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Kristina Randle, Ph.D., LCSW

Kristina Randle, Ph.D., LCSW is a licensed psychotherapist and Assistant Professor of Social Work and Forensics with extensive experience in the field of mental health. She works in private practice with adults, adolescents and families. Kristina has worked in a large array of settings including community mental health, college counseling and university research centers.

Continuing Symptoms Despite Treatment

by Kristina Randle, Ph.D., LCSW April 27th, 2024
written by Kristina Randle, Ph.D., LCSW

Thank you. A month ago (or so) Dr. Kristina Randle helped me answering my question. (Misperceiving reality without medication). After reading the answer I decided to contact my former psychiatrist (the one I used to trust) and started a treatment with her.

I was feeling so much better and wanted to write just to say thank you, was not fine yet, but better, lot better. So thanks 😀 really.

I understand you answered my question, and don’t want to continue bothering you, but I’m in a little despair. My delusions diminished a lot, I think my official diagnosis is Bipolar Disorder with Psychotic features (or something like that), my mood was fluctuating, but was ok.

The thing is that 3 days ago I started to think of myself dead, uh… not sure how to say it. Like I see me killing myself in my mind (hope makes sense), was not feeling depressed or sad, actually I was fine, just this idea, and it started to invade my thoughts and now I just think in it. I don’t want to really kill myself, despite everything, I love my life, my plans. It has been hard to achieve certain stability, and I like being functional, but there’s this image that don’t leave me alone.

Then I started to listen other people’s thoughts (again), but I usually heard the thoughts of one person at a time, and now are a lot of thoughts of lot of people, so I can’t distinguish everything and my head is aching all the time because of the constant noise.

I wrote to my doctor explaining, I try not to call unless is a real emergency I don’t like when I am demanding, anyway I wrote to her, and she told me I have to give time to the med to kick in.

I know I have to be patient, but I can’t concentrate, or work, and I have datelines, and now I am starting to feel desperation, and don’t know how to deal with this until the med works fine, what if the meds don’t work? What if I’m not fine again?

And I ask myself if I really can’t control this or why am I doing it? Why a person would be like imagining things? Listening or seeing things that really are not there or happening? Am I just a freak? Should people be afraid of me? Should I stay away from people, to avoid hurting them?

And I feel so guilty and afraid for thinking of “me killing myself,” I know I like my life now (generally speaking), and was hard to get to this point. And people say that if you say it is just because you want attention, that people who wants to do it just do it. I don’t want to do anything like that, and also don’t want to have this images in my head, but don’t want to like to “call for attention.” How do I know if I have to say it to someone or not? How do I know if is real, and I should be worried or not? I used to want to die, I even try once and barely survived, and I am grateful I did, ’cause some years after my life improved and I liked it, but I feel ashamed as well (of feeling, saying and trying to kill myself and be alive) because it makes me feel like it was fake, that I was fake. Does that make sense? Should I ask for help or just wait until the meds work?

I’m sorry, I wanted to be just a thank you note, and I understand there are other people, and you have answered a question of mine before, so it’s OK if u don’t answer this time.

Thanks a lot for your time and previous advice.

I’m so glad to hear that you contacted your psychiatrist and have begun treatment again. I very much appreciate you writing back and letting me know how you’re doing. Thank you.

Please never feel that you are bothering me. I am glad to help you.

Your symptoms are obviously distressing but they are not your fault. No one would willingly choose to experience what you are experiencing. Those thoughts and images are essentially your brain playing tricks on you. It’s unfair, unpleasant, and frightening, and I’m sorry that this is happening to you. It will stop. It does take time. Be patient but also carefully monitor the suicidal thoughts that are occurring. If you feel that you might attempt suicide, you should call 911 or go to the emergency room. Keep your doctor informed about every change in your thinking.

You were wise to inform your doctor about your ongoing symptoms. Don’t feel like you’re a bother to your doctor. You are not. If you are a bother to your doctor, then she should find a new occupation. No good therapist would ever be upset with your providing the very information that they need to do their very best work. She needs you to keep her informed or she simply cannot do her job. What I am trying to say is you are being a responsible client. Without your self-reporting, she would not know how you are doing. As she noted, it may take time for the medication to “kick in.” Alternatively, your ongoing symptoms may be a sign that a dosage adjustment is needed. It’s important that you continue to inform her about your symptoms. It helps her to know whether your medication needs adjustment.

You may also want to consider the addition of psychotherapy. A therapist could help you to stay grounded in reality. For instance, he or she could help you to distinguish between what is real and what is not, teach you strategies for dealing with distressing hallucinations, voices, paranoia, and suicidal thoughts. During any distressing time, it’s important to surround yourself with a great deal of support. The more support you have, the better you will feel.

Thanks again for writing to let me know how you’re doing. Please consider writing back to keep me posted on your progress. I wish you continued success. Please take care.

Dr. Kristina Randle

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Depressed, Suicidal & No One to Talk to

by Kristina Randle, Ph.D., LCSW April 25th, 2024
written by Kristina Randle, Ph.D., LCSW

hi. im 14. and to be honest, im really depressed. im suicidal almost every night, and sometimes in the daytime. im really mature for my age. i self harm a lot. i suffered for 2 years, stopped, then picked it up again. i have severe depression, bpd, and anxiety. i think im bipolar and ive talked to my mom about it but she doesnt believe me. my parents are extremely harsh on me and i feel i have no reason to live. i just wish somebody out there would listen to me and take me seriously. i think i have some anger issues too, and ive punched walls and taken out my anger on people and my pet cat, which i feel guilty about immediatly afterwards. i dont abuse my friends or pet but i yell and say mean things. i just hate myself and im too scared and depressed and too much of a failure to complete life. i have a therapist but shes stupid and doesnt even listen to me. whatever. i guess this is goodbye to the world sine i want to commit suicide within the next 3 mmonths. i have many plans, i just need some anthehistamines to make sure i dont puke up the pills if i choose that way. i hope someone here listens and doesnt take me for granted and think im kidding. i mean it.

I am sorry for what you’re experiencing. It is difficult to feel that you have no options and no one to talk to but realize that suicide is never the answer. It is always the wrong choice. The problems you are facing can be resolved. Your life can get better. It has for many people and it can for you too.

People may contemplate suicide for many reasons but fundamentally it’s due to the pain that they feel and because they have not yet developed the appropriate coping skills. There are many good ways to deal with the issues that are causing you distress.

You have a therapist but you don’t feel that she’s helpful. Have you told her about your suicidal feelings? If not, you should do so immediately. It is possible that she isn’t helping because you are concealing important personal information from her. It is also possible that she’s providing ineffective therapy. Without more details about your situation, I can’t say with certainty what the problems are.

The fact that you have a therapist shows that your parents understand that you need help. It shows that they care. I would encourage you to tell your parents about your ineffective therapy sessions and your suicidal thoughts. They may be able to assist you in receiving more effective treatment.

You are clearly suffering and you need to make that known to those around you. It also important to realize that at this point in time you are not thinking clearly. The proof is demonstrated by your belief that your situation cannot improve. It can and it has for millions of people before you.

I don’t underestimate your pain. It can feel overwhelming but the truth is, it just feels that way. In reality it is not overwhelming. It hurts but that pain will end and much more quickly with the help of a good therapist. Do not mistakenly believe that the only way to help yourself is to end your life. There are good ways to deal with life problems and those skills can be learned. Please get help now.

If you feel that you cannot protect yourself, go to the hospital or call 911. Please take care.

Dr. Kristina Randle

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How Can I Stop Things From Getting Worse?

by Kristina Randle, Ph.D., LCSW April 20th, 2024
written by Kristina Randle, Ph.D., LCSW

I don’t know what is wrong with me and probably I will never figure it out until i die. Probably I don’t even have the words to express things on here but I will do my best. Well basically I look at myself and I see that I have virtually no friends, nothing to do at all, almost no career, no relationship, only an apartment with all kinds of random things laying around that I dont even feel like cleaning, a suitcase that I haven’t unpacked since I moved in 4 months ago. How can I express it? The thing that bothers me the most is that I have no girlfriend, and don’t think I can ever find one again. It seems like those positive things like love that it seems virtually everyone experiences will not be for me. I have never really had anyone I loved love me back. I was with one woman for 4 years who was wonderful and loved me alot but she was nine years older than me and I couldn’t love her because I didn’t think that this was meant to be. I felt guilty all the time and during all those years I was trying to figure out how to leave the only person who has loved me. She took care of this eventually when she found someone else.

This is basically the only girl I have ever slept with (well ok, one other, sort of) and I don’t know why this is. People say I am very good looking but there is some sort of wall between me and the rest of the world. Also I don’t have friends, just one guy who I go out drinking with occasionally (not so much though, I dont drink alot) but even though we have known each other for a long time I still don’t see us as close friends. During this year when I haven’t had a single date he has had five or six girlfriends, many who he met when out with me. I have lived in my city for 5 years and hardly know a soul.

There are probably lots of things i dont understand about human interactions, but I do realize sort of why I have no one and nothing. I was just trying to fill out a match.com profile and I realized that there is nothing to say about myself. You are supposed to be positive, but there is nothing positive to say. What do I do all day? I don’t know. I am wasting my life and I feel miserable at every second. I haven’t had a single positive thing in years. I know if I met one person to love who loved me back it would change everything. You might think it isn’t true but I think it is because I was close recently. I met a beautiful girl and she was changing everything. Then after a month she told me that she had a boyfriend/fiance. This was devastating, but after a little while we started talking again (over the internet, she lives in a different city but we had met in person) and it got pretty intense, we were spending all day on there talking, etc. Then I saw her when I had a connection through her city and after that she started to move away from me, back to her boyfriend, who lives in a different country. But during those times everything changed, she was saying she loved me and everything was different.

