Chronic Illness

Isolation Versus Dissociative Disorders: How to tell the difference

A recent survey of 20,000 U.S. adults found that nearly half of people suffer from feelings of loneliness and isolation. This is a normal part of life and can often be related to very common transitions such as moving away from home or the in ability to have time for friends and family due to work obligations. Other factors can also contribute to feeling lonely such as low self esteem or ending a romantic relationship. Lack of sleep (which impacts over 60 million Americans) can make feelings of loneliness and isolation more intense.

But how do we know when it’s something more than isolation?

One experience that feels similar to isolation but clearly isn’t is that of a dissociative disorder.

What are Dissociative Disorders?

According to the National Association of Mental Health (NAMI):

Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness and memory. People from all age groups and racial, ethnic and socioeconomic backgrounds can experience a dissociative disorder.

Its estimated that 2% of people experience dissociative disorders, with women being more likely than men to be diagnosed. Almost half of adults in the United States experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes.

Dissociative disorders differ from generalized anxiety, depression and loneliness due to their intense physical experience of being separate or “not real”. Dissociative disorders can increase and cause feelings of intense loneliness.

Do any of these symptoms seem familiar to you?

  • Significant memory loss of specific times, people and events

  • Out-of-body experiences, such as feeling as though you are watching a movie of yourself

  • Mental health problems such as depression, anxiety and thoughts of suicide

  • A sense of detachment from your emotions, or emotional numbness

  • A lack of a sense of self-identity

-        From NAMI website

If you have any of the above symptoms you may be experiencing something more than isolation, anxiety/panic or depression.

Dissociative disorders (DIDs) include depersonalization (not feeling yourself or like a human), derealization (not feeling real or feeling like you are viewing life as a movie) and dissociative amnesia (inability to remember chunks of time).

The causes of DIDs can range from unknown to severe anxiety to a trauma response as well as physical health issues like Lyme disease & other chronic infections. Dissociative disorders can be treated. Often practitioners will use a combination of psychotherapy like Dialectical Behavioral Therapy or Cognitive Therapy in conjunction with medications.

You can feel better despite having a dissociative experience. Call us today to learn more.

Take Control of Feeling Overwhelmed

By Kacie Mitterando, LMSW

“I am feeling so overwhelmed today”

“Life is just becoming extremely overwhelming.”

These are few of the statements surrounding overwhelm that I’ve recently heard in several of my sessions. Interestingly enough, I’ve noticed the majority of these statements expressed by those who are experiencing “all-or-nothing” behavior that is causing mild to moderate stress and anxiety in their day to day.

What is overwhelm anyways?

Webster’s dictionary defines overwhelm as “defeat completely” and “give too much of a thing to someone else.” As a therapist, I have been discovering that there’s much more than a simple dictionary definition to this emotion of overwhelm and where it initially stems from. Research led me to an important topic that many of us struggle with from time to time… balance.

Answer emails, answer your friends’ phone call, maintain a relationship with your partner, take the dog for a walk, keep up with the dishes and don’t forget to try to make it to the gym for your cardiovascular health. How do we manage all of this plus more without completely falling over backwards? Defining what’s a priority, reducing multitasking and setting boundaries may help us lead a more balanced life, however, why is this more difficult when we also find ourselves experiencing an “all or nothing” mentality (1)?

Our adult selves are able to handle stressors, threats to our emotional wellbeing and emergencies by using tools we have, such as self-soothing and coping modalities. Conversely, often times and especially when we’re experiencing “all or nothing” mindset we find ourselves thrown into our child self. This is described in theory as transactional analysis. Transactional analysis is a concept based in the principle that we can switch between a parent, adult and childlike ego state and therefore, assess and react to situations based on whichever state we are in (2).

So how do we move away from an all-or-nothing approach and towards our adult-like states to help us efficiently practice balance and reduce overwhelm?

Observe the ego state you are in throughout a conversation with someone you are close to:

When a conversation goes poorly it is often attributed to the conversation being on a sensitive topic. This may be a conversation about politics, religion, or sex. Ask yourself what ego state you were in when a conversation goes wrong. Did my child-like self respond when someone was seeking a parent response? What did I say that could have triggered the child-like self in this person that matters to me (4)?

Identify all or nothing language:

Recognize times in which you are using words such as “always,” “never,” and “every-time.” Some examples of instances in which we all may fall victim to using all or nothing language is statements like “my anxiety ruins everything,” “I will never fight the right person,” or possible to your partner- “you always forget to take the garbage out.” Once recognizing, spend some time thinking of ways in which you can replace this all-or-nothing language with a more realistic approach.

