Co-occurring Disorders and Dual Diagnosis

Posted on by
6

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

Hands with pills

Addiction and Mental illness. 
Photo courtesy of Pixabay

What are these things? They sound serious. – They are.

Someone who has two problems may have a harder time getting help than people with only one problem. Once society recognized that it was possible to help people with mental and emotional problems instead of just locking them up in an institution, we began to create special programs to deal with these issues.

The problem has been that most programs that were meant to help, was that they were organized around problems and not around people.

Mental Health programs.

Programs for the mentally ill were separated from those that treated other problems. We were afraid the mentally ill would become violent. We were afraid they might hurt themselves. Mostly we were just afraid. If they acted out we arrested them and locked them away.

Then medications for the mentally ill were discovered and we decided that maybe we did not need to keep locking them away. They could be helped in outpatient settings. Mental health clinics were created.

Substance Use Disorders.

Substance abusers were segregated also. At first, the thought was that “those people” chose to do what they do. We arrested and incarcerated the alcoholics and addicts. The thought was “they never get better” or they just need to quit.

Alcoholics Anonymous changed our way of understanding alcoholism. Groups of alcoholics got together and talked about recovery, they got better. After Alcoholics Anonymous came Narcotics Anonymous, followed by hundreds of other 12 step groups and ultimately the creation of substance abuse facilities.

Treatment for addiction and alcoholism worked.

The Silos

The specialized programs quickly evolved into silos. The Mental health programs treated the mentally ill, they sent all substance abusers away – referred them to a substance abuse program.

The substance abuse programs referred the mentally ill to a mental health program.

The programs developed mantras.

If you do drugs, drink alcohol, you can’t be in a mental health program. Get 30 (or 90 or more) days clean and come back.

The substance abuse programs told clients they could not attend drug classes if they took psychiatric medication. Some counselors told clients that “if you take psych meds you are not clean.”

Old-timers grumbled that the Big Book says to follow the doctor’s advice and take your meds as prescribed. Still the programs sent anyone with a mental health problem to mental health.

The client was ping-ponged back and forth between mental health and substance abuse programs often ending up in the hospital emergency room where they received their treatment one E. R. visit at a time.

Dual Diagnosis programs are created.

Over time the number of people who were identified with both mental illness and substance abuse problems began to be recognized as significant. They were seen at the doors of mental health clinics, substance abuse programs, hospitals, homeless shelters, and welfare offices.

People with both a substance abuse disorder and mental illness usually can’t work. They burn out their families. They live on the street and in low-income neighborhoods.

People who live on the street, have no medical care, get sick, and end up in E.R.’s We began to designate this condition as “Dual Diagnosis.”

Books were written on Dual diagnosis, what it is, how to treat it. Some programs began to train beginning professionals on how to recognize the presence of substance abuse and mental illness. Still, most programs were organized as if all clients had one and only one problem.

Dual Diagnosis swells.

Doctors do most of the diagnosing and most of the clients with substance use disorders and a mental illness end up in the emergency clinics, they have few other options. Counselors saw dual diagnoses as one thing, doctors saw another.

The term dual diagnosis began to widen to include anyone with two (or more) diagnoses. From a medical treatment perspective, this makes sense. A client with diabetes or a heart condition and substance abuse has two problems. Someone with a mental illness and hypertension has two problems also. And for the treating physician, this can be very important. Medications for the psychiatric problem or the alcohol and street drugs can interact with the medications for the physical problem. The doctors need to know these things. There are articles now on dual-diagnoses that are about treating two medical problems at the same time.

Co-occurring Disorders emerge.

The term “Co-occurring Disorders” began to be used for that common issue of clients who had both a mental illness and a substance use disorder. Specialized trainings and even programs were created for people with those two problems that occur together so often.

The expression “co-occurring disorders are an expectation, not an exception” was born.

Things have begun to get better for the client who has both of these problems. But there are still clinicians who work in one area and are uncomfortable with clients who have the other problem also. Programs still see themselves as providing service either to substance abusers or to the mentally ill but not both.

Behavioral Health programs.

Behavioral health agencies now exist with the mandate to serve the mentally ill and the substance abuse clients. Some programs also include services for the mentally retarded and the developmentally delayed. Programs continue to be developed around problems and not people.

Could a developmentally delayed person also have a mental illness, say depression, and abuse substances?

Even the term “behavioral health” is problematic. It focuses on the problem as behavior. “Those people” do not do what society wants. It has been taken to mean that the people who receive services at behavioral health chose to be the way they are rather than that they have a disorder that is treatable.

The coordination of substance abuse and mental health services is a step forward but it is far from the end of the journey.

The future.

In the future, we hope to see a time when anyone who needs help gets it regardless of the specific combinations of challenges they are faced with. A time when mental health services and substance abuse treatment is offered alongside physical health services.

