Writing 201: Finding Your Story; Day One: What’s Your Angle

Posted on February 1, 2016 by Gertie

As many of you are well aware of I am taking yet another WordPress course. It starts today and todays assignment is on what my angle is. Like many other courses I have taken it is how one interprets the assignment on how that person does the assignment. Or at least that is my understanding. The following is my first assignment:

What’s my angle? My angle has always been geared toward sharing my story with recovery with the mental illness I struggle with. I have done this to help educate others who do not struggle mental illness as well as to give others hope that recovery is possible for those of us who struggle with mental illness. Don’t worry, this is still going to be a part of my angle, I have just recently added more angles to my blog.

I have realized over the last year, that people don’t really discuss (or write about) miscarriage and the pain that comes along with it or how to deal with the grief and loss one experience’s when they have a miscarriage. So, I am adding a couple of more angles to my blog. They are to share my journey through my grief and loss with my both my miscarriages. That means the added angles to my blog are miscarriage and grief and loss.

On a side note for those who are new to reading my blog I miscarried January of last year (2015). I miscarried my second set of twins in fourteen months. Over the last year I have struggled greatly with both miscarriages and realized no one ever talks about grief and loss and how to deal with it or even miscarriage.

Now that you are now aware of what my new added angles are, I am going to end this post in a moment. I am grateful that I was able to take my lunch break today. Most importantly I am grateful I haven’t been called back early so I could do todays assignment. Well, I need to get back to work. Have a wonderful day. Most importantly have a great work week. Peace out!!!

Improving My Blogging Once Again

Posted on January 31, 2016 by Gertie

Good evening everyone! I once again signed up for another WordPress course. I signed up for Writing 201: Finding Your Story. There are many reasons I signed up for this course.

The first is in improve my blogging skills. The second is to get back into blogging since I have gotten out of the habit of blogging due to my mental illness flaring up. The third reason is to give me some structure on days I don’t have much or any structure at all. Last but not least the fourth reason why I am doing this is to have fun.

I hope to have my first assignment done on my lunch hour tomorrow at work. Considering I work in the mental health field that might not happen but it is worth a try. I am looking forward to learning more about myself and blogging through this course.

Well, I am going to end this post for now. I don’t have much more to discuss at the moment. Have a wonderful rest of your weekend. Most importantly have a wonderful week ahead of you and peace out.

Daily Prompt: Tattoo….You?

Posted on October 31, 2015 by Gertie

In response to The Daily Post’s writing prompt: “Tattoo….You?.” Do you have a tattoo? If so, what’s the story behind your ink? If you don’t have a tattoo, what might you consider getting emblazoned on you skin?

I just wanted to share with you all my first tattoo. In fact I got it yesterday, Friday, October 30, 2015. I got the semi-colon for a multitude of reasons and all of them are in regards to mental health. As some of you may or may not know that there is a project out there call Project Semi-Colon. It was created, if I’m not mistaken, to bring awareness to the stigma of cutting even in the mental health world. It was also created to bring awareness to those who deal with depression, anxiety and other such mental health diagnoses as well as those who lost their life to suicide. Another thing is that life is similar to a semi-colon; A semi-colon is used when a sentence could have been ended but wasn’t.

I personally got the semi-colon to remind myself how far I have come in my recovery and how many times I could have ended my life. In fact I have tried to take my life on many different occasions yet those attempts weren’t successful. Thankfully those attempts were intercepted by a semi-colon because clearly my story isn’t over. It isn’t over because I can share my recovery story with others. My story isn’t over because I can discuss how my life has been affected by mental illness to not only help others but to help lessen the stigma of mental illness.

Now on to why I chose the color I did. As you can tell from the picture my semi-colon tattoo is outlined in black and in filled in with purple. The purple has special meaning to me. When I was struggling a few years back my therapist reminded me to not think in black or white but shades of gray. I informed her that shades of gray weren’t exactly easy to do because it was gray out and it was depressing. She then suggested white and red would come up with shades of pink and she quickly remembered I’m not exactly a pink kind of woman. I then came up with red and blue which make purple. Long story short the purple is to help me think in shades of gray but only in color. Purple also has other meanings to me.

As you can tell, I basically got the semi-colon tattoo to help start a conversation about mental health issues. If just one conversation about my tattoo helps lessen the stigma with mental illness then it’s done its job.

Thank you for reading. Have a good day. Stay safe out there today and have fun. Happy Halloween.

Dialectical Behavior Therapy (DBT)

Posted on October 9, 2015 by Gertie

Happy Friday!!! It being Friday, that means it is time for me to do my educational feature. I have decided to do the topic of Dialectical Behavior Therapy (DBT). The reason being is because I did the topic of Borderline Personality Disorder (BPD). I got the following information off of the Linehan Institute; Behavior Tech at: http://behavioraltech.org/resources/whatisdbt.cfm

What is DBT?

