Let’s Talk About Making a Safety Plan

The concept of the safety plan isn't new, though I can't seem to find any information online about when exactly it came to be widely used as a suicide prevention technique. Still, it's a new thing for me, so I thought I would share my experience in making one with you all, and hopefully if you or someone you love is thinking about suicide, maybe it will be helpful for you.

So first things first, I just want to relay a piece of advice my therapist gave me. A piece of paper won't save your life, so don't expect it to. If you are in crisis, reach out and get help. The idea is to keep your safety plan some place that is readily accessible to you, and go over it from time to time to cement the information it contains in your mind, so that you can learn to recognize when a crisis is developing and take steps to prevent it.

The first item on the safety plan worksheet that I filled out with my therapist (and if you want to follow along, or make a safety plan of your own you can find a blank worksheet here, courtesy of suicidepreventionlifeline.org) is warning signs. These signs should include any thoughts, images, mood, situation, or behavior that you typically experience before you start feeling suicidal. Some examples of what I put there are financial stress, anxiety and negative self talk, and I shut down and isolate myself. These aren't all of the warning signs I wrote down, by any means, and I've added a few more since my session. You should feel free to write everything that you feel might be a warning sign, because the more comprehensive your list is, the easier it will be to determine if your headed towards a crisis.

Item number two is internal coping strategies. These are things you can do by yourself to distract yourself from the negative thoughts and emotions you are having. I put recalling and writing down happy memories here, as well as spending time with my big fluffy Teddy dog. Self-care and exercise can also be good ways to distract yourself.

Items three through five are all about other people that you can reach out to. You don't necessarily have to tell everyone on that list all of the dark thoughts inside your head. Sometimes you just need a distraction, and that's ok. It's also important to know who you can call when it does become a crisis, so there are spaces on the worksheet for emergency numbers.

Step number six is making your environment safe. This is all about removing your tools of self destruction, or at least making them more difficult to access. Maybe for you this means instead of storing your kitchen knives in a butcher block, you tuck them away in a drawer. Maybe it means throwing away the box of razor blades you use to cut on yourself. You don't have to do it right away, but you should write it down, and think about doing it. You can also include things to avoid that tend to make you feel worse. This step is all about feeling safer, like giving your keys to someone else when you are drinking, so you don't drive while under the influence of alcohol.

For me that meant thinking about giving my noose to my husband, which you may be pleased to know that I actually went through with today. I won't say I'm one hundred percent ok with having done it, but I did, and it's gone.

Now there is one difference between the form I linked to, and the one my therapist had me do, and that is that my worksheet has an extra question: What can others do to help? This was a tough one for me, because I thought this was just supposed to be about helping myself. I was clueless, so my therapist suggested maybe what others can do is listen to me, and ask how I'm doing.

Finally, the last question is what is the one thing that is the most important to me, and worth living for? If you can't think of anything off the top of your head, then think about the last time you were tempted to kill yourself, but didn't. What was it that changed your mind? That's what you should write here.

Well, that's it. That is the whole safety plan. Hopefully this will be helpful to some of you. I hope you all have a wonderful weekend, stay safe, and know that you can reach out to me if you need help, or just want somebody to talk to.

Let’s Talk About Paranoia

Paranoia is something I know very little about, although I have frequently thought I was feeling it.  The more I read about the difference between paranoia and anxiety, the more muddled and confused I get.  On the one hand, I have been learning that paranoia and anxiety are different things, despite their similarities, but as I read about the ways that they differ, I become more and more convinced that I might have paranoid in addition to my social anxiety, OCD, and bipolar disorder.  Before I go into my own experiences, however, let me share what I’ve learned today.

Let’s start by defining paranoia.  According to my research paranoia is being suspicious of other’s motives, feeling anxious or afraid that these other people intend to hurt or exploit them in some way.  It sounds a lot like social anxiety, doesn’t it?  According to what I’ve read, however, it is not.  Social anxiety differs from paranoia in that paranoia  most commonly involves fears that people are actively out to hurt you, rather than just thinking bad things about you and disliking you.  There is a very thorough explanation on Mind that you can read by clicking here, and Robert A. Lindsay wrote about the difference between the two, including actual cases of each type on his blog Beyond Highbrow, and here is a link to his article titled Paranoia Versus Social Anxiety.

Alright, so if it’s that straightforward, why am I confused?  Well, it’s because of all the many and different things that I think and feel when I go out in public, and sometimes even when I’m alone.  I don’t doubt at all that my diagnoses are correct, I just wonder if maybe there is something else going on here that I should bring up next time I have money to see a therapist.  

Something I don’t often share is that I am extremely uncomfortable around shiny objects.  As soon as I learned there was such a thing as one way mirrors, I became convinced that shiny = hidden camera, and every shiny surface from my bathroom mirror to the handle on the toilet held the potential of hiding a camera that someone could be watching and recording me through.  This fear causes me a great deal of distress when I am fixated on a particular antagonist, like an angry ex, but most of the time it only moderately bothers me.  I check sometimes, to make sure I’m wrong, although I suppose that we could have technology that I am unaware of that enables people to make microscopic cameras that are invisible to the human eye.  I know this is crazy, and logically I realize that I am not that interesting or important in the grand scheme of things, so I’d hazard a guess that I’m not delusional, but am I paranoid?

