The Link Between Mood Disorders and Addiction

About 20% of Americans with an anxiety or other mood disorder (like depression) also have an alcohol or other substance use disorder.

Do you get anxious when you have to speak in front of an audience, take a test, or talk with a superior? Or maybe when you are facing debt, in an argument with someone you care about or at the precipice of a potentially life-altering decision? Every human being faces experiences that cause anxiety, but some feel it more than others. Research indicates that there is a genetic predisposition to anxiety; some of our nervous systems are more prone to anxiety than others. According to the National Institute of Mental Health, nearly 40 million people in the United States have suffered from some kind of anxiety disorder, including panic attacks and phobias. When you face anxiety, how will you handle it?

(Note: While this blog post focuses primarily on the link between anxiety and addiction, I have witnessed, with my clients, that this information can be generalized to other mood disorders as well.)

Individuals who come from unstable families and lack secure attachment often experience generalized anxiety; they may turn to drugs to calm themselves down. Many teens begin to abuse alcohol in their adolescence; it is their way of managing social anxiety.  A friend of mine abused prescription medications after her brother’s suicide; it was her way of muting her overwhelming feelings of loss. Many addicts relapse; it is their way to escape reality. Several of my clients suffering from post-traumatic stress disorder (PTSD) experience major anxiety; they have a difficult time regulating their nervous system responses and often turn to addictive substances for comfort.  Some people, however, face anxiety head on with exercise, self-care, hobbies, a balanced diet, etc. While everyone experiences some form of anxiety or a mood disorder (like depression) during their lives, only some individuals combat their anxiety with addictive substances.

The question begging to be asked is–does a mood disorder like  anxiety or depression cause addiction? No. So is there a link between anxiety and addiction? That answer is a resounding yes. Can it lead to it? Absolutely.

Anxiety consists of the excessive need for control; ignoring psychological and physical signs of stress; the unending need for approval; perfectionism; and strong reactions within the body and mind. The physical and psychological symptoms of anxiety are similar to withdrawal symptoms from drugs and alcohol. An addict will turn to substances, or other addictive behaviors to calm an anxious state. The avoidance of uncomfortable physical agitation and painful emotions are some of the key components that maintain the connection between addiction and anxiety. Both anxiety and addiction strengthen as the addictive behavior continues. Substance abuse can mask anxious feelings preventing the addict from receiving proper treatment for anxiety.

People who experience anxious moments, but who do not have anxiety disorders, will be able to go about their day when the crisis passes; people with anxiety disorders cannot stop the effects of their anxiety disrupting their everyday life. Professional, social, familial, and academic obligations will be interrupted and damaged by the sense of panic, stress, and foreboding that comes as a part of the condition. Social anxiety disorder frequently “travels in the company” of alcohol or drug abuse, as people with social anxiety disorder might try to make use of alcohol or cocaine to help make them feel more comfortable and less inhibited in social settings.

For individuals struggling with anxiety, substances offer an escape. For others, substances bring a feeling of relative normalcy (self-medication). For some, anxiety is a factor of their personality that also includes aspects like impulsivity that make the anxious person more likely to use substances.  Although not entirely understood, there is a connection between anxiety disorders and substance abuse. About 20% of those with an alcohol or substance use disorder also have an anxiety or mood disorder. In fact, many of my clients with an addiction (mostly sex addiction) are self-medicating their anxiety and depression with their addiction! It is also important to note that addiction can happen without any substances; you can be addicted to an eating disorder, gaming, sex, exercise, etc. The point is that mood disorders can either reinforce or be reinforced by addictive substances.

Treating substance abuse without treating the anxiety that causes it is a fruitless endeavor. 

Treating substance abuse without treating the co-occurring disorder can lead to higher rates of relapse. Due to the similarity of drug and alcohol withdrawal symptoms and anxiety symptoms, both need to be treated at the same time. The treatment for anxiety and addiction is referred to as dual diagnosis and it is important to find an addiction treatment facility, or a therapist, that can address both the addiction and the anxiety.

It is only through therapy that clients can make tangible strides towards restoring a sense of balance and stable mental health to their lives. Simply walking away from treatment after detox is ineffective…and might even prove more harmful. Now is the time to address the symptoms of anxiety and addiction that feed off of each other and keep you in the self-defeating cycle. Allow me to help you break the dependence on the substance or behavior, you have used to manage your anxiety and distress, as well as provide sustainable ways to cope with your mood disorder. Happiness is possible. Healing is possible. Contact me today to get started.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.


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Bulimia Nervosa at a Glance

“For me, the bulimia was about stuffing my emotions. So I stopped suppressing my feelings.” ~Cheryl James

My friend’s dad is a dentist; within the first minute of looking into someone’s mouth, he can tell if the person struggles with bulimia nervosa. This is because bulimia–the binging and purging of food–wreaks havoc on a person’s teeth. The acid from the stomach visibly destroys the enamel of the teeth and causes noticeable discoloration. But this particular side-effect of bulimia is only the tip of the iceberg among much more serious consequences that come from this eating disorder and mental illness. Continue reading to learn what it is, what causes it, as well as the symptoms, consequences, and recovery options for bulimia nervosa. 

