Lisa Find Love

We have all been dealt a set of genetic cards. Some may determine our height, athletic prowess, proclivity for creative writing, or the ability to rapidly add successive numbers. But how we play those cards — through the stimuli we expose ourselves to, how we interact with the world around us, and even the thoughts we endorse — ultimately determines the trajectory of our lives.

No longer does our genetic hand determine our destiny. We now know that we have the ability to program our genes, by turning them on and off, through the actions we take.

“The successful mapping of the human genome was only a first big step, it turns out, one that would become the foundation for yet another quantum leap in biology. More advanced research, especially in the last decade, points to the advent of a new field called epigenetics, which studies the human epigenome,” writes Kenneth R. Pelletier.

In his new book, Change Your Genes, Change Your Life: Creating Optimal Health With the New Science of Epigenetics, Pelletier integrates a lifetime of research and experiences to distill the new science of how our genes respond to everything we do, and importantly, just how we can now use this science to achieve optimal health.

While the assumption had long been that genes are deterministic in their expression, we now know that our genes respond to how we interact with the world. What we eat, who we surround ourselves with, what we see and breathe, and even the pharmaceuticals we take all influence how our epigenome functions.

Pelletier writes, “Today we know that surrounding every gene is a complex set of switches that determine what property of the gene will or will not be expressed.”

Genes don’t work alone, and most common disorders arise due to a complex set of interactions between many genes and the environment. However, this is also reason to hope.

Pelletier writes, “Hundreds of studies show that our genes are responsive to the biochemical and energetic environment we create in and around our cells through our daily choices. As a result, a thrilling new picture is emerging: the discovery that our biology is modifiable.”

Epigenomics refers to the study of the chemical markers that appear above — signified by the Greek prefix epi, which means “above” — the genes and influence how the genes function.

Pelletier writes, “It is almost as if there are two languages being ‘spoken’ by our DNA: the original ‘script’ of our genome, and a secondary and more powerful linguistic control system that sits on top of each gene.”

And what we do in our lifetime doesn’t only affect how our epigenome functions — it also affects our future generations. “The epigenetic alterations that you may acquire don’t just change your biology during your lifetime; some of these modifications can be passed on to future generations the follow you,” writes Pelletier.

Gene mapping is now a thing of the past. Instead, what epigenetic mapping offers is a way to see, for example, that people with Alzheimer’s disease, at some point, had epigenetic changes related to their immune system.

“At different points over a person’s lifetime we will be able to create a picture of that person’s ‘epigenetic state.’ Or, epidemiologists will be able to create ‘epigenetic maps’ of groups of people in a specific local to help explain their biological relationship with their immediate environment,” writes Pelletier.

One powerful example Pelletier gives is chronic inflammation, which contributes to numerous diseases, such as cardiovascular disease, obesity, osteoporosis, cancer, inflammatory bowel disease, asthma, and allergies. However, when we include anti-inflammatory foods like beets, broccoli, nuts, berries, and garlic in our diet, our risk is significantly lowered.

Similarly, when we begin to isolate food allergies and detoxify the body, we reset our biology, improve our ability to detect triggers, and reduce cravings and addictive behavior.

And due to epigenetic transgenerational inheritance, our dietary habits affect our children. Pelletier writes, “Epidemiological studies as well as animal experiments have shown that the maternal diet during pregnancy can produce epigenetic changes through altered methylation in the mother that are inherited by the offspring.”

Pelletier points to the long-term study of some 23,000 people which asked them to make four simple behavioral choices: not smoking; exercising 3.5 hours per week; eating a diet of fruits, vegetable, beans, whole grains, nuts, seeds, and low red meat; and maintaining a healthy weight, which they defined as a body mass index (BMI) of less than 30.

After eight years, these people had a 93 percent lower risk of developing diabetes, an 81 percent reduction in heart attacks, a 50 percent fewer strokes, and 36 percent fewer cancers.

While early life trauma can also cause epigenetic changes, engaging in meditation, social support, and massage, and countering damaging unconscious beliefs can change the way the epigenome functions.

And stress — biological or psychological — affects every single one of our cells. Yet, so does happiness.

Pelletier writes, “Once a pathway is established in our mental or emotional life through habitual behaviors, it is self-perpetuating and continues its positive or negative influence on our physical and mental health until we intervene to change it. If your aim is to achieve optimal health, it is my firm belief that you must intervene on the side of creating positive changes to your present state of consciousness, which we now know can have long-lasting biological effects.”

Redefining our understanding of genetic influence and empowering our understanding of the impact our everyday choices have on our long-term health, Change Your Genes, Change Your Life is a goldmine for anyone interested in integrative medicine.

Change Your Genes, Change Your Life: Creating Optimal Health with the New Science of Epigenetics
Origin Press, October 2018
Paperback, 230 pages

There’s something about turning forty. What that is, exactly, is the question addressed by fifteen women and the editor, Lindsey Mead, in the thoughtful, spirited, poignant, and immensely readable anthology, On Being 40 (ish). The contributors, mostly Generation Xers, are a who’s who of writers, artists, thinkers, an even an actress (Jill Kargman of “Odd Mom Out,” who did not become an actress until she was 39). I already knew and admired the work of some of them when I picked up the book; once I read all of their biographical sketches, I realized I should have known about all of them.

Happily, the topic of being forty is not very constraining. As I approached the end of each chapter, I couldn’t wait to get to the next to see what that person would do with it. Not even the format was predictable. One contributor, Jena Schwartz, wrote a poem, and another, Sujean Rim, told her story in a series of illustrations.

Interspersed among the chapters were some great sentence-completion items, to which the contributors offered brief responses: “The biggest surprise of life after forty is…”, “The single most important lesson I’ve learned in my life so far is…”, “The thing I’ve given myself permission to do now that I am forty is…”, and “The quote or mantra that most speaks to me about this moment in my life is…”.

In the hands of a lesser editor, an anthology on being 40-ish could have been a cliché, with every woman a married mother, grumbling about “work-life balance” and getting squeezed between caring for kids and looking after aging parents. Those themes were addressed, as they should be, but so were other kinds of themes and other kinds of lives.

Meghan Daum, who was once married, wrote an ode to living alone that I suspect I will come back to again and again. Kate Bolick told the story I was eager to hear about the life-changing experience of writing a wildly popular cover story for The Atlantic, “All the Single Ladies,” followed by her bestselling book, Spinster: Making a Life of One’s Own. Julie Klam’s “The People Who Got Me Here” was a touching tribute to her mother and aunt. “I guess one of the things about getting older,” she said, “is we develop an appreciation for the team who got us here, whatever your support system is: friends, teachers, therapists, or family.”

Lindsey Mead’s introduction could have been a screenplay for a movie. Six forty-something women, friends since college, get together in a fabulous place on a tiny, infamous island (Chappaquiddick) for their seventh annual weekend reunion. They do what they’ve been doing for about two decades: talk about everything. “Forty feels like we’ve come to the top of the Ferris wheel,” Mead says; “the view is dazzling, in no small part because we know how quickly the descent will go.”

“It’s a Game of Two Halves” is the title of Veronica Chambers’ essay and her summary of “the act and art of being in my forties.” She adds, “And here’s the thing: no matter what happens, you can’t win in the first half.”

“Soul Mates: A Timeline in Clothing,” by Catherine Newman, starts off as a sweet tale of a special friendship, unveiled by recounting the clothes she and her soul mate wore at age four, and then at subsequent ages. It is all light and airy until a casual entry for the year 2011 forewarns that this breezy essay is not going to have a happy ending. But it was a beautiful ending, too.

Two other “before and after” kinds of essays were riveting. Allison Winn Scotch was the woman who could juggle everything and handle anything until a devastating injury left her unable to walk for months. Her closing paragraph is perfect; I love when that happens. For Lee Woodruff, “I am beyond happy” is how she described the “before” part of her life. Then her husband, reporter Bob Woodruff, was felled by a roadside bomb in Iraq and nearly died. “Woe is me” is not the moral of either story.

