Category Archives: Trauma- and Stressor-Related Disorders

What are the six types of Adjustment Disorders?

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

What is

What are the six types of Adjustment Disorders?
Photo courtesy of Pixabay.

Adjustment Disorders include six types or specifiers.

In another post, I wrote about adjustment disorders. You might want to take a look at that post.  You will find it in the trauma- and stressor-related disorders category. But to briefly recap, an adjustment disorder is a time when you experience stress and that amount of stress is more than you can handle.

The kind of things that you might find stressful, and how that stress might affect you, can vary a great deal from one person to another.  Adjustment Disorder can be very chameleon-like, changing from person to person and from time to time. As a result of this variation and in order to help find the correct treatment for each person, professionals use six different specifiers for various presentations of adjustment disorder.  Listed below are the six specifiers or sub-types of adjustment disorder that are listed in the new DSM – 5.

Adjustment Disorder with Depressed Mood (F43.21).

Sometimes in addition to having difficulty coping with a stressor, as a result of this life problem, people develop depression.  If this goes on long enough or is severe enough they might eventually get a diagnosis of Major Depressive Disorder.  But until that happens treatment will mainly focus on the stressor and the depression that stressor is causing.

Adjustment Disorder with Anxiety (F43.22).

Sometimes the primary symptom that people experience when they are going through stress is an increase in their anxiety.  If this increase in anxiety is related to a specific stressor, is more severe than we expect, or goes on too long, Adjustment Disorder with Anxiety is the likely problem.

Adjustment Disorder with both Depression and Anxiety (F43.23).

Anxiety and depression frequently happen to people at the same time.  If this stressor has produced both depression and anxiety, then this specifier should be added.

Adjustment Disorder with Conduct Problems (F43.24).

Sometimes the principle way we know that stress has affected somebody is that they begin to act in inappropriate ways.  This diagnosis with this specifier is most commonly seen in children who rather than show their symptoms as anxiety or depression, begin to act out.

Adjustment Disorder with Disturbance of Emotions and Conduct (F43.25).

When stress overcomes a person’s ability to cope, we may see changes both in their behavior and in their feelings.  This is often the case in children and adolescents but may also be seen in adults with poor emotional regulation.

Adjustment Disorder Unspecified (F43.20).

When the counselor knows that the problem the client has is caused by their reaction to stress but none of the other sub-types quite seem to fit, this category may be used.

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

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

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 are Adjustment Disorders?

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

What is

What are adjustment disorders?
Photo courtesy of Pixabay.

You don’t have to be “crazy” to have a mental illness.

Sometimes bad things happen, and those difficulties in life can overwhelm you. When these things happen, often people get right back up, but if something bad has happened to you and you find that you can’t get back on track you might well have an Adjustment Disorder. Adjustment Disorders are the result of bad things happening to you.

Professionals need to be careful not to turn everything that could possibly happen to someone into some sort of mental disorder.  Beginning professionals are cautioned to avoid pathologizing their clients by being so sure everyone who comes to their office must have some kind of extreme mental disorder.

Stress affects everyone differently.

A particular stress, divorce, for example, can have a very different meaning for different people.  One person may become very depressed.  Another might become quite angry.  Some people may even be happy and throw a party.

We know that stress can be quite difficult to handle.  But if someone’s response is far beyond what we expect, then that excessive response gets diagnosed as an adjustment disorder. To be diagnosed with an adjustment disorder your distress as a result of what happened has to be in excess of what we would normally expect.

Because of the large number of possible ways stress might affect someone there are six specifiers or some types of adjustment disorder.

This inability to adjust can result in suicide.

Adjustment disorders have come to be recognized as serious mental health issues because of the high rate of suicide, homicide, or other negative behavior that can occur in the aftermath of the stressor.  Things like divorce, loss of a job, business failure, or other negative events can overwhelm a person and exceed their ability to cope.

Adjustment disorder requires an identifiable trauma or stressor.

Just any difficulty coping with life does not get diagnosed as an adjustment disorder. In this condition, we know clearly that something specific happened in your life.  We call this the identified stressor. We expect to see the results of that experience start happening within three months of the original incident.  We also believe that adjustment disorder normally stops all by itself within six months of the time it began.

