Category Archives: PTSD & Stress

Anxiety makes you sick in so many ways.

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

anxiety

Anxiety makes you sick.
Photo courtesy of Pixabay.com

Lots of illness, is it anxiety telling you to be sick?

Many mental illnesses have very real physical symptoms. Those symptoms of depression and anxiety are not just in your head. Stress puts your body through some very debilitating changes. Having an anxiety disorder can look like a physical illness. If Anxiety goes on too long, those chemicals your nervous system is throwing out can lead to some long-term physical illnesses.

The mind-body connection does not just work in one direction. Physical illnesses can cause emotional problems. Emotional problems unrecognized and untreated can contribute to many physical illnesses. If you have any of the following psychical problems check first with your doctor. If that doctor can’t find a physical cause, consider working with a mental health professional to reduce your stress or treat your anxiety and depression.

Getting mental health help does not mean you are “crazy” or are losing your mind. Not getting help is you cheating yourself out of something that could do you some good.

Because anxiety symptoms mimic physical health symptoms when in doubt see your physician.

Anxiety causes sleep disturbances.

Being anxious interferes with your sleep and poor sleep contributes to physical illnesses. If you are lying awake at night turning problems over and over in your mind, a process called rumination, your anxiety is out of control and needs treatment.

Anxiety causes your mind to race.

Mind racing interferes with work and with relationships. Your mind leaves on its own and there is no space in your head left for the things you need to be thinking about. Mind racing from anxiety is very different from the inattention in Attention Deficit Hyperactivity Disorder (ADHD) or the impulsive thoughts in Bipolar Disorder. In anxiety disorders, the racing mind is about what has happened and what might happen and how terrible it would be if those things were to happen.

Anxiety leads to indecision.

Anxiety uses up so much of your brain that there is not much “computing capacity” left for other decisions. People who are high in anxiety find it hard to make decisions and remember everyday items. This leads some to question if they are developing Alzheimer’s or dementia.

With Anxiety, you may find it hard to breathe.

People with high levels of anxiety tend to breathe from the upper chest, almost the throat area rather from way down deep near the diaphragm. The symptoms of this altered breathing are easy to recognize. They remind me of the dog that is out of breath and pants fast and shallow. Healthy breathing puts air in the bloodstream, anxious breathing, hyperventilating, leaves you worse off.

Anxiety leaves you light-headed.

That strange disoriented feeling, where you feel light-headed and out of things may be the result of excess anxiety. The changes in breathing described above contribute to these feelings of light-headedness.

In “Anxiety Attacks” the heart races. Having sudden episodes of anxiety is common if you are in a dangerous situation or under stress. When these events get severe they get diagnosed as Panic Disorder, a recognized mental illness.

These feelings of chest palpitations result in people with anxiety symptoms ending up in the emergency room. The first few times the symptoms of a panic attack can resemble a heart attack. You need a doctor to check you out to be sure. People who have frequent panic attacks come to recognize the difference as they have been through this before. Unless you are sure, it is wise to get this checked out. One sure way to tell the difference is to try slow breathing and hold your breath for a few seconds between breaths. As the breaths slow down the symptoms should subside if this is a panic attack.

Anxiety prevents swallowing.

Anxiety can constrict your throat and make it hard to swallow. That feeling of choking that can happen before anything has entered your mouth likely is anxiety. Fear of something bad happening can create the same symptoms you feared.

Anxiety kicks in the flight mode.

High levels of anxiety prepare you to run, There may be trembling in the legs like a car revving up to take off. You may develop a restless feeling and want to run. Some people report jelly-like legs. Sweating and shivering may also be caused by anxiety.

Anxiety disturbs your appetite.

Some experience this as a loss of appetite, others feel nauseous and unable to eat. You might also have feelings of wanting to throw up. All of these digestive interfering results of anxiety are the body’s ways of lightening the load and diverting blood from the stomach to prepare you to flee. If you really do need to run, all well and good. But if you, like many other people in modern life, have more anxiety than you need, these digestive irritations can do harm to your digestive system over time.

With all these health-related symptoms there is a huge tendency for people to ask for, even demand, medication from their doctors. Anti-anxiety meds can be helpful in the short run but reducing the stress and anxiety-provoking situations in your life coupled with other anxiety-reducing techniques will work in the long run without the risk of becoming medication dependent. People who combine medication and counseling intervention seem to get past the anxiety faster.

Do any of these symptoms of anxiety affect you? Have you seen the doctor? Have you found other methods to control or reduce your anxiety?

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

Ways you create drama.

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

Is your life drama?
Photo courtesy of Pixabay.com

Are you making your own drama?

Do you find yourself saying that there is way too much drama in your life? Feel like you live in a soap opera? There are ways you can turn the drama down even if you live in a drama-filled environment. There are also ways you may be the architect of your own drama.

Here are some ways you may be the creator of your own life soap opera.

You stick your nose in other people’s business.

Do you spend a lot of time telling others what they should and should not do? Any surprise that they are paying you back? If you want to avoid drama in your life, avoid interfering in other’s lives. You may think that your family member or friend is making wrong choices but if you get involved in the choices you also get involved in the drama.

Live your life and let them live theirs. People who keep poking around in others’ lives become a part of that other person’s drama. Want less drama in your life? Focus your attention on your life and let others live theirs.

Doing too much creates drama.

If you say you will do something do it! Making commitments and then backing out is a sure way to increase the drama in your life.

