Category Archives: Mental Health

What is a Specific Phobia?

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

What is

What is a Specific Phobia?
Photo courtesy of Pixabay.

There are lots of things you might be afraid of.

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

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

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

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

Coding Specific Phobia.

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

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

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

F40.230 Medical, blood

F40.231 Medical, injections

F40.232 Medical, other procedures

F40.233 Injuries

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

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

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

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

The treatment of choice for Specific phobias is systematic desensitization.

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

com.

What is Bulimia Nervosa? (Was 307.51 now F50.2)

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

What is

What is Bulimia Nervosa? (Was 307.51 now F50.2)
Photo courtesy of Pixabay.

When eating and avoiding weight gain collide.

Bulimia Nervosa, Bulimia for short, is one of the feeding and eating disorders and is diagnosed about 4 times more often than Anorexia Nervosa according to the DSM-5. For the full description consult the DSM-5, what follows is my simple language version of this disorder and my experiences in seeing clients with these issues.

Women are ten times as likely to receive this diagnosis as men. Bulimia has three defining characteristics, “pigging out” and extreme measures to make up for that episode of excessive calorie intake as well as self-esteem or self-worth that is excessively based on weight and body type. These three characteristics make Bulimia sort of like Anorexia Nervosa on the one hand and Binge Eating Disorder on the other.

Pigging out is more than just liking to eat.

What makes the pigging-out or “binge eating” different in this disorder is the feeling of loss of control. In Bulimia, the client will eat far more than would be normal and do this in a relatively short time. The official definition sets this time limit more or less at 2 hours.

So binge eating is not snacking all day or having a big appetite. It is a loss of control over how much they eat and once they start the eating run it goes on until something interrupts the binge. Some have described these loss-of-control episodes as “spacing out” or dissociating. What they binge on can be very individual and can vary from episode to episode.

This loss of control is very similar to what we see in Substance Use Disorders. Turns out that about 30 % of those with Bulimia also develop a substance use disorder. Mostly this will be alcohol which is readily and legally available and can temporarily dissolve the guilt that comes from overeating. The other common drug of choice among many people with Bulimia is a stimulant use disorder. Start off on the “Jenny-Crank” diet to lose weight and you too may develop a Stimulant Use Disorder.

Once the guilt sets in you try to undo the binge.

A characteristic of Bulimia is the use of unhealthy ways of offsetting the excess calories consumed on the binge.  Those with Bulimia may force themselves to vomit to get rid of the over-full feeling and to lose weight. They also can try laxatives, water pills (diuretics), and extreme episodes of fasting. Those fasts by the way often end with another binge.

In Bulimia, self-worth is based on weight.

All this pigging-out style overeating and then trying to make up by extreme measures is hard on the self-esteem and self-confidence. Those with Bulimia base their self-esteem and self-worth on their weight and or body. So when they put on weight, they feel bad about themselves.

Bulimia is not something that just happens during Thanksgiving week.

To be defined as Bulimia we expect this person’s dance with overeating to go on for say three months or more and they will probably be binging at least once per week. In Bulimia the revolving pattern is binge, feel bad about yourself, and then do the extreme measures to keep the weight off. The recurring story the person with Bulimia tells themselves is that if they were just thinner they would feel better about themselves and others would like them more. Unfortunately, the only way to discharge the anxiety around food is with another binge and purge.

Which eating disorder is which?

Bulimia is separated from Anorexia mostly by the person’s body weight. In Anorexia they weigh significantly less than they should and are trying to stay that way or lose even more. In Bulimia, the person weighs about normal or even a little beyond but they are defiantly not obese. In Bulimia, the main difference is that they binge and then feel they have to do extreme measures to compensate. In Binge Eating Disorder there is still the binging and the feeling bad but no compensating behaviors.

For more on this and related topics see – Feeding and Eating Disorders.

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Anger Burns.

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Sunday Inspiration.   Post by David Joel Miller.

Anger Burns.

Anger burning

Anger Burns the Holder.
Photo courtesy of Pixabay.com

Holding on to anger burns the holder.

“Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.”

