Angry, Anxious, Insecure and Sad Children
Excessive anger in children can be a major source of tension and conflict in families and marriages. This section is meant to help parents come to a deeper understanding of how they can protect the emotional lives of their children and guide them. A number of virtues will be presented which can help children and teenagers grow in their ability to deal with their anger and fears in an appropriate manner. Case studies from the child chapter of Helping Clients Forgive: An Empirical Guide for Resolving Anger and Restoring Hope (American Psychological Association Books, 2000) will be presented.
In a recent research update on child and adolescent psychiatric disorders the authors stated that there is mounting evidence that many, if not most, lifetime psychiatric disorders will first appear in childhood or adolescence and that methods are now available to monitor youths and to make early intervention feasible.
One of the most effective interventions for children is through the use of forgiveness. Forgiveness can reduce excessive anger in children and in teenagers and may prevent the development of later psychiatric disorders by giving children and teenager a proven method for resolving anger.
A 2005 national study of psychiatric disorders revealed that the lifetime prevalence estimates of psychiatric disorders are as follows:
- anxiety disorders - 28.8%
- impulse-control disorders - 24.8%
- mood disorders - 20.8%
- substance use disorders - 14.6%
The median age of onset is
- 11 years for anxiety disorders
- 11 years for impulse-control disorders
- 20 years substance use
- 30 years mood disorders
Half of all lifetime cases start by age 14 years and three fourths by age 24 years.
Impulse control disorders are essentially disorders marked by high levels of expressed anger which can respond to forgiveness interventions.
Common Origins of Childhood Anger
- Conflicts in Parents
- Parental enabling of narcissism
- Rejection by siblings
- Rejection by peers
- Modeling Parental Anger
- Day Care
- Marital Conflicts
- Selfishness
- Low self-esteem
- Loneliness/Sadness
- Difficulty in Trusting
- Divorce/Separation
- Poverty
- Poor body image
- Athletic insecurities
- Academic difficulties
- Excessive time in sports activities
- Lack of balance.
Please rate your child's anger on the following anger checklists.
Active Anger in Children/Adolescents
Mild
- Irritable
- Often loses temper
- Impatient
- Regularly annoyed
- Blurts out answers before questions have been asked
- Impertinent; talks back
- Verbally aggressive
- Pouts and sulks
- Uncooperative with teacher
- Constant teasing
- Difficulty waiting one’s turn
- Frequently frustrated
- Intrudes on others
- Defiant
- Argues, quarrels
- Acts “smart”
- Negative
- Disobedient
Moderate
- Lying
- Chronic violation of rules at home or school
- Overly aggressive
- Initiates fights
- Cheating
- Stays out at night
- Excessive recklessness
- Tries to dominate others
- Hostile
- Excessive swearing
- Hits others
- Rude
- Class clown - disruptive at school
- Violent threats
- Spiteful, vindictive
- Has “bad” companions
Severe
- Suspension from school
- Stealing
- Violent acts against people, animals or property
- Running away from home
- Violent acts against oneself
- Constant truancy
- Expulsion from school
- Substance abuse
- Fire setting
- Forced sexual activity
- Carries a weapon
Passive-Aggressive Anger in Children/Adolescents
Mild
- Always late/leaves early
- Deliberately sloppy
- Uncooperative attitude
- Forgetful
- Procrastination - deliberately put things off
- Twist the truth
- Refuse to do what is reasonably expected
- Rehashing the past
- Deliberate making of mistakes
- Often loses things necessary for tasks or activities
- Door banging
- Withdrawn
- Deliberately slow
- Pretend not to hear or see
- Walk out on people
- Refuse to listen
- Always controls the T.V.
- Manipulative
- Deliberate inattention
Moderate
- Refuse to clean the home or oneself
- Act sick or helpless
- Withhold love or support
- School grades markedly below one’s ability
- Impulsive - failure to plan ahead
- Deliberately avoid or ignore someone
- Refusal to function in a responsible manner
- Divisive
- Always negative
- Overly stubborn
- Silent treatment
- Absenteeism in school
- Refuse to be responsible
- Refuse to study regularly
- Enjoy seeing people become upset
Severe
- Refuse to eat
- Deliberately fail in school
- Failure to care about anything
- Deliberately try to be sick
- False accusations
Uncovering Selfishness
Selfishness is one of the major causes of anger in children. Please rate your child by identifying the appropriate number using this scale on the following narcissism checklist:
0 - Never | 1 - Very Little | 2 - Moderately Often | 3 - Very Often
Narcissism Checklist
Narcissism Total:
A total of less than 30 indicates mild selfishness; a total of 30 to 60 indicates moderate selfishness and greater than 60 demonstrates strong selfishness.
Three Basic Mechanisms for Dealing with Anger in Children
In Helping Clients Forgive: An Empirical Guide for Resolving Anger and Restoring Hope, I wrote, parents can provide valuable assistance to children by helping them develop an understanding of the three basic mechanisms used to cope.
Denial
During early childhood, the most common method for dealing with anger is denial. The dangers attached to denial include emotional harm to the child, increased feelings of sadness, guilt and shame, or the misdirection of the resentment toward others.