The things you committed to are the things others expect of you. Promise too much and do not deliver and you invite other people to be angry with you.

When you run from one thing to another you risk being perpetually late and not meeting your commitments. You also start to feel overwhelmed. All of this creates extra drama. Want a relaxed world? Reduce the things you do every day. Give yourself breaks between things.

Reducing the “must’s” and the “should’s” reduces drama.

Those rules you set for yourself become cruel taskmasters. Let go of all those “Musts” and “Should’s” and just relax and enjoy the ride. Some things, like right and wrong and moral values, are major big things and yes you should expect yourself to live up to those things. But if your list of things you have to do to be an OK person gets too long you are creating a drama-filled life.

Let the little things go.

Telling the truth reduces drama.

Some people lie to get away with things. Others lie because they do not want to disappoint people. The more you mislead others, regardless of the reasons, the more you invite their anger or hurt when they find you out. Tell the truth when possible and if it is not possible, try saying little or nothing.

Being dishonest with others is a huge drama maker.

You do not need to answer every social media post.

Lots of people post lots of trivial stuff online. Do not get sucked into answering every post you see. Ignore the comments that do not make your life better. Use social media to connect with friends and have fun but beware the trolls.

Some people say things just to start an argument. Some comments are hurtful. If you disagree you do not need to argue with every person out there. Read things carefully. Plenty of drama-filled exchanges begins when one person misunderstands what another is saying and then begins to argue with a statement that was never made.

You do not need to become a part of the thought police.

Let others be wrong some of the time.

You do not need to correct everyone’s errors. Allow others to be wrong some of the time. Pointing out other’s mistakes invites them to retaliate and point out your flaws. Finger-pointing can consume all your time and is a huge drama machine.

Feel better about yourself and finding other’s mistakes becomes less important. Humans make mistakes, some by accident and some intentionally. You will make errors in tour life, let others have the same privilege.

Stay out of the gossip to reduce the drama.

Sharing about other people is tempting. Spreading that gossip “Have you heard what SHE did?” sucks you into the gossip vortex. Once you start going round and round that circle the drama accelerates.

For less drama stop trying to change others.

Most efforts to change others is doomed to failure. The more you try to manipulate others and get them to live the way you want them to the more drama you create. For people you can’t agree with the best option may be to cut them out of your life. If you can’t do that, some family members may refuse to go away, you can reduce your contact with people who are not good for your mental health.

Trying to make others change to suit you invites them to push back. All that pushing and pulling is the stuff that drama is made of. Live your life and extend that same privilege to others.

Let sick people be sick. It is not about you.

Some people are just mean. Some are thoughtless or rude. Do not get into conflicts with people who are not capable of being any different than they are. It is not your job to change them and the more you insist that they be other than they are the more drama you create.

Do not upset yourself when other people are imperfect. You may need to set a boundary. You may even need to call the police. But do not get sucked into a long-term feud with people whose lifestyle or behavior does not suit you.

Are you ready to make the move from a drama-filled life to a happy 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

Is your Anxiety a disease?

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By David Joel Miller

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

Some fear is normal, too much is an anxiety disorder.

How can you tell if your fears and anxieties are normal or are they the signs of a more serious mental illness? In everyday language, there is not much difference between fears and anxieties. In technical, mental health terms there are some key differences between fears, anxieties, and the times your anxiety symptoms get out of control and get diagnosed as a mental illness.

Of all the mental illnesses, Anxiety disorders are the most common. In any given year one in five Americans will experience Anxiety so severe it should be diagnosed as an anxiety disorder. Prevalence rates around the world are very similar to the U. S. experience. Anxiety disorders are also the ones most likely to be seen by medical doctors as the symptoms often look like symptoms of physical illnesses.

Fear in the mental health sense is a reaction to a thing or situation that causes an immediate reaction. You see something, something happens and you get that feeling you need to do something now. The standard reactions are to freeze, flee, or fight.

Say you see a poisonous snake and you become very scared. This sounds rational. But if you are afraid to visit a school because they might have pictures of snakes up in the science classroom, that is excessive and should qualify you for some kind of mental health diagnosis. Which diagnosis? We are not there yet.

Anxiety, the mental health type definition, is a feeling of nervousness or uncomfortable about something that may happen in the future. People with anxiety disorders become so afraid that something will or might happen in the future that they have to alter their present to avoid these possibilities.

People commonly report that they have “Panic attacks” or “Anxiety attacks.” If the thing setting off the anxiety attack is something that has a real potential danger then having fear and freezing, fleeing, or fighting might all be reasonable adaptive behaviors. Attacks of a symptom do not always equal a mental illness.

While some anxiety disorders are brief most, to get diagnosed, need to be more than temporary conditions. The criteria for many anxiety disorders it’s that you must have had this anxiety for six months or more. Of course, during that time period, your anxiety may have episodes of getting stronger, and other times it may be less troublesome. If it has interfered with your life for 6 months or more you most likely have an anxiety disorder.

Not every case of nervousness or anxiety is the result of having an anxiety disorder. Someone who is depressed and has difficulty doing things they used to do is likely to become anxious. We include that kind of anxiety as part of the depression. Same thing when someone with a psychotic disorder becomes fearful and think people are watching them. That paranoia is part of the psychosis and does not get a separate diagnosis of an anxiety disorder.

