Speech Impairment Awareness in Behavioral Health

Have you ever traveled to a foreign country and not known the local language? Ever blanked while speaking publicly? Perhaps you’ve experienced the terror of choking and not being able to yell for help? For those of us without consistent barriers to verbal communication, it’s easy to forget how integral speech is in our lives until, in a moment of dire need, we cannot access the necessary words. 

People who live with speech disorders, however, are much more attuned to barriers in verbal communication. Speech disorders are conditions that affect someone’s ability to make the speech sounds needed for verbal communication (Eske, 2019). Stuttering, a common type of speech disorder, interrupts speech-flow through involuntary stretching, repeating, and blocks in speech sounds (Eske, 2019).  It is estimated that over three million people living in the United States stutter (Quick 2017).

Developmental stuttering, resulting from genetic factors and abnormalities in speech motor control, affects children ages two to six and is the most common form of stuttering (Mayo, 2017; Quick, 2017). Twenty-five percent of children who stutter will experience persistent developmental stuttering, in which stuttering continues through development into adulthood (Quick, 2017). Traumatic brain injuries, brain disorders, and strokes can give rise to neurogenic stuttering.  (Mayo, 2017). Emotional trauma can bring about psyhogenic stuttering and other speech disturbances in the form of conversion reactions, though these can be difficult to distinguish from neurogenic stuttering (Mayo 2017; Almada, Simões, Constante, Casquinha, & Heitor, 2016).

Like many other health conditions, stuttering is among those that may not seem immediately tied to behavioral health. This is far from the truth. People who chronically stutter can experience feelings of anxiety, fear, shame, and frustration around the condition and may make effort to order their lives so as to avoid situations, words, people or activities that activate the alarming feelings associated with the stutter (Ginsberg & Wexler, 2000). For instance, one study that examined the effects of stuttering on quality of life in adults  found that stuttering negatively affects mental health, social functioning, and emotional functioning (Craig, Blumgart, & Tran, 2009). Another study found that stuttering puts adults at greater risk for anxiety disorders than non-stuttering adults (Iverach, et al., 2009).

Stuttering and Post Traumatic Stress Disorder (PTSD), a complex psychiatric condition resulting from experiencing intolerable amounts of stress, have been found to intersect on several levels. For instance, one case study examining the relationship between stuttering and PTSD found that the two conditions have similar neurobiological effects and symptoms, including slowed speech, slowed functioning, and memory loss from disassociation (Bigleveld, 2015). Starkweather and Givens (2004) in their report on stuttering as a variant of PTSD emphasized that stuttering itself has the potential to be a form of social PTSD. Both conditions, though distinguished from one another in levels of severity, are marked by cycles of hyper-arousal and distress around the hyper-aroused states.

As a result of the chronic, intrusive nature of the hyperaroused states, including feelings of terror, fear, anger, shame, and frustration, people with PTSD or stuttering may order their lives so as to avoid these states as much as possible (Starkweather & Givens, 2004). For instance, someone who stutters may feel immediate frustration and anxiety around saying certain speech sounds in front of a group and experience physical symptoms such as sweating or increased heart rate. The person may then try to avoid saying those words or sounds altogether. Someone who suffers from PTSD may similarly avoid those situations where triggers abound. This ultimately can impact the flow of short-term decisions, such as asking someone on a date or going grocery shopping, and long-term decisions, such as moving to a new place or choosing a career path. 

Disassociation serves as a complex mechanism in both PTSD and stuttering to protect a person from feeling the full intensity of hyper-aroused states. When someone disassociates, they may “leave” their body for a period of a few hours or days and lose touch with their sense of identity as well as other reality markers such as time and surroundings (Starkweather & Givens, 2004).

