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May 23, 2011

A Very Brief Introduction to Loneliness and Dating

Posted by Nathen under advice, attraction, dating, hygiene, lists, loneliness, mere familiarity, rejection, relationships, social class
1 Comment 

It’s funny to find myself giving a presentation about getting a date, as I’ve asked exactly one person for a date and was rejected. I agreed to help with a presentation in my Sex Therapy class about clients who are lonely and want to date. This is my rough (but roughly accurate) outline for my part of the presentation, about what the research says:

Things to Know About Loneliness

It’s common. 10-25% of people are significantly lonely. Adolescents and young adults are the loneliest groups.

There are two kinds: Social and emotional—a lack of a sense of social integration, and the absence of an attachment figure. Most research is about social loneliness, and the two can get confounded. Our clients may mistake one for the other.

It is bad for us. Both social integration and attachment figures are human needs. It significantly increases morbidity and mortality, probably mediated by stress and also possibly by metabolic syndrome. Predicts 25-30% of suicidal behavior. Loneliness is a key vulnerability in sexual offending.

Things to Know About Dating

Lots of people are single. Maybe close to half.

Rejection hurts. Physically. Seriously. It may actually help to take a Tylenol. Normalize the pain and the fear of pain.

There is a lot of research and it may be good to know, for psychoed purposes:

Awareness. To get a date, other people must be aware of you. Are your clients making others aware of them? The general rule here is to stand out from the crowd in some way that does not violate social norms. Standing out in a negative way will not help.

Attraction.

Physical attractiveness is a big deal. Sorry, it just is. If it is an issue, consider a conversation with clients about grooming. Beyond that, blame the media and move on to the points below.

Appropriateness. Again, violating social norms generally will turn people off. There is also a lot of research on stuff like age, social/economic status, and race/ethnicity acting as “appropriateness” filters for affiliation, but I’m not sure how helpful that will be for clients.

Familiarity. People will like you more just because they know you. As long as you didn’t make an initial negative impression, becoming a regular will help you.

Similarity. Opposites attract is wrong. People like people who are like them. This is a good plug for meeting people at special-interest events. (Bars are an exception. Very few real relationships start in bars.)

Responsiveness. We like people who seem interested in us. Eye contact, questions, turning towards bids for attention. Check your clients for an exaggerated sense of putting themselves out there.

Approach/Affiliation. If you want someone to approach you and choose you, you need to be accessible and receptive. These are much like the awareness, familiarity, and responsiveness principles, above.

 

May 16, 2011

Diagnostic Criteria For Posttraumatic Stress Disorder

Posted by Nathen under diagnosis, diagnostic criteria, DSM-IV, DSM-IV-TR, DSM-V, ideas, lists, maps, mental disorders, post-traumatic stress disorder, suggestions, veterans
[2] Comments 

PTSD was recognized in the early 1970s and formalized in 1980, largely the result of work by and with US veterans of the war in Vietnam. Many people who think about these things consider this recognition to be a turning point in psychological diagnosis. In fact, one way of thinking about psychological diagnosis is that most of what we now call Mental Disorders are basically variants of PTSD–the ways that different people respond to different traumas. If the committee working on version V of the DSM were to humor us, they might rename the tome The North American and European Catalog of Post-Traumatic Stress Behavior Patterns Plus a Few Other Human Difficulties.

Here’s a fuzzy map from the wikipedia article, showing PTSD rates. The darker the red, the more PTSD, and the lighter the yellow, the less:

Here are the criteria, word for word, from the Diagnostic and Statistical Manual of Mental Disorders IV-TR, pages 467 and 468:

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

(2) the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or More ) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep

(2) irritability or outbursts of anger

(3) difficulty concentrating

(4) hypervigilance

(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The distrubance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than 3 months

Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

 

April 6, 2011

DSM-IV-TR Diagnostic Criteria for Asperger’s Disorder

Posted by Nathen under Asperger's Disorder, Autism Spectrum, diagnostic criteria, DSM-IV-TR, DSM-V, emotions, language, lists, mental disorders
[7] Comments 

There is quite a bit of controversy about it, but it looks as if Asperger’s Disorder will only be around for a couple more years. This diagnosis will probably get the axe in the upcoming DSM-V, when it arrives, subsumed into the so-called Autism Spectrum. It will be interesting to watch how a change in language will change how we think about a certain constellation of behaviors. If you’re interested, I have a link here to the proposed changes to the DSM.

