Mental Health

People with obsessive-compulsive disorder and body dysmorphic disorder are more likely to be dependent on tanning

You know the type. They have dark brown skin in the middle of February and take constant trips to the tanning salon. It’s the tanning addict.

We may joke about Snooki’s bad habits, but new research published in the Journal of the American Academy of Dermatology suggests that people who tan excessively also experience some mental health symptoms that should be taken seriously, like obsessive-compulsive disorder (OCD) and body dysmorphic disorders (BDD).

The researchers surveyed 533 tanning students at Bowling Green State University in Ohio and determined which ones exhibited behaviors dependent on tanning. Participants who responded “yes” to a minimum of three out of eight criteria points in the Tanning-DSM–a modified guide from the substance abuse criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders–were classified as tanning dependent. Participants who answered yes to two out of four questions on a tanning version of a CAGE alcohol screener–which tests for alcoholism–were classified as exhibiting problematic tanning.

Researchers discovered that women who screened positive for BDD and OCD were at a greater risk for being tanning dependent. The participants who reported tanning at a minimum of nine times in the last 30 days were at the greatest risk of being dependent on it.

But calling a behavior “addicting” is serious business, and psychiatry is not quick to do so. “We have tanning addiction in the title, but we don’t jump to the conclusion automatically that tanning is and can be an addiction,” writes study author Lisham Ashrafioun. “We’re saying that we shouldn’t necessarily rule this out especially if people are tanning excessively, even if they aren’t experiencing any OCD or body dysmorphic disorder.”

The pressure to choose a public identity can be harmful for people who haven’t decided on a private one, but at the very least seeing that long list can make you feel less isolated

At age 8, Eli Erlick wanted to be treated as a girl. But teachers denied the child’s request to join the girls’ gymnastic team or play on the girl’s side in the “Battle of the Sexes” academic competition. “That’s impossible, Eli,” they said. “You’re a boy.” Still, Eli persisted in wearing lip gloss and skirts, and spent the rest of elementary school eating lunch alone to escape the daily harassment of classmates.

By 13, Eli’s parents allowed their child to begin the transition from male to female, which meant adopting a feminine appearance, changing school records, and starting hormone treatment a few years later. That’s also when she learned about the concept of transgender, an umbrella term used to describe people whose gender identity differs from the sex they were assigned at birth. “It was such a relief. I found a word to finally describe who I was,” says Erlick, 18, a freshman at Pitzer College in Claremont, California, who founded the national advocacy organization Trans Student Equality Resources.

She also found joy in Facebook’s announcement last week that the social media giant has added 58 new options to the binary “male” and “female” choices in the user profile gender question. They include everything from androgynous to gender questioning to pangender. Erlick checked three boxes she felt represented her: Trans Woman, Trans Person, and Trans Feminine (because that’s how she presents herself to the world). “Being able to identify as a trans woman is so powerful,” she said. “I want to be among people like me.”

Mental health professionals who serve the transgender community overwhelmingly praise the decision for giving a voice to the more than 700,000 transgender people living in the U.S. who have long felt invisible. In 2012, the term “gender identity disorder” was stricken from the The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2012, though gender dysphoria is recognized and describes those who experience emotional distress over “a marked incongruence between one’s experienced/expressed gender and assigned gender,” which can lead to depression, post-traumatic stress, suicide, and other mental health disorders.

But “for people who are clear about who they are and want to be visible and have people mirror their identity back to them, this is a tremendous movement forward,” says Diane Ehrensaft, PhD, a clinical psychologist and director of the Mental Health Child and Adolescent Gender Center in Oakland, California.

But what if you’re 15 and not sure who you are? The sheer number of choices can be overwhelming, cautions Ehrensaft. The pressure to choose a public identity can actually be harmful for people who haven’t yet decided on a private one.

Many transgender people like Erlick knew who they were from a young age, but others need years – even decades – before they’re ready to check a box (or several). While the “coming out” experience is widely varied, there is a common sequence. “There’s a coming to consciousness that there’s something going on inside me that doesn’t match how the world sees me. One child told me ‘I shouldn’t have a penis. I’m a girl,’” says Ehrensaft. Then there’s a period of exploration. “You try a lot of things on for size. The expansive Facebook categories give you lots of choices. You’re swimming around in them. You might just grab a pole. You can always change it,” she says. (The last two stages involve disclosing your identity and then resolving to live in your gender.)

