Illness Anxiety Disorder (F45.21.)

By David Joel Miller.

What is Illness Anxiety Disorder?

Acute or Chronic Illness

Illness Anxiety Disorder
Photo courtesy of Pixabay.com

Illness Anxiety Disorder is a condition in which the patient is preoccupied with the idea that they have or will get a physical illness. The person with Illness Anxiety Disorder may have no physical symptoms, or the symptoms that have could be relatively mild. The concern they have is not about the symptoms, but it is about their worry that they might have or be developing an illness. In the past, this condition was included as part of the Somatization Disorder, but the symptoms are sufficiently distinct that in the DSM-5 it was listed separately.

People with Illness Anxiety Disorder have high anxiety about their health. They can be easily alarmed by very small changes in their health status. The smallest symptom will convince them they are developing a serious, possibly fatal, disease.

The possibility of an illness takes over their lives.

People with Illness Anxiety Disorder spend a lot of time looking for symptoms. They may do a lot of self-exams, or have large numbers of laboratory tests performed. They often see multiple doctors to get second opinions. Even when reassured that there is nothing seriously wrong with them they convinced themselves that the doctor had missed something. They find it impossible to believe there is nothing wrong with them and may complain that the doctor didn’t care and did nothing to help them.

Illness Anxiety Disorder is not a short-term condition. To meet criteria for this condition the patient must have had symptoms for at least six months or more. Most people have symptoms for much longer time periods, though during these times the particular condition they are concerned about may keep changing.

Illness Anxiety Disorder seriously affects people’s lives.

People with this condition spend a lot of time talking about their illness or illnesses. Their ill-health becomes their principal topic of conversation. Their limited focus on illness damages relationships. The belief that they are will become sick turns them into invalids, afraid to be active or leave the house.

Medical treatment becomes their primary focus.

Considerable time can be spent visiting various doctors and specialists and having tests run and rerun. Despite reassurance from doctors that there is nothing wrong with them or that their condition is not serious, these patients continue to believe they are becoming seriously ill. In older adults, the primary concern may be memory loss. Despite reassurances that some forgetting is normal, they may worry that having forgotten something means they are developing Alzheimer’s or dementia.

As this condition progresses, they may spend considerable time on the Internet reading about and researching their perceived symptoms.

Triggers for developing Illness Anxiety Disorder.

Hearing about someone falling ill and developing a rare medical condition is a common trigger for Illness Anxiety Disorder. Reading articles or news stories about medical conditions increase the risk for developing Illness Anxiety Disorder.

Illness anxiety disorder comes in two types.

  1. Care seeking.

This type is largely seen in medical settings where they are likely to have accumulated thick files, had many tests, and have been prescribed a significant number of medications.

  1. Care avoidance.

Despite considerable worry and personal research on the possibility they have or are contracting a serious illness, care avoidance types avoid doctors who might confirm their fears.

My first book is out.

Bumps on the Road of Life.

Your cruising along the road of life and then wham, something knocks you in the ditch.

Sometimes you get your life going again quickly. Other times you may stay off track and

Bumps on the Road of Life.

Bumps on the Road of Life.
By David Joel Miller

in the ditch for a considerable time. If you have gone through a divorce, break up, or lost a job, you may have found your life off track. Professionals call those problems caused by life-altering events “Adjustment Disorders.” Bumps on the Road of Life is the story of Adjustment Disorders, how they get people off track and how to get your life out of the ditch.

Bumps on the Road of life

Amazon Author Page – David Joel Miller

More to come as other books are completed.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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Why your life’s going nowhere.

By David Joel Miller.

You can’t get very far with a flat tire.

Life out of balance

You can’t get very far with a flat tire.
Photo courtesy of Pixabay.com

The circle is a very ancient symbol of a balanced life.  To keep your life in balance, you need to keep all the different parts of your life in their proper size.  It’s easy to focus on one part of your life and neglect the others.  It helps to think of a well-functioning life as a wheel with many spokes. Look at each of these life segments and see if there are areas of your life that need improvement.