What makes this fear diagnosable is when it begins to interfere with or change your behavior or upset you. If you can’t leave the house or work because of your anxiety, that is probably a diagnosable anxiety disorder. If your extreme fearfulness, anxiety, or hyper reactiveness start affecting your relationships, that is a probable diagnosis.

There are a number of different types of anxiety disorders depending on what is causing your fear or anxiety. Further complicating this picture is that many people who have anxiety disorders have more than one kind. Having multiple anxiety disorders is considered very common.

Since people with anxiety disorders have by definition “excessive” fear or anxiety it takes an outside observer, usually a therapist to evaluate the risk and see if this person’s fear is reasonable given their situation and their life experiences.

Most anxiety disorders start in childhood, often before the end of middle school. Over time and untreated anxiety disorders get worse. The stats say two of every three people with anxiety disorders are women. I believe this is partly cultural. Boys and men are taught to approach what they fear. Attack it. Women are supposed to get away. This results in anxious men becoming more violent or using a substance to cover up their anxiety and as a result, they get a behavioral or substance use diagnosis.

Physical sensations may be symptoms of anxiety.

Different people experience anxiety differently. Anxiety symptoms are frequently physical and many people interpret their anxiety symptoms as a physical illness.

If you experience an anxiety attack you may feel dizzy or light-headed. You may feel disoriented, have difficulty breathing or swallowing. The heart may race, you might sweat or tremble all over.  Despite the feeling you want to run your legs could become rubbery or jelly-like.

Some people experience gastrointestinal symptoms, constipation, diarrhea, nausea or feeling like you may vomit. Sleep disturbances, mind racing, and confused thoughts can result in Anxiety disorders getting confused with Bipolar Disorder and other mental illnesses.

Here is the most recent list of recognized Anxiety Disorders. These are necessarily brief, general descriptions of the disorders in plain language. For the specific criteria consult the relevant edition of the DSM.  For more on each separate disorder look for the articles I have written on specific disorders. I plan to write more of these posts on specific anxiety disorders in the future.

You will find the link to other articles on anxiety below.

Separation Anxiety Disorder.

This disorder customarily starts early in life. The child is afraid to leave or be away from a caregiver. They may think that something bad will happen to them or the caregiver if they are separated. We used to think of this mostly as a disorder of children and that they should “grow out of it.” We are starting to think that you can have this at any point in your life and that many clingy needy adults had this and or an attachment disorder since childhood.

Selective Mutism.

Someone who speaks normally at home but is afraid to or refuses to speak when in public or around strangers fits the description of Selective Mutism. The criteria for this disorder does not imply that the child is being poorly behaved but just that they are so afraid they can’t speak around strangers. The result is poor grades or school failure. As they get older this may lessen but again there are adults who just avoid speaking around strangers as much as possible.

Specific Phobia.

Spiders and snakes, blood, heights, or flying can all be objects of a specific phobia. With Specific Phobia we can point to things or situations that are the cause of the anxiety. People with specific phobias often had fears of several things or situations and may have other anxiety disorders as well.

Social Anxiety Disorder (Social Phobia).

In this disorder, the anxious person is afraid of social situations where others may watch them, evaluate them, or otherwise form an opinion about them. The fear here is about doing something “wrong” or being judged. This is about having your peers think poorly of you, what you wear, or how you do things. In severe cases, people avoid eating in public or going to social gatherings.

Panic Disorder.

Panic disorder involves many of the physical symptoms we talked about above. The person having a panic attack may have shortness of breath or chest pain and think they are having a heart attack. Having had one attack people become afraid to leave the house for fear they will have another and not be able to get help in time.

Agoraphobia.

Agoraphobia translates as “fear of the marketplace” mostly this involves crowded situations. Fear of buses, standing in lines, crowded places, stores, and similar situations. In severe cases, the person becomes unable to leave the house to go shopping and either needs someone to go with them or just go at times the store will be very empty.

Generalized Anxiety Disorder.

This involves being over-anxious all the time. A person with Generalized Anxiety Disorder is anxious all the time about most anything. There may be real-life causes for this anxiety, like living through a war or being assaulted or harmed. The professional has to look carefully to separate this from PTSD or other Trauma and Stressor-related disorders.

There are also diagnoses for anxiety problems caused by drugs, medications, medical conditions, or other factors.

For more on Anxiety, treatments for anxiety and related issues see:

counselorssoapbox.com Anxiety Post list.

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

PTSD or Acute Stress?

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

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

What’s the difference between PTSD and Acute Stress?

Stressed

Feeling stressed out?
Photo courtesy of Pixabay.com

PTSD, Post-Traumatic Stress Disorder has made the news a lot recently. This is a good thing. More recognition of PTSD should result in more treatment and less suffering from those who have PTSD. Stress caused problems may or may not be from a Trauma.

What hasn’t gotten as much notice and should have, is the role of Acute Stress Disorder in the events that knock people down and cause a lot of suffering. Acute Stress Disorder creates a lot of problems for a lot of people. Reactions to severe stress can cause long-term changes in people’s feelings and behaviors. Many of these changes go unrecognized and untreated. Acute Stress Disorder may be missed more often than it is diagnosed. More on that later in this blog post.

Stress can harm you.

We know stress is a problem a lot of the time, for a lot of people. Outside the field of mental health, there are lots of blog posts and books on stress, what it is, and how to deal with it.  I have written posts about stress and managing it for those of you who have too much stress in your life even if it does not get you a diagnosis or disability.

