Monthly Archives: June 2012

What do drug dreams mean?

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By David Joel Miller.

Drug dreams.
Photo courtesy of pixabay.

Drug dreams and nightmares in people with co-occurring issues.

An increase in dreams is a common occurrence among people in early substance abuse recovery. Some of these dreams become especially vivid and troubling. Many drugs suppress dreaming and the brain seems to need to make up for those lost dreams. Some of these dreams are memories being consolidated or current issues. Other previously suppressed dreams may be unfinished business, especially traumas that had not been processed while the client was using or drinking.

I remind clients that being unconscious is not the same thing as sleeping. The heavy use of drugs and alcohol has not allowed normal dreaming to take place.

Often there is an increase in nightmares as the person gets more time off the drugs or alcohol. As we discussed in a previous post (Getting rid of nightmares that maintain depression and PTSD) those dreams that are interpreted as nightmares play a role in maintaining depression, anxiety, and PTSD. This is an extra problem for those who have used alcohol to avoid the disturbing nightmares and now experience nightmares as a trigger for relapse.

One commonly reported dream by people in recovery is the dream about using their drug of choice. The conventional wisdom is that as the person withdraws from the drug, the brain adjusts to a new balance without the presence of drugs and at this point dreams about the drug are common.

Clients who awake from a dream and are genuinely scared that they may have used may experience a panicked reaction. They need reassurance that dreams of drug use which result in a fear of use are a common and expected occurrence in recovery.

Some drug use dreams are so realistic that the client has the sense of tasting the drug in their mouth or feeling the familiar body changes. This sensation can be especially disturbing and may be a relapse trigger.

Positive drug use dreams can be dangerous. Franey and Christo, researchers from London, report that of clients with six weeks or more clean, 85% had drug use dreams. The average number of dreams was between two and three per month. The more drug use dreams the more the risk of relapse.

Frequent positive dreams may be a warning that the addictive part of your brain is craving drugs.

If you have drug use dreams it is important to talk with someone whom you trust as soon as possible after awakening from the dream.

The use of alcohol or sleeping pills is generally not recommended for people with substance abuse issues. The risk of abuse is great and the benefits generally small. If you feel you need some sleeping aids, talk with your doctor or psychiatrists about the risks and benefits before starting to take anything.  Make sure you remind your doctor of any substance abuse issues or mental health diagnosis before beginning a treatment program that includes sleep aids.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

Have you experienced drug use dreams? Feel free to leave a comment about your experiences with drug or alcohol use dreams.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Why Blaming, Scolding and Criticizing don’t work

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Why blaming, scolding, and criticizing don’t work.
Photo courtesy of Pixabay.com

Ways to tame the blaming, scolding, and criticizing.

We all know someone who relies on these techniques and we know that these methods of communicating don’t make us want to do what they are asking. In many families, this becomes the primary way in which people communicate even when the person doing the blaming knows they don’t like the feeling of being on the receiving end of this sort of communication.

You can recognize someone doing these behaviors easily, but recognizing when you are doing them and changing to more effective behaviors takes some effort and practice. Responding to a scolder with scolding does not solve the problem. It only further escalates the conflict.

Blaming as communication.

Blaming is one of the three “communication stances” described by Virginia Satir, one of the founders of family therapy, and others of her colleagues. She describes people as communicating in three basic ways – Blaming, Placating, and congruent communications.

Blaming is the looking down on other’s stance, it includes all sorts of putting the person you are talking to down and making them “less than.”

Placating communication scrambles the message.

Placating might be described as the “victim stance.” We see puppies take this stance when they roll over and expose their bellies. Children will cower when yelled at. Placating says I give in. It says nothing about agreeing.

Congruent communication.

Congruent communication is the preferred mode in which people talk to each other as equals. Congruent communication does not look for whose fault it is that things are out of whack. the goal here is understanding.

Criticizing sabotages communication.

Criticizing has been described as attacking the person, not the action you want to change. Scolding includes a range of behaviors, verbal and physical that is designed to make the person being scolded “smaller” and the scolder feels more powerful and in control.

Some authors have suggested there is a difference between “complaining” in which you ask for a change and “criticizing” in which you just run the other person down in an effort to get revenge. One way to become more aware of these behaviors is to actually practice them until you recognize when you are doing them. Ben Furman has described some of these behaviors related to scolding. Done as a group activity the behaviors can be exaggerated until they become downright funny.

Here are the things a good blamer, scolder, and criticizer should be able to do automatically.

1. Tower over the person to be upbraided.

Parents have a natural advantage here. They are taller to start with. But if the person you are trying to demean is near your size, wait till they are seated and then pulling yourself up as much as possible and crowd in close so they can’t get up. In a pinch, a ladder or standing on a chair might help.

2. Stick your finger in their face.

This gesture, the universal sign of I am right and you are no good works, best if the finger motion includes several wags. Practice the up-down pound them into the ground move and the left-right “bad dog” move.

3. Leave no doubt that they are totally worthless.

Use plenty of words that leave no room for them to ever make it up to you or redeem themselves. You never, you always and other categorical statements should prove their worthlessness.

4. Demean their intelligence.

Statements like “anyone with half a brain would know” are especially good. Remind them they are dumb, stupid and that they have none of that rare commodity “common sense.” It helps to remind them how much common sense you have.

5. Ask questions for which there are no answers.

Don’t you understand that—?

Why did you do that?