Instead of starting this new year off with a lot of resolutions that are likely to be quickly discarded, try making some small improvements in each of the major areas of your life. Take small steps repeatedly, and you will go a long way.

Physical health affects your life.

Your body and your mind are not two separate things.  They are interconnected.  When people are in the problem, mental illness, substance abuse or any other issue, they tend to neglect their physical health.  Attend your physical health is an important part of recovery.  Working on your physical health may include going to a doctor, improving your diet, drinking more water and getting more sleep.

Don’t fall into the trap of thinking that you can’t be happy because you have health challenges. Make every effort to do what you can to take good care of your physical body.

Emotional and mental health are important.

Problems in your emotional life will interfere with all the other areas. If you are struggling with depression, anxiety, anger issues, or a drug and alcohol problems you need to attend to those issues. Trying to struggle through life with one of these weights on your back is not a virtue. You can only drive your car so far on a flat tire. Being willing to get help for your emotional problems is a sign of strength and a first step on the road to a happy life.

Your Financial Life shouldn’t cause you unhappiness.

When life’s not going the way, you want it to; it’s very tempting to try to make yourself feel better by treating yourself. Those little splurges add up over time. The majority of Americans, then this is true of many other developed countries, have little or no savings. In the short run, it’s hard but over the lifetime learning to earn more money, spend a little less, pay off your bills and develop a financial cushion results in a life that’s in much better balance.

Job and career activities should be more than just income.

If you don’t have a job getting one is important. Somehow everyone needs a source of income. If there’s any way, you can work you will feel better about yourself earning your income. If you have a disability that prevents that working look for a volunteer opportunity or some other way to be productive. Going each day to do something you enjoy filter life with happiness. Once past that initial job, it’s important to look at your career. Where will this job take you in 10, 20 or 40 years?

Family and friends can support your success or your failure.

Humans need positive, supportive relationships. Try to resolve differences with those that are close to you. Work at creating friendships that support you and in which you’re able to support your friends. If you have family members who have their own emotional problems, you may need to limit your time and exposure to them. Invest some time in creating new friendships. Time spent in enjoyable activities with friends is not wasted time. It is time invested in having a quality life.

Your spiritual or religious life is important.

Having a spiritual or religious belief can be a source of strength and support in the difficult times. If you have a faith or tradition that enriches your life, invest time in your practices. Many people find they need to re-examine their religious beliefs. If you’ve adopted a faith because it was what your family or someone else believed you need to ask yourself this is what you believe?

A spiritual or religious belief should make you a better person and a happier one. If you find that the religion you are following makes you feel bad about yourself or makes you angry and hate others, you may need to take another look at whether this is what your higher power wants for you.

Many people find that they benefit from time spent with other people who have the same faith. Just as it’s often helpful to get financial advice, see a counselor for emotional help, or get career guidance many people find that their lives are enriched by having a spiritual adviser.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What is Sleep Walking?

By David Joel Miller.

Can people really do all that stuff while asleep?

Sleep Walking?

Sleep Walking?
Photo courtesy of Pixabay.com

Turns out that people can do a number of things while mostly asleep. Sleep Walking (Was DSM-IV 307.46 Now DSM-5 F51.3) and Sleep Terrors (DSM-IV 307.47 now DSM-5 F51.4)) use to be considered separate disorders. In the New DSM-5, they have been combined into one category, Non-Rapid Eye Movement Sleep Arousal Disorders. Despite now being one disorder with subtypes they get coded with two different numbers. (DSM is a registered trademark of the APA.) In the new lists, ICD-9, ICD-10 and oh my ICD-11, these numbers may all keep changing, sorry about that.

The Sleep Walking part also covers some other behaviors that can take place while the person is mostly asleep. It is also possible to engage in Sleep Eating and Sleep Sex. Sex while mostly asleep has also been called sexsomnia. Sleep Eating and Sleep Sex are specifiers added onto the Sleep Walking diagnosis. These specifiers do not get their own numbers.

