Excoriation (skin picking) L98.1

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

Skin picking

Scab or skin picking?
Photo courtesy of Pixabay.com

 

Sometimes skin picking is a mental health problem.

Excoriation, also known as skin picking, is included in the DSM-5 in the chapter on Obsessive-Compulsive and Related Disorders. Excoriation is one of those unusual crossover kinds of disorders. Sort of a medical problem, but also a mental health issue. Most mental health disorders have either an F or a Z code.

What is Excoriation (skin picking?)

To meet the criteria for this disorder, the skin picking must be both recurrent and must result in visible skin lesions. People with skin picking disorder often spend a lot of time in this activity, and it made go on for years. The picking is commonly done with fingernails, but it may be done by using tools or instruments. While skin picking can take place anywhere on the body, is most often done on the face, the arms, or the hands. Some people try to hide the results of picking under clothing.

OCD mental health part involves attempts to control, reduce, or stop the picking.

Like other mental health diagnoses, the skin picking needs to impair social relationships, school or job function, interfere with other important activities, or be very upsetting to the person doing the picking. Skin picking often occurs in response to negative feelings. Excoriation can be triggered by unpleasant emotions and may be used to manage uncomfortable feelings.

Excoriation is reported much more commonly in females. Some reports estimate the rate of Excoriation at between one and two percent of the population. It is common for those with Excoriation Disorder to also have other OCD related disorders.

Excoriation is not the same thing as “Meth” or “Coke” bugs.

The kind of picking you commonly see among drug users is the result of abuse of stimulant drugs. Stimulant drugs create the sensation the bugs are crawling on the skin. If the user quits doing the drugs, the feeling of bugs crawling on the skin, he goes away. Long-term methamphetamine or cocaine users may have picked at their skin so much that there is permanent scarring.

What else could Excoriation (skin picking) be?

Before someone gets this diagnosis, medical causes and effects of drugs or other substances must be ruled out. If the picking is the result of a psychotic disorder or body dysmorphic, a stereotypic movement disorder or is intentional, the picking gets diagnosed as part of these other disorders.

There are some similarities between Skin Picking Disorder and non-suicidal self-injury, also known as “cutting.” Nonsuicidal self-injury is currently considered a symptom of borderline personality disorder, but it continues to be studied and may one day be recognized as a separate disorder.

As of now, Skin Picking Disorder is recognized as a specific disorder which may coexist with other conditions. If you or someone you know has symptoms of Excoriation (skin picking), you need to get medical attention. If those urges to skin pick are being triggered by feelings, seeing a therapist could help.

Staying connected with David Joel Miller

Four David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

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

Books are now available on Amazon.

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

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking, and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter.

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Why your problems never end.

By David Joel Miller.

Problems time travel

Do your problems follow you around?
Photo courtesy of Pixabay.com

How come problems never end?

Doesn’t it seem like no matter what you do you have another problem? Some people think that life is nothing but a “veil of tears.” Have you started to feel like no matter what you do another challenge will be headed your way before you take a breath? Some people attribute their constant problems to bad luck or something wrong with them, but the truth is humans tend to view the world in a cognitively biased way. When you look at the world through dirty glasses, everything appears filthy.

We keep moving the goal posts – concept creep.

The closer you look at things, the more flaws you’re likely to see. From a distance, the lawn looks beautiful, but when you get close, you begin to see the weeds. Once you have defined what a weed is, the more weeds you will locate. Roughly a hundred years ago you wouldn’t find the word allergy in the dictionary. Once we created the idea, there was such a thing as an allergy more and more people have discovered they are allergic to more and more things.

When people lived far apart in rural areas what you did in your own home was pretty much your own business. The closer people live together the more laws have been enacted. The more laws we have, the more crime have.

This process of first identifying a problem and then finding more and more examples of similar issues has been going on long enough that we now have a name for this phenomenon, these constantly expanding definitions can be called “concept creep.”