Expression
The next method commonly used for dealing with anger is either to express it openly and honestly or to release it in a passive-aggressive manner. It is of benefit to review with children the numerous ways in which anger can be vented passively. The therapist might consider having the young patient complete an anger checklist to identify these behaviors. Many parents can also participate in the evaluation of their child's anger by completing an anger checklist in relation to their son or daughter and thus provide the therapist with additional information on the degree of the child's anger.
It may be helpful to view actively expressed anger as encompassing three types: appropriate, excessive, and misdirected. Children benefit from learning the value of healthy assertiveness as well as the danger of responding consistently to situations in an excessively angry manner. It is important for them to realize that when they do not resolve their anger from a particular hurt, they may later misdirect the resentment toward others. Such anger can damage friendships, interfere with learning, harm family relationships, and limit participation in team sports. In clinical practice, we find that the most common recipients of misdirected anger are younger siblings, peers, mothers, and teachers.
Concepts of displacement and the consequences of displacing anger can be difficult for children to understand and accept so concrete examples need to be used. At times, it can be helpful if parents or a therapist relate stories of misdirected anger from their own youthful experience.
Some therapists believe they have been successful in treating anger in children and adolescents when their young patients express the anger they had previously denied. Actually, what has been accomplished is only one step toward actual resolution because, in itself, expression is incapable of freeing children from the burden of resentment which they carry. The experience of anger can lead to a desire for revenge which does not diminish until the existence of the resentful feelings are uncovered and subsequently resolved. Without this uncovering and resolution, anger can be displaced for many years onto others and erupt decades later in loving relationships. Anger may not be fully resolved until a conscious decision is made to work on forgiving the offender.
Victims of Misdirected Anger
- mothers
- siblings
- teachers
- peers
- oneself
- society
- The Church/God (see Faith of the Fatherless: The Psychology of Atheism)
Forgiveness
Not surprisingly, what forgiveness is not needs clarification. We find that children need to learn the following issues. Specifically, forgiveness is not tolerating and enabling angry, abusive people to express their anger. It is not being a doormat or acting in a weak manner and it does not limit healthy assertiveness. It does not mean trusting or reconciling with those who are abusive, insensitive, or show no motivation to change their unacceptable behavior. Finally, forgiveness is not necessarily going to others and informing them that one is forgiving them.
As already stated, clinicians often discover that the relationship in which children experience the greatest degree of disappointment, and subsequently the greatest degree of anger, is in the parental relationship, especially the one with the father. This is particularly true at the present time when almost forty percent of children and teenagers do not have their biological fathers at home. Numerous studies have documented difficulties with resentment and aggressive behavior in the children of divorce (Block, Block, & Gjerde, 1988; Guidubaldi, 1988; Hetherington, 1989; Johnston, Kline, & Tschann, 1989; Wallerstein 1983, 1985, 1991; Wallerstein & Blakeslee, 1989). One study of parental love-deprivation and forgiveness revealed that most respondents implicated the father, not the mother, as being emotionally distant (Al-Mabuk, Enright, & Cardis, 1995).
The major cause of anger in the father relationship is the result of growing up with a father who had difficulty in communicating his love and in affirming his children. Misdirected father anger may be a contributing conflict in our schools and homes today. Many children who have intense father-anger present with conduct disorders, oppositional defiant disorders, attention-deficit/ hyperactivity disorders, and intermittent explosive disorders.
Difficulties in the mother relationship that lead to intense anger can be the result of not experiencing enough love and praise, feeling controlled or criticized, or being made to feel that one does not measure up to some standard. At times, too, the child may have felt overly responsible for the mother, or may have come to the conclusion that she was overly critical of the father.
Other sources of anger sometimes result from hurts and disappointments from siblings or rejection by peers. Often an older child misdirects anger at a younger sibling that is really meant for a parent or peers. Many children and adolescents crave peer acceptance to develop a positive sense of self and to protect themselves from loneliness. Those children who are scapegoated regularly in school rarely tell their parents how they are being treated because they are so ashamed or because they believe that their parents cannot protect them. Therefore, parents need to be aware of the various ways in which this conflict can manifest itself. These include: isolation, withdrawal, ventilation of hostility toward others, social anxiety, or depression.
Some children have difficulties with their anger as a result of modeling after a parent who could not control anger. This excessive expression of anger is then passed from one generation to the next. In our experience, this modeling occurs most often with the father.
Many in the mental health field believe that the excessive anger seen in ADHD and other disorders in children is biologically determined (see, for example, Hechtman 1991). However, at this time, no specific neurotransmitters have been identified which cause excessive anger. Also, the use of addictive substances can trigger excessive anger as well as personality conflicts, especially narcissism.
Parents can assist their children in their character development by teaching them to be understanding and forgiving when angry. We refer to this as an immediate forgiveness exercise. This does not preclude punishing a child for a display of excessive or misdirected anger, nor asking an angry child to apologize to the recipient of their excessive anger. Appropriate punishment for angry behaviors often helps a child learn to control anger.
After an angry incident the child can be recommended to try to forgive if they have been truly hurt by another. Also, children can learn to stop denying their anger and to resolve it by thinking at bedtime of forgiving anyone who may have hurt them on that particular day or in the past. In Ephesians 4, St. Paul recommends that we not let the sun go down on our anger. Unfortunately, many children and adults do because they do not work on developing and using the virtue of forgiveness at the end of the day.