I also am acutely aware that it is possible for someone to hack my phone, tablet, computer, or security system to observe me through those cameras.  Again, most of the time I can rationalize that it’s not true, but then I’ll come across something on the internet, like a series of pictures that are not pictures of me, but are pictures of things I was just doing, with captions that seem to be talking directly to me, and it freaks me out,and I have to cover up all my cameras and I try to act totally normal while doing it, as not to alert any potential observers.  I become extra cautious about being naked when this happens, and it can impact my personal hygene, as the fixtures in the shower are reflective.  Basically I start feeling all the symptoms of my social anxiety, even though I’m alone, and I know that logically there is no one there to see me or pass judgement.

Reasonably, I think that these things could be a symptom of social anxiety, since the elicit the same response.  However, I have a couple of other outlying issues that make me even more convinced that what I’m describing could be paranoia.  

I am extremely uncomfortable around law enforcement officials and military personnel.  I don’t participate in illegal activities, so I have no rational fear regarding these individuals, and out of uniform and one on one I can even relax and enjoy their company, but when I see someone in uniform I begin to unravel.  I am instantly afraid that something I do may be misconstrued as threatening to public welfare and that they will arrest or shoot me.  This was particularly difficult for me when my husband’s father, who was in the Airforce, and my husband would drag me along with them to go grocery shopping on the base.  We’d go to lunch on the base, head into the BX (base exchange) to do some window shopping and pick up a few odds and ends, then go to the commissary for groceries.  We would be on base for two or three hours at a time, and the whole time I would be jumpy and skittish.  No matter how many times my husband told me that my fears were completely irrational, I couldn’t shake them.  Every time we approached the gate, I thought for sure this time I would screw the pooch and wind up dead or in Guantanamo.

Then there’s driving.  Apart from some OCD anxiety about locking the doors, and the discomfort I discussed earlier around shiny objects and cameras, I feel pretty safe in my home, however, when I’m driving I am constantly afraid that someone is following me.  I think they are offended by something I did, or that they are prowling for someone to rob, and trying to follow me home so that they can break in to hurt me or steal my stuff.  When I still had a license I would drive around for hours sometimes just to make sure they’d given up, and then I’d sit by the window and watch for their car.  I tend to be reckless behind the wheel, so it doesn’t seem irrational to imagine someone would be upset by my driving and wish to punish me for it.  I even drove a fairly nice car, not high end, but nice, so it didn’t seem beyond the realm of possibility that someone might decide I’d be a passable mark either.

Like I said, it’s all very confusing to me, and I wish I could better understand what I’m experiencing.  What do you think?  Am I paranoid, or is this just anxiety after all?  Do you have any stories about anxiety or paranoia that you’d like to share?  As always, feel free to comment, and thank you for reading!



Let’s Talk About Positive Self-Talk

Lately, I’ve been made aware of this thing called positive self-talk.  I had a vague idea that it is basically saying thank you to your brain for acknowledging fears or flaws and then reassuring it that there isn’t a problem after all, but through researching it today I’ve discovered that it is a little different and maybe more complicated than that.  It’s actually reprogramming your brain to stop saying negative things about yourself, and replacing those thoughts with more positive ones.

On Psychology Today Gregory L. Jantz, Ph.D. writes the following:

Each of us has a set of messages that play over and over in our minds. This internal dialogue, or personal commentary, frames our reactions to life and its circumstances. One of the ways to recognize, promote, and sustain optimism, hope, and joy is to intentionally fill our thoughts with positive self-talk. 

Too often, the pattern of self-talk we’ve developed is negative. We remember the negative things we were told as children by our parents, siblings, or teachers. We remember the negative reactions from other children that diminished how we felt about ourselves. Throughout the years, these messages have played over and over in our minds, fueling our feelings of anger, fear, guilt, and hopelessness. 

One of the most critical avenues we use in therapy with those suffering from depression is to identify the source of these messages and then work with the person to intentionally “overwrite” them. If a person learned as a child he was worthless, we show him how truly special he is. If while growing up a person learned to expect crises and destructive events, we show her a better way to anticipate the future. 

You can access his full article here.

He encourages us to write down some of the negative thoughts that we have in our heads and then try to counter act them with  “positive truths.”  It’s important that you be honest about the positive things you tell yourself for a couple of reasons. Firstly, you don’t want to delude yourself into thinking that nothing is wrong when there actually is a problem, and secondly because you have to be able to actually believe what you are saying about yourself.

So how do we walk that tightrope between acknowledging what is wrong and being positive about it?  Polly Campbell from Spirituality & Health has some ideas.  

1. Listen Critically to Your Inner Critic

In high-pressure situations self-talk is often relentless and critical, says Ethan Kross, PhD, the laboratory director of the Emotion & Self-Control Lab at the University of Michigan. Instead of thinking deliberately and logically, our inner voices are stoked by emotion, and that influences everything from how we talk to ourselves to our behaviors and beliefs, attitudes, and habits.

So your first step is to listen critically to what you are saying to yourself—and how you are saying it. When your inner voices start running amok with words of disdain and discouragement, pause the conversation as you consider ways to change it.

