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My Boyfriend with Bipolar Broke Up with Me During His Episode

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

My boyfriend of one year, who I have been looking at apartments with, broke up with me out of the blue. He has been feeling suicidal, which he dropped on me as we were walking into my parents house. I was completely caught off guard and said this was a selfish (cringe) time to disclose this information since we are always together. I apologized right after we had dealt with my family and tried to talk but he didn’t want to. He said everything was fine. I offered we go home and he said he wanted to stay. We went out on a boat trip with my family the next day. My boyfriend got really drunk and got into a fight with me because he wanted me to drive him to his friends (we were in the middle of the ocean). I tried hugging him to show I loved him and it was okay and to calm down but that just made it worse. He said I tried to smother him, broke up with me in front of my family, and forced my family to take him to a private beach where he waited for someone to pick him up. Once we both got back home a few days later we tried to talk but he told me that I never supported his mental health. I had no idea he felt this way, that episodes like this were so intense. He told me he had bipolar but he never talked about it. I was really involved in finding him a therapist and I was always there but he would tell me he just “needed to be quiet” and he was “okay.” I’m not sure what to do. He won’t talk to me anymore and has wiped me from his life. This is the total opposite of the person who asked my grandfather (one month ago) for permission to marry me. I’m extremely lost. I have PTSD and so all of this is extremely triggering for me. I’ve been completely open with my mental health and the boundaries I need. I don’t know if I should keep checking on him or leave him alone. I left him alone because he said he wanted space when this first happened but then he threw in my face that i wasn’t there for him when we did talk.

Leave him alone for right now. Regardless of what the diagnosis is for your boyfriend, the timing is too important to ignore. Whether we blame this on his illness, insecurity, nerves, lack of self-confidence, or simply inappropriate behavior your boyfriend sabotaged the relationship as it was on the brink of blossoming. As I see it your boyfriend didn’t break up with you during his episode as much as his episode came during the greatest intimacy of your relationship. He asks permission to marry you, then announces he is feeling suicidal when walking into your parent’s home. You seeing this as selfish is an honest reaction, but it isn’t so much selfish as it is interesting timing, which I think is what you are reacting to.

Based on the timing alone I’d say he was having great difficulty in tolerating good things happening in his life with you. This would explain why he moved toward greater intimacy and once it became imminent he found a way to bail. Also, he didn’t take you up on the offer to go home because (my guess) he was determined (at least unconsciously) to sabotage it. Hence the drinking episode and impossible demand for you to follow through on.

This isn’t something you can fix or couple therapy can help. Your ex-boyfriend has some major issues in his life that need to be dealt with personally and professionally. They aren’t going to improve with your love and support if they can’t be taken in. As much as these things are necessary for all types of recovery a person must be able to receive them. If he is hell-bent on sabotaging your best efforts at supporting him and greater intimacy—you’ll want to give him a great deal of space—and work on nurturing yourself for now.

The find help tab at the top of the page can help you find a therapist in your area.

Wishing you patience and peace,
Dr. Dan

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Was I Misdiagnosed?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Hello, I’m a 17-year-old boy. I was admitted into acute care for mania and self-harm after my father passed away. I was diagnosed with severe PTSD (not acute, because I’d been diagnosed in the past with it) and Bipolar 1 Disorder with Psychosis and Mixed Episodes. But I don’t think that’s the case, my psychosis isn’t only when I’m manic or depressed, it’s even when I’m stable. I’ll hear voices all the time, I’m almost always paranoid or delusional. But because I have some insight into this, I’ve been told I’m faking before. I don’t feel like I’m faking though, an example of a hallucination was I was checking my air conditioning vent and I saw a very vivid face in the vent, and I had a severe panic attack. I’ll hear voices calling my name all the time, or bells ringing, or children laughing at 2am. It’s horrifying and I don’t know what to do. Is this Schizoaffective? I even have the disorganised speech, it’s not very intense but I constantly have people asking me what I’m talking about because what I’m saying, even though it makes sense to me, doesn’t make sense to them. I know I have the major depressive episodes and the mania, but the psychosis doesn’t line up with it. I’m not always in a flux of either one or the other. Thank you for taking the time to read this.

If you were admitted into 10 different psychiatric emergency rooms and evaluated by 10 different physicians, you may receive 10 different psychiatric diagnoses. Diagnosis is not an exact science. That’s why many clinicians, myself included, believe that diagnosis is often less important than finding the right treatment.

Psychiatric diagnosis is especially difficult for youth. Adolescents are in the process of growing, developing and maturing. For that reason, many clinicians feel uncomfortable diagnosing adolescents with a mental illness.

Medication is the primary treatment for psychosis. You may need to try several medications to find what works best for you. Trial and error is a normal part of the treatment process. The fact that you are continuing to have symptoms, despite being in treatment, is concerning. It would suggest that adjustments are needed. Finding the best symptom improvement is where your focus should be.

Counseling should also be added to your treatment plan. It will help you learn alternative ways of coping with unpleasant and difficult emotions. The death of a parent is difficult for anyone, at any age. Counseling is the ideal place to safely grieve the loss of your father. It will also teach you better methods of coping so that you will be less inclined to engage in self-harm. People who engage in self-harm often do so because they lack psychologically healthy coping skills. Counseling can remedy many, if not all, of the problems you have described. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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If He Recovers from Depression, Will We?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From the U.S.: A little over a month ago, my boyfriend decided he was no longer happy with me and broke off our four year relationship. He thought I didn’t trust him. He thought I wanted to keep him isolated.

Lately, he parties more, eats less, doesn’t want to be around his friends or his family, has difficulty sleeping, and seems generally sad and/or angry.

In the last week, I’ve tried letting him know that I will always be there for him. I wrote him a note that let him know how much he meant to me, and how I am happier having him in my life.

He keeps saying he doesn’t to hurt me. He keeps apologizing for letting me down and hurting me, no matter how often I let him know that he isn’t doing anything wrong. I try to bring him out with me and invite him to spend time with our mutual friends. He tells me he would rather stay in, but then it seems he does not come home. I eventually moved out of the house we rented together. I’ve suggested having him see a therapist about possible depression, but he is adamant that this is not an issue for him.

I don’t know if the breakup was caused by depression (he lost a family member back in September and has been undergoing a lot of stress since then). And I wanted to know if it’s possible that the breakup was caused by that depression. Do people who end their relationships because of depression end up back with their spouses? How do I help him recover from the depression if he does not believe he’s dealing with it?

I’m sorry this is so difficult for you. It was wise of you to leave the house. Sharing space while the two of you sort this out would be painful.

I’m not convinced from what you wrote that your boyfriend is depressed. It’s possible, of course. But it’s also possible that he is trying out what it means to be on his own and is partying with the idea that he is reclaiming being single. He may be trying to meet new people rather than hang out with people who know you both and who have opinions about who he is and what he should do.

If he is depressed, there is nothing you can do to encourage him to get help that you haven’t already done. But if he is truly wanting to take a break from the relationship, the best thing you can do is take some distance for yourself.

What you didn’t mention in your letter is how you are doing. I imagine that the possibility of really losing him after 4 years is very difficult. I hope you are taking care of yourself and thinking about how to move forward if he decides it is truly over between you. Do reach out to friends and do whatever you need to do to grieve, to learn from the experience and to heal.

