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Accurate Diagnosis

Bipolar?

by Kristina Randle, Ph.D., LCSW July 7, 2023

written by Kristina Randle, Ph.D., LCSW

Hi. I am a 38-year-old female who was diagnosed with bipolar disorder in 2008. Since the age of 13, I have found myself depressed more often than not, with episodes of hypomania few and far between and intermittent periods of normalcy.

I sometimes have auditory and visual hallucinations, with the auditory ones occurring more frequently than the visual ones. I can usually identify them as being unreal — they sound like a radio that has been turned on very suddenly, then they fade as though the volume is gradually turned down. I also sometimes get strange and illogical ideas that I only recently realized are considered unusual. For example, I will feel like it’s really a different era than the present one, and as a result everything feels wrong – everyone is dressed wrong, the cars are all wrong, etc, because they don’t fit the era I feel like it is. I know that it isn’t really that era, but the idea persists, and I can’t shake it.

I have always been something of a loner, but recently I have gone beyond simply not wanting to be around people to feeling unsafe among them. They all somehow look and seem ominous, as do many environments such as bars, theaters, etc. Everyday objects also seem to have a “scary” edge to them, especially shadows. Even though I know it’s illogical, I often feel like someone is watching me or someone else is around when I know I’m alone. This feeling worsens at night. I’m suddenly very anxious around groups of people, whereas before I could just ignore them. Along with the new feelings of anxiety and fear, I intermittently find myself having difficulty putting my thoughts into sentences, and forgetting things. My memory has always been terrible, but it is much more so now. I feel generally confused and out of sorts most of the time. I often feel unreal or like what I’m experiencing is a dream, and while those feelings often go along with my depression, they are much more intense now.

I’m wondering — do all these things tie in with bipolar disorder? If so, why all of a sudden would they start after all this time? I am on no medications, for bipolarism or anything else, so I know it can’t be medication related.

Without thoroughly evaluating you in-person, I can’t determine if your symptoms are related to bipolar disorder. Only a clinician who conducted a thorough mental health evaluation could make that determination.

Your symptoms are concerning. As you noted, they are worsening. You described auditory hallucinations, a number of illogical thinking patterns, social isolation, paranoia, memory and other cognition problems. You may be experiencing psychosis. Psychosis is a break with reality.

It’s imperative that you are evaluated by a mental health professional. He or she can determine the nature and origin of your symptoms. After an evaluation, treatment will be recommended. In your case, they may suggest counseling and medication. Counseling can help you to stay grounded in reality. Medication is particularly effective in reducing symptoms of psychosis.

You should not ignore your symptoms. Psychosis generally does not improve on its own. Treatment is almost always required. Fortunately, there are very effective treatments for your symptoms. Early treatment of active psychosis is associated with positive outcomes. Please take care.

Dr. Kristina Randle

July 7, 2023 0 comments

Separation Anxiety Disorder

by Kristina Randle, Ph.D., LCSW February 7, 2021

written by Kristina Randle, Ph.D., LCSW

I’m 18 years old and I was home schooled until my sophomore year in high school. When I was in second grade my parents had to pull me out of school and home school me because I would throw up everyday before school and I would cry because I didn’t want to leave my mom. I would continually have nightmares that I would get kidnapped and so I slept every night in my moms bed until age 11. Once I was in high school my problem seemed to go away and I figured it was just me being a little kid. I remained fine until my senior year. I met a boy and we began dating. I didn’t really care that much about the relationship in the beginning and everything was fine. One night we went to a party and I had a psychological reaction to a synthetic drug. I went to the hospital and they let me go thinking I was physically ok. After that night my “fear” came back slowly. I started wanting to be around him all the time and wanting to spend the night at his house or having him come to my house. After we graduated we attended schools in the same town. I got an apartment with some of my friends I told everyone it was time for me to branch out, but the real reason was just so I could be closer to his dorm. I thought that would be enough but then I started wanting him to stay over all the time and I didn’t want him to go. And when he would say it was time for him to leave I would start sobbing and throwing up or shacking. I would do anything to make him stay there with me. He now lives with me and its still getting worse. It doesn’t seem to stop ever. If he talks about possibly going out of town for the weekend I freak out. If I don’t know where he is or he doesn’t answer my calls I get so scared and I begin to feel sick. I literally can’t stand this feeling, but I don’t know what I should do or how I can change this? Please help me.

