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Depression

Is It Normal to Have Nothing to Love but Myself?

by Dr. Marie Hartwell-Walker March 8th, 2024
written by Dr. Marie Hartwell-Walker

From a teen in Egypt: I could remember myself back 3-4 years ago. I was just trying to be ‘normal’, because I was just a kid. I didn’t know what I want or even who I’m, so I used to try to stick to what’s known as ‘good’ if you know what I mean.

I thought about it and I found out that what I knew then for sure is that I want to look at myself with pride and ego.
As I grew up, and found no use of what I was trying to do. I decided to consider it an issue, I took advantage of my talent of writing and wrote about myself, recognized who I’m, until I actually got it. It seemed like a victory to me, loving myself and finally looking at the world with a perspective of mine, not only that vision which the society wants me to observe and conclude by (sometimes we agree)

It has progressed over the years, as I’ve become totally self-centered. I’m deeply the most selfish person I know, and what’s surprising me is that I’m dearly proud of it. I love myself for reasons and for no reasons. This is a clear-enough description of myself..

I technically live inside my head. I don’t care (not even slightly) about what people think and how they describe or see things. Everything is analysable (like seriously, EVERYTHING around me). I love being alone, even when it’s making me the most bored person on earth, I’d prefer entertaining myself by books and TV shows which satisfies my imagination on a long-term. I very rarely feel anything related to ‘love’ towards anybody but my own family (we live in the same house),

I left my girlfriend after 2.5 years together and I felt nothing but the absence of some daily conversations and activities, and I never feel sorry for anybody who dies (I might feel angry if it was terrible, but never sorry). I admire what I like, no matter how people see what I like evil or crazy or messed up. I don’t ever feel guilt towards anybody but myself (if some of my actions scratched my ego). I never get angry at anybody or expect anything bad or good from anybody whatsoever. I love myself more
than I’d ever love anybody. And most importantly : I’m only satisfied when I’m totally alone (that’s why I’m here).

The simple answer to your question is “No”. It’s not normal to be so isolated. Human beings are social creatures by nature. As much as you want to think you live in a universe of one, you don’t. Like everyone else in the world, you are dependent on other people in a variety of ways. Even a hermit needs other people to be a hermit from.

You’ve compensated for not being able to figure out how to get along by withdrawing from the social world. If you continue to live like this, it is going to have negative effects on both your mental and physical well-being.

So, as much as I think you are going to hate it, I do think you need to see a mental health specialist for an evaluation. You may be right that you are just a misanthropic individual but, even if that’s the case, it may be important to understand why. With that understanding, you can decide if you want to keep it up or change it. It also occurs to me that you may be on the high end of the autism spectrum. If that’s the case, your thinking and behavior may have come about as a compensation. There are better ways to deal with it.

You do have a talent for writing as demonstrated by your clear letter. But even the solitary task of writing is usually for and about other people. We have to live life in order to have things to write about.

I think you deserve better than you’ve got right now. Narcissus, the character in Greek legend and the person for whole narcissism is named, loved himself as you do and it caused his death. People are not meant to narrow their world and their love to only themselves. When they do, it results in a kind of mental atrophy and the world becomes a very lonely place.

I wish you well.
Dr. Marie

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Am I Going Insane?

by Dr. Marie Hartwell-Walker March 1st, 2024
written by Dr. Marie Hartwell-Walker

From a teen in Serbia: My psychological state was never quite alright ever since I entered puberty it seems. It first all started with a case of mild depression as a result of having some existential dilemmas and coming face to face with the uglier face of this world for the first time. Slowly but surely this feeling of dread started creeping into me, and I completely shut myself of from the rest of the world somewhere at the age of 13, spending my days in the darkness of my room along with a book.

I don’t want to go too deeply into how that all progressed, so let’s just skip to my current state. My “depression” from these past few years at least rarely surpassed the borders of sanity. It still felt like I had my grip on reality and that my brain still functioned alright when it came to some basic human functions, it still felt like everything was somewhat compact and in it’s place although that immense feeling of dread was never ever leaving me. But today, I… I don’t even know.

It’s like everything has fallen apart at the very basis of my psyche. Nothing functions normally anymore I… I can’t memorize as I used to. My thoughts, it would be an understatement to say that they are only completely unorganized – they’re absolutely ludicrous. My identity has become some sort of a mystical term I do not believe in anymore. It’s become incredibly tough trying to organize this chaos constantly, with no end to it.

I’ve locked myself away in my room. Socializing has become harder for me than ever and I just can’t bring myself to go through such torture anymore. Being awake becomes more and more torturous by every passing day. And even in my dreams I can’t find comfort because I constantly have nightmares, nightmares like I’ve never had before. With gruesome pictures of hell. I’m scared. I’m scared. I’m tired.

I understand why you are frightened. I don’t understand how it is that you’ve been able to isolate yourself so severely since you were 13. You didn’t mention what your parents have done or not done about your behavior. I hope you are keeping them informed of your feelings and that they can be supportive and take the needed steps to get you the help you deserve.

Without more information, I have no way to determine if what you are experiencing is the result of a sleep disorder (which I suspect is at least part of the problem), social anxiety, depression or some other problem. I do know that you can’t handle the situation by yourself. You need help. You need a proper evaluation of your sleep habits, your diet, your general physical health and your mental state.

The place to start is with your regular primary doctor. I believe that Serbia has been working on reforming mental health services for almost 20 years. Your doctor will be able to refer you to the appropriate professionals.

Adolescence is tough for a lot of young people. You are certainly not alone in withdrawing into your room. But feelings such as you describe should not be ignored or untreated.

You’ve already lived with this distress for 3 years. There is no need to continue feeling so terrible and so afraid. Please come out of your room and out of your own head and reach out for the support that is available to you.

I wish you well.
Dr. Marie

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I am on an emotional roller-coaster

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP February 28th, 2024
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Since high school I have had a very low self-esteem. I sometimes just stare into the mirror for an hour just observing my flaws and feeling like a total gross 19-year-old girl. But the funny thing is that one day I would feel like the most ugliest person in the world who doesn’t deserve anything…and the next day I would be happy and satisfied with the way looked. This is a continuing cycle that I cannot stop and it is making me very depressed. From elation and appreciation for life to feeling pathetic and worthless…it keeps going on and on and on.

My self-esteem in the past has been so low to the point that I would not look into people’s eyes when talking to them, with the exception of my school friends. I would always avoid big social groups and be the quiet one in the corner.

I have also been hurt in the past when guys would prefer my attractive friend compared to me, which led to me to create this imaginary world in my head where I am the prettiest.

I do this very often. Create these movie-like fantasies in my head to relieve the pain of not having these physical attributes or my desires in reality. I can sit for hours just imagining. I don’t know what’s wrong with me.

I also have a very small group of friends. And this bothers me as my other friends are invited to parties and have boyfriends and enjoying the prime of their age and life…while I am just at home. Sometimes I feel pathetic and jealous. Me not having a boyfriend also fuels this feeling of worthlessness. My friends would talk among themselves about the issues of relationships and it makes me feel horrible.

On the days that I do feel slightly confident and happy I make a real effort to make friends at college and during class…however I feel like a total awkward fool afterwards because speaking to new people always makes me feel uncomfortable.

My brother is always teasing me that I do not have enough friends and although I joke with him about it, it hurts me deep inside. When I am hurt or confused…I go back to imagining a better life in my head.

I am also very, very self-conscious. I feel like everybody is looking at me sometimes and so my actions are very conscious and never relaxed and natural.

