Persistent Depressive Disorder – PDD (F34.1)

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

What is

What is Persistent Depressive Disorder?
Photo courtesy of pixabay.

What if you don’t ever remember being happy?

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

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

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

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

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

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

Persistent Depressive Disorder (PDD) is chameleon-like.

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

Specifiers include with:

Anxious distress – anxiety commonly co-occurs with depression.

Mixed features

Melancholy features

Atypical features

Mood-congruent psychotic features

Mood-incongruent psychotic features

Peripartum features

In partial remission

In full remission

Early onset – before 21

Late onset – at or after age 21

Pure dysthymia syndrome

Persistent major depressive episode

Intermittent major depressive episode, currently with MDD

Intermittent major depressive episode, currently without MDD

Mild

Moderate

Severe

The symptoms of Persistent Depressive Disorder.

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

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

Be careful with the PDD label.

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

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

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

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

Staying connected with David Joel Miller

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 Polydrug or Polysubstance use?

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

Polydrug use is common.

Drugs

What is Polydrug or Polysubstance use?
Photo courtesy of Pixabay.com

Polydrug use, sometimes referred to as multiple drug use, is an increasingly common pattern. Diagnosis of Substance Use Disorders used to be divided along the lines of the particular substance that someone used or abused. Treatment systems separated the alcoholics from the Heroin users and so on. There was a lot of validity to that model but it is becoming less and less possible as more people are using combinations of many drugs.

Most drug users have a preferred “High.” Stimulant users like being way up. Depressant users like the falling asleep, passing out kind of high. Hallucinogen users are chasing an altered reality. Some people dabble in all three types and their pattern of addiction is more to the process of using drugs than to any one particular substance.

I have heard people with a history of polysubstance use describe themselves as “trashcan junkies” just open the lid and throw something in. When asked what drugs they do, the standard answer is “What have you got?”

Drugs of abuse have cultures.

Alcohol users and abusers tend to hang out together. They have their preferred beverage of choice and their favorite method of consumption. If you drink the way others in your social circle drink then you can maintain the illusion that your drinking is under control. Some drinking groups divide up a 12 or 24 pack, some pass around a bottle of wine or a paper bag containing the hard stuff. Other groups order fancy mixed drinks from the cocktail waitress. Alcohol is everywhere and most people develop some familiarity with this culture.

Weed smokers have their culture also. They pass around the blunt, smoke a bowl or roll a joint. They have particular names for the varieties of marijuana they smoke or those they disdain. Most drink alcohol from time to time. Many weed smokers also have cultural decorations, tribal music, and cultural heroes who smoked a lot of weed. But in a group of consistent marijuana users, it is likely that most primarily smoke marijuana.

Heroin users develop their own special culture. They know the process of making a rig. Users learn the concepts of going to the cotton and cotton fever. They also know the struggles of kicking and going cold turkey.

Some of the younger opiate abusers believe they are from a different tribe. They do their opiates as pills and liquids, obtained from doctors, pharmacies, and diverted medical supplies. They may even hold fast to the myth that they are not addicts because they do not use needles. That myth gets shattered when their supply is interrupted and they have to kick along with the heroin addicts.

Polysubstance users move between cultures.

Increasingly we are seeing those whose allegiance is not to one drug of choice but to the process of doing drugs of any and every kind. The use of multiple substances is the norm rather than the exception. Most people in drug treatment and a major part of our jail and prison populations have long histories of using a wide variety of substances.

Polysubstance dependence is a problem without a diagnosis.

The most recent edition of the DSM eliminated the diagnosis of polysubstance dependence. We never did use polysubstance abuse. From here on the plan is to list each drug someone may have developed a problem with and then rate each use disorder as mild, moderate or severe.

For those working in the Substance Use Disorder field, this is problematic. While a client may have a mild problem with each of eight or ten different drugs, overall they can have a significant problem living life without using drugs or destructive behaviors.

My own experience has been that when someone has this “polysubstance dependence” problem, there are usually some other significant mental health issues going on.  The best treatment when polysubstance abuse or dependence is encountered is the treatment of the mental health issues and substance use issues at the same time.

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs and AOD professionals and the terms and descriptions used in the DSM.

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

Thinking mistakes you are making.

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Is your thinking full of bad habits?
Photo courtesy of Pixabay.com

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

Is your thinking full of bad habits?

It is easy to drift into bad habits. Do something a certain way a few times and that becomes the default setting for your brain. After that, you need to put conscious effort into responding in a different way.