You refer to this problem as separation anxiety disorder but a more accurate diagnosis may be dependent personality disorder. In order to determine what disorder, if any, you have, it would be best to consult a mental health professional who could interview you in person and gather a detailed biopsychosocial history of your life.

As you have described this problem, it is significantly hindering your life. It seems as though you struggle to have the confidence to be an independent person. Fortunately, you recognize that a problem exists and are willing to seek help. The prognosis for such an open-minded individual who is receptive to treatment is excellent.

Many people your age struggle with developing their identities and gaining their independence. You might struggle with this issue moreso than the average individual but it is still a correctable problem.

You also mentioned that you had a reaction to taking a “synthetic” drug. You did not detail that situation any further but that experience may have had a negative impact on your psychological state of mind.

My recommendation is to receive counseling. A mental health professional could assist you in addressing this problem. It is important to seek help sooner rather than later. The main reason is because this problem is interfering with many aspects of your life and if left untreated would likely continue. The find help tab, at the top of this page, could help you to locate a mental health professional in your community. Please take care.

Dr. Kristina Randle

February 7, 2021 0 comments

How to Tell My Family that I’m Schizoaffective?

by Kristina Randle, Ph.D., LCSW January 17, 2021

written by Kristina Randle, Ph.D., LCSW

I’m getting evaluated by a psychiatrist on Monday, but everything points in that direction or at least to the schizophrenia spectrum.

My mom is convinced that I’m bipolar since years, but I was never sure, because I had many stressors before. But I once tried lithium and my mood symptoms increased quickly, but I drank much and had to pee all the time and I’ve already issues with that.

… I realised over the last days and weeks that I just “woke up” from a paranoid delusion that the psychiatry wants to hurt me. It started three years ago when I was in the locked ward and after that my symptoms got more severe. It started at Christmas, sitting in the church, having the feeling that Virgin Maria wants to tell me something, but I kind of knew it was just my mind… I got scared leaving the bus on certain bus stations, because I was afraid that evil spirits could be present, but also that was more like a thought that popped up in my mind.

My problem is now, if the dx gets confirmed, how to tell my family or tell them at all?
… The thing is that my half brother had paranoid schizophrenia and committed suicide several years ago and because he was locked up on regular bases my mom (my half brother and I, we shared the same dad) even “forbid” me to tell psychiatrist about his dx. She once even told me: “oh maybe he had just hallucinations because of stress and depressions.”, because she can’t deal with anything that starts with “schizo-“.

Because of that I dunno what to do… If and how I should tell my family!?

Mental health diagnosis is an inexact science. Diagnosis can vary depending upon the evaluator. If an individual with the same set of symptoms were to be evaluated by 10 different diagnosticians, it’s possible that he or she would receive four or five different diagnoses. It’s very common.

It may be best not to tell your family about your diagnosis, whatever it may be. At the very least, you should try to deemphasize it because of their possible negative reaction.

In my clinical experience, gaining the “correct” diagnosis is less important than acquiring competent mental health treatment. Focus on treatment rather than your diagnosis.

Your mother is concerned about you sharing your family’s psychological history with your psychiatrist. You can and should provide all details about your family history with your psychiatrist. Remember, the information that you share with the psychiatrist is confidential. Neither your mother nor anyone else will be privy to information shared with your treatment provider. Health laws protect your privacy.

Finally, I would recommend that you discuss whether or not to tell your family with your psychiatrist. After collecting a great deal of personal history and assessing your psychosocial situation, he or she can provide specific advice about how to handle your family. Counseling also would be beneficial to you in many other ways. Please take care.

Dr. Kristina Randle

January 17, 2021 0 comments

Am I Clinically Depressed?

by Kristina Randle, Ph.D., LCSW August 27, 2011

written by Kristina Randle, Ph.D., LCSW

I’m always depressed when I’m not around my ex. because he’s the only one who really gets me and knows me and really listens when I talk. When he isn’t around I have no one to talk to so I start thinking that everyone(my ex, my son, everyone) is better off without me. I never leave my bed or my house very much(online schooling). I wake up all night and I never wanna get up in the mornings. I hate the thought of people not wanting me around. I cry all the time! I hate myself a lot/most of the time. The only time I leave my house is family events or my ex convinces me to go somewhere with him. I’m always in pain unless I’m venting to my ex. I mean emotional and physical. I just ache all over. I want to get better and need to for my son and ex(we might get back together later on and he’s my rock and I’m his and if I’m sick I can’t be there for him like I’d like). My ex is the only one that I know who knows about me thinking I’m sick because I don’t want to go to the doctors and have them put me on meds or something. Am I clinically depressed? Should I ask my mom to take me to the doctor to get help or am I fine? I need to know!!

