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I Think I Have Some Kind of Bipolar Disorder

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 20th, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I started taking a medication that has several purposes but my reason was for precautionary measures after a single seizure. It’s Lamictal and you very well know it’s also used to manage bipolar disorder. I’ve been on it since February and it’s September now, so it’s been 7 months. My dosage is 200mg a day.

As soon as I started taking it in the beginning I began to notice a gradual stabilization in my mood. Before I would become depressed and apathetic and have moments of restlessness and hyper motivation. Thoughts of suicide have crossed my mind for years but I’ve never acted on them because I know I’d probably think differently later.

I’ve done my research on mental illness since I was 14. I’ve always had some strange attachment to them, specifically the types of bipolar disorders, borderline, and avoidant personality. I display a lot of symptoms for AvPD that I wouldn’t doubt I’d at least qualify for an evaluation. Oddly enough, I am able to manage myself because I’d like to avoid criticism as much as possible. And I have found fairly successful ways to manage my anxiety. But that’s not the point of my question. I realize my details are pretty vague and it’s basically impossible to be evaluated through text. But I do feel there is something wrong with me. I sometimes get careless with taking my medications because I feel it’s unnecessary. So I’ll go a few days to a week or so without it and then my anxiety gradually returns along with depressive thoughts, irritability and carelessness. Ive gone on some spending missions, luckily I grant myself a limit. So there is some personal control there. I’ll stay up late planning things I want to do and so on.

To sum it all up, I need to know how I can make sure I stay on this medication without having to go to a psychologist? My neuro doctor planned on weaning me off after a year and that year is up in 5 months. I like the stability. I’ve gotten so used to it that I worry I’ll crash hard when I’m completely cut off from lamictal. I feel the only way to stay on it is to somehow figure out what caused my seizure 7 months ago and trigger it again.

I deeply appreciate your thoughtful description of resilience and ongoing coping with your symptoms. It takes a lot of courage to manage, and throughout your description I notice how much grit, self-control, willpower, and self-regulation you bring to the table.

I do have a suggestion about the medicine, but I want to highlight your extraordinary coping skills. These are essential ingredients for your well-being going forward.

The physician prescribing The Lamictal is well aware of its other properties as well. I think I would show him or her this detailed letter and explain your stability that has come from taking the medicine. I believe this type of consultation is invaluable in your case. The physician is then in the best position to offer feedback about your options.

Wishing you patience and peace,
Dr. Dan

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Should I Take Medication?

by Dr. Marie Hartwell-Walker December 4th, 2022
written by Dr. Marie Hartwell-Walker

From a teen in Russia: Hi. I’m an 18 year old professional/competitive athlete[Runner/figure skater.] Past few months I’ve been feeling worse than ever. Well, bad might not be the word rather empty. I’m good at communicating so I don’t have anxiety or anything of the sort and I LOVE the way I feel after training, it’s when I don’t feel empty but rather alive. The only other thing making me “snap out” are dogs, which I cannot own due to the way things are in Europe. Ik this is American forum but I have nowhere else to ask.

I likely have of smiling depression and I’ve been combating that for ages. I always force myself to go cause I know I’ll like it but it takes so much will power of persuarsion and my family would rather have me focus on other , safer, things but I don’t like anything else. I’ve been going through injuries and as well as sleep and eating problems and now it’s causing a red flag for my career slowly.

I feel like no matter what I do can’t save me anymore and I don’t even wish to combat my head. The only things that help are training, dogs and ice baths all which my family ruins by suggesting each is bad and casual “Oh don’t go” or “don’t do”. I don’t know. Would medication help? Is this depression? Is it normal to feel that empty? I don’t know much about it but the symptoms seem to fit and I’m quite desparate. Please help, I feel like I’ll lose my whole life, sport, at the point I’m sinking to. Should I just try and combat it again, would medication be a bad idea? I’m very tired of battling it and it seems tempting to have it controlled, but I fear the bad side effects and I just no longer feel like continuing the battle. Because I’m always happy to everyone nobody even understands. I am just used to acting this way. I don’t know what to do anymore. Should I live with it always? Give everything up? Medicate it?

No, it is not normal to feel this empty. No. You shouldn’t live with it. I’m very, very glad you wrote to us.

I can’t give you a diagnosis on the basis of a letter but I can tell you that what you report is consistent with a diagnosis of depression. It makes sense to me that you feel better when you push yourself physically or take ice baths. Both produce endorphins, a natural “anti-depressant” of sorts. The dogs give you unconditional love and don’t expect anything of you other than your affection. It makes sense to me that being with them also makes you feel better.

All that being said, as you are finding out, it is not enough. What you need now is a professional evaluation by a mental health provider. That person can help you decide if medication might be helpful. You are not obligated to follow the recommendations. However, the conversation will help you understand what is going on and will offer you alternatives to help you feel better.

Usually the treatment of choice for someone who feels as you do is a combination of medication for a while and talk therapy. The medication may give you some relief once it reaches a therapeutic level, but you also need to learn other ways to feel good about yourself and just to feel good besides pushing your body to physical extremes.

Please follow up and get yourself an evaluation. Learning how to take better care of yourself emotionally as well as physically will set you on a path for a much happier and healthier future.

I wish you well.
Dr. Marie

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Torn about Diagnosis of Bipolar II

by Holly Counts, Psy.D. November 18th, 2022
written by Holly Counts, Psy.D.

Hi there, I’m torn between accepting or rejecting a diagnosis of Bipolar II. A clinical psychologist diagnosed me with Bipolar II a week ago and now I am under a primary care physician to receive mood stabilizing medication this week. I don’t think I have bipolar disorder though. Can personality not sometimes resemble bipolar? I am sometimes hyperactive and able to take on a 100 projects, feel super smart and pretty and am at the top of my game. I need little sleep and in fact find sleep an annoying timewaster. Then I have times, probably more often, where I feel sorry for myself, feel ugly, stupid and can barely clean my flat or look after my pets. When I’m hyper, I harm no one, I don’t spend too much or gamble or drink or do anything that could be considered damaging. I just work really hard, accomplish a lot (I work fulltime as a project manager, am a freelance educational writer and am in the third year of a science degree for which I have had 18 distinctions so far). When I am down, I do feel very sad and think of killing myself every now and then, but I would never kill myself as I know logically this would be stupid and that I always feel better again. In my mind, I am just a highly functional individual who is able to achieve a lot, use my time to the max, sometimes feeling on the top of the world and sometimes not. I’m used to feeling like this and I have all sorts of coping mechanisms around it. I am completely alone, no family and few uninvolved friends, so my state of mood never affects anyone. I also have no support structure should it really be bipolar and should I need help. I don’t understand why I should go on mood stabilizers and antipsychotics. I’ve had no breaks with reality, just a few very minor private breakdowns where I have cried a lot. But I got over those and I was just overworked and under a lot of pressure and it didn’t affect anyone other than me. What do you do when you are torn between accepting a diagnosis and thinking it is total nonsense? I change my mind at least 20 times a day. I can’t imagine I will be able to be compliant with taking medication or accepting help. (age 38, from South Africa)

Based on what you have described here, I tend to agree with the diagnosis that the psychologist has given you. It does sound like you meet the criteria. Most people experience some ups and downs, and yes, some personalities can include some opposing traits and tendencies, but the swings that you mention here do hit some of the classic extremes that are included in Bipolar Disorder and/or Cyclothymic Disorder.

