I was diagnosed with depression and severe anxiety as a teenager, dealing with cutting and bulimia. As the years have gone by, I’ve been on and off of medications and while I knew I still dealt with the mental illness, I felt like I’d grown a lot. Over the last couple of years, though, things have gotten bad again. It seems that I’ll be fine or at least stable for months until something will go wrong, and it’s like a house of cards toppling over. It’ll send me spiraling into what I refer to as an episode for lack of a better word. I’ve described episodes before to my previous nurse practitioner/psychologists, but it never occurred to me until recently that I should’ve told them about the voice I would hear during the episodes. I’ve always just thought of it as my own thoughts, except way louder and more aggressive, but after reading about the difference between your own voice in your head and hearing a voice, I’m now more concerned about the episodes. The last time I had one, I ended up grabbing a bottle of pills, stealing a knife from my sister’s house, sending my mom a goodbye text, and walking the streets in 20 degree weather while cutting myself and all at the urging of what I thought to be my own thoughts. However, looking back on it, I can still hear the voice berating me, referring to me in the third person instead of first. My thinking is completely distorted during these episodes, and as soon as I come out of it (usually within a few hours), I’m embarrassed by my actions and think clearly again. For example, one time I was so anxious that no one would pick me to do a group project with them in class, that I went home and started cutting so my mom would have to take me to the hospital and I’d get to miss school the day they chose partners. Is that delusional thinking? I’ve never met someone with depression/anxiety who has episodes that intense and rapid. It’s like feeling the craziness of mania, but without the happiness/confidence. Is there a such thing as having depression with psychotic episodes or is that normal and I’m just thinking too deep into it or being a hypochondriac?
Unfortunately, it’s impossible to give a diagnosis via the internet. Your treatment team would be in the best position to answer your questions. I would encourage you to have this discussion with them.
It’s also important to remember that diagnosing is not an exact science. It’s common for diagnoses to change over time and to differ based upon the practitioner.
The voice you described is indeed worthy of exploration. In your view, it’s not your voice. It’s not clear to me whether it’s indicative of psychosis or simply a highly critical element of your personality.
In the examples provided, you responded to the stressful situations with self-harm. No matter the diagnosis, more healthy coping skills are needed.
You might ask your treating professionals about dialectical behavioral therapy (DBT). It’s an especially effective treatment for the symptoms you have described. It’s designed for assisting individuals in regulating their emotions, developing healthy coping skills, and in the treatment of suicidal and other to self-destructive behaviors. Though DBT was originally designed for individuals with borderline personality disorder, many therapists have successfully utilized its’ treatment components for other disorders. I hope this helps. Please take care.
Dr. Kristina Randle