― Mark Twain

“Anybody can become angry — that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way — that is not within everybody’s power and is not easy.”

― Aristotle

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

What is Anorexia Nervosa (307.1, F50.01 or F50.02)

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

What is

What is Anorexia Nervosa (307.1, F50.01 or F50.02)
Photo courtesy of Pixabay.

Anorexia is an eating disorder that is about more than food.

Anorexia Nervosa, Anorexia for short, is one of the Feeding and Eating Disorders that are officially recognized as a mental disorder in the DSM-5. Anorexia has recognized “subtypes.” Like that of many other mental health disorders, these subtypes may over time change enough that a person might get several different diagnoses during their life.

There have been several prominent people who have suffered from Anorexia and death is a possible outcome of this disease. This disorder affects women about ten times as often as it does men. Researchers and writers have compared this disorder to OCD and addiction. Similar pathways in the brain may be affected in all these conditions. More information on the alteration of the brain’s functioning in these disorders is likely to become available in the future.

The big three Anorexia symptoms.

There are three significant symptoms that professionals look for in diagnosing Anorexia. These include how the person with Anorexia sees their body, similar to the distortions we see in Body Dysmorphic Disorder. Also on the symptoms list is how the client feels about their body weight and lastly comes the result of this distorted body image and their altered feelings about body weight. This post as other posts on counselorssoapbox.com is my simplified, common language description. For the full text check out the DSM-5 by the APA.

People with Anorexia think they are fat even when the mirror disagrees.

It is common for those with Anorexia to report they dislike themselves because they are “fat” or overweight. They will persist in believing they are fat even when told by their doctor or other professional that their body weight falls below the minimum needed for health.

When asked about their weight they will often report that they need to lose a few pounds even when they are experiencing medical issues from malnutrition.

Some may only report that one part of their body is too large or misshapen. The solution to this oversized body part in their mind is extreme weight loss.

In Anorexia weight gain is more feared than death.

Someone who has Anorexia will demonstrate an extreme fear of gaining weight. They continue to assert that if they eat they will become “fat” and will go to extreme lengths to avoid weight gain.

A dislike of the self because of this distorted view of their body is common. Even when they know that this self-view is unrealistic they can’t seem to shake the belief that if they could just lose some more weight than they would be acceptable,

Using more calories than you take in is the continual goal.

Someone with Anorexia will attempt to reduce the calories taken in each day below the amount they need to maintain a normal weight. This is done not simply to prevent weight gain but to result in a loss of weight. This is nothing like typical dieting where the goal is to maintain a healthy weight. The goal here, presumably, is to continue to lose weight even when they are already thinner than a healthy weight.

Because of the two criteria above the person with Anorexia continues to think of themselves as fat and to fear any weight gain no matter how low the body weight may go.

In children or young adults, this may manifest more as a failure to grow and put on weight during the growing years rather than a measurable loss of weight.

There are two recognized types of Anorexia, although this may change over time.

Restricting type Anorexia.

In this condition, the person avoids taking in calories as much as possible. They may avoid eating around others, say they are full or not feeling well, or otherwise try to avoid even a minimal amount of calories.

Binge eating and purging type Anorexia.

In this subtype of Anorexia Nervosa, the person with Anorexia may give in to the look or taste of food and eat. When they do this it is like the alcoholic who just relapsed. Any food in sight is fair game. But as soon as they have eaten, they are overcome with an intense fear of weight gain and guilt. At this point, they will use extraordinary efforts to get rid of the unwanted calories.

These compensatory efforts may include purging, self-induced vomiting, or the use of laxatives to produce intense diarrhea. Some will resort to strenuous exercise in an effort to atone for the eating binge.

The primary distinction between Anorexia and Bulimia Nervosa is that the person with Bulimia looks like they have a normal body weight. They may even be a few pounds over and they eat well, just they use the compensatory methods to avoid weight gain.  Those purging binges can damage their health. In Anorexia the risk is that the damage to health may be more rapid and may result in death. More on Bulimia Nervosa in an upcoming What is. post

Risk factors for developing Anorexia include having currently or in the past had an Anxiety disorder, as well as cultures, occupations, or activities that emphasize being thin.