I also feel like that nobody knows the TRUE me, as I feel most comfortable in my own skin when I am by myself. I feel like I am a different kind of person for everybody. I am a different person when talking with my family, my friends, my best friend, my college friends and strangers. I feel so conflicted sometimes that I wonder why bother living, when living is a total lie of my true self.

I want-I need to be cured somehow. Thanks for listening to my ramblings.

First, let me say that these are not ramblings to me. This sounds like a very caring, sensitive person trying to find the best way to be known in the world.

There is a Cherokee legend of a grandfather teaching his grandson about life. “A fight is going on inside me,” he said to the boy. “It is a terrible fight and it is between two wolves. One is evil – he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego. The other is good – he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. The same fight is going on inside you – and inside every other person, too.”

The grandson thought about it for a minute and then asked his grandfather, “Which wolf will win?” The old Cherokee simply replied, “The one you feed.”

In the opening of your letter you say that you spend hours looking for flaws, and, no surprise, you find them. When you look and allow yourself to be satisfied with what you see there is happiness. This actually is one of the principles emerging from positive psychology. Over time research has shown you can learn to identify the good things about you and your life and savor them. More on this approach is available here.

Issues of self-esteem are often tethered to things we are avoiding. We avoid them to try to cope, but then we end up feeling bad about the fact we are not dealing with the issue, and this keeps our self-esteem low. We then feel emotionally unable to deal with the issue the next time around, so we avoid it, and the vicious cycle starts again. It seems like social situations and new people are where the rub is. An acting class for beginners will put you in with other people who are looking to grow. The other possibility might be an assertiveness training class. Most communities will offer these through non-credit continuing education courses.

Group therapy can be a place where your roller-coaster ride can be discussed, and experiment with new ways of relating to others in a safe environment. Check this list for therapists in your area.

We can often recognize when our true self is emerging. There is a sense of wholeness and well-being that comes with it. Pay attention to when this is occurring with you, and particularly notice the people, places and things that allow for this true self to be known.

The goal isn’t to feel good about everything and everyone, but to develop strategies for coping with the inevitable difficulties, while returning to the people, places and things that help restore our balance.

Cultivate an appreciation of who you are and your unique gifts and talents. You get to choose the wolf you feed. As you become pleased with who you are, others are likely to join in.

Wishing you patience and peace,
Dr. Dan

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Something Is Probably Wrong with Me I Guess

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

I don’t really know how to properly start this so I’m going to head straight in. I’m L, I’m 14 years old and a maladaptive daydreamer. I’ve always felt different from other kids, as if I knew something that nobody else did, and there was something about me that set me apart from the crowd (I have yet to figure out what those ‘somethings’ are). I was physically bullied at school from when I was 6-8, by three different people. I have little to no memories of anything around that time, just a few ‘pictures’. I moved schools after that, and was okay for a few years, but when secondary school started my friends cut me off and I started self-harming. I went through a really dark time, in which I was on the brink of suicide a number of times (I’m trying to heal now, which is one heck of a ride, but I think I’m slowly getting there)

Anyway, to my point: I keep trying to make myself ‘different’. Something inside me doesn’t feel normal to the point where I’m googling every possible answer as to what it could be. I’ve considered all kinds of things, from DID to the kin community, and it’s getting to the point where I’ll take any answer. Most of the ‘conclusions’ I come to are some form of dissociative disorder, coping mechanism or something to do with hearing voices. I guess the paras in my daydreams could be that though? I’ve been doing this sort of thing since I was 11, which is when I got access to the internet, but I was already trying to figure whatever ‘this’ is out beforehand.

Point being: Is this a normal thing for teens to do? Am I attention seeking? Or am I just being daft?

I’m not asking for a diagnosis, just some pointers would be nice.

(Also, before you tell me to tell my parents, I’ve already spoken to them. They think I’m being ludicrous. They also don’t have the money to take me to a private psychiatrist/psychologist, and they’ve told me on multiple occasions.)

(The NHS will just take me to CAHMS which offers Cognitive-Behavioural Therapy (CBT). I’ve already tried it. and it really wasn’t for me)

Generally speaking, many teens are experiencing the same types of problems you are (with a few exceptions, which I’ll get to below). That’s because the teenage years are very challenging. It’s time when you’re getting to know yourself, who you are, what your likes and dislikes are, and so forth. It’s a very confusing time in one’s life. To say that the teenage years are difficult would be an understatement.

In developmental psychological theory, being confused about one’s identity in one’s youth is considered a normal stage of human development. According to Erik Erikson’s psychosocial developmental theory, you may be experiencing “identity versus identity confusion.” This stage generally occurs in one’s high school years. At this stage in life, individuals are attempting to find their own identity. This includes trying many new things to learn what one likes. During this time, individuals are attempting to determine who they are, what they like, who they want to be, etc. The ultimate goal for this stage is for an individual to find their own identities and to eventually become independent thinkers. If an individual is unsuccessful at this stage, they will experience “role confusion.” If they are successful, they will have more clarity about their identity, their likes and dislikes, and so forth.

Given your age, you may be experiencing identity versus identity confusion. If so, that would be normal for this stage in your life.

You mentioned that you think of yourself as being ‘different’ but you didn’t explain how. Generally speaking, every person has their own unique personality. You are likely very different from other people and that’s not necessarily a bad thing. Normal is relative.

You mentioned that you engage in self-harm and had considered suicide. Though many teenagers have engaged in self-harm and have suicidal thoughts, it is not the norm. This would suggest that something is wrong. They are typically indicators of unhappiness and depression. The key to knowing how to cure these problems is determining the underlying motivations. This is best done in counseling.

You asked several specific questions including: (1) is this a normal thing for teens to do? (2) Am I attention seeking? (3) Or am I just being daft?
The answers to those are questions are addressed below.

1) To some extent, some of what you’re experiencing may be “normal,” as explained earlier, however, cutting and suicidal ideation are abnormal and a sign that something may be wrong.

2) No, you’re not attention-seeking. You simply are acknowledging a potential problem and attempting to describe it. If you’re not feeling mentally well, it’s good to acknowledge it and to seek help for it.

3) You are not being daft. You’re being responsible. It’s a shame that your parents believe you are being “ludicrous” but they may simply not know how to help you.

You mentioned having tried cognitive behavioral therapy (CBT) and it wasn’t for you. CBT is one of the most effective therapeutic treatments in existence. Perhaps you need a different therapist. They’re not all the same. Some are certainly better than others. You may want to try a different therapist. You shouldn’t stop trying to find good help.

You might also ask whether dialectical behavioral therapy (DBT) is available at the CAHMS. DBT is effective for people with certain types of problems and disorders, including borderline personality disorder, individuals who engage in self-harm, among others. It’s not uncommon for therapists who know CBT to also know DBT. You might inquire about whether DBT is available and whether or not it’s appropriate for you. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Needing Help

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

I’m a 15-year-old female. The past 6 months of my school life and sleep schedule have been deteriorating to me physically, but recently it seems like my emotions have been going haywire too. I used to get 8-9 hours of sleep nightly, but have now gotten 4-5 hours of sleep for the past 5 months and have been holed up in my room doing homework more than ever.

I get irritated with everyone much more easily, and find myself sighing and glaring at everyone and everything. I didn’t tell my friends because I don’t want them to be worried about me either. I think of death almost constantly, and it happens out of nowhere. I’m afraid of death, but have had increasing thoughts of killing myself and how I could do it. I don’t believe I’d act on it, but I still get scared. I haven’t self harmed since I’m too afraid to hurt myself either.

My (12 yrs divorced) parents believe I’m overreacting, and refuse to take me to a therapist or mental health professional. (one of them has bipolar disorder and extreme anger management issues too) I have no money to take myself or get a proper evaluation.

Am I overreacting about this?

