Julie Miller's Mental Health Blog

Archive for April 2010

Celebrity shoplifters, per google search:

W*nona Ryder (we all know the story); her career has slumped significantly since her conviction.

Rex Reed allegedly stole some music CDs.  Haven’t heard from him in a while.

Bess Myerson (who is she you might ask?) former Miss America, allegedly stole $44 worth of stuff from a drug store.  Not much of a career for her after that.

Adam Rickets (actor/model?) allegedly stole some coffee & cheese.  How’s his career?

Jennifer Capriati (tennis player) allegedly stole a ring from a Mall, and later was charged with possession of pot.  No career since.

So the point isn’t about the celebrity part of this – it’s about the suffering and lack of healthy functioning, the lack of ability to continue to move forward in one’s life and achieve one’s goals.

These are unfortunate and very public examples of a psychiatric issue impeding an individual’s progress in their life.

All these individuals could pay for the items they took (allegedly; remember, I don’t want to get sued).  It was a means by which they could regulate their central nervous system.

So if you find yourself doing some shoplifting yourself, consider reframing it as just wanting to calm and soothe yourself, trying to regulate.

Wow, so this thing with the DSM diagnoses can be quite boring.  I didn’t start this blog with the intention of becoming another text book and boring not only you, the reader, but also myself.  I find myself not wanting to post another piece about a psychiatric diagnosis and the appropriate treatment.

I want to go back to all my previous posts and delete them…lol!  What’s fun about blogging is that you can really put yourself, your personality, into it.  I love mental health issues, teasing apart what is happening for a client and tracing it to its roots, then helping the client correct the problem.

That’s what’s interesting.  This blog is not interesting.

Okay, so, here’s a little way of looking at this.

Have you ever known someone who was a compulsive thief?  Have you been a compulsive thief?  I have worked with clients who were kleptomaniacs, and pretty much we have all heard of W*nona R*der, right?  (Can she sue me for calling her a kleptomaniac?)

It’s hard to understand why W*nona would steal a ton of clothes she could afford, right?  Okay, well too I think there were prescription pills involved, but was there a conviction about that?  Don’t remember.  And frankly, I don’t want to do the research.  The old way of blogging would be to do the research and make sure I have my facts right and so on and so on.  But again, that’s boring.

W*nona’s a child actor who grew up into a kleptomaniac opiate addict adult actor.  Has anyone ever in the history of acting been a child actor who grew up into a really healthy, functional adult?  Send your thoughts.  I can’t think of one right off hand.

Who are some other high profile kleptomaniacs?  Now that might take some research, and that might be fun…

The DSM-IV describes kleptomania is an impulse control disorder (see previous posts regarding “I” is for Impulse Control).  It encompasses inability to resist urges to steal, and the objects are not stolen for monetary gain or need.  Additionally, the individual experiences an increase in tension before committing the theft, and a sense of relief, lessening of tension, or pleasure after stealing.

Like many of the issues discussed in this blog, kleptomania is a means by which an individual can regulate the central nervous system.  In that sense, kleptomania is similar to other impulse control disorders and addictions (chemical and behavioral).

Regulation of the central nervous system (CNS) is essential for healthy human functioning.  If I am excessively over activated (e.g., anxiety), my CNS will work to return me to homeostasis.

Not one single diagnosis from the DSM, nor any form of psychotherapy or other pertinent topic I can come up with starts with “J.”  Anyone have suggestions?

Self-soothing/self-regulation are critical in management of this illness, along with most other psychiatric diagnoses.

To regulate the central nervous system, we can use external resources or behaviors (which include the negative behaviors listed in post #1 about this issue), or we can learn and practice new skills which rely on internal resources.

Internal resources are about using the central nervous system to calm and regulate itself.  An example is creative visualization/guided imagery.  I lump them together here because they use the same principal – if I can see something in my mind’s eye, my body will believe it’s actually happening.

I can imagine a peaceful, calm place, and my body will begin to calm and relax.  If I imagine a safe place, my body will calm and I will feel safe.

Use of a safe/peaceful place as a tool to regulate takes a great deal of development and practice to become second nature.  I use the safe place “exercise” as a beginning for therapy with every issue for which a person might seek treatment.

