Different Yet the Same: OCD & OCPD

For many, OCD (obsessive-compulsive disorder) means avid hand-washing, excessive organizing, color-coding and deep cleaning. Though associating OCD with these habits isn’t exactly wrong, it leaves out an important part of the picture.

You may be familiar with Jack Nicholson in As Good As It Gets who plays the part of an author with OCD. Throughout the film, he engages in ritualistic behaviors (also known as compulsions) that disrupt his interpersonal and professional life.  To avoid contaminants outside of his apartment, he wears gloves in public and warns pedestrians not to touch him. He refuses to use restaurant silverware and instead brings his own plastic utensils wrapped inside a protective bag. And upon returning to his orderly apartment, he immediately disposes of the gloves and commences a multi-step cleansing ritual by washing with scalding hot water and multiple new bars of soap.

This is a common portrayal of obsessive-compulsive disorder. You are likely familiar with this disorder, especially because it is common to joke about yourself or others being, “so OCD,” or overly tidy. In this post, I will delve deeper into OCD and explain the differences between this disorder and its closely named counterpart, OCPD.

Obsessive-compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder defined by the presence of obsessive and compulsive behaviors. These behaviors occur together and interfere with a person’s quality of life and ability to function. Individuals with OCD have frequent, upsetting thoughts (obsessions) that they try to control by repeating particular behaviors (compulsions). This cycle sparks a great deal of anxiety because it is not only intrusive and unwanted, but also recurrent. All else gets paused until the compulsion is appeased.

OCD is a genetic predisposition and it usually makes its first appearance in childhood or adolescence. It is often triggered by a stressful or traumatic experience. The behaviors of individuals with OCD are driven by fear, anxiety, and uncertainty. They are aware their thoughts are irrational, but their fear and anxiety is the reason behind their compulsions. Many individuals suffering from OCD seek treatment to alleviate their anxiety.

Obsessive-compulsive Personality Disorder

Obsessive-compulsive personality disorder (OCPD) is a personality disorder defined by strict orderliness and control over of one’s environment at the expense of all else. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) describes OCPD as “a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.” Individuals with OCPD tend to think their way of doing things is the only way, and they are unlikely to delegate unless they know people will do things as well as they do. Their perfectionism keeps them at a high standard, so though they succeed at work, they are difficult to work with. They show unhealthy perfectionism and want to be in control of what is going on around them. They are judgmental, controlling, and stubborn. People with OCPD are difficult to live with and relationships suffer. They often feel paralyzed and unable to make decisions because they fear making the wrong one. They even struggle getting rid of items that no longer have value, which often leads to hoarding.

This disorder is usually diagnosed in late adolescence or young adulthood. It is approximated that men are twice as likely as women to be diagnosed with OCPD.

Juxtaposition

These two disorders have a few shared traits that connect them–a fear of contamination, a preoccupation with symmetry, and a nagging sense of doubt. If you are still unsure of the difference between these two disorders, allow me to further compare and contrast them:

  1. OCD is an anxiety disorder while OCPD is a personality disorder.
  2. Studies indicate that those with OCD are continually in search of immediate gratification, while those with OCPD can delay immediate reward.
  3. The symptoms of OCD tend to fluctuate in association with the underlying anxiety. Because OCPD is defined by inflexibility, the behaviors tend to be persistent and unchanging over time.
  4. Persons with OCD will often seek professional help to overcome the irrational nature of their behavior and the persistent state of anxiety they live under. Persons with OCPD will usually not seek help because they do not see that anything they are doing is abnormal or irrational.
  5. Individuals with OCPD do not experience an OCD cycle.

I want to elaborate on that final point, because it is the best way to differentiate OCD from OCPD. The key difference between the two is the cycle that sufferers experience, or the trigger. Those with OCD may constantly notice things out of place (trigger), and they will obsess over “fixing” the problem (compulsion) to the point that they are unable to focus on other tasks. If they do not appease their compulsions, anxiety will mount. Once the time is taken to “fix” things, they feel relief…until the next trigger appears. With OCPD, the behaviors are not directed by uncontrollable thoughts or irrational behaviors that are repeated over and over again. These individuals fully believe that their actions have an aim and purpose, and they consistently act this way, independent of their circumstances or surroundings. In other words, their actions are not triggered by anything, but are instead simply they way they operate.

Treatment

Living with OCD or OCPD can be difficult and even debilitating. Symptoms can wax and wane, getting better at times and worse at others. The good news for individuals who have either one (or both!) is that help is available. With appropriate treatment, these disorders can be managed to the point that the disruption to their lives is minimized. Treatment may involve a combination of psychotherapy, medication, and mindfulness techniques. To come to an informed diagnosis and find appropriate treatment, it is important to seek the care of a qualified mental health professional, such as a psychiatrist or psychologist. My door is always open to answer questions or offer therapy sessions. Click here to schedule with me today!

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

Resources:

Phobias: When Fear Becomes Debilitating

Scared woman covering mouth Free Photo

You are probably aware of the more common phobias, such as arachnophobia (fear of spiders) and claustrophobia (fear of enclosed spaces). But did you know there are also words which describe the fear of dawn, glass, and poverty? Read on to learn the 411 on over 200 phobias in existence today.

I sometimes joke that I have arachnophobia. I hate spiders. I am honestly sheepish to admit how much they terrify me and that I often need help to get rid of them! I know that my fear is irrational, but I cannot help it. I also recognize that my small fear of spiders is nowhere near as debilitating as any of the actual phobias that an estimated 19 million Americans face. Today I want to give an overview of phobias and urge you, or anyone living in fear caused by a phobia, to get help.