Stress, plain simple stress, can break people down even if they never meet the criteria for a mental illness. Think of stress like this:

Remember those spectacular car crashes at those televised car races? Some of those crashes were the result of car parts (or drivers) under stress. All-day, for hundreds of miles that car and that poor car part, ran hard and fast. The stress just kept coming, then suddenly that part breaks, that car goes all which way and the crash occurs.

Stress on people can be like that. Too much stress too long and the person develops mental health problems. Some of those problems need a day off, others become diagnosable illnesses. In the past, we tended to think of stress-related disorders like Post-Traumatic Stress Disorder (PTSD) as close cousins to Anxiety. That has started to change.

Beginning soon mental health professionals will begin to use new coding systems. The DSM-5 or the newer ICD codes. In those systems, Stress and Trauma-Related Disorders get their own chapter. While Stressor-Related Disorders can cause anxiety and have some symptoms in common with anxiety disorders they also have some differences.

Trauma- and Stressor-Related Disorders.

From the day you are born till the day you die too much stress can cause you a problem. One key factor in Trauma- and Stressor-Related Disorders is that there has to be a specific thing that happened to you, the stressor. Trauma is the king of all stressors.

So these things do not just suddenly happen for no reason and they are presumably not something you are born with. This fuzzes up the expression that mental illness is a brain disorder, in that the cause of these disorders are things that happen to you.

If life events result in acquiring a mental illness, then events, as in therapy and learning, can be helpful in treating that disorder.  Much of the treatments for stressor-related disorders are cognitive type therapies.

Trauma and Stressor-Related Disorders also can have features that are similar, we might even say overlap, depression, anxiety, obsessive-compulsive, and the often overlooked dissociation. Not every other mental illness is caused by stress or trauma. We just need to be aware that sometimes there can be connections. This similarity to other issues results in a lot of stress-related disorders not being diagnosed until years later when the person is severely mentally ill or disabled.

What is Acute Stress Disorder and why is it important?

Acute Stress Disorder has two sets of “symptoms,” the things people experience that are a problem for them and the technical things professionals use to give out the diagnosis.

Some of the things you might experience as a result of having Acute Stress Disorder are also symptoms of other mental health issues or other mental illnesses. There are a variety of diagnoses that someone might get as a result of injuries they sustained due to stress.

These symptoms can impact your life in long-term ways. People may find their personality has changed.

Poor or no sleep is a cause for worry. Poor sleep now, predicts mental health issues down the road. In the aftermath of stressors, many people report that they do not sleep well. Some report bad dreams, nightmares, or night terrors. A few days of bad sleep after you are stressed and you should get back to normal. If the sleep disturbance goes on for very long it starts to change your functioning and your life.

Panic attacks are common in the first month after a severe life stressor. The time period of thirty days becomes important when we try to separate Acute Stress Disorder from other problems. This panic attack may first be experienced immediately after a stressful incident and then go on to become Panic Disorder.

If you have been through a severely stressful incident it is not unusual for you to blame yourself for not expecting it, not doing something differently, and not being able to prevent it. Rationally you should know that it may not have been possible to prevent what happened, but people commonly experience guilt or even shame over not being able to stop that trauma.

After a trauma, some people report that happiness or joy has been sucked out of life. They stop caring about themselves or others. They may begin to take risks that they never took before. They drive too fast, gamble, take more sexual risks. Some trauma or stress survivors become angry, bitter, and more argumentative. They get in more fights, verbally, and physically. It is as if they have changed who they are and they no longer care.

If you knew about the traumatic experience you might understand why the changes in behavior occurred. If that trauma survivor kept the trauma a secret, and many do, you might think this was all bad behavior.

Trauma survivors, even those who do not go on to develop more serious mental health problems, may become confused or think they are losing their minds. They may get tested for or treated for concussions. They could have both a concussion and a longer-term mental illness.

After a trauma or a crisis from the buildup of long-term stress, you may find it difficult to go back to places that remind you of the trauma. People become unable to go back to work, visit certain places or they avoid social situations.

How do professionals diagnose Acute Stress Disorder and why is that diagnosis so rare?

The official criteria for Acute Stress disorder are found in the DSM-5 or DSM-4-TR if your agency is still using that one. The DSM’s are published by the APA and you can order the full text from them. Here is my oversimplified plain language version of that criteria. I hope I do not make errors in this explanation.

A warning

Self-diagnosis or diagnosing your family and friends is a risky behavior. If after reading all this you believe you or someone close to you has Acute Stress Disorder, another Trauma- and Stressor-Related Disorder, or any other mental health problem, go see a professional and get it checked out. There are treatments available for all of these conditions and there is no need to suffer alone.

There are 5 things the professional needs to look at for Acute Stress Disorder

  1. Did you experience a really bad Traumatic Stressor Recently?

There is a “waiting period” of 3 days. Most people have difficulty for a few days after a serious trauma. Then there is the requirement that the problems you are having must last UP TO 30 days. This is a huge thing for Acute Stress Disorder. If your problems go on more than 30 days the name we call this (diagnostic code) changes to something more long-term like Post-Traumatic Stress Disorder (PTSD.)

The result of this time factor is that a whole lot of people who have this problem do not ever get diagnosed. In outpatient settings, it can take 30 days to get your insurance settled and to get in for an appointment. In hospital settings this diagnosis may be found more often using “strict criteria” but in most other places the results of trauma do not show up till years later and the issues then get called something other than Acute Stress Disorder.