Children are usually pleased to learn how the virtue of forgiveness can help them control and resolve their angry feelings.
We will now examine some of the specific childhood and adolescent disorders with a focus on the treatment of the excessive anger. The resolution of this resentment facilitates the healing of childhood disorders. The childhood disorders with the greatest degree of anger are attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, intermittent explosive disorder and character/personality weaknesses.
Oppositional Defiant Disorder
One of the most common conflicts leading to excessive anger and defiant behaviors in children is oppositional defiant disorder (ODD). ODD in children can lead to severe stress in the home, marital conflicts, abuse of family members, an undermining of parental leadership and strong anger toward the child with ODD. Outside the home children with ODD can create chaos in the classroom and school, abuse on school buses, difficulty in teaching and learning in schools and psychological harm to teachers, other students and children in the neighborhood.
The symptoms of ODD are:
- Often loses temper
- Often argues with adults
- Often actively defies or refuses to comply with adults’ requests or rules
- Often deliberately annoys people
- Often blames others for his or her mistakes or misbehavior
- Is often touchy or easily annoyed by others
- Is often angry and resentful
- Is often spiteful or vindictive
ODD arises from a number of conflicts including:
- Unjust hurts, injustice, poverty
- Selfishness
- Marital and family conflicts
- Modeling after an angry parent, sibling peers.
The most common conflict we uncover and address in children with ODD is excessive selfishness.
Oppositional defiant disorder (ODD) has been seen as a developmental precursor to conduct disorders and is more common in families where there is serious marital discord (DSM-IV). ODD is also co morbid with ADHD, major depression, bipolar disorders, substance abuse and anxiety disorders (Greene, R.W., 2002). A number of studies have shown that males were over represented, as were children of divorced parents and of mothers with low socioeconomic status (Kadesjo, C., 2003). In addition in the major journal of child psychiatry, a report on ODD stated that "It is imperative that clinicians pay specific attention to the presence of childhood ODD behaviors (Whittenger, N.S., 2007)." Parents also need to give attention to these symptoms in children.
The excessive anger seen in ODD is not as severe as that in conduct disorders in that most of these youngsters do not yet struggle with violent impulses and fantasies. The psychotherapeutic use of forgiveness can play an important role in decreasing or resolving the hostile feelings, thoughts and behaviors seen in ODD. If the strong anger in ODD is treated effectively, our experience indicates it may prevent the later development of conduct disorders.
In our clinical experience we believe that parents can prevent the development of ODD and diminish its influence by working closely with their children on growth in virtues and by giving them appropriate corrections for their anger and their selfishness. These virtues include obedience, gratitude, generosity, respect and forgiveness. Also, couples should commit themselves to build healthy, strong marriages because of the trauma caused to children by marital conflict, separation and divorce. In this regard we regularly recommend that parents read Men, Women and the Mystery of Love: Practical Insights into John Paul II's Love and Responsibility by Edward Sri, Servant Books.
Now, please consider rating a child you may concerned about on the anger checklist and narcissism checklist.
Case Study
This case demonstrates the use of forgiveness in ODD.
Sean, a seven-year-old, became increasingly angry and rebellious with his mother after his father left the family. He regularly lost his temper, refused to listen to his mother, and provoked his sisters. He also became much more defiant and narcissistic and demanded that his mother buy him new toys several times weekly.
In the sessions with his mother and sisters, Sean admitted , I'm really mad at Dad. He doesn't care about us. All he ever did was watch TV anyway. Sean's mother told him that his anger was hurting her and his sisters and that it reminded her of his fathers selfish temper tantrums. Sean became tearful and remorseful during the session and stated that he did not want to hurt anyone. He agreed to try to let go of his anger with his father on a daily basis and thus attempt to avoid repeating his dads self-centered behaviors. This intervention seemed to motivate Sean and when he slipped back into oppositional defiant behavior, his mother would remind him to continue to forgive his father. Over the course of several months, the work of daily thinking that he wanted to understand and try to forgive his father helped Sean to gain more control over his angry feelings and behaviors. However, there were times when, after spending a weekend with his selfish father, it would take several days to gain control over his sad and angry feelings.
Attention-Deficit/ Hyperactivity Disorder
Attention-deficit/ hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder of children (Anderson,et al., 1989). The three subtypes of ADHD are the predominantly inattentive type, the combined hyperactive-and inattentive type, and the predominantly hyperactve-impulsive type. Please rate your child for ADHD on the following criteria of the Diagnostic and Statistical Manual of the APA.
(1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Inattention
- often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- often has difficulty sustaining attention in tasks or play activities
- often does not seem to listen when spoken to directly
- often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
- often has difficulty organizing tasks and activities
- often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- is often easily distracted by extraneous stimuli
- is often forgetful in daily activities
(2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
- often fidgets with hands or feet or squirms in seat
- often leaves seat in classroom or in other situations in which remaining seated is expected
- often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- often has difficulty playing or engaging in leisure activities quietly
- is often “on the go” or often acts as if “driven by a motor”
- often talks excessively
Impulsivity
- often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- is often easily distracted by extraneous stimuli
- is often forgetful in daily activities
Hyperactivity-Impulsivity Total:
The estimated prevalence of ADHD among teenagers in a recent major European study was 8.5% with a male/female ratio of 5.7:1. Also, in this study of 6,622 followed from childhood and evaluated into adolescence (ages 16-18), 64% had the inattentive type, 28% the combined type and 8% hyperactive-impulsive (Smalley, S, et al, 2007).
