Category Archives: Mental Health

What causes mental illness?

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

Could you be mentally ill?

What Causes Mental Illness?

If we find the cause of mental illness can we cure it?

Mental illness is costing us a lot more than most people realize.

Turns out that mental illness, untreated, undertreated, or treated in ways that are not working are costing us a lot more than most of us realize. Cases of violent behavior are an almost daily part of our news media’s presentation. When a tragedy strikes the first question is almost always about the mental health status of the perpetrator of violence. If we could spot the mentally ill and treat them shouldn’t we, society, and the professionals, be able to prevent this violence? Let’s set aside for the moment the uncomfortable truth that the mentally ill are more likely to be victims than perpetrators of violence.

Besides the human cost, mental illness is costing us a ton of money.

When we look at the cost to the economy of disabilities, the largest of all disabilities, as measured by days of work lost, that major disability is Major Depressive Disorder.

Mental illness is the major factor driving up health care costs.

In the discussion of what health care is costing us and how we pay for this ever-increasing cost, the role of mental illness is often overlooked.

Five percent of patients account for HALF of all medical spending. What do those patients have in common? These super heavy users of medical services are not heart patients, not cancer patients, not even diabetes patients, though they may have one, two, or all three of those diseases. The majority of super-heavy users have mental illness, substance use disorders and often they have both of these.

What are these things we are calling mental illnesses?

Over time professionals from a number of different professions have attempted to identify and categorize these things we call mental and emotional illnesses. The professions do not always agree and there are varying lists of just what should be diagnosed as an illness. Two lists are commonly in current use. The DSM (from the American Psychiatric Association) in the United States and the International Classification of Diseases from the World Health Organization. While these two lists are moving closer together there is still not an exact one-to-one correspondence between them.

Most of the things we are calling mental illnesses are in fact “syndromes” groups of people who have symptoms similar enough that they get lumped together even if their conditions are not exactly the same.

Take Depression for example.

We all sort of know what depression is like. If that sadness lasts for more than two weeks and there are changes in sleep and appetite then we start looking for depression. Some people eat more and sleep more like the bear hibernating for winter. Other people can’t sleep, are agitated, pacing around and they lose their appetite. We might think that both are “depressed” but the part of the brain involved may be very different. We also know that the reasons people become depressed can be very different. We can’t be sure that all the people we are calling depressed really have the same disease. So just how many different things can be the “cause” Of depression?

Most of these “disorders” are diagnosed by using checklists of symptoms. We run down the list, you have 5 of 8 symptoms and you get the diagnosis. Cross one of these off and add a different one and you get a different disorder. Before we can be really sure about causes we would need to be reasonably certain that we are looking at the same disorder in all those cases.

Spectrum Disorders may have many causes.

Since these things we are calling mental illness vary in their presentation from one person to another, we needed to create more and more disorders. No two people are exactly alike so in theory, we could end up with one unique mental illness for each and every person on earth.

The other option was to think of these things as “spectrums” that range from mild to severe.  One person could have one symptom and another might have three. But this raises the question if Bob has symptoms 1 and 3 and Mary has symptoms 1 and 4 do they have the same disease? You mathematician types will see that there is a very large number of possible combinations of symptoms that someone might have, not even considering the possible severity of each symptom. Different combinations of symptoms and symptom severities could have different causes.

What is causing these mental illnesses?

Lots of things have been postulated as causes for mental illnesses. The “chemical imbalance” theory has been especially popular. Unfortunately, this idea has not been especially helpful in either diagnosing or treating mental illness. If we could find one specific cause of an illness, depression for example, then we should be able to test and treat people for this illness reliably.

Turns out there are two groups of things that are implicated as causes of mental illnesses. The causes from way back when called distant or distal causes and the recent causes, that just happened which are often called close or proximal causes.

Distant causes of mental illness.

The distant cause of mental illness are things like genetics, or childhood trauma, abuse, and neglect. Inheriting certain genes would up your risk of getting schizophrenia or having an episode of depression. So far this has not worked exactly. Some disorders, schizophrenia and Autism spectrum, for example, have over a hundred different genes that increase the risk of getting this disorder but an increased risk does not guarantee you will get it. Two siblings, twins may both inherit the gene, but one gets a disorder and the other does not.

Other distant things can also increase the risk of getting a mental illness, exposure to drugs or alcohol in the womb, early childhood experiences, abuse, neglect, and just the stress of living.

Today’s, proximal, causes of mental illness.

Most mental illnesses get diagnosed because there has been a sudden change in functioning. Often this is the direct result of a recent life event. People get divorced or they lose their job. As a result of these events, they become depressed. Maybe it is the result of a death in the family or living through a traumatic event.

Many “first breaks” or episodes of a mental illness occur as the body changes in puberty or when someone leaves home for the first time and attends college. Substance use, drug experimentation can also precipitate the occurrence of a mental or emotional issue. All sorts of life events can cause someone to develop symptoms for the first time.

How can we treat mental illness if we don’t know what causes it?

Current treatments for mental illness are a lot more hit and miss than we would wish. Given a diagnosis and a medication on average one-third of people receiving that medication will get better and two-thirds will not improve. This partially explains why doctors often need to change meds and or add a second medication.

Psychotherapy fares only slightly better. Given any particular type of therapy, assuming it is done reasonably well, about half the people get better and the other half do not. Over time therapists may change the therapy they are doing with a client. If what they have been doing is not helping, and the client may need to change therapists also.

The conclusion.

At this point is history there is a lot more that can be done to help someone with a mental illness than ever before. None of this is anywhere near an exact science. We can spot risk factors for some people some of the time but risk does not mean you will get it. Meds or therapy can be helpful but there are no guarantees on either for all people all the time.