Much thanks.

You’re not overreacting. Whenever you think something may be wrong, you should take action. Not everyone does, but they should and your instinct to ask for help is a very good one.

Part of why you may be feeling more irritable is a lack of sleep. People are more irritable and emotional when they do not receive the proper amount of sleep. As a teenager, ideally, you should be receiving a minimum of nine hours of sleep. If you’re not getting the amount of sleep you need, you will be less sharp, and more emotional and irritable.

What’s most concerning are your thoughts of suicide. Suicidal ideation is not necessarily a side effect of lack of sleep. It may be exacerbated by a lack of sleep, but it is not generally caused by it. It might suggest that something else is wrong such as depression.

Because your parents are reluctant to take you to a therapist, one way around this may be to consult your school guidance counselor or another trusted faculty member. The more direct you are with them, the more they will be able to assist you. They may also be able to speak to your parents on your behalf and convince them that mental health treatment is the solution to this problem.

It’s good that you are proactive and are attempting to seek treatment. The school guidance counselor will likely be able to assist you with this problem. If not, and you are still thinking about suicide, do not hesitate to contact emergency services. The phone number for the National Suicide Prevention Hotline is 1-800-273-8255. The crisis text line information is the following: text HOME to 741741 in the United States. They will know how to keep you safe. Please take care.

Dr. Kristina Randle

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I Know There Is Something Wrong

by Dr. Marie Hartwell-Walker February 16th, 2024
written by Dr. Marie Hartwell-Walker

From an 18 year old woman in the U.S.: I used to be a talkative outgoing person that would communicate with others and had the ability of making friends. My freshman year in high school I had the most friends. I talked to a lot of people had great energy. I was happy most of the time and would be myself with my friends. I had the best of times.

My sophomore year I became distant to all my friends and focused more on school. I was also disciplined, ate healthy, exercised regularly and had good night sleep. I would also spend a lot of time alone and had little to no communication on a daily basis. I had my happy moments during those times I would feel this energy and happiness, but I would only show it when I was by myself in my room. One moment I would be dancing and jumping in my room and the other I would simply crawl on my bed and begin doing my homework like nothing happened, and I would just assume it was my teenage hormones. I would feel a lot of déjà vu and I would relate my dreams to real life and started to believe I could predict the future (I know its unrealistic).

My junior year is when my anxiety started. I would feel nervous around others and I would keep my head down at all times. I couldn’t keep straight eye contact with most people my friends started to diminish and I started to become alone. Eventually I started feeling anxious with my own family too.

I started college and going to class started to get hard, not because I did not want to go and learn, but because my stomach would make strange noises and it was embarrassing. I would also have anxious moments and then at other times I would feel with a great energy, and I would feel happy/excited for no apparent reason. I also have difficulty sleeping at night. I forget things easily and I have a hard time concentrating. There are moments when I feel sad and depressed and then all of a sudden the depression would disappear. I am not shy. I just get very anxious around others and I can’t control it. I am not sure if I simply have depression or an anxiety disorder, but it is taking over my life little by little.

I’m so sorry you have been handling this for so long on your own. The first thing you do is make an appointment with your primary care physician. It’s always important to make sure there isn’t an underlying medical condition — especially when symptoms have been progressive as yours have been. Share your letter with your doctor if that makes it easier to present your symptoms.

If you do not have a medical issue, then go to see a mental health professional for a complete evaluation. There is no reason for you to continue to be buffeted about by your feelings. There are treatment options including medications and talk therapy that can help you be your best self. The life you had during your freshman year shouldn’t be just a good memory. With treatment you should be able to reclaim that more involved, happier self.

I wish you well.
Dr. Marie

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New job. New town. Old depression.

by Dr. Marie Hartwell-Walker February 9th, 2024
written by Dr. Marie Hartwell-Walker

I am in my early 20s and have been struggling with depression for the past few months. I recently began a new job and moved to a new city, away from my friends and family. I am constantly stressed out and unhappy, and as I am often alone, my feelings continue to become stronger. I know that my job has contributed to my unhappiness, but I feel that I cannot leave it for a variety of reasons.

When I am depressed, I have a tendency to overeat. In high school, I was anorexic, and this evolved into episodes of bingeing and purging in college and afterwards. When I overeat, I experience intense feelings of guilt, which leads to greater feelings of depression. As a result, the cycle repeats. I feel that my behavior has gotten more out of control, and I often feel like I am punishing myself with food. I feel that I have lost perspective, and I no longer know how to regulate what I eat.

I have exhausted my options other than getting professional help. I have tried keeping a food diary, planning meals, and even ordering pre-packaged meals to keep my overeating in check. This has worked only temporarily, but within a few days, I am back to my habits.

I am a very independent person, and I am not sure if I am comfortable talking to a psychologist. I am more interested in possibly seeing a psychiatrist. I know that there are medications that have been proven very effective for depression. I think that this could help me solve my overeating problem and find more balance in my life. I would like to know whether you think this would be a viable option for me.

One thing I am concerned about is becoming dependent on the drugs to control my moods. Is this something I should worry about? I would like to have some way to get to the point that I feel in control again, but I do not want to feel like I rely on the medication. Thank you so much for your help.

You understand yourself pretty well. Now it’s time to take some action. I suggest a three pronged approach: First, you need to find a reason to get out of your house and out of yourself. You need to meet some people in your new town and begin to feel part of your new community. Even if you’re not a “joiner” by nature, you do need to be around people doing something positive to help yourself feel better.

Identify something you truly love to do and find people who like to do it. That could be singing in a chorus or attending a church or volunteering in a political campaign or going on hikes with a singles group. It almost doesn’t matter what you do as long as you do something that you remember you like to do and you do it with others. It also doesn’t matter if you don’t feel like it. Trust me. Getting even a little more active will help.

As far as professional help goes: I think you need both a psychiatrist and a counselor (psychologist or social worker or licensed counselor). Research shows that the treatment of choice for depression is a combination of medicine to elevate your mood and talk therapy to learn some ways to manage your life so you are less susceptible to depression. Especially since you also have a history of an eating disorder, learning and relearning ways to cope with stress is essential. Most people are able to phase out the medicines once they have mastered those coping skills and surrounded themselves with supportive people they care about.

I wish you well.
Dr. Marie

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Depression & Pessimism

by Kristina Randle, Ph.D., LCSW February 7th, 2024
written by Kristina Randle, Ph.D., LCSW

Hello, I’m here to say that I was diagnosed with Major Depressive Disorder and OCD during my hospitalization. I have been hospitalized twice for suicide and depression, as well as grief for the first time. I lost my dad a year ago when I was 12, now I am fourteen, so one year and 5 months. I lost him to a stroke as well as a long-term sickness from diabetes and kidney failure. I went through a deep long bereavement as well as my inhumane thoughts. They would make fun of me and my dead dad, calling me an n%$#r and showing me disgusting images. During that period, I attempted suicide three times. Right now, I feel so hopeless and pessimistic. I don’t believe things will get any better any time soon and I’m convinced that life will get progressively worse from here now on. I believe that the evil in this world triumphs any good people will try to harness. I feel like I’m just mentally dragging myself day by day to only fulfill the needs of my peers and teachers. I really despise going to High school, and I’m only a Freshman! There is no passion in my school nor in my life. I mean, I wanna become an animator and animate my own show and have a family in The U.K, but these are all goals, I don’t know what I truly want to do and I don’t think I will anytime soon. See I have this fear having a different goal, and if I did, then I’d be depressed. Now, I feel Nothing, I’ve been self-harming, technically three times. My purpose was to feel something. At least when I was suicidal I felt something, like, pain and worthlessness. I also miss being depressed. It was like my own little shell that I can keep. It was my safety blanket. No, it was my identity. When I get mad, I get really mad, like I’m gonna do something terrible to myself mad, but that only happened once in my entire life, but these feeling of numbness didn’t come from nowhere. I intellectualized my feelings when I was a young atheist, spiritual now. So, I don’t know what to do, I take medication of course but I wanna get off it because i don’t need a drugs to make me happy. Advice?