An in-person interview, with a trained diagnostician, would provide the most accurate diagnosis but depression may be a realistic possibility. According to your letter, your symptoms include: a desire to isolate, physical and emotional pain, low self-esteem, and the consistent urge to cry. Those are common signs of depression.

Your symptoms are interfering with your life and they should be treated. To answer your question directly, yes, you should ask your mother to take you to a doctor. Being evaluated by a doctor does not mean that you will have to take medication. Many people who are receiving treatment for depression don’t take medication. Instead, they undergo counseling. With the right therapist, counseling is an effective treatment modality.

What are your next steps? Speak to your mother. Tell her about your symptoms. Ask her if she will schedule an appointment for you with either a primary care physician (PCP) or a local therapist. Consider seeing your PCP first to rule out possible medical problems. The PCP can then refer you to a therapist. If you choose not to see a PCP, the “find help” tab, at the top of this page, can help you to locate a therapist in your community.

The best way to find the right therapist is to call at least four or five and ask them various questions, including:

Can they help you?
How exactly would they help you?
What would they suggest that you do?
Would they be willing to see you and if so, how soon and how often?
How long have they been in practice?
Have they helped other individuals with similar problems?
What were the outcomes of those situations?

Choose the therapist who you feel most comfortable with and schedule an appointment. I wish you the best. Please take care.

Dr. Kristina Randle

August 27, 2011 0 comments

Does this sound consistent with ADD?

by Dr. Marie Hartwell-Walker January 11, 2011

written by Dr. Marie Hartwell-Walker

My whole life I have been told by teachers and everything that I have ADD. I was always in trouble, failing stuff, talked to much, made noise and never could sit still. I even always had reading comprehension problems. My teachers even tried to tell my mom but I have a mother that doesn’t believe in it. Now i’m in college and still having almost all the same problems. I’ve Always been the kid that thinks there listening but is tapping there pencil staring out the window or moving my feet around which makes people around you mad. It takes me forever to read something i even have to read the questions close before i tAke it in. Im a good reader it’s just like my mind doesn’t know what it just read. I don’t know how to explain it. I want to be a teacher so bad but Im still having problems at school now I’m on academic probation. I still am close to one of my teachers I had all threw high school and she still tells me she thinks I have that. Im very impulsive and always full of energy Ive even had a run in wihh the law. Does this sound consistent to ADD to you?? Im at my witts end and really wanna suceed And dont know what to do..

It must be terribly frustrating to know what you want to do academically but feel so helpless to do it. You know you are smart enough to do well in school but something keeps getting in your way. I’m not sure if the problem is ADHD. What you describe could be accounted for by any number of learning disabilities as well as by an impulse control disorder. You absolutely need to get an accurate diagnosis.

Most colleges these days have a counseling service available for their students. You can get some testing there to help you understand just what the problem is. Your parents don’t have to know about it unless you want them to. Once you have been evaluated, you and the counselors will then have a solid basis for developing a plan to help you manage school. It’s also possible that you will need some accomodations to help you do your very best.

There are lots and lots of smart kids who have learning differences that make it difficult for them to be successful in school. Being able to sit quietly for long periods of time, to change subjects at arbitrary times, to focus on several different subjects every day, to take timed tests, etc. may be the traditional demands of American schools but they are not necessarily reflective of someone’s intelligence or abilities. Let’s face it. You’ll never have to do things like that once you get out into the work world. Even teachers get to walk around and to change things up a little when they get restless.

I hope you will take steps to learn more about your own learning style and how to use it. Then I also hope you will stick with your goal of becoming a teacher. Too often kids with undiagnosed learning differences decide they are stupid and develop terrible self-esteem. We need more educators who understand that being different doesn’t mean being deficient or dumb. It just means they need to work a little differently. Good minds like yours (and your future students) shouldn’t go to waste.

I wish you well.
Dr. Marie

January 11, 2011 0 comments