Author Archives: David Joel Miller

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About David Joel Miller

David Miller is a California Licensed Marriage and Family Therapist, Clinical Counselor, faculty member at a local college, certified trainer and writer.

What is “Conditions for Further Study?”

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

What is

What is?
Photo courtesy of pixabay.

Are there more mental illnesses than we know about?

“Conditions for Further Study” is a chapter in the DSM-5 which describes some possible mental illnesses that have not yet gotten full official recognition. These are not something a clinician can diagnose or one which insurance companies will pay to treat, not by these descriptions anyway.

You would think that by now we would have identified every possible mental, emotional or behavioral disorder, and come up with sure-fire treatments for each of them. Unfortunately, it doesn’t work that way.

Periodically a new disease comes along. It wasn’t all that long ago that no one had ever heard of AIDS or even HIV. The same thing, sort of, is happening in mental health. Researchers would like to be sure that when they tell you about the characteristics of and the treatment for a mental illness that everyone who was a subject in the research had the same disease.

Clinicians know that not everyone who has the same “diagnostic label” has the same symptoms. So you get a group of people who supposedly all have the same thing, say PTSD, and then you give them tests and assessments. For some things, personality characteristics like say introversion and extraversion, people will be on a continuum.

For other things like Posttraumatic Stress Disorder there will be clusters of people who all have similar symptoms and then clusters of other people who have different symptoms.

Lumpers and splitters.

Some people want only a few categories, like dogs and cats. The trouble with this is that Poodles are very different from Rottweilers. The house cat sitting on my desk is nowhere near like a Lion. So while we want to be specific about a mental, emotional or behavioral disorder someone might have, we also want to avoid creating several billion mental illness descriptions, one for each person.

Researchers and clinicians who notice these different clusters may become convinced that there are differences in symptoms that should be categorized as separate illnesses. For example, not all PTSD is alike. The PTSD that results from combat may show different features than the PTSD we see in battered women or abused children. Currently, they may all get a diagnosis of PTSD but there are different treatment approaches. Some clinicians have taken to referring to the form of PTSD that is the result of repeated abuse as “complex trauma” even though this is not officially a DSM diagnosis.

Are behavioral disorders a mental illness?

We see some similarities between drug and alcohol use disorders and some behaviors. Children and adolescents get some behavioral disorder diagnoses, things I sometimes refer to as “bad kid” diagnosis. But in adults not much in the way of behavior currently, meets the criteria for a mental illness.

So far the only behavior that has gotten included in the Substance-Related and Addictive Disorders chapter is Gambling. Other behaviors, internet usage, compulsive gaming and pornography all have features that look like the loss of impulse control seen in Gambling.

Some of the major things that counselors treat are not diagnoses.

Anger is a huge reason for referrals to therapy, yet anger currently is not a specific diagnosis. While anger may be the reason for referral, currently it is seen as a symptom of some other problem, not a specific diagnosis. Despite the common practice of court-ordered Anger Management classes, Anger is not a diagnosis.

Suicidal behavior is not an official mental illness either.

Same problem with non-suicidal self-injury sometimes called cutting. Currently, the only place this fits is under Borderline Personality Disorder where it may be a symptom. This seems problematic. Does adding Non-Suicidal self-injury inflate the number of people with a diagnosis of Borderline Personality Disorder? Can you have one without the other? Shouldn’t someone who is thinking about killing themselves qualify for a diagnosis for that reason alone?

Disorders of special populations.

Several group-specific problems may be the focus of treatment but so far are not recognized as mental illnesses. This is a particularly acute problem for the treatment of military personnel. Moral Injury is a situation in which you are required to do something that violates your sense of right and wrong. In civilian life, you may find ways to avoid this dilemma but in the military, there are few choices. Sometimes to do one good thing, following orders, you have to do something else that troubles your conscience.

Military sexual trauma is another non-DSM issue. In combat, you count on your comrades to keep you safe. Being raped by someone in your unit is a very traumatic incident. Having to continue to have good relationships with your abuser in order to stay alive is a tough situation.

Certainly, there are other problems, cultural or situational, that have not yet reached official disorder status but that require more research.

Do Conditions for further study make it to become a full diagnosis?

In each edition of the DSM, there are a number of proposed new diagnoses. Most do not make it as a separate mental illness. After much research, they may get lumped in with existing disorders. Many of these proposed new disorders have long specific names. My observation is that the fewer words in the name the more likely it will get its own place in the DSM. Binge Eating Disorder made it. I have my doubts that Neurobiological Disorder Associated with Prenatal Alcohol Exposure will make it unless it gets a short name.  (More on Fetal Alcohol Exposure Problems is coming up in future posts.)

