we deal with stress is one of those things that we learn by watching others in our life — on TV, our parents, and our friends. We learn to do positive things, such as exercise or writing in a journal, as well as negative stress relievers, such as drinking too much or bottling it up inside ourselves, letting it simmer. Look at how others around you deal with stress and pick just one different, positive way of dealing with stress and try it out. It may feel a little unnatural at first, but give it a week or two and you may find it is another helpful alternative to place in your stress relief arsenal.
And remember to live. Aren’t we doing that already? How can I do that differently? You know, so many of us spend our lives in “quiet desperation.” That is, we live from day to day without giving much thought to our lives’ meaning. We yearn to do something more, something different, but most of us never spend much effort to achieving that. But you can take little steps, instead of giant strides, to live a life that has more meaning to you. What that meaning is, only you can decide. But instead of putting off getting to that meaning, you can make a start — today — toward it.


Perhaps you’d like to be in a different career, so start thinking about the careers that interest you. Perhaps you’d like to be in a new relationship, so start thinking about what qualities you truly appreciate in another person. Perhaps you’d like to be a better parent, so start finding little ways you can improve your parenting skills. Perhaps you’d like to write a poem or book, so start writing — it doesn’t have to have form or function, just desire.
Sometimes the greatest challenge we face in changing something about our lives is the actual act of doing. We put up barriers within ourselves to stop ourselves from even trying to do something different, because we believe we will fail, it is too difficult to change, or it will take too long. We never even start.


So don’t start today. Don’t start tomorrow. But start just one of these things within the next month, and you’ll find that you will succeed if you only try.

Health Tip: Travel Well, Eat Well

Health Tip
Going on vacation doesn't mean that you have to blow your diet. You can still eat well while you're traveling.
The American Society of Travel Agents offers these suggestions for eating healthy on the road:

- If you're flying to your destination, ask for a low-fat or vegetarian meal on the plane.

- If you're driving, skip fast food drive-throughs. Instead, pack a cooler with healthy sandwiches, fruit and drinks.

- Bring along fresh, crunchy vegetables, crackers, granola and yogurt.

- If you do stop for a bite, make healthy choices. Order your sandwich without high-fat sauces or dressing, and skip the fries.

- Once you're at the hotel, steer clear of the mini bar.

- If your hotel offers breakfast, turn down the danishes and doughnuts. Instead, look for cereal, fresh fruit, and other low-fat options. If you do eat too much or splurge on a high-calorie meal, just make up for it at the next one.

Communicating Effectively When Alzheimer's Is an Issue

Alzheimer's Disease Center

Tips for making a connection to someone with Alzheimer's disease

By Michele Bloomquist


Of all the effects of Alzheimer's disease, perhaps the most difficult is the way the illness changes the ability to freely communicate — both for the person affected by Alzheimer's and for those around them. And yet, no matter what the stage of the illness — early or progressed — there are simple steps you can take to help keep the lines of communication open.

"It's also important to keep in mind that what works for one person, may not work for another," says Erin Heintz, public relations associate director for the Alzheimer's Association. "So be open to learning — and it may take some trial and error — which techniques will work best for you." Some useful tips developed by the Alzheimer's experts include the following:

Know the Effects: Alzheimer's affects each person differently. Some common communication obstacles, however, include difficulty finding the right word or words, repeating words, losing a train of thought, difficulty with logic, reverting to a native language, using gestures in place of words, and an increased use of curse words. If these occur, it's important to remember that these changes are due to the illness, that they're beyond the person's control, and that they are not aimed at you personally.

Encourage Participation: While someone with mid-stage Alzheimer's may not be able to drive or handle their own finances, they may still be able to participate in some life decisions, such as how they'd like to spend their time or what they'd prefer when it comes to care. "Let them make as many decisions as they can," says Elizabeth Gould, MSW and director of the Quality Care Programs for the Alzheimer's Association. "They should be able to be as involved as they can be." Encouraging such participation, when possible, helps reduce the frustration caused by the loss of control and independence that the illness brings.