However, just because you meet the criteria for a disorder does not mean that you need to be medicated for it (or even treated). If you feel that you truly have the coping skills already in place to manage your mood and energy changes, you don’t have to pursue further treatment. But the fact that you consulted with a psychologist in the first place and state that you don’t have a support structure to rely on, indicates that you could at least benefit from the help of a therapist.

Most people with Bipolar love their highs and hate their lows, so you are not alone in this aspect. Deciding how much the mood changes impact your life and your ability to function, as well as affecting your “quality of life,” will help you with the decision to medicate. Mood stabilizers will not change your personality, they will level out the highs and lows so that you have more consistency in your state of being. But you have every right to seek a second opinion if you are still struggling with the decision whether or not to pursue further treatment. I hope this information helps.

All the best,

Dr. Holly Counts

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Explaining “Quick” Anger and Rapidly Changing Moods

by Kristina Randle, Ph.D., LCSW October 18th, 2022
written by Kristina Randle, Ph.D., LCSW

I do not really know where to start. The past three years of my life have been a hell not to mention a blur. I have been diagnosed with sevral disorders, and I am aware that my bi polar disorder can explain my rapid mood swings, but what is happening now is out of hand. For the past month, I might even maybe 2 months I have had these day long events. Starts out normal enough and the day is going fine and then bang I’m angry and not like ‘Oh I’m angry, I’ll get over it, it’s more the anger where your hands shake and your fgriends turn into your worst enemies. I wanna break things and acts of voilence have corssed my mind more then once. I have been verbal all my life so argueing and being hurtful with my word is nothiong new but wanting to take it to the next level and feeling that loss of control is scaring me to death. Ive had fits of rage that turn into a crying session pulled out some of my hair in furstration. there is the other side of that spectrum as well…the depression…crying for hours on end and afriad of everything thats in my life..fearing my self above all. I dont understand why this is happeneing what might have caused it or even exactly what it is. I have been dealing with bipolar, adhd, borderline personality disorder and depression since I was a child. I have never dealt with anything like this and I need some insight. Please help.

My sense of the situation is that your symptoms are not under control. You said that you have bipolar disorder as well as a few other disorders but you did not say whether you are taking medication or are in treatment.

You asked about what could account for your increase in anger. There could be a number of possible explanations. A change in medication could explain a shift in mood. This might include a decrease in medication, an increase, or a change to other medications. As I mentioned above, you did not indicate whether you are taking medications but if you are, this is one area to explore. A change in your medicine could affect your mood.

Was there a change in your life? This is one possibility to explore. Think about what, if anything has changed recently in your life. This could account for mood shifts.

Other possible reasons to explain a change in your mood may include lack of sleep and using drugs or alcohol. A lack of sleep can cause irritability. For instance, if you are used to getting seven or eight hours of sleep and you are now getting less, then you should expect to see a change in your mood. It is difficult to manage your emotions when you’re tired.

Without more detailed information it is difficult to know why you are experiencing anger outbursts. If you would like to write back and provide information related to whether there has been a change in any of the aforementioned areas discussed above, I’d be happy to try to provide you with a more specific answer. Without that information, I can only give you a general answer. I would suggest that you meet with a mental health professional, if you are not already in treatment. You should also be evaluated by a psychiatrist to determine whether medication is necessary or if a medication change would be helpful. If you would like to search for a therapist in your area please follow this link. Thank you for your question.

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Should I Disclose Depression?

by Kristina Randle, Ph.D., LCSW June 25th, 2022
written by Kristina Randle, Ph.D., LCSW

When I was 21 years old I started having visions and hearing things that others did not. I thought and still do think, I am special because of it. However, I started to feel like I did not want to be special any more. I went to the doctor and was treated for depression…

I am now 35 years old. I am college educated, I had a great career…children and now everything is falling apart. I used to be able to drown out the voices when they became overwhelming. I am having trouble dealing with it. They call me names and scream at me. They used to be friendly and even helpful. I am also extremely worried that someone will hurt me and my children.

I started seeing a therapist in October but I could not tell him everything. I did not really trust him. I felt by the way he was speaking to me that he was trying to judge me. I was also very afraid that he would have me arrested and take away my children. I was taking medication, but the voices told me that if I continued to take them I would die…I thought it would be in my best interest to listen….

I have an appointment with a new doctor next month…what should I do? Should I tell the doctor everything? Is this normal? Am I suffering from a depression?

Yes, you should tell your doctor about the symptoms that you are having. Withholding information from your doctor makes it difficult for him or her to properly treat your problem. The fact the you withheld this information from previous mental health professionals means that they may have misdiagnosed you with depression. Nothing in your letter suggests that you have depression. Your primary symptoms seem to be delusions and hallucinations, neither of which are symptoms of depression. They are in fact symptoms of a possible psychotic disorder such as bipolar disorder or schizophrenia. I cannot say with certainty whether or not you have a psychotic disorder but it is a possibility. That is why it is imperative that you report all symptoms to your doctor so that he or she can treat your symptoms accordingly.

There’s no reason to believe that you will be arrested or that your children will be taken away from you. Your children are not in danger. The authorities only remove children from their parents in cases of imminent danger. You’ve done nothing to suggest that you might harm your children. Simply having symptoms of a mental health disorder does not make you a danger to your children.

I would encourage you to read the New York Times article by Elyn Saks entitled “Successful and Schizophrenic.” Elyn Saks is a university professor, a successful researcher and the recipient of the MacArthur Foundation genius grant. She has schizophrenia and has been wildly successful in her life. In the article, she describes some of the ways in which highly successful individuals with schizophrenia manage their delusions and hallucinations. Some utilize cognitive techniques. In one instance, one particular individual would ask the following questions of himself when he began to experience hallucinations: “what’s the evidence for that? Or is it just a perception problem?”

She describes another individual who would simply “blow off” their derogatory voices. Another individual identified their triggers for the purpose of preventing a “full blown experience of symptoms.” Others used techniques such as minimizing sensory outputs, exercising, focusing on work, getting proper sleep, healthy diet, avoiding alcohol, and prayer.

There are very effective treatments and strategies that you can employ to significantly decrease or eliminate your symptoms. The sooner that you report these symptoms to your doctor, the sooner your symptoms can be properly dealt with. Please take care.

