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I like a girl with paranoid schizophrenia, but should i get involved?

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

Q. In July of 2007, I spent time in a psych hospital. While I was there I met this girl. She was the most beautiful I have ever saw. I spent seven days there, and I left. Most of the days I spent in the hospital were spent talking to her about herself, and she really opened up to me. She never told me that she had Schizophrenia, and when I would ask her what she was diagnosed with, she would say I don’t know. I did notice little things, like staring into space, she would always keep her arms folded, and was very quiet.

When I left I got her number, and I thought she would be out not long after I left. When I got out of the psych hospital, I called her in the hospital now and then to see how she was. I asked her If I could visit, and she said yes. I visited her three times. She is still in the hospital now. She has been there all summer, and now it’s fall. I used to call alot and I want to visit her, but everytime I call and ask her if I could visit her, she says her parents are coming at that time. I know it’s not true.

The other week, I called her and she said she met someone in the hospital, and she was serious about this person, and I found out that wasn’t true. I do not know why she is pushing me away. The last time I visited her, at the end of the visit she said to me how it was real that her co-workers were after her. She still gives me one word answers when I speak with her. The last time I asked her if it was alright that I call you, and she said, it’s no problem. I really like her, and I want to visit her. I do not know if they are delusions of a boyfriend, and why she doesn’t want me to visit her.

There could be innumerable reasons why you are getting these types of responses. When someone is in the hospital, it can be an extremely frightening, confusing and trying time. Many people are at their worst when they are in the hospital and this is likely the case with her. Also, the fact that she has been there for so long is an indicator that she is likely suffering from significant mental health issues and is probably not ready to begin or maintain a relationship at this time. In addition, her behavior is being monitored constantly and this can alter how someone may act in person or on the phone. Also, she may be taking fairly high doses of medication or is being tried on new medications or therapies, all of which can make someone act different day to day. Lastly, as you mentioned, she may in fact be having delusions or other mental illness related symptoms. You said that she thought that her co-workers were after her and this is a sign of paranoia. It is difficult to say with any certainty if any of these above-mentioned reasons could explain her reactions.

My suggestion is that you let her know that will be there for her (if you still want to) when she is in need of a friend. Let her call you when and if she is ready. Be sensitive to the fact that she may need time to recover from whatever it was that brought her to the hospital. I know this may be difficult since you have grown so fond of her but my sense is that she needs time to heal. I hope this answers your question.

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Is My Mom Schizophrenic or Narcissistic?

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

I’ve been aware that something is not quite right with my mom for some time now, and I’m having a hard time telling what’s wrong with her. For a while, at the thought of my therapist, I thought she was narcissistic. However, I was looking into sensory integration disorder for myself on the internet and stumbled upon the term thought disorders in a forum where a woman thought her son had SI and mentioned he didn’t speak right. When I looked it up on Wikipedia it mentioned symptoms like blocking, circumferential speech, derailment, distractible speech, loss of goal, and semantic paraphasia. All of which I’ve known her to do. She’s mostly coherent but often does at least one every time I see her. Usually several. For example, if it’s just the two of us she’ll go on and on rambling about nothing in particular while often switching topics. Then she’ll experience blocking and ask what she was just talking about. Or she’ll substitute words in sentences with random words. She does this last one a lot. For example, she’ll say, “I slipped on the water outside on the patio.” And I’ll correct her, “No, it was inside in the kitchen.” She’ll respond, “That’s what I said”. And I’ll say, “no it wasn’t.” She just say “oh” and shrug her shoulders. I don’t think she’s ever called me by my own name. She often calls me by one of my brother’s names and vice versa.

Since thought disorders are as sign of schizophrenia I looked that up but I’ve never known her to hallucinate or be delusional or out of touch with reality but the opposite. Her behavior is also not disorganized as she showers every day, can take care of herself, and keeps a clean house.

On the other hand she also can’t differentiate between me and her. She can logically if I ask but in actual practice she doesn’t show that she does. For example, she thinks I feel the same way about everything as she does. She still tells everyone that I chose to go to an all girls high school, which I did but we fought over it since all my friends went to a co-ed high school that one of my older brothers also attended. And she always suggests a steak house for my birthday dinner (I’m a vegetarian).

She was also never there for me emotionally and never did “mom” things like tell me about boys, show me how to do things, tell me about my period, or help me deal with issues. She fed my brothers and I all our 3 meals a day, made sure we got to school, and did our homework, but I dealt with everything else on my own.
She seems to either over react or under react to emotional situations. She’ll cry like crazy during an episode of Extreme Home Makeover but not blink and eye if my oldest brother was dragging me down the stairs by my feet. She doesn’t seem like she’s faking her emotions. But I’m not the best at reading people either.
I know you can’t really make a formal diagnosis over the internet but any help is appreciated as I feel she doesn’t think anything is wrong with her and is not likely to go seek help.

Based on your description, I do not believe that your mother has schizophrenia. As you noted, she does not experience delusions or hallucinations or most of the other symptoms associated with the disorder.