More issues become mental illnesses, milder cases become disorders.

At one time there were only two types of mental illnesses, psychosis, and neurosis. Neurosis was just the everyday problems of life. Psychosis was a term for people who were thought of as “crazy.” Psychotic people were locked away in a mental sanitarium. Today we have medication, and we have treatment.

Where once someone had to be so severely depressed they couldn’t hold a job or maintain a relationship to receive a diagnosis of depression, we now recognize that major depressive disorder can come in severities from mild to moderate to severe. I see people with mild forms of mental illness who absolutely needed help to get their lives back. But as we recognize more and more varieties and intensities of mental illness, the list has gone from one serious mental illness that needed hospitalization to hundreds of types that require treatment.

When the problems look unsolvable, anything is progress.

Many people in America have financial problems. Up to two-thirds of all Americans are either in debt on credit cards or have so little money in the bank that if they are car broke down they couldn’t pay for the repairs. When you’re without savings or in credit card debt, becoming financially solvent looks like an overwhelming obstacle.

People who undertake getting out of debt may start by creating a small savings account. For others, financial health means paying down credit card debt. Months or even years later that goal of reducing debt becomes paying the charge cards off. The initial goal of saving 100 dollars becomes saving $1,000. Notice that people with lots of money still believe they need more to feel secure.

When crimes go down, neighbors call about “suspicious people.”

Many people are reluctant to call the police unless they’re the ones who have been victimized. There are still neighborhoods where nobody wants to call the police. To offset this lack of people caring about each other some areas instituted community watches. Initially, this can help the police prevent or solve crimes. Recently however we have seen people who are calling the police about all kinds of marginal issues. Be careful not to let your lawnmower get over onto the neighbor’s grass, or you may get the police called on you.

Find the purple dot – when there are no purple dots the blue ones get picked.

Psychologists attempted to see how well people can distinguish significant things. They would show them pictures of various colored dots. If you show people blue dots, purple dots, and green dots and tell them to keep track of how many purple dots they do well. But if you ask them the same thing but this time show them only the blue and green dots many people think that they saw a certain number of purple dots. Or put another way if they must press a computer key when they see a purple dot on the screen but are shown no purple dots they began pressing that key when shown the blue dots.

When the quality gets better things that used to pass get rejected.

People study quality control issues have discovered that as the quality on an assembly-line gets better things that used to pass get rejected. Rather than being able to identify poor quality items inspectors tend to pick a certain fixed percentage to reject.

Big depends on the last thing you looked at.

Humans have a cognitive bias to describe things as big or small by comparison to the object they looked at just before it. Show them several very tiny items, and suddenly the coin appears large. Show them a lot of car parts, and that coin looks small.

Food looks like more on a small plate.

The same amount of food on two different size plates is perceived differently. If you want to cut down on the amount of food you eat, use smaller plates. If you want kids to eat more give them larger plates. The same thing happens with problems. When you don’t have much everything can become a problem.

Given all these cognitive biases is it any wonder that no matter how many problems you solve you will still identify some of the things in your life as problems?

The way we perceive problems determines how many problems we have.

Staying connected with David Joel Miller

Four David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter.

Can you prevent depression?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Depression is no joke.

The World Health Organization has identified major depressive disorder as the most significant cause of disability worldwide. Even though depression is a significant source of disability most research on depression has focused on causes and treatment rather than ways to prevent depression or ways to prevent depressive relapses in those who have recovered from an episode of depression. A disease as common as major depression needs more focus on prevention.

Depression can be prevented.

All humans may suffer from some depressive symptoms from time to time, but if those symptoms become severe enough, you will be diagnosed with major depressive disorder. You should know that major depressive disorder rarely goes away on its own, untreated. There are certain lifestyle adjustments you can make which can reduce the likelihood you will get depression or once you have been treated; these techniques can reduce the risk that you will have subsequent episodes of depression. Researchers believe that up to half of all depression could be prevented. More than 30 randomized controlled trials have shown that depression can be prevented.