We hope the day will come when the largest housing facilities for the mentally ill are not in jails and where the bulk of substance abuse treatment is not done in prisons. Where we as a society provide prevention and treatment in the childhood years before our children have to go to jails and prisons rather than wait to offer services to them in prison.

We have a long way to go before the treatment of dual diagnoses becomes routine, but the fields of mental illness, substance use disorder treatment, and physical health management are changing for the better.

For more on Dual Diagnosis, Co-occurring disorders, substance abuse, and mental health topics see the categories list to the right. Coming soon will be a list of “Dual Diagnosis links and resources.”

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 Morning Questions?

Posted on by
Reply

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Morning Questions?

Sometimes a question or comment comes in or someone uses a search term that needs a short answer but not a post. Occasionally in the early morning, I will post answers to those questions.

Here is the most recent list of morning questions. You should also be able to reach them from the list of categories to the right of the posts.

Morning Question # 1 – MFT trainee or MFTT?

Morning Question # 2 Does Methcathinone help you get big in the gym?

Morning Question # 3 What stimulant drug causes mental illnesses?

Morning Question # 4 – Is there a mental illness you can’t recover from?

Morning Question # 5 How often and how long should you see a therapist?

Morning Question #6 – Could a father’s meth use cause Schizoaffective Disorder?

Morning Question #7 – Toxicology not picking up bath salts?

Morning Question # 8 – Which personality Disorders can’t read other people?

Morning Question # 9 Is Substance abuse or mental illness first?

Morning Question #10 Do counselors report crimes?

Morning Question #11 Adjustment disorder, depression & mania

Morning Question #12 – Double Depression

Morning Question #13 Is anxiety a mental illness?

Morning Question #14 Is Dysthymia better in the morning or worse?

Morning Question #15 Blackouts -common or rare?

Morning Question #16 Can one person be a support system?

Morning Question #17 Should LPC interns tell people they are interns?

Morning Question #18 Is stress a diagnosable reason for time off from work?

Morning Question #19 What if a client tells you they had sex with their last psychotherapist?

Morning Question #20 Side effects by being impregnated by a Methcathinone user?

Hope this helps you find what you are looking for. If you have other questions or suggestions please drop me a line.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How does someone become an addict?

Posted on by
Reply

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

Drugs of addiction

Addiction.
Photo courtesy of Pixabay.com

How to become an addict – The process of addiction.

I haven’t met anyone yet who deliberately set out to become an addict. Some people intended to do all the drugs or drink all the alcohol they could, but mostly they did not expect to really become addicted. How does this thing called addiction develop and why don’t people stop before it is too late?

I don’t remember Alcoholic being on the list of occupations in our school career classes. Even without instruction plenty of people go on to become addicted. You would think that highly educated people would know better than to put themselves at risk. Clearly learning and teaching the process of addiction has been left out of our educational system.

Here is how we teach the process of addiction in substance abuse and co-occurring disorder classes.

You too could become an addict in five easy steps. Not everyone goes through all these steps in exactly this order, but most people do. You could go through all of the steps quickly or slowly. Stay on the using course and you should eventually get to the endpoint of addiction. After the addition, doctors call this chemical dependency; you will find death, incarceration, or psychiatric facilities.

Step One – Experimentation with substances.

At some point, the child or young adult tries a substance. Forget what you have heard about pushers. They are too busy making deliveries to do the startup work of creating a new addict. Most kids get their first drug from their parents or grandparents. (See my post on Grandma as a drug pusher.)

The first time for most kids is sneaking some of their parent’s cigarettes or finishing a parent’s beer. Plenty of kids tell me they drank for years emptying out dad’s bottle of vodka halfway and then topping it off with water.

This process even happens in families where the parents don’t smoke or drink. Boys usually are introduced to substances by other male relatives, an older brother, cousin, uncle, or friends. Girls are often given something by a boyfriend or would-be boyfriend.

For a while, this may go a long hit or miss. The person tries this or that, likes some things and does more of that drug or does not like the feeling and does not do that again.

People from non-smoking and non-drinking homes are not immune from this process. They may find a friend to mentor them in drug use or they may delay the experimentation till they leave home for college, the military, or after marriage.

Step Two – Social substance use.

At some point in this process, the person finds that all their friends are into a particular drug. It might be that their crowd smokes cigarettes. Once the underage smoker has lite up that second cigarette there is an 85% chance they will smoke for the rest of their life.

But maybe your group of friends gets together somewhere and drinks a few beers or smokes some weed. That shouldn’t lead to an addiction right? Well not directly. You still have time to avoid that consequence but you are moving closer.

Drug users of any type tend to clump together. Each drug of choice has a culture. Beer drinkers party together and so do weed smokers and heroin injectors.