If you have a strong reaction to a stressor in the first month after the incident, we call that Acute Stress Disorder, a condition that usually resolves very shortly.

An Adjustment Disorder results in a change in your feelings or behavior.

As a result of this stressor, people find their feelings overwhelming them.  That may become depressed, anxious, or angry.  Not only are these feelings negative but they’re far beyond what would be useful.

People with Adjustment Disorders may begin behaving in ways that are just not normal for them.  That may be constantly angry, become violent, or begin abusing drugs and alcohol.  Some develop other addictions.

People with an adjustment disorder are at high risk to become violent towards those they blame for their misfortune.

Bereavement is not the same as Adjustment Disorder.

Having someone close to you die is something everyone experiences sooner or later.  Mental health professionals see this loss of a loved one as quite different from Adjustment Disorder. While everyone needs to grieve in their own way, most people eventually get past the loss of a loved one.

In an Adjustment Disorder not being able to adjust damages your life.

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

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

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 Acute Stress Disorder?

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

What is

What is Acute Stress Disorder?
Photo courtesy of Pixabay.

Stress can knock you down and leave you in the mud.

Most people have heard of the granddaddy of all the Trauma- and Stressor-Related Disorders, Posttraumatic Stress Disorder, far fewer people have heard of the smaller member of this family, Acute Stress Disorder.

Acute Stress Disorder is a condition in which something bad happens and it knocks you for a loop but eventually, it goes away. We do not want to make the normal problems of living into a mental disorder so we only begin counting things as possible disorders when the stressor is still affecting your life at least 3 days after the incident.

A great many people experience some stressor which does not end up becoming PTSD. If you are still having symptoms a month after the event we start thinking this may become long-term and then you get the designation of Posttraumatic Stress Disorder.

We want to keep normal life events out of this equation, so expected events like having an elderly person in your family die an expected death do not count as a trauma disorder, either Acute Stress Disorder or Posttraumatic Stress Disorder.

The full text of the DSM-5 includes a detailed description of how to recognize Acute Stress Disorder but here is a short description of the condition.

Four conditions need to be met for this trauma to be Acute Stress Disorder.

  1. You get exposed to something that could kill or seriously injure you or someone close to you.
  2. It happens in the real world. Movies, TV, or your imagination does not count.
  3. This is unexpected.
  4. You can’t escape the results of this experience. You re-experience the events in more ways than one. Think of people who investigate child abuse or first responders at shootings or those who recover body parts in the war zone in addition to those who were the direct victim.

This experiencing and re-experiencing causes you problems.

The DSM-5 lists 14 symptoms. I will not repeat them all here. For the full text see the DSM-5. These 14 symptoms are clustered in 5 categories. To get Acute Stress Disorder you need to have at least 9 of the 14 symptoms but they can be from any category.

1.The experience keeps coming back.

You may have nightmares, intrusive thoughts, flashbacks, spacing out and this may be triggered by either internal thoughts or external triggers.

2. This experience bums you out.

Basically, you get into and stay in a really negative mood.

3.The trauma spaces you out.

You may get overwhelmed and just “bounce” mentally. In more clinical language we would call this dissociation.

4.The result of the experience is it keeps you away from things.

You may find yourself avoiding people, places, or things that remind you of the trauma. Some people do not like to be alone or they may use drugs and alcohol to knock themselves out rather than just falling asleep.

5.You are on edge and stay that way.

This could come out as poor sleep, being irritable or angry all the time, be losing your ability to concentrate, or being easily triggered by any little thing. People in this condition are always on high alert for something that might go wrong. The door slams down the block and those with Acute Stress Disorder will jump at a sound others will not notice.

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

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

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 it Anxiety, Stress or PTSD?

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

Stress person

Stress.
Photo courtesy of Pixabay.com

Just how stressed out are you?