Dr. Kristina Randle

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Boyfriend Refuses Help

by Kristina Randle, Ph.D., LCSW June 19th, 2022
written by Kristina Randle, Ph.D., LCSW

Dear Psych central, I am a recent high school graduate and will be attending college in the fall. My boyfriend and I began dating a few months ago although we were close friends all throughout high school. I love him very much and am deeply concerned for his mental wellbeing. He currently acts entirely normal and can function as any other person could, however, he has what seem to me to be undeniable signs of schizophrenia and acknowledges them but rejects the idea of taking any medication. He will be turning twenty this year, however, right before his 18th birthday during his senior year of high school he entered into some form of psychosis which he attributes to smoking marijuana and salvia and as he refers to it as “never coming down from it” his trip lasted around two months I believe during which he explains he had delusions, hallucinations and extreme paranoia. Many of these delusions were religious in nature which I attribute to his strong religious beliefs. He was taken to a hospital and diagnosed with something relating to schizophrenia. He was given medication I believe although I don’t know what exactly. He was previously a heavy marijuana smoker and has since quit entirely as he attributes the smoking to the triggering of the trip. His 25 year old half brother was also recently diagnosed with schizophrenia and was in an institution until recently although he too denies having any real problem. Today he told me that while he was at work taking a customer’s order he began hallucinating and saw the man’s face change into something horrific and then go back to normal after a few seconds. I had never before confronted him about his illness because I know it is a touchy subject for him although he frequently jokes about how he is crazy and “schizo”. I suggested he get help now because he is at the exact age that signs of schizophrenia manifest themselves and he could potentially prevent things from getting worse but he sees his trip as a one time isolated incident that wont be progressing into something more serious. Additionally I think he has kind of a macho man complex and believes he can use his own will power to fight off the delusions and does not want to be dependent on any kind of medication. We will be going to separate colleges and I will not be seeing him on an entirely regular basis to detect signs of unusual behavior. What can and should I do? How do I get him help without pushing too hard? Like I said he functions entirely normally now and only had that one episode. Thank you so much for reading, I leave for college in three weeks and would deeply appreciate if you could get back to me prior to then!

Some people only have one psychotic episode and never have another. It’s concerning that some of his symptoms have begun to reemerge. Thankfully they don’t last long but your concerns are justified. Treatment could prevent his symptoms from getting worse.

His refusal to accept treatment is obviously problematic. As you have correctly noted, it could prevent the possible development of a severe mental illness. Without treatment, he is at risk for having additional episodes of psychosis.

It’s very encouraging that he is no longer using drugs. It significantly decreases, though does not eliminate, his chances of having another psychotic episode.

The only time an individual can be forced into psychiatric treatment is when they are an imminent danger to themselves or to others. Otherwise, they are free to decide not to accept treatment. That is a difficult reality for loved ones. They know that treatment would help and could prevent future problems but they are often powerless to intervene.

Are there family members who might convince him to accept treatment? What about a friend who he likes or respects? If there is someone who you think can help, contact them immediately and discuss your concerns. You would feel better if you knew that someone was looking after him while you are away at college.

Do everything that you can to help him but realize that your power is limited. You can’t force him into treatment. You should continue to encourage him to accept treatment but ultimately the decision is his. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Depression Which Resulted in Anxiety/OCD

by Kristina Randle, Ph.D., LCSW May 19th, 2022
written by Kristina Randle, Ph.D., LCSW

I Had Since 7 Years A Depression Which Resulted In Anxiety/OCD after using lexapro for certain period I was kind of cured. now a year ago I felt the symptoms came back but more extreme. I have sense of wanting to control my senses and It feel strange to me examples.. I try to control my head when I talk or U feel the words coming out of my mouth strange.. to summarize it I feel strange to the nature of being me and this gives me huge anxiety especially that it keeps running all the time in my head. I have used this year the following medications without real benefit : lexapro-sertarline-brintellix-fevarin and now am on venlafaxine. I have some times during the day some good moments where I feel kind of normal and my sleep eating patroon is good, but the strange feeling of myself does not allow me to go back to work yet.. (main problem is monitoring myself too much ) what do you recommend especially that I tried CBT but also without real results.. am afraid this will take longer time and am already fed up with the situation that I cannot concentrate on the main things in life and instead am only busy monitoring myself ( my eyes blinks, my mouth when I talk , my head when am talking, my hands if I move them.. everything seems weird to me) further I do not use any drugs neither I drink alcohol. Please send me your advice and I will be grateful.

I understand your frustration. but you shouldn’t give up. Finding the right treatment(s) is often a trial and error process. It is to be expected. That is especially true with medication. It’s common for people to have to try different medications to find the one they like or that works best for them. Even when they find something that works, after a while, they often need an adjustment in dosage or a new medication altogether.

You also mentioned therapy. It wasn’t successful thus far but that doesn’t mean it won’t be in the future. I always recommend that people contact four or five therapists. Interview them over the phone and ask them many questions. These questions can include: How would you characterize my problem? How would you treat my problem? How much experience do you have? Have you helped other people with similar problems and how have those people fared? What would your strategy be for treating me? Do you think you could help me and if so, how would you do it?

Then, you would want to ask practical questions such as: Do you take my insurance? How much are co-pays? How soon could you see me? How often should our sessions be? When could I expect to feel better?

Therapists are very different from one another. They vary in their strategies. Some are certainly better than others. Choosing a therapist takes time. It’s important to find the one you like, are comfortable with and who you think has the best chance of helping you. That is the therapist who will likely be your best match.

Once you begin treatment, you should feel at least a little better after each session. If that’s not happening, it may be time to find a new therapist.

The problems you have described are highly treatable. Depression and anxiety are two of the most common disorders in the world. The fact that you’ve already tried treatment and are open to trying it again is very good. You are moving in the right direction. Your openness and willingness to engage in treatment significantly increases the probability of overcoming these issues. It’s important to highlight that fact, since many people refuse to seek treatment and suffer with treatable problems. Thankfully, that is not the case with you.

A common complaint among clients regarding treatment is that they hate to start all over again, with a new therapist. They don’t like the idea of having to retell their entire life stories all over again. It’s an understandable complaint but finding the right therapist is well worth the effort. There are good therapists who can help you but it isn’t always easy to find them. You have to search for them. Consider my advice, above, about contacting four or five therapists, and hopefully you’ll find one you like.

You have the right attitude regarding treatment, which will significantly increase the likelihood of your success. Good luck with your efforts. Please take care.

Dr. Kristina Randle

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Extreme Anxiety

by Dr. Marie Hartwell-Walker May 11th, 2022
written by Dr. Marie Hartwell-Walker

For as long as I can remember I have had extreme anxiety issues. I have social anxiety, but the main source of my anxiety is my health. I can’t do anything, and I mean anything without worrying that I am going to die. For example, me and my family went to Disneyland the other day, I was having panic attacks and worrying that I would either just drop dead for no reason or since I had a little bit of a headache that day I was scared was going to have a brain aneurysm. Its always something everyday with my health, it’s exhuasting. All I want to do is sleep all day or just zone out in front of the TV so I dont have to think.

I also have other symptoms, but am not sure if they are part of the anxiety or not they are: feeling like I am in a dream or like a spaced out feeling, weird “what if” thoughts (ex: What if I killed myself or someone else?) and by no means do I want to do this or even have the urge, but since I thought it I get anxiety about it, thinking I am crazy for thinking such things or I am afraid I might sleep walk or something and do it out of my control.

I dont have a job right now and no health insurance, I am just trying to figure out whats going on with me. I am sick of feeling like this. I just want to feel “normal”.

I should mention that I have been on Effexor XR since my daughter was born in 2006, I had Postpartum Depression. I am still taking the Effexor XR, which doesn’t seem to help much anymore, and I am taking 1mg Ativan as needed. I hope you can give me some insight and direction from where to go from here.

Thank you

Thank you for writing. The first thing to do is to go back to the doctor who prescribed the Effexor. The period of time that a postpartum depression generally lasts is long over. If you haven’t been back for a discussion about your symptoms and how you are doing on the medication, you should immediately make an appointment. One of the potential side effects of Effexor is anxiety. What you are taking for depression may possibly be contributing to your anxiety. If your PCP or OB-GYN has been prescribing your medication, I do suggest you see a psychiatrist to get a specialist’s take on whether you still need the medication or if you are taking the right one.