A passionate and inspiring essay on teaching was contributed by Jessica Lahey. I teach a course on teaching, and I may need to expand my syllabus next time to include it. Taffy Brodesser-Akner offers a meditation on how time is experienced at ages 18, 27, 35, 40, and one day after turning forty. Sloane Crosley tells us “What We Talk about When We Talk about Our Face.” Sophfronia Scott describes something I hope I will understand someday: feeling chill about President Trump.

KJ Dell’Antonia is 47, has a husband and four kids, and lives in New Hampshire. I’m 65, I’ve been single all my life, I have no kids, and I live in California. I would not have predicted that her essay, “Why I Didn’t Answer Your Email,” would be one of my favorites.

On Being 4o (ish) is a quick read and I ended up wanting more. I would love to see parallel anthologies for each round number, starting at 20-ish and continuing up through 70 or 80 or, these days, who knows. I’d like to hear men’s voices, too.

On Being 40 (ish)

Simon & Schuster, February 2019

Paperback, 229 pages

“No one woke up this morning to make your life miserable,” writes Dr. Wayne Pernell. And yet many people do feel miserable, as if their life is not going in the right direction, and they are not in the right career, relationship, or city.

Feeling stuck, however, is not the problem. It is what you do when you feel that way.

In his new book, Choosing Your Power: Becoming Who You Deserve to be at Home and in the World, Dr. Wayne Pernell offers the tools, insights, and tips to live a more authentic, balanced, and fulfilling life — even when it seems impossible.

One of the first things we can do is check our thinking. Pernell writes, “You can choose what you think by interrupting what you were thinking. After practicing choosing your words and selecting what you think, you actually begin to choose how you think.”

And how we present ourselves to others acts as a reflection of how we feel about ourselves. “How have you judged yourself? How have you allowed others to treat you? How have you been training others to treat you?” Pernell asks.

We do have a choice. We can question the times we have apologized, felt like we didn’t belong, or that it wasn’t okay to do something for ourselves.

“You are entitled to your voice, your opinion, your wants, your dreams, and your desires,” writes Pernell.

Yet for many people — especially peacemakers — abdicating their power becomes a means of avoiding conflict. The end result, however, is resentment, internal conflict, and even depression.

Pernell writes, “The ugly cycle is that the more you say you are sorry, the sorrier you’ll feel. The sorrier you feel, the less of you that shows up as worthy in the world.”

We can all feel like an impostor at times, that we will be found out for all we don’t know, and it is this fear that stops people from pursuing their dreams. The question Pernell suggests we ask ourselves is not, What if I am not good enough? Instead, we should be asking ourselves, What if I am?

He writes, “Stop looking for evidence of not knowing enough, and for the sake of practice, begin looking at ways your gift is unique.”

Change starts with taking a risk. Pernell relates his own experience of questioning himself and his abilities while in graduate school and ultimately blocking his growth while attempting to keep his world safe.

He writes, “My little world was becoming smaller because I was making it so. I was not acknowledging that I was good enough at the moment. Neither was I able to see that I could own the process by looking in the mirror each morning and telling myself, ‘Today is the day you are Choosing Your Power.’”

Instead of wishing people to be safe, we should be wishing them to “risk well,” and find one thing that is different from yesterday’s definition of safety, and, in doing so, move past what was.

Similarly, we should stop seeking perfection and look instead for progress in the risks we take, our ability to forgive our transgressions, move out of our safety bubble, and build competence and confidence in ourselves.

Change is scary and demands that we redefine our version of happiness to include accepting some discomfort, uncertainty, and pain as part of personal growth.

“People tend to live with unhappiness because it is easier than changing,” writes Pernell.

By envisioning where we’d like to be — what Pernell calls our Envisioned Positive Outcome (EPO) — overcoming our resistance to change, and using our imagination to find the best route to where we’d like to be, we can begin to live the process.

Pernell writes, “Only by living in harmony with the process will other doors open that allow you to realize your EPO smoothly and efficiently.”

As one  major difference between people who are effective in the world and those who are victims of the world is where their sense of control lies, Pernell suggests that we check our language and eliminate words like, maybe, never, always, should, try, can’t, but, need, and the question why.

We can choose instead to be grateful for what we have, to embrace an attitude of possibility, to forgo a life of lack, and go after the life we really want. For Pernell, it all starts when we choose our power.

Insightful, witty, and humorous, Choosing Your Power, offers the tools, tips, and exercises to move out of fear, resistance, and uncertainty and into a life of confidence, gratitude, and possibility.

Choosing Your Power: Becoming Who You Deserve to be at Home and in the World
Balboa Press, January 2013
Paperback, 173 pages

Have you ever felt like an imposter or fraud? You’re not alone. Particularly in a professional setting, people may have this feeling, but lack the words to describe it. This is called imposter syndrome, which means feeling like a fraud due to self-doubt and lack of confidence. It stems from low self-esteem that makes us afraid of being discovered and judged inadequate or incompetent. We’re convinced that we’re really an “imposter,” just tricking everyone. In an intimate relationship, we’re afraid of being found out and left.

The consequence is that even when we excel — get high marks, accomplishments, raises, promotions, or compliments, we feel so undeserving due to deep shame that it doesn’t change our opinion of ourselves. We’ll make excuses or discount our successes. It’s normal to exaggerate or emphasize our strengths on a resume or job interview. However, an “imposter” really feels unqualified in comparison to other candidates — wants the position but is half terrified of getting it.

Underlying Shame

The deep underlying shame stimulates fault-finding thoughts when compared to our high expectations of ourselves and others. We also compare ourselves negatively to other people who appear to have it all together. When others make a mistake, we might be forgiving, because we have double standards, judging ourselves more harshly than others.

When we feel like an imposter, we live in constant fear of being found out — that a new boss or romantic partner will eventually realize he or she made a big mistake. Insecurity mounts with every task or assignment about whether we can satisfactorily complete it. Every time we have to perform, we feel like our job, career, family security — everything — is on the line. One mistake and our façade will crumble, like a house of cards. When something good happens, it must be a mistake, luck, or a warning that the other shoe will soon drop. In fact, the more success we have or the closer we get to a new mate, the greater is our anxiety.

Positive acknowledgement is felt undeserved and is written off with the belief that the other person is manipulating, lying, has poor judgment, or just doesn’t know the real truth about us. If we’re offered kindness or a promotion, we’re more than surprised. We wonder why — why would they want to do that? If we receive an honor, we feel like it was a mistake. We dismiss it as being routine, very easy, low standards, or no competition. Additionally, when we do well, we’re afraid that we’ve now raised others’ expectations and will likely fail in the future. Better to have a low profile than risk criticism, judgment, or rejection.

Though other people might like us, inside we feel flawed, inadequate, a mess, a disappointment. We imagine others are judging us for things that in reality they didn’t even notice or long forgot. Meanwhile, we can’t let go of it and even judge ourselves for things we can’t control — like a computer glitch that delayed in completing something on time.

Low Self-Esteem

Low self-esteem is how we evaluate and think about ourselves. Many of us live with a harsh inner judge, our critic, who sees flaws that no one else notices, much less cares about. It tyrannizes us about how we look, how we should act, what we should have done differently, or should be doing that we’re not. When we’re self-critical, our self-esteem is low, and we lose confidence in our abilities. Our critic also makes us sensitive to criticism, because it mirrors the doubts we already have about ourselves and our behavior. Moreover, we imagine other people think what our critic thinks. In other words, we project our critic onto other people. Even if when questioned, they deny our assumptions, we likely won’t believe them.

