Why are Teenagers Getting Fibro?

There are many things that are unique about adolescence. It is a developmentally tumultuous time that involves many physical and emotional systems. When a teenager is having a normal day, they are inundated with hormones, physical growth, emotional confusion and intensive brain activity. Introduce stress and sometimes the balance is tipped a bit too much. Teenagers are suffering from stress-related and stress-induced illnesses like never before. Recent studies suggest that seven percent of all teens suffer from chronic illnesses like Fibromyalgia or Chronic Fatigue Syndrome. While these illnesses have traditionally been far more common among women and girls than men or boys, this is beginning to shift. There is no known cause for Fibro, and as of yet, no known cure. There are many treatment options, but unfortunately no one treatment helps everyone.

One thing we do know, however, is that stress is a huge factor in the onset of chronic illness, and Fibromyalgia has been gaining popularity among teenagers at an alarming rate. Defined as a collection of pain points throughout the body, Fibromyalgia is a debilitating, intractable and mysterious condition. It is a long and arduous process to diagnose in adults, and even more so in teens. If you believe your teenager might have Fibromyalgia, it is essential that your doctor eliminate as many other possible conditions that may be life threatening. Fibro is annoying and hard to live with, but not fatal.

So, why are teenagers coming down with Fibro? There are a number of possible explanations. The most obvious is stress. Teenagers are under incredible amounts of stress while they juggle their insecurities and shortcomings in a competitive and success-driven adult world. They are inundated with information and flooded by constant communication without end. They are less physically active than ever, yet more stimulated than ever.

I heard a theory this week that people are stressed because of the lack of face-to-face contact, as so much of our social interaction is done online. The natural triggers for the parasympathetic nervous system, the part responsible for calming, are less available when we are communicating remotely. All of these things combined make for a stressed out teen population.

I worked with a teenage girl a few years ago who climbed into bed with a virus and didn't get up for three months. She is doing great now, but had to work very hard to find her way out of the fog. There were a few things about her case that were uniquely teen: One, she was torn between pleasing her parents and doing what seemed right for her. Two, she enjoyed being at home with her mom while she was ill.

During the course of our work together, she used the tools of CBT to shift her thinking enough to get well and stay that way. The good news is that teens are naturally flexible in their minds and are more responsive to treatment than most adults.

So, if your teen has unexplained chronic pain and fatigue, speak to your doctor about Fibromyalgia as a possible diagnosis.

Sara Halevi Kalech, MA CBT is now available by Skype, anywhere in the world. Email her at sarahalevi@gmail.com and get help today.

How Fear Makes Pain Worse

Everyone experiences pain. There are no exceptions to this. In graduate school I often heard a well-worn phrase, "everyone's pain hurts." That was brought to teach us not to judge our clients, to accept that everyone has a different ability to tolerate pain, and so we should never think we would tolerate someone else's pain better than they do. One difference in the various degrees to which people tolerate pain seems to be the amount of fear the client engages in response to the pain.

This is a sophisticated partnership. As soon as the brain receives the pain signal, the fear instinct kicks in. This is a beautiful thing, as the signal for pain tells the primitive basic survival instinct that the body is in danger. The fear reflex brings with it a series of mechanisms that assist the fight or flight instinct, many of which are recognisable: muscles tense, breathing becomes rapid and shallow in order to increase oxygen flow to the muscles, and the mind shifts its focus to become hyper aware of the painful sensations it wants to avoid.

The problem with allowing the fear reflex to take over is that it prepares us for something that never comes. The experience of pain that is not being induced by a lion's jaw clamping down on our thighs is exacerbated by the stress reaction. In other words, once the fear kicks in, bringing a host of physical and psychological responses with it, all of that preparedness just sits there, making us anxious. And, this makes the pain even worse!

So, what do we do if the body is NOT in danger?

We can stop the pain-fear reflex from happening.With mindfulness and other meditation techniques, we can unlearn this primal pattern of pain-fear and undo the process of gearing up for fight or flight. We can learn to talk ourselves down from the hyper-alert readiness state, and relax our bodies. Once we unwrap all the layers of fear and stress, an amazing thing happens: The pain hurts less.