Overview

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

What are the components of DBT?

In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.

DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.
DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

What skills are taught in DBT?

DBT includes four sets of behavioral skills.

Mindfulness: the practice of being fully aware and present in this one moment
Distress Tolerance: how to tolerate pain in difficult situations, not change it
Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
Emotion Regulation: how to change emotions that you want to change

There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings.

What does “dialectical” mean?

The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

How does DBT prioritize treatment targets?

Clients who receive DBT typically have multiple problems that require treatment. DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are:

Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Within a session, presenting problems are addressed in the above order. For example, if the client is expressing a wish to commit suicide and reports recurrent binge eating, the therapist will target the suicidal behaviors first. The underlying assumption is that DBT will be ineffective if the client is dead or refuses to attend treatment sessions.

What are the stages of treatment in DBT?

DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.

In Stage 1, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

How effective is DBT?

Research has shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning. For a review of the research on DBT, click here. In this video, DBT Developer and Behavioral Tech founder Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

Dive Deeper

Philosophy and Principles of DBT

DBT is based on three philosophical positions. Behavioral science underpins the DBT bio-social model of the development of BPD, as well as the DBT behavioral change strategies and protocols. Zen and contemplative practices underpin DBT mindfulness skills and acceptance practices for both therapists and clients. DBT was the first psychotherapy to incorporate mindfulness as a core component, and the Mindfulness skills in DBT are a behavioral translation of Zen practice. The dialectical synthesis of a “technology” of acceptance with a “technology” of change was what distinguished DBT from the behavioral interventions of the 1970s and 1980s. Dialectics furthermore keeps the entire treatment focused on a synthesis of opposites, primarily on acceptance and change, but also on the whole as well as the parts, and maintains an emphasis on flexibility, movement, speed, and flow in the treatment.

True to dialectics, DBT strategies are designed in pairs representing acceptance (validation, reciprocal communication, environmental intervention on behalf of the client) and change (problem solving, irreverence, consultation-to-the-patients about how they can change their own environment). Strategies are further divided into procedures; a set of principles guides the selection of strategies and procedures depending on the needs of the individual client. Clients are also taught a series of behavioral skills designed to promote both acceptance and change. A focus on replacing dysfunctional behaviors with skillful behaviors is woven throughout DBT.

DBT is a principle-based treatment that includes protocols. As a principle-based treatment, DBT is quite flexible due to its modular construction. Not only are strategies and procedures individualized, but various aspects of the treatment, such as disorder-specific protocols, can be included or withdrawn from the treatment as needed. To guide therapists in individualizing priorities for targeting disorders and behavioral problems, DBT incorporates a concept of levels of disorder (based on severity, risk, disability, pervasiveness, and complexity) that in turn guides stages of treatment and provides a hierarchy of what to treat when for a particular patient. In contrast, skills training is protocol based. Once a skills curriculum is determined, what is taught in a session is guided by the curriculum, not by the needs of a single client during that session.

The Development of DBT

In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, and non-suicidal injury. Trained as a behaviorist, she was interested in treating these and other discrete behaviors. Through consultation with colleagues, however, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD). In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Dr. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:

Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.

In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

They added acceptance-based or validation strategies to the change-based strategies of CBT. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: clients must change if they want to build a life worth living.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play. Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become entrenched in arguments and polarizing or extreme positions.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

In her original treatment manual, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993), Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must:

Enhance and maintain the client’s motivation to change
Enhance the client’s capabilities
Ensure that the client’s new capabilities are generalized to all relevant environments
Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
Structure the environment so that treatment can take place

As already described, the structure of DBT includes four components: skills group, individual treatment, DBT phone coaching, and consultation team. These components meet the five critical functions of a comprehensive psychotherapy in the following ways:

It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home

Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.
In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

Enhance and maintain the client’s motivation to change
Enhance the client’s capabilities
Ensure that the client’s new capabilities are generalized to all relevant environments
Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
Structure the environment so that treatment can take place

It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home.

DBT has personally saved my life and am grateful to have had the opportunity to take an intensive outpatient DBT program. DBT is awesome and it is one of the best decisions I have made in my life. Have an awesome Friday and Peace Out!!

Bipolar Disorder

Posted on September 18, 2015 by Gertie

Happy Friday everyone. It Friday and that means it is time for my blogging feature. Today I’ve decided to give you information on Bipolar Disorder. The information that I am about to share with you I got from The Mayo Clinic at http://www.mayoclinic.org/.

Definition

By Mayo Clinic Staff

Bipolar disorder, formerly called manic depression, causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year or as often as several times a week.

Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. For each type, the exact symptoms of bipolar disorder can vary from person to person. Bipolar I and bipolar II disorders also have additional specific features that can be added to the diagnosis based on your particular signs and symptoms.