But jumping around from “gender nonconforming” to “gender fluid” to “transsexual” may be harder in a forum like Facebook after making a public statement, especially to an audience of family and friends who don’t understand their nuances, she says. (Parents of some of Ehrensaft’s clients learned about their children’s gender identity this way.) Also, even though the act of declaring who you are to the Internet can feel liberating, it’s also anxiety-producing. “Every time they make themselves public, they open themselves up for possible pushback from hostile people,” she says.

Yet there is an upside to so many choices. For those people who are wrestling with their identity, the existence of something other than the generic “transgender” is educational, adds Ruben Hopwood, PhD, trans health program coordinator at Fenway Health in Boston. “I see people who tell me ‘I don’t like my gender.’ Now this will push them to think more thoroughly about what they’re feeling,” he says.

Even if you refuse to check any gender box (just like you don’t have to advertise your relationship status or political views), seeing that long list can make you feel less isolated. “People going through this often think they’re the only ones like this in the world,” Hopwood says. “This is a message that you’re not alone.”

A previous version of this story stated that Eli learned about the concept of transgender at age 16. It has been corrected.

Sarah Elizabeth Richards is the author of Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It.

Get moving and seek out sunlight... but avoid bingeing on junk food and Netflix

It’s President’s Day, and thanks to the polar vortex you’ve probably been cooped up inside your house for days or maybe even a full week as the snow continues to fall. And the weather is taking a toll. Many are complaining of cabin fever or worse — snow rage.

Cabin fever isn’t a psychiatric diagnosis, but it does exist, says Josh Klapow, a clinical psychologist with a PhD at the school of public health at the University of Alabama at Birmingham. “Basically, it’s your mind’s way of telling you that the environment you are in is less than optimal for normal functioning,” he says. “It’s when you’re in a space of restricted freedom for a period of time that you can no longer tolerate.”

Before you get full on “snow rage” — a term the media has coined for the extreme angst people are feeling about the weather — and pull a shotgun on a snow plow driver, here’s how you can recognize when you’re getting too stir crazy and how you can cope.

You probably are getting cabin fever if any of the following are true:

1. You’re feeling cooped up
2. You’re having difficulty concentrating on what’s in front of you
3. You feel lethargic, or simply feel unmotivated to do anything
4. You are feeling irritated and on edge for no apparent reason

The best way to get yourself out of your slump and in a happier mood is to get moving, find natural sunlight, and do anything that can engage your cognitive activity. The more ambitious snowed-in people can go for a run around the bloc, start a home improvement project or read a book by window. Those feeling a little less motivated can at least make a snow angel for 10 minutes, sketch out projects they will take on once it’s sunny again, or at least pull up the blinds and play a brain-teasing app like QuizUp. Anything but watching marathons of TV on the couch. Sorry, House of Cards fans, but unless your body and brain are active you are likely to become listless and depressed.

Also, avoid foods that will only make you feel more sluggish or more irritated. “We have a tendency, particularly in this country, of shoving ourselves full of high-carb and high-fat foods when we have nothing else to do. That’s not good because they create lethargy,” says Klapow. “The other thing we do is sit around and drink coffee, which is also bad because that feeds agitation.”

For some, it’s not just a matter of motivating themselves to cheer up but also motivating kids who have been stuck inside during a series of snow days. “I can say as someone whose kids have been home for the last four days, you get to a point where you’re turning around and being like, ‘Are you still here?’” jokes Klapow.

Though having children home for days at a time during the school week can be tough, solving their cabin fever is even easier than solving yours. “Kids are going display their cabin fever in a more obvious sort of way. They’re going to pick on each other or they’re going to jump up and down,” says Klapow. “But we can tell them to go bundle up and run around outside for 15 minutes, whereas its harder to motivate ourselves to do the same as adults. You can control what they’re eating, even though its harder for us to regulate our own food intake. But helping your kids get energized with games and the right eating habits can help you alleviate your cabin fever too.”

