How lonely will you be?

By David Joel Miller.

Will loneliness cause you problems?

loneliness

Loneliness.
Photo courtesy of Pixabay.com

Loneliness can result in significant emotional problems. While loneliness isn’t considered a specific mental illness, it plays a role in creating and worsening several mental health issues. Loneliness can undermine self-esteem by making people feel, empty, worthless and unwanted. Loneliness is both a cause of and a result of social isolation. If you are feeling lonely, you probably feel that you lack something in your life. Loneliness coupled with anxiety and depression increases your risk of feeling threatened and may result in paranoia.

In its milder forms, loneliness can be a motivator for you to seek out human contact. Stronger versions of loneliness result from feeling you have too few social connections or the relationships you have are one-sided and unhelpful.

Researchers have discovered strong connections between loneliness and depression. Lonely people are at an increased risk to think about suicide or to even attempt suicide. Lonely people are more likely to use and abuse drugs and alcohol resulting in alcoholism and addiction. The combination of substance use disorders, feeling lonely and depressed, and believing that others are rejecting you, increases the risk of violent behavior. Loneliness has also been linked to physical health problems and poor emotional development.

The very young and very old are at increased risk for feelings of loneliness. Particular life transition points also increase these risks.

Your thinking can make your loneliness better or worse.

How lonely you feel is less likely to be the result of how many friends you have or how much time you spend with others, and is more connected to your attitudes about the quantity and quality of your social connections.

Your feelings of loneliness are primarily the result of your beliefs about four separate factors. When you’re feeling lonely, it is important to look at both the facts and your beliefs in these areas. One way to reduce the feelings of loneliness is to develop the skills you need to change your situation. The other way to feel less lonely is to reconsider your beliefs about things. Often negative emotions are caused not by the situation, but by the beliefs you have about your circumstances.

What do you think about your friendships?

Loneliness is reduced more by having close, true friends, than by the number of casual friendships you have. It’s not how many friends you have, especially your social media friends, but how close you and your friends are.

True friendships should be reciprocal. You care about them, and they care about you. You should be willing to do for them, and they should be equally willing to do for you. If you find that your relationship is all about that other person, that you must do what they want to keep their friendship, that’s not a healthy, positive friendship.

It’s wonderful to have a BFF (best friend forever.) Having only one close friend limits the ability of your friendship to be supportive. No one will be able to devote every minute of their life to meeting your needs. If you call that one best friend constantly about your problems, you are likely to burn them out.

Recovery programs often recommend that you have at least five separate people in your support system. Your friends should have other people in their lives beside you. If you’re in a relationship where you can’t have other friends or where you resent the other people in their life, these are not healthy relationships.

Emotionally healthy people belong to a group of friends rather than being dependent on only one person. Having only one person to meet their emotional needs is a large issue for couples. When there are difficulties in your relationship, you will find it hard to turn to your partner for emotional support. It’s risky to turn to friends with whom you might be tempted to develop a close sexual relationship. For heterosexual people, this is the time you need to have friends of your own gender.

Are you isolated?

Feeling socially isolated causes loneliness. If you feel like you have no friends and no one you can talk to, this should prompt you to reach out and make connections. For some people, this means professional counseling, which can help in the short-term. In the long-term, you need to put yourself into situations where you can make friends, and need to learn the skills necessary for creating and maintaining friendships.

Is being alone a bad thing?

Your attitude towards solitude will magnify or reduce your feelings of loneliness. Ask yourself how you feel about spending time with you? Some people find that when they are alone, they don’t know what to do. Are you bored when there’s no one else around?

Being alone shouldn’t make you unhappy. Alone time is an opportunity to find out about yourself. Focusing on the negative will increase your loneliness. Feeling negative about being alone will cause the time to drag. Filling the alone time with things you enjoy doing turns loneliness into happiness.

Can Solitude be a good thing?

When you are alone, look for the positives. Your time alone should be an opportunity to get to know yourself better. Develop a friendship with yourself. Throughout your life, the one constant will be you. Everywhere you go, every minute of your life, you will be there. Work on enjoying the time you by yourself.

Life can get hectic at times. Sometimes it’s nice to get away from it all. If when you get that chance to get away from life’s hassles, you discover you’re getting lonely, consider developing a stronger friendship with yourself.

Other posts about feeling lonely will are found in the category – Loneliness.

Staying connected with David Joel Miller

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.