I don’t know how I was able to relate to her, but it was a one-in-a-million chance. Of course since I cannot relate to people I cannot find reasonable employment. This isnt so bad right now because I survive by winning chess tournaments but it is very lonely life and I read and hear about people’s varied experiences I don’t understand why I could never find any kind of job. Other times I was not doing so well in chess and financially I could not survive. It took me years to establish my life after college, and I even tried to kill myself one time. I don’t know how to express my total emptiness, lets just say that the only pleasurable thing I have had for years is nicotine, and that I have to quit. I feel somewhat normal during chess tournaments but then I collapse back into darkness.

Whenever I try to talk about these things with people, they say something like “well you are intelligent, good looking, you have a lot going for you” that type of thing. Well I dont know if these things are true or not, but it doesnt explain the empirical evidence–having no friends, basically not having a date for a year (and I have tried), and the feeling of complete emptiness in my life. If those above things are true, it only makes things worse for me since then it means I am wasting myself.

What kind of advice can you give me? I don’t know if medication would help me, i used to take some and I think about it alot but I stopped taking it 4 years ago and am not sure I want to start again. Also I am afraid it is going to mess up my ability to play chess, when I stopped taking it before I improved alot. Also I don’t know if taking it burns out the receptors and has just made my problems worse.

The crux of cognitive-behavioral therapy (CBT) involves challenging the thoughts of clients. Are their thoughts realistic? Do they make sense? What evidence is available to support their thoughts and ideas? CBT is primarily based on the idea that your thoughts cause you to feel a certain way and examining those thoughts might help to alter or improve the perception of a person’s situation. I am going to take that approach with you in this response. I will also focus on reality, truth and logic.

Essentially, what you have done is compared yourself to how you think others are living and concluded that since you are not like everyone else there is something profoundly wrong with you.

Even though it’s human nature to compare yourself to others, you should try to avoid it. It’s not realistic. It does not matter what other people are doing with their lives. All that matters is what you are doing and what is best for you. You are unique. There is no one exactly like you. Each person lives a different life with a diverse set of experiences. You have different talents, family members, genes and hereditary traits, etc. than other people do. You have you own life circumstances that are vastly different from others. Because of this, it’s not fair for you to compare yourself to other people. Thus when you compare yourself to other people you are doing yourself a disservice.

With respect to having a girlfriend, you had one but for whatever reason you did not nurture the relationship and she left you. You said that you did not think it was “meant to be.” What exactly does that mean? You said later in your letter that if you could find someone to love you back, “it would change everything.” It seems you had someone who loved you back but it did not change anything.

As for the woman you met who had a fiancé, it did not seem that you knew her for very long. Nor did it seem that you knew her very well. But when you learned that she had a fiancé, you were devastated. I am wondering why you were crushed by this news when you hardly knew her. You may have overreacted.

Ideally, you should strive to be happy with or without a significant other in your life. It’s not healthy that other people can dictate whether or not you’ll be happy. Happiness needs to come from you and by you and should not be dependent upon the will and actions of other people.

With regard to friendships, you said that you only have one friend. You see this as a failure. Psychologist Abraham Maslow noted in his study of self-actualized people that the psychologically healthiest people have very few friends. Why? Because it’s difficult to maintain deep and meaningful relationships with many people simultaneously. It’s time consuming to build long-lasting relationships. If you inspected the relationships among people who have many friends, you’d probably discover that most of those friendships are superficial. Typically, the person who has many friends has “friendships of convenience.” This means that they only interact with those “friends” when their bored and have nothing else to do, rather than because they enjoy and cherish their presence.

With regard to a career, maybe you have not found what you are best suited for. Rather than putting yourself down consider the fact that you may be misperceiving your situation. It is also an extremely difficult time to find a job. The world is in a recession. That may be why you do not have a job. But there could be other reasons as well. Maybe you are not trying hard enough.

Things may not be as bad as you think they are. There are positive aspects of your life that you overlooked such as your health. Don’t underestimate how lucky you are to be physically healthy. You’re also a chess player. It takes incredible patience and talent to play chess. It is a “thinking” game and not many people have the skill to play chess professionally.

You asked what my advice to you would be. I would suggest if you continue to feel depressed that you consider therapy. Depression by definition is the sense of feeling empty. It seems that you have lost the meaning in your life and a good therapist could help with this.

You can also try your own version of self-help by reframing your life situation and basing your thinking on truth and reality. But if you find that you are unsuccessful with self-analysis then professional assistance may be warranted.

You also asked whether or not medication would be helpful. I cannot be sure because that is best determined by a mental health professional who evaluates you in person. But my initial thought is that medication is not necessary. Thanks for writing.

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I’m Not Sure I Can Recover & I Don’t Know What to Do

by Kristina Randle, Ph.D., LCSW April 17th, 2024
written by Kristina Randle, Ph.D., LCSW

Hi, I’m 26 years old and have struggled with depression and anorexia since I was 13. In the past 3 years, my anorexia has got particularly bad (before, I managed to maintain a BMI of 15) after an eating disorder (ED) admission which triggered some very distressing memories and I was consequently diagnosed with PTSD.

My anorexia has become a coping mechanism and every time I’ve got to safer weight, my depression/ PTSD gets worse, particularly when trying to address them in therapy. I do want to be well but I’m caught in a cycle and have no idea how to get out of it. I was sectioned in 2018 for a year after my BMI dropped to 11/12 and then got transferred to a residential house for people with severe and enduring EDs. I’ve got to a BMI of 15 but I’m already slipping backwards and am unable to work on my PTSD due to the COVID-19 situation and my therapist thinks I won’t cope mentally due to being trapped in a house with 4 other patients plus up to 3 staff (I’m very hypervigilant). I’m so tired of it all and just want to feel better/ happier and not have to feel so on edge and not have nightmares constantly.

I’m feeling pretty hopeless and don’t know how to keep going. Any suggestions? Can I ever get out of this situation?

I understand that this is very difficult situation made even more challenging with the pandemic. Much like yourself, people are feeling more stressed than usual. People are frightened of becoming sick, losing their jobs, and not being able to leave their homes. A Newsweek article recently reported a 34% increase in the number of anxiety medications and other mental health medications being prescribed. People are clearly struggling.

Insomnia and nightmares are also problems for many people. One Harvard University professor collected approximately 6,000 dream samples from over 2,400 people. She was able to collect such a large sample of dreams because of the increased number of people discussing their pandemic dreams. Many of them are dreaming about being sick with the virus, being in crowded public places without a mask or inappropriate levels of social distancing. Others dream of losing control, and some are simply nightmares. That suggests that people are struggling, missing out on the things they are used to, and reacting to the stress of this unprecedented time in our lives.

In some respects, much of what you’re experiencing is consistent with what many others are experiencing. Unfortunately, you’re experiencing it on top of the other issues you mentioned including anorexia, depression and PTSD. Understandably, it can feel overwhelming but there is hope for you. All of the disorders you have are treatable. It may take some time, and it may take you finding the right therapist or type of therapy but it is worth trying. There is hope for people who have these disorders.

You have a therapist now and is important to evaluate whether or not she is the right therapist for you. In addition, it’s important to evaluate your current type of therapy. Are you in the therapy you need to be in? Are you feeling at least slightly better after each session? Are you working with a therapist who has successfully treated other people with similar problems?

As you may already know, anorexia is a complex disorder. It is thought that environmental and psychological factors influence the expression of genetic risk that leads to the eating pathology. The most current research would suggest that anorexia is a brain-based disorder that overlaps neurobiologically with anxiety disorders and addictions. Studies have indicated, regarding treatment, that eating disorder-focused therapy is superior to individual therapy among adolescents. It is less clear what treatment modality works best with adults. One novel treatment that is showing promise is cognitive remediation therapy (CRT). This particular therapy aims to improve cognitive flexibility and holistic information processing. Another potential promising therapy is exposure therapy for anorexia. Exposure therapy involves fear conditioning, by systematically and slowly exposing one to one’s fears in order to overcome them. Other approaches involve medications such as olanzapine which can increase one’s appetite.

The most important thing for you at this time is not giving up and realizing that there is hope for you. It might be helpful to read the stories of individuals who have overcome anorexia, to learn more about what they did, and their mindsets. It may also be helpful to work with your therapist to adjust your medication during the pandemic as well as developing better coping skills. The more coping skills you have, and the more flexible you are in your thinking, the easier it will be to endure this difficult time.

I mentioned flexible thinking and coping mechanisms because I think they’re vitally important in overcoming anorexia. The fact that anorexia has become your coping mechanism suggests that a modification is desperately needed. The most concerning aspect of anorexia is the physical toll it takes on one’s body. It has the highest mortality rate of all psychiatric illnesses. Thus, it’s important to develop alternative strategies for dealing with stress, and there are many of them. You have to be willing to use them which means being willing to tolerate the discomfort that comes from not giving in to your more habitual coping mechanisms (i.e. anorexia).

Finally, you might find it useful to watch the show Obsessed. It used to be on the A&E Network but most of the episodes can now be found on YouTube. Obsessed focuses on individuals with obsessive-compulsive disorder. You don’t have obsessive-compulsive disorder however, I think there are many similarities between OCD and anorexia, specifically the inability to be cognitively flexible and the unwillingness to tolerate uncomfortable feelings. Part of what makes the show potentially helpful is that they demonstrate how exposure therapy can work quite effectively for individuals with OCD. It might help you to see what it’s like for people to tolerate uncomfortable feelings. An important element of exposure therapy is that even when someone feels uncomfortable and excessively anxious, those feelings eventually diminish and subside. It’s helpful to see firsthand that even when feeling overly anxious, eventually those feelings will subside.