Preventing depression is different than treating depression.

When can depression be prevented?

You can experience depression at any time in your life, but there are certain times when you will be under stress, and the risks increase. Your quality of life will be much better if you focus on preventing depression rather than waiting until you experience a severe episode of depression.

There are two approaches to preventing depression. One is to try to avoid the first episode of major depressive disorder. The second approach is those efforts made by people who have recovered from a major depressive episode to prevent having a relapse into depression.

Your sleep affects your depression.

Changes in sleep are a symptom of depression. In melancholy depression, people can’t sleep and can’t eat. In atypical depression, people become like the bear ready to hibernate for the winter. They eat everything in sight and then sleep for abnormally long periods. If you have multiple days on end where you can’t sleep, or you feel chronically tired and can’t get out of bed in the morning despite sleeping for more than a healthy number of hours, you should be evaluated for major depressive disorder.

Better sleep requires more than simply more hours in bed.

It’s important to develop good sleep habits. The quality of your sleep matters. Aim for at least seven to eight hours of good restful sleep. Allocate enough hours each night for sleep. Give yourself an hour or two to wind down before bedtime. If you’re having difficulty sleeping because of emotional problems, talk over those problems with your support system or seek professional help.

Smoking is connected to depression.

Depressed people are more likely to begin to smoke, have difficulty quitting, and if they do stop depressed people are more likely to start again. This relationship is bidirectional. Smoking increases the risk you will become depressed. Smoking has been connected to a number of mental health problems. Not having to go through the daily process of taking doses of nicotine and then rapidly withdrawing can increase your emotional stability and reduce the risk of depression.

Increase positive emotions to avoid depression relapses.

Learn to be a happiness expert. Preventing depression includes expanding positive experiences in your life. The more happy, positive feelings you have the less room there is in your emotional life for depression. Magnify the positive to minimize the negative.

Decreasing negative emotions lowers the risk of depressions returned.

Try to rid your life of negative emotions. Too much anger can wear you out emotionally. Loneliness, especially the kind of loneliness that comes from poor quality relationships, quickly needs to depression.

Avoid alcohol to sidestep depression.

Alcohol is a depressant. Even a little bit of alcohol can dampen your mood. If you have a history of alcohol use disorder is probably not safe to drink alcohol. If you’ve recovered from depression drinking alcohol may lead to relapse. If you are recovering or have recovered from depression, why risk a relapse of depression by consuming alcohol?

Continuing treatment for depression longer can prevent relapses.

If you have taken medication for depression don’t discontinue it the minute you feel better. Always consult with your doctor before discontinuing or changing medication. Stopping medication too soon increases the risk of a depression relapse.

Continuing to participate in Cognitive behavioral therapy after the immediate crisis also reduces relapses into depression. If you have done other things to treat your depression continue those life improvement practices also. Staying in treatment a little longer can be very helpful in preventing relapses of depression.

Staying connected with David Joel Miller

Four David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter.

Eight ways depression gets overlooked in adults.

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

Older people

Elderly couple.
Photo courtesy of Pixabay.com

As people age, the ways they show depression changes.

In mature adults, depression can often be overlooked. As people age, the symptoms of depression change and treatable depression is likely to be dismissed as just a part of the normal process of aging. Younger people commonly express their sadness by crying. Among older adults, depression is more likely to manifest as withdrawal, hopelessness, loss of appetite, and apathy.

Symptoms of depression in mature people are often misinterpreted as aches and pains. Depressed people of all ages are likely to self-medicate emotional problems by using pain relievers. Untreated depression in older adults can lead to their failure to take care of their physical needs. Failure to recognize and treat depression among older adults can make the course of their physical illnesses worse and can result in an increased risk of suicide.

Gerontologists have recognized many ways in which depression in older adults can be overlooked. Here are eight ways depression often goes unnoticed in older adults.