2. Create Psychological Distance from Yourself 

Using first-person phrasing, such as “why am I so stressed?” or “how can I do better?” may increase feelings of shame or anxiety. 

Instead, Kross suggests using your own name or a second- or third-person pronoun when referring to your situation. Asking yourself, “Why are you feeling so stressed?” is one way to create the psychological distance you need to regulate emotion and be able to lessen your discomfort rather than add to it.

As Kross explains, “People who use their own name or ‘you’ begin to think of the task more as an interesting challenge rather than as a threat.” 

3. Fit Your Conversation to Your Goal

You are talking to yourself, so consider where you ultimately want to go. Hatzigeorgiadis’s research indicates that different types of self-talk work best for specific goals. 

Instructional self-talk like “shoulders back” or “keep the left arm straight” or “temper the eggs before mixing” work best to improve technique. 

Motivational self-talk such as “you’ve got this,” or “you can do it,” “keep going,” can help with confidence, strength, or endurance.

4. Treat Yourself as a Friend

 Demeaning, disparaging, or negative self-talk is only going to amp up your stress and hold you back. Instead, speak compassionately to yourself—just as you would to a friend. 

Rescript negative messages to include a positive spin. “I am not good at this” can be changed to “Relax. You are prepared for this.” 
“I don’t know what to say” can be rescripted to “Remember to smile and ask good questions.”

5. Say, “I Don’t,” instead of “I Can’t”

Several experiments by Vanessa Patrick, a professor of marketing at the University of Houston, found that people using the phrase “I don’t” to resist temptation fared better for longer than those who said “I can’t.” Saying “I can’t” communicates limitation or constraint. Saying “I don’t” demonstrates that you are in charge of your thoughts and behaviors, and that is a powerful reminder that will help you prevail.

Try it for yourself and feel the difference.

“I can’t miss my workouts” versus “I don’t miss my workouts.”

“I can’t buy these shoes until payday” versus “I don’t buy shoes until payday.”

“I can’t eat dessert” versus “I don’t eat dessert.”

Her full article is linked here.

Above all the key to changing your inner monologue from negative to positive is repetition.  This article (click here) on Sound-Mind.org suggests that you repeat your positive self-talk at least once a day for fifteen minutes, preferably first thing in the morning and just before bed.  It also suggests that if you have a hard time saying it out loud to yourself, you may try recording it so that you can play it back to yourself.  This method may even prove more effective than saying it every time, though the article did not supply any research to back up that claim.

Well then, since I am still really struggling with my self worth issues, this seems like an excellent place to start, so I’m going to give it a shot.  I’ll post my list later on today, so you can have a real world example of how it’s done, and I will keep you all updated as I try to follow through with this plan.

As always, feel free to leave any advice or personal experiences in the comments.  Thanks again for reading, and I hope you all have a pleasant day.  



Let’s Talk About Self-Care

Self-care is a phrase that up until this year, I had never heard before.  Now in the space of less than a month I have seen it pop up on several blogs that I follow, and it’s also popped up in a few of the conversations I’ve had in the real world.  It is not a new concept for me, however, but this new phrasing somehow makes it feel more important than when I would hear “You need to take care of your self.”  I have always had trouble with taking time out for self-care, likely because of my low self esteem, but thanks to all the advice that I’ve been receiving, both personally and en mass, I’ve made a real effort over the last week to take that time for myself, and at the end of this post I’ll share with you what I’ve found out.

Before we get there though, let’s do a little research.  What exactly is self-care?  GoodTherapy.org defines it as follows:

The term self-care describes the actions that an individual might take in order to reach optimal physical and mental health. Mental health professionals often use the term self-care to refer to one’s ability to take care of the activities of daily living, or ADLs, such as feeding oneself, showering, brushing one’s teeth, wearing clean clothes, and attending to medical concerns. Physical self-care, such as sleep and exercise, is also an ADL.

Self-care can also refer to activities that an individual engages in to relax or attain emotional well-being, such as meditating, journaling, or visiting a counselor. Because an extended failure to care for one’s self can result in illness or hospitalization, individuals who find themselves unable to take care of their own needs may find it helpful to speak to a therapist.

I don’t know about you, but the idea of having to be hospitalized because you have neglected yourself seems strange to me, despite the fact that often when I’m manic I will forget to eat or drink anything, sometimes for more than twenty four hours, and I get crazy amounts of insomnia.  I know these things are important, but they always seem so irrelevant to what I’m doing in the moment.  Reading this made me take a closer look at what I’m doing to myself however, and I wanted to know more about what I am doing to my body.  So I did some research.

Well, I found a YouTube channel called AsapScience that has a separate video for each of these things. You can click here to watch the one about what happens if you stop eating.  Basically, for the first six hours your body functions normally, breaking down the glycogen in your blood into glucose to fuel your brain and provide nutrients to other parts of your body, but after that your supply of glycogen runs out and you have to start using your fat to survive, which can be bad because your brain can only get 75% of it’s energy this way.

This link will take you to their video about what happens when you stop drinking water.  Apparently your brain actually shrink when you become dehydrated, and according to Shape.com the effects of mild dehydration set in as little as four to eight hours after you stop drinking.  So this means that at six hours of not eating or drinking anything your brain is running at only 75% capacity and shriveling up inside your skull.  I’m betting that makes it a lot harder to process things and make intelligent decisions.