  1. You must have at least 9 of 14 possible symptoms.

This leads to lots of ifs. Depending on who is doing the evaluating some things get counted and not others. Another problem is that trauma victims do not like to talk about their trauma. One symptom is avoiding reminders of the trauma and talking about it again is a reminder. So not having said they have a symptom can rule people out who did, in fact, meet the criteria and do have Acute Stress Disorder.

I will not go through all the 14 criteria here, just a few of the big ones.

You can’t get the trauma or stressor out of your head.

This is sometimes called intrusive thoughts. You may also have dreams and things will trigger the memories so much you begin avoiding those emotional triggers. After the 30 days waiting period this may become PTSD.

From now on you are in a bad mood and can’t get out of it.

The happiness and joy get sucked out of your life. You are in a bad mood all the time for no apparent reason. Some people, kids, and men mostly, become irritable, angry, and possibly violent. In my view, Acute Stress Disorder and its aftermath are involved in a lot of these unexpected violent incidents.

People may “space out.”

Researchers have noted that zoning out, technically called dissociation, is common, almost universal in the first three days after a trauma. If that dissociation continues after the third day we think it indicates Acute Stress Disorder. After thirty days that dissociation gets diagnosed as something else. I believe that there are more cases of dissociation than gets recognized. Some are ignored and some get another name like Psychosis NOS (not otherwise specified.)

Acute Stress Disorder is time-limited.

Acute Stress Disorder must last more than three days and less than thirty. Beyond the thirty the name gets changed. Many people try their hardest to cope and do not report symptoms. They can’t work and go on disability for a while until that runs out. Some end up alone and homeless. They get angry, depressed, or anxious and their relationships suffer. They develop panic attacks or obsessive-compulsive disorders. Some get other mental illness diagnoses.

Having Acute Stress Disorder really matters.

This disorder, like most things we call mental illness, really makes a difference in people’s lives. It interferes with their ability to work or go to school. Having Acute Stress disorder can interfere with or destroy relationships with family and friends. It causes the people who have it a lot of suffering even when they can’t express how or why they are suffering. It can also damage other important areas of your life, such as religious observances, hobbies, and so forth.

Acute Stress Disorder is not something else.

Professionals are continually reminded to avoid putting the wrong label (diagnoses) on things. If you only have these symptoms because of a medical issue or because you are drunk or high when you have the symptoms then we do not say you have Acute Stress Disorder.

This does not mean that people with medical problems or who use drugs can’t get Acute Stress Disorder, we just want to be careful we do not get the diagnosis wrong and count as symptoms things that were not caused by the stressor.

One last thing to consider.

There are two other groups of mental health problems in the Trauma and Stressor-Related Disorder chapter. Attachments Disorders, those problems that begin in very early life and Adjustment Disorders, which are reactions to stress that may not be life-threatening but have a huge impact on your mental health. These groups of life problems, sometimes, they rise to the level of a mental illness or a mental health problem.

I have written elsewhere about how Attachment Disorders and Adjustment Disorders can wreck someone’s life if not attended to. I am out of time and space here to talk about these other groups of Trauma and Stressor-Related Disorders.

Hope this post did not run too long. I do not think I have written a post of this length in the past but this seemed like a topic that needed more space and discussion.

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

Your thoughts making you anxious?

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

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

9 ways to tell if your thoughts are causing your anxiety.

Is anxiety a constant feature in your life? Anxiety has its place. It tells you if you are in a dangerous situation and keeps you alert. But if you are always in an anxious state you will wear yourself out and anxiety no longer becomes protective, it becomes your tormentor.

If you have a pattern of thinking anxious thoughts even when they are not necessary then you may be training your brain to maintain an anxious state at times you should be relaxed and calm.

How many of these over-anxious thoughts are you practicing?

1. Your negative thoughts have become a habit.

Is your default brain setting to look for the danger, for what could go wrong? Have you made looking for the negative a habit? Start looking for the good, the unexpected. Meditate on the positive things in your life and challenge yourself to stop ruminating on what could go wrong and begin looking for all the constructive things in your life.

Developing a list of things you are grateful for can increase the habit of seeing the good and reduce the tendency to look for the anxiety-provoking cues in your environment.

2. A recurring thought interferes with your life.

Do you have a recurring fear that you are or will get sick? Do you worry about finances and think you will go broke? Do you practice the thoughts you will have when something bad might happen?

Look for the facts in these situations. See a doctor. Get your health checked out. Work on your finances. Look for ways to earn more, spend less, and save some. Buy some insurance.

Stop practicing that fearful, anxious thought and begin to take action. Include in those actions learning to relax and to look for the positive. Give yourself credit for the things you have accomplished.

3. You worry about things that don’t really matter.

Do you worry that something will happen, somewhere, to someone, and you do not even know why? Do you worry that characters on shows will die or fictional couples will break up?

When you find yourself worrying, ask yourself, does this matter? Does it matter to you? Does it matter right now?

Do you worry about whether to buy one kind of vegetable or the other? Make a choice and the worry ends. For many of life’s choices, there is no correct answer. Pick the thing you want and move forward.

4. Your need for everything to be perfect makes you anxious.

You are a human, aren’t you? No human is perfect. We learn from our mistakes. Learn from your mistake and do better next time. Everything can never be perfect. Your perfect will not be someone else’s.