1. Joint and back pain can be symptoms of depression.

Joint and back pain can be symptoms of depression, or they can lead to depression. One study found that the more joints that are in pain, the more likely the person is to have depression. If someone has joint pain or back pain, they need to see a medical doctor and get that pain treated, but they also need to be screened for depression. Pain can be depressing, but depression can make the pain feel worse.

2. Cognitive impairment may be depression rather than aging.

Problems with memory and thinking among older adults may well be the results of depression rather than age-related disorders. A lack of motivation, apathy, is a characteristic feature of depression. Depression leads to confusion about your options and what to do. The longer the depression goes untreated, the higher the risks it will be dismissed as cognitive impairment due to aging.

3. Chest pain can be made worse by depression.

Having a heart condition or chest pain can lead to depression. People with depression are likely to experience those pains more acutely. While you shouldn’t neglect medical treatment for chest pain, an older adult who has chest pain should also be screened for possible depression and treated for depression if it’s present. Having depression leads to poor compliance with the doctor’s instructions, not taking medication as prescribed, and a poor prognosis.

4. Irritability is a common symptom of depression.

Regardless of age, when you don’t feel well, you’re more likely to be irritable and push people away. Among older adults with depression, irritability is such a common symptom; it is almost universal. If you find that you’re becoming more irritable as you age considered getting professional help for possible mental health issues.

Depression may also express itself in other negative emotions. Guilt, shame, fear, anxiety, and loss of hope all feelings that may be associated with depression.

5. Headaches, especially migraines, can be a sign of depression.

One large study found that among those people with migraines, more than half also had depression. This connection can run in either direction. We can’t be sure whether the headaches caused the depression or being depressed increases the chances of headaches and migraines. If headaches have begun to interfere with an older adult’s life, they should be screened for depression and anxiety disorders.

6. Digestive problems can be a sign of depression.

One of the core criteria symptoms for depression is changes in appetite. In younger people with depression, we usually see them either unable to eat or binge eating large amounts of food. In older adults, these changes in appetite may also be reflected in nausea, constipation, diarrhea, or other gastrointestinal upsets.

7. Changes in sleep patterns may be caused by depression.

There are two types of depression recognized, melancholy depression, and atypical depression. In melancholy depression, people can’t sleep or sleep poorly. In atypical depression, the person will be chronically tired and spend an increased amount of time in bed. Some changes in sleep are common across the lifespan. But if an older adult finds they are having trouble sleeping or sleeping a great deal more than usual, that change in sleep may be a result of an underlying depression.

8. Increased use of alcohol and drugs are connected to depression.

In the past, there’s been a tendency to excuse increased alcohol consumption among the elderly. They don’t need to work anymore and why shouldn’t they enjoy themselves? The truth is drinking to intoxication is not likely to be enjoyable. Depressed people tend to drink more, and alcohol is a depressant, making the heavy drinkers more depressed. Drinking to intoxication has been linked to a massive increase in the risk of suicide. For older adults, even a small amount of alcohol can make their physical health worse.

Historically, as people grew older, most of them, gave up their use of drugs. The baby boomer generation has tended to continue their use of drugs well into their retirement years. Escalating drug use can be a symptom of depression in older adults and can lead to creating and exacerbating physical health issues.

If you’re an adult moving to the older adult years, or you have a friend or family member in that age range, don’t overlook the signs of depression. Depression is not something you have to put up with as you age. Severe depression is a crippling disorder which is treatable by both medication and talk therapy. No one should have to suffer from depression in their “golden years.”

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter.

Learning about alcohol and drugs.

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

Drugs.

Drugs.
Photo courtesy of Pixabay.

How much do you really know about alcohol and drugs?

Despite the prevalence of drugs and alcohol in our society, many people have never had any formal education about drugs or alcohol. Most people get their education in this area the same way they learn about sex, on the street, and by experimentation.