So what happens when you add sleep deprivation to all of this?  Well, AsapScience’s video here says that after your first sleepless night your dopamine levels increase, which can lead to increased energy, positivity, and sex drive, which seems like it would be a good thing, but your brain also gradually shuts off the regions that control reasoning and impulses, which means that again you are leaving yourself open to acting irresponsibly or irrationaly.

So between all of these factors, I imagine that my brain is only operating at about twenty five to fifty percent of it’s capacity when I neglect these three important things, and it happens surprisingly quickly when you add all these factors together.  Wow.  I want to take a nap just thinking about that.  I want to be clear, though, that I’m not saying don’t fast ever, or never pull an all nighter.  When you do it once in a while it won’t lead to any long term effects.  Just don’t do what I did and forgo all three for two or more days in a row.  I know that from now on, I’ll be paying more attention to this aspect of self-care.

On the other side of the self-care spectrum is taking time out for your emotional wellbeing.  Thinking about it I realize that neglecting this can also wind up with being hospitalized, because if you don’t take time out to do the things that you love doing you can end up depressed, and even suicidal.  This one is easy for me on the one hand because I am always reading or watching TV, but it can be hard not to feel selfish and lazy for indulging in these things, particularly because of the issues I have with other areas of self care like preforming household chores, and even just making sure I shower every day.

So how can you teach yourself to take this time out for emotional and mental health without feeling guilty?  Well, for my part the first step is not to over indulge.  If like me you find yourself watching more than five hours of TV per day, or reading a three hundred page book from start to finish in one sitting, it’s time to take a look at the other things in your life that need your attention.  Don’t let them overwhelm you though, because it can be easy to go the other way, too, and this can be especially difficult for parents.  Try and remember that you are no good to anybody if you burn yourself out by trying to do everything for your kids, and that it’s also important for your children to see you taking care of yourself so that they can develop healthy attitudes toward self-care as well.

So how do you go about setting up healthy habits with regards to self-care?  How much time should you devote to the different aspects of this important practice, so that you’re not burning out, or slacking off?  Well, there’s no easy answer, because everyone has different needs and responsibilities, but here’s what I found in my online research.  

According to most of the articles I’ve found that actually list an amount of time that you should spend on relaxation, seven hours is the minimum requirement for health and happiness.  This seems absurd to me.  How on earth are you supposed to fit seven hours of doing nothing important in your day?  I know, I know, I did just tell you that I routinely spend five hours a day watching television, and in fact that’s a low ball estimate, but I am a notorious multitasker.  I am never just doing one thing.  I’ve been know to have the TV going while I eat, research, and write, all at the same time, and sometimes I add music to the list if I’m trying to come up with a Pandora station or iTunes playlist that fits the personality of one of my characters.  My deadlines may be self imposed at this point, but they are very real to me and I am in a big hurry to meet them.

Still in the spirit of better understanding I’m going to take a look at what I think a day should consist of and compare it to the alarming number I’ve just quoted to you.  Ok, so I know I am supposed to have eight hours of sleep, and I try to make sure I work on some aspect of my books or my blog for eight hours as well, so of the twenty four hours available that leaves eight hours.  Ok, it’s starting to feel a little more reasonable to spend seven of those taking time for relaxing.  According to the article that I mentioned at the start of this post, which you can access via this link, you should spend between 75 and 150 minutes exercising per week, which boils down to 10.7 to 21.4 minutes per day. Alright, we’re still in the green zone, if only just, but how much of that time would be taken up if I actually did my chores I wonder.  Well, if I did them more regularly I could probably get away with just doing 35-50 minutes per day. Wow, this actually seems doable.

So why don’t I feel like I have time to take care of, or enjoy myself the way that I should?  After working dillegently on only a few self-care items throuought the week last week I have an answer.  Anxiety.  I spend so much time feeling anxious about the things that I don’t feel like I have time for that, frankly, I don’t have time for them!  I caught myself refreshing my stats on WordPress every five minutes or so for more than an hour last week.  That’s just stupid.  During that time I was stressing over the fact that no one had clicked like, or “visited” my post I could have literally been doing anything else and it would have affected it the same amount.  I wasn’t influencing the outcome one way or another by sitting there stressing, I was simply wasing my precious time.

When I came to that conclusion, I decided that from now on when I start feeling anxiety I’m going to do something else.  I started going on my walk, like I promised my husband I would, I would publish my post, and then go brush my teeth, or shave my legs.  I shower every day now, and even this little bit is helping me to feel more positive, and productive, not to mention my social anxiety and OCD are feeling better about the possibility of leaving the house.

Now I’m not saying that this tactic will work for everyone, but I encourage all of you, if you feel like there is no possible way you can take seven hours of your day to just enjoy life, sit down and make a list.  Chart out how much time you have available, and you might be surprised, like I was, at how much time you actually do have.  Also please feel free to share your own tips on what you do to manage your self-care in the comments here, or share a link to other articles on the subject that you’ve found helpful, or written yourself.

Really quick, before I let you go back to your lives, I’d also like to share a resource I found while researching today.  It’s called You Feel Like Shit: an Interactive Self-Care Guide.  I tried it out, and I love it.  If you’re feeling down, or anxious about something specific, or even if you just feel crappy and you don’t know why, I highly recommend giving this a shot.  Have a wonderful day, people, and remember to take care of yourself!