Many times people drift into bad thought habits and from then on having unhelpful thoughts pop into your mind becomes your usual way of thinking. Just because this is the way you always think about things does not make those thoughts true. Your bad thought habits may be making your problems worse and interfering with your having a happy life.

There are 11 ways your thinking may be full of bad habits.

1. Thinking it is all about you, personalizing.

If you walk into the room and people laugh you might think they were all talking about you. When someone is short or curt with you, do you think they are being disrespectful? Many times in life when someone ignores us or is less than helpful it has nothing to do with us. One of the great lessons of growing up is that most of the time other people are just too preoccupied with their own lives and problems to give you a second thought.

2. Your magnifying mind blows things out of proportion.

When you think about what could happen, do you imagine the worst possible thing? If your mind can turn a minor inconvenience into the end of the world you have trained your thinking to be a magic magnifying mind.

You went on a date, you liked that other person and they said they would give you a call. But the next day comes and goes and no call. You are now convinced that they will never call, that you will never meet that special someone, and that you will live the rest of your life alone. When they call an hour later you are now so bummed out from ruminating about this life alone you just don’t want to talk to them and you do not answer the phone.

There are lots of variations to this thought pattern. It rains for a few minutes and you are sure it will flood, you get stuck behind a truck and are sure you will be late to work and get fired. In each scenario, your mind leaps from a small problem to a happy-life threatening outcome.

3. Minimizing, discounting the positive.

You got ninety-nine questions out of a hundred right, but you are upset about the question you missed. Some people find it hard to take credit for the things they do well. The underlying thought here is that you should be perfect and that anything less is not acceptable.

If you can’t take a compliment, or you find it hard to accept credit for what you have done, you may have trained your brain to ignore anything you did well and focus only on the mistakes of life. This can result in a pretty bleak, discouraging way of looking at things.

4. Either Or, Black and White thinking, means you are either a winner or a loser.

High achievers are at extra risk for this one. If you have trained your brain to go for being the best at everything it can be hard to accept the size of the achievement that a second-place might be.

Do not let your brain cheat you out of enjoying an accomplishment by insisting you have to be better than everyone else to be worthwhile.

5. Taking events out of context.

So you get the job but all you remember from the process is that you did not have a good answer for one of the questions. One criticism from your partner becomes they “never” like anything you do. You are on vacation for two weeks but the thing you most remember is the traffic jam on the way out-of-town that first day.

If when you think back on past events all you can remember are the rough spots you are falling into making too much of the small things and forgetting the big ones.

6. Jumping to conclusions.

He didn’t return my text right away so that means he does not want to talk to me. You feel a lump somewhere and don’t go to the doctor convinced you must have cancer and only days to live. Many people have developed the habit of jumping over all the possible good outcomes and landing in a pit of pain.

7. Overgeneralizing leads you to bad places.

“I did not get this job” becomes “I will never get a job.” That thought can get you so worked up that you stop looking for work. Believing because something did not go your way once that means you will never achieve your objective, can become the greatest obstacle to progress.

8. Self-Blame, believing you made a mistake so you are stupid, no good.

This mental and verbal self-abuse does not motivate you to work harder. Beating yourself up leads to feelings of helplessness and giving up. You shouldn’t accept this kind of treatment from others. Don’t abuse yourself this way.

9. Are you that good at mind-reading?

Do you tell yourself, “When he does that it means — If she loved me she would know.”

Believing others should know what you want and need and then thinking less of them for not reading your mindsets your relationships up for failure. Believing that others should be able to read your mind and anticipate your needs without your voicing them creates misunderstandings.

10. Comparing up, that model or star is better than me.

Comparing yourself to others sets you up for disappointment. There are always people who have more friends on social media and who make more money. To feel better about yourself stop comparing. Especially do not compare yourself in your gardening outfit to someone walking down the red carpet.

11. Catastrophizing is thinking the worst possible outcome will happen.

Do you think “he is late, he probably got in an accident and died?” When things happen that are not to your liking is your first thought that this absolutely must not happen? Catastrophizing is looking for the worst possible outcome and then mentally rehearsing that thought in your head until it demolishes your sanity.

If you are practicing any of these bad thought habits work with someone on changing these unhelpful thoughts to more adaptive ones.

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

All Temptations are not equal.

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Sunday Inspiration.   Post By David Joel Miller.

Temptation.

Temptation

Some temptations are worth giving in to.
Photo courtesy of Pixabay.com

Some temptations are worth giving in to.

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

What is Disruptive Mood Dysregulation Disorder?

