Latest / Clinically Chaotic / Episode 6: McDonald’s Sprite, Cheese Cravings, And The DSM

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Episode 6: McDonald’s Sprite, Cheese Cravings, And The DSM · Clinically Chaotic

0:08
SPEAKER_01: Welcome back to Clinically Chaotic Podcast with Erica and Tara.
0:13
SPEAKER_00: It's good to be here.
0:14
SPEAKER_00: Happy, what day of the week is it?
0:17
SPEAKER_00: Wednesday, Tuesday.
0:18
SPEAKER_00: Tuesday.
0:20
SPEAKER_01: Yeah, we're just girls figuring it out.
0:22
SPEAKER_00: Okay.
0:23
SPEAKER_00: How have you been?
0:24
SPEAKER_01: Overall, work has been busy.
0:26
SPEAKER_01: I worked the weekend, so I kind of have half a brain, but doing well.
0:30
SPEAKER_01: How are you?
0:31
SPEAKER_00: That's okay.
0:32
SPEAKER_00: I am refreshed.
0:34
SPEAKER_00: I finally transitioned from working at two practices simultaneously, which was a personal nightmare.
0:40
SPEAKER_00: Not because the work wasn't great, just transitioning from two practices that are like two hours away from each other was a disaster.
0:49
SPEAKER_00: I spent so much time in my car.
0:52
SPEAKER_00: I also met with my sister-in-law briefly.
0:55
SPEAKER_00: And by met, I mean she called me.
0:57
SPEAKER_00: So not really a meeting at all.
0:59
SPEAKER_00: She is wonderful and one of my very favorite people of all time.
1:03
SPEAKER_00: And she's very funny in the way she delivers feedback.
1:06
SPEAKER_00: But she goes, I was listening to your podcast and I don't know who it's for.
1:12
SPEAKER_00: Which made me laugh hysterically because I know that's her most gentle way of being like, hey, do the thing.
1:20
SPEAKER_00: So I know I wrote it and I write it at the beginning of all of our intros and descriptions, but I don't know why I would think that anybody who's listening to this podcast has time to read any of that.
1:32
SPEAKER_00: If you do, golden star for you.
1:35
SPEAKER_00: I don't read any of those things.
1:37
SPEAKER_00: So I did want to clarify Clinically Chaotic is a podcast by therapists, me and Tara, for therapists, for anybody going through grad school to work in the mental health field, or for anyone who is just curious, kind of what goes on behind the scenes or about mental health in general.
1:56
SPEAKER_00: Is it always serious?
1:58
SPEAKER_00: No, very rarely.
1:59
SPEAKER_00: We're going to get things wrong.
2:01
SPEAKER_00: We're just here to create a space that feels not so judgmental or clinical or sterile, which sometimes our job can feel that way.
2:10
SPEAKER_00: That being said, the topic I wanted to bring to you this week is a little clinical, but it's something that is really interesting to me personally.
2:19
SPEAKER_00: And I wanted to talk about the history of the DSM.
2:22
SPEAKER_01: This is exciting.
2:23
SPEAKER_01: I feel like my knowledge in general around the DSM lacks.
2:27
SPEAKER_01: So if anything, this could be a good conversation and a learning moment.
2:33
SPEAKER_00: Most of us use it for the same 15 or 16 things that we're diagnosing.
2:37
SPEAKER_00: And honestly, that's generous, probably like five to 10.
2:41
SPEAKER_00: But we all have this book sitting in our office or somewhere, and at some point in time, I think it's important to reference because the history of the DSM kind of perfectly encompasses the chaos and the ever-changing evolution of our field.
2:59
SPEAKER_00: If there's anything that says we as clinicians are not perfect, we do get things wrong and we have to figure it out along the way, revise, take accountability, the DSM does that.
3:17
SPEAKER_01: Should I take like a wild guess or something?
3:19
SPEAKER_01: Because I have no idea.
3:20
SPEAKER_01: Yeah, go for it.
3:22
SPEAKER_01: But I'm gonna say maybe 1975.
3:26
SPEAKER_00: Wow.
3:26
SPEAKER_00: I mean, you're in the 19s, so close.
3:29
SPEAKER_00: 1952 by the APA, which I didn't know was around back then.
3:35
SPEAKER_00: But it was primarily for the military and psychiatric hospitals, so they could share the same definition, which I think is important to think about the foundations of that, because I think that really set the tone for why some people view therapy as like you have to have really intense symptoms to need it.
3:56
SPEAKER_00: Just when you think about how only military and psychiatric hospitals were really using it at the time.
4:21
SPEAKER_01: Rather than people showing up to therapy when they've experienced some massive form of trauma or a stressor, an abrupt change in life.
4:30
SPEAKER_01: I feel it is quick for people to suggest going to talk to someone, going to get help for that, rather than someone who's doing well in life and maybe has some balance or doesn't have a bunch of stressors going on at the time.
4:42
SPEAKER_01: It's never really talked about or suggested having that human being showing up to therapy, even though that is what therapists would like to see is people showing up to treatment as a preventative measure and learning the skills in a space where they can really adapt and utilize the skill.
5:02
SPEAKER_01: It doesn't have to be like a crisis moment or a rush to help someone feel better if they're already in a state where they're not feeling that bad.
5:11
SPEAKER_00: I think if people used more of it as a preventative measure, overall, we would probably see things like lower rates of divorce.
5:19
SPEAKER_00: I have had the pleasure of working with a couple of people or couples in the past who have come to therapy specifically because they knew they were signing up for a major life transition.