I wish you well
Dr. Marie

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What Might be Wrong with Me?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

I have had many deep rooted issues since birth… Whether it has been issues at home (i.e. Alcoholic parents & Grandparents), raised by Mother’s parents while my mother was binge drugging and drinking, consistency of serious health issues at a young age (heart surgery, ulcerative colitis, asthma), only stable “mother-figure”, my grandmother, died when I was a young age, emotionally and sometimes physically abusive parents, in group homes from 15/16 yrs old until 17, Father has bipolar disorder and my mother’s brother had successfully committed suicide almost 6 months ago which has taken it’s toll on me…
I could go on for days… Long story short, I have endured so many trials and tribulations, my step father often tells me I should write a book… Maybe I should.

I have attempted suicide several times, several years ago…But have had absolutely no desire for quite some time now. I have been diagnosed with major depression, then bipolar, then one doctor told me he believed I had ADHD and had been misdiagnosed…

My main question/concern at the moment is…
I am a very loving and compassionate person, but at times the smallest issue can set me off and i stay upset and argumentative. I have the most amazing and understanding boyfriend, the man I would love to marry one day, yet I am pushing him away every time I become upset, starting arguments over nothing. I am completely aware of it, but no matter how much I do not want it to happen, it does. It almost feels like a compulsion. I want nothing more in the world than to stop this behavior, but have no idea where to even begin. Also, this has been a problem with almost all of my relationships. [Side Note: My mother’s youngest sister (who is just like a sister to me, and was still living with my grandparents when I was and also raised in a fighting household) had told me her therapist told her that she was trying to re-create the drama from her childhood, since that was the norm for us.Maybe that is true, maybe not.] Please help! Any advice would be deeply appreciated. I’d like to rectify this issue and move on with my life.
Thank you.

You may have many issues but you are also a survivor. You have come through so much, it’s a wonder that you can take the risk to love. Be proud of yourself for that. I’m thinking that past events may still be the core of things. Your are obviously an insightful and sensitive person but you grew up in an environment that was extremely unstable. People you loved and trusted kept leaving, through addictions, abandonment, and death. Even your own body wasn’t something your could trust. This kind of history is possibly the makings of a borderline personality disorder (BPD). You want love and closeness but it’s so very hard to trust it after so many years of uncertainty. You fear abandonment but expect it and sometimes create it just to get it over with.

If I’m right, there is good news. There is a well-researched and documented treatment for BPD called Dialectical Behavior Therapy (DBT). I suggest you find a therapist who is trained in the method and ask for an evaluation. Even if you don’t meet the full criteria for BPD, you have enough of the symptoms that the model might help you settle down. You can learn more about it by just searching the web.

You have found the courage to love a man who loves you. I think you both deserve to get your old issues out of your relationship.

I wish you well.
Dr. Marie

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I Just Started Cutting Myself…

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I’m 15 years old and just started cutting myself last night, I don’t know what’s wrong with me. My biological father died the beginning of this month, and I just feel like crap. All my mom and step-dad do is yell at me, I have no friends and no one to talk to. I’m so far behind in my school work and I think about killing myself all the time. I’ve felt bad and had problems even before things started getting worse. I was actually diagnosed with bipolar when I was 10, but my mother took me out of therapy after the lady said I had bipolar. If I mention anything about the diagnosis she just says there is nothing wrong with me and that I’m fine. I go to an online schooling program so I never leave the house and spend most of my time in my room. I do start normal school next year though. Last night I just felt horrible and I just don’t know. I hate to admit it but I don’t really take care of myself either. It’s really hard for me to get out of bed and brush my teeth or take a shower. I don’t really do anything anymore. I don’t think I could be put in therapy. Even if my parents would allow me to go they wouldn’t be able to afford it. Everything just got worse after my dad died. We were not close so I didn’t think it would affect me when he died. He did drugs, cheated on my mom, he even threatened to kill us when I was a kid. I don’t think my mom really helped, she would tell us everything he would say. Doctors threatened to put me and my brother in foster care because of the condition we were living in. Now my mom has been married to this guy for 4 years and they fight all the time. We live in a trailer so I can always here when their fighting. My grades have dropped and I just don’t know. I feel like this is all over the place. What’s should I do?

I am so glad you chose to write us here and tell us what’s been going on. I’m sorry that you lost your dad. Profound losses in our lives can often throw us off. It sounds like your mom and stepdad have more on their own plate than they can handle. This means it is time for you to take care of your needs more directly. Just like you reached out here — I am going to encourage you to reach out directly and your community for help. Your city has a large and well organized woman center. Your parents aren’t giving you the help you need so it is time to ask these agencies directly. If you have begun cutting please do this sooner rather than later. The center has low or no cost therapy that you should be able to use.

In the meantime please use our forums here at LifeHelper to talk with others about what you are going through.

Wishing you patience and peace,
Dr. Dan

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Define Bipolar Spectrum?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have suffered with depression a lot in my life. I have been on and off meds and it keeps coming back. I told my family doc and she tried different meds and still it seemed to work for about a month and then nothing. She put me on the maximum amount of wellbutrin (450mg) and .5mg klonapin and said she thinks I need a mood stabilizer so I contacted a psychiatry practice to try and understand this more.

I have horrible mood swings, I get irritated very easily. I start the day feel great, I get my cleaning done, play with my kids and then i start to get irritable and depressed which just leads to more irribility and frustration because i can’t stop feeling angry and depressed.

My doc appt yesterday i reviewed my family and self history. It was extremely difficult to talk about everything but i told her that i go between depression, irribility, anger, anxiety to feeling like i can take on anything (more creative/clear thoughts).

She told me i definitely fall somewhere on the bipolar spectrum but never explained that. What does “falling on the bipolar spectrum actually mean?” Does it mean I am actually bipolar? What is the bipolar spectrum?

Your doctor may have used the phrase “bipolar spectrum” because she believes that you have bipolar disorder but is not sure which type. The three main types include bipolar I disorder, bipolar II and cyclothymic disorder. Bipolar I is considered the most severe and cyclothymic disorder, the least severe.

Individuals who have bipolar I disorder experience episodes of mania. People with mania feel euphoria, grandiosity and emotionally “high.” They can also feel irritable. Their mood shifts rapidly. They can feel euphoric one moment and then quickly feel depressed and angry. Their behavior is erratic and they often behave in irresponsible ways. Psychosis can also be present.

Individuals who are diagnosed with bipolar II also experience mood instability but not to the same degree that occurs with bipolar I disorder. Typically, more depressive symptoms are present than hypomania symptoms.

Cyclothymic disorder is a chronic mood disorder that is present for at least two years. Like bipolar I and bipolar II, it is characterized by fluctuating mood disturbances and hypomania but the symptoms are less severe and less frequent. Many consider it a milder form of bipolar disorder.

You take medication for your symptoms but that is not enough. Psychotherapy is an important treatment for mood disorders. Medication can stabilize your symptoms but psychotherapy allows you to address the underlying problem. You found it difficult to detail your family and self-history which tells me that you have yet to address the emotional pain that may be at the heart of some of your symptoms.

I would recommend psychotherapy. Please consider it. Comprehensive psychological treatment involves both psychotherapy and medication. I wish you the best of luck.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Bipolar & Anxiety

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I suffer from bipolar and anxiety. I’m a wife and a mother of two. I had seen the same psych doctor for 10 years. Then it got to the point that I couldn’t drag myself to go to my spots. Finally, they booted me from the clinic. I’m still taking the same meds I begged my doctor to change as they were not working. My mother passed away in jan 2015 and my step dad in April 2016. They have me on 3 different meds cymbals, gabapentin n Valium. I started school in March to try to take my thoughts away from all the overwhelming stuff. Well the whole time I’ve been in a brain fog. I feel disassociated with reality. I either sleep alot or to much. I don’t go in public because I get high anxiety or pop two or three Valiums. I sleep to much or to little. Thoughts of suicide come and go. Because I think of all the suicidal lies. I’m scared some days of it but I get threw it somehow. There’s day where I plan out to do it but don’t. I’m not really suicidal right now. I can’t
lock myself up as I’m going threw an adoption. I seen one psych doctor ge was weird but made me go up on my meds that I don’t like I don’t feel they are helping. I can’t seem to get out of this brain fog or funk whatever u wanna call it. I feel like smoking pot though I havent. I’m tired all the time. I never feel fully rested no matter how much I sleep and I generally feel overwhelmed in life. What are your thoughts and suggestions?

