Tag Archives: borderline personality disorder

What are personality disorder clusters?

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

What is

What are personality disorder clusters?
Photo courtesy of Pixabay.

What are the three main groups of personality disorders?

The newest edition of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders divides personality disorders into three categories based on their similarities.  Personality disorders are long-term or enduring patterns of behavior.  The old way of thinking about these issues was that this is just the way someone is and treatment was not likely to be successful.

Recently treatments for many of the personality disorders have become available.  Currently, we think of many of these personality disorders as problems of living which may occur in varying degrees.  Someone who is low in self-esteem might be described as low in narcissism.  If they were high in narcissism they might be lacking in the ability to empathize with others.  Below is a list of the clusters of Personality disorders with brief descriptions of the disorders in that cluster.  For longer discussions of the personality disorders see separate posts on the specific personality disorder.

Cluster A personality disorders.

This group of personality disorders includes people who appear odd or eccentric.  Among the Cluster, A personality disorders, are Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder.

Paranoid Personality Disorder involves people who are more fearful of people, life, and events that would be warranted.  They are especially likely to think that other people are out to get them.

Those with Schizoid Personality Disorder are detached from others and seem to have little desire to have close personal relationships. They have less ability to express emotions.

In Schizotypal Personality Disorder, people are very uncomfortable in close relationships, have eccentric behavior, and may have thinking or perceptual difficulties.

Cluster B personality disorders.

Cluster B personality disorders include things like Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.

Those with antisocial personality disorder seem to have little regard for others and their rights.  They don’t mind taking advantage of people around them.  This is different from those people who may make a living out of crime and intentionally steal from, or harm others.  Career criminals get a diagnosis of Adult antisocial behavior Z72.811.

People with Borderline Personality Disorder are likely to have a poor self-image, low self-esteem, fluctuating emotions, and often are very impulsive in their relationships.  Those with Borderline Personality Disorder may also self-harm.

Histrionic Personality Disorder might be described as the typical “Sarah Bernhardt” actress.  Someone with histrionic personality disorder is excessively emotional and is always looking for more attention.

Cluster C personality disorders.

Cluster C personality disorders include disorders related to relationships with other people.  These personality disorders in Cluster C are thought to begin in early childhood. They include unusual ways of relating to close people in their life. This includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder.

People with Avoidant Personality Disorder avoid other people, feel that they’re inadequate, and are often very sensitive to criticism.

Those with Dependent Personality Disorder are the people likely to become co-dependents.   They are often submissive, clingy, with an excessive need to find someone who will take care of them and control their lives.

Obsessive-Compulsive Personality Disorder is different and separate from Obsessive-Compulsive Disorder.  When the pattern of being obsessive-compulsive becomes a preoccupation with orderliness, perfection, control, having everything exactly the way they need it to be at all times, this moves from a single obsessive-compulsive behavior to the level of a continuing personality disorder.

In addition to the three personality disorder clusters, two other personality disorder characteristics are described in the DSM-5.  Sometimes a personality disorder can be the result of medical conditions.  The DSM-5 also allows for other specified personality disorder or other unspecified personality disorder when one exists that does not fit this list.

Each of these personality disorders is described more completely in other “What is” posts about that specific personality disorder.

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.

Having mild forms of these disorders does not qualify unless it causes you problems.  In that case, you may have the issues, but you will 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 characteristics need to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get this diagnosis.

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

See also Recommended Books.    “What is.” and Personality Disorders

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Are you a Co-ruminator?

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

rumination

Rumination.
Photo courtesy of Pixabay.

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

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

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

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

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

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

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

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

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

You and a friend frequently talk about your problems.

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

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

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

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

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

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

You encourage each other to talk about problems.

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

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

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

Talk about what something meant not what happened.

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

Co-rumination can be a group activity.

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Do you have Borderline Personality Disorder?

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

personality disorder

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

What are the signs and symptoms of Borderline Personality Disorder?

Problems with identifying Borderline Personality Disorder.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Borderline Personality is not common except in psychiatric hospitals.

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

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

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

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

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

Borderline symptom – troubled, vacillating relationships with others.