To answer question directly, yes you can overcome this situation. Please don’t give up and keep trying, until you find something that works for you. You might also try treatments that are focused more on depression and/or PTSD. Perhaps, if those issues are dealt with, you might have an easier time overcoming the anorexia. Good luck and please take care.

Dr. Kristina Randle

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I Just Can’t Seem to Be Helped

by Kristina Randle, Ph.D., LCSW April 15th, 2024
written by Kristina Randle, Ph.D., LCSW

I have never been diagnosed with anything, but I’ve been dealing with a lot of things recently, and it impacted my everyday life greatly. People started noticing and they tried to help. My friends tried to do as much as they could but, us all being high school students and them having their own life to live they eventually stopped talking about it. I live alone with my mother and we have a very bad relationship so I didn’t really turn toward her for help. In the end it was just my partner that stayed by my side and did everything he could to make my life a bit easier.

One of the big problems is that I have a tendency not to feel things when I’m upset, and it can last for months or even years at a time, so when I’m in a bad place and he tries to help, and he goes out of his way to ease my burden even if it’s just a little, and I know that my non-reaction to all of his sacrifices is hurting him. He feels worthless because no matter how hard he tries I just don’t seem to be able to accept his help.

I know that I’m hurting him by just doing nothing and being empty but I just can’t snap out of it. No matter what he says to cheer me up, or when he tells me that I’m beautiful and that I’m the best things to ever happen to him, I just listen and think “Yeah, we both know that’s not true”.

I feel like I just can’t be helped, like it’s just plain impossible. I know exactly what’s wrong and I don’t do anything about it to the point of hurting the one person that I love. I keep destroying myself and I can’t seem to care, even if I know that I should care and that I should get professional help.

I feel like an empty shell, even typing this I don’t know if it’s sincere of if it’s just me pretending to care. I really don’t know what to do and it doesn’t bother me at all, I don’t even know what I’m expecting of this. I won’t say “help me” because really I feel nothing, but I don’t want my partner to suffer because of me. What can I do about that?

The symptoms you have described may be consistent with depression. People with depression often use similar words and phrases to describe their experiences. They feel numb. Their friends and family try to help, without much success. They can’t get out of bed. Every day seems worse than the day before. They feel like a burden to people, and so on. Depression can feel like a never-ending cycle of sadness and hopelessness.

Depression most assuredly feels bad but it is treatable. In fact, it may be one of the most treatable mental health conditions in the world. It’s only untreatable when people fail to seek help. Great treatments are available for depression and virtually all mental health conditions. Many people simply don’t seek help for it and suffer needlessly. Don’t make that mistake.

It’s also important to note that I’m not diagnosing you with depression or any other condition. Diagnosis over the Internet is impossible. Thus, it’s important for you to consult, in-person, a professional who can assess your symptoms and determine what may be wrong. They would be in the best position to help you.

Let’s further examine the idea that you cannot be helped. You’ve never consulted a professional, yet you have concluded that you cannot be helped. Logically, that’s a very inconsistent and irrational position.

Imagine, for a moment, that you had broken your leg. In this scenario, you never go to a doctor. You simply lugged around your broken leg and tolerated the immense pain. That’s essentially what you’re doing by not having sought treatment for the symptoms you have described. You are simply living with your emotional pain, never having sought professional help and subsequently concluding that you are a hopeless case. Nothing could be further from the truth.

When you recognize that something is wrong, and you’re not feeling good, you should always consult a professional. There’s nothing to be ashamed of. We all struggle from time to time and need the assistance of experts. Mental health treatment is available if you ask for it.

Regarding your partner, neither of you should have the expectation that he could cure these problems. As a layperson, he does not have expertise to effectively treat your symptoms. You would not have expected him to fix a broken leg because everyone knows only a trained physician, with expertise in orthopedics, could do that. Apply that same logic to mental health problems. Friends and family can offer you support but they cannot treat mental health problems. They are simply not trained to do so. Mental health professionals have the right expertise to help you.

I would highly recommend that you consult a mental health professional. If you don’t feel comfortable asking your mother, then perhaps another relative could assist you. Another option is to ask your family doctor or the school guidance counselor for their assistance.

Your symptoms are highly treatable if you are open and willing to seek help. I hope that my letter has convinced you to seek treatment. Please take care.

Dr. Kristina Randle

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Anxiety But Not the One for Counseling

by Kristina Randle, Ph.D., LCSW April 13th, 2024
written by Kristina Randle, Ph.D., LCSW

Alright, so I’m 19 and for a while now I’ve been realizing that I have bad anxiety. I actually know a few people that are on different anxiety medicines and had the same symptoms as me and it really has made a difference for them. Two of them goes to therapy and one doesn’t…my problem is i am not at all the type of person for therapy and that’s what keeping me from going to any doctor at all.. i don’t want them to try to force me to go when i KNOW that it won’t work for me, i just already know by my personality. i have small panic attack over the smallest things.. during them i usually get dizzy/lightheaded and start feeling really sick, which is usually accompanied by a headache. Also i have HUGE mood swings for no reason , where i can be having a good day then just feel overwhelmed and anxious. i can barely ever focus on anything and if i do for too long i tend to just blank out sort of. and sleeping has became a huge problem for me too, i can be out and busy all day then come home and still be wide awake. i don’t know what to do… i know medication isn’t the first option but i know counseling isn’t for me . my question is will the psychologist give me an option ?

If I understand you correctly, you don’t want to go to the doctor because you’re worried that he or she will recommend psychotherapy and you don’t think you can handle it because of your anxiety. You also don’t think therapy will work for you because of your “personality.”

Anxiety is an unpleasant feeling. People want to avoid it and often find ways to do so, to their detriment. For instance, I imagine that each time you consider seeking help, your anxiety level rises. When you feel highly anxious, you might then abandon the idea to seek help and your anxiety level reduces. This might seem counterintuitive, but in that scenario your deciding against seeking help (inadvertently) worsens your anxiety problems.

You know from other people, who sought help, that treatment works. I know it’s difficult but you should try to be open to seeking help; it’s your first step in overcoming your anxiety disorder.

You should start by making an appointment with your primary care physician. He or she could prescribe medicine to reduce your anxiety. Once your anxiety is more manageable, you might then be open to psychotherapy.

You might ultimately find that medication works and you don’t need psychotherapy. Psychotherapy in combination with medication is the most efficient way to treat anxiety disorders; however, not everyone needs or utilizes both. You will have to see what works best for you.

Finally, you don’t think that psychotherapy would work for you but it is unclear why you believe this. It might be that you’re simply not open to it and in this case, it probably would not work. Psychotherapy works best when people are open to receiving help.

Seeking professional help for mental health problems should be no different than going to the dentist for a cavity or consulting a lawyer for a legal problem. Just like a dentist is an expert in dental problems and a lawyer in legal problems, so too is the psychotherapist an expert in mental health problems. Why not consult the professionals who underwent years of rigorous training to learn how to treat the very problems with which you are struggling? The alternative is to continue to suffer with what is a highly treatable condition. Please take care.

Dr. Kristina Randle

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Male to Female Transsexual

by Kristina Randle, Ph.D., LCSW April 12th, 2024
written by Kristina Randle, Ph.D., LCSW

Q. I am a MTF TRANSSEXUAL PERSON (PREOP): I cant get a job, my parents are in USA. They don’t understand what am going through. I cant even afford hormones. I did a bilateral orchidectomy on myself and a month ago I tried to amputate my penis and I ended up in the hospital. They reattached the portions I had tried to cut and am just trapped. No doctor in Kenya will try this kind of surgery cause everybody is scared because there was this one case and the doctored died of depression related stuff cause of condemnation. I tried suicide the same time I tried to amputate my penis. I have been seeing psychiatrists and one of them gave some antidepressants. Imiprimine I think is the name. I want to kill myself by suffocating myself with carbon monoxide in my room. Its so lonely and tears are always in my eyes. I pass for a gal but you see the moment I go for interviews I get disqualified because in Kenya people don’t understand this things. Its miserable. I cant live as a man cause its depressing and I would rather die than be a man. I want to be a gal. Why are people so hateful. I lost almost all my relatives and I wish they were there to help me fight this thing. I have been planning to sell one of my kidneys so that I could raise some money for hormones and sex reassignment surgery but i don’t know where to start. I don’t have a religion i.e. the opium of the mass and I wonder why I dont just kill myself. I wish I was gone for ever. Last week I told my aunts th at I wanted to be creamted once I was dead and they don’t want it. They plan to bury me. I don’t want to decay. Am trapped. Whether dead or alive. Why do people discriminate against me.

It has been five years and I think I have to be courageous and end this cause its just to painful to be part of my everyday future. What the hell do i do?

I am sorry that you are experiencing such a difficult life circumstance but what you can’t do now is give up. Suicide is absolutely not the answer.

I have repeated the same message in response to many individuals who, like you, find themselves living through tremendous daily emotional and psychological distress. They too write that they have come to the (incorrect) conclusion that suicide is the answer. Please know that it is not.

With regard to your specific situation, you said that your psychological distress comes from several areas, one is that you want desperately to live as a woman and you cannot afford the operation and secondly you feel that you have no support from family and you even endure ridicule from others.

Unfortunately, there are many individuals in this world who are judgmental. As you seem to be experiencing firsthand, there are individuals who will judge you because they feel that you’re not “like them” or because you do not hold the same beliefs that they do. There are even some people who would not only judge you for your choices and beliefs but who would go out of their way to make their disdain for you known publicly as a way to humiliate you. The fact that people judge others is a sad and tragic part of our world. Society tends to criticize and punish those who they perceive as “different.” This seems to be what is happening to you, not only from others but largely from your family.

