Abnormal Psychology – Licensed Mental Health Counselor

A Journey into the Mind: Understanding the Alice in Wonderland Syndrome

18 Aug 2023by Torey C. Richards, LMHCLeave a Comment

“Curiouser and curiouser!” cried Alice as she tumbled down the rabbit hole into a world that defied logic and reason. Lewis Carroll’s fantastical adventure has not only entertained readers for generations but also inspired a curious medical phenomenon known as the Alice in Wonderland Syndrome (AIWS). This condition, much like Alice’s adventures, involves distortions of perception and reality, leading one to question what’s truly real.

What Is Alice in Wonderland Syndrome?

AIWS is a disorienting neurological condition that affects perception. Individuals with this syndrome may perceive objects as smaller or larger than they actually are, feel as though their body is changing size, or even lose a sense of time’s passage. These experiences can be both fascinating and frightening, taking one on an unexpected mental journey.

Symptoms of AIWS

Alice’s strange adventures in Wonderland resonate in the experiences of those with AIWS. Symptoms might include:

Size Distortions: Objects or parts of the body might appear larger (macropsia) or smaller (micropsia) than they actually are.
Time Distortions: Time may seem to slow down or speed up, causing disorientation.
Spatial Distortions: Distances may appear incorrect, with things seeming too close or too far away.
Altered Body Image: One might feel as if certain body parts are growing or shrinking.

Causes and Triggers

AIWS is not a disease itself, but a symptom that can be associated with various underlying conditions, including:

Migraines: The connection between migraines and AIWS is well-established, with distorted perceptions often occurring before or during a migraine attack.
Epilepsy: Seizures can sometimes trigger AIWS symptoms.
Infections: Certain infections, particularly in children, can lead to transient episodes of AIWS.
Psychiatric Conditions: Although less common, some psychiatric disorders might lead to experiences akin to AIWS.

Understanding the root cause is essential for proper management and treatment, which can vary widely depending on the underlying condition.

Diagnosis and Treatment

AIWS can be a challenge to diagnose, as its symptoms are so subjective and often transient. Medical history, detailed descriptions of the symptoms, and appropriate testing can lead to a diagnosis. Treatment usually focuses on managing the underlying condition, such as migraines, epilepsy, or infections.

The Mind’s Mysteries Unveiled

The Alice in Wonderland Syndrome offers a captivating glimpse into the complex and sometimes mysterious workings of the human mind. It reminds us that perception is not always an accurate reflection of reality, and our brains are capable of creating experiences as surreal and whimsical as any Lewis Carroll tale.

AIWS in Popular Culture

Beyond medicine, AIWS has inspired artists, writers, and thinkers. Its association with altered states of consciousness has led to explorations in literature, visual arts, and even philosophical discourse.

Conclusion: A Window into Perception

Alice’s adventures in Wonderland are more than mere children’s tales. They provide a metaphor for a medical phenomenon that challenges our understanding of perception and consciousness. AIWS is a rare but captivating condition that encourages us to reflect on how our minds construct reality.

Though it may seem fantastical, AIWS is a reminder that our perception of the world is a complex and delicate system, easily swayed by various factors. It invites us to question what we perceive as real and to marvel at the human brain’s ability to create worlds within worlds.

As we navigate our own rabbit holes in life, we can take a moment to appreciate the wonder and complexity of our minds, knowing that reality is sometimes as malleable and extraordinary as a journey through Wonderland.

Abnormal Psychology

Avoidant Personality Disorder

13 Apr 2022by Torey C. Richards, LMHCLeave a Comment

Recently I had an opportunity to interview a young man who has been diagnosed with avoidant personality disorder (AvPD). AvPD is a personality disorder where the person suffers from high social anxiety and fear of intimacy despite also desiring social interaction and intimacy in most cases.

The person often feel as if they are being judged or ridiculed by others and feel unattractive, uncomfortable, or inept in social interactions. They are usually extremely sensitive to the opinions of others and fear rejection and being judge negatively. To cope they usually withdraw from social interactions as much as possible which while it may help them successfully avoid the things they fear, it also often leaves them feeling more socially inept, lonely, anxious and depressed.

Avoidant personality disorder often results when a child has been rejected by one or both parents or his or her peer group, but it can also be caused by other factors such as a history of abuse and/or neglect.

People with avoidant personality disorder often only socialize with others they feel assured will not reject them. A very small number of people (often only one or two) will usually have gained their trust enough for them to feel confident and secure in their relationship with them.

They often look down upon themselves, minimizing their positive traits while inflating whatever flaws they perceive themselves as having. The person I interviewed is a serial “ghoster”. He would attempt to make friends and do so successfully, just to end up ghosting them. He told me that the fear of pain of what he saw was the inevitable (his friends rejection or abandoning him), was so strong that he would reject them before they had a chance to reject him. He isolated himself. He doesn’t have any current friends, but he does have a longtime girlfriend who is the one person he is closes to. He purposely chose a job where he works from home and has to deal with other people rarely. He has tried in the past to be more social. He went to college, but dropped out because the stress of having to interact with others was unbearable. He eventually went back and completed an online program. He has also often thought about suicide because he often fells anxious, lonely and undesirable and reports that it is a constant battle. He is in ongoing therapy to help keep him grounded.

Is Social Anxiety and Avoidant Personality Disorder the Same?