ADHD is regularly seen in association with oppositional defiant disorder, depressive and anxiety disorders, substance abuse and learning disorders.
A leading expert on ADHD has stated that many, if not the majority, of those with ADHD have problems with aggression and emotional control (Barkley 1990). Also, the importance of identifying and treating the anger in this disorder is supported by studies which reveal that ADHD is associated with a ten-fold increased incidence of antisocial personality (Klein, 1991; Weiss, et al.,1985), a twenty-five fold excess risk for institutionalization for delinquency (Satterfield, et al. 1982), up to a five-fold increased risk of drug abuse (Gittelman, et al. 1985; Klein, 1991), and up to a nine-fold increased risk of incarceration (Mannuzza, et al., 1989).
We have found that the therapeutic use of forgiveness is effective in diminishing the excessive anger in ADHD, particularly in the hyperactive and impulsive types. The expression of anger in ADHD is not limited to the active release of this emotion. Some of the symptoms in the inattentive type of ADHD in some children may be the passive-aggressive expression of anger. These include not listening, failing to follow through with instructions, forgetfulness, or careless mistakes. Some youngsters engage in these behaviors deliberately by not cooperating with teachers or parents as a way to vent anger.
Many children and teenagers with ADHD are not aware of being overly angry, or, if they are aware, they are unable to identify the origin of their anger. In the uncovering phase of treatment, they begin to identify major disappointments in their lives and the anger associated with the hurts they experienced. Some decide to learn how to use forgiveness, although others discover benefits gained from holding onto their anger.
Old habits are hard to break and the development of a new habit of employing forgiveness to deal with anger is acquired slowly. The following case study on treating anger in ADHD is from Helping Clients Forgive.
Case Study
Earl was a seven-year-old who was finishing first grade and presented with symptoms of ADHD, hyperactive and impulsive types, and symptoms of oppositional defiant disorder. He had almost no ability to control his angry behavior. Both of his parents were adult children of angry alcoholic fathers and they had been in marital therapy for over a year working on controlling their tempers through the use of forgiveness. The level of excessive anger in the marital relationship had diminished significantly.
Earl was able to recognize that he had been very angry with his parents as a result of their fighting. His parents asked for his forgiveness, promised to try to work to overcome their bad tempers and to curtail their fighting. Earl nodded in agreement. The therapist responded, Earl, I would like you to see whether you can tell your parents now that you want to try to forgive them. He proceeded to verbalize his desire to forgive them and then went over to them and gave each a hug.
The therapist next asked his parents to explain to him the causes of the their fighting. They told Earl that each of them had brought a great deal of anger into their marriage from their family backgrounds from the paternal grandfather, the maternal grandfather, and grandmother. Without realizing what they were doing, they related that they had misdirected this anger toward each other. With an attempt at a smile, he said, I'm glad you told me. At least I'm not the reason you're always mad. At the end of the session Earl was given a note from the therapist which suggested that daily he think, I want to forgive mommy and daddy for all their fights. At the succeeding sessions his ability to use forgiveness to control his anger was reviewed. Although he continued being angry, the episodes were somewhat less frequent and less intense.
Neither Earl or his parents were able to identify anyone in else in neighborhood or at school with whom he might be angry. After an initial diminishment in his anger, it erupted again and he had great difficulty controlling his rageful feelings. Ritalin then used. Shortly thereafter, another major source of previously denied anger was identified.
His mother visited the after-school program he attended, and was extremely upset by the way the older boys taunted him. Earl was ashamed of this treatment and had never told his parents. After an attempt to remedy the situation failed because of the failure of those in the after-school program to control the bullies, Earl's mother removed him from this program and his explosive anger diminished greatly.
In the deepening phase, Earl was pleased that he had learned of a way to control his temper and that he was able to help his younger brother to work at controlling his anger by talking with him about forgiving others.
Separation Anxiety Disorder
Separation anxiety disorder is common among children and teenagers. Symptoms of separation anxiety disorder are:
- recurrent excessive distress when separation from home or a parent occurs
- excessive worry about losing or harm befalling a parent
- excessive worry that an untoward event will lead to separation from a parent
- persistent reluctance or refusal to go to school or elsewhere because of fear of separation
- fearful of being alone without a parent at home
- persistent fears of going to sleep without a parent in the home
- persistent nightmares involving the theme of separation
- repeated complaints of physical symptoms.
The psychiatric diagnostic manual, DSM - IV, indicates that these children may show anger or hit someone who is forcing separation. Also, the child’s demands can lead to resentment and conflict within the family.
Studies of co morbidity in SAD reveal depression in one third and other anxiety disorders in one half (Klein, 1989; Last, et al., 1987). Studies of depressed pre pubertal children and adolescents have found concurrent SAD in 30 to 60% of subjects (Biederman, et al., 1989; Ryan, et al, 1987).