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

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

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

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

Impulsive acts are common in Borderline Personality Disorders.

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

Suicidal Behaviors or Self-Mutilation.

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

Borderline makes people feel empty.

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

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

Episodes of strong, excessive anger.

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

Borderline may include Stress-related Dissociation or Paranoia.

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Do you have Nightmare Disorder?

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

Nightmare

Nightmares maintain depression and PTSD.
Photo courtesy of Pixabay

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

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

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

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

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

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

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

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

Poor sleep could be anxiety, depression, or PTSD.

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

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

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

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

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

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

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

What are the symptoms of Nightmare Disorder?

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

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

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

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

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

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

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

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

Sleep

Dreams and Nightmares 

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Can’t make up your mind? Indecision, rumination and depression.

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

Hard to choose?

Indecision, rumination, and depression.

If you can’t make up your mind it may be because you are depressed. Indecision is a common result of depression and certain types of rumination ramp this symptom up.

When you are depressed it becomes incredibly difficult to decide. Even a little depression can make decisions difficult and a significant level of depression can make decision-making impossible. How you are thinking about things, especially rumination, makes this indecision worse.

Depression impairs decision-making.

Depressed people tend to rely on others to make their decisions for them. If you find you don’t trust yourself to make a decision and you expect someone else to decide for you, it is time to take a look at this.

Depressed people tend to brood about things, turn them over and over in their heads. The thinking part bogs down. The tendency is to look for global abstract reasons. What is wrong with me? Why does this keep happening to me? What you need to be asking yourself is, how you are going to get this done.

Depressed people stop trusting themselves. They do not use their intuition; that gut-level information based on experience. When depressed do you stop trusting your judgment and start over-thinking everything?

Many of the symptoms of depression involve reduced ability to make decisions. When depressed there is less rational reasoning coupled with low activity levels. Can’t do and can’t decide defines depression. There is also less information gathering going on. The result of all this avoiding making decisions and self-doubt is an increase in negative emotions. Increasing negative emotions creates more severe depression and so the cycle goes.

Indecision and low self-esteem.

Indecisiveness has been linked to low self-esteem. Can’t decide you feel bad about yourself. Feel bad about yourself you will find it hard to decide. The result if indecision is more procrastination. One culprit in this indecision, low self-esteem connection is that ancient enemy perfectionism.

Perfectionists have trouble deciding.

If you are one of those people who are trying to be perfect, a largely neurotic trait, you will never make it. The search for the perfect prevents what can be.

This human fallacy, the search for abstract universal answers, leads to the wrong conclusions. It is not “why do bad things happen to me” or anyone else. The questions you should be asking is what are you going to do now and how will you do it.

We should note here that researchers have concluded that not having a good vocabulary to describe what and how you are feeling can result in an increased risk of depression. You need to have words for the feelings to begin to work on the consequences.

Rumination does more than result in an increased risk of depression and more difficulty making decisions. Depressed people who do decide are less committed and more likely to have difficulty following through on the course of action they have decided on.

The solution to all this indecision, rumination, depression, resulting in more indecision trap?

Gather all the information you can. Make the best decision you can and then stick with it until contrary information comes in. Stop looking for global reasons and look for the facts in this specific instance.

If indecision is plaguing you or you feel like simple decisions are beyond your ability consider getting some professional help.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Emotional Avalanches and Feelings Landslides

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

Do your emotions sometimes just sweep you away?

Emotional avalanches. 
Photo courtesy of pixabay.

Everyone has ups and downs in life. There are times you are up and times you are down. Those ups and downs can come slowly or they can come quickly. For some people, those changes in their emotional landscape suddenly and unexpectedly sweep them away. There may be things you are doing that are triggering these emotional avalanches.

In your journey of life, there may be times when the trip is mostly uphill; things go as planned and in a positive direction. People who seem to be able to keep their emotional journeys on an even keel have the ability to regulate their emotions and keep them in bounds. Not everyone has that option.