A phobia is a type of anxiety disorder that causes an individual to experience extreme, irrational fear about a situation, living creature, place, or object. The way you know you have a phobia is if you are organizing your life around avoiding whatever causes your fear. The impact of a phobia can range from annoying to severely disabling. People with phobias often realize their fear is irrational, but they are unable to do anything about it. Such fears can interfere with work, school, and personal relationships.

What causes a phobia? As with most mental illness, both genetic and environmental factors can play a part. For instance, a child who has a close relative with an anxiety disorder is at risk of developing a phobia. Distressing events, such as nearly drowning, can bring on a phobia. Exposure to confined spaces, extreme heights, and animal or insect bites can all be sources of phobias. People with ongoing medical conditions or health concerns often have phobias. There is also a high incidence of people developing phobias after traumatic brain injuries. Substance abuse and depression can often be connected to phobias.

We are most familiar with a phobia connected to a specific trigger, or a specific phobia. Aside from this, there are two additional types of phobias recognized by the American Psychiatric Association (APA):

  • Specific phobia. An intense, irrational fear of a specific trigger, like snakes, spiders, or heights. Specific phobias are known as simple phobias as they can be linked to an identifiable cause that may not frequently occur, thus not significantly affecting day-to-day life.
  • Social phobia or social anxiety: The idea of large social gatherings is terrifying for someone with social anxiety. This is a profound fear of public humiliation and being singled out or judged by others in a social situation. Social phobias are complex, as it is harder to avoid triggers, such as leaving the house or being in large crowds.
  • Agoraphobia: This is the fear of a situation that may cause you to panic and make you feel trapped, helpless or embarrassed. You may fear using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd. This is also a complex phobia because day-to-day life is surely affected.

Phobias are diagnosable mental disorders. There is hope in overcoming them! In saying so, I do not wish to minimize any one phobia. Phobias are more serious than simple fear sensations. Many individuals are aware that their phobia is irrational, but they cannot control the fear reaction. Some phobias may even cause physical symptoms like sweating and chest pains.

The beautiful news is that treatment is available. Phobias are much more widely understood today, and treatment often includes medication and behavioral therapy. If you have a phobia, it is critical that you seek treatment.  You do not need to live your life at the mercy of your fear! With treatment, you can learn to manage your phobia and live the happy, free and fulfilling life you want to. Please contact me today or click here to schedule your first session. You know I am more than happy to help!

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

Resources:

Oxford Dictionaries: “List of Phobias”

Living with Anxiety: 5 Suggestions to Thrive

Living-with-Anxiety-Cluff-Counseling-Lewisville-Therapist

“Worry never robs tomorrow of its sorrow, it only saps today of its joy.” -Leo Buscaglia

We all experience some level of anxiety from time to time. In fact, anxiety is a completely normal reaction to a stressful situation. The cold sweat of anxiety is the fight or flight response that kept our ancestors safe from grizzly bears and other dangers. That adrenaline rush still serves us well under some circumstances today; anxiety can even be helpful in certain instances! We worry about the common things in our lives–like finances, work, friends, and family–and this worry has the potential to help us make good decisions in these areas. Anxiety can motivate us, prepare us for things we have to face, and even give us energy to take action when we need to.

It is very possible, however, for anxiety to have an unmistakably negative affect. Serious anxiety may mean procrastinating to the point of being afraid to take a step at all. You may be so nervous about going to your child’s school to talk to the teacher that you do not go at all–you miss the appointment altogether. Your anxiety becomes so overwhelming that it interferes with day-to-day activities, it keeps you from going places, and from doing things you need to do. If you are experiencing worries that are excessive, uncontrollable, or irrational, and have been experiencing these worries for an extended period of time, you may be suffering from Generalised Anxiety Disorder, or GAD.

Regardless of the level or intensity of anxiety you are experiencing, it is important that you manage it properly. Anxiety can take a serious toll on your mind and body. You may have trouble sleeping, eating, and concentrating. You may get headaches or have an upset stomach. You may even have a panic attack, a pounding heart, and/or a feeling of lightheadedness. So what can you do when you are feeling anxious? Here are five simple suggestions that you can do anytime, anywhere:

  1. Label your emotions. Figure out exactly what is bothering you by giving a name to what you are feeling. Naming an emotion is the first step in being mindful of it. This activates your prefrontal cortex and can help you balance and self-regulate by creating a relationship with the experience.
  2. Drop the story. Emotions are often driven by the stories you tell yourself. For example: You have an important presentation in class. Your anxiety escalates this assignment into a fantastically worrisome story where you mess up, everyone laughs at you, you fail the class, never graduate college, have to live with your parents forever… and on and on. My suggestion here is to drop the story. Separate the real risks and dangers that a situation presents and those your imagination is making worse. Cut out negative thoughts. No need to worry unnecessarily!
  3. Focus on the task at hand. What can you control? In the class presentation example, what you can control is your preparation and delivery. Try not to stress about peripheral factors–like how others may react or respond. It is a twist on the old adage: “Take control of the things you can, and accept those you can’t change.”
  4. Relax. Stop what you are doing and take deep breaths. Meditate. Do yoga or get some exercise–this is a terrific outlet for anxiety! As you focus on calming your mind and body, you will become more proficient with managing ongoing anxiety.
  5. Be kind to yourself. Feeling anxious is uncomfortable. A good dose of self-care can go a long way to bringing relief and perspective. This may mean practicing a hobby like painting, hiking, singing, baking, exercising, reading, taking a long bath or even sleeping. Whatever self-care looks like for you, make the time to take care of yourself.