6. Call them names.

Calling the person you are talking to “stupid” or “idiot” is sure to get a dramatic response out of the person you are talking at. Not a positive response necessarily, but a huge response none the less.

7. Be as vague as possible.

Never ask specifically for what you want and if by some chance they should request a clarification fall back on the old standbys “you know what I mean” or “If I have to explain it, you wouldn’t understand anyway.”

8. When all else fails try threatening.

Remind your children that if they don’t start doing as you tell them you will ground them for life. Threatening to take away the cell phone till they turn thirty can be especially ineffective. Make threats as large, outlandish, and impossible as you can. No sense in threatening with something you might actually be able to do.

Now should you want to really communicate in a positive way, which may be harder and require more work, then reverse the process and do the opposite of the things described above.

There you have it, 8 suggestions for becoming really good at Blaming, Scolding and Criticizing, and one antidote for poor communication.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Getting rid of Nightmares that maintain Depression and PTSD

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Nightmares maintain depression and PTSD.
Photo courtesy of Pixabay

Then Come Nightmares.

Frequent nightmares play a major role in maintaining depression, PTSD, and other mental health problems. It is common for people to think that they need to cure the PTSD or Depression and then the nightmares will go away.  The opposite approach is more likely to be productive.

Most treatments for PTSD do not target the nightmares. There are treatments for nightmares available, some as brief as three sessions. These have been shown to help reduce nightmares and promote recovery from other problems.

Treatment for nightmares has been shown to reduce symptoms of PTSD and depression.

Children also suffer from nightmare related problems. Children who are fearful because of a family problem, moves, divorces, or separation develop symptoms of mental illness. “Bad dreams” are the result of the child’s out of control fear and are at the root of many childhood attention or conduct disturbances. When the child gets a good night’s sleep they behave, when they don’t sleep they don’t pay attention, and they don’t mind.

Nightmares are associated with high levels of anxiety. They are fear-based.

Most people who have PTSD, depression, bipolar disorder, or any other diagnosis also have a co-occurring anxiety problem. Now sometimes anxiety is good, it protects you from danger. But when the anxiety circuits do not turn off the anxiety gets to be the problem rather than the solution.

We also see lots of disturbing dreams in clients recovering from substance abuse problems. Substance abuse counselors report clients sharing about drug-using dreams. We have some simple interventions around those issues, but not much research has been done in this area because substance abusers, people with Bipolar Disorder, and people with psychosis are routinely excluded from research studies. I believe that the treatment for nightmares will work for anyone.

The solution is to tone down that fear circuit.

Before I describe a treatment method for reducing nightmares – a word of caution, working on nightmares, especially those that maintain PTSD, can be a painful process. It is best to work with a therapist or other professional person, and you need to make sure you have a strong support system in place in case you have difficulty coping.  For more on support systems see “How to develop a support system” or “How supportive is your support system?”

Taming nightmares involves three steps.

1. Learn relaxation methods.

Nightmares are fear-based, and the fear persists after you awake. Sitting thinking about the scary part of the dream might reinforce the nightmare and result in memorizing your nightmare. Fear and relaxations are not compatible. The more you relax, the less fear you will have. As you get better at relaxing your fear shrinks and your dreams become less traumatic.

2. Learn sleep hygiene

Keeping regular bedtimes, reducing or eliminating caffeine especially in the hours before bedtime and other efforts to improve sleep naturally are helpful. It is important to allow plenty of time for sleep.

People who stay up late and get up early gradually become sleep deprived. Lack of sleep aggravates all sorts of mental health issues. Insufficient sleep increases the possibilities that you will be suddenly awakened and will remember the “bad dreams.”

During sleep the brain keeps working on our issues, memories are consolidated and thoughts organized. We only call dreams “nightmares” if we awake during the dream and have memories of it. Better sleep can result in fewer nightmares.

3. Begin treatment of the nightmares once you are relaxed and well-rested.

The process of “reframing” nightmares makes them less scary and more manageable. Reframing or reprocessing is helpful for intrusive daytime thoughts as well as for nightmares.  The application of this to reducing or eliminating nightmares was described by Rhudy et al. in their 2010 article on CBT treatment for nightmares in trauma-exposed people, where they called it “ERRT” therapy.  Ben Furman has also described a similar approach for use with children.

Disclaimer- Rhudy et al.’s study, like most research in the mental health area, excluded substance abusers, people with mania or psychosis, and probably screened out all people with Bipolar Disorders. The sample size was also low with about twenty people per group. There is so much overlap between substance abuse, bipolar disorder, and PTSD in the clients I see these studies leave out exactly the people who most need new effective treatments. That said – the ideas appear to be fully appropriate for clients with co-occurring disorders.

Here is how it works:

To reprocess or reframe nightmares do the following things:

A. Write out as full a description of the nightmare as possible.

Getting it down on paper tames the story and makes it manageable. It also allows you to go back over it and add missing details. In step C you will be rewriting it with added insight.

Remember that it is a normal process for your brain to use your dreams to make sense of your experiences. In dreams, your brain will turn the experience around and examine it from all sides. Your brain may also play out multiple alternative endings for the event. It is not the dream that is the problem; it is the connection between the dream and fear that makes this a nightmare.

If you have several versions of the dream try to write them all down.

B. Read the nightmare story aloud.

Listen for the themes in the story. What are the fear messages? I think it is helpful to be able to read this to a therapist or other support person who can keep you from being overwhelmed and can provide some insight into things you may not immediately see. Just don’t make someone listen to your nightmare that is not emotionally able to hear the story.