Avoid black and white extremes:

Black and white thinking is not always bad. In fact, it may have helped you get through some tough and challenging moments in life. However, black and white to the extreme can be dangerous and impact overall mood and well being. Once recognizing this thinking, ask yourself another way to look at this situation? For illustration, if a family member did something hurtful and you find yourself thinking “they are a completely terrible person.” Try and reframe this situation by asking yourself “could there be a reason why they made this decision (3)?”


Make a list of what is important to you right now as well as your goals for the upcoming month. Lean on this outline to remind you to place importance on what you would like to get done so balancing tasks becomes a habit. This list doesn’t have to be limited to accomplishments at work or organizational tasks at home but should address many different parts of your life. It is perfectly OK to include in your prioritization list satisfying your social needs or setting a self-care schedule.

If you find yourself struggling with all-or-nothing thinking and your ability to achieve balance is not working, therapists are here to help.

How To Achieve Balance. (n.d.). Retrieved from

Description of Transactional Analysis and Games by Dr. Eric Berne MD. (n.d.). Retrieved from

5 Ways Black and White Thinking Poisons Your Perspective. (2018, September 11). Retrieved from

Morad, N. (2018, February 28). How to Use Psychology to Communicate Better and Avoid Conflict. Retrieved from

Making Decisions With Ease

Categories: Anxiety, Depression, Chronic Illness

Only make decisions that support your self-image, self-esteem, and self-worth. - Oprah Winfrey

Not being able to decide is a very frustrating place to be.  Indecision shows up for a number of factors.  Sometimes we are paralyzed by fear. Other times we are looking at a decision that requires we compromise our values in some way.  And sometimes we are just faced with so many decisions that we become overwhelmed. Whatever the reason, indecision sucks.  Let's take a look at some thing that make for a really good decision.  

1. Start With The End In Mind

Goal setting is useful in all aspects of our lives big and small.  Start asking yourself the questions that are going to clarify your goals.  For example, what is the overall feel you want to have in your home?  It will make picking paint colors easier if you want your home to feel calm versus cheerful.  And for the bigger stuff like "Where should I invest my money?" start thinking about what guides your investment decisions. Is it a particular amount of money?  Maybe you are more interested in only investing in companies that share your values.  

Big or small, it's important to start asking questions to clarify your goals. 

2. Set Fear Aside

From my experience, making decisions from fear has just not turned out that well for me.  This article from Bustle breaks down the term "decidaphobia" which was coined in 1973.  Fear can stop us from moving forward. In order to make good decisions we all have to develop habits that reduce our anxieties and allow us to feel safe in our lives.  Once fear has been removed, your real motives can goals can shine through and guide you to the perfect choice. 

3. Make Decisions With Your Wellbeing As A Focus

Are you someone that always makes decisions with others in mind?  Possibly you are the biggest people pleaser you know.  Well, coming to therapy...or reading this blog is a big reminder to stop that.  Yes it's good to be nice.  Yes it's good to keep people in mind.  But your decisions should always be guided from a place of self love first.  Remember, just like I tell my clinicians and my clients- You are the most important person in the room, wherever you go. 

Before we wrap up I just want to take a look at one more thing.  Maybe you are in a situation where you really want to make a relationship better or maybe you want to move forward with something but in reality you have dome everything you can.  In those moments it's important to remember that your deicison-making isn't flawed...rather, it's your ability to manage uncertainty that needs a closer look.  To manage uncertainty is to tame your fear.  And after all, the reality is, all of us are walking around just trying to figure things out the best way we can.  We cannot predict the future and we can only do what we believe is best with the most information we have.  Beyond that, our practice is to let go. 

How well do you manage uncertainty?

Tell me what you think in the comments below...




Lyme Disease, Kundalini and the Near Death Experience

Categories: Chronic Illness, Depression, Lyme Disease

Many people who have Lyme disease have experienced a condition that is part seizure, part convulsions.  Some describe a feeling of electrical shock and flashing lights or the sensation of a gunshot going off inside the skull. When taken to the emergency room, there is often "nothing" found wrong.  While this experience might seem completely dreadful (and it is), I can't think of anything more powerful than the sensation of electrocution to bring us closer to God.  That is why I love to tell people Lyme disease was the best thing that ever happened to me. The severe pain that accompanied Lyme disease completely and totally woke me up to my life.  I have never been the same. 