FYI these recent “What is” posts are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. The descriptions are largely my own plain language versions.

For more on this and related topics see – Feeding and Eating Disorders.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

The hidden cause of stress.

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

Stressed

Feeling stressed out?
Photo courtesy of Pixabay.com

Why are you stressed out if things are going so well?

Stress is epidemic in our modern world. Everyone has heard about stress management classes and tools. Everywhere you go these days people are talking about their stress levels and how hard their life is. We live in a world with more material comforts and technology than ever before. Why is everyone so stressed?

What comes as a surprise many times is that the people who are reporting the most stress are not the people who are going through the roughest times. Now we know that hard times are not always apparent. Some people have really difficult things going on in their lives and they never mention it. But what is so amazing is how people who for all apparent evidence are doing well, have so much stress.

Being unemployed is stressful but working can be even more stressful. Someone has a good job, one that pays well, and they work every day but the work is stressing them out. They have a relatively new car and the payments on that car are stressful. Frankly, the biggest stressors in life are often not the things that are the most harmful or the most painful. Why when so many people in the western industrial world have so very many things that look like advantages do we also have the corner on the world’s inventory of stress?

You can end up stressed out even if nothing bad ever happens.

What has largely gone unnoticed is that you can be so stressed out even when nothing bad ever happens. See it is not the actual event that is stressful. The fear you will lose your job can be more stressful than the actual loss. People live for years worrying that the place they work at will close or downsize and they will lose their job. That is stressful. Then the closure happens and life changes.

People can go through life always on edge, always stressed even when none of the bad things that should be the cause of their stress ever happen. Sometimes when it happens it is even a relief. At least once the shoe drops you can start making plans for the rest of your life.

The threat is more stressful than the event.

Stress is not about the actual event, at least most of the time it isn’t. Once the bad event happens people go through the grieving and adjusting process and then they get to work fixing things and rebuilding things. People who are out of work and unemployed may even go about the process of reinventing themselves.

Worry about the end of a relationship can be stressful, the thoughts about why and how come and what will you do next. But once you are convinced the relationship is in fact over and gone you can let go of the stress and start moving forward finding out who you are outside of that relationship.

Even good things can be very stressful.

The first week at a new job many people get sick. Trying to learn that new role can be stressful. You want to do well. Weddings and the birth of a child can all be extremely stressful. So can falling in love. Happy things can cause lots of stress.

What causes stress is not the reality. What is stressful are the expectations about what will or might happen. Uncertainty is stressful. Not knowing and worry wear you out.

Stress is about anticipation.

Turns out in the end that the major factor that decides if something will cause you stress is what you anticipate happening. Worry works the stress hormones over time. Fear and anticipation take their toll. Holding on to expectations, especially negative, fearful, possible results of things makes even the best of situations stressful.

It is the things we worry about, the things outside our control that are the most stressful. We can’t control the future. The most we may be able to do is to be prepared and work to influence the outcomes.

Are you ready to give up your expectations and let life be what it is? When will you be ready to release the stress?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is Social Anxiety Disorder (Social Phobia.)

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By David Joel Miller.

What is

What is Social Anxiety Disorder (Social Phobia.)
Photo courtesy of Pixabay.

Social Anxiety Disorder (Social Phobia.) Was 300.23 now F40.10.

Social Anxiety Disorder sometimes called Social Phobia is far more common and debilitating here in the United States than is generally recognized. The most recent estimates are that in excess of seven percent or over 22 million Americans have Social Anxiety Disorder. The U.S rate runs 3 to 6 times the rate reported in other countries.

Fully three-fourths of those who will revive this diagnosis first have symptoms during childhood from the fourth to the tenth grade. This results in significantly lower graduation rates by those with Social Anxiety Disorder. Lifetime someone with Social Anxiety Disorder is more likely to be lower-income and socioeconomic status.

The rates of Social Anxiety Disorder are highest among those who are single, unmarried, or divorced. The disorder may be severe when young and single, become milder when the person is married, and reemerge when they are divorced. The typical person with this disorder waits from fifteen to twenty years before seeking treatment.

