Causes and Effects of Dysfunctional Family Relationships

To raise a healthy child requires consistent reliable diligence, love, kindness, effective communication and the ability to apply reasonable parameters and boundaries of discipline in the home. Understandably, financial and emotional provisions are standard necessities if one is to raise a balanced family and have a reasonable lifestyle. When parents repeatedly fail to deliver their roles with awareness and sensitivity to each member of the family, the family unit may become unbalanced. Difficult behaviours may result in one or all of the family members. Dysfunctional relationships occur and are maintained when the action and communication lines are continuously breeched and broken and can not be restored for the benefit of each party.

The infant is designed positively at birth to receive a level of quality nurturing from its biological care givers. Apart from the infant's absolute dependency, all infants come into this world with physiological and emotional needs that ought to be considered responsibly and lovingly as they grow and develop. The family environment that parents create plays an important role in determining how an infant will be raised and whether it will be a well adjusted child, teenager and finally, a responsible adult, who in turn will rear its own well orientated family.

Long term deprivation, neglect or abuse of specific needs (caused by insensitive parenting roles), are able to affect a child's development, emotional responses and personality formation. These behaviours will readily transfer from parents to their offspring. If dysfunctional role modelling and communication have occurred within the family without any intervention and no behaviour modifications are managed in the individual's lifetime, the transmission of these behaviours is probable and will very likely prevail into the next generation.

Frequent displays of negative (or absent) communication and behaviour, by one or more persons within the family, which are ultimately difficult for the family members to cope with, will seep into the family, creating a dysfunctional set of relationships. Each individual in the family may encounter a level of reaction while relationships spiral and change into a fixed pattern of responses that deal with what they are experiencing. These burdening moments defy the norm. Families may be openly oblivious of these events and may accept the havoc as it comes because this is what they are used to, while others unused to the change may grasp for unusual coping mechanisms or hopefully, realistic and humane solutions to avoid their re-occurrence .

All families experience their unique troubles and problems at some stage or another. In all fairness, these events should pass. We all know this. Life in this millennium is not designed to be a straight line without hitches and bumpy rides now and again. However, when problems re-occur frequently in the home, parents need to be aware of them and pay attention to their remedy if they are to avoid permanently dysfunctional relationships within the family.

Symptoms that may be the cause or effect of the dysfunctional family may include one or more of these consistent behaviours:

– Difficult parents without adequate flexibility and insight
– Absent parenting style (there, but not there)
– Ridicule or belittling, or over-criticizing
– Prejudice towards one or more family members
– Mixed feelings of love and hate
– Faulty communication
– Lack of attentiveness to issues of importance (brush off, downplay or avoidance)
– Lack of care or concern for the needs of another (absent care or denial)
– Lacking in the ability to empathise with children, siblings or parents

– Dual values ​​and double standards, or lack of clear boundaries
– Diminished ability to make decisions
– Over-interest or micro management of one member or the entire family
– Insensitivity towards other family member (s)
– Emotional intolerance
– Emotional outbursts
– Emotional insecurities
– Depression, deep rooted anxiety and feelings of gloom and despair
– Childish behaviours in adults
– Poor self image and worth, or lack of sufficient self identity
– Controlled / contrived speech or stifled speech
– Verbal abuse which others must tolerate
– Sexual or physical abuse that other members must accommodate
– Overworked family environment lacking any family fun (workaholic – no recreation)
– Perfectionist behaviours, over-demanding parents or children
– Disowning behaviours of parents or children
– Isolation or inadequate socialising with others
– Narcissistic parents or children
– Rule-by-fear parenting
– Bullying (to re-gain the upper hand)
– Growing up too fast because of advanced roles
– Reduction of roles and responsibilities caused by over protectiveness

Source by Kiki Bakker

Gifts For Kids With Down Syndrome

Down syndrome is a disorder which can not be treated though there are techniques and tips to keep the developmental abilities of the kids and infants to be responsive to the environment.

If you are a grandparent or a person who needs to pick up a gift for a kid or a teen with Down syndrome you need to be well aware what Down syndrome is and what kind of gift works well with the kids with this disorder so as to not offend the sensibilities of the kid. Often the gifts need to be sensitive to the parents feeling too as it is they who have this child who is different than other kids.

The kids with Down syndrome have to be specifically geared to responds to the social fabric around them as well as be receptive to the needs of the social environment they are in. Down syndrome can affect the sensory movements of the kids or the moor movements of the kids.

The motor movements are of two types namely the large motor movements and the fine motor movements. The large motor movements are of the legs and arms. There are special gifts for kids who are slow to have these movements. These toys can be given as gifts for the kids for example toys with sounds or toys with special gyms in it which will help develop the strength in arms and legs.

The sensory skills of the kids with Down syndrome are also very weak and the best gifts for kids with Down syndrome are to give them things which can develop these skills. These gifts include the blankets or special paying quilts with big patches of different colors and sizes as that will help develop the sense of color and sizes.

Another very special need of kids with disorder sis need to have a companion they socialize with also they need to be told that they are sensitive and can be taken cares of. The need for emotional security is very foremost for them. Hence in the market place there are dolls which are made in cognizance of the above fact I have stated above regarding the need for emotional and social security.

So make sure to give an appropriate downs syndrome gift.