5:30
SPEAKER_00: And even if that transition is exciting, it for most people means we're taking on more responsibility.
5:36
SPEAKER_00: And so you're exactly right.
5:37
SPEAKER_00: If you come in then, you have the tools to scaffold through all of these things without building resentment.
5:44
SPEAKER_00: That is really important.
5:46
SPEAKER_00: I don't think the original DSM helped people with that.
5:49
SPEAKER_00: It was only 32 pages long and included 106 possible diagnoses.
5:54
SPEAKER_00: Wow.
5:55
SPEAKER_00: Interesting.
5:57
SPEAKER_00: So virtually nothing, and we didn't get the second edition until 1968.
6:03
SPEAKER_00: I found almost no information on what was contained in the second edition.
6:09
SPEAKER_00: By no information, I mean I only used Wikipedia because that's how much energy I had last night.
6:15
unknown: Perfect.
6:16
SPEAKER_00: So I guess it just existed and was there, and maybe something changed, but who knows?
6:21
SPEAKER_00: Then we get the third in 1980.
6:24
SPEAKER_00: And this is really important because this is when the DSM changes.
6:29
SPEAKER_00: So initially it was all about psychoanalysis and really the interpretation of the therapist in that moment.
6:38
SPEAKER_00: So at this point in time, all of the diagnoses change to kind of a checklist.
6:44
SPEAKER_00: And so that's when we get criteria, and you have to meet X amount of criteria for this diagnosis.
6:50
SPEAKER_00: So this changes the field entirely because now we have a more accurate way to record what's going on for people.
6:58
SPEAKER_00: I can't imagine before if it was like depression, you know, it's a feeling.
7:03
SPEAKER_00: Use your judgment.
7:06
SPEAKER_01: Must have low energy and feel sad five to seven days out of the week.
7:12
SPEAKER_00: Like there wasn't criteria though.
7:14
SPEAKER_00: It was just analyze this person and see what you think they fit into.
7:21
SPEAKER_01: I guess curious if that correlated to having more people with diagnoses and labels on them or less people because maybe clinicians were unsure of how to kind of structure diagnoses or when to kind of put the label or kind of make the decision that the diagnosis is fitting versus now having kind of a checklist that you have to go through so that you know was it more up to the therapist's interpretation?
7:52
SPEAKER_01: Kind of wild.
7:53
SPEAKER_00: Oh man, I bet you it was more incorrect diagnoses.
7:56
SPEAKER_00: If I were to wager a guess based on my vague assumption of Wikipedia reading.
8:02
SPEAKER_00: But it is wild.
8:04
SPEAKER_00: This is a really important time because this is when things begin to be removed from the DSM.
8:09
SPEAKER_00: So, as I'm sure you know, a really important one in 1973, they finally remove homosexuality as a diagnosis in the DSM.
8:19
SPEAKER_01: Oh my gosh, pray the gaze away.
8:22
SPEAKER_00: No 1973.
8:25
SPEAKER_00: That seems insane to me.
8:27
SPEAKER_00: That is so late.
8:29
SPEAKER_00: It was an actual diagnosis that clinicians and doctors could use prior to that date.
8:37
SPEAKER_00: 1978?
8:39
SPEAKER_01: 73.
8:40
SPEAKER_01: 73.
8:42
SPEAKER_01: Wow.
8:42
SPEAKER_01: Okay.
8:43
SPEAKER_00: Baffling.
8:45
SPEAKER_00: The idea that you could be hospitalized and receive psychiatric treatment because of your sexual identity is insane to me.
8:55
SPEAKER_00: And the fact that it took until 1973 is insane.
8:59
SPEAKER_00: No wonder people weren't talking about it.
9:02
SPEAKER_01: That is actually really interesting.
9:04
SPEAKER_01: For those of you who are listening who don't know me personally, I do identify as part of the LGBTQ community.
9:12
SPEAKER_01: And never in my life have I really maybe had the perception that my sexuality aligns or correlates with mental health issues in any type of way.
9:25
SPEAKER_01: I have also lived the majority of my life with generalized anxiety and ADHD.
9:31
SPEAKER_01: And those definitely, in my mind, would be categorized as mental health disorders or things that need to be addressed.
9:38
SPEAKER_01: But I can't say there's been even a moment in my life before coming a clinician or after that I ever would have considered my sexuality and identity being something that um would be addressed in a clinical setting.
9:53
SPEAKER_00: It's insane.
9:54
SPEAKER_00: Obviously, I'm in the same boat of not believing that to be a disorder in any capacity.
10:01
SPEAKER_00: It kind of highlights just how important social causes are outside of the DSM, right?
10:07
SPEAKER_00: The primary reason for this push to change and evolve is because of the activism that was going on in the world at that time.
10:16
SPEAKER_00: And so I know it is in our code of ethics as therapists, but I just want to harp on how important it is to be active in our community, to really be pushing for things that don't feel right, because even our current DSM is imperfect.
10:29
SPEAKER_00: And I'm gonna get to that later, I swear, after I walk you through the rest of this.
10:35
SPEAKER_00: So come 1994, the DSM 4 is released.
10:40
SPEAKER_00: All it does is refine previous criteria.
10:43
SPEAKER_00: I'm starting to think that the even number DSMs are lame and they don't really do anything, but the odd numbers apparently are where the change happens.
10:52
SPEAKER_00: So our most current version is the DSM 5, and this is released in 2013, which feels like a long time ago, and to me feels a little insane that we're still continuing to use it.