C. Re-script the nightmare.

What is the expected ending? What is an alternative ending? Write out the story this time with a new less scary ending. Read the new version out loud. Has seeing a new possible ending tamed the fear?

Furman described a story, not sure where it originated, in which a grandmother applied the sort of approach to her grandson’s nightmare.

The child came to the grandmother scared because of a nightmare.

“Grandma, ” he said, “I had a nightmare.”

“There are no such things as nightmares,” The grandmother said “Only goodmares. All dreams should have happy endings. The problem is you keep waking up before the end. What is a good ending that could have happened?”

In this story, the child then works with his grandmother to find new happy endings for these scary dreams. The result – fewer scary dreams and less fear when bad dreams occurred.

Warring – in people with PTSD who were treated with re-scripting the fear declined first, anger later and the frequency and length of nightmares were the last things to decline.

Talk to your care provider about this process. If you try this process, see if it works. Learn to relax more. Tame your sleep. Then tame your nightmares. If you have had success in changing your nightmares ending please share your success with the rest of us.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

6 ways to recover from Complex Trauma or Complex PTSD

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

You can recover from Complex Trauma or Complex PTSD.

Complex Trauma or Complex PTSD is the result of repeated injuries, each of which creates additional trauma. Complex Trauma frequently arises in children who are abused or neglected over long periods of time or survivors of sexual assaults who are re-assaulted.

Being injured once is bad enough but repeated traumatization can result in problems far in excess of those caused by a single trauma. People who were traumatized in childhood and then retraumatize in later life are likely to develop severe and debilitating symptoms. Some researchers have suggested the name of Complex Trauma or Complex PTSD for this condition.

It appears that many people can experience severe trauma, recover, and not develop PTSD. Some of the symptoms of PTSD are normal reactions to experiencing trauma – in the short run. If the reaction is excessive, interferes with a job, friendships or relationships then it first becomes Acute Stress Disorder when the symptoms continue for long periods of time and seriously interfere with functioning the name and diagnosis is changed to Posttraumatic Stress Disorder (PTSD).

Complex Trauma adds trauma upon trauma and results in long-term suffering.

Some treatments make the symptoms of Complex Trauma worse and some things are effective in treatment. Here are the basic rules for recovering from Complex Trauma. I based this on the research of Conner & Higgins and their description of the work of Chu, with my own usually twists.

1. CAUTION – do not start digging until you know what is buried out there, avoid black holes.

The first reaction of someone trying to recover from complex trauma and the approach of many counselors is to go searching for the buried details. People ask “Why can’t I remember things?” Counselors are tempted to try to recover those lost memories. This can result in more trauma and pain and runs the risk of digging up stuff that wasn’t really buried in your yard but the yards of neighbors or even fictional characters.

Some serious damage has been done by forcing people to remember things way before they were ready and by hunting for things that you are not sure happened. Ask a kid often enough about sexual abuse and they will begin to “remember” things that “may have happened” or they “think” happened. These contaminated memories have resulted in a lot of extra pain.

There are a number of other steps that need to be completed before you go digging into the past for answers. The brain tries to protect us by hiding details from us that might keep us from functioning well enough to survive. Trust the process.

2. Have a supportive therapist or counselor as well as a support system in place.

You can’t make this journey of healing alone and the more capable the companions you have on the journey the better. Professionals are important because there may be things you need to tell them that you won’t feel safe telling others. Peers are also helpful for similar reasons.

Group counseling can be especially effective when and if you are ready to talk in front of others.

3. Ensure your personal safety

If you are in a dangerous situation healing is not likely until you deal with the current emergency. Make a safety plan and execute it. You need to feel safe and have reliable food clothing and shelter before you think about other aspects of recovery. But don’t put off recovery waiting for the day you will miraculously feel safe. Get started on the safety part first. Just taking steps to move to a safe place can be empowering.

Challenges to your safety don’t only come from outside. You may be a big part of the danger. Avoid, control, or work on urges and cravings. Confront any urges to commit suicide and seek help immediately if you have thoughts of suicide. Recognize and deal with non-suicidal self-injury, substance abuse, eating disorders, and the urge to try out risky behaviors. Don’t put yourself at risk to be victimized anymore.

4. Get your daily routines and rituals in place.

Most people who experience a crisis lose that ability to get up, eat, care for themselves, and then move about their day. The sooner you re-establish your daily routine the better.

When children are involved the recommendation is the sooner you can resume family rituals the better. Get back to your spiritual home. Remember to have some sort of ritual in your life; birthdays, Christmas, or any other familiar activity makes everyone feel better.

Returning to a job or other activity can be a great way to begin your recovery. If you can’t work at a paid job consider volunteering. Having a reason to get up and out of the house can jump-start your recovery.

A regular and consistent amount of sleep is important. So is some form of exercise. Be as consistent as possible with mealtimes and bedtimes. Include time for relaxation and positive activities.

5. Learn as much as you can about stress, acute stress, and the more difficult forms of PTSD and Chronic Stress. Learn to manage your primary symptoms.

Knowledge is power. When you know you are not “crazy” or “losing your mind” but that the things you are experiencing are common responses to what you have been through, then it is easier to look for the things others have found useful in recovering from their chronic stress.

Accept what you feel. Try to learn to feel what you are feeling rather than run from the uncomfortable feelings. The feelings will come and go. Learn that you don’t have to run from feelings, but you do need to move away from real danger.

6. Begin work on your long-term issues, the chronic stress symptoms, the problems you had before the stressor, and lastly the actual event.