Even though Derek Zoolander downplays the significance of bulimia nervosa, it is a very serious, potentially life-threatening eating disorder. People with bulimia secretly binge and then purge to get rid of extra calories in an unhealthy and unnatural way. Binging includes discretely eating a large amount of food, within a small amount of time, accompanied by a lack of control during this episode. Purging methods vary from regularly self-induced vomiting, misusing laxatives, weight-loss supplements, diuretics or even enemas after bingeing. Other ways include denying calories to prevent weight gain through fasting, strict dieting or excessive exercise.  The severity of bulimia is determined by the number of times a week that a person purges, usually at least once a week for at least three months. 

The exact cause of bulimia is unknown. Many factors could play a role in the development of eating disorders, including genetics, biology, emotional health, societal expectations and other issues.  Women are more likely to struggle with bulimia than men, but the latter are still susceptible. Bulimia typically begins in the late teens or early adulthood.

Bulimia shares several symptoms with other mental illnesses: Negative self-esteem, problems with relationships and social functioning, difficulty concentrating, poor sleep patterns, withdrawal from friends, etc. Symptoms specific to bulimia nervosa include extreme preoccupation with self-image, body shape and weight; fear of gaining weight; feeling uncomfortable eating around others; trying to “fill up” by ingesting unsubstantial food (ie. condiments), drinking excessive amounts of water or non-caloric beverages, or trying to chew food for an unnecessarily long amount of time; hoarding food in strange places; disappearing after eating (often to purge in a private place); frequently using mints, mouthwash and gum to cover unnaturally bad breath; and maintaining a rigid exercise regimen to “burn off” calories ingested. 

Bulimia nervosa affects far more than how an individual perceives him- or herself or what he/she eats. This eating disorder truly harms a person’s body in the following ways:

  • Unusual swelling of the cheeks or jaw area  
  • Calluses on the back of the hands and knuckles from self-induced vomiting 
  • Bloating from fluid retention  
  • Stomach cramps and other gastrointestinal issues (constipation, acid reflux, etc.) 
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 
  • Dizziness 
  • Fainting/syncope 
  • Feeling cold all the time 
  • Dental problems like enamel erosion, cavities, and tooth sensitivity 
  • Dry skin 
  • Dry and brittle nails 
  • Swelling around salivary glands 
  • Thinning of hair on head, dry and brittle hair (lanugo) 
  • Muscle weakness 
  • Yellow skin (in context of eating large amounts of carrots) 
  • Cold, mottled hands and feet or swelling of feet 
  • Menstrual irregularities
  • Poor wound healing 
  • Impaired immune functioning
  • Dehydration (leading to kidney failure)
  • Heart problems, such as an irregular heartbeat or heart failure
  • Severe tooth decay and gum disease
  • Absent or irregular periods in females
  • Digestive problems
  • Anxiety, depression, personality disorders or bipolar disorder
  • Fertility issues (in women)

Many people with bulimia nervosa also struggle with co-occurring conditions, such as self-injury (cutting and other forms of self-harm without suicidal intention), substance abuse, impulsivity (risky sexual behaviors, shoplifting, etc.), and even diabulimia (intentional misuse of insulin for type 1 diabetes). 

While bulimia nervosa is a very serious mental illness, the good news is that it is not a life sentence. There are many options available for treatment, including medication, support groups and group therapy, and individual therapy. By identifying your triggers, I can help you manage stress and avoid the cycle of binging and purging. Getting support and help often gives you extra strength to fight your eating disorder.  Because bulimia is related to self-image–and not just about food–bulimia can be hard to overcome on your own. Effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications. Contact me today to get started.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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When Self-Regulation Seems Near-Impossible: Borderline Personality Disorder

Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, but are commonly misdiagnosed with PTSD or depression. 

We all have mood swings, and some are more intense than others. As a therapist, I teach my clients how to self-regulate, or soothe, when a strong emotion washes over them; I have to practice those same techniques when I feel an especially heavy emotion. Although many of us are able to regulate our thoughts and emotions with practice, others struggle with it. The diagnosis of Borderline Personality Disorder may shed light for those struggling in this area. My wish is that by introducing this disorder, I may bring hope to those who want to understand and correct the cycles they find themselves stuck in.

Borderline Personality Disorder (BPD) is a condition characterized by difficulty regulating emotions. People who experience BPD feel intense emotions for extended periods of time, which makes it difficult to return to a stable baseline. Ordinarily, people can tolerate the ambivalence of experiencing two contradictory states at one time. People with BPD, however, feel emotions so strongly that they cannot see past whatever they are currently feeling. If they are in a bad state, for example, they have no awareness of the good state. They view things in extremes–all good or all bad. This includes their opinions of other people; an individual who is seen as a good friend one day may be considered an enemy the next. This unpredictable pendulum of emotions affects how they see everything, including themselves and their role in the world, resulting in impulsivity, insecurity, changing interests and values, and self-image issues. Difficulties with self-regulation can also result in dangerous behaviors such as self-harm and suicidal thoughts and behaviors.  