It’s important, he says, to find ways to up our mood before we reach our tipping point. “Snow rage is not a clinical diagnosis,” Klapow says. “But you can think of it as the point where individuals have lost their ability to control their emotions, and the results are actions that are harmful to others — like yelling at a spouse or hitting your neighbor with a snow shovel.”

Let’s hope the snow ends soon so it doesn’t come to that.

The source is age-old problems like what they should do after high school

Since 2007, the American Psychological Association (APA) has conducted a survey of different aspects of stress in America. This year’s analysis focused on teens, and on a 10-point scale, adolescents ranked their stress at 5.8, compared with a score of 5.1 reported by adults.

Even more disturbing, says Norman Anderson, CEO and executive vice president of the APA, is the fact that most teens knew their stress levels weren’t healthy – they said 3.9 was probably more desirable – but did little about it. In fact, the survey revealed that 42% of teens aren’t doing enough to manage their stress.

That’s concerning, since unaddressed stress can lead to both short-term mental-health issues such as depression, as well as lay the seeds for chronic conditions such as heart disease, diabetes, and high blood pressure in adulthood.

MORE: Eat Better and Stress Less: It’ll Make Your Cells (and Maybe You) Live Longer

What’s causing teens to feel so anxious? Eighty three percent cited school as a source of stress, including concerns about their future after high school and worries about college. For some, family financial issues also caused anxiety, which wasn’t surprising since previous studies found that parental stress can trickle down to children, even at very young ages.

“This population is underserved, and not taken seriously sometimes,” said Katherine Nordal, of the APA. “We wanted to shine light on some of the problems we know teens are having and whether they are successful at coping with them or not.”

MORE: The Most Stressed-Out Generation? Young Adults

Clearly, said Anderson, “We have work to do to manage stress overall. Stress levels among Americans continue to be high, but coping mechanisms remain ineffective.” Teens reported doing everything that they probably shouldn’t in order to relieve stress – they aren’t getting enough sleep, which can add to anxious feelings, and they’s less physically active. Exercise is among the best ways to reduce stress, but the survey found that teens were beginning to rely on sedentary activities, such as surfing the internet, engaging in social media or watching videos, to relieve stress.

The developer seems to have choked under the pressure of his game's success

On Saturday, Flappy Bird developer Dong Nguyen disappointed millions when he announced he would be deleting the astronomically popular mobile game. Twenty-two hours later, he did just that.

Nguyen’s game was killing it. Flappy Bird was downloaded more than 50 million times and was raking in $50,000 a day from ads, according to The Verge. But the little-known Vietnamese indie game developer started to hint that things were about to blow up. There’s some speculation that legal issues were brewing because the game had many similarities to Nintendo’s Super Mario Bros, though Nguyen denies this.

But Nguyen’s Twitter feed suggests something more personal may have been going on. Is it possible that Flappy Bird–and subsequently Nguyen–got too famous, too fast? He tweets:

Press people are overrating the success of my games. It is something I never want. Please give me peace.—
Dong Nguyen (@dongatory) February 04, 2014

I can call 'Flappy Bird' is a success of mine. But it also ruins my simple life. So now I hate it.—
Dong Nguyen (@dongatory) February 08, 2014

I am sorry 'Flappy Bird' users, 22 hours from now, I will take 'Flappy Bird' down. I cannot take this anymore.—
Dong Nguyen (@dongatory) February 08, 2014

“In a quick rise to fame, there are added demands to your time and attention. If the spotlight is causing a lot of stress and anxiety and not allowing a person to function, getting rid of it can alleviate some of that negativity,” says Sian L. Beilock, a University of Chicago psychologist and author of the book Choke. Not to mention, social media has the ability to quickly elevate someone and plop them into the middle of the national conversation in a way that wasn’t possible in the past.

Often, what psychologists refer to as “Impostor Syndrome” comes into play. Individuals cannot process their successes or feel like they are not up for the attention, and instead feel like they’re an impostor in the situation. The syndrome creates anxiety over a person’s ability to succeed.