Imposter Syndrome in Relationships

Healthy relationships depend on self-esteem. These imposter fears can cause us to provoke arguments and assume we’re being judged or rejected when we’re not. We may push people who want to get close to use or love us away for fear of being judged or found out. This makes it hard to have a committed, intimate relationship. We might settle for someone who needs us, is dependent on us, abuses us, or in our mind is in some way beneath us. This way, we’re assured they won’t leave us.

Cognitive Distortions

Shame and low self-esteem lead to cognitive distortions. Our thoughts often reflect thinking that is shame-based (“should’s” and self-criticisms), inflexible, black and white, and negative projections. Other cognitive distortions include overgeneralizing, catastrophic thinking, and hyperfocus on details, which obfuscate the main objective.

Our shame filters reality and skews how our perceptions. A typical pattern is to project the negative and dismiss the positive. We filter reality to exclude the positive while magnifying the negative and our fears. We take things personally and overgeneralize something small to condemn ourselves and our potential. We use black and white, all-or-nothing thinking to rule out a middle ground and other possibilities and options. We believe I must be perfect and please everyone (impossible) or I’m a failure and no good. These thinking habits distort reality, lower our self-esteem, and can create anxiety and depression.

Perfectionism

Many people with imposter syndrome are perfectionists. They set unrealistic, demanding goals for themselves and regard any failure to achieve them as unacceptable and a sign of personal worthlessness. Perfection is an illusion, and perfectionism is driven by shame and reinforces shame. The fear of failure or making mistakes can be paralyzing. This can lead to avoidance, giving up, and procrastination.

Our inner critic interferes with our attempts to take risks, achieve, create, and learn. The disparity between reality and our expectations generates internal conflict, self-doubt, and fear of mistakes that cause suffering and serious symptoms. 

We can overcome shame, low self-esteem, and perfectionism by changing our thoughts and behavior, healing our wounds, and developing self-compassion.

© Darlene Lancer 2019

You didn’t get much sleep because your toddler was up half the night. You woke up on the wrong side of the bed. Just because. You got to work way too late, and it feels like nothing has been going right since. You had a misunderstanding with a friend that you still don’t understand.

And so, you feel frustrated or tense. You’re upset and annoyed. You have a hard time focusing. Or you just feel off.

Self-care coach Tara Pringle Jefferson noted that her clients have blah days simply because they’re human. And that extends to all of us. That is, she said, when we’re having an iffy day, it isn’t because of some personal failing. Rather, it’s part of the human condition.

We are complex beings who feel a range of emotions on any given day. Sometimes, there’s a specific reason. Sometimes, there isn’t.

Where we can occasionally falter is in how we handle our blah days. For instance, we use social media to numb and escape, said Megan Gunnell, LMSW, a psychotherapist, speaker, writer and international retreat leader in Grosse Pointe, Mich. “Social media often takes us down the path of comparison, envy, jealousy and shame.”

In other words, it makes a blah day a whole lot worse.

We also completely gloss over our feelings. We either try to push through without acknowledging our emotions, or we minimize them, telling ourselves: “Well, other people have it worse so let me stop complaining,” said Jefferson, also a writer, speaker and founder of the Self-Care Suite, a multicultural and intergenerational community dedicated to easy living through the lens of self-care.

And, sometimes, the opposite is true: We wallow in the frustration. We hyper-focus on why we’re feeling this way, and what’s not going right. And we quickly spiral downward, staying in this emotional space for too long, according to Denise Sumbry, Chief Energy Officer and Reiki master of Positive Life Haven.

Thankfully, it doesn’t take much to turn a tough day around. Even tiny tweaks can have terrific results. Here are nine tweaks to try.

Keep a list of mood-lifting activities. Jefferson stressed the importance of acknowledging that you’re having a blah day and asking yourself what would help you to feel better. She keeps a list of 20 mood-lifting activities in her phone. This way when she’s not feeling great, she scrolls through to see what she needs in the moment. Her list includes everything from watching an episode of “Scrubs” to cooking her favorite meal.

Reach out to kind-hearted others. Sharing our struggle with close loved ones helps us to feel less alone, said Gunnell. The supportive people in our lives “can validate our feelings and act as an encouraging and uplifting reminder that a blah day isn’t our baseline. They can remind us of who we really are and what we’re really capable of.”

Sharing also shrinks shame, which is vital because shame flourishes in secrecy, Gunnell said. “When we share our struggle, it automatically feels smaller and more manageable.”

Create super specific playlists. “Music always helps me get my mind right, which is why I have playlists for several different—and oddly specific—moods I’d like to feel,” said Jefferson.

For instance, she has a playlist called “Take Me Back to When I Had No Bills,” which includes 90s songs and 90s R&B. She has another playlist called “I Need to Reset with A Dance Party,” which is basically all Beyoncé. A third playlist called “Feeling Like I Need Some Spiritual Guidance” features late 90s and early ’00s gospel. A fourth playlist is called “I Procrastinated and Need to Focus,” and has a lot of Amel Larrieux.

Jefferson noted that our favorite music can transport us to a time when we felt light. What kind of music does this for you? What unique-to-you playlists can you create? Because you can use music to meet your specific needs.

Tweak your perspective. When we’re having negative thoughts, it’s all-too easy to get wrapped up in them. It’s all-too easy to let them dictate our day, and, as Sumbry mentioned already, to spark a downward spiral. Instead, the key is to shift our perspective.

Acceptance and Commitment Therapy has a powerful metaphor for this, which Gunnell writes about in this post: Think of yourself as a bus driver. You’re driving your bus and focusing on what’s in front of you, such as the trees and other cars. As you begin making stops, you pick up “thought” passengers, and these passengers are quite noisy. They’re so noisy that they hijack your attention, and you start feeling frustrated, distracted and tense.

Do you stop the bus, and go back to engage with the thoughts? Do you get the thoughts off your bus (even though more might come)? Or do you acknowledge the presence of the noisy thoughts and keep focusing on what’s in front of you?

As Gunnell writes, “this week as you go about your business, try to keep driving the bus—stay mindfully in the moment of what you’re choosing to focus on and don’t allow yourself to be too distracted or upset by anxious, fearful or distorted ‘thought passengers’ who hop on for a ride every now and then!”

Redirect your attention toward joyful moments. According to Sumbry, one way of doing this is to create a photo album or Pinterest board with all your favorite, memorable photos. This might include photos of family vacations, birthdays, holidays, pets and natural surroundings. The key is that these photos “bring you joy and happiness as you reflect and replay the moment back in your mind.”

Turn to water. For many of us water is grounding, calming and rejuvenating. For Jefferson, it’s all these things and more. “Once I’m done I usually have a better appreciation for how I’m feeling,” she said. In the summertime and fall she heads to the lake; year-round, she takes a bath or shower.

Sumbry suggested taking an “aura cleansing shower,” which can help you wash away “anything that doesn’t serve you physically, emotionally or spiritually.” An aura, she writes here, is “the magnetic energy field that can be sensed, felt, or even seen around the physical body.”

Begin by dry brushing your body in a circular motion, starting at the top of your toes, and moving to your shoulders. Express gratitude for the body part you’re brushing. Next step into the shower, and tell yourself that you’re cleansing the layers of your aura. Close your eyes, and visualize a waterfall. “Take four deep breaths in and out, holding for 3 to 4 seconds as you inhale and exhale and envision a bright white or gold light embody your whole body and aura.”

As the light envelopes your body, see the frustration, burdens and negativity going down the drain. Then consider three intentions you’d like to embody, such as vitality and peace. As you wash each body part, mention again why you love it (e.g., “I love my feet because…”). Finally, as you finish up, set your intention for the rest of the day or night, and give thanks.

Savor the sun. “Sunlight is a natural mood lifter, so finding 5 to 10 minutes to stand in the sun will perk you up,” said Jefferson. Maybe you can get outside during your lunch break. Maybe you can take a walk around the block after you get home. Maybe you can eat your breakfast on the balcony, or sit and sip a cup of tea by an open window. (Jefferson drinks two cups of tea a day, “first thing in the morning and last thing at night, and those are the two most peaceful times of my day.”)