Listed below are the symptoms of borderline personality disorder. While this list is fairly comprehensive, it is important to remember that not everyone with BPD experiences every symptom. Some individuals experience only a few symptoms, while others have many. And these symptoms can be triggered by seemingly ordinary events and then be otherwise dormant.

  • An intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
  • Unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate her”).
  • Distorted and unstable self-image.
  • Risky and impulsive behaviors (excessive spending, unsafe sex, substance abuse or reckless driving).
  • Self-harming behavior (including suicidal threats or attempts, often in response to fear of separation or rejection).
  • Long periods of intense depressed mood, irritability or anxiety.
  • Chronic feelings of boredom or emptiness.
  • Dissociative feelings—disconnecting from your thoughts or sense of identity or “out of body” type of feelings (severe cases of stress can also lead to brief psychotic episodes).
  • Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety
  • Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights

The causes of BPD are not entirely understood, though scientists believe that this disorder is caused by a combination of factors. First, genetics: although no specific gene has yet been directly linked to this disorder, research has found that people who have a close family member with BPD are at higher risk of developing the disorder themselves.  Secondly, environmental factors like abuse or parental separation from a parent during childhood. Third, the neurological makeup is different in individuals with BPD than those without–particularly the parts of the brain which control emotions and decision making. This disorder commonly makes itself manifest by early adulthood.

Borderline personality disorder does not have to dictate your quality of life. Only 20% of the most serious cases necessitate psychiatric hospitalization and the vast majority of those stabilize and lead productive lives after their hospitalization. Please do not get discouraged if you have been diagnosed with BPD; you can learn to live a satisfying life with rewarding relationships. Help is available. Recovery options include therapy, medications, and group, peer and family support. The ultimate goal is for a person with BPD to self-direct their own treatment plan and to learn to regulate their emotions. Contact me to today to get started on the road to healing and recovery.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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The Link Between Insomnia and Mental Illness

“I’ve always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed.”  ~ David Benioff (co-creator of Game of Thrones)

Surely you have experienced a poor night’s sleep. You wake up feeling unrested, groggy, like you got hit by a train… And the fun lasts throughout the day with slow reflexes, foggy brain, inability to concentrate, impatience, stress, worry, anxiety and even headaches. It is absolutely no surprise that sleep quality has a direct impact on your physical and mental health. Today I am going to highlight the connection between insomnia and mental illness, in hopes that those experiencing it can get the help they deserve.

Insomnia is defined as the inability to get the necessary amount of sleep to function efficiently during the daytime. It is a sleep disorder that is characterized by difficulty falling asleep, waking up often throughout the night, having trouble going back to sleep, and waking up too early in the morning. In essence, insomnia results in feeling tired upon waking. Understandably, said fatigue can lead to difficulties functioning during the daytime and have unpleasant effects on work, social and family life. 

You likely already knew all of that about insomnia. But what you may be unaware of is that insomnia can be indicative of more serious issues, including medical issues like sleep apnea, or even mental illnesses like anxiety, depression, schizophrenia, bipolar disorder, and attention deficit hyperactivity disorder (ADHD). Sleep issues can even be a sign of an impending condition such as bipolar disorder. Many existing medical and mental health conditions can be worsened by sleep-related problems because lack of sleep slows recovery from mental illness. People with depression who continue to experience insomnia, for instance, are less likely to respond to treatment for depression. They are also at greater risk of relapse than those without sleeping problems.

Many people do not know there is an undeniable link between insomnia and mental health issues. More than fifty percent of insomnia cases are related to depression, anxiety or psychological stress, and many anxiety disorders are associated with difficulty sleeping. For instance, obsessive-compulsive disorder (OCD) is frequently associated with poor sleep. Panic attacks during sleep may suggest a panic disorder. Poor sleep resulting from nightmares may be associated with post-traumatic stress disorder (PTSD). The severity of sleep issues can determine the type of mental illness a person my experience. For example, early morning wakefulness, low energy, inability to concentrate, sadness and a change in appetite or weight can be indicative of depression. A sudden dramatic decrease in sleep accompanied by an increase in energy (or the lack of need for sleep) may be a sign of mania

Poor sleep patterns can not only be indicative of mental health issues, but it can also significantly worsen them. Insomnia makes it difficult to process and react to appropriately to negative emotions. Severe sleep problems can decrease the effectiveness of certain treatments. Treatment of sleep disorders has also been studied in relationship to schizophrenia, ADHD and other mental illnesses. All of the scientific data shows the connection between medical and mental illnesses: good sleep is necessary for recovery—or prevention—in both types of conditions.