Everyone experiences a little stress in their day-to-day life.  Having anxiety in your life is considered just a part of modern life.  But sometimes that stress and anxiety overwhelm people.  The things that get called trauma come in all shapes and sizes.  Many times these traumas resolve in a short period of time.  Traumas that don’t resolve, that hang on for long periods of time and interrupt your daily life, can turn into a serious mental illness such as an anxiety disorder a stress-related disorder, or even Posttraumatic Stress Disorder.

If you’re struggling with difficulties, anxieties, stress, or even some traumatic events it is helpful to know just what kind of problem you’re dealing with.  Some things will sort themselves out on their own.  Other times anxiety, stress, and trauma need professional help.  Here are some of the problems that you might be experiencing and some thoughts about how to tell the different problems apart.

Stress.

Stress is the reaction the body has to challenges from the environment.  Stress can be small and repeated or large and dramatic.  Even good things can be stressful.  That first day on a new job can be full of stress even when you really want that job.  Many people get sick the first week on a new job.  Weddings or the birth of a baby can be stressful also, even when these have been something you have looked forward to.

Most of the time people have stress and it goes away.  But over time people can accumulate a great deal of stress, and this can result in physical, emotional, and mental illnesses.  One very important life skill is learning how to manage and reduce stress.  Take a look at the other posts on counselorssoapbox.com about stress and stress management.

Animals get stressed and so do people.

Humans are not the only creatures to get stressed.  Animals in the wild can have a very stressful life.  Sapolsky wrote a very interesting book called “Why Zebras Don’t Get Ulcers.”  The main difference between humans and animals seems to be how they adjust to stress after it has come and gone.  Animals who were stressed returned to a low-stress state very quickly.  Humans get stressed and years later they are still experiencing that stress.  For humans, this accumulation of stress over time can result in chronic illnesses.

Anxiety.

Anxiety is a normal human response.  But when it gets out of control it can become a disease.  If you’re in a dangerous situation, anxiety and even fear can help you stay safe.  If the volume on your anxiety is turned up too high, it can cause you to overreact to many everyday situations.  Sometimes people have what they call anxiety attacks.  For a brief period of time, they feel excessive anxiety but eventually, these anxieties attacks subside.

When this high anxiety continues too long and begins to interfere with your daily life, your job, or your relationships, it is excessive and may be diagnosed as an anxiety disorder.  There are a number of different recognized Anxiety disorders depending on the particular features of your anxiety.

Post-Traumatic Stress Disorder or PTSD.

Post-traumatic Stress Disorder or PTSD is a diagnosable mental illness.  Sometimes in life people experience overwhelming traumatic experiences.  They may witness a violent death, a tornado, hurricane, or other natural disasters.  In these events, the person may fear that they or someone close to them is going to die.

This condition was originally identified in the veterans returning from war zones.  It has since been identified in civilian populations who have been exposed to traumatic events and feared for their lives.

As a result of this trauma, people begin to develop difficulties functioning.  Some people will struggle with these problems for a short period of time, a month or so.  Other people will very quickly return to normal function.  In some cases, as a result of these traumatic experiences, people will continue to have symptoms for years afterward.  These continuing symptoms may be PTSD.

Complex trauma.

Repeated traumatization becomes more difficult to heal from.  There has been a good deal of research and writing about a condition that is sometimes called complex trauma.  While it’s not an official diagnosis, is helpful for many people to think about it this way.  Someone may be able to experience a trauma and recover from it.  If that same person experiences the same trauma repeatedly, each time it becomes more difficult to recover.

If you are struggling with anxiety, stress or PTSD consider getting professional help.

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 Nightmare Disorder?

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

Nightmare

Nightmares maintain depression and PTSD.
Photo courtesy of Pixabay

Do you have bad dreams or is that a Nightmare Disorder?

We know there are connections between sleep, sleep disruptions, and a number of mental illnesses. The connection between nightmares and Posttraumatic Stress Disorder (PTSD) is fairly well-recognized. Dreams related to your trauma is one of the symptoms of PTSD. What often goes unnoticed is just how connected poor sleep and having a mental or physical health issue can be.