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.

Your “feeling bad” may be Dysphoria.

By David Joel Miller.

Dysphoria – the feeling bad problem.

Unhappy

Dysphoric.
Photo courtesy of Pixabay.com

Sometimes you just feel bad. Many times, people feel bad but can’t describe what that feeling is. Ask someone at random how they feel, and the most common answers will be, good, bad, or angry. Some of this stems from the bad reputation feelings have received. Many people go to great lengths to avoid any negative feelings. When you tried to avoid negative feelings, it’s no surprise that when you do feel bad, you have difficulty identifying that feeling and giving it a name.

You may have been labeled dysphoric without your knowledge.

If you have been to see a professional because you were “feeling bad” but you didn’t know the specific reason, the professional may have written down somewhere in your file that you were “dysphoric.”

When you’re under stress, the chemicals your nervous system produces are felt widely throughout your body. Panic attacks can feel like a heart attack. Depression can leave you exhausted, lacking the energy to get out of bed. A high percentage of clients who experienced these symptoms go to the medical doctor first. Which is not a bad idea. You need to rule out a medical issue. Sitting and talking to your counselor during your heart attack could be fatal.

Once your medical Doctor has ruled out immediate, life-threatening illnesses, you may be referred to see a psychiatrist, counselor, or therapist. Seeing a counselor does not mean you are crazy. What it tells us is that your nervous system has been sending out chemicals alerting the body to an emotional crisis. The result is an episode of dysphoria.

Is dysphoria a mental illness?

Dysphoria is a term that goes back to the days of Freud. Back then someone was either diagnosed with psychosis, that meant you were crazy, or neuroses which largely meant you were struggling with the problems of living. I have seen the term dysphoria in a lot of the older literature from the fields of psychology and psychoanalysis. Today professionals use the DSM-5 to diagnose mental illness. The DSM lists about 400 different varieties of mental illnesses. Dysphoria can be an underlying symptom of many of these illnesses, but it is not one specific disorder.

No client has ever told me they felt dysphoric. But I’ve heard that they “feel bad” plenty of times. I have seen the word dysphoria on assessment forms several times, usually as a checkbox for a feeling the client might be having. As my students have heard, I think of a good assessment as more than just checking the boxes and filling out a form.

To help someone who is “feeling bad” the counselor needs to examine that feeling, identify the specific feelings involved and ideally match them up with a specific mental, emotional, or behavioral problem.

What exactly is dysphoria?

OxfordDictionaries defines dysphoria as “a state of unease or generalized dissatisfaction with life. The opposite of euphoria.” Some words are easiest to define by saying that they are the opposite of something else. Unfortunately defining dysphoria by saying it’s the opposite of euphoria is not much help.

The Century Dictionary and Cyclopedia, from 1889, gets us closer to a useful definition. I think this is an important point. When you are reading books which were written a long time ago, Freud and Jung, even the psychoanalysts who wrote before the DSM Four, it’s important to ask what the words meant to them. The English language has always been in a state of change.

The Century Dictionary and Cyclopedia defines dysphoria as; pain hard to be borne, anguish, impatience under affliction, a state of dissatisfaction, restlessness, fidgeting, or inquietude.

In Psychology dysphoria generally means one of 3 things.

Martin Seligman in his book What You Can Change and What You Can’t begins with the idea of dysphoria and then breaks it down into three specific negative emotions. I would highly recommend this book by the way. One point he makes here is that to date there is no medication which cures any mental illness. At the time he wrote this book; he listed 14 mental illnesses that could be effectively treated, cured, or greatly reduced, using specific forms of talk therapy. I’m inclined to think in the years since he wrote this book other therapies have proven effective for additional mental and emotional disorders.

Anxiety can look like a physical illness.

Anxiety disorders are the “great pretenders.” During episodes of anxiety, the thoughts in the brain mobilize the body for flight or flight activities. Anxiety reduces a lot of physical symptoms in your body and is frequently mistaken for a physical illness.

Professionals split anxiety disorders into a number of specific types. Most are temporarily manageable with medication, but when the medication wears off the anxiety returns worse than before. Therapy of several varieties, coupled with relaxation techniques and life skills training can greatly reduce the levels of anxiety.

Recently, trauma and stressor-related disorders such as PTSD were separated from the Anxiety Disorders. These problems have added symptoms such as nightmares and flashbacks. There are treatments for these disorders, but those treatments are very different from the ones used for anxiety.