In my work with Lyme disease clients, this particular symptom seems to bring about an experience similar to a near death experience (NDE).   Let's take a look at some of the common language and experiences of those with (NDE): 

According to the International Association of Near Death Studies (IANDS) these are the common and reoccurring psychological changes of those post NDE:

  • Loss of the fear of death
  • Describe themselves as more spiritual and not religious
  • Increased abstract thinking
  • Tend to bouts of depression
  • Increased generosity
  • Unresolved childhood trauma resurfaces
  • Convinced of life purpose
  • Heightened sense of taste, touch, smell
  • Less detached
  • Reported increased intuition and psychic abilities

For all practical purposes I can stop the article here and just state that NDEs sound word for word like what has been experienced by those who have had a spiritual awakening due to Lyme. This was also very much my experience. 

Now, let's take a look at another shared experience from a different population - Yogis and the Kundalini Awakening. Here is what a Kundalini awakening looks like when it's happening: 

  • Involuntary jerks and tremors
  • Energy rushes and feelings of electrical shock
  • Surfacing of repressed emotions
  • Headache, migraine and pressure in the skull
  • Emotional numbness and depression
  • Pain in back and neck
  • Sensitivity to light, sound and touch
  • Feelings of blissful love and connection to all things

Any of these sound familiar?

As humans we really have a need to find patterns in things. I am also a therapist and have an even greater need to find patterns in words and gestures.  Lots of things can cause trembling and seizures, but from the stories of my clients and my personal experience, the seizures that came from Lyme were more than a physical jolt.  They were a shift in consciousness.  

Another writer who shares her experience with Lyme as a spiritual awakening is Lyme coach Jenny Rush.  Her book, Chronic Illness as an Access to Quantum Healing describes her own process of awakening. Through personal narrative, Jenny describes the spontaneous changes that come from having Lyme disease and chronic illness as well as those that came gradually as she continued to heal. Jenny eloquently reiterates the theme of turning toward pain, sitting with our own experience and gently letting go of all the things that continue to hold us back from a peaceful life. 

Not everyone has to experience a medical trauma to feel more connected to others or feel a deep sense of life purpose.  If we are open, our lives can be full of both spontaneous growth and the change that comes from being persistent.  When have you experienced moments of spontaneous growth in your life?  

References -

Artwork - 

Indigo Dreams (c) by Jo Jayson



Lessons from Lyme: Getting Back to Work After Chronic Illness

Categories: Lyme Disease, Chronic Illness

Going back to work after chronic illness or during the treatment process can be an emotionally overwhelming experience. 

I remember walking home from the grocery store in the Spring of 2015. At that time my day was filled with daily tasks most people take for granted: groceries, laundry, mail...etc. In the  midst of Lyme disease, I was focused on detoxification, supplement protocols, food elimination diets and combating insomnia.  While I was unable to work a full time job, but certainly had plenty to do.  Days seemed a blur going from one treatment regimen to the next. This particular cold spring day, my body was completely wracked with pain. I was in such a painful depression that I couldn't help but weep the entire walk home.  

My neighbor saw me coming in the building. The look on her face signaled she had seen a ghost.  Her reaction set me off into an uncontrollable, ugly cry that was thoroughly embarrassing.  And the cascade of critical self talk began: I can't even carry groceries to the elevator.  How am I ever going to get back into my life?...Yeah that's probably not going to happen. In that moment I viewed myself as completely and totally pathetic.  

Looking back on that version of me, I have a tremendous amount of empathy.  I can empathize with her pain and suffering.  I can empathize with her feelings of defeat.  I can even empathize with her near daily feeling of just wanting to turn in my batch and check out of life. 

The process of coming out of that level of pain is just that - a process.  Many of us are left with deep feelings of trauma associated with isolation and loneliness, excessive medical procedures, and neurological damage associated with our illness.  Physically recovering is only half the battle when it comes to re joining the workforce.

Have you processed your physical crisis? 

Anyone who has been through a severe medical trauma owes it to themselves to take time to debrief and process their experience.  This is a courtesy we extend to anyone who has been through a physical disaster. Lyme and other chronic conditions can be a physical disaster.  They demand the same level of recovery and care. 

When I looked and felt well enough to return to work I still had unfinished emotional business. This led to falling back into some of the same behaviors and relationships that contributed to me getting sick in the first place such as setting clearer boundaries and limits to prevent burnout.

How has your medical experience impacted your personality?

What new things do you believe you need to feel supported at work? 

Have you developed a plan for managing panic or overwhelm that might arise during the transition back to work? 

Are you feeling comfortable stepping into the same role you had before you were ill?

 The thing that Lyme and other disabling chronic illnesses take away is our ability to have perspective. The more planning we can put into place for our emotional health, the easier the transition.  Having a plan for emotional crisis is as important as a plan for any other type of emergency.  With some attention and support, you can have a successful transition back into the workplace.  