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

What is Disruptive Mood Dysregulation Disorder?
Photo courtesy of Pixabay.com

Maybe that child does not have Bipolar Disorder?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mood dysregulation happens in more than one place.

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

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

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

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

Other Disruptive Mood Dysregulation Disorder (DMDD) issues.

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

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

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

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

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

Staying connected with David Joel Miller

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 Bath Salts?

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

New drugs

Bath salts.
Photo courtesy of Pixabay.com

How come people are abusing Bath Salts?

There is a growing tidal wave of use and abuse of Bath Salts. These are not the kind of Bath Salts you would ever put in water and soak in. Bath Salts are also sold under a number of other names including Plant Food, Water Pipe Cleaner as well as a host of brand and product names.

These products made use of a loophole in the laws of the U. S. and other countries, which exempted chemicals from regulation as drugs if they were “Not for Human Consumption.” These drugs were imported without restriction because of being labeled for uses other than human consumption. Here in the U. S. they were then repackaged in small amounts and sold in small stores. While labeled “not for human consumption” it has always been clear that users were buying these packages to consume them.

The primary ingredients in many of these products are amphetamine-like chemicals in the Cathinone Family. Cathinones are synthetic versions of a drug originally found in the Khat plant from north-eastern Africa. Before becoming popular as drugs of abuse these drugs were primarily used to kill insects hence the name “plant food.” The name “bath salts” is reported to come from the way these drugs are often packaged to look like bath salts.

Bath Salts can be consumed by snorting, swallowing, smoking, or injecting. Other possible routes of administration are sure to be attempted.

The use of Bath Salts has resulted in a significant number of admissions to hospital emergency rooms. Symptoms of Bath Salt intoxication include a number of serious symptoms including agitation, violent behaviors, heart palpitations, and psychotic symptoms. There are reports of these symptoms, particularity psychosis, lasting long after the drugs have been metabolized. At high doses, these drugs can be fatal.

The Synthetic Drug Abuse Act of 2012 was intended to reduce the problems with Bath Salts. Some particular ingredients have been made illegal. Unfortunately, this is a very large family of synthetic chemicals and many have never been tested. As fast as one chemical has been tested, found to be harmful to humans and banned, other chemicals have been substituted.

More and more synthetic chemicals are being sold and experimented with by drug users. The line between Bath Salts, Synthetic Cannabinoids, and other research chemicals has become fuzzy. New formulations are appearing so rapidly they are now being referred to as NPS (New Psychoactive Substances.) Expect Bath Salts of new formulations and other synthetics to become an increasing problem.

For more on these topics see:    Drug Use, Abuse and Addiction     Recovery      What is

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs and AOD professionals and the terms and descriptions used in the DSM.

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 your life out of balance?

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

stay in balance

Balance.
Photo courtesy of Pixabay.com

Ways to get your life back in balance.

It is easy to get stressed out. Getting ahead is getting more and more difficult. People tell me all the time that they are overwhelmed and that they just can’t keep up anymore. In the quest to be successful at work or competitive activities, one of the first things to suffer is your work-life balance.

Trying to be and do more results in relationships that get neglected. In extreme cases, people find they have neglected self-care and their physical and mental health have suffered. If you find your life has gotten way out of balance here are some tips on how to get that out of balance life back in balance.

Try doing less for a more balanced life.

The first step in a balanced life is to review the things on your plate and decide which are really necessary. There are plenty of things you could do but just because you can, does not mean you should.

Set a bedtime for a more balanced life.

There are times you can cut corners and squeeze a little more out, but giving up sleep time in the quest for success is a really bad idea. You can only get so many miles out of an unmaintained vehicle and the human body will not function well without adequate rest. Try cutting corners on sleep and you will find you will begin to make really bad decisions.

Make up a daily schedule to maintain balance.

Having a daily schedule all written out helps you chart a course for your day just like a road map will help you get to your destination. Writing out your day’s schedule will point to the times you have more to do than you could possibly be accomplished. A schedule can also help you see that you need to be across town two minutes after you started a meeting with your boss. Use the schedule to even out the workflow.

Reviewing that daily schedule at the end of the day may help you spot where you filled time with a water cooler session or a video game binge. It is those diversions that drag on and on which rob your day of a lot of potentially productive hours.

Allow adequate meal times to keep yourself healthy.

You can’t run your car on an empty tank nor can you run your body on substandard nutrition. Rushing through meals results in eating fewer healthy foods and more of those over-processed ones.

Investing more time in yourself keeps all aspects of your life balanced.