One possibility is that your mother has an autism spectrum disorder. These disorders include autism, Aspergers syndrome or pervasive developmental disorder (PDD) not otherwise specified (NOS).

Your mother seems to be exhibiting symptoms that are similar to those on the autism spectrum. I am specifically referring to:

  • Speech Derailment: Individuals with autism have difficulty staying focused on one topic. This is referred to clinically as speech derailment.
  • Her language problems: This is one of the hallmarks of autism. Individuals who demonstrate language problems are more likely to have a diagnosis of autism than Aspergers syndrome (a milder form of autism).
  • The behavior that you characterized as narcissism: It may not be necessarily narcissism but a difficulty with empathy. Empathy is the ability to put oneself in someone else’s shoes. Difficulty with empathy is another possible sign of an autism spectrum disorder.
  • Her inappropriate emotional responses: This is another possible indicator of an autism spectrum disorder. This would include difficulty showing the proper emotions, which is a situation you described witnessing (i.e. crying during Extreme Home Makeover).

Interestingly, research shows that males are more likely to be diagnosed with autism spectrum disorders than females. There is a limited understanding as to why this might be true but there are ongoing investigations to better understand the phenomenon.

It is also interesting to note that schizophrenia and autism may be on the same “spectrum” with schizophrenia being at one end of the spectrum and autism on the other. To some degree individuals with schizophrenia and autism share conceptually similar types of symptoms but they are two distinctly different disorders.

Of course, it would be best for your mother to be evaluated by a mental health professional to determine if she has an autism spectrum disorder. Should it be decided that she needs an evaluation, I would recommend you finding someone who specializes in the treatment of autism spectrum disorders among adults. I would also encourage you to read more about autism spectrum disorders. Even if evaluation and intervention are not necessary at this time, learning more about these disorders may help you to better understand your mother’s behaviors.

I hope this helps. Please take care. I wish you well.

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How Can I Help My Schizophrenic Friend?

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

I have a friend with paranoid schizophrenia. He suffers from it for 10 years and is on meds all the time. He lives with his sister and her family with few social contacts, more or less isolated. His mother died and his father doesn’t want to see him much due to the fact he’s so ill.

Ever since I’ve met him I saw the relationships in the family are rather bad. He’s subjected to mockery and is getting scolded fairly often. I’ve never felt much – if any – support from them. He usually does nothing at all just to minimise the possibility of spoiling something. He’s unkempt, not able to keep his room clean, doesn’t care about his grooming and neither do his family. He only keeps painting all the time. But I know he’s capable of a difference as he e.g. shaves when I’m about to visit. He can talk about many things just fine, at least with me, and it is clear that behind the disease there’s a very clever person.

It pains me to see he could possibly get better if treated differently or living in a better environment that would support him and lead him to being more independent. But what can I do? He’s legally competent and adult. Talking about changes frightens him. And I can’t take him to my house and I can’t talk to his family members. I’m not a part of his family and they wouldn’t listen anyway.

Should I really try to let it be as it’s not in my capacity to change it? Sometimes it gets so painful to watch and the helplessness is the worst part…Thanks so much for any advice!

You said that he takes medication which means that he sees a mental health professional. You can encourage him to speak to his doctor about independent living arrangements; however, if he’s not ready, then you must respect his wishes.

As you suspect, your power is limited in this situation. You’ve tried to talk to him about moving and the idea of change frightens him. His family won’t listen. You’ve really done all that you can.

Many people with schizophrenia are frightened of change. In some cases, too much change, too quickly can lead to a psychotic episode. Even knowing that he is not living in the ideal set of circumstances, it may be in his best interest to simply leave him be. He may someday be ready to move out but now doesn’t seem like the right time.

You are his friend when no one else seems to be. You care about him even when it seems that no one else does. You may think that you are not doing enough for him but your friendship undoubtedly means a great deal. Perhaps in time, he will lean on your caring and support to become independent. Research has consistently shown that having strong social support significantly improves the outcomes of people with schizophrenia. Your relationship with him has the potential to create strong positive change.

Continue to be a friend and an advocate and maybe in the future, he will be ready for independence. He may never be ready but should he be, your relationship will have served as an important lifeline. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Eldest Daughter Hearing Voices

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

Our eldest daughter is 36 and has always been very out going and helpiful to eveyone. While she is now living in another state, we learned from her sister and friends she says she hears voices in her head and begins cursing and telling the voices to stop. No one else hears any voices and the sudden outburts are disturbing and can occur even when she’s speaking on the phone. She asked her mother to vist recently and her mother found the stories true, but she has seen a psychologist who refered her for an MRI .

I would like to know how I could help her. The issue has occurred about 10 years after we found her youngest brother had paranoia; our son absolutely refused help and won’t see a doctor. He got in some legal problems a few years ago and it was our daughter who helped bail him out by paying for a lawyer. She was very active in sports throughout high school and college. I can’t think of which is worse – a possible tumor or an uncureable mental problem.