5. Your worry about things that are out of your control makes you anxious.

Some things are your job. Some things are not. Worrying about someone else’s job is unproductive. You may think about what would happen, you may even make contingency plans, but let others worry about their stuff.

Worrying about things over which you have no control does not protect you from danger. It diverts resources from doing the things you need to do into unproductive worrying.

6. You beat yourself up about things everyone does – normal behavior.

Accept your humanness, embrace it. Sometimes you will burp, sometimes you will pass gas, possible at the most embarrassing moment. All humans sometimes trip or fall.

We all make errors and do uncomfortable things. Try to minimize your number and the nature of your embarrassing moments but do not beat yourself up.

Hint here. Turn your cell phone off during church services and do not eat beans just before an important meeting. Do things proactively to reduce your embarrassing moments, but once they happen, accept that you to are blessed with those normal human moments.

7. Calling yourself names increases your anxieties.

Call a child stupid often enough and they believe you. Eventually, they will stop trying to learn. You can do the same thing to yourself. Calling yourself names is not helpful. It will result in anxiety over your self-worth. You are worthwhile simply because you are you.

8. Second-guessing decisions will paralyze you with anxiety.

Once a decision is made move forward. There are times when situations change when you get new information, and you need to reevaluate. If you find yourself rethinking every decision realize that this is wasting time looking back over your shoulder at the past and you should be living in the present.

9. Telling yourself that good things will never happen for you feeds the anxiety.

What you tell yourself over and over your brain believes. If you say you can’t your brain will avoid trying. If you repeatedly tell yourself things will never get better, they won’t. This is a negative affirmation. Negative affirmations like positive ones work. Try telling yourself that you can do things and good things become possible.

Do you practice any of those 9 thinking patterns that cause anxiety? Would you be willing to part with some of your fearfulness? Try practicing more positive and more helpful ways of thinking. Practice helpful thoughts over and over and see if your anxieties don’t melt away.

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

Seasonal Anxiety?

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

Anxious woman

Seasonal anxiety?
Photo courtesy of Pixabay.

Is there seasonal anxiety?

Officially there is no diagnosis for any seasonal disorder, but the profession does recognize that there is a form of Major Depressive Disorder that is highly influenced by the seasons. We denote this by referring to it as Major Depressive Disorder with a seasonal pattern.

Researchers on a lot of other mental and emotional illnesses are reporting that they find seasonal patterns in their disorders also, so far no one seems to be considering these seasonal influences on disorders like Anxiety.

So what other effects might the weather and the change of seasons be having on Anxiety and other disorders?

People who regularly see their doctors and have their blood pressure checked are more likely to find that they have elevated blood pressure as a result of stress in the winter months than in the summer months.

Yes, we do get stressed out more in the winter than in those lazy days of summer even when we are well into our working lives.

Women, particularly those working as supervisors and in responsible positions, report more anxiety and stress during the winter months than in the summer. They also report more physical ailments at that time of year for which no medical problem is found. Researchers are apt to call those issues “Somatic symptoms even though actual physical illnesses can’t be ruled out.

The bottom line here is, however, you see these complaints, stress, and anxiety are causing these women more problems in the winter than the rest of the year.

Anxiety disorder is worse in winter but Panic Disorder gets worse in the summer.

Several researchers into Panic Disorders have reported that panic disorder gets worse in the summer months. This appears to be related to the heat more than the hours of light.

Dehydration has been reported as a cause of this heat-related panic attack. Some people when out in public avoid drinking water because of the need to find restrooms. Don’t drink enough water and you get dehydrated which can trigger panic attacks.

One corollary to this was an article that reported more people in America are “Sunbirds” than “Snowbirds” that is more people go up north to escape the heat in the summer than go to the south in the winter to escape the snow in that northern tier of states.

There is a season to anxiety disorders and for most people, that season is throughout the wintertime.

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

Reactive Attachment Disorder is now a Trauma and Stressor-Related Disorder

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

Words about PTSD

Stress and Trauma. 
Photo courtesy of Pixabay.com

Reactive Attainment is related to Stress and Trauma but how?

We know children can be affected by reactive attachments but now we are wondering if it might underlie some problems of adults. We know what happens to you growing up can shape and affect you for the rest of your life, how much might reactive attachment disorder be contributing to adult mental health issues?

Reactive Attachment Disorder (RAD) used to be a problem relegated to a special section on childhood issues; it has been moved to the Stress and Trauma section of the new DSM-5. Two things to consider – the way in which this childhood problem may be affecting adults and how might this be another case of how much is it affecting adults rather than a simple yes or no question.

Reactive Attachment is a serious problem for very young children as any Child Protective services worker will tell you. We have a fairly good idea of what causes it and some methods of treating it but the long-term consequences seem to get lost when the child reaches the school years and beyond.

Working with adults I see some of these characteristics from time to time. I do not want to minimize the problem in children nor do I think every adult problem should get blamed on childhood experiences. Just the same there are these tendencies we see in adults and I can’t help wondering how many of those adult problems had their roots in childhood experiences.

First the 7 criteria for Reactive Attachment Disorder (very roughly paraphrased from the DSM-5) and along the way some thoughts on how other adult issues may be like this one and may be different from RAD. For the full, precise set of characteristics and diagnostic criteria see the DSM-5.

1. The child is always or almost always is inhibited and withdrawn. They do not go to adults for comfort and when the adult tries they do not appear to be comforted.