I would love to hear your feedback on this article! Plus if you want a brief intro into feeling more confident at work, sign up for my FREE 10 Day Confidence in the Workplace Mini Course



Reclaiming Your Sex Life Despite Chronic Illness

Categories: Chronic Illness, Relationships

If you are someone experiencing a chronic illness, you might have come to a point where you wondered if having a healthy sex life was something you would ever get to experience again. This post is all about saying "good question" and most importantly, "yes you can" to your concern. 

Generally when clients pose this question in therapy, it isn't the only question they have.  Feelings of overwhelm and frustration usually arise from thoughts like:

  • How am I supposed to have sex when I'm not feeling well or I'm tired all the time?
  • Post diagnosis, everything hurts, including sex.
  • What if I no longer feel desirable?  
  • I'm not sure if I can please my partner anymore.

In the above scenario, there are two main themes: competence and confidence. The first two questions fall into the "competence" category and often require practical problem solving and sex education.  If our bodies have suddenly changed or are limited in some ways compared to the past, we may be confused about where to begin with sex. This is reasonable.  In fact, for many, it is incredibly helpful to speak with a professional about redefining your sex life post-diagnosis. The second set of questions come from assumptions around confidence in sexual relationships. When we understand our abilities, we can again feel confident with our sexual experiences.

Before jumping into addressing the questions, let's take a look at why it's a good idea to prioritize sex in the first place. 

Dr Staphanie Beuhler of the Beuhler Institute lists several reasons why we should prioritize sex especially with chronic illness. Some of those include: 

  • Sex makes us feel normal and alive. 

One of the major complaints of clients with chronic illness is their wanting desperately to feel normal again. Reclaiming your sex life (even if it looks a bit different than before) can be one of the more pleasurable ways of feeling like you are back to living your life. 

  • Sex provides us with pleasure. 

Chronic illness robs us of many aspects of our lives.  The foods we eat, the places we go, the people we get to spend time with.  If the issue of pleasure is not addressed, our lives can become very small, cold and empty.  It doesn't have to be that way.  Just because you have a chronic illness doesn't mean you don't deserve pleasure.  In fact, I encourage clients to put major emphasis on this post diagnosis. And don't get me started on the subject of intentionally depriving ourselves of pleasure as a form of punishment because of diagnosis. I will save that for another blog. 

  • Sex increases intimacy between partners.

If you have a chronic illness or if you are in a relationship lacking sexual intimacy, you are most likely facing some amount of isolation or loneliness.  Loneliness is a painful state that can literally cause us to be sick.  It wreaks havoc on the immune system. Feelings of isolation are activated in the same regions of the brain as physical pain.  We need physical affection to be happy and healthy.  I say "yes" to boosting the immune system through intimacy.

Now, let's look at some tips for addressing the questions above. 

1. Talk To Your Healthcare Professional. Before you get back into physical intimacy, ask your physician or other healthcare provider if there are any common barriers to sex that may come up with your condition.

2. Plan Time for Intimacy. First, let's start by saying that you absolutely don't have to have intercourse when you aren't feeling well or tired. However, there is value in planning time to be intimate with your partner in some way. For a time, there may be a need to actually plan intimacy for when you and your partner are rested and free of distractions.  And that's ok to start.  All we are looking for here is momentum. 

3. Be Open to Redefining Intimacy. Part of getting back into a healthy sex life includes redefining what sex and intimacy look like to you and your partner. If you aren't intimate at all, consider exploring any ways that you can start to feel pleasure again including gentle, sensual massage, taking time to hold each other or deep breathing exercises. Try to schedule time for intimate moments even if they don't involve intercourse. Oh and one last thing, if intercourse is just plane painful and not in the cards at all, you can always head on over to this link on frottage as an option.  No matter how you decide to be intimate, it is important to remember that you are still a sexual being.  That didn't change just because you got sick. 

4. Be Emotionally Open With Your Partner. Talk to your partner about your apprehensions and fears around intimacy.  This can relieve fears and clarify the needs and wants of both you and your partner. If you feel there is miscommunication or you aren't feeling emotionally supported in this area, it could be useful to speak with a professional. 

5. Seek Safe Forums To Discuss And Learn. Consider joining support groups for your illness or seeking the consultation of a sex therapist or sex educator.  Sex educators are a great resource and can offer suggestions on modifying and adapting sexual positions for those with disabilities as well as helping to normalize your experience post diagnosis. 

Some additional great resources: 

Sex, Disability and Confidence

Sexuality Education Resource Centre

If you are seeking support for your relationship post chronic illness diagnosis, therapy can help. I offer confidential video therapy in the comfort of your home as well as in-person sessions in midtown Manhattan. Call for a free 15 minute consultation: 347.994.9301