Criteria for bipolar disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing bipolar and related disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for bipolar and related disorders are based on the specific type of disorder:

Bipolar I disorder. You’ve had at least one manic episode. The manic episode may be preceded by or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).
Bipolar II disorder. You’ve had at least one major depressive episode lasting at least two weeks and at least one hypomanic episode lasting at least four days, but you’ve never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.
Cyclothymic disorder. You’ve had at least two years — or one year in children and teenagers — of numerous periods of hypomania symptoms (less severe than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During that time, symptoms occur at least half the time and never go away for more than two months. Symptoms cause significant distress in important areas of your life.
Other types. These include, for example, bipolar and related disorder due to another medical condition, such as Cushing’s disease, multiple sclerosis or stroke. Another type is called substance and medication-induced bipolar and related disorder.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Criteria for a manic or hypomanic episode

The DSM-5 has specific criteria for the diagnosis of manic and hypomanic episodes:

A manic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). The episode includes persistently increased goal-directed activity or energy.
A hypomanic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least four consecutive days.

For both a manic and a hypomanic episode, during the period of disturbed mood and increased energy, three or more of the following symptoms (four if the mood is only irritable) must be present and represent a noticeable change from your usual behavior:

Inflated self-esteem or grandiosity
Decreased need for sleep (for example, you feel rested after only three hours of sleep)
Unusual talkativeness
Racing thoughts
Distractibility
Increased goal-directed activity (either socially, at work or school, or sexually) or agitation
Doing things that are unusual and that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments

To be considered a manic episode:

The mood disturbance must be severe enough to cause noticeable difficulty at work, at school or in social activities or relationships; or to require hospitalization to prevent harm to yourself or others; or to trigger a break from reality (psychosis).
Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

To be considered a hypomanic episode:

The episode is a distinct change in mood and functioning that is not characteristic of you when the symptoms are not present, and enough of a change that other people notice.
The episode isn’t severe enough to cause significant difficulty at work, at school or in social activities or relationships, and it doesn’t require hospitalization or trigger a break from reality.
Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

Criteria for a major depressive episode

The DSM-5 also lists criteria for diagnosis of a major depressive episode:

Five or more of the symptoms below over a two-week period that represent a change from previous mood and functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure.
Symptoms can be based on your own feelings or on the observations of someone else.

Signs and symptoms include:

Depressed mood most of the day, nearly every day, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
Markedly reduced interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in children, failure to gain weight as expected can be a sign of depression)
Either insomnia or sleeping excessively nearly every day
Either restlessness or slowed behavior that can be observed by others
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt, such as believing things that are not true, nearly every day
Decreased ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death or suicide, or suicide planning or attempt

To be considered a major depressive episode:

Symptoms must be severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships
Symptoms are not due to the direct effects of something else, such as alcohol or drug use, a medication or a medical condition
Symptoms are not caused by grieving, such as after the loss of a loved one

Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include additional features.

Anxious distress — having anxiety, such as feeling keyed up, tense or restless, having trouble concentrating because of worry, fearing something awful may happen, or feeling you may not be able to control yourself
Mixed features — meeting the criteria for a manic or hypomanic episode, but also having some or all symptoms of major depressive episode at the same time
Melancholic features — having a loss of pleasure in all or most activities and not feeling significantly better, even when something good happens
Atypical features — experiencing symptoms that are not typical of a major depressive episode, such as having a significantly improved mood when something good happens
Catatonia — not reacting to your environment, holding your body in an unusual position, not speaking, or mimicking another person’s speech or movement
Peripartum onset — bipolar disorder symptoms that occur during pregnancy or in the four weeks after delivery
Seasonal pattern — a lifetime pattern of manic, hypomanic or major depressive episodes that change with the seasons
Rapid cycling — having four or more mood swing episodes within a single year, with full or partial remission of symptoms in between manic, hypomanic or major depressive episodes
Psychosis — severe episode of either mania or depression (but not hypomania) that results in a detachment from reality and includes symptoms of false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations)

Symptoms in children and teens

The same DSM-5 criteria used to diagnose bipolar disorder in adults are used to diagnose children and teenagers. Children and teens may have distinct major depressive, manic or hypomanic episodes, between which they return to their usual behavior, but that’s not always the case. And moods can rapidly shift during acute episodes.

Symptoms of bipolar disorder can be difficult to identify in children and teens. It’s often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. And children who have bipolar disorder are frequently also diagnosed with other mental health conditions.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn’t get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.

Many people with bipolar disorder don’t get the treatment they need. Despite the mood extremes, people with bipolar disorder often don’t recognize how much their emotional instability disrupts their lives and the lives of their loved ones.

And if you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.

If you’re reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. He or she may be able to help you take the first steps to successful treatment.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options:

Reach out to a close friend or loved one.
Contact a minister, spiritual leader or someone in your faith community.
Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
Make an appointment with your doctor, mental health provider or other health care provider.