Regardless of what has caused a mental or emotional illness remember that treatment has helped millions of people overcome their issues and live meaningful, productive lives.

For more on this topic take a look at the article by Tom Insel’s (former director of the National Institute of Mental Health.)  Director’s Blog: What Caused This to Happen? – Part 2  where he talks about the causes of mental illnesses and what we know about them.

You might also want to check out the piece that Jonathan Roiser wrote for the British Psychological Society titled “What has neuroscience ever done for us?”

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How much baggage are you carrying?

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

Baggage

Baggage.
Photo courtesy of Pixabay.com

You don’t realize how much stuff you are carrying until you empty that bag out.

So much emotional baggage around these days. Most of the time when we say baggage, people think about past relationships and the scars left from those relationships. When you reach the point you are ready to move on in your life you might be amazed at all the emotional baggage you have stored away in your cupboards.

If you have reached the time of starting over in life, of reinventing yourself, here are some types of baggage you may need to go through and see what you can dispose of. That extra baggage can weigh you down badly and keep you from ever reaching the happy, recovered life you deserve.

Some people find they can dispose of this unwanted baggage all by themselves. They use acceptance, radical acceptance even, to get rid of unwanted emotional luggage. Other people find that it helps to get professional help. For a house, you might need the help of a cleaning crew or an exterminator. For emotional things consider getting help from a counselor or therapist. Here are a few of the things that people have found they needed to get rid of if they wanted to move on in their lives.

Childhood hurts that keep you from moving forward.

One serious form of emotional baggage that brings people to therapy, or should anyway, is those hurts from childhood or early adulthood that you can’t seem to let go of. If someone let you down, or they were not capable of meeting your needs back then you need to find ways to make sense of this and stop demanding that somehow the past needs to change for you to be able to be happy in the future.

One reason that childhood hurts can linger on is that we learned those pains from the child’s perspective. Now that you are grown you need to take another look at those life lessons and see if you want to reexamine the meaning of things that happened or didn’t happen way back when.

Some of you have life blueprints you learned way back when that are not suited for a happy adult life.

Negative self-beliefs are terrible burdens.

If you have negative beliefs about yourself, that you are not good enough or don’t deserve something, those will drag at you and keep you stuck in place.

We used to talk about self-esteem a lot. There are plenty of ways to boost your self-esteem. One primary way is to do more things you can be proud of.

Other ways to avoid the trap of negative self-beliefs are to work hard on self-acceptance. However, you are is acceptable. Cut out that constant self-evaluation, stop rating yourself, and move on with life.

A counselor can help you with this, so can self-help books and positive affirmations.

Failed relationships don’t have to hold you back.

If you look at relationships that are no more and see them as failures, then you lose the lessons you needed to have learned. Process this experience with someone trustworthy and then see how much of that pain and suffering you are ready to let go of.

People come into and out of your life, for better or worse. That one relationship ended does not mean another cannot be. What you need to do is take a look at that past relationship. See what you can learn from it and see how it has made you who you are. From that vantage, you can decide where you want to go.

What you need to avoid is thinking that everything that went wrong was someone’s fault. Learn from the experience. Why did you pick them? What should you be looking for in the future?

Self-doubts are like a chain holding you back.

Stop doubting yourself. You are who you are. You need to try. You will accomplish some things and others will not happen for you. The only way to avoid failure would be to never try and that is the worst form of failure. Pick goals carefully and then aim high.

For a more fulfilling life let go of those doubts. No one knows how the game of life will turn out until it is over. Don’t let ruminating about what might happen to keep you from living in the present.

Unfinished business keeps you looking back over your shoulder.

It is hard to drive looking back over your shoulder. You can’t get on in life if your primary focus is on the past. Shift those experiences into memory and use the major part of your brain to keep your eyes on the present and the future.

Have unfinished business? Finish it! Write a letter to the past and then destroy it. Apologize or make amends. Please do not say that you can’t move on until someone else does something. Do your part to solve things and let the past go. Sometimes the only way to finish that unfinished business is to accept that what happened is the whole story and stop insisting that there should be another ending. Write “the end” and find your peace.

Addictions and bad habits own you.

If you have an addiction work on ending it. Bad habits will continue to hold you back until you toss them. Overcoming an addiction is not easy, but it has been done over and over. Look for help. Get support from a community of others that are seeking recovery and you will find that letting go of an addiction is the greatest achievement you can have.

Having gone through that baggage and tossed the things that are holding you back you will be ready to move on to the best possible future.

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

Are you a Co-ruminator?

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

rumination

Rumination.
Photo courtesy of Pixabay.

What is Co-rumination and how does it affect you?

Having friends, positive ones, can be very helpful for your mental health, wellness, and recovery. Talking about your problems can be beneficial. This talking through your life problems is a major part of what counselors and therapists do when they use the “talking cure.’ Unfortunately not all talking over your problems is helpful.

We know that rumination, that constant reviewing, and hanging on to your problems, can make things worse. Focus on past difficulties over and over and you are likely to perpetuate your depression. Review repeatedly those things that might happen in the future and you can crank up the levels of anxiety you feel.

One especially problematic form of rumination is when one person enlists another to help them ruminate over their problems. So how can you tell if the time you spend with a friend or supporter is helping you work through and understand your problems or is this repeated discussion making things worse?

One definition of co-rumination is the excessive sharing of problems with peers. It has been seen and studied in those with poor relationships with caregivers and attachment disorders. Those who have been abused or traumatized are more likely to co-ruminate but anyone can become a co-ruminator.

Those who co-ruminate develop more not less mental health issues.

Sharing your problems with someone else should help you feel better, not worse. Co-rumination is not just a matter of talking about your problems with someone else. It also is about how frequently, intensely, and how much time you spend on sharing those problems.