The symptoms of Social Anxiety Disorder.

People with Social Anxiety Disorder become extremely, excessively, anxious when they will be in social situations where they may be judged or evaluated by others. While you are only required to be anxious in one social situation to be diagnosed with Social Anxiety Disorder most people with this condition are anxious in many situations.

Someone with Social Anxiety Disorder will report that they can’t relax around others. They may hide achievements that would get them noticed, avoid attention, avoid eating in front of others, and when in social situations they will listen instead of speak.

Other ways this disorder will manifest include, avoid confrontations, preferring to work alone, being afraid to ask questions, avoiding social gatherings, parties, etc. They will underachieve to avoid attention, may drop out of school, or not apply for a job or promotion.

Performance Anxiety is a special case of Social Anxiety Disorder.

People who are in the public eye are at extra risk for Social Anxiety Disorder. Many people are afraid of public speaking, this will not count towards Social Anxiety Disorder if you do not normally need to speak in public. But if your job requires public speaking, or being on stage and when you do this you become extremely anxious then that would be considered a case of Social Anxiety Disorder.

Children with Social Anxiety Disorder.

For children, we do not count situations in which they become anxious in front of adults. Children who develop the disorder also need to be excessively anxious in front of their peers.

Children may try to avoid social anxiety by crying excessively, having tantrums, being clingy, or going mute.

With Social Anxiety Disorder you can run or suffer.

Most people with Social Anxiety Disorder will go to great lengths to avoid social interactions. Some attempt to stay at home with parents well into adulthood convinced that they simply can’t venture out around strangers. They may settle for living in poverty, staying in abusive or dysfunctional relationships rather than attempt to move outside their residence.

Social Anxiety Disorder is neither brief nor temporary.

When we talk about Social Anxiety Disorder we are expecting a problem that is ongoing not a brief temporary fear of a social situation. Typically this has lasted for six months or more. Though clinicians are encouraged to use some judgment here. If you come in asking for help after only five months and three weeks you should get the help despite it being less than six months. In this disorder, the fear also should be far more severe than the situation would merit. If the danger is real and severe, this is not Social Anxiety Disorder.

Treatment for Social Anxiety Disorder.

Treatment for Social Anxiety Disorder can be very effective if the client can get to the treatment. One promising development has been the use of distance counseling over the internet for those too anxious to travel to the counselor’s office. Treatment has been effective both in reducing the Anxiety symptoms and in shortening the duration of the disorder.

There are other things that kind of look like Social Anxiety Disorder.

Professionals need to look at a bunch of other things and make sure that they are not sticking this diagnosis on someone when another diagnosis would fit better. The DSM-5 lists fifteen things that need to be ruled out before deciding on Social Anxiety Disorder. At the top of that list? Social Anxiety Disorder needs to be more severe and cause way more problems than just normal shyness.

As with the other things we are calling a mental illness, Social Anxiety Disorder 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 diagnosis if this is a preference, not a problem. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem this fear needs to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get the Social Anxiety 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

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Shouldn’t evolution end mental illness?

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

Confused brain

Mental illness.
Photo courtesy of Pixabay.com

Why are there so very many different genes involved in mental health?

Clearly, there were lots of lifeforms on the earth in the past that are no longer around. Without getting sidetracked here by the whole question of evolution or creation or some variant of the two, one still has to wonder how all those things which are calling mental illnesses arose. And why do mental illnesses still exist?

Every additional study I read tells me that someone has identified a gene they believe may be involved in creating or exacerbating a condition we are calling a mental illness. If they haven’t found that gene then they are suggesting one must exist and remains to be found.

This raises the question: “Why are there so many of these mutations?”

That makes me wonder if all these conditions we are calling mental illnesses are of recent origin or did they at some time in the past have some evolutionary advantage. If mental illness did not serve some purpose in the past, why does it still exist?

Ancient literature, the Bible, and other writings mention things like alcoholism, drunkenness, and some people with impaired reality testing who would in past times have been described as “mad.”  This was Mad as in insane or mentally ill not mad as in uncontrolled anger.

Shouldn’t natural selection be reducing not increasing the number of mental illnesses?