In the beginning drug use is a social thing. When the group you are in or want to be in gets together they drink this stuff, smoke this stuff, do this drug, you do it also or you stop hanging out with them. Why do you want to spend every Friday night with people who are drinking if you don’t drink?

Step Three – substance use becomes a habit.

One week all your friends are gone, out of town, and here you are stuck at home alone. It is Friday night – this is the night that you drink a few beers or smoke some weed right? So you drink a few or light one up.

At this point using a particular drug has moved from being a social activity you do with others to a habit you have. It may stay there for a long while. You may keep your beer drinking or smoking weed to Friday nights, only but most people don’t.

If you like the drug you would like to do it more than one time a week. If you don’t like it you may move on and try something else. Maybe find a new group of friends and adopt their drug of choice. You might take up drinking coffee or smoking methamphetamine.

One thing about drugs, mild or strong is that they are reliable. You do them and they change the way you feel. If you like the head change you want more. If you do not like the change you probably will pick a new drug you do like, or stop altogether. But that means you have to get new friends. So your trip down the addiction road continues.

Psychological dependency develops after a while.

One week you find you are alone, you want to drink or smoke and you have to go somewhere with the family or somewhere there will be no drugs. You get upset, you get angry, you may even pick a fight with your family and storm out. Then it is their fault you had to go get high.

At this point, you want the drug more than ever before. You need the drug to get by. You think about her all the time. And when you don’t get to do your drug you are angry about it – or depressed or anxious – until you get to get high again.

You are not yet physically addicted but you have developed a psychological need for the drug. This is the last stop on the path before you reach full chemical dependency. And you are thinking at this point that the drug is your friend and your helper.

Physical Addiction can be the last house on the block.

One day you can’t get the drug. You become sick, psychically, or emotionally ill. You may end up in the hospital, the psychiatric ward, or the jail. Suddenly you realize that even when you want to quit when you try to go for a few days without that drug, you just can’t do it.

Beyond addiction, now what?

Once you have reached the point of addiction, doctors call this chemical dependency, you have very few choices. You can quit, which turns out to be very difficult without help. You could go to some meetings, get a sponsor, and work some steps in the process of change. You might go to a program or see a counselor or you might just decide that you are helpless and you will stay addicted. Lots of people chose to stay addicted.

The A.A. big book tells us that beyond addiction if you chose not to accept help, you are headed for misery, jails, institutions, or death. But as with all the stages before this, the choice is of course yours. Lots of addicted people cycle through psychiatric facilities as the drug addiction warps their thinking. We call this joint problem of addiction and mental illness co-occurring disorders or dual diagnosis.

Any questions about my description of how an addiction could develop, be maintained, and result in a co-occurring addiction and mental illness?

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

Side effects by being impregnated by a Methcathinone user? – Morning Question #20

Posted on by
1

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Should you worry if you get pregnant by a Methcathinone user?

Anything that damages an egg or the sperm could result in birth defects, age, the physical health of either party, and so on. There is always a risk of spontaneous mutations and genetic damage. I have not seen much good research that indicates that one drug is better or worse than another when used by the father.

ANY drug use by the mother during pregnancy is risky. Sorry ladies. Doctors even take pregnant women off some prescribed medications. Alcohol is the biggest risk factor for preventable birth defects we know of. The only fully safe amount of alcohol a woman should consume during pregnancy is NONE!

If you are worried about the drug use of the father of your child you have more to worry about than possible birth defects. YOUR BABY’S DADDY MIGHT BE A DRUG ADDICT.

Pick your baby’s daddies and mamma’s wisely, you can break up with your partner but your child’s other parent is forever.

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

ADHD epidemic rages out of control – News Update

Posted on by
2

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

ADHD?
Photo courtesy of Pixabay.com

Almost all U. S. children infected with Attention Deficit Hyperactivity Disorder.

In my morning news was the startling report that Attention Deficit Hyperactivity Disorder is spreading among America’s children (AHRQ, September 2012.) It now appears likely that all U. S. Children will not be able to pay attention sufficiently to grow into mature adults.

In a short ten-year period (2000 to 2010) the number of ADHD-related visits to doctors’ offices increased by a whopping 68%. During the much longer decade of the 1960s, most doctor’s office visits centered on getting children off drugs.

If I read those news statistics right, in just four of those recent years (2003-2007) 5.4 million children caught a case of ADHD.

So far this epidemic has been confined to the United States. The United Kingdom and northern Europe have not yet seen a flood of ADHD cases, but given the prevalence of internet viruses, the impact of this epidemic may soon be felt worldwide.

This problem has become so severe that two and three-year-old’s are now being brought in for diagnosis and medication to improve their attention. The fear has become that some children may forget how to grow older if they do not get medications.