Depression comes in many varieties.

Professionals categorize depression more by the physical symptoms you experience than by the cause of the depression. Some types of depression have a specific cause, and others don’t. Many of the symptoms of depression look like those of physical illness. Changes in appetite, eating either too much or too little, can all be part of depression. Changes in sleep are also an element of depression. Some people, when depressed, experience significant fatigue. Depressed people may take to bed and feel too tired to get up. Underlying depression is the loss of the ability to experience happiness. Some people can feel a few bursts of pleasure, but the temporary pleasant sensation quickly fades.

Anger and irritability are often components of dysphoria.

When someone doesn’t feel well, they are out of sorts, they become irritable and push others away. Some people feel “bad” and experience a lot of anger. Neither anger nor irritability is considered a specific mental illness, but they may be symptoms of several mental health challenges.

It would be wonderful if there were specific blood tests or x-rays that would determine that the physical symptoms you have are the result of dysphoria and could be identified as one specific mental illness. Unfortunately, it doesn’t work that way. First, you need to see a medical Doctor to rule out physical illness. Next, you would see a counselor who would talk to you about your symptoms. Based on the number and severity of symptoms you would get a specific diagnosis.

Treatment should be tailored to you and your particular symptoms. Therapy is not something the counselor should do to you. Therapy is something the counselor and client do together. As a result of counseling, you should learn skills and new ways of thinking that will help you manage dysphoric feelings and learn to increase the number of positive feelings you experience.

If you have been feeling bad, one or more of the dysphoric feelings, please consider getting help.

Staying connected with David Joel Miller.

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.

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.

Could you start over after a trauma?

By David Joel Miller.

Ninety-nine cent Kindle book sale.

The Kindle Edition of my latest book, a novel about a man forced to recover from an incredible trauma, is on sale right now for just ninety-nine cents.

Casino Robbery.

The robbers wanted more than money; they planned to kill Arthur’s fiancé and her boss.

Arthur Mitchell was trying to start his life over with a fiancé and a new job. That all ends

Photo of Casino Robbery book

Casino Robbery.

when the casino robbers shoot Arthur, kill his fiancée, and her boss. Arthur would like to forget that horrible day, but the traumatic nightmares and constant reminders won’t let him, and someone is still out to get him. When he tries to start over by running a rural thrift store, someone knocks him unconscious, vandalize the store, and finally tries to kill him. His only chance to find peace is to figure out what the killers want from him and why.

Casino Robbery is a novel that explores the world of a man with PTSD who has to cope with his symptoms to solve the mystery and create a new life.

The Kindle Edition can be ordered now for just 99 cents!

Casino Robbery is also available in paperback.

Bumps on the Road of Life

Don’t forget about my first book.

Bumps on the Road of Life is now available in Kindle format. It was released 11/13/17. The paperback version is also available. Look at the description below. Thank you, to those who have already ordered paperback copies or the Kindle Edition.

Bumps on the Road of Life

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

Bumps on the Road of Life.

Bumps on the Road of Life.
By David Joel Miller

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

Please visit my Amazon Author Page – David Joel Miller

if you purchased either of my books, reviews are appreciated.

I sincerely hope you all enjoy reading my book as much as I enjoyed writing them. If you do, I would greatly appreciate a short review on Amazon or your favorite book website. Reviews are crucial for any author, and even just a line or two can make a huge difference.

Thanks again for reading this blog, pardon the short digression, next time we will return to another post about mental health, substance use disorders, and having a happy successful life.

David Joel Miller.

What is Reactive Attachment Disorder (RAD) F94.1?

By David Joel Miller.

Reactive Attachment Disorder begins early in life.

What is? Series

Reactive Attachment Disorder (RAD)
Photo courtesy of Pixabay.com

Reactive Attachment Disorder (RAD) is one of those disorders which was moved in the DSM-5.

It used to be included in the chapter on Disorders First Diagnosed in Infancy, Childhood, and Adolescence.

RAD now appears in the chapter on Trauma- and Stressor-Related Disorders.

Reactive Attachment Disorder is the result of deficiencies in early life care.

Reactive Attachment Disorder is an internalizing disorder. A related disorder called Disinhibited Social Engagement Disorder involves externalizing behaviors.  Both conditions are thought to be caused by poor caregiving early in life. RAD involves a consistent pattern of shutting down, withdrawing and inhibiting emotions. This disorder starts before age five and is rarely given after that age.