There was a research trial done where fifty-one percent of individuals who overcame depression after psychological treatment (therapy) or medication were still experiencing insomnia. Insomnia tends to persist unless it is directly targeted for treatment. Insomnia can either be short-term or long-term; short-term insomnia is very common and has many causes such as stress, travel or other life events. It can generally be relieved by simple sleep hygiene interventions such as exercise, a hot bath, warm milk or changing your bedroom environment. Long-term insomnia lasts for more than three weeks. This is when you need to be examined by a physician with a potential referral to a sleep disorder specialist (a psychiatrist, neurologist or pulmonologist who have expertise in sleep disorders) for assistance. A balanced diet, regular exercise, meditation and relaxation, good sleeping habits, herbal remedies, medication and therapy are powerful actions that can help relieve insomnia. 

Living with insomnia is hard. The constant exhaustion and inability to sleep is an ailment which may require medical attention to overcome. Remember that insomnia often comes paired with a mental illness. Only as you work through both ailments will you find lasting relief. But it is doable, and I am here to help! Please do not hesitate to contact me today!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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The 5 Chairs of Grief

“Should you shield the valleys from the windstorms, you would never see the beauty of their canyons.” ~ Elisabeth Kübler-Ross

No matter where you live, how old you are, what color your skin is, or your career choice, you will experience loss and grief at some point in your life. It is universal. Maybe it will be from the death of a loved one, the loss of a job, the end of a relationship, the diagnosis of a terminal illness, or a life-altering change. In hopes that I can help someone out there, I wish to share what one of my friends is experiencing in relation to the stages of grief.

A dear friend of hers recently passed away. She was young; she had a husband who adored her, an active one year-old daughter, a lively dog, a new apartment, a flourishing photography business, and an entire life ahead of her. Though she had experienced some fairly serious health issues during her short time on earth, no one thought the common cold would be what would ultimately take her while she slept. Her death shook the community, her family, friends, and many loved ones. She is deeply, deeply missed. In dealing with her loss, my friend has had to confront the five stages of grief in a very real, very personal way. 

The five stages of grief was introduced by a Swiss-American psychiatrist named Elisabeth Kübler-Ross. She did research with terminally ill patients, and published a well-known book called On Death and Dying. Through her work, she identified five common stages of grief her patients all experienced–denial/isolation, anger, bargaining, depression and acceptance: 

  1. Denial and isolation: This can’t be happening… Denial is a common defense mechanism that buffers the immediate shock of the loss, and numbs your emotions. You hide from the facts. Denial is the brain’s way of making sure you do not get too high a dose of grief before you are ready. 
  2. Anger: Where is God in this…? Reality and its pain emerge. You likely do not feel ready. The intense emotions are deflected from your vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family, or even yourself.
  3. Bargaining: If only we had gotten medical attention sooner… This is the need to regain control through a series of “If only” statements. Guilt often accompanies bargaining. You start to believe there was something you could have done differently to have helped save your loved one. You spend time reviewing how different scenarios would have played out, but it does not change your reality.
  4. Depression: She won’t even get the chance to see her kids grow up…Once bargaining no longer feels like an option, you face reality and are hit squarely with an intense sadness. You withdraw from life, left in a fog of intense sadness, wondering if there is any point in going on. When loss fully settles in your soul, the realization that your entire life will be different is understandably depressing.
  5. Acceptance: This is my new reality and I need to learn to live with it… Reaching this stage of grieving is a gift not afforded to everyone. Although most people never stop missing their departed loved ones, the painful emotions they feel shortly after the death nearly always soften with time. This phase is marked by withdrawal and calm. It does not mean you are okay with the loss or that everything is “alright”; this stage is about accepting your new reality without your loved one. You learn to live with it. You accept that life has been forever changed and that you must readjust. You reorganize roles, re-assign them to others or take them on yourself. Finding acceptance may be just having more good days than bad ones. 


The only issue with these stages–what my friend has had to re-learn and what I witness in clients–is that we perceive them to be linear steps. First, you deny it. Then you feel anger. After that you bargain, and so on and so forth until we magically “accept” the loss and all is well in the world. But what happens when you find that you seemed to have digressed back to the first so-called “step” and am in denial again? In her grieving process, she found that she was not progressing neatly from one step to the other. This has helped her see and remember, in a very personal way, that these steps are more like symptoms–they come and go, worsen and lessen with time. And that is okay! 

I like to think of these stages of grief as five chairs. Shortly after loss, you may sit for a solid hour in the denial chair. Then you may get up and move in any direction and sit for any amount of time. Maybe you move from the “denial” chair to sit in “acceptance,” but then you might go back to the denial one for a minute–or anger, or any of the other chairs.  You might feel like you have worked through the anger of losing someone or something valuable, and feel surprised to be feeling anger again. You might think, Wait, I thought I worked through anger. Why is it back all this time later? It is okay. You simply moved chairs. That is normal and you are healing just the way your soul needs to. In your bereavement, you will spend different lengths of time working through each step and express each stage with different levels of intensity. Contrary to popular belief, the five stages of loss do not necessarily occur in any specific order. You will likely play musical chairs and move between stages before achieving a more peaceful acceptance of death. 

