What are you wishing for? What is on your holiday list?

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

What is on your holiday wish list this year?

As we kick off the run-up to Christmas, the stores are getting busy. There are black-whatever deals and there are wish lists for Santa, mom, dad and the government.

Watching the news this season has made me wonder whether we should be so disappointed with what we do not have or grateful for the things we do have.

Are you saying that you need a newer larger house?

No Roof.

No Roof.
Photo courtesy of Pixabay.com

OR – Do you wish your house had a roof?

Are you griping about the electricity bill?

No Power.
Photo courtesy of Pixabay.com

OR – Do you wish you had electricity?

Are you carving Chocolate?

Empty Refrigerator.
Photo courtesy of Pixabay.com

OR – Are you carving some food for your children?

Are you wishing for more time off from work?

Unemployed.
Photo courtesy of Pixabay.com

OR – Do you wish you had a job?

Maybe this season we should continue to remember the lists we made of things to be thankful for and expand our gratitude lists at a faster rate than we add to our wish lists.

Staying connected with David Joel Miller

Six David Joel Miller Books are available now!

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: Some family secrets can be deadly.

What if your family secrets put you in danger?

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?

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Sasquatch. Wandering through a hole in time, they encounter Sasquatch. Can they survive?

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

Books are now available on Amazon.

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

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking, and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders, see my Facebook author’s page, davidjoelmillerwriter.

Where you live can make you lonely.

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

Lonely person

Loneliness.
Photo courtesy of Pixabay.com

Where you live can make you lonely.

Where do you think people, are most likely to be lonely?

When I saw the research on location and loneliness, I was surprised.

It seemed logical the people who live in remote, rural areas would have less human contact and would be lonelier. That’s not what the research showed.

The highest rates of loneliness are reported in crowded, urban areas. It’s not surprising then that with more than half the world’s population living in large cities loneliness is on the rise. Here are some of the reasons we think people who live in large cities experience more loneliness.

Not knowing people in the neighborhood makes you lonely.

One of the common complaints about small towns is that everyone knows everyone else’s business. It’s harder, maybe impossible, to be anonymous in a small town. The upside of having everyone else know about you is that you know about them. In a large city, you may live in an apartment for years and never get to know other people in nearby apartments. That lack of connection results in loneliness. One cure for loneliness is to frequent places where people know your name.

Lots of crime around you increases loneliness.

If you live in an area with a high crime rate, you avoid other people. In cities with high murder rates, people stay indoors at night. If you believe you live in a high crime area, you are likely to stay boarded up in your dwelling, hiding from other people. Work with other civic-minded people to reduce crime and dispel the loneliness.

Not expecting help makes you feel lonely.

When you don’t know people nearby, you don’t expect them to help you. People who have close relationships with those around them feel safer and are less likely to feel lonely. In crowded areas, people are often reluctant to help those around them. When there are many people present everyone tends to think someone else will take care of it. The result of this thinking is that when everyone expects someone else to help no one may act.

Not feeling safe where you live can make you lonely.

Lack of safety, feeling at risk and vulnerable increases your isolation and loneliness. People who feel unsafe barricade themselves behind locked doors.

Being afraid to leave the house makes you lonely.

Fear isolates people. As your fear of leaving your house increases, you will feel a corresponding increase in loneliness. People in poor, crowded, environments, become increasingly lonely because they try to avoid contact with others who they fear will harm them. Not feeling safe has resulted in a generation of kids who grow up playing in their homes, connecting only with electronics because their parents are afraid to let them go outside.

People who are afraid to go walking after dark experience an increase in loneliness.

Have you noticed the news stories about a group of people who all go walking together after dark? The premise here is that people’s fear of leaving their homes after dark increases their loneliness and increases isolation, and turns the streets over to people out to harm others.

If you live in a neighborhood was well-lit streets and have a busy shopping area close to your home are more likely to go out at night. When you must travel long distances, alone in your car, to connect with other people are likely to stay home and feel lonely.

What do you do if where you live makes you feel lonely?

The greatest cure for loneliness is human connections. Get to know your neighbors. Enlarge your social network. For some people moving to another neighborhood where they feel safe and accepted is an option. For other people, the solution is to work to change the neighborhood in which you live. Join community groups dedicated to making your neighborhood safer and a better environment. Make friends and be a friend. Loneliness, the feeling, tells you that you need more human connection. Increasing your social connections will help you overcome that feeling of loneliness.