For someone to get this diagnosis these things must happen repeatedly not just occasionally.

And yes these things are considered real diseases not just excuses for things people do that may bother others.

Sleepwalking along with sleep eating and sleep sex are all things people do early in the sleep cycle before REM sleep, hence the name Non-Rapid Eye Movement Sleep Arousal Disorders.

One characteristic of Sleepwalkers is the blank look on their faces. Other clues that this person is not awake and is functioning on autopilot are the difficulty you will have in waking the sleepwalker up.

There was a belief that you should never wake someone up who was sleep walking. I see no evidence that this is particularly harmful other than the sudden jolt that comes from waking up in a place other than where you went to bed. On the other hand as hard as it is to wake sleep walkers most of us will elect to just lead them back to bed and try to get them in the correct posture for sleep.

Sleepwalkers are also unresponsive to efforts to communicate with them. You can talk to them all you want but they just keep wandering around. Picture the actors you see in those zombie movies and you have a close approximation to the characteristic sleep-walker.

These episodes of sleep walking happening in Non-REM sleep come without memories. This is described as having an “amnesia” for the events that happened during the sleep walk.

The full diagnostic criteria are in the DSM-5. As with most other disorders, this one does not get used if the cause of this event is drugs or medications or if it seems to be caused by some other medical or psychological condition.

Sleep Walking Disorder is separate from Nightmares for several reasons. Nightmares and Bad dreams happen later in the sleep cycle predominantly during REM sleep. People remember what happened during nightmares and bad dreams. Nightmares often are connected to real life events as in PTSD. Sleepwalking just happens out of nowhere.

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.

You might want to take a look at other posts on:      Sleep   Dreams and Nightmares

More “What is” posts will be found at What is.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Forgiveness lets you grow.

Sunday Inspiration.   Post by David Joel Miller.

Forgiveness lets you grow.

Forgiveness

Forgiveness lets you grow.
Photo courtesy of Pixabay.com

“There is hope in forgiveness”

― John Piper, A Sweet and Bitter Providence: Sex, Race, and the Sovereignty of God

“The forgiving state of mind is a magnetic power for attracting good.”

― Catherine Ponder

“Always forgive your enemies; nothing annoys them so much.”

― Oscar Wilde

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.

Dream On!

Sunday Inspiration    Post By David Joel Miller.

Dream On!

Dreams

Dream On!
Photo courtesy of Pixabay.com

“There is nothing like a dream to create the future.”

― Victor Hugo, Les Misérables

“It is a happiness to wonder; — it is a happiness to dream.”

― Edgar Allan Poe, Complete Stories and Poems of Edgar Allen Poe

“Nothing happens unless first a dream.”

― Carl Sandburg, The Complete Poems

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

When old – you just sit.

By David Joel Miller.

Has your life become – just sitting?

Seated Santa Photo courtesy of Pixabay.com

Seated Santa
Photo courtesy of Pixabay.com

Recently I have been talking with and hearing from an increasing number of “older people.” In the past, I have steadfastly avoided learning about the elderly in the belief that I did not know any of them. This belief, that neither I nor anyone I know is yet in that elderly class is constantly getting challenged by people who ask “How old are you?” with an incredulous look.

Those annoying people who sell medical insurance continue to force this topic on me by sending me advertisements asking me to switch my old age insurance to their company. Worse yet they have been sending those notices to me for some years now. One of my life goals has become to outlive some of these annoying insurance companies.

My thinking, at this junction, is that being old is a combination of the effects of the physical process of aging and the mental attitude one takes towards this process. Self-care along the way is certainly a factor. Unfortunately, I learned that life lesson later rather than earlier. While my body may be accumulating aches and pains, defects of the body, I continue to work on keeping my mental faculties working.

I read somewhere that when you get old you just sit.

