Carter Cares Educational Blog

Disclaimer:  Information provided as a part of this blog is not intended to diagnose or treat medical, psychiatric, or addiction disorders. Please reach out to a licensed mental health or medical professional in order to receive an assessment, proper diagnosis, and treatment for these disorders. This blog is only for informational purposes.

PMS vs. PMDD:  What is this and how do you treat it?

April 30, 2019

What is PMS and PMDD?

PMS or Premenstrual Syndrome is a pattern of physical (tender breasts, fatigue, muscle aches, bloating, acne, constipation, diarrhea), emotional (depression, irritability), and behavior symptoms (food cravings).  These symptoms usually show up one to two weeks before your period and often go away after your period starts. The cause is often attributed to hormonal changes.  These changes occur chemically in the brain.   PMS is very common and can affect 30-80% of women who are still in their reproductive ages (12-49).  

PMDD or Premenstrual Dysphoric Disorder often covers the mood and behavior-related symptoms that is also a part of PMS.  It is common for a woman who already has depression or anxiety to also experience PMDD.  The hormonal changes that happen in a woman's body before a period can potentially make mood disorders worse.  The mood and behavioral symptoms of PMDD must happen about two weeks leading up to your period.  Medical professionals will often give you a diagnosis of PMDD after charting your symptoms over a period of time.  You must meet criteria as outlined in the DSM-5 in order to receive this diagnosis.

How Can I manage PMS and PMDD?

The first thing that you should do it start tracking your cycle.  Apps such as My Flo and Clue allow you to track your cycle as well as changes in your mood as well as symptoms.  Changes in your diet, lifestyle, and exercise can also help you to manage your symptoms.  Diet changes may include eating smaller meals, eating more frequent meals, limiting salty foods, and incorporating more complex carbohydrates (fruit, vegetables).  Calcium-rich food has shown to help improve PMS symptoms.  Limiting alcohol and caffeine may also help.  Exercise can help with fatigue and depression.  Managing stress and getting more sleep can also help you to manage your symptoms.

Your doctor can often other treatments or medications which include antidepressants, NSAIDS, diuretics, and hormonal contraceptives.  These treatments are often used when lifestyle changes don't help.


The Process of Addiction

April 28, 2019

The Process of Addiction can be broken down into Three Stages.

Stage 1:  experimental/social use

Frequency of Use:  occasional, few times a month usually on weekends;  may use alone

Sources:  Friends/peers;  youth may get from parents

Reasons for Use:  to satisfy curiosity;  to acquiesce to peer pressure;  obtain social acceptance;  to defy parental limits;  to take a risk or seek a thrill;  to appear grown up;  to relieve boredom;  to produce pleasurable feelings;  to diminish inhibitions in social situations

Effects:  person will experience euphoria and return to a normal state after using.  A small amount may cause intoxication;  Feelings sought include fun, excitement, thrill, belonging, and control

Behavioral Indications:  little noticeable change;  some may lie about use or whereabouts;  some may experience moderate hangovers;  occasionally there is evidence of use such as beer or a marijuana joint.

Stage 2 (Abuse):  The amount of drug use increases;  consequences are encountered to include work or school difficulties;  changes in friends;  family problems;  physical illness;  weight loss;  financial and legal issues;  personality and emotional changes

Frequency of Use:  Regular, may use several times per week;  may begin using during the day;  may use alone rather than with friends.

Sources:  Friends;  begin buying enough to be prepared;  may sell drugs to keep a supply for personal use;  may begin stealing to have money to buy alcohol and other drugs.

Reasons for Use:  to manipulate emotions;  to experience the pleasure the substance(s) produce;  to cope with stress and uncomfortable feelings of pain, guilt, anxiety, and sadness;  to overcome feelings of inadequacy;  persons who progress to this stage of alcohol and other drugs involvement often experience depression or other uncomfortable feelings when not using;  substances are used to stay high or at least maintain normal feelings.

Effects:  euphoria is the desired feeling;  may return to a normal state following use or may experience pain, depression, and general discomfort;  intoxication begins to occur regularly, however feelings sought include pleasure, relief from negative feelings, such as boredom, anxiety, or stress reduction;  may begin to feel some guilt, fear, and shame;  suicidal ideation or attempts may occur;  tries to control use, but is unsuccessful;  more of the substance is needed to produce the same effect

Behavioral Indications:  school or work performance and attendance may decline;  mood swings;  changes in personality;  lying and conning;  change in friendships; decrease in extra-curricular activities;  begins adopting drug culture appearance;  conflict with family members may increase;  behavior may be more rebellious;  all interest is focused on procuring and using alcohol or other drugs.