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

 

Dextromethorphan and paranoia.

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

Grim Reaper

Paranoia.
Photo courtesy of pixabay.

Sometimes over-the-counter medications cause paranoia.

Dextromethorphan is a common antitussive (cough suppressant) medication found in over-the-counter medications. It is a common ingredient in over 140 over-the-counter medications. Unfortunately, Dextromethorphan has become an increasingly abused substance among those in the 18 to 25-year-old range. Abuse by younger teens is reported to be on the rise.

Because dextromethorphan can be purchased over-the-counter or stolen from grocery stores and pharmacies, many users have underestimated the serious, long-term effects of dextromethorphan abuse.

When taken according to directions most over-the-counter medications are relatively safe. Any medication, including over-the-counter medications, may result in side effects or allergic reactions. Abuse of Dextromethorphan can have some serious health consequences.

When Dextromethorphan is taken in larger than recommended amounts it can produce psychoactive effects. “Use in amounts exceeding those recommended, a practice which is known as “Robotripping,” may result in a toxidrome of psychomotor agitation, hallucinations and paranoia best characterized as Intoxication Delirium (Stanciu, C. et al., 2016.)

Dextromethorphan shares pharmacologic and neurobehavioral properties similar to opiates and phencyclidine (PCP.) Because of its cough suppression action is like the opiate codeine, as the dose increases it can produce dreamlike states and hallucinations somewhat like the “pipedreams” of opium smokers. As the dose increases significant unpleasant and health impairing results occur. At very high doses Delirium and misperceptions occur, resulting in paranoia and violent behavior similar to PCP intoxication.

“Intoxicated excited delirium describes the most serious and potentially deadly DXM-induced medical condition involving psychotic behavior, elevated temperature, and an extreme psychomotor agitation fight-or-flight response by the nervous system. Due to extreme violence frequently encountered such presentations, typically encountered in the emergency room setting with law enforcement involvement, have resulted in sudden death secondary to cardiac or respiratory arrest, an outcome associated with the use of physical restraints” (Stanciu, C. et al., 2016.)

One online user bulletin board, I will leave the website name out, included a number of user warnings. Users report tolerance to dextromethorphan happens rapidly, often after a single dose. Reports of paranoia were common, both paranoia caused by taking dextromethorphan and users reports of high anxiety which they called “paranoid” about the many other negative results from use.

Users have reported impaired daily functioning for as long as six years afterward.

On the way to psychosis and paranoia, users may experience a variety of alterations in perception. Commonly reported are auditory, visual, and tactile hallucinations. That may pass through a period of excitability and pressured speech which can easily be mistaken for bipolar mania. Nervousness, confusion, and disorientation can occur. A variety of physical symptoms are also likely, including tremors, slurred speech, and occasionally seizures. Some less pleasant symptoms include nausea, vomiting, respiratory depression, coma, and even death.

The particular gene responsible for metabolizing dextromethorphan is polymorphic meaning there are a number of different mutations of this gene in humans. Because of this a new user never knows just how dextromethorphan may affect them. Some people need to take a large amount to feel the effects while other people can have a serious adverse effect even at doses only a little above the label recommendations (Stanciu, C. et al., 2016.)

There are antidotal reports of serious interactions between dextromethorphan and commonly used substances such as alcohol and marijuana. In medical settings, life-threatening interactions between prescribed psychiatric medications and intentional overdoses of dextromethorphan-containing products.

Dextromethorphan is not the only drug of abuse which has been connected to an increased risk of developing paranoia. Reports of paranoia among drug users are common. Paranoia can be difficult to identify and diagnose. It is often only considered in the context of diagnosing the paranoid type Schizophrenia or Paranoid Personality Disorder. Recent studies have suggested that paranoia falls on a continuum and paranoia has rarely been studied outside the seriously mentally ill. Many things about the drug using lifestyle increase the risk of paranoia. Another reason for the shortage of information about rates of paranoia and its treatment among drug users has been the systematic exclusion of those with a substance use disorder from psychological research. Given the large overlap between those with a substance use disorder and a diagnosed mental illness, there’s a lot we haven’t learned about trust issues, suspicion, and various levels of paranoia among those with a co-occurring disorder.

I’ll continue to watch for and read research about the trust to suspicion continuum so watch for future posts on this topic.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is an E.A.P.?