The therapeutic techniques for addressing PTSD and stuttering are similar in that the aim is to integrate intrusive, emotionally dysregulating experiences into the larger framework of a person’s life. Sustainable integration means that the PTSD or stuttering are no longer the defining factors in one’s life but instead become adaptable, moveable pieces in the puzzle. As the hyper-aroused states and other challenges associated with each condition become less central to a person’s life, the person can then move flexibly to and from states that are more livable (Starkweather & Givens, 2004). This may sound straightforward, but it is important to remember that the processes of integration are nonlinear, and every person’s therapeutic experience will different. What works for one person may not work for another.

Also like PTSD and many behavioral health topics, stuttering and other speech impairments are subject to societal misunderstanding and stigma. It is always best to take on a perspective of curiosity and get information from reliable, non-biased sources when delving into any of these issues. Let’s remember this especially as we celebrate Better Speech and Hearing Month!

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References:

Almada, A., Simões, R., Constante, M., Casquinha, P., & Heitor, M. (2016). Psychogenic stuttering: A case and review. European Psychiatry, 33. doi: 10.1016/j.eurpsy.2016.01.1389

Bijleveld, H.-A. (2015). Post-traumatic Stress Disorder and Stuttering: A Diagnostic Challenge in a Case Study. Procedia – Social and Behavioral Sciences193, 37–43. doi: 10.1016/j.sbspro.2015.03.242

Craig, A., Blumgart, E., & Tran, Y. (2009). The impact of stuttering on the quality of life in adults who stutter. Journal of Fluency Disorders, 34(2), 61–71. doi: 10.1016/j.jfludis.2009.05.002

Eske, J. (2019, March 21). Speech disorders: Types, symptoms, causes, and treatment. Retrieved from https://www.medicalnewstoday.com/articles/324764#types

Ginsberg, A. P., & Wexler, K. B. (2000). Understanding Stuttering and Counseling Clients Who Stutter. Journal of Mental Health Counseling, 22(3), 228–239.

Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., … Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 23(7), 928–934. doi: 10.1016/j.janxdis.2009.06.003

Starkweather, W., & Givens, J. (2004). Stuttering as A Variant of Post Traumatic Stress Disorder. Retrieved from https://www.stuttering-specialist.com/post/stuttering-as-a-variant-of-post-traumatic-stress-disorder

Mayo Clinic. Stuttering. (2017, August 1). Retrieved from https://www.mayoclinic.org/diseases-conditions/stuttering/symptoms-causes/syc-20353572

Quick Statistics About Voice, Speech, Language. (2017, December 21). Retrieved from https://www.nidcd.nih.gov/health/statistics/quick-statistics-voice-speech-language

Image credit: https://www.labourmobility.com/we-all-speak-english-dont-we/

Mind the Gap: Mutual Benefits of Intergenerational Relationships

Relationships between the elderly and young generations vary widely across cultures. As demonstrated in the high prevalence of multi-generational households in many collectivist cultures, adult children live with their own children and care for aging parents in the same household. In collectivist-leaning cultures, ties to family and the care for older family members take precedence over other things like one’s career or mobility. Traditionally, multi-generational households and family-provided care are not givens in cultures that place great value on individualism. However, in recent years, some highly individualistic cultures, specifically the United States and United Kingdom, have seen an increase in the prevalence of multigenerational households (Intergenerational, 2020; Tapper, 2019).

In 2015, the chief of geriatrics and palliative medicine at Northwell Health in New York, Maria D. Carney, MD, estimated through her research that twenty-five percent of adults over the age of sixty-five in the U.S. lack a caregiver and may become isolated socially and physically (Aging 2015). A body of research demonstrates that strong intergenerational relationships are significant in diminishing the negative mental health effects of elderly isolation and are mutually beneficial for young people as well (Zhang 2018). Intergenerational relationships benefit youth in fostering a positive, more accessible outlook on the aging process, increasing self esteem, and creating opportunities to practice social skills, empathy, tolerance, and patience. (Lloyd, 2008; Elizz, 2016). Likewise, these relationships are necessary for exchanging cultural identity, values, and knowledge (Lloyd, 2008). 