Source by Alka Kheterpal

Pathological Eating Disorders and Poly-Behavioral Addiction

When considering that pathological eating disorders and their related diseases now afflict more people globally than malnutrition, some experts in the medical field are presently purporting that the world's number one health problem is no longer heart disease or cancer, but obesity. According to the World Health Organization (June, 2005), "obesity has reached epidemic proportions globally, with more than 1 billion adults overweight – at least 300 million of them clinically obese – and is a major contributor to the global burden of chronic disease and disability. Often coexisting in developing countries with under-nutrition, obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups. "The US Centers for Disease Control and Prevention (June, 2005), reports that" during the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30 percent of US adults 20 years of age and older – over 60 million people – are obese. This increase is not limited to adults. The percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6-19 years, 16 percent (over 9 million young people) are considered overweight. "

Morbid obesity is a condition that is described as being 100lbs. or more above ideal weight, or having a Body Mass Index (BMI) equal to or greater than 30. Being obese alone puts one at a much greater risk of suffering from a combination of several other metabolic factors such as having high blood pressure, being insulin resistant, and / or having abnormal cholesterol levels that are all related to a poor diet and a lack of exercise. The sum is greater than the parts. Each metabolic problem is a risk for other diseases separately, but together they multiply the chances of life-threatening illness such as heart disease, cancer, diabetes, and stroke, etc. Up to 30.5% of our Nations' adults suffer from morbid obesity, and two thirds or 66% of adults are overweight measured by having a Body Mass Index (BMI) greater than 25. Considering that the US population is now over 290,000,000, some estimate that up to 73,000,000 Americans could benefit from some type of education awareness and / or treatment for a pathological eating disorder or food addiction. Typically, eating patterns are considered pathological problems when issues concerning weight and / or eating habits, (eg, overeating, under eating, binging, purging, and / or obsessing over diets and calories, etc.) become the focus of a persons' life , causing them to feel shame, guilt, and embarrassment with related symptoms of depression and anxiety that cause significant maladaptive social and / or occupational impairment in functioning.

We must consider that some people develop dependencies on certain life-functioning activities such as eating that can be just as life threatening as drug addiction and just as socially and psychologically damaging as alcoholism. Some do suffer from hormonal or metabolic disorders, but most obese individuals simply consume more calories than they burn due to an out of control overeating Food Addiction. Hyper-obesity resulting from gross, habitual overeating is considered to be more like the problems found in those ingrained personality disorders that involve loss of control over appetite of some kind (Orford, 1985). Binge-eating Disorder episodes are characterized in part by a feeling that one can not stop or control how much or what one is eating (DSM-IV-TR, 2000). Lienard and Vamecq (2004) have proposed an "auto-addictive" hypothesis for pathological eating disorders. They report that, "eating disorders are associated with abnormal levels of endorphins and share clinical similarities with psychoactive drug abuse. The key role of endorphins has recently been demonstrated in animals with regard to certain aspects of normal, pathological and experimental eating habits (food restriction combined with stress, loco-motor hyperactivity). "They report that the" pathological management of eating disorders may lead to two extreme situations: the absence of ingestion (anorexia) and excessive ingestion (bulimia). "

Co-morbidity & Mortality

Addictions and other mental disorders as a rule do not develop in isolation. The National Co-morbidity Survey (NCS) that sampled the entire US population in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), roughly 50% had a diagnosable Axis I mental disorder at some time in their lives. This survey's results indicated that 35% of males will at some time in their lives have abused substances to the point of qualifying for a mental disorder diagnosis, and nearly 25% of women will have qualified for a serious mood disorder (mostly major depression). A significant finding of note from the NCS study was the widespread occurrence of co-morbidity among diagnosed disorders. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more additional disorders. These persons with a history of three or more co-morbid disorders were estimated to be one-sixth of the US population, or some 43 million people (Kessler, 1994).

McGinnis and Foege, (1994) report that, "the most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000) , toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Acknowledging that the leading cause of preventable morbidity and mortality was risky behavior lifestyles, the US Prevention Services Task Force set out to research behavioral counseling interventions in health care settings (Williams & Wilkins, 1996).

Poor Prognosis

We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private treatment programs (for example) relapse within the first year following treatment (Gorski, T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?

Diagnostic Delineation

Thus far, the DSM-IV-TR has not delineated a diagnosis for the complexity of multiple behavioral and substance addictions. It has reserved the Poly-substance Dependence diagnosis for a person who is repeatedly using at least three groups of substances during the same 12-month period, but the criteria for this diagnosis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting Medical Condition's section (DSM-IV-TR, 2000); maladaptive health behaviors (eg, overeating, unsafe sexual practices, excessive alcohol and drug use, etc.) may be listed on Axis I only if they are significantly affecting the course of treatment of a medical or mental condition.

Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field, when the latest DSM-IV- TR does not even include a diagnosis for multiple addictive behavioral disorders. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictive and mental health disorders and related treatment needs and comprehensively provide education / awareness, prevention strategy groups, and / or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals' life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.

New Proposed Diagnosis

To assist in resolving the limited DSM-IV-TRs' diagnostic capability, a multidimensional diagnosis of "Poly-behavioral Addiction," is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and / or sex / pornography, etc.). Behavioral addictions are just as damaging – psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.

Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and / or spiritual / religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and / or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and / or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 – month period in which an individual is pathologically involved with three or more behavioral and / or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (eg, using / abusing substances – nicotine, alcohol, & drugs, and / or acting impulsively or obsessively compulsive in regards to gambling, food binging , sex, and / or religion, etc.) simultaneously.

New Proposed Theory

The Addictions Recovery Measurement System's (ARMS) theory is a nonlinear, dynamical, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. Multiple influences trigger and operate within high-risk situations and influence the global multidimensional functioning of an individual. The process of relapse incorporates the interaction between background factors (eg, family history, social support, years of possible dependence, and co-morbid psychopathology), physiological states (eg, physical withdrawal), cognitive processes (eg, self-efficacy, cravings , motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in an individual's behavior can result in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous little interactions.

