Depression

For as long as I can remember I have always been a shy and quiet girl, but despite that I used to hate to be left alone and would always try to be around my family and friends, tagging them along wherever they went. My mother said it was after my grandmother’s death that I had started to change. I was twelve years old, still shy and quiet; but I started to push people away, preferring to be left alone. I became less active and preferred to stay in my room all day playing video games. Then at night I would find myself unable to go to sleep and would toss and turn for hours until I eventually passed out.

I began to develop a habit of needing to keep things clean and organized. I would alphabetize my books and cds, and I would color code all of my clothing. If anything was untidy or disorganized, I would begin to feel hopeless and overwhelmed. At this point I began procrastinating, putting things off until I was in the mood to do it which sometimes never came.

Things got worse and new problems developed throughout my years in middle school and high school. It got so bad that I ended up dropping out of high school at the beginning of my senior year. I have pretty much cut all contact with my friends and whenever they would try to call me, I would ignore them, not wanting to talk to them or to go anywhere. I hardly ever left home, hardly left my room for months on end.

Now at the age of twenty I am still living at home with my parents with no job, spending my day’s safe in my room. I just feel too stressed, too depressed to do anything, even the things I once enjoyed dearly.

For awhile I caused myself harm, cutting myself, until my mother caught me with a knife under my bed. I felt so ashamed and felt like I betrayed her. So I stopped cutting myself. However I still feel as anxious and distressed as I ever have. I have had my share of suicidal thoughts but I never acted on them nor am I planning on it. For awhile I tried to talk about it with my mother, but she would always say it had to do with my menstrual cycle messing up my hormones or the seasons and weather.

Now I have become extremely paranoid and I suppose a bit delusional, and it has gotten so bad that I am afraid to go to sleep at night. I have to force myself to try and get some sleep, but it still takes me hours to fall asleep, and then when I do, I just end up waking up several times during the night. It is getting to the point where I do not even know why I bother trying.

I also have these intrusive, morbid, tormenting thoughts, most revolving around death, disasters and violence. I cannot control these thoughts nor can I make them go away. They make me feel so helpless and make want to cry my eyes out. But the truth is I have not been able to cry since… I don’t know when. I mean I could not even bring myself to cry when my closest grandfather died five years or so ago, which made me feel completely guilty.

Aside from the intrusive thoughts, I have also experienced hallucinations, such as bugs crawling all over my floors and walls, the bathroom sink being full of blood and dead rodents covering the kitchen floor. However I do not see things as much as I hear things. I hear voices a lot, sometimes they sound as if they are just in my mind, and then other times they sound as if they are right behind me or next to me, almost like someone else is there. I have such difficult time thinking and focusing on things anymore and my short term memory is well, deteriorating rather rapidly to say the least.

I just honestly do not know what to do anymore. I am anxious, nervous and paranoid all the time now, I have not had a decent night’s sleep in years and I am so depressed and I feel as though I am losing my grip on reality. My family only has enough money to just keep us going, and I do not currently have health insurance, unless my parents can spend $9,000 ($3,000 per person), but I already know we can’t. I cannot bring myself to talk about these things with my parents and I am pretty sure my father hates be because he thinks I am just lazy.

My mother seems to think I may have schizophrenia and/or possibly OCD. I have done a bit of research on these two disorders and found that a lot of the symptoms seem to fit. I also learned that people with schizophrenia can develop OCD. But of course with our severe money problems, it is not like I can go out to a therapist or doctor to have this confirmed. So what should I do, what can I do? What are my options because I cannot stand being a nuisance and disappointment to my parents anymore!

It would be irresponsible to give or confirm a diagnosis over the Internet but I do believe that I can offer some insight. Many of your symptoms match obsessive compulsive disorder (OCD). Many people develop OCD following the pattern in your life. They experience a traumatic event such as losing a loved one and subsequently develop the obsessive need or desire to create order in their lives. It is as though the traumatic event creates a sense of being out of control. This out-of-control feeling prompts an outward attempt to create order and control. Perhaps psychologically the loss or traumatic event frightens individuals to the point where they feel the need to gain control. Thus OCD develops.

In addition to possible OCD symptoms, you may be experiencing depression. Specific symptoms include: your desire to self-harm, short-term memory loss, difficulty sleeping, and the increasing desire to isolate. Individuals with depression tend to want to isolate. That is what you seem to have done.

In addition to the social isolation, you are not working or sleeping well. You barely leave the house. This combination of life circumstances may be contributing to your symptoms.

Of particular concern is your sleep deprivation. Severe sleep deprivation negatively impacts brain functioning. Prolonged sleep deprivation might explain your hallucinations and delusions.

Your family may not be able to afford private psychotherapy sessions because of a lack of insurance coverage but there are other options. Community mental health centers (CMHC) usually offer free or low-cost services. Check your local white or yellow pages for the phone number to your local CMHC.

Also, call the local health department to inquire what free or low-cost services may be available to you. Another idea is to enroll in a university-based study investigating OCD or depression. Often study participants have access to cutting-edge psychological treatments.

I cannot confirm or rule out a psychiatric diagnosis. It is always best to be evaluated in person, by a mental health professional to determine when a diagnosis is warranted.

Schizophrenia may be a possibility but it’s difficult to know based on a short letter. Sleep deprivation and other possible psychological and medical problems would need to be ruled out before a diagnosis of schizophrenia could be confirmed.

I hope that you consider investigating free or low-cost services in your community. Please take care. If I can answer any additional questions, please do not hesitate to write again.

Dr. Kristina Randle