It is so very frustrating as a parent to be unable to help your children even when they are adults now and making a living of their own. I know my concern now should be only for them, but I just want to cry. What did my wife and I do wrong?

I want to first address the last question in your letter, which is what did you and your wife do wrong. Please do not blame yourself. Perhaps there is more to the story but nothing you have described leads me to believe that you are to blame. You said that your adult children are having problems with paranoia and hearing voices. If this is true they may be suffering from psychosis-based disorders. These may include disorders such as psychotic disorder not otherwise specified (NOS), schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, and the like. Science has not identified the precise cause of these disorders, but there is strong research to support the theory that they are organically based. That means that they are caused by a brain disorder or some unknown physiological or biological factor. You are not to blame.

There are other possible explanations for the symptoms such as neurological problems. Luckily, your daughter has been referred for an MRI. The other possibility to explain the voices could be drug use. You did not mention whether drug use was a factor but depending on the type of drugs, they can cause psychotic-like symptoms.

The main challenge you’re facing in this situation is distance. Your daughter lives in another state. This limits how effectively you can intervene. From a distance, you could speak to your daughter on the telephone and let her know you support and care about her. You could also act as a support system for those who are caring for her. Another way that you can support her and the family is to research psychotic disorders and share your knowledge with other family members. If your daughter has children perhaps you could suggest they temporarily stay with you and your wife. This might give your daughter a chance to receive the help she needs without the children having to witness this difficult time.

I understand that what you’re going through is not easy. It has to be stressful and frustrating to know that your daughter is suffering and there is little that can be done. It’s important to recognize that even if you were her neighbor there still may be little you could do to help.

To help yourself through this difficult time you may want to consider joining a local support group for individuals who have family members with mental illness. The most popular family support group around the country is offered through the National Alliance on Mental Illness (NAMI). Many people find these groups to be very helpful.

Please do not blame yourself for what is happening. There is no reason to blame yourself. This is especially true if your adult children are dealing with organically-based disorders. I invite you to write back if you have any further questions. Thank you for your question.

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Does My Partner Have Schizophrenia?

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

I think my partner may be experiencing Schizophrenia or something similar. Before I met my girlfriend she had been diagnosed with depression and general anxiety disorder. Within the last year she has stopped taking her medication (Paxil) because she felt it was no longer helping her. In fact her episodes of depression seemed to be worse. A month and a half ago we moved to Toronto and since that time she has been complaining about people we don’t know (customers at a local restaurant behind our house) are laughing at her and know what she’s been writing about in her journal. Furthermore she has, for the last four weeks, been complaing about people sending her sexually perverse images and sounds into her head. She can hear moaning, animals screaming, children begging not to do something, and a man with a deep voice bitching at a woman to stop. During this time she has been even more sexually insatiable than normal. She complains of being constantly sexually stimulated or abused by people who are just not here. At one point she claimed that it was people using magic (a cult of satanists, or pagans). She complains of feeling that she is not complete, that some part of her is where these practioners of magic (or whoever is responsible for this stimulation) are. She has on a few occasions asked, no begged, me to help her kill herself because of this unending torture. I have found her with a cable wrapped around her neck several times as if she had just tried to strangle herself. At first she believed that the people responsible were here in the neighborhood but now believes that they are further away and taking that part of her that is missing with them. Could you shed some light on this for me?

Thank you,
A concerned boyfriend

Dear concerned boyfriend, I can understand why you’re worried. Your girlfriend’s symptoms are severe. The most concerning aspect of her behavior is that on several occasions you found her with a cable wrapped around her neck ready to end her life. It does not seem as if she’s depressed. It’s as if she’s being driven to behave in such a manner by her delusions, paranoia and hallucinations.

Her symptoms may be indicative of a schizophrenia or bipolar-like disorder. It may also be a generalized psychosis. It’s difficult to diagnose an individual over the Internet so I can’t know with certainty.

If I could ask you followup questions I would want to know what, if anything precipitated her symptoms. Was there a stressful event that had recently occurred? Was there a recent trauma in her life? Did something in her life recently change? Was there a death in the family, loss of a job, or a move to a new town or city? Does she use illegal drugs or alcohol? Has she had a recent head injury? If I knew this information I might be better able to determine what is causing her abnormal behavior.

You also mentioned that she has recently stopped taking Paxil. Though it is rare, there are some occasions when abruptly stopping a medication causes a negative reaction. Usually these negative reactions are more commonly associated with other medications such as antipsychotics and not necessarily antidepressants. As I’ve mentioned, it’s rare but it’s possible that her behavior is the result of the discontinuation of Paxil.

Has she been to a doctor? It is unsafe for her to be left alone while she is in the condition you have described. This is evidenced by the fact that she has made multiple attempts to end her life.

Please do not ignore or avoid this problem. My advice is to bring her to an emergency room or to make an immediate appointment with a mental health clinician. She needs to be evaluated as soon as possible. Do not leave her unsupervised. Please let me know if there are any other questions I can answer for you.

