Ask Dr. Dombeck for February 2004

Mark Dombeck, Ph.D.

Hypochondriac Daughter

My 14 yo step-daughter is a hypercondreact. She always (everyday) complains of a headache. unless things are going her way. I know it is an attention thing, but what should I do about it? Normally we ignore it, hoping she will grow out of the phase, but it has been 2 years now. and it is not just headaches, some days she tries "toe" hurts, stomach hurts, her knees are weak..... Her new thing (last 3 months) have been she says she needs glasses. We had her eyes checked almost a year ago and she has 20/20. Is this mental? What should we do in this situation. The constant complaining is driving us nuts! If she hurts her arm in gym (or else where - basketball), she puts a bandage on, and complains non stop. We have tried all mean of giving her positive attention (not babying her problem) but good attention in other areas of life, but it is not working. SHE IS 14 YEARS OLD. If we go and do something she loves to do, her arm is miraculously healed! PLEASE HELP!

Dr. Dombeck replies:

You've got yourself a problem child there. I don't have any magic bullets to recommend to you, except to say that psychotherapy of some sort – I'm envisioning something ideally family focused (as your daughter is not acting out like this in a vacuum, but rather in the context of your family), but also practical (perhaps with a behavioral parent training component where a therapist can help you to learn practical strategies to punish bad behaviors and to reward good ones – is definitely indicated. Getting professional help from a behavioral child-oriented psychologist is recommended. Using reward and punishment to shape a child's behavior is a very delicate business and easy to mess up. The risk is that you'll put out a lot of effort in trying to put together a program and it won't work all that well if you get it wrong. For instance, you must pick rewards and punishers with great care, always making sure that what you use as a reward is truly rewarding to your daughter, and that what you use as a punishment is truly aversive (but not damaging) to your daughter. You have to do this work as soon as possible, because the older she gets, the more independent of your control she will become.

The other side of the story is that you should also not take the weight of the world on your shoulders if you can avoid it. You are only the parents of this girl. You are not God. She has free-will- freedom to make good, life affirming decisions and also stupid self-destructive ones. You have a responsibility to do as much as you can to show her proper ways to behave, but you can't ultimately force her to do anything she isn't ready to do. Two old sayings come to mind:

"You can lead a horse to water but you can't make him drink"

"God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference"

Good luck.

Dr. Dombeck

Electroconvulsive Therapy

i hope you will respond to this question on your web site, but i have a feeling you wont. my question is about ECT. i have refractive depression that plaques me every moment of my life. I've been on over 30 medication, and none helped me whatsoever.. not even a little bit. so, I'm dreadfully considering ECT. Questions: if i miss any time at work, they will fire me--no exaggeration. does the effects of ECT make it difficult to work that very day or the next day? how many days is average for recovery? is there a difference between recovery when doing ECT 3 times a week versus 1 time a week? also, I've read an article from a woman who has had ECT over a 3-5 year timespan. she now has constant black outs and her memory is long gone. she warns people about doing ect. my memory used to be so good. i was actually smart .until i get depressed. now, my mind is in a constant fog as it is. i need what memory cells i have left to do my job. I'm very afraid that ect will wipe out what i have left. and even if just temporary, how long is temporary? I'd have to go to work the next day, and I'd need my memory in tact. I'd really appreciate any information or suggestions from you. p.s. my therapist is a behavioral therapist.

Dr. Dombeck replies:

ECT is a medical procedure, and as such it is really a specialized treatment only available from a Psychiatrist (an MD, not a Ph.D. like myself). While I don't have first hand knowledge dealing with ECT, I can say that, in the past, highly respected psychiatrists I worked under had high regard for it's utility as a treatment for serious depression when other (pharmacological, psychotherapeutic) methods failed to be helpful.

I encourage you to read the Consensus Document on ECT published by the National Institute of Health in 1985. While this document is almost 20 years old, (normally too old to be of more than historical interest), I can't quickly find anything authoritative that is more recent. Here is the link. I quote below from the Consensus Document in a section that addresses your questions.

"Depressive disorders are characterized by cognitive deficits that may be difficult to differentiate from those due to ECT. It is, however, well established that ECT produces memory deficits. Deficits in memory function, which have been demonstrated objectively and repeatedly, persist after the termination of a normal course of ECT. Severity of the deficit is related to the number of treatments, type of electrode placement, and nature of the electric stimulus. Greater deficit occurs from bilateral than from unilateral placement. Sine wave current has been found to impair memory more than pulsed current."

"The ability to learn and retain new information is adversely affected for a time following the administration of ECT; several weeks after its termination, however, this ability typically returns to normal. There is also objective evidence, based on neuropsychological testing, of loss of memory for a few weeks surrounding the treatment; such objective tests have not firmly established persistent or permanent deficits for a more extensive period, particularly for unilateral ECT. However, research conducted as long as 3 years after treatment has found that many patients report that their memory was not as good as it was prior to the treatment. They report particular difficulties for events that occurred on average 6 months before ECT (retrograde amnesia) and on average 2 months after the treatment (anterograde amnesia). Because there is also a wide difference in individual perception of the memory deficit, the subjective loss can be extremely distressing to some and of little concern to others."

So it would appear that it is indeed fairly likely that one day after a treatment you could experience noticable confusion. You would appear to be 'between a rock and a hard place' as the saying goes. On the one hand, you might very well get fired by your draconian boss if you get sick. On the other hand, if your boss is so ready to fire you for being sick, might you not get fired for no reason anyway, at any time (e.g., how secure is your job even if you have a perfect attendance record?). On still another hand, if no other treatments are helping, and depression is seriously threatening your life, to not accept a treatment that promises to help might not be wise. Depression can be lethal. Suicide secondary to depression is a leading cause of death in adults and teens. Is it better to be dead, out of work and a little happier, or working and in a very depressed place? Only you (and those you allow to counsel you) can figure out the right answers.

Dr. Dombeck


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