While this is a diagnosis primarily applied to very young children, in working with adults we often see conditions that probably began as Reactive Attachment Disorder.  A common statement is that they “just don’t get close to others.” This condition involves an inability to regulate emotion and unexplained anger, both issues we frequently see in adults who came from dysfunctional homes.

With children, we usually know that the symptoms are caused by neglect and poor parenting.  With adults, similar symptoms show up as depression, chronic sadness, anxiety disorders or even personality disorders.  Our understanding of reactive attachment disorder is pretty much an all or nothing condition.  I can’t help wonder about the effects which varying degrees of neglect or failure to meet the child’s emotional needs might be causing.

Reactive Attachment Disorder involves a consistent behavioral pattern.

Most of the Trauma- and Stressor-Related Disorders are related to anxiety and obsessive-compulsive disorders and are fear based. Reactive Attachment Disorder is about shutting down and internalizing. In Reactive Attachment Disorder, there is chronic sadness, depression, and loss of the pleasure.  There may also be accompanying anger, aggression, and dissociation. This involves a lot of withdrawal and inhibited emotion.

Reactive Attachment Disorder involves social and emotional problems.

Children with RAD are unresponsive to others.  They’re rarely happy or positive.  RAD involves frequent irritation, sadness and sometimes being afraid. Children with this disorder often react to adult caregivers in a negative way for no apparent reason. These patterns of poor relationships with adults continue even when caregivers change.

In adults, we see similar patterns with those people who get diagnosed with Persistent Depressive Disorder.  They often say they do not ever remember being happy.  What we often don’t know is if this person really had deficient care as a child or if they had a temperament which makes them difficult to parent.  Sick, or irritable temperamental children are harder to parent and more likely to be abused or neglected.

Extremely deficient care results in Reactive Attachment Disorder.

Characteristics of this less-than-adequate care include emotional needs not being met, frequent changes in caregivers, and being raised in impersonal institutionalize settings.  Mostly this deficient care results in poor relationships with caregivers and other adults, but it may also affect peer relationships.

Sometimes other things look like Reactive Attachment Disorder.

Sometimes children with Autism or developmental delays exhibit symptoms that can look like Reactive Attachment Disorder. In young children, it is important to be sure the problems were caused by poor caregiving.  In adults, we see behaviors that we suspect began as Reactive Attachment Disorder, but without a prior diagnosis, we can’t be sure. RAD may affect many other developmental areas.

Some cautions.

As with the other things we are calling a mental illness this RAD needs to interfere with the ability to work, or in children, go to school, relationships, or other enjoyable activities or cause personal distress. Otherwise, there may be issues, but the diagnoses will not be given. If the only time this happens is when someone is under the influence of drugs or medicines or because of some other physical or medical problem these problems would need to be more than the situation otherwise warrants. These other issues may need treating first, then if there are still symptoms, the diagnosis will be given.

Treatment for Reactive Attachment Disorder.

For children, getting into a situation with a caring, responsible, caregiver, can make all the difference.  For adults with problems now, which may or may not be the result of early childhood experiences, there are several therapies which may be helpful.

It is imperative that children who have Reactive Attachment Disorder get treatment early to prevent lifelong difficulties.  Adults who struggle with emotional difficulties may find that they still have early childhood issues that need to be addressed before their adult problems will resolve.

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

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. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Lessons Depression teaches you.

By David Joel Miller.

Are you learning from your issues?

Lessons Depression teaches you.

Lessons Depression teaches you.
Photo courtesy of Pixabay.com

People who are able to learn from their problems do better in the future.  Whether you have an episode of  – Major Depressive Disorder, Persistent Depressive Disorder or some other type of anxiety or depression it is important to learn the lessons from that experience.  People who learn lessons from their issues seem to develop the skill of resiliency and they recover more quickly from future difficulties.  Below are some of the lessons that your depression may be able to teach you.

Sleep is more important than hard work.

One characteristic of depression is changes in sleep.  You may be sleeping far more than before or far less.  Not getting enough sleep puts you at risk to develop or worsen your depression.  Chronically getting too little sleep is one risk factor for episodes of depression and bipolar disorder.  If you’re losing sleep in order to work more or longer, that loss of sleep may impair your judgment and eventually undermine the progress you are making in your work.