If the time you spend talking with someone about your life problems does not seem to make you feel better than you may be engaged in a process called co-ruminations.

Here are some ways you can tell if the time spent discussing problems is co-rumination.

You and a friend frequently talk about your problems.

If the bulk of the time you and this friend spend together is talking about the problems of one or both of you then you are drifting into a co-rumination mode. Ask yourself do you ever talk about happy things? Do you have anything in common other than your discussion of problems? Do you talk about the same problems over and over?

Good friends can help each other through things. But if all you have in common is the problems then this is not much of a relationship.

What happens if you run out of problems to talk about? Do you share your day or do you revisit some past problem saturated conversation?

Co-rumination is talking about the same problems over and over.

If you find you are stuck on one problem and every conversation returns to that problem then this is co-rumination. Some co-ruminators take turns discussing their problems. You know before the conversation starts that when your turn comes you will be expected to revisit the problem you two always talk about.

Should you ever try to move the conversation forward to some new topic you can count on your partner in co-rumination to remind you of the time your problem occurred.

You encourage each other to talk about problems.

Do you frequently ask your friend questions about their problems? If every conversation turns into revisiting problems you are engaged in co-rumination. Certainly, it is good to have a friend you know will listen when you have a problem but be cautious if all they ever want to hear about are your problems. Good friends also share happy times.

You focus on negative feelings and what is wrong with you.

If the only topics of conversation becomes what is wrong, you are not supporting each other in being well. You and your friend should be able to switch to a dissuasion of what is going well in your life. Too much focus on the negative will make you increasingly depressed or anxious and you will find it harder to have any positive thoughts.

Talk about what something meant not what happened.

Co-ruminating talk is heavy on why and how-come questions. It is not about revisiting the story and what happened but involves trying to figure out what is wrong with you that these things keep happening. Co-rumination is heavy on blame talk and whose fault things are and short on ways to cope and move forward.

Co-rumination can be a group activity.

While co-rumination most often happens when two best friends begin to spend all their time together going over and over their respective problems it can become a group activity. Especially among teen or preteen girls. In that life stage, we see groups whose primary activity together and on social media is endlessly rehashing each other’s problems.

If all the posts on your social media page are about your problems and your friend’s problems, you have a problem sustaining relationships.

More posts on this topic are under the category Rumination.  Anxiety and Depression.

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

When being OK is not a good thing.

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

ok

When being OK is not a good thing.
Photo courtesy of Pixabay.com

Some days being OK is a long way from being good.

The other day I asked someone how they were doing.

They said, “I am doing OK and that’s not a good thing.”

This got me to thinking about how often we ask someone how they are doing and take that OK as a positive response.

Sometimes doing OK is a really bad thing. Let me explain.

What does being OK mean to a homeless person?

Ask any homeless person how they are doing and you are likely to get an OK unless they trust you enough for a more factual response like “How do you think I am doing? Or “My life sucks!”

For a homeless person, OK may mean they had something to eat last night or yesterday. It could mean that they didn’t get rolled or beaten for their belongings last night. It is a long way from being able to say they got their needs, physical, emotional, or medical, met any time recently.

What OK may mean for a homeless person is that their mental illness or drug addiction hasn’t totally destroyed them – yet.

What’s OK mean when you have a mental illness?

People with a mental illness try their hardest to be “OK” as if trying could prevent mental illness. For some, an OK day means they are not suicidal today. The voices are at a manageable level or their depression has not gotten so horrific that they are unable to get out of bed. Maybe OK means they are not suicidal – today.

Being OK when you have a mental illness is a long way from being stable or symptoms free. Mostly when you have a mental illness and you are having an OK day you are trying really hard to not show how difficult your life really is.

What is OK for the couple who can’t get along?

The couple in relationship counseling, for them OK may mean that today they didn’t fight, not as much anyway. For them, OK may be a day when they are not planning their divorce. Sometimes it means that despite the separation or the divorce today they managed to get up and pretend they were over the break-up and having a happy life.

Maybe today “OK” for people with a troubled or failing relationship means a day where the pain is a little less acute. Sometimes OK just means I will make it through today but I don’t know about tomorrow.

How is OK for the terminally ill person?

Sit around a waiting room in a critical care facility or visit the intensive care wards in any hospital. You will find some incredibly sick people in some severe pain. Ask them how they are doing?  You will probably get an OK.

For the terminally ill “OK” may mean that the pain isn’t any worse today than yesterday. More likely it means they are trying their hardest to hang on and make some sense of this experience that we call life. OK may mean that they are resigned to their suffering.

What is an OK day for the elderly?

What’s OK to someone in a long-term care facility? Not the fancy kind the well-to-do see but the publicly funded ones where people who have no family and friends left, go to be stored until they cede their bed to the next occupant when they die.

You hear a lot of OK’s in those kinds of facilities. What that means is that they have become numb to loneliness or isolation. It may mean that they have managed to get out of bed today or that they are doing their best to just sit there waiting for whatever.

What is OK for the addict/ alcoholic?

For the addict, an OK day may mean that the withdrawal symptoms are getting less painful. This may be the day that they were able to make it all day without drinking or using even when the cravings were about to drive them crazy.

If today your own mind was not yelling at you all day that you needed a drink or some dope that might be an OK day. If you were able to make it to a meeting or treatment today even while having those thoughts and cravings the whole time, then for you today was an OK day.

Saying OK does not mean you are cured, that you will never drink or use again. It means that you just might make it through today clean and sober.

Forgive me if I question you.

So if when I ask you how you are doing and you tell me “OK,” can you see why I might ask you if that is a good thing or a bad thing? See for some people an OK day is nowhere near a good day.