Beilock’s research shows that the all-eyes-on-you phenomenon and the impostor syndrome can make people self-conscious and even paralyzed. “These worries can be taxing and cognitively demanding. They take up resources that could otherwise focus on problems. It’s like when an athlete thinks too much about the little things and falls on their face,” she says.

It has happened plenty of times before. Even Olympic athletes choke under the pressure, like Lolo Jones who clipped a hurdle at the Beijing Olympics and came in in seventh place instead of first. And many times, under pressure and stardom, people retreat. Comedian Dave Chapelle unexpectedly left during the production of Chappelle’s Show for a trip to South Africa. Former NFL player Barry Sanders retired from the Detroit Lions at the peak of his success. Three-time Oscar winner for Best Actor Daniel Day-Lewis has taken multiple breaks from acting, some as long as five years.

“What makes people rise to the challenge or shy away from it is the billion-dollar question,” says Beilock. For Nguyen, it’s possible it was too much, too fast–for the game, and for himself.

Nguyen did not respond to requests for comment.

Young Thais not receiving enough positive social-media feedback for their selfies spells trouble ahead for the Southeast Asian nation, claims Thailand's Department of Mental Health

Global warming, drugs and corruption are among the oft-touted threats to society at large. But according to Thailand’s Department of Mental Health, a more pressing danger is threatening the future “development of the country” — the selfie.

On Sunday, government psychiatrist Dr. Panpimol Wipulakorn warned that young Thais who post pictures of themselves on social media but don’t receive enough positive feedback are encountering emotional problems, which in turn is creating a dearth of well-balanced citizens and could eventually spell trouble ahead for the Southeast Asian nation.

“If they feel they don’t get enough Likes for their selfie as expected, they decide to post another, but still do not receive a good response,” she said in a statement, according to the Bangkok Post. “This could affect their thoughts. They can lose self-confidence and have a negative attitude toward themselves, such as feeling dissatisfied with themselves or their body.”

She added: “This could affect the development of the country in the future as the number of new-generation leaders will fall short. It will hinder the country’s creativity and innovation.”

While you’d be hard-pressed to find a smartphone owner anywhere who hasn’t indulged at some point, that Thais have a penchant for narcissistic camerawork is undeniable — even celebrated royals are selfie-obssessed, and recent antigovernment protests in Bangkok were inundated with hordes of selfie-snapping demonstrators.

“We call them Instagram protesters,” Pakkarat Phattanathanya, a producer with SpokeDark TV, tells TIME. “They turn up and take photos of themselves, but when we interview them they can’t say what the protest is about.”

Pakkarat, 29, herself admits to probably posting two selfies in the past two weeks, but because she’s “not a girlie girl” it’s likely that many of her peers take more. “I don’t think it’s a problem, but some people may get depressed,” she says, adding that “obviously the more Likes, the better.”

Panpimol warns young Thais to guard against selfie addiction by placing themselves in situations where photos are socially taboo. “If you can pass that point,” she says, “next time you will be able to control your selfie-taking behavior.” And who knows? It could even save the country.

New study says we only have four: happy, sad, afraid/surprised, and angry/disgusted

Forget the conventional thinking that humans are complex creatures with a wide range of emotions. New research suggest we only have four.

The widely held scientific assumption is that we have six emotions: happy, surprised, afraid, disgusted, angry, and sad. But a new study from University of Glasgow scientists published in the journal Current Biology this week says humans may only have four biologically based emotions: happy, sad, afraid/surprised, and angry/disgusted.

Participants of the study were shown computer-generated facial expressions and asked to identify the emotion from among the six predominantly accepted ones. At the start, anger and disgust, as well as fear and surprise, looked very similar. For example, surprise and fear have similar eyebrow movements. As the expressions developed, though, participants were able to distinguish between them, but only over time, suggesting that differences in anger, disgust, surprise, and fear are the result of social evolution rather than biological.

Emo kids everywhere are processing this news with a much more limited scope of emotion than before.

[Current Biology]

The growth of animal-assisted therapy means that man's best friend may soon be man's best medicine

During a couples-therapy session, therapist Ellen Winston of Lakewood, Colo., brought along her assistant, Sasha — who happens to be a dog.