Often people who develop PTSD or a chronic stress disorder discover they had other issues before the stress that put them at risk for PTSD.

Begin to talk about you. What does the experience mean to you? Who are you aside from the trauma? What does the trauma say about the person or thing that hurt you? What if any sense can you make of this?

The discussion of what actually happened should occur when you are ready to tackle this information.

7. Have patience with yourself and the persistence to work through your problems.

Recovery does not happen all at once. There may be sudden leaps forward or slips back but a continued effort will get you to recovery.

Use tools like positive affirmations. You are a worthwhile person no matter what has happened to you. Give yourself credit for the things you accomplish.

You can recover from Complex Trauma or Complex PTSD.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Hyperthymia, Hyperthymic Personality Disorder and Bipolar Disorder.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Does you temperament predispose you to mental illness?

Hyperthymia person

Hyperthymia, hyperthymia personality disorder, and bipolar. Photo courtesy of pixabay.

Personality characteristics may be a risk factor for certain mental illnesses but the exact connection continues to be far from clear. Psychologists have long been interested in various personalities. Are you outgoing – let’s call that extroverted. Psychopharmacologists look for connections between meds, drugs of abuse, and temperaments or personalities.

For the mental health community, the connection becomes more problematic. We are reluctant to diagnose someone as “mentally ill” because they are introverted, extroverted or have some other “personality type.” We really want to know that your personality issue or temperament is somehow interfering with your life, job, and friendships or making you miserable before we start saying that the way you are and were born, is somehow a disorder.

We know, or think we know, that some personality characteristics might increase your risk for certain disorders. To the extent that genetics plays a role in mental illness your temperament just might be a factor in developing mental illness.

Hyperthymia is one of those possible risk factors.

Hyperthymic people are those people who have so much energy, do so many things, and get so much done they annoy others. Goel, Terman, and Terman (2002) defined Hyperthymia as equivalent to Hypomania but without the impairment. So if you lose control it is hypomania and you get diagnosed with a mental illness (Bipolar.) But Hyperthymia by this definition means you are able to hold it together.

In their discussion of Bipolar and creativity, Shapiro and Weisberg (1999) define Hyperthymia as those people who have had periods of hypomania but there had not been a period of depression. This inconsistency in definition for Hyperthymia leads to a lot of inconsistencies in our understanding of this personality dimension.

Does that mean people with Hyperthymia are mentally ill?

A Hyperthymic personality has been suggested as a possible precursor for Bipolar Disorder. Currently, the DSM-4 includes diagnoses for Bipolar I, the most severe kind, and the Bipolar II variety with less visible mania, but not necessarily less severe, as the choices. Some theoreticians have suggested that there are also some “soft bipolar disorders.” They have suggested designations of Bipolar III and Bipolar IV for the less obvious forms.

Enter Bipolar III.

Shapiro and Weisberg suggested a diagnosis of Bipolar III for people who have depressive episodes and then when given antidepressants, experience hypomania. For them, the only time Bipolar III’s are manic is when on meds. Other authors suggest or imply that most any person with Bipolar Disorder will react quickly and dramatically to antidepressants.

Could Hyperthymia be Bipolar IV?

One area of research has been the search for connections, precursors, or predictors of future mental illness. These precursors are sometimes called “premorbid” conditions. If we knew that some currently small symptoms meant you were at high risk to develop a mental illness maybe we could begin treatment early and reduce the severity and length of a mental illness. Hyperthymia just might be such a precursor.

Hyperthymia seems to be one of several personality characteristics that increase the likelihood of developing some symptoms of Bipolar Disorder. But an increase in risk does not equal you having or getting the disorder.

People with Hyperthymic personality characteristics who experience depression, even a mild depression may “overreact” to antidepressants. Doctors have been warned to look out for high energy people who have an episode of depression and when given an antidepressant are propelled into mania or hypomania. An excess reaction to antidepressants could be one way of diagnosing Bipolar Disorder. One research study (Hoaki et al. 2011 published in Psychopharmacology) suggests that doctors should consider giving these Hyperthymic type people a mood stabilizer rather than an antidepressant.

Risk factors for Hyperthymia.

These researchers also found some other risk factors for developing Hyperthymic personality and presumably a soft form of Bipolar Disorder. Now, this is my understanding from reading this and other studies but a lot more research is needed in this area. Remember this is my opinion not necessarily the researchers.

When subjects for research were first screened there seemed to be a connection between how much they exercised and how “Hyperthymic” they were. Presumably, if you exercise more you have more energy. This did not end up in the lists of the risk factors for Hyperthymia so at this point it does not seem likely that more exercise will push people with risk factors into a Bipolar Disorder. But frankly, at this point, any connection between exercise and Hyperthymia or Bipolar Disorder seems like a wild guess. If anyone out there with Bipolar Disorder has seen a connection please drop me an email or leave a comment.

More light- More Hyperthymia.

Hoaki and his colleges found the relationship between light and Hyperthymia to be fairly strong. Even people who did not exercise much, when they were in brighter surroundings, had more energy and more Hyperthymic personality traits. So being outside or around more light might improve your energy level. We know that lack of light is one reason some people suffer from SAD (Seasonal Affective Disorder) but this makes us wonder, could changes in light level provoke Hyperthymic episodes, and might this be a risk factor for a hypomanic episode?

More variation in sleep – More Hyperthymia.