If you have a loved one who is in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
Inherited traits. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder
Periods of high stress
Drug or alcohol abuse
Major life changes, such as the death of a loved one or other traumatic experiences

Conditions that commonly occur with bipolar disorder

If you have bipolar disorder, you may also have another health condition that’s diagnosed before or after your diagnosis of bipolar disorder. Such conditions need to be diagnosed and treated because they may worsen existing bipolar disorder or make treatment less successful. They include:

Anxiety disorders. Examples include social anxiety disorder and generalized anxiety disorder.
Post-traumatic stress disorder (PTSD). Some people with PTSD, a trauma- and stressor-related disorder, also have bipolar disorder.
Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms that overlap with bipolar disorder. For this reason, bipolar disorder can be difficult to differentiate from ADHD. Sometimes one is mistaken for the other. In some cases, a person may be diagnosed with both conditions.
Addiction or substance abuse. Many people with bipolar disorder also have alcohol, tobacco or drug problems. Drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania.
Physical health problems. People diagnosed with bipolar disorder are more likely to have certain other health problems, such as heart disease, thyroid problems or obesity

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These may include:

Problems related to drug and alcohol use
Suicide or suicide attempts
Legal problems
Financial problems
Relationship troubles
Isolation and loneliness
Poor work or school performance
Frequent absences from work or school

Preparing for your appointment

You may start by seeing your primary care doctor or you may choose to see a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).

What you can do

Before your appointment, make a list of:

Any symptoms you’ve had, including any that may seem unrelated to the reason for the appointment
Key personal information, including any major stresses or recent life changes
All medications, vitamins or other supplements that you’re taking, and their dose
Questions to ask your doctor

Take a family member or friend along, if possible. That person may provide more information or remember something that you missed or forgot.

Some basic questions to ask your doctor include:

Do I have bipolar disorder?
Are there any other possible causes for my symptoms?
What kinds of tests will I need?
What treatments are available? Which do you recommend for me?
What side effects are possible with that treatment?
What are the alternatives to the primary approach that you’re suggesting?
I have these other health conditions. How can I best manage these conditions together?
Should I see a psychiatrist or other mental health provider?
Is there a generic alternative to the medicine you’re prescribing?
Are there any brochures or other printed material that I can have? What websites do you recommend?

Don’t hesitate to ask questions at any time during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you or your loved ones first begin noticing your symptoms of depression, mania or hypomania?
How frequently do your moods change?
Do you ever have suicidal thoughts when you’re feeling down?
Do your symptoms interfere with your daily life or relationships?
Do you have any blood relatives with bipolar disorder or depression?
What other mental or physical health conditions do you have?
Do you drink alcohol, smoke cigarettes or use street drugs?
How much do you sleep at night? Does it change over time?
Do you go through periods when you take risks that you wouldn’t normally take, such as unsafe sex or unwise, spontaneous financial decisions?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?

Tests and diagnosis

When doctors suspect someone has bipolar disorder, they typically do a number of tests and exams. These can help rule out other problems, pinpoint a diagnosis and also check for any related complications. These may include:

Physical exam. A physical exam and lab tests may be done to help identify any medical problems that could be causing your symptoms.
Psychological evaluation. Your doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.
Mood charting. To identify exactly what’s going on, your doctor may have you keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
Signs and symptoms. Your doctor or mental health professional typically will compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders to determine a diagnosis.

Diagnosis in children

Although bipolar disorder can occur in young children, typically it’s diagnosed in the teenage years or early 20s. It’s often hard to tell whether a child’s emotional ups and downs are normal for his or her age, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Bipolar symptoms in children and teens often have different patterns than they do in adults and may not fit neatly into the categories used for diagnosis. And children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems.

Your child’s doctor can help you learn the symptoms of bipolar disorder and how they differ from behavior related to your child’s developmental age, the situation and appropriate cultural behavior.

Treatments and drugs

Treatment is best guided by a psychiatrist skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.

Depending on your needs, treatment may include:

Initial treatment. Often, you’ll need to start taking medications to balance your moods right away. Once your symptoms are under control, you’ll work with your doctor to find the best long-term treatment.
Continued treatment. Bipolar disorder requires lifelong treatment, even during periods when you feel better. Maintenance treatment is used to manage bipolar disorder on a long-term basis. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
Substance abuse treatment. If you have problems with alcohol or drugs, you’ll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
Hospitalization. Your doctor may recommend hospitalization if you’re behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you’re having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy), and may include education and support groups.

Medications

A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.

Medications may include:

Mood stabilizers. Whether you have bipolar I or II disorder, you’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.
Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.
Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep. Benzodiazepines are generally used for relieving anxiety only on a short-term basis.

Side effects

Talk to your doctor or mental health provider about side effects. If side effects seem intolerable, you may be tempted to stop taking your medication or to reduce your dose on your own. Don’t do it. You may experience withdrawal effects or your symptoms may return.