The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual's develop to any one form of treatment to a single dimension of their lives, because the effects of an individual's addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (eg nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual's primary addiction. The ARMS 'theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual's life dimensions in addition to developing specific goals and objectives for each dimension.

The ARMS acknowledges the complexity and unpredictable nature of lifestyle addictions following the commitment of an individual to accept assistance with changing their lifestyles. The Stages of Change model (Prochaska & DiClemente, 1984) is supported as a model of motivation, incorporating five stages of readiness to change: pre-contemplation, contemplation, preparation, action, and maintenance. The ARMS theory supports the constructs of self-efficacy and social networking as outcome predictors of future behavior across a wide variety of lifestyle risk factors (Bandura, 1977). The Relapse Prevention cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the ARMS theory.

The ARMS continues to promote Twelve Step Recovery Groups such as Food Addicts and Alcoholics Anonymous along with spiritual and religious recovery activities as a necessary means to maintain outcome effectiveness. The beneficial effects of AA may be attributable in part to the replacement of the participant's social network of drinking friends with a fellowship of AA members who can provide motivation and support for maintaining abstinence (Humphreys, K .; Mankowski, ES, 1999) and ( Morgenstern, J .; Labouvie, E .; McCrady, BS; Kahler, CW; and Frey, RM, 1997). In addition, AA's approach often results in the development of coping skills, many of which are similar to those taught in more structured psychosocial treatment settings, thereby leading to reductions in alcohol consumption (NIAAA, June 2005).

Treatment Progress Dimensions

The American Society of Addiction Medicine's (2003), "Patient Placement Criteria for the Treatment of Substance-Related Disorders, 3rd Edition", has set the standard in the field of addiction treatment for recognizing the totality of the individual in his or her life situation . This includes the internal interconnection of multiple dimensions from biomedical to spiritual, as well as external relationships of the individual to the family and larger social groups. Life-style addictions may affect many domains of an individual's functioning and frequently require multi-modal treatment. Real progress however, requires appropriate interventions and motivating strategies for every dimension of an individual's life.

The Addictions Recovery Measurement System (ARMS) has identified the following seven treatment progress areas (dimensions) in an effort to: (1) assist clinicians with identifying additional motivational techniques that can increase an individual's awareness to make progress: (2) measure within treatment progress, and (3) measure after treatment outcome effectiveness:

PD- 1. Abstinence / Relapse: Progress Dimension

PD- 2. Bio-medical / Physical: Progress Dimension

PD- 3. Mental / Emotional: Progress Dimension

PD- 4. Social / Cultural: Progress Dimension

PD- 5. Educational / Occupational: Progress Dimension

PD- 6. Attitude / Behavioral: Progress Dimension

PD- 7. Spirituality / Religious: Progress Dimension

Considering that addictions involve unbalanced life-styles operating within semi-stable equilibrium force fields, the ARMS philosophy promotes that positive treatment effectiveness and successful outcomes are the result of a synergistic relationship with "The Higher Power," that spiritually elevates and connects an individuals' multiple life functioning dimensions by reducing chaos and increasing resilience to bring an individual harmony, wellness, and productivity.

Addictions Recovery Measurement – Subsystems

Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions can not be cured, but only managed – how should we effectively manage poly-behavioral addiction?

The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual's comprehensive life-functioning progress dimensions. The "ARMS" – systematically, methodically, interactively, & spiritually combines the following five versatile subsystems that may be utilized individually or incorporated together:

1) The Prognostication System – composed of twelve screening instruments developed to evaluate an individual's total life-functioning dimensions for a comprehensive bio-psychosocial assessment for an objective 5-Axis diagnosis with a point-based Global Assessment of Functioning score;

2) The Target Intervention System – that includes the Target Intervention Measure (TIM) and Target Progress Reports (A) & (B), for individualized goal-specific treatment planning;

3) The Progress Point System – a standardized performance-based motivational recovery point system utilized to produce in-treatment progress reports on six life-functioning individual dimensions;

4) The Multidimensional Tracking System – with its Tracking Team Surveys (A) & (B), along with the ARMS Discharge criteria guidelines utilizes a multidisciplinary tracking team to assist with discharge planning; and

5) The Treatment Outcome Measurement System – that utilizes the following two measurement instruments: (a) The Treatment Outcome Measure (TOM); and (b) the Global Assessment of Progress (GAP), to assist with aftercare treatment planning.

National Movement

With the end of the Cold War, the threat of a world nuclear war has diminished considerably. It may be hard to imagine that in the end, comedians may be exploiting the humor in the fact that it was not nuclear warheads, but "French fries" that annihilated the human race. On a more serious note, lifestyle diseases and addictions are the leading cause of preventable morbidity and mortality, yet brief preventive behavioral assessments and counseling interventions are under-utilized in health care settings (Whitlock, 2002).

The US Preventive Services Task Force concluded that effective behavioral counseling interventions that address personal health practices hold greater promise for improving overall health than many secondary preventive measures, such as routine screening for early disease (USPSTF, 1996). Common health-promoting behaviors include healthy diet, regular physical exercise, smoking cessation, appropriate alcohol / medication use, and responsible sexual practices to include use of condoms and contraceptives.

350 national organizations and 250 State public health, mental health, substance abuse, and environmental agencies support the US Department of Health and Human Services, "Healthy People 2010" program. This national initiative recommends that primary care clinicians utilize clinical preventive assessments and brief behavioral counseling for early detection, prevention, and treatment of lifestyle disease and addiction indicators for all patients' upon every healthcare visit.

