Impulse Control Disorder Answers

How to prevent being aquaholic

Dear Khalis,   Thank you for your message and for sharing with me how you've been interacting with yourself, especially how you've been handling unpleasant feelings and emotions when it comes to the urge to drink water. As you said this has also affected your life significantly. Perhaps by addressing how to handle unpleasant emotions/urges in a healthier manner, we can dive into addressing the issues in your life as well?   Often the experience we've had about anxiety (or any strong emotion such as stress/depression) was so terrible (even physically) that our body sort of becomes traumatized to it. We naturally become nervous about these unpleasant feelings because we don't like these sensations and experiences. As a result, we would do everything we can to avoid/fight these anxious feelings, often using numbing techniques such as using substances or distracting ourselves. Yet only to find that the anxiety gets stronger over time because we have never been able to make peace with it.   Therefore rather than trying to "change" / "fight" / "get rid of" these unpleasant sensations, perhaps the best thing that we can do is to make room for these feelings and even sensations while staying on track to do what brings us meaning and fulfillment. Floating without judging / blaming ourselves through the anxiety experience, while focusing on making room for anxiety can be helpful.   Here is a short video put up by the author of the book "The Happiness Trap" which does a good job explaining this concept:   Please take some time to watch this and share your thoughts later :) I also highly recommend picking that book as well to supplement this therapy process.   https://www.youtube.com/watch?v=rCp1l16GCXI    We as human beings do not like suffering, therefore often times we would be doing our best to fight it. However just like the analogy of swimming vs floating that we have talked about before, the more we fight it, the faster we sink. While if we can learn to float with these waves, we will realize that we won't sink.   Radical acceptance / Expansion is about accepting life on life's terms and not resisting what you cannot or choose not to change. Radical Acceptance is about saying yes to life and all that life brings (including all sorts of emotions such as joy, sadness, peace, and pain), just as it is without forcing our ways into our lives.   Why do we want to accept life as it is? Because with anything that we do in life that brings us meaning and fulfillment, it always accompanies a wide range of emotions, we can't possibly just choose the ones that we like and fight/avoid those that we don't like. Learning to experience all emotions as they are, is a sign that we are living our lives to the fullest.   To do so we must learn to accept (and make room for) any unpleasant sensations, feelings, or thoughts that we experience.   We don't want to fight it because the more we fight, the stronger they will come back.   We don't want to avoid it either because the more we avoid it, the more we'll be afraid of it.   So the key here is to make room for these sensations, feelings, and thoughts, while continuing to do what brings us meaning and fulfillment in life.    Learning to "co-exist" with these feelings will naturally reduce their intensity.   Floating is a form of learning to accept these feelings and make room for them.   Let me give you some practical guidelines on what I mean by accepting these feelings and make room for it.   You can look up the "expansion technique" under Acceptance and Commitment Therapy (ACT) for more information as well.   How to accept our emotions (and make room for them):   1. OBSERVE. Bring awareness to the feelings in your body.   2. BREATHE. Take a few deep breaths. Breathe into and around them.   3. EXPAND. Make room for these feelings. Create some space for them.   4. ALLOW. Allow them to be there. Make peace with them   Some people find it helpful to silently say to themselves, 'I don't like this feeling, but I have room for it,' or 'It's unpleasant, but I can accept it.'   • When you're feeling an unpleasant emotion, the first step is to take a few slow, deep breaths, and quickly scan your body from head to toe.   • You will probably notice several uncomfortable sensations. Look for the strongest sensation - the one that bothers you the most. For example, it may be a lump in your throat, or a knot in your stomach, or an ache in your chest.   • Focus your attention on that sensation. Observe it curiously, as if you are a friendly scientist, discovering some interesting new phenomenon.   • Observe the sensation carefully. Notice where it starts and where it ends. Learn as much about it as you can. If you had to draw a line around the sensation, what would the outline look like? Is it on the surface of the body, or inside you, or both? How far inside you does it go? Where is the sensation most intense? Where is it weakest? How is it different in the center than around the edges? Is there any pulsation, or vibration within it? Is it light or heavy? Moving or still? What is its temperature?   • Take a few more deep breaths and let go of the struggle with that sensation. Breathe into it. Imagine your breath flowing in and around it.   • Make room for it. Loosen up around it. Allow it to be there. You don't have to like it or want it. Simply let it be.   • The idea is to observe the sensation - not to think about it. So when your mind starts commenting on what's happening, just say 'Thanks, mind!' and come back to observing.   • You may find this difficult. You may feel a strong urge to fight with it or push it away. If so, just acknowledge this urge, without giving in to it. (Acknowledging is rather like nodding your head in recognition, as if to say 'There you are. I see you.') Once you've acknowledged that urge, bring your attention back to the sensation itself.   • Don't try to get rid of the sensation or alter it. If it changes by itself, that's okay. If it doesn't change, that's okay too. Changing or getting rid of it is not the goal.   • You may need to focus on this sensation for anything from a few seconds to a few minutes until you completely give up the struggle with it. Be patient. Take as long as you need. You're learning a valuable skill.   • Once you've done this, scan your body again and see if there's another strong sensation that's bothering you. If so, repeat the procedure with that one.   • You can do this with as many different sensations as you want to. Keep going until you have a sense of no longer struggling with your feelings.   • As you do this exercise one of two things will happen: either your feelings will change - or they won't. It doesn't matter either way. This exercise is not about changing your feelings. It's about accepting them.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 10/20/2021