The only form of treatment you are receiving seems to be medication. I would strongly recommend counseling. Counseling might be the missing element in your treatment. Medication without counseling is not a comprehensive treatment when it comes to most mental health disorders. You might also benefit from group counseling or a bereavement support group.

You may have taken on too much responsibility. At the height of your suffering, you decided to begin school and apparently are in the process of adoption, all while trying to care for yourself, your two children and grieving the recent loss of your mother and stepfather. In addition, you’re not sleeping. It would make sense that you might feel overwhelmed; most people would feel exactly the same way.

This is a serious issue because of your suicidal thoughts. Consider delaying the things that can wait (i.e. school and perhaps adoption) until you are feeling more stable. You should also seek counseling. Once you begin counseling, your therapist can refer you to a new psychiatrist to determine if a medication change is necessary.

If you have suicidal thoughts, go to the emergency room or call emergency services. They can protect you from harming yourself.

These issues are highly treatable. Counseling can make a major difference in your life. It is well worth trying. Please take care.

Dr. Kristina Randle

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Is There Anything I Can Do to Be More Connected in Society?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From a teen in South Africa: So from what other people have told me, I’m not exactly considered normal. People often seem to find my behaviour odd. I’m very introverted. I spend days at a time sitting in my room without anyone else, and I’ve had full blown conversations with myself for hours on end while doing so. I tend to talk to myself very often, even in public without realising it. Usually I recite the numbers “1 2 9 10 5 9” if I realise that I’m talking to myself in public because I start to panic and think people are going to think I’m strange even when no one has noticed. It’s something that’s been happening for a long time now where i will suddenly just say something out loud and realise that I said it and a sudden panic comes over me so I recite those numbers to calm myself down, sometimes I add other random numbers between 1 and 10 as well.

Anyways, so I’m going to summarize a bit because I seem to be babbling again.

-I was diagnosed as Bipolar when I was 16 after being stuck in a lock downward for 4 weeks straight and going basically crazy
– I’m a very fidgety person, I can’t sit still for very long and do nothing and I can’t stay in one place for more than a couple of days without getting a very aggressive mind set, and a short temper.
-I’m often finding myself intrigued and entertained by blood, gore, and the ideas of killing people, I find death fascinating and I have contemplated suicide on several occasions.
-my mother died when I was 10
-I crave human attention constantly, yet as soon as I’m around people, all I want to do is be alone again.
-I tend to get into an extremely depressed state if I get into any form of trouble with anyone. I have a thing about being yelled at by people, if I get into trouble then I end up getting super depressed for days and being barely able to get out of bed. The closer I am to that person, the worse it is.
-I hate authority, I can’t stand anyone telling me what to do or making themselves seem more important than me in any way. I can’t stand people who are in a position of authority and ended up clashing with basically every teacher I ever had because of this.
-I talk to myself a lot; in public places, alone, and I tend to even scream in my sleep according to my dad.
-I have a lot of nightmares. Whenever I have one, the root of the fear is always my brother (he has anger issues, temper lobe epilepsy, he’s a lot bigger and stronger than me, and he used to bully me and sexually harass me while we were growing up by grabbing my breasts randomly and sneaking into my room when he thought I was asleep.
-I tend to take on the personality of other people at random. If I watch a certain show or hang out with a certain person long enough to learn their characteristics, the way they speak and act, then I end up talking, acting, and even thinking in a way that mimics that person for the next few days.
-I was bullied a lot in school
-I only had one friend from 1st-7th grade. 7th grade I made friends with my current best friend who is currently in a completely different area of the country 2 hours away from me.
– I live in a town where I literally know no one other than the people I live with, no friends, no outside connections, no job, etc. Yet for some reason i feel perfectly content to sit here alone for hours every day
-I sleep excessive amounts. Anywhere between 12 hours in one day to 32 hours within two days. I’m also constantly tired and ready for another nap.
-I like to torture bugs. I have two Carnivorous plants and my favourite pass time if I haven’t been active for too long is to hunt bugs, pick them up with tweezers, make them scared, then force them into the Monkey cup or Venus fly trap alive and watch them desperately try their best to get free even though they’re going to die.
-I have hygiene issues. I don’t bath very often or brush my teeth, or hair, and I never shave or wear a bra. It’s not that I have anything against bathing or brushing my teeth, or being clean, I just don’t do it for whatever reason. I’m not sure why but I’ve always had an issue with hygiene.
-I’ve been questioning myself for a long time as to who and what I am. I feel uncomfortable when referred to as a girl, and more at home being referred to as a boy. I like male fashion a lot more than woman fashion and I even wear male deo because I like the smell better than the female deos. I created an online persona called “Zack” where I’m a male, and spend a lot of time talking to people who only know me as Zack (I do tell them what the situation is so I’m not catfishing them or lying to them) but at the same time, I can’t bring myself to discuss this with anyone in my family, or talk to anyone at all in irl about this. I also don’t know if I can consider myself a trans or if I’m just a girl who likes to act like a boy. It’s something that’s confused me for a few years now.

I’m sorry, I’m ranting. My real question, now that I’ve given you a bit too much information, is how do I stop these bad habits, and what should I do to be more connected and more successful socially? Because at the moment I literally have no social life and the last few people I hung out with all thought I was very weird.

 If you could stop your “bad habits” you would have done so long ago. I can’t diagnose you on the basis of a letter, of course. But I can tell you that from what you wrote, you do have serious problems that 1) need to be addressed if you are to have a satisfying and happy life and 2) that are treatable.

Although your behaviors meet the criteria for several different diagnoses, I do wonder if maybe you are on the high functioning end of the autism spectrum (either instead or or in addition to whatever other diagnoses have been assigned to you). If that has not be explored, please do get an evaluation.

I think you already know that therapy would be helpful. I also encourage you to get involved with group, as well as individual, treatment. Group therapy provides a safe place to talk about your issues with others and to get feedback from other members of the group about what you do that distances you from others and how to correct that. A good group becomes an important support while the members learn more about themselves in interaction with others and rehearse new behaviors.

Please take care of yourself. Stop obsessing about all that is “wrong” with you and get the treatment you need to discover and bring out all that is “right.” As a starting point, you might find it reassuring to take the Strengths assessment at http://www.viacharacter.org/www/Character-Strengths-Survey. Once you know your personal character strengths, you can build on them to improve your outlook and your life.

I wish you well.
Dr. Marie

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Unstable Emotions

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I’m not getting much help from my doctor: Ok so i have the following symptoms: depression (a lot); low mood; sometimes i feel i have too much energy and can actually feel the adrenalin inside my body running through my veins when i look in the mirror i mostly strongly dislike what i see but sometimes i feel almost amazed at the fact i look good (i feel big headed when this happens; i either have very little energy or way too much no in-between; i suffer from rapid speech all the time; I’m always losing my train of thought in the middle of a sentence or discussion; i get like itchy all over my body

I have OCD i have to count a lot and rhythmically and routinely do things, have things a very certain way, count my steps and so on. i find myself not just talking to myself but arguing constantly. as if im having a row with someone else but im playing both sides. it takes literally nothing to make me cry. i have a real problem accepting both praise and criticism. i feel constantly like a failure to myself others and family and my hcildren like im not worth the air i breath. altho i will do anything to make other people happy sometimes i fond myself having a total disregard for toher peoples feelings. not that i want to upset someone on purpose but more like im past caring. i get these sudden bouts of irritability which i take out on myself or my partner, not my children i have to add. this is really affecting my daily life and i just want it to stop.

