Grief Resources

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The Survivor's Guide by S. Simpson

Grief for a Season by Mildred Tendbom

Sometimes I Hurt by Mildred Tendbom

The Fountain and the Furnace: The Way of Tears and Fire by Maggie Ross

A Rumor of Angels: Quotations for Living, Dying and Letting Go by Gail and Jill Perry

Living Beyond Loss by Walsh and McGuldrick

I Will Not Leave You Desulate by Martha Hickman

Bereavement Magazine Bereavement Publishing, 8133 Telegraph Drive, Culorado Springs, CO 80920

Surviving, Healing and Growing by Culgrove, Bloomfield, and McWilliams

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Addicted to Love

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"Might as well face it, you're addicted to love..." - Robert Palmer

Can you be addicted to love? Anything in bloated portions can be dangerous, even something as wonderful as a good relationship. Some people have stayed in a relationship until it literally killed them, just for love. Take the short quiz below, as it illustrates many of the signs and symptoms of love gone bad.

If seven or more of the following describe you, the danger of love addiction is very real.

You:

• come from a family in which emotional needs were not met;
• assumed a caretaker/pleaser role to gain approval;
• are attracted to people who don't treat you well;
• find loving, kind, stable people boring;
• put forth over 50% of the effort, or take over 50% of the responsibility;
• are very tolerant of others and spend a long time hoping for something different;
• make excuses for his/her behavior, holding out for the way it used to be, or could be;
• have a low self-image: you believe you have to earn happiness;
• are terrified of abandonment and being alone;
• control or manage your partner's life in an effort to help him/her;
• focus on others, thereby avoiding personal responsibility;
• have other addictive tendencies: overeating, too much TV, working too much, etc.;
• fear disapproval so much you rarely say 'no', or express your true opinion for fear of displeasing or losing your partner.

Sternberg (1988) identified ten indicators of healthy love. As you read over the following list, keep your marriage and other personal relationships in mind, but also asses your professional liaisons as well.

Successful partners:

• do not take their relationship for granted;
• make their relationship an important priority;
• actively seek to meet each other's needs;
• know when and when not to change in response to the other;
• value themselves;
• love each other, not their idealization of each other;
• tolerate what they cannot change;
• are open with each other;
• make good times together and grow through the bad ones;
• do unto each other as they would have the other do unto them.

As you have been reading this column, rivers and streams are slowly eroding mountains of solid rock. But you would have great difficulty detecting the process because of its gradual, quiet destruction. Similarly, relationship addiction slowly erodes intimacy by imposing unhealthy demands, crossing various boundaries, and ignoring vital information.

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Dealing with Difficult People

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The following is a brief look at some of the major points in Megan Johntz’s seminar, Snake Charming: PsychTools for Dealing with Difficult People. For more information, contact Megan at 314.378.3384 or by email: Megan@PsychToolBox.com.com.

TRY TO DIFFUSE

• Don't be a Perp
  • Perps refuse to take responsibility for their behavior
  • Perps refuse to notice the negative impact of their actions
  • Perps refuse to make restitution
• Prepare them well in advance of the bad news
• Stay ahead of them - anticipate, but stay mentally flexible
• Mirror their non-verbals and paraverbals
• Empathy galore (not sympathy)
  

WHEN YOU HAVE TO CONFRONT

• Preparation / rehearsal
• Timing
  • Day of the week is important
  • Time of the day is important
  • Pay attention to your mood and timing
  • Good news first?
• Humor
• Timing
• Humor backfires sometimes
• There is a difference between assertiveness and aggressiveness

RECOVER

• S.O.L.V.E. the problem
• Reality check to get perspective
• You may need to do some Anger Work so you don’t take it out on co-workers or spouses
• Self-care - take time for all of your basic 5 levels

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HARNESSING YOUR HABITS

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PsychTools for Every Day Success

Eat right. Exercise. Take Geritol. Stop biting your fingernails. Be more organized. Work smarter. (Do I sound like your mother?) If I could wave my magic wand and you instantly changed every bad habit, and mastered every effective habit, would you take me up on it? Sounds like snake oil, doesn’t it? And yet you got those habits somehow, right? You learned that annoying pattern of avoiding unpleasant tasks until someone’s screaming at you, or taking your gym bag to work once again, only to toss it in the trunk on your way to Wendy’s for lunch. What was your New Year’s resolution by the way? If it was to save money or lose weight, you’re in the vast majority. And you’ll still be in the majority on December 31st, 2000 when you take one more drink and promise to do better in 2001.