Avoidant personality disorder shares some of the same characteristics of social anxiety, but is less common. People with AvPD tend to have more severe symptoms of anxiety and depression than people with social anxiety. Also, people with social anxiety tend to fear the social circumstances (i.e., being at a party with a bunch of people judging how they look, act, etc.) while AvPD is more an aversion to intimacy in relationships.

How is Avoidant Personality Disorder Diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association has a diagnostic code for avoidant personality disorder diagnosis (301.82) and describes it as a widespread pattern of inhibition around people, feeling inadequate and being very sensitive to negative evaluation. Symptoms begin by early adulthood and occur in a range of situations.

Four of the following seven symptoms have to be present to make a diagnosis of AvPD.

Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
is unwilling to get involved with people unless certain of being liked
shows restraint within intimate relationships because of the fear of being shamed or ridiculed
is preoccupied with being criticized or rejected in social situations
is inhibited in new interpersonal situations because of feelings of inadequacy
views self as socially inept, personally unappealing, or inferior to others
is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing

Treatments

Some of the treatments for avoidant personality disorder include cognitive therapy, social kills training, group therapy and drug treatments. As I said earlier, this particular young man is actively in therapy with a psychotherapist. He still prefers to isolate himself even making it a point to let me know that the only reason he felt comfortable opening up to me about his experience with AvPD was because he knew he would never talk to me again.

Abnormal Psychology, Popular Psychology

Psychopaths Most Dangerous Trait: “He Seems So Normal”

3 Jan 20193 Jan 2019by Torey C. Richards, LMHCLeave a Comment

Every day I work with some of the worst of mankind; killers, rapists, molesters, etc. Most of these individuals easily fit into the category of psychopaths or sociopaths. Although these terms are often used interchangeably, the difference mostly comes down to nature versus nurture.

Psychopaths are thought to be born that way. Their traits are more innate and often have underdeveloped parts of the brain that influence emotions such as empathy. Sociopaths on the other hand tend to be the result of their upbringing and environment. Both are covered in the Diagnostic and Statistical Manual of Mental Disorders under Antisocial Personality Disorder.

Not everyone with Antisocial Personality Disorder ends up being a criminal. Studies show that many leaders, CEOs and medical doctors have Antisocial Personality Disorder. In some ways, it is what makes them able to do their jobs so well. However, many career criminals, especially does engaged in some of the most violent and heinous crimes, do fall under the constructs of psychopaths or sociopaths.

A common and what I consider to be the most dangerous trait that most of these individuals possess is the ability to appear perfectly “normal”.

They are not the creepy, easily recognizable monsters we would like to believe they are. They don’t look scary. They don’t cause us to cross the street when we come across them on the sidewalk.

They are the guy next door we see every day and says hello, yet he’s got death bodies hidden in his apartment (Jeffrey Dahmer). They are the charismatic friend we never could imagine is going out raping and killing women (Ted Bundy). They are the neighbor who dresses up like a clown and entertains the kids, yet is killing and torturing young boys (John Wayne Gacy).

They are the people you could never imagine had such violent tendencies and could carry out such devious acts because they act so “normal” and blend in with the rest of society so well. Many not only appear harmless, but also appear weak.

Watching a documentary on Jeffery Dahmer, one person interviewed commented that when he first met Dahmer, he found him unassuming and thought to himself that his seventeen-year-old son could easily beat him up, yet Dahmer successful drugged, sexually assaulted and killed seventeen males.

Ted Bundy often put his arm in a sling and put on a facade making himself appear harmless and handicap, that’s as if his relatively good looks and charm weren’t enough to lower his victims defenses.

I’ve spoken to a man who attacked two women with an axe, brutally killing one, yet he portrayed himself to me and others as barely able to walk and incapable of moving as fast as the blitz attack he was later convicted of committing called for.

Another man I spoke to killed his wife, dismembered and discarded her body, yet during our interview who portrayed himself as being fragile and sick with mobility issues. Many of the healthcare staff who came in contact with him commented on how they felt sorry for him, that he was so weak and needy that they couldn’t imagine him hurting a fly.

And that’s how psychopaths and sociopaths get you. You think they are harmless, your guard is down and then they hit you in the back of the head and stuff you in the trunk of their car, or the back of their van.

I recently spoke to a serial rapist who, once again presented himself to me as being emotionally weak, compliant and an overall nice guy, yet he has attacked, abducted, beat and raped women in his van. He is a good-looking young man, that with his charm and apparent mild-mannered disposition allowed him to meet women who had no idea they were putting their lives in the hands of a monster.

I’m not saying you can’t trust people, but what I am saying is to listen to your gut. Society has slowly been pushing us as to ignore our natural instincts that say “something isn’t right here”, and that ignoring our natural instincts can make us easy targets for people to victimize us and not just rapist and killers, but those who are less deviant such con-artist and scammers.

The person who could have ended up being Jeffrey Dahmer’s next victim, felt like something wasn’t right when Dahmer had him back at his apartment and wanted to take pictures of him handcuffed and lying face down on the bed. This person found an opportunity to leave and this saved his life and ended Dahmer’s killing streak. How many other of his 17 victims also felt like something wasn’t right, but overrode their innate warning system and told themselves nothing bad was going to happen.

