14 October 2013

94th percentile

I was subjected to a lengthy lecture by the boys' pediatrician because A2 now sits squarely on the 94th percentile for body mass index (up from the 90th percentile as last year's well visit).

I'm not one of those mothers who cannot see any fault in her children, so I certainly realize that he's differently shaped compared to his brother.  I can even see that his weight exceeds that of peers of the same height so I'm not going to delve into some futile argument about dense bones or unaccounted muscle mass.  Still, 94th percentile seems...off.  It means that in a room of 100 kids his height, only 6 would weigh more than him. 

So I looked into this revered formula created about 175 years ago by a mathematician (i.e., not a physician) whose arbitrary exponent of 2 in the denominator still has some scratching their heads.  BMI is apparently an insensitive measure (where sensitivity indicates true positives and specificity indicates true negatives) that is a terrible predictor variable for important outcomes like cardiovascular and cerebrovascular events as well as mortality in general.  Where it works wonderfully is as a political tool to point at America's slovenliness by the World Health Organization and as a monetary tool by big insurance companies to decline or punish "obese" subscribers.

This isn't to say that I'm not helping him make healthy choices about what he consumes.  I just wish there were other indices outside of BMI. 

Here we are on one of our recent healthy choices, otherwise known as a hike with the dog:

No need to pass the buck

A2 finally started Cub Scouting after 2 years of watching his brother's every move.  He's very excited, to say the least. 

I can't understand why anyone would miss out on this opportunity to make a substantive contribution to their son's development.  Two prospective parents recently contacted me regarding A2's now full den.  I strongly encouraged those families to come to our Pack to start their own Den with full support from me and my various resources (an offer that was NEVER extended my way, by the way) and one parent has completely gone under the radar while the other joined a neighboring Pack with a preexisting Tiger Den so that she wouldn't have to take on a leadership role. 

Bury it

Once I've complained, as I so triumphantly did in the previous post, I like to bury it deep down with at least a few fluffy posts.  Just like in real life!  So here are the boys and the dog enjoying the spout that refills the pool.  See?  Fluff.

Idealization and devaluation

Every field has its proud jargon and psychology is no different.  I've gotten so used to certain terms that I don't even correct people any more.  I mean,  when someone claims, "I'm completely antisocial," I'm quite certain she doesn't mean that she is a psychopath or a sociopath, but that she prefers solitude over social engagement.

I've also found that when folks describe themselves or others as bipolar, it is not in reference to alternating manic and depressive episodes, but to either benign fluctuations of thoughts and feelings or to the much more malignant cycle of idealization and devaluation as seen in Borderline Personality Disorder (BPD).

The DSM-V (Yes, my full time stay-at-home status somehow necessitated my purchasing this expensive guide to quell my growing sense of professional obsolescence.) doesn't deviate from its predecessor in describing BPD as a pervasive pattern of unstable self-image, interpersonal relationships, and affects.

The aforementioned idealization and devaluation can been seen as happening on three levels: within the self, within the dyad, and within the group.  Self idealization may take the form of impulsivity in excessive spending or reckless driving reminiscent of manic episodes.  Then instability of self structures means the onset of dysphoria punctuated by rage or panic.  The patient who presents with BPD is easy to spot.  She doesn't bother to build a working alliance but instead quickly reveals intimate details, professing the clinician's therapeutic prowess.  And then, just as suddenly, a real or, more often, an imagined, abandonment by the clinician turns him into a cruel, rejecting monster and thusly the object of the patient's extreme anger.  This is the patient who falsely reports you to the Board for sexual misconduct and who terrorizes your online presence with scathing reviews.  Either way, the prospect of a session with her incites you to defensive actions or simply drains you of breath.  Because, folks, countertransference is the name of the game!

Finding the BPD patient among a group may be a little trickier because she instigates the chaos, but from a hidden sheltered position that (initially) conceals her.  In a group, the individual with BPD finds a sympathetic ear and turns this person into the target of idealization.  This is particularly easy for targets who already have narcissistic traits, which, let's face it, is often the case among clinicians.  Now armed with an idealized supporter, the BPD patient then goes on the attack against the party or parties who were seen as neglectful or abandoning.  On inpatient wards, small preexisting rifts among staff members are ripped wide open by defensive BPD patients who, at first, escape blame because the feud appears as though it only involves two disparate factions among the staff.  So the next time it seems as if there is infighting amongst previously peaceful staff members, question whether is a frantic BPD instigator right in the middle of it!

On a much lighter note, here are the boys on a hike:


I'm such a blogging failure.  Now that the summer activities are over and we've moved well into the school year, the boys are less likely to visit the blog to see their images so there's no haste in posting.  Still, I need to do a photo dump!

Anna Banana likes to take herself out for swims.  She's independent like that.

Though it's probably got to do with the fact that we take her out there regularly enough that she thinks it's a daily occurrence.  

A1 wanted to see how far out he could stretch his balloon before it popped.  He got nervous and deflated it after this was captured:

The boys grew some reptiles in water.  I realize this "post" image would be much more compelling had I the "pre" versions for comparison.  But that takes the level of forethought that I clearly lack these days.

This is my friend Kristina Quinn and if you need a realtor in the N. Tustin area, she is a rock star.  I won't even hold the fact that she left me, still immersed in school volunteerism and drowning in glue and glitter, while she prances off into her magnificent adult world where she gets to make decisions and have conversations and fancy stuff like that.  See?  I'm not bitter at all.