If you travel in emotionally rough territory you may have a lot more ups and downs. The key in those times is to keep your eye on the distant goal, pace yourself, and not let those trips downhill define your whole journey. The more the ups and downs in life, the steeper the emotional terrain, the faster those emotions may come at you. To surmount tough emotional terrain you need to have your climbing skills well perfected. Sometimes those emotional regulation skills just are not enough.

If your emotional life is mostly flat terrain, relatively few ups and downs, a professional might think of you as having or experiencing good emotional regulation. Some people seem to be able to find the flattest path through life even in hilly terrain.

If your emotional journey has more than the expected ups and downs we professionals might think of this as you having high emotional liability. Your emotions shift in repose to things that happen and the faster things happen in your life the faster your mood shifts.

Please do not jump to the conclusion that people who are emotionally very labile have Bipolar Disorder. While people with Bipolar disorder do experience times of mood shifts, I think of their mood shifts as less related to the life events, the emotionally hilly terrain, and more related to an internal journey.

Lots of people have emotional ups and downs; some of them out of control, and these people do not all have Bipolar disorder.

Some people are just walking along and out of nowhere, so it appears, the emotional ground falls out from under them.

One cause of these emotional avalanches is a human habit called rumination. All humans think about the things that they have done and the things that have happened in the past. The way in which you think about these things is what determines the result of this rethinking. In other posts, I have and will talk more about the ways in which rumination can destroy your emotional health, create or increase depression or anxiety.

In an emotional avalanche, the person begins to think about something and that thought begins to grow the more they think about it. There may have been a trigger that brought the thought into their mind or a random memory may have been the trigger.

We suspect that those who do non-suicidal self-injury, cutting for short, are particularly prone to these emotional landslides. Once the thought occurs, any negative self-evaluative thought will do here, it becomes increasingly difficult to stop that emotional mountain from falling on you.

These emotional landslides are the cause of lots of sudden impulsive behaviors. Can’t get that thought out of your head? You might choose to drink over it. Someone else might cut on an arm or leg to distract themselves from that thought. This inability to stop the thought avalanche once it starts explains a lot of impulsive behavior better than either long-term anxiety or depression.

Being sad and then beginning to brood (ruminate) over that sadness is a strong predictor of emotional avalanches. Productive thought about past events is about how can I change that, what will I do next. Unproductive rumination is about why me and how could this happen to me.

Believing that a past stress or trauma means there is something wrong with you leads to global beliefs about yourself. That you will never be better and things can’t change. Asking how you will get past these results and create a desire to learn the skills you will need to be successful in life.

If you find that sometimes out of nowhere your emotions carry you away in a bad way, take another look at your thinking process and see if you have developed the habit of ruminating, thinking about something bad in your life over and over. Make sure you do not spend time with friends in group rumination. Having a support system can be helpful, hanging out with a group of co-ruminators can really bring you down.

You might want to check out the other posts on counselorssoapbox about rumination. There are more posts on this topic to come.

If you experience emotional avalanches that are causing you problems consider seeing a professional counselor or therapist for help. It is not “just you” and you can learn ways to have a happy productive life.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Nonsuicidal Self Injury – Cutting to stop pain

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

Cutting – nonsuicidal self-injury.
Photo courtesy of Pixabay.com

What is cutting – Non-suicidal Self-Injury?

Non-suicidal self-injury often called cutting, is another of those troubling conditions that send people to hospitals, physical and mental hospitals. Intentional self-burning, head banging, hair pulling, hitting yourself, and repetitive skin picking are other examples of this thing we call Non-suicidal self-injury. Non-suicidal self-injury causes a lot of suffering for those who do it and for those around them, and yet this problem, like anger, does not get the recognition of a separate diagnosis. FYI Hair pulling has gotten its own diagnosis called Trichotillomania.

Deliberate self-injury is a behavior. Like many behaviors, it can be misunderstood. If someone waves at you, they may be calling you over, they may be telling you to get away from where you are or it may be a way to say hello. It might even have another meaning. Self-injury is like that, a behavior, which may have different meanings.

Non-suicidal self-injury is a condition that has been researched and has been proposed for inclusion in the DSM as a recognizable mental illness. Currently, it is not a “stand-alone diagnosis.” Non-suicidal self-injury is listed in the back of the DSM-5 as a “condition for further study.”