Not that this totally summarizes my point nor do I necessarily agree with everything said in this clip, but listen to what Saundra Bullocks character says in this clip from the movie Crash about ignoring her gut. Some things can not be avoided, but from my research, individuals like psychopaths and sociopaths are counting on us to ignore our innate instincts in order to become their next victims.

Abnormal Psychology, Popular Psychology

To The Bone: A Film Review From A Mental Health Professional

15 Jul 201715 Jul 2017by Torey C. Richards, LMHCLeave a Comment

Content warning: This post deals with eating disorders and may be triggering for some readers.

To The Bone is a new Netflix original movie about a 20-year-old woman, Ellen, who suffers from anorexia nervosa and ends up in a group recovery home for individuals with eating disorders. The official trailer is included at the very end of this post.

Just like with 13 Reasons Why, there is a ton of controversy surrounding the appropriateness of this film. Many individuals, including many mental health professionals believe that this movie is very dangerous because they believe it will glamorize eating disorders. Some are even calling for Netflix to take the movie down.

Once again, just like with 13 Reasons Why, the majority of these individuals have not even seen the movie yet. Their fears however have some legitimacy.

Research suggests that it’s triggering for those who already have an eating disorder or who are struggling with unhealthy thoughts surrounding eating, body image and weight issues to watch other people displaying eating disorder behaviors, even if it’s a story of hope and recovery.

With that said, I do not think that those individuals should watch this movie.

If you are someone or you are the parent of a child or friend of someone who is suffering from an eating disorder, I do not think this is a movie you should watch with them. Watch it yourself for sure, as I believe the movie gives some great insight into what it’s like to suffer from an eating disorder, but do not watch it with them in hopes this will be a great conversation starter between the two of you. It could possibly do more harm than good.

There are definitely some images and events in the movie that can be triggering to certain individuals, such as the main character herself who is scary thin, to the calorie counting and food avoiding behaviors displayed throughout the movie.

Banning this movie however I do not agree with because it is just that, a conversation starter. It’s a movie that needed to be made.

My Issue With The Movie

My only issue with the movie is that Ellen, played by British actress Lily Collins is scary thin. This in itself can trigger individuals who already have issues with their body weight or have an eating disorder.

The real issue is that Lily Collins herself struggled with anorexia nervosa and bulimia nervosa at some point in her 27 years of life and writes a chapter about it in her book, “Unfiltered: No Shame, No Regrets, Just Me.”

For the movie she had to lose a lot of weight to look the part of a very unwell young woman. Although she reports that they did it in a healthy way with the help of a dietician, I still found it alarming that anyone would subject someone who already has a history of struggling with eating disorders, to losing so much weight and then this almost skeletal person is the main character that millions of viewers, some of who will be susceptible to triggers, have to watch on-screen for two hours.

As I watched the movie, before I did my research, I couldn’t tell if she was really that thin or if it was some tricks of the camera or make-up, but upon learning that she actually had to lose such a large amount of weight to play her character, it was just a bit unsettling.

I’m not sure if this film could have been done any other way.

Anorexia Nervosa Versus Bulimia Nervosa

Unless I missed it, the one thing I don’t think the movie did a good job on was differentiating between anorexia nervosa and bulimia nervosa. People tend to think that the only difference is that those with anorexia nervosa severely restrict their calories while those with bulimia nervosa eat and then purge (vomit) in order to control their food intake.

However, there are two types of anorexia nervosa.

One is the restrictive subtype that is more of what people are familiar with. They rarely eat, count calories religiously and may use laxatives, but usually do not purge. The second subtype is the bingeing and purging subtype. These individuals are more like those with bulimia nervosa as they will binge (over eat) and then purge their food.

The main difference between the two is that individuals with anorexia nervosa have a difficult time maintaining the minimal amount of weight considered healthy and individuals with bulimia nervosa are usually at a healthy weight or even overweight.

While anorexia nervosa and bulimia nervosa are the two eating disorders people are most familiar with, other common eating disorders include pica, binge eating disorder, and avoidant/restrictive food intake disorder.

Most eating disorders last 6 to 8 years which is a large part of someones life.

While body image, food and weight loss are generally the focus of an eating disorder, they usually aren’t the underlying causes.

Issues that may trigger eating disorders include a history of abuse or trauma, bullying, parent relational problems, low self-esteem, personality disorders, substance abuse, difficulty dealing with conflict, genetics and feeling as if they have no control over their lives.

Millions of Americans suffer from disordered eating and they’re not all thin, young white girls. People who suffer from eating disorders come in all shapes, sizes and ethnicities from the rail thin to the morbidly obese.

I worked with a 10th grade Haitain-American girl, along with another therapist who specialized in eating disorders as well as a dietician for two years. She struggled with anorexia and it was some of the most difficult work I have ever done.

Eating disorders, just like most mental health disorders, are always hard and uncomfortable topics to discuss and many people would prefer to act like they simply do not exist or are something they never will have to deal with. That is why 13 Reasons Why faced such backlash and why To The Bone is as well. Avoiding these issues will not make them go away.

If people want to be angry with Netflix for making movies such as To The Bone then we also need to be angry with our media in general because it glamorizes weight-loss and thinness. Girls as young as elementary school have started engaging in unhealthy diets and calorie counting due to the images they see on a daily basis through our media.

Marti Noxon, the writer and director of To the Bone says that the movie is based on her experience of struggling with an eating disorder and that the film is intended as “a conversation starter about an issue that is too often clouded by secrecy and misconception”.