How to deal with my mental illness on top of overlapping personality disorders?

Greetings Jason, I read your question, and because you have not yet received treatment, it is not yet know that you are dealing with BPD (Borderline Personality Disorder).  It is important that you find a therapist who specializes in mood and personality disorders. Other mood disorders such as OCD, anxiety, and depression can also be challenges that accompany this condition.  We call these co-occurring disorders. As a therapist, I would like to provide you with psychoeducation regarding BPD. First, let's look at BPD and the signs and symptoms:   People with a borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly. People with a borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships. Other signs or symptoms may include: Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being abandoned A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation) Distorted and unstable self-image or sense of self, impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating. Please note: If these behaviors occur primarily during a period of elevated mood or energy, they may be signs of a mood disorder—not a borderline personality disorder. Self-harming behavior, such as cutting, recurring thoughts of suicidal behaviors or threats, intense and highly changeable moods, with each episode lasting from a few hours to a few days, chronic feelings of emptiness, inappropriate, intense anger or problems controlling anger, difficulty trusting, which is sometimes accompanied by an irrational fear of other people’s intentions, feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality.  BPD can be challenging to regulate, however it is possible with becoming proactive in continuing with consistent mental health care.  I suggest that you seriously consider ongoing therapy in order to receive a proper assessment and diagnosis of your symptoms.  If in fact you are diagnosed with BPD, there are effective treatments such as Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) which have been proven to be successful in treating BPD.  DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help with controlling intense emotions, reducing self-destructive behaviors, and improving relationships.  CBT will help identify and change core beliefs and behaviors that underlie inaccurate self-perceptions as well as, perceptions of others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors. Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as: mood swings, depression, and other co-occurring mental disorders.  Just know that you can find balance, and improved mental health with the right interventions.  I hope this information will be helpful in creating greater awareness regarding what you may be experiencing.   Tami Robinson, LCSW/Therapist                                                                                                                    SoulPath Counseling and Therapeutic Services, LLC
(MSSA, LCSW)
Answered on 10/20/2021

What is the most effective treatment for Maladaptive Daydreaming Disorder(MDD)?