Currently, there are 8 “Conditions for Further Study” listed in the DSM-5. The DSM-IV-TR had 16, most of which disappeared in this revision.

What are those Conditions for Further Study in the DSM-5?

  1. Attenuated Psychosis Syndrome.
  2. Depressive Episodes with Short-Duration Hypomania
  3. Persistent Complex Bereavement.
  4. Caffeine Use Disorder.
  5. Internet Gaming Disorder.
  6. Neurobiological Disorder Associated with Prenatal Alcohol Exposure.
  7. Suicidal Behavior Disorder.
  8. Non-Suicidal Self-Injury.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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

What is Cannabis (Marijuana) Withdrawal?

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

Cannabis

Marijuana withdrawal.
Photo courtesy of Pixabay.com

Is there really such a thing as Marijuana Withdrawal?

Marijuana withdrawal is real and a lot more common than many people think. Among heavy marijuana smokers who enter residential treatment up to 95% experience very real symptoms of marijuana withdrawal. This set of symptoms is so significant that it was included in the new DSM-5 under the name Cannabis Withdrawal (F12.288.)

Cannabis covers a number of preparations made from the Cannabis Sativa plant including Marijuana, Hashish, and Hash Oil. There are hundreds of different chemicals in the cannabis plant, though current thinking is that the primary psychoactive chemical is THC (tetahydrocanibinoid.)

When we say withdrawal many people think of severe physical symptoms the way someone might experience withdrawal from Heroin. The symptoms of cannabis withdrawal while more subtle than that can be very problematic.

Back in the 1960s the thinking was that there were no withdrawal symptoms from marijuana. Some people still think that. One difference then to now is that the levels of THC are higher now. There are also a much larger number of people smoking marijuana on a regular daily basis.

SAMHSA published a treatment guide titled “Brief Counseling for Marijuana Dependence” based on studies of people who voluntarily requested treatment for a Marijuana Use Disorder. One of their conclusions was that people who experience this problem smoked marijuana 28 days a month or more. In other words, daily smoking is much more likely to result in a use disorder and withdrawal disorder than the occasional one-time user.

Cannabis Withdrawal, according to the DSM-5, is only diagnosed if you have a moderate to severe cannabis use disorder. This requires smoking most days for two months or more. Symptoms customarily start 24 to 72 hours after you last smoked. Symptom peak at one week and most are gone by two weeks. Sleep problems may continue for 30 days or more.

Cannabis withdrawal can also occur when people reduce their consumption of cannabis even when they do not completely stop. Family members or others living with the heavy weed smoker may recognize the symptoms of cannabis withdrawal before the smoker does.

In Cannabis Withdrawal seven signs or symptoms have been described as significant enough that they are common features of withdrawal from Marijuana and or other forms of Cannabis. Each of these symptoms might better be called a category of symptoms. For example, emotional issues list three possible emotions and physical symptoms list seven. To get diagnosed with Cannabis withdrawal you need to have one of the signs or symptoms from 3 or more of the categories.

The seven signs or symptoms of Marijuana Withdrawal.

1. Negative, Grouchy emotions during marijuana withdrawal.

Irritability, anger, or aggression are common during marijuana withdrawal.

2. High Anxiety during marijuana withdrawal.

During withdrawal from marijuana, people can become nervous, anxious, or fearful.  It is common for marijuana smokers to conclude that marijuana was helping them control anxiety and return to smoking before the withdrawal is completed.

3. Messed up sleep during marijuana withdrawal.

During the initial withdrawal from marijuana, you may experience difficulty falling asleep, staying asleep or you may have bad disturbing dreams. This initial period of poor sleep might also be followed by a period of rebound sleep during which you will experience an increased need for sleep.

4. You may lose your appetite during marijuana withdrawal.

Early in the withdrawal from marijuana you may lose your appetite or even lose some weight. This period of poor appetite may be followed by a rebound of hunger.

5. Restlessness accompanies withdrawal from cannabis.

6. Depressed mood is common during marijuana withdrawals.

This is one of the more common symptoms of giving up almost all drugs. Regular users get close to their drug of choice. Most miss the drug and the related rituals when they stop. Many become depressed or grieve for the loss of the drug’s companionship.