Next time you have someone tell you they are OK and you know they are going through it, think of a way to make them laugh or smile. Is there a way you can lighten that load and make their OK day less burdensome? Maybe you can be the one who can make someone’s OK day just a little brighter.

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

Posting your way to unhappiness on Social Media.

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

Unhappy emoticon

Unhappy.
Photo courtesy of Pixabay.com

Are your social media posts making you emotionally sick?

Writing about your problems and your feelings is a standard treatment in mental health and recovery settings. Researchers tell us that writing about your issues can speed your recovery. They also tell us consistently, in multiple studies, that the more time people spend on social media the less mentally healthy you become. How can we make sense of this? Is writing about your feelings good or bad?

Studies say “expressive writing” can make you healthy and happy.

There are a lot of reasons that talking about and writing about what is on your mind can improve your mental health. It depends however on who you write to and what kind of reaction you want from them.

Writing in a journal or other private place can help you work through difficult things. Exposing yourself online to the attacks of the trolls leads to emotional damage.

Writing out your story brings clarity.

Writing things out can help you explore what you are thinking. It can turn a jumble of feelings into a coherent story of your life and make meaning out of your experiences. It can also expose you to a lot of negative consequences if the trolls get hold of that story.

When we write for friends and supporters we do it to express ourselves. On social media, it is more about hoping for a favorable response. People start measuring the value of what they have written and therefore their self-worth, on how many “friends” they have and how many “likes” they get.

True friends like you no matter what. Trolls feel so bad about themselves that they look for people to pull down. Have you ever know someone who felt so bad about themselves that they needed to put everyone else down in order to feel OK about themselves? Those type trolls gravitate towards social media where they can spew their venom and move on.

One reason that negative comments affect us so deeply, especially online, is the human tendency to compare up. You do not compare your popularity with the person with only one friend – you. We tend to compare ourselves with those who have thousands of friends. Some people wage relentless quests to accumulate the most “fake friends.” There are even places you can buy friends, likes, and followers.

Social media works on intermittent reinforcement just like drugs and slot machines.

One week you get 5 likes on your social media page. This means that people like you right? Next week you get 3 likes. This should equal 8 likes in two weeks. That should be good. What we see however is not that we have now accumulated 8 likes but that this week’s likes are down by 40% a severe decline in your popularity. And you had a couple of snarky comments also. You are now likely to be desperate.

Most people will at this point increase the number of posts they make. If you want to be popular, if you want to have friends and be considered an OK person, you need to be online all the time. You need to put in more posting hours. At this point, you are becoming hooked and your self-worth is dependent on those electronic rewards, the friends, and likes, that pop-up with you say and do the “right” things.

Rewriting changes the ending.

In expressive writing, we can write, rewrite, and revise. This presents opportunities to think more about these feelings and to change them from unhelpful thoughts to more helpful thoughts. Staying up all night posting online, hoping someone will like your results in sleep deprivation, disappointment, and depression.

On-line once you click post you are stuck with the result. One typo and you can kick yourself for being stupid forever. That typo will never be recalled but all the good things you have ever done will fade away.

People who are told that what they are going through is normal may get better.

In counseling and with support systems there is a good chance you will be told that what you are going through is normal and that helps ease the pain of the moment. On-line those fake friends will tell you how they never have that problem and announce to the world all manner of negative things. That has to deflate your self-esteem.

Consider your online presence.

Are your online activities making your life better and happier? Or are you like so many others becoming addicted to social media? The more time you spend on social media the more likely you are to become dependent on the opinions of others and the lower your self-esteem may become.

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

Do you have anger issues?

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

Angry person

Anger.
Picture courtesy of Pixabay.

When should you seek counseling for your anger issues?

Anger and “anger issues” are one of the more common problems that result in people calling my office for a counseling appointment. Having anger building up inside you can harm you. All those excess stress hormones are really hard on your heart and other organs.

But anger, an excess of that stuff, can also damage relationships with family, friends, and those you work with. Untreated anger issues may result in the police being called and you going to jail. Excess anger also results in lost jobs and in divorces.

In extreme cases, too much anger will get you locked up and court-ordered to 26 weeks of anger management classes or 52 weeks of batterer’s treatment classes. Out of control anger can make a mess out of your life.

That must mean that anger is one of the more common and major mental illnesses, right? Wrong.

Despite all the problems an excess of anger can bring it is not recognized as a mental illness. Say what? Yes, you read that right. We think anger, rather than being any one specific mental or emotional illness is a “secondary” emotion. That is you are feeling one thing but you end up expressing this other feeling as anger. When hurt, emotionally or psychically hurt, many of us express this as anger.

Regardless of what is causing your anger or why you are angry, counseling can help you tame that anger beast.

There are several reasons you might need to go for some anger management counseling.

  1. You do not like the person you become when you are angry.

If your anger is bothering you then it is time to see a counselor. This is true of a whole lot of other unpleasant or negative emotions. You do not need to be mentally ill to seek out counseling. If you do things when angry, sad, or anxious you would not do otherwise, that is a bad sign. Just having to live with that anger all the time can make you miserable.

Some of you are thinking that you are in a situation where another person is always “making you angry.” Do not let that stop you from seeking help. You can learn ways to turn the volume down on your anger so you become less angry and angry less often or your counselor may help you with some life coaching to change the situation so that you are not going to get your anger triggered.

  1. Your anger is interfering with your relationships.

Any time an emotional, mental, or behavioral issue interferes with your relationships with family and friends that need attention. This may be an indication of a mental illness or it may just be stress. Either way, you need help for anything that is damaging your relationships.

Humans need other people. Having a good group of supportive people around you improves the quality of your life. Do not let anger drive your friends and family away and leave you unsupported.