Very often, it is possible to get past an anxiety cycle with the help of friends or family to help you sort out your problems. But when anxiety becomes overwhelming, it may be time for you to consider seeing a therapist, taking medication, or both. Anxiety is the most common mental illness among American adults–with women experiencing it at roughly twice the rate as men–and only half of those affected receive treatment.  Please do not be part of that statistic. Get the help you need and deserve in order to find happiness. Many of my clients face some form of anxiety, and I have been able to help them overcome the negative effects that come with this mental illness. If you or someone you care about could use help living with the effects of anxiety, please contact me today. Additionally, you can click here 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.

Resources:

The Truth About Men and Depression

The Truth About Men & Depression - Cluff Counseling - Lewisville TherapistAlthough women are more likely to attempt suicide due to depression, men are 4x more likely to succeed. This means that the suicide rate is 4 x greater in men than in women! I believe that talking about and raising awareness about men and depression will hopefully set in motion some necessary changes to our societal stigmas.

Certain stigmas, in our society, have become widely believed despite the fact that they are inaccurate or untrue. Last month I addressed one of these in my blog post about women who face pornography addiction–in hopes to dispel the misnomer that men are by and large the ones to become porn addicts. This month, I wish to speak to another fallacy: that women are the main ones who face depression. Last May I wrote a general post on Depression entitled “Depression is Not a Life Sentence”, Today I want to build on that foundation and hone in on a more specific group suffering from depression: MEN.

There is a wonderful book by Terrence Real entitled, I Don’t Want to Talk About It which addresses this issue head on. I highly recommend reading it if you or a male loved one is battling depression. It is a compelling read uncovering the frightening fact that just as many men face depression as women, but only a fraction get help.  He writes about how these men battling depression often go undiagnosed because they do not want to tell others for fear of no one listening or of damaging their image.

The truth is that everyone feels sad or irritable and has trouble sleeping once in a while. But these feelings pass after a little while–usually a couple of days. Depression, on the other hand, is a common yet serious mood disorder that has symptoms that do not dissipate with time. Depression affects one’s ability to feel, think, and handle daily activities.  To be diagnosed as depression, these symptoms must be experienced for at least two weeks.

Signs and symptoms of depression in men

Just like with any illness or mental illness, there are a plethora of symptoms, but the common depression symptoms include the following:

  • Anger or irritability
  • Feeling anxious or restless
  • Loss of interest in work, family, or hobbies
  • Problems with sexual desire and performance
  • Feeling sad, empty, or hopeless
  • Difficulty concentrating or remembering details
  • Fatigue, not being able to sleep, and/or oversleeping
  • Overeating
  • Loss of appetite
  • Thoughts of suicide or suicide attempts
  • Physical aches or pains, headaches, cramps, or digestive problems
  • Inability to meet the responsibilities of work, caring for family, or other important activities
  • Engaging in high-risk activities
  • A need for alcohol or drugs
  • Withdrawing from family and friends; isolation.

Every man will respond to his depressive feelings differently. Some may exhibit several of these behaviors while others may only experience a few.

Causes of depression in men


Current research suggests that depression is caused by a combination of risk factors including genetics, environmental stressors (like financial problems, loss of a loved on, major life changes, or any stressful situation), and illness (particularly serious illnesses like diabetes, cancer, heart disease or Parkinson’s disease). There is no difference with how men and women arrive at depression–it is a chemical imbalance in the brain. Studies suggest you are at greater risk of developing depression if you’ve suffered a severe loss as a child, an overwhelmingly stressful event as an adult, or you have a family history of depression.

Regardless of how one develops depression, men react differently than women.  When men experience depressive episodes, they retract completely from their social circles. One man reported that he did not want to get out of bed or leave the house, that his depression took over his life. He said, “Men are not supposed to be depressed. Men are supposed to be the providers, the pillar of strength, the one everyone else turns to. You can’t talk about it because…you don’t want to admit any weaknesses.” Men facing depression feel ashamed and embarrassed, which leads them to internalize their struggle with depression, close themselves off from others, and not seek professional help. This greatly affects their work performance, their relationships, as well as their self-image and self-worth. Many men who feel depressed enter into this negative cycle of denying/ignoring their symptoms, isolating themselves, experiencing diminished self-worth, and not receiving treatment. It is likely because of this that men are four times more likely to commit suicide than women!

Treatment for with depression

Now knowing that both men and women can experience depression, let’s talk about treatment. These suggestions are not gender specific. Such suggestions include spending time with friends, family, or coworkers; increasing your level of physical activity (particularly important for men who are supposed to be masculine and strong); breaking large tasks up into small ones; delaying important decisions until you feel better; keeping daily routines; and avoiding alcohol, drugs, or harmful substances. These are suggestions that will help if are not yet ready to receive professional help.

For those that have had enough and are ready to stand up to depression, here is my plea: Remember that help is available! To effectively treat depression, a combination of medication and therapy is recommended–regardless of gender.  If you are struggling with depression, it is okay to ask for help. I want to support you. I want to offer you hope! The amazing news is that researchers has proven that between talk therapy and medications, about 80 percent of depression cases can now be treated effectively–for both women and men! In reality, the risks of untreated depression far outweigh those of taking antidepressant medications under a doctor’s supervision. You do not need to carry the heavy burden of depression any longer. Please, contact me today or click here to schedule a session. You are not alone! Help is out there!