Practice a simple body scan. Gunnell suggested closing your eyes and scanning your body from head to toe. “Pause where you feel bodily tension and bring your breath to that area to loosen and soften.” You also might try a guided body scan, such as this 3-minute meditation or this 11-minute meditation.

Expand your gratitude. Journaling about what we’re grateful for is a quick and powerful way to shift our energy, Sumbry said. She recommended finding a quiet place, closing your eyes and taking four slow, deep breaths. Then consider these questions to expand your gratitude, she said: What made me smile or laugh? What surprised me? What did I learn? Who did I help today, and why? Who helped me, and why? What special connection did I make with someone today?

Blah days happen to all of us. “It’s not a matter of ‘if’ but ‘when,’” Jefferson said. “Knowing that, it’s crucial to be a student of yourself and understand what gets you out of those funks so you can rest in that knowledge when you need to.”

Dissociation may be thought of simply as disconnection or disruption. In terms of posttraumatic stress disorder, we talk about dissociation as a disruption in four different areas of functioning: identity, memory, consciousness, self-awareness, and awareness of surroundings.

In understanding the human response to trauma, it is thought that dissociation is a central defense mechanism because it provides a method of escape ¹. When physical escape is impossible, dissociation provides a type of mental escape.

Those who experience dissociation may notice lapses in memory of certain time periods or events. Personal information can also be forgotten. They may also experience a sense of disconnection and detachment from themselves and their emotions. A blurred sense of identity is also common.

Compartmentalization is another form of escape from trauma. Compartmentalization occurs when aspects of psychological functioning are not linked together. Opposing views or behaviors can be held separate in order to avoid uncomfortable feelings when one has conflicting values, beliefs, and emotions ².

Depersonalization refers to the feeling of being detached from one’s own life. Some describe it as the feeling of living in a dream or experiencing the sensation of watching events in their life as if it were a movie.

Every form of dissociation is a coping mechanism. Disengaging or separating from ourselves and the situation can prevent us from experiencing too much pain, either physical or emotional. Studies have found individuals with high levels of dissociative symptoms also have higher levels of posttraumatic stress disorder symptoms ³.

Implications for Therapists

When working with a client experiencing dissociation and related symptoms of trauma, the client requires help in strengthening his or her sense of self. Traumatized individuals often experience issues with identity.

They may even suffer from a conflicting inner dialogue. In severe cases, more than one voice can participate in inner self-talk. For example, a personal narrative “I am bad … I do not deserve to live …” Can switch to “You are bad … You do not deserve to live.” In a case like this, the person is no longer the only one telling his or her personal story ¹. This situation can lead to the sense that more than oneself exists.

In therapy, it is important to help the client create a shared narrative among the different aspects of self. The goal is to facilitate collaboration among the distinctly compartmentalized feelings, beliefs, motivations, and goals. Further, helping the client develop a sense of self-compassion is critical to overcoming symptoms and distress associated with trauma and dissociative effects.

The treatment recommendation for dissociation is long-term psychotherapy. Talk therapy, hypnotherapy, even movement, and art therapy can be helpful. The therapeutic relationship allows the traumatized client to reach out and hold onto something that will provide a sense of stability and safety (the therapist). It takes time to re-wire the brain into a cohesive and secure feeling self. It is human nature to heal through connection with others. In this unique way, a therapist can provide the safe space and opportunity for healing.

References

1. Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6(1), 27905.
2. Spitzer, C., Barnow, S., Freyberger, H. J., & Grabe, H. J. (2006). Recent developments in the theory of dissociation. World Psychiatry, 5(2), 82.
3. Swart, S., Wildschut, M., Draijer, N., Langeland, W., & Smit, J. H. (2017). The clinical course of trauma-related disorders and personality disorders: study protocol of two-year follow-up based on structured interviews. BMC Psychiatry, 17(1), 173.

With all the news media accounts and reports from governmental health organizations about the opioid epidemic, including the 70,237 drug overdose deaths in 2017, a newly emerging threat is gaining attention: use and misuse of benzodiazepines, opioid drugs and Z-drugs. Specifically, combining these three drugs can create a deadly combination that snuffs out lives.

Benzodiazepine Overdose Deaths on the Rise

Benzodiazepines, a class of sedative narcotic drugs including Xanax and Valium used to treat anxiety, insomnia and other disorders and classified as Schedule IV under the Controlled Substances Act by the Drug Enforcement Agency (DEA), are increasingly misused, diverted and abused. These are powerful drugs that are highly addictive and can be fatal, especially when combined with opioids, alcohol (and Z-drugs, per recent findings). Prescriptions filled for benzos jumped 67 percent, from 8.1 million in 1996 to 13.5 million in 2013, according to a 2016 study reported in the American Journal of Public Health. Benzodiazepines are also considered responsible for a dramatic increase in overdose deaths in recent years, rising from 1,135 in 1999 to 8,791 in 2015 and 10,684 in 2016. The Centers for Disease Control and Prevention (CDC)  highlighted the fact that benzodiazepine overdose deaths among women spiked 830 percent from 1999 (0.54 deaths per 100,000) to 2017 (5.02 deaths per 100,000).

Some 5.3 million people (of 30.6 million who said they used benzodiazepines) reported misuse, or not using them properly, according to a 2018 study published in the online version of Psychiatric Services. Misuse means taking the drug in a way other than prescribed by a doctor.

Why are benzos so dangerous?

Due to their sedative effect, benzodiazepines – especially when combined with other drugs and substances that slow breathing (such as opioids and alcohol) can result in a user falling asleep and never waking up. The fact that benzos are often prescribed along with opioid drugs is a major factor contributing to the 75 percent of benzodiazepine-involved overdose deaths.

The main effects of benzodiazepines is muscle relaxation, general anesthesia, sleepiness and drowsiness — the reason they’re prescribed to treat certain conditions. While benzos may be effective to treat insomnia and anxiety, when used in combination with painkilling narcotics (opioids), or other substances (Z-drugs, alcohol) that suppress breathing, the combination can prove fatal.

What are Z-Drugs?

The so-called Z-drugs are sedative hypnotics, classified as Schedule IV controlled substances under the Controlled Substances Act. They are usually prescribed for the short-term treatment of insomnia. They’re called Z-drugs because they begin with the letter “Z,” and include zolpidem (brand name, Ambien, Ambien CR), zaleplon (brand name, Sonata), and zoplicone (eszoplicone, sold in the U.S. under the brand name, Lunesta).

Z-drugs are not benzodiazepines, but are a separate class of medicine, non-benzodiazepine sedative-hypnotic agent, although they do work in a similar manner. Both Z-drugs and benzodiazepines have a similar effect on brain cells. Both also have similar problems stemming from long-term use.

How do Z-drugs cause problems?

Just as with prescription benzodiazepines, when prescribed Z-drugs are used for the short-term treatment of a medical condition (such as anxiety, sleeping problems and other disorders), the user can generally stop taking the medication without problems. Short-term use is typically 2-4 weeks, depending on the treating physician’s prescription dose, duration and recommendations.

What happens when someone takes Z-drugs (and benzodiazepines) for longer than prescribed? The first noticeable symptom is tolerance, meaning the user has to take more of the medication to achieve the same effect it initially produced. This may mean taking more Z-drug to alleviate anxiety or to combat sleep problems. After a short period of time, the increased doses (or higher frequency of use) no longer works. Thus, the user enters the second stage: dependence. He or she has to take the medication in order to stave off withdrawal symptoms. These are physical and psychological symptoms, some of which may seem like the original symptoms of anxiety for which the drug(s) were prescribed. Finally, continuing to take Z-drugs leads to addiction, which often requires professional detox and counseling to successfully overcome.