One diagnostic marker for manic and hypomanic episodes is a decreased need for sleep. What Hoaki’s article seems to suggest is that it is not just that a reduced need for sleep is a problem, but fluctuations in the amount of sleep from night-to-night may be a risk factor to set off Hyperthymic characteristics. Hoaki frames this as changes in bedtime; presumably, his subjects have a constant time to get up for work or school. Studying sleep fluctuations in people who have no set time to get up might clarify this issue.

Could fluctuations in the amounts of sleep be a risk factor for inducing Mania and Hypomania?

Hoaki et al. speculate that a consistent amount of sleep might be a preventative for developing Bipolar Disorder.

People with a Hyperthymic personality or temperament also had a tendency toward Serotonin Dysregulation. So the way in which Serotonin is used in the brain may be an important marker for Hyperthymic Personality as well as for mood disorders. Hoaki notes that other authors have suggested that people with a Hyperthymic personality may also have differences in the way their brains regulate dopamine. The more we learn about the brain the more neurotransmitters seem to be involved in the way our brains work.

The conclusion of Hoaki’s study is that light, sleep, and serotonin activity are all factors in Hyperthymic personality characteristics and in Bipolar disorder, so there is likely a connection between these two conditions. How the two conditions are related we are just not so sure.

Is Hyperthymia a personality disorder?

The lists of Personality Disorders listed in the DSM-4 as diagnosable mental illness is short and specific. Hyperthymic personality is not recognized as a disorder. It would be correct to consider Hyperthymia a personality characteristic or someone’s temperament but not as a disorder.

Those very energetic people may be annoying to some but they are just not considered mentally ill at this point.

More on the recognized personality disorders to come

Hope this helped to clarify Hyperthymia, Hyperthymic Personality characteristics and why there is not a recognized Hyperthymic Personality Disorder.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How do you develop a support system?

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14

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Supporters

Support system.
Photo courtesy of Pixabay.com

5 tips for developing a support system.

In the early stage of recovery developing a support system can be a challenge. We all know we need someone to support us, but who and how do we enlist their support? Let’s start with a description of a person in recovery from alcoholism and then expanded the description to other forms of recovery.

Newcomers in A.A. are encouraged to find a sponsor. It can be embarrassing to ask someone you hardly know to sponsor you. This relationship needs to be a good fit. The sponsor should be someone who has something in the way of recovery to offer and someone you feel comfortable in discussing your life with. They should also be someone you can trust to tell you the truth.

Have you ever done anything to help someone else? Let’s say you did something to help a child or an elderly person, how did that feel? Did it feel good to be able to help that person?

Sponsors do things for the person because it feels good to do so. They also work with others as part of the A.A. program because helping others keeps them sober. You are not imposing on a sponsor when you ask them to be your sponsor; you are offering them a chance to feel good about helping and to further their recovery. Don’t cheat a potential sponsor out of the opportunity to be of service.

Here is the process for selecting a sponsor that will likely be helpful.

1. Attend a variety of meetings

There are lots of A.A. and N.A. meetings. Most areas have central offices that can give you the address of a meeting nearby. With the changes in technology, there are lots of online resources, meeting lists, and even online meetings. If at all possible attend in-person meetings; it is important to make personal contacts.

Look for fellowships or places that have frequent meetings at the same location. Your car can find the bar without you steering it. Make it easy for your car to find the A.A. meeting on its own. Make a habit of going even when you don’t think you need to go. Someone there may need to see you. Support systems work in two directions.

There is likely to be one meeting that feels more comfortable than others. This may become your homegroup. Don’t stop there, however. Try out other groups for that time when you can’t go to your regular group but need a meeting. As you make friends at your home group consider going to other meetings together.

2. Get phone numbers.

At each meeting listen for people who say something that strikes you as helpful. After the meeting ask for their number. Many meetings will send around a phone card for members to give the newcomer their numbers.

Should you ask someone and they say no, please do not take this as something about you. Some people are very busy and don’t think they have the time for phone calls. Others, because of their jobs or situations, are not supposed to give out their phone number. If the potential sponsor says no keep asking till you find someone who is able to give out their number.

3. Every day call one other person in recovery.

When an alcoholic is thinking of drinking they will find that the phone receiver weighs two thousand pounds. They can’t lift the phone to their face to talk. By practicing phone calling every day you strengthen your arm and your habit of calling a recovering person. Sometimes you will find the other person needed the call even more than you did.

Don’t stop after one try. If the first person you call is not home or can’t talk keep calling until you reach someone. Having more than one person in your support circle is a huge plus.

It is also recommended that you not wait until after you are drunk to call. Call before you drink. Call as a way to manage the urges. Call as a way to build that connection with your support system.

4. Select someone to be your sponsor

One of those people you are calling, the one that is there for you, that is the person you are likely to ask to be your sponsor. Ask them. If they decline ask them for a recommendation. If you trusted them enough to ask them, trust them to refer you.

5. Develop social relationships with other recovering people

The best meetings are often the meeting-before-the-meeting and the meeting-after-the-meeting. Sit and talk. Go for coffee or dessert after the meeting. People hang out and talk not only about recovery but about the challenges of living life after drugs or alcohol.

Attend your fellowship’s social events, potlucks, picnics, sporting events, and so on. The more you develop social friendships the more people you have as potential support systems. Don’t wait until the crisis strikes to form strong friendships.

The process for finding sponsors at N.A. or other twelve-step programs is much the same.

What if your problem is a mental illness, not addiction, or both?