Please read my disclaimer here about diagnosing yourself or anyone you know. The short version is, you can’t do it.

And, for the time being, here are the diagnostic criteria, word-for-word from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, page 84. As with Autistic Disorder, note the absence of qualities we may think of as common in Asperger’s Disorder, such as being picky about food or other things, being sensitive to things like noise or texture, any visual processing abnormalities such as non-susceptibility to visual illusion, being easily upset, self-harming behaviors, high IQ or “splinter skills.” None of these are considered in the diagnosis.

Diagnostic criteria for 299.80 Asperger’s Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(2) failure to develop peer relationships appropriate to developmental level

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skill, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

 

April 4, 2011

DSM-IV-TR Diagnostic Criteria for Autistic Disorder

Posted by Nathen under Autistic Disorder, diagnosis, diagnostic criteria, DSM-IV-TR, eye contact, language, lists, mental disorders, psychology
1 Comment 

Please remember that I post diagnostic criteria here because it is interesting to know what kinds of behaviors can get you what kinds of diagnoses, not so you can diagnose yourself, anyone in your family, or any of your friends. You just cannot be objective enough and it often leads to people walking around thinking they have Mental Disorders that they do not have. This is especially not good if that person is a child.

This may be especially true for Autism-Spectrum Disorders, which require a team of experts collaborating with the family to make a good diagnosis, including ideally a developmental pediatrician, a psychologist, a social worker, a speech language specialist, an occupational therapist, and a physical therapist. Also maybe a family advocate and an early interventionist.  And that’s just for a medical diagnosis. It varies by state, but often educational eligibility requires, additionally, a school psychologist, a behavior specialist, and an autism specialist.

Notice in the criteria below that diagnosis is made based on social problems, language problems, and repetitive/stereotyped behaviors. Other qualities that we may associate with Autism, such as pickiness about food or other things, sensitivity to noise or textures, visual processing problems, being easily upset, self-harming behaviors, and “splinter skills” are not part of a diagnosis for Autistic Disorder. Even with extreme versions of those qualities, you do not an AD diagnosis without fitting the criteria below.

And here are the criteria, word for word from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (p. 75):

Diagnostic criteria for 299.00 Autistic Disorder

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:

(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

 

January 29, 2011

Diagnostic Criteria for Sleep Terror Disorder

Posted by Nathen under benzodiazepines, diagnostic criteria, DSM-IV-TR, fear, lists, sleep, Sleep Terror Disorder
1 Comment 

We don’t really know but the DSM estimates between 1 and 6% of children and many fewer adults have this experience. You are more likely to have this happen if you are related to someone who has had this happen, but we have no idea why. It usually just goes away in adolescence. If my parents had been the type to take their kids to mental health professionals, I almost certainly would have gotten this diagnosis as a kid. If so, and if my parents had been the drug-giving kind, I might have been prescribed a benzodiazepine (like Valium) for it. Generally, though, it can be treated by comforting your child when they wake up like this, until it goes away. If you think there might have been a triggering event for the condition, therapy might be helpful.

Here are the criteria, quoted word-for-word from the Diagnostic and Statistical Manual of Mental Disorders IV-TR, page 639:

Diagnostic criteria for 307.46 Sleep Terror Disorder

A. Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream.

B. Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode.

C. Relative unresponsiveness to efforts of others to comfort the person during the episode.

D. No detailed dream is recalled and there is amnesia for the episode.

E. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to  the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

 

 

January 21, 2011

The Definition of Disease

Posted by Nathen under ADHD, alcohol abuse, American Medical Association, Anorexia Nervosa, Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, death, diagnostic criteria, disease, DSM-IV-TR, lists, mental disorders, suicidality
[2] Comments 

I attended a lecture today about addiction where the lecturer claimed that the American Medical Association requires that a phenomenon meet the following criteria to be considered a disease:

1) It must be progressive

2) It must manifest identifiable symptoms

3) It must occur chronically in affected individuals

4) It must be fatal if left untreated

That makes some things obvious diseases. Cancers, for example. There are many things that we consider diseases that do not fit these criteria, though. I believe that obesity, for example, is not officially considered a disease because it is not fatal. It’s correlated with many fatal conditions but isn’t fatal on its own. Most mental disorders fail to meet this criteria too. Anorexia is fatal if untreated, but anxiety disorders, dissociative disorders, ADHD, learning disorders, conduct disorders, psychotic disorders, and dissociative disorders and many others are not. There is a pretty good case to make for  alcoholism and some other addictions meeting these criteria. Disorders that are associated with suicidality, too, might qualify, like severe depression, and possibly “gender identity disorder,” though GID may not be progressive and so fail the first criteria.