The magnitude of this crisis has required that an army of child psychiatrists be redeployed from less serious issues like schizophrenia and suicidal depression to facing the onslaught of pediatric ADHD.

The news release on this topic reports that the huge increase in public education of ADHD may have led parents, children, and providers to identify conditions that previously would have been dismissed as behavioral and conduct disorders to now be attributed to ADHD.

Over this time period while we have been spending an increasing share of our resources on fighting a war on stimulant abuse in adults, from 87% to 98% of children identified with ADHD have been prescribed amphetamine-like stimulant ADHD medication. If amphetamines have been so effective in improving attention and behavior in children it is hard to understand why the widespread use of Methamphetamines has not eliminated the occurrence of adult crime.

In fairness to the manufacturers of stimulant ADHD medications, the evidence does not indicate that childhood use of stimulant ADHD medications increases adult drug abuse.

This huge rise in the number of American Children leads me to several possible Hypotheses.

1. All children have ADHD and should receive a prescription for medication at the time of birth.

OR

2. Children are inherently young and immature and no amount of effort on our part will get children to act like responsible adults until they have in fact grown old enough to legally be adults.

In support of hypothesis two I note that in countries where children start school at older ages, they have significantly less ADHD. Also, children, who receive more exercise and are allowed to waste time at recess on physical activity, are better able to sit quietly in class. Classrooms that eliminate recess to increases classroom time and test scores are those that have higher rates of ADHD.

All that said, with tongue protruding from my cheek, I do believe there legitimately are cases of ADHD, and those with ADHD are vastly helped by medication. My concern continues to be that we are trying to medicate our way out of family, societal, and economic problems, lack of quality education, and efforts to raise test schools by excessive expectations of very young children rather than more educational opportunity as the school experience progresses.

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

Could psych meds kill?

Posted on by
Reply

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

Drugs

Drug counseling.
Photo courtesy of Pixabay.com

Taking your medication could kill you or someone else.

When we think of drug-related deaths we think first of illegal street drugs and overdose deaths but in fact, legal drugs or medication kill a lot more people than the illegal ones. Psych meds do result in deaths and serious injury.

Several recent studies have highlighted the dangers of taking a prescription medication and driving. The problem of impaired drivers includes those taking prescribed psychiatric medication. A recent large study in Taiwan confirms what other studies in the United States have suggested. There is a definite link between taking some, but not all, prescription psychiatric medication and serious car accidents.

At the top of the list for possible danger is sleeping medications. Sleeping pills have been implicated in episodes where people who have no history of substance abuse still had a “blackout” and drove without a memory of taking the trip. Now we have evidence that people who take sleeping pills are more likely to be involved in serious accidents. Even if you do not feel impaired you may be at risk. The person who is in no shape to drive is also the person who can’t tell if they are impaired.

Anti-anxiety medications particularly Benzodiazepines have been involved in a number of cases of serious car accidents.

Antidepressants are also present in the system of people who are involved in accidents in a disproportionate number of car crashes. Why antidepressants should be involved is still unclear.

Surprisingly the recent studies have not shown any significant connection between antipsychotics and accidents.

It is not those diagnosed with paranoid-schizophrenia but the anxious-insomniacs who are crashing into us.

My guess is that the increased use of the newer atypical antipsychotic medications has resulted in people with psychosis leading better, safer lives.

Another overlooked factor in accident prevention has been the association between marijuana smoking and serious car accidents. Most people know about the connection between alcohol and accidents but weed?

Studies have shown that the majority of drivers involved in serious accidents are positive for marijuana (THC) at the time of their accident. Either smoking marijuana is increasing your risk of an accident, or most people these days are smoking weed.

Regardless of your feelings about marijuana, drug legalization or decriminalization there appears to be a connection between being high on weed and getting in an accident. So if you smoke I would prefer it if you stayed off the road, especially while I am out there.

So now we know more about this subject of medications, drugs, and driving.

It is not just illegal drugs or alcohol that can impair your driving ability, prescribed drugs including some psychiatric ones also can increase the risk of you hurting yourself or others while driving.

The combination of prescribed medication, street drugs, and or alcohol, is just asking to be in a serious accident.

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

Mania in children?

Posted on by
Reply

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Do children really have mania?

Parents bring children into the emergency rooms and the psychiatric facilities because their child “flips out” and begins damaging property. Say the child begins breaking out all the windows in a row of buildings. They are angry and out of control. Efforts to get them to stop are unsuccessful and they may continue even when threatened with violence. Is this an early sign that the child has Bipolar disorder?

Diagnosing Bipolar Disorder in children is highly controversial. To make that diagnosis we need to know if children really have episodes of mania or hypomania. No mania and there should be no Bipolar Diagnosis. Anger and mania are related; they may overlap but are they part of the same thing? The researchers in this area are clearly not in agreement. I will save my opinion for the end.