Meanwhile — you really should consider finding some therapy for yourself. Some cognitive-behavioral therapy could help you get your anxiety under more control so that you can enjoy life. I know you have no health insurance. Before you give up on the idea of getting any help, I do suggest that you talk with your doctor or spiritual leader about any free or low-cost resources that may be available in your area. Many private therapists also offer a sliding fee scale or low-income slots.

Please be more concerned about finding treatment and less concerned about finding a label for yourself. As you said, the important thing is to get back to feeling “normal.” You deserve it. Your daughter deserves to have a mom who feels stable and able to cope.

I wish you well.
Dr. Marie

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Major Depression Seems To Be My Ball And Chain

by Kristina Randle, Ph.D., LCSW April 13th, 2022
written by Kristina Randle, Ph.D., LCSW

I’ve been on antidepressants since 1985. I’ve had a bunch of therapy over the years mostly in the mid to late 80’s. I believe I understand and have dealt with my childhood issues.

Every few years or so I have to switch meds because they stop working. As you probably know this can be a hellish experience. I’ve been off of Cymbalta for 20 days and was hoping that the worst was over… but I’m not sure. I’ve been on Nortrriptyline for about a month at a very low dose (25mg) because I don’t like certain side effects and will likely taper off of the 25mg. I’m hesitant to go forward with different meds because of when I have to switch again. My Psychiatrist is suggesting Zoloft based on the drugs I’ve already been on.

I’m kind of scared…I feel so agitated/angry/crazy at times. If you asked someone who knows me their first thoughts about me they would include something about how much I love animals. We’ve got 2 high energy dogs (herding breeds) that I take out daily to exercise (them and me). Usually we walk for an hour and I let them run in an open field at the end of the walk. Lately (the past week or a little more) I feel so irritated by them when we go for walks or for a car ride to the dog park that I am almost abusive to them. Yelling at them in the car just because they are panting too loud! What is wrong with me? Is this from the Nortriptyline? Or part of the problems coming off of the Cymbalta? Or is this some new depression thing? Whatever it is it is really awful and I wish someone could just put me out of my misery.

You are currently in the midst of a medication transition. You have described that experience as “hellish.” Many people would concur with that assessment. They too find it to be an unpleasant process. It is “hellish” largely because of the emotional dysregulation that often characterizes that experience. It is very likely contributing to your current feelings of agitation, irritability and your overall emotional instability.

You should consider returning to counseling. You tried counseling approximately 20 years ago yet the depression has remained.

Therapy could be advantageous for several reasons. One reason is that it might clarify whether you are currently having a depression episode or if your symptoms are associated with the transitional medication process. Secondly, a therapist could assist you in the development of relaxation techniques that might increase your emotional stability during this transitional period. Finally, therapy could help you to address your symptoms of major depression that have been your “ball and chain” for more than a quarter of a century. There are effective therapeutic modalities that can significantly minimize your depression or eliminate it from your life. Psychotherapeutic treatments have advanced a great deal since the 1980s.

I would encourage you to discuss your symptoms with your psychiatrist. He or she might prescribe a medication that can quell your agitation and irritable feelings while you are transitioning to a new set of medications. Also, I hope that you will consider counseling. A competent therapist can help to permanently remove depression from your life. I wish you the best. Please take care.

Dr. Kristina Randle
@DrKRandle

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Does Psychosis Go Away on its Own?

by Kristina Randle, Ph.D., LCSW March 15th, 2022
written by Kristina Randle, Ph.D., LCSW

About 8mths ago, my husband woke one day and said he was hearing voice, he complained of headaches; he wasn’t sleeping and became very religious. He said my family had tried to poison him or something spiritual- he also was paranoid. He was very cold, almost like a different person. He was loosing weight- just said things that didn’t make sense. I believe he had a psychotic episode either suffering from psychosis or depression- he may even be bipolar. About a month after, I came home and some of his things were gone. And was the last time I seen him. He is ok now, living on his own and sounds very functional, except that he calls with private #s, and still talks about my family poisoning him which is not the case. He’s a very intelligent man and so stubborn. I know he would have to be Denzel Washington to pull off what happen to him, so I don’t believe he was faking. I’ve seem him in the club drinking and dancing as if nothing happened. He didn’t seek medical attention (counseling or medication)…is it possible to recover the way he is now, functional without medication or at any given time it could happen again?

Any information you can give would be appreciated.

It may be possible to recover from psychosis without treatment but that is the exception rather than the norm. Generally, untreated psychosis becomes worse over time. Individuals typically continue to experience symptoms until the psychosis is treated. He may seem “okay” right now but you may not be seeing the full picture. His unwillingness to seek treatment is concerning as is his drinking. Alcohol and other drug use can exacerbate psychosis.

Based on information that you have provided, I do not think he is well. He needs treatment. Psychosis does not generally improve on its own. In virtually all cases, treatment is necessary. Without such treatment, decompensation occurs.

This is a very challenging situation. He is an adult and as such it is difficult to force him into treatment, especially if he does not want it or does not think that it is needed. Unfortunately, in many states, the only time that you can force someone into treatment is when they are on the verge of seriously harming themselves or someone else.

My recommendation is to try to convince him to seek treatment. I understand that he may not be willing but it is worth a try. I would also recommend attempting to connect with other friends or family members who are concerned about his condition. He may be willing to attend treatment if several individuals share the opinion that he is not well.

Two websites may be of assistance to you: the Treatment Advocacy Center and the National Alliance On Mental Illness(NAMI). The Treatment Advocacy Center provides information about state civil commitment laws. Their website also provides information about how to handle psychiatric emergencies and when to call for help. NAMI may be a helpful resource because they provide educational information about mental health disorders as well as guidance about navigating the mental health system. NAMI has support groups for family members who have a loved one with a mental illness. Most communities throughout the United States have such support groups. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Why can’t I just be happy?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 18th, 2021
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Hi I am 20 years old and just recently moved to Chile with my mother after the separation with my step dad. I have always suffered from depression and have taken medication for it but it seems to never work. These past few years it seems that I have gotten worse. I am constantly down on myself never thinking I am good enough. I can’t even remember what it feels like to be happy. I get angry over what my mother tells me are small things but I tell her they aren’t small to me. I am always on a rollercoaster of emotions, I can be having a good time and the simplest thing will bring me down and I am upset the rest of the day.

I don’t have a home anymore and am staying with family and they are constantly taking my things and it makes me so angry and I just want to cry. Whenever I try to explain to my mom or anyone how I am feeling I start to cry. I have gotten to a point where I get so angry I don’t even scream anymore I am just silent and cry. I feel like I am filled with all these emotions all the time and I hate that I feel so sad and angry all the time but it seems like I can’t be happy.

It makes me feel like I am a burden on everyone and it would just be better if I was gone. Why am I this way? Why can’t I just be happy?

I am sorry this has become such a difficult time in your life. Depression is often activated when we feel we cannot control various aspects of our life, and gaining control of the areas we can is typically the key for feeling better.

There are several things we can do to combat depression that I have identified elsewhere. I will encourage you to read through these as a foundation for change.