 

November 19, 2010

Some Views on the Nature of Reality

Posted by Nathen under epistemology, family therapy, lists, metaframeworks, philosophy
[3] Comments 

In the field of family therapy, most theorists these days are postmodern and take care to spell out their epistemological lens–how and why they think they know what they know. They know that their theories are colored by their beliefs, so they want their readers to know what biases were involved in creating their theory.

I’m on page 33 of a very promising family-therapy-theory book called Metaframeworks: Transcending the Models of Family Therapy. The authors describe four views of reality, how they relate to each other, and which one they choose. The four are:

Objectivism: The often unconscious belief that there is an objective reality and that we have direct access to it. This view is also called “naive realism.”

Constructivism: This camp generally believe that a reality exists out there independent of us, but that we can’t know what it is like because our access to it is completely mediated and limited by our senses and cognitive processes. This is also called “pessimistic realism.”

Perspectivism: There is a reality out there and we have only mediated, distorted access to it, but it is possible to map it to greater and greater degrees of accuracy. That is, some maps are better than others. This is the authors’ camp.

Radical Constructivism: As far as we know, “reality” exists only in the mind. We are not qualified to make any statements about what actually exists or goes on “out there.”

 

November 12, 2010

Some Do’s and Don’ts For Sacroiliac Sprains

Posted by Nathen under advice, chiropractic, injuries, lists
[2] Comments 

Today a chiropractor told me, based on my x-rays, that my left pelvic bone had gotten stuck. He held his hands out as if he were going to catch a basketball and said, “Imagine my hands are your pelvic bones and we’re looking at them from behind. Your pelvis did this [bending his left wrist back] and got stuck there.” He adjusted my pelvis, which seemed like a very mild adjustment for the problem he described, and gave me this list of “do’s and don’ts” for the next few weeks. Following them will mean walking a lot more and sitting a lot less–probably a good thing even if my pelvis wasn’t twisted.

1. Do not sit for extended periods of time. Alternate your positions–standing, sitting, walking, lying down. When driving long distances plan to stop every half hour or so for a brief walk.

2. Walking is the best exercise for you at this time. Temporarily discontinue all other sports activity and exercise programs. Ask us about a particular activity if you are not sure.

3. Avoid movements that use your abdominal muscles and the muscles of your lower back. Avoid awkward twisting, bending, and lifting movements. Get next to, under, or behind any object or load that you need to lift. Use your leg muscles as much as possible and spare the muscles of your lower back. Avoid “sit-up” type movements.

4. Avoid movements that spread one leg far apart from the other–all straddling positions.

5. Do not cross your legs or ankles.

6. If any discomfort occurs in the sacroiliac area ice can be applied 15 minutes out of every hour.

7. The proper procedure for lying down and getting up is most important. To lie down, first sit and then slowly lower your body bringing up both of your legs, being careful to keep them together. Then, turn your body on your back using your arm and leg muscles. When arising, turn your body on its side, drop your feet to the floor while pushing up with your arms and legs, not using your stomach or back muscles.

8. When moving objects from one place to another, make sure that both your feet are pointing in the same direction as your upper body. Do not keep one foot planted while twisting your body and moving the other foot the direction your are twisting.

 

September 29, 2010

Intentions for Year 40

Posted by Nathen under affection, being kind to myself, exercise, food, graduate school, healthcare, lists, meditation, rituals, self-care, therapy
1 Comment 

I turned 39 at 8:50 this morning. I’m on the cusp of middle age! As usual, I used my flights to and from Not Back to School Camp to brainstorm about my 40th year. Camp is a great end-of-year celebration and source of inspiration. I’m going to do a lot this year–finish my Master’s degree and see clients for at least 400 hours, for example–but I’ve decided not to put that stuff on my list. I want to concentrate on how I do it. I just watched the outgoing cohort finish up my program and they seemed really stressed out. I want to do it without overwhelming myself, in good health. I want to enjoy it. So I came up with one intention that sums it all up:

This year, I intend to take exquisitely good care of myself.