THE HABIT TRAP
Most people still struggle with habits that plagued them 20 years ago. It seems to be the human condition to struggle with all kinds of habits, from habits of the head (‘I can’t do that – what if I screwed up?’ or ‘There’s no way I can get all this done’), to habits of the hands (smoking, eating, etc.) Even sleeping poorly, procrastination, and forgetting are habits waiting to be broken.

Steven Covey in Seven Habits of Highly Effective People pounded it into our heads – habits make or break success. But how do you break the cycle? Or better yet, how do you gain the habits that lead to success? Covey set the destination, but we need a road map – concrete tools - telling us how to get there.

You have a natural ability to master habits. I know this because you’re human. And if you argue that point, you have bigger hurdles than mastering habits. Every human has habits. Even if you’re very unorganized, and like variety (or out and out chaos), you’re still a creature of habit. If you’re raising kids watch them. They thrive in a routine, almost deadly predictable environment, because on a very basic level we don’t like change. We realize life is loony and strange, and we’d like to know what’s around the next corner. The peephole in your front door helps reduce stress of the unknown: is it a land shark knocking, waiting to swallow me whole? Or is it my granny in pastel paisley coming to take me to tea? That’s why habits are necessary; they give us predictable, safe feelings of being in control of a little chunk of an otherwise loopy world.

THE CHALLENGE
So are your habits controlling you, or do you use them to get what you want? In my seminar, PsychTools for Mastering Habits, I’ll teach you simple, do-able tools for breaking or creating habits, but you need some information first. Three quick tools to try before my talk: ask around, ask inside, and prioritize.

A client walked into my office and said, ‘People don’t like me.’ Hmmmm, I said. Why? ‘I don’t know. I’m nice to them. I say nice things. But people take a long time to warm up to me, and I’m often lonely.’ I stopped the session and asked permission to videotape. The next week that woman bounded into my office, hugging that videotape. ‘I never knew!’ she said. No one had ever told you?, I asked. And she reported remembering several times, even in grade school, when people had commented on it, but she had dismissed it. The video showed it: her natural, resting face was a cartoonish scowl. Her habit of frowning had drawn lines in a relatively young face, and she still didn’t realize her insides and her outsides didn’t match – she was coming across as a spinstress schoolmarm, even when she felt happy inside! Other people will sometimes tell you your bad habits, or comment on the habits you need but don’t have. It’s our fault for not asking, and not listening when the information comes. Try this experiment: ask three close friends or family members what three habits you need to master, and which three habits get in your way.

One client of mine hated a co-worker, and spent a lot of therapy dollars venting and strategizing ways to deal with this difficult person. I noticed she had a common habit of not looking at me when I was giving her difficult feedback. She would look away, pick at her hands, or even close her eyes. I asked her if she looked at this difficult co-worker, and she responded, yes – of course. I asked her to watch. She thought I was odd, but I am so that’s okay, and she went away.

The next week she came through the door with a sheepish grin, and said she found it very difficult to look at someone she was in conflict with. Ah, ha! What do you lose when you don’t look at someone? You lose all the subtle non-verbals that make up (depending on who you read) 85 – 90% of all communication. This difficult co-worker had a very shrill, parental voice, but her non-verbals were kind and compassionate. My client took the challenge of simply changing the habit her eyes were in, and she reported becoming friends with her adversary in a few weeks. My client wasn’t even aware of her habit to avoid eye contact in difficult situations, until an outside observer pointed it out. Ask people who will tell you the truth about your habits.

Ask inside is similar, but you become your own video camera. Watch two things: your thoughts, and your actions. Some people like to keep a short journal at the end of the day, capturing thought and action, so they can see patterns emerge. Also, ask yourself what three habits you want, and which three you’d like to leave behind. Then take one habit a week, and just live life watching to see how things would be different if you enhanced or erased that habit. Don’t change anything; just contemplate how life would be better. I’ll tell you in the seminar why this experiment has actually helped you change and you didn’t even know it.