7. Physical symptoms can accompany Marijuana withdrawal.

Symptoms commonly reported during marijuana withdrawal include abdominal pain, shakiness, tremors, sweating, fever, chills, and headache.

These signs or symptoms need to happen during the first 3 weeks of abstinence otherwise we begin to look for other possible causes. Many marijuana smokers are using other drugs which obscure the signs of cannabis withdrawal.

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs, AOD professionals, and the terms and descriptions used in the DSM.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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 anxiety holds you back.

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

How anxiety holds you back.
Photo courtesy of pixabay.

Ways your fears keep you from living.

Anxiety and his friends “The Pack of Fears” are sneaky. They try to tell you that they are protecting you from bad things happening. Anxiety and Fear are like an abusive controlling lover wanting all your attention. Anxiety’s constant insistence that you pay him all your attention prevents you from turning your gaze to positive, happy things.

When you listen to Anxiety a lot, he begins to think he can tell you anything. Remember that sometimes your fears are telling you lies. The key is to become a discriminating listener and discover when your fears are warning you of real danger and when they are just trying to keep you from doing something new.

If you have been listening to Anxiety and the chorus of Fear a lot, here are some of the ways they have been holding you back from having the happy, positive life you deserve.

There are no good surprises.

When you expect the worst and avoid unexpected things that might make you anxious you make unexpected pleasant possibilities impossible.  In the negative zone, people expect anything out of the ordinary to be bad and harmful. The result of this thinking is to never be in the places where pleasant surprises occur.

People who live in the positive zone allow new and unique things to occur in their lives and they are able to see the positive when unexpected things happen. Some of the happiest moments in life are the result of serendipitous pleasant occurrences, but you have to go where those happy moments are to experience them.

Your comfort zone limits who you become.

Since Anxiety wants you to stay close to home, the wall of fear grows high. You can’t experience things outside that wall and your world, over time, shrinks. The pleasures you might have discovered just beyond that wall of fears won’t become a part of your life as long as you stay behind the fear wall.

Flowers don’t grow well in the dark shade of negativity. The longer you stay inside your comfort zone prison the harder it becomes to escape. Over time the wall of fears grows higher and you can be crushed by the weight of those fears pressing in on you.

That fear wall can keep out all the things that might have made you smile and laugh. Fears keep you from getting in on things that could have made your life a joyful place.

Your dreams all become nightmares. You can only imagine bad things happening.

Since Anxiety tells you to expect the worst and prepare for the worst, you see only two things happening, the worst and the almost worst. If you can’t imagine wonderful, joyful things happening you can’t have big dreams for yourself.

With no dreams to pursue, life in that walled prison of fears becomes a lifetime sentence to suffer.

They protect you from the uncomfortable part of growth.

Developing your personal strengths and growth as a person requires emotional exercise. You need to stretch your abilities to develop as a person. Exercise can leave you with sore muscles sometimes. Fear will tell you not to participate in life because you might get hurt. Eventually, your muscles, physical, mental, and emotional ones, will become soft and underdeveloped.

People who exercise their bodies become healthier. Those who don’t grow flabby and weak. Same in the emotional realm. If you avoid learning the hard lessons in life by not trying, you will be ill-prepared for the inevitable bumps on the road of life.

Fear of bad experiences prevents the good ones.

The price you pay for trying to avoid confronting Anxiety and his gang of fears is that they keep you captive and away from living a happy productive life.  Your own doubts become one of life’s worst bullies.

If you have allowed Anxiety and Fear to hold you hostage and your life has become a prison walled off from happiness, isn’t it time you began to confront those fears and see just what bullies they are?

How are you going to stand up to Anxiety and banish the voices of fear?

For more on this topic see Emotions and Feelings. and  Anxiety

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

Confidence.

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Sunday Inspiration.   Post by David Joel Miller.

Confidence.

Confidence

Confidence.
Photo courtesy of Pixabay.com

“Relentless, repetitive self-talk is what changes our self-image.” — Denis Waitley

“You probably wouldn’t worry about what people think of you if you could know how seldom they do.” ― Olin Miller

“Too many people spend money they haven’t earned, to buy things they don’t want, to impress people they don’t like.” – Will Rogers

Wanted to share some inspirational quotes with you.  Today seemed like a good time to do this. If any of these quotes strike a chord with you please share them.

What is an Alcohol Use Disorder?

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

Liquor

Alcoholic beverages.
Photo courtesy of Pixabay.com

How is Alcohol Use Disorder different from Alcoholism?