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

Resources:

Practical Ways to Practice Mental Hygiene

Mental Hygeine - Cluff Counseling, Lewisville Marriage & Family TherapistOver the last few years, much progress has been made in understanding how to take care of ourselves physically–we see the value in exercising, eating healthy, and taking advantage of modern medicine. We believe in maintaining our physical hygiene and encourage our children to take care of themselves, too. But are you doing anything to take care of your minds?

Let’s change that!

Think about it. Once or twice a day we brush our teeth–even before there is a cavity. We exercise regularly and we try to eat a balanced diet because we know it is good for our heart health and our bodies in general. We wear sunscreen to prevent skin cancer. We eat vitamins to  ensure we are getting the necessary nutrients. All this to maintain our physical health. But what are we doing for our mental hygiene?

Just like doctors who take care of us physically, psychologists and therapists are most certainly available when there is a mental health problem. Yes, therapists and psychologists are trained to understand mental illness and a certain level of dysfunction, but what can we preemptively do to take care of our mental health…before there is a problem necessitating a trained individual? In this blog post, I will first define mental hygiene, explain why it is necessary to maintain, and I will end by giving some ideas for how to stay on top of your mental health.

What is mental hygiene?

We need to take care of our minds just as much as we need to take care of our bodies!  Mental hygiene is simple. Basically, it entails redirecting your thoughts to be more uplifting and positive, managing stress in a productive manner, and having a healthy inner dialogue. Allowing anything that is uplifting and good into your life is practicing mental hygiene. It is focusing on the good instead of lingering on the negative. You might find that this is best done for you through praying, meditating, getting out in nature, or maybe you are unsure. Keeping up on your mental hygiene will prepare you for and help prevent the roadblocks of failure, rejection, and disappointment that life will inevitably deliver. Read on for strategies on how to practice mental hygiene, which will help you recover from mental injuries as well as develop mental resilience.

Why practice mental hygiene?

Life is hard. There are certain experiences we all go through that may be roadblocks to positive mental health, but we can recover from them if we practice good mental hygiene. The first roadblock to positive mental health I would like to mention is failure. Our initial inclination is to make excuses, retreat, or give up. But if we are actively trying to practice healthy mental hygiene, we can instead recognize and remember that failure is an incredibly valuable teacher and we will all experience failure at some point. Then, we can evaluate why we failed and make a plan for success in the future. See the difference? By practicing healthy mental hygiene, we can have a healthy mindset around failure even before we fail and sets us up nicely to respond to failure in a healthy manner in the future (because we are sure to face it again!).

The second inevitable roadblock to positive mental health is rejection and judgement. Unfortunately, we all judge because it is part of our human nature. And sometimes that judgement is pointed at us. When other people judge or dislike us, it hurts. Our natural tendency is to get defensive or reflect those negative feelings onto others. What practicing good mental hygiene means here is that we will remember that other people’s opinions are the variable…not us! If someone does not like us, that absolutely does not mean we are not loveable!  Instead of getting defensive and upset by what other people think about us, we will focus on positive emotions, take their criticisms constructively, and remember our self worth. Practicing good mental hygiene means that we will be able to separate our worth from what people think about us–which is hard and takes practice.

The final roadblock practicing good mental hygiene can prepare us for is disappointment. Whether this disappointment is unmet expectations or tragic news (like sickness, death, financial instability, infidelity, etc), it is bound to happen at some point or another. Our natural tendency is to respond poorly, possibly even shut down or shut others out. But if we are practicing healthy mental hygiene, we can respond in a positive way, manage our stress effectively, self-regulate or manage our emotions. It is impossible to prepare for this type of mental roadblock specifically, but we can prepare for how we will respond by taking care of our mental health. This means that we must know how we react in stressful situations, be able to practice gratitude during difficult times, ask for help, find an outlet, and many other possibilities.

How do I practice mental hygiene?

You might be feeling like you have no idea how to take care of your mental hygiene. I understand that mental hygiene might seem like a new idea even still, but there are so many things you might already be doing or want to be doing that will help you take care of your mental health. The following list of ideas will provide simple ideas on how you can start to improve your mental health today:

  1. Focus on the good things in your life.
  2. Track gratitude and achievement in a journal.
  3. Set up a getaway (check out this post from last week on how traveling will benefit your relationship!).
  4. Use your talents/strengths.
  5. Mindfully set some goals.
  6. Get creative! Try a new recipe, paint, pick up an instrument…
  7. Make someone else feel loved (cue Love Languages).
  8. Eat dark chocolate. Seriously, it boost brain power!
  9. Open up. Whether it is to your partner or a confidant, on social media, in a journal, or with a therapist, do not bottle up your emotions.
  10. Color. Yes, it may seem childish, but it will help clear your mind.
  11. Laugh. Comedic relief is real.
  12. Unplug. Try doing a digital detox or going off the grid to get some clarity.
  13. Dance. It truly reduces cortisol, the stress hormone!
  14. Take a warm bath.
  15. Do animal therapy. Fuzzy friends always make everything better.
  16. Tour your own town.
  17. Meal plan and prep. It will offer some control over your week!
  18. Practice forgiveness. The people who forgive have better mental health and report being more satisfied with their lives.
  19. Smile. It really helps!
  20. Send a thank you note.
  21. Exercise or get outside.
  22. Get some sun. Vitamin D is a mood elevator.
  23. Eat well, drink lots of H20, and avoid drugs and alcohol.
  24. Surround yourself with good people.
  25. Quiet your mind.
  26. Practice positive affirmations.
  27. Sleep!