Side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications.

Finding the right medication

Finding the right medication or medications for you will likely take some trial and error. If one doesn’t work well for you, there are several others to try.

This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects. Discuss these issues with your doctor:

Birth control options, as birth control medications may lose effectiveness when taken along with certain bipolar disorder medications
Treatment options if you plan to become pregnant
Breast-feeding, as some bipolar medications can pass through breast milk to your infant

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:

Cognitive behavioral therapy. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what’s going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleep, wake and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.
Other therapies. Other therapies have been studied with some evidence of success. Ask your doctor if any other options may be appropriate for you.

Other treatment options

Depending on your needs, other treatments may be added to your depression therapy, such as:

Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain and typically offers immediate relief of even severe depression when other treatments don’t work. Physical side effects, such as headache, are tolerable. Some people also have memory loss, which is usually temporary. ECT is usually used for people who don’t get better with medications, can’t take antidepressants for health reasons or are at high risk of suicide. ECT may be an option if you have mania or severe depression when you’re pregnant and cannot take your regular medications.
Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven’t responded to antidepressants. During TMS, you sit in a reclining chair with a treatment coil placed against your scalp. The coil sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression. Typically, you’ll have five treatments each week for up to six weeks.

Treatment in children and teenagers

Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors.

Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There’s less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
Psychotherapy. Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy can help children develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems, common in older children with bipolar disorder.
Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

Lifestyle and home remedies

You’ll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:

Quit drinking or using illegal drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
Steer clear of unhealthy relationships. Surround yourself with people who are a positive influence and won’t encourage unhealthy behavior or attitudes that can worsen your bipolar disorder.
Get regular physical activity and exercise. Moderate, regular physical activity and exercise can help steady your mood. Working out releases brain chemicals that make you feel good (endorphins), can help you sleep and has a number of other benefits. Check with your doctor before starting any exercise program, especially if you’re taking lithium, to make sure exercise won’t interfere with your medication.
Get plenty of sleep. Don’t stay up all night. Instead, get plenty of sleep. Sleeping enough is an important part of managing your mood. If you have trouble sleeping, talk to your doctor or mental health provider about what you can do.

Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There’s less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
Psychotherapy. Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy can help children develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems, common in older children with bipolar disorder.
Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

Coping and support

Coping with bipolar disorder can be challenging. Here are some strategies that can help:

Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Help educate your family and friends about what you’re going through.
Stay focused on your goals. Recovery from bipolar disorder can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.
Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.
Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.

Prevention

There’s no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you’ve been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You and your caregivers may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
Avoid drugs and alcohol. Using alcohol or street drugs can worsen your symptoms and make them more likely to come back.
Take your medications exactly as directed. You may be tempted to stop treatment — but don’t. This can have immediate consequences — you may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.
Check first before taking other medications. Call the doctor who’s treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of bipolar disorder or may interfere with medications you’re already taking to treat bipolar disorder.

Thank you for reading. Just remember I am not professional. The above information I got from the Mayo Clinic. I best be going. I will post my Writing 101 assignment later on. Have a good weekend and Peace Out!!!!

Writing 101: Finding Your Inspiration; Day Nine: Reinvent The Letter Format

Posted on September 17, 2015 by Gertie

Todays writing assignment is to write a letter. We have several choices to choose from. I am going to write a letter to my brother’s dad. My brother’s dad is the one the severally abused me as a child. For my abusers “protection” I am going to call him “D.” I know he doesn’t deserve protection. I will be calling my brother Jay in this letter. In fact some people do call him Jay. I am writing this letter to ultimately help me in my healing process.

Dear D, Thursday, September 17, 2015

I am pretty sure you don’t remember me but I sure in the hell remember you. I remember how you forced me to “have sex” with you at the age of nine for the first time. I remember how you use to sell me to others so they can have “their fun” with me. I remember how you would spike my drinks with alcohol and sometimes drugs. I remember how you would give me home baked goodies with a variety of drugs in them. You did this so I wouldn’t fight back or scream when you r*p*d me. You made sure my mom was passed out drunk and/or high when you brutally r*p*d me. I remember when Jay was born. You weren’t there because you were in jail. I remember when you got out, you gave mom a ton of drugs so she wouldn’t know what you were doing to me. You put me in a position at the age of 11 that nobody should be put in. You made me choose to either have Jay get abused and have me watch and then get r*p*d myself or have me take his abuse along with mine which made it a hundred times worse. Me being the only sister by 11 years, I am of course going to make sure Jay wouldn’t get abused. How dare you abuse anyone especially your on child. Most importantly how dare you put an 11 year old to make a decision like that. How could you abandon your own disabled son at the age of one? I am beyond angry with you. I wish I could type more but I need to end this letter for the sake of my own mental health. I just wish I didn’t have to re-experience all the shit you did to me 25 plus years later. I need to stop this letter. You are a fucken asshole.