This was reported in an article about a woman who had passed her hundredth birthday. Is this a good thing or a bad thing? I can see that it might be nice to be relaxed and no longer stressed running hither and yon. But then it might also be that once you stop moving, at least mentally, your life loses purpose.

I have forgotten who that woman was or what age milestone she had just passed. This is a shame because I have a long-held belief that once you start school you have to stop counting half-years as in four-and-a-half and you do not get to begin counting those half years again until you pass that hundred mark. Anyone who lives past one hundred years ought to be recognized more than once per year.

You are all invited to my one-hundred-and-a-half birthday celebration. My fervent hope is that I will be able to attend it with you and will be lucid enough to realize what this gathering is for.

It has become apparent to me however that a lot of people entering those golden years have neither gold nor years. In fact, one great loss among the elderly is a loss of purpose. What do you do when you can’t go to school or work?

Young people are rushing to enter their disabled-years.

It is fully understandable that as we age we can accumulate injuries and disorders. As life moves on some people find it hard to get up and move around. For them, life’s high point may well be waking up and being able to watch some video entertainment.

What surprises me is the number of very young people who are resigned to sitting worshiping a talking box or a moving wall image. Have you all not heard the more time you spend seated the sooner that chair may become attached to your anatomy?

Despite all the encouragement to get up, out and exercise, more and more people past the age of 5 seem most motivated to sit as much as possible.

Has exercise become a spectator sport?

Lots of people drive in their cars (seated) to a sporting event where they can watch (seated) athletes perform. This is sometimes called “playing” a game.  Though most sporting events past preschool take on all the playfulness of gladiator bouts.

An oft-heard life plan is to work hard enough to make enough money to be able to sit around and do nothing. Once you retire from the active world of work, it would appear that you have to join a gym, take up golf or otherwise pay others to allow you to exercise.

Why are there so few hero action figures of old people?

There was a time when old people figured prominently in our culture. Think of father time and the Greek god Zeus. Now that I think of it the Christian deity, when he gets any consideration at all is depicted as an elderly man.

It will soon be Christmas. Santa Clause used to be a prominent personality at this time of year. The last few years Saint Nick, and his propensity for generosity has been losing ground to Ghosts, vampires, turkeys, the babies of the New Year and cupid. Getting the latest entertainment device has supplanted giving the gift of happiness in our common lives.

My suspicion is that one reason for our cultural shift from old people and wisdom to preschool heroes is that giving required getting up and doing, while receiving can be done passively in a seated position.

If, at this time of year you find yourself  “just sitting”, my hope for you is that this is a reward for a lot of lifetime doing, not the beginning of your resignation to spending the rest of your life in the not doing, seated position.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Nightmare Treatments.

By David Joel Miller.

What are the top Nightmare treatments?

Nightmare Zombie

Nightmare Disorder
Photo courtesy of Pixabay.com

Many people have an occasional “bad dream.” But some people, and you know this if you are one of them, have frequent recurrent nightmares. An occasional episode of a bad dream is probably no big deal, though if you just had one last night it may be very disturbing today.

Technically we think there are differences between bad dreams, nightmares and night terrors. Night Terrors are when you wake up in a panic and possibly screaming but can’t remember what was happening just before. A “bad dream” is when you do not wake up till morning but you remember the disturbing dream. Nightmares are the worst for most people. This is when the dream wakes you up and you remember what it was about. Not everyone uses the same meanings for this which makes reading articles on negative dreams confusing.

What caused the Nightmare?

Treatment for nightmares partially depends on what is causing them, or more specifically what the content of the nightmare is about. Is there a specific trigger for your dream?

Children can begin to have nightmares after watching a particularly scary movie. This I think of as “contamination.” You see or hear about something that happened somewhere else to someone else and your mind begins to process this. Avoiding things that trigger you can help.

Sometimes we are going through a difficult time at work or school. If your department is being reorganized and you are having scary dreams, nightmares even, about being laid off, fired or transferred, then we can work on these in a very specific way.