If you are experiencing grief, be gentle with yourself. Remember, grief is not a simple process with clean steps that you will complete before moving towards acceptance; rather it is often messy and tangled, with setbacks and delays. People who are grieving do not go through the stages in the same order and may not even experience all of them. So take your time; sit in whatever chair you need to as you work through your loss and know that it is just what you need. As always, please do not hesitate to contact me and schedule a session should you need additional assistance while coping with loss. 

Note: Kubler-Ross herself said that grief does not proceed in a linear and predictable fashion. She regretted that her stages had been misunderstood as steps. The five stages of grief were originally developed to explain what patients go through as they come to terms with their own terminal illnesses; only later were they applied to individuals grieving the loss of someone or something else.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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When Stealing Is a Compulsion, Not a Choice

“A kleptomaniac is a person who helps himself because he can’t help himself.” ~ Henry Morgan

Although kleptomania is a relatively rare mental illness–affecting 6 in 1000 or 1.2 million Americans–you have likely heard someone referred to as a “klepto.”  An example of a public figure, who is thought to struggle with kleptomania, is Winona Ryder, one of the lead actresses from Stranger Things. She was caught stealing over $5,000 worth of designer clothes from Saks Fifth Avenue in 2001.

Kleptomania is a mental health disorder summarized as the recurrent inability to resist urges to steal. Very rarely do kleptomaniacs steal items of great worth; more often than not, they steal items that they do not need, that they could afford to buy, and that have little to no monetary value…like a keychain.  People affected by kleptomania do not compulsively steal for personal gain, on a dare, for revenge or out of rebellion; they steal simply because the urge is so powerful that they cannot resist it. Such episodes nearly always occur spontaneously, with little to no premeditation or forethought. Kleptomaniacs tend to steal from public places like stores and supermarkets. Some may even steal from friends or acquaintances. The stolen items are either stashed away, never to be used, or potentially donated, given away to family or friends, or even secretly returned to the place from which they were stolen. Kleptomania can cause much emotional pain to you and your loved ones if not treated.

Kleptomania vs. Stealing

Kleptomania is different from flat-out stealing. Ordinary theft (regardless of whether it is planned or impulsive) is deliberate and motivated by the usefulness of an object or its monetary worth. Kleptomania, on the other hand, is the recurring impulse to steal items even though said items are not needed for personal use or monetary value. Often a sense of entitlement comes with stealing, a feeling of “I deserve this”. Stealing is driven by need or want; kleptomania is a compulsion. 

Causes

The causes of kleptomania are unknown. Some scientists believe that kleptomania is part of an alcohol or substance addiction. Some think it is due to an imbalance of the brain chemical, serotonin–which helps regulate mood and emotions (low levels of serotonin are common in people prone to impulsive behaviors). Others consider it to be a deviation of an impulse control disorder like eating disorders or obsessive-compulsive disorder.  Although, in theory, anyone can have kleptomania, it seems its onset generally occurs in late adolescence or early adulthood among women. 

Symptoms

Signs of kleptomania are commonly misdiagnosed as everyday theft, but there are a few telltale symptoms and signs that accompany clinical kleptomania, such as the following:

  • Stress
  • Thoughts of intrusion
  • Powerful urges to steal items not needed
  • Inability to resist the compulsion to steal
  • Feeling pleasure, relief or gratification while stealing
  • Release of pressure following the theft
  • Feeling terrible guilt, remorse, self-loathing, shame or fear of arrest after the theft
  • Return of the urges and a repetition of the kleptomania cycle

Effects

Aside from the emotional turmoil that would accompany dealing with the previously listed symptoms, the physical and social effects can include arrest, incarceration, being labeled a thief, developing substance abuse problems, being ostracised from loved ones, losing a job, having poor self-image, and even incurring a criminal record. Additionally, if left untreated, kleptomania can lead to other impulse-control disorders, alcohol/substance abuse, eating disorders, depression, anxiety, and even suicidal thoughts.

Kleptomania comes with a great deal of shame and guilt, as well as the potential for serious legal consequences. Uncontrollable stealing can prevent anyone battling kleptomania from living a productive life. This mood disorder is destructive to both the kleptomaniac and their loved ones, but the good news is that help is available. Although it cannot be cured, kleptomania can be managed with a combination of pharmaceutical and behavioral treatments. I am available to offer professional support to help you or your loved one live a fulfilling life, free from the grips of kleptomania. Please do not hesitate to contact me to today. Help is one click or call away!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Hypochondriasis: When Worrying About Your Health Goes Too Far

“All the powers of imagination combine in hypochondria.” ~ Mason Cooley

If you were to google the symptoms from hunger pains and a low-grade fever, the internet might tell you you have appendicitis or another life-threatening illness. It is likely that you have had something similar happen–thinking a minor sickness is actually something far more concerning. While this may be laughable for many people, some individuals genuinely and subconsciously worry they have contracted (or may contract) a very serious illness from day-to-day life. This type of excessive worry is uncontrollable for some, and is a type of mental illness called hypochondriasis.