So with some warning I recommend this film to anyone interested in learning more about what it is like to struggle with an eating disorder, but not to anyone who is already struggling with body image issues or unhealthy issues about food and weight.

The hope is that this film increases the conversation without increasing the risk of triggering others, but honestly I don’t know if it’s possible to have these type of conversations without anyone ever being triggered. It’s the nature of the beast.

If you or anyone you know are struggling with an eating disorder, please contact The National Eating Disorder Association (NEDA)at http://www.nationaleatingdisorders.org

Abnormal Psychology, Popular Psychology

The Mentally Ill and Incarceration: A Broken System

27 Jan 201727 Jan 2017by Torey C. Richards, LMHCLeave a Comment

Working in a jail or prison is like working in a large mental health hospital, without all the necessary trained staff needed to actually run effectively.

As a matter of fact, the biggest mental health providers in our nation right now are our jails. The three biggest mental-health providers in the nation today are: the Cook County Jail in Chicago, the Los Angeles County Jail and Rikers Island jail in New York.

These are no places for people who are severely and chronically mentally ill.

Decades ago when there were plenty of beds in state hospitals, the most severely ill were often locked away in asylums and forgotten in order to “keep society safe”. Often times they were locked away and offered no real help and suffered horrible conditions and treatment.

Today jails and prisons have become the new asylums.

The mentally ill often get into trouble due to their illness. Often the crimes are as harmless as sleeping on a park bench, trespassing or having an open container of alcohol. Rarely are they violent offenses.

A 2010 study by the Treatment Advocacy Center and the National Sheriffs’ Association estimated that 40 percent of the seriously mentally ill have been in jail or prison at least once in their lives.

In the county jail I work in I would say about 75% have some sort of mental illness while about 10% have a severe mental illness that should be treated at a psychiatric facility and not in jail.

Most jails and prisons, like us are understaffed. We currently have four full mental health professionals including myself and a psychiatrist. Ideally, we’d have at least three or four more but there’s not enough funding.

Many corrections officers are under trained when it comes to dealing with the mentally ill and the overall outlook of mentally ill inmates on both medical and security staff in jails and prisons is not usually conducive to effective treatment. Especially for the severely and chronically mentally ill who are often in and out of jail.

Like the young lady I met earlier this week. She’s a 38 year old woman who came up in the foster care system. She had came from an abusive and neglectful family and it’s unclear if the abuse and neglect caused her mental illness or if she was abused and neglected because of it. Either way, starting at a young age she suffered almost every kind of horrible abuse you can imagine.

As an adult she has been arrested over 20 times for everything from possession of cocaine, parole violations and battery.

In 2001 she was arrested for aggravated battery after she attacked and kicked a state hospital guard who ended up suffering a heart attack and dying.

In 2003 she was arrested after two men reported they had unprotected sex with her without knowing she was HIV positive. She later told authorities she knew she had HIV since 1999 and didn’t tell any of the at least 200 men she claims to have had unprotected sex with. She plead guilty and served 23 months.

She continues to cycle between being on the streets, going to jail, the state hospital and prison.

Often times no one wants to take her (the state nor DCF) because she is so mentally ill and has grown more and more violent.

When she came into our jail there was a big push to get her out and back to some place that could manage her better.She’s trapped in a system that in some ways may have helped create her and doesn’t want anything to do with her.

In many ways she has been abandoned since she was a child and as an adult who is now nearing the end stages of AIDS, she is still alone and abandoned.

Continuing to incarcerate the mentally ill over and over again doesn’t work. It doesn’t help anyone. We lock them up where they may or may not get treatment and then send them back out on the street where they may or may not get treatment.

What’s the solution?

We need more state and federal funding for mental health, reform treatment laws to address intervention, assisted outpatient treatment for released mentally ill inmates, expansion of mental health courts that offer treatment instead of incarceration and ideally a health care system that provides systematic health care for those suffering from a mental illness.

If we can find a way and the money to build a wall between between the United States and Mexico, surely we can do this!

Abnormal Psychology, Popular Psychology

The Narcissistic Parent

27 Jun 2016by Torey C. Richards, LMHCLeave a Comment

“I do not love; I do not love anybody except myself. That is a rather shocking thing to admit. I have none of the selfless love of my mother. I have none of the plodding, practical love. . . . . I am, to be blunt and concise, in love only with myself, my puny being with its small inadequate breasts and meager, thin talents. I am capable of affection for those who reflect my own world.” – Sylvia Plath

Sylvia Plath, the poet and author of the quote above was a narcissistic parent who committed perhaps the most selfish and narcissistic act of all. She killed herself by sticking her head in a gas oven while her two children were asleep in the same apartment. She did however seal off their rooms with towels so that they would live. Why? Most likely so someone could carry on her memory and mourn for her after death.

How do you think this affected her children? Well her daughter, Freida Hughes is an English poet and painter, but she’s been married three times and is currently divorced. Her son, Nicholas Hughes, suffered from depression and hung himself in 2009.

What Is A Narcissist?

To the outside world, a narcissistic parent may appear to be the perfect example of a gentleman or a loving, supportive mother who is passionate about her kids. However, to the child of a narcissistic parent, they are living a constant nightmare of never being good enough and being constantly reminded of it.