Children often develop separation anxiety disorder after some major life stress or traumatic experience which can include: a mothers serious illness, prolonged separation from the mother, excessive fighting between parents, marital separation or divorce, a serious illness in the child, change in school, move to a new neighborhood, or the death of a sibling.
Children whose family histories are positive for depression, panic disorder, and alcoholism appear to be at increased risk. Clinically we find that ridicule and the experience of being a scapegoat by other children may lead to intense fears of betrayal outside the home and separation anxiety. Also, one study found that 83% of mothers of children with SAD had a lifetime diagnosis of anxiety disorder, 53% had a lifetime diagnosis of major depression, and 57% had a current anxiety disorder diagnosis (Last, et al., 1987)
While these youngsters are aware of their intense fears of separation from their mothers or fathers, most are unaware of the cause of their fears and they are not conscious of the anger they have toward those who have hurt or disappointed them. The identification of the origin of their fears and the resolution of the anger associated with the traumatic experience through forgiveness therapy facilitates the treatment of their separation anxiety symptoms. Therapists can relate to these youngsters how their fears are tied into anger from various hurts and will diminish if they can learn to resolve their anger.
Case Study
This case study from Helping Clients Forgive demonstrates the value of forgiveness in resolving symptoms of separation anxiety disorder.
Marty developed separation anxiety symptoms at the beginning of second grade. He had great difficulty leaving his mother and begged her to ride on the school bus with him. When she did not join him, he would fly into a rage and tell her that he would not talk to her when he returned from school. In the evenings he became increasingly fearful and anxious. The history revealed that there had been no traumatic experiences with his peers that could produce such intense fears. His parents, however, had been separated for a period of six months and his father had only recently moved back home. For two years Marty had witnessed such intense fighting between his parents that, at times, it subsided only with police intervention.
After several therapy sessions Marty was able to identify that he was angry with his parents and that he had strong fear of another separation. “Don’t you love each other anymore?”, he asked perceptively. His parents were no longer fighting, but they had great difficulty trusting each other and, subsequently, they were not particularly affectionate.
In family sessions, Marty’s parents apologized to him for their behavior and insisted that they were motivated to improve their marital relationship. They specified, “You don’t have to be afraid. Were not going to separate again because we love each other and were going to work this out .” Although these words comforted Marty, he did not trust them fully.
When it was explained to Marty that the resolution of his own anger would help his fears diminish, he decided to work on thinking of forgiving his par ents for the hurts and disappointments of the past. His work on forgiving was aided by the fact that his parents regularly requested forgiveness from him for all the stress they had caused him.
As Marty worked at forgiving his parents, he became aware that he had much more anger than he realized with each of them. The therapist made the recommendation that he should not feel guilty because the anger was justified and if he worked regularly at forgiving, he would experience his anger diminishing in time. Over the course of several months, Marty experienced a much greater degree of comfort and sense of safety in going to school and found himself feeling much less angry with his parents.
At the same time, the therapist was seeing Marty’s parents and attempting to strengthen the trust in their relationship and work on forgiveness between them. Consequently, the improvement in the marital relationship helped to diminish Marty’s separation anxiety disorder symptoms in a significant way.
Separation anxiety disorder symptoms are found frequently in the children of divorce and marital separation. Children respond to absence of a parent in the home and the collapse of their parents marriage as a major traumatic emotional event. They regularly develop the catastrophic fear that they may then lose their mother.
During the absence of a father from the home, mothers can help their children by reminding them that they have another father who is with them, St. Joseph, and by placing images of this saint in the bedrooms of the children. These sad, angry and fearful children are also supported by meditating during the day, “Lord, you are with me as a friend. Help me to feel safe and to believe that you will protect my mother.”
Obsessive-Compulsive Disorders in Children
Obsessive-compulsive symptoms are often a defense against strong feelings of fear and anger which the child is unable to face. Damage to trust leads to the development of fears which is often unrecognized. Also, very sensitive children are often predisposed by their temperament to the development of anxiety. Fears can lead to obsessional thinking and to compulsive behaviors which are an unconscious attempt to diminish anxiety.
Please go to the mistrust checklist later in this chapter to evaluate your child’s symptoms of mistrust and the possible origins of this conflict. If many symptoms of mistrust are identified, please write a list of fears you believe your child may have struggled with at different ages. Next, please go to the anger checklist earlier in this chapter and rate your child’s anger.
Forgiveness helps to resolve the anger and associated aggressive obsessions in these youngsters and thereby assists in their recovery from OCD. It also helps to “ purify the memory” by diminishing the anxiety from the past.
In a major study of adolescents with OCD there was a high co morbidity (association) with disruptive disorders and tic (Tourette's Disorder), mood, and anxiety disorders (Geller D, 1996). Many children whom we have treated with rapid, involuntary, sudden movements have very strong fears of a catastrophic event occurring in their lives such as the loss of a parent. Catastrophic obsessional thinking can also be manifested as a fear of suicide in a child who is not hopeless and who does not want to die.