You mentioned that you are taking medication but what about counseling? You should not be only taking medication. Counseling is often the treatment of choice or a necessary adjunctive treatment for many psychological issues. If you’re not in counseling, you should be.

It’s also important because of your expression of hopelessness and pessimism. Depression and related ailments can make you think things that are not true. It clouds your judgment and can lead to faulty conclusions. People who are depressed often believe that their lives will not improve and that nothing will change. That type of thinking is obviously wrong and can lead you astray.

Counseling is especially important because of your admitted self-harm. People who engage in self-harm often do so because they lack healthy coping mechanisms. A therapist will assist you in developing healthy coping skills so that you will stop harming yourself.

The solution is to seek professional help, via counseling. Tell your prescriber that you would like more assistance than you are receiving and that medication is simply not enough. Once you begin counseling, you should begin to feel better. With every session you should feel a slight improvement. If not, then find a different therapist. If you feel that you might harm yourself or someone else, contact emergency services. They will protect you and ensure that you receive the proper assistance. Stay safe and please take care.

Dr. Kristina Randle

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Anxiety / Depression?

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

I don’t really know I haven’t been diagnosed I just don’t feel normal. I feel like my whole life probably mainly since the start of school I’ve struggled to connect with people and be myself. I feel like I’ve always been SO focused on what other people think and I just feel so awkward most of the time. I try and force myself to change and it comes of worse. I have people I can talk to but I feel like I’ve never had a friendship that I feel completely comfortable in. I think I have social anxiety mixed with other stuff. I just don’t feel normal. Had a boy that liked me and I really liked him recently and we had great chats over text, felt really close but in person I felt anxious and I just couldn’t open up and I hate myself for it, so it didn’t work out. I just want to be free and live to be honest. Ok so heres my question. Ive had 3 sessions with a psychologist so far and I feel like it wasn’t how I expected. I kind of really want to see a psychiatrist and try some medication but my parents are really against that, but they don’t see how desperate I am- Im way to scared to tell them I have suicidal thoughts a lot because I know they do so much for me, I just feel really desperate and want to try out medication so I’m just wondering if you can offer some advice on what approach I should take to this situation. Thankyou. P.S I know this is not a crisis hotline. I’ve had thoughts from time to time but I don’t think I could do that to my parents. I just mainly want advice on the whole medication thing.

Many people benefit from psychiatric medication, but there are pros and cons. One of the positive aspects about medication is that it can decrease the severity of your symptoms. You might have fewer mood swings and feel your emotions less intensely.

Alternatively, some people complain that medication blunts all of their emotions both good and bad. In that way, the medication might only serve as a Band-Aid for your problems and not a cure. You should read more about the pros and cons of medication by doing research and or by talking to your therapist.

You shouldn’t give up on counseling. You’ve only just started. Three sessions is just a beginning. You said that you didn’t “feel like … how I expected” but you didn’t elaborate on what you meant. Give it more time. It’s good that you’re in counseling. It is where you should be. A good counselor can teach you to correct the problems you have described.

Ideally, if you do begin taking medication, you should do it in conjunction with some form of psychotherapy. Most psychologists will work in conjunction with psychiatrists when they feel that medication would be helpful. Medication alone generally offers very limited relief. Therapy may be enough but medication can certainly be added if indicated. Please take care.

Dr. Kristina Randle

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I’m Not Good Enough to Keep My Mom from Being Depressed

by Holly Counts, Psy.D. February 2nd, 2024
written by Holly Counts, Psy.D.

I’m 15 years old and I’m an only child. When I was 10 I found out that when I was two my mom had suffered from depression, my dad said it was because she was pregnant and then had a still born baby on Christmas Eve. However very soon after my parents talked to me about that my mom lost her job and was out of work for two years. She started changing, she was gaining a lot of weight and would cry all the time. All my life she had been able to sleep a lot but once she lost her job she wouldn’t get out of bed for days. Once she got a new job she seemed “happier” but then she became obsessed with work and likewise obsessed with my schoolwork. It was unacceptable if I got a B, it wasn’t “good enough.” However even though she had a job she would sleep all the time and would always be crying. It got to the point that between work and sleeping she didn’t have time for any of the normal mom things. She stopped doing laundry, cleaning, coming to my basketball games, and so I picked up her slack. Ever since I’ve been doing all my families laundry, cleaning the house, planning out what we need from the grocery store every week and if she ever offered to for example do the dishes so I could go to bed I’d wake up the next morning and they wouldn’t be done. Whenever I would talk to my dad about her he would say that that’s just how she is now because of her brain and that whenever she freaked out on me to not take it personally. Recently me and my mom were driving to Pennsylvania to visit family and she had a panic attack while driving she swore that the truck drivers were out to get her so she pulled over for an hour trying to “clear her head”. Also every time I try to talk to her about a problem with a guy or anything she turns it into her problem and I always end up holding her while she can’t stop crying. All of this started, because she lost the baby and after she lost the baby it was like I wasn’t good enough for her. I wasn’t a good enough reason for her to try to get better I wasn’t good enough to keep her happy I wasn’t good enough for her because I got a 92 in biology and “ruined my chances of going to a good college.” If I’ve never been good enough for her then how can I be good enough to help her? (age 15, from US)

Reading your question breaks my heart for all of you. Your mother’s depression is not your fault. It has nothing to do with whether or not you are good enough. Depression is a real issue that no one can cause someone else to have. Would you blame yourself if she was diagnosed with diabetes?

Losing a child is one of the hardest things people can go through and it sounds like what may have started as grief, or post partum depression, has turned into clinical depression and anxiety. These disorders can affect your not only your mood, but also sleep, thinking, energy level, and even how someone perceives the world. As hard as it may be, you have to not take the things your mother says or does (or doesn’t do) personally. It is about how badly she feels and she may be projecting this onto you without meaning to do it.

You should not be taking on adult responsibilities within the house. It’s one thing to do some chores and help out, but it’s another to run the household. You need to focus on school, friends, hobbies and age appropriate activities. It is not your job to take care of anyone else.

I strongly suggest that you ask to go to family therapy. This is all too much for you to handle without an ally and guide. A therapist can help rebalance the family and provide a safe place to talk about feelings. All of you would also benefit from seeing someone individually as well. Talk to your father about therapy soon, and if you need some extra help with this, you might consider speaking with your school counselor or doctor first.

You are a strong, caring person. You are good enough just the way you are. But, it’s time to be a kid.