Partnerships and coordination among service providers, government departments, and community organizations in providing treatment programs are a necessity in addressing the multi-task solution to poly-behavioral addiction. I encourage you to support the mental health and addiction programs in America, and hope that the (ARMS) resources can assist you to personally fight the War on pathological eating disorders within poly-behavioral addiction.

For more info see:
Poly-Behavioral Addiction and the Addictions Recovery Measurement System,
By James Slobodzien, Psy.D., CSAC at:

[Http://www.geocities.com/drslbdzn/Behavioral-Addictions.html]

Addicts Anonymous Food: Http://www.foodaddictsanonymous.org/
Anonymous Alcoholics: Http://www.alcoholics-anonymous.org/

References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision. Washington, DC, American Psychiatric Association, 2000, p. 787 & p. 731.
American Society of Addiction Medicine's (2003), "Patient Placement Criteria for the
Treatment of Substance-Related Disorders, 3rd Edition ,. Retrieved, June 18, 2005, from:

http://www.asam.org/
Bandura, A. (1977), Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review,
84.191-215.
Brownell, KD, Marlatt, GA, Lichtenstein, E., & Wilson, GT (1986). Understanding and preventing relapse. American Psychologist, 41, 765-782.
Centers for Disease Control and Prevention (CDC). June 18 Retrieved, 2005, from: Http://www.cdc.gov/nccdphp/dnpa/obesity/
Gorski, T. (2001), Relapse Prevention In The Managed Care Environment. GORSKI-CENAPS Web
2010. Retrieved People Healthy June 20, 2005, from: Http://www.healthypeople.gov/
Publications. June 20 Retrieved, 2005, from: Http://www.tgorski.com
Lienard, J. & Vamecq, J. (2004), Presse Med, Oct 23; 33 (18 Suppl): 33-40.
Marlatt, GA (1985). Relapse prevention: Theoretical rationale and overview of the model. In GA
Marlatt & JR Gordon (Eds.), Relapse prevention (pp. 250-280). New York: Guilford Press.
McGinnis JM, Foege WH (1994). Actual causes of death in the United States. US Department of Health and Human Services, Washington, DC 20201
Humphreys, K .; Mankowski, ES; Moos, RH; and Finney, JW (1999). Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Ann Behav Med 21 (1): 54-60.
Kessler, RC, McGonagle, KA, Zhao, S., Nelson, CB, Hughes, M., Eshleman, S., Wittchen, H. H, -U, & Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United
States: Results from the national co morbidity survey. Arch. Gen. Psychiat., 51, 8-19.
Morgenstern, J .; Labouvie, E .; McCrady, BS; Kahler, CW; and Frey, RM (1997). Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. J Consult Clin Psychol 65 (5): 768-777.
Orford, J. (1985). Excessive appetites: A psychological view of addiction. New York: Wiley.
Prochaska, JO, & DiClemente, CC (1984). The transtheoretical approach: Crossing the boundaries of therapy. Malabar, FL: Krieger.
Slobodzien, J. (2005). Poly-behavioral Addiction and the Addictions Recovery Measurement System (ARMS), Booklocker.com, Inc., p. 5.
Whitlock, EP (1996). Evaluating Primary Care Behavioral Counseling Interventions: An Evidence-based Approach. Am J Prev Med 2002; 22 (4): 267-84.Williams & Wilkins. US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria, VA.
US Department of Health and Human Services. Healthy People 2010 (Conference Edition). Washington, DC: US ​​Government Printing Office; 2000.
World Health Organization, (WHO). June 18 Retrieved, 2005, from: Http://www.who.int/topics/obesity/en/

Source by James Slobodzien

Common Reasons That Affairs Do not Last

I get a good deal of correspondence from wives who are hoping that their husband's affair fails miserably. These wives are typically looking for statistics that are going to give them reassurance that the affair is ultimately going to end and go up in flames.

Someone might ask: "my friends are telling me that affairs never last and that my husband's affair is eventually going to end without my needing to do a lot about it. They say that I am wasting a lot of energy worrying because the odds are in my favor. In truth, I do not know a lot of people who have cheated. and the one couple that I do know who met each other when having an affair actually ended up leaving their spouses and getting married. Admittedly, they have a rocky marriage and trust is always an issue between them. But their relationship is still going. so is it true that most affairs do not last? and if so, why? "

The Numbers: It is absolutely true that most affairs do not last. Statistically speaking, only between 3 and 5 percent of affairs end in marriage. This is quite low. And when you consider that 75% of second marriages fail, you get a sense of how unlikely it is that even if an affair couple marries, they will have a life-long relationship. I'd suspect that the divorce rate for couples whose relationship started as an affair would be higher than the 75% divorce rate of second marriages.

Post why? For the same reasons that affairs in general do not last. I will list some of these reasons below.

The Relationship Is Based On Secrecy, A Lack Of Integrity, And Lies: Any time your relationship is based on negative, shameful things like secrecy and lies, this does not give it a very good foundation. In truth, neither person likely feels very proud of this background. There is shame and guilt from the very beginning. While other couples will proudly reminisce about meeting in church or on a blind date, the cheating couple have to reminisce about how they pretty much started their relationship in a closet while lying to others. This is not the best way to begin. Not only that, but often this couple's friends and family members are secretly hoping that they fail because they do not approve of how the relationship started.

If He'll Do It With You, He'll Do It To You: This is probably the biggest obstacle that these couples face. They struggle with trust. And this is understandable because each person has already shown themselves to be capable of cheating and leaving their spouse for the cheating partner. Now that the cheating parter has become the spouse, what is to stop the cheating from happening with someone new? Of course, every one wants to believe that they are so special that they are soul mates who will never need or want to cheat again. Statistically speaking though, this is usually not true.