In a nutshell, some strategies listed in this article include:

“Positive psychology – strategies designed to shift your thoughts and feelings toward a more positive framework. This isn’t a simplistic “think-happy-thoughts” approach, but rather a focused effort at cognitive restructuring of your thought process. The strongest combination to approach depression is therapy combined with an antidepressant. If you do not want to take an antidepressant there are several homeopathic or herbal alternatives that may be helpful. You may want to consider group therapy as a means of supplementing your individual therapy. Group therapy is different in that there is an interactive feature that can’t be duplicated in individual therapy, and it often provides a vehicle for support as you begin to make changes in your life. Your therapist may know someone he or she can refer you to in your area. Meditation – learning how to self-soothe your emotional turmoil is perhaps the most important skill you can learn. Aerobic exercise – the value of exercise in combating depression is very well documented and this is particularly true for any exercise involving aerobic displacement. Review your diet – our emotional life often changes our craving for various foods, which may not have the best impact on our biochemistry.”

The short answer is that coping with a depression is like walking up a down escalator and we must find the tools and the strength to deal with changing our thoughts and attitude as a way of neutralizing and overcoming these feelings. In particular I would encourage the use of the technique called the “Three Blessings” because it can be used as a direct way to start changing your thoughts.

I would encourage you to seek counseling now to develop a support system in your new location. The find help tab may be helpful as international links are included.

Wishing you patience and peace,
Dr. Dan

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I Get Angry Easily and Cry a lot

by Dr. Marie Hartwell-Walker November 14th, 2021
written by Dr. Marie Hartwell-Walker

I dont know if I have a problem or not but I want to make sure. I get angry easily and snap at my sister or mom a lot. And I always end up feeling guilty. I can’t control myself sometimes. Several times I’ve punched walls and messed up my hand or put a whole in the wall. I usually do this when I’m alone. I never seem to be in control with my emotions. I always end up crying at night and fall asleep like that. I always thought it was around my period but frequently it’s all the time.

I’m stressing out about college because (even though my sister is in college) she isnt really helping me out. I always look up to her for advice but recently I haven’t been able to trust her. My cousin, who I was close with until some previous problems occurred, it’s of much help with college even though we’re going to the same community college. She always assumes something bad of me. I feel like a failure because I have no idea what I’m doing in college and what I want to study. I feel like this because my sister has everything figured out. And every time someone brings up about school I get mad and irritable but now it’s about every mistake I make.

I can’t ever seem to control what comes out of my mouth an end up getting my sister mad and she disputes with me and gets me even more angrier. I spoke to my mon and found out she is taking medication for anger and it’s starting to worry me. Do I have the probability of having bipolar issues or am I depressed? I have no idea what to do and I don’t want others to know I’m struggling mentally. I’m afraid that next time I get really angry I will end up hurting someone physically. Because several times in the past when I would punch walls I would only see darkness and let myself succum to my anger. But afterwards I’d feel horrible.

Thank you for writing. The first thing to do is to get a complete medical checkup. Sometimes the emotional ups and downs that you are reporting have a physical cause. Make sure you check it out before you decide that this is all in your head and start worrying about a mental health diagnosis.

Having said that, I do have another idea. Sometimes our inner self is wiser than we give it credit for. It just may be that your emotionality is a way you are telling yourself that you are simply not interested in college at this time. I want you to know you’re not alone in this. Many recent high school grads have no idea what they want to study or why they are headed to college. Everyone they knew just kind of assumed that of course they were going and they went with what felt like an inevitability. Often these are the kids who drop out. If they do complete the four years, they often aren’t happy with the major or the career they ended up with.

I think you should take a step off the conveyor belt that is taking you to college and really think about what you want to do. It’s not a crime to go your own way. It’s only wise to take time out to figure yourself out. There are progams called “Gap Year” that are intended for teens just like you. Search the web and you’ll see all kinds of interesting ways to make a contribution in the world and to expand your own horizons. I wrote a couple of articles for Psych Central that address this issue because I was getting many letters like yours. Click the links to take a look.

Are You Ready for College? Alternatives for the Unsure

Ready or Not: Immature but Headed to College

You are your own person. You are not your sister. You are not your cousin. Taking more time before choosing a path toward your future is only smart. College costs a great deal of money and time. You want to be sure that it is necessary and that you are motivated to do the work before you pack your bags to go.

I wish you well.
Dr. Marie

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Hallucinations, Mania and OCD

by Kristina Randle, Ph.D., LCSW October 24th, 2021
written by Kristina Randle, Ph.D., LCSW

I see and hears things that none else can see, mainly demonic faces everywhere that looks like a zombie looking alien with huge goat looking horns, the other things i see could be black shadows that fly so quick past me or someone else with me that it looks like a black bird thats flew past, or even see things that im afraid of like when i seen millions of spiders all over the floor but was told nothing was there. i hear voices that tell me i should cut myself or try to kill myself and the voice sounds evil,not human, i sometimes also hear like as though the telly or radio is going off but nothings on at the time. there are times i end up having really high moods where i end up going out shopping spending £100s in a day on just stuff to use for all my ideas i have in my thoughts, when i think of lots of ideas i cant concentrate when others try talking to me, and i end up shouting at them aggressively just to be quiet while i think. according to my friends or family i dont make sense to them or think of too much and talk too fast for them to know exactly what ideas im talking about. I have told my doctor all of this and a counsellor but none of them seem to believe a word i say as though they just think im a freak or making the whole thing up, what should i do? as its getting worse every week.

Your symptoms are unusual. What you are seeing and hearing is distressing to you. Your symptoms seem indicative of an ongoing, untreated psychosis. You are also experiencing mood swings and having difficulty controlling your behavior. If you are currently in the midst of a psychotic episode, then it makes sense that you would have difficulty controlling your mood and behavior.

Psychotic episodes require immediate treatment. They typically do not get better on their own. Medication could significantly reduce or eliminate your symptoms.

I understand that you have told your doctor and counselor about the symptoms but it’s unclear why they have not taken action. If they continue to ignore your symptoms, then you must find a different set of mental health professionals who can help.

I am also concerned about the voices telling you to harm yourself. This is a common experience among people who hear voices. If you feel that you might harm yourself or someone else, then it’s imperative to go to an emergency room immediately. The hospital can protect you and ensure that you receive the proper treatment. They can also assist you in finding a treatment team who will take your concerns seriously. You must do what it takes to get the proper help. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Depression, Substance Abuse & Tired of Living

by Kristina Randle, Ph.D., LCSW August 30th, 2021
written by Kristina Randle, Ph.D., LCSW

I am so fed up with the fact that I was born the way I was born. I am ugly, fat and have no motivation. It is so hard to watch TV because all I see are pretty people with lots of money. It is hard for me to go to the store or anywhere for that matter because everyone around me is prettier, skinnier, an richer than me. It is heart breaking that I have to live with myself. It is getting harder and harder to wake up in the mornings. The only peace I have is when I am asleep. I pray something horrible will happen to me just so I don’t have to continue another day of agony. I have started drinking more than usual. I wake up and need a beer to calm my nerves. I recently graduated college and I am having no luck finding a job, I live with my husband’s parents and I feel like such a piece of crap. I don’t want to feel this way because I have a daughter, but I am finding my drinking becoming more and more of an issue. I really need help. I feel so ugly I dont even want to show people my face. Sometimes I overeat, over drink and smoke to make myself feel comfortable in my own skin. Help. I am losing control and I am on the edge of giving up on everything..

There are several issues to address here. Foremost among them is the fact that you may be depressed. The content, tone and theme of your letter is consistent with an individual who may be experiencing depression. Your self-perception is negatively skewed. You have described yourself in very derogatory terms. Those are typical signs of depression.