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Many Questions About What’s Wrong

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

Hi I have been having intuitions and seeing things as long as I can remember. Mostly gods I am a hindu in our family it was considered good to see these things and have intuitions. It was a sign of spritual maturity. My cousin on my mothers side suffers from paranoid scrizophrenia. But some how or other I was not diagnosed and not taken to dr. I finally suffered complete breakdown and was admitted to institution after being treated as out pt. I have been taking medicines regularly for 6 years now. I am well in a way and am a ok husband, father and have 3 children. Right now I am on trifluoperazine 5 mg and trihexiphenidyl 2 mg twice a day. I have been given medicines for paranoid scrizophrenia, bipolar disorder, sedatives for sleep, ocd and stress. I have been to therapist for 4 yrs. Now my problem is following:

1. My sex drive is too much according to my psychiatrist. I need to have sex atleast 5-7 times of week. We have sex almost everyday except when my wife is in her periods.We have been married for 14 yrs and still cant get enough of her. I tried to reduce my drive but I ended up seeing things and hearing voices once again. I used to be frustrated thru out day and lost my temper often. What do I do and is my sex drive ok. My wife seems ok with twice a week but does it more often because I ask her to.

2. I cant seem to enjoy life and I am always looking at negative things in life.

3. I have a cycle of temper. I start getting stressed on thursday evening and it increases till saturday when I loose my temper. And by sunday I am ok. I usually loose my temper on my wife. My dr has given me medicine for that loranzopam 2 mg but it doesnt work. What else can I do?

4. I need to educate my family and myself about the course of my disease I read “surviving schizophrenia” but it was too depressing and all I learnt how much better off I am. Can you suggest anything?

5. I have this need to talk and expess myself but cant seem to make any friends. I just have my relatives and wife to talk to. Is this normal?

6. I smoke about 15 cigarettes a day. I have this unknown fear that if I give up smoking something will go wrong. What do I do/ My wife is pushing me to give up but I am scared like hell. Thanks.

Thank you for writing to Psych Central with your questions. I will address each of them below:

  1. Sex drive: the desire to have sex once a day is not abnormal. Inequality in sexual desire is also common in relationships. It’s only a problem if one person in the relationship considers it to be a problem. You desire to have sex more often than your wife does but she may be all right with this in an effort to help you meet your needs. A couple has to agree on a level of frequency that is comfortable and acceptable to them.

    Some medications can affect sex drive. I would suggest speaking to your psychiatrist about this possibility. Your psychiatrist may be able to make modifications to your medication regimen. He also may not be willing to adjust your medication, fearing that it might endanger your psychological well-being.

  2. Negative thoughts: I would suggest talk therapy to help with your negative thoughts. Medication can be helpful for treating psychotic events but it may not be effective for negative thinking. Talking to a therapist can help you learn how to find happiness. Finding happiness is a journey and everyone needs to find what makes them happy in life. If you continue to struggle with negative thinking, consider talk therapy in addition to medication management with your psychiatrist.
  3. Anger issues: Talk therapy could also help with anger management. Anger management techniques can be very effective. Your anger issues may have nothing to do with your psychotic disorders. I would highly recommend talk therapy for this issue.
  4. Books: There are many books about schizophrenia that you may find very helpful. I would also recommend books about bipolar disorder or other serious mental illnesses. Below are six books that are highly rated:
    • Schizophrenia For Dummies by Jerome Levine and Irene S. Levine
    • An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison
    • Welcome, Silence by Carol North
    • Five Lost Years: A Personal Exploration of Schizophrenia by Christina Alexandra
    • The Soloist: A Lost Dream, an Unlikely Friendship, and the Redemptive Power of Music by Steve Lopez
    • A Beautiful Mind: The Life of Mathematical Genius and Nobel Laureate John Nash by Sylvia Nasar
  5. Social interaction: A therapist can help to determine whether or not there’s a problem with your social interaction. He or she could point out social mistakes and help you to correct them in an effective way.
  6. Smoking cigarettes: I do not believe that you should attempt to stop smoking without the assistance of your psychiatrist or other mental health professional. Your fear that you may relapse if you quit smoking may not be unfounded. It’s not that smoking cessation could cause a psychotic relapse per se. It may be that it could elevate your stress level which might in turn increase the likelihood of an illness relapse. Should you decide to quit smoking, there are medications that your psychiatrist could prescribe that can assist you in this process. A therapist can also help monitor your mood and behavior. Both your psychiatrist and therapist would monitor changes in behavior, changes in thinking, or any other affective changes that may occur during the smoking cessation process.

I also want to add that you seem to have a great level of insight. In addition, you’re open to correcting problematic behaviors, you consistently take your medication and seem dedicated to treatment. All of these factors can help you remain psychologically stable and prevent psychotic relapses.

I hope that I’ve adequately answered your questions. Good luck and please do not hesitate to write back if you have any additional questions. Please take care.