As a society, we have a love-hate relationship with drugs and alcohol. The consensus seems to be that drinking and doing drugs can be enjoyable, but that “losing control” of that habit can be harmful maybe even deadly. Clearly simplistic solutions, just say no, or saying only bad people have problems is not working.

Ignoring the effects of addiction and alcoholism is easy.

Most people try to ignore the problem until it overwhelms them personally, or someone close to them. It’s reassuring to believe that addiction or alcoholism is something that happens to “those kinds of people,” the weak, or the lazy.

Not everyone who experiments with drugs or alcohol develops a problem. We know that young people are likely to try new and exciting experiences. Initially, it all sounds like fun. Most go on to have typical lives. But increasingly we are seeing people of all ages, including the older generation, whose lives are being damaged by substances.

Most people’s conception of an alcoholic is the homeless bum on the street, someone who can’t work and drinks all day every day. The unpleasant truth is that 95% of all alcoholics have full-time jobs. It’s entirely possible that you meet these hidden alcoholics every day. For every person with a drinking problem, estimates tell us that, 5 to 8 other people are harmed by that person’s drinking.

In some hospitals, half of the bed are taken up by people whose illness is primarily caused by or made worse by the direct results of alcoholism.

The problems with alcoholism and addiction are all around us.

In every city in America of any size, and I feel confident this happens everywhere else on planet Earth, we see the harm caused by the misuse of substances. A quick look at last night’s paper shows several people arrested for DUI. Several accidents in which one or both drivers were intoxicated. And an occasional story about someone dying of a drug overdose.

The war on drugs misled us.

American’s have noticed a staggering increase in the number of people who are dying from overdoses of prescribed opiate drugs. Despite a long-running war on drugs, the devastation is worse now than it was before. Several unpleasant facts emerge from studying substances and substance use disorders.

The majority of drug overdose deaths arise from prescribed medications, not street drugs.

Legal or tolerated drugs, nicotine, and alcohol each kill more people per year than all the illegal street drugs combined. Most of the deaths from drug overdoses involve people who have more than one drug in their bloodstream. Mixing alcohol with other drugs, prescription or street drugs, increases the risk of death.

Many professionals lack education about the effects of drugs and alcohol.

Most professionals working in the mental health field have minimal training in substance-related problems. Most counselors and therapists receive from one to three units in substance-related classes in an entire master’s program. Surveys indicate that the majority of people with substance use disorder, 60% or more, also have a co-occurring disorder. Furthermore, many people with diagnosed mental illness, approximately 50%, also have a substance use disorder.

In my own experience, it is extremely common to find someone with severe depression or high anxiety, who is also abusing substances. Use of alcohol or drugs may temporarily mask symptoms but in the long run, using substances as a crutch makes the problem worse.

Therapists who work with couples often find that one or both parties are using drugs or alcohol, and this is contributing to the marital discord. Unfortunately, many counselors who were not trained in substance use disorders ignore the problem rather than ask about it.

Since I started in the counseling field as a substance use disorder counselor, I’m acutely aware of how commonly mental health problems and alcoholism or addiction occur together. Substance abuse counselors, at least here in California, typically go through a 36-unit program with many of the classes specifically focused on alcohol, drugs, and the process of moving from use to addiction.

Very soon school will be back in session, and this semester I will be teaching several classes in the substance use disorder program. While I don’t want to shift the counselorsoapbox.com blog specifically towards drugs and addiction, I thought it might be useful to share with you some of the material I use in my substance abuse counseling classes. Also, in the near future, I am planning to release some of this material as videos on our very own counselorssoapbox YouTube channel. Stay tuned, and I will let you know how the videos are progressing.

If you made it this far, thanks for reading, and please remember to click like if you enjoyed this post and please leave comments. Talk to you again soon.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, Google Play, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Obsessive-Compulsive and Related Disorders.

By David Joel Miller.

Obsessive-Compulsive Related Disorders.