Gertie

Thanks for reading my letter. This was a tough assignment for me to do. I have a lot more to say to D but for my own mental health I had to end it. Yes, I will be okay. Thankfully, I have Junior by my side to help me through. Have a good night and peace out all!!

Writing 101: Finding Your Inspiration; Day Seven: Hook ’em With A Quote

Posted on September 15, 2015 by Gertie

I learned a long time ago the wisest thing I can do is be on my side, be an advocate for myself and others like me.

Maya Angelou

When I got today’s assignment, I thought of the above quote from Ms. Maya Angelou. I thought about it first because part of my blog includes being an advocate for myself and others who have similar struggles to me. In fact advocating for yourself is one of the main objectives of being in recovery.

As I quote Ms. Maya Angelou, it is my desire that I be an inspiration to others like she was to many people around the world. Ms. Maya Angelou is a person I would have loved to meet while she was still here but unfortunately she is no longer with us in person but thankfully she is with us in spirit. I will end with another quote from Ms. Maya Angelou.

All great achievements require time.

Maya Angelou

Daily Prompt: Inside the Bubble

Posted on September 15, 2015 by Gertie

In response to The Daily Post’s writing prompt: “Inside the Bubble.” A contagious disease requires you to be put into quarantine for a whole month (don’t worry, you get well by the time you’re free to go!). How would you spend your time in isolation?

As I was looking through past daily prompts, I found this one. I don’t know why but it grabbed my eye. For some reason this is an easy prompt for me to do. Maybe it is because, I have been in the hospital for a month and sometimes longer however it was not due to a contagious disease but mental health reasons.

If allowed, I would have my laptop so I would be able to have access to the hospital’s Wi-Fi. I would want to be able to not only keep everyone up to date on what was going on with me through various social media sites, I would want to be able to blog. Blogging to me is very important to me. Having my laptop would allow me to have access to music. Without music I would not be able to survive. I would also be able to play games on POGO at http://www.pogo.com/ with my laptop so I could help fight the boredom I would be dealing with.

I would also have plenty of books and comic books by my bedside. I would get extremely bored if I didn’t have access to a variety of reading materials. I would have to make sure that there are plenty of Wonder Woman comic books. Of course the books I would be reading would be Sci-Fi, Fantasy or Mysteries because those are the genre’s that most grab my attention and keep my attention.

Another way I would be spending my time in medical isolation is coloring. I would need plenty of colored pencils, a pencil sharpener and my coloring pages and posters I ordered from Stuff 2 Color at: http://www.stuff2color.com/ Coloring would be quite helpful and relaxing. Plus it wouldn’t take much attention to be able to do especially at the beginning of the month long isolation when I would be feeling at my worst.

I would probably be sleeping a lot to get better. I would most likely be going stir crazy as time went on. I would hope that I would be able to have visitors but not sure if I would able to have any because of being contagious.

Well, I need to end this post for now. I need to finish getting ready for work. Have a wonderful day everyone and peace out!!!

Post-Traumatic Stress Disorder

Posted on September 11, 2015 by Gertie

It’s Friday and that means it is time for my blogging feature. Today, I choose the topic of Post-traumatic Stress Disorder (PTSD) because it is the 14th anniversary of the 9/11 terrorist attacks. I choose this topic in honor of both who perished in the attacks and those who survived it. The information I am about to give you is found at: http://www.mayoclinic.org/. Please remember that myself and the Mayo Clinic are just giving you the facts. I am not a professional so if you need help please don’t hesitate to call your local crisis line or the national suicide hotline that will be included. Again I got the following info from: http://www.mayoclinic.org/.

Definition

By Mayo Clinic Staff

Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Many people who go through traumatic events have difficulty adjusting and coping for a while, but they don’t have PTSD — with time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with your functioning, you may have PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.

Symptoms

Post-traumatic stress disorder symptoms may start within three months of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, or changes in emotional reactions.

Intrusive memories

Symptoms of intrusive memories may include:

Recurrent, unwanted distressing memories of the traumatic event
Reliving the traumatic event as if it were happening again (flashbacks)
Upsetting dreams about the traumatic event
Severe emotional distress or physical reactions to something that reminds you of the event

Avoidance

Symptoms of avoidance may include:

Trying to avoid thinking or talking about the traumatic event
Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

Negative feelings about yourself or other people
Inability to experience positive emotions
Feeling emotionally numb
Lack of interest in activities you once enjoyed
Hopelessness about the future
Memory problems, including not remembering important aspects of the traumatic event
Difficulty maintaining close relationships

Changes in emotional reactions

Symptoms of changes in emotional reactions (also called arousal symptoms) may include:

Irritability, angry outbursts or aggressive behavior
Always being on guard for danger
Overwhelming guilt or shame
Self-destructive behavior, such as drinking too much or driving too fast
Trouble concentrating
Trouble sleeping
Being easily startled or frightened

Intensity of symptoms

PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you’re stressed in general, or when you run into reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

When to see a doctor

If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your health care professional. Get treatment as soon as possible to help prevent PTSD symptoms from getting worse.