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Is My Girlfriend Disassociating?

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

I have been with my partner for over 6 years. In times of high stress, she will “go to her box” as she calls it, and another personality will take her place in the world for a while.

She says she “goes to her box” to get away from the stress and that there is a faceless young girl in the box with her each time. This is NOT the person who takes over for her in the real world. This is a third person who makes her punish herself at times (I’ve seen her hitting herself) but will normally just sit with her.

Her latest episode, however, has lasted almost 2 months. Until now, I’d never seen it last more than a few hours.

Due to work, I had the leave the state and we would be apart for 8 months. Within a week of my leaving, she started spending inordinate amounts of time in her box. She is saying that the girl in the box is making many of her decisions for her ever since. And, when I offered to come back, she said no, that she afraid to see me.

She is a different person from when I left and I am scared for her. She has mentioned hurting herself, but says if I tell anyone in her family about this (I am the only one who knows about “the box”) she will never speak to me again.

Is this some sort of Schizophrenia? I’m not sure if it is, though, because unless she goes to her box, she doesn’t hear voices or anything like that. She has complete control of when she goes to the box. But, she is saying that she’s confused because of what the girl in the box is telling her. She will not tell me what the girls says, however, as she says she is not allowed to.

Can you help me help her? Thank you.

It is difficult to determine what is happening to your partner. It doesn’t appear consistent with schizophrenia but only an in-depth, in-person clinical interview could determine a diagnosis.

She may be experiencing a form of disassociation or potentially dissociative identity disorder (DID). DID used to be called multiple personality disorder. It is a diagnosis contained in the Diagnostic and Statistical Manual of Mental Health Disorders, however some mental health professionals are skeptical about whether DID is a valid diagnosis and thus it remains controversial.

Dissociative disorders are real and can be debilitating. She probably utilizes “the box” when she is feeling stressed or unsafe in the world. It seems as though “the box” is a form of protection for her that makes her feel safe. “The box” is a defense mechanism, however she is using it more often and for longer periods of time. She is now confused and apparently believes that she is interacting with other people while in “the box.” These are all concerning symptoms.

She needs to be evaluated by a mental health professional. She should see a specialist who is trained to deal with dissociative disorders or trauma. You may be able to find a therapist by visiting the International Society for the Study of Trauma and Disassociation, an organization of therapists who focus on assessing and treating dissociative disorders. Click on the “find a therapist” tab to locate a specialist in your community. Do your best to convince her to seek treatment. It is highly recommended that she seek professional help. She’s not well and intervention is needed. Please take care.

Dr. Kristina Randle

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Daughter Says She Is Pregnant with Jesus Christ

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

Hello, I am not sure where to start to look for help, for my 23 year old daughter says she is okay.

My daughter says she is pregnant with Jesus Christ himself. Her religion has taken a turn for the extreme over the last 6 months. She wanted me to stop putting chlorine in the pool so she could baptize and she also said she is going to stop wearing shoes so she can be one with the people. She also told me that God has spoken to her through the tv.

2 weeks ago she told me she was pregnant. I took her to the store and bought her a box of pregnancy tests, she took one and it came out negative. She took a test the next day and told me it was positive. She came over later that day and said that when she was at the coffee shop, a transient told her she was pregnant with Jesus Christ.

I am thinking she has PTSD or something, she is just not herself. How do I go about getting help for her if she says she doesn’t need it? She really does believe this and is now posting it on her facebook account for the world to see, I am scared for her.

Any guidance would be greatly appreciated!
Thanks, Desperate mom

Dear Desperate mom, I understand your concern. Post-traumatic stress disorder may not be the primary problem. Your daughter seems to be experiencing a psychotic episode. Psychosis is a break from reality. It’s associated with disorders such as schizophrenia and schizoaffective disorder. Religious delusions are common among individuals with psychosis.

The fact that she doesn’t think she needs treatment is also very common among people with psychosis. Psychosis causes individuals to be confused, disorganized and frightened.

Your daughter needs immediate, emergency assistance. If you cannot convince her to go to the hospital, then another option is to call the local emergency mental health crisis team. Check the white pages to see what services are available in your community. The mobile crisis team, will come to your home to perform an evaluation. If they believe that she requires hospitalization, they will provide the arrangements.

If nothing else works, then call the police. Involving the police should be a “last resort” option. If they believe that your daughter is a danger to herself or to someone else, they can forcibly escort her to the hospital for an evaluation.

Coercing an individual into a mental health evaluation or hospitalization is never the ideal situation but you must do what is necessary to protect your daughter. When people are psychotic, they may do things that they normally wouldn’t do. It is a high-risk situation.

Finally, I would encourage you to reach out to your local National Alliance on Mental Illness (NAMI) support group. Virtually every community has a NAMI presence. Contact them and ask for support and guidance. They can assist you in the process of helping your daughter. Many of the NAMI members are seasoned veterans of the mental health system. They can tell you how it works and what to expect.