Prioritize. You can change any habit in 21 days, but there’s a catch: you can only work on one habit at a time. So take a look at the information you gathered from outside sources, and from your internal study, and pick the top five. For overachieving, type-A folks, this may be distasteful, but if you are in the habit of overwhelming your schedule, maybe that’s one of the first habits to tackle! Don’t set yourself up to fail by taking on more than the human brain can handle. Try to change every habit you have, and your brain will blow up. That’s fairly messy, plus my liability policy doesn’t cover audience’s heads blowing up.

THE END -- UNTIL THE SEMINAR

Will you be a perfect person after the Mastering Your Habits speech? Probably not. Will you walk in with the great pre-tool of solid data about your habits, and walk out with concrete tools to change those you don’t want and master those you need? Definitely. Your habits often define you; they can make or break careers and marriages. They’re slippery little buggers, so join me in the quest for habit mastery, and we’ll learn how to make them serve us, instead of being slaves to another broken New Year’s resolution.

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MOOD MANAGEMENT

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SUCCESS UNDER YOUR SKIN

The following is a short excerpt from Megan Johntz’ workshop on Mood Management for corporations and organizations wanting to improve their most valuable commodity - their people.

A recent survey found 36% of workplace violence was caused by marital or relationship issues; 24% of workplace violence was caused by stress of the job or stress from co-worker strife, and only 18% of violent acts at work were due to being fired. American workers are often on the edge, and unskilled at managing their emotions well.

Those who have mastered their moods, are shining, and rising to the upper levels of corporate America, but there seems to be a huge gap between those people and the majority of employees in a given company.

Imagine the success of an organization able to say about each employee that he or she is emotionally mature, able to take criticism well, take responsibility for their mistakes, look for creative solutions benefiting the whole company instead of becoming territorial for one department, and on and on. That’s the company able to survive and prosper in this fiercely competitive age.

So let’s take a look at what to do with these troublesome emotions. Pay attention to each tool you learn, for they translate into your family life as well as they do at work.

Feeling basics:

• We are always feeling - 24 hours a day.
• We are inherently capable of the full range of feelings.
• Feelings are personal facts that become reports on our emotional state when shared.
• Appropriate expression of feelings enhances intimacy in relationships.
• Feelings don't kill, however not expressing feelings can.
• We are each responsible for our own feelings and their expression.
• There is no bad emotion in and of itself. What you do with that feeling when it comes is what either helps or hurts the situation, others, or yourself.
  

Trouble emotions:

• anger
• fear
• sadness

Physiology of feelings

Feelings are simply a chemical dump in your body, which in turn creates many physical and mental reactions that we have come to label with the terms “anger” or “happiness”, etc. These chemicals running around in your bloodstream do some very helpful things (extra adrenaline during a crisis helps you fight back or flee), but when misunderstood and mismanaged, they can build up and be detrimental to your very physical health. In the seven years or so that I’ve been studying emotions and health, I’ve run across many studies indicating a build up of these emotions - these chemicals - may be linked to serious health problems.

The following list is simply what Megan Johntz has come across in seven years, so I’m sure there are other studies out there that I just haven’t had time to investigate. You probably have heard of some other physical ailment associated with anger, or depression, etc. So take my partial list, and then keep an ear open during the nightly news, as researchers are finding new correlations between emotional distress and physical health every day.

As I write this, today a study was reported in the Journal of the American Medical Association citing childhood trauma - emotional scars from mom and dad divorcing or childhood abuse - making it more likely that person will smoke, and have a harder time quitting than someone who did not suffer major childhood trauma.

Please remember back to your horrendous statistics class, and know that just because two things (i.e.: anger mismanagement and the growth rate of cancer) seem to exist together, it doesn’t mean one causes the other. We always need more research. So all of that said, the following is a list of studies I’ve come across that associate mismanaged feelings with physical ailments.

During the workshop, participants explore areas such as:

• What do I do with anger, sadness, and fear?
• How do I handle a co-worker who is definitely not managing his or her emotions well?
• How do I teach my kids or encourage my employees toward emotional maturity?
• Why would I not notice a feeling - learn to disconnect?
• How can building self-awareness of anger, increase peace?
• How can my head help my heart, which ultimately improves the work of my hands?
• How can not waking up refreshed effect my emotions, and what are the top 5 tools for getting a good night’s sleep?
• How does the food on my plate effect my emotions?
• What’s all this I hear about light bulbs making me happy?
• Does exercise really make me less stressed?
• What’s the role of humor? Is laughter really the best medicine?