Children have temper outbursts. If we reduce the level of symptoms needed to include those outbursts as a mental illness all children would get the label and the diagnoses would become meaningless.

To be considered Mania it should last 7 days, for Hypomania an episode needs to last for at least four days. This rules out all those brief temper outbursts from consideration.  It also excludes those times when any and all of us might have a time period of excitement when we sleep less or are excited to pursue a new activity, like a new love interest.

Recently there has been an increase in the use of the Bipolar NOS diagnoses in children because this allows for some judgment calls as to the length of the episode needed to make the diagnosis. One study (Stringaris et al. 2010) looked at children who had been diagnosed with Bipolar and concluded there was no evidence of mania in children under the age of thirteen, meaning no child that young should be getting the diagnosis of Bipolar. Other researchers disagree.

Stringaris did find that of those children who had brief episodes, too brief to meet criteria for a hypomanic episode, fully 25% did go on to develop all the symptoms needed to diagnose Bipolar Disorder within two years. His conclusion is that we should wait until the teen years and the full criterion is met before diagnosing Bipolar Disorder.

This is a problem for me. Why would we begin treating a child if they do not have an illness? No diagnosis no treatment. So to get the family the help they need, we need the diagnosis. If not Bipolar Disorder then what would we call this child’s problem? Also, the study tells us that 25% of these brief episodes will develop symptoms in 2 years. What about 10 years or 20?  I have not yet found research that answers those questions.

Early-onset researchers come up with a different answer. Telling us that – Mania, Bipolar one mostly starts in the adolescent period (McNamara, 2010.) This study goes on to cite 6 factors that may constitute risk factors for the early development of Bipolar Disorder.

One significant risk factor is a history of being the victim of abuse and neglect. We know that early childhood experiences can induce changes in the wiring of the brain. So can later life traumas. Psycho-social stressors are also listed as risk factors. These are also risk factors for personality disorders and other mental illnesses.

This tells us that experience and learning can be risk factors for developing Bipolar Disorder.

A family history of Bipolar is also a risk factor. Not just family members living in the home, but first-degree family members who have any mood disorder, whether in the home or not, appear to increase the risk of developing Bipolar.

That says that heredity is a risk factor for Bipolar Disorder.

A history of substance abuse, prescribed antidepressants and stimulants, and dietary deficiencies all have been implicated as having a connection to Bipolar disorder.

See: Do medications and drugs cause Mania or Bipolar Disorder and other Co-occurring blog posts

Lastly, McNamara sums up the argument for diagnosing Bipolar Disorder in children by saying that most people who go on to get the diagnosis had “prodromal” or early symptoms 10 full years before they were diagnosed.

We know from other mental health research that the sooner an illness is recognized and treated the better the chance of a full recovery.

My opinion

Children who have a brief – one day temper or behavioral outburst are unlikely to be having Bipolar disorder. This is anger or bad behavior and you should try treating them for anger and behavior first. But the pattern needs monitoring.

There are dangers from over-treating psychiatric illnesses in children and there are dangers of under-treating. Pick a provider you trust and listen to their advice and judgment. I especially recommend a consultation with a child psychiatrist whenever possible.

Don’t adopt a wait and attitude, even if you decide to skip the medication for now, if your child has these kinds of symptoms get the child counseling or therapy.

Care to share or comment?

Has your child had outbursts that looked like mania or hypomania and have you considered the possibility they may have Bipolar disorder?

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

Types of Mania and Dual Mania

Posted on by
Reply

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How many types of mania are there?

Just what mental health symptoms are illnesses and how many mental illnesses are there? Counting Manias is especially difficult.

We think we know mania when we see it, but it is such a diverse group of symptoms that it has become established as “manic episodes” that are building blocks of diagnosis, rather than separate diagnoses. It functions primarily to separate Bipolar Disorder, formerly called manic-depressive disorder from the other depressive conditions.

Mania has been described as the most heterogeneous mental health symptom there is, raising the question “When we say mania are we all talking about the same thing?” Are there types of mania that have different causes and indicate varying diseases?

Currently, there are over 400 recognized disorders or conditions that might be the focus of treatment in the DSM-4. As you may have seen from previous posts many of these disorders have lots of subtypes that look different in practice and may require different treatments.

Mania and Bipolar disorders are especially difficult because of their wide diversity of symptoms. For more on the DSM-4 and some to be DSM-5 descriptions see: What is mania? And What is hypomania?

Encarta Dictionary definitions of mania include:
1. An excessive and intense interest or enthusiasm for something and 2. A psychiatric disorder characterized by excessive physical activity, rapidly changing ideas, and impulsive behavior. The two uses of the word mania don’t have a lot in common.