The couple were dealing with behavioral problems in their children and, on top of that, getting a divorce. “The split was not entirely amicable, and there were very hurt and angry feelings all around,” Winston says. “The parents struggled to have a civil conversation and it often escalated into yelling, and then tears, on both sides.”

During the sessions, the couple would sit on complete opposite sides of the couch. Sasha would hop in the middle, curl up and fall asleep. Both partners would stroke Sasha at particularly emotional moments, and it helped them calm down. Still, they continued to get agitated, often letting therapy sessions intensify into screaming matches. When that happened, Sasha would quickly get up and walk to the door. Winston used those moments as teaching points.

“We [discussed] that if this is how they interact regularly, their children were likely also picking up on their moods and acting out as a result. This was one of the first times they realized that their children may be impacted by the parents own relationship.”

(MORE: Comfort Creatures)

Winston’s sessions are one of the ways animal-assisted therapy is changing. Animal-assisted therapy is different from service animals who accompany someone dealing with anxiety or depression. Those are certified as emotional-support animals (ESA), who are daily companions and covered under the Americans With Disabilities Act. Therapy animals, on the other hand, are meant to be used in counseling, whether a professional session or an informal one. Although the American Psychological Association and the American Psychiatric Association have no formal position on animal-assisted therapy, there’s evidence that small practices and individuals are exploring it. Animals are appearing in all sorts of places: in emergency rooms, prisons, juvenile-detention centers, nursing homes and, increasingly, your therapist’s office. There are no official numbers yet, but Pet Partners, a nonprofit that registers animals for animal-assisted therapy use (the largest organization to do so in the U.S.), says there were more than 1 million reported interactions between registered animals and patients last year. This number includes everything from nursing-home visits to therapy sessions.

Kathryn Kimbley, director of HumAnima CIC, an animal-assisted therapy service in West Midlands, England, brings her therapy dog Flossie to individual sessions with clients, as well as to larger groups, to comfort patients with depression, behavioral problems or even mental-health issues like PTSD. “Dogs can act very much like a social catalyst. In various settings they will encourage people to interact with one another,” Kimbley says. “It lifts the mood and makes people feel better.”

Kimbley has found that her clients feel more at ease talking to her when they’re physically distracted. “If someone is talking, they might sort of tap their foot or fidget. They have this energy they want to redirect somewhere, and they have no outlet for it. So if Flossie is in this situation, it is much easier for them.”

A therapy pet can also modulate a relationship between a client and his or her counselor. “You are dealing with powerful and overwhelming emotions, but you can’t hug a client,” says Kimbley. “With a dog present, that need is therefore met.”

(VIDEO: Rescued Stray Becomes a Therapist)

Emerging research confirms the benefits of pets on people. A 2009 study found that preschool kids with special needs were better able to follow directions during assigned tasks if they were with a trained poodle than when they were alone, with another human or with a stuffed animal dog. Other research has shown that animals are social facilitators: people tend to be viewed as more trustworthy if they have a pet, and pets are known to instigate more conversations among strangers. Animals can also lower a person’s anxiety level. “You can see some of the same changes in physiological response from looking at a fish tank as you do with petting a dog, cat or a horse,” says Sheryl Pipe, an adjunct professor of anthrozoology (the study of human-animal interaction) at Canisius College in Buffalo, N.Y. “But in terms of social facilitation, that is better suited for mammals.”

Of course, there are certain people who don’t respond well to animals in their sessions, and therapists need to distinguish between those who will benefit and those who need pet-free space. And not just any animal will work. Therapy animals are most successful when they’re a bit older and have more experience. There are no set guidelines for training animals used in therapy, and many groups use their own rubrics. Kimbley makes sure her animals are properly socialized and can react normally in a variety of situations.

But, Pipe warns, a therapy animal should be considered a partner rather than a tool. “We tend to have a greater willingness to consider the impact on our partner than our tools. We have to make sure an animal is happy participating and still has adequate time to behave like the animal that they are,” says Pipe.

“The field is still relatively in its infancy, but the data that’s beginning to come in is really encouraging in terms of how impactful this work can be.” Man’s best friend, it seems, can also be man’s best medicine.

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