What is extremely important for you to realize is that it does not and should not matter what society and others think about you. Only your opinion should matter. Who knows you better than you? Who can say what is right for you better than you? Do you really believe that society or even those in your family fully understand what you are going through? It should not matter because only you know the truth about your situation.

Your challenge is to become immune to what other people think about you, to come to your own conclusions about what you think you should do with your own body and to focus on doing what is best for you. At this time you may not have the money to have a sex change operation but maybe in the future you will.

Here is another way to think about your situation. If your friend came to you with the same problem, feeling like a societal outcast, feeling desperate enough to consider taking his own life because of how others perceived him, would you suggest that he consider suicide? It is highly doubtful that you would advise your friend to end his life. You’d probably suggest that he seek help and to stop caring about what other people think of his situation.

Furthermore, there is no guarantee that ending your life would end your suffering. Even though it is not known what happens to us after we die or whether or not there is an afterlife, many distressed people assume suicide will help them out of their desperate situation. But what if it didn’t? What if they are wrong? What if suicide makes an individual’s psychological situation worse? The book Life After Life by Raymond Moody contains interesting antidotes of individuals who attempted suicide, had hellish near death experiences (NDE) and now believe that the act of suicide may actually increase their suffering after death, in the “afterlife” (if such a dimension exists).

You need more help than I can offer over the Internet and that is why I strongly suggest that you seek help either from a hospital (because of your suicidal thinking) or from a mental health clinician. You are not thinking clearly or rationally. Please recognize that suicide is not the answer and find yourself help immediately. If there is little help available, please try to realize that what other people think of you does not matter. Other people’s opinions should not determine how you think about yourself; those opinions are not worth hurting yourself for. Continue to be courageous as you have over the past five years and challenge yourself to stop caring about what other people think about you. And please try to find help immediately.

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Depression & Suicide

by Kristina Randle, Ph.D., LCSW April 6th, 2024
written by Kristina Randle, Ph.D., LCSW

Don’t know where to start so… I’m a 28-year-old male have no kids never been a relationship and don’t have a really have much else. Surprisingly though I’m actually very interested in psychology and can see people problems including my own, but still have I hard time continuing with my own life. Everything I seem to want or achieve in life just doesn’t happen from goals in life to the simplest whatever. Just doesn’t seem to work out for me. I don’t really have friends and I feel like the people I do have around me aren’t really there. One of two problems I come to discover is my mother. I come to realization that she’s a big problem to my mental health. She never really pushed me or ever been supportive anything I do. So, I’m not very affectionate or close to anyone. Another is I have a twin brother who I have nothing in common with so i unconsciously tried to be the opposite in any way I could. I have lost interest in continuing life if I can’t even think about something that just won’t happen and it just frustrating. I’m 28 never had a girlfriend, no job, still live with my parents and don’t really own anything. I thought about suicide since maybe my early 20’s. I’m really just done with life and feel like if my life is just failure after failure that I can’t even think of whatever it maybe then what’s the purpose.

Ending your life is not how you should try to solve this or any problem. It should not even be a consideration. You are assuming that because you haven’t identified your life’s purpose that you never will. That is a flawed assumption. It could simply be, as it is for many people in the world, that you haven’t found your purpose yet; it does not mean that you never will or that you should stop trying.

Finding one’s purpose is usually not a straightforward process. It involves soul searching and experimentation with an open mind. It can be enriching, joyful and glorious. It might even be said that it is our purpose in life to find our purpose in life. It is perhaps our reason for being.

You stated that your life isn’t going as planned. Perhaps that is because you have made incorrect choices. Many people make life choices that are not in their best interest often because they are misguided about what they think will make them happy. Abraham Maslow, in writing about the process of self-actualization, believes that “the average normal, well-adjusted person often has not the slightest idea of what he is, of what he wants, of what his own opinions are,” in part because they have not uncovered their own wants and desires. You can change this with conscious self-exploration and counseling. A good therapist will examine your life and assist you in making the proper adjustments. Counseling can help you to achieve your life goals more efficiently.

People often erroneously believe that they’re supposed to know how to solve all of their life problems. If they can’t, they feel weak, helpless or like a failure. The reality is that we are not born knowing how to do these types of things. There is no shame in not knowing. When we know that we don’t know, we must look for those answers in books, mentors, education, and counseling, etc. Once we learn what we need to know we can then use that knowledge to make better choices. That is how we learn, grow and change.

It’s common for people who are depressed to compare themselves to other people and then judge themselves as a failure. Depressed people often see everyone else as being happy and successful but their perception is skewed. At some point, everyone struggles in life. Thankfully, treatment is available and can assist you in making the necessary life course corrections.

Be kind to yourself. Do not be judgmental and harsh. That can often be easier said than done because we live in a culture that is competitive, focused on status and the accumulation of material goods and wealth. Many people are misguided about what they think will make them happy and are suffering as a result.

In the meantime, you might try volunteering and being useful to others. Studies show that helping others can be deeply spiritually rewarding. Volunteerism is not a treatment for depression per se but in the short-term, it could help you in positive ways.

If you’re open to it, contact a local therapist. Try asking your primary care physician for a referral. Alternatively, you can use the “find help” tab, at the top of this page, to search for a good therapist. I always recommend contacting four to five therapists. Contact them and discuss these issues over the phone. Choose the one with whom you feel the most comfortable and then meet in person. Finally, if you cannot protect yourself, contact emergency services. They will keep you safe and ensure that you receive the proper treatment. Please take care.

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What Am I? Selective Mutism? Can’t Sleep? Crazy? Stress? Anxiety?

by Kristina Randle, Ph.D., LCSW April 5th, 2024
written by Kristina Randle, Ph.D., LCSW

Someone has probably asked about this but anyways. I took the quiz and it stated that I have around 9 serious concerns. I will try to make it simple. (Please note that the following issues hv been going for a 3 months or above)

Single child. Not in relationship. Student. Not poor or rich

Past issues (gotten over): Mysophobia

Selective Mutism? Im am a shy quite girl since young but I do talk a lot to a few close friends.Most of the time, People do approach me and talk to me, but Im always having a hard time to respond or reply them. It seems that there’s a wall in my voicebox and I couldn’t make out any voices. If I do respond to them, it’ll always be a nod or a single word reply. People always said:”Why are you so quite?””Are you depressed?”

I do like shutting myself from everyone even my family. I tend to always lock myself up at home. Watching or reading or drawing in my room. Im always on the Internet but I don’t communicate with anyone on social media. Well, I don’t like to communicate with anyone either in real life.

I cant sleep recently. I’ve been getting less than 3h of sleep everyday. Maybe it’s due to the loads of schoolwork and exams. I have two important exams this year and this stressed me out. I always have loads of thoughts bfore I sleep and it is really suffering. I just cant stop thinking.

I hv serious mood swings but Im mostly feel down (for no reasons). I suffered heavy breathing whenever the teachers call me up or when im panicked. I get stomachache from times to times whenever I go to school. I panicked at everything. I have really low self esteem. Sometimes, I cried for no reasons.

Maybe everything I said above is not really a big deal, I might just be thinking too much and make it seem so serious. Consult a profession therapist? Impossible, my parents always just shrugged of this problems. If I were to go and consult, my parents would think that Im insane.

Following serious concerns detected which I think it might be true: Depression, Self esteem, General Coping, Anxiety, Obsessions/Compulsions, Posttraumatic Stress.

Being a teenager is difficult. It’s more difficult than most people realize. Emotionally, it can be a monumental struggle. The good news, is that it won’t last forever and it gets better.

Having said that, your experiences are consistent with people who have depression and anxiety but only an in-person evaluation, with a mental health professional, could determine a diagnosis. You should consult a therapist. That would be the most efficient and most meaningful approach to solving this problem.

You said that your parents will think that you are “insane” if you were to ask for professional help but that might not be true. It might be the reaction that you fear. Fears are often irrational and yours might be too. Have you ever genuinely asked them to assist you in consulting a mental health professional? If not, that should be your next step.

Try making a sincere plea to them for their assistance in consulting a mental health professional. To demonstrate your seriousness, you might show them the letter you wrote to us at Psych Central. If they still don’t take you seriously, then consider discussing this matter with a school faculty member who would contact your parents for you.

Your problems are highly treatable with therapy. You should try to convince your parents that you want and need treatment. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Have Problems Socially & Personally

by Kristina Randle, Ph.D., LCSW April 3rd, 2024
written by Kristina Randle, Ph.D., LCSW

I am a 19-year-old college student, and for all of my life I have had problems interacting socially, but it has gotten much worse as I have gotten older. To the point where for the past few years I have only a couple friends who I don’t even really like very much. I have made two friends in college but I find myself choosing to spend time by myself most of the time. Even when I am by myself, for example going for a walk, I end up feeling angry if there are too many people outside because I feel like they are invading my space even though I know they have every right to be there.

I also have trouble in school because I can’t work with people, which makes me get bad grades on group projects because I get low participation scores. No matter how hard I try I can’t bring up my scores. Now that I’m in college, I know that this is a more serious problem, especially when I will have a job, so I went to a therapist but found it to be very unhelpful and I wasn’t able to successfully communicate my issues.

Another thing that concerns me is that I started getting hypnagogic hallucinations a few years ago. They used to be mostly auditory, but now they have become mostly visual. I have always disliked this because it makes me scared to go to sleep because I’m afraid I will see the scary faces and hear creepy voices. The voices usually shout at me and startle me awake, which is scary and makes it hard to fall asleep.