While hypochondriasis is the proper name for this illness, you have likely heard of it referred to as health anxiety, illness anxiety disorder, hypochondria, or that someone struggling with this mental illness is a “hypochondriac.” It is defined as the excessive worry of being or becoming seriously ill–even with the absence of worrisome physical symptoms. You may believe that normal body sensations or minor symptoms are signs of severe illness, even if or when a thorough medical exam does not reveal a serious medical condition.

This mental illness, like several others, is difficult in the fact that it is relentless–it never stops. No matter where you go, you worry about germs and contracting deadly sicknesses; it is as if the rest of your life is merely background music to the constant worrying that is hypochondriasis. This severe distress can majorly interrupt your life.

Symptoms of illness anxiety disorder involve preoccupation with the idea that you are seriously ill, based on normal body sensations (like the sounds of a hungry stomach) or minor signs (like a minor rash). Signs and symptoms may include:

  • Being preoccupied with having or getting a serious disease or health condition
  • Worrying that minor symptoms or body sensations are indicative of a serious illness
  • Being easily alarmed about your health status
  • Finding little or no reassurance from doctor visits or negative test results
  • Worrying about a specific medical condition because it runs in your family
  • Having so much distress about possible illnesses that it is hard for you to function
  • Repeatedly checking your body for signs of illness or disease
  • Frequently making medical appointments for reassurance (or even avoiding medical care for fear of being diagnosed with a serious illness)
  • Avoiding people, places or activities for fear of health risks
  • Constantly talking about your health and possible illnesses
  • Frequently searching the internet for causes of symptoms or possible illnesses

The causes for hypochondria are unclear, but there are three common hypothesis. First, you may have a difficult time accepting the uncertainty of an uncomfortable or unusual symptom in your body, which may lead you to search for evidence that would provide a more concrete answer–often resulting in an unnecessarily serious diagnosis. The second option is that you have had a parent or other family member excessively worry about their own or your health. The third possibility is that you have had a past experience with a serious illness that has created an overwhelming fear or paranoia surrounding unusual physical sensations.

The best prevention and treatments for hypochondria are simple. First, see your doctor for your routine check-ups to ensure optimal health. He/she can help reassure you that you are healthy, and this professional diagnosis may be useful to fall back on if you start worrying about your overall health. Second, if you have problems with anxiety, seek professional guidance from a mental health counselor as quickly as possible to help stop symptoms from worsening and impairing your quality of life. Third, learn to recognize when you are feeling stressed, how stress affects your body, and how to manage your stress (think meditation, exercise, a healthy diet, self-care, etc). And lastly, stick with your treatment plan to help prevent relapses or worsening of symptoms.

Just as you would go to a medical doctor with a broken limb or an unresolved alarming health concern, you should see a qualified, trained and experienced therapist to treat your mental needs. Hypochondria is a very real and debilitating mental illness. There is a way to work through your excessive worries and fears of sickness. I am here to help. Please contact me today with questions or to schedule a session.
Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Supporting A Loved One Through Alcohol Addiction

Each Al-Anon Family Group has but one purpose: to help families of alcoholics. We do this by practicing the Twelve Steps of AA ourselves, by encouraging and understanding our alcoholic relatives, and by welcoming and giving comfort to families of alcoholics.

It can be so difficult to know your place if you have a friend or family member struggling with an alcohol addiction. You may not know what to say or how to help; you may feel like their addiction is straining your relationship; you may resent their choices. While it is true that you cannot force a person to get help for alcoholism, there are various ways you can support them and encourage them to seek treatment.

You have likely heard of Alcoholics Anonymous (or AA). In April, I wrote a post that detailed the basics of Alcoholics Anonymous. I tried to cover everything from what it is, to how it started, its main tenets, if it works, and how it applies to those who do not believe in God. I detailed the strength that comes from utilizing this specialized support group of complete strangers who understand the path of the alcoholic’s addiction.  This is a program of recovery for specifically for alcoholics; Al-Anon, however, is different. It is a program of recovery for people who are affected by someone else’s drinking, whether that be a friend or family. It is one of many resources available to support those indirectly affected by alcoholism. This post is dedicated to how you can support a loved one through alcohol addiction.