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

Man questioning

E.A.P. Sometimes you need a little help.
Photo courtesy of Pixabay.com

E. A. P. stands for employee assistance program.

Many companies have a series of services available to their employees to help with outside of work issues. These out of work problems can affect an employee’s performance at work. Employees with legal problems, tax problems, or emotional and relational problems may have difficulty functioning effectively at work.

Companies may offer their employees the opportunity to consult with a professional about personal issues. The option to use an E.A.P. is often part of the employee’s benefits package. There are outside companies who contract with employers to provide E.A.P. services. The E.A.P. provider then contracts with lawyers, accountants, and counselors and therapists. Some medical insurance companies also offer E.A.P. programs.

E.A.P.’s and therapy.

One important E.A.P. service is counseling or therapy. Plans vary widely in how much counseling and what kinds of counseling are covered. These plans are not meant to replace medical insurance for long-term and serious mental illnesses. What the E.A.P plan does cover is a small number of sessions with a counselor or therapist to help people deal with the problems of life.

How E.A.P. counseling works.

An employee at a company with an E.A.P. plan decides they have a problem they need to talk about, but they may not want to talk to their supervisor about this issue. They call their companies E.A.P. provider. This company has been contracted in advance to provide services for all the companies employees. The E.A.P. company may provide the service themselves, but more commonly when it comes to emotional issues, they will refer that employee to a counselor who can provide the needed service.

Generally, the E.A.P. Company authorizes a set number of sessions of counseling. E.A.P. counseling is meant to be brief in nature. Depending on the employer’s plan, three, six, or even 12 free sessions of counseling are provided. The details of what the client talks about are not reported to the company they work for. Once the counselor sees the client, they bill the E.A.P. company for the session.

What kind of problems does E.A.P. counseling cover?

Relationship issues, with either partners, children, or parents are frequent topics of E.A.P. counseling. Other common E.A.P. counseling topics include drinking and substance use problems, educational issues, moves, deaths in the family and other grief and loss challenges.

What problems are generally not included in E.A.P. counseling?

E.A.P. counseling is designed to be brief and covers a limited number of sessions. It is sometimes described as “non-medical counseling.” Most plans exclude serious and persistent mental illness. If the client receives a mental health diagnosis, they will be referred to a therapist on the client’s medical insurance panel.

Does brief E.A.P. counseling work?

Counselors who work with E.A.P.’s do a lot of brief counseling interventions. These can be highly effective in helping people through an immediate crisis. In my private practice, I do a lot of brief E.A.P. type work. I find it very rewarding to be able to help people reduce their problems and improve the quality of their life.

If you work somewhere that has an E.A.P. plan and you have been struggling with an emotional challenge, consider using your E.A.P. to help you through the struggles you are facing.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is empathy?

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

What is

What is empathy?
Photo courtesy of Pixabay.

Why is empathy in short supply?

Empathy is a vital ingredient in modern life.

Empathy is described variously as, understanding another’s feelings, the ability to

identify with and understand somebody else’s feelings or difficulties or the abilities to put yourself in the other’s position. It can have to do with both cognitive understanding and emotional experience.

Empathy is considered a fundamental skill for beginning counselors to have or to develop. I looked this word up in my 1898 Century Dictionary and Cyclopedia only to find – it’s not there!

The word empathy was introduced into the English language in the year 1908.  It came from a German word which had come into use extensively in the 1870s.  There was clearly a need for a word that more accurately expressed this concept.  Originally the word empathy was closely related to sympathy but went beyond the concept of feeling sorry for someone.  Empathy came to mean a ‘felt sense” or an understanding at a deeper level.

Today this word is often used to denote the ability to understand and experience what someone else is feeling.  To really feel empathy and you needed to not only understand what the person may be thinking but what they may be feeling.

In order to develop your understanding of the skill of empathy take a look at the list below of ways to tell if someone is truly empathetic.

Empathy is seeing life through someone else’s eyes.

Empathy is not simply saying I know what you mean or I understand what you are going through.  It is that true desire to actually be able to put yourself in the other person’s position and see what they’re seeing in the way they are seeing it.

Empathy is being genuinely curious about others.

People who are high in empathy are genuinely curious about other people’s lives and what it would be like to live life the way that person lives.

Empathy wants to understand not judge.