Used to be a time when doctors treated medical issues, Therapists treated mental illness, Social services treated poverty-related issues, and – well – no one exactly wanted to do anything with drug addicts and alcoholics. Times are changing.

Turns out that no matter where you are and who you work with there is a good chance that people around you are being affected by chemicals, alcohol in particular, long before they reach the “alcoholic” or “Chemically Dependent” stage.

In Drug and Alcohol counseling we used to spend a lot of time debating what made you an alcoholic or addict. Turns out the lines are fuzzy. One estimate is that 90% of alcoholics have full-time jobs. Some people do not drink that often. Half the adult U. S. population did not drink in the last thirty days.

Even if you only drink once a year, say for New Year, if you have gotten into fights while drinking, gotten DUI’s several times, then your only drink once a year is not of much import. If when you drink, bad things happen, then you have an Alcohol Use Disorder. The DSM uses the expression “Problematic Pattern of Alcohol Use.”

What we discovered was that it was not so much what you drink or when you drink that matters when it comes to Alcohol Use Disorders, it is what happens when you drink that is significant.

The Symptoms of Alcohol Use Disorder.

The new DSM-5 has switched to the use of the term “Alcohol Use Disorder” to indicate someone whose use of alcohol is causing them problems whether they are “Alcoholic” or not and lists 11 criteria for Alcohol Use being a problem. Here is my plain language version of those Criteria.

  1. Once you start drinking you drink more than you planned on and/ or keep drinking longer than planned.
  2. You keep trying to cut down on your drinking. In other Alcoholism texts, this is also described as efforts to control your drinking or to quit drinking. See, people do not try to cut down, control, or quit drinking unless it is a problem.
  3. Drinking eats up a lot of your time.
  4. You have cravings for alcohol when you are not drinking.
  5. Drinking gets in the way of work, school, home life, or recreation. A real Alcoholic cuts out this other stuff so they can concentrate on their drinking.
  6. You know that when you drink bad stuff happens but you keep drinking anyway.
  7. You start cutting out other parts of your life to spend more time drinking.
  8. You try to get away with drinking even when you know it makes the situation dangerous.
  9. You keep drinking even though you now realize it is causing you problems.
  10. Your body starts building up tolerance. (See post “What is Tolerance” in the “What is” section.)
  11. You experience “withdrawal” when you stop drinking and the blood alcohol level starts dropping. (See post “What is Withdrawal” in the “What is” section.)

These problems with Alcohol can come in mild, moderate or severe. Mild Alcohol Use Disorder would have 2-3 of these symptoms, Moderate has 4-5 symptoms and severe has 6 or more.

If you or someone you know is exhibiting these symptoms think about treatment and or self-help groups. The sooner Alcohol Use Disorder gets treated the better the life prognosis. While sooner is better it is never too late to get treatment for an alcohol use disorder as long as you are alive.

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs, AOD professionals, and the terms and descriptions used in the DSM.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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

Ways to take back control of your life.

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

Control

Self-Control?
Photo courtesy of Pixabay.com

Taking control of your life is a choice, not an accident.

Do you ever feel that your life has gotten out of control? Would you like to find a way to get some of that control back? Here are some principles you need to apply to your life to get it back in your control. Some of these are easy, you just make the decision and then do it. Others are skills you need to learn and practice until they become automatic. Either way here are my tips for getting your life back in control.

Learn when to take advice.

When things are going out of control it can be hard to admit that you have lost it and need help. The first step in getting your life under control may be looking for and accepting the need to get some good sound advice.

This does not mean letting your family or friends tell you what to do. Have money problems, get financial advice. Have legal problems, get legal advice. Having career problems talk, with someone who has worked in your field for a while and who can offer you some sound advice.

If you are in recovery you might well find that your sponsor or mentor can share with you some personal experiences and a different viewpoint. A support or 12 step group cumulatively can offer you a better perspective than a single individual.

Being able to recognize when you need the advice of experts and experienced people and then using that advice is a practice that can help you get where you are going in life.

Decide when to steer your own course.

As much as you need to be able to accept needed advice there are times when you need to steer your own course. Don’t try to live your life headed to someone else’s dream. The job that was right for a family member may not be a good fit for you.

Spend some time getting clear about what your values are and then set some goals. If you let others be in control of your life you end up where they would go not where you wanted to be.

Learn to like yourself.