Let’s Talk About Numbers

As I mention on my All About Me page, I have an obsession with numbers, specifically three, five, and ten, and if I’m being honest, the ten is only in the list because I need there to be at least three items.  This often presents me with some interesting problems when I’m working on a book.  Although I’ve noticed it also adds a few interesting quirks to my writing as well.

It is often apparent in the choices I make as my story unfolds, and most frequently it is completely subconscious.  I don’t even know I’m doing it until I look for it in my drafts.  Today I noticed that with my book Killer Therapy (working title) I have given the main character two siblings, a brother and a sister, and both of her parents are alive.  Her brother is married with a baby on the way, her sister is engaged, and there is an additional member of the family that I won’t mention here to avoid spoiling my book for any of you that are interested in reading it.  Broken down, that means that there are five members of her primary family unit, her brother’s family has three people in it, and counting her sister’s fiancé and the mystery character, there are nine people in her family that I write about in the book.  I also noticed that in my book Road Trip (also a working title) the main character’s family consists of a father and two boys.  I chose to have the mother abandon her family before the story begins.

Now those of you who don’t have OCD may be thinking that I am drawing inaccurate conclusions, or straining to make it fit, but the ones who have OCD, particularly writers, I think you can probably relate.  Writing isn’t just about putting words on a page, it’s about pouring your heart and soul onto the paper, and you have to feel it.  Preforming rituals and giving in to your compulsions feels good.  It feels right.  So when I’m writing a story and I feel like there should be another character, I can’t honestly tell you if that character is in the book because my writer’s instinct told me they needed to be there, or if I needed the character in there because my OCD demanded it.

Because I know about my quirk with numbers, I try very hard to make sure that anything in my books that has a number attached to it has a reason to be that number besides my OCD, and if it doesn’t I’ll try and change it.  After all, very rarely in life do we see anything having the same numbers over and over again unless it is designed to be that way, and I want to suspend disbelief, not induce it.  So when I made the main character from Killer Therapy thirty, I thought to myself, “Why does she need to be thirty?” Obviously she needed to be old enough to have completed the required schooling to get her degrees, but I also wanted to make her young enough that she would have a long life as a serial killer ahead of her.  So why not make her thirty seven, or forty two?  I didn’t have a good answer for that, so I made her thirty one, which, despite making me a little crazy, I think is a bit more realistic.  Conversely, when I decided to make the main character in Road Trip eighteen, I had a good reason.  He has just been released from a juvenile detention center at the start of the book, so I kept it.

For the most part I’m happy with my obsession over numbers, it helps with a lot of things. For example I rarely loose count of stitches when I crochet because I always have a running tally in my head.  It can be frustrating, though, too.  When I’m watching TV with my husband and he adjusts the volume I am almost always adjusting it right after because the numbers need to be right, but he puts up with my too loud watching of the TV, and I try to not see the numbers when he changes the volume, so we make it work.  

Anyway, that’s all I have for you today.  As always feel free to comment or ask questions, and thank you for reading!

Let’s Talk About Bipolar

So my post yesterday was all about how I feel about bipolar disorder.  For me it highlighted the fact that I really don’t know that much about the subject.  In my therapy sessions with my behavioral therapist we always focused on my OCD, and all of my other therapists focused on my depression and self esteem issues.  I got put on medications that helped, but I never really talked about the bipolar disorder specifically, and how to cope with it.  So today I’d like to do some research and share with you all what I find.

First things first, what is bipolar disorder?  The National Institute of Mental Health, or NIMH, has this to say on the subject, “Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.”  They also list the four different types of bipolar disorder.  I have bipolar 1.

Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.

Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.

Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

You can find the full article I reference here.

Ok, so let’s discuss mania.  Psych Central describes manic symptoms as inflated self esteem or grandiosity, decreased need for sleep, becoming more talkative than is usual, racing thoughts, attention to small irrelevant details, an increase in goal directed activity or psychomotor agitation, and excessive risk taking.  When doing research for my book, I read a lot of articles on drug use, and it seems like the high you get from doing uppers like meth or cocaine is very much like what it feels like to be manic.  You feel like you could do anything, and you need to do it all at once.  You don’t feel like you need to sleep, I personally get insomnia, so even when I’m tired I can’t sleep, at least not for long.  Additionally, I experience hyper sexuality, which falls under risk taking behavior.  This lasts for a week at a time before coming down. 

There’s also hypomania, which is just like mania, but less severe.  Basically this means that it has the same symptoms, but they don’t interfere as much with the sufferers daily life.  There’s also mixed features episodes where you have both manic and depressed symptoms at the same time, which I don’t think I’ve had, but it sounds like it really sucks.