The most difficult nightmares to have and to treat are dreams about real life trauma that has happened to you. Nightmares about past trauma can perpetuate your mental health issues. Nightmares play a role in keeping you depressed or in maintaining your Posttraumatic Stress Disorder (PTSD.)

Rule out medical causes of nightmares.

Medical issues, especially breathing problems during sleep, can be a cause of bad dreams and nightmares. It pays to talk with your medical doctor and be sure that there are no underlying medical problems that are causing or worsening your nightmares. This “medical rule out” is a good idea for all mental illnesses.

The talk approach to reducing nightmares.

This is the starting point for most treatment. In this system, you work on remembering your dreams, good and bad. Often people keep a diary or pad of paper by the bed and upon awakening then write down anything they can remember about the dreams they have been having that night. If you get up and do things before writing you will lose most of the content of the dreams. Write a few things down and you have a better chance of recalling more details of the dream.

This dream record then can become the basis of your discussion with your counselor. For simple non-threatening dream work, you may want to work with a friend or group and do mutual discussion of your dreams.

What you want to avoid here is repeatedly talking about dreams based on real trauma. Going over and over the story of your rape or abuse will reinforce it not reduce it. For dreams that are maintaining PTSD or complex trauma, you need to work with a more specialized professional.

Medication for nightmares.

Medication has its place in managing Nightmares. If you are currently under stress you may need medication to sleep. Say you are having to testify in a case involving a crime you witnessed or that happened to you. You need to be able to sleep to get through this. Seeing your doctor is a good idea.

Soldiers in a combat zone may need medication so they sleep and are alert the next day. Not sleeping the night before can get you or someone else killing in this kind of situation. You may be able to talk with a comrade but even that is difficult. The middle of combat is no time for any lengthy therapy.

Medications have one disadvantage. They suppress dreaming but they do not eliminate the need to dream. In dreaming our minds process the events of the dream. Your dream and the memory waits in line to be worked on. When you stop the meds the memories can come back and they have had time to bulk up and become scarier than before.

Image rehearsal therapy.

This method has some good research to back it up and has worked across a range of different types of nightmares from children with scary monster dreams to victims of abuse and violence. In working with a counselor to use this method you focus more on learning the skill of imagery rehearsal than on discussing the specifics of your nightmare. Here is the basic process. I recommend that you try doing this with a professional to avoid creating other problems while working on the nightmare.

You keep track of your nightmare. A written journal helps but if you can remember it well you can do it that way.  Ask yourself what would need to happen for the dream to be less scary.

Say in your nightmare an ex breaks into the house and beats you up. This is based on a history of the ex. stalking you and trying to harm you. You imagine putting a metal door on your house. You imagine installing a dead bolt and an alarm that automatically calls the police if someone tries to break in. Imagine the ex tries to break in and the police are called and they catch and arrest him.

If you practice this new less scary dream each night before you fall asleep many people will discover that they have the new less scary dream. If you can imagine the new ending and can learn to recognize that you are dreaming, a process called lucid dreaming, you can in effect rewrite the dream and over time it will get processed and become less of a problem.

Scheduled Awakenings.

This is a new method. I have not read a lot about it and can’t tell you if it really works. People who have tried everything else without success have reported this one helped them.

In sleep, we cycle through deep and shallow sleep about every 90 minutes. As we age you may find yourself waking up every 90 minutes or so. It is in these cycles that dreaming occurs. So if you set an alarm clock to wake you up every 90 minutes or so it could stop the dream cycle before the dream gets really scary.

The goal here is to wake up to the alarm before the nightmare, set the alarm and go back to sleep. This will result in choppy sleep.  You may need more time in bed but you can theoretically get a full 8 hours of sleep and that without nightmares. Over time the nightmares should reduce. If any of you have tried this let me know how it worked.

Have you used any of these methods and how did they work for you? Has anything else helped you to reduce nightmares?

You might also want to take a look at other sleep and dream related posts that have been published here on counselorssoapbox.com .

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

box.com .