If you do not like yourself you make it hard for others to like you. We teach others how to treat us. You need to be your own best supporter and friend. Caring about you is not being selfish. It is being the captain of your own life.

Insecure adults who do not like the person they have become, contribute to the development of children who do not feel good about themselves and have low self-esteem.

You can’t please everyone – please yourself.

Trying too hard to please everyone leaves no one happy, especially you. Think carefully about what you want from life. Make sure you are not living someone else’s life. Do not be influenced by passing fads and fancies which come and go. Living well is timeless.

Doing what everyone else is doing creates a poor copy of others. Be yourself, be unique and you will create a life that you can be proud of.

Other people’s opinions of you matter very little.

You know in your heart if you are living your life. Do not be easily swayed by others. It is very reasonable to consider other people’s opinions but the final decision is yours. Do the thing you feel is right not the popular or expedient thing.

Learn when to say no.

One sure sign of an out of control life is someone who can’t say no. You need to decline offers and invitations that are not good for you. You should not be doing things only to please others. If you have to go along with things that make you uncomfortable for others to like you they are users, not friends.

Learn when to say yes.

Don’t let fear and reticence keep you from doing things that might do you some good. Many older people have reported that their great regrets in life were not the things they did but the things that they passed on that they now wish they had tried.

Do not let fear, timidity, or the opinions of the crowd keep you from the things that may bring joy to your life.

Keep your self-talk positive.

Negative self-talk creates a negative life. Don’t do that to yourself. Use positive self-talk. A good morning affirmation can set the whole day off on the right course. Tell yourself you can, you will, and that you deserve a good life and see what you create.

Get clear on your values.

There are lots of things you will be tempted to do. Ask yourself how this relates to your values. Do not do things that are objectionable to you just for the approval of those around you. Values determine how you will take this trip we call life.

Set some goals. Don’t be a victim.

Without goals, your life will wander aimlessly. Decide where you want to go, today and in the distant future. When it is done what do you want your life to be about? Set big goals then break them up into smaller sub-goals. Take the little steps each and every day and you will find you have traveled a long way in the right direction.

Be OK with disagreement.

You do not need everyone to agree with you. Accept that not everyone will agree with you. You do not need the agreement of the crowd to be good with yourself.  The more you stand for something, the more you accomplish, the more people will criticize you and disagree. Great people follow their own vision despite others urging them to take the easy path where no one criticizes.

Accept yourself warts and all.

Do not pretend to be more than you are. Accept yourself. However, you are is just fine. After accepting yourself think about those improvement opportunities. How you are is fine but how would you like to improve? Self-acceptance is the starting place on the path to being the best you can be.

Dream big.

If you set your sights low you end up in the dirt. Set high sites and even if you do not reach the moon you may well wind up in the sky.

Stop trying to be perfect and please everyone.

There are no perfect people. You cannot please everyone. Be the best you there is and do the best you can. Accept how you are and you will discover that you, not someone else, is in control of your destiny.

Get the bad, negative stuff, out of your life.

If you are controlled by addictions, bad habits or negativity get that self-limiting stuff out of your life. Addictions can take over control of your life. You won’t get back in control until you clear the negative influences out.

When will you get your life back under your control?

You may want to check out the other counselorssoapbox.com self-help posts.

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

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Happy Easter.
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What is a Specific Phobia?

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

What is

What is a Specific Phobia?
Photo courtesy of Pixabay.

There are lots of things you might be afraid of.

Most Specific Phobias are easy to recognize when you see them. If you have one of these fears you may even wonder how this could get called a mental illness. The key, as far as diagnosing them goes, is that people with a specific phobia are far more afraid of the thing, object, or situation than the real danger might objectively warrant. But if you experience this particular fear there is no such thing as being objective about it.

About twenty-eight to thirty million Americans are believed to suffer from a specific phobia. This number may be low as some people can arrange their life to avoid ever having to experience the thing that scares them. If your job never requires flying that phobia may not come up.

Adults can tell you that this or that scares them. Children usually exhibit their fear through their behavior. The child may cry, scream, have a tantrum, freeze up, or be clingy. For all age groups we expect this very specific fear or phobia to have lasted for a while, customarily six months or more. This particular “thing” almost always triggers the same fear.

The list of things that get diagnosed using the DSM is lengthy and even this list is likely not totally inclusive. See Coding below for the new improved ICD-10 list.

Coding Specific Phobia.

Specific phobia used to all be coded in the DSM-4 as 300.29 now in the DSM-5 with the ICD-10 numbers the “objects” which could be things, animals, or situations, all get classified. Here is the list

F40.218 Animals as in snakes, mice, etc.