If you have additional questions, please don’t hesitate to write again. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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

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

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

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

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

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

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

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

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

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

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

Good luck my friend.

Dr. Kristina Randle

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Schizoid, Schizotypal or Schizophrenia?

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

Hi, firstly, english is not my native language, so forgive me if I make some grammatical mistakes.

I’ve been experiencing depersonalization and other symptoms since I was 14 (I’m 20 now). It all started kind of suddenly and made me become very reclusive during my adolescence. At the time when I first started having those feelings, I looked for psychological and psychiatric help but none of them worked (with the exception of clonazepam).

My social life got better, but I’m still very reserved, shy and introspective and found out that I tend to intellectualize my feelings in psychotherapy (which is a symptom of schizoid personality disorder), but I’m also depersonalized and rather paranoid and have problems to associate my thoughts sometimes (for example: I think “wall” and say “mall)- which is a symptom of schizotypal personality disorder.

To make things worse, I have a lot of relatives (none of them are of first-degree) with schizophrenia and I wonder if I’m displaying prodome symptoms of it throughout the years.

Am I going silently crazy?

It is difficult to know what disorder, if any, you may have. It is true that having a family history of schizophrenia may make it more likely that you would develop the disorder. Yes, it slightly increases your chances, but it does not mean that you are destined to develop schizophrenia.

You may not have any one particular disorder. You may be suffering from a number of various symptoms but nothing that is diagnosable at this time. I would suggest meeting with a mental health professional for a diagnostic evaluation.

I find it encouraging that over time your social life and presumably your social skills have improved. You do, however, continue to feel depersonalization as well as paranoia and those symptoms are concerning.

You asked about whether your symptoms are prodromal symptoms, presumably a sign that schizophrenia is imminent. It is difficult to answer that question. You have had symptoms since the age of 14. That would be an abnormally long prodromal phase. It is possible that what you are experiencing are prodromal symptoms but I cannot tell based on a short letter. The typical age for the onset of a schizophrenia episode among males is approximately 18 years old.

Because it may be possible that you are experiencing prodromal symptoms, I would strongly encourage that you be evaluated and that you consider treatment. If you are in fact experiencing the prodromal symptoms of schizophrenia then being in treatment could help to prevent a psychotic episode. When it comes to psychosis or schizophrenia early treatment is very important. Research has shown that early intervention is associated with a more favorable response to treatment and better outcomes.

I think it is wise to be concerned. It is also important to be proactive with treatment, especially when it comes to psychosis or schizophrenia. As I mentioned above I do not know if you are experiencing prodromal symptoms, but if you are then it would be advantageous to be in treatment with a mental health professional. Delays in treatment have been associated with less favorable outcomes.

If you’d like to search for mental health treatment in your community, please consult this directory.

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Psychotic Episode as a Child: Why?

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

I had a psychotic episode during childhood and am not sure why. For a relatively brief period of time during my childhood, I suffered a psychotic break. I believed that evil aliens had infiltrated my school and that I was a grand hero who would eventually defeat them. I also started believing that certain fictional books and TV shows were real.

The break began when I was 10 and lasted for around a year, at which point it spontaneously resolved itself. I didn’t see a therapist or go on medication. It’s been how many years since then and I haven’t had another psychotic episode. I don’t seem to have schizophrenia, although I have been diagnosed with major depression.
I was a fairly ‘normal’ child before then and other than being quite shy, had no big problems. Nothing particularly traumatizing happened to me before the episode, so I can’t think of a good reason for why my mind broke like that.

My questions are: What could have possibly caused the psychotic episode and is there any kind of specific diagnosis for what happened to me? I’ve searched far and wide, but have yet to find answers.

You may have had a psychotic break but maybe not. Children go through many emotional and psychological changes throughout their developing years. If you had a psychotic break, it would have been difficult to have been overlooked. Undoubtedly, someone would have noticed your odd behavior or thinking. It is possible that you had a psychotic break but unless you were evaluated and diagnosed, then it is difficult to know for certain.

To answer your questions, determining the cause of a psychotic episode is very difficult. Psychosis in children is rare but research shows that they can experience symptoms of psychotic disorders such as schizophrenia.

Generally speaking, there are multiple possible causes of psychosis in children that include: stress, environmental factors or genetic influences. Other possible causes of psychosis include organic or physical illnesses such as epilepsy or a brain tumor. Only a neurological or physical examination could have ruled out these latter possibilities.

The reality is, it will be difficult to know with certainty what could have caused a possible psychotic episode. Sometimes people display symptoms but do not necessarily meet the criteria for a specific disorder. The latest edition of the DSM-IV TR, the book mental health professionals use to diagnose mental health disorders, includes a specific disorder, diagnosable only in adults, called schizophreniform disorder. Schizophreniform disorder is basically when an individual has one schizophrenia episode but never has another. To the best of my knowledge, this particular disorder has not been investigated among children but research has shown that individuals who report psychotic symptoms as children may be at risk for developing schizophreniform disorder later in adulthood. It is important to keep in mind that even if you had a psychotic episode as a child, it does not mean that you will have another.