Some of your symptoms are suggestive of bipolar disorder. Inflated self-esteem, being easily distracted, rapid or pressured speech, and irritability are characteristics of mania. A mania episode diagnosis, according to the DSM-5, requires that your symptoms be present for at least a week and last most of each day, are not attributable to some other physiological effect such as drug use or a medication side effect, and are causing you significant impairment in social or occupational functioning.

You also mentioned that you have OCD. OCD is an anxiety disorder. It does not seem as if your OCD symptoms are under control. People with OCD feel out of control and engage in counting and strictly adhering to routines in order to make themselves feel more in control. The rituals and routines are unhelpful and following them only makes your OCD worse. They may make you temporarily feel better but in the long run they reinforce your anxiety.

Arguing, having difficulty accepting both criticism and praise, feeling like a failure, possessing no regard for other people’s feelings, are not necessarily signs of any one particular mental health disorder but generally are signs of emotional instability. It’s possible that they are associated with your out-of-control OCD symptoms or perhaps bipolar disorder but without more information it’s difficult to determine the exact nature of these issues.

You are currently seeing a doctor but said he is unhelpful. If the help that you are receiving is ineffective, then consider seeing a new mental health professional. You can ask for a referral or simply find one on your own. Search for a mental health professional with whom you feel comfortable and who has a good track record of success. Choose a therapist who specializes in mood disorders. OCD and bipolar disorder are highly treatable with both medication and psychotherapy. Changing doctors might be just what you need to solve this problem. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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I Can’t Stand to Be Touched

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From Finland: Hi, thanks for reading me.

As a child I was sexually abused, first a neighbor, then when I was 11 my father. When everything blow up, my father talked to me and explained that he had alcoholism, but now he was sober, and it’ll never happen again. My family continued as a normal family, until my mom finally divorced him several years later.

I developed bipolar disorder with psychotic features, and my adult life has been a roller coaster, but I get along with my both parents, as a normal relationship, the subject is rarely mentioned. I did not blame them for the past, but finding a way to get stable has been hard, and most of the times they have been absent in my crisis.

This last year I’ve been working with a new therapist, and she has helped me a lot with my “weird ideas,” and voices, etc. I’ve been doing a big effort to grasp the reality, my reality. As a result, I am getting more functional, and starting to desire things, like having friends, or maybe a boyfriend. But there’s an issue, I can’t stand being touched, that’s one of the reasons my relationships never work.

And with it, I’m feeling really angry, specially at my dad, because of what he did, I know is totally out of time, but is there, I can’t hardly see him, I can’t stand him, actually I’m moving to another state, to be far away from him.

I tried to talk to him. I was like, I understand it was your alcoholism, and wasn’t your intention, and you have changed a lot since then, but I feel it had consequences. He told me it was in the past, that I had to let it go, etc.

And now I don’t know what to do, I feel guilty for being so mad, but I am. I feel I’m being unfair. All I want to do is keep my stability and being able to relate to others, but don’t know how.
Help me please.

 

It’s not at all unusual for a person who has been sexually abused to have fears about being touched. It’s not inappropriate for you to continue to be angry. It’s not realistic or appropriate for your father to believe you can just “let go” of what he did to you. His explanation that “alcohol made me do it” is how he is avoiding his responsibility for hurting you. He still owes you a heartfelt apology.

You can’t afford to wait for that apology to get on with your own life. It may never come. Even if he did apologize, you still are left with the consequences of being abused by a man you trusted. The good news is that you can heal without his apology, permission or participation.

You’ve made marked progress in your therapy. I am so glad you found a therapist you can really talk to and work with. Your letter didn’t indicate why you wrote to us here at LifeHelper instead of talking to her about this issue. I’m guessing that discussions about abuse, touch and sex are particularly scary for you and your letter is a first step in dealing with them.

To me, your letter shows you are ready to go to the next level of treatment. You have done impressive and important work so far. You have allowed yourself to trust a therapist and become an active participant in your treatment. Your letter shows you to be intelligent and sensitive. My vote is for you to take a deep breath, find your inner courage, and talk to the therapist who has been so helpful to you. It might help if you shared your letter and this response with the therapist as a way to introduce the topic.

From what you told me about your therapy experience so far, I have every reason to believe that your therapist will help you manage these issues with sensitivity and good support.

I wish you well.
Dr. Marie

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Had Constant Mood Swings Since I Was Young

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From the U.S.: Since young I had constant mood swings and extreme emotions. I said things that weren’t logical or had any sense at all. Most of the times I’ll get so mad I’ll hit someone or say horrible things to them. Had problems with self harm and people thinking that something was wrong inside my head.

My family always told me the same thing over and over. They said they didn’t know what was wrong with me and tried to take me to a psychologist, but it didn’t help at all. I’ve passed through depression too. My wise family said I never had nothing in between, never had a balance. It was either black or white they said. No in between. That’s why they thought and still think my emotions are extreme.

Personally I don’t notice when I’m acting this way, I just don’t notice it. Most of the time out of my head I apparently “see” things that aren’t there, but maybe it’s just my mind. I’m mostly bored all the time. Everything gets me bored easily.

I’m sorry if what I’m saying doesn’t have sense, I’m really sorry.

I guess this is due to a bad childhood. I didn’t really have any friends and used to bother other people a lot. Bother them in a physical way hitting them or anything else related, I can’t remember clearly. In elementary I didn’t have any friends, it seemed like there was one person, but they always backed of or left me aside.

During middle school it wasn’t the same, people ignored me even more and I didn’t have friends. As a result I talked with myself and responded like if I was with someone else. That was my way of not getting bored. I still enjoy taking to myself. My mother got scared every time I talked alone and claimed that I was “crazy”. I didn’t really notice my extreme emotions or mood swings until my family told me. I could go from being really happy and joyful to a crisis moment, and I’ll laugh when it wasn’t really meant to. Most of the times when I was crying I started to laugh and felt really happy, then went back to feeling awfull and continue crying. If I had to do a resume then it’s: Mood swings, extreme emotions, talking ilogic things, taking to myself and seeing things that aren’t there.

Although you’ve provided me with a description of your distressing feelings and behavior, you didn’t ask a question. All I can do is respond with what I think you need to know — which is this:

Just because therapy didn’t help at one time doesn’t mean that it isn’t helpful. You just didn’t find the right helper for you. Clearly you are troubled. Clearly you have difficulty making friends and relationships, dealing with your volatile emotions and idiosyncratic behaviors. You may be correct that this all started with the bullying in school, but you haven’t been able to end it. If you could have talked yourself out of the problems, you would have done so long ago.

Please. Listen to the people who love you. They are right to be concerned. They are doing their best to give you solid advice. But they can’t make you help yourself and they don’t have the skills to help you learn to control your moods or behavior.

Make an appointment with a therapist. If you don’t like what is happening in the first few sessions, talk about it. Maybe you and the therapist can adjust how your sessions are going. Maybe you need to look again for someone who is a better “fit” for you.

I wish you well.
Dr. Marie

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Can I Have Both OCD and Bipolar?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From Egypt: I was diagnosed with OCD by my doctor and I am sure I have OCD but I have some other symptoms that my doctor said that I have also bipolar disorder and he told me in advanced level of master studies OCD is related to bipolar disorder but I am doubtful so I will tell you these additional symptoms and tell me please if that bipolar or not

1. excessive fantasizing or maladaptive daydreaming

2. I make sad stories about me in my mind that made me cry but the most important part in these stories is that all the world must know what is happening to me ,you know like the world see a movie about my life or the world see what is happening to me on T.V (of course the imagined life story)

3. sometime I imagine myself with a personality with certain traits and other time I imagine myself a person with personality with the contrary traits (ex. I imagine myself as a romantic person with women and other time I imagine myself as aggressive person with women) and sometimes I feel I need the both traits and sometimes not all my fantasies about one concept which is (the need for attention)…I always imagine myself as a hero or as a victim, I have to be the core of focus of others attention in my day dreams

4. something may happen in real world that make me imagine talking to a certain person for a certain purpose in my mind but suddenly I found myself talking to myself in real world (ex.I got angry from someone so I go away from him but I imagine blaming him for the bad thing he did…but suddenly I found myself say the blaming speech to myself in the real world not only in imagination )and sometime I do moves with my talking in real world (ex.I do angry hand moves when I blaming the person in my mind

5. all my daydreams and fantasies focus on fighting, violence, girls, hero, sacrifice, bravery
I feel I attracted to lots of girls to the point I found myself I am not inbalance and I cannot determine who I will marry in the future

7.I feel I am low in confidence and I have several fears like I fear to drive my car

I’m sorry, I can’t answer your question about diagnosis without talking to you in person. But I can tell you that it probably isn’t helpful to be spending time on labeling yourself. Instead, I hope you will work with your doctor to relieve your considerable distress. For some reason, you are withdrawing into the world of fantasy and imagination instead of dealing with real every day life. I’m sure there is a good reason but the methods you are using to deal with whatever it is aren’t working.

I urge you to work with your doctor to get to the root of the problem and to find new and happier ways to manage whatever challenges are in your way. You deserve a better life.

I wish you well.
Dr. Marie

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I Am Bipolar and Have Been Using Cocaine Every Day for 2 Months

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Someone needs to know the truth. Anybody at this point.
I am in desperate need of help and guidance. I am struggling with addiction in a major way.
In turn, I have not kept track of my bipolar at all and at this point don’t even know where I am
at emotionally. Physically I am ill. I have flu. I vomit. I barely eat. I sometimes don’t know how I am surviving. But I am afraid. I am very afraid. If this goes on it might be too late before I even realize it and I do not want this to happen. I have been using cocaine almost on a daily basis for 2 months. (I relapsed)

I do not speak to my therapist or psychiatrist because all they suggest does not work for me.
My psychiatrist says I am intellectualizing but I don’t know how to explain– the system of the 12 step agenda is not me. It does not work for me. I don’t say this out of hate but out of experience. It depresses me.

I am desperate to stay clean but I need to find a way that works for me or I will never stay clean.
with that said right now I just need help.

I don’t speak to my therapist or psychiatrist because of trust issues regarding them telling my parents when I am 39 years old. I want to speak to them openly and honestly but I want them to respect the oath or ethical rule of “what is said in here stays in here” I would find it so much easier to be open and honest and perhaps get some real help form them in being honest with them.

I am desperate to be honest.

please advise, because I am at a loss and I am tired of this spiral. I am scared I end up dead (be it a heart attack, a stroke or suicide.) (From South Africa)

Thank you for being so brave in opening up about your needs in recovery. If you are 100 percent certain that the therapists are telling others about your condition find someone new, explain the situation and start with a person you can build trust with. But you must be 100 percent certain they are breaching your confidentiality — not merely a suspicion. I am saying this because unless you have proof and the breach of confidentiality wasn’t because they feared you would hurt yourself or others, then you must talk to them about revising, enhancing, or completely changing the plan for your recovery.

Secondly, consider a residential treatment facility. If you are feeling this depleted then a residential treatment might be needed to break the cycle of addiction.

Finally, look for a group therapy format outside of twelve-step that helps individuals get and stay clean. These are typically outpatient facilities that are community-based and use group therapy to help keep people accountable.

Until these changes in your approach to therapy kick in, you may want to visit our forums to continue getting ideas and support.

Wishing you patience and peace,
Dr. Dan

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Bipolar? Gender Identity Disorder?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Hello.

This is practically my last stop, as I don’t know who else to ask. As you may know, my country doesn’t have many ‘good’ therapists. I’ve been through 4 already, and I still haven’t got the answer I need.

Sorry if the question is a bit too big, there are just too many things that shouldn’t be left out about me.

Basically, I like to picture myself as an inverted triangle, with the bottom edge being the regular me, and the two other edges being my two main ‘problems’.

One of those edges symbolizes the thing I’ve felt since I was a kid. Not belonging, not wanting to study, hating school, not being interested in any career. The part of me that’s always bored with this “normal” life.

I think I might have figured some things out by myself. First thing being my highly sensitive brain, and how that makes me see more than the exterior of people. I think of it as a gift, but it often makes me think people might be saying bad things about me. Most of the time, it doesn’t bother me at all; I just thought I’d point that out.

Anyways, another quality of mine that I think is linked to that is the fact that I can copy mostly every thing I hear, see or feel; be it from people, games or movies, there’s always something I take from those things and incorporate into myself. Then, after a while, I filter out the secondary things. I’ve come to accept that most of those things have shaped me into the person I am today.

I think of me as a chameleon. I can do practically everything, and I’m not saying it in a narcissistic kind of way, it’s just simply true. Whenever I feel like going out or meeting people, I do it, and I never fail. I can engage in conversation with anyone, and I’m able to examine them and analyze my surroundings while doing that.

Short example. If I watch a movie about cops, I’ll want to be a cop, and I’ll often act like the cops in that movie. Just small secondary actions, but still. Or, let’s say I’m playing a fighter jet game. The minute I close the game, I want to be a pilot. I feel the rush for flying through the skies and being part of something.

For the record, gender doesn’t matter. I can like being a male character the same as being a female one.

In that sense, I know I have a bit of a problem with reality. Sometimes, I get detached from it and wish I could have a less boring life. I know there’s absolutely no career for me that will give me the, sometimes even surreal, ‘action’ I want.

Now, on to the other edge of the triangle.

When I was 18, I stumbled upon the thought of being someone else. A girl, specifically. I looked up ‘mind transfer’, and found out something totally different. Turns out this feeling of being in the wrong body that I had, was Gender Identity Disorder. That’s what I thought at the time, anyways.

After doing a little retrospective, I remembered I used to go through mom’s clothes and try them on. This was probably between 10 and 13 years of age. Also, my father was hardly ever home. He used to have a public transport business back then, and he also drank heavily and scared mom and me whenever he was in a bad mood. I’m sure those things have left a scar in me, but oh well.

So, nowadays, whenever I look at a girl, makeup, clothes, even the word ‘girl’, I feel sad about being a man. At the same time, it doesn’t happen with women. Not above their 50s, at least. Something about youth and beauty, and the fear of not having it some day. In the end, I guess we’ll all have to worry about it when the time comes, it just scares me. The fact that I may not want to grow up and lose my ‘beauty’.

Beauty, that’s a word I relate to ‘girl’. Sometimes, I definitely know I still have what it takes to be a girl. Other times, I see every single thing that would work against me due to my age. Depends on the mood, I guess.

My last therapist told me that might have been a thought I created. A ‘safe-zone’, so to speak, and that I had to actually go out before I could make a decision. I always thought he was wrong, because at the time this thought came to my head, back when I was 18, I did had some friends and went out several times a week. Even though I had just finished high school and had given me a ‘free year’, I never spent most of my time alone.

For these past 5 years, I’ve always, always wanted to make sure I don’t make the wrong decision. That’s what hurts me too, most of the time. Thinking I should’ve just taken some hormones and get over with it. But I’m here now, and the past is, well, the past.

So, I did went out to see meet some people whom I shared some interests with. Those few times, I tried acting like ‘myself’, like a girl, and it was great. Like I said, I can start a conversation with mostly anyone, and it turned out to be a great night.

Still, whenever the other edge of the triangle comes into my mind, it makes me feel like ‘pretending’ to be a girl is just a way of lying to myself. In the end, I know how I behaved, and how great it felt. It’s just whenever I find new characters to extract some features from; I step out of the ‘girl’ mindset, just for some brief moments.

And so, I’m finally here. I’ve read about what I think is my condition, and there’s only one more thing standing in my way.

Do I have a Bipolar Disorder, or GID?

Some people say that GID can originate from Bipolar Disorder, and if that were the case, then I would be making the wrong decision by taking hormones. If it’s the other way around, and it turns out I have both things, I would honestly feel a lot more relieved.

That’s the only answer I’m looking for. The closure, who I really am. Again, sorry for making this question so big. I just had a lot of things in my head. I do have a lot of things. Most of the time.

It would be presumptuous of me to use the information you have given me to make a diagnosis, but I will say this. I greatly admire your resilience and perseverance in finding treatment for yourself. The fact that you keep searching, and working on finding a answer is not only admirable, but a clear strength of yours that is emerging. Perhaps that is the thing I can offer you. Regardless of what your diagnosis is you have strengths that are clear and present. I would strongly encourage you to take the signature strengths survey. I have written about it here and there is a link for you to take it from the article. This is the most widely known and used tool to focus on psychological strengths and characteristics. It is very detailed and will give you excellent information about yourself. It is free, and will take about 40 minutes to do.

While I am not denying the need for an accurate diagnosis, the need to focus on strengths has no downside, will enhance whatever your diagnosis is, and can be a real source of support for yourself.

Wishing you patience and peace,
Dr. Dan

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Depression, Isolation, Counting Calories, Pressure To Be Skinny & Ways To Cope

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I know I am very young, but I feel so hopeless, out of control, and desperate that this was my last resort. I have come to realize that I have depression. One of my family members suffers with Bipolar disorder and depression and is currently on medications to keep them under control. I hate myself. Although people would specify me as “popular” in school, I feel like a loser. All my popular friends could EASILY live without me so what is my point in this world? I used to have one very good best friend, but she ditched me for someone else. We stay on speaking terms, but hang out rarely. Since summer has started, I’ve completely isolated myself and spent all my time alone in my room on the computer. I’ve began to obsessively exercise and become obsessed with counting calories. I’m at a normal weight now (5’5 and 114 pounds) but I look so fat that I’m surprised I’m even a normal weight. I still eat, but I only eat half of what I used to and only healthy foods. I exercise SO much. But there is one thing that keeps me going. My hope that someday this will get better. You see, I went to a performing arts high school camp where I was completely accepted for who I was. I made friends instantly, but the camp was over in 2 weeks and we all had to depart. The only thing to keep me going is the hope that in 2 years when I audition for that performing arts school is that I will make it in. I’ve made friends with all the teachers and am currently taking the ADVANCED ballet and modern classes (I’m going into seventh grade and am taking a class with college students). I really want to be a dancer. I just love how I feel when I’m there. I feel like I belong, like I’m part of a family. Everyone is accepted and loved. I just LOVE that feeling! The school is full of talented people, and I’m afraid that if I’m not skinny enough I cannot make it in. I also just want to stand out. My school now is HUGE like GINORMOUS! No one really stands out unless they are massively popular. In this school, everyone stands out in their own way. I just want this so bad, and it’s the drive to keep me going. But I feel like if I’m fat I can’t do it. I feel like I NEED to continue this diet and exercise regimen for an entire 2 YEARS before I make it in (NO DESSERTS, NO WHITE BREAD, ONLY SMALL PORTIONS OF RICE AND PASTA, ABSOLUTELY NO CANDY, AND NO EATING OUT). But I know that’s impossible to keep it going that long, but I just need to do it. I feel like I can’t, but I really want to. How can I cope with being extremely pressured to be skinny, with my depression and isolation, and with my friend problems? Please please please please help me. i’m desperate.

The pressure you feel to be thin is a major concern. It is driving your obsession with being thin. It is an unhealthy obsession. In your mind, you “need” to do it. You have given yourself no choice. Your ability to limit your weight has become paramount.

In addition, your body, its size and shape, has become your primary vehicle for success in life. A thin body, in your mind, has become the one and only pathway to popularity, attention, belonging, and to professional dancing. It is everything. The pressure you feel to be thin only makes sense in the context that you have placed on the importance of body size.

You wrote that you are desperate. I can understand why. All of your hopes and dreams depend on your ability to limit the size of your body. The idea that being thin is the key to your happiness is an illusion. For those who believe this illusion, no amount of weight loss is ever enough. More is always better even when it isn’t.

This problem is further complicated by the fact that your view of your body is distorted. As you mentioned, you are a “normal” weight but continue to see yourself as “fat.” That one line from your letter to me, shows you are no longer able to see the reality of your appearance. If the scale and the charts show that you are a normal body weight, in the normal range, you can not appear to be fat, not to others, not to trained professionals. You can see yourself looking fat in the mirror but that is an illusion. Almost everyone with an eating disorder sees an illusion staring back at them in the mirror. A fat illusion.

It is important to recognize the incorrectness of your thinking. If it continues, it can lead you down a dangerous road. Some individuals who feel extreme pressure to be thin ultimately develop eating disorders.

My recommendation is to discuss this matter with your parents as soon as possible. Don’t be afraid to ask for help. Ask your parents if they will take you to counseling. Counseling could help you to develop a healthier relationship with your body. It could also help you to manage your weight in a healthy, controlled manner and address your depression and feelings of isolation.

Now is the time to seek help. You may or may not have an eating disorder. Counseling can eliminate the possibility or stop it before the problem becomes unmanageable. The “find help” tab at the top of this page can help you and your parents locate a therapist in your community. Please take care.

Dr. Kristina Randle

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Treating The Correct Disorder When You Have Bipolar and PTSD

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My therapists help me to identify long-standing bipolar I but is it possible to have that without having never been treated and never suffered any negative consequences. My manias fueled a high-pressure career and I’ve been able to self-monitor and control my tendencies to overwhelm people with my activity and talkative levels. I haven’t had a depression since 1991 and even though I know that one of my first depressive episodes nearly ended in a psychotic break, I was still able to get through it without intervention. My family says they’ve never had a problem with my behavior. Fast forward I also have a serious PSTD problem from living with violent people for 53 of my 58 years. I’ve had inappropriate adrenaline surges for the past 6 years which have been treated with increasing levels of Paxil (up to 60 mg/day now). I cannot get my therapists to focus of the PSTD problems (flashbacks and nigtmares and severe anxiety) and they want me on an anti-psychotic even though there’s never been any hint of a problem with the Paxil setting off the bipolar. Help — what do I do? I want them to trust me to self-report if I see any bipolar symptoms and not start an expensive drug when I don’t need it right now.

I cannot answer your first question: Is it possible to have bipolar disorder despite not having suffered any negative consequences? I would need more information. It would depend on what you consider to be negative consequences. Without knowing that information, I can only speculate.

It seems as though you perceive your symptoms as being advantageous. You are not alone with your beliefs. You may find the article, “Just Manic Enough: Seeking Perfect Entrepreneurs” (in The New York Times business section), to be interesting. It discusses a very similar point to the one that you are making. It essentially argues that in order to succeed as an entrepreneur, a certain amount of hypermania is necessary.

Many mental health professionals would disagree with the premise of that article. Many of them believe that mania, in all cases, is dangerous and would recommend psychological intervention. I can’t say with certainty but I believe that may be the opinion of your treatment team.

It is common for people with bipolar disorder to report that they like the feeling of mania. Tara Parker-Pope, who maintains the Well blog at The New York Times, featured a number of individuals who were willing to share their experiences with mania. One insightful quote came from Carter Goodwin, a 42-year-old artist with bipolar disorder, who said “I miss the mania…I love the mania. It feels so good to feel like I can do anything and like there is something really special about me. But it’s all chemical. It’s not true.”

Goodwin’s point is an important one. The mania makes him feel as though he has special powers and abilities but it’s a delusion. It’s not real and therefore has the potential to be harmful. To live in a world that is not based in reality is delusional.

Another complication of this situation is that you might have become accustomed to living with your symptoms and now they “seem” normal to you. You may now lack the ability to be objective about your symptoms. Thoughts and behaviors that seem normal to you may not seem normal to your treatment team.

You mentioned two additional issues regarding your treatment team. They do not focus on what you believe to be post-traumatic stress disorder symptoms (PTSD) and they want you to take a medication that you do not want to take. If you believe they are providing you with unsatisfactory service, then you might want to consider seeking a second opinion. If the second opinion is consistent with the first, it could be very telling. A second opinion could also provide information about how next to proceed.

If you’d like to write back and provide more information about how you define negative consequences, in reference to your first question, then I might be able to provide you with a more specific answer. I wish you the best. Please take care.

Dr. Kristina Randle

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How to deal with borderline personality disorder

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I don’t even know where to begin, honestly. I came here because I’ve been researching tons of things trying to come up with an idea of what to do with myself. I have borderline personality disorder and bipolar disorder according to a psychiatrist I saw for a while but no longer see anymore. I had a very dysfunctional childhood with an abusive mother both physical and mental when I got older. I guess I could go on and on about my background but that’s not really the question…I don’t really know what to do right now; at this point I’m lost. I push everyone away; nobody wants to deal with me. I harm myself physically and other emotionally. I go into fits of rage and depression over stuff I shouldn’t even care about and I’ll do stupid things when I do like break something I actually really care about or say things I don’t mean. I don’t like leaving my house, Id rather sit in bed or on here all day then actually get dressed and go out. I go through stages of numbness, where I feel nothing and like I don’t care about anyone– not even myself. Right now honestly I feel like a mix of feelings, sad and angry and hopeless. I was on meds originally but my mom wants nothing to do with my grandparents cant and me afford anything. I have tried to commit suicide numerous times, gotten in fights with just about everyone, pushed away loved ones, abused alcohol, had risky sexual relations that I didn’t really want to do that were against my morals and recently I shoplifted and was caught, I gave up on school too.

I don’t honestly know what to do, I feel like I’m hopeless and I’d be better off dead which basically my own mother agrees with, which is pretty sad. I need help, and I just don’t know who or where to turn to. Any advice any help anything would be greatly appreciated. Please.

One of the things that comes through in your letter is a desire to change. While I hear the frustration and sense of not being able to evolve past all this, I am also very much aware of the fact that you very seriously want a positive change in your life.

First let me say that you need to find a way to minimize the effect your mother has on you. If there is any safe way you can get away from such a toxic individual do it now. How can you get healthy and have peace in your life when your mother gives you exactly the wrong information? I would perhaps ask your grandparents for help directly. Your mother isn’t giving you good information. That is a sign of her own pathology, and not something for you to accept.

I am going to recommend the National Alliance on Mental Illness (NAMI) groups in your area. Here is a link to those. But you may also need a psychiatric evaluation so some medicine can be prescribed. I would make an appointment with a psychiatrist in your area as soon as possible. If your grandparents are not able to help, you can use a local clinic who can provide services for low or no cost. Use the NAMI site to get information in your area.

Here is a self-help site for dialectical-behavioral therapy (DBT). This is an effective form of therapy for some of the symptoms you have described, and you may be able to find a program in your area. I would also consider the LifeHelper forums here, which are free.

Use your desire for change to find the help that you need now. The symptoms you’ve described are difficult, but certainly possible to cope with.

Wishing you patience and peace,
Dr. Dan

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She wants to reunite with ex-husband

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

I want to go back to my ex-husband from whom I’ve been divorced for over three years because of his violence. Before the divorce he ended up in jail for almost a year for domestic abuse. Since his release he says he’s changed. He’s gone to a local community mental health facility, was diagnosed with bipolar disorder, PTSD, and adult ADHD. He’s on medication and collecting social security disability and has a payee handle his finances. I see him on a regular basis and realize we still love each other, although it’s hard to believe that he loved me when he was abusive, which I now attribute to mental illness. The problem is threefold:

1) My three grown sons (not his biological children) grew up witnessing the abuse and now hate him and categorically don’t want me to go back to him, no matter how he says he’s changed. They absolutely refuse to give him another chance and let me know unequivocally that they would have hard feelings toward me if I went back to my ex.
2) My ex has no income other than his social security disability; his chance of becoming gainfully employed is small. Also he doesn’t qualify for regular social security retirement benefits because at 57 years of age he’s too young. I am older than he (ten years) retired and collecting social security on a former spouse’s record, but it is not enough for me to live on; so I subsidize it by substitute teaching. But if I remarry him I will lose my social security benefits and won’t qualify to get any on my ex’s record. So there are serious financial consequences for me if I marry him again.
3) He is still somewhat quirky, dominating in his speech, and feels that he is spiritually more enlightened than most people. I see it as a sign of delusions of grandeur. He also appears somewhat narcissistic in that he has a hard time allowing me to speak when I have a different opinion from him, especially when it comes to our relationship.

What makes him upset and angry is when I tell him that even though we love each other, there are so many obstacles standing in our way and that perhaps we should just be friends from here on in. At those moments he tells me I’m unfaithful to our relationship and that just because we’re divorced legally doesn’t mean we are divorced spiritually. He maintains we are “One” and meant to be with each other–no matter what my grown kids say or anybody else for that matter, and if I really loved him the way I should I wouldn’t even think of not being with him. He makes sure he underscores his point by accusing me of bailing out on him, the only one who truly loves me.

I feel he certainly has a right to his anger and as long as he isn’t abusive, I can respect how he feels. Still my intuition tells me, that although I believe he won’t hit me anymore, he still will always have the tendency to be emotionally dominating. On the other hand I believe if I truly love him, I will accept that he will never act like most people do because of his bipolar illness and accept him anyway.

I am so conflicted. I’m torn between my children and my ex, torn between the desire to be with him again and my need to just get on with it and have a normal life. My heart tells me I want to be with him, while my mind tells me for the sake of my grown children’s peace of mind I should stay away.

It sounds to me like you already have a reasonable solution. You don’t have to marry in order to be friends and lovers. You have more to lose than to gain by giving in to his demands to somehow prove to him that you are there for him. What concerns me most is that he asserts he is the only one who truly loves you. These are the words of a potential abuser. Love isn’t about isolating someone. It’s not about making someone feel they can’t be loved by others. Real love is generous and kind. I hope you don’t believe that he’s the only one who cares. Your sons certainly love you and are protective of you when you aren’t protective of yourself. It’s one thing to “accept” him as he is. It’s another to cave in to unreasonable and selfish demands. I hope you will trust your intuition.

I wish you well.
Dr. Marie

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Confused About What’s Wrong in My Life

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

As of a few months ago (2 or 3) i’ve been feeling really bad. actually it’s been a really long time since i felt not so good about life, but it got worse around this time. i decided to take to googleing my possible problems when my friends started saying they think i’m bipolar, because i have periods of extreme niceness and other occasions of being really mean or down in the dumps… sometimes i feel like everyone thinks i’m ugly and dumb and other things, and other times i feel like i’m totally awesome.

i told my mom that my friends think i’m bipolar and she said “yeah right” and just blew it off. she’s bipolar by the way. i also asked my dad and he said i’m kinda acting depressed more than bipolar, but niether of them really know what’s going through my head. sometimes i have totally random mood swings that i don’t tell anyone about, so that’s probably an important thing to say. another thing is that sometimes i feel like life really sucks and is pointless (not suicidal tho), and other times i feel happy and loved. it’s kind of 50-50 on which one of those i feel like though.

Bipolar disorder may be a possibility but only a psychiatric evaluation could determine this for certain. Sometimes individuals experience problems but don’t have a diagnosable mental health disorder.

You are having difficulty regulating and understanding your emotions. Many people can relate to this especially if they have never received proper emotional guidance from parents or mentors. Managing and understanding emotions are skills that can be learned. If an individual lacks a healthy model for dealing with their emotions effectively, then maladaptive reactions may develop. This may in part be the cause of your current difficulties.

A major problem is that when you experience “random” mood swings you do not let others know. You keep it to yourself. Perhaps this is due to fear. You may not want others knowing how you feel. Sharing that type information can make an individual feel vulnerable. Another possibility is you want to talk but you believe that others are not interested in what you have to say. Your mother did not take you seriously when you expressed the possibility of having bipolar disorder. If you feel shunned by your family, then your reluctance would be understandable.

I would suggest having another discussion with your mother. Inform her that you wrote to Psych Central. It may help to underscore the seriousness of your concerns. You should also discuss with her the possibility of seeing a therapist. If she has had positive experiences with the mental health system, then she may be open to you seeing a mental health professional. In the meantime, here are some suggestions that you might want to utilize when trying to regulate your emotions:

• Keep a journal. Journaling can help release pent-up emotions. It also serves as a record of your feelings. After a week or two of continuous journaling a clear pattern may emerge. For instance, if you notice that you feel anger after interacting with a particular relative then it may explain the source of your feelings. Analyze what happened just before a particular feeling emerged.

• Label your emotions. Journaling can help with this. When you feel a particular way write down precisely what is happening and try to give it a name. This might help you further clarify your emotions.

• If you’re feeling overly emotional leave the situation if possible and allow yourself at least 10 minutes of quiet time. During this time alone, try to relax. Breathe deeply and attempt to emotionally stabilize. Try to answer the question “What just happened?” This would be a great time to record your feelings in your journal.

• Attempt to maintain an even emotional keel at all times. It is not healthy to allow yourself to be overly happy or overly sad. Don’t react impulsively without taking time to think through a response. When we feel emotional we may say or do things that are not rational or that we may later regret.

I hope this answer helps. I wish you the best and please consider writing back and letting us know how you are doing. Please take care.

Dr. Kristina Randle

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BPD, Schizophrenia or PTSD?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have had issues with getting diagnosed. My psychiatrist whom I’ve had for 5 years says Schizophrenia. I have had multiple hospitalizations, and they have said BPD, PTSD and one even said Bipolar. Testing said “CPTSD with psychotic delusions”. My therapist of 2 yrs insists BPD, because of self injury and multiple hospitalizations. Here’s the deal, I have maintained long term relationships. I maintained the same job for over 20 yrs. I never confront or argue, never break rules, am always on time. I score 3 off the BPD checklist…suicidal thoughts/self injury, emptiness and disassociation. I have a history of trauma as a child, but I never relive the trauma, dream about it, or even think of it much. Since my freshman yr. of college I have experienced voices from satellites that command me to do things (like cutting), am scared all the time, blurt out weird things that I can’t control, see shadow people. I know some of these things can be caused by the PTSD, I don’t think I am violent enough to be schizophrenic but it’s in my family and it’s the only one on the dsm iv that I score high on.

So what do you think? Am I getting pigeonholed into BPD and PTSD just because I have a trauma history and self injury? Can schizophrenia cause self injury and suicidal thinking?

Unfortunately, I cannot give you a diagnosis over the Internet. I would need to conduct a full and thorough evaluation as well as know more about your psychiatric history to be able to offer a reliable diagnosis. I will attempt to answer your questions based on the information that you have provided.

You mentioned BPD and bipolar disorder. I am not certain if these two are being used interchangeably (i.e. BPD= bipolar disorder) or if you are using the acronym BPD to mean borderline personality disorder. For purposes of my answer, I will assume that BPD refers to borderline personality disorder.

The mental health professionals who have offered you a diagnosis may be having difficulty because many of your symptoms, including trauma history, self-injury and suicidal thinking, are characteristic of multiple disorders such as borderline personality disorder, PTSD, bipolar disorder and schizophrenia. This may be why you are receiving different diagnoses from multiple mental health professionals. It is not uncommon to receive different diagnoses from different mental health professionals. Unfortunately, psychiatric diagnosis is not an exact science. I can understand your frustration.

As you mentioned, you only have some of the symptoms of borderline personality disorder. If this is true, then the conclusion would be that you have some of the traits of BPD but not enough to warrant the diagnosis.

One constant symptom that you have is command hallucinations. The voices are telling you to harm yourself. If it is the voices that are telling you to harm yourself then this would be a different type of self-injury than typically associated with borderline personality disorder. What is the difference? The motivation or the reason for the self-injury. In your case, it seems as if you are engaging in self-injury because you hear voices that are telling you to harm yourself. An individual with borderline personality disorder may engage in self-injury because he or she might believe that they “deserve” to suffer. The purpose in the latter instance is self-punishment. It does not seem as if you are deliberately harming yourself. The motivation or the reason for your self-harm is apparently not within your control. You seem to be engaging in self-injury because you are being “commanded” to and not because you are punishing yourself.

Command hallucinations are associated with psychotic disorders, specifically schizophrenia. It is not a symptom of borderline personality disorder. Individuals with borderline personality disorder can experience psychosis but it is rare and generally brief in duration. If you are engaging in self-harm because the voices are telling you to do so, this would not be a symptom of borderline personality disorder or PTSD. It would more likely be a symptom of schizophrenia or bipolar disorder.

To answer your specific question, symptoms of schizophrenia can lead one to engage in self-injury and to have suicidal thoughts. Individuals with schizophrenia may experience voices that “command” them to harm themselves. This is one example of how schizophrenia symptoms may lead to self-injury and suicidal thoughts.

I also want to clarify one aspect of your letter related to schizophrenia. You said “I don’t think I am violent enough to be schizophrenic.” Please understand that violence is not a symptom of schizophrenia. Unfortunately, there is an ongoing misconception that individuals with schizophrenia are violent. There are a small number of individuals with schizophrenia who are violent and it is these cases that tend to make media headlines. The facts are quite different from what is portrayed in the media. Individuals with schizophrenia are much more likely to be victims of violence rather than perpetrators of violence.

I suspect the diagnosis of schizophrenia may be the most accurate among those that you have presented but again, without extensive interviewing, it is too difficult for me to be certain.

I hope that my response answers your questions. Should you need clarification or have further questions please do not hesitate to write again. I wish you well. Please take care.

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