11:07
SPEAKER_00: So I just want you to think about how many things can change since 2013.
11:12
SPEAKER_00: For example, tell me a little bit about yourself in 2013 and how it's not at all the way you are now.
11:19
SPEAKER_01: Oh my gosh, 2013.
11:22
SPEAKER_01: And first thing that comes to mind is we've experienced like a pandemic since then in 2013.
11:28
SPEAKER_01: What was that?
11:29
SPEAKER_01: I was graduating high school.
11:30
SPEAKER_00: Yes, that was the year we graduated high school.
11:33
SPEAKER_01: I like can't even uh get my brain to just like revisit uh high school Tara.
11:40
SPEAKER_00: Spabling.
11:42
SPEAKER_00: I don't blame you.
11:43
SPEAKER_00: We had just graduated high school.
11:46
SPEAKER_00: Macklemore was really big at the time.
11:49
SPEAKER_00: I wore a high-low prom dress.
11:52
SPEAKER_00: That was a thing that people were doing.
11:55
SPEAKER_00: Vibes.
11:56
SPEAKER_00: Absolutely.
11:57
SPEAKER_00: It was a time and place.
11:59
SPEAKER_00: I think about just that version of myself in 2013 and how much has changed for me personally, but also how much has changed about the way that I understand the world.
12:10
SPEAKER_00: It really speaks to the need for a new DSM or a revised DSM, because it's too old.
12:18
SPEAKER_00: I'm going to come out and say that.
12:20
SPEAKER_01: Absolutely.
12:21
SPEAKER_01: I would agree.
12:22
SPEAKER_01: And you're completely right, especially thinking about it in terms of what my life looked like 10 years ago, who I was as an individual, the knowledge I had, kind of like who I was, couldn't be more of a different person than who I am today.
12:37
SPEAKER_01: So the tools that now we're using that may have been appropriate for a decade ago, it's completely reasonable to assume that the accuracy is not on point these days.
12:50
SPEAKER_00: Definitely not.
12:51
SPEAKER_00: It was really interesting though, what I was reading, which has come up for me a lot as a clinician lately, is essentially how it altered the autism spectrum disorder and what that means, right?
13:03
SPEAKER_00: When it absorbed, oh my gosh, my brain is going blank.
13:08
SPEAKER_00: The movie Rain Man.
13:09
SPEAKER_00: Do you know what I'm talking about?
13:11
SPEAKER_01: Wait, okay, so no, I'm actually terrible with movies.
13:15
SPEAKER_01: I'll put it out now that I am I struggle with movies because of my ADHD.
13:20
SPEAKER_01: So I actually haven't seen this movie.
13:22
SPEAKER_01: I'm sorry.
13:22
SPEAKER_01: Okay.
13:23
SPEAKER_00: It's part of autism spectrum disorder.
13:27
SPEAKER_00: Gosh, this is embarrassing now.
13:29
SPEAKER_00: Uh, and it essentially is like an incredible amount of intelligence.
13:36
SPEAKER_00: And people now, or even in my experience, sometimes if they qualify for what would have been this diagnosis previously, God, I have to remember the name.
13:47
SPEAKER_00: Why can't I think of this?
13:49
SPEAKER_00: I'm gonna Google it.
13:50
SPEAKER_00: Give me two seconds.
13:51
SPEAKER_01: Yeah, go ahead.
13:53
SPEAKER_01: Um, I wish I could.
13:55
SPEAKER_01: Is it's not Ashbergers, right?
13:56
SPEAKER_00: You're not yes, it is.
13:57
SPEAKER_00: It is Asperger's.
13:58
SPEAKER_01: Oh, okay.
13:59
SPEAKER_01: My understanding of Ashbergers was at some point it was included in the DSM and it was symbolic for being on the autism spectrum, but it was the adult version, whereas people who were not adults were diagnosed with autism.
14:15
SPEAKER_01: Is that what we're getting at here?
14:16
SPEAKER_00: Yes, that's what I'm getting at.
14:18
SPEAKER_00: Essentially, it was absorbed in 2013 in all of these things.
14:22
SPEAKER_00: And it's interesting because I think it carries a different stigma attached to it.
14:28
SPEAKER_00: Uh, people associate people who previously had an Asperger's diagnosis with being highly intelligent and very successful.
14:36
SPEAKER_00: And you can be those things and still have autism, right?
14:40
SPEAKER_00: It's so many overlapping symptoms that were so similar, which is why it was absorbed in the first place.
14:46
SPEAKER_00: But it is interesting how even now, even though this definition has been altered since 2013, people are hesitant to accept one diagnosis over the other, even though they are one and the same now.
15:00
SPEAKER_01: Hmm, I actually didn't know about the higher levels of intelligence being correlated with Ashburgers, because in my mind, maybe this is just because I've worked a lot with the ASD community, especially in my work, but I always thought the only distinction was adult versus child, which was always confusing because if you know the symptoms were matched for both diagnoses, what is the point of having two different diagnoses if the only difference is age?
15:32
SPEAKER_01: So that was always confusing to me.
15:35
SPEAKER_00: It is really confusing.
15:36
SPEAKER_00: It's also really confusing as to why that stigma still exists when it's been what feels like a significant amount of time that this has been this way, but people are only just now really discovering it.
15:49
SPEAKER_00: Oftentimes things change, and I don't think we necessarily acknowledge it, or the world around us doesn't acknowledge how the DSM changes over time.