In light of the fact that many elderly adults are left to age in isolation, the source of care for those to whom care is accessible (another harsh truth) lies in geriatric social workers and social programs (Snedeker, 2017). Fortunately social initiatives to combat ageism and create frameworks for intergenerational relationships to thrive are in place and expanding in some traditionally individualistic cultures. For instance, Generations United, a U.S. organization whose mission is to improve lives through opportunities for intergenerational connection, has a database containing almost 700 intergenerational programs in the U.S. According to the database, in New Orleans, some intergenerational programming can be found through Kingsley House and Tulane University’s CACTUS Project: Project Grand People.

Playtime is a prime vehicle for facilitating strong intergenerational bonds. As the 20th century psychoanalyst Donald Winnicott put it, “It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in being creative the individual discovers the self.” One 2017 article on intergenerational learning programs suggests the use play prompts, such as reading picture books, having tea with a tea-set, blowing bubbles, singing songs, and drawing with crayons (Durand, 2017). For store-bought games and toys, if the packaging says “for ages 0-99,” it’s in the clear! 

Intergenerational relationships facilitated through play can extend beyond the physical world into the digital world. Building on past research exploring the beneficial nature of digital gameplay between young people and the elderly, a 2018 study found that quality gaming served as a fun way for family members of different generations to keep in touch (Zhang, 2018). In the times we are living in, specifically in the spin of COVID-19, elderly isolation is particularly poignant, and the intergenerational relationship solutions that remain (for now) are relegated to the digital realm. Although confinement to platforms such as Zoom and Skype has its own set of challenges, it also serves as an opportunity to create solutions in the world of digital accessibility.

This quarantine…

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References:

Aging baby boomers, childless and unmarried, at risk of becoming ‘elder orphans’. (2015, May 15). Retrieved from https://www.sciencedaily.com/releases/2015/05/150515083532.htm

Elizz: Benefits of intergenerational programs for seniors (2016). https://elizz.com/caregiver-resources/cool-stuff/benefits-intergenerational-programs-seniors.

Lloyd, J.: The State of Intergenerational Relations Today: A Research and Discussion Paper.International Longevity Centre, London (2008)

Multigenerational Households. (2020). Retrieved from https://www.gu.org/explore-our-topics/multigenerational-households/

Durand, S. (2017, September 12). You’re Never Too Old To Play: Intergenerational Learning Programs. Retrieved from https://www.geteduca.com/blog/intergenerational-learning/

Snedeker, L. (2017). Aging and Isolation–Causes and Impacts. Social Work Today, 17.

Tapper, J. (2019, March 10). All under one roof: the rise and rise of multigenerational life. Retrieved from https://www.theguardian.com/society/2019/mar/10/rise-of-multigenerational-family-living

Zhang, F. (2018). Intergenerational Play Between Young People and Old Family Members: Patterns, Benefits, and Challenges. Human Aspects of IT for the Aged Population. Acceptance, Communication and Participation Lecture Notes in Computer Science, 581–593. doi: 10.1007/978-3-319-92034-4_44

Image Credit: https://www.istockphoto.com/video/old-hand-in-young-hands-for-holding-helping-giving-support-gm1003673508-271147554

Let’s Not Forget Water, Folks

Water–indispensable. It makes up 71% of the earth’s surface and 55-75% of the human body, depending on age. In addition to the necessity of clean water for consumption and cleaning, water’s role in keeping the whole human body healthy extends even farther. We can also use it for play and exercise, each of which has its own benefits, specifically for mental health.

Water In Us

“Water, water everywhere, and not a drop to drink.” says the centuries-old poem by Samuel Taylor Coleridge.  As the majority of the earth’s surface is covered in water, and less than one percent of that water is drinkable, it’s safe to say Mr. Coleridge’s lyric is correct. While safe drinking water is  a basic necessity, the harsh truth is that 780 million people in the world do not have access to a safe drinking water according to the CDC’s Global Wash, Sanitation and Hygiene (WASH) reports (2016). 