There are an increasing number of peer-run centers and peer-run groups. Ask at your local mental health providers about peer groups. Many areas have local NAMI chapters they can be especially helpful in referring you to peer support groups, so should local mental health agencies.

There are also online groups for mental health issues.

If you have both a substance abuse issue and a mental health issue look for co-occurring groups. It can also be helpful if you have multiple issues to attend more than one fellowship.

Think about how you would like your support system to support you.  Write out the things you would like them to do and not do. Make sure you discuss your wishes should a crisis strike. Make sure your support system knows about your professional providers or who to call if you have a crisis.

So there are some suggestions for creating and strengthening a support system. What have you done to create a support system?

Other posts about support systems can be found at:

How supportive is your support system?

Can one person be a support system?

How do you develop a support system?

Support meetings for family members?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How supportive is your support system?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Supporters

Support system.
Photo courtesy of Pixabay.com

Support system – Resource or stressor?

Recovering people, those with mental illnesses, addictions, or alcoholism, are reminded of the need for a support system. The evidence seems clear. Those who have a good functioning support system do better. Alcoholics and addicts with a good support system are less likely to pick up, to use, or drink again. The mentally ill with an encouraging support system are more likely to stay in treatment and less likely to end up in a psychiatric hospital.

Not all support systems are equal. The quality and the quantity of supports are both important. Who is in your support system? Who should be a member of that group? Making up a written list of the people in your support system before the crisis can help you find resources when the time of need comes.

We speak of support system as if it was a single group, one recovering person – one support system. That is not the best way to build support.  People in recovery need multiple people and need more than one support group. Any single person may not be available when support is needed. Too much reliance on a few support people can burn them out. Not every person in your support system can provide all the support you need.

Here are some categories of the people who might be included in your support system.

Family members can support you.

Family members have been with you for a long time. Even when friends leave you the family remembers you and feels an urge to help you. They will likely feel a desire to help you when no one else will. Support from a parent or sibling can be very helpful for a recovering person, as long as the family is not also part of the problem.

If your family members have a mental illness or an addiction themselves, and often problems run in families, they can’t always provide the support you need. If the course of your illness has been long or serious your family may be burned out on you. They may be unable to provide the help you need at the time you need it most. Many recovering people have a circle of family members in their support system but that is often not enough.

Family members can also be a huge source of extra stress. One study of veterans with PTSD found that family members were rated as the most supportive but also the most stressful relationships those vets had. The stress caused by family members exceeded the support provided.

While it may be helpful to have family in your support system you will need more.

Spouses, partners, and longtime friends can be supportive.

Spouses and partners can be very supportive. People with Schizophrenia who live with a supportive partner were half as likely to end up back in the hospital. If you have a partner they should be a part of your support system, but no partner can carry that full burden. Over time if your partner’s main job is to support you the relationship will suffer. Good relationships need to be maintained with positive interactions. People in recovery do lots of damage to their relationships.

It is hard for a partner to listen to you talk about your symptoms and your urges. They may want to be helpful but being your support system is not a one-person job.

Longtime friends can also be great sources of support. Sometimes these old friends feel like family. Just be sure of how much support any one friend is able to provide and keep people who are unhealthy off the list. An alcoholic can’t get much support on their recovery from someone who is still drinking.

People like you can be a part of the support system you need.

Finding a group of people with problems and interests like yours can be extremely helpful. Addicts relate well to other addicts. Veterans find support groups of other veterans hugely helpful and people with a mental illness should look for a support group of other people with the same sort of problems they have.

Twelve-step groups are highly effective because they are made up of people a lot like you. Alcoholics find A.A. useful because not only does it include a process of change in its “working the steps” it also is helpful in creating a support system of people who, like you, are struggling with their issues. Your 12 step support system will include not only your sponsor but other members of your group whom you can call when you need to talk. Many recovering people also socialize with members of their recovery group.

Veterans often report that they feel able to talk about things in veterans groups that they can discuss nowhere else. Rape victims say the same thing.

In the mental health field, “consumer” groups are becoming more common. So are “dual-diagnosis groups.”  If this is your situation, look for groups like this and participle when you can. If no group exists in your area consider an online group or starting a local affiliate of one of the national groups.

Sponsors and mentors belong in your support system.

Sponsors and mentors can be an especially important part of your support symptom. Most often these will be people from the group like you category above but they develop a special relationship with you as they help by sharing their experiences and hope. They will most likely be focused on one issue, your alcoholism or addiction but every support system needs at least one “old-timer” who can help you along in your recovery.

People who are less like you can still provide support.

People in recovery need to develop outside interests and activities. The longer you are in recovery the more likely you are to become involved in groups that are centered on things other than recovery.

Religious and spiritual groups can be extremely supportive. Include these activities when possible. If you have a hobby or vocation, consider belonging to a group for that interest.

As you move into groups outside the focus of your recovery, think about how much it is appropriate to share with the members of this group. Some people will be anxious when they learn about your mental illness. You may need to keep the discussion of your recovery for a recovery group while talking with members of your spiritual group about your spiritual issues.

Include professionals in your support system.

In developing your support system make sure to include professional people. They may not be available as often as friends, family, or members of support groups but they can be just what you need when you have a crisis.

Keep an up-to-date list of Doctors you see and the meds you take with you. Have phone numbers for the counselors and therapists you see or have seen in case you need to get more help.

Make sure you invest the time in creating and strengthening your support system.

Other posts about support systems can be found at:

Can one person be a support system?

How do you develop a support system?