Does mental hygiene make a little more sense now? Another term for practicing mental hygiene is mindfulness. Taking care of our minds is something we need to do each and every day; all of the suggestions above can be carried out regularly and will not require much time or money to accomplish. When you find what works for you, try to incorporate that good habit into your life–make it a regular practice. I assure you that you will feel its effects in your life!

And as always, one of the best things you can do for your mental health is to get help. Even before there is an actual problem–or a mental illness. Get help. Trusting a licensed, experienced therapist can be one of the healthiest things you will ever do for your mental health. Contact me with questions or click here to schedule a session today.

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

Resources:

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Are You Are Just A Worrywart or is it Something More?

Are You Are Just A Worrywart or is it Something More - Cluff Counseling - Denton TherapistAnxiety disorders are the most common psychiatric illnesses affecting children and adults. An estimated 44 million American adults suffer from anxiety, and–even though the disorders are highly treatable–only about one-third of those receive treatment!

Do you get the jitters when you have to speak in front of an audience, take a test, or talk with a superior. To a degree, this is completely normal. But for those with an anxiety disorder, these feelings are persistent, seemingly uncontrollable, disabling, overwhelming, and excessive, to the point where they can be filled with irrational dread of everyday situations and it interferes with their daily life. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time.

If this is you, listen to me–there is no shame! Many people suffer from one type of anxiety disorder or another…even I used to! When I was little, I would fret over everything to the point that my parents coined Bob Marley’s famous beat as my theme song: “Don’t worry, be happy!” The best news of all is that help is available. My hope with this post is twofold: First, to offer a couple signs to help you differentiate between everyday anxieties and an actual anxiety disorder; and second, to eradicate the false notion that having anxiety or a “disorder” means that you are broken.

Let’s start by giving anxiety disorders a face. Anxiety disorders are real–just like physical disorders such as heart disease or diabetes. Anxiety disorders are the most common and pervasive mental disorders in the United States, and they manifest themselves in many different forms including the following: Generalized anxiety disorder (GAD), panic attacks, agoraphobia, social anxiety disorder, separation anxiety, Irritable Bowel Syndrome (IBS), obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), and depression.

I am certain that all of us have either experienced or heard of some of the above conditions. But does that mean you have an anxiety disorder? Although the distinction between an official diagnosis and “normal” anxiety isn’t always clear, here are some signs that may indicate your worries are clinically significant:

  • Sleep problems. You struggle falling asleep or staying awake (this is more than just tossing and turning with anticipation the night before a big speech or job interview).  I mean that you routinely find yourself lying awake, worried or agitated—about a specific problem or even nothing in particular.
  • Stage fright. Sure, most everyone get butterflies before addressing a group of people or being in the spotlight. But if the fear is so strong that no amount of coaching or practicing will placate it, or if you spend an excessive amount of time thinking and worrying about it, you may have a form of social anxiety disorder. Those with social anxiety will worry for days or even weeks leading up to a particular event or situation, and may consider extreme methods to evade said responsibility! Even if they do manage to go through with it, they tend to be incredibly uncomfortable and will dwell on their performance for a long time afterward, worrying about how they were judged.
  • Self-consciousness. We are all self-conscious about how we look or appear to others–especially when we are in the limelight. This symptom may be an indication of an anxiety disorder when your self-consciousness is provoked by everyday situations such as making one-on-one conversation at a party, or eating and drinking in front of even a small number of people. In these situations, people with social anxiety disorder tend to feel like all eyes are on them, and they often experience blushing, trembling, nausea, profuse sweating, or difficulty talking. These symptoms can be so disruptive that they make it hard to meet new people, maintain relationships, and advance at work or school!
  • Muscle tension. Near-constant muscle tension (from clenching your jaw, balling your fists, or flexing muscles throughout your body) often accompanies anxiety disorders. This is the sort of tension that even regular exercise and stretching cannot abate. (Muscle tension of this severity can be so persistent and pervasive that people who have lived with it for a long time may stop noticing it after a while!)
  • Chronic indigestion. Anxiety may start in the mind, but it often manifests itself in the body. A common example is Irritable Bowel Syndrome (IBS), in which the individual experiences near constant stomach aches, cramping, bloating, gas, constipation, and/or diarrhea. This is basically anxiety in the digestive tract! (A note: IBS is not always related to anxiety, but the two often occur together and can make each other worse.)
  • Panic. A panic attack can be a sudden, gripping feeling of fear and helplessness that can last for several minutes and be accompanied by scary physical symptoms such as breathing problems, a pounding or racing heart, tingling or numb hands, sweating, weakness or dizziness, chest pain, stomach pain, and feeling hot or cold.  It is possible to be diagnosed with general anxiety disorder and have panic symptoms, but not be diagnosed with panic disorder. Not everyone who has a panic attack has an anxiety disorder, but people who experience them repeatedly may be diagnosed with panic disorder.
  • Flashbacks. Reliving a disturbing or traumatic event–like a violent accident or the sudden death of a loved one–is a hallmark of post-traumatic stress disorder (PTSD), which shares features with many anxiety disorders. (In fact, up until very recently, PTSD was seen as a type of anxiety disorder rather than a stand-alone condition.)
  • Perfectionism. This prevalent and obsessive mindset goes hand in hand with anxiety disorders. This is where you are constantly judging yourself, and have relentless anticipatory anxiety about making mistakes or falling short of your [unattainably high] standards. Some individuals with perfectionism even see fit to punish themselves through publicly slandering themselves or taking on extra responsibilities when they fail to reach the high standards they have placed upon themselves.
  • Compulsive behaviors. In order to be diagnosed with obsessive-compulsive disorder, a person’s obsessiveness and intrusive thoughts must be accompanied by compulsive action or behavior. This may be mental (like repeatedly reminding yourself that things will be okay) or physical (like excessive hand-washing, not leaving home until your makeup is perfect, hair plucking, or repeatedly checking to ensure the oven is off).