Some individuals with depression utilize alcohol as a method of self-medication. They drink because it temporarily numbs their negative feelings. Chemically speaking, alcohol is a nervous system depressant. It may be contributing to your depressed mood.

Although it is common to do so, comparing oneself to others can provide an inaccurate view of reality. Your situation is very unique. Thus any outward comparisons that you make can never be fully accurate.

You are being unreasonably critical of yourself. You both maximize the negative aspects of yourself (i.e. “ugly, fat and no motivation”) and the positive attributes of others (“prettier, skinnier, and richer”). There are no objective standards for beauty or for what is desirable. There are doubtlessly people who look at you and consider you prettier, richer and thinner. Those people are not necessarily unhappy or depressed because they see you that way. For almost everyone, wouldn’t it be safe to say that there are people in the world who are prettier, skinnier and richer? Wouldn’t this even be true for movie stars?

Should only the richest, the prettiest and the thinnest person in the world be allowed to be happy while all of the runners-up are forbidden happiness? Of course not. Happiness is not something you win in an outward contest with others but instead something that comes from deep inside.

As you stated, you are “on the edge of giving up on everything.” Now, more than ever, is the time to seek help. If not for yourself then do it for your daughter, whose mental health and well-being is largely dependent upon having a psychologically healthy caretaker.

Counseling could provide the objective third-party perspective that is necessary in this situation. It could also provide necessary direction, guidance and support. Check the find help tab, at the top of this page, to locate professional psychological services in your community. Please take care.

Dr. Kristina Randle
@DrKRandle

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I Keep Hallucinating

by Kristina Randle, Ph.D., LCSW July 16th, 2021
written by Kristina Randle, Ph.D., LCSW

Earlier this year I started to have tactile hallucinations as soon as i turned to go to bed, It felt like rats crawling on my bed. I have a slight phobia of rats and mice so i thought it was just that. I told my mental health doctor and they upped my seroquel to 1000mg from 200mg.

Since then these hallucinations are getting worse, now its not just bedtime I am constantly seeing a box but i cant see any details although there is some sort of device like an antenna protruding from the top. I also hear children crying and calling my name I try to ignore them but its getting worse and my friends are noticing “looks of terror” in my face.

I no longer drink alcohol but i occasionally smoke marijuana and very rarely take mdma (about 83mg once a year) I tell my doctor but its a different person every time and I freeze up and cant open myself to these people, hell i cant even talk to my long term girlfriend how are my supposed to talk to a complete stranger. Anyway they just write me a script (1000mg seroquel 200mg in the morning 800mg at night). I try to be regular about my sleep pattern always going to bexd at 11 but the meds make me sleep through my alarms or maybe its the fact im laying there for at least 8 hours in terror at what i feel is going all around me which has moved from small sensations on my body to a feeling of being in a busy train station being buffeted from every side.
I cant work, i hardly eat or wash these days im constantly tired and my moods are up and down on a near daily basis, and im no longer sure this is all in my head.

The symptoms that you described are concerning. You are taking medication but continue to experience significant symptoms that are disrupting your life. Part of the problem may be that you are not fully reporting your symptoms to your psychiatrist. If your psychiatrist is unaware of all your specific problems, the risk is that he or she will not treat the correct symptoms.

A related issue is that you are taking a high dose of medication which doesn’t seem to be helping. Again, this likely stems from the fact that your psychiatrist is unaware of what is truly going on.

It may also be that you are taking the wrong medication. Finding the right medication or the right combination of medications often involves a great deal of trial and error.

Since it is difficult for you to speak candidly to your psychiatrist, it might be helpful to make a list of your symptoms to take with you to your next psychiatry appointment. You may even want to take this letter to your next appointment. It clearly describes what you have been experiencing. It’s not unusual for patients to bring notes to their appointments. I would recommend it.

It would also be advantageous to consult a social worker or a case manager, in addition to your psychiatrist. They may be able to assist you with your psychiatry appointments in various ways including advocating on your behalf, speaking to your psychiatrist for you, or finding you a new psychiatrist if necessary, and so forth.

Finally, are there friends or family members who can assist you? For instance, perhaps they can attend your next psychiatry appointment with you and speak to the psychiatrist on your behalf. Utilize the support of others around you. I hope that you are able to receive the help that you desire. Please take care.

Dr. Kristina Randle

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Fearing Inpatient Hospitalization

by Kristina Randle, Ph.D., LCSW June 29th, 2021
written by Kristina Randle, Ph.D., LCSW

I’m a seventeen year old student in school, and I’m trying to figure out life. I have had issues with self harm for a short time (2yrs).My parents and friends are worried that the depression and self harm arent getting any better and im sufferring.I was diagnosed with major depression recently and i feel so bad all the time.So my therapist recommended inpatient to my family because i cant take care of myself anymore.And im afraid because i know how bad i feel, and i dont want to be locked away forever.Right now im having issues with like basic hygeine,i cant sleep, i havent been eating.I want to be normal and do normal stuff young people do but i dont see the point anymore.However i have told my parents and therapist im afraid of inpatient because i dont understand how it works and whos gonna help me there.And i have never been on medication so my family thinks this is a good time to consider it as a option.

I dont know what to do im tired of struggling to get through the school day. I’ve read horror stories on the internet about inpatient hospitals.And im so scared i dont want anything bad to happen to me.I agree with my therapist that outpatient therapy isnt enough anymore i feel so alone and afraid.I do trust my parents and therapist but im so afraid of inpatient and being locked away forever.I want to be able to take care of myself again and enjoy life.So my question to you is Does inpatient hospitalization have to be so scary?Also what happens when a young person is hospitalized for mental health issues? Thank you for time.

I’m sorry you’re struggling. I understand your concern about the hospital. Apparently you’ve heard very negative things about the hospital experience. You mention your fear about “being locked away forever.” That may be part of why you fear the hospital. Your fear may also be related to not knowing what to expect in an inpatient setting. People tend to fear the unknown.

I can’t be certain of what your particular hospital experience would be like but I can give you a general overview of what it might be like. It is important to note that no one can be “locked away forever” in a psychiatric hospital (or any hospital for that matter). In fact, individuals sometimes complain that their stay is too short. Generally speaking, individuals tend to stay for short periods of time in a psychiatric hospital. This is not true in every case but it is for many. Length of stay depends on the nature of one’s symptoms. Generally, psychiatric hospital stays are meant to be temporary, to help a patient stabilize. Once stabilized, the hospital staff is usually attempting to move the patient to the next least restrictive level of care, which may be a partial hospitalization program (where you attend sessions at the hospital during the day but go to your own home at night) or an outpatient setting.

Your family, friends and therapist care about you. They see that you’re unstable and not doing well. They believe that the hospital might be a temporary respite to help decrease your symptoms of depression and to help decrease your desire to self-harm. If you go to the psychiatric hospital, generally there are two ways that one could be admitted: voluntarily and involuntarily. If you choose to enter the hospital voluntarily then you are free to leave at any time. Yes, the inpatient floor doors are locked but you are under no legal obligation to stay. Generally, an individual may enter the hospital voluntarily when they know they need help to stabilize and if they feel that they are a danger to themselves or others. Your family may believe that you are a danger to yourself because of your cutting behavior. They may also be concerned about your depression. Some individuals with depression contemplate suicide.