The most frequently reported obsessions were:
- fearful thoughts of catastrophic events, often involving a loved one or oneself
- violent thoughts of hurting someone which are often the result of unresolved anger
The other disorders seen in association with OCD were:
- 53% had a disruptive disorder
- 43% had oppositional defiant disorder
- 73% had major depression
- 33% had ADHD
Origins of OCD in children:
- fear of illness, death,
- fear of being hurt by others
- unresolved anger
- rejection by peers or siblings
- severe weakness in confidence
- parental fears/ OCD
- excessive parental anger
- perfectionistic thinking acquired from a parent
- traumatic family events with serious illnesses/early deaths
- fears of parental loss or divorce
- loss of trust due to insensitive caretakers of child when young.
Case Study
This case study from Helping Clients Forgive demonstrates the value of forgiveness in resolving symptoms in an obsessive-compulsive disorder.
Van, a seven-year-old first grader, developed a severe germ phobia and extremely compulsive behaviors. After going to the bathroom he would regularly spend twenty minutes to a half an hour cleaning himself. At school he would not open or close any doors without first covering his hand with his sweater to protect himself from germs. He limited his play with his friends because of his fear of being contaminated by germs. His compulsive behaviors increased and required larger amounts of time. The only anger Van manifested was when his parents tried to shorten the time he spent in compulsive behaviors.
Initially, Van had no awareness of any difficulties which preceded the development of his symptoms. However, when his parents were seen alone, they related numerous stresses in their relationship. His mother had been sick over the previous two years with severe chronic fatigue and numerous vague health problems which resulted in prolonged bed rest. She had had a very stressful relationship with her mother as a child and had difficulty in trusting her husband. Also, even though Van's parents rarely quarreled, there was very little affection in the marital relationship. Although each was dissatisfied with the marriage, they were not considering separation or divorce; neither were they working to improve their marital relationship.
Van denied having any fear that his parents might separate or divorce although he had been informed by them that there was considerable stress in the marriage. He, in fact, called their relationship good. When asked about his mother who had been in bed for almost two years, he insisted, I'm not worried about her. She’ll be fine. It was suggested to Van that he might have developed a fear of something bad happening to him as a result of his mothers illness and of the stress in his parents marriage. It was explained to him that these fears might have been too frightening to face, so instead of addressing them, he acquired the fear that he might contract a serious illness from germs.
Van’s parents made a commitment to work toward a resolution of their difficulties so that their relationship would improve. The therapist then told Van that he thought he had also denied angry feelings toward his parents and validated those feelings as being normal. Then he was asked to think daily that he wanted to forgive his parents. He reluctantly agreed to think of forgiving his parents for those times when they were not kind or loving to one another even though he was not consciously aware of being angry with them. After several months of therapy Van was able to admit having angry feelings toward his parents. Also, Van was encouraged to trust that his parents marriage would become a happier one. Work on forgiveness and trust over a period of six months, in addition to participation in marital therapy by the parents, resulted in a significant improvement of Van’s obsessive-compulsive symptoms.
Other helpful interventions for OCD include:
- treatment of parental fears, perfectionistic thinking and anger
- forgiving those who have been insensitive in the past
- working against catastrophic thoughts by trusting more
- medication
- creating distance from school bullies including home bound education or a school change
- the use of serotonin reuptake inhibitors (SSRIs) for children with severe symptoms
- employing, when appropriate, the role of faith by encouraging the child to ask the Lord or Our Lady to help the child feel safe and by trusting the Lord with one’s fears
- trying to make acts of trust before giving into compulsive behaviors such as hand washing and checking
- consulting with a Catholic priest for Catholic children whose OCD is the result of severe fears of illness and death.
Obstacles in the treatment of OCD include:
- a compulsive need to control in the child or a parent
- a desire to punish others or seek revenge with a refusal to give up anger
- withdrawal into the sick or victim role as a way to avoid or control others
- unwillingness of parents to address their anxiety, perfectionistic thinking and anger
- permissive parenting.
Major Peer Disorder: Adjustment Disorder with Anxiety due to Bullying
We have seen large numbers of patients over the past 30 years whose emotional pain was primarily the result of peer rejection, insensitivity and ridicule in their childhood and adolescence. A major reason for insensitive peer treatment today is narcissism. While the diagnosis in these children and teenagers is often adjustment disorder with anxiety, we suggest to these children and their parents that their diagnosis should really be a major peer disorder. In fact, these children are frequently very gifted boys and girls.
Several studies cite that 21% of children in middle school (Bouton, 1992) and 22% in elementary school (Austin, 1996) report that they have been bullied. Children who are bullied by their peers often develop a number of psychological difficulties including social isolation and loneliness (Boulton, 1992), psychosomatic symptoms and hyperactivity (Kumpulainen, 1998), anxiety, social phobia (Gilmartin, 1987), depression and suicidal ideation (Rigby, 1999), fear of going to school and low self-esteem. Also, their peers regularly side with the bullies against them, do not support them and even develop strong anger toward them (Rigby, 1991). As a result of harsh treatment by their peers these children and teenagers develop regularly intense anger and at times violent impulses for revenge against their tormentors.
These impulses can become obsessive even though usually they are not acted upon. The anger in these children which is really meant for their peers can be misdirected often into the home toward younger siblings or the mother. Embarrassment concerning the abusive treatment by peers often keeps the child from relating their feelings to their parents. Subsequently, parents are often unaware of the causes of their children’s excessive anger.