I don’t know if saying any of this is helpful but I just feel like there is something wrong with me because I just seem so different from everyone else, and can’t seem to fit into any situation that involves other people. I am very isolated, but I also don’t feel lonely. If anything I wish I could be more alone. I know therapy would probably help me, but I also hate the idea of going to another therapist because when I went to one before it was not helpful, and also getting there would be hard because I don’t have a car.

It’s okay to want to be alone, especially if that’s your preference, however it’s not good for your mental health. Human beings are social creatures. We generally like to be around other people. Of course, there are some people who prefer more independence than others and that is perfectly fine, but, generally, most people want to be around others. Even if it’s not their preference, they can at least tolerate being around others.

Studies show that there are many benefits to having social relationships. When comparing people who have more active social lives to people with less active social lives, researchers consistently find that the former experience many positive benefits. These include living longer, having better physical health and mental health outcomes, increased resiliency, and a decreased risk of developing dementia.

What matters most is having relationships that are meaningful. Being friends with everyone isn’t necessarily good for your mental health. Most psychologically healthy people have only a few good friends. That’s because these relationships take a great deal of time to cultivate and maintain.

It would be good to understand why you are increasingly self-isolating. The main problem you seem to have is your inability to tolerate being around other people. This inability has led to negative outcomes in your life. It’s causing you to have poor grades and could potentially be a major problem for you once you graduate and try to enter the workforce.

Unless you work from home, you’re going to have to interact with people. Even if you did work from home, you would likely have your own business or work for a business, and in that circumstance, you’re probably still going to have to interact with people. If you cannot interact with people in a manner that is acceptable to them, then your business would suffer. The bottom line is that it’s important to explore why you have developed this intolerance to people and most importantly, how to fix it so that you can function in the world. Otherwise, it is you who will suffer the consequences. If you can’t work then you can’t pay your bills. It is important not ignore this problem and face it head on.

The solution to this problem is counseling. Counseling, in your view, is not desirable or convenient but you have admitted to their being a problem in your life. Whenever you have a problem, the most responsible course of action is to seek help for it. I know that you tried counseling once and it wasn’t helpful but you shouldn’t stop trying.

Not all therapists are the same. It takes time to find the right therapist. You shouldn’t give up after only one try. I usually suggest that consulting at least four or five therapists before choosing the one you like. You may even have to consult more than that. Finding good help could make all the difference in your life. It could mean the difference between unhappiness and happiness, success and failure. Some people are not willing to put forth the time it takes to find a good therapist but it is well worth the effort.

Hopefully, I have convinced you to try therapy again. Good luck and please take care.

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A Lot of Factors Seemingly Contributing to a Poor Living of Life

by Kristina Randle, Ph.D., LCSW March 31st, 2024
written by Kristina Randle, Ph.D., LCSW

As a child I loved reading and drawing. I was a smart student, but I thought the world was against me. I was picked on because of my skin color. And I think I must have been a bad child because I was hit a lot, but other than not participating in physical things, I don’t remember being bad.

I am now 32 and still feeling that the world is against me. I try to work hard everyday, I try to make friends with other people, I don’t drink or smoke or take drugs, and I keep generally physically healthy. I have had a tough relationship with my family as far back as I can remember. I also have a tough time making friends. People know me and they leave. I am generally not a happy person, I don’t think I know what true happiness feels like. I mostly feel worried, angry, nothing, sad, anxious, etc. I’ve fallen into severe depression a few times, and I’ve also been raped a number of times. I don’t feel like I’ve not worked as hard as others, however I have made very little progress in all areas of my life in comparison. I see everyone progressing in some aspect of life at least whether its meeting a life partner, or having a descent career, or having a great social life. I seem to be going backwards and no-where in all of these aspects no matter how hard I try.

Also in the last 4-5 years, my memories are fading quickly, and I do not remember much anymore. My brain is always numb and foggy, I tire quickly, it takes me forever to do anything, I get frustrated and give up so easily, I cannot focus, and I no longer care how I look.

I know I am hurting the few people still around me by these changes they see in me, and so they yell at me and berate me in the hopes that I will turn things around, but I feel like a ship at storm and am flailing. I feel like something must be very wrong with me, but I have no clue what. Any insights you may have would be greatly appreciated. Thank you.

There are two main areas that I would like to focus on in my response to your question. The first is that you have described symptoms that potentially indicate depression. You have had episodes of “severe depression” but there is no indication of treatment. The people trying to help you may be inadvertently making things worse. No wonder you feel like a “ship at storm.”

Sometimes our loved ones inadvertently do more harm than good. Family and friends can offer support and love, but they are not trained mental health professionals. We should not expect them to know how to solve complex life problems.

Depression should be treated by mental health professionals. A therapist will offer evidence-based ideas and solutions. They will not yell at you or berate you. They are knowledgeable, non-judgmental, kind, and supportive.

The second area of focus involves your thinking. You seem to be comparing yourself to the ever-abstract and ill-defined “other people” in society. It is simply inaccurate to compare yourself against people whose life circumstances you do not know.

Further complicating these matters is that many people have expectations about how they believe life is supposed to be. They compare themselves against a set of abstract standards and deem themselves as not being good enough. They incorrectly assume that other people are doing better than they are which naturally leads to feelings of inferiority, and so forth. This type of thinking is particularly prevalent among people with depression.

Social media adds to the struggle. People on social media often appear to be living perfect, trouble-free lives but that is far from the truth. It’s an illusion. Avoid overgeneralized thinking traps.

Treatment can help you to address these problems. Choose a therapist who specializes in cognitive behavioral therapy. It’s the best type of treatment to address both depression and the thinking errors that accompany depression. Once your symptoms are treated and your thinking becomes more realistic, you will feel better and less stressed. Please take care.

Dr. Kristina Randle

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Extreme Trust Issues

by Kristina Randle, Ph.D., LCSW March 29th, 2024
written by Kristina Randle, Ph.D., LCSW

Through the years, I have developed horrible trust issues. When I was younger, I had a best friend. She was a compulsive liar. Lies, lies, lies, it’s all she said. I had been friends with her for 9 long years until I stopped being friends with her almost a year ago. I have been deeply scarred from her constant lying. She controlled me, made me her own little doll. I believed her lies. Now I can trust no one. Not even my real best friend who I have also known for a really long time. I feel I have paranoia problems. I get very very very worried when I think people are mad at me. Once I contemplated suicide when I thought someone was mad at me. I am terrified that I am crazy. Whenever she texts or hangs out with someone I feel like they are talking about me from my ex- best friend who would constantly do that. I am scarred on the inside, deeply. I want to be at peace once again and be able to be happy. I also feel like I can’t hang out with anyone but my best friend, for a feeling she will get angry. All I feel I can do is hang out with her AND a group of people. Help me, please :'(

I do not think that you are “crazy.” I think that you may be overreacting to the possibility of others being angry with you. You have difficulty dealing with people. These problems are making it difficult for you to have healthy, sustainable relationships.

Being overly concerned with what others think is a problem. It can mean that other people have a large degree of influence in your life. It is okay to be concerned about what other people think of you, to a certain extent. You will know that you have gone too far when your wants and needs are neglected in relationships. This often leads to unhappiness. It is a sign of an unbalanced relationship.

Also, you cannot please everyone. No one can. No matter what you do there will likely be someone who is displeased with you. If you try to please everyone, you are fighting a losing battle.

A third problem is that in your effort to please others, you may do things that you would probably rather not do. For instance, let’s say you want to go to movie A but your best friend wants to go to movie B. You don’t want to see movie B but you go because you do not want to anger your best friend. It would be fine to take turns but wrong to consistently do what you don’t want to do, simply to please others. Your fear of angering others may be driving you to engage in very one-sided relationships. Again, this can lead to resentment and anger on your part.

Your wants, needs and desires in relationships do matter. Relationships are not supposed to be one-sided. If your friend asks you to go to the movies one week, you should ask her to go the movies the next week. If your friend calls you, you should call her. If a friend invites you to his or her home, you should invite him or her to your home, and so on. If someone treats you badly that doesn’t mean you should reciprocate but you may want to reconsider your friendship with that individual. This would not be selfish; it would be self-preservation.

Part of why you avoid confrontation may be because you do not want to lose friends. The problem with this, as I explained above, is that one-sided relationships typically do not last long. The good news is that you can learn better relationship skills. You may not be able to trust others now but you can learn to trust again.

I believe now is a good time to seek help for this problem. It can be corrected. A therapist could be very helpful. He or she could help you in the following ways:

  • Teach you how to have healthy relationships with others.
  • Model what a healthy relationship is like.
  • Teach you how to select and attract respectful friends.
  • Advise you about how to deal with situations when a friend becomes angry with you.
  • Teach you how not to overreact when difficult situations arise.

As you mentioned, this problem has complicated your life to the degree that you were considering suicide. This is why it is very, very important that you seek help immediately.

I would strongly encourage you to speak with your parents. Perhaps they have advice about friendship that they can offer you. They may also be able to help you deal with your anxiety. I would highly recommend counseling in addition to speaking to your parents. I believe it could benefit you. Here is a link to a list of therapists. Please seek help immediately. If you are feeling suicidal, call 800-273-8255 or go to the nearest emergency room.