To have empathy you have to suspend judgment.  The people who are high in empathy make the effort to understand the other person, their life situations, and what they have gone through.  The goal of empathy is to experience what it would be like to be that other person.

Empathy values the other person’s experience.

Having empathy places a high value on other people and their experiences.  People from other backgrounds can have important contributions to make to our understanding of the world we live in.  An empathetic person does not look for ways to make the other person more like themselves.  They look for ways in which that other person’s thinking and behavior make sense, given their life experiences.

Empathy is a mirror that reflects what is inside us.

As you seek to practice empathy for others you are likely to discover that it says a lot about you.  Looking and listening to other people’s life experiences evokes emotions deep within ourselves.  Much of what we may be feeling about someone else reflects what we would be feeling in that situation.  Deep empathy moves beyond our own experience and attempts to experience things from the others point of view.

Empathy understands feelings as well as facts.

Empathy is about more than simply understand the facts and the situations of someone existence.  The highest form of empathy is to seek to understand how someone feels.  This goes beyond thief understand of facts of someone’s life, to how that person interprets those facts and the feelings those situations result in.

Have you developed your skills for experiencing empathy?

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

What is an Adjustment Like Disorder? (F43.9)

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

What is

What is an Adjustment Like Disorder? (F43.9)
Photo courtesy of Pixabay.

When is an adjustment disorder not an adjustment disorder?

Sometimes people have symptoms as a result of experiencing trauma or stress.

These difficulties are sufficiently severe that we think this person needs treatment but the exact group of symptoms they have doesn’t quite fit a listed disorder.

The new DSM – 5 solves this problem by creating another name for adjustment like disorders.

Other Specified Trauma- and Stressor-Related Disorders (F43.9)

This designation gives us five more ways to categorize problems of everyday living which were caused by stressors or trauma but do not quite neatly fit the defined adjustment disorders.  Below are the five reasons you might get an adjustment like disorder diagnosis.

1. You had a stressor but your problems did not begin until more than three months after the stressor.

2. The problems continue for more than six months even though the stressor has ended but your symptoms have not turned into another diagnosis.

3. You were having an “ataque de nervious.” This particular condition is listed in the back of the DSM – 5 under cultural concepts of distress. While not recognized in the United States as a mental disorder, this particular group of symptoms is widely recognized in Spanish-speaking countries.

4. Another cultural syndrome. There are a number of cultural syndromes that are recognized in a particular geographic or ethnic area.  The cultural syndromes are understood as an inability to cope with a particular stressor.

5. Persistent Complex Bereavement Disorder. This condition is listed in an appendix to the DSM under conditions for further study.  Since it didn’t make the list of official diagnoses, researchers needed a way to code it.  The result is this condition ended up here under adjustment like disorders.

I don’t think I’ve ever seen an adjustment like disorder listed in the person’s chart nor have I ever use this particular diagnoses myself.  But when I saw it was right there in the DSM-5 I just couldn’t resist letting you all know about this.  Maybe this illustrates how learning to diagnose mental illnesses is both an imprecise science and an area for continuing learning.

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

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

See Recommended Books.     More “What is” posts will be found at “What is.”

For more on this topic see Adjustment Disorders in the Trauma- and Stressor-Related Disorders category.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is

What is an Adjustment Like Disorder? (F43.9)
Photo courtesy of Pixabay.

What is Selective Mutism (F94.0)?

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

Selective Mutism is the failure to speak at times when speech is necessary.

What is

What is Selective Mutism (F94.0)?
Photo courtesy of Pixabay.

Selective Mutism is an interesting disorder. It is one of the less common anxiety disorders and one which commonly first appears in childhood.  This disorder often co-occurs with Social Anxiety Disorder.  As with all the anxiety disorders, Selective Mutism may continue well into adulthood.

Selective Mutism is not the inability to speak or the willful refusal to speak.  Selective Mutism occurs when someone chooses not to speak in a particular situation even when not speaking may cause them difficult.  Children with this condition will avoid starting a conversation with other children.  When spoken to they will fail to respond.

Selective Mutism gets noticed when children begin to attend school.

Children with Selective Mutism do poorly in school because they do not respond verbally to the teacher and do not read out loud.  Those with this disorder may use other ways of communicating rather than speaking.  Sometimes they will point, grunt or used personally significant gestures.  They may also be willing to engage in social activities when speech is not required.