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SELF-AWARENESS

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The following is an experiment. You are with yourself every moment, and yet most people don’t know some basic things about themselves. You know the person who is ghastly unaware of their motives, fears, ‘hang-ups’ -- they ooze this ‘issues’ from every pore, but they’re the only one in the room not to notice it. If you don’t know what your strengths and struggles are, growing and maturing into the person you want to be is quite difficult. Hence this self-awareness experiment.

Read the first part of the following sentences and then write what first comes to you as a completion of that sentence. Try the experiment writing the first thing that comes into your mind, and then if you want some more information about yourself, take each question and give the answer some thought.

When finished, look back to see what patterns run through your answers. Watch for anything surprising. You can give it to a person who knows you well, and ask them for their feedback. You can put it away and take it out again in 6 months or a year, running the experiment again and noting any differences. I had one client who did this every year the day after her birthday and kept them as a record of how she changed from year to year.

You may also note which questions you had difficulty with, which if any you left blank, and which had answers that came right to you. All of this is great information about you.

The hard thing about intimate communication is

________________________________________________________

If I were not concerned about the listener’s response

_______________________________________________________

One of the ways I sometimes make it difficult for people to talk to me is

_______________________________________________________

My view of myself

________________________________________________________

My mother told me I was

________________________________________________________

One of the greatest things about being me is

________________________________________________________

I’m beginning to suspect

________________________________________________________

I feel loved and appreciated when

________________________________________________________

All my life

________________________________________________________

If I felt free to show my excitement

________________________________________________________

I am beginning to feel

________________________________________________________

If I choose to look at myself with my own eyes

________________________________________________________

I am a person who

________________________________________________________

I feel invisible when

________________________________________________________

I wish people understood

________________________________________________________

If I were willing to be vulnerable

________________________________________________________

One of the things I wish I better understood about me is

________________________________________________________

As I grow more comfortable accepting my own feelings

________________________________________________________

If I allowed myself to enjoy who I am

________________________________________________________

I am becoming aware

________________________________________________________

Ever since I was a child

________________________________________________________

My mom

________________________________________________________

Aloneness means

________________________________________________________

If I were willing to use my own power

________________________________________________________

I try to sabotage

________________________________________________________

By keeping others uncertain as to my feelings about them

________________________________________________________

My dad

________________________________________________________

One thing I’d like people to know about me

________________________________________________________

My fear

________________________________________________________

If I were to communicate who I am to someone else

________________________________________________________

One of the scary things

________________________________________________________

One of the ways I hurt myself

________________________________________________________

As I grow more independent from my parents

________________________________________________________

A safe person

________________________________________________________

The sadness I have

________________________________________________________

My family thinks

________________________________________________________

I want other people to

________________________________________________________

It’s hard to admit that

________________________________________________________

Sometimes my mother speaks through my voice when I

________________________________________________________

One of the things that originally attracts me to others

________________________________________________________

My anger

________________________________________________________

One of the scary things about feeling positive

________________________________________________________

Honesty is

________________________________________________________

One of the things I wish others understood about my anger is

________________________________________________________

If the part of me that’s still a kid could speak

________________________________________________________

I still have feelings about

________________________________________________________

I push people away

________________________________________________________

If I could be certain that I wouldn’t be condemned

________________________________________________________

A secret

________________________________________________________

My mother gave me the message that love was

________________________________________________________

My greatest

________________________________________________________

My spirituality

________________________________________________________

My father told me I was

________________________________________________________

I’m amazed

________________________________________________________

Sometimes I hear my father’s voice when

________________________________________________________

One of the ways I hide

________________________________________________________

Problems

________________________________________________________

I feel happy when

________________________________________________________

When I was angry as a child

________________________________________________________

Children

________________________________________________________

If I like who I am

________________________________________________________

My worst

________________________________________________________

My father gave me the message that love was

________________________________________________________

Locked away inside me is

________________________________________________________

One of the greatest things about myself

________________________________________________________

If any of what I’m saying is true

________________________________________________________

I don’t talk about

________________________________________________________

If I allowed myself to understand the things I’ve been saying here

________________________________________________________

As I look back over my answers

________________________________________________________

If I were to communicate all this

________________________________________________________

This exercise has been

________________________________________________________

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THE SOCK-DRAWER SYNDROME

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Margaret's getting divorced. Her soon-to-be ex-husband is playing games with the settlement and the kids, she's having to move into a smaller house, and now her insurance is changing right before a minor surgery. So she cleans the kitchen floor even though it doesn't need it, and attacks the messy garage with a vengeance.

