From binge to balance

Binge has become a common word these days.  I most often hear it in terms of Netflix, as in “I binge watched House of Cards all weekend.”  The idea is that you get to watch several seasons (or at least one full season) of a show, in a set period of time, getting up only to order food, go to the bathroom and occasionally make sure the Earth is still revolving.

In clinical terms, “binge” has a more serious connotation. Clinicians often associate it with two activities- binge eating or binge drinking.  Binge eating disorder is an actual disorder, meaning you can be diagnosed with it.  Binge drinking is also a disorder, but falls under Alcohol Dependent Type II.  There were some revisions to this when the DSM 5 came on the scene, but either way, binge drinking is bad news, whether its a disorder or a symptom.

I had a patient make a statement yesterday that stuck with me.  She was talking about how overwhelmed she was with work and other activities (preach it!) and she said “I found myself trying to binge relax over the weekend.”  That’s when it hit me.  We have become a people of extremes.  Many of us binge work- whether it’s actual work, house work, side work, etc.  Then on the weekends we are left to try to binge relax- binge eat, binge watch, binge drink.

Finding a work/rest balance would be the key.  We wouldn’t feel the need to “binge relax” if we weren’t working ourselves to death (for some, literally) every week.

Take a page from those that have found self care to be an every day thing.  They take a 15 minute walk, they watch their favorite tv show (ONE episode), they meditate, they take a hot bath, they work out- whatever is part of their self care routine. But they do it daily.

Finding this balance would make life a lot easier on our bodies and minds.  That’s not to say we can never binge watch Netflix.  It just won’t seem like it is our only option on the weekends.




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It’s Domestic Violence awareness month, but it’s there 365, 24/7.

I never saw myself as a DV counselor.  I did a very brief internship due to my supervisor volunteering at a DV shelter when I was in grad school.  I don’t think I “got” domestic violence back then.  I was lucky enough to grow up in a house where I never witnessed any, and despite dating a few violent a$$h*oles in high school and college, I still couldn’t relate.  Why? Because I walked away from above mentioned a holes. We were just casually dating.  I moved on, they moved on.

It wasn’t until I started working with victims (and some perpetrators) of DV that I realized how dependent the victims are on their perpetrator.  The perp will make the money, be in charge of all of the accounts, sometimes cut them off from family and friends, etc.

But please don’t think that victims of DV are cowering, helpless women that never go outside.  They can be professional women, with kids and jobs.  They can be military, civilian, doctors, lawyers.  They can even be MEN.  Yes, I’ve worked with several victims that are men.  No one ever suspects that the reason they are late for work, or walk with a limp is because their partner abused them.

Another trend in the DV world that I’m seeing more and more of is dual perp, dual victim.  This essentially means that within the couple, both partners are guilty of committing DV acts against the other.  Sometimes at the same time.  While you might  think that’s called a “fight” when it involves an intimate partner, a spouse or the mother/father of your child it is classified as Domestic Violence EVEN if they don’t reside together.

So what can you do?  Be aware.  Be observant.  DV can be a screaming argument in the grocery store, it can be a woman that can’t buy her own things because her partner controls the money, it can even be a LOOK.  You know that look.  The “you better know your place” look.   I’m not saying that every verbal argument, every disagreement qualifies as Domestic Violence.  We all argue with our spouses/SO, it’s of part of being a couple.  The minute it becomes physical it qualifies as DV.  If there is a pervasive pattern of emotional or verbal abuse, it does.

What can you do?  Be there for the person.  Let them know there are resources available, if they choose to use them.  Don’t chastise the person.  Their self-esteem is low enough already.  You actually (unintentionally) mimic the abuser when you tell them “just leave, you can do better, you don’t deserve this.”  Just be supportive.   Let them know of local resources.  Don’t know of any- find some! I guarantee there are some in your area, they just might be a little hidden to protect the victims.

Since DV is around us all the time, educating yourself on resources will be useful at some point in your life.

If you ever get the chance to see “Domestic Violence: the Musical” (yes, I’m not making that up) see it!  It explains DV from the victim’s perspective, the abuser’s perspective, and the friends and family’s perspective.

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Phobias 101


I have recently started seeing two patients that have phobias.  As odd as this sounds, it’s a different kind of fun challenge when I get a patient that has an issue that I haven’t dealt with.  I should clarify this by saying that I treat EACH patient individually- even if I see six Veterans with PTSD in one day, each one has a different treatment plan, a different approach to therapy, etc.  That being said, while I’m always on the search for new PTSD resources and info, a lot of my searches are repetitive.

So when I get a client with a phobia, especially an irrational phobia, it’s a fun challenge. A word of caution: be careful when googling about phobias.  Google is NOT nice, and will embed images in your search.  Googling “spider phobia” will get you some pretty scary images.