2. Low or no social interaction with others, and does not look happy or like they are enjoying themselves. Lots of sadness, irritability, and fear for no good reason.

3. The child has been neglected and did not get their needs met by adults in their life. Parents could not or did not meet the child’s needs or the child moved from caregiver to caregiver so much no pattern of care got off the ground. Group settings with too few adults per child can also cause this.

4. We think the lack of care caused the problem. (This can be the tricky one as we may not know what this person’s care was like way back when.)

5. This is not Autism or something like autism (The DSM lists ways to tell these apart.)

6. This started before age 5.

7. The child is developmentally at least 9 months old.

Now if you got all that you should have a picture of what this neglected (maybe also abused) child might look like. This kid could be a very difficult child to raise. The just sit there and look at you.

Most kids we expect to be cute. Give them a toy to play with and they smile. Hug them and they hug you back. Not the child with RAD. This kid cries for no reason and does not stop when you hold them. They never smile and they are always irritable. They jump at the slightest sound and then refuse your touch when you try to comfort them. Getting the picture?

Now the criteria wants us to see and know all this before 5 years and know that the neglect (or abuse) caused this.

What would this child look like in ten or twenty years as they grow up and for some reason first appear in the mental health system?

What might these symptoms look like if it was not an all or nothing situation? Say the parents worked all the time and the child had to fend for themselves. They moved around a lot and had no friends or close family members?

As this person ages, they might live in various group homes. The caregiver would keep changing. They would develop trust issues. They might believe that you can’t rely on others because they will leave you.

In the teen years, this child might, still angry, irritable, anxious, act out, and get in trouble. These would be the children that blow foster home placements or move from group home to group home. Even if they lived with some family member, grandma or aunt, they would never really get close to that person and eventually, they would “hook up with” a member of the opposite sex and have some more little ones.

Not able to feel cared for they might not be able to care for their own children and they might abuse or neglect the next generation.

While Reactive attachment is an extreme case I think by now you might see how low caregiver contact, abuse, neglect, or frequent changes in living situations could produce some of these characteristics to a greater or lesser degree as the child grows to adulthood.

Not knowing or feeling loved is at the core of these problems.

We may well have been underestimating the effects of lifespan issues in our evaluation of adult mental and emotional issues.

People can and do recover from almost all forms of mental and emotional disorders, but recovery from Reactive Attachment Disorder is a difficult process.

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

Is life freaking you out? Can’t calm down?

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

Stress person

Stress.
Photo courtesy of Pixabay.com

What do you do when life overwhelms you?

Ever have someone tell you to – “Just calm down?” Some people seem to be born with that skill but others of us once overwhelmed find it easy to get worked up and upset and a whole lot harder to calm down afterward.

Adults have a habit of telling children to feel this way or that. This approach, invalidating the child’s feelings, will cause problems later. If you were told to feel a certain way or told you had no right to feel as you did, you may have learned the lesson that feelings were bad. Suppressing feelings can cause you to ignore valuable information coming from that part of the nervous system.

Learning to listen to your emotions is a valuable skill. Unfortunately sometimes our emotions start yelling in their “outside voice” and will not shut up long enough to let us think. At that point, you need to be able to control those feelings. Note that controlling is not the same thing as ignoring, as any parent of young children will probably learn.

What is left out in this instruction, “calm down, stop getting upset” and so on, is how you get yourself to feel other than what you feel.

We call this skill of being able to change your feelings to match the situation “Emotional regulation.”

Many of us learned fear; anger and other negative emotions by watching the adults around us act them out. We may have learned happiness and love that way also. What was usually missing is how you get from full emotional turmoil to calm again.

Regulating your emotions, calming yourself down, is a skill that can be learned.

One post on emotional regulation will not make you an expert in this. It takes learning the skill, practicing the skill, and then over-learning the skill until rather than something you have to think about this emotional regulation is something you do automatically.

Here is a quick summary of things that may help to reduce the emotional intensity of negative feelings or to prevent them in the first place.

1. Use thought-stopping to reduce negativity.

When that thought that provokes your anger or anxiety first occurs find ways to interrupt that thought. Think of other things instead. Having a “happy place” or affirming memory can be a great help here.

2. Question this unhelpful thought.

What is the belief behind the thought? Challenge that belief. No one is “always” a certain way. There are many other ways to alter your thoughts and beliefs and the result is a change in your feelings.

 3. Tell yourself things that you find reassuring or grounding.

For people who are easily overwhelmed by negative emotions getting out of the movie playing in your head and back to the current moment can be very helpful. Start with the simple things. Therapists refer to these as “orientations.” Ask and answer some right here and now questions. Things like; Who are you? (Your name, not the meaning of your life.)  Where are you? What are you doing now? Who are the others around you?

Try to avoid taking detours down those “mean streets” in your head. Forget trying to “not think about things.” (See the post Don’t think about Elephants.)

Keep bringing yourself back to reality.

There are literally hundreds of ways to turn down the level of emotions and get yourself back to a safe mental place. These techniques need to be practiced beforehand otherwise while running in panic, you will never remember what you were going to do.

Watch counselorssoapbox.com for more posts on ways to regulate your emotions. You might want to subscribe to the blog if you find these posts helpful.

P. S. Stay tuned for info on the book I am working on. More on that in the posts to come.

Have you found ways to calm yourself down and regulate your emotions? Care to share?

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 Dissociation?

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

Confusion.