Just think–the brain, which regulates cognition and mood, cannot properly function if it does not get enough water! If dehydration sets in, one might become dizzy, feel sleepy and irritable, and experience headaches among other symptoms (Khatri, 2019). Even mild dehydration has been  shown to impair cognitive processes such as memory and attention and have adverse effects on mood, specifically in children, the elderly, and women (Khatri, 2019)

Water Around Us

Spring has sprung, in some places, and it is getting warm enough to entertain a dip. Although public pools are out of the question right now, there’s nothing stopping you from setting up the kiddie pool and having a ball or swimming in a regular-sized pool–that works too. Along with the mental health benefits of better sleep and mood-boosting endorphins, a recent study in the American Journal of Psychiatry demonstrated that regular exercise can help prevent against symptoms of depression (Harvey, et al., 2018). Likewise swimming, as a low-impact, non weight-bearing exercise, is fully accessible to people with physical injuries.

Cold showers, anyone? Perhaps this sounds a bit uncomfortable to some, but the discomfort might be worth it in terms of reaping a reward. Like exercising, taking cold showers releases bodily endorphins, which have a positive effect on mood. Likewise, findings from one 2017 study illustrated that cold showers can reduce symptoms of depression in certain people. This occurs when cold temperature-receptors in the skin send a high volume of electrical impulses to the brain, resulting in a mild electric shock therapy effect (Shevchuk, 2008).

The moral of the story: Put water into you. Get into water. Your brain and body will thank you immensely.

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References:

Global WASH Fast Facts. (2016, April 11). Retrieved from https://www.cdc.gov/healthywater/global/wash_statistics.html

Harvey, S. B., Øverland, S., Hatch, S. L., Wessely, S., Mykletun, A., & Hotopf, M. (2018). Exercise and the Prevention of Depression: Results of the HUNT Cohort Study. American Journal of Psychiatry, 175(1), 28–36. doi: 10.1176/appi.ajp.2017.16111223

Khatri, M. (2019, May 30). Dehydration – Signs, Symptoms, Causes, and Prevention. Retrieved from https://www.webmd.com/a-to-z-guides/dehydration-adults#1

Shevchuk, N. A. (2008). Adapted cold shower as a potential treatment for depression. Medical Hypotheses, 70(5), 995–1001. doi: 10.1016/j.mehy.2007.04.052

Image Credit: https://www.smart-energy.com/regional-news/africa-middle-east/water-efficiency-programmes-auw/

Green Matters: A Look at Nature’s Role in Mental Health

There is no question that the relationship between humans and nature presents a withstanding duality. While nature’s elements , such as agents of disease and natural disasters, are the cause of many ailments and fatalities, humans are dependent upon physiological exchange with nature for food, clean water, air, and a myriad of other health benefits.

While beliefs and shared experiences around the holistic benefits of contact with nature have held true for much of human history, qualitative and quantitative research on this relationship has only just begun to gain momentum in the past twenty years. Reduction in human-to-nature contact because of factors like poor urban planning, exploitation of resources, and resulting lifestyle changes  is one shift that has made way for increased scientific exploration of the relationship between humans and nature (Hartig, Mitchell, Vries, & Frumkin, 2014). Likewise, the rise of the biopsychosocial model for informing the clinical community’s understanding of health has made way for studies that examine the nature-human relationship beyond “absence of illness” frameworks to include factors like subjective well being (SWB) and self actualization (Song, 2017; Hartig et al., 2014).

The body of research on the relationship between human contact with nature and mental health ranges across varying types of nature contact, including physical access to green space, “blue space” (aquatic environments), urban and rural gardens, indoor plant presence, window views of nature elements, virtual reality (VR) experiences, and even photographs (Song, 2017; Hartig et al., 2014). Many of the findings across these contexts provide evidence to support psycho-evolutionary theory, which hypothesizes contact with nature supports the function of the parasympathetic nervous system by reducing physiological activation (Hartig et al., 2014).