The National Institute of Mental Health reports that 19 percent of American adults are affected by an anxiety disorder each year, and it is more prevalent in women, in people under 35, and in those who live in North America or Western European countries. According to these statistics, many people experience an anxiety disorder in their lifetime!

As I have said previously and will continue to emphasize, having a mental illness like an anxiety disorder is not a life sentence. You are not damaged goods. There is nothing inherently wrong with you. If we are going to take the stigma out of mental illness, we need to believe it ourselves first! This will happen as you recognize your worth and find the courage to accept help. Just a friendly reminder that help is readily available for those with anxiety disorders. There are a myriad of medications and treatments–including therapy from a licensed, experienced therapist–that can help you or your loved one control anxiety. Help is one click or phone call away. Please contact me today!

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

Resources:

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Teen Mental Health: Recognize It, Talk About It, Care For It

Teen Mental Health - Cluff Counseling, Carrollton Therapist1 in 5 teens lives with a mental health condition and less than half are receiving the support he/she needs. The fear of discrimination and being viewed as different by their friends and peers is a large barrier to young people receiving mental health services. Learn the warning signs and be aware of your teen’s mental health.

When you ask a child or teen about mental health, often they will not know how to answer or will not want to talk about it. This may not seem like a big deal, but considering the staggering statistic of 1 in 5 teens living with a mental illness, this is something we must face. We need to be talking about it with our youth! We need to be mindful of the signs and symptoms so we can recognize if/when something may be awry.

One of my good friends of many years recently told me about an interesting conversation she had with her parents.  This friend of mine had suffered abuse as a child and ensuing mental health issues that landed her in a treatment center in our twenties. She told me her dad admitted to recognizing a big warning sign in his teenage daughter–a lack of range of emotions. My friend always feigned happiness. She pretended like everything was okay. Because she was such a good actress, everyone fell for it, me included. Her dad wisely said, “Children and teens are supposed to feel and exhibit a wide range of emotions. If a child is consistently only displaying one emotion, there is a problem.”

Hindsight is 20/20 for these parents. They wish they would have seen the signs. Thankfully there has been enough experience and research done to give you and I a fairly comprehensive list of criteria to be aware of. The following are warning signs of mental illness to watch out for in your child or teen:

  1. Feeling very sad or withdrawn for two or more weeks
  2. Severe mood swings that cause problems in relationships
  3. Intense worries or fears that gets in the way of daily activities
  4. Sudden, overwhelming fear for no reason
  5. Dramatic changes in behavior (ie. if your once-ambitious or strong willed child suddenly loses desire to participate in activities he/she once did and/or is lethargic or empathetic)
  6. Plans or attempts at self-harm, or to harm others.
  7. Drastic changes in behavior, personality, sleeping, and/or eating habits
  8. Not eating, throwing up, or using laxatives to lose weight
  9. Significant weight loss or weight gain
  10. Severe out-of-control risk taking behavior that could cause harm to oneself or others
  11. Repeated use of drugs or alcohol
  12. Extreme difficulty concentrating or staying still
  13. Adrenaline rushes, cold sweats, and/or panic attacks

If you see these signs in your child or teen, tell someone you trust. Ask for help. A diagnosis of a mental health disorder will not define who your child is or their value. They can live a full life with their mental health struggles.

The best advice I can give to someone who has kids–especially teens–is to be aware of their mental health.  Remember, mental health is a person’s condition with regard to their psychological and emotional well-being. Children and teens are our most vulnerable and innocent population. Watch for changes in them.  Do not be afraid to ask questions.  Get in their business. Let them know you care about and are there for them. Adolescents fear of discrimination and being viewed as different by their friends and peers is a large barrier to seeking mental health services. Not talking about mental health increases the stigma around mental health; the fewer conversations we have about mental health conditions, the more these negative perceptions endure!

I hope that learning about these warning signs educates and helps you. Many adolescents  struggle with their mental health, but do not understand what is happening to them or have the words to reach out. We must be there for them! Please do not hesitate to contact me with any questions or concerns you may have. If a child or teen you know is experiencing one or more of these signs, talk with their parents immediately. Help with mental health is widely available and my door is always open. Please contact me today or click here 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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SPLIT: A Deeper Look into Multiple Personalities

Britney Spears, Nicki Minaj, Marilyn Monroe, Lady Gaga, and Mel Gibson are a few famous individuals who have shared that they face Dissociative Identity Disorder–more commonly known as multiple personality disorder.  The average number of alternate personalities a person with DID has is between eight and 13, but there have been cases reported of more than 100 personalities within one individual. Read on to learn more about the cause and treatments for this mental illness.

Dissociative identity disorder (DID), often called multiple personality disorder (MPD), has fascinated people for over a century. In 2017, this disorder caught a bit of the limelight with the release of M. Night Shyamalan’s hit movie, “Split,” where the murderous villain has 24 personalities manifesting themselves throughout the abduction of three teenage girls. Although this movie was entertaining for some, 1% of the population who truly face this horror, may not have been as amused.