Hello Rakesh, I am glad you reached out for support at this time.  I am sorry you are struggling in this moment.  I would encourage you to start to work with a therapist to help you learn skills to help you overcome your struggles.  If we were to meet I would first talk to you about the counseling process through our site and how together we could help you obtain your goals going forward, how I work as a counselor and how I would try to help you through the counseling process.  I would also take the first session to get to know you by asking you a few questions to get a better understanding of your struggles so that I am able to focus on a plan and goals to work on going forward. I want you to know that you are not alone during this time even though you may feel like you are alone at this time.  During the therapy process, you can have support 100% of the time as you are able to reach out and talk to a therapist 24 hours a day 7 days a week.  A few of the questions I would ask would include the following:Can you tell me more about your past history?How long have you been on medication?How long have you been in therapy? What are some struggles you have been having with your daily living?I am going to send you some skills and tools to help you during this time of struggle you are having.  If we were to work together we would be going over these and more tools to help you through your struggles and be able to ask for support from others. I understand you are in therapy at the moment and do not want to step on the other therapist's toes or skills they have been working with you on.  I will send you some skills that maybe helpful for you without confusing you on what to use from each therapist. These skills can help with identifying maladaptive thinking and intentionally making specific, strategic behavioral changes to achieve the desired outcome. Some are general skills, while others are more targeted to specific issues or needs.Behavioral experimentsBehavioral experiments are designed to test thinking and identify thought patterns that influence behaviors.By intentionally ‘trying out’ specific ways of thinking and observing the outcome behaviors, you will gain a deeper awareness of the patterns of thinking that may be holding you back from reaching your goals.Thought recordsThought records are also designed to test the validity of our thoughts. Actually recording our thoughts provides a way for us to evaluate the evidence for or against a particular way of thinking – essentially, is it true or not true based on the situation? Thought records help to establish a more balanced way of thinking based on logic what is as opposed to what you feel?ExposureExposure is a powerful technique used to help you to face your fears or phobias in a controlled way. Basically, having the client be exposed to the very thing they fear. It will, of course, be scary for them.When used properly, exposure has been proven to be effective in the reduction of fears and phobias.There are many exposure techniques and even more ways to implement them. Here are some of the more common and well-known techniques.Situation exposure hierarchiesIn this technique, the client make a list of feared objects or situations. The client then rates, on a scale of 0 to 10, how distressed they would be by each item. For example, a person who fears dogs might say “Not seeing a dog in the yard” is 0. “A dog licking my hand” might be their 10.Starting with the least distressing, I can help you work through each situation in the list. This is a way of gradually increasing exposure and diminishing the distress of exposure.FloodingFlooding also uses exposure hierarchies, but generally begins with the more difficult or distressing scenarios or objects. Caution should be used when choosing this technique, as it can elicit strong responses. This technique is best utilized as a part of a therapeutic intervention and most of the time done best in personSystematic desensitizationThis technique involves combining exposure with relaxation exercises. You are taught strategies to remain relaxed in situations that would normally elicit fear. Gradually, you start to associate your feared object or situation with relaxation rather than powerful negative feelings.JournalingJournaling is a great way to gather information about thoughts and feelings. The journal can be used as a place to identify, describe, and evaluate moods, thoughts, scenarios, and responses. Having a place to ‘unpack’ and explore can lead to tremendous insight.Cognitive restructuring – unraveling cognitive distortions.Cognitive distortions are patterns of faulty thinking that convince us something is true when it is not. There are several types of cognitive distortions. The plan would be to help you identify and challenge your distortions in thinking. This can also be accomplished through the therapist-client dialogue. The goal, of course, is to have you learn to do this on your own.Here are five ‘thought challenges.  You can use these to take a closer look at your negative thought patterns.1. What are the chances…?The things you worry about may be very unlikely to happen. Would you be willing to put money on it happening?2. What is the worst thing…?The things you worry about might happen, but you are making way too much of them. Consider whether it would really be that bad if the worst did happen and realize that it might not be worth all that anxiety.3. Am I right to think that…?You might be missing important information that would help you with decisions. As you gather more information, your worry and stress may abate.4. The five-year rule (‘the history game’)This challenge has been applied to lots of situations within and outside of our work together to put events that have happened or will happen into perspective. Ask yourself, “Five years from now, will it really matter?”5. What is this worth?Consider just how important this thing you are worried about is. Life is too short to be spent worrying about things that just do not deserve that kind of time investment.Functional assessment (ABCs)A functional assessment tool allows the client to record the ABCs (antecedents, behaviors, consequences) of a situation. If you are wanting this tool, I will send you a worksheet for this.  This data allows both myself and you to begin to identify patterns of behavior.  ReframingIt’s easy to fall into familiar patterns of negative thinking. One way to counteract negative thinking is through reframing. Reframing is the act of replacing negative thoughts with positive ones as soon as the negative thought occurs.Reframing disrupts the negative cycle of perpetuation and resets the focus on something positive. Relaxation and mindfulnessThree of my favorite relaxation and mindfulness practices are progressive muscle relaxation (PMR), meditation, and deep breathing. Each is a bit different in its implementation and intent.PMR involves the systematic tensing and releasing of each muscle group, combined with deep breathing and mental imagery. Mindfulness meditation involves clearing the mind and focusing on the sensations and thoughts in the moment, observing them and allowing them to pass. Deep breathing is an action that is physiologically incompatible with anxiety.Relaxation and mindfulness techniques gives you a new and different way to respond to distressing situations. This change of response can break the cycle of perpetuation. Relaxation also helps to quiet your mind so that you can think more rationally and logically. The SOLVED techniqueThis technique is used to teach problem-solving skills. While there are many variations on this technique (and lots of other names for it), structured problem solving is a critical skill for clients to learn. The acronym SOLVED gives the client a tangible, memorable tool for working through the problem-solving steps.S – Select a problem that the client wants to solve.O – Open your mind to all solutions – brainstorm all the options with your client.L – List the potential pros and cons of each potential solution.V – Verify the best solution – decide which choices are practical or desirable.E – Enact the plan.D – Decide if the plan worked. I hope that these skills have been helpful for you in the struggles you have been facing at this time.
Answered on 10/20/2021