Obsessive-Compulsive and Related Disorders.
Photo courtesy of Pixabay.com

Obsessive-compulsive is a label that is frequently misused. Most people, when they say they are obsessive-compulsive, mean that they have strong preferences for the way they want the thing to be done. In the mental health field, what we mean by Obsessive-Compulsive Related Disorders are a group of disorders which seriously interfere with a person’s relationships, their ability to work, cause them distress, or prevent them from engaging in other important activities.

A personal story about compulsions to illustrate this difference.

I have a preferred breakfast meal. It comes frozen and is relatively inexpensive. Each week when I do the grocery shopping, I buy enough for the following week. I tend to eat this meal every day. Should I end up traveling, or get behind schedule I’m open to eating something else.

Someone with OCD or a related disorder might feel that their failure to eat the required breakfast, could cause their day to be ruined. They might believe, even though they know it is illogical, that their failure to eat the required breakfast, in a specific order, could result in someone starving to death, or harm coming to a family member. These beliefs that their actions or inactions, can cause harm results in an overwhelming compulsion to perform actions.

I have used an extremely exaggerated example here, but I hope you can see the difference between an extremely strong preference and a compulsion. A compulsion is something you feel forced to do even when it makes no sense. It is as if the person with OCD is being controlled by an outside force.

Defining obsessions and compulsions.

Obsessions are persistent, unwanted, and intrusive thoughts, urges, or pictures that you can’t get out of your head. Compulsions are the things people feel required to do to reduce the tension caused by the obsessions. These behaviors are often done a specific number of times. Compulsions may involve inflexible rules which must be obeyed to prevent something bad happening. Some Obsessive-Compulsive Related Disorders involve self-injury, like hair pulling or skin picking, which continues despite efforts reduce or stop the behavior.

Classifying Obsessive-Compulsive Related Disorders.

In the past, Obsessive-Compulsive Related Disorders were scattered throughout the diagnostic manual. Some of these disorders were in the chapter on anxiety; some were mixed in with impulse control disorders, others were under somatoform disorders. A few were not even recognized as mental illnesses in the past. In the most recent DSM-5, these issues were brought together in a single Obsessive-Compulsive and Related Disorders chapter.

Sometimes it’s hard for professionals to diagnose which disorder a person has. It is possible for one person to have several of the Obsessive-Compulsive Related Disorders. Many people with Obsessive-Compulsive Related Disorders also have anxiety disorders, trauma and stressor-related disorders and some form of depression.

OCD leads the Obsessive-Compulsive Related Disorders parade.

Among the Obsessive-Compulsive Related Disorders, the best-known disorder is Obsessive-Compulsive Disorder, a serious mental health issue which is estimated to affect between 1% and 2% of the population worldwide.

Other Obsessive-Compulsive Related Disorders include Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, (hair pulling), and excoriation (skin picking). All of these disorders significantly interfere with people’s lives. Symptoms in these disorders recur, despite repeated efforts to control or stop the Obsessive-Compulsive Related Behaviors.

Substances and medications can cause, or induce, Obsessive-Compulsive Related Disorders. Some medical conditions can also cause obsessive-compulsive behaviors. In the DSM-5 they are also seven other conditions lumped together under the heading Other Specified Obsessive-Compulsive Disorders. One of those conditions is Obsessional Jealousy. This is one of the few times jealousy counts as a symptom of a mental health disorder. More on Obsessional Jealousy in a future post.

Treatment for Obsessive-Compulsive Related Disorders.

The primary treatment for Obsessive-Compulsive Disorder (OCD) is exposure and response prevention therapy. While exposure and response prevention therapy has some similarities to systematic desensitization, which is used to treat specific phobias, relatively few therapists are trained in exposure and response prevention therapy.