The Dynamic Of The Relationship Changes: Remember when I said that the people in the cheating relationship believe that they are special? Well, in a sense they are sort of right. It is hard for a marriage to compete with an affair – at least on one level – because it's a fantasy that is not rooted in reality. The affair partner is not having to pick up anyone's dirty socks. And the woman in the affair just wants to focus on the positive – she does not nag or exhibit any real expectations, especially at first. Theoretically, it is all about fun.

But when they are in a long term relationship or married, this changes. Suddenly, she does have to pick up his dirty socks. She seems him the bathroom cutting his nose hairs and burping at the dinning room table. He sees her dying her hair and plucking her eyebrows. That's not as attractive as seeing her only when she's only at her best.

In short, the monotony of a marriage suddenly replaces the excitement of the affair. And it's not nearly as exciting and magical. This can leave both people feeling very let down and disappointed that they traded in their old life and hurt so many people when they are now pretty much living their old life with someone new and still having a new set of complications.

In Hindsight, The Affair Did Not Make Everything Better: People often assume that the affair is going to fix all of their problems or insecurities. This just is not possible as you have to do this for yourself. So that is another set of disappointments that soon become apparent.

In short, an affair rarely lives up to the promise it starts with. Once it has to exist in reality, it changes. Plus, it often starts with so much against it that is nearly impossible to keep the momentum going.

So I would agree with your friends that the odds are definitely in your favor – simply because the odds and statistics tell us that most affairs are not lasting and do not end in marriage. However, I do not think that this is a reason to just sit back and do nothing for your own healing. There is plenty that you can do for yourself to move yourself forward regardless of what your husband is doing at the time. I think that it's important that you do not just wait around for him to come to a decision or realization. Self help or counseling can mean that you move forward regardless of what he decides. And this does not mean that you're moving away from your marriage necessarily. It just means that you are strengthening yourself so that when there is a resolution, you are ready.

Source by Katie Lersch

Gifts They'll Love – 12 Thoughtful, Memorable, Useful Gifts

Socks, shirts and sweaters – they do make useful gifts, but they're boring.

Here are some GREAT gift ideas …

(In other words … How to make your girlfriend / boyfriend love you forever.)

GIFTS FOR HER

You can not go far wrong with chocolates and flowers, but you can find gifts which are even better.

The trick to thoughtful, considerate, MEMORABLE gift giving is to give a gift which involves a little bit of work on your part. When she sees your gift and realizes the trouble you went to just for her, she'll be impressed. Let's face it – she may actually be amazed to discover that you're not the inconsiderate slob she thought you were.

Here are some ideas for memorable gifts …

1. This is SO simple, but she'll love it – and you, for being so thoughtful.

Give her a digital photo frame. But wait! That's NOT the gift. Gather together a collection of your best pics of the two of you together (nice romantic ones) and load them into the photo frame. For years to come, every time she looks at those photos, she'll love you a little bit more. You'll keep winning points every day!

(An attractive photo album will make a good gift, too. Remember to fill it with pictures of the two of you together.)

What's so convenient about this gift is that it does not matter if she already has half a dozen digital photo frames or photo albums. It's adding your own personal touch that makes YOUR gift so memorable.

She'll love the fact that you went to a little bit of trouble to make this gift so special.

2. Give a promise. For this thoughtful gift idea, you're limited only by your imagination – and by how well you know her.

Give her a nice card saying: "The owner of this card is entitled to a full body massage by …" and YOU be the one who gives her the full body massage. That's a gift for two, right?

You could promise "an afternoon of pampering at XYZ Beauty Salon".

Or your card could promise a romantic night in. Candles, a setting for two, and a meal cooked by you.

3. What if you do not trust your own cooking? That's OK. In the US, you can get delicious gourmet meals delivered to your door by GourmetStation.com. You can choose from various styles – Parisian, Cajun, Fusion, etc., and even get special Christmas and Thanksgiving dinners. What a fabulous gift.

4. Perfume is not very original, but think of the benefits … It's a wonderfully effective gift because (a) women love perfume and (b) she'll think of you every time the scent you gave her wafts into her nostrils. Think how often that is! So make sure to be VERY careful to buy her favorite brand or one very similar. Have a little chat with her best friend or sister and ask for tips.

5. Gift certificates. OK, I'll admit this is a little bit boring, but a Gift Certificate is a very useful gift because you can 100% guarantee that she's going to receive a gift she WANTS – because she'll choose it. And it will fit.

6. Wine is a lovely gift. Think about it. What goes WITH a nice bottle of wine? Answer: A cozy, memorable meal for two while you sample your gift. And afterwards …? Well, that's up to you. If you're feeling specially generous, give her a Wine of the Month Club membership. Remember, gifts that keep on giving, keep her thinking of you. (A wine club membership can be a perfect gift for a man, too, for all the same reasons.)

Want to know what other gifts your girlfriend may like to receive? You can listen to hints she drops as her birthday or Christmas approaches, but it will probably be much more useful if you have a little chat with her best friend.

GIFTS FOR HIM

Men are basically simple. They like gifts they can eat or drink. Here are some ideas …

1. A Micro Beer of the Month Club membership. How could you possibly go wrong with a gift like this? He'll think of you fondly every month when a new beer arrives to sample.