F40.228 Nature, storms, water, heights, etc.

F40.230 Medical, blood

F40.231 Medical, injections

F40.232 Medical, other procedures

F40.233 Injuries

F40.248 Situations, enclosed spaces, elevators, planes, etc.

F40.298 Other stuff, choking, vomiting, in children – cartoon characters or loud noises

Yes, it is possible for someone to have more than one specific phobia. If you do, the profession should list all the codes and “objects” that cause you significant anxiety. In clinician jargon, this is “stacking up” or listing multiple diagnoses. Specific phobia also often coexists with other disorders such as Depression, Anxiety, and OCD. There are rules in the DSM to tell clinicians, which disorder to diagnose, when to diagnose several disorders, and when to only diagnose one.

Seventy-five percent of those with Specific Phobia are afraid of more than one thing. The majority of all those with Specific Phobia have 3 or more fears that merit diagnoses. Typically these fears get stronger the closer you get to the thing that triggers your phobia. Just thinking about it can be a trigger. For example, people who need to fly but have a specific phobia of flying will begin to get anxious in the days before the flight every time they think about having to fly.

The treatment of choice for Specific phobias is systematic desensitization.

For some with specific phobia, the symptoms can be every bit as severe as those who experience panic attacks or panic disorder. See the “What is” posts on both of these for more on these topics.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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

com.

What is Drug Withdrawal?

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

Drugs.

Drugs.
Photo courtesy of Pixabay.

You’re more likely to have a drug withdrawal than you might think.

When people think of drug withdrawal the picture they see is the one of classic heroin withdrawal. Someone coming off heroin or other opiates does some “kicking” both drug wise and legs-wise. They also have diarrhea and “goosebumps.” Because opiates are pain relievers during withdrawals people can experience high levels of pain.

That dramatic type of withdrawal is not the only kind you might have. Each drug you might take can have some effects when the level in your body, principally in your bloodstream, begins to drop.

Drug Withdrawal Defined.

Drug withdrawal is an identifiable illness or syndrome that happens when someone stops taking a drug or reduces the amount they are using significantly. The symptoms begin when the level of a drug in the blood drops. Withdrawal symptoms can vary in severity and each drug has its own pattern of withdrawal symptoms. An alternative name for withdrawal is Abstinence Syndrome.

In the early stages of drug use, withdrawal symptoms may be minimal and go unnoticed. Once the body has adjusted to having that drug present and made adaptations the symptoms become more pronounced. Symptoms may not be entirely physical. For some drugs the primary withdrawal symptoms are psychological.

Withdrawal symptoms make it harder to stop using drugs.

The more severe the withdrawal symptoms the more likely the user is to pick that drug back up to reduce those symptoms. A withdrawal symptom of drugs taken to reduce anxiety, prescribed or self-medicated ones, is an increase in anxiety. People who smoke marijuana to reduce anxiety report that the anxiety gets really bad after they discontinue smoking it. This results in a return to marijuana use.

Getting rid of withdrawal symptoms is a strong motivator to resume drug use again.

The DSM-5 lists withdrawal effects for eight of the eleven classes of substances.

I find it interesting that some drugs such as Inhalants and Hallucinogens have no withdrawal symptoms specified. We also have only one diagnosis and F code for the group of drugs, Sedative, Hypnotic or Anxiolytic Drugs. Withdrawal from these drugs can be different with different drugs. Stimulant Withdrawal is separated and has one code for Cocaine and another for Amphetamines and other stimulants. These DSM-5 codes are a rough sketch. For the full details consult the DSM-5 text. Also, note that there are well-defined withdrawal criteria for Cannabis (Marijuana) and Caffeine.

Alcohol Withdrawal (F10.239 or F10.232)

Caffeine Withdrawal (F15.93)

Cannabis (Marijuana) Withdrawal (F12.288)

Opioid Withdrawal (F11.23)

Sedative, Hypnotic or Anxiolytic Withdrawal (F13.239, F13.232)

Stimulant Withdrawal

Amphetamine or other stimulant (F15.23)

Cocaine Withdrawal (F14.23)

Tobacco Withdrawal (F17.203)

Other (or Unknown) Substance Withdrawal (F19.239)

For more on drugs and recovery see:

Drug Use, Abuse, and Addiction      Recovery

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs, AOD professionals and the terms and descriptions used in the DSM.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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