Should I get counselling or at least a diagnosis? Should I consider taking medication? How bad does it have to get until I have to get help? Can I just ignore it? Try to fix it on my own?

Hi thanks for reaching out, on your journey to discover what may be going on with you internally it is important to receive the proper treatment and support that you need in order to cope, heal and move on with your life. A diagnosis is not the end of the world and your life will not stop. If you go on and act like there is nothing wrong the symptoms will not go away permanently and there will be periods of exacerbation that will impact your studies and your goals. Based on your own research you determined that you may or may not have symptoms consistent with Borderline Personality Disorder so with that I'm sure you reviewed the most beneficial evidenced based treatment and that how prolonged treatment and/or medication will cause irreparable damage/progress if not addressed before it gets out of control. When you look at having a chemical imbalance in your brain as such early detection just like in medical terms a proper diagnosis makes a huge difference in your recovery rate and survival in having a healthy and fulfilled life despite having a mental health diagnosis. Try to look at this way, if you go on through life and act as if nothing is impacting you, you know that the symptoms will remain and get worse, or plan B you get the help that you need and learn to accept the reality of what you are experiencing and continue on with your life. In my experience the best way to overcome this challenge is to challenge yourself to make choices that will change your life. With not having much support this journey can become more difficult however there are many programs and support groups that will and can help you along the way and you can beat this, it is not the end of you, it is part of you but does not define who you are. Seeing a Psychiatrist or a Licensed Therapist can definitely help to see which direction you should go in and your recovery can begin sooner than later. Please remember today is the first day of your life to make that change.... do not let your fears, doubts or your past depict how you approach this. YOU CAN BEAT THIS but not alone, help is here for you and ignoring it will not make it go away.
(LMSW, CAADC)
Answered on 10/20/2021

How does one know for sure if they have OCD and if it's linked to anxiety?

Diagnosing Obsessive Compulsive Disorder is difficult to diagnose as it may present as symptoms of other diagnoses. Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress. You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD. Clinically Obsessive Compulsive Disorder Symptoms: Symptoms can be either obsessions or compulsions, or both Symptoms can be mild and gradually progress in severity Stress worsens the symptoms Persistent, repeated and unwanted thoughts Urges or images that are intrusive Compulsive or ritualistic behavior to get rid of the thoughts As with obsessions, compulsions typically have themes, such as: Washing and cleaning Checking Counting Orderliness Following a strict routine Demanding reassurance Examples of compulsion signs and symptoms include: Hand-washing until your skin becomes raw Checking doors repeatedly to make sure they're locked Checking the stove repeatedly to make sure it's off Counting in certain patterns Silently repeating a prayer, word or phrase Arranging your canned goods to face the same way This needs to persist over time. To have a concrete diagnosis you would need to speak to a medical professional to evaluate the compulsion/obsession fully. Obsessive Compulsive Disorder can be linked to anxiety if the compulsion or obsession cannot be completed or accomplished. The anxiety can also come from frustration of not being able to control the thoughts associated with the compulsion. Stress and anxiety trigger and worsen obsessive compulsive disorder so it is important to be mindful of this. The best thing to do now is to try and manage your stress and keep an accurate diary of your symptoms and issues so that when you discuss them with a specialist they have an idea of what's going on and how to help you.
(LCSW)
Answered on 10/20/2021