Victims of bullying may:
- be harassed because of his/her clothing
- not be good in sports/lack of eye hand coordination
- be intellectually gifted
- have strong creative and artistic gifts
- have strong moral code
- be small in stature, overweight, thin, etc.
- be from a wealthier family
- be confident.
Case Study
Miguel, a ten-year-old boy, told his parents whenever other children made him a scapegoat at school or at sports. Although he was the smartest student in his class and a good athlete, he became increasingly anxious and angry as a result of the constant ridicule by peers. The apparent reason for the abuse was his protruding front teeth. They called him Bucky the Beaver at every opportunity. To his credit, even when he was outnumbered, he was emotionally strong and had no difficulty responding in an assertive way to his tormentors. However, he developed symptoms of anxiety as a result of peer ridicule.
The anger with his peers regularly spilled over into his relationships with others in the family. Miguel knew he was misdirecting anger and was motivated to try to resolve his resentment with his peers. He was asked daily to try to view his peers as being jealous of his intelligence and athletic abilities and then to think of forgiving them. He was helped in this process with his fathers encouragement. Miguel’s dad told his son that he had been subjected to similar treatment as a boy. Miguel actually came to feel compassion for his peers and viewed them as being weak males who could not face him individually, but needed to hide in a group.
Our clinical experience from treating bully-victims for over two decades is that bullying has increased significantly in our schools and communities. Teachers, regardless of length of service, report not being confident in their ability to deal with bullying and 87 per cent want more training (Boulton 1997). New programs for teachers and students need to be developed to protect children in our schools, to help victims learn how to resolve their strong anger with impulses for revenge, to encourage peers to understand bullies and to support victims, and to provide treatment protocols for the hostility in bullies.
When parents complain to the school about the bullying of a child, a common response from school administrators is to hold the victim equally responsible for the conflict(s). In our clinical experience this often is not the case. Then, parents can present a written list of the bullying episodes with the name(s) of the bully and insist that bullies participate in an empirically proven anger management program. They may also request that teachers receive more training on dealing with anger in the classroom and with bullying.
The experience of being bullied can lead to a major depression and loneliness, intense anger and impulses for revenge, anxiety and mistrust, low confidence, obsessive-compulsive symptoms, social isolation and even paranoid ideation. In addition to trying to resolve anger with the bullies by a process of forgiveness, many of these youngsters benefit from working on attempting to build their ability to trust;that is, their ability to feel safe with their peers.
When appropriate, the role of faith can be beneficial in the healing process. Growth in trust can occur in some children by suggesting that they meditate several times daily, “Lord help me to feel safe with friends whom I can trust .” Also, participation in parish youth groups lead to a new ability to feel safe with peers. Many youngsters have been hurt so deeply by bullies that they are unable to forgive them. discover that they cannot forgive those who have bullied them. Catholic youngsters can be helped by giving their anger to God, reflecting that revenge belongs to God or taking their deep resentment into the Sacrament of Reconciliation. The process of resolving anger with bullies is challenging and requires a great deal of strength and grace.
Some male also discover within themselves an anger with God for allowing them to be hurt regularly by their peers. They can experience a relief by expressing aloud, "God, why did you let this happen to me?"
Growth in confidence in the victims can occur in a number of ways including by working on male friendships and by being thankful regularly for one's special God-given gifts.
When the school is unable to protect children from the pain of ongoing harassment or insensitive treatment, other options can be considered including enrollment in a chart school or placement in another school.
Children of Divorce/Stepchildren
Conflicts with excessive anger and mistrust in children from divorce families have been reported in many studies (The Unexpected Legacy of Divorce, Wallerstein, 1991). Also, some stepchildren harbor serious resentment toward their biological parents which is often hard to control. They may deny the anger, but this powerful emotion can emerge in times of stress. Stepparents can also have difficulties with their anger as a result of a number of factors including residual resentment from their previous marriage.
Parents who are considering divorce should also consider reading Between two worlds; The inner lives of children of divorce by E. Marquadt, 2006 and The effects of divorce on America, The Backgrounder, Executive Summary by P. Fagan and R. Recto, 2000, the Hertiage Foundation.
Case Study
Rachel was a thirty-five year old married woman who, in addition to her own two children, had two stepchildren in her home. The step-children had been deeply hurt by their alcoholic mother and her abusive boyfriend before they had come to live with Rachel. The children's anger that was meant for the adults with whom they had formerly lived was frequently misdirected toward Rachel and the other children. Their angry behaviors created enormous tension in the home. Rachel became so exhausted and overwhelmed that she even considered separating from her husband, Aaron. She began therapy and quickly after the first session took steps to become assertive with her stepchildren. She identified the origin of their anger and encouraged them to try to let go of their resentment by forgiving their mother and her boyfriend rather than by misdirecting their anger.
It was particularly difficult for Rachel's stepson, Brad, to let go of his anger with his mothers physically abusive boyfriend. Brad viewed that this man as being emotionally sick and his opinion was validated by the therapist. The treatment of his anger was facilitated by punching a pillow and then by thinking he wanted to let go of his impulses to strike back.