All the best,

Dr. Holly Counts

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Potential Abuse from Stepfather

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP January 29th, 2024
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

At the age of 12 I lost my biological father from a rapid stroke. I’ve witnessed the moment when the stroke happened and when his body was convulsing on the sofa while I watched and cried terrified. A few years later by my encouragement, my mother registered on the single dating site. She successfully found this man who might be the beginning of all my next troubles. Maybe a whole year has passed by and I as a fresh model was insisting to live in the capital city of Poland as it was easier for me to continue my modeling carrier and get a better education. My mother agreed but insisted that I would live with this man that she was in a relationship with for a year or so. I agreed. I liked him somewhat. One of the first red flags was the thought that I had while entering the new “home” do the neighbors think that I am his girlfriend or something? (at the time I was around 16 and he was over 50). My mother was to visit me and him every other weekend or we would visit her (4hr ride distance). At the agency, I was constantly encouraged to get “skinnier” and lose weight. Once like every other visit, the agency told me to lose some weight. After coming home, I told this man about this (he was very invested in my loosing-weight journey as in many other things e.g. school). He proposed to me this massaging machine and told me that it might help. So I took it and tried to massage the front and back of my lower part of the body (hips, thighs). Throughout the days he has been insisting to help me with massaging myself because I “could not do this properly myself”. I rejected his offer once or twice but at the end, I gave up. So there I was, laying down on the bed while he was putting oil and massaging my legs with this massaging machine. I had shorts on and thrown over a towel on the shorts. Yet I felt naked. I tried to do something on my phone or talk to him. Just to break the silence. The worst part was when he was massaging me near my private places and between the legs with this thing. I want to underline that he never penetrated me or anything. And because of that, I am so confused. Because it wasn’t abuse now was it? After that, it maybe occurred a few times more. I remember that I just wanted to tell my mother what had happened but I just brushed it off. After that on the spectrum of years, I have suffered from depression, suicidal thoughts and failing at committing suicide, self-harm, thinking I was a male —suffering from gender dysphoria (I still would like to change gender), suffering from Ptsd and recently at age 19, being diagnosed with Asperger syndrome. In the meantime, I was having non-major eating disorders, undiagnosed and untold. I am currently on antidepressants and recently I got myself drunk and cut my leg by scissors. The fact of potential abuse and Asperger syndrome is constantly on my mind. I want to tell my mother and my therapist is encouraging it but I didn’t think she can handle it. I am living alone at my apartment now so I don’t have to see very often that garbage that this man is. I hate him yet I don’t think my feelings are.. valid or legit? I am confused. (From Poland)

There is a lot here — and you’ve displayed a great deal of courage by explaining all of this in your email. I am very glad you are working with a therapist. Having someone guide you through all of this is important.

Since the therapist thought it was a good idea to tell your mom, ask him or her if they would be willing to have a session where you invite your mom in to talk about what you are thinking and feeling — and perhaps to then talk about what happened. This is a very difficult situation you are in, but the fact that you ate still caught in the middle between having these feelings and the man still with your mother makes it particularly uncomfortable.

These things typically have many layers. To begin with, the internal conflict you are having and struggle with your mental well-being isn’t known by your mother. If the therapist is recommending and is willing. Taking care of this layer of communicating with your mom is important. I’d begin by talking to your therapist about this prospect and then take it from there. Keeping it a secret may be causing many of the difficulties or at least contributing to them.

Wishing you patience and peace,
Dr. Dan

 

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Struggling With My Life

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

This year has been very rough for me. In the summer I decided to tell my doctor that I am depressed. I have been depressed for the past six years due to my dad’s suicide. My doctor decided to refer me to a psychiatrist for psychotherapy.

The university I go to has had several problems making an already difficult experience worse. School has been very stressful and I am falling behind on the workload. Usually when I go to school I act happy or at least normal but I can’t do it anymore. I don’t even have the energy to fake a smile. People at school are constantly asking me what is wrong.

I also have issues at home because I live with my mom and her husband. They treat me like an object and my mom’s husband calls me “roommate” (which is actually one of the nicer things he calls me) because I am not part of the family. When I’m at home I get blamed for everything and if they’re having a bad day they yell and take it out on me because they know I can’t do anything about it. Whenever I argue back they threaten to kick me out and I can’t afford to move out because my tuition is very expensive. When I am at home I go straight to my room and stay there because I can’t handle them anymore. Every cut I have made on my body was because of them.

I have never been this depressed before. The only reason why I get out of bed every day is because of school even though it is stressful. It has been a dream of mine to get into this very competitive program at school. I am so confused because I love the program I am taking but I also want to give up because I am doing really badly in some of my courses. It seems like I have issues with school or personal problems every day, I feel like everything in my life gets screwed up and it is because of me.

This week I went to see my psychiatrist for psychotherapy for the first time. It was very awkward and I felt very uncomfortable. I was so nervous I didn’t take off my coat the entire time I was in there. I barely talked and stared out the window for most of the session as he typed away on his computer. He brought up some things I didn’t want to talk about like my dad’s suicide and said we could discuss them later. The thing is I don’t want to go back. I know I don’t talk a lot so this is going be an issue and even if I do talk I don’t get how this is going to help me. He said I have depression and I should continue talk therapy and take antidepressants. I told him I didn’t want to take antidepressants so he told me to think about it. By the end of the session I guess I looked a little unimpressed because he asked me if I was coming back and I replied I don’t know.

The next day I had class I just sat there staring at my binder. I couldn’t focus because I was so depressed. My friend noticed and I told her I was having a bad day but she didn’t buy it so she asked again in the hall and I told her about my depression. While we were in the hall the teacher walked by and asked if I was okay but I just brushed her off. Well, yesterday my teacher sent me an email saying “Are you ok? You are very quiet in class. If there is anything bothering you about the class please speak with me. I would like to speak with you anyhow Please make an appt for next Tues after class. I will be meeting with some Level 4 students and I can meet you right afterwards”. I don’t know what she wants and it is making me really anxious. I really hope I don’t have to explain to her what has been going on lately because it’s very personal.

I don’t know what to do anymore. I feel like I am failing university and all I want to do is give up. I use to have suicidal thoughts to escape my reality but now I have a very strong urge to do it. Every time something goes wrong I want to kill myself. I don’t think I want to die but it just seems like it would be easier and no one is going to miss me so who cares. I know I should phone the psychiatrist and make another appointment but I am scared that this is my last option to make things better and it isn’t going to help.

Please give me some advice because I am struggling with my life.

I think it is important that you try to talk about your issues with a therapist. I cannot tell if you are uncomfortable talking about your issues in general or if you do not like your particular therapist. If it is the latter, then consider making an appointment with another therapist. You do not have to keep the same therapist. If you find someone who you like and trust, then you may have an easier time discussing your issues. The right therapist can make all the difference.

As I alluded to above, a large part of being helped requires that you be willing to share your thoughts and feelings. The depression you are experiencing is understandable. It makes perfect sense. Many people would feel the same way. You lost your father to suicide. Losing a loved one, especially in such a tragic manner, is one of the most difficult experiences in a person’s life. I suspect that you have yet to properly grieve the loss of your father. In addition to your father’s death, your current living situation is stressful. The stress associated with your living situation is negatively impacting you at school. You are suffering emotionally and you are struggling to function day-to-day.

My biggest concern about your letter is that you are contemplating suicide. You need to know that there are many ways to handle the issues you are facing. Suicide is never the answer. People often feel suicidal when they feel there is nothing left for them to try. If you examined your situation logically, you would see that you have yet to try treatment. You went once and barely spoke. Help is available. Psychotherapy helps millions of people. You can be helped too, if you give treatment a chance.

What if you had a friend who was struggling with issues in her life? What advice would you give her? What if she wanted to end her life? You would probably beg and plead with her not to do it. Why? Probably because you would see that she could be helped and committing suicide would be an absolute tragedy. It is difficult to think clearly and logically when you are in the depths of depression. Thinking about it from the perspective of a concerned friend may help you to better understand why suicide is never the answer.

My advice is that you try to attend psychotherapy appointments and change therapists if needed. Force yourself to go if you have to. It might take a while to feel comfortable about opening up in therapy and that is okay. Not everyone comes into therapy ready and willing to share their life’s story in the first few sessions. It takes time to build trust between a client and therapist, just like it would in any other relationship.