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Eating Disorder Has Returned

by Kristina Randle, Ph.D., LCSW March 28th, 2024
written by Kristina Randle, Ph.D., LCSW

I am falling back into the depths of my eating disorder and I can’t tell anyone. I have suffered with an eating disorder since I was 13 (I am 18 now). It started out as bulimia/binge eating. I would binge and sometimes purge. I was overweight from the time I was a kid and I was always self conscious about my body. Over the years I began purging more and also experimenting with laxatives and diet pills. During my junior year of high school my eating disorder morphed into anorexia/bulimia. I wouldn’t eat all day and sometimes after everyone in my house went to sleep I would binge and purge or sneak out to run a few miles. I am 5’6″ and my weight went from 165 pounds to 115 from September to January. I started regularly bingeing and purging again and I gained about 15 pounds by the end of February. In early March a teacher found out that I was taking diet pills and called my parents. (This teacher had been questioning me about my weight loss for a while). My parents had suspected an ED and eventually I wound up in residential treatment. I was there for 5 weeks, went home, relapsed, attempted suicide and was sent back to residential for another two months. I was discharged to a outpatient program in July and spent July and half of August doing the OP program as well as seeing an outpatient therapist twice a week. When I was discharged from residential my weight had gotten up to 145 pounds. I started binge eating again and my weight rose to 155 over the remainder of the summer. I was too embarrassed to tell my treatment team about bingeing because I felt so disgusting for doing it. In September I went back to school for my senior year and started heavily restricting and exercising again. After a few weeks I landed in the hospital dehydrated and was sent back to residential for a third time. I spent a month there and then the following three months in an Intensive Outpatient Program because my insurance would not cover partial. I also so my individual therapist twice a week. Since then I have graduated from high school (I completed all my classes at home with a tutor) and got accepted into a top boarding school for a postgraduate year.

However, in the past month things have really taken a turn for the worse. I am so unhappy with my weight and I can’t stand the way I look. I feel so fat and disgusting and the thought of wearing anything other than baggy sweats scares me because I dont want anybody to see my disgusting body. My body has maintained a weight of 155 pounds and I am extremely uncomfortable with that number especially because I KNOW that my “set point weight” is between 140 and 145. I desperately want my weight to get back to 115 where I was in the depths of the anorexia phase of my eating disorder. Although I know this is an unhealthy weight for me, I cant seem to stop thinking about how much better I would look and feel at that weight.

In the past month my eating disorder has been all over the place. It started with severe restricting. I ate about 500 calories over a 7 day period and my weight immediately dropped to about 145. This sever restriction however was followed by a week of severe bingeing where I gained the weight back (and then some) Then I went away for a week to a sports camp where I was playing 9 hours a day of intense volleyball and eating maybe 1200 calories at most. I came home and hadn’t lost any weight which sent me into a week of severe bingeing and purging, followed by a family vacation where I felt pressured to eat foods I was uncomfortable with (it was a week of indulgence… I wouldn’t say bingeing because I wasn’t consuming massive amounts of food) After I got home my weight had climbed yet again and I started taking 10 laxatives daily. My weight has gone down and is now hovering around 155 again but I am still really unhappy with this number. Today I started restricting and purging again. Meaning I am not eating but anything I do eat is being purged.

I feel awful. I cry myself to sleep almost every night and I feel like a fat, disgusting failure. I am still seeing my outpatient therapist twice a week but I cant bring myself to tell her. I am so afraid that if I am honest she will tell my parents that I am not mentally stable enough to go away to school, which I have been looking forward to for over a year. However, most of the time I dream of going away to school because school distracts me so much from food and I can lose weight a lot easier when I am wrapped up in academics and athletics. Although I am a high achieving, top tier school-bound student I feel as though my only goal in life is to reach a weight I am comfortable with- an emaciated body. But at the same time, I really do love school and learning and the school I am going to will be a great opportunity for me. I don’t want to give it up because of my eating disorder. I can’t miss out on another year of my life because I am in treatment.

There are few days when thoughts of pursuing an education and becoming a successful doctor excite me but the majority of the time the only thing I want to achieve is a perfect body.

I don’t know what to do. My thoughts are so extreme, so black and white. No therapy technique (mindfulness, thought stopping, DBT, CBT, relaxation, etc) has ever worked for me. Sometimes journaling helps me get my thoughts out but my journal entries usually end up as some twisted plot to lose a ton of weight.

I really need someone to talk to. I love my therapist but I feel so self conscious around her because I am bigger than her. I feel like I don’t deserve to talk about how I “feel” fat when my BMI proves that I am overweight. I am embarrassed to even bring it up in a session because I know that my therapist knows what my weight is and I cant bear to hear the number aloud.

I don’t know what to do. I feel so alone with my thoughts and I feel like recovery will never be possible because I am so ambivalent about it. –Pam

A recent article/ blog entry in the New York Times entitled Is Anorexia a Lifelong Illness? featured Dr. Kathryn Zerbe, an expert on eating disorders. In this article individuals were able to ask her questions. One response was particularly insightful. An individual by the name of “DJ” wrote this about her battle with bulimia “…ironically, in an effort to avoid obesity and to be attractive, I have ruined my appearance further.”

With that statement she was referring to how she ruined her teeth and had to spend large amounts of money on dental work. Not to mention, as she goes on to say, the fact that her health is at great risk because of her eating disorder.

You are likely in the same position she is with regard to your health. In addition, because of the eating disorder you also face the possibility of not being able to achieve your lifelong dream of wanting to become a doctor. Your obsession with finding the “perfect weight” is essentially ruining your life.

You are keeping your ordeal a secret and I strongly discourage this. You are in treatment with a therapist but are unable to reveal the truth about your situation. I understand that you feel ashamed about certain aspects of your behavior. I would encourage you to try to move past these feelings, as difficult as it may be, and talk about them with your therapist. You have the opportunity to be treated, but fear of what others think of you is standing in your way. Your therapist knows already that you’re struggling with eating issues. She’s not going to think any less of you because you’re having difficulty. Her job is to help you when you are having difficulty but she can’t if she doesn’t know you’re having a problem. You’re not helping yourself by withholding the truth from the very person who is attempting to help you.

I also noticed you’re overly critical of your behavior. It’s a common characteristic among individuals with an eating disorder. In your case, it leads you to believe that your therapist will also be critical of your behavior. There’s a very good likelihood that your perception of how you believe your therapist will react is inaccurate. It is important for you to tell her the truth no matter what you think her reaction will be. You need help and you need it now.

I recognize that you’re frightened but you can be helped. Many people have sought treatment for eating disorders and it has saved their lives. The same can be true for you but it begins with you not keeping the reemergence of your disorder a secret. I wish you luck.

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How Can I Not Pass On My Eating Disorder?

by Kristina Randle, Ph.D., LCSW March 26th, 2024
written by Kristina Randle, Ph.D., LCSW

I need help on how to raise my daughter while struggling with Anorexia. I’m a 26 year old mother to a 7-year-old girl. Her father and I separated and eventually divorced when she was 2 years-old. She has always been under my primary care. I was diagnosed with Anorexia when I was 14 years old (I also have diagnoses of Borderline Personality, Depression, Self Injury, and PTSD). I have been inpatient for short stays, completed day programs and been in individual therapy. I have also been on over 10 different medications. Recently my eating disorder has flared up. I have for the most part stopped self injuring (I slip occassionally, but always get right back on track). My daughter is now at the age where “I’m not feeling well” isn’t going to cut it and I know that. I want nothing more than to prevent her from following my footsteps down this path of physical self destruction. I have good days and bad, but no health insurance and can’t afford to get the treatment I know I need to truly recover. I eat dinner with her every night and have been doing well with keeping that one meal down. I don’t eat anything but the meal usually. I go to the gym as often as I can and run 5-10 miles with no food in me and only 4 oz of water allowed. I am spiraling and I don’t want her to follow. I love her and we have a great relationship, but I need to know how to talk to her or not talk to her about this issue and what I can do until I reach recovery to lessen the likelihood that she will embrace this disorder that I can’t seem to rid myself of. Please help.

You have asked a very good question. It is important to acknowledge that you are in a challenging situation. You are not yet stable but you recognize that it’s important to teach your daughter how to be stable so that she does not follow in your footsteps.

One of the ways children learn to behave is through modeling. This means that they learn how to behave usually by mimicking the behavior of their parents. This is also true with regard to developing a relationship with food. If your daughter sees you eating only small amounts of food then it’s very possible that she will model your behavior. Generally, the best way to show your child how to develop a healthy relationship with food is to model it for her.

You are currently not in treatment because you do not have health insurance. Unfortunately, many people are in a similar situation. Even so, there are ways to access treatment that are affordable and in some cases, free. Community mental health centers usually offer sliding scale fees or free services based on income. Your daughter may also be able to be seen by a therapist at a community mental health center. Perhaps the two of you could try family therapy. The therapist can help you be a better model for your daughter in terms of eating. He or she could also advise you about how to prevent the development of the disorder in your daughter. You may find family therapy to be very effective.

The bottom line is that you need to be stable for your daughter. That is going to be the best way to prevent the development of any mental health disorder in your daughter. When instructing passengers before a flight, the flight attendants prepare passengers in the event of an emergency. They advise parents to first secure their oxygen mask before attending to their children. Why? Because they recognize that a parent who can’t breathe, who essentially is unstable, cannot effectively help their child. The point is that to effectively help your child you first need to be well yourself.

You clearly are a caring mother who’s worried about her daughter. Accessing effective treatment needs to be your priority. Your motivation could be that you do not want to pass an eating disorder on to your child. The best way to find a community mental health center in your area is to search through the white or yellow pages in the phone book. Call different agencies in your community and ask where you could find help. Thank you for your question. I hope you’re able to find the help that you need.