When Truddi Chase was just two years old, she moved out to the country with her mother and stepfather. At this time, she was sexually abused by her stepfather, and the trauma ultimately led to a DID diagnosis. For years, Chase was able to suppress her memories by holding them in alternate personalities that rarely came to the surface. Each of her 92 personalities held different memories, served different roles, and played different parts in protecting her from the past. One personality named Black Catherine held most of her rage. Another personality, Rabbit, held the pain. Chase wrote a book about her life, When Rabbit Howls, and, later, a movie was produced about her entitled, “The Voices Within: The Lives of Truddi Chase.”

The American Psychiatric Association defines Dissociative Identity Disorder as a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he/she is. To some degree, this is a normal process that everyone has experienced. Examples of common dissociation are daydreaming, highway hypnosis or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings. The difference between those more daily acts of dissociation and Dissociative Identity Disorder, however, is that DID is nearly always caused by a traumatic experience–such as an accident, disaster or crime victimization. Dissociation helps a person tolerate more than what he/she normally could. A person may mentally escape from the fear, pain and horror–which may make it difficult later to remember/recount the details of the experience.

Although there is so much we do not know about DID, we do know some things about DID:

  • Dissociation is present in all races, but is more common in American children.
  • Females experience more childhood abuse than males at a ratio of 10:1 and thus more females suffer from DID.
  • However, more males who have been abused may experience pathological dissociation.
  • Dissociative identity disorder is typically caused by trauma occurring at less than nine years of age.
  • Early age of abuse onset predicts a greater degree of dissociation.

DID is nearly always the aftermath of some form of trauma. Multiple personalities are unconsciously created in order to shield and protect the individual from reliving and remembering the traumatic experience. Sometimes these personalities can lay dormant as life stabilizes, but may manifest themselves during stressful periods of life. There is no medical attention formulated specific to DID; the recommended methods of treatment include the following three steps: 1) stabilization, 2) trauma-work and 3) integration. Dissociative patients who are not appropriately treated or who attempt to treat themselves tend to get worse and DID then becomes one of the most difficult to treat psychiatric conditions. Alternate personalities do not integrate spontaneously; treatment is necessary. Untreated DID tends to leave the sufferer vulnerable to to further trauma.

As with nearly all mental illness, there is a stigma associated with multiple personalities. We need to remember that this is a natural coping mechanism for those who have experienced intense trauma. The way I see it, those people who have DID are courageously fighting to survive and overcome past trauma. This means that functional, high performing, otherwise healthy individuals can experience DID depending on their childhood history. Mary Higgins Clark wrote a book called, All Around the Town where Laurie, the protagonist, is kidnapped at a very young age. She develops DID to face the sexual and emotional abuse she endures. After her release two years later, and the ensuing stabilization of her life, her multiple personalities subside for a time, only to reemerge after being triggered by her parents’ tragic deaths, causing her to confront the horrors of her past in order to heal. This book was incredibly interesting; I likely dissociated into Laurie’s world as I allowed myself to be fascinated by the manifestation of her mental illness!

My hope for those with DID and any other mental illness, is that they can find healing and hope. I never judge my clients facing these difficult challenges. It is important to remember that SPLIT was incredibly dramatized, and that the individuals with DID are just seeking to cope with life. It is likewise important to keep in mind that we all dissociate to some degree as the stresses of life close in on us! As previously stated, the best methods of treatment for Dissociative Identity Disorder is therapy, eye movement desensitization and reprocessing (also known as EMDR–of which I am trained in), and medications to treat depression or related symptoms. As with all mental illnesses, DID is not a life sentence.  Address the trauma that originally led to intense dissociation is the first step.  I am passionate about helping you find hope and healing. Please contact me today or click here 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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Strength in Numbers: Support Groups

“Regardless of the road we follow, we all head for the same destination, recovery of the [alcoholic] person. Together, we can do what none of us could accomplish alone. We can serve as a source of personal experience and be an ongoing support system for recovering alcoholics.”            -Alcoholics Anonymous

I posted an article mid-February about disclosing mental illness–when, how, where, to whom, etc. It may seem easier to deal with mental illness alone, but great strength can be found in numbers. The same is true with addiction; more often than not, disclosing addiction to trustworthy individuals can empower and motivate you to overcome your addiction. There is great power found letting other people in so they can can comfort you, support you, and keep you accountable. Your family and friends will have an important role in your recovery and healing, but this post is about the kinship and healing you can find beyond your immediate circle of support and in support groups.

You have likely heard of Alcoholics Anonymous or “A.A.” This is an international fellowship where those looking to overcome alcoholism will be encouraged and supported towards sobriety. People all across the spectrum of alcoholism take part in these A.A. meetings, and participants become friends and a support system.  Alcoholics Anonymous is one of the most well-known examples of a support group, but support groups are certainly not limited to overcoming alcoholism. In short, a support group is a gathering of people who share a common health concern/condition, an interest or a specific situation–such as breast cancer, diabetes, heart disease, addiction, or long-term caregiving.  

The general purpose of support groups is to help identify healthy and effective coping strategies, as well as skills often geared to mitigating feelings of angst, fear, pain, and loss. The groups also provide a great support network—in support groups you can find other members in similar circumstances with similar feelings with whom you can share in an open and unedited fashion. The group allows you to be where you are and validates and normalizes what you are feeling. Imagine the benefits of being surrounded by people who not only support you, but understand what you are feeling and going through!

Support groups are available worldwide. If you are in search of a particular support group, ask your doctor, or mental health provider for recommendations, or search the internet, contact local centers (community centers, libraries, churches, etc.), or ask someone you know in a similar situation for their suggestions. In addition, there are many options online including chat rooms, email lists, newsgroups, FaceBook groups, blogs, or social networking sites. Help is out there!