One resource you may want to consult is the WordPress blog ocdtalk.  http://ocdtalk.wordpress.com/

For more information on Obsessive-Compulsive and Related Disorders see:

Obsessive-Compulsive Related Disorders category

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder

Hoarding Disorder

Trichotillomania, (hair pulling)

Excoriation (skin picking)

Obsessive-Compulsive Personality Disorder

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Why do you worry?

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

Man worrying,

Some things you do not need to worry about.
Photo courtesy of Pixabay.com

Excess worry damages your mental health.

Many people know that worry and rumination can damage their mental health. Those same people may hold contradictory beliefs that they must worry to prevent bad things from happening.

People who hold both positive and negative beliefs about worry are likely to be higher in anxiety, experience more depression, and have impaired physical as well as mental health.

Positive beliefs about worry encourage worrying.

People who are high in worry, often have firm beliefs about the positive consequences of worrying. The way you think about worrying plays a role in creating and maintaining that worry. It’s hard to give up worry, no matter how painful it is, if you have positive beliefs about the benefits of worrying. If you worry a lot, examine your beliefs about worry. You may be expecting worry to play a role in life; it’s not able to fill.

People who worry a lot believe Worry will keep them safe.

People who worry a lot, often have a belief that worrying will make possible future negative events less likely to happen or will prevent those bad results from happening altogether. People who worry a lot expect that worry will reduce the consequences should a bad event happened.

Some worriers believe that worry motivates them.

Humans tend to be loss averse. Most people will work a lot harder to avoid losing something they have then they will work to get an item of equal value. If you worry about flooding, you may buy flood insurance.

When they are unhappy with their current job, a worrier is likely to put more effort into avoiding the loss of the current job then they will put into securing a new better job.

People who frequently worry may believe worry helps analytic thinking.

At the beginning of a project, most people see only probable success. Worriers have the belief that by worrying about what could go wrong they will spot possible dangers.

Frequent worriers believe that they need to control their thoughts.

People who are high in worry often believe that their brains will think dangerous thoughts. Sometimes they confuse the difference between thinking about something and causing it to happen.

Worriers are intolerance of uncertainty.

People who have difficulty accepting that some things are out of their control are at increased risk to develop excessive, pathological worry. People who are high in worry and anxiety believe they are responsible for controlling outcomes. Not being able to predict what will happen coupled with the belief that with enough thought and effort you should be able to control the results, can result in debilitating worry and anxiety.

Worriers use the “as many as I can” worry stop rule.

People who plan focus on the high probability issues. Worriers attempt to anticipate everything that could go wrong. Because of their efforts to anticipate every possible negative outcome, worriers spend a lot of time focused on low probability events and often are unprepared for the things that do occur. People who are low in worry use the “good enough worrying” rule. They worry only about a few high probability outcomes.

Worriers believe they must have cognitive confidence.

People who worry a lot, value high levels of confidence. They’re uncomfortable with uncertainty. Many life events contain large amounts of uncertainty. Worriers try to reduce that uncertainty by turning the possibilities over and over looking for other things that could go wrong.

People who worry a lot tell themselves worry is uncontrollable.

The focusing for worriers is on preventing negative feelings and consequences rather than on preventing worry. If you believe worry is uncontrollable, then it is something you are required to do. Believing worry is uncontrollable, but that you are responsible for controlling what happens leads to superstitious beliefs and may result in repetitive obsessive-compulsive disorder behaviors.

High levels of negative feelings create worry.

Feelings of pessimism, personal inadequacy or incompetence, and personal despair and hopelessness make it more likely they will worry. People who are sad or depressed are likely to worry more.

Worry can be used to avoid facing unpleasant life events.

When you worry, you can stay focused on what might happen, and you don’t have to think about what is taking place in your life today. Studies have demonstrated that people use worry as a way of avoiding unpleasant situations and feelings. By staying “up in your head” in worry, you can block the part of the nervous system that processes feelings.

If you worry a lot, now might be a good time to challenge some of the beliefs you have about worry.

David Joel Miller, MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.