For instance, one study demonstrated that subjects recovered from stress-inducing situations quickly and more completely when they were exposed to audio-visual media depicting natural settings than when they were exposed to media showing urban settings (Ulrich, et al., 1991). The physiological responses to nature contact that were recorded in this study show clearly the effects on nervous system-regulation. Similarly, Farrow and Washburn (2019) studied parasympathetic activation in the context of a Japanese therapeutic practice called “shirin-yoku,” or forest bathing. The practice consists of mindful interactions with the forest environment that engage sight, smell, hearing, touch and even taste. Building on previous research supporting that shirin-yoku can reduce anxiety, stress, and symptoms of depression, this 2019 study found increases in lnHF, a chemical associated with lowering anxiety and parasympathetic activation, as well as reduced cortisol and blood pressure levels in participants of the study (Farrow & Washburn, 2019).

In addition to the physiological evidence of nature’s effects on mental health, research on human-nature contact supports improved states of psychological well-being through self-report measures and improved cognitive function(Bratman, et al., 2019). For instance, one 2017 German study found a positive association between neighborhoods with salient green spaces and social satisfaction, perceived safety, and strong relationship networks (Orban, Sutcliffe, Dragano, Jöckel, & Moebus, 2017). Likewise, findings from a 2015 study on the effects of nature walks on affect and cognition illustrated decreases in anxiety, negative affect, and rumination (Bratman, Daily, Levy, & Gross, 2015).

It is true that humans have always been navigating the push and pull of environmental relations, and we will stay in the process of navigating for as long as we are walking around as a species. One perspective is that, by virtue of living in an industrialized, Capitalist nation, we are subject to societal frameworks that are largely divorced from collective attention on the implications of human relationship with the natural environment. Through the lens of COVID-19, however, society at large sits in a unique collective space that is unified around consideration for human-to-nature relations.

 Although the the orientation to COVID-19 is saturated in collective anxiety as people face the realities of mortality, sickness, and unstable economic structures, this time of collective focused attention offers the opportunity for a shift in how we, as a society, define and maintain our systems that sustain life. In part, this could mean a societal reorientation around natural environments, perhaps through a deeper respect of our nuanced interdependence and participation in nature exploring how we can best support the natural environment as a pillar to individual and community holistic health. 

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References:

Bratman, G. N., Anderson, C. B., Berman, M. G., Cochran, B., de Vries, S., Flanders, J., … Daily, G. (2019). Nature and mental health: An ecosystem service perspective. Science Advances. doi: DOI: 10.1126/sciadv.aax0903

Bratman, G. N., Daily, G. C., Levy, B. J., & Gross, J. J. (2015). The benefits of nature experience: Improved affect and cognition. Landscape and Urban Planning, 138, 41–50. doi: 10.1016/j.landurbplan.2015.02.005

Farrow, M. R., & Washburn, K. (2019). A Review of Field Experiments on the Effect of Forest Bathing on Anxiety and Heart Rate Variability. Global Advances in Health and Medicine, 8, 216495611984865. doi: 10.1177/2164956119848654

Hartig, T., Mitchell, R., Vries, S. D., & Frumkin, H. (2014). Nature and Health. Annual Review of Public Health, 35(1), 207–228. doi: 10.1146/annurev-publhealth-032013-182443

Orban, E., Sutcliffe, R., Dragano, N., Jöckel, K.-H., & Moebus, S. (2017). Residential Surrounding Greenness, Self-Rated Health and Interrelations with Aspects of Neighborhood Environment and Social Relations. Journal of Urban Health, 94(2), 158–169. doi: 10.1007/s11524-016-0112-3

Song, Y. (2017). A cross-state comparison of measures of subjective wellbeing. International Journal of Wellbeing, 7(1), 65–83. doi: 10.5502/ijw.v7i1.561Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. (1991). Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology, 11(3), 201–230. doi: 10.1016/s0272-4944(05)80184-7

Image Credit: https://tranquilmonkey.com/artist-depicts-eternal-connection-humans-nature-wonderful-soft-dreamy-illustrations/

How Close is Too Close?: This Is Not About Social Distancing

No matter where or how folks are existing during COVID-19, there is no question that potentially triggering challenges may arise. The collective is thinking about having enough, getting needs met, the future, and the indefinite uncertainties around these things. With so much unknown and out of individuals’ control, what is certain is that today many people are spending time quarantined either alone or with others and have to cope with their environments somehow.