If you are actively suicidal and strongly considering harming yourself then please call 911 or go the emergency room immediately. If you need someone to speak with or are feeling overwhelmed don’t hesitate to call the suicidal hotline. Their number is 800-273-8255.

Lastly, I must reiterate this to you: suicide is not the answer. Suicide is a human tragedy. People who have attempted suicide and lived often thank God that they did not die. Usually they see that life does improve for them. They see that help is available. Life can get better for you, just like it did for all those other people who like you were convinced that it would not. Learn from the people who nearly died from a suicide attempt and lived to witness an improvement in their lives.

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I need to be needy

by Dr. Marie Hartwell-Walker January 26th, 2024
written by Dr. Marie Hartwell-Walker

I am very heavily emotionally invested in maintaining my self-image as a needy, immature, unworthy child instead of a confident, mature, attractive adult woman. The very idea that I am actually an middle-aged adult woman has been upsetting, as I’ve never thought of myself as a responsible adult ever. It shows in my life. No relationship, no children, no decent job, nothing to show for my life. The only thing I see that I’m getting out of these thoughts and feelings are the sticky comfort of old habits. I refuse to take risks, even though logically, I know I’ve “failed” before and survived. It’s as if I can’t bear making any more mistakes or lose another relationship or put myself out there again for anything.

Recently, when I realized that I’ve put myself down for no reason at all for 35+ years, I actually cried, not from relief, but from the knowledge that I have to do some difficult work to break these thought patterns. It feels like it would be so much easier to just let the habitual thoughts hold sway. I’m used to being poor, working crap jobs and not being in a relationship.

I’ve had some pretty convoluted thoughts that I’ve used to keep me safe in my comfort zone of doing the bare minimum to get by in life, such as convincing myself that I’ll only attract losers forever, or that I’m not as talented as I think I am in the field of endeavor I wish to pursue; both of which have been proven wrong in reality repeatedly. But when the opportunities come, I run the other way, convinced that I can’t handle them and that it’s wrong for me to take advantage of them. I also feel “better” believing that no one likes me and that I don’t fit in, and that my desires and ideas are “above my station,” thus unattainable and that I’m unworthy of working towards what I want.

I am mired in what is almost these fake self-doubts. It’s as if I believe that if I have some self-confidence, I’ll become a person who’s too big for their britches or that by succeeding, I’m hurting other people.

How can I stop feeling angry about knowing that these self-defeating thoughts must change? My life is slipping away.

What an insightful letter! You’ve done half the work already. You’ve clearly outlined the problem and you seem ready to consider some changes. Without talking with you further, I can’t venture why you’ve backed away from life so utterly. I am sure that there is a good, but not very useful, reason. It’s important to get to some new understanding so that you can stop scolding yourself and instead have compassion for the younger you who came up with the best solution she could at the time. Once you know what the problem is (or was), you can turn your adult mind to finding a better way to address the problem than staying stuck in a kind of perpetual adolescence. I hope you’ll make some calls to find a therapist who can help you make sense of yourself and move forward. You are fortunate to live in a city where there are probably thousands of qualified therapists. Ask your doctor or people you trust for a referral.

The anger you are feeling is energy. You can use it either to dig your hole deeper or to jumpstart yourself into some action. I really, really hope you’ll do the latter. Get the support and help you need so that the second half of your life isn’t a repeat of the first. You deserve so much more.

I wish you well.
Dr. Marie

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My Daughter Blames Me for Her Suicide in Her Farewell Letter. How Can I Survive?

by Kristina Randle, Ph.D., LCSW January 23rd, 2024
written by Kristina Randle, Ph.D., LCSW

From Netherlands: Our beloved daughter committed suicide at age 20 on 9 September 2014. She was a brilliant student but had difficulties with her studies and holding friends. She was depressed and liked to be home with us her parents and sister. She was diagnosed with autism or schizoid. She decided not to be treated. She could never express her feelings, she said she could not feel. She took pills and left us on 9 September 2014.

We found an extensive farewell letter in English called ‘Lost cause’ of 16 pages. She describes the trauma coming early but not saying what is was. She said love was supposed to be something special. She was always feeling guilty about her parents potentially breaking up and not understanding why others did not see it her way. She called herself empty and got directions about feelings from her ‘inside thing’ taking over since age 5. She left us also a copy of an article about priming trying to make clear why she was so upset about breaking love and used priming to make a link to her past at age 5 when I had an affair and left home for 2 months and my wife cried a lot. My daughter states in her letter: don’t leave, we can work it out, we don’t need money.

Ever since finding the farewell note O blame myself that she had relationship trauma and became schizoid of this. I am seeing a therapist but I blame myself and cannot find a way to prove that a break up of 2 months could not have caused her death. A copy of her farewell letter can be forwarded.

Mental illness can be difficult to treat. In your letter you said that she chose not to take treatment. Without treatment, there is very little chance of improvement. With the course that she chose her suicide is not to be unexpected.

Her suicide is a result of her mental illness and that is clear. What you are questioning is the cause of her mental illness. With schizophrenia and autism there is no evidence to suggest that the actions or inactions of a parent can cause these disorders. This research is objective and if there was a possible link to the actions of a parent as the cause or a potential cause of these disorders, it would have been reported in the literature.

Unfortunately, it is very difficult and in many cases impossible to force someone into therapy or to take medication. There are many family members, who have loved their daughter, brother, mother, sister, father, etc., as much as it is possible to love and still they were unable to get their very loved family member, to accept treatment.

It is safe to say, that leaving your wife and child for two months did not cause your daughter’s schizophrenia or autism. Leaving for two years would not have caused your daughter’s mental illness. Divorcing your wife and never again contacting her or your daughter, would not have caused your daughter’s schizophrenia or autism. It is obvious from your letter that you love your daughter very much. It is also safe to say that from what I’ve read, at least in my opinion, you would have very gladly given up your life for your daughter, and if it would bring her back you probably still would. However, even sacrificing your life for your daughter would have neither prevented or cured her schizophrenia or autism.

If you had never known that you had a daughter, if you had never known that you had impregnated her mother and thus never even known of the existence of your daughter, her schizophrenia or autism would still have occurred. Her death was a result of her mental illness, just as surely as a death caused by cancer.

Use the love that you have for your daughter, take that love and spread it in the world by doing good for others. Honor your daughter by helping others. Spreading flowers on her grave will not help your grief. Spreading love in this world will.

Good luck my friend.

Dr. Kristina Randle

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PTSD & Don’t Know What to Do

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

I have been on multiple deployments, recipient of the Purple Heart in combat. I have been diagnosed with PTSD and not on any drugs of any kind because I don’t want to be. The Army doctors are only interested in giving me drugs and since I am not suicidal there is nothing they can do for me. For the past 2 years I have felt more and more socially isolated. I spend my days at work and in my barracks room, I do not do anything besides sit in my chair and watch TV. I do not see the point of going out and doing anything because plan and simple cant find a reason to leave my room other than going to the store for essentials. Do to age and being single my social group is extremely limited in my opinion, most people that live in the barracks are 5 to 8 years younger than me and are only interested in going out and getting drunk to have a good time. I do not drink heavy and will not start, i think being drunk is pointless so actually going to bars around here is something i just don’t do. That again limited my social interaction so i just sit here without a social group and friends.

Naturally I have been single for over two years, this fact has led me to do most everything alone. I will do most everything by myself, from going out to eat to going to the movies. That got old quick so I just stopped going out. I just don’t know what to do with myself anymore, just getting to the point of not caring about much of anything.

I am not familiar with the mental health services that are available to you at your military base. I am assuming that if you are allowed to leave the barracks to go to bars and movies, then you could attend mental health services as well. Are there are psychological services outside of the barracks that you could utilize? Perhaps there are mental health facilities that offer support groups, group therapy or individualize therapy sessions.