We know that mental illness shortens the lifespan, the mentally ill live fewer years than those without a diagnosable illness. Over time there should be fewer and fewer of the mentally ill left to reproduce. That would make some sense unless there was at some time, current or past, some advantage to what we now call a mental illness.

Humans now live longer and in larger clusters.

Some authors have suggested that many of the diseases we are now most concerned about, heart conditions, cancers, and diabetes are largely the result of humans living longer than before. When the average lifespan was 30 or 40 years, few people lived long enough to get those old-people diseases. See Sapolsky’s “Why Zebras Don’t Get Ulcers” for more on this topic.

So people live longer now and they also are living more and more in large industrial cities. Crowding of the sort that happens in cities can cause stress and changes in behavior. Is it possible that humans are mentally and emotionally un-adapted to live in large city masses?

There has been an avalanche of children getting mental health diagnosis.

We used to think that childhood was essentially a happy time and then you grew up and had to work. Only back then most children did not grow up, they died. So the more we look at the childhood prevalence of things we call emotional disturbances the more of these things we find. ADHD in elementary school girls is up 600 percent. Depression is more common than expected in children. Suicide rates of children are occurring in younger children and becoming more common.

Are mental illnesses ancient survival mechanisms?

What if some of those things we call mental illness helped people survive in the times when most people lived in rural areas, forests and jungles even, and some of these things use to be good things, but they are no longer as helpful in modern industrial situations.

How could some anger be a good thing?

Anger and its link to the fight or flight responses in the brain appear to occur in all the animals with a brain stem. For creatures of any kind that primitive response to threat can keep you alive in times of hunger when you need to fight for the food. Getting angry and fighting can also keep you from becoming that food.

Killing to preserve your life and your food supply makes sense when you live in the woods and that is a mountain lion out to eat you. That same anger mechanism is less helpful when someone cuts in line in front of you at the supermarket. Get angry and hit someone there and you may be the one getting carted off to jail or the psych hospital.

Why do bipolar people reproduce?

One of the characteristics of bipolar disorder is hyper-sexuality. This same driven sexual behavior can be seen in drug addicts also. Sexual “acting out” as it gets called, can get people with bipolar disorder in trouble with their family and their mates.

People, most of them, who are faithful to their mates get more sex on a regular basis and they tend to live longer than those who have lots of sexual partners. For someone in extreme danger who might get eaten at any moment being hypersexual may not improve your survival but that increased number of offspring may have helped humans expand their population at the expense of other animals.

What is good for the population as a whole is not always good for the individual person and vice versa.

Could depression have been an asset in the past?

Some of the characteristics of depression, the atypical type, are eating everything in sight and then sleeping as much as possible. This is a great strategy if you live in an ice age cave where food is unreliable and you need to conserve energy.

Eating everything in sight and sleeping all day does not work so well when you have a job to go to every day.

The point I am making is that many of the things we think of as “mental illness” may have been functional in the past. Some of these things that are getting labeled illnesses are more “maladaptations.” Even the bears don’t get to hibernate the way they used to.

ADHD may have saved lives.

One of the characteristics of this thing we are calling ADHD is restlessness and hyperactivity. This is useful if you need to outrun run a lion. The more you run around the stronger your legs get. Being fast on your feet keeps you from getting eaten or killed in some situations.

Today children need to stay put and not move to keep the teacher happy. That ancient part of the brain is telling them to run, play, and move fast. It may take a long time for the human brain to catch up with the move from the woods to the big city.

Just my speculation on how these things we call mental illnesses may at points in the past have been more adaptive than they are today.  What do you think about this?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Generalized Anxiety Disorder. (GAD Was 300.02 now F41.1)

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

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

In Generalized Anxiety Disorder, everything is scary.

The key feature of Generalized Anxiety Disorder (GAD) is that in this disorder the worry-weed just keeps growing. Worry in GAD is all out of proportion. Clients with this problem worry the majority of their time. While you need to have been worrying for at least six months to get this diagnosis, most people with GAD have been worrying far longer. It is common to hear from someone with GAD that they have been worrying all their lives or that they can’t remember a time before they began worrying.