What is a phobia? An extreme or irrational fear of something.

Is this different than a fear?  Yes.  You can be afraid of something and still live your daily life.  Someone can be afraid of bugs, and they just try to avoid them.  If they are entomophobic (phobic of bugs) they will go out of there way to avoid them, and it might inhibit their ability to live their daily life.  If they see a bug outside their door, they might not be able to leave the house.  Someone merely afraid of bugs would probably just use another door or even use the door with the bug outside of it, just taking care not to touch it.

Are there different kinds of phobias?  Yes, if you search “phobias” you will get an extensive list.  The main way I like to break them down is into two categories- Rational and Irrational phobias.

Rational phobias are said to be “in our system” from caveman days.  They are phobias of things that potentially could hurt (or kill) you. These things obviously posed a much higher risk in prehistoric times, before modern medicine. These include:

Phobia of Heights (the fall could kill you)

Phobia of Bodies of Water (drown)

Phobia of Insects (their bite could kill you)

Phobia of Snakes (same as above)

Phobia of Spiders (same as above)

Phobia of Fire (die by fire, have materials/dwelling destroyed by fire)

Phobia of Dogs (their bite could kill you)

Now clinicians (myself included) are seeing more irrational phobias.  These include phobias like

Trypophobia – fear of circles or circular patterns

Cherophobia- fear of happiness

Leukophobia- fear of the color white

It is a little harder to find a cause or origin of these phobias.  Some might be steeped in prehistoric days.  For instance, Trypophobia could stem from mold spores, rashes that signified illness and there are some studies that suggest it might stem from certain patterns of snakes that were poisonous.

However, these more irrational phobias could also be personalized to the patient.  For example, if a person was very sick as a child and frequented the doctor regularly, he might associate bright white clothing with pain, therefore leading to Leukophobia.

The thing to remember with phobias is that they are treatable.  There are also many kinds of treatment types- you don’t have to do flooding (sometimes called exposure therapy).  You don’t HAVE to be confronted with the actual thing you’re phobic of but a good therapist will challenge you with talking about it and thinking about  it.  They will also understand that this can cause anxiety and will be able to address this.

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Your Positive 1st Post of the New Year


Negativity is so…easy.  It’s so easy to look at things with a critical eye- to find faults with ourselves, our friends, the general public, experiences and even things.  How many times have you had a great night out- good friends, great food/new restaurant, fun time but you were able to name at least 5 things that could have been better? “That was a great meal but the server could have smiled more, the portions could have been a little bigger, the chairs could have been more comfortable, did XYZ have to laugh at every corny joke her husband told?”

Why do we do that?  You can search “negativity bias” and read countless psychological studies on why the negative always overshadows the positive in human nature.  I want to challenge that.  My personal 2015 goal is to find something positive in every situation and (here’s the big part) to really focus on ignoring the negative aspects.

I’ve always been a “hunt the good” person, even long before Resiliency Training (shout out to all the MRTs out there!) It’s not always easy, and sometimes it can take days, months before I can see the good in a situation.

If you know me personally, you know that I’m not a ray of sunshine.  I’m not trying to sound like I am.  I try to be pleasant and positive- my patients have even commented on it. “You are so good at finding the good in this awful situation.”

Why? Because in my mind,  good=hope.  As long as I have hope, no matter how dismal things look, I can keep going.  I am human- I still might have the breakdown, the cry, the overreaction, the day where I have to drag myself out of bed, but I will find the hope. Even if the hope is “it  can’t get any worse than this.”

I challenge you to reflect on your negative thoughts and statements- be aware of them, rate their validity, and always try to find that silver lining, because sometimes that’s all that’s keeping someone alive today.

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Halloween and PTSD


That’s a broad topic (Halloween and PTSD).  When I mentioned blogging on this topic to a friend she said “There’s a connection between the two?”.

The answer is yes.  Halloween can be a really scary (no pun intended) season for SOME people with PTSD.   Some people that have PTSD might be triggered with the gore/props, jump scares and the masks or cloaking that take place for Halloween.

Gore/props- fake blood, body parts, bones can be a trigger, especially for combat Veterans with PTSD. Body parts and blood come right out of a battlefield scene and can bring back morbid memories.

Jump scares- sneaking out from behind a corner and shouting “boo” might seem like a funny idea, but to someone that has PTSD and is already hyper vigilant (over stimulated, constantly scanning) it can be detrimental.  That initial shock of adrenaline that happens to anyone when they are scared can actually trigger physiological stimuli in the body, and “prepare” the body for combat, or any other traumatic scenario the person has experienced.