Now I’m sure that most of us have heard about depression, experienced it, or known someone who has, but according to bphope.com there is a difference between major depressive disorder and the depressive cycle of bipolar disorder.  They list the symptoms for each as follows:

MAJOR DEPRESSIVE DISORDER

• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Difficulty concentrating
• Loss of interest or pleasure in hobbies and activities that were once enjoyed
• Difficulty sleeping
• Overeating or loss of appetite
• Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
• Thoughts of suicide, suicide attempts

BIPOLAR DISORDER

• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Difficulty concentrating
• Loss of interest or pleasure in hobbies and activities that were once enjoyed
• May experience sleep disturbances, or oversleeping
• Overeating or loss of appetite
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
• More suicide attempts than with major depressive disorder
• A profound loss of energy
• Severe depression more likely to include psychotic symptoms
• Onset of depression occurs at a younger age
• More likely to have a co-occurring mental illness, such as obsessive-compulsive disorder, panic disorder, or substance abuse
• More likely to have a family history of mania
• More episodes of depression than with unipolar depression
• Use of antidepressant—without mood-stabilizer—may cause hypomania or mania

Click here to read the article.

So, what causes the disorder?  According to Medical News Today “Most experts agree that bipolar disorder has no single cause. It is more likely the result of many factors acting together.”  It would seem that there are genetic factors, people who are related to someone who has been diagnosed with bipolar are at higher risk of developing it themselves.  There may be biological traits that contribute as well such as physical changes in the brain, and chemical imbalances in the brain have been shown to play a key role in many mood disorders, including bipolar.  Hormonal imbalances may play a role, and trauma may also be a risk factor.

The cycling may sound like it runs on a schedule, and sometimes it kind of feels like it does, but more often it happens randomly.  Sometimes I’ll go straight from manic to depressed, and other times I’ll have a week or two of normalcy between the extremes.  This is because, like many mental health disorders, bipolar cycles can be triggered.

According to Everyday Health there are nine major triggers that someone with bipolar should look out for.  The first of these listed is interrupting your sleep cycle.  Sleep is important for everyone one, but for those of us who have bipolar if you stay up late to cram for a test, or you switch from working days to working nights, you run the risk of triggering an episode.  The second and third on the list deal with relationship stress.  Having a fight with a loved one may be a sign that you are about to have an episode, but it can also cause one, and going through a breakup or divorce is a major trigger.  Alcohol and drug use is number four on the list, and it makes sense since people often use these substances to alter their emotional states.  Number five is antidepressants.  It hasn’t been definitavely proven that antidepressants cause manic episodes in people who have bipolar disorder, some therapists have reported cases where it has, so it is important to discuss the possibility with your prescriber before going on one.  A change in season can also trigger an episode, as the amount of available sunlight changes, so do your circadian rhythms.  Becoming a parent is laden with stress, and changes the sleep cycle of both parents, but is even more devastating for women because of the hormonal changes, and the fact that you have to go off your meds when you become pregnant.  The eighth trigger on the list is loosing your job.  It is a life altering event, and whenever your life changes your mood can be affected.  Finally, the last item on the list is grief.  You may think that this would trigger a depressed cycle, but there is also a possibility of triggering “funeral mania.”

Alright, so that’s a lot of info on what bipolar disorder is, but how do you treat it?  Going back to the article on the NIMH, they say, “An effective treatment plan usually includes a combination of medication and psychotherapy (also called “talk therapy”). Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment helps to control these symptoms.”  

I wish I had better news.  I wish that I could say there’s a cure, or that eventually you’ll get past it.  But there’s not, and although with therapy and practice you can get more control, those feelings won’t ever just disappear.  It’s hard not to get discouraged when reading that, but we have to try and accept the things in life that we cannot change, and in order to better understand and love yourself it’s important to embrace the things that make us who we are even if it is difficult.

So let’s talk about the different types of therapy that are used to treat bipolar.  Medication seems to be the primary treatment.  The three kinds are mood stabilizers, atypical antipsychotics, and antidepressants.  Your doctor or therapist will go over the different kinds and work with you to find the right combination of medications for you.  There’s also CBT, which is cognitive behavioral therapy, which is used in the treatment of anxiety disorders as well, but what you need to understand about CBT is that it is a type of therapy that is tailored to each of the disorders that it is used to treat, so if your treating your OCD with CBT, it won’t be effective in treating your bipolar, and vice versa.  Your therapist will help you find a program that fits your specific needs, and it may include other psychotherapies as well, like family or marriage counseling.  Sleeping pills can help with the insomnia, but for myself I don’t use them.  The way they drag me kicking and screaming into sleep terrifies me, and they can be addictive over long periods.  In extreme cases ECT, aka electroconvulsive therapy, can be used if nothing else works.

Alright, this is a lot of information to take in, so I’m going to leave it here for now, but you can look forward to seeing more posts as I learn more about this complicated disorder.

Let’s Talk About Social Anxiety Disorder

Social anxiety disorder, also known as social phobia, was the first diagnosis I ever received in therapy.  Unlike my OCD and bipolar disorder, I had had no idea at the time that this was a real thing, but once my therapist talked to me about it it was an “Aha!” moment.  So many of the things that I had been feeling and doing made sense now.  I wasn’t a wuss for crying when I had to make a phone call, I was social phobic.  I wasn’t stupid for feeling jumpy about going to a party, I was just anxious.  It may seem silly, but having that diagnosis boosted my self esteem a lot, because suddenly these things were explainable, and they were not my fault.

So what exactly is social phobia?  Is it like arachnophobia, or claustrophobia?  Is it being afraid of talking to people, or is it a fear of people in general?  