Support meetings for family members?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Why research is not about your problems – co-occurring diagnoses

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

White mouse

Sometimes the mice get it wrong.
Photo courtesy of Pixabay.com

Feeling left out? You probably have been.

Have you had difficulty finding information that applies to the problems you are facing? You are not alone. The latest research usually doesn’t apply to your condition and should you find a relevant article it may end with the statement, this treatment has not been studied in patients with X, Y, or Z.  In the mental health field, this issue is especially acute, “acute” meaning sharp and painful not “a cute” as in nice to look at.

Most people don’t have only one problem. We have many, many problems. So when we look for treatment we want something that might help us. When people have multiple problems we call that dual diagnosis or co-occurring disorders. You may have two mental health diagnoses, maybe more. Sometimes this is called multi-occurring or even “complex.”

Most people with a mental illness will meet the criteria for two or more conditions. The overlap between substance abuse and mental illness is the rule, not the exception. People with mental illnesses are more likely to develop an addiction or substance abuse disorder than those without mental illness.

People with a mental illness often have a physical illness. People with an earlier physical illness are more likely to develop a mental illness. If you are seriously and chronically ill you might be a little depressed and anxious wouldn’t you?

As a therapist and a blog writer, I am always looking for the latest in research, things that might help my client. There are some new things, but frankly, there are a lot of studies that are not very helpful.

Most studies exclude from their population anyone who had a substance abuse problem until they are clean and sober for at least 6 months or more. They also exclude from studies those who have had a psychosis such as schizophrenia.

Most of my career has been spent in substance abuse facilities, crisis units, and psychiatric hospitals. Clients there have the greatest need for new effective treatments. They also have the most co-occurring disorders.  The newest treatments have not been tested on the people who need the help the most.

Drug companies would love to play this game. Many psychiatric meds cause weight gain. This excess weight gain can result in obesity and diabetes. So if I am a drug manufacturer and want to minimize side effects which I need to report to the government I would want to exclude a person who had diabetes, better yet let’s leave out anyone who is overweight. When it comes to drug companies there are regulatory agencies that keep an eye out for this sort of thing, with psychotherapy not so much.

Recently I have been doing some reading on the problems related to treating people with PTSD. We need to find better ways to help people with this condition. Right now there are lots of possible treatments but even the big names in therapy don’t seem to agree on the best approach. If therapists don’t agree on the best treatment how is the client to know if the treatment will help or harm them?

Most of the clients I see who have PTSD also have other problems. Substance Abuse is common. With those recurring intrusive memories that keep you from a good night’s sleep for years on end would you be tempted to drink?  Most of the “controlled” studies on PTSD exclude anyone with a substance use disorder or psychosis. These are the clients for whom we most need to find better treatments.

People who have a combination of PTSD and depression or substance abuse are at greater risk. Does it make sense to exclude high-risk clients from efforts to evaluate treatment for high-risk clients?

Recently I came across a study on a new treatment for PTSD. I won’t spoil the fun by telling you whose study this was.

The introduction sounded good until I read further. They excluded from their study anyone with Bipolar Disorder, Psychosis, or a history of addiction. By the time they got done excluding they were down to less than ten subjects. They had excluded more people than they included. To me, this means they should have gone the other way and tried this new treatment on the people with the most problems, the larger group. When they did their study they found out that all but one of their subjects had a history of alcohol abuse. While they had screened out current alcoholics they missed that all the people they serve had at some time or other had an alcohol problem.

A further concern should be mentioned here. Treatment should not make a client worse. Some of the current treatments for PTSD seem to make clients worse off, the treatment can retraumatize them.  Treatments that are too painful result in clients dropping out of treatment. I continue to believe that people do not benefit from the treatment they do not receive, no matter how great the treatment looked in a research study.

I will post more about treatments for PTSD as I wade through the newer studies.

For more blog posts on PTSD, substance abuse, or Co-occurring disorders see the newly revised list by categories to the right.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Acute Stress Disorder vs. PTSD

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Stress.
Photo courtesy of Pixabay.com

What is the difference between stress, Acute Stress Disorder, and PTSD?

Stress is a normal human reaction to something that threatens us or challenges our ability to cope. When challenged our bodies to respond. Even good things we have looked forward to, like new jobs, marriages, or the birth of a child, can cause stress. Negative events, loss of a job, divorce, sickness, or the death of someone we love can be even more stressful. Stress is a normal part of life unless it gets out of control.

Acute stress disorder is when something stresses us out and this stress results in impairment of our ability to function. It goes far beyond just being stressed out and needing time to recuperate.

Acute Stress Disorder is a diagnosable mental illness, though much of it goes untreated and unnoticed and like adjustment problems or a mild depressive episode may go away by its self, untreated. If it becomes severe enough it needs treatment before the symptoms get out of hand. The symptoms of Acute Stress Disorder must last for at least two days and must happen during the thirty days after the stressful event. Once the episode lasts more than 30 days we reclassify it as PTSD. PTSD may also intensify and produce symptoms that are in excess of those seen in Acute Stress Disorder.

Acute Stress Disorder.

Acute Stress Disorder is not just being stressed out or needing time off from work, it is far more debilitating than those symptoms.

Here are the things that need to happen for the stress to be Acute Stress Disorder. This is in my words, not the official DSM language.

Warning: This description is not meant as a diagnose-your-self project. If you think you recognize yourself, a family member, or friend in these descriptions you really should see a professional.