A narcissist is someone who has an inflated sense of self-worth. This is different from what’s considered “healthy narcissism” in which you believe in yourself and your abilities in a realistic fashion. You have good self-esteem, but can empathize with other people and aren’t devastated by mistakes or criticism. Your self worth isn’t dependent on other people admiring you.

On the other hand there is “malignant narcissism”, in which the person has a very fragile sense of self that is dependent on how other people see them. These people have an unrealistic, inflated sense which they use to hide insecurities and shame. They need to be praised, admired and approved by others and are deeply hurt by criticism and honest feedback. Their relationships with others tend to be superficial as they focus mostly on how other people reflect on them with little or no care about the other persons feelings. They believe they are better than everyone else, special even, but can get very sensitive and angry when faced with critique.

For a narcissist, everything is always about them. They are extremely selfish individuals who never give recognition, gratitude or appreciation to those around them. It’s “me, me, me” all day, all the time. If they ask you, “How is your day?” and you reply, “Horrible, I just totaled my new Mustang”, they may reply, “I had a Mustang once. A 1968 convertible. Man I loved that car. Brought it brand new off the showroom floor…”. They really don’t care about you and are only looking for opportunities to talk about and inflate themselves.

Imagine growing up having this type of person as a parent? Someone who is practically incapable of loving anyone other than themselves, when as a parent, you have to give so much love to a child.

Why then would a narcissist have children?

A narcissist does not have a child for the reasons most people do. They do not have children because they want to love and nourish another person, they do so in order to create mirrors of themselves and to create an automatic relationship where they have power and control over someone.

Having control over other people is the narcissists ultimate goal. From an early age the child of a narcissist learns to realize that they exits to please their parent and to be a reflection of them.

Like any child, the children of narcissist will try to please their parent, going through great lengths of anguish and frustration to please someone who will never be pleased for long. One day, if they are lucky, they will realize that it’s the parent who is not quite right, not them.

Until then, these children learn that they are a reflection on their parent and will try to mold themselves, mentally and behaviorally into being that perfect representation their parent wants.

This creates much anxiety as the child is continuously trying to be what they are not in order to please the parent and when they fail, which they will time and time again, they are exposed to punishment that can range from physical to psychological.

These children are often mentally on edge and tormented by the unpredictable and sometimes confusing nature of the narcissistic parent. They may think over and over again that they are a failure, that something is wrong with them . The child may experience a great deal of shame and low self esteem because they don’t feel constantly loved. They are taught that they are only as good as the parent says they are and that they’ll only be loved if they are completely compliant.

Take for example a child who throws a tantrum in the store. Most parents may remove the child, redirect them, or try some other tactic to calm the child down. A narcissistic parent is likely to chastise the child by saying something like, “You’re a spoiled little brat. You always find a way to ruin my life.” Such harsh words for a narcissist are nothing, even directed at their own child.

On the other side of this poor parent-child attachment is neglect. The narcissist parent may be so self-absorbed that the child is neglected and nearly forgotten. Their needs, desires and aspiration always thrown aside for the sake of the parents’ wants and desires.

For example, a daughter going to her high school prom may have all of her desires for the dress she wants and the way she wants her hair styled cast away in favor of what her mom wants her to wear and wants her hair styled. If she doesn’t go along with this and protests, then her mother may call her an ungrateful child and refuse to help her with her big night.

Later in life, these children grow up and often develop narcissism themselves or end up in drama filled relationships with toxic partners because they grew up believing that they were bad and don’t deserve good things to happen to them. They often question if they are deserving of love.

In a healthy relationship with a healthy partner, these individuals wouldn’t know how to respond to unconditional love and would be filled with so much anxiety and discomfort. Understandably they would seek out other individuals who are emotionally unavailable, cold and critical just like the narcissistic parent they grew up with. It’s familiar and sadly, even comfortable to them.

Hopefully, through good relationships, friendships and sometimes therapy, these children are able to recover from the wombs of growing up with a narcissistic parent and not succumb to them.

Abnormal Psychology, Popular Psychology

Too Scared To Talk: Children with Selective Mutism

15 Jan 201515 Jan 2015by Torey C. Richards, LMHCLeave a Comment

The other day I was speaking to a mother who was describing her son’s symptoms to me. She reported that he had difficultly and sometimes just couldn’t speak at all in various social situations, especially at school and around strangers. He had been tested for Autism and that was ruled out. She was very frustrated with her son, but also felt bad for him because she could tell that he was also in distress. She just couldn’t understand why her son would suddenly become mute in social situations when he was such a funny, outgoing and talkative kid at home.

After listening some more, I realized that her son did not have an autistic spectrum disorder as she still believed, but that he had what is called Selective Mutism.

Selective Mutism is the inability to speak and communicate in social settings, but the ability to speak in settings where the child feels comfortable, relaxed and secure. Many parents think their child has absolute control over this, hence their frustration, but Selective Mutism is an anxiety related disorder .

90% of children with Selective Mutism also have social anxiety or social phobia. While many parents initially think their child is faking or playing games, Selective Mutism is very painful and debilitating to the child.

Children with Selective Mutism have a real, paralyzing fear about speaking and therefore this totally impairs their ability to develop social relationships or to participate in social situations.

Not every child expresses Selective Mutism in the same way. While some children are totally mute in social situations, others can only manage to whisper while some will remain perfectlu still, seemingly unable to speak or move, while less severe children can manage to speak totally normal to a select few individuals in social situations. This type of anxiety goes well beyond the normal range of shyness seen in other children.