 Now, more than ever, is a time for considering relationships. This could look like reaching out to old friends and building community through electronic communication or perhaps taking measures to navigate being “stuck” in one place with the same people or person day after day. Perhaps some people are taking the time to go off the grid and focus on the relationship with themselves. Maybe some folks are encountering a mixture of these and other relational nuances. Regardless of what the exact circumstances are, it is true that navigating relationships at this time may take some extra care and creativity. 

Although we won’t be covering best practices for physical distance during COVID-19, we will be breaching the topic of boundaries in relationships. Not far off, right? The Cambridge English Dictionary  has several definitions for the term “boundary” that can create frameworks for how we look at relational boundaries. The first is, “a real or imagined line that marks the edge or limit of something.” The edge could be a personal edge or limit. In this thinking for example, a boundary might mark where my personal experience ends and someone else’s experience begins. The second definition is, “the limit of what someone considers to be acceptable behavior.” Here, a boundary could dictate my orientation around another person’s actions; ie: what can I tolerate? It is true that everyone has different experiences and levels of awareness concerning the content and function of relational boundaries and that we as humans are constantly navigating these nuances as they arise in our relationships. 

One view of boundary negotiation is demonstrated in the challenge of enmeshment within relationships. During the systems theory renaissance of the 1960s and 1970s in the U.S., Salvador Minuchin, pioneer of structural family therapy, coined the term “enmeshment” to describe family systems in which personal boundaries are diffuse, absent, or ill-defined (Dorfman, 1998; 2015). When a family is enmeshed, expectations to adhere to spoken or unspoken rules concerning beliefs, values, emotions, and life experiences hinder the family members from developing functional autonomous selves. Members learn to self-regulate based upon the needs of other family members or the family as a whole rather than on personal needs (Paul, 2019)

A consequence of enmeshment-informed regulation is the sense that, “I am only ok when this/these relationship(s) are ok.” While this form of regulation appears to keep the family system “intact,” it does not support the evolution of individuals as separate from their families. While the term “enmeshment” was developed in the context of understanding families, it can actually occur in any relationship (Paul, 2019). Although the qualities of enmeshment can describe a breadth of relational contexts, it is also important to remember that the concept originated in a Westernized lens supporting the philosophy of individualism. As a result, this area of study sees limitation around cultures that operate under collectivistic, rather than individualistic, value systems (Barrera, Blumer, & Soenksen, 2011).

While everyone will consider boundaries differently according to their own unique life experiences and cultural contexts, it could be helpful to think of relational boundaries as systems that allow individuals to feel the most resourced in the contexts of their relationships. For instance, the term boundary can connote a meaning that puts the focus on the outside, ie: keeping something or some behavior out of my space. While this is not an unhelpful connotation, another way to look at a boundary is exploring what the imaginary line is keeping inside. This internal view of boundaries lends opportunities for an individual to create boundaries based upon self-knowledge and exploration rather than reactions to outside circumstances. Given that a person’s internal experience can shift from moment to moment, boundaries that serve the function of inward resourcing can be fluid and change to best serve the dynamic needs that result from changing internal states. 

Grappling with boundaries in personal and work relationships circa COVID-19? Here at TPN.Health we are here to support our clinical community and remind you that you are not alone here. You can gain access to all of our online resources–digital CEUs, clinical discussion panels, AND a trusted referral network–when you create a TPN.Health clinical profile. Click here to get started.

References:

Barrera, A. M., Blumer, M. L. C., & Soenksen, S. H. (2011). Revisiting adolescent separation-individuation in the contexts of enmeshment and allocentrism. PsycEXTRA Dataset. doi: 10.1037/e741452011-008

BOUNDARY: definition in the Cambridge English Dictionary. (n.d.). Retrieved from https://dictionary.cambridge.org/us/dictionary/english/boundary

Dorfman, R. A. H. (1998). Paradigms of clinical social work. New York: Brunner Mazel.