I hope this answers your questions. If you’re interested in learning more about this topic I would recommend your reading more about psychosis in children.

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Mom With Schizophrenia Refuses Treatment

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

Me and my 20yr old sis take care of her and everything else. So, It all Started about 8 years ago when i was 14 and my sister was 12. My mother had a drug induced schizophrenic break – Crystal Meth was her drug of choice, though she didn’t limit herself to that, also drinking HEAVILY and smoking pot and cigarettes. over a series of months, and many crazy jumbled stories that came from her mouth, we came to realize it was more than just the drug use making her act like that. Then something happened, i cant remember the exact catalyst anymore that set her off but, She went into a full on ranting fit screaming and running through our whole neighborhood – which led to her being taken on her first 51/50. They held her for a couple hours (til she was sober and comprehendible i presume, i was young) and then after having a conversation with her decided she was fine and released her. This has been the biggest downfall to my story, my mothers intelligence. She is a Graduate of USC, majored in English, and generally can talk her way out of ANYTHING – and i don’t say this with any sort light sense. My mother is far from stupid, and in that regard still very much in touch with the world, she knows the date, she knows Obama is the president, she knew very well she didn’t like Sara Palin, and she knows Brian is her favorite character on Family Guy. Like I said, this has been my biggest down fall, my mother has no problem putting on the show for everyone else. Everyone except me and my sister.

This same pattern went on for a few months, big loud screaming ranting fits followed by brief 51/50 holds, only to have her return home in the same condition…if not worse. Eventually something finally happened, my mother deluded herself into thinking she was having a heart attack, which she definitely was not – even me and my sister were aware of this and we had barely hit our teens.

Anyway, she made us call 911 – leading to another 51/50 – this time someone caught on to her. they saw she wasn’t quit right even if she could answer all there questions. At last we had an answer: Paranoid Schizophrenia. She was diagnosed and put on meds (again cant remember which type, i was only about 15 at this point) she took it for a while, and i have a vague memory of thinking my mom might be back. Oh how wrong i was! About 6 months later she stopped taking the medication claiming she felt all better and didnt need it anymore. which was true…for about 2 days.

This how now gone on for years. The same repeated pattern, shell be ok for a little – maybe a couple weeks, then shell start going down hill, then we hit a point where she gets really crazy, constantly talking to herself, then she will through a huge fit, which often involves the police, then once she is calmed there is usually a brief period of guilt, and then it starts all over – not that the voices ever go away – she talks to them all day all night 24/7.

2 Years ago me and my sister moved into our own apartment trying to escape the Madness, we have an older sister – but she only contributes to the problem, she is no help. My mother was basically left on our doorstep and we had no choice but to take her in. We still cant get her on meds, and i feel while we have taken some steps forward in the past 2 years i also know we havent gotten anywhere. She is Sober now, generally speaking, She hasnt been anywhere near meth or any hard drugs as i wont let it within 20 miles of my apartment, where as my older sister had no problem supplying her with it for the 3 years before she moved into my place. She isnt allowed any hard alcohol. i will let her have a beer every now and then, but i avidly regulate only pouring her a small glass at a time and having her drink it over a long period with food and such. Its more of a fixation thing with her, so i try to kinda trick her with little things like that. and she can have her cigs, but that’s it. occasionally she will get her hands on some pot from my lovely father – but i try to avoid this at all costs.

However, even though we have removed the substances from her life she isnt getting any better – more like she is getting worse. She literally cant function as a normal person – i am in firm belief she will never be able to hold down a job again. and she still has rage filled violent outbursts – she would never touch me or my sister and has never hurt us in anyway – but she has punched my neighbors window through, and broken my sisters radio with her fist in bits of rage. Most recently was the window incident which landed her on another 51/50 and in the hospital. Between all the nurses, doctors, security guards and cops, they couldn’t even get her calmed down enough to take her blood, let alone give her a shot of something to calm her down. Eventually they came and asked me and my sister to come back and see if we could get her to sit still.

Now here is the weird part. we walked in, she took one look at us, and was instantly calm. she asked us what happened, why she was there, and what everyone wanted from her. like she didn’t even remember it. Me and my sister refer to this as Mom 1 and Mom 2. her 2 personalities don’t correspond and she has no recollection when one of her personalities does something. we actually have it down to a kind of math – we know immediatly which one she is at any given time.

Anyways, they actually held her this time, for 2 whole nights! this is truly a vacation to me as awful as that sounds to say! but after many meetings with therapists they decided again with the paranoid schizophrenic diagnosis. they did prescribe her a medicine – something that started with an R, i cant remember exactly, and then released her to me and my sister. she was very very normal for the next few days, she seemed extremely happy to be back to our little apartment, and was acting what is now Strangely Normal to me. We tried to go get the prescription filled but whatever they prescribed cost some $200 for a 2 weeks supply!! Obviously we could NOT afford this! so after the few days of this new nice mom, the medicine wore off and she went back to her regular crazy self.