On the other hand, group therapy is a more formal type of mental health treatment that brings together several people with similar conditions under the guidance of a trained mental health provider. Its focus is more educational, therapeutic, and process-oriented. It provides a forum for change and growth, and there is often a theme presented for the entire group, with specific outcomes anticipated.  Support groups are less structured, with no set curriculum, and the facilitator can be a lay person or anyone who has an interest in the subject (instead, many themes may enter a discussion by a fluid group of members, and the facilitator guiding from the side). The following are a few of the key differences between support groups and group therapy:

  • Openness. Oftentimes, support groups are very open, meaning individuals can come and go as they please. If participants are unable to make it, the group carries on as normal. With a therapy group, participant’s attendance is crucial to the benefit of the whole.
  • Size.  Therapy groups range from four or six to ten individuals. Support groups can be communal, allowing more participants.
  • Facilitator’s role. Therapy groups function because of the therapist at the helm, directly leading and educating the group. In support groups, however, the facilitator, who is typically a selected participant, guides from the side, allowing participants to make comments and build off of one another. In both cases, facilitators objective is to create a safe learning space for all participants.

Each type of group offers a unique dynamic and the key is finding a group that meets your specific needs and association. Not everyone will find it helpful to participate in the more intense, focused, therapy-based experience of group therapy; however, nearly everyone can benefit from a support group. Support groups are readily available and are often free. Benefits from participating in both a support group as well as group therapy include feeling less lonely, isolated or judged; gaining a sense of empowerment and control; improving coping skills; talking openly and honestly about your feelings; reducing distress, depression, anxiety or fatigue; developing a clearer understanding of what to expect with your situation; getting practical advice or information about treatment options; and comparing notes about resources, such as doctors and alternative options.

Support groups and group therapy have an important place in healing and recovery–be it from addiction or from mental illness. Depending on the situation, it may be beneficial to see a therapist one-on-one, in addition to attending groups. In some cases, medication is also necessary. If you would like more information, please contact me today. I am more than happy to schedule a session with you or your loved one and help create a plan for healing. When looking for resources to address addiction or mental health issues, do not forget about the strength of numbers you can find by participating in support groups and/or group therapy!

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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Creating Conversation Around Your Mental Illness

According to the National Alliance on Mental Illness (NAMI), 1 in 5 American adults experiences mental illness in a given year. That is 43.8 million people! You are not alone in this arduous struggle. Even though so many face this trial, there is often a great amount of shame that comes with mental illness that may inhibit you from telling people. This post will focus on how you can let others in.

Imagine if you had Ulcerative Colitis (an inflammatory disease of the digestive tract) and you told your family and friends about it. Your parents and friends would likely have many questions, would want to learn more about the disease itself, and discuss how they could help you. You would probably feel slight to no discomfort disclosing your medical condition and would welcome their help and support.

A mental illness is just as important and serious as a physical injury. Chemical imbalances that cause depression, bipolar, or obsessive compulsive disorder, are out of our control. Whereas we feel little discomfort sharing about a physical illness or injury, we often feel much discomfort and some shame around sharing our struggles with mental illness and thus remain silent. Last year, I wrote a blog post about taking the stigma out of mental illness and I stand by it. We have got to change the way we perceive and discuss mental illness! My purpose in this post is to give you a tangible first step to take. Instead of keeping it to yourself, reach out to your closest friends and family members. Not sure how to do that? Read on.

WHEN?

  • When you have a specific need. Maybe your friends have noticed your behavior being off. Maybe you need transportation to an appointment. Maybe you need your employer to be aware of your situation to receive accommodations at work. Maybe you need someone to be accountable to. Maybe you simply just need someone to talk to. Whatever the reason, it could be a trigger to help you summon the courage to be vulnerable and share your situation. It will make things easier for you in the long run.
  • When you choose. Disclosing something so personal needs to be done on your own time. Do not feel pressured or guilted by anyone (including yourself) to let people know on their timeline...do it for you, on your time.

HOW?

  • Set expectations. Prepare your listeners by informing them that you need their help and ask them to just listen. You might say something like, “There’s something going on in my life that’s been really hard. I need to talk to someone about it. Please don’t make light of it.”
  • Give a specific problem. There is no reason for you to beat around the bush. If you are having a hard time sharing your diagnosis, state how it began, or how you noticed a potential problem. “I started realizing something was off when I couldn’t sleep more than a couple hours at night. It’s been hurting my work and I feel out of control.”
  • Offer suggestions for support. People may feel unsure about how they can help you; it will be quite advantageous if you come prepared with ideas already in mind for how your support system can be there for you. You may want to request help finding a doctor or therapist (if one has not already been secured), rides to appointments/treatment, check-ins from family members, hugs from friends, listening ears from siblings, etc. Equip your people with specific ways they can assist you as you fight mental illness.

Mental illnesses are a challenge…period! Having a solid support system can help make things a little easier when things get hard. Those people you let in to your support system will comfort you when you feel alone, will be aware of what you are going through, will be able to check-in on you, and will provide a safe environment where you can honestly disclose what you are facing. Having that extra love and support will greatly aid you along the way.

Yes, letting others in about your mental illness can be daunting and scary, but all of the support, understanding, and accountability that comes with having others by your side will be worth it. I have helped many clients down this road, and the ones who take to treatment faster are those who have a support system to fall back on. If–even after reading this blog post–you are unsure about what to say or with whom to say it, please contact me today for help. It takes great courage to admit you need help, but you will reap positive dividends in the long run. Schedule a session with me today and we can take this important first step of forming your support circle together.

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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