15:59
SPEAKER_00: Pop psychology is very much so behind what we've known or have been learning about as clinicians for quite some time.
16:07
SPEAKER_00: And I did want to talk a little bit about pop psychology and its role in diagnosing.
16:15
SPEAKER_00: I don't know if you know this, but apparently, and I guess I've never looked at this section, the DSM has a section of things that are essentially pending, things that they're still researching, still figuring it out, as possible potential diagnoses that are not yet recognized.
16:34
SPEAKER_00: So this was a long list, and I just took out the ones that I thought were most interesting.
16:40
SPEAKER_00: One of them is caffeine use disorder, which I found fascinating.
16:44
SPEAKER_00: Interesting.
16:46
SPEAKER_00: I've never thought about that, but as our world evolves and people rely more and more on caffeine to get through the day because we're working longer hours, we're doing all these things that people weren't before, it has come to the point that it is actually affecting people's lives and that not only are they experiencing withdrawal symptoms, but the inability to not use it despite its adverse reactions.
17:11
SPEAKER_01: I've actually just recently worked with a client who had a really intense caffeine addiction.
17:17
SPEAKER_01: I have to wonder, so would that disorder fall under like substance use disorder?
17:23
SPEAKER_00: That's a great question.
17:24
SPEAKER_00: Right now it's still in the maybe, maybe not part of the DSM.
17:29
SPEAKER_00: But honestly, it feels really targeted.
17:33
SPEAKER_00: Yeah.
17:34
SPEAKER_00: I know that that's not their intention.
17:36
SPEAKER_00: They're not like, hey, this is for you.
17:38
SPEAKER_00: But just being in Seattle, I'm like, are we the epicenter of this issue?
17:46
SPEAKER_00: Oh, interesting.
17:48
SPEAKER_00: Well, another one that I thought was really interesting was internet gaming disorder, which of course makes sense that this was not an issue in previous DSMs and that it hasn't been fully adopted yet, because we're still obviously getting more information about the impact of screens and the internet, especially on children and adults over time.
18:10
SPEAKER_00: But you think about it as an addiction, because it's not technically classified as an addiction yet.
18:16
SPEAKER_00: I could fully see the importance of this one and how not necessarily having any kind of diagnosis for it can keep people from A, getting help and B, understanding the seriousness of what's going on.
18:30
SPEAKER_01: Yeah, they both sound like addiction disorders to me and almost like subcategories that could be established within addiction disorders.
18:40
SPEAKER_01: I'm really racking my brain right now because in grad school, maybe you could pick this out.
18:46
SPEAKER_01: Um, there was a class that I took where I think it was my substance use treatment class, and it talked about the different types of addictions.
18:55
SPEAKER_01: There was like two categories of addictions.
18:58
SPEAKER_01: One of them, and I want to almost say it was separated into like tangible things versus non-tangible things, like having a sex addiction versus like a drug addiction.
19:09
SPEAKER_01: One of them is like a behavior and an act versus one of them is you're utilizing something, like putting something in your body or consuming something that's not good for you.
19:21
SPEAKER_01: Maybe that was the difference, consumption versus non-consumption.
19:24
SPEAKER_01: I don't know if you know what I'm talking about, but that's kind of almost what it seems like it could fall into these subcategories of different things that people become addicted to.
19:35
SPEAKER_01: I do know what you're talking about and kind of the difference.
19:38
SPEAKER_01: I did take a couple substance use classes in my grad program, but I've spent very little time working with adults or even teens or children who do engage in substance use.
19:48
SPEAKER_01: It is not something I'm super familiar with.
19:50
SPEAKER_01: However, my understanding of addiction is addiction is anything that you continue to go back to, even if there are harmful effects that are impacting your well-being in one way or another.
20:05
SPEAKER_01: It's in my mind, who's to say what things count as an addiction?
20:09
SPEAKER_01: Somebody, yes, could be addicted to watching reality TV or could be addicted to fast food specifically.
20:18
SPEAKER_01: There are just so many things that come to mind.
20:20
SPEAKER_01: So personally, maybe I don't know enough about it.
20:23
SPEAKER_00: One of my favorite facts, buy really good cheese apparently activates a similar part of your brain.
20:30
SPEAKER_00: Addictions are really interesting because that I feel is still heavily open to interpretation by the therapist.
20:39
SPEAKER_01: Okay, wait.
20:40
SPEAKER_01: I just have to take a pause really quick because I just heard you say addiction around cheese.
20:47
SPEAKER_01: I have no idea how this is coming up right now because not that long ago.
20:52
SPEAKER_01: I'm just taking this on a quick side quest.
20:54
SPEAKER_01: Not that long ago, one of my very best friends was telling me that she feels like she has an addiction to the McDonald's cheese that they put on their cheeseburgers, quarter pounders, whatever.
21:10
SPEAKER_01: She was so seriously telling me, she was like, Tara, I at night, like I sit there and I think about the cheese or I crave the cheese.
21:18
SPEAKER_01: And at first, of course, I was like laughing.
21:20
SPEAKER_01: I thought I thought it was absolutely hilarious.
21:22
SPEAKER_01: Granted, she is one of my best friends, so my response can be a little less gentle with her.
21:27
SPEAKER_01: I was just, I thought it was so funny that she was telling me that.
21:31
SPEAKER_01: But now the fact that you've just brought up an actual addiction around cheese and it being like a known thing, I find that hilarious.
21:41
SPEAKER_00: That's amazing.
21:42
SPEAKER_00: I've never heard of that specifically being McDonald's cheese, that it's amazing, but I get it.