  1. Anger is affecting your work or schooling.

If you miss work or get in trouble on the job because of anger or other emotional flare-ups, this means that your feelings are a problem that needs attention.  If you are not working but are in school then we consider going to school and doing your homework your job. Wish I could convince kids who tell me they don’t want to go to school, that school is their job and if they can’t do that one they may need to work on their being homeless skills.

  1. Your anger has interfered with other things you used to like to do.

If you used to play softball or go bowling but because of your anger and fights you got into you can’t go there any more than your anger has been and continues to be a problem. Letting anger or any other emotional issue cut you off from things that make you happy is a bad idea. Life should be more than working and suffering. Try restructuring your life to make it a life worth living.

That is the short list, you may think of other reasons you need to go see a counselor or life coach. Just remember you do not need to wait until your problems become serious mental illnesses before you seek help. Have you put up with anger for longer than you need to? Is it time for you to get some help, learn some skills, to get that anger creature out of your life?

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

Suicide – Addiction Proclamations.

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Proclamation, Proclamation so many Proclamations.

Town crier proclamation.
Photo courtesy of Pixabay.com

By David Joel Miller.

Two very special proclamations came across my desk on the very same day this week. The president has proclaimed September as National Alcohol and Drug Addiction Recovery Month.

Here in Fresno County, California, our Board of Supervisors has declared September 7 through September 13th as Suicide Prevention Week. I suspect that lots of other jurisdictions are issuing proclamations for Suicide Prevention Week what with The World Suicide Prevention Day coming up on September 10th.

Why does Suicide Prevention Day and Week share the attention with Addiction Month?

Turns out there are a lot of connections between addiction, alcoholism, and suicide. Addiction, suicide, and mental health issues all co-exist and these are challenges that many people are reluctant to talk about. As uncomfortable as having these conversations may be they are topics we all need to think about and be prepared to discuss with those we come in contact with.

Most people are uneasy with the topic of suicide. Professionals get special training in how to talk with clients about their urges to self-harm and their thoughts of suicide. Even with that training, there are counselors who feel uncomfortable asking the simple questions like “Are you thinking of killing yourself?”

No one should ever feel uncomfortable with this question. If you have concerns about someone ask away. Just make sure you ask in a caring non-judgmental way. I see no evidence that asking someone if they are thinking about a suicidal act will put the idea in that person’s head. Many people who have started to think of suicide as a solution to their problems are just waiting for someone to care enough to ask.

Learning about mental illness, suicide prevention, and substance use disorders.

At some point in your life, you will encounter a person with a mental health challenge, an addiction or possible you will cross paths with a suicidal person. What should you do? One important thing to do is to prepare for those possibilities now. An excellent source of information on mental health issues is the Mental Health First Aid course.

Certified Mental Health First Aid instructors are available across the United States and most of the rest of the world. Consider taking the class or better yet get your group to sponsor trainings in your area. If you need more information please feel free to leave a comment or contact me.

There is also a special Mental Health First Aid training for those who work with youth which trains you on how to respond to a youth who is having mental health issues.

One other handy resource for a potentially suicidal person is the

National Suicide Prevention Lifeline – 1 (800) 273-8255 which has services available 24-7 and in both English and Spanish languages. Website: www.suicidepreventionlifeline.org

Your local 911 or emergency number is also a good resource in a crisis.

Why the connection between suicide prevention and addiction?

We find that those who drink heavily, binge drinkers, are about fifty-five times more likely to attempt suicide. Intravenous drug users are about fourteen times more likely than the general population to try to suicide. Other drug users? Any drug use disorder raises the risk of a suicide attempt by at least tenfold.

If you know someone who has a substance use disorder encourage them to get help and learn all you can about the impact that substance use disorders are having on our country.

People with an addiction can recover.

This month during National Alcohol and Drug Addiction Recovery Month it is important to emphasize how very possible it is to recover from an addiction, a mental illness, or other emotional challenges. People do change, recover, and go on to live happy productive lives no matter what the challenge is they have faced.

Today, this week, and all this month think about the problems we all face whether we know it or not, every day with addiction, substance use disorders, and the possibility that someone close to you may start thinking that suicide is an option for them.

Maybe together we can all do just a little to help those who are feeling hopeless and helpless today.

Photo by Marcus Jeffrey 

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

Preventing mental illness.

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

Could you be mentally ill?

What Causes Mental Illness?

Is it possible to prevent mental illness?

There was a time when we, we as in society, thought there were two types of people, the normal ones, and then those others, the mentally ill.  Today we know it is a lot more complicated than that. There are things that can be done by professionals and by consumers that can make the impact of mental illness less difficult.

This tells us there are things that can be done early on before someone becomes sick, which can prevent the development of a mental illness or lessen the severity. People with a healthy physical lifestyle get physically ill less often. People who use certain wellness tools are less likely to be debilitated by a mental illness.

Prevention services can reduce the risk of developing an illness in both the physical and the mental health areas. It is easy to see the need for treating an illness once it develops but harder to get systems to offer treatment to prevent an illness. Some physical health systems offer preventative treatment. Unfortunately, the mental health systems are far behind the physical health systems in this area. If you want help for an emotional problem before it becomes a mental illness you probably need to seek help on your own.

Most of the things we now call a mental illness are the result of stress and trauma, injuries you accumulate in the process of living. Bad things happen to you. Maybe a lot of them and over time those events wear you down. At first, you become sad or discouraged, eventually, this sadness could deepen and reach the point of being an episode of Major Depressive Disorder.

People are exposed to trauma and stress, sometimes this develops into Posttraumatic Stress Disorder (PTSD), for other people this reaction to the stress of life lingers on as excess anxiety or persistent sadness. Those conditions may be severe enough to get diagnosed and treated by a professional. Lots of people spend major chunks of their life struggling with things the professionals and the insurance companies call “subclinical” cases of emotional issues.