Kraepelin, whose work has formed much of the foundation for modern efforts to divide up and diagnose illnesses, reported there were 6 types of mania. His distinctions seem to have been blended together into the one thing we now call Mania. But are all manias really the same?

Research has been less than helpful here as most researchers exclude a lot of people from their studies. If you exclude enough people, for enough reasons, the group left may look all alike. That does not mean the resulting study tells us anything about the various problems people with mania are undergoing.

One study (Haro et al., 2006) tells us that they found three very different forms of mania. The most common form of mania they called “typical mania” and this group contained 60% of the people in the study. But the other 40% had symptoms that were so different that the authors separated them into two additional subtypes of mania.

Psychotic mania is not like “Typical mania.”

Psychotic symptoms sometimes end up in making mania for a bipolar diagnosis but psychotic episodes can occur in other illnesses such as schizophrenia. It is common for families to have members who have been diagnosed with bipolar disorders and others who were diagnosed with schizophrenia. Psychotic mania looks a lot like psychosis and bipolar at the same time, but then we have another illness schizoaffective disorder to use for that also. This leaves the diagnosis of psychotic Bipolar in doubt. I have seen doctors record a diagnosis of schizophrenia – bipolar type.

Dual Mania is similar to other dual diagnoses

Dual Mania was described by Haro et al. as significantly different from other types of mania. Dual-diagnosis mania has been poorly recognized simply because most people who abuse substances are routinely excluded from research studies. Haro et al. report that this systematic exclusion of people with multiple problems leaves a huge gap in our understanding of mania and therefore Bipolar Disorder.

Dual Diagnosis client with mania spent significantly more days in the psychiatric hospital and had more suicide attempts. This is consistent with other studies that have shown people with Bipolar Two are at the highest risk for a suicide attempt and that people who abuse substances have higher risks also. Unfortunately acutely suicidal clients are also routinely excluded from studies of mania and Bipolar Disorders despite there being overrepresented in substance abuse treatment and acute psychiatric facilities.

Other characteristics of clients with “dual mania” included being male and younger than others with a manic episode. Dual mania resulted in higher disability levels. Dual mania was also more likely to cause job and relational problems.

Of those clients in the Haro et al study, 25% had a history of alcohol abuse. Of those with dual mania, 40% had a history of marijuana use or abuse. So that means many dual mania clients had abused both.

In substance abuse treatment the pattern of alcohol and marijuana use coupled with job, relational and legal problems is so common as to be almost universal. Among those in treatment for methamphetamine abuse, manic and hypomanic symptoms are commonly reported even when the client is not using drugs. Episodes of manic or hypomanic symptoms are also commonly reported as triggers for substance abuse relapse.

Of those with long-term mania and multiple hospitalizations the “aggressive type, ” all had histories of substance abuse (Soto, 2003.) This study did not specifically include a substance abuse type of mania but noted that among those with long-term mania and a history of substance abuse those who had not used in the last 30 days were no different than those who had used or drank. The suggestion to me is that there is something different about those who experience mania and abuse substances. Mania predisposes people to abuse substances and both conditions need to be treated.

My conclusion

The continued exclusion of substance abusers and those who are suicidal results in research data that excludes those at the highest risk and those who most use mental health services.

Comments on Mania, Bipolar co-occurring disorder, and recovery, and most anything mental health-related are always welcomed.

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

Mid-life and later life eating disorders?

Posted on by
2

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

Unhealthy food

Unhealthy relationship with food.
Photo courtesy of Pixabay

Why are mid-lifers and seniors developing eating disorders?

Eating disorders have traditionally been thought of as diseases of adolescence and young adulthood. Recently we think we are seeing an increase in eating disorders in middle age and older adults. Are people first developing an eating disorder as adults and if so why?

The first eating disorder to be recognized and studied was anorexia. When someone weighs less than 85% of the “average” weight for their height and age they stand out. Consider also that those average weight charts cited in some of the research may date from 1959 when most people here in the U. S. were smaller than we are now.

Bulimia was not recognized as a separate disorder until very recently and the closer we look the more eating disorders we find. Currently, a very large number of eating disorders are lumped together under the heading Eating Disorders Not Otherwise Specified (EDNOS). When the DSM-5 comes out next year (2013) there will be a whole new way of categorizing eating disorders and our understanding is likely to change.

Anorexia has long been thought of as a disease that first starts in adolescence or early adulthood. We thought it was brought on by a distorted body image or the influences of media emphasis on thinness. Anorexia is often a life long illness with relapses and can be fatal. We thought if you got out of your teen years without this illness you were home free.

We also thought that eating disorders were mostly a problem for women because of the emphasis of society on valuing women for their bodies. So when men began to be diagnosed with eating disorders this made us question what we knew about eating disorders. That change in thinking came slowly.