There is no one exact formula that will tell you how to support someone facing an addiction to alcohol. Every person is different and, therefore, each person’s recovery process will be unique. Some people may rely heavily on their support system and want to involve you in each step during treatment; others may be more reserved and may only come to you when they need a listening ear or want to talk. The best thing you can do for a loved one who is recovering is to motivate and support them every step of the way. Here are several specific ideas for how you can get involved and offer support:

  • Learn about his/her condition. Understanding that, over time, alcohol rewires a person’s brain and causes it to function differently, sheds light on why he/she cannot simply choose to stop drinking alcohol.
  • Know the warning signs. Some signs are recognizable while others are subtle. Several telltale signs of a potential drinking problem are irrational behavior, lack of interest in hobbies and ignoring responsibilities. (This step is particularly important for those who have not yet recognized the need for help to overcome an alcohol addiction.)
  • Offer to help research alcohol rehab programs and types of therapy. Deciding on where to go for treatment is one of the most important factors in a person’s recovery journey.
  • Attend support group meetings or counseling sessions with your loved one. This will give you insight to their journey as well as guide you in how to handle different situations. (AA meetings are generally open, which means you can attend with your loved one. These meetings offer a great deal of support and advice for living with someone who has a drinking problem.)
  • Attend Al-Anon meetings. Just as those facing alcohol addiction will attend AA meetings, you should attend Al-Anon meetings. Here you will find support as you meet others who also love someone with an alcohol addiction, and will be able to personally work through the 12 steps of Al-Anon. Visit this website to find a meeting near you.
  • Help with the post-rehab recovery plan. Be constant as your loved one navigates life as a recovering addict.
  • Be optimistic. Addiction recovery is a steady uphill battle that will come with victories and defeats. When setbacks come, try not to be critical and face the future with hope. When progress occurs, celebrate it and continue pushing forward.

Family and friends should understand that the recovery process can come with many ups and downs–for both parties. When things get difficult, remember that having a steady support system will make a profound difference for your loved one. Your support will surely influence whether or not he/she seeks help for their drinking problem, will buoy him/her through treatment, and will increase the likelihood that he/she will maintain sobriety after treatment. Your role is crucial!

More than 15 million people struggle with an alcohol use disorder in the United States, but less than eight percent of those receive treatment.  Alcoholics Anonymous is a free resource available to all that will offer tools to both the individual facing the addiction, as well as his/her loved ones. Alcoholism affects everyone, including family members and friends of the alcoholic. This can damage relationships and cause you to feel a wide range of emotions like disappointment, anger, doubt and denial. Although your primary goal is likely to get your loved one help, be sure to get the help you might also need. In many instances, speaking with a counselor is helpful and even necessary. If you feel you could use professional help, I invite you to contact me today or schedule a session. Whether you are the one facing the addiction, or the one offering support, I am here to help you every step of the way!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Continuing the Conversation on Teen Suicide: How to Help

“Don’t you know things can change / Things’ll go your way / If you hold on for one more day / Can you hold on for one more day?” ~ ”Hold On” by Wilson Phillips

Our community has felt the rippling effects of tragic suicides over the last year. We continue to grieve the loss of students and loved ones we miss so dearly. We know our community is not the only one experiencing the difficult aftermath of suicide, so we want to raise our voice to raise awareness.

Over the last few months, I have written two posts on the subject of teen suicide. Because this is such an important topic, I decided to split up my posts to do each one justice. First, I gave a general overview of teen suicide. Then I discussed the warning signs. Finally, I want to offer my personal and professional advice about how you can help.

National Suicide Prevention Hotline (24 hours a day): 1-800-273-8255

As I said, I dedicated an entire post to the warning signs someone considering suicide will likely exhibit. Please refer to that for a greater understanding on that subject. The main indicators are suicidal talk, self-harm, hopelessness, and neglecting appearance/friends/important activities.

If you see any of these warning signs in a friend or family member, the first thing you could do is talk about it. While it may be uncomfortable to discuss suicidal thoughts and behaviors, it may end up curbing a suicide attempt and saving a life. It is worth it! Some ideas to start this conversation could be something like, “I have been feeling concerned about you lately,” or, “Recently, I have noticed some differences in you and wondered how you are doing.” Similarly, you could say, “I wanted to check in with you because you have not seemed yourself lately.” If the person admits to feeling suicidal, you can then ask things like, “When did you begin feeling like this?” or, “Did something happen to make you start feeling this way?” as well as, “How can I best support you right now?” and even, “Have you thought about getting help?” Finally, words of comfort might include, “You are not alone in this. I’m here for you.” Another powerful idea is, “I may not be able to understand exactly how you feel, but I care about you and want to help,” as well as, “When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.”

If someone confides in you that he/she is considering suicide, evaluate the seriousness of the situation. Those at the highest risk for committing suicide in the near future have a specific suicide plan, the means to carry out the plan, a time set for doing it, and an intention to do it. Here is a suggestion for how to assess someone’s risk to suicide:

Low: Some suicidal thoughts. No suicide plan. Says he or she won’t attempt suicide.

Moderate: Suicidal thoughts. Vague plan that isn’t very lethal. Says he or she won’t attempt suicide.

High: Suicidal thoughts. Specific plan that is highly lethal. Says he or she won’t attempt suicide.