A very select few children with Selective Mutism don’t appear to be shy at all. They actually do a very good job trying to mime their way through social situations. In these children, Selective Mutism may be a symptom of something else, such as the child initially being mute and never grasping communication and are basically stuck in the nonverbal stage of communication.

Why Does A Child Develop Selective Mutism?

Most children who have Selective Mutism have a genetic predisposition to anxiety. This means that it is inherited. Almost from infancy on, these children may show severe separation anxiety, moodiness, frequent tantrums, inflexibility, show extreme shyness and have sleep problems.

Some children with Selective Mutism may have Sensory Processing Disorder (DSI), which basically means they may be sensitive to sounds and lights, and that they may perceive environmental and social cues differently than most people. They become easily frustrated, angry, confused, withdrawn or act out because the signals they are receiving from their brain are alerting them to danger and fear causing them to have anxiety.

Up to 30% of children with Selective Mutism also have a speech, language, processing or learning disorder which can increase their anxiety and inability to communicate effectively in social situations.

There is no evidence that abuse or trauma causes Selective Mutism, which is different from Traumatic Mutism.

In Selective Mutism the child can usually speak normally at least in situations where they are comfortable. In Traumatic Mustism, a child witnesses or experiences a tragedy so devastating that they can’t comprehend it, they stop speaking altogether in every situation suddenly.

Selective Mutism can progress to the point where the child stops speaking and becomes totally mute, but that is usually gradual and when negative reinforcements cause the child to slowly start limiting the places and people he/she feels comfortable talking to.

Diagnosing Selective Mustism

Most children are diagnosed with Selective Mutism between the ages of 3 and 8. Most of these children have already exhibited severe symptoms of anxiety. If a child stops speaking for more than a month than the parents need to take the child to a doctor.

Here is the diagnostic criteria for diagnosing Selective Mutism. Note that this criteria shouldn’t be the only criteria used to diagnose or rule out Selective Mutism since each child and case is different:

DSM-IV-TR (2000):
1. Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
2. The disturbance interferes with educational or occupational achievement or with social communication.
3. The duration of the disturbance is at least 1 month (not limited to the first month of school).
4. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
5. The disturbance is not better accounted for by a Communication Disorder (e.g., stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.
Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at home. There may be severe impairment in social and school functioning. Teasing or goading by peers is common. Although children with this disorder generally have normal language skills, there may occasionally be an associated Communication Disorder (e.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive- Expressive Language Disorder) or a general medical condition that causes abnormalities of articulation. Mental Retardation, hospitalization or extreme psychosocial stressors may be associated with the disorder. In addition, in clinical settings children with Selective Mutism are almost always given an additional diagnosis of Anxiety Disorder, especially Social Phobia is common.

Many parents, teachers and even professionals do not understand Selective Mutism because research is so limited. Many think the child is being defiant, controlling, that they are just shy and will grow out of it, or that they have some other disability such as autism.

Children with Selective Mutism tend to want friends, they are just too anxious to develop friendships easily while children with autism tend to not care to have any friends at all.

When considering seeking treatment for a child with Selective Mutism, parents should be careful not to find a professional who believes that Selective Mutism is behavioral and about the child being defiant or controlling. These type of professionals tend to try to use punishment and forcing the child to speak as treatment, which consequently increases the anxiety of the child and worsens the condition.

Good professionals who understand Selective Mutism will focus on making the child feel comfortable, decreasing anxiety and helping the child learn coping skills to deal with anxious feelings. This is often done with a combination of therapy and medication and as a collaborative approach with the professional, parents and the school.

Dealing with a child with Selective Mutism can be frustrating, but understanding what Selective Mutism is and is not helps decrease the frustration.

For more information and help, go to http://www.childmind.org

Abnormal Psychology, Popular Psychology

Blinded By Beauty: Ignorance Towards The Mentally Ill

1 Oct 20131 Oct 2013by Torey C. Richards, LMHC1 Comment

Yesterday while watching the local news, I saw a story about an officer who was called to an apartment complex after residents called bout a naked woman outside of her apartment.

Upon arriving, officer Ryan McIntosh found 20-year-old Ayanna Alexander outside of her apartment, but she had put on clothing by then.

Ayanna, who is an exotic dancer, told the officer that she was upset because she didn’t have a ride to work at Rachels, a local strip club.

The officer didn’t think Ayanna was impaired or had any other medical conditions, so he called his supervisor and got permission to drive Ayanna to work. He dropped her off and left, only to be called back shortly afterwards to a nearby restaurant after receiving a call about a naked woman thrashing the restaurant and disturbing patrons.

The officers arrived at the restaurant to find Ayanns with no pants or underwear on and during questioning by the police, she removed her shirt and bra and said she wanted to go to jail.

Ayanna was charged with disturbing the peace, indecent exposure and trespassing.

The problem I have with this is, not many people in their right minds, especially an “attractive” 20-year-old woman would just strip naked and cause havoc. To me, this just screams mental illness from the start, rather it is bipolar disorder or something else, but from the start of this story i felt like this woman should have been taken to the hospital for a mental evaluation, not taken to work and just dropped off.