Stage 3:  Dependency/Addiction

have physical or psychological distress upon discontinuing use of the alcohol or other drugs;  compulsive use; impaired control over using substance; preoccupation with obtaining and using the alcohol or other drugs and continued use despite adverse consequences

Frequency of Use:  daily use; continuous

Sources:  will use by any means necessary to obtain and secure alcohol and other drugs;  will take serious risks;  will often engage in criminal behavior i.e. shoplifting and burglary

Reasons for Use:  alcohol and other drugs are needed to avoid pain and depression;  many wish to escape the realities of daily living and use is out of control

Effects:  person's normal state is pain or discomfort;  alcohol and other drugs help them feel normal;  when the effects wear off they again feel pain;  they are unlikely to experience euphoria at this state;  they may experience suicidal ideation or attempts; often feel remorse, guilt, or shame;  may experience black outs;  may experience changing emotions i.e. depression, aggression, irritation, and apathy

Behavioral Indications:  physical deterioration inc. weight loss and health problems;  appearance is poor;  may experience memory loss, flashbacks, paranoia, volatile mood swings, and other mental problems;  likely to drop out or be expelled from school or lose job;  may be absent from home much of the time;  possible overdoses;  lack of concern about being caught using;  only focus on procuring and using alcohol and other drugs.

What is Anxiety and How Do I Treat It?

August 27, 2019

Anxiety is the mind and body's reaction to stress, danger, and unfamiliar situations.  You may feel uneasy, distressed, or even dread often right before you experience an event or situation.  Anxiety is not always bad.  Have you ever heard of "fight or flight"? This is when your body reacts to potential danger or harm. A certain level of anxiety helps us to stay alert and aware.  You may also experience a little anxiety right before you perform in front of a crowd or have a presentation in front of others at work or school. You may experience "butterflies in your stomach", but the anxiety that you feel usually goes away after you finish the presentation. This is perfectly normal.

For some people their anxiety can be debilitating and far from being normal.  People are usually diagnosed with an Anxiety Disorder when their anxiety becomes so severe that it interferes with their daily life.  The anxiety that these people experience often cause them to not be able to sleep, concentrate, talk or be around other people, or even leave their homes.  For people who suffer from an Anxiety Disorder they often experience irrational, overwhelming, and disproportionate anxiety symptoms.  They feel like they have no control over their feelings and it can cause both physical and emotional symptoms.  Some of the physical symptoms include headaches, nausea, or trembling.  

Types of Disorders:

There are several types of Anxiety-Related Disorders.  They can be divided into three categories.

1.  Anxiety Disorders-often have an excessive fear component and/or anxiety (i.e. worrying about a future threat).  These disorders can have negative behavioral and emotional consequences.

2.  Obsessive-Compulsive and Related Disorders-These disorders are characterized by obsessive, intrusive thoughts (i.e. worrying about staying clean) that trigger a compulsive behavior (i.e. repeated hand-washing, checking the front door twenty times).  The compulsive behaviors are often performed to alleviate the anxiety associated with the obsessive thoughts.

3.  Trauma-and Stressor-Related Disorders-These anxiety disorders are related to the experience of a trauma (i.e. unexpected death of a loved one in a car accident; veteran experiencing war, or sexual assault) or a stressor (i.e. divorce, beginning college, moving).

Some common Anxiety or Trauma and Stress Related Disorders include:

Post-Traumatic Stress Disorder (PTSD)-related to experience of a trauma or stressor.  This also includes Acute Stress Disorder (initial onset of anxiety or trauma) and Adjustment Disorder (experience symptoms for a short amount of time i.e six months).

Generalized Anxiety Disorder (GAD)-includes excessive, uncontrollable worry over events and activities and potential negative outcomes.  The anxiety and worry often interferes with your daily life, work, school, or social functioning.

Panic Disorder-Includes having sudden panic symptoms out of the blue without specific triggers.  There is also fear of having a panic attack.  Panic attacks can last for a few minutes up to an hour.  

Obsessive-Compulsive Disorder (OCD)-Repeated and persistent thoughts that cause distress and the compulsive behaviors that occur to try to relieve the anxiety and distress.