2. Most men love gadgets, too. Hugely popular right now is the Flip Mino HD camcorder / video camera. This tiny camcorder is super slim, super sleek, weighs only 3.3 ounces and yet it will take one hour of high-quality video. He can use the USB to plug it into his computer to recharge it, and connect it by cable to the TV to watch the videos on TV. Even if he has not mentioned the Flip Mino, he WANTS this! You can have fun together using it.

3. A Cloud 9 Experience. Here's something he'll remember for the rest of his life – and remember the thoughtful person who gave it to him. It's an extraordinary, special experience from Cloud9Living.com. Experiences range from ballooning, car racing, dune buggy rides and bungee jumping to more sedate but still memorable experiences such as wine tasting or a gondola cruise, and a whole lot of other adventure experiences. You can also choose a Cloud 9 experience you share together. Check it out. He'll love this.

4. Times are tougher, now, right? But you do not want to hand over money. Giving money is thoughtful but somehow misses the spot, does not it? Here's something better … Give him an investment in one of America's big businesses. Think you can not afford that? Do not worry – OneShare.com specializes in selling ONE SHARE in each of a lot of large companies. This gift will remain a talking point for years to come – and he'll think of you every time that big company is in the news. If it makes him think of you, it's got to be a useful gift!

5. Steak. A man who does not drool over a luscious, tender steak is rare indeed. Make his favorite dinner and turn it into a special occasion by candlelight. Sound too simple? Do not be fooled. He'll LOVE this!

6. Lobsters delivered. Show him how much you love him by ordering something really special. With any luck, you'll get to share the delicious meal. You can order gourmet meals from GourmetStation.com – you job is to provide the candlelight and the romance. Enjoy!

Source by Trish Donella

What Is a Trilogy Ring?

Many people are confused and curious as to what this three stone ring is and represents. The most succinct definition of the word trilogy is a group of three. Initially the three pertained to three related literary works, either books or films, but later the word trilogy has been combined with the word ring in the jewellery world to represent a certain style of ring.

The trilogy ring is a three stone ring consisting of purely diamonds, or two diamonds and a feature gemstone.

When would you present a trilogy ring?

Many people use these three stone rings instead of the more traditional diamond solitaire engagement ring, to propose to their loved one. Another instance when the ring is used is on significant anniversaries or occasions which are meaningful to you as a couple and partnership. The gentleman may also present this ring as a gift to his wife or partner upon the birth of their child.

These rings are not only a modern phenomenon and have been available for some time now. Many antique trilogy rings can be found in the Victorian era, where they were equally as popular. Many more modern takes of this three stone ring can now also be found.

Trilogy versus the eternity ring

The Eternity ring is a full circle of diamonds and this represents the full circle of love, this full circle also signifies never ending. Whereas the trilogy represent love of past, present and future! Although they both differ in their meaning they both stem from the sentiment of love. Therefore the preferred ring would simply depend on the message and sentiment you are trying to convey to your loved one as well as what you feel they personally would prefer.

So what does the trilogy ring stand for ?

The symbolism behind the trilogy ring appeals to today's generation, offering the declaration (and confirmation) of you are my past, my present and my future, which replaces the simpler sentiment of I love you offered at the turn of the century.

Often with trilogy ring, the central stone is slightly larger, or set slightly higher than the other two supporting stones, to signify the importance of the present, reaffirming the significance of we are in this moment together. Diamonds are thought to be the ultimate symbol of love and durability of promises made, however the centre stone of a trilogy ring may be a particular gemstone employed to convey a further feeling or emotion, such as: green emerald for faithfulness, the blue sapphire for truth and peace and the red ruby ​​for passion.

When the trilogy ring is given in a mature relationship, it is said that the centre stone defines commitment, and the supporting stones, trust and respect. Many Christian couples may consider an alternative meaning with the centre stone representing God as the hub of the relationship and the two side stones the couple joined through their faith in God.

The engagement ring, wedding ring and eternity ring all signify particular moments or events. The versatile trilogy ring may be presented as an engagement ring or as alternative to the more conventional eternity ring. The trilogy ring may also be given as a token of expression around a personal celebration or sentiment such as the birth of a child, or an anniversary.

So, what is the meaning of a trilogy ring? In a nutshell, a trilogy ring declares: You are my life – My past, present and future are with you. Could there be a more romantic way to acknowledge your relationship than to celebrate the past, present and future you share together?

Source by Andrew Stuart Campbell

Texting Games to Play With Your Boyfriend at Night

Sometimes, nights can be long and exchanging normal boring text messages with your boyfriend can do very little to stop the tossing and turning. However, thanks to dirty texting games, you can turn those boring nights into one of erotic moments and sexual anticipation.

There's something about night and text messages, somehow you seem to always know what to say one text after the other. Maybe it's the state of relaxation that we find ourselves in when lying between the sheets that make our mind's wander into the creativity world.

To help keep your boyfriend engaged during those nights when you find yourself feeling a little raunchy, here are some texting games you might consider trying;

Story builder … This game involves building up a story with imaginary characters from scratch. The beauty of this game is that you can take it any direction you want as long as it excites both of you. You can make it dirty at some point, funny, naughty or intimate. Alternatively you can select a theme and build a story around it. You can agree on the rules or sets of words and even the character limits just to keep it exciting.

Kiss marry kill … One of the most intriguing and entertaining games, Kiss marry kill is a perfect game to play with your boyfriend when you want to make your night's shorter. Basically, your boyfriend will name three personalities be it famous or close people in your life and you will choose who you want to kiss marry and kill. The intention of this game is to bring out some laughter in both of you, but you can add a sexual twist to it.

This can be done by using dirty lines to describe the actions of some characters in the game which will effectively turn it into dirty texting games you can engage in with your boyfriend during those nights when time seems to stand still.