Masks/Costumes- masks are a metaphor for hiding your true feelings or the “true” person underneath.  On Halloween, they are not viewed that way, they are for fun and celebration. To a person with PTSD, not being able to read the facial expressions and subtle cues because of a mask can make them extremely uncomfortable and stand offish.

I don’t want you to misunderstand what I’m saying- not ALL people with PTSD have issues with Halloween.  Several years ago, I had the privilege of working with the Warrior Transition Battalion at Ft. Bragg. Their Commander asked each Company to do a Halloween themed Trunk or Treat and Haunted House. I was leery, and spent the week leading up to Halloween (their prep and construction time) waiting for these Vets to be triggered. If anyone was, they didn’t show it. They had some of the goriest, scariest scenes constructed and they took great delight in scaring each other and older visitors. It was one of the biggest morale building events I had ever seen.

On the contrary, last year, several of my Active Duty Soldiers and Airmen called to tell me they were having issues because they had been triggered by another Soldier who had dressed up and hid in the bushes along their PT route, jumping out to scare people. When someone reported it, the Chain of Command made this Soldier stop, but some damage had already been done.

In summary, just use caution and discretion when engaging people in your Halloween festivities.  Don’t criticize for lack of costume, not wanting to go to Halloween parties or “haunted” houses/corn mazes/hayrides.  You never know how they are being interpreted to others.

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Happy National Coffee Day–are you addicted?


Recent data shows that 90% of American adults consume caffeine daily. Caffeine comes in so many forms, naturally like coffee and tea, and chemically enhanced beverages like soft drinks, energy drinks as well as caffeine enhanced water, gum and candy.

Caffeine is such an accepted part of our culture, most people don’t think of it as a drug. Caffeine is a psychoactive drug, a stimulant.  It can cause addiction, withdrawal,  and tolerance like other stimulants.

Some common symptoms of caffeine addiction are usually not seen until one goes into the withdrawal stages (anywhere from 8-48 hours after last use).  These can include irritability, fatigue, headache, migraine, and craving caffeine.

Most doctors recommend you titrate yourself off of caffeine, unless you have to quit “cold turkey” for a medical reason.  If you have to, stock up on OTC pain relief and try to do it over a weekend or other 48 hour period in which you don’t work.  Stay hydrated!  That will help.

Healthier Substitutes:




Eat more protein

Lifestyle changes- more sleep, less “blue light” in your room at night, exercise

Nothing is wrong with moderate amounts of  coffee or tea daily.  Be cautious of more man made and chemically altered drinks like soda and energy drinks.  These often have additional ingredients that are more damaging to the body than caffeine.

Cheers! *clinks coffee cups*

***This blog is for information/entertainment purposes only and is
not meant to be a substitute for mental health therapy. If you believe
you are suffering from a mental or physical illness see the
appropriate mental health/medical professional as soon as possible. If
the situation is life threatening dial 911 or proceed to the nearest
emergency room.***

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lunatic (adj.) late 13c., “affected with periodic insanity, dependent on the changes of the moon,” from Old French lunatique, lunage “insane,” or directly from Late Latin lunaticus “moon-struck,” from Latin luna “moon” (see Luna). Compare Old English monseoc “lunatic,” literally “moon-sick;” Middle High German lune “humor, temper, mood, whim, fancy” (German Laune), from Latin luna.

This weekend 19-21 September, we had a full moon, as well as the Fall Equinox (21-22).  I also had to do my first commitment, since going into private practice, for a patient who was displaying suicidal and homicidal behavior with a plan. Scary.  I had 2 other patients schedule emergency appointments this weekend as well.  I blamed the moon, jokingly.  In all seriousness though, all three patients had similar themes to their emergencies, and I wanted to address that here.

It is OKAY to have a crying meltdown.  It is OKAY to need a day off for mental health reasons.  It is OKAY to say “no” to someone you love, if you don’t have the time/energy/ability to do what they are asking.  It is NOT Okay to keep neglecting yourself, driving yourself to a nervous breakdown/psychotic breakdown, whatever you want to call it.

As a therapist, I am seeing this trend more and more- people refusing to take care of themselves holistically- body, mind and spirit.  Instead, we pop a pill, drink another energy drink and “push through”.  I know I sound preachy, and trust me, I’m guilty of some of the above.

My recommendations- stop ignoring your red flags. Your body or mind will tell you when you need a break.  When you get that warning- take a break! From as  simple and inexpensive as meditating, snuggling in bed with a book or a movie to as involved as a weekend getaway.  Do what you need to do to stay sane. Learn to say no. People will understand.

***This blog is for information/entertainment purposes only and is
not meant to be a substitute for mental health therapy. If you believe
you are suffering from a mental or physical illness see the
appropriate mental health/medical professional as soon as possible. If
the situation is life threatening dial 911 or proceed to the nearest
emergency room.***

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