Social phobia is defined on The Social Anxiety Association’s website as “…the fear of social situations that involve interaction with other people.”  This fear stems largely from the fact that it’s sufferers are mostly concerned with being judged by others and found lacking in some way.  As you can imagine this can have a huge impact on a person’s life.  Humans are social creatures, and we crave the company of others, but for those of us with social anxiety the thought of even being seen by another person can be down right terrifying.  Worst of all, the disorder is chronic, which means that left untreated it can only get worse.  On HealthyPlace.com Natasha Tracy writes, “Social phobia is often a precursor to agoraphobia… Agoraphobia spreads the phobia to many more situations, often with panic attacks.” A link to her full article on the subject can be found here.

While similar to other phobias, social anxiety disorder has one fairly unique trait.  Imagine, if you will, having arachnophobia so bad that you can’t even look at a basement or attic because there may be spiders there.  Now imagine that what you want more than anything in the world is to make friends with the spiders.  That’s basically what it’s like to have social phobia.  We are not anti-social people, even though on the surface it can look like that.  We long to feel connected to others, have friendships, and romantic relationships, but our fear keeps us from reaching out and engaging in the types of activities that would allow us to form those bonds.

Like other phobias, there is a list of things that can trigger an anxiety attack in someone who suffers from social phobia.  My basic rule of thumb for anyone out there who is trying to understand a friend or family member who has this is if another person can see you doing it, it will make someone with this disorder anxious.  Of course there are varying levels to the amount of anxiety that each thing can elicit, and everybody is unique, so while I might be fine going to a movie, because the lights are low and there’s a huge screen to distract people from looking my way, my brother in law who also suffers from this could become so afraid in this situation that he feels he might die if he can not get out of there.  There can even be varying degrees of effect within the same category.  For example, going through a drive through I am relatively ok with, but going inside the very same restaurant makes my palms sweat and my heart race.

Something else of note that I discovered while researching this post, is that social phobia is a genetic disorder.  On Psychology Today it says, “… first-degree relatives have a two to six times higher chance of developing social anxiety disorder.”  It also talks about how the National Institute of Mental Health has even pinpointed a gene in mice that affects fears that are passed on genetically.  The article does not completely discount environmental factors however, and childhood trauma can also play a significant role in the developing of symptoms.

So how is this debilitating disorder treated?  Well, there are medications you can take to lessen the severity of the symptoms, but ultimately the only treatment that will produce long term effects is CBT, or cognitive behavioral therapy.  This means working with a therapist and a support group made up of other people who suffer from social anxiety to overcome the irrational thoughts and incorrect perceptions that we place on ourselves.  If you know someone who struggles with social anxiety, please be patient with them, and try not to take it personally.  Remember that the things you want to do with them are appealing to them too, they are just afraid to participate, and it hurts them to say no to you because they really don’t want to hurt you.

If you are suffering from social anxiety disorder, please get help.  If you think you might have social phobia you can click here to take a quiz on HealthyPlace.com, and bring your results to a licensed therapist.  If you are in a treatment program, stick with it!  I know it can be tempting to give up, and that it is really hard to change, but you can do it!  Good luck you guys, and remember you are not alone.

Let’s Talk About OCD

My behavioral therapist told me that OCD is like a broken gear shifter.  A normal brain observes a situation, shifts to the worst possible outcome, assesses and shifts to the likely outcome, and then acts accordingly.  My brain observes the situation, shifts to the worst possible outcome, and gets stuck there.  This causes my fight or flight response to kick in, and it can happen with anything from switching on a light switch, to going out the door.

I had always thought I was a little OCD, because of some of the quirky little things I do, but I had no idea how much it affected my life until after I was diagnosed.  I have a few little compulsions that are cute on the surface, like eating skittles based on color, and peeling the labels off of soda bottles, but the thing is that they are not as benign as they appear.  My husband has misophonia, a syndrome that affects how he reacts to sound and repetitive movements that happen in his peripheral vision, and the soda bottle thing really sets him off.  So every time I eat or drink something with a label I have to choose between setting him off or feeling a sense of dread because I have not completed my compulsion.  I love my husband, but I almost always cave.  The feeling is so overwhelming and awful.  It’s like having bugs crawling around under my skin and the need just gets louder and louder, until I just cannot resist it anymore.

Then there are the obsessions.  They make absolutely no sense, at least mine don’t, but it doesn’t matter if I believe them because I feel them.  I have a thing about raw meat. It is gross, and slimy, and chicken in particular always makes me think that I will get a disease and die if I touch it.  Now, I am not a germaphobe.  I believe in the ten second rule, and I have no problem sharing a soda, but I am convinced that touching that piece of raw meat that has been packaged, and kept in carefully controlled conditions to prevent bacteria from growing on it, is going to literally kill me.  I have tried wearing gloves, and it doesn’t help.  If I wear super thick dishwashing gloves I worry I’m contaminating the meat, if I wear latex gloves I still feel like it’s killing me.  I’ve found that the best option is to just rush through it as quickly as I can and then scrub myself with soap and water until the feeling goes away, or better yet, have somebody else touch it instead.