1. You experience or see something that makes you afraid you or someone close to you like a friend or family member will be killed or seriously injured. This could be an actual event or someone who threatened you and you believed them. As a result of this harm or risk of harm, you become intensely fearful, helpless, or horror-struck. Note this is pretty bad stuff, not just being chewed out by your boss or the risk of being fired. Those milder things are stressful and might result in an adjustment disorder if they affect you enough, but those non-life-threatening things don’t get called Acute Stress Disorder or PTSD.

2. You get lots of DISSOCIATIVE symptoms – 3 or more. Dissociative symptoms, those are bad.  Here is the list:

A. Numbing or not feeling emotions

B. You don’t feel like things are real – called derealization

C. You can’t be sure you are you – called depersonalization

D. You get dissociative amnesia – can’t remember big chunks of what happened.

3. You keep reliving this experience, like that episode of Star Trek where every day they got up and it all happened again. Your life turns into a rerun.

4. You would go a mile out of your way to avoid places or people like that again.

5. You are on edge, jumpy and the least little thing sets you off again.

6.  You get so upset you can’t go to work, avoid friends and are afraid to talk about this let alone ask for help.

7. This experience and all its terror lasts 2 days to 30 days.

8. By the way, if you did bad drugs and imagined this or there is something medically wrong with you – forget all the above and get to a doctor right away.

So what makes it PTSD?

If you have the above and it goes on over thirty days we change the name to PTSD. But then the longer this goes on the more the symptoms. This is one reason we are thinking that if we could get to people who have been injured and treat them right away we just might keep this Acute Stress Disorder from turning into PTSD. That means treating some people who could get better on their own without treatment in order to prevent others from getting PTSD, but given the long-term debilitating results of PTSD, a little extra treatment might be worth it.

Not sure what you think, but I believe that if we could provide appropriate services to all those returning GI’s from the Middle East we could prevent a lot of long-term suffering.

Those guys are worth the effort right? For the accountants out there, prevention saves a lot of money on long-term treatment also.

As Acute Stress Disorder goes past the 30-day mark lots of more severe symptoms develop, nightmares, extreme efforts to avoid anything that might remind them of the trauma, and lots of drug and alcohol abuse. PTSD and alcoholism are best friends.

There is disagreement right now about the best way to treat PTSD. I will write more in future posts on PTSD, stress, and some available treatments and new approaches that sound really interesting.

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

8 warning signs you have PTSD

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Eating Disorders and substance abuse

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5

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Unhealthy food

Unhealthy relationship with food.
Photo courtesy of Pixabay

More about eating disorders and substance abuse.

Risk factors for eating disorders.

Eating disorders, especially Anorexia, and Bulimia are far more common in women than in men. The ratio runs 10 women for every man. Our society’s emphasis on physical appearance puts young girls at extreme risk as they try to fit the image they see portrayed in the media. Eating disorders that begin in the teen or preteen years are unlikely to go away without treatment.

Certain activities and later on in life specific occupations have built-in an emphasis on keeping the weight off and having a particular body shape. Young women who train to become models, gymnasts, and dancers are at high risk.

Young men who engage in sports that emphasize weight classes are also at risk of developing Anorexia or Bulimia. Male gymnasts, wrestlers, and jockeys all experience pressure to lose weight and keep it off that may become unhealthy.

Added eating disorder dangers.

The dangers of eating disorders are not confined to those with anorexia who reach low body weight. Even when the bodyweight looks normal, the process of purging, intentional vomiting, and extreme dieting, can create health risks. Some methods harm health while being ineffective for weight loss.

Purging and diuretics can create extreme dehydration and an electrolyte imbalance. Dehydration does not equate with a loss of total weight and can seriously impair health.

Subclinical forms of eating disorders.

Milder forms of eating disorders are more common than previously thought. As the emphasis on obesity and weight loss has grown, many more people have resorted to extreme measures to get a sudden weight loss or to reduce weight gain. Despite the health risks involved it is tempting to allow yourself an occasional purge to offset the guilty feeling surrounding overeating or a meal with excess calories.

Co-occurrence of Eating Disorders and substance use disorders.

The overlap between Bulimia and substance abuse may be larger than previously thought.

Assorted studies on the co-occurrence of Bulimia and substance abuse have given varying estimates of the number of people with both issues. Current estimates run between a median of 25% and a high of 50%. Clearly, lots of milder cases of combined Bulimia and substance abuse are going undetected and untreated until one or both problems become acute. These two problems together are much more than the sum of adding up both disorders.

People with eating disorders are also more likely to currently have or have had a history of an anxiety disorder and a mood disorder. Many with an eating disorder have three or more disorders.

Those with eating disorders are at high risk to abuse or become dependent on stimulants. The “Jenny Crank” diet is legendary among Methamphetamine abusers. Abuse of stimulants for weight control regularly results in chemical dependency and serious health problems.

Boundaries between eating disorders are not firm.

During their lifetime people with eating disorders may move between the three principal eating disorders.

Medical issues in eating disorders are noteworthy.

Medical problems are especially challenging for those with an eating disorder. Untreated an eating disorder can lead to serious medical problems and sometimes death. Eating Disorders rarely go away by themselves and need professional treatment before the damage to the body and the emotions becomes permanent and possibly irreversible.

Other Eating Disorder posts can be found at:

Binge Eating Disorder – the other side of Anorexia and Bulimia 

Middle class and starving to death in America – An Eating Disorder called Anorexia

Love Hate relationship with food – Bulimia Nervosa

Avoidant Restrictive Food Intake Disorder

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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