What about people born with a problem, say Schizophrenia, you are asking. Aren’t mental illnesses hereditary things? This continues to be a problematic issue in the mental health field. Two siblings, identical twins, have a family history of schizophrenia, say mom has the disorder. They should both get it to right? Not always. Sometimes one will develop the disease and the other will have much milder symptoms of emotional issues. Why does this happen?

There is a lot of ongoing research in this field. Someday we may have the final answer to this question. Boy if you were a drug company and could develop a med that would keep people from “catching” schizophrenia you could make a lot of money. But for now, what we think is involved is that there are risk factors and protective factors.

If you were one of those twins you would likely be looking to add some of those protective factors to your life.

If you were doing a stressful job, you might go looking for ways to reduce the stress before it became overwhelming and developed a mental or emotional disorder. People who have a life that is less than they would like, they also might be looking for ways to make that life more fulfilling.

Not everyone who has a lot of stress or sadness in their life goes on to develop a severe mental illness. You may be one of those people who can just take a lot of stress and disappointment. Still, the statistics tell us that about half of the U. S. population at some point in their life will develop symptoms that should be treated. Wouldn’t it make sense to take a few doses of a preventative?

Anger management is another area where prevention is better than treatment. You can get help for your anger issues now or wait for the court-ordered 52-week program.

If you are under stress, have disappointments, or just find that you are irritable and angry a lot, maybe you are using alcohol or drugs to cope, what might you do to keep this from escalating? Do you need to run to see a counselor? That might help, getting a professional opinion can get you started on the right track. But here is a list of possibilities.

  1. Learn self-help skills and stress reduction skills

You will find a number of posts here on counselorssoapbox on stress reduction, self-help, and so on. There a lot of other good resources out there.

  1. Develop a personal wellness plan.

WRAP, wellness, and recovery action planning is a good one. There are free materials out there and the books are relatively inexpensive. You do not need to wait to develop a mental illness to create a wellness plan.

  1. Read self-help books.

I especially recommend books based on Cognitive Behavioral therapy. They can create the optimum benefit and in less time than many other therapies. David Burns’s book Feeling Good jumps to mind. There is also a list of recommended books over on the website for my private practice counselorfresno.com

  1. Try some non-medical counseling or life coaching

Many employee assistance plans offer a limited number of sessions, (three, six, maybe twelve sessions), with a counselor or therapist to work on general life issues. This is commonly called non-medical counseling. Stay tuned for a longer post on this topic.

If your child won’t mind, you have excess anger, you are stressed at work, or just not sure about what you want to do with your life, these non-medical counseling sessions can be helpful in clarifying where you are at and what you want to do.

Life coaching is a new and evolving field. There are some warnings about this one. Clients tell me that they want coaching not therapy because they are not “crazy” I tell them I agree they are not “crazy” by which I mean they do not have a diagnosable mental illness. Still, they could use some counseling. For them, it is easier to think of this as coaching.

Most professional counselors and some therapists do this sort of work. Helping you plan the life you want. Seeing them for preventive counseling or coaching is a good idea. A number of people recently are advertising as “life coaches.”  There are no set standards or licenses for coaches in most places. Some are well-trained with degrees in coaching psychology others just took their GED and rented an office expecting to make a lot of money coaching people. If your life coach does not also have a mental health license you need to be extra careful. More on the whole life coaching thing in an upcoming post.

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

Do you have Borderline Personality Disorder?

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

personality disorder

What is borderline personality disorder?
Photo courtesy of Pixabay.com

What are the signs and symptoms of Borderline Personality Disorder?

Problems with identifying Borderline Personality Disorder.

Borderline Personality Disorder formerly called Borderline conditions has received a lot of attention recently. It is one of those troubling conditions that looks different to different people.

If you have Borderline Personality Disorder you know the suffering having this disorder can cause. If you have lived with someone who has Borderline Personality Disorder you know how frustrating this can be. This difference in perspective is one of the problems with the increased attention to the disorder.

Many of the symptoms of Borderline Personality Disorder overlap or are the same as symptoms of other disorders. So when should someone get a Borderline diagnosis and when should we call it something else? Sometimes those iffy cases get a notation put on their chart “Borderline traits” rather than the full diagnosis. Electronic medical records are making it harder to leave notes like that and this may result in more people getting the full diagnosis.

For the record, diagnosis is not a do it yourself project. Mental Health, as well as physical health diagnosing, should be done by a professional. But so many people out there are being called Borderline these days and talking about it is so common, it is worth looking at the whole “what is Borderline Personality Disorder?” question.

There are efforts to come up with some kind of definitive test for borderline and other mental health conditions. At this time we can read research reports of “markers” and risk factors for many mental illnesses but we can’t be sure what is causing them. For example over 95% of people with Borderline Personality Disorder also have a sleep disorder.

Lacking a good test, mental conditions are diagnosed by looking at symptoms and seeing if someone has enough symptoms and if they are severe enough to need treatment.

With so many Borderline symptoms overlapping or look just like symptoms of other mental illnesses, what name something gets called may depend on which symptoms are seen at any given appointment and the perspective of the viewer. We want to avoid normal problems of life being called diseases but this causes another problem.

Many mental illnesses are caused by identifiable life events. PTSD and other stress disorders need an identifiable stressor to get diagnosed. Many, but not all, people with Borderline Personality Disorder can point to some life event that started their symptoms.

As more people know about Borderline Personality Disorder more people are coming to believe that they have the condition. Family, Friends, and relationship partners are likely to blame all the interpersonal or relationship problems on someone having Borderline Personality Disorder. I suspect that professionals are going along with this and giving the diagnosis out more often.

Is Borderline Personality Disorder an illness or a lack of mental wellness?