One study from a large European service reported in what they called a “definitive” study, that there were no cases of eating disorders that developed after age 26. I have left the name of the author of this report out from a sense of kindness. The trouble with the study was that they ended up, after looking at ten years of cases, with only eleven patients they were able to interview. Among those eleven were only one man, one person with Bulimia Nervosa, and one person with EDNOS. They conclude that no one gets an eating disorder as an adult.

A study by a U. S. nonprofit of clients who were in treatment for an eating disorder in their midlife reported on a sample of 100 clients (Kally, Cumella, 2008.) They found significant incidences of late-onset of an eating disorder and differences in why they may occur.

Kally & Cumella considered the question “Could these later life presentations just be people who always had the disorder but never got diagnosed and were just now reaching treatment?”

They conclude that eating disorders can and do first develop in midlife and beyond but for different reasons than those reported in samples of younger people.

They looked at three factors, background factors that predisposed the person to an eating disorder, the immediate precipitator or trigger for the episode, and factors that maintain the disorder once it is established. What they found strikes me as having implications for eating disorder sufferers of all ages as well as pointing us in the direction of why more men are receiving the diagnosis these days.

The largest contributing factors they found (in my words not necessarily theirs) were a history of abuse or neglect, not just as children but at any age, and critical non-affirming people in their support system. Respondents reported that factors in the home they lived in were more important than some general societal messages.

This agrees with the things many children have told me. They developed eating problems because a parent or sibling called them fat not because of some celebrity’s appearance. Family pressure to look a certain way, parents who controlled food or abuse substances, along with a history of abuse or neglect were some of the background reasons or risk factors for developing an eating disorder.

It takes more than a background risk factor to cause an eating disorder.

Most of the sample talked about a specific triggering event and the triggers were different for older onset cases. Children developed symptoms as a result of their family of origin problems. Those who develop eating disorders later were often triggered by events in their family of choice. So if you were abused or neglected as a child or your parents divorced you might get through the event without developing a psychiatric diagnosis. But if that sort of event happened to you as an adult, you get a divorce, then you might develop an eating disorder. People with the risk factor might show increased sensitivity to the same sort of event happening at a later point in their life.

There are more differences between early-onset and late-onset eating disorders.

Adolescents are more likely to be triggered by their body image. This is the result of a natural process of growth and development. The body changes and it can be uncomfortable. This is more likely if those in your house are unsupporting or critical.

Adults develop eating disorders because of changes in the family they have created. Divorce, separation, and relationship conflicts are all triggers. As the rate of divorce increased so did the rate of adults with an eating disorder. Adults also can be triggered by health and medical issues. There was a time when there was no such thing as being too heavy. A baby who was chubby was referred to as healthy. As people live longer and become heavier we see more and more negative effects of excess weight.

Men also are feeling the effects of a shift in societal views. Overweight men are now expected to lose weight. People of both sexes have an increasing problem of weight gain caused by medications. More than ever before people are facing medication caused weight gain.

Children who were forced to diet early in life are more likely to develop a binge eating or overeating disorder in adulthood (Rubenstein, et al., 2010.) In adulthood, the number of men who develop eating disorders begins to catch up with the number of women (Keel et al., 2010.)

The eating disorder conclusion.

Young people develop eating disorders because of a faulty or poor body image. Adults, as they get older, develop eating disorders because they do not like the changes in their bodies and in their life that aging causes.

What are your thoughts about why mid-lifers and seniors are developing eating disorders?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How is Hypomania different from Mania or a Manic Episode?

Posted on by
4

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Hypomanic Episodes.

In a post on Manic Episodes we talked about how episodes, according to the DSM are not diagnoses, they are “building blocks” out of which diagnosis is created. Someone could have either a manic episode or a hypomanic episode. The primary significance is the decision on labeling the condition as Bipolar one or Bipolar two. No Manic or Hypomanic Episode and you will not get the Bipolar label.

The Bipolar Disorder spectrum currently is very confused and confusing. It includes Bipolar I, Bipolar II, proposals for Bipolar III, IV, and so on, as well as hypomania, mania, Cyclothymic Disorder, Hyperthymia, Hyperthymic personality disorder, and so on. This spectrum is a very divergent group. Disorders involving an elevated mood may be the most Heterogeneous group there is (Van O’s et al. 2007.)

Lumping all these varieties together may be overlooking the possibility that there are “Types of Bipolar Disorders.”

Hypomania requires a specific time period in which someone has had the symptoms of “elevated, expansive, or irritable mood.” The difference is that for full mania the period needs to last for a full week, hypomania need only last for four days.