If someone engages in non-suicidal self-injury, the kind we think is a mental illness, the most likely way it gets categorized is as a symptom of Borderline Personality Disorder. Sometimes it is a symptom of Borderline Personality Disorder or Borderline traits, sometimes not. Borderline Personality disorder is the only mental health condition that lists both suicide and Nonsuicidal self-injury as symptoms despite the high or increased rates of self-harm in other disorders like depression, bipolar, and alcohol use disorders. First, the things Nonsuicidal self-injury is not and then what we or I think it is.

What Non-suicidal self-injury is not.

Non-suicidal self-injury is not simply a teen thing.

The kind of thing we mean when we talk about Non-suicidal self-injury, the one that gets diagnosed and treated is not a fad or a rite of passage. I know there are those who cut, tattoo or brand themselves because they want to scar their body to look cool or to impress their friends. This is not what we are talking about when we say Non-suicidal self-injury – the disease.

Nonsuicidal self-injury is not a request for attention.

Yes, some people do this behavior to get noticed or to get something they want. One way to differentiate this is to ask where they self-injury. Most people who seek attention cut in places that are clearly visible. Those who do it as a result of an emotional or mental issue cut or otherwise self-injure in places that are not visible, the stomach or the thighs and they often wear long sleeves, even in the heat of the summer, to cover the cuts. The distinction is that those who develop the illness Non-suicidal self-injury often try to hide their cutting.

What Nonsuicidal self-injury is.

A way to cope with emotional pain.

Transforming emotional pain into physical pain can seem like a way to escape that emotional pain. While it does work, at least some of the time it is not a desirable way to cope. Good coping mechanisms need to be not only effective but safe also. Treatments for Non-suicidal self-injury include lots of learning and practice of alternative coping skills sometimes referred to as recovery tools.

A way to cope with dissociation

Some people report they self-harm to feel or to feel real. This numbing out is a symptom of dissociation and related disorders. Dissociation is not always recognized for what it is. Dissociation needs treatment for what it is not just for behaviors like anger or cutting.

If you live in chronic emotional numbness then the only time you may be able to feel anything is when you substitute physical pain for the constant numbing emotional hurts.

Non-suicidal self-injury is a way to regulate emotions.

Some people have difficulty regulating their emotions. They may have suffered traumas, grown up in a dysfunctional home, or have personality characteristics that make them more prone to be overloaded with emotions. Take a look at the post Emotional Avalanches and Feelings Landslides which discusses how people can be suddenly swept away by feelings floods.

Cutting or other types of non-suicidal self-injury is one way some people cope with these feelings avalanches. Violent outburst is another way. The topic of violent outbursts and emotional regulation is covered in the series on “Anger Management.”

Rumination plays a major role in depression, anxiety, and anger as well as in causing emotional landslides.

Some of the links above may not be active yet. The bold-underlined terms mean that a post is up or will be coming shortly. I will try to get the links in here as the new articles post. If any links (the ones in blue) do not work let me know and I will work on fixing them.

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 Rumination Chewing up your mental health?

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

rumination

Rumination.
Photo courtesy of Pixabay.

What is Rumination and why is rumination destroying your mental wellness?

Rumination, that habit of turning things over and over in your mind, has a lot of impact on your mental health. The more we learn about rumination the more seriously we find it is affecting people’s mental health.

Various authors have suggested alternative definitions for rumination as applied to mental health. Rumination means, to me, that something is bothering you and you keep turning that thing over and over in your mind. Reynolds (2014) describes rumination as a “maladaptive form of self-reflection.”

In rumination the focus is on yourself, judging yourself and how you reacted to the event, rather than in learning from those events. For the ruminator, if things went wrong this must mean that you are bad, people treated you badly, or that this is the result of some personal weakness that will continue to hold you back.

Casey Truffo refers to this as “chewing on the thing that is eating you.” The result is that rather than finding a solution to your problem or moving forward, you stay stuck in your upset over these things.

Excess rumination has been linked to depression, anxiety, stress, and other mental illnesses.