Sleep disturbances can be both the result of and the cause of significant life problems. Many people ignore their bad dreams and nightmares. You shouldn’t. Disturbed sleep may be a warning that something much worse is on its way. Some of these issues can threaten your life and your sanity. Frequent nightmares increase the risk someone will attempt suicide. Drinking to shut off the nightmares increases the suicide risk even more.

Nightmare Disorder is included as a Mental Disorder in the DSM-5.

Nightmares fall along a continuum which runs from an occasional upsetting dream through frequent bad dreams that leave you feeling upset when you wake up, to those severe things like Nightmares, and ends at the point of Sleep Terror Disorder where people wake up screaming. Sleep Terror Disorder along with Sleep Walking was combined in the DSM-5 getting the new name Non-Rapid Eye Movement Disorders, but that’s a topic that needs to wait for a future post.

Bad sleep is a symptom found in several other mental Illnesses so sleep disorders get little attention from most Therapists. Given the human tendency to pretend there is nothing wrong with us until we hit the wall so to speak, it is not surprising a lot of sleep disorders go undiagnosed or get diagnosed as something else.

Nightmare Disorder is part of a group of conditions called Sleep-Wake Disorders.

Sleep-Wake disorders do not get diagnosed or treated by therapists of counselors all that often. Usually, sleep problems get one of two problematic treatments. They could be referred to a sleep disorder specialist who uses the International Classification of Sleep Disorders (ICSD-2) with its myriad subcategories. The other possibility is that sleep disorders are often taken as a symptom of a more common mental illness.

Poor sleep could be anxiety, depression, or PTSD.

Nightmares or Bad Dreams can be a part of some anxiety disorders. Changes in sleep and appetite are key symptoms of depression. But just having bad dreams in and of itself does not automatically get you an anxiety or depression diagnosis.

Many nightmares are a part of Posttraumatic Stress Disorder (PTSD.)

Trauma- and Stressor-Related Disorders are such major factors in mental health that the Trauma- and Stressor-Related Disorders now have their own DSM chapter. Bad dreams and nightmares are one major factor in PTSD and other similar disorders that once you say you have bad dreams expect the professional to ask about any trauma history and any recent or current stressors.

If you have PTSD or another Trauma-Stress related issue nightmares are likely, but just because you have bad dreams does not mean you have PTSD. When I decide to write this post on Nightmare Disorder I looked up a hundred or so recent research articles on Nightmares and Bad Dreams. The largest part, a strong majority of those articles, were about Nightmares in people with PTSD. But there were a bunch of other mental health conditions that were connected to poor sleep also.

Nightmares and Bad dreams are connected to Borderline Personality Disorder, OCD, DID, GAD, and aging.

That is only part of the list. OCD stands for Obsessive-Compulsive Disorder, DID is Dissociative Identity Disorder and GAD is for Generalized Anxiety Disorder. Each of these diagnoses has related OCD like, Dissociative and Anxiety Disorders.

All these related disorders including bad dreams of one kind or another which makes me wonder if many people with one mental illness should also be getting a diagnosis of Nightmare Disorder. That and sleep disorders are one of the factors leading to the development of other mental health issues. In that vein, sleep disorders also greatly increase the risk of relapse in those with a substance use disorder.

What are the symptoms of Nightmare Disorder?

For the full text of the symptom see the official DSM-5 but here is my short, plain language version.

  1. Frequent, upsetting, bad dreams that really scare you.
  2. You can wake up quickly.
  3. These bad dreams are getting in the way of you living your life (family friends, job, etc.)
  4. Drugs, alcohol, or another mental illness are not the best explanation for why this is happening.

On top of these and a few other more specific criteria, Nightmare Disorder has a bunch of “specifiers” about when how often, and how bad these dreams are.

A word of caution here. This is post is an effort to explain some kind-of complicated stuff. Diagnosis should not be a do-it-yourself project. There are a bunch of other Sleep-Wake Disorders that might also need to be ruled in or out. Some sleep problems are a sign of life-threatening physical conditions. You may also have some other mental issue or guess what?

Your bad dreams may be a normal reaction to some stress in your life right now.