This creates some problems. What if you have manic-like symptoms for only three days? Do you get left out of the Bipolar spectrum? If someone has serious mania but it only lasts 6 days do they get Bipolar II not Bipolar I?

The effort to separate out conditions by the length of symptom duration may help psychiatrists decide what medication to prescribe but it does not make much difference to the client who has short but intense episodes of manic-like symptoms.

Since some of the changes in Hypomania may be subtle we take the word of others who know you or live with you to make this decision.

Most of the symptoms used to define hypomania are the same as those used to define a manic episode. The primary difference is the duration, four days to six is hypomania and a week or more is mania.

The exception here is that since hypomania is supposed to be a milder or different from mania.

If you have ever had hallucinations or delusions (not caused by drugs) then we skip the hypomania label and go directly to mania.

Here are the hypomania symptoms, then the exclusions. This narrative parallels the DSM but is my less technical, more colorful explanation.

The symptoms list is a lot like the list for Mania. I have italicized some of the differences.

A. For at least 4 days the person has an episode of “elevated, expansive or irritable mood.” Elevated does not mean happiness. There are lots of descriptions of these elevated moods and they vary from person to person but the key factor is that these episodes are not like other people and that there are times when this person is not like this. If this episode is really bad we may waive the 4-day rule.

B. Pick 3 or four symptoms from a list of seven.

Each of these symptoms can vary in intensity and it is a judgment call. The result is that diagnosis can vary from clinician to clinician and even from time to time for the same person and the same clinician.

Here are the 7 symptoms needed to make a manic episode.

1. Grandiosity and excessive self-esteem. They can make no mistakes and can’t understand why people question them.

2. Sleep changes. You don’t need to sleep. Someone with Bipolar I can stay up for days and is full of energy. They may only sleep three or four hours a night. And in the morning they are not tired.

This reduced need for sleep may be a little less than in mania but the result is the same. People who are going manic or hypomanic get accused of drug use but if tested they have no drugs in the system or at least no drugs that explain the excess energy.

This is a troubling part of the diagnosis. Research studies (Carver & Johnson 2008) say that a lack of sleep can “induce” mania. So the lack of sleep is both a cause and a symptom of Mania? This sleep mania question needs more research. If the definitive study of this connection has been done so far I have not found it.

Not sleeping and not feeling tired does not mean that the person is rested. The longer this below normal sleep episode goes on the more irritable and delusional the person is likely to get. They may even begin to hallucinate. Only they don’t know they are delusional. They are convinced they are right and other people are dumb to not see how smart they are. If the hallucinations or delusions are noticeable to others we call it mania, not hypomania.

3. They talk a lot.

In hypomania, you may be able to interrupt them but not for long. They have a lot to say. Sometimes they talk too loudly and too emphatically. This is not the same as the way we old people talk when wound up, but that might give you a picture.

4. They feel their thoughts are “racing.”

Too many things to think about. In kids, this looks a lot like ADHD.

5. Lack of focus and easily distracted.

They are in such a hurry they move from topic to topic, project to project, and can’t figure out what to do next. Lots of things left half-finished and on to the next one.

6. Increased goal-directed activity.

In mania it is excessive, in hypomania, those around them notice an increase but can’t explain why.

This can be trying to do too much at work, socially, sexually, or in most any area of life. This over goal-directed activity can lead to excessive physical motion like a person whose engine is always running.

7. Overdoing pleasurable activities.

Hard to believe that someone could have too much fun but what we are looking for here is not that they have a lot of fun but that they continue to do pleasurable things despite negative consequences. This could also be affected by the assessor’s values judgments.

Examples of excesses are overspending, reckless or dangerous activities, “sexual indiscretions” and so forth. This needs to be more than someone who just likes to do something, like collect something. There is an episodic nature to these activities and most everyone will agree that this person has binges of overdoing things despite them getting in trouble.

This characteristic is highly related to the continued use despite negative consequences we see in substance abuse. As a matter of fact, people with a Bipolar diagnosis are much more likely to also have addiction and alcoholism issues than the general population.

The result?

To be diagnosed with a hypomanic episode you need to have three of the seven symptoms. We want four if you are just irritable but not expansive or elevated in mood. But with hypomania, the symptoms can be milder, more of a judgment call, and can be briefer in time duration.

If you or someone you know has symptoms of hypomania please see a professional. This article is not meant to be enough for you to do “do it yourself diagnosis.” There are many effective treatments for Mania, Bipolar Disorder, and related conditions.

BIG QUESTION: What about people who have these symptoms for less than four days? Or those that move in and out of Hypomania very quickly? Are we missing some other type of Bipolar Disorder? Or is that moodiness something else?

Stay tuned for more on Mania, Hypomania, Cyclothymia and Bipolar Disorder, and Types of Bipolar Disorder and the things we know and don’t know about all these topics.

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