This work of forgiveness was a lengthy and difficult process for the children and, at times, they continued to overreact in anger toward Rachel. When that would happen, she would remind them that she did not deserve their anger and would encourage them to try to let go of their resentment with their mother by forgiving her. They were helped in the process by trying to recall that much of their mothers behavior was the result of her illness of alcoholism. Finally, Rachel modeled forgiveness in the home by asking for forgiveness for any ways in which she may have disappointed the children and by granting it to others who hurt her, including their father.
Some children from divorced families harbor rage and some have violent impulses against a parent. Often these young people are unable to use the word forgiveness because they sincerely believe that the parent, stepparent or parents friend should not be forgiven. In lieu of using the word forgiveness, when these children choose the spiritual form of forgiveness, they are asked to think that they are powerless over their anger and want to turn it over to God.
It is important for such strong anger to be addressed because the failure to do so can result in hostile impulses becoming misdirected internally or outwardly toward the family, school, or community. Also, the failure to face and resolve the anger predisposes these children to depressive episodes and difficulties in trusting.
Adopted Children
Adopted children and adolescents can have difficulty with excessive anger. In our experience, this anger originates from a number of sources, including traumatic memories with their birth parents or other caregivers, shame, a profound difficulty in trusting, or other experiences of rejection. These youngsters can exhibit angry behavior and usually lack an understanding of the origin of their resentment. Their anger can diminish by discussing the early-life, unconscious betrayal anger which may develop after separation from a biological parent. The youngster should be encouraged to consider making a decision to work at forgiveness rather than venting anger in an excessive manner. In some cases forgiveness exercises are given to them in which the young people are asked to think of forgiving one or both biological parents for abandoning them.
The hostile feelings in such children are a defense against their feelings of vulnerability and fear of further betrayal. These youngsters often will only work at changing hostile behavior after their trust in the adopted parents has grown significantly.
Case Study
Amber was an intelligent nine-year-old girl who was adopted from Russia at the age of five with her two-year-old brother. After being taken away from her drug addicted mother who was a prostitute, Amber was placed in a strict orphanage and later related being treated in a harsh manner there. Her adjustment to her family and community was quite difficult. She distanced her adoptive parents, children in the neighborhood, and anyone who tried to befriend her. She became increasingly angry and later engaged in violent behavior toward her mother.
The therapist told Amber, You have every reason to feel very angry about what happened to you in Russia with your mother and in the orphanage. However, that anger has never left you and now you are misdirecting at your mother and others. Why not try to think that you want to forgive your birth mother rather than take that resentment out on your mother? I have seen forgiveness diminish the anger in other adopted children. Amber denied this anger for months.
At home her mother was told to tell her that she didn't deserve her hostile aggressive treatment and that if she could forgive her birth mother her anger would diminish and they might have even have a good relationship.
Amber slowly acknowledged that she had felt a great deal of resentment toward her birth mother for her addictive behavior and for failing to protect both her and her brother. She also expressed anger toward the caretakers of the orphanage in Russia. Painful memories emerged in which she recalled hitting her birth mother in Russia when she was drunk. It was suggested to Amber that at the present time she was misdirecting intense hostile feelings that she had for her birth mother toward her adoptive mother and was using her anger as a defense to keep everyone at a distance.
Amber was given handwritten forgiveness notes to take home and work on between sessions. These notes stated, (1). I want to stop misdirecting my anger at those who don't deserve it. (2). I want to try to understand that my birth mother was sick with a drug addiction and I want to try to forgive her. (3.) I want to let go of the anger from Russia so that I can be free and not controlled by the past. She was challenged to trust people more than her mother had ever been able to trust. It was stated that unless she took these steps, she might be as lonely, unhappy, and fearful as her birth mother.
As she worked on trust and forgiveness of past hurts, Amber became aware that some good could come from her pain. She expressed the desire to become a health professional and someday go back to Russia to help children who had suffered in the same manner as she. As her resentment diminished and her trust grew, she became much less defensive and hostile toward her mother and toward her peers.
Amber's mother had a great devotion to Our Lady and encouraged her to think of Mary protecting her now and as her other loving, healthy mother when she was in Russia. She also asked her to reflect that Our Lady could help her to feel safer in relationships and that this would diminish her fears of being abandoned.
In an important study published in 2005 of 1,484 young adult inter country adoptees in the Netherlands the adopted young adults were 1.52 times as likely to meet the criteria for an anxiety disorder as the non adopted young adults. The adoptees were 2.05 times as likely to meet the criteria for substance abuse or dependence. The adopted men were 3.76 times as likely to have a mood disorder as non adopted men. Surprisingly, the adoptees with high parental socioeconomic status were 2.17 times as likely to meet the criteria for a disorder as non adoptees with high parental socioeconomic status. (Tieman,, 2005).
Mistrust Checklist
Children who experience separation anxiety disorders, divorce and separation stress, bullying victimization or adoption have sustained damage to their basic ability to trust and feel safe in or outside the home. Their difficulty in trusting is often not identified adequately. The mistrust checklist below has helped many parents in understanding the nature of their children s’ conflicts.
Please answer by identifying the appropriate number which applies to your child using this scale on the following mistrust checklist:
0 - Never | 1 - Very Little | 2 - Moderately Often | 3 - Very Often