Once in the hospital, you will likely meet with psychiatrists, social workers and other various mental health professionals. Their goal is to assess your situation, to make a diagnosis and to offer treatment. Their overarching goal is to ensure your safety, keep you stable and ultimately link you to an effective treatment. Perhaps outpatient therapy is not working for you now. The hospital staff may be able to reassess your situation and find a more appropriate program or a more intense treatment to better suit your needs.

During your stay in the hospital, in addition to meeting with psychiatrists and other mental health professionals, you may be asked to participate in individual or group therapy. Some people find group therapy helpful while others do not. You may not be forced to attend group therapy but these groups are generally encouraged. You may also interact with other patients. Some people find this helpful because they meet people who are struggling with similar issues.

Depending on the hospital, there may be certain times when phone use is restricted (i.e. during meal times, group therapy, and so forth). Most facilities will not allow you to have access to your cell phone or other electronic devices (i.e. laptops, computers, etc.) Many facilities allow visitors but like most hospitals, there will be specific visiting hours.

Your case will constantly be evaluated by mental health professionals. If an individual is not a threat to themselves or to others, the hospital staff will make arrangements for the individual to leave and to attend a new program or type of treatment.

If your friends, family and therapist are concerned about your well-being and are suggesting the hospital, you may want to consider their recommendations. You could go to the hospital with your family and be evaluated for inpatient admission. You can go to a hospital to be evaluated by a mental health clinician, psychiatrist or other mental health personnel who will assess your symptoms and determine whether inpatient hospitalization is necessary or recommended. This might be a good place to start. There is no guarantee that if you go to the hospital for an evaluation that you will be admitted. In many states, there are strict voluntary and involuntary commitment criteria. That means that even if you wanted to be admitted to a psychiatric hospital, there’s no guarantee that the hospital staff will admit you.

I would encourage you to speak to your therapist and family about your fears and concerns relating to the hospital. Please try not to be frightened and understand that the hospital staff is not going to “lock you away forever.” They are there to help.

I hope that I have shed light on what the hospital experience may be like. Please consider writing back in the near future and updating me about your situation. Also, don’t hesitate to write back with further questions. I wish you the best of luck.

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Suffering From Depression?

by Kristina Randle, Ph.D., LCSW June 25th, 2021
written by Kristina Randle, Ph.D., LCSW

I feel like i have always suffered from depression but i’m not 100% sure. To start off with the issue/issues:

1)I have always been bullied for most of my life from elementary school onward not so much anymore. I was either mainly bullied by my siblings(brother and sister)when i was the middle child growing up. They picked on me for whatever reason they could think of. One main reason they picked on me was my weight. I was also bullied by peers in my grade, and or friends.

2)I have always been extremely shy, and i struggle with low self-esteem. As i got older, the low self-esteem was still there, but i have now noticed that i am extremely self-conscious of the way i look, i have always struggled with my weight, and i usually hate looking in any mirror because i can see all of my flaws with how gross and ugly i look from being overweight. I do believe this is a form of body dysmorphic disorder? i’m convinced i have it.

3)I was diagnosed with a learning disability so whenever it came to school, i struggled with that and grades sometimes. It was especially hard during the spring semester of the new college i was going to because of the harder classes. Even though i did well for the fall semester. I didn’t realize that i get anxiety a lot, with school but i do.

4)continued from number 3: I was seeing a counselor at the school that i was going to for the fall semester of 2012, because i was super stressed and anxiety driven. I continued seeing a counselor at school for the spring semester 2013, both of them said i had depression. The last one i was seeing said that counseling would not help, but medication with the counseling helped. I learned the hard way when i was at college during the spring semester that college can be extremely lonely at times. I was even hospitalized for suicidal ideation. At that time i was put on 3 medications, i guess all for depression. I have yet to see my doctor about it though even though its been 6 months from that specific incident.

However now that i’m home i’m still convinced that i have depression like the counselor and hospital said. Could the issues that i have struggled with all lead to major depression. any advice would be greatly appreciated.

Yes, the issues that you are struggling with can lead to depression. It’s good that you are seeking professional help but it seems that you require more help than you are currently receiving. As you mentioned, it’s been six months since you have seen your doctor. That’s too long to go without professional help, especially after being hospitalized for suicidal ideation.

The counseling that you have been receiving at school is a great first step but it’s not enough. Typically, college counseling centers are geared toward assessment, emergencies and short-term problems. Given the chronic nature of your depression, you would benefit from professional help that is more intensive and long-term.

I would recommend seeking mental health treatment, outside of the college counseling setting, that involves both counseling and medication. You can ask the school counselors for a referral to a therapist in your community. You can also check with your primary care physician for referrals. They can assist you in receiving the proper help.

The issues that you have been struggling with are correctable. Your depression has been chronic perhaps in part because you have only just begun to receive mental health treatment. Once you’re established with a long-term therapist, and have found a medication that provides symptom relief, your quality of life should improve greatly. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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OCD and Headaches

by Kristina Randle, Ph.D., LCSW June 16th, 2021
written by Kristina Randle, Ph.D., LCSW

Dear Therapist, I would like to have some advice. I’m only 15 years old and very mature for my age. but thats not what i need advice about. I’m too young to be worrying about my life the way I do. i have a very good body image and I try to keep it that way as best as i can. a little too much. I believe I suffer from Obsessive Compulsive Dissorder. I havent really been able to admit it to myself or anyone around me. I believe I’ve had it for maybe two years or so, but its gotten worse over time. It starts with waking up. If i dont sit up a certain way that doesnt make me comfortanle, I lay back down. I go down stairs to eat my breakfast. if i dont see something i like on TV i have to blink 10 times or until im confortable to get the image out of my mind. in school, i cant sit on chairs without whiping it off 5 times because if i dont, i think ill get fat. i can’t touch doorknobs because im afraid ill get sick from the germs. If i smell something bad, or something i dont like, i have to “push out” the bad scent out of my nose three times and breathe in “good smells” once or twice. My friends notice that I’ve been acting strange but i usually cover it up by saying like my nose itches or there were crumbs on the seat. Its really hard for me to live with and i am soo frustrated from it. Im only a sophmore in High School. I should be worrying about school. i strongly think my grades are suffering from it too. i Already see a therapist because my mom thinks im have anger problems. but i can never bring up the guts to tell her about my suffering. What im asking is to know that I’m not the only one whos going threw this or if I’ve diagnosed myself correctly. Ive researched it and all signs point to OCD. But i also am angry all the time towards my mother. she grosses me out but i cant control it. when im around her my ‘habits’ act up. but theyre more like natural reactions than habits. I dont know if medication will help with these problems or if i need sleep or if its stress. I really need some advice because i hate living like this. Am I going crazy? (life at home) My mom some times goes a little crazy or acts stranger than usual. she yells at me than apologizes. it gives me whipelash. i know she sees a therapist and i just hope that craziness isnt heretitary. can living with someone make you sick of them? even if their your own mother? and my father is an alcholic. but he has been 7 months sober. i am the middle child and i get along fine with my siblings. although my brother often gets annoyed with me because of my breathing habits. they annoy him. I also have severe headaches. Sometimes they give me excrutiating pains and sometimes they are dull. I also feel depressed and sad all the time. I try to act happy when im around my friends but i want to feel truely happy. Im usually in my room all day after school breathing in and out in certain ways, trying to reset the “bad germs” that i have breathed in. (im sorry if ive confused you). I had a concussion in the past but im not sure if ive fully healed, or its all in my head. i get weird head aches in the front of my mind when im doing my rituals and it throws off my day. sometimes i dont feel like im in my body/mind. i feel like im always tired and i feel like im always asleep. and i dont feel my emotions to the fullest. sometimes i dont feel any emotions. its hard to explain. but i just need some advice. Im handeling this all on my own and Im not sure WHAT to do. i keep a journal of everything that goes on and it makes me more depressed. im not sure if you know what im asking or not. but please help me if you can!