Drinking alcohol to quiet bad dreams is a really bad idea. The amount it takes to knock you out is very close to the amount that will kill you. Especially do not mix alcohol with prescribed sleep or anxiety meds. You can work with your doctor on meds for bad dreams but when the meds wear off the dreams can get worse.

If you are having sleep disruption, bad dreams, nightmares, night terrors, or related sleep problems, talk with your doctor or other professional and see if medication, therapy, or some other treatment might be helpful to you. Don’t put it off. Even normal sleep issues if left untreated can eventually impair your physical or mental health.

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

Sleep

Dreams and Nightmares 

Stay tuned, more on sleep’s connections to mental health, wellness and recovery are coming.

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

17 Ways to de-stress

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

Stressed

Feeling stressed out?
Photo courtesy of Pixabay.com

How do you manage stress?

Stress can overwhelm you at any time or anywhere – Here are some suggested ways to turn down the stress volume.

1. Breath.

Under stress, most of us forget to breathe. The result is fewer shorter breathes and an overwhelming sense of panic that can follow a lack of air in your lungs.

Slow your breathing down. Take deep breaths from the diaphragm. You should feel your stomach moving in and out. Short fast breaths from high up in your chest can increase the feelings of stress.

Breathe slowly and deeply, pause between breaths. Watch your stress move out each time you breathe out and pause before taking in that next deep breath.

2. Make friends with silence.

There is noise everywhere. We have our radios and our televisions, our iPad’s and other electronics all screaming away at once. Add on people talking at you all day long and a few people screaming for whatever reason and you are bound to feel the stress meter rise.

Think back to that last time you felt really relaxed and distressed. Maybe a vacation in the mountains or at the beach. One thing you are likely to remember about that time is how quiet it was.

Those voices in your head can get awfully loud some days. Learn to quiet your mind down and embrace the silence. I keep a set of headphones at my desk to minimize the noise. Soft nature sounds help, sometimes no sound at all helps even more to reduce my stress.

3. Say a positive affirmation.

Affirmations are those little saying you tell yourself that help you to cope. Don’t lie to yourself or the whole affirmation will backfire. Tell yourself that this may be stressful but you can handle it. This too shall pass or whatever other saying works for you to put this current stress in perspective.

4. Make a list of the good things in your life.

If you keep thinking about all the problems your life story gets soaked through with problems. Most of us have lots of positive things going on. Take those little sparkling moments and hold on to them.

Writing out a list of things that are good, things you are grateful for can put the rest of your life in perspective. This list, sometimes called a gratitude list, can be a reference guide when things get tough.

The very act of writing down positive things in your life reinforces those things. Thinking saves the thought briefly in one part of the brain. Writing stores these blessings in a second part of the brain. Sharing them out loud with a friend stores them in a third part of the brain. The more of your brain that is full of happiness the less room there is for stress.

5. Stand more.

Stand and get the body moving. Stretch and relax those tense muscles. Tight muscles can be a result of stress but they can also be the cause of your body thinking that the stress is worse than it really is.

People who stand burn more calories than those who sit. Standing is a quick easy way to relax and reduce the stress of the moment.

6. Walk more.

Walking can be very effective in reducing depression. When the body shares the load the mind can get a rest. A quick walk to the end of the hall, the water cooler, or the bathroom can refocus the mind and move the stress off the front burner.

7. Make prioritized lists.

The human brain has a limit on the number of things you can keep in conscious memory at any one time. The more you try to keep in the front of the mind the less space is available to work on the current task.

Writing down a “to-do list” can free up space in your brain to get this task done. It also reduces the anxiety you may be feeling that you might forget something.

Once the list is down on paper, prioritize those things. Do one big hard thing first and leave the long list of quick things for later when you may only have a few minutes left.

Check those items off your list as you do them and by the end of the day you may find that you are far more productive and less stressed than when you were spending all that time trying to remember all those things you needed to get done today.

8. Feel what you’re feeling.

Feelings are not the enemy. They can convey much-needed information. Feelings like human friends are not always right. Because something scares you does not mean it is dangerous. Listen to the feelings but then make informed decisions on how you will handle those feelings.