If you are too busy to learn a new skill then you are far too busy. Invest in your body and mind and they will still be serviceable when you reach the rewards of your life. Do you want to be one of those people who worked hard to have enough in retirement and find you are too sick to enjoy it? If you work yourself to death someone else can enjoy the fruits of your efforts.

Include social – friend time in the schedule for better work and life balance.

Humans are social creatures. You need positive supportive people in your life. Investing in friendships and socializing for the sake of enjoyment are not wastes of productive time. Having a good social life is the asset that will get you through those tough times in life.

Break up big tasks – chunking.

Life gets off-kilter rapidly when you throw yourself at a task that is too big to complete all at once and you stay with it beyond the point of making progress. An occasional all-night work binge may be part of life in this millennium but if taking on huge tasks and wearing yourself out in the process is your modus operandi try breaking that task up into smaller sub-tasks and doing one of these tasks each day.

Start accepting what is.

One of the biggest time sucks and a waste of energy is time spent on complaining about what is, should be, and so on. Do not squander time saying something should not have happened or looking for whose fault it was.

Invest your energy in accepting the current situation as it exists and then focus on how to change it. Hint here. The solution probably consists of changing you and what you do rather than in trying to change other’s behavior to suit you.

Set time limits on tasks to prevent their expanding.

Ever had a fifteen-minute task take four hours? Work can expand to fill the time allotted. So can diversions. Set limits and if you are not done in the allotted time move on down your list. When you create your plan for the next day or revise today’s, try being more realistic about how much time this supposed fifteen-minute task will take.

Invest time in goal setting and planning.

Creating a specific goal and planning the steps to get you there is not a waste of time. Having clear goals can give your project and your life a focus. Developing a clear plan with periodic review points can keep you headed in the right direction. Good plans also prevent leaving out steps and then having to start the project all over again.

Make lists.

Make lists. Make lots of lists. Do what is most important to them and ignore the maybe’s. A list of materials needed can help you avoid having to stop partway through because you are out of “stuff.” Lists that include rest and relaxation can keep you from being the machine that breaks down unexpectedly.

Prioritize – what should you be doing not what you can do.

A lot of time can get flushed away on all the things that you could be doing and result in little or no time for the big major jobs that were the real heart of the project. Let someone else do the optional tasks or delete them from your list altogether.

Was this post helpful? You might also want to check out these other counselorssoapbox posts.     Life Hacks     Self-improvement     Success

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 something you can brag about.

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Sunday Inspiration.   Post By David Joel Miller.

Self-Esteem

Building self-esteem

Do something you can brag about.
Photo courtesy of Pixabay.com

For better self-esteem do better things.

Do something you can brag about.

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

What is Sleep Walking?

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

Sleep Walking.
Photo courtesy of Pixabay.com

Can people really do all that stuff while asleep?

Turns out that people can do a number of things while mostly asleep. Sleep Walking (Was DSM-IV 307.46 Now DSM-5 F51.3) and Sleep Terrors (DSM-IV 307.47 now DSM-5 F51.4)) use to be considered separate disorders. In the New DSM-5, they have been combined into one category, Non-Rapid Eye Movement Sleep Arousal Disorders. Despite now being one disorder with subtypes they get coded with two different numbers. (DSM is a registered trademark of the APA.) In the new lists, ICD-9, ICD-10, and oh my ICD-11, these numbers may all keep changing, sorry about that.

The Sleep Walking part also covers some other behaviors that can take place while the person is mostly asleep. It is also possible to engage in Sleep Eating and Sleep Sex. Sex while mostly asleep has also been called sexsomnia. Sleep Eating and Sleep Sex are specifiers added to the Sleep Walking diagnosis. These specifiers do not get their own numbers.

For someone to get this diagnosis these things must happen repeatedly not just occasionally.

And yes these things are considered real diseases not just excuses for things people do that may bother others.

Sleepwalking along with sleep eating and sleep sex are all things people do early in the sleep cycle before REM sleep, hence the name Non-Rapid Eye Movement Sleep Arousal Disorders.

One characteristic of Sleepwalkers is the blank look on their faces. Other clues that this person is not awake and is functioning on autopilot are the difficulty you will have in waking the sleepwalker up.

There was a belief that you should never wake someone up who was sleepwalking. I see no evidence that this is particularly harmful other than the sudden jolt that comes from waking up in a place other than where you went to bed. On the other hand as hard as it is to wake sleepwalkers most of us will elect to just lead them back to bed and try to get them in the correct posture for sleep.

Sleepwalkers are also unresponsive to efforts to communicate with them. You can talk to them all you want but they just keep wandering around. Picture the actors you see in those zombie movies and you have a close approximation to the characteristic sleep-walker.