You are currently seeing a therapist. That is good but you are making a mistake by withholding important information. This makes it difficult for the therapist to help you. You do seem to have some of the symptoms of OCD but only your therapist can determine a diagnosis with certainty.

My other concerns are your headaches and the possibility of an existing concussion. I would recommend reporting these symptoms to your mother immediately. She needs to know about the headaches so she can relay this information to your primary care physician. The majority of people occasionally experience headaches. That is normal but your headaches seem unusual because they are associated with OCD rituals. This needs to be reported to a physician. It is important to determine the nature and cause of your headaches.

The next steps for you are clear: speak to your therapist about your OCD symptoms and meet with a physician about your headaches. Your therapist can help you with the OCD but not if he or she is unaware of the problem. OCD tends to be a progressive disorder which is why it is important that is treated sooner rather than later. I hope that my answer helps you to proceed correctly. If you have any additional questions, please do not hesitate to write again. Good luck. Please take care.

Dr. Kristina Randle

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Trouble Forming Emotional Attachments

by Diane Walcutt, Ph.D. March 26th, 2021
written by Diane Walcutt, Ph.D.

For as long as I can remember people have been telling me I am depressed.  When I was young – in my teenage years- I tried counseling and complained that I was worried I didn’t know how to make friends or form emotional attachments to people.  This has continued even though I am now on medication for depression.  The only difference seems to be that I am now able to articulate what seems wrong.

Problem:  A lack of attachment.  I have friends, and they act like friends do, but where they seem to have an emotional attachment to me, I don’t feel anything.  I’ve been trying to talk through this with some of them, and mostly get that I should talk to a professional.  I have taken the time to look at everything around me to try and feel some attachment to something, some sentiment from things I own, and I still feel no attachment.  This worries me.

Question(s):  What could be wrong with me?  Could I simply have not learned how to make these connections?  Should I see a professional, and if so what type?

Hello, and thank you for your question. You may have what we would call an “Attachment Disorder” and these often begin in very early childhood.

According to Wikipedia, “Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from a failure to form normal attachments to primary care giving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between 6 months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A person’s attachment style is permanently established before the age of three. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder. The term attachment disorder is used to describe emotional and behavioral problems of young children, and also applied to school-age children, teenagers and adults. The specific difficulties implied depend on the age of the individual being assessed, and a child’s attachment-related behaviors may be very different with one familiar adult than with another, suggesting that the disorder is within the relationship and interactions of the two people rather than an aspect of one or the other personality. No list of symptoms can legitimately be presented but generally the term attachment disorder refers to the absence or distortion of age appropriate social behaviors with adults. For example, in a toddler, attachment-disordered behavior could include a failure to stay near familiar adults in a strange environment or to be comforted by contact with a familiar person, whereas in a six-year-old attachment-disordered behavior might involve excessive friendliness and inappropriate approaches to strangers.”

It could be that you were separated from one or both parents physically, or that Mom was depressed or Dad was emotionally distant. The result is often the same; we don’t learn how to attach and form deep trusting bonds when we are “supposed to” that is, in infancy and early childhood.

That doesn’t mean that a therapist can’t help you. One trained in this kind of problem can teach you how to trust more, risk relationships more and find deeply intimate and wonderful connections with people, but you can’t do this on your own.

You have identified the cause, and you need help in learning how to do this on our own. You can find a therapist at PsychologyToday.com one who is in your area and takes your insurance or offers a sliding scale. The same therapist will likely be able to help you with your depression as well.

Best of luck,

Dr. Diana Walcutt

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Overcoming Barriers to Getting Help

by Kristina Randle, Ph.D., LCSW February 13th, 2021
written by Kristina Randle, Ph.D., LCSW

When I was in high school I was depressed. Not seriously so, just a constant hurt that wouldn’t go away. I was prescribed some medication by my doctor and was seeing a therapist once a month. Medications didn’t seem to improve anything and was eventually taken off them. Therapy continued but I felt like I was being rushed, and that I was wasting her time which she could be using to help someone worse off than I was. I was having tremendous problems opening up. Eventually I became frustrated with it and stopped going.

Over the last 15 years I have learned to live with how I feel. I’ve passed up many other opportunities to get help again, which I regret. Every time I always found a barrier to do anything. It’s always been easier to push away my emotions, pretend I am fine and not do anything. I’ve felt under control though, not happy but able to manage my life. I know this isn’t a healthy way to deal with my problems, I’ve been dealing with other medical problems in a similar way, but it’s the only tool I know.

I recently had a very vivid dream. It wasn’t frightening in any way, just a stranger unexpectedly caring for me. It’s very unusual for me to remember dreams at all but for some reason I’ve fixated on this one and am thinking about it constantly. It’s caused me to re-examine my life. I don’t feel in control anymore of my emotions right now, they are all over the map. I have anxiety like I’ve never had before. My chest is so tight it feels like it’s on fire. I feel ready to burst into tears, but I can’t. I’m having trouble falling asleep and am waking up too early in the morning.

I know I need help to change this, but I don’t have the strength to follow through. I’m scared to tell my wife how I feel. It’s not just telling her, its how she’ll react. I don’t know how this will affect my life. I’m scared to ask my doctor for help. I’ve always hoped that the worse I got the easier it would be, but logically I know this isn’t true.

How do I get past my barriers to get help for my problems? How do I not make new ones?

You have to force yourself to do what you know is right. It won’t be easy. It will be going against your long history of minimizing your problems. Asking for help will seem foreign to you. It may feel as though you’re doing something wrong but logically you must force yourself to receive the help that you should have received years ago.

Perhaps your dream will serve as an important catalyst. In many ways, it’s disrupted your life. You focus on it and it’s causing you to think about things in a different, though not necessarily healthier, way. Your life now feels chaotic and out of control but it might be what’s needed to propel you into finally receiving psychological help.

It’s time to do what you know you should have done years ago which is to receive professional help. I urge you to seek help as soon as possible.

You’re worried your wife will react negatively to your getting help. People with depression tend to perceive the world through the scope of pessimism. This makes them prone to misjudgments. When you attempted therapy in the past, you likely misjudged that situation. You concluded that you were unworthy of help and ultimately decided to quit. That type of thinking hurt you then and it’s hurting you now.

Your wife might be grateful that you finally have decided to receive help. Undoubtedly, your problems affect her and perhaps more than you know. You don’t think you would have the “strength” to follow through but I believe that you would. Help is available but you must make the choice. The choice is yours.

You tried to wait it out. You gave it a chance to go away. You’ve been patient for 15 years. It hasn’t gone away. You should get help now. Perhaps the therapist that you had long ago just wasn’t right for you. It happens.

People don’t choose to be depressed but they can choose to be helped. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice

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