You need to take care of yourself.

Just taking good care of yourself will not automatically prevent depression, but part of the process of recovering from depression is learning to take better care of yourself.  Depression teaches you the importance of good preventive self-care.

Taking care of you is not being selfish.

Another lesson depression can teach you is that in order to do for others you need to first take care of yourself.  You will find that taking care of yourself is not the same thing as being selfish.  Make self-care a priority to reduce the risks of future episodes of depression.

No one is perfect.

Depression can teach you that no one is perfect, there are plenty of improvement opportunities in every life.  Being too hard on yourself can easily put you in a negative frame of mind.  Trying to be perfect is setting yourself up for failure.  Learn to accept yourself just as you are.  Having this excepting frame of mind will help to inoculate you against future episodes of depression.

Sick people can do sick things.

Sometimes depression is a reaction to the hurtful things other people do to you.  Depression can teach you that other people can sometimes do very painful things.  Being a recipient of people’s negativity does not mean that you were at fault.  Sometimes people blame themselves for things that others have done when in fact that other person is a very sick person.  If someone has done something deliberately to harm you this does not mean you were at fault.

Stuff can’t make you happy.

It’s easy to slip into the trap of thinking if you just had more, bigger and prettier things, that then you would be happy.  Depression doesn’t care how much stuff you have.  Depression can teach you that experiences and relationships are far more important than material things.

Giving up on things can be a victory.

Persistence and dedication are virtues.  Sometimes we continue to try for far too long. Learning when to let go of something that is no longer making you happy is an important step in recovery.  Hanging on to lost causes is a sure way to increase your sadness and depression

It is OK to feel badly.

One lesson depression teaches is that sometimes it is OK to just feel the way you feel.  It is possible to feel badly and simply accept that feeling.  Just because something is hurtful, or painful does not mean that it needs to destroy you.

Feelings can be your friends.

Feelings, both good and bad can be your friends.  Feelings provide you with information.  They can tell you that things are good for you, or that they are bad for you.  Just because you feel badly you do not have to fall apart.

Your experiences made you who you are.

Living through feelings, good and bad, can be painful, but it ends up teaching you valuable lessons.  Your life experiences have made you who you are.  You can stay stuck in the past asking why things had to happen, or you can make peace with what happened and accept that this has become a part of who you are.

You need to measure your accomplishments, not the errors.

Most people have had many accomplishments.  Everyone who tries has some things that don’t work out the way they were planned.  If you only keep score of your errors you’ll run up a very large score.  When all you do was look at your faults it to be very discouraging.  Make sure you give yourself credit for the things you have accomplished.  It is likely that you accomplished far more things than you are aware of.  Depression likes to obscure your view of the positive things in life.

Friends will either buoy you up or pull you down.

Depression can tell you a lot about friends.  Some will help pull you up, others drag you down.  Let depression teach you about the characteristics of your friends.  Work on getting rid of friends who are negative.  A good support system can help you recover from any adversity.  Depression teaches you the value of good friends and encourages you to expand your support system.

What you tell yourself comes to be.

Words are powerful.  The things you tell yourself tend to come true.  Tell yourself that you can’t and you won’t be able to.  Tell yourself that somehow you will find a way to get past this and things go better.

How to really be grateful.

When everything is going well we forget to be grateful.  Depression teaches you to pay attention to the good things that happen in your life.  Sometimes we can become so discouraged by the things we don’t have, we lose the pleasure from the very many things we do have.  Recovery from depression can help you put all the parts of your life into proper perspective.

What lessons have you learned from your issues?

Take some time and consider what your personal issues may have taught you.  Have your life’s struggles make you stronger and more resilient or have you ignored the lessons they were trying to teach you?

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. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Persistent Depressive Disorder – PDD (F34.1)

By David Joel Miller.

What if you don’t ever remember being happy?

What is? Series

Persistent Depressive Disorder
Photo courtesy of Pixabay.com

Persistent Depressive Disorder – PDD (F34.1) is new to the DSM-5. The DSM is the book professionals use to identify mental illnesses. This diagnosis is the result of merging Dysthymia and another group of symptoms which was being researched as Chronic Major Depression. Some other variations on the depressive theme were being called Minor Depressive Disorder, which did not get recognized as such but kind of fits here.

While we may label these conditions as chronic or minor, there is nothing minor about them if you are someone who has this condition?