Confusion.
Photo courtesy of Pixabay.com

Does Dissociation really happen? What causes it?

Personally, I think there is more misunderstanding around this condition than most other mental health issues. First off Dissociation is way more common than most people realize. It comes in varying intensities; much of it is mild and goes unrecognized, denied and undiagnosed.

Dissociation, particularly Dissociative Identity Disorder has so much stigma around it that when we see it in clinical practice, I believe most clinicians call it something else more acceptable, like stress or Posttraumatic Stress Disorder, and let it go at that. This leaves people with more severe cases of dissociation with less than adequate treatment.

My view is that milder forms of dissociation are a normal protective behavior for most vertebrates, humans included. Under stress, the brain stem engages the “F’s” and takes over the functions of the brain to ensure survival.

Dissociation in its milder forms is, as I understand it, a functional survival mechanism. It is a close cousin to daydreaming and alcoholic blackouts.

Some simple examples of Dissociation.

I am driving along, I am thinking about something I need to do tonight. In my mind, I am picturing a set of slides that I want to create for the PowerPoint. I realize all of a sudden that I am miles past my freeway exit and I have no memory of driving this way. My mind has blanked out.

At this point, I turn around, drive as fast as I can, and reach my destination. Do I tell everyone about my “zoning out?” Not a chance. I make some lame excuse about traffic and getting off work late.

Next example, more severe

A woman who was gang-raped in the past is walking around downtown. She sees some men who are wearing gang colors and look kind of like the men that assaulted her. She becomes frightened and crosses the street, she begins walking fast to get away. A few minutes later she slows down. Her panic is subsiding. She looks around and finds she is walking through a neighborhood and she has no idea where she is or how she got here.

So now we can see a mechanism by which someone who is upset might do actions like run away and be functioning essentially on autopilot. High levels of stress, like high levels of alcohol in blackouts, might shut off the connection between current functioning and memory.

Does that mean this woman has some form of Dissociative Disorder?

Maybe, maybe not. The new DSM-5 lists five major kinds of Dissociative Disorders plus some specifiers and or sub-types.

This woman, now upset because this past problem, memories of the rape, is messing up her life and also a lot worried because she ended up in a strange neighborhood with no memory of how she got there comes to see a therapist.

She begins to talk about her experience. She had an experience that brought back memories of her rape (Intrusive thoughts.) She tried to avoid things, ran away (avoidance, yes.) She has been anxious for several nights since and has lost sleep over this. Maybe even had a nightmare and this has been affecting her home life and her relationship.

At this point she gets assessed, a treatment plan created and treatment begins.

She was embarrassed so she left out the part about walking for a while and having no memory how she got there.

Her diagnosis – it’s likely to be Posttraumatic Stress Disorder.

In clinical settings, stress-related disorders get diagnosed a lot more than dissociative disorders. Sometimes it is a judgment call. Which disorder are this woman’s symptoms more like? But I think we professionals may be overlooking a lot of dissociative symptoms. The result may be that in outpatient settings we are under-diagnosing Dissociative Disorder and over-diagnosing PTSD.

In carefully controlled research the prevalence of Dissociative Disorders of all 5 types exceeded 5% of the population. That makes dissociation up to 17 times more common than Schizophrenia.

Dissociative Disorders are the next chapter over in the DSM-5 from stress-related disorders. We see a huge overlap between those two groups. There is also an overlap with Borderline Personality Disorder another misunderstood condition.

If we think of all these conditions as reasonable responses to stress given the person’s biology and experiences we can see how some of the things that occur to a person with dissociation make sense.

Dissociative Disorders are most commonly found in the aftermath of traumatic events. Some of the symptoms of dissociation are embarrassment, confusion, and a desire to hide the existence of your symptoms. If you are the victim of trauma and let on how much the trauma affected you, this might put you at risk to be revictimized.

People under stress will have gaps in their memory. People with dissociation may also not know they have those gaps until someone asks about something they can’t remember. This is referred to in the literature as “amnesia about the amnesia.”

Dissociative Disorders, all 5 of them according to the DSM-5, include both positive and negative symptoms. In the past the only other disorder that I remember being described that way was Schizophrenia, but as I think about them other disorders have both also.

Positive and negative symptoms do not mean they are good and bad. What this means is that people with a disorder lose the ability to do some things others can do. This loss is called negative symptoms.

They also develop symptoms that others do not have. These added symptoms are called positive symptoms.

Since I believe people can and do recover I think that these areas of altered functioning can vary in intensity and can get better or worse depending on time, traumas, conditions, and treatment. More on negative and positive symptoms in future posts.

Another area of concern in talking about dissociation is something called state or trait theory. Trait would imply that once you got it you always got it. So if you dissociate then you are a goner and who wants to believe that. But if dissociation is a state then you can move into and out of it.

One other cause of Dissociative symptoms are efforts to reprogram or expose someone to “thought reform.” This mental reprogramming, like brainwashing, results in a brain that at some level believes two contradictory things. Can you see how that brain could pop in and out of contact with others?

Last, despite all the press about extreme cases of dissociation and the recurrent belief that this is something that only happens to women, the research tells me it is, in fact, more common among men than women. I have some theories about why that might be but that like the rest of this needs to wait till another post.

Dissociative disorders vary from person to person and from time to time. Nothing I can say will fit everyone and there is a lot to be said for listening to the “lived experience” of those who have these disorders. More to come on this topic, but in the meantime what do all of 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

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