21:48
SPEAKER_00: They have a lot of things that I think they specifically scientifically alter to make it more crepeable.
21:54
SPEAKER_00: Their sprite is one of my favorite things of all time.
21:57
SPEAKER_00: I think about it frequently and I I try it in other countries and it's never as good.
22:02
SPEAKER_00: So it's like American McDonald's Sprite.
22:05
SPEAKER_00: Feels like a drug sometimes.
22:07
SPEAKER_01: Well, I will be the first to tell you here McDonald's Sprite in this country does contain crack cocaine.
22:14
SPEAKER_01: That must be why it's so good.
22:16
SPEAKER_01: Because I'm just kidding.
22:17
SPEAKER_01: It feels that way.
22:19
SPEAKER_01: Like once you take the first tip, it's almost like, wow, I have to get another.
22:23
SPEAKER_00: There's something there.
22:25
SPEAKER_00: And I could argue that it is detrimental to most people's health to continuously be consuming McDonald's spray.
22:32
SPEAKER_00: Does that make it qualify for an addiction?
22:35
SPEAKER_00: Or what is the threshold?
22:37
SPEAKER_00: I think with addictions, the DSM has a threshold that's kind of clear, but it could maybe be better defined.
22:45
SPEAKER_01: I have no idea what the threshold is, but in my mind it goes straight to like the ability to control engaging in whatever it is.
22:52
SPEAKER_01: If I have this, let's say I have an addiction around McDonald's cheese, the moment comes where I have the urge where I want to go to go get McDonald's.
23:02
SPEAKER_01: If I'm able to manage that urge and that urge can subside without completely taking over and forcing my body kind of into going and retrieving the cheeseburger, then I think that's when it becomes an addiction, is when your brain has lost control around making the decision of what is better for you versus what you really want in that moment.
23:26
SPEAKER_00: I wonder because you do work with kids, you might hear some of these terms more often.
23:30
SPEAKER_00: These are both terms that are not recognized as part of the DSM, but have been heavily used on social media recently.
23:39
SPEAKER_00: So one of those is CPTSD.
23:42
SPEAKER_00: Is that something you're familiar with?
23:44
SPEAKER_00: Is complex CPS uh PTSD, right?
23:47
SPEAKER_00: Yes.
23:47
SPEAKER_00: Yeah.
23:49
SPEAKER_00: A lot of people are coming in and talking about it like it's a known diagnosis, and technically it is not.
23:58
SPEAKER_00: How would you best kind of sum it up from your perspective what that means?
24:02
SPEAKER_00: And do you think there's a difference between that and a current PTSD diagnosis?
24:08
SPEAKER_01: Yes, because I work with children and the nature of the program I work in, I actually don't do any diagnosing in my job.
24:16
SPEAKER_01: By the time I get my client, somebody else has provided the diagnosis and kind of delivered it to me.
24:22
SPEAKER_01: So I don't do a lot of diagnosing.
24:25
SPEAKER_01: Actually, now that I'm trying to answer this question, I can't actually remember the question that you asked me.
24:33
SPEAKER_00: That's okay.
24:34
SPEAKER_00: Uh see PTSD, and if you feel like it's an accurate diagnosis.
24:39
SPEAKER_00: PTSD, currently one of the qualifiers, is that you have to believe your life is in danger.
24:44
SPEAKER_00: It doesn't necessarily have to be that there is a threat.
24:48
SPEAKER_00: If you believe that there's a threat, that's enough to qualify for it.
24:51
SPEAKER_00: But it usually is referencing exposure to specific events where what I think CPTSD does, and you can correct me if I'm wrong.
25:01
SPEAKER_00: This is just for my vague understanding and what I've gathered, is that it is more comprehensive, that it looks at exposure over time.
25:10
SPEAKER_00: So how you can have symptoms of PTSD, maybe from long-term verbal abuse, where maybe you weren't actually in fear for your life, but there was still a lot of impact based on the abuse that was occurring.
25:24
SPEAKER_01: Okay, I don't know if I have the most refined understanding, but it is more comprehensive.
25:30
SPEAKER_01: And my understanding is the complexity comes in where somebody could be experiencing PTSD from one stressor that has caused this response or reaction in a person.
25:43
SPEAKER_01: Whereas my understanding of complex PTSD is somebody could have experienced multiple stressors and are now having traumatic responses from different individualized stressors.
25:55
SPEAKER_01: So for example, someone with PTSD could be an individual who got into a car accident several years prior and is still experiencing symptoms from that traumatic event, whereas complex PTSD would be somebody who got in a car accident and then on their way to the hospital was sexually assaulted in the ambulance, and then upon arriving to the hospital, was mistreated at the hospital.
26:21
SPEAKER_01: Upon discharging, was discharged to their abusive domestic partner.
26:27
SPEAKER_01: There's like multiple traumatic events that are piling into this person's kind of nervous system and traumatic response, whereas PTSD could be one individual event that caused this response.
26:42
SPEAKER_00: Yes, somewhat.
26:49
SPEAKER_00: So the exposure time of being in war and being around constant death or the threat of death.
26:57
SPEAKER_00: And so sometimes it does encompass longer periods of time.
27:01
SPEAKER_00: But I think where C PTSD differs is that it doesn't necessarily need to have that imminent threat of death.
27:11
SPEAKER_00: Does that make sense?
27:13
SPEAKER_00: Yeah, totally.
27:14
SPEAKER_00: So interesting.