Try this – think of a place where you have been as an adult, or where you can imagine being, where you felt calm, peaceful, relaxed, safe, maybe the best you can remember feeling as an adult.

Then put yourself in that place, just by yourself, in your imagination, and see the sights.  Notice the sounds.  Breath in the smells and scents around you.  What are you doing in that scene?  Walking, standing, sitting, laying down?  If you could reach out and touch something there, what would it be?  What does it feel like?  Is it warm, cool, cloudy, sunny?

Then notice your body – any place where you feel any calm or peace?  Focus on that sensation, wherever it is in your body, and let your breath come in to where you feel it.  The use of EMDR by a qualified practitioner can enhance this experience and get it really “installed” in your psyche, but simply using your imagination to see and feel this place can be enough with practice.

What do you call this place?  “Beach,” “Mountains,” “Forrest,” etc.?  Practice going there daily, more than once a day, to really get that in the neural networks and enhance your ability to bring that place up in your mind and soothe your body.

Then, you can use this place in your imagination to calm and soothe if agitated, anxious, frustrated, afraid, etc.  Say the name of your safe place, bring up the images, hear the sounds and smell the smells.  Unless you are absolutely in danger in the moment, there’s no rush to respond to the situation you are in immediately.  Slow down.  Lower the temperature in your central nervous system – calm, soothe.

If I’m acting on my anxiety or other urgent feeling, my brain is not functioning at it’s highest level.  The blood flow has decreased to the brain, and is flowing to my extremities for a “fight or flight” response.  Again, unless I am in imminent danger, there is no rush, and it will best soothe me to slow down.

Using the safe place can help return the central nervous system to baseline and then be more in control of my behavior.

This is one possible tool for use with impulse control issues.  It is not a magic bullet.  It is not a cure.  It can be helpful.  It can help me learn to be in charge of my own central nervous system, and therefore in charge of my behavior.

Self-regulation/self-soothing is a tremendously important skill for all humans, and in American culture, we’re just not that good at it.

Self-soothing is a skill we are supposed to learn from our caregivers (parents, etc.) when we are small children.  We learn by observing our caregivers soothe themselves when distressed, and if they self-soothe in a healthy, internally-focused manner, we will learn to do that as well.  If they drink, rage, obsess, or act out in some other compulsive manner to soothe, then we’ll do the same.

We may have a slightly different “flavor” of acting out to self-soothe, but the principal will be the same.  Obsessive compulsive spectrum disorders, including impulse control disorders, are most certainly about soothing anxiety.

As a trauma therapist, my perspective is that trauma underlies the problematic behaviors.  The affect (emotion) and negative self-referencing beliefs can be targeted in therapy (especially EMDR).  We can trace back to the first time the individual believed this negative belief, or experienced the emotions.  We can also target the worst experience they had based on this belief or emotion.

Resolution of the underlying trauma can give the individual a “foot in the door” to gain a sense of control over the problematic impulses and behavior.

Impulse control disorders includes hot-headedness (intermittent explosive disorder), stealing (kleptomania), pathological gambling, fire-starting (pyromania), compulsive hair pulling (trichotillomania), compulsive nail biting (onychophagia), and compulsive skin picking (dermatillomania).  Individuals often resist these urges or attempt to quit in some way, and frequently fail.

The individual suffering with one or more of these conditions feels an irresistible urge to act out in the behavior, with increasing anxiety should the individual succeed in resisting for any length of time.  The anxiety is not relieved until the compulsion is fulfilled.

“What can be done?” you might ask.  “I chew my cuticles until they bleed.”  “I can’t stop raging.” “I can’t stop…..”  That is the key phrase here.  The urge appears for whatever reason, and resistance is futile, so the cycle continues.  Often there is shame or self-recrimination after the behavior, which may then trigger uncomfortable feelings, and then the urge to act out begins again, with ensuing anxiety if the behavior is resisted.

The solution is simple and complex.  The simple answer is that one just replace the troubling behavior with some other self-soothing behavior.  This is complex in that individuals are prone to relapse and often require treatment from a variety of perspectives, including medication, psychotherapy, spirituality, diet/exercise/stress management, and anything else that will help.