Is your house clean? Is your sock drawer neat and tidy? If not, you may need a little crisis in your life. When life gets out of control, or when chaos hits, many people find themselves tackling tasks that previously inhabited the permanent to-do list. Margaret gets a divorce, and her kitchen has never been so spotless. Carol loses her job and suddenly finds herself spending hours planting flowers in her back yard. This "Sock-Drawer Syndrome" can be adaptive or harmful, depending upon its function.

SOCKS AS THERAPY

Sometimes when life is truly out of our control, we search for rituals and tasks allowing us to regain a lost sense of mastery over our world. When Margaret realizes she cannot control the actions of her soon-to-be ex-husband, she finds herself cleaning, sweeping, mopping, and disinfecting at midnight. This gives her a sense of control when life is out of control, and reduces her tension. She accomplishes a small task when it may be impossible to change the major events of her life as a healing ritual and reminder of her efficacy. For women especially, the urge to clean or organize your home environment is often symbolic of trying to do the same with the internal environment, which

If Margaret has done everything in her power to stabilize the chaos, but it continues, organizing the sock drawer functions as an adaptive declaration of her ability. But if she has not thoroughly investigated and worked through her options, the Sock-Drawer Syndrome may be harmful, as in the case of Carol.

THE TROUBLE WITH SOCKS

Carol loses her job, and spends so much time on the backyard, she remains unemployed longer and uses up her savings. The trouble with this phenomenon is the denial factor. It's comforting and rewarding to accomplish this gardening task, but spending all her energy on side issues won't get Carol to her ultimate goal of finding a new job. Hopes, dreams and even daily necessities can be killed by over-attending to the small demands in life.

Most people who experience this form of denial report being extremely uncomfortable with anger, fear, or sadness. They are experiencing these emotions, yet medicating them away by concentrating on the pleasant feelings associated with small accomplishments. Medicating feelings away leads to their building up, resulting in anger outbursts, crying jags, or panic attacks. If Carol turns toward those uncomfortable emotions she may realize she can feel and function.

WHAT AM I DOING?

We all may at times organize or accomplish as a way to feel effective in an out-of-control situation, and organize or accomplish to avoid some more pressing issue. The following questions will help to educate yourself on how you use the "Sock-Drawer Syndrome" in your own life:

- What can I control?

- Do I spend adequate time moving toward my goals in areas under my control?

- What can I not control?

- Am I trying to control these areas anyway? How?

- Do I use activity to numb out or medicate?

- Do I use activity to feel competent when I know I've done all I can?

When life hits hard or you're feeling out of control, watch and discover how you use the small tasks to your advantage or disadvantage. Happy folding!

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EATING DISORDERS

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Eating disorders are becoming much more prevalent, and can be devastating to all involved, even leading to the death of those who struggle to put food in a healthy perspective. The following is by no means everything you’d need to know on eating disorders, but I wanted to give a basic primer, because there is so much mis-information about what eating disorders are. This information was originally presented to the Dallas Independent School District teachers and administrators.

-Megan Johntz

From the Diagnostic and Statistical Manual of Mental Disorders, IV, published by the American Psychiatric Association, the following criteria must be present in order to warrant a diagnosis of an eating disorder.