What if … What if, just like the name implies is an answer and question game. It involves asking your boyfriend how he would react to certain situations. For instance you can ask him what if both of you were left on an island alone. Ask him what the first thing he would do to you. The answers to the questions do not necessarily have to be true, but they should always remain suggestive to pave the way for the next question.

I spy … This classic game is fun and thrilling if played the right way. Start by telling your boyfriend where you are. That way he will know the type of item he is looking for. From there on, send him a text saying, I spy with my little eye an item that starts with … followed by the first letter of the item you're looking for. He should guess the answer of the item you're looking for.

It's either he gets it right or gives up. You will send him the answer and it will be your turn. To bring in a sexual feel to the game ask for items that have sexual attachment to them like your lingerie, his pants and so on. Remember the aim here is take ordinary games and turn them to dirty texting games as long as they fulfill your desires.

I want to … There is nothing as sexy and arousing than telling your man what you want to do at night or finding out what he wants to do. "I want to" game is the perfect game to play if you want to get naughty all night long with your boyfriend. This game can turn overly sensual and leave both of you craving for each other's body. It's one of those texting games you play when you want to set the stage for explosive sex the next time you meet with your boyfriend.

Not only can you make your night's shorter with these games, but you can increase your sexual drive and that of your boyfriend as well. As long as you have a phone, there's no reason why you have to spend sleepless nights tossing and turning in bed.

Source by Connie Lewis

Special Occasion Flower Delivery

Do you want to surprise that special someone? Is it someone's birthday? Do you want to send a "just because" message to someone? Well then you should look into using flower delivery service.

A flower delivery service always saves the day with those last minute special occasion gifts. If you are trapped at the office and can not find the time to get away to buy a gift for that someone special, you should send a bouquet of flowers to brighten their day and let them know you care.

If a person is having a bad day and they need a little cheering up, you can let them know you care with a small "I'm thinking about you" flower bouquet. Everyone likes to know that they have someone who cares about them enough to make an effort for them just for no reason at all. You can take advantage of the delivery service that will come with the purchase of the flowers too.

The flowers can be ordered over the phone or online and then with a credit card and a delivery address the flowers can be on their way whenever you ask them to be there. The flowers can arrive even the same day of the purchase. Rush deliveries may cost you a little more but they are always available. Whether you are trying to book a flower delivery a month from the date you purchase them or even a few days from the date, it is going to cost you the same amount and will be the same fresh flowers you ordered every time.

Weddings often use special occasion flower delivery services. It is hard to get THAT many flowers from point A. to point B. unless you have a van or a truck. These services will prepare decorations and bouquets of flowers of your choice and have them delivered and set up at the place the event is being held.

Birthdays also deserve a little sweetening too. People love getting flowers for their birthday. They look great at work or at home to freshen up any room or desk. If someone is working on their birthday it is always a nice gesture to give a bouquet of flowers to them to brighten up their day.

Getting flowers just makes people feel good. You do not need to go all out spending all that time finding a meaningless gift at the mall or what have you. Whatever the occasion and no matter how special it is, the flowers will be extra special to the person receiving such a thoughtful gift.

Source by Mark Middleton

Sexual Roleplaying – What it is and the Best Way to Do It

Roleplaying is simply when participants adopt and act out characters that are not themselves. Sexual roleplaying therefore is when couples act out characters with an erotic motivation as part of a sexual fantasy. It can range from being serious with costumes, accents, props, etc. to just being something that is imagined, like being stuck on a deserted island. Practically any role could be involved in sexual roleplaying as long as both people involved are interested. Pretending to be someone you are not can be fun and exciting when done correctly.

Roleplaying can also be good for a marriage as it may be an opportunity for a spouse to ask for something she has always wanted done to her or done for her, but never felt comfortable asking for. For example, in a roleplay where the wife is the dominant person (boss) she might feel more open about telling her husband (employee) that she wants to have her body rubbed in a certain way that she had never asked for before. The reduction of inhibitions can be great for a marriage as inhibitions are a killer of sexual enjoyment.

Some roleplaying scenarios are:

* Animal-related where one is treated as a non-human animal such as a dog or pony
* Hospital fantasies involving doctors, nurses and patients
* Stranger-related one or both spouse pretend to "meet" for the first time
* School related – Headmistress and Student or Teacher and Naughty Schoolgirl
* Photographer and Model
* Stripper and Client
* Business related – Boss and Employee, Boss and Secretary

If this is your first time thinking about roleplaying, start with something simple, like Photographer and Model and then move on to ones where the acting requirement is a little higher.

Roleplaying is a lot of fun and is easy, but there are a few important requirements:

1. requires open communication
2. It requires a willingness to participate
3. requires honesty
4. It requires not taking yourself too seriously
5. requires establishing rules

Let's examine these requirements in a little more depth.

1. Roleplaying requires open communication – Roleplaying can involve actions that when taken too far, might be uncomfortable for one or both partners. Let's say a couple pretends to be strangers who meet in a bar. They pretend to have different pasts and even different names. As the night continues, the husband begins to feel uncomfortable being called a different name. As soon as he realizes this, he needs to be able to communicate with his wife that he wants to end the fantasy or just be called his real name and continue, or another option he feels comfortable with. Whichever he chooses, being able to discuss that with his wife, even in the middle of the roleplaying, is vitally important.

2. Roleplaying requires a willingness to participate – Perhaps a husband wants to be the boss and have his wife pretend to be his secretary with a German accent. His wife should not worry about whether that makes sense, if she knows what a secretary does all day, or if she has any idea what a German accent sounds like. She should give it her best try and of course, have fun!