To me, that means that I think about myself like I do my best friends, with affection and optimism, with care. I am not a slave to being productive.

When I touch myself, I do so gently, with attention, not mechanically or absent-mindedly. Like I would someone I love.

I don’t eat crap.

I meditate 30 minutes every day.

I exercise 45 minutes every day.

I do my physiotherapy daily and get health care whenever I need it.

I get good attention, from friends, co-counselors, or a therapist, when I need it.

I take a day off every week.

I say yes to social invitations.

I sleep a bare minimum of 8 hours a night. That means giving myself an hour to chill out with nothing electric and no reading before bed, and an hour to lie in bed before I need to be asleep, so I don’t get worried about falling asleep quickly enough.

I keep my living space looking nice.

I have some ritual (yet to be designed) which helps me stop thinking about my clients when I leave the clinic.

I’ve also put a lot of thought into how I will prioritize my commitments. They will probably often conflict with each other and I’d like to be able to make choices about what to do and what to leave out with minimal stress. That part will be a work in progress for a while

 

July 27, 2010

No Guilty Pleasures

Posted by Nathen under 10000 hour rule, CFT cohort, dancing, guilty pleasures, lists, mastery, reading, record production, self-care, therapy, writing
[7] Comments 

Our check-out at the end of group supervision last night was naming our “guilty pleasures.” My cohort-mates mostly talked about TV shows they were watching, plus some fiction reading. When it was my turn, they shot down every single extracurricular activity I offered. Not one qualified as a guilty pleasure. Here’s the list:

Reading Ken Wilber’s Integral Psychology

Watching Ken Burns’ documentary Jazz

Listening to Sol Stein’s Stein on Writing on audiobook

Listening to This American Life, Radiolab, and a couple other podcasts

Recording Reanna a cover of “Got To Get You Into My Life”

Dancing every week

I think they might have given me dancing if I hadn’t tried their patience with the other stuff first. I didn’t think to say writing for my blog, which is probably the pleasure I feel the guiltiest about, but they probably wouldn’t have given me that either.

It doesn’t seem like I have time to watch TV. I don’t even have a TV, come to think of it, and I haven’t figured out how to get TV shows on the internet. I’m watching a little of the jazz doc each night as I brush my teeth, but it’s hard to imagine watching multiple seasons of TV shows, like my cohort-mates are. It would take a major shift in lifestyle. I did listen to Murakami’s (excellent) The Wind-Up Bird Chronicle last spring, but only while I was driving, so it took 15 weeks to finish.

I feel conflicted about my lack of guilty pleasures. I’d like to have that kind of laid-back lifestyle. I want to be more relaxed. This summer–this next four weeks of this summer–is my only even partly unstructured time before I graduate next June. And who knows after that? I’ll have loans to pay off.

On the other hand, it doesn’t sound relaxing to add something to my schedule! Plus, I like the stuff that I’m doing, and I’m working on wrapping my head around something with infinite depth. When I finished my two-year record-production program in the 1990s, my teacher Josh Hecht said, “This is a deep subject that you have scratched the surface of, but you now know what you need to be able to do. The next step is figuring out a way to do it for 14 hours a day, every day. In 20 years or so, you’ll be very good at it.” That was his lifestyle, and it made him an excellent record producer. He worked all day, had no time for non-audio entertainment, read only the two very best trade magazines, participated in only the two very best trade organizations. He slept five hours a night.

This is a path of mastery like Erickson’s 10,000 hour rule; to get good at any complex endeavor, you have to put in about 10,000 hours. Being a therapist certainly qualifies as a complex endeavor! The catch is, weeks after Josh told us how to become a good record producer, he got very ill and was forced to take a long vacation–his first vacation in decades, I believe. I think that was the point my supervisor was making about guilty pleasures; this is a demanding career in many ways. How do I master it while maintaining my health, motivation, and clarity?

 

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