27:16
SPEAKER_00: With that, are you for or against this being added to the DSL?
27:21
SPEAKER_01: You know, this might sound kind of lame, but I don't know if I have like a strong stance either way, mainly because if I'm being completely honest, I've been a therapist for almost two years now and I do not open my DSM.
27:33
SPEAKER_01: It sits on my bookshelf and has a really pretty spot.
27:36
SPEAKER_01: I love it.
27:36
SPEAKER_01: And I know that if I need it, I can pick it up and open it.
27:40
SPEAKER_01: And maybe one day in my life I will work in a position where I will have to be diagnosing clients and have some more familiarity with the DSM.
27:50
SPEAKER_01: And the current role that I work in, it's just not one of the tools that I'm utilizing or having to utilize.
27:57
SPEAKER_01: I'm not diagnosing my clients when they come in through intake, somebody else is doing that for me.
28:02
SPEAKER_01: So I don't know if I have a strong stance one way or another, but I will say, I guess if it makes sense for somebody to have a more refined diagnosis and in some way that is benefiting or helping or supporting someone's understanding of what they're experiencing and how they can be helped, then I would be all for it.
28:26
SPEAKER_00: I think I'm all for it.
28:28
SPEAKER_00: I do utilize my DSM regularly, even though I typically see the same range of roughly 10 diagnoses, but I'm curious.
28:37
SPEAKER_00: I always want to know what's out there.
28:39
SPEAKER_00: I want to have a better understanding.
28:41
SPEAKER_00: I want to make sure I'm rolling things out because in my role, I do have to do that.
28:45
SPEAKER_00: Oftentimes I spend a lot of time in the sections that are not really related to what I do, but more so what I'm fascinated by.
28:53
SPEAKER_00: And I have noticed this might be a hot take, people can disagree with me, that there are not always a lot of diagnoses to specifically support individuals who are experiencing long-term abuse that is not life-threatening.
29:09
SPEAKER_00: I think that's really important.
29:11
SPEAKER_00: The introduction of CPTSD could actually be really beneficial for people who have gone through that, to not only have a community to discuss these things and to be a part of it, but maybe to not have their trauma kind of toned down.
29:27
SPEAKER_00: Like, oh, you weren't in the war and therefore you can't have these side effects.
29:33
SPEAKER_00: No, that was terrible and this is terrible too.
29:36
SPEAKER_00: And we can both have the same level of acknowledgement.
29:39
SPEAKER_00: Absolutely.
29:40
SPEAKER_00: Yeah, I like that.
29:42
SPEAKER_00: I want to get to another one.
29:44
SPEAKER_00: A lot of the younger generation is bringing it up right now.
29:47
SPEAKER_00: Since you do have a confirmed diagnosis of ADHD, I don't know if this is something you're familiar with or not, but the concept of RSD, specifically in relation to ADHD.
30:00
SPEAKER_01: Mm-mm.
30:01
SPEAKER_00: I got nothing.
30:02
SPEAKER_00: That's okay.
30:03
SPEAKER_00: Uh rejection sensitive dysphoria, or I've also heard it referred to as rejection sensitivity disorder.
30:10
SPEAKER_00: So I'm not really sure where that lands right now with people.
30:12
SPEAKER_00: Given that it's not part of the DSM, I guess you could call it either one.
30:16
SPEAKER_01: Ooh, okay.
30:17
SPEAKER_01: Interesting again.
30:18
SPEAKER_01: Um, because my psychiatrist, I I've only been working with her for a year, but she has been absolutely lovely.
30:25
SPEAKER_01: My psychiatrist does a lot of teaching me and informing me about women with ADHD.
30:33
SPEAKER_01: She's done a lot of studying and how your hormones play um a role, your weight, just your body movement, everything goes into ADHD in a woman.
30:45
SPEAKER_01: And she just recently sent me an article about what is it, rejection.
30:52
SPEAKER_01: I don't even know the name of it yet.
30:53
SPEAKER_00: Uh sensitive dysphoria or sensitivity disorder, whatever you want to coin it.
30:58
SPEAKER_01: She just had sent me an article about this.
31:01
SPEAKER_01: Actually, it was in correlation.
31:03
SPEAKER_01: She was teaching me about guanfacine.
31:05
SPEAKER_01: I don't know how familiar you are with guanfacine, but she was talking about how recently she's really been advocating for a lot of her female clients who have ADHD to start trying guanfacine and seeing how that can affect the article had to do with that disorder.
31:21
SPEAKER_01: And so I am not familiar.
31:23
SPEAKER_01: However, I feel like at this point now I should go back and review the reading materials since this is coming up again.
31:29
SPEAKER_00: I think you might find it fascinating.
31:32
SPEAKER_00: From what I've gathered, it's essentially the idea that specifically people with an ADHD diagnosis experience rejection, perceived or real, in a different way than a neurotypical brain.
31:45
SPEAKER_00: It's lighting up different areas, and that is causing the feeling of rejection to be more drastic internally, if that makes sense.
31:56
SPEAKER_00: And that can kind of lead to the irritability or the reactive behavior that sometimes you see in these moments that would be explained by the overactivity in your brain versus what a neurotypical brain might experience.
32:10
SPEAKER_01: Okay, and this is one of the pending?
32:14
SPEAKER_00: Not even pending, which is interesting.
32:16
SPEAKER_00: It's something that's being looked into.
32:18
SPEAKER_00: They're trying to gather a lot of information, but right now it really is like TikTok pop psychology.