Symptoms of Borderline personality disorder can vary from person to person and they may vary in intensity. This has resulted in an increasing amount of discussion, and a past counselorssoapbox blog post about whether there may be Levels or Types of Borderline Personality Disorder.  There has also been some professional discussion about whether some clients have been given the diagnosis because they angered the treating professional.

Some of you have noticed from my other writings that I believe strongly in Wellness and Recovery. (See post on Mental Illness or Mental Health.)

Many of the things we call “Mental illness” are on a continuum. Those problems get better or they get worse. Sometimes in life, we get sad. When that sadness keeps you from working or enjoying life we call it depression and it deserves to get treated. The same thing is true of Borderline Personality Disorder. Many people with this condition do get better.

As we look at the symptoms of Borderline Personality Disorder below I will comment on some of the questions you might have about each one of the symptoms. This discussion is based on the SAMHSA publication titled An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders. This publication was written primarily for professionals but I include it here in case any of you want to see the original source. The SAMHSA publication draws on the –DSM-5 (DSM is a registered trademark of the APA,) which some of you may also want to consult. The paraphrasing and comments are mine, so let’s hope I get this right. If you have or think you may have this condition please see a professional in your area.

Below are some of the typical features of Borderline Personality Disorder.

Borderline Personality is not common except in psychiatric hospitals.

Estimates of how common Borderline Personality really vary. In the general population, it is estimated at around one to two percent. In inpatient psychiatric facilities the rate of Borderline Personality Diagnosis can reach 20%. That suggests to me that this is a very impairing condition.

Notice as we go through these symptoms that many of these are things that have been considered “female” characteristics. Turns out that three out of every four people who get the Borderline Personality Disorder Diagnosis are female. Also, many of these symptoms are exactly what we would expect in someone with a Stress or Trauma-Related Disorder as in Posttraumatic Stress Disorder or a Dissociative Disorder.

Borderline Personality Disorder is not simply a matter of being overly dramatic or wanting attention. Most, about 80%, attempt suicide and they die from suicide attempts at about 50 TIMES the rate of the general population. This does not need to happen as there are effective treatments for Borderline Personality Disorder available. Additionally about 80 percent of those with this diagnosis cut on themselves, which is often called Non-Suicidal Self Injury. Some people with this condition both cut and attempt suicide.

Symptom – Intense fear of abandonment and efforts to avoid it.

Many, not all, people with Borderline Personality Disorder were abused or neglected as children. Some had this experience in adult life. This suggests that these fears are both rationally based on experience and learned. If you learned to be fearful you can learn to not be fearful. But lessons learned very early in life may be much more difficult to unlearn. For many this fear of abandonment makes sense.

Borderline symptom – troubled, vacillating relationships with others.

In a single session with a therapist, someone high in borderline traits may tell the therapist that they love them and they are the only on that ever understood them and then later they will say that they hate the therapist and “you just don’t understand at all.”

The same thing happens in their personal relationships. They fall in love quickly and they fall out just as rapidly. They have overinflated views of their potential partners and then they feel tricked, deceived, and angry. Relationships with someone who has Borderline Personality Disorder can include fabulous sex followed by violent fights.

Don’t know who you are and who you are keeps changing.

People with borderline conditions have more difficulty than others in telling you what they like, who they are and they look to others to define themselves.

Impulsive acts are common in Borderline Personality Disorders.

Risky sexual behaviors are the most commonly noted behaviors. Over-spending and reckless driving are also included in this definition. Frequent conflicts with others are common.

Suicidal Behaviors or Self-Mutilation.

People with borderline personality disorder are often overwhelmed by emotion and then hurt themselves rather than express their anger towards the person that angered or hurt them. This kind of sudden flip in their feelings towards others and then their impulsive behavior can look a lot like Bipolar and turns out that many people get both diagnoses or they are moved back and forth. It is of course very possible for someone to have more than one disorder.

Borderline makes people feel empty.

Since people with Borderline do not know who they are and they fear being abandoned, this makes sense. If you look for your self-worth from others and then feel empty or nothing at all when you are not getting positive interactions from those others you can feel empty. Some of these characteristics may sound like an immature or selfish person. If you did not get enough food as a child you may be physically stunted. If you are abused or neglected as a child or abused drugs and alcohol, then you may not have learned the lessons you need to learn back then. The result is continuing to use coping strategies that may have kept you alive or got some of your needs met as a child but they are not working now. This is true of some people with Borderline Personality Disorder but not all.

Remember that these explanations are ideas about how things could happen but not precise formulas for how it did happen to any one particular person.

Episodes of strong, excessive anger.

There is no specific diagnosis for “anger issues” despite how common referrals to therapy for “Anger Management” are. Anger is a symptom reported in many other mental or emotional issues. What further clouds this picture is the high rate of Bipolar Disorder and Substance Use Disorders among those with Borderline Personality Disorder. Depression can also lead to irritability and then anger. What is looked for in Borderline Personality Disorders is sudden explosive anger often with fights and violence, that come on unexpectedly with someone who shortly before was a close friend or loved one.

Borderline may include Stress-related Dissociation or Paranoia.

This can be a problematic symptom in practice. Part of the way we identify paranoia is that the fear is excessive. Men are taught to approach things they fear. Kill it if possible. This results in men getting acting out, violence-related diagnoses. Women are taught to avoid danger and if you have been victimized in the past you recognize danger coming. So if you have been abused once the fear that your new boyfriend will abuse you sounds reasonable, not paranoid. See how this can be an issue?

It is also possible that “dissociation” gets pathologized. Some dissociating or “spacing out” is normal in children or those who are overwhelmed. People who suffer trauma may well dissociate. So it seems to me that cases of excessive dissociation may get swept into the Borderline Personality Disorder category rather than being recognized for what they are. As before someone could have both Borderline Personality Disorder and Dissociative Disorder.