As it turns out, fear is far more painful than just pain. The pain we experience with Fibro will not do us any actual harm. We have nothing to fear from this pain. It's just pain. It's not dangerous. When we allow this message into our deeper being, we hurt less. I encourage you to try it.

Need help managing your chronic pain or illness? Contact me to set up a Skype counselling session. Email me Sarahalevi@gmail.com

Diagnosis: Sick of It

Boundary issues

There are a few common themes with young fibro patients, and this is one: Weak boundaries. They tend to be very caring, very empathic with their friends, siblings, parents. They are the family peacemakers, the one the other family members count on to be solidly supportive at all times. Parents see them as very intelligent, caring, hard working, intense. This is the child who cannot let it go. Often the phenomenon of adolescent onset illness can be attributed to a specific stressor; SATs, death of a loved one, illness or absence of a parent; the teen is unable to stop the stressor at the surface and allows it to penetrate her actual physical being. It can also be triggered by an upcoming event; adulthood. This sounds oversimplified. More often than not, however, I see a young woman, 17 years old, in the prime of her life, bright, talented, friendly, pretty, now lying in bed for months at a time. This is simply not a coincidence. The responsibilities of adulthood are daunting enough; for the particularly sensitive adolescent, the competition and drive required to succeed can be so emotionally overwhelming that they manifest physical symptoms. A child will not achieve his developmental task of individuation while lying in bed, needing his parents’ care and attention! This is a complex psychological and medical picture. If your teenager is so stressed out that she is making herself sick, CBT is a good place to start.

Building Trust With Practitioners

I recently treated a teenager who had learned to mistrust her doctors. Though she clearly was suffering from a severely debilitating case of Fibro, many of the physicians she had consulted had been derailed by her obesity. Instead of viewing her weight as a symptom (one of many) of Fibro, the doctors had decided the presenting pathology was obesity. Not only was this unhelpful to the diagnostic process, it delayed treatment and was humiliating and harmful to the already suffering child; somewhere between insensitive and negligent, at the very least it was not good medicine.

As with all things adolescent, trust is imperative in the treatment of Fibro/CFS. The more information the doctors have, the more effective the treatment process will be. The key to gleaning pertinent information from the adolescent patient is good listening. If she feels heard and taken seriously, she will tell you what you need to know. If he feels stupid or judged, he will shut down. In the famous words of Sean Covey (adult son of "7 Habits" author Stephen Covey): Listen more than you talk. You have two ears and one mouth. Duh!

All in your head?

Psyche and Soma

Fibro is, in the strictest sense, psychosomatic; in other words, there is a clear connection between the mind and body. Stress exacerbates symptoms; relaxation and stress reduction alleviate symptoms. However, this is not to say that the pain is not real, or, as many of my cases have been told, “all in your head.” If this were the case, heart disease, stroke and ulcers could also be deemed psychosomatic. It is abundantly clear to the suffering adolescent that stress affects her symptoms. It is in the best interest of all the practitioners involved to not only understand and acknowledge this, but to strengthen awareness of the mind-body link throughout treatment.

While practitioners have come to understand that Fibromyalgia is a real syndrome, there is a social phenomenon that perpetuates the belief that it is a “soft” diagnosis. This myth is often then reinforced by the absence of Fibro’s most common presenting symptom (pain points) in children and teens. The diverse and often varying or shifting symptoms in adolescent onset Fibro further confuse many practitioners. 

The next step is to assemble a treatment team. 

If the teen does not trust the PCP, it may be necessary to find her a doc of her own. In choosing a physician, consider the following statement; Fibromyalgia hurts. It really, really hurts. If the PCP suggests the symptoms are not real, or are in some way exaggerated, this is an indication that this doctor may not be appropriate for your treatment team. Fibro and its symptoms are largely subjective and self-reported. So, Fibro must be treated in the spirit of the great truism of mental health, “everyone’s pain hurts.”

The core of the treatment team should be a cognitive behavioral therapist.

Next: How can CBT help?