The defining characteristic of Persistent Depressive Disorder – PDD, is a pervasive sadness that just won’t go away. People who have this condition are always sad or unhappy. They may describe themselves as “always down” or having the blues. While this can cause a lot of impairment, people who have PDD come to think of their chronic sadness as “Just the way I am.”

It is estimated that about two percent of the U. S. population has PDD. Many people with PDD also experience a substance use disorder. There is also an overlap between PDD and Cluster B and Cluster C personality disorders, both of which, to my way of thinking, may have their roots in negative childhood experiences.

Persistent Depressive Disorder (PDD) is more disabling than Major Depressive Disorder.

PDD has been identified on brain scans and seems to affect at least four separate brain regions. PDD is long-lasting, at least two years, often more. During this time someone with PDD may also experience an episode of Major Depressive Disorder. While the major depressive episode may come and go the PDD often remains relatively constant. Because of this constant feature, people with PDD may not be able to ever feel really happy and their functioning, day-to-day, is more impacted than those with Major Depressive Disorder only.

Persistent Depressive Disorder (PDD) is chameleon-like.

Chronic unending depression has a lot of variations. This disorder can exhibit itself a great many ways. As a result, there are eighteen separate specifiers that can and should be added after the F43.1 These specifiers are not exclusive, so one person may also get several specifiers added to the Persistent Depressive Disorder (PDD) diagnosis.

Specifiers include with:

Anxious distress – anxiety commonly co-occurs with depression.

Mixed features

Melancholy features

Atypical features

Mood-congruent psychotic features

Mood-incongruent psychotic features

Peripartum features

In partial remission

In full remission

Early onset – before 21

Late onset – at or after age 21

Pure dysthymia syndrome

Persistent major depressive episode

Intermittent major depressive episode, currently with MDD

Intermittent major depressive episode, currently without MDD

Mild

Moderate

Severe

The symptoms of Persistent Depressive Disorder.

To qualify for PDD a person should have the following symptoms:

  1. Felt depressed or down, or had others see them this way, most of the day, most days, over a two-year period.
  2. Had at least two of the following six symptoms. These symptoms should be caused by emotions not by dieting or working long hours, etc.
  3. Change in appetite either up or down.
  4. Changes in sleep either too much or too little.
  5. Felt low in energy or fatigued a lot.
  6. Low self-esteem.
  7. Difficulty deciding things or poor concentration.
  8. Hopeless.
  9. Most of the usual exclusions. This has to be causing problems with work, school, relationships, should interfere with important activities or upset the client. It should not overlap Bipolar Disorder or Psychotic Disorder but may overlap Major Depressive Disorder. These symptoms should not be the result of medical or substance use issues.
  10. These symptoms have been constant and not gone away for two months or more over the required two-year period.

Be careful with the PDD label.

Calling Persistent Depressive Disorder by the label PDD could be problematic. In the past, we had another PDD – Pervasive Developmental Delay which is now recognized as a part of the Autism Spectrum. Persistent Depressive Disorder – PDD is about depression and has nothing to do with Autism. Be careful in reading articles that if they use the label PDD you know which of these two they are talking about. From here on I will call Persistent Depressive Disorder – PDD.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is a personal characteristic, not a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem these symptoms need to be more than your situation would warrant. These other issues may need treating first, then if you still have symptoms you could get this diagnosis.

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.

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

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. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is Disruptive Mood Dysregulation Disorder?

By David Joel Miller.

Maybe that child does not have Bipolar Disorder?

What is? Series

Disruptive Mood Dysregulation Disorder
Photo courtesy of Pixabay.com

Disruptive Mood Dysregulation Disorder F34.8 was added to the new DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) partially because way too many children were getting diagnoses of Bipolar Disorder. Most of these children grew up and never had an episode of mania or hypomania, the one thing that is required for a Bipolar Diagnosis.

The research supports the idea that a particular type of childhood depression was not getting the treatment it deserved. As a result, a lot of children were getting diagnoses they should not have had. Bipolar is only one of these possible incorrect diagnoses.

Some of the prominent symptoms of Disruptive Mood Dysregulation Disorder (DMDD) are temper tantrums and chronic irritability. These symptoms are quite different from the pressured uncontrollable behavior seen in Bipolar. DMDD has also been misdiagnosed as several other psychiatric disorders in the past.