Those are my thoughts on recognizing Borderline Personality Disorder and how it and other conditions may be getting mixed together. If you or someone you care about may have this condition consider professional help. If they do not have this problem please stop calling everyone you dislike Borderline. You may also want to check out other counselorssoapbox posts on Personality 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

Why are sleep disorders listed as mental illnesses?

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

View of dreamland.

Dreamland.

What are Sleep-Wake Disorders?

Are problems with sleeping or staying awake making a mess of your life? Then you may have a sleep-wake disorder on top of all your other problems. Why does this matter? Because an untreated sleep-wake disorder will make all your other problems worse.

These issues turn up in the therapist or mental health counselor’s office when people start talking about their concerns with both the quality and the quantity of their sleep. Often this is because those sleep issues are impacting their wide-awake life. When sleep issues start interfering with your job, relationship, or just plain making you not care anymore it needs attention.

This group of disorders sits at the intersection of mental and physical problems and reminds us that the distinction between body and mind is not all that clear-cut. The nervous system connects with the limbic system so your thoughts and feelings impact your immune system. Your body’s physical ailments affect your mood.

With the introduction of the DSM-5 clinicians in the mental health, area are getting a chance to take another look at the connections between sleep and mental health. One rule for therapists is to not be practicing medicine. If a therapist has any doubts, they should refer you to a medical doctor to get a purely medical cause of your issues ruled out or treated before using a primarily talk method to help you.

Some sleep disorder problems can best be determined by sleep specialists. These issues look differently when you try to describe them the next day versus when you are being monitored in a sleep lab and they can be detected right then and there. Your diagnosis may depend on whether the problem occurs during REM sleep or non-REM sleep. Even medical doctors can’t get this part sometimes without sleep tests. The International Classification of Sleep disorders – 2 is far more exhaustive than the DSM or other possible lists, but it requires a sleep specialist to run tests to get this right.

Poor sleep can be a symptom of a mental disorder. Changes in sleep and appetite are one of the things that professionals look for in diagnosing depressive disorders. But poor sleep is not specific to depression or any one particular mental disorder. Sleep-wake cycle disorders affect a host of mental, emotional, and behavioral disorders.

Poor sleep, especially distressing dreams, bad dreams, and nightmares have been connected to depression, anxiety disorders, panic attacks, ADHD, borderline personality disorder, dissociative disorders, substance use disorder, substance withdrawal, an increase in suicide risk, PTSD, and non-suicidal self-injury also known as cutting.

While poor sleep is found in conjunction with a lot of mental illnesses, it has also been suspected to cause mental illnesses. For example, nightmares are a key factor in maintaining Posttraumatic Stress Disorder (PTSD.) Having frequent distressing dreams in childhood predicts the development of an anxiety disorder 5 years later. While nightmares and bad dreams may change and decline as you age, the majority of people who will get diagnosed with an anxiety disorder will have symptoms in middle school at just the time disturbing dreams are at their worst.

Sleep problems are also connected to behavioral problems. Children who are treated for behavioral issues also have nightmares or bad dreams on a regular basis. People with insomnia are at risk to have more nightmares and more nightmares increase the risk of developing a stress-related disorder like PTSD.

It is easy for a therapist or counselor to overlook sleep-wake disorders. If you have depression or anxiety, those sleep issues may be considered symptoms of your depression or anxiety. Make sure you mention the sleep problems to your therapist. If you have sleep-wake cycle problems, whether they are caused by another mental illness or not, if they bother you they should get diagnosed and treated along with the other issue.

Some Nightmares are harder to treat than others. The ones found in PTSD about things that have really happened to you are harder to get rid of than other bad dreams, but there are treatments for these nightmares that do work. Bad dreams based on generalized anxiety have been treated in children with as little as one therapy session. There will be more on treatments for sleep-wake cycle issues in upcoming posts.

Here is the list of Sleep-Wake disorders based on the DSM with their most current numbers.

Scary list isn’t it? For a full discussion, you would need to check out the APA’s book DSM-5. I will try to give you the short plain language versions of these issues in upcoming posts.

Sleep-Wake Disorders

Insomnia Disorder 780-52 (G47.00)

Hypersomnolence 780.54 (G47.10)

Narcolepsy (subtypes/specifiers have different numbers.)

Breathing-Related Sleep Disorders

Obstructive Sleep Apnea-Hypopnea 327.23 (G47.33)

Central Sleep Apnea (subtypes/specifiers have different numbers.)

Sleep-Related Hypoventilation (subtypes/specifiers have different numbers.)

Circadian Rhythm Sleep-Wake Disorders (subtypes/specifiers have different numbers.)

Parasomnias

Non-Rapid Eye Movement Sleep Arousal Disorders

Nightmare Disorder 307.47 (F51.5)

Rapid Eye Movement Sleep Behavior disorder 327.42 (G47.52)

Restless Legs Syndrome 33.94 (G25.81)

Substance/Medication-Induced Sleep Disorder (you need a number chart for this one)

Other Specified/ Other unspecified – Insomnia/ Hypersomnolence or Sleep-Wake Disorder (6 total)

Which sleep-wake disorders are mental health issues?

Some of these disorders are pretty straightforward, some are medical issues, some are psychological and a few are mixed, other sleep-wake disorders are even more complex. Nightmare disorder is a good example of the confusion. In common speech, nightmares are those bad dreams you have that upset you. In technical terms, bad dreams, nightmares, night terrors are all different things, sometimes. Even the researchers use different definitions in their articles.

In coming posts let’s look at the various sleep-wake disorders and treatments for them. Until then sleep well or consider getting help.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

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.

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