Children with Selective Mutism are able to speak normally at home with their parents or primary caregivers.  They may be unwilling to speak in the presence of close relatives including cousins, aunts and uncles, and grandparents.

Risk factors for Selective Mutism.

Children who are shy are at extra risk to develop this disorder.  Having parents who are withdrawn or growing up in a socially isolated environment may also be risk factors.  It is possible that having overprotective or controlling parents increases this risk.  There’s some evidence that children with this disorder have difficulty understanding the things that are said to them.  Having Social Anxiety Disorder or a family history of it may also increase the risks.

Other problems may accompany Selective Mutism.

People with Selective Mutism also frequently are shy and experience social embarrassment.  They may be isolated and withdrawn.  Children with Selective Mutism may be clingy and become easily upset.  They may also exhibit temper tantrums and oppositional behavior.

Having this disorder early in life and not getting treatment for it puts the child at extra risk for poor development and failure to learn needed social skills.

Things that are excluded from a Selective Mutism diagnosis.

To get this diagnosis, this condition of not speaking even when you need to speak must go on for at a month or more.  If the thing keeping you from speaking is the result of not knowing the English language or being bilingual in some way, this is not a case of Selective Mutism.

Also excluded from the definition of Selective Mutism are things related to speech fluency.  If the person involved is experiencing an episode of hearing voices, if being psychotic, or a schizophrenia-like condition, this also is outside the definition of Selective Mutism.

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

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

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is Genuineness?

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

Being genuine means being honestly who you are.

To be genuine means to be truthful and to be the real thing.  Genuine people are exactly what they represent themselves to be.  Genuine people are never fake.  What you see is what you get.  Genuine people are never copies or imitations of others.

Being genuine makes your life better.

What is genuine?
Photo courtesy of pixabay

Being genuine can be hard. You have to put yourself out there and risk being disliked. What you may discover is that the opposite of genuine is being fake. People who are fake get found out. If you try too hard to please others, you may end up not even pleasing yourself.  This been a lot written recently about living an authentic life.  An authentic life begins first with getting honest with yourself and becoming a genuine person.

While being genuine can be scary sometimes and you need to be cautious just how much and what parts of yourself you show to whom, people who develop genuineness as a part of their character end up likening themselves a whole lot more. Below are some simple advantages to becoming more genuine.

You don’t have to pretend to be something you’re not.

Genuine people stop having to pretend.  If you have ever felt you had to pretend to be something you’re not in order to have people like you, what happened was you probably lost a lot of yourself in the process.

The most important person you have to stop pretending to is yourself.  If in your life you only get honest with one person, that one person needs to be you.  Once you’ve developed that self-honesty it becomes much easier, to be honest with others.

People who don’t like you the way you are, don’t really like you.  Hang out with people like that and what you find is that people who like the fake you are fake friends.  Real friends know the real you can still like you.

You get to say what you mean and people accept it.

Genuine people say what they mean and mean what they say.  Start acting genuine and people either accept you the way you are or they quickly exit your life.  You shouldn’t have to hide your thoughts and feelings from others to win their approval.

Being genuine doesn’t mean that you have to blurt out every criticism that comes to mind.  When you’re genuine your friends don’t have to wonder if what you’re telling them is the truth.  Genuine people are very valued for their honesty.

You get to live your life, not someone else’s.

Genuine people get to live their own authentic lives.  Trying to pretend you’re something you know you are not, results in your living a life someone else wants not the life you want.  Genuine people get to live their lives their way.  When you live a genuine life you do not have to have regrets.

You don’t have to avoid responsibility.

Genuine people take responsibility for what they do.  They understand that it’s OK to try things and fail.  Since they are really being themselves, they can also admit when they are less than perfect.  Being genuine means it’s OK to make mistakes and be less than perfect.

People who are afraid to be genuine, the fake person kind, spend a great deal of time hiding their mistakes.  When you live in a genuine way, it is easier to live up to your responsibilities.

It is easier to accept compliments.

Phony people have trouble accepting compliments.  Genuine people have no difficulty in accepting compliments when they have done something well.  Genuine, authentic people are able to accept praise for things done well because they are also able to give themselves that credit.

You can recognize and compliment others. No need for jealousy.

Since genuine people accept themselves exactly as they are, they can give others the space to be themselves.  There’s no need for a genuine person to be jealous. Complementing someone else doesn’t diminish you when you feel good about yourself. Genuine people find it easy to recognize when others have done something well and are able to complement them on it.