Even after the second incident, instead of taking her to jail, I still feel like she should have been taken for a mental evaluation. Something clearly isn’t right. Maybe it is drugs, who knows? The officer said she didn’t seem impaired, but her behavior was abnormal and he didn’t do a urinary drug screen to rule out she was on anything.

Also, he was obviously not a Crisis Intervention Team officer or had much training, experience or exposure to mental illnesses or he would have recognized that this woman was in need of help, not a ride to her place of employment.

I’m not necessarily blaming the officer for not being trained properly, but I am blaming him for being ignorant and perhaps even blinded by an attractive female and wanting to do the “nice” thing by giving her a ride to work instead of truly investigating the incident.

At the hospital I work at it’s not uncommon for officers to bring us young, attractive, 20 something year old women they find naked running or walking through the streets or just sitting in the middle of the road. Nine times out of ten these women are not under the influence of any drugs or alcohol, but are suffering some type of mental break.

Often times it’s their first psychotic episode and they go on to be diagnosed and treated for bipolar disorder (most commonly), and other times they are people with long histories of mental illness.

The late teens and early twenties are the prime ages for the development of bipolar disorder and it’s not uncommon for people to present with symptoms of erratic, impulsive and irrational behavior for the first time around 20.

If this woman is simply arrested, charged and then released, she will get no help and eventually spiral out of control again, but maybe next time she won’t run into a naive officer who is trying to be nice, but maybe a predator or someone else who instead of helping this lady may victimize her or she may do something much more reckless and dangerous than taking off her clothing and throwing food in a restaurant.

Sometimes it’s hard to recognize and start treating the first symptoms of a mental illness, but to me it’s common sense that if you come across a naked, exotic dancer who gets paid to take her clothes off, doing it for free outside in the daytime, something isn’t right and the two most likely culprits are drugs and mental illness.

If the officer quickly decided she wasn’t impaired or had a medical conditions, why didn’t he take her to rule out a mental health condition other than ignorance? This is a problem on many occasions, but especially when you consider that the jails and prisons in our country today house many more mentally ill people than all of the mental hospitals, clinics and institutions combined.

Untrained officers come in contact with mentally ill people on nearly a daily basis and often times the result is tragic (numerous officer related shootings involving mentally ill people is what sparked crisis intervention team training for law enforcement officers), or they are arrested or simply ignored.

In this case, two out of three happened. Her mental condition was ignored and then she was arrested.

Abnormal Psychology, Taking Control of Your LIfe, Therapist are Humans Too

Sensitive People: Absorbing Other People Emotions

22 Sep 2013by Torey C. Richards, LMHCLeave a Comment

I’m highly sensitive to other people emotions and energy. I have been for probably all of my life, but it is something I have just become aware of in the past few years. I can be having a good day, feeling happy and all it can take is an interaction without someone close to me, to bring me down.

When I discovered this sensitivity, it was quite alarming. It seemed like my mood and even the way I felt about myself were dependent on how the people around me were feeling and even how they felt towards me at that moment. You can imagine the amount of stress, anxiety and uncertainty it would cause me and often times I didn’t understand why. Looking back I think I thought that they’re mood and feelings had something to do with me. It took a lot of introspection before I realized a few things:

Rarely if ever did the other persons mood, feelings or behavior have absolutely anything to do with me and,
I can not control other people’s feelings.

A large part of it boiled down to control. I wanted everyone around me to be happy, to like me, to treat me the way I would treat them, and when they didn’t, I automatically assumed it was my fault and whatever joy or happiness I had would go away and turn into either self-blame, dysthymia or anger, especially when the people were close to me such as a girlfriend or close friend.

It took a long time for me to start working on not allowing other people emotions to affect mine, and honestly it is something I still struggle with on nearly a daily basis. Some days are better than others and when I do find myself losing my inner peace to someone else’s energy, I get discouraged because I know it’s not about me and that I can’t control their emotions nor should I allow them to have power over mine.

I learned however that if I beat myself up too bad for allowing someone to move me from my inner peace, I end up doing more emotional harm than good because I become negative towards myself for being “weak” or even “stupid” (negative self-talk never helps and is almost always a recipe for increased anxiety and depression).

I’m starting to realize that one way to stop giving so much power to other people over my emotions is by not expecting things from them that they can not give me, such as unconditional love, unconditional positive regard or fulfilling any of my various needs that can only be filled by me and God. By not expecting those needs to be met by others I have taken back much of my power, but still at times, it’s a struggle just like when trying to undo any bad habit physically or mentally.

Some Negatives to Being Hypersensitive

As I stated above, being hypersensitive to other people emotions makes it very easy to be affected by others emotions, usually not for the better. This can be very draining and overwhelming and can easily lead to anxiety and depression. This can cause us to withdraw so that we can process and deal with our emotions, which other people may not understand and take it negatively that we need time and space alone, especially since we live in a culture that devalues sensitivity. Lastly, hypersensitive people may have unrealistic expectations of perfectionism towards themselves (i.e., everyone is supposed to like me).

Some Positives About Being Hypersensitive

Just like most things that are negative, there are of course positive things about being hypersensitive emotionally. I think evolutionarily it helps us to pick up slight shifts in someones temperament or even the energy around us. I’ve been in rooms where everyone around me was talking, yet no one noticed the sudden shift in tension, or how someone else became emotional, angry or nervous during a certain topic. I would sometimes leave those situations knowing more about a person I didn’t even talk to just by watching the subtle changes in their expressions.