There are also compulsions that are physically damaging.  I pick at my skin, and hair, and fingernails.  If there is a scab or zit anywhere on my body I will find it and pick at it.  This causes me to have open wounds that don’t heal for weeks because I am messing with the healing process.  It’s something I do when I am stressed.  I find every thing on my body that I can possibly pick at, and then I feel better. If I am really stressed I’ll get a pair of tweezers and pull out my leg hairs one at a time until it feels right.  If it gets too painful, I’ll switch to the other leg.  I did both legs and an arm one day because I was stressing over going back to work the next day.  These are just a few of the things that I do.

So how do I fight the unhealthy compulsions and obsessions that plague my life?  Well, I didn’t stick with therapy long enough to find out a lot of things because I got stressed about money, but one of the things I did learn from her is how to change my behavior.  For example, instead of checking the lock on the front door, I count backward from 102 by threes until the desire to go check it stops.  Singing also helps because I have to think about the lyrics.  I still give in once in a while, but I have made some progress, and hopefully some day I’ll be able to go back to therapy and get my OCD under control.

Let’s Talk About Shame

Every single one of us from the president of the United States to a bum on the street has felt the pull of shame at some point in our lives, unless you’re a psychopath, or supernaturally confident.  It is, in my opinion, the absolute worst, most damaging emotion a person can feel.  It can cause you to hide unhealthy habits from the people you love, and keep you from getting help.  It can also make you feel worthless and ugly, even when you’re at your best.  The worst thing about it, is that it hides, lurking just under the surface until you are at your most vulnerable, and then it rears it’s ugly head and drags you under to drown you in self pity and doubt.

Margaret Paul, Ph.D. wrote in her article Why We Feel Shame, and How to Conquer It, “The feeling of shame comes from the belief that, “I am basically flawed, inadequate, wrong, bad, undeserving or not good enough.””  For me this happens every day.  Every time I look in the mirror I think, “I am fat, and ugly, and totally worthless.”  If I am hungry in the middle of the night, which happens often when I don’t sleep, I think, “I am weak willed, and this is why I will never loose weight.”  Even my good traits can seem like flaws to my over critical and shame tinted eyes, for example I like math and I’m right handed.  In my mind that means that my left brain is strong and big, and my right brain is shriveled and weak.  Since I am an artist, photographer and writer, I think that I can’t possibly be any good at any of those things because creativity lives on the right side.  I know this is flawed logic, because I am often told by many people that I am exceptionally creative, but I just can’t shake that feeling of inadequacy.

Shame is seductive.  I know that seems like a counter intuitive thing to say, but it’s true.  It is all about control.  We use shame to assert control over how other people react to us.  If someone is busy when I want to talk to them, then I think I must not be interesting.  If I am ugly, then it makes sense that people wouldn’t want to look at me.  I use shame to deal with almost every negative emotion I feel, and I am so addicted to it that I sometimes use it to avoid feeling good things, too.  For example, if my husband tells me I look beautiful, I think, “He’s only saying that because I’m so hideous he feels sorry for me.”  There’s that control again. I am taking what he said and twisting it around to say that I am in control of what he thinks, and how he feels about me by being so disgusting he couldn’t possibly feel any other way.

Some articles I’ve read (here, and here) say that shame started out as a defensive strategy to protect ourselves from being abandoned by society.  Way back when we first started living in groups it was vital to be accepted or you might find yourself out in the cold with no food or access to water.  Many evolutionary psychologists and researchers suggest that same is still a helpful emotion in today’s society.  They say that it can help us live within our limitations, keep us with in societal norms, and prevent us from committing crimes.

I disagree profusely with that, and I’ll tell you why: Shame is a runaway horse pulling a wagon full of fertilizer.  It can foster change, but it is more likely to breed secrecy.  Furthermore, a person who is ashamed may act contrary to their own values in an effort to avoid the feeling of shame.  For example, someone who is poor, and ashamed, may steal things in order to promote the illusion of having means.  Another person may turn to drugs because they feel worthless, and then rather than seeking help they hide this behavior from their family and friends because they are ashamed that they were not strong enough to resist.  When I was a child and had wet the bed, shame had me bunching up my wet bedding, and hiding it in my closet rather than face the shame of telling my parents what I had done. Then I would lie to them about it, saying that those had been there since the last time it happened.  Later, when I started smoking at the socially, and legally acceptable age, I did the same thing.  I hid it from my family.  When I smelled like smoke, I told them I had been standing near some friends while they smoked.  When I was caught in the act I would say, “I’m trying to quit,” even if I wasn’t.  All because of shame, and rather than protecting my bond with society it drove in a wedge.

So how do we fix it?  How do we stop spreading around the shame, and start moving past it?  For that I go back to Margaret Paul, “When you let go of your need to control others, and instead move into compassion for yourself and others, you will let go of your false beliefs about yourself that cause the feeling of shame.”  Compassion for yourself and others.  Wow.  That is powerful.  Have compassion.  Let yourself be okay with falling short sometimes.  Remind yourself that we are all only human, and that few if any mistakes are irreversible.  Like in alchoholics anonymous, accept the things you can’t change, and find the will to fix the ones you can.  Love yourself, and don’t be ashamed to do it!  Let go of your control, and open yourself up to feeling your feelings.  Above all, know that you are special and unique, and the whole world is bigger, and more diverse, and therefore more beautiful for having you in it.