32:25
SPEAKER_01: No, I would really be curious to more uh to learn more about that, especially just because over the past couple of years, my AG ADHD has always been present in my life, but I feel like specifically over like the past five years or so, I have really narrowed in on addressing and learning more about my ADHD because I think for many, many years I was wrapped up in focusing on managing my anxiety.
32:49
SPEAKER_01: That was kind of the focus.
32:51
SPEAKER_01: My psychiatrist right now has really kind of taught me the value in maybe moving away from addressing some of the anxiety and really going back to the root of the issue, which is the ADHD that can amplify my anxiety.
33:04
SPEAKER_01: I think that was amiss for me a lot of my life kind of juggling ADHD and anxiety.
33:10
SPEAKER_01: I was always very hyper-focused on treating the anxiety.
33:14
SPEAKER_01: Whereas nowadays, especially in the past couple of years, I focus much more on treating the ADHD and then kind of seeing how my anxiety fluctuates with it.
33:24
SPEAKER_00: Sometimes ADHD and anxiety feel like they can be best friends, right?
33:28
SPEAKER_00: They're just skipping down the lane, hyping each other up.
33:31
SPEAKER_00: Or maybe I want to change that picture a little bit.
33:34
SPEAKER_00: Anxiety and ADHD are best friends.
33:39
SPEAKER_00: They are 23-year-old girls at a club, and they are there to enable the other person sometimes to make the worst decision possible because they can hype each other up in really negative ways if they're in that space.
33:54
SPEAKER_00: Yeah, they're there to fuck shit up together.
33:59
SPEAKER_00: Always.
34:00
SPEAKER_00: They're doing it with a smile on their face, but they're like, let's make the worst choices possible.
34:06
SPEAKER_00: That seems like a good idea.
34:07
SPEAKER_00: You definitely want a jello shot.
34:10
SPEAKER_01: Yeah, I'm on board.
34:11
SPEAKER_01: I'm still trying to manage the skipping down the lane anxiety and ADHD because they move quick and it's hard to keep them managed.
34:20
SPEAKER_00: Sometimes they're fun, right?
34:22
SPEAKER_00: Sometimes I think it leads to people being really funny, people having really great stories, people being able to maybe have more energy to be a part of things.
34:33
SPEAKER_00: So sometimes a little bit of it's reinforced because there's not a lot of education around that interaction for people specifically, it can go mistreated.
34:44
SPEAKER_00: Sometimes it makes people feel like they're losing their mind a little bit.
34:49
SPEAKER_00: Yeah, I could see that, and I do agree.
34:52
SPEAKER_00: It's upsetting.
34:53
SPEAKER_00: I do want to say though, our DSM is not perfect, but it does have the ability to change over time without a new manual entirely.
35:03
SPEAKER_00: So specifically in 2022, they added prolonged grief disorder.
35:09
SPEAKER_00: Have you ever heard of this?
35:11
SPEAKER_01: Ooh, I have not.
35:12
SPEAKER_01: Sounds intriguing though.
35:14
SPEAKER_00: Essentially was established to distinguish healthy grief from, and I'm sure this was not the verbiage, but this is what I wrote late last night while I was doing my homework: life-shattering grief lasting more than a year.
35:28
SPEAKER_00: So essentially differentiating what is or is not appropriate when it comes to a grief timeline.
35:36
SPEAKER_01: Ooh, that is interesting because how does one determine grief?
35:45
SPEAKER_01: I mean, there are different types of grief, there's ambiguous grief, and that could get actually really interesting.
35:53
SPEAKER_00: I see the message constantly that grief is not linear.
35:56
SPEAKER_00: And that's something that I preach as well: that there's not always a timeline.
36:00
SPEAKER_00: But according to this addition to the DSM, as a clinician, you get to say this is an appropriate level of grief, and this is maybe being so stuck in the grief that it's prohibiting you from moving forward in any capacity.
36:15
SPEAKER_01: Maybe being so stuck in the grief that it is now creating additional stressors in one's life.
36:22
SPEAKER_01: They can't get out of bed to go to work, overall physical health declines and the loss of interpersonal relationships with other people.
36:32
SPEAKER_01: I mean, I could see that, I guess, criteria or like go through a checklist of additional stressors that have been caused based on the grief response.
36:43
SPEAKER_00: It feels slightly unethical to diagnose from our side, but I guess if I look at it from the perspective that does feel more ethical, it's giving away for clients who have experienced a major stressor to have a diagnosis that is now billable by insurance beyond an adjustment disorder.
37:02
SPEAKER_00: Okay.
37:03
SPEAKER_00: Which I think is important because aside from that, I don't know how people do get long-term treatment for grief if it doesn't meet any of the other criteria.
37:14
SPEAKER_00: Another one that was added in 2013 was disruptive mood dysregulation disorder.
37:20
SPEAKER_00: I have mixed feelings on this one.
37:22
SPEAKER_00: And I know working at Residential, we saw this quite a bit, similar to oppositional defiant disorder.
37:31
SPEAKER_00: I understand why it exists.
37:35
SPEAKER_00: They added it to stop people from overdiagnosing bipolar in children, because that was leading to a lot of kids taking heavy antipsychotics from childhood through adulthood, and that was problematic.
37:48
SPEAKER_00: It wasn't actually helping.
37:50
SPEAKER_00: But simultaneously, and it's okay if people have a different take on this, I can see the harm it does as well.
37:59
SPEAKER_00: Categorizing a child as you're difficult and it's just the way you are.
38:04
SPEAKER_00: Your mood is just all over the place.