If you have suicidal thoughts

If you or someone you know is having suicidal thoughts, get help right away through one or more of these resources:

Reach out to a close friend or loved one.
Contact a minister, a spiritual leader or someone in your faith community.
Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
Make an appointment with your doctor, mental health provider or other health care professional.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

If you know someone who’s in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

Causes

You can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.

Doctors aren’t sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:

Inherited mental health risks, such as an increased risk of anxiety and depression
Life experiences, including the amount and severity of trauma you’ve gone through since early childhood
Inherited aspects of your personality — often called your temperament
The way your brain regulates the chemicals and hormones your body releases in response to stress

Risk factors

People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop PTSD after a traumatic event, such as:

Experiencing intense or long-lasting trauma
Having experienced other trauma earlier in life, including childhood abuse or neglect
Having a job that increases your risk of being exposed to traumatic events, such as military personnel and first responders
Having other mental health problems, such as anxiety or depression
Lacking a good support system of family and friends
Having biological (blood) relatives with mental health problems, including PTSD or depression

Kinds of traumatic events

The most common events leading to the development of PTSD include:

Combat exposure
Childhood neglect and physical abuse
Sexual assault
Physical attack
Being threatened with a weapon

Many other traumatic events also can lead to PTSD, such as fire, natural disaster, mugging, robbery, car accident, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.

Complications

Post-traumatic stress disorder can disrupt your whole life: your job, your relationships, your health and your enjoyment of everyday activities.

Having PTSD also may increase your risk of other mental health problems, such as:

Depression and anxiety
Issues with drugs or alcohol use
Eating disorders
Suicidal thoughts and actions

Preparing for your appointment

If you think you may have post-traumatic stress disorder, make an appointment with your primary care provider or a mental health provider. Here’s some information to help you prepare for your appointment, and what to expect.

What you can do

Before your appointment, make a list of:

Any symptoms you’ve been experiencing, and for how long.
Key personal information, especially events or experiences — even in your distant past — that have made you feel intense fear, helplessness or horror. It will help your doctor to know if there are memories you can’t directly access without feeling an overwhelming need to push them out of your mind.
Your medical information, including other physical or mental health conditions with which you’ve been diagnosed. Also include any medications or supplements you’re taking and the dosages.

Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you.

Make a list of questions to ask so you can make the most of your appointment. For PTSD, some basic questions include:

What do you believe is causing my symptoms?
Are there any other possible causes?
How will you determine my diagnosis?
Is my condition likely temporary or long term?
What treatments do you recommend for this disorder?
I have other health problems. How best can I manage these together with PTSD?
How soon do you expect my symptoms to improve?
Does PTSD increase my risk of other mental health problems?
Do you recommend any changes at home, work or school to encourage recovery?
Would it help my recovery to tell my teachers or work colleagues about my diagnosis?
Are there any printed materials on PTSD that I can have? What websites do you recommend?

Don’t hesitate to ask questions anytime you don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

What are your symptoms?
When did you or your loved ones first notice your symptoms?
Have you ever experienced or witnessed an event that was life-threatening to you or someone else?
Have you ever been physically, sexually or emotionally harmed?
Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
Do you ever feel as if you’re reliving the traumatic event, through flashbacks or hallucinations?
Do you avoid certain people, places or situations that remind you of the traumatic experience?
Have you lost interest in things or felt numb?
Do you feel jumpy, on guard or easily startled?
Do you frequently feel irritable or angry?
Are you having trouble sleeping?
Is anything happening in your life right now that’s making you feel unsafe?
Have you been having any problems at school, work or in your personal relationships?
Have you ever thought about harming yourself or others?
Do you drink alcohol or use illegal drugs? How often?
Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?

Tests and diagnosis

Post-traumatic stress disorder is diagnosed based on signs and symptoms and a thorough psychological evaluation. Your health care provider will likely ask you to describe your signs and symptoms and the event that led up to them. You may also have a physical exam to check for medical problems.

To be diagnosed with PTSD, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

DSM criteria for PTSD

Diagnosis of PTSD requires exposure to an event that involved or held the threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

You experienced the traumatic event
You witnessed, in person, the traumatic event
You learned someone close to you experienced or was threatened by the traumatic event
You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You experience one or more of the following signs or symptoms after the traumatic event:

You relive experiences of the traumatic event, such as having distressing images and memories.
You have upsetting dreams about the traumatic event.
You experience flashbacks as if you were experiencing the traumatic event again.
You experience ongoing or severe emotional distress or physical symptoms if something reminds you of the traumatic event.