Originally, Z-drugs were not thought to be as addictive or habit-forming as benzodiazepines, although that consensus has changed with reports of dependence and addiction. Z-drugs can cause problems with psychomotor impairment, especially in older users, and users are cautioned to avoid driving when taking the medication. Adverse reactions, tolerance, dependence and addiction can result. In addition, additive effects occur from combining Z-drugs with other central nervous system (CNS) depressants (benzodiazepines, opioids, and alcohol), which may lead to overdose and death.  

Opioid Drugs Add to the Risk of Overdose Deaths

Millions of Americans take prescription opioid drugs to combat pain, whether from a recent surgery or chronic pain due to cancer or other disease. Millions also become dependent upon and then addicted to the painkillers, taking them far longer than the short-term use for which they were originally prescribed. Yet, they’re mostly taking them for the same purposes they originally did – to relieve pain. They’re not, according to the Center for Behavioral Statistics and Quality Report, taking them to get high. However, once dependent on and subsequently addicted to opioids, it’s almost impossible to overcome the compulsion to use these potent narcotics without professional detox and subsequent behavioral therapy and other treatment modalities.

As a study published in 2019 in the International Journal of Geriatric Psychiatry points out, prescription opioids and benzodiazepine misuse is associated with suicidal ideation in older adults. According to the study findings, although 2.2 percent of older adults in the U.S. who were not engaged in opioid or benzodiazepine misuse reported suicidal thoughts, 25.4 percent of those who misused both said they endorsed such suicidality. A report from the New England Journal of Medicine found that opioids were linked to a doubling of suicides and overdoses since 2000.

Prescription opioids include natural , semisynthetic opioids (including oxycodone and hydrocodone), methadone, synthetic opioids other than methadone (including fentanyl, fentanyl analogs, and tramadol),

And, further complicating an already serious situation, misusing opioids in combination with benzodiazepine and Z-drug misuse can lead to fatal overdoses. A 2019 study reported in Sleep looked at co-usage of benzodiazepines and opioids in the U.S. and noted that the “progressive increases in these two forms of psychoactive medication polypharmacy is concerning, given that these drug use patterns are associated with increased risk for serious adverse outcomes.”

The Dangers of Polydrug Addiction

Addiction to opiate narcotics can co-occur with addiction to benzodiazepines and Z-drugs. This is called polydrug addiction. The danger is that even with legitimate prescriptions for painkillers, anxiety and sleep medications, tolerance, dependence and addiction can result. Using all three classes of drugs simultaneously not only increases the risk of addiction, it also escalates the risk of overdose and death.

Anyone who is abusing, misusing or is addicted to benzos, opioids and/or Z-drugs is advised to seek professional help to safely detox and wean off use through counseling and other behavioral therapies.

References

Hedegaard, H.,Miniño, A.M., & Warner, M. (2018, November). Drug Overdose Deaths in the United States, 1999–2017 [data brief]. National Center for Health Statistics. Retrieved from http://bit.ly/2sHKLR2

Cunningham, A. (2019, January 17). Overdose deaths tied to antianxiety drugs like Xanax continue to rise. Science News. Retrieved from http://bit.ly/2MiqGcU

Drug scheduling [fact sheet]. United States Drug Enforcement Administration. Retrieved from http://bit.ly/2sFRr26

Bachhuber, M.A., Hennessy, S., Cunningham C.O., Starrels, J.L. (2016). Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013. American Journal of Public Health, April 106(4):686-8. Retrieved from http://bit.ly/2MrU9Bv

VanHouten, J.P., Rudd, R.A., Ballesteros, M.F., Mack, K.A. (2019, January 11) Drug Overdose Deaths Among Women Aged 30–64 Years — United States, 1999–2017 [report]. Mortality and Morbidity Weekly Report, 68(1);1–5. Retrieved from http://bit.ly/2sFzT6n

Lipari, R.N., Williams, M., VanHorn, S.L. (2017, July 27). Why Do Adults Misuse Prescription Drugs? [report]. The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-. Retrieved from http://bit.ly/2Mu4z3j

Schepis, T.S., Simoni-Wastila, L., McCabe, S.E. (2019, January). Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults. International Journal of Geriatric Psychiatry, 34(1): 122-129.Retrieved from http://bit.ly/2sHQ4Qz

Vozoris, N.T. (2019, January 17). Benzodiazepine and opioid co-usage in the US population, 1999–2014: an exploratory analysis. Sleep, zsy264. Retrieved from http://bit.ly/2Mu4A7n

According to the Centers for Disease Control and Prevention, chronic diseases affect 133 million Americans, representing more than 40% of the population of this country. By 2020, that number is projected to be an estimated 157 million, with 81 million having multiple conditions. Chronic illness can have profound negative effects on a relationship and sexual satisfaction. More Americans are living with not just one chronic illness, such as diabetes, heart disease or depression, but with two or more conditions. Almost a third of the population is now living with multiple chronic conditions.

Many chronic diseases can cause problems with sexual function. These conditions can include diabetes, heart and vascular diseases, neurological, and autoimmune diseases. Recent research suggests that sexual dysfunction in couples may be one of the least talked about symptoms of chronic illness.

Experiencing a chronic illness can be earth-shattering. Individuals who are chronically ill often experience emotional distress. This includes the person’s ability to engage in occupational, social, and recreational activities. But what is its impact on sex and the couple? Sex can involve a mix of feelings and emotions when battling a chronic illness. Life becomes uncertain and you both feel at a loss. Your partner feels overwhelmed because you feel shame. You may feel less attractive, less confident, and concerned about how your body works and adapts to an illness. You both become plagued with anxiety due to the worry of sexual activity, and with desire and arousal issues.  

When experiencing a chronic illness, some changes may be physical, such as the changes with your body, side effects from medication, sexual dysfunction, fatigue, and pain. You may experience psychological changes such as depression and anxiety. Most of all, there is constant fear around your sexual ability and your sexual performance. We all know that physical intimacy is paramount to the quality of life, and it is still important if you are living with a chronic illness.

Your relationship as a couple can affect the development and management of a chronic illness in a variety of ways. When the both of you are at the optimal balance between intimacy and autonomy, your boundaries touch yet remains distinct. It is critical that both of you are aware of each other’s needs and emotions. Why is this so important? Because this will drive and determine the sexual intimacy in your relationship. It is important to note that your previous success in resolving sexual intimacy concerns will determine how well the both of you will cope with an illness.

Since general coping skills and sexual function are linked in the chronically ill, it is important to identify and foster strengths in your relationship that can mitigate the stress of illness. Even during an illness, relationships should not be neglected. Illness can make each partner vulnerable to fear and loss and to loneliness. Taking time to communicate and to reduce the impact of the illness on intimacy is the key to maintaining happiness despite health problems. One part of that intimacy is sexuality. What people don’t know is that with a life restricted by pain and illness, sex can be a powerful source for comfort, pleasure and intimacy. You and your partner can learn what is possible as opposed to what was once achievable by enhancing their sexual awareness, communication, and sexual styles.

Here are my tips:

• Communicate your needs to your partner and have them communicate their needs. Problem-solve together by making it a team approach. State your emotional needs around sexual intimacy and the other factors in your relationship.
• Consider couples psychotherapy. I recommend you see a sex therapist. I say this because they will have the knowledge and skill set in helping you and your partner with sexual problems such as the issues related to sexual functioning. They will also provide you with other suggestions to engage in if there is sexual dysfunction (i.e., desire and arousal issues, erectile dysfunction, and sexual pain).
• Read up on your condition and share this with your partner. Having knowledge on the illness can bring you closer together. This can build intimacy!
• Check in with each other. For the partner who does not have a chronic illness, watch for depression in them and keep an eye on their health as well. The goal here is to be lover not a caregiver, but we find at times, the partner may take on this role. They may want to seek individual counseling. This is healthy!
• Acknowledge your loss and build a relationship with the illness. This can help the both of you develop the “new normal” in your relationship.  With acceptance, the issue isn’t whether or not you can come to some profound insight about the nature of the illness and your experience with the illness, but rather, it is about how to live your life day to day. The ultimate goal is to accept condition and learn to live well with it. Of course, this is not easy. I watch couples experience this all the time in my practice and when they finally decide to work as a team instead of opponents or avoiders, there is this sense of hope that emerges. This hope promotes what is possible instead of what is achievable. They also report a healthier sex life!
• Address stress as much as possible. I would not avoid the stress. Avoidance can make the pain worse or it cause a flare up. I see this all the time with my clients with fibromyalgia. I know this is easier said than done, but try to address the financial issues and the divisions of family responsibilities. Addressing these stressors can help promote the desire in being physically intimate.
• Try to be sociable. Socially isolating is common for people with a chronic illness. Try to find a balance where you can be sociable because this can make you feel more positive about life.
• Being kind is great. Doing something for your partner can build what is needed for sexual intimacy.

Resources:

Enzlin, P. (2014). Sexuality in the context of chronic illness. In Y. Binik & K. Hall (Eds), Principles and practices of sex therapy (5th ed., pp. 436-456). New York, NY: The Guilford Press.

Schover, L.R., & Jensen, S. B. (1988). Sexuality and chronic illness: A comprehensive approach. New York, NY: The Guilford Press.

The world’s most popular online video game costs nothing to play, is available on seven different platforms, has more than 200 million registered players worldwide, and its CEO is now worth over $7 billion. Launched in the summer of 2017, Fortnite has blown away the competition to become the go-to video game for any serious or would-be gamer. Fortnite may also be responsible for a serious decline in your child’s health as evidence mounts about the effects on kids obsessed with playing.

While the World Health Organization (WHO) recognizes gaming disorder (compulsive and obsessive playing of video games) as a diagnosable condition, the American Psychiatric Association (APA) says there is currently insufficient evidence to support gaming disorder as a unique mental disorder, calling for further research.

To gain valuable insight on the potential harm that obsessive video gaming can cause in young people, I spoke with Dr. Anita Gadhia-Smith, a psychotherapist in Washington, D.C. who specializes in addictions, recovery and relationship issues.

How Electronic Gaming Addiction Affects Families

Dr. Gadhia-Smith acknowledges that electronic gaming addiction is on the rise. She says she has worked with numerous families who are experiencing the phenomenon of their sons and daughters being addicted to online video games, particularly Fortnite. Parents are understandably frustrated over what to do. “It is especially difficult when one parent feels more strongly about setting limits than the other,” Dr. Gadhia-Smith says. “This can cause tremendous conflict between the parents, which then affects the entire family emotionally.

“Children can split the parents and then form a stronger alliance with one, making it even more difficult for the parents to set boundaries together in a unified way.”

What Repeated Electronic Device Use Does to the Brain

Continuous daily use of electronics is more than merely annoying. It’s also more concerning than taking children’s attention away from healthier activities, such as playing sports, interacting with friends on a face-to-face basis and more. According to Gadhia-Smith, this non-stop use of electronics is changing the human brain. “It is causing changes in the prefrontal cortex, especially affecting young developing brains.”

What about the addictive aspect of such use? “Part of the addictive component involves a continuous release of dopamine,” she says. “Every time someone gets a notification on their phone, or attends to their electronic game, there is another release of dopamine, thereby increasing very addictive behaviors and natural endo-chemicals produced by our own biochemistry.”

Gadhia-Smith calls this the inner drugstore, and says our own endo-chemicals can be just as addictive as taking drugs externally. “It is similar to cocaine addiction, or a gambler’s addiction to a slot machine. The dopamine drip is a powerful force, and our brains are wired to seek this pleasure hormone.” Therein lies the heart of the problem, she continues. “When we are continually flooded with dopamine, normal amounts no longer satisfy us. So then we need more and more dopamine to even feel normal. This is part of the reason that it is so hard to pry people away from their electronics. They are literally addicted to them.”

How Video Game and Electronics Attachment Specifically Harms Kids

What happens when young people remain glued to their video game screens and dismiss or avoid other activities in order to continue playing? What are the social, psychological and physical effects of such an obsession? Gadhia-Smith offers the following assessment. “Adolescents and children need to learn how to be with other human beings, how to interact face-to-face, how to read and respond to verbal and social cues, and how to communicate effectively. There is no substitute for face to face personal interaction.

“If children are continuously attached to machines, then they lack normal human development and the capacity to integrate the full range of human interaction. We  see reduced vocabularies, a lessening capacity for healthy social interaction, communication, and reduced social skills and capacity to form and sustain healthy relationships.” 

Warning About Violent Video Games

Gadhia-Smith has a special warning concerning the effects of violent video games on young minds. “With video gaming that includes violence, violence becomes normalized and acceptable,” she says. “People become desensitized to violence, and lose the capacity to understand what it really means. As evidenced by gang violence and rampant use of guns by mass shooters, we are witnessing a change in the value of human life. To the extent that violent games contribute to this, as well as movies and other media, we need to closely examine what we are feeding the minds of our young people. Whatever they are feeding their minds is likely to come out in their lives.”

How to Counter the Argument that Everyone’s Doing It

Every parent has heard the excuse that everybody’s playing Fortnite. “Just because someone’s friends are doing something doesn’t necessarily mean that it’s OK for your children to do it,” Gadhia-Smith says. “Parents have a responsibility to be involved and aware about what their children are feeding their minds. Just like you need to be aware what you’re feeding your body, you also need to be aware what you are feeding your mind.”

Gadhia-Smith offers the following advice for parents on how to combat their child’s Fortnite obsession:

• Limiting children’s’ time with electronics is especially important.
• Facilitating face-to-face human interaction, including sports, will help children to achieve more balance.
• Sports provide your children with a healthy outlet for competitive energy, teamwork, and learning how to get along with other people.
• Sports also is a way for your kids to release aggression in a healthy manner.

“I recommend that parents work on both being aligned on the same policies, and then implement reasonable boundaries with their children. Allowing them to check out from life and reality, will deprive them of developing the skills that they need to survive in this world. This requires more work and perseverance from parents, perhaps more than ever before, as we are living in a world that is ever far-reaching and more complex in every way.” 

What Parents Can Do

If you are still unsure whether anything you do will have an effect, Gadhia-Smith has some specific recommendations on what parents can do in coping with their child’s (or their own) video game addiction. “The best case scenario for changing the focus of your children’s attention is to find something healthy that will attract them even more than the video games. Help them to find fun and healthy activities that surpasses the pleasure that they get from the game.”

But if you find yourself running into obstacles or your child refuses to cooperate, you have to step in. Gadhia-Smith says that all you can do is to set limits on how much time they play. She says there are basically two ways to detox your children from video games.

• The first is cold turkey, which is the most painful. “I recommend this in very extreme cases where everything else has been tried and failed.”
• The second method is to gradually taper down their time. “If you can slowly reduce the time that they spend each day, perhaps without them even knowing it, you may be able to bring the monster down to a manageable size if they are going to continue playing at all.”

Gadhia-Smith notes that the capacity to learn to tolerate frustration and to learn to self-soothe in healthy ways is a critical part of human development. She says that parents need to model these behaviors for their children whenever possible. “If children are so defiant and angry that under no circumstances will they respond to any limits, turn off the Internet or take away the computer. There are apps available to turn off Internet service.”

Trying to ensure your child is never hurt or unhappy may be part of parental DNA, but Gadhia-Smith urges caution. “It is a fantasy to believe that we must never hurt or be unhappy. Parents also need to examine if they have a larger pattern of over indulging their children in other ways and enabling them to develop entitled, unhealthy attitudes and behaviors due to overindulgence. There are some things that parents need to solve for their children, but there are others that children need to learn to solve for themselves. And the capacity to self-soothe can only be learned by oneself.” 

What about angry outbursts from your child over these new limitations? “If your children become angry or enraged about your setting limits, let them be angry. It is OK for kids to not like the limits that are set for their own good. That is often the way it is supposed to be.”

Gadhia-Smith adds that eventually, the children can use their anger creatively and pursue new activities. She says that many new creative pursuits have been born out of anger and discomfort. “Parents need to live with their own discomfort when their children are upset. That means that you do not have to feel guilty when you have done the right thing. It actually causes harm to your children not to set proper limits, and in the long run you are limiting their lives and enabling them in a very unhealthy way.

“Parents need to remember that they are the ones in control, and not hand over the steering wheel to the children out of fear, laziness, or unwillingness to step up and do what needs to be done. It may take several repetitions of setting limits before your children understand that the limits are real, but if you keep doing it, it will set a new standard and a new normal.”

References

Bailey, D. (2018). Fortnite’s total player count has topped 200 million [blog post]. Retrieved from http://bit.ly/2zbk2OJ

Gilbert, B. (2018, December 31). The CEO behind ‘Fortnite’ is now worth over $7 billion. Business Insider. Retrieved from https://read.bi/2SuLbW6

Slater Tate, A. (2018, April 20). Kids are obsessed with ‘Fortnite.’ Is it bad for them? [blog post]. Retrieved from https://on.today.com/2FNhdJx

Orlando J. (2018, June 19). Could Playing Fortnite Lead to Video Game Addiction? The WHO Says Yes, But Others Disagree [blog post]. Retrieved from http://bit.ly/2FDl0Kl

Prescott, A.T., Sargent, J.D., & Hull, J.G. (2018). Metaanalysis of the relationship between violent video game play and physical aggression over time. PNAS, 115 (40): 9882-9888. Retrieved from http://bit.ly/2FNhf47

The fear of vomiting, or emetophobia, affects people of all ages. It is often seen in childhood and if left untreated, can become debilitating. It is also known to develop during adulthood, perhaps after an associated experience such as a severe stomach illness or episode of vomiting. The consequences of vomit phobia can be extreme, leading to such things as school refusal, social isolation, and job loss. Emetophobia can also take away any joy in life, hindering travel and leisure activities, romantic relationships, and even pregnancy (afraid of morning sickness).

To be clear, emetophobia is not just being afraid of throwing up. Rather it is an excessive or irrational fear about the possibility of vomiting. In fact, says Dr. Steve Seay, most of the people he treats for emetophobia have symptoms of other conditions such as social anxiety, agoraphobia or obsessive-compulsive disorder (OCD). This post will focus on emetophobia and OCD.

First, it is important to discuss some examples of behavior that present with all types of emetophobia:

• Avoidance behaviors such as not eating certain foods (severe cases could lead to anorexia), not going to specific places, or not participating in certain events you might associate with vomiting (could be something as simple as avoiding parties with food).
• “Health-conscious” behaviors such as refusing to shake hands with others in case they are/were sick, excessive handwashing, and unreasonable amounts of time and attention paid to food selection, preparation and cleanliness.
• “Checking” behaviors to detect early signs of illness, such as being hypervigilant with your own health (taking your temperature 5 times a day), as well as being keenly aware of the health of others (watching other people eat to make sure they are not or don’t get sick).
• Actions done specifically to reduce the possibility of throwing up, such as the performance of rituals (If I repeat “I won’t throw up” over and over in my head, then I won’t throw up).

For those with OCD who suffer with emetophobia, symptoms are also likely to include the concern that vomiting signals something much worse than it typically is, such as indication of a deadly disease. People with obsessive-compulsive disorder also might believe that if they do vomit, they will not be able to cope with the situation. Not surprisingly, those with OCD and emetophobia demonstrate more cleaning and checking rituals than others with emetophobia. While they know intellectually these rituals make no sense, they are not able to control them.

As with all types of OCD, exposure and response prevention (ERP) therapy is needed to battle emetophobia. For example, a child who will only eat certain foods because she is afraid of vomiting might be asked to eat something different, and then feel the subsequent anxiety. Another exposure might include watching videos over and over of people vomiting, sitting with the anxiety and not engaging in avoidance. With more exposures (and no rituals) the person with OCD will get used to the idea of vomiting, lessening the hold of OCD and emetophobia. This is known as habituation.

I think it’s safe to say that nobody enjoys vomiting. But if the fear of it is overtaking your life, please seek help. With a competent therapist, emetophobia, with or without OCD, is absolutely treatable.

A covert narcissist is just as much a narcissist as your typical extroverted narcissist. Some narcissists emphasize one personality trait more than others. One person with outgoing personality might always show off and need to be the center of attention, while another narcissist might be a vindictive bully, an entitled playboy, an imperious authoritarian, or an exacting know-it-all, as articulated by Madonna, “Listen, everyone is entitled to my opinion.”

Some public figures and celebrities exemplify extroverted narcissists — people who are, grandiose and crave attention. Radio host and psychologist Dr. Wendy Walsh said, “Narcissistic personality disorder is not only accepted in the entertainment industry, it’s often a requirement.” The Diagnostic and Statistical Manual criteria describe these types as “Exhibitionist Narcissists.”

The Covert Narcissist

There are several subtypes of narcissists. Among them are covert narcissists. Psychoanalyst James Masterson first identified the “Closet Narcissist” — someone deflated, with an inadequate self-perception. Lacking the aggressiveness of the exhibitionistic narcissist, they’re more prone to depression and feelings of emptiness or like things are falling apart. This subtype has also been referred to as a “covert narcissist,” “vulnerable narcissist,” or “or introverted narcissists.”

On the surface, they can be hard to identify. These narcissists may appear shy, humble, or anxious. Their gratification may be indirect through their emotional investment in someone they admire. They take things personally and feel distrustful, mistreated, unappreciated, and misunderstood. Although they devalue themselves, they dream of greatness and wonder why people don’t appreciate and understand them.

They still qualify for narcissistic personality disorder (NPD), particularly feeling special and wanting admiration (perhaps secretly), lacking empathy, and feeling entitled. They’re still self-centered and expect special treatment. They often feel that their specialness is not appreciated, that they’re misunderstood, or that people or the world at large hasn’t sufficiently recognized their uniqueness. Some play the role of victim and a martyr.

They might be a philanthropist or in the clergy or helping professions. Yet, despite the fact that they may appear to genuinely care for others, they’re motivated by a need for recognition, power over others, or egoistic pride. They might help by taking over without even asking permission. They behave self-righteously superior, moralistic, or like an exploited, resentful sufferer for all their giving.

Contrasting with the Exhibitionist Narcissist

Despite sharing core traits, in a sense, behaviorally the covert narcissist is the mirror image of the exhibitionist narcissist. While the latter demands to be the center of attention, the former feels slighted that they’re not, or gets attention by playing the victim. Instead of working the room, the covert narcissist is self-absorbed. Normal introverts are generally good listeners, but not this narcissist. They consider others boring or ignorant. Rather than ordering others around, the covert narcissist can get their way indirectly through passive-aggressive behavior. They may agree to things, but not follow through, be late, forget, or pretend there was no agreement. All narcissists are manipulative. Covert narcissists may add self-pity to their toolkit to control others. Rather than put down others directly, they are more likely to express envy.

Due to their introversion, instead of bragging openly, covert narcissists display reserved smugness and judge everyone as inferior. They might act aloof and disinterested or make dismissive or discounting gestures, like looking away, sighing, yawning impolitely, or acting bored. While all narcissists react poorly to criticism, the introvert may have the thinnest skin of all, because they believe they’re uniquely sensitive. Instead of the aggressive and exploitative nature of extroverted narcissist, coverts have feelings of neglect or belittlement, hypersensitivity, anxiety, and delusions of persecution.

The Covert Narcissist in Relationships

Covert narcissists can be just as destructive to relationships as the extroverted types. The emotional abuse might be more silent and subtle, but can wear you down and demoralize you. Your needs and pleas for attention will be discounted or ignored. You can get sucked into trying to console and help this manipulative martyr to no avail. There’s no way you can fill their emptiness or change their victim mentality. You’re left feeling resentful and angry.

Meanwhile, your self-esteem is gradually undermined. The narcissist lacks empathy for you, won’t see you as a separate individual, and will do what’s necessary to maintain power and control. Their pain and needs will always take precedence, so you’re left feeling alone and neglected.

Extroverted narcissists sometimes also act covertly, pout, and play the victim in order to manipulate. Don’t get caught up in definitions. If your needs and feelings are being discounted, if you feel manipulated or abused, see a therapist and learn how to confront this behavior.

References:

Battaglio, S. (2017, April 11). ‘I really did it for my daughters’: L.A. radio host Wendy Walsh on why she spoke out against Bill O’Reilly. Los Angeles Times. Retrieved from https://lat.ms/2Hdi9JG

Dahl, M. (2015, August 6). Are You an Introvert — Or Are You Maybe an Undercover Narcissist? [blog post]. Science of Us. 

© Darlene Lancer 2018

With the start of the New Year, many people make themselves promises to engage in healthier behaviors, to jumpstart in earnest a pursuit of personal happiness. New Year’s resolutions notwithstanding, the pursuit of happiness is not only a worthwhile endeavor, it’s also life-affirming and can result in lasting change to overall well-being.

To delve deeper into realistic ways to achieve happiness, I recently spoke with Tim Bono, a psychology lecturer in Arts & Sciences who teaches courses in happiness at Washington University in St. Louis. Bono is the author of When Likes Aren’t Enough: A Crash Course in the Science of Happiness.

You say “life-changing” and that there’s a science to happiness. Can you explain what you mean by that?

TB: People have been interested in pursuing the good life for as long as there have been people. Over the last few decades, the field of psychology has applied the scientific method to the age-old questions around how we can increase our well-being and strengthen our psychological health. Beyond just intuition and conventional wisdom, the scientific method tests hypotheses by collecting data on large groups of people to identify the behaviors and mindsets that are most effective at increasing our happiness.

What are your top tips for making this a happier New Year – by doing something proactive to get a handle on personal happiness?

TB: I have a few I recommend, as follows:

• Get outside, move around, take a walk.
• Get more happiness for your money. Buy experiences instead of things and spend your money on others.
• Carve out time to be happy, then give it away. Thirty minutes helping others is more rewarding and actually leaves us feeling empowered to tackle the next project, helping us feel more in control of our lives and even less pressed for time. This translates to higher levels of happiness and satisfaction.
• Delay the positive, dispatch the negative. Anticipation itself is pleasurable, and looking forward to an enjoyable experience can make it all that much sweeter.
• Enjoy the ride. People who focus more on process than outcome tend to remain motivated in the face of setbacks.
• Embrace failure. How we think about failure determines whether it makes us happy or sad.
• Sweet dreams. Get a full night’s sleep on a regular basis.
• Strengthen your willpower muscles. Exercising willpower muscles in small, everyday behaviors strengthens our ability to stay focused at work.
• Introduce variety into your day-to-day activities.
• Stop comparing yourself to others.
• Reach out and connect with someone.
• Limit time on social media.
• Use your phone in the way phones were originally intended.
• Practice gratitude.

The most effective interventions in my view are gratitude, sleep, exercise, and social connection.

Are most of your tips on how to achieve happiness – like going outside for a walk – more physical than mental? That is, do you initiate the code to happiness by doing something physical? Or is it more of a balance between the two?

TB: We know there is a strong link between our psychological health and our physical health. One of the most effective ways to take care of our minds is to take care of our bodies. Physical activity releases neurotransmitters like endorphins, dopamine, and serotonin, which are the brain’s natural “feel-good” chemicals. There’s also a feeling of accomplishment (what psychologists call “self-efficacy”) that comes from completing the hard work of an intense exercise or workout routine.  In this way, exercise is a very important way to strengthen psychological well-being. But there are, of course, many other ways to increase happiness that aren’t predicated on physical activity. Gratitude, meditation, and prosocial behavior are chief among them and do not require physical labor of any kind.

Do different stages of life have anything to do with how easy or difficult it is to achieve happiness?

TB: On average, there doesn’t seem to be a strong relationship between age and happiness. However, there is evidence to suggest that older adults tend to be slightly happier than younger people, which could be due, in part, to a tendency to savor life more during its later stages instead of striving for the next promotion or worrying whether their career is on the right track for optimal future success. Older adults are more likely to live in there here and now, and that kind of mindfulness is important for our well-being.

What additional methods, if any, do those in recovery from addiction (alcohol, painkillers, polydrug use) and/or mental health disorder (anxiety, depression, PTSD, eating disorder) need to employ in order to get on the road toward feeling happier?

TB: One of the most important ways to recover from addiction or disorder and get back on track toward mental health is with a strong social support system. Caring people who provide a shoulder to lean on during the inevitable difficult times along the way, as well as people who are there to help you celebrate your successes, are extremely valuable on the road to recovery. When people you trust know about your goals to improve your well-being, they hold you accountable and provide support, both of which can go a long way toward making progress.

Any advice on how to deal with obstructive others – that is, those closest to you (family, loved ones, friends, even co-workers) who try to dampen your enthusiasm or are critical of your efforts to prioritize you and work on your personal happiness?

TB: As difficult as it may be, bring sympathy toward your interaction with that person. Anyone who stands to obstruct another person from improving their own happiness and well-being is likely battling their own inner demons. If someone criticizes you or otherwise attempts to derail your efforts, you might choose to acknowledge that you’ve heard them, but do not modify your behaviors to accommodate their negativity. Find friends or colleagues who support you—or better yet, want to join you in these efforts—and spend more time with them. Negative people are unavoidable in our daily lives but that does not mean that we have to allow them to dictate our behaviors. As you make progress toward your own psychological health goals, you might also consider serving as a model for those who were not initially supportive. Don’t do this to show off, but merely to show that it can be done. I’m a strong believer in the sentiment that we should be kind to unkind people—they’re the ones who need it the most.

How best to cope with disappointments? Maybe you’ve been on a great trajectory, but some unexpected glitch or problem has suddenly derailed your progress. How do you get back on track and not feel like you’ve failed?

TB: First, use failures and setbacks as learning opportunities . Like a lot of other things, failure is neither inherently positive nor is it negative, but the beliefs we hold about it make is positive or negative. As Winston Churchill once said, “Never let a good crisis go to waste.” Maybe something didn’t turn out as we hoped or expected, but there are likely important lessons that could be gleaned from the experience, which can serve us well in the future.  Plus, we are gaining more and more awareness today of how successful people have gotten to where they are, and we now see that for most it has involved a circuitous path with stumbles along the way. The most successful people will tell you that in order to achieve their success they had to learn a lot along the way.  Often, a very effective way to learn where there’s still work to be done, or to figure out what needs to change in our approach, is through failure–trying things one way, identifying what doesn’t work, and then making the appropriate modifications.

Second, acknowledge that failure is important for growth. There’s other research showing that adults who had to overcome a moderate level of adversity while growing up tend to have the greatest outcomes later in life because they have had to engage their social support networks and develop the coping mechanisms that are necessary to negotiate life’s challenges. Developing these skills early on comes in handy for bouncing back from later hardships and responding to future adversity. The people who have the strongest psychological health later in life are often those who have learned how to fail. They’ve learned how to pick themselves back up after being knocked down, reflect on the experience, grow from it, and soldier on.