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Think I’m Worrying an Unhealthy Amount

by Kristina Randle, Ph.D., LCSW March 24th, 2024
written by Kristina Randle, Ph.D., LCSW

Around a month and a half ago, my friend introduced to a new drug i hadn’t experimented with called spice. We went outside for a smoke and i treated the substance like marijuana. With it being “synthetic marijuana” i assumed that would be appropriate. Easy to say i overdosed. 5-10 minutes after we smoked my legs began to get numb. I was freaking out. The numbness continued to move upward and eventually i became limp(fainted). All i remember was thinking i was going to die. The worst expirence of my life.i kept telling myself breath you will live. I woke up feeling dizzy and light-headed. Those symptoms went away but now all i think about is somethjng being wrong. I feel like my vision is messed up, way to hard to describe. Sometimes only my eyes zone out where i can still do task but my eyes are focused on one thing. It hasnt impaired my memory and at times i believe my memory to have increase. I have relatively small panic attacks with a few larger ones mainly occuring when im bored, alone, or getting ready for bed. Am i ok? Is this some stress related issue? Am i tricking myself into thinking something is wrong? I look up a few symptoms to make me feel better and it only makes me think i had a stroke, seizure, brain trauma, etc. i find myself wondering if i will ever be normal again. I’m scared that i will go insane or disconnect myself from society or something crazy like that. Please help.

According to the Drug Enforcement Agency (DEA), K2 or “spice” has the same psychoactive properties as marijuana, which is categorized as a hallucinogenic drug. Psychological effects of “spice” include paranoia, panic attacks and giddiness. Some users report extreme anxiety and hallucinations. Physiologically, those who ingest spice may experience an increased heart rate and an increase in blood pressure. It can also reduce blood flow to the heart and heart attacks have been reported in a few cases. The long-term effects on the body are unknown.

It is important to understand that illicit drug use is never “appropriate.” Many people have negative experiences with drugs. A common experience after using drugs is the development of frightening psychological side effects. The user worries that the drugs have caused permanent damage and they wonder if they will ever return to their pre-drug use, psychological state. In some cases, they don’t and the damage is permanent. Simply put, drugs are dangerous.

I cannot determine if something is “wrong.” If you continue to experience concerning symptoms, then you should be evaluated by a physician or a mental health professional. The health care professional with whom you would meet cannot “turn you in” for having used “spice” in the past. Many states have banned “spice” and have made it a misdemeanor to buy, sell or possess the drug.

Finally, learn a lesson from this experience. The lesson to be learned is that drug use is dangerous and it has the potential to permanently alter your psychological state of being and psychological health. There is no safe drug use. Many people who use drugs are permanently damaged. That may sound dramatic but it is the truth. Please take care.

Dr. Kristina Randle

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How to Help My Bipolar Daughter Make Better Choices

by Kristina Randle, Ph.D., LCSW March 22nd, 2024
written by Kristina Randle, Ph.D., LCSW

Q. My 47 yr old daughter is Bipolar and about to get sick at this time because her son plans to study in Germany. My 47 year old daughter was diagnosed Bipolar some (7) years ago and had about six episodes mostly triggered by heavy load of work in the office. Her husband and our family have counseled her not to take too much load and to this date, she has accepted that she cannot afford to work more than she should, in order to prevent episodes. However, last month, her only son who is 20 years old expressed desire to study in Germany for (1) year and being a mother who would do anything for her son, she together with her husband agreed to shoulder the cost despite their financial difficulty, and right now, she got sick again. Our family analyzed the reason why she got sick and we can tell it’s because of the financial aspect coupled with emotional aspect. This is actually her situation: (1) they are not realistically able to tackle the financial responsibility for the entire year of his schooling because her 64 husband who was injured is not earning enough as a salesman (2) She has to take out $18,000 from her 401K which leaves her with only $22,000 if she does. In addition, her husband does not have a 401K and currently does not have a life insurance. Ergo, she will have the financial burden for as long as her son is in Germany.

We are thinking maybe in the back of her mind, she is worried if they can really afford to take care of it for the whole year. We explained to her that the fee for the tuition and the lodging is just a part of the expenses…that the incidentals and maintenance for the whole year will be a lot especially that the Euros are very high presently. But like I said, being a mother, she agreed to take on the responsibility, and that is why she started to get sick. What can I do to convince her to say No to her son ? That her worry about the financial responsibility is the one that triggered her getting sick again ? She does not seem to accept the reality. I want to find out from a professional therapist if I am right in assuming so. I would appreciate very much for any answer or advice you can give me.

I think you see the truth very clearly in this situation but your daughter does not. Trying to get her to think about this matter correctly and logically is something you can try (and it seems like you already have) but she still may not listen.

You are correct when you note that it is not a good idea to essentially go into financial debt so she can send her child to Germany for a vacation. This is not a wise parenting decision. But in her specific instance, it’s not only a bad idea financially but mentally for her, it can lead to a relapse.

All you can do is try again to make your case. But once you have made your case and she still is not interested in taking your advice, you must stop. There are several reasons for this. One is because you will be wasting your time and energy. You cannot “make” anyone take your advice, no matter how good the advice is or how right you are. Also, you do not want to risk adding further stress to the situation because as you mentioned she has bipolar disorder, and the increased stress may expedite a disorder relapse.

Try your hardest to make your case but stop when it is clear that she is not interested. I know it’s difficult to sit on the “sidelines” and watch someone you love make poor choices that clearly are detrimental but unfortunately it might be all that you can do. Thanks for writing.

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OCD vs. Phobia Problem?

by Kristina Randle, Ph.D., LCSW March 21st, 2024
written by Kristina Randle, Ph.D., LCSW

Hello, please help! I am a 48 year old male, married with kids. I have always had some degree of anxiety (a worrier), usually very minor but with all the stressors I’ve endured lately (double job loss, part time business failure), I believe it has accelerated to an OCD condition – I have a fear of hazardous material, and in particular asbestos and the diseases it causes. My fear is heightened when I think my family may be exposed as well. I’ve had this fear (to a much lesser extent) for quite some time since learning the horrors of contracting mesothelioma, but it has seemed to peak – I can take the thoughts to the extreme as described below.

I feel compelled to check every old / antique thing we own for it and everywhere I go, and have taken several samples from our home into a lab to get checked (drywall mud, paint, ceiling texture, etc.), although our home was built well after asbestos was banned for those uses. I also have had articles from the yard tested (old cooler insulation, concrete fireplace, antique painted fencing and lawn furniture, etc.). Everything has tested “no asbestos”. It seems that as soon as I get the good news of a negative test, my anxiety drops for a bit, but I soon find something else to obsess over. I even get paranoid in older buildings – is there asbestos above the drop ceiling? Have they remodeled recently, releasing fibers into the air? Is that sprayed on stuff on the ceiling support asbestos? I called the school system about the school where my wife works to ask about some vinyl tile, the city to ask about dust being raised from the dump by the road, and I email experts often when I have anxiety about certain objects or substances. My wife only knows a fraction of my activity for fear of her thinking I am completely nuts.

I always go through several layers of “what if”, and it is maddening. I feel that I need to find a way to retire from being the “asbestos police” – I know the odds of an illness are very remote, and exposure and illness are essentially out of my control. I feel that this may be my main issue – I have such a current lack of control over my life, I must need to control something. I have seen a therapist several times and it has helped to bring down my overall anxiety level, but the obsession to check for asbestos everywhere remains. I do have moments of clarity, when I see my obsession as a problem and have very low anxiety, but they are fleeting. Do I fit the description as having OCD, or am I just phobic and overly “cautious”? I really want to be back to my old self, virtually without a thought about asbestos.

Though I cannot provide a diagnosis over the Internet, your symptoms seem indicative of obsessive-compulsive disorder (OCD). OCD is an anxiety disorder that is characterized by unwanted, reoccurring thoughts and repetitive behaviors.

Among OCD sufferers, specifically among those with health-related anxieties such as yours, often no amount of reassurance is enough. In fact, the act of seeking reassurance can make OCD worse. It temporarily decreases anxiety but it reinforces the “seeking reassurance” behavior.

OCD sufferers should resist the urge to seek reassurance and instead endure their anxiety. If an individual habitually seeks reassurance when they feel anxious, then not doing so will increase their anxiety, possibly to very intense levels.

Those levels cannot be sustained. Anxiety always decreases. In that way, anxiety can be likened to the law of gravity: what goes up must come down. Individuals with OCD are unwilling to endure their anxiety. They do everything in their power to escape it. That is a mistake. Anxiety avoided in the short run is only intensified in the long run.

As you stated, “I know the odds of an illness are very remote, and exposure and illness are essentially out of my control.” It is generally believed that individuals with OCD, through their rituals, are attempting to establish control over events and situations that in reality they cannot control.

You can reduce or eliminate your anxiety by focusing on reality. If you force yourself to believe in reality, then your anxiety will diminish.

Beginning therapy was a very wise choice. I would strongly urge you to continue. Therapy can help you to understand and to be comfortable with things that are beyond your control. This wisdom has been shared by mankind since the beginning of recorded history and perhaps before. It is exemplified in the Serenity Prayer, (adopted by Alcoholics Anonymous) “God, grant us the Serenity to accept things we cannot change, Courage to change the things we can, and the Wisdom to know the difference…”

OCD tends to be a progressive disorder but this is not true for everyone. Symptoms may occur on certain occasions or on all, decrease over time or increase. There are effective treatments for OCD including cognitive-behavioral therapy and relaxation training. A specific form of cognitive-behavioral therapy, known as exposure and prevention response, has been shown to be a very effective treatment. Medication can help as well.