You become more secure.

People who live a genuine, authentic life get to lose the insecurities.  The more genuine you are the more secure you can be because you accept yourself just the way you are.  Genuineness breeds security.  Since you are not trying to be fake, you don’t have to hide parts of yourself and you don’t worry about being found out.

You are not threatened by others successes.

People who are genuinely themselves are not in a competition with others to be something they are not.  And they can be fully themselves and still allow others to be who they are.  Genuine people can feel honestly good about other people’s successes.  Genuine people get to enjoy watching their friends and colleagues achieve great things.

You can admit when you are wrong.

Genuine people can admit when they are wrong.  There is no need to cover up or hide any of their imperfections.

You don’t worry about being a fraud. Your words and actions match.

Dishonest people are always afraid of being found out, they believe they are frauds.  When you live a genuine life you don’t have to worry about being found out.  Genuine people allow their words to match their actions and their actions to match their words.

You don’t need stuff to feel good about yourself.

Genuine people feel good about themselves and don’t need to accumulate a lot of stuff in order to validate themselves.  If you’re living the life you genuinely want, there’s no need to keep up with these Joneses.  Genuine people buy things because they want them not because they need to pretend.

How genuine a life are you living?

Now might be a great time to take another look at your life and see if your living the kind of life you really want.  Can you see how being genuine can have advantages for your mental health?  Work on being genuine and honest with yourself and see if you don’t feel a whole lot better about who you are.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is Amotivational Syndrome?

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

Unmotivated.
Photo courtesy of Pixabay.com

Have you lost your drive or your desire to do something?

Amotivational Syndrome is often connected with the smoking of marijuana.  This is something quite different from what we see in depression.  In depression, people lose the desire to do things they use to make them happy.  We call that loss of pleasure anhedonia.

In Amotivational Syndrome people seem to spend more time looking inward and contemplating things and less time actively doing them.  This syndrome was originally recognized in younger, marijuana smokers who were heavier daily users.

Does marijuana smoking cause loss of motivation?

Things that are, or were, associated with Amotivational Syndrome include the development of apathy and loss of ambition.  Heavy smokers just seem to become indifferent and stop caring about anything except smoking.  They seem to have fewer goals and decreased effectiveness.  Problems with attention and concentration have also been attributed to heavy marijuana smoking and Amotivational Syndrome.

Many of these characteristics are seen in daily, heavy, marijuana smokers.  What is unclear is whether the marijuana smoking causes this cluster of symptoms or whether those people who are low in motivation like to smoke marijuana.  At one point it was commonly accepted that some marijuana smokers are likely to suffer from Amotivational Syndrome.

Not all marijuana smokers are low in motivation.

Because of the many famous, popular people, who have been reported to be regular marijuana smokers, the connection between smoking marijuana and low motivation has come into question. It is unclear how common this condition is, or even if this is a valid syndrome.  Amotivational Syndrome has not been reported in countries other than the United States.  There’s some question whether Amotivational Syndrome is, in fact, a cultural rather than a mental condition.

Animals on marijuana don’t lose motivation.

Laboratory studies of both humans and animals have not found evidence of the Amotivational Syndrome for those using marijuana.  Amotivational Syndrome or loss of goals and direction has been found in many groups of young people who are not using marijuana on a regular basis.  This has led some writers to conclude that Amotivational Syndrome is a personality characteristic rather than the result of smoking marijuana.  It may be that those people with low motivation are attracted to using marijuana and other intoxicating substances.

One other possibility that has been suggested is that those people who are under the influence of drugs and alcohol or other substances may have low motivations to do anything while under the influence.  What we may be seeing in those people who were described as having Amotivational Syndrome may, in fact, be the effects of intoxication and withdrawal from marijuana or other substances.

As with the other things we are calling a mental illness or symptoms of a mental illness Amotivational Syndrome would need to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress for it to be the focus of clinical attention. Otherwise, while you may have lost some motivation you will not be identified as someone needing clinical assistance.  If the only time you have low motivation is when you are under the influence of marijuana or another drug this would be diagnosed as drug intoxication.

For more on this and related topics see the other posts on counselorssoapbox.com under        Drug Use, Abuse, and Addiction

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

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What are personality disorder clusters?

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 life out of crime and intentionally steal from, or harm other.  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

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.