Generalized Anxiety Disorder is a relatively common disorder despite being very disabling for so many. In any given year here in the U. S., it is estimated 3 million people will receive this diagnosis. Cumulatively this amounts to between 27 and 35 million people who are estimated to be living with GAD.

Generalized Anxiety Disorder can begin at any age but many people first realized they were worriers or over-anxious in childhood or adolescence. There used to be a diagnosis for over-anxious children but that one got merged into the GAD diagnosis. While Generalized Anxiety Disorder can strike at any age and often stays with you, your whole life what people will worry about changes as you age.

Common worry themes in GAD are punctuality, natural disasters, being a victim of crime, and the need to do things perfectly and be perfect. With all these worries it is common for someone with Generalized Anxiety Disorder to seek reassurance. If they adopt rituals to keep themselves safe it can be a short hop to OCD or a related disorder.

What separates GAD from other anxiety disorders is the length of the list of things you worry about. People with GAD worry about many things most or all the time, not simply a few things occasionally. Someone with Generalized Anxiety Disorder is frequently apprehensive about what might happen and they tend to expect the worse. The anxiety bully whispers in their ear (figuratively) that something bad is about to happen and over time they come to believe these thoughts.

In GAD it is not that they hear these thoughts, as in an auditory hallucination, but the thoughts can take on a life of their own and they start believing that if they think this thought it must be true. One characteristic of GAD is the loss of control over the worry. It happens whether you want or need to worry or not.

Physical symptoms are very common with mental illnesses. This does not mean things are just “in your head.”  The increase in stress hormones results in physical signs and symptoms in the body. Adults will have at least three of the six symptoms below. Less than 3 probably mean that one or more of the other anxiety disorders would be a better fit for the problem than GAD. Here are the six physical and emotional problems, 3 of which should be present in GAD.

  1. Motor racing – Feeling keyed up or restless.
  2. Tired, worn-out, or fatigued for no good reason.
  3. The mind goes blank, can’t focus or concentrate.
  4. Grouchy, irritable.
  5. Muscle tension.
  6. Poor sleep, reduced, disturbed, or otherwise disrupted for no discernible reason.

Note that some of these symptoms are combinations of emotional and physical issues. This is why before giving someone a diagnosis a therapist always wants to be sure that you have recently seen a medical doctor and ruled out a medical condition. We also have to ask about drug and alcohol use, not because we want to pry, but because if you are doing drugs, especially stimulants, this may be causing or aggravating the anxiety.

An important consideration, for this to be Generalized Anxiety Disorder, is that the anxiety needs to be way out of proportion to the actual life risks. A significant part of your thinking brain will be used up on worry leaving less to use in actually living life.

Much of the worry in Generalized Anxiety Disorder can be directed towards what you “should be” doing as opposed to what you are actually doing. People with GAD are likely to have exaggerated startle responses. Most of us will jump if a gun goes off close by, or we probably should. Someone with GAD will jump when a car door slams on the next block.

If you or someone you know has symptoms of GAD, seek professional help. There are treatments that can reduce or eliminate the symptoms of Generalized Anxiety Disorder.

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is Agoraphobia? (300.22, now F40.00)

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

What is

What is Agoraphobia?
Photo courtesy of Pixabay.

Agoraphobia is about fear.

Agoraphobia is often translated as “fear of the marketplace.” This disorder involves being overwhelmed when you encounter people outside your home or “nest.” People with this problem become fearful when they have to venture out. It is not required that the person actually leaves their house and experience the situation, just thinking about the possibility, and then having symptoms can qualify as Agoraphobia. For some people, these symptoms and their efforts to avoid feeling these feelings can result in their becoming home-bound.

This disorder has been associated with panic attacks and panic disorder. We used to diagnose this as Panic Disorder with or without Agoraphobia. The new trend, as dictated by the DSM-5, is to separate Panic Disorder from Agoraphobia as some people can have either one without the other, some people have both in which case they get both diagnoses put on their chart.