These episodes of sleepwalking happening in Non-REM sleep come without memories. This is described as having an “amnesia” for the events that happened during the sleepwalking.

The full diagnostic criteria are in the DSM-5. As with most other disorders, this one does not get used if the cause of this event is drugs or medications or if it seems to be caused by some other medical or psychological condition.

Sleep Walking Disorder is separate from Nightmares for several reasons. Nightmares and Bad dreams happen later in the sleep cycle predominantly during REM sleep. People remember what happened during nightmares and bad dreams. Nightmares often are connected to real-life events as in PTSD. Sleepwalking just happens out of nowhere.

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.

You might want to take a look at other posts on Sleep   Dreams and Nightmares

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

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 Binge Drinking?

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

Drinking

Binge drinking.
Photo courtesy of Pixabay.com

Binge drinking is a huge problem.

Some people have one drink after dinner each night. Other people save them up and have all seven on Friday night. Drinking seven drinks on Friday night is not the equivalent of one drink a day. The negative consequences, psychically, mentally, and legally, increase rapidly as the blood alcohol content rises on any one drinking occasion, a practice called binge drinking.

Binge drinking is defined as having five or more drinks on one drinking occasion for a man. For a woman, because of her reduced metabolism of alcohol in the stomach, four drinks on one occasion is considered binge drinking. That one “drinking occasion” could be over a short period of time, like drinking shots, or it might entail a more measure drinking like doing in most of a six-pack over the course of the afternoon.

Lots of people resisted the idea that they could be an “alcoholic” because they did not drink every day. The newer way of thinking about this is that it is not what you drink or how often you drink but what happens when you drink that defines an alcohol use disorder. If when you drink you end up drunk or you drink excessively, then you have an alcohol use disorder.

If you only drink occasionally, but when you do drink you consume a lot, you are a binge drinker and at risk for a great many alcohol-related problems.

Binge drinking alcohol is associated with increased drug use.

Among drinkers between 12 and 25, those whose typical pattern was to binge drink when they drank, they were also much more likely to use multiple other drugs. This pattern of drug use, called Poly-Substance use, is extra risky and correlates with a lot of complications physically, mentally, and legally.

Patterns of drinking can obscure the magnitude of alcohol use problems.

In treatment programs, there has been a tendency to separate drug users from the people who have legal consequences because they drove drunk. Rarely is a drunk driving case a driving problem despite all our efforts to treat DUI’s as if the problem was the driving after drinking.

There are a lot of misconceptions about who drinks, how often they drink, and how much the average American drinks. Half of all Americans have not had a drink in the last month. Ten percent of our population consumes half of all the alcohol. Those who binge drink can hide the existence of an alcohol use disorder for a long time by concentrating that drinking in occasional drinking binges.

Medical problems from Binge drinking.

Binging as well as daily high levels of alcohol consumption are associated with a large number of physical health problems. While one drink a day has been touted as good for everyone but fetuses and potentially pregnant women. Unfortunately the more you drink the more the risks of illness.

Alcohol consumption is associated with an increased risk of cancers, heart disease, problems of the digestive system, a variety of liver maladies, pancreatitis, and the list goes on and on.

Binge Drinking and Fetal Alcohol Spectrum Disorder.

Current thinking is that any amount of drinking on the part of a pregnant woman can affect the fetus. Binge drinking is particularly risky for women who are or may become pregnant. One challenging aspect of this problem is that women frequently do not know they are pregnant until after some period of time has passed. Women who binge drink are at increased risk to drink heavily, engage in risky sexual behaviors, and then find out that they became pregnant during that period of heavy drinking.

Mental Health overlooks a lot of alcohol and drug-related problems.

Those who work in the substance use disorder field see a lot of connections between substance use and mental, emotional, and behavioral disorders. Those who focus specifically on physical or mental health issues are less likely to notice those substance use disorders, especially something like binge drinking.

In drug treatment, those who only use occasionally and even then rarely get into trouble, are at high risk of developing problems eventually if when they use they binge. A small amount of alcohol consumption increases the risk of having problems with depression. Binge drinking even one time a year can result in DUI’s or other legal issues. Even occasional polysubstance abuse can result in life-altering consequences.

If you binge drink there is help available.

If when you drink you binge, or you find you are drinking and using more than intended consider getting help, talking with a professional, before your partying becomes a life-altering or ending event.

For more on these topics see:  Drug Use, Abuse and Addiction    Recovery   What is 

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs and AOD professionals and the terms and descriptions used in the DSM.

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