Severe: Suicidal thoughts. Specific plan that is highly lethal. Says he or she will attempt suicide.

National Suicide Prevention Hotline (24 hours a day): 1-800-273-8255

If it seems the person is in the low to moderate range, offer empathy and a listening ear. Let your loved one know that he or she is not alone and that you care. A teen’s school counselors, teachers, or administration are trained and equipped to help too! If you are afraid to talk to someone face to face, call or text a crisis line for advice and referrals. Where applicable, you can help your friend/family member locate a treatment facility or take them to doctor appointments. Overall, I highly recommend encouraging the person to see a certified mental health professional as soon as possible.

If the person is in the high to severe ranges, and a suicide attempt seems imminent, call a local crisis center, dial 911, or take the person to an emergency room immediately. Remove anything that could be potentially harmful, like guns, drugs, knives, and other lethal objects from the vicinity. Do not, under any circumstances, leave a suicidal person alone!

If you are the one experiencing suicidal thoughts or feelings, surround yourself with people you trust and get help. There are so many resources available today, including the National Suicide Prevention Hotline (24 hours a day at 1-800-273-8255) as well as counselors in the schools. They can be trusted to help you. Remember that suicide closely affects at least six people–often many more! Absolutely no one will be better off with you gone…quite the contrary, actually. You matter. You are worthy of love and life. Life is worth fighting for. Do not give up on yourself!

A suicidal person may not ask for help, but that does not mean help is not wanted. People who take their lives do not want to die—they simply want to escape the hurt. Suicide prevention starts with recognizing the warning signs and taking them seriously. If you think a friend or family member is considering suicide (or if you are considering taking your own life), be brave. Speak up. Get help. Talking openly about suicidal thoughts and feelings can save a life, including yours!

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Continuing the Conversation on Teen Suicide: Warning Signs

“There’s no need to go and blow the candle out / Because you’re not done. / You’re far too young / And the best is yet to come.” ~”Lullaby” by Nickelback

Suicide is devastating to family, friends, and a community. The loss from suicide leaves a gaping hole in families, neighborhoods, schools, and communities; each suicide intimately affects at least six other people. Parents, siblings, classmates, coaches, and neighbors may be left wondering if they could have done something to prevent that young person from turning to suicide. In this post I will go over the suicide warning signs someone who is contemplating suicide might exhibit. In a future post, I will discuss how to help this person, or get help if you are the one considering suicide.

The World Health Organization estimates that approximately 1 million people worldwide die each year from suicide. For those who are not in the grips of suicidal depression and despair, it may be difficult and even confusing to understand what would drive so many individuals to take their own lives. However, a suicidal person is in so much pain that he or she can see no other option. This is why knowing what to look for can prevent suicide and provide help and hope as an alternative.

National Suicide Prevention Hotline (24 hours a day): 1-800-273-8255

WARNING SIGNS

There are many potential warning signs to suicide; the following are some of the most common red flags to look for:

  1. Self-harm or suicidal talk. Take any talk or mention of suicide very seriously. This is not just a warning sign, it is a cry for help!
  2. Talking or writing a lot about death or dying.
  3. Hopelessness. Though subtle, studies have found that hopelessness is a strong predictor of suicide. This hopelessness is often accompanied by “unbearable” feelings, a bleak future, and feeling like there nothing to look forward to.
  4. Loss of interest in day-to-day activities.
  5. Neglect of his/her appearance.
  6. Big changes in eating or sleeping habits.
  7. Withdrawing from friends and family. Increasing social isolation and the desire to be left alone.
  8. Dramatic mood swings or sudden personality changes, such as switching from outgoing to withdrawn or well-behaved to rebellious.
  9. Self-loathing and self-hatred. Feelings of worthlessness, guilt, shame, and self-hatred; feeling like a burden that no one would miss.
  10. Self-destructive behaviors. Increased alcohol or drug use, reckless driving, unsafe sex.
  11. Seeking out lethal means, such as weapons and drugs.
  12. Getting affairs in order. Making out a will, giving away prized possessions, making arrangements for family members.
  13. Saying goodbyes. This might include unusual or unexpected visits or calls to family and friends and saying goodbye to people as if they will not be seeing each other again.

These signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide. Take these red flags very seriously!

National Suicide Prevention Hotline (24 hours a day): 1-800-273-8255

If you see or experience any of these warning signs, do not dismiss them! I will write a detailed post on what to say and how to help in these situations next week. If you need immediate help, I suggest approaching a teacher or school counselor–they are trained to assist you and your classmates with this delicate yet urgent matter. Additionally, the National Suicide Prevention Hotline is available for calls and chats 24 hours a day (1-800-273-8255), and most communities have hotlines you can text for immediate anonymous help. In dire circumstances, call 911.

Knowing these warning signs could save a life. Pay attention to your peers. As always, please do not hesitate to contact me with questions. If you are battling thoughts and feelings of hopelessness and self-harm, please click here to schedule a session. My door is always open for you!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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