Current estimates are that between five and six million Americans have Agoraphobia. Somewhere between one-third and half of these also have panic attacks. Many do not receive treatment because they are too fearful to leave their homes and go for treatment. Agoraphobia is a major cause of disability with over one-third of those with Agoraphobia being home-bound and unable to work. There are treatments for Agoraphobia if you are able to access them.

Some people report that when they experience settings that would qualify them for the diagnosis of Agoraphobia they have “Anxiety Attacks.” Having a brief increase in Anxiety as in an “Anxiety Attack” can be a part of other illnesses such as any Anxiety disorder, trauma, and stressor-related disorders, depression, and so on.

To be Agoraphobia, by definition, you need to experience these fear-based symptoms in two or more specific situations. This helps separate the Agoraphobia condition from a narrower specific fear or phobia. These fears also need to be excessive or unrealistic. Fear of leaving the house does not count if you live in a war zone or a high crime neighborhood.

The 5 specific fears of Agoraphobia you asked?

  1. Being on public transportation.
  2. Open spaces.
  3. Closed or confined spaces.
  4. Standing in a line or being in a crowd.
  5. Being outside your home alone.

To get the diagnosis of Agoraphobia it is not enough that you just be scared or nervous in these situations. People with Agoraphobia avoids these and possibly related experiences. This interfering with the rest of your life is one of the hallmarks of a mental health issue that should get diagnosed and treated.

People with Agoraphobia also worry excessively that they may not be able to escape or won’t be able to get help in these situations. It is these two key characteristics, not being able to escape and the belief that something terrible will happen that make Agoraphobia so debilitating.

For this diagnosis to “fit” this intense fear can’t be just a one time or occasional occurrence. It has to happen most or all the time you encounter these situations.  People with Agoraphobia often insist on having a companion to reassure them when they leave the house and they can only endure these situations by ensuring intense fear.

Symptoms for Agoraphobia are a little wider than the psychical ones seen in Panic Disorder. Other possible symptoms would include the risk of having an embarrassing or incapacitating incident such as loss of control over bodily functions or falling, passing out, or getting lost. In the elderly, it is hard to separate real concerns from excessive ones that would count towards Agoraphobia.

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 fear but you may not get the diagnoses if this is a preference, not a problem. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem this fear needs to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get the Agoraphobia diagnosis.

For more on these topics see Anxiety Disorders,

Stress and Trauma-Related Disorders,

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is the ICD?

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

What is

What is the ICD?
Photo courtesy of Pixabay.

International Classification of Diseases by the WHO.

The ICD stands for the International Classification of Diseases, a compilation by the World Health Organization of the various diseases and disorders that might be diagnosed. The ICD has undergone a number of updates and revisions. Currently, we in the U. S. are using the ICD-10. The ICD-11 is expected to be available for implementation by October of 2018.

The ICD includes a large number of diseases that are outside the scope of practice of mental health professionals. In the U. S. mental health professionals are used to using the DSM (see the post on the DSM.) What tends to get overlooked is that while the descriptions in the DSM come from the APA (American Psychiatric Association) the numbers in the DSM are from the ICD. This resulted in the most recent DSM, the DSM-5 including two sets of numbers, those from the older ICD-9 and the newer numbers from the ICD-10.

Under the ICD-10 system, each specialty has a letter followed by numbers for each disease or disorder.

Using the new numbers all mental, emotional and behavioral disorders a counselor might expect to treat will begin with the letter F while the other life issues, like partner relational conflict, will all be prefaced with the letter Z. Beyond that, there are very few issues a counselor might treat.

The early ICD’s were mainly a list of causes of death prior to the issuance of the ICD-6. Starting with the ICD-6 in 1949 causes of illnesses were included along with causes of death.

By 1975 the WHO had reached version ICD-9 and in 1978 the ICD-9-CM (clinical modification.) The rest of the world adopted the ICD-10 in 1990 but the U. S. delayed adoption until October of 2015. Any treatment that is reimbursable under HIPAA covered insurance must use the ICD-10-CM.

The ICD-11 is expected to be released in 2018. When the U. S. will adopt the ICD-11, who will use it and what they will use it for remains to be seen.

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 counselorssoapbox.com posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel