Julie Miller's Mental Health Blog

That’s right.  There is no DSM diagnosis that starts with “w.”

Sure, I could spend some time coming up with some entertaining possibilities…  how about:

Wacko disorder NOS (not otherwise specified)

But that’s too easy.

Okay, so let’s just end it here.  Has it been fun?  Certainly.  Entertaining?  Mmmm… that’s for the reader to say.  It was certainly entertaining to me.  Informative?  Well, maybe.  I learned a few things.  I also learned what blogging is like, and that, frankly, leaves much to be desired…lol!

Stay safe, avoid diagnostic d/o if at all possible.


“Voyeurism is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual observes an unsuspecting stranger who is naked, disrobing, or engaging in sexual activity. To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning.”

If an individual is not distressed about their fantasies or behaviors, and it doesn’t interfere with the individual’s functioning, it’s not a problem.  So if you fantasize in arounsing ways, this definition suggests there is nothing to worry about.

My concern about this definition is this:  sometimes individuals behave in an unhealthy manner and don’t think it’s a problem.  They may not be distressed.  However, it may be a problem for others, including those on whom this person might “peep.”

In the case of someone peeping through your window, you could call the police and press charges if the individual is apprehended.  Perhaps it would cause the individual distress to be chased by police, even if not caught. 

The distress really caused could simply be the internalized shame of having to hide this behavior, and as the behavior progresses (as it usually does) to higher, more risky levels of sexual acting out, it will begin to interfere with functioning, such as getting to work, relationship issues, etc.

Occasionally, an individual experiences no shame about their behavior.  This is definitive for certain characterological issues, including anti-social personality (aka “sociopath”).

Treatment can be successful by examining and healing from underlying trauma/abuse issues.  Treatment with a highly skilled & trained therapist is a must!

What?  Another letter for which there is no diagnosis in the DSM-IV-TR?

You’d think we could come up with something.  Good heavens – what about these:

Umbrella Abuse (the compulsive opening of an umbrella inside; when I was a kid, if they told me not to do it, I had to do it, right?  Come on, how many of you have done it…?)

Unglued Disorder (actually, this one probably goes under another name, like “psychotic disorder NOS,” etc.)

UFO Phobia (aka “alienaphobia”; speaks for itself)

Unemployed syndrome (aka, “recession syndrome”)

Unibrow Disorder (again, speaks for itself)

Unique Personality Disorder (aka “Special and Different Personality”)

UPC Disorder (compulsive need to decipher the UPC barcodes on packages of Oreos, cell phones, pretty much anything…)

Utopic Personality Disorder (aka Pollyana Syndrome)

Ullagone Syndrome (compulsive funeral lamentation)

Ultion Disorder (obsession with revenge or vengeance)

Ultraism Syndrome (aka, stubborn holding of extreme opinions on a subject)

Umbilical Disorder (inability to separate from mother)

Unbosoming Abuse (to abuse those around by pouring out or freely telling anyone available each and every detail of one’s life, regardless of interest on the part of the listener; therapists are automatically exempt from this diagnosis)

Undecennial Depressive Disorder (depression that happens only every eleven years)

Undinism (psychological obsession with urine and urination; this is real; I did not make this up)

Unlealism (unfaithfulness)

Uranomania (obsession with the idea of divinity, and yes, it’s real; I did not make this up)

So there you go.

P.S.  Most of these are fictitious; do not ask your psychiatrist if you should be diagnosed with these disorders.  Then you would be diagnosed with “Diagnostic Disorder NOS.”

“Trichotilomania” is recurrent pulling out of one’s own hair that results in noticeable hair loss.

Trich (for short) is classified under “Impulse Control Disorders,” which I translate as a process addiction.  Pathological gambling is classified in the same way, as is pyromania, kleptomania, and intermittent explosive disorder (failure to resist aggressive impulses).

Many of us play with or twist our hair (if it’s long enough!) out of anxiety, a behavior that can restore regulation to the central nervous system if agitated.  The hair damage from this  “habit” is minimal, if any.  It probably also does not cause significant distress to the individual.

Distress is significant for an individual with trich.  Damage from trich includes patches of baldness and damaged hair.

Imagine being a girl with trich which began in about 4th grade.  The girl may have significant patches of baldness in her hair, and so wears a wig (yes, this does happen in youngsters).  In junior high, for the first time, she must take off all her clothes in front of her peers, get in a bathing suit, swim, and shower in the same room as her classmates.

How will she navigate that without the class and teacher finding out that she wears a wig?  How will she explain the hair loss?  Teasing and stigma are sure to follow.

How will she keep her wig in place on a windy day?  How will she handle slumber parties?  Will she wake up in a room full of girls with her wig twisted to the side, or laying on the floor next to her pillow?

If she chooses to go without the wig, will she shave her hair close to her head so she is not tempted to pull (can’t pull the hair if it’s only 1/4″ long)?

If she goes without a wig and leaves her hair long, will she increase the size of the bald spot with continued pulling?  Long hair is a powerful trigger for trich.  The shame and hiding that comes with trich in our society is enormous.

Triching (the act of pulling)  is a CNS regulating behavior.  It is especially notable in individuals with anxiety, and acts to soothe the individual.  The individual may also be dissociated while triching.  Like any other negative regulating behavior, it can become deeply ingrained in an individual’s regulation repertoire.

Treatment may include such things as medication (SSRIs, etc.), cognitive behavioral therapy, motivational interviewing, 12-step, DBT.

The individual you see in front of you at the supermarket with bald patches on their head may well suffer from this illness.  Your compassion, kindness, and a warm smile, not staring, may be the best gift you can give them.

Social phobia is also known as “social anxiety.”  The primary symptoms are marked and persistent fear of social or performance situations in which you are exposed to unfamiliar people or to possible scrutiny by others (DSM-IV p. 416).

Everyone gets nervous every now and then.  Some individuals are afraid of public speaking, so they join Toastmasters to overcome their fear, especially if their job requires they speak publically.

You might be a little anxious meeting new people, but you get through it, enjoy it, and make plans to hang out again.

A musician might feel nervous just before a concert, but once they get on stage and begin performing, the nerves calm.

Social phobia is an excessive or unreasonable fear of social or performance situations.

The fear may be so great that the individual cannot focus on anything but sweating palms or a pounding heart.  Perhaps he cannot focus on what others are saying, or can only think about what “they” are thinking of him.  And the assumption is that they are thinking poorly of him.

The fear may interfere with normal activities, routines, or other areas of functioning, such as work, family, school, etc.

He may begin to avoid these social or performance situations, increasing the impact of the anxiety on his life.

How is it that just about any topic I pick here has a great deal of basis in trauma?  That’s interesting.

If I ask the individual to trace back the symptoms of the social phobia, or the belief he has about himself (“I’m not good enough” or maybe “I’m stupid”), it may likely go to a specific situation or incident experienced early in life.  Perhaps in school, or a family or social setting.  There may have been humiliation or public embarrassment involved.

Treatment can allow him to resolve the overwhelming experience(s) from earlier in life so that the experience is finally in the past and not directing his life today.

So it’s late, and I’m tired.  Is this a good time to bring up a touchy subject with my spouse?  Good guess – no.

I used to think I ought to be able to handle anything emotionally in my relationship.  I’m a therapist right?  I’ve had tons of therapy right?  Yes, and yes.  BUT (and as you can see this is a big BUT) I’m also human.

The less I accept my humanity, and all the foibles that go with it, the more likely I am to step in it (“it” of course being doo doo) in my relationship.

Everyone has limitations.  It doesn’t make me weak.  It means I’m human.  Being human is much more acceptable to me than it used to be.  It’s okay to say, “you know, I just can’t be there for you now,” or “I know you want me to do you a favor, but I’m wiped out, so…  sorry.”

I accept my limitations and my humanity more and more.  I accept others’ limitations and humanity more and more.  That makes for a lot more peace in relationship with others.


Humans require relationships.  Perhaps some cultures are better at them than we are in America.  Perhaps some individuals are better at them than the mainstream in the United States.

Divorce rate now around 50%, right?  There are websites by the thousands purporting to help keep relationships together, or help you make a good choice for a mate.  There are opinions everywhere about why the divorce/break up rate is so high.  (If we count break ups where the two individuals aren’t married, would that make the rate higher or lower?)

Are we getting worse at relationships in America?  This culture moves so quickly, it’s hard to tell what, if anything, might be the cause, if indeed we are getting worse at it.

I can tell you one thing that will definitely make a relationship rocky – attachment issues.  If I wasn’t attached securely as an infant/toddler/child, then I will struggle with it as an adult.  And successful relationships require attachment.

Haven’t you heard?  We marry our mother/father/significant caregivers when we grow up.  Well, you know what I mean.  If my heart doesn’t go “pitty pat” when I’m dating someone, I am not interested, right?  And if my heart does go “pitty pat,” you can rest assured that there are some significant shared dynamics between the man/woman of my dreams and my mother/father/significant caregiver from childhood.

Just look at your own relationship.  What are the positives about your childhood caregivers?  The negatives?

Now, make a list of those same characteristics (+ and -) about your boyfriend/girlfriend/lover/partner/husband/wife/etc.  Circle the similar dynamics.  Take your time and be honest with yourself.

It’s not like it’s a BAD thing; it’s just how it is.  This is how humans work.  Like we have a choice.

There’s no point in looking for “Mr./Ms. Right.”  Sure, you can maybe find someone who reminds you of your caregiver who has a job as opposed to one who doesn’t, but the underlying dynamics will remain similar.  “Trading up,” is what we call that.

Given that it is what is, use the insight to grow, to improve yourself.  Since there’s no “Mr./Ms. Right” out there, become “Mr. or Ms. Right” for yourself.