I would like to make it clear that my friend has not been formally diagnosed by any of her (former) therapists, at least to my knowledge. I have known her for a few years now, so I would like to say that I know her pretty well. She epitomizes the descriptions and symptoms of APD. She has horrible self esteem, is very self critical, has panic attacks from seemingly normal things because they include some form of social interaction, mistrusts others, is hyper-sensitive, isolates herself, feels unworthy of anything, and is generally miserable. And when I say panic attacks, I mean vomiting and hyperventilating, sometimes missing school. And while I accept that my own little “diagnosis” has every chance of being completely wrong, I would still like to be able to be there for her. She has refused therapy, because she says it makes her feel worse. When she has gone to therapists, and they will only prescribe anxiety medication to her if she promises to continue with therapy, which, like I said, she won’t. She constantly goes to me when she has trouble though. I have no problem giving advice, but I don’t want to give her the wrong kind. Keep in mind that I have been encouraging professional help almost every time. I’m talking about what to say to help her feel better. What do I say when she says she feels ugly? Feels worthless? Feels lonely? Feels resentment (towards others)? Do I just keep throwing as many positive thoughts and compliments as possible her way? Does it matter if they are true? Because I try to keep them truthful. Should I tell her how she is being unreasonable and stick to it? Should I act as if what she is saying is true and how to work around it? All of the above? None of the above? I will admit it is a lot of pressure, but I sincerely don’t mind. She’s one of my closest friends, and she’s usually there for me, so I want to be too. How should I be there to help her?
From your well-thought-out letter it is very clear how much you care for your friend. But the truth is you are not going to be the one that can change her. If it really is APD the heavy lifting on that is going to be done by a professional. But there are some things you can do to help.
Stop.
The dynamic of you helping and trying to figure out how to change her and make her better is actually part of the pattern that needs to be broken. Here is the cycle: You try, she fails, you feel frustrated, and she doesn’t get better while you wrack your brains trying to make her feel better. What I would encourage is for you to stop this cycle of trying to get her to feel better. From your description nothing you have done has worked, and if makes you feel frustrated it is time to stop.
Instead I would find ways to accept your friend as she is, and highlight the genuine things she does that are positive in spite of her emotional and behavioral patterns. This isn’t to fix her, per se, but to remind her that even though she has some avoidant patterns she still is able to have these positive features.
Finally I would tell her what your frustration and difficulty has been, and is, being around her. If this is going to be an honest friendship then you saying your truth, and her being able to hear it, is important. You are not her therapist; you are her friend. Friends need to get something from each other and give something to each other. Let her know how you feel and what you need. Otherwise you will spend your time trying to rescue her, and being frustrated.
Wishing you patience and peace,
Dr. Dan