I think being hypersensitive to other people emotions help me to be more in touch with my own emotions. I’m always amazed at how many people aren’t in touch with their emotions and as a counselor, often it’s my job to help them to get in touch with their true emotions so that they can start living a real, authentic life. We hide from our emotions, mask our emotions (even from ourselves) and often don’t know why we feel or act in certain ways because we are not used to being in touch with that part of us. Hypersensitive people are almost always, sometimes neurotically checking in with their thoughts and emotions.

I think being hypersensitive also leads to being more creative, to being able to express ones emotions more through music, art, dance, poetry and writing for example. It also makes us more empathetic to others which in the field of mental health is a must.

Some Tips for Hypersensitive People

You have to recognize and acknowledge that you are absorbing other people emotions. I’ve been doing it for years and until I actually realized it, I wasn’t doing anything different to try to stop it.
When you start feeling a certain way after an encounter with someone, ask yourself if what you are feeling is really your emotion or theirs. You’ll be surprised to find out that most of the time it’s not yours and if it’s theirs then immediately release it. This alone will make you feel better most of the time.
Remember that you are not responsible for nor can you control other people emotions so don’t worry over it because in doing so, you’ll just be absorbing it into your own emotional state.
Identify what/who is making you feel a certain way and try to distance yourself if you can. If you can’t, go back through steps 1 to 3. Sometimes it’s a particular friend or group of coworkers that are the main source. Putting some distance between you and them can help alleviate the problem.
When you start to feel overwhelmed by other people emotions, even if you can’t get away, try mindfulness or deep breathing techniques to help bring you back to your own inner peace.
Speaking of inner peace, always try to work on building up your own inner peace by being good to yourself, exercising, eating right, maintaining good emotional, physical and mental health and surrounding yourself with people who bring you good and positive energy. BE GOOD TO YOURSELF!

Being hypersensitive to other people emotions is both a gift and a curse, but look at it like a power that you have to master so that you are in control of your emotions and able to use all of the positive qualities that come along with being sensitive to other people emotions.

Abnormal Psychology, Popular Psychology

The Face of Mental Illness

15 Sep 2013by Torey C. Richards, LMHC3 Comments

I love working in a psychiatric hospital because it’s rarely boring. The type of people who come through the door are everyday people, no different from you or me, it’s just that what they are dealing with at the time is more than they or most likely any of us can handle.

I remember when I first started working here, a senior co-worker said that the only thing separating us from the patients is that we have the keys that let us in and out.

That’s one reason customer service, even in a mental hospital is so important. We strive on treating everyone, no matter what their circumstances or mental state, fairly and therapeutically because you never know when we or one of our family members or friends will end up in a place like this and it’s fairly easy.

Say the “magic words” to the right person and you may find yourself involuntarily hospitalized. Have an over exaggerated emotional or behavioral reaction and you may end up placed in a mental hospital to help you calm down.

Since I’ve been here I’ve seen correction officers, police officers, teachers, college students, professional athletes, lawyers, daughters of politicians, doctors, nurses and business owners come through our doors under involuntary hospitalization statuses.

People are placed here everyday who feel like they shouldn’t be and some may very well not be, but the majority at least need a cool down period.

For example, last week a college student got into a fight with his girlfriend and someone reported he threatened to kill himself. He denied does accusations, but he was emotionally upset enough that law enforcement thought it was best that he was brought here for his safety and the safety of those around him.

Now that he was here he didn’t want to be here and wanted to leave. He kept trying to convince me and everyone that he didn’t need to be here, but in doing so, he was getting more and more upset and therefore appearing more and more like he needed to be here for his safety and those around him.

I kept trying to talk to him and tell him that if he truly didn’t think he should be hospitalized then he needed to be calm and relaxed, otherwise he was risking looking like every other patient in the hospital who truly needed to be there.

However, he was so agitated and insistent on leaving that we had to place him on an elopement risk which lessened the chance of him being released sooner than he would have been otherwise.

When people think of the patients in a mental hospital, they almost automatically get an image in their head as if mental illness has a face. Those of us who work in the field or know someone or are ourselves suffering from a mental illness know that this couldn’t be further from the truth.

This morning I spoke with the mother of one of our patients who just graduated with an advanced degree and has an extremely high IQ, but has a long history of bipolar disorder and hasn’t been on her medication in over a year.

This is a beautiful young lady who was found sitting outside naked, stating that her old self had died and given birth to her new self with a new name she was calling herself by and a new age. She also believed she had God like powers.

Here at the hospital, for the most part, this young lady was selectively mute and at times appeared catatonic. We even had to carry and pose her limp body at one point when we had to transport her to another part of our facility.

She was definitely in need of some medication to help her start getting back to her “normal” self.

I was really hoping to speak with her, I throughly enjoy talking to people who both have a long history of mental illness and the ability and awareness to really talk about it and analyze their experiences, but she wasn’t speaking to anyone, so I spoke with her mother for a while about her history of treatment and tried to help calm her mother’s fears about her daughter’s recent deterioration.

This young lady reminds me that mental illness is all around us and it’s nothing to be ashamed of or to run from. Sometimes it’s in your face like the guy talking to himself while begging for change or it’s wrapped in the package of a pretty grad school graduate who on most days could hold the most intellectual conversations, but today she’s just staring into out of space unresponsive to the world around her.