Enmeshment. (2015, August 19). Retrieved from https://www.kimmelpsychology.com/enmeshment-revisited/Paul, J. (2019, November 26). Signs that You May Be in an Enmeshed Relationship. Retrieved from https://grandrapidstherapygroup.com/signs-enmeshed-relationship/

Image credit: https://positivepsychology.com/great-self-care-setting-healthy-boundaries/

STDs: Physical, Psychological, and Social

Sexually transmitted diseases (STDs), while physical in nature, incorporate a breadth of social and psychological contributing factors and consequences. In recent years, sexually transmitted diseases in the United States are more common than ever with reported cases reaching a record high at 2,457,188 cases in 2018 (2019). No one who is sexually active is exempt from STD susceptibility, but some groups, such as women, young adults, youth, people of color (POC), men who have sex with men (MSM), and incarcerated people, have a particularly high-risk for contracting STDs (2010). 

With a growing number of reported cases of STDs, developing prevention measures is paramount. However prevention and treatment of STDs undergo a variety of barriers. Some of these barriers involve policy, such as recent budget restrictions on state and local STD programs. However, many of the obstacles to both treatment and prevention are more complex, such as pervasive shame and stigma, comorbidity with other mental health issues, and population-specific challenges such as equity and access. 

Shame is defined as the negative opinion of oneself that results when failing to live up to a perceived standard, while stigma refers to a discriminatory label resulting from a link between a group of people and a set of unpleasant characteristics (Fortenberry, et al., 2002). One report on the relationship between shame, stigma, and STDs notes that shame is often referred to as an internalization of stigma (Fortenberry, et al., 2002). Studies show that MSM are especially vulnerable to homophobic stigma, and youth/young adults are vulnerable to shame and embarrassment as barriers to STD prevention (2010). With marginalized groups, it is also suggested that a ‘layered stigma’ effect can occur (Morris, et al., 2014).

A 2014 study examining the effects of STDs on quality of life in women revealed that women in the sample experienced feeling “dirty,” decreased self esteem, fear, anger, shame, and sexual undesirability (Passanisi, Leanza, & Leanza, 2014). Likewise, STD studies show high comorbidity rates with mental health and substance use issues among specific populations, namely incarcerated populations, as these specific comorbidities can facilitate STD transmission (2019).

Research on STDs demonstrates not only the physical but the poignant social and psychological implications for individuals and communities. Although some barriers to treatment and prevention can seem easy to pinpoint and resolve, it is largely the complex social and psychological implications that contribute to the challenges of societal attitudes and action around addressing STDs.

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References:

Fortenberry, J. D., Mcfarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., … Stoner, B. P. (2002). Relationships of Stigma and Shame to Gonorrhea and HIV Screening. American Journal of Public Health, 92(3), 378–381. doi: 10.2105/ajph.92.3.378

The Impact of STDs in Different Populations. (2010, August 4). Retrieved from https://www.ncsddc.org/resource/the-impact-of-stds-in-different-populations/

Morris, J. L., Lippman, S. A., Philip, S., Bernstein, K., Neilands, T. B., & Lightfoot, M. (2014, September). Sexually transmitted infection related stigma and shame among African American male youth: implications for testing practices, partner notification, and treatment. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135319/

Passanisi, A., Leanza, V., & Leanza, G. (2014, March 19). The impact of sexually transmitted diseases on quality of life: application of three validated measures. Retrieved from https://www.giog.it/materiale_cic/728_XXXV_6/6297_impact/article.htm

STDs Continue to Rise in the U.S. Press Release. (2019, October 8). Retrieved from https://www.cdc.gov/nchhstp/newsroom/2019/2018-STD-surveillance-report-press-release.html

Image Credit: https://www.prioritystdtesting.com/blog/bacterial-stds/