In addition, for more than one month after the traumatic event you may:

Try to avoid situations or things that remind you of the traumatic event
Not remember important parts of the traumatic event
View yourself, others and the world in a negative way
Lose interest in activities you used to enjoy and feel detached from family and friends
Feel a sense of emotional numbness, feel irritable or have angry or violent outbursts
Engage in dangerous or self-destructive behavior
Feel as if you’re constantly on guard or alert for signs of danger and startle easily
Have trouble sleeping or concentrating

Your symptoms cause significant distress in your life or interfere with your ability to go about your normal daily tasks.

For children younger than 6 years old, signs and symptoms may include:

Reenacting the traumatic event or aspects of the traumatic event through play
Frightening dreams that may or may not include aspects of the traumatic event

Treatments and drugs

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but often includes medication. Combining these treatments can help improve your symptoms, teach you skills to address your symptoms, help you feel better about yourself and learn ways to cope if any symptoms arise again.

Psychotherapy and medications can also help you if you’ve developed other problems related to your traumatic experience, such as depression, anxiety, or misuse of alcohol or drugs. You don’t have to try to handle the burden of PTSD on your own.

Psychotherapy

Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations. For PTSD, cognitive therapy often is used along with exposure therapy.
Exposure therapy. This behavioral therapy helps you safely face what you find frightening so that you can learn to cope with it effectively. One approach to exposure therapy uses “virtual reality” programs that allow you to re-enter the setting in which you experienced trauma.
Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to traumatic memories.

All these approaches can help you gain control of lasting fear after a traumatic event. You and your health care professional can discuss what type of therapy or combination of therapies may best meet your needs.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.

Medications

Several types of medications can help improve symptoms of PTSD:

Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
Anti-anxiety medications. These drugs also can improve feelings of anxiety and stress for a short time to relieve severe anxiety and related problems. Because these medications have the potential for abuse, they are not usually taken long term.
Prazosin. If symptoms include insomnia or recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA-approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.

You and your doctor can work together to figure out the best treatment, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Tell your health care professional about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.

Coping and support

If stress and other problems caused by a traumatic event affect your life, see your health care professional. You also can take these actions as you continue with treatment for post-traumatic stress disorder:

Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan will help move you forward.
Learn about PTSD. This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively.
Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
Don’t self-medicate. Turning to alcohol or drugs to numb your feelings isn’t healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
Talk to someone. Stay connected with supportive and caring people — family, friends, faith leaders or others. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can offer healing and comfort.
Consider a support group. Ask your health professional for help finding a support group, or contact veterans’ organizations or your community’s social services system. Or look for local support groups in an online directory or in your phone book.

When someone you love has PTSD

The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. PTSD can significantly strain the emotional and mental health of loved ones and friends.

Hearing about the trauma that led to your loved one’s PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can’t fix your loved one or hurry up the process of healing.

Remember that you can’t change someone. However, you can:

Learn about PTSD. This can help you understand what your loved one is going through.
Recognize that withdrawal is part of the disorder. If your loved one resists your help, allow space and let your loved one know that you’re available when he or she is ready to accept your help.
Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
Be willing to listen. Let your loved one know you’re willing to listen, but you understand if he or she doesn’t want to talk.
Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your emotions.
Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive

Prevention

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what’s happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.

Getting support can help you recover. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health provider for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. Support from others may also help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.

Thank you for reading. I realize that this is an extra long post and apologize for its length. I got the above information at the Mayo Clinic at: http://www.mayoclinic.org/. If you need immediate help please call 911. Have a wonderful day. Please don’t forget to take a moment of silence for those who lost their lives in 9/11 as well as for those who survived it.

Writing 101: Finding Your Inspiration; Day Five: Let Social Media Inspire You

Posted on September 11, 2015 by Gertie

Todays assignment is to let social media inspire us. So WordPress suggested using Twitter. They had a handful of Twitter quotes that we could choose from but they weren’t exactly inspiring to me so I looked for a quote that did inspire me. It took me a while to find one and it happens to be one of my all time favorite quotes.

The future belongs…. #quotes #success #dreambig pic.twitter.com/fXf1ZwKbne

— BluChip Marketing (@BluChipMrktng) September 1, 2015

The above quote from Eleanor Roosevelt resonates with me. It resonates with me because I believe that the dreams I have in regards to my future are possible. I believe they are possible because of being in recovery. There was a time where I didn’t believe I had a future or at least much of a future because of my struggles with a mental illness. Being in recovery I realized that my future belongs to me because I see the beauty of my dreams. Plus, I am determined to make my dreams and future come true.

Recovery is an awesome experience and because of recovery I now have the future I have always dreamed of. Have a wonderful day. Peace Out!!

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Writing 101: Finding Your Inspiration; Day Five: Let Social Media Inspire You

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What is DBT?

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Definition

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