38:06
SPEAKER_00: This is just happening.
38:07
SPEAKER_00: I think places them in a box that they're the problem.
38:11
SPEAKER_00: And I genuinely believe the problem is usually their environment, their surroundings, the adults in their life, the trauma they've experienced.
38:20
SPEAKER_00: Sometimes I think this label keeps people from treating those things.
38:24
SPEAKER_01: It's ironic if they were trying to move away from a harmful bipolar diagnosis, almost creating another diagnosis that is equally as damaging, even just in the name of it.
38:37
SPEAKER_00: It's a hard one.
38:39
SPEAKER_00: All of this is important to talk about regularly because there are still clinicians who stand by that.
38:45
SPEAKER_00: So even within the field itself, we are so divided on what we will or will not diagnose and what we do or do not believe, which really encompasses just how much of this field is taking your time to understand.
39:01
SPEAKER_00: If you're moving quickly, there's so much room for error and misunderstanding.
39:05
SPEAKER_00: And this diagnosis is a perfect example of that.
39:08
SPEAKER_00: The pressure to fix a problem so immediately to save someone that you potentially cause more harm in the long run because there's not enough time to really think it through.
39:21
SPEAKER_00: Yeah, that is interesting.
39:22
SPEAKER_00: I realize all of this is really heavy and is a lot for us to think about as clinicians.
39:28
SPEAKER_00: And so I want to take you on a hard left turn.
39:31
SPEAKER_00: What was your good thing of the week or something you're looking forward to?
39:35
SPEAKER_01: Let's see, good thing of the week.
39:38
SPEAKER_01: I honestly am really just looking forward to some downtime this weekend.
39:44
SPEAKER_01: I do have plans Friday night, but Saturday and Sunday are both pretty open days for me.
39:51
SPEAKER_01: So I'm really looking forward to maybe just having a little reset, moment of silence, just relaxing.
39:59
SPEAKER_01: What about for you?
40:01
SPEAKER_00: Fantastic.
40:02
SPEAKER_00: This last weekend, I helped throw my very good friend Janelle a birthday party.
40:10
SPEAKER_00: And she had had a couple of beverages, and I watched her accidentally throw soup all over herself and the couch and then drop to the ground.
40:22
SPEAKER_00: And it reminded me of that moment in the office when they spill all that chili.
40:26
SPEAKER_00: Like so special in every way.
40:30
SPEAKER_00: I had really been very tired going into that week.
40:34
SPEAKER_00: And I think that moment really uplifted me.
40:37
SPEAKER_00: She wasn't injured for the record in any way.
40:39
SPEAKER_00: It was just hilarious.
40:41
SPEAKER_00: So, in her honor, we are throwing a soup night this coming week so that she can redeem herself and everybody can bring home soup for the week.
40:51
SPEAKER_00: Ooh, what kind of soup are you gonna bring?
40:54
SPEAKER_00: That's a great question.
40:55
SPEAKER_00: I'm sure, as you know, I cannot cook to save my life.
41:00
SPEAKER_00: But I have a partner who kills it.
41:02
SPEAKER_00: So I think he is going to figure out the best soup, and I'm going to make the most basic soup so that I don't mess it up.
41:11
SPEAKER_00: Amazing.
41:13
SPEAKER_01: You could just at that point, you could just go like purchase, you know, a tub of soup, throw it in a crock pot or something.
41:19
SPEAKER_00: I might just go to Panera and then just throw it all and pretend like I served it.
41:24
SPEAKER_00: I know last night he goes, Is beef burguignon a soup?
41:27
SPEAKER_00: And I was like, I don't know.
41:29
SPEAKER_00: I don't even know what that means.
41:31
SPEAKER_00: Never heard of it.
41:32
SPEAKER_00: Yeah, very different upbringings, clearly.
41:35
SPEAKER_00: Because I was like, uh, is chicken noodle soup from a Campbell's can of soup?
41:40
SPEAKER_00: Because that's what I can bring to this party.
41:43
SPEAKER_01: Love it.
41:44
SPEAKER_00: I'm glad it's soup season.
41:46
SPEAKER_00: I'm glad it's fall.
41:47
SPEAKER_00: I think things are gonna get cozier.
41:49
SPEAKER_00: My hope is that maybe they get less busy and there's just more time to relax and read and do puzzles.
41:57
SPEAKER_00: I did want to show you this because I am on, as you know, like a local artist binge right now.
42:04
SPEAKER_00: So I went to an art fair and I fell in love with this print.
42:09
SPEAKER_00: You're gonna love it.
42:10
SPEAKER_00: So I acquired this for my office this week.
42:16
SPEAKER_01: Oh my gosh, I love it.
42:19
SPEAKER_00: Doesn't need chickens.
42:21
SPEAKER_00: I think the trend of everything needing to be whimsical and just putting stickers on single-use plastic is not whimsical.
42:31
SPEAKER_00: So we're trying to do more of creating a space that is unique and just surrounded by all the things that you love.
42:39
SPEAKER_00: So I have Disney Prince and three smiling chickens now, and I just acquired a bunny that somebody painted recently.
42:46
SPEAKER_00: So why not have a little bit of everything?
42:49
SPEAKER_00: That's perfect.
42:50
SPEAKER_00: I love it.
42:51
SPEAKER_00: Oh, I realize it's about that time.
42:54
SPEAKER_00: It is what it is.
42:56
SPEAKER_00: It is what it is, and we'll see you next week.
43:00
SPEAKER_00: Goodbye.