There are other less common Anxiety Disorders to include Separation Anxiety Disorder, Agoraphobia, Specific Phobia, Selective Mutism, and Social Anxiety.

Other Obssessive-Compulsive Related Disorders include Body Dysmorphic Disorder, Hoarding, Trichotillomania (Hair-Pulling Disorder), Excoriation (Skin-Picking Disorder)

Treatment Options:

Counseling or Psychotherapy:  Psychiatrists, Licensed Psychologists, Psychiatric Nurses, or Licensed Master's Level Mental Health Counselors (LMHC, LCSW, LPC, LMFT) can all provide counseling or psychotherapy.  Treatment inventions that have been shown to effectively treat Anxiety and Trauma-and Stress-Related Disorders include Cognitive Behavioral Therapy (CBT), Prolonged Exposure Therapy, Eye Movement Desensitization Reprocessing Therapy (EMDR), Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Family Therapy.  

Medication:  Certain medications can also be helpful in treating Anxiety Disorders.  Medical Doctors (MD,DO), Psychiatric Nurse Practitioners (NP), and Physician Assistants (PA) can all prescribe medication.  Medications used to treat anxiety and trauma-and stressor-related disorders include Antidepressants, Buspirone, Benzodiazepines, and Beta Blockers.  Medication if often used in conjunction with psychotherapy.  

Complementary and Alternative Therapies:  Stress Management, Meditation/Mindfulness, and Yoga have also proven to be effective in reducing anxiety symptoms.

Other Options To Consider for Treatment of Anxiety and Trauma-and Stress-Related Disorders:

Exercise, Healthy Diet, and Rest

Having Awareness of and Identifying Triggers

Having Supportive Friendships and Family


The ABCs of ZZZs

February 26, 2020

Are You Getting Enough Sleep?

Does it take you more than 30 minutes to fall asleep at night?  Do you wake up frequently during the night or too early in the morning?  Do you have a hard time going back to sleep?  Do you feel groggy and lethargic when you awaken?  Do you feel drowsy during the day particularly during monotonous situations?

If you answered yes to any of these questions, you have have a "sleep debt" that is affecting you in ways you don't even realize.  It has been estimated that 60% of American adults experience sleep problems.

Why We Need Sleep

Sleep is essential for good health, mental, and emotional functioning and safety.  Research has shown that people with chronic insomnia are more likely to develop several kinds of psychiatric problems and are also likely to make greater use of healthcare services.  People who suffer from sleep apnea are likely to have health blood pressure while they sleep and suffer from excessive daytime sleepiness.  Occasional sleeping problems can make daily life feel more stressful.  Sleep loss can cause you to be less productive and impair your ability to perform tasks involving memory, learning, and logical reasoning.  Insufficient sleep can be extremely dangerous, leading to serious or even fatal accidents.

Who Is At Risk for Poor Sleep

Certain individuals are most vulnerable to include students, shift workers, travelers, and persons suffering from acute stress, depression, or chronic pain.  Older adults have frequent difficulty with sleep problems, but inadequate sleep is not an inevitable part of the aging process.  Sleep issues in elderly adults can include impaired health, pain, and increased use of medications.  Being overweight increases the risk of sleep apnea.

The Biggest "Sleep Stealers"

  • Psychological factors to include stress
  • Lifestyle Stressors
  • Shift Work
  • Jet Lag
  • Environmental Interferences
  • Physical Factors
  • Medications 
The Secret to Good Sleep
  • Avoid caffeine, nicotine and alcohol in the late afternoon and evening
  • Exercise regularly, but at least three hours before bedtime
  • Don't use your bed for anything other than sleep or sex
  • Consider your sleep environment.  Make it pleasant, comfortable, dark, and quiet
  • If you have trouble sleeping when you go to bed, don't nap during the day
  • Establish a regular, relaxing bedtime routine that will allow yo to unwind and send a signal to your brain that it's time to sleep
  • If you can't go to sleep after 30 minutes, don't stay in bed tossing and turning.  Get up and involve yourself in a relaxing activity until you feel sleepy.
  • Try to clear your mind-Don't use the time to sleep to solve your daily problems.
When to Seek Help
  • If sleep problems persist for longer than a week and are bothersome
  • If sleepiness interferes with the way you feel or function during the day
  • Try to keep a diary of your sleep habits for about ten day to share with your doctor
  • Your doctor may prescribe medications and/or a sleep study 
Information gathered from brochure printed by the National Sleep Foundation (2002). 

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