One reason this has been getting noticed is that children who have the particular group of symptoms now recognized as DMDD rarely grow up to have Bipolar Disorder or behavioral disorders. What they develop as they grow are significant levels of depression and anxiety.

Disruptive Mood Dysregulation Disorder (DMDD) is similar to depression.

DMDD shares some characteristics with other forms of Depression. In both DMDD and the other depressions, there are mood issues, sadness, feeling empty or being chronically irritable. These mood issues result in changes to the body, physical symptoms, as well as changes in thinking and behavior. The result is that the person with DMDD or depression can’t function well even when they want to. DMDD is now found in the DSM chapter on depression. For many with adult depression, their issues all started in childhood with DMDD.

What are the symptoms of Disruptive Mood Dysregulation Disorder (DMDD?)

Disruptive Mood Dysregulation Disorder (DMDD) results in temper tantrums.

Children with Disruptive Mood Dysregulation can’t respond to frustration appropriately. The result of this lack of frustration tolerance is frequent temper tantrums or outbursts. These outbursts may be expressed verbally, or behaviorally. The defining characteristic of these temper outbursts is that they are excessive for the child’s developmental stage.

Even when this child is not having temper tantrums they are almost always in an angry or irritable mood. This angry irritable mood should be something that others can readily see by observing the child.

Age of onset of Disruptive Mood Dysregulation Disorder (DMDD.)

DMDD is only diagnosed if the symptoms first appear between the age of 6 and 18. The expectation is that the symptoms of depression seen with DMDD are inconsistent with the person’s developmental level. This is an issue of not being able to regulate your emotions.

Before age six we expect young or school-age children to have difficulty regulating emotions and to react with sadness, irritability or temper tantrums when frustrated. Young children may become frustrated and not able to exercise self-control no matter what the encouragement or punishment they receive.

Even if this disorder does not get recognized and diagnosed until later teen years the child must have had these symptoms before age ten. This separates DMDD from things that may be typical of adolescents during the teenage years.

Frequency and duration of Disruptive Mood Dysregulation Disorder (DMDD.)

On average, a child with DMDD should be having three or more episodes of mood dysregulation per week. This separates out the child who has occasional difficulties in response to a stressor from those who just can’t regulate emotions and are triggered more easily than they should be given their age.

These temper outbursts and mood dysregulation should go on most of the time for a year or more. This is no passing phase. Even if there are brief periods when the irritable angry mood is not present these periods of better mood should not last for more than three months.

Mood dysregulation happens in more than one place.

For us to think this child’s issue is a disorder we would expect the symptoms to appear in more than one setting, school, home, organized activates and so forth. In at least one of these setting, probably more, the outbursts are expected to be severe.

If there is mania it is not Disruptive Mood Dysregulation Disorder (DMDD.)

For a small group of children, there will be symptoms of mania or hypomania. If that is present then yes Bipolar Disorder is more appropriate and they are likely to develop more severe bipolar symptoms over time. Early treatment for childhood Bipolar Disorder can reduce the severity and impact of the disease but only if we are getting the diagnosis correctly.

One other difference between of Disruptive Mood Dysregulation Disorder (DMDD) and Bipolar is the way symptoms fluctuate. DMDD fluctuates in response to frustration. Bipolar symptoms come and go as a function of time.

Other Disruptive Mood Dysregulation Disorder (DMDD) issues.

DMDD has a lot of co-morbidity with other disorders. Children with DMDD are at increased risk of abusing substance and developing a substance use disorder (SUD.) And yes, we see SUD in elementary school children.

Because girls tend to internalize problems, while boys externalize, there is likely to be a bias in the diagnosis of Disruptive Mood Dysregulation Disorder (DMDD.) Only time will tell if this turns out to be another label for young boys.

Symptoms of Disruptive Mood Dysregulation Disorder (DMDD) are likely to change as the child grows and matures. It will be interesting to see if children who receive the DMDD diagnosis go on to experience Major Depression or some other adult mental health issues. Hopefully, treatment for this disorder while the child is young can prevent lifelong problems.

As with the other things we are calling a mental illness DMDD needs to interfere with the child’s ability to go to school, their relationships, and enjoyable activities or cause them personal distress. Otherwise, they may have the issues but not get the diagnoses. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem these symptoms need to be more than the situation would warrant. Other issues may need treating first, then if the child still has symptoms they could get this diagnosis.

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

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. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.