I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Personality Disorder? What’s Wrong with Me?

by Kristina Randle, Ph.D., LCSW March 19th, 2024
written by Kristina Randle, Ph.D., LCSW

I’m feel like there is something seriously wrong with my head and I just don’t know what it is? I’ve researched a lot of different mental disorders and I can relate to a lot of the symptoms of so many of them. When I was in 4th grade I was diagnosed with ADD and I’ve have had on and off depression, disordered eating habits, and anxiety since then but I was diagnosed with depression and anxiety 3 months ago. Lately I have been feeling very disconnected and can’t stop zoning out, when I’m not zoned out my vision is distorted. Everything looks like its shifting, breathing, certain things pop out a lot, and when I read text it waves and spirals into itself. Sometimes when I walk I feel the curve of the earth and everything to the side of me looks downhill. Kind of like tripping but not. I did do LSD twice about 5 months ago but I’ve only been experiencing these symptoms for 2 or 3 months so it’s not because of the acid. I question reality and get confused about the concept of time and sometimes I completely forget who I am. Also been having bad insomnia and strange sleep patterns. I’ve been impulsive and doing things that I regret later; smoking a lot more than usual, drinking all the time and trying other harder drugs like Xanax and coke(once) but thats weird for me because I’ve always thought of myself as weed only. I’ve also been hooking up with a lot more guys which is weird for me because I’ve always been kind of afraid of and have never been in a relationship and am very self conscious but I keep hooking up with guys I don’t care about. I also just really hate my personality. I try to seem unique but really I have no personality, I’ m nothing but a bunch of stolen identities. When I ask someone to hang out and they can’t I get extremely hurt by that to the point of tears and think that everyone thinks I’m annoying and that girl that I think is cool and I wish people could see me the same way as people see her knows that I’m copying her. Sometimes I’m afraid to go on the deck because I think I can’t control myself and I might jump off.

It’s not possible to determine a diagnosis over the Internet. The other issue is your age. Some mental health professionals are reluctant to diagnose teenagers with a mental illness because it is a turbulent time, both developmentally and emotionally.

When mental health problems are a concern, it is especially important to refrain from using drugs and alcohol. They can negatively impact your mood and personality. They could make your symptoms worse or perhaps may even be causing them. Therefore it would be in your best interest to stop using drugs and alcohol.

It was your opinion that you don’t possess a “unique personality ” and that you are a conglomeration of a “bunch of stolen identities.” What I think you might mean is that you are behaving in ways that you believe other people want you to instead of just being yourself. That could stem from low self-esteem.

Lack of self-esteem might also be evidenced by your “hooking up with guys [you] don’t care about.” You might not be so willing to indiscriminately “hook up” with these people if you felt better about yourself.

You have received different diagnoses. This would suggest that you have been evaluated by a mental health clinician. It’s good that you were in contact with mental health professionals, but you did not mention being in treatment. Counseling is the ideal treatment for the problems you have described. Medication could also help with your symptoms.

Erik Erikson is a famous and well-accepted developmental theorist. He talks about a stage that people go through when growing up. It is called identity vs. identity confusion. In essence he is saying that a teenager must go through a stage where they will find out who they are. They need to find their identity. You can read about this and see if it explains some of your feelings.

The symptoms you described require treatment. Contact a mental health professional and ask for his or her assistance. What’s most important is treating your symptoms with counseling and if necessary, medication. Please take care.

Dr. Kristina Randle

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Friend Has Fallen for “Lovesick” Therapist

by Kristina Randle, Ph.D., LCSW March 17th, 2024
written by Kristina Randle, Ph.D., LCSW

A female friend has always had a bond with her older male therapist. She terminated a year ago with him after revealing her childhood rape in detail to him. However, she continued to see him and pay him for “sessions”. Now she is seeing him at his office as “friends”. This was the result of him coming out and expressing his love for her after finding out she was getting close to me. He texts her and calls her. The therapist is married with children. Well, she has swooned. She thinks he will leave his wife and they will be together. She believes that their love is an exception to the transference and countertransference of a theraputic context. She believes that the therapist is a good person and love can transcend the theraputic context and that they are “soulmates”. This intense bond occurred when she revealed her rape. I have warned her repeatly. Her response is that she is a big girl and can make her own decisions. Do I leave it alone or do I confront this lovesick therapist? I am torn.

I am curious about your relationship with your female friend. Is this an individual who you are attracted to or were formerly involved with? Having said that, I believe your concerns are valid and understandable.

There are two main concerns with the relationship. One is ethical. Mental health professionals are obliged to abide by ethical codes of conduct. He may be in violation of these codes. Many of these codes of conduct are in place to prevent intimate relationships between a therapist and client from developing. I’m not certain what specific type of therapist he is (i.e. psychologist, psychiatrist, social worker, etc) but if you feel it necessary, you could file a formal complaint with his respective governing board.

The second concern is that the therapist is married. Your friend believes that he is going to leave his wife and children to be with her. She may soon find out that oftentimes the cheating spouse claims they will end their marriage but do not. It’s one of the hazards of being involved with an individual who is married.

To answer your question, I’m not certain about whether confronting the therapist is the best course of action. It may anger your friend and drive her away from you. Try to understand it from her perspective. She said she is “in love” him. Your confrontation may be interpreted as an attack on her “soul mate.”

I understand that it is difficult to watch your friend possibly get hurt as a result of her involvement with this individual. It’s not easy to watch someone you care about suffer and make bad decisions. Unfortunately, you cannot control the behavior of other people. You can offer advice but she can choose to ignore it. As your friend stated, she is a “big girl who can make her own decisions.” What she is saying is that she is free to do what she wants, regardless of your opinion. She may have to learn “the hard way,” which is that if she continues the relationship, she risks getting hurt. For her sake, I hope that doesn’t happen but unfortunately that is usually the end result of affairs.

What should you do? Recognize that your power is limited in the situation. You should talk to your friend. Let her know about your concerns and continue to encourage her to be careful about the situation she’s involved in. You may also want to suggest that she see another therapist. You could frame the suggestion like this: “You are dealing with many difficult issues right now and things are complicated with your current therapist. It might be a good idea if you saw a different therapist who can be objective.” The new therapist may not be able to convince her to stop seeing her therapist romantically but perhaps he or she could offer a new perspective or an objective opinion that changes her mind.

The bottom line is that there is no easy solution to this problem. Your advice might be wise and logical but if someone does not want it, you cannot force them to accept it. If your relationship with her reaches that point, know that you have done all you can. Thanks for writing.

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Spontaneous Blushing A Symptom?

by Kristina Randle, Ph.D., LCSW March 14th, 2024
written by Kristina Randle, Ph.D., LCSW

Ever since I can remember, I’ve always had a problem with blushing when I am the center of attention. It was so bad when I was growing up that even if a single person would talk to me for any length of time, I blushed or was terrified of blushing. I would obsess about not blushing so much while communicating with a person that I wouldn’t pay attention to anything the person said. This blushing problem has improved since I became an adult, but from time to time while engaging in conversation with anyone (especially men), I still get that anxiety and make excuses to end the conversation or anything to avoid the person seeing me blush. Blushing has always been a huge source of embarrassment for me. I want to know why I had and still have this problem and what I can do to change it. Is it a symptom of something?

I know of no mental health disorder in which blushing is a specific diagnostic symptom. While blushing is not a specific symptom of any one particular mental illness per se, it may be associated with social anxiety disorder. Individuals with social anxiety or social phobias feel particularly anxious in the presence of other people, especially when they are the center of attention. These symptoms seem to match your experiences.

Among individuals with social anxiety disorder, everyday situations can be fearful. Individuals with social anxiety often do not feel confident about themselves. Because of this, they tend to avoid the situations that make them anxious. In the short run, avoidance decreases anxiety but overtime, it can increase its severity.

Can social anxiety be treated? The answer is yes. Cognitive behavioral therapy (CBT) has been shown to be effective. CBT is a treatment that addresses both behaviors and thoughts related to anxiety. Generally CBT lasts for approximately 12 weeks but the length of treatment depends on problem severity. Some CBT therapists require clients to complete homework assignments such as recording your daily moods or feelings. Therapy sessions can be conducted individually or in a group setting. Another very effective treatment is exposure and prevention response (EPR) therapy. Usually, EPR is used to treat individuals with obsessive-compulsive disorder though it has been effective for other types of anxiety disorders.

Another idea is a concept called “hyper-intension.” I’ve written about this concept in other answers but I think it may apply to you. The idea was written about by psychiatrist Viktor Frankl in his 1946 book Man’s Search for Meaning. He believes that when a person intensely focuses on their fear that attention may have the unintended consequence of producing or increasing the fear. In other words, a person’s fear is made worse by their intense focus on it.

The solution to this problem, Frankl says, is to apply a technique called “paradoxical intention.” Paradoxical intention means that you do the opposite of what you would normally do in response to a fear.

What is encouraging about your problem is that it has improved. The reason for this may be related to an increase in self-confidence. Another reason may be because you have trained yourself to be less anxious over time. There may be other explanations as well.

When you feel the blushing occur, I would encourage you to remain in the uncomfortable situation. If you force yourself to endure your anxiety it will diminish. Don’t avoid a situation because you think you may blush. As I mentioned earlier, avoidance could make your anxiety worse.

Also, keep in mind that while you may focus on the blushing other people may not notice. If you surveyed the other people present when a blushing episode occurred you would likely find this to be the case. Even if others did notice they most likely would not comment. Blushing does not necessarily have a negative connotation. In fact, some people may find it endearing.

If this is a problem that continues to bother you then I would encourage you to see a therapist. Because your fear is so specific (i.e. blushing) and it has improved over time, it may only take a few targeted therapy sessions to extinguish. I’d highly recommend it. I wish you well. Thanks for writing.

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