See the post Making Friends with Feelings

9. Look at things that make you happy.

If you run from place to place with no time to take in the joys of life you will only accumulate more stress. Slow down sometimes and notice the pleasant things. Take an extra second or two and taste the thing you are eating. Pause to notice those flowers growing outside your office.

Accumulating those brief doses of pleasure can make the rest of the day less stressful.

Ever stop to really look at the pictures your workplace put up in the hall?

10. Carry a worry stone

A worry stone, religious symbol, or other personal object carried in your pocket can absorb a lot of that stress you are holding onto.

11. Make time for family and friends.

When you don’t have friends and family around you, then you are all alone. Seek out positive people for a role in your stress reduction plan.

12. A pet can help you reduce stress.

When no one else listens, when you feel all alone, that pet, a dog or cat, is waiting at the door when you come home. A pet is a great example of unconditional love.

13. Be an indoor explorer – look for new experiences.

Check out a new deli or other places to eat. Visit a new store or library. Keep an eye peeled for things you might try that you have never done. A local adult education or college class may offer all kinds of opportunities for new experiences.

There are lots of resources on the internet these days to allow you to take a class at a far off university or learn about something that interests you.

14. Develop a skill.

Is there a new skill you might develop? Something you always wanted to do but never got around to? Take the time to develop that skill and see where it takes you. Those breaks while you practice that skill reduce stress and challenge you to keep working on your self-improvement.

15. Do self-care.

The more stressed-out people get the less time they take for self-care. Do something nice for yourself. Look for ways to treat yourself well.

16. Practice your spirituality.

If you have a faith, practice it. Religion or spirituality are comforting when times are tough. If you have a belief make sure that your actions are consistent with that belief. Pray, meditate, or engage in other spiritual practices. Those moments of faith can get that stress volume down to a realistic size.

17. Express Yourself.

Write not because you have to but because you chose to. Draw if that interests you. Do this for yourself, not for the approval of others. Dance, pantomime or practice any other expressive skill.

There are my suggestions of 17 ways to reduce stress. Do you have other ways you have found to help you manage your stress?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Emotional healing takes several tries

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

Emotional healing.
Photo courtesy of Pixabay.com

Emotional Healing.

Some pain and trauma are just too intense to get past the first time around.

Getting over things is a process. Some things need time to heal. It is hard for others to sit and watch you suffer but sometimes you just need that space to get past it. What you can’t do is pretend it never happened and hope the pain will go away.

People come for counseling and they expect the pain to end right away. It can’t always happen that way. We find that pain, from trauma or grief and loss, takes time, and repeated attempts to get better.

Clients who have suffered a severe loss, someone close to them has died, find it hard to talk about that person at first. In the beginning, it is mostly about the pain of the loss and the tears.

Over time, the process of recovery is like the way you might peel an onion. You strip away an outer layer and then you cry. Then as your tears dry you strip away another layer. Eventually, you reach the core.

In the early stages of grief, all you can feel is the pain. What can happen if you keep working on the process is that with time you can let the pain recede and begin to remember the good things, the treasured memories, you have of that person.

People mean well when they tell you to just get over it but what they often do not understand is that getting over it is a process, not a destination. Some things in life we never get over, not completely, but we can reach a place of peace with what happened.

In counseling, we find that to push the client to talk about things before they are ready can cause more trauma rather than aid healing. Some clients come for a while, go as far as they can, and then go off to live their lives for a while. Some find that they need to return to continue or finish the process. Others have the drive to get the painful part over with as soon as possible. You may find that the pain keeps reminding you that help is needed and you can’t let it go until you finish the project.

Either way, I hope that if you are feeling the pain of a loss, a death, a trauma, a life disappointment, that you will find someone to work with on this issue that helps you move through the pain by leading you along not by forcing you to go faster than you are ready to go.

Therapy should heal the emotions not create new wounds.

If you are only partway along in your healing process, keep moving forward and know that eventually, you can reach a point of finding the meaning in the loss. Not having someone now should not take all those happy memories from you. Having suffered a terrible trauma need not rob you of your future.

The road of recovery can be difficult, but recovery is worth the effort.

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