You should also consider attending a church and becoming involved in their activities. For many people, there are significant psychological benefits to both participating in church activities and assisting others in need. For many people, it provides great meaning to their lives.

Twenty years ago, there was a lot less known about post-traumatic stress disorder (PTSD). Current, cutting-edge treatments typically involve more than medication. I would encourage you to talk to the clinicians at your base about what you have been experiencing. Inquire whether they offer group or individual therapy for individuals with PTSD. There may be other treatments for PTSD of which you’re unaware.

I also wouldn’t rule out medication. It is possible that a low-dose medication could significantly improve your symptoms. You should be open to any treatment which could improve your life.

I hope that you will consider my suggestions. You may also want to review these resources: the Iraq and Afghanistan veterans of America (IAVA) and the Womack Army Medical Center. Please take care.

Dr. Kristina Randle

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What is My Diagnosis?

by Kristina Randle, Ph.D., LCSW January 9th, 2024
written by Kristina Randle, Ph.D., LCSW

Q. What could I possibly be as far a diagnosis? I was just wondering if you could at least give me some direction in which diagnosis I probably have. Sexually abused 6 times by different men, unable to recall certain events in my early life and bad short term memory. When I trigger, I guess you could call it, I tend to rock back and forth, repeat things, (ex-im a bad girl, bad girl), tend to go into the fetal position, I get exteremly paranoid, I play with my hair, in really bad times I suck my thumb, I hear things out loud at times not alot though (ex. Theres a spider in there)…when I sort of trigger, I tend to repeat things in my head but thats it or rock standing up..its not that noticably though.My triggers happen everyday though I do not know why. I have nightmares ever ynight, and I have been an SI for over 6 years. I have never been diagnosed or have a therapist, Im currently trying to get one. I dont do those tests because I feel Id be biased and get test results maybe not so accurate. I have had sucidial attempts 6 times. but I have been trying to hurt myself since I was very young…dropping my moms weights on my feet trying to break them, sitting in the middle of the road playing cards waiting for cars to run me over, and trying to put my legs on the car exhaust pipe to burn them. I never thought those were SI attempts however I put two and two together later realizing they were performed intentionally for intentional harm plus this website helped me realize that. Do you have any outline on what I might have? What it possibly seems like, I know you cant diagnose me but any idea would help.I have asked others about this, however I am getting sick of being mentally unwell and not knowing what I possibly have.Thank you.

As you have alluded to in your question, it is difficult for me to give a diagnosis over the Internet. To be honest, I am unsure whether you have a psychiatric diagnosis per say. I am not saying that you are not suffering and I am not saying that you do not have any diagnostic symptoms. What I do mean is that your symptoms do not seem to match any one formal diagnosis, as measured in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Given the little information that I do have from your e-mail, your symptoms seem to be closest to matching the diagnosis of Major Depression. You must remember that I am basing this on very little information and I have no true way to know what diagnosis you may actually have. The truth of the matter is that having or getting a diagnosis, in many cases, has little utility. What matters most in your situation is that you are suffering and have suffered with depression and suicidal ideation since you were a young child, and you have yet to seek treatment. The goal for you now is not to find out if your symptoms match DSM-IV criteria. Rather, your time and energy should be geared towards finding a mental health professional who can help you relieve your mental anguish so that you can start living a happier, healthier life, free from depression and suicidal ideation. You have lived with mental anguish for far too long and for your own well being, it is time that you make your way to a professional. I am glad that you are getting sick of feeling mentally unwell. Perhaps now you will take the necessary actions needed to help yourself feel better.

Allow your therapist to thoroughly investigate your case and allow that person to find the source and solution to your problem. Many conditions have multiple components and as such fit no one diagnosis code well. Good luck on your journey into therapy. It could be the road to the contented, happy life that each person so richly deserves. Take care.

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Do I have anorexia?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP January 8th, 2024
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Two years ago – 2008, my freshman year of college – I weighed nearly 200 pounds, but after apparently successfully dieting and cutting certain foods/liquids out of my life (namely soda/caffeine) and incorporating exercise into my routine, I now weigh nearly 155 pounds. Prior to my weight loss, I was miserable and self-conscious about my weight and appearance, but these results have boosted my confidence. This past semester (2010), however, I started forcing myself to vomit on occasion – beginning in February. I can’t remember how or why this started, but for the past four months, I feel on certain occasions when I eat more than 1200 calories that I am immediately becoming overweight and fat. I always count calories, and try to maintain a 1200-calorie diet. When I exercise (which was normally when I was at school) I primarily run (about 10 miles a week) but since my return home, I’ve fallen out of my routine and I’ve become very anxious about my physical activity – I feel like every moment I’m not moving, I’m developing muscular dystrophy. My vomiting as a result has become more frequent. As a result, I’m frequently light-headed, dizzy, lethargic, miserable, nervous, and lacking of an appetite. I’m trying to seek help for this, but I don’t know how to properly diagnose myself – and I’d like to understand what’s wrong first. Am I suffering from bulimia or anorexia nervosa? I don’t know if I’m bulimic because I’m told you need to vomit after every “big” meal, and sometimes I go days without vomiting. I’m also a guy, and I’m told eating disorders are more frequent in women, so this has me doubting and confused. Please help!

Thank you for writing us about your issue. Eating disorders run the gamut. While they have criteria that more specifically characterize one over another, it is not uncommon for a variety of symptoms to be present at different times. I can understand your confusion and hesitation. But you have described enough details here to indicate that the weight loss, change in routine, self-induced vomiting, lightheadedness, lethargy, nervousness, lack of appetite and dizziness are cause for concern.

Although you did not mention your height, it is very likely that your 1200-calorie count is too low to maintain without the help of a professional. You may want to enlist the help of a registered dietitian who can monitor your diet and make recommendations for balancing out your eating, exercise and nutrition. You can find direct help in your area from the American Dietetic Association.

You may also want to work with an eating disorders therapist (available at the top of the page under “find help”) to help with understanding the emotions often associated with eating disorders. I think with the right professional guidance you will be able to orchestrate a plan that allows for positive changes.

While it wouldn’t be possible to answer your question about a diagnosis for you, I do want to respond to your question about men and eating disorders, particularly anorexia. While estimates vary, men constitute five to 10 percent of the cases. Dennis Quaid, the famous actor, recently used the phrase “manorexia” when describing his bout with the disorder.

You have already demonstrated that you are very willing to work hard at bringing productive and sustainable change into your life. I hope this has been helpful.

Wishing you patience and peace,
Dr. Dan

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How to get parents into therapy?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 30th, 2023
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I’m a happily married 27 year-old living with my wife. My problem is with my in-laws. They have been married for 28 years… mostly not happily. Over the last few years and especially over the last few months things have been escalating with serious thoughts of divorce. The problem is that they simply do not know how to communicate and so they go around in circles when arguing often attacking/defending themselves and each other. My question is quiet simple:

How do you get someone into therapy who is not interested in seeing a ‘shrink’ or ‘paying someone to listen’?

This is a very good question, and I do have some thoughts I can share with you. But my views on this take a more functional approach to getting the couple into therapy rather than the usual path of helping a couple work together with a therapist for the goal of improving the relationship and staying together. Let me explain.

From your description they are not good or easy candidates for couples work because of their resistance and lack of motivation for healing. In these instances, since it looks like they are heading toward a divorce, I appeal to couples to save themselves a fortune and make one of three recommendations. All of these tend to move them out of the boxing ring.