Thinking about the past and the future can be helpful. This review of life can aid us in recognizing errors and learning from experience. It can also be part of planning for the future. What goes wrong in ruminating is that the focus shifts from the facts, this is what did or may happen, to looking at the feelings. I could not stand it if this or that happened. Or you may be saying this is too painful to bear, is not fair, and so on.

Rumination is about judging the rightness and wrongness of things. It involves beliefs that things will not be well and looking for who to blame. Most often this involves beliefs that the reason something bad happened is because you did something “wrong.” Ruminating about the future includes beliefs that you are powerless and helpless if things happen that you do not foresee and can’t control.

This pattern of ruminating on the past and certain negative possible futures seems to me to also be involved in maintaining and aggravating the adjustment and stress-related disorders. Intrusive thoughts become worse the more you focus on them. Looking for possible crises can result in being overwhelmed and living in a world full of crises.

There is a strong connection between ruminating and alcohol abuse. Ruminators are most likely to binge drink in response to their negative self-thoughts. Those who are frequent Ruminators are also more likely to have anger management problems.

Ruminating is also an aggravating factor in eating disorders and is hugely connected with non-suicidal self-injury. Rumination can damage relationships and is related to adult attachment style issues.

Dwelling on your negative thoughts, your reviewing of past failures keeps you stuck.

Rumination has been linked to negative automatic thoughts. Think negative thoughts often enough and those thoughts are practiced to the point of becoming automatic. Practice thinking that everything is wrong, awful, and horrible, and will always be that way, and you have created a negative destiny.

Rumination is that annoying advertising jingle that keeps playing in your head. Think about those negative thoughts enough and they may be stuck in there forever.

Ruminating about the past cranks up the depression feelings.

The questions most often asked by ruminators are “Why?” and “What if?” Continuing to think about why did this happen, it should not have happened, it is horrible, awful, that this happened, results in ever-increasing feelings of sadness and depression.

Ruminating about the future is a major cause of Anxiety Disorders.

Repeated thoughts of what if? Rehearsing all the possible things that could go wrong, is a good way to anxious yourself up.

The belief that you “should” ruminate, that repeatedly turning over these past experiences or future possibilities are necessary, maintains the rumination, and results in ever-increasing spirals of negative emotions. Your own belief that you need to figure this out keeps you stuck. Some things can’t be figured out or do not need to be analyzed. Dwelling on your negative thoughts, your reviewing of past failures keeps you trapped. Acceptance rather than rumination may be the best option.

Co-rumination.

Some ruminators bring others in on their rumination process. The term co-rumination has been coined to refer to times when a relationship between two people exists primarily so they can both ruminate together about each other’s problems. Spend all your time ruminating and others in your life either have to join in the negative thought game or find a way to escape the negativity. Ruminating may drive family and friends away. Those who are left will be as negative as you.

How this is like and how it is different from therapy will be a part of a future post on co-rumination.

Do you ruminate? Are you stuck on turning those thoughts of past mistakes over and over in your head? Now is the time to break the rumination cycle and start a new happy and mentally healthy life.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is Dissociation?

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

Confusion.

Confusion.
Photo courtesy of Pixabay.com

Does Dissociation really happen? What causes it?

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

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

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

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

Some simple examples of Dissociation.

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

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

Next example, more severe

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Top counselorssoapbox.com posts for Sept 2013

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Counselorssoapbox.com

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

Well, the month is not quite over but here they are the most-read posts on counselorssoapbox.com for the last 30 days, just in case you missed one.

How much should you tell a therapist?                     

Levels or types of Borderline Personality Disorder               

Do therapists have to report a crime?            

Hyperthymia, Hyperthymic Personality Disorder and Bipolar Disorder                   

Do people really forget what happened when drinking? – Blackouts                       

Which border is Borderline Intellectual Functioning on?                  

Reasons Counselors and Therapists Lose Licenses               

Are you Hyperthymic?                      

6 ways to recover from Complex Trauma or Complex PTSD                       

Is nicotine a stimulant or a depressant?                     

Do therapists like, fall in love with their clients? Why don’t they tell them?           

Can you force a teenager to go for therapy? 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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