THE DEFINITIONS

Anorexia Nervosa (DSM IV 307.1)

Refusal to maintain a body weight at or above a minimally normal weight for age and height;

Intense fear of gaining weight or becoming fat, even though underweight;

Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight;

In postmenarcheal females, amenorrhea (loss of menstruation cycle)

Types:

Restricting Type

Binge-Eating/Purging Type

Bulimia Nervosa (DSM IV 307.51)

Recurrent episodes of binge eating. An episode is characterized by both:

(1) eating, in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances;

(2) a sense of lack of control over eating during the episode

Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise;

The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months;

Self-evaluation is unduly influenced by body shape and weight;

The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Types:

Purging Type

Nonpurging Type

Compulsive Overeating

No DSM IV diagnosis

Medication of feelings

Trauma aspects

Self-esteem issues

Femininity fears

 

PSYCHOLOGICAL DYNAMICS

• This is not a diet gone out of control
• Usually it’s an attempt to find a solution to personal difficulties
• Often people with eating disorders feel helpless and ineffective
• They focus on the needs and demands of others, and are often unable to identify own needs/feelings
• Weight becomes only measure of self-esteem and success
• Rigid discipline gives experience of being in control
• Paradox: In trying to gain control, they lose it
• There is an increased incidence of depression, perfectionism, dependency needs, need for approval, coupled with lowered self-esteem, poor assertiveness, and underdeveloped interpersonal skills with heterosexual relationships.
• For bulimia, there is an anxiety-binge-anxiety-purge-guilt cycle
• Anorexia = trying to be in control
• Bulimia = feeling out of control

FAMILY DYNAMICS

• Enmeshment between family members
• Overprotectiveness of the child by one or both parents
• Conflict-Avoidance is a theme in most eating disordered families
• Rigid boundaries and rules also is a theme in most eating disordered families
• Usually there is spoken or unspoken parental conflict

SOCIAL DYNAMICS EFFECTING PERCEPTIONS OF IDEAL BODY WEIGHT

• Media
• Female and male cultural stereotype
• Peer influences

TYPICAL INTERVENTIONS

• Hospital stabilization
• Medical interventions
• Psychoeducation
  
• Therapy
  Cognitive/Behavioral
  Family Systems
  Group Therapy

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MAJOR DEPRESSIVE EPISODE

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Most people do not know exactly what depression is, so I wanted to give you the exact criteria therapists use (this comes straight out of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association) to diagnose depression. The following is the list of symptoms you’d have to have in order to be diagnosed as depressed. This is not meant to replace assessment by a licensed and competent clinician, but only as a reference point.

-Megan Johntz, M.S., L.P.C.

From the Diagnostic and Statistical Manual of Mental Disorders, IV, published by the American Psychiatric Association, the following criteria must be present in order to warrant a diagnosis of Major Depression.

1) Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

• depressed mood most of the day, nearly every day.
• markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day.
• significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
• insomnia or hypersomnia nearly every day.
• psychomotor agitation or retardation nearly every day.
• fatigue or loss of energy nearly every day.
• feelings of worthlessness or excessive or inappropriate guilt nearly every day.
• diminished ability to think or concentrate, or indecisiveness, nearly every day.
• recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

2) These symptoms do not meet criteria for a mixed episode.

3) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4) The symptoms are not due to the direct physiological effects of a substance, or a general medical condition.

5) The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

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DYSTHYMIC DISORDER

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The following is the list of symptoms you’d have to have in order to be diagnosed with Dysthymia (sometimes referred to as Melancholia or “Minor-Depression”. Most people do not know exactly what depression is, or if their symptoms are severe enough to be depression, so I wanted to give you the exact criteria therapists use (this comes straight out of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association) to diagnose depression (see Depression criteria), and Dysthymia. This is not meant to replace assessment by a licensed and competent clinician, but only as a reference point.

-Megan Johntz, M.S., L.P.C.

From the Diagnostic and Statistical Manual of Mental Disorders, IV, published by the American Psychiatric Association, the following criteria must be present in order to warrant a diagnosis of Dysthymia.

1) Depressed mood for most of the day, for more days than not, for at least two years.

2) Presence, while depressed, of two or more of the following:

poor appetite or overeating

insomnia or hypersomnia

low energy or fatigue

low self-esteem

poor concentration or difficulty in making decisions

feelings of hopelessness

3) During the two year period of the disturbance, the person has never been without the symptoms in Criteria 1 and 2 for more than 2 months at a time.

4) No major depressive episode has been present during the first 2 years of the disturbance.

5) There has never been a manic episode, a mixed episode, or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

6) The disturbance does not occur exclusively during the course of a chronic psychotic disorder.

7) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

8) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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