I recommend a divorce mediator (NOT divorce lawyers). A divorce mediator is someone specifically trained in putting together a memorandum of understanding that saves the couple tens of thousands of dollars in the divorce process. But what it more often than not does is let the couple stand on the rake of reality with a third party present. The divorce mediators are trained to detect how ready a couple is to move forward in a divorce and are usually in the position of being able to recommend a professional couples counselor to help with the emotional issues.

Secondly, when couples are this cantankerous I recommend they do a couples weekend where they use an intensive approach such as Imago, to get the issues out and clarified. In these instances I make this recommendation by saying they have spent X amount of time together and they should give it at least one weekend to see if there is anything left that can be salvaged. I also point out that they will want to understand what went wrong in this marriage because it is likely they will make the same mistake again with their next partner and they should try to learn from this relationship how to avoid making that error again.

Finally, I implore them to go for a one-shot assessment with a couples expert who would see them once, usually for an extended session, to help them with the next step. Again, the approach is a functional one as I say that a divorce is expensive and a mediator, a weekend, or an assessment can save a lot. This often appeals to couples at a level they intuitively know to be true. The message is: just because you are angry at each other doesn’t mean you have to both waste your resources on fighting through lawyers. This, somehow, has been an effective approach.

Wishing you patience and peace,
Dr. Dan

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Bipolar or Just Lonely?

by Dr. Marie Hartwell-Walker December 28th, 2023
written by Dr. Marie Hartwell-Walker

I graduated from college last year but I moved to a new country and haven’t got a job yet. Hence I spend most of my time at home alone. I have bipolar 2 disorder diagnosed 2 years ago. I am on daily medication(Valproate 750 mg). My illness is well controlled on the whole. I haven’t had hypomanic episodes after i started medication. However, I have been feeling low and don’t feel like doing anything for the last few months. I have been taking a language course for the last 1 month so that was keeping me busy in the mornings. I feel normal when I’m out around classmates or with my husband. However once I’m back home and alone, I feel depressed and lonely. I don’t have real friends here. Just a handful of people I hang out with once a week or once in 2 weeks.

Now that my course is over, I just feel depressed all day. Don’t feel like studying, doing house chores…nothing. I just eat(I also want to binge) and watch TV all day. I feel like im sabotaging and self-destructing myself but can’t help it. I feel safe and comfortable just lying on the sofa all day. The only time of the day I feel better is when my husband is back from work and I have him around.
This feels so much like the depressive periods I used to have years ago before I got diagnosed. However, it isn’t as serious as before. I don’t know how to get out of this vicious cycle.
I also haven’t visited a psychiatrist here and it’s going to be complicated since I’m in a new place.

Do you think it’s my Bipolar or the loneliness or stress of moving/not having a job?
What can I do to help myself?
Thanks

Thank you for writing. You have made many changes in the last year that are causing you stress. Please don’t scold yourself for it. Many people would find your situation challenging. That being said, it’s time you took better care of yourself. You are taking serious medication without any support of monitoring from a psychiatrist. It may be that you need a change in dose or a change in medication. Please identify a psychiatrist today and make an appointment.

And, yes, you may be quite lonely and at loose ends. As difficult as it may be to think about, you need to do more to connect with people and make some new friends. A job will help. So will finding an activity or club (book club? art lessons? political work?) that puts you in contact with people who share some of your interests. It’s a time of winter sports in your part of the world. If you don’t know how to ski or skate, think about taking some group lessons. You will get out of the house and you will meet some people. As you know, some strangers are just friends you haven’t met yet. Gather up your courage and get out there. With more to do and more people to do it with, you will soon feel more comfortable in your adopted home.

I wish you well.
Dr. Marie

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Depression or Bipolar?

by Kristina Randle, Ph.D., LCSW December 12th, 2023
written by Kristina Randle, Ph.D., LCSW

I’m not really sure where to start. For about 4-5 years I’ve alternated between depression and a very hyper and (usually) happy mood. The depression usually lasts a few weeks, sometimes a month or so. The hyper mood rarely lasts as long, usually a week or two.

I usually think about suicide a little when I’m depressed, and seriously consider it every few months but talk myself out of it because I know I’ll feel better eventually. (I also know I’ll get depressed again, but I don’t think about that when I feel that way.) Occasionally it will seem like I’m sort of disconnected from everything, like everthing is hazy, like in a dream although I know what’s real and whats not. Once it got so bad that I started to believe my mom was keeping me at home forever (I’m homeschooled) and would kill me if I tried to escape or found out about her “plan”, and that my brother was part of it(not true at all by the way). Other than that I don’t know what else to say about it, I guess it’s mostly just typical depression. Now I’ll explain the hyper mood.
It starts with me not being tired at all and just feeling silly.

I can sleep 0-5 hours a night for several days and still not be tired. It seems like I do everything faster, and after a little while it gets annoying because everything else seems too slow and starts to get boring/frustrating. I get distracted almost constantly by how fast I think. My thoughts are loosely connected by one detail of each thought, or I make up conversations I’d like to have with people (almost like daydreaming). It used to get so weird that I would start to believe impossible or nearly impossible things. When I was about 13 I learned one song on guitar and believed i would be the most famous guitarist in the world by the time I turned 14. I once believed invisible cameras were following me and somehow recording what I did then to be used in interview or something in the future when I would be on TV. Similar things like that happened alot until I was about 15, I still daydream like that alot but never believe it as much as I used to. Colors seem brighter and its like I’m aware of everything. Sounds, smells, peoples conversations, basically everything becomes clearer. Recently its been more anger and anxiety than happiness, especially after several days of it. That’s all I can think of for explaining that part.

Ive occasionally heard things in either/both moods. Usually just noises or my name. Sometimes I get really angry, sometimes over very little things. When I was younger I would throw/break things when I got really mad, after awhile my mom nearly made me go to therapy so I learned to stop throwing/breaking things but I still get just as mad. It usually feels like I can’t control it, like the anger takes over me completely.
My family history:

Ive occasionally heard it mentioned that my dad is bipolar, but I dont know for sure because I havent asked him.
grandma, aunt and uncle on antidepressants (dont know exactly why)
Cousin that attemped suicide once (also dont know why)
other cousin that was kicked out of the coast gurd for some mental or emotional issue (again dont know exactly what/why)
grandmas brother that was severely depressed almost his whole life
Thats all I remember.

Because of my dad I’ve taken the bipolar quiz on this site and I scored a 43, but I’m not taking it too seriously because its just a quiz.
Well thats it, sorry its really long but I tried to put as much detail as possible. Thanks for reading this.

If you are a regular reader of my column then you know that it is difficult for me to give an individual a reliable diagnosis over the Internet. Based on your letter it is possible that you have bipolar disorder. You have described periods of depression and mania. What you describe as being “a hyper mood” is fairly consistent with the description of mania. If you would like to read more about the signs and symptoms of bipolar disorder please click this link.

What can and should you do? Make an appointment with a mental health professional. He or she could help you determine if you meet the criteria for a diagnosis of bipolar disorder. You may want to choose a mental health professional who specializes in the treatment of bipolar disorder.

After you have been evaluated discuss with the clinician what type of treatment would be best for you. I would not recommend ignoring your symptoms. Aside from the fact that you may have bipolar disorder my concern is that you have suicidal thoughts. Individuals with bipolar disorder are more likely to attempt and complete suicide. This potentially places you at a higher risk for suicide. Suicidal thoughts need to be taken very seriously. I would advise anyone who is having thoughts of suicide to see a mental health professional immediately.

Writing a letter is a starting point but more needs to be done. I hope you will follow through and make an appointment with a mental health professional. If you have any further questions, please do not hesitate to write back. Lastly, here is a link to the Psychology Today website where you can search for a therapist in your community. I wish you well.

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