3. Roleplaying requires honesty – The husband finds his new doctor very attractive so he gets his wife to pretend to be a doctor and tries to make the fantasy about his new doctor. This is NOT a situation in which roleplaying should be used, nor is it the purpose of roleplaying. The husband needs to be honest with himself about his motivations for the roleplaying. He may not need to tell his wife he is attracted to his doctor, but he definitely should not start a roleplaying session with the goal of thinking about anyone other than his wife. All sexual fantasy, including roleplaying, is just a tool that helps married couples increase their sexual pleasure with each other.

4. Roleplaying requires not taking yourself too seriously – In a roleplaying session, the husband might pretend to be an airline pilot while the wife pretends to be a stewardess. Since neither of them have real airline clothing, they make do with what they have. His outfit leaves him looking more like a butler than an airline pilot which could lead him to cutting short the session out of embarrassment. Instead if he is able to play around and ignore the idea that he looks silly, he will probably end up having a great time.

5. Roleplaying requires establishing rules – Similar to open communication, rules are important should something need to change or stop during a roleplaying session. This might be as simple as "no" means "no" or could be something that has been pre-arranged as in a certain stopping time for a specific situation. A couple should always stay where they are both comfortable even if a fantasy heads in an unplanned direction. Also, setting and timing need to be right (as with any sexual encounter). Perhaps a roleplaying scenario was planned for today and a wife comes home from a horrible day at work. A postponing may be in order. Again, the ultimate point of roleplaying is to have fun and enjoy each other.

Source by Ron Chapman Jr.

Paradise Lost & Epic Simile

Satan is depicted in epic terms throughout Paradise Lost, but in ever diminishing ways. Beginning with the arch fiend's address to his nearest mate, Beelzebub, (1.192-208), Satan is a Titanian figure, yet even here referred to, immediately following, in lesser form as Earth-born, a foreshadowing of his coming diminution. The text goes on, calling Satan Leviathan, a whale in size, that creature which God had made the hugest that swim th 'ocean stream, (1.202). He is imagined asleep on the Norway foam, a reference to things northern, thus implying mammoth dimensions in the reader's mind. Milton returns to this reference later in his depiction of fallen cohorts. Continuing, Satan is so big that a sailor might take him for a small island, dropping anchor overnight to escape the sea wind, and wait till morning. (1.205)

The implication of an ongoing fall continues, as if Satan's plunge may never end. He is allowed to pursue his dark designs, but he does so only with the high permission of all ruling heaven, (1.212). Heavenly permission granted, Satan sprouts wings, takes off into air that felt unusual weight, and alights once more with his sidekick Beelzebub. Both have recovered slightly, escaping the Stygian flood as Gods, and not by the sufferance of supernal power, (1.240-241). Satan's determination to overcome his fate is on display, as he rouses himself and his fellow fallen angel.

Further on, (1.283-302), Satan is shown in even more graphic, yet still epic ways, as the superior fiend. Beelzebub has just finished addressing Satan, which but th 'omnipotent none could have foiled, thus raising his profile. But Milton again takes him down a notch in a very subtle way, comparing his shield in epic terms to the moon, (1.287), which object everyone knows hangs suspended in Earth's orbit, and reflecting not its own light, but light from a larger , more powerful source. The author ends the simile by referring to Satan's massive following of fellow fallen angels. Once again Milton chooses a rather pathetic analogy, saying that Satan's legions are Thick as Autumnal leaves, (1.302), thus not only fallen to the ground, but a symbol of death, low regard and seasonal change as well.

Satan reproaches his Princes and Potentates, (1.315), rousing them to fight back. Those other fallen angels are then shown in epic terms, as they stirred to obey, their general's voice, (1.337). Their numbers were such that they resembled a plague of locusts, a reference to Moses' showering Egypt with a horde of those biblical insects, turning day to night. This reference is telling, since the fallen are once again described in terms of dark versus light. The plague is not only dark, it is carried on an eastern wind, a symbol in Milton's world of ominous change, since the east was a source of exotic and dangerous infidels. The geographic menace is extended, when the angels are compared to hordes arriving, this time from the north, home of barbarous tribes spreading over Europe, beneath Gibraltar to Lybian sands, (1.355), thus engulfing the civilized world.

Beelzebub is depicted in epic ways in Book 2 of Paradise Lost. Satan's second in command, Beelzebub is shown as an almost epically sad figure, perhaps a mirror image of man in his inability to exercise free will, and thus suffer the fate of a stronger angel. His name, from a Caananite reference meaning Lord of the Flies, presents an image of servitude, of someone willing to take whatever falls from the table. He rises, with, grave aspect, as a pillar of state, (2.303). Here, Beelzebub appears to be rising to the occasion, claiming his rightful place as Satan's counselor, Majestic though in ruin. Proud, but obsequious, he may be Satan's alter ego. He is reluctant to lead, yet eager to serve, to operate in reflected light. This is epic hubris, as it represents hero-worship, and the refusal to exercise free will.

The epic simile continues, citing Beelzebub's Atlantean shoulders fit to bear the weight of mightiest monarchies, (2.306). Is this strength and resilience, or willingness to suffer under someone else's dictates? Or is it perhaps Milton's first mention of the need for human reverence and obedience to the Almighty? Regardless, Beelzebub is ready to serve. Yet, like Adam embracing his fate at the end of the poem, Beelzebub's counsel is taken. Hearing of the coming of a new creature, some new race called Man, (2.348), Satan adopts Beelzebub's wisdom, and the epic contest is begun.

Source by Edgington Byron