In the last 6 months since this incidence it has been a total roller coaster with her. some days she is fine and she will get up and shower and pick up the apartment and do her laundry, other days she lays in bed and cries literally ALL DAY. She is always saying she doesn’t feel good, but wont go to the doctor. and is up almost every night mumbling to the voices in her head. we try to get her up get her do things but at this point i have lost hope. I tried to apply for disability and got declined – something to do with age and SS credits.

At this point i just need some advice, some options i might have. I have no idea what to do or how to move forward. my sister and i cant take care of her forever like this. we are broke, work 5 jobs between the 2 of us, and barely make enough to cover the rent and necessary bills. We need a break. but we cant leave her alone. we cant give her $5 for food without her trying to go to the liquor store and buy some vodka. we don’t even know where we can take her to get some help. is there like day care for someone like her…again i know how awful this sounds, but i am just so lost with this. Me and my sister have figured it all out on our own since i was 14 and she was 12, we are 22 and 20 now respectively. we are at a lose of ideas.

So what do i do with my schizophrenic mom? How can i help her and help my situation at the same time? Please, any advice would help!

Thank You for your time!! Jenna

Dear Jenna, you may only have a few options in this situation. Your mother has schizophrenia, she’s clearly out of control, she’s constantly interacting with the police and hospital, she needs to be watched 24/7 and she refuses to take her medication. This essentially leaves her to remain psychotic and probably you and your sister feeling helpless. You and your sister work five jobs between the both of you and it’s barely enough to pay the bills. The two options I see for you in the situation are 1) that you and your sister work together to create a plan in which you coerce your mother into taking her medication; or 2) move her into a group home or residential living facility in which she could be constantly monitored and given her medication by medical and psychiatric staff.

Let’s examine the first option which is that you and your sister create a plan that focuses on your mother taking her medication. I’m essentially suggesting you create rules for her based on the premise that if she wants to remain in your home she must take her medication. To make certain she does take the medicine you and your sister could take turns administering the medication each day. For instance, you would be responsible for Monday, Wednesday and Friday and she would be responsible for Tuesday, Thursday, Saturday and Sunday or vice versa. You can choose whatever days or times work best for you and your sister based on your work schedules.

Each time you or your sister gives her the medicine do a “mouth check” (i.e. ask that she open her mouth to prove she swallowed it). This may be difficult to enforce because she could “cheek” the pill. “Cheeking” the pill means she hides it underneath her cheek or tongue and pretends as though she swallowed it. You want to check for this. If she believes that she doesn’t need the medicine because she “feels better,” then she may be trying to act as though she took it.

If you choose this method I would also advise you to keep the medication in your possession. That way, she cannot say that she has already taken it for the day. If it’s in your possession, you’ll know if and when you gave it to her.

It also might be a challenge to keep a consistent medication administration schedule between you and your sister if the both of you are working odd or late hours. If coordinated correctly, and if you and your sister make a commitment to administering the medication every single day, this may be a way that she could continue to live with you and not constantly be in and out of the hospital.

You may also want to offer her rewards for taking the medication. For instance, if she complies with taking the medication for a month perhaps you and your sister could take her out for dinner or to a movie. This may create a positive association in her mind between taking medication and the getting to spend time with her daughters.

This method also ensures that she doesn’t have to continually experience psychotic episodes. There is some evidence that with each psychotic episode it takes longer for an individual to “come out” of that episode. There is also evidence that with each psychotic episode it is difficult for the individual to fully return to their previous state of psychological functioning. This is called stepwise decompensation. For these reasons, it is important to prevent reoccurring psychotic episodes with medication. Medication is the best method to prevent these episodes.

Also anticipate the possibility that your mother may not be open to the idea of her daughters administering her medication. She may feel that she is being treated like a child. She may feel this way at first but that feeling may fade with time. I can understand why she may feel that way but the problem is she is not willing to stay on her medication even though each time she stops taking it she has another psychotic episode that lands her in the hospital or involvement with the police.

Unfortunately, she needs help and she’s not able to care for herself at this time. There may come a time in the future when she is able to consistently take her medication on her own and remain symptom-free but at this time, she has a track record of not being able to do so.

A variation of this option would be to stipulate that in order for her to continue living with you and your sister she must accept an injectable form of medication. Currently, there are several antipsychotic medications that can be administered as an injection. Risperdal Consta, for instance, is an injection that can be given in the arm, upper thigh, or buttocks. It’s typically given twice a month. The injection is administered by a psychiatric nurse or a doctor. In many communities, there are services that come to the home to give the injection. If your mother took an injectable form of medication this might give you peace of mind. It could prevent her from having a relapse and it would keep her out of the hospital.

There’s also the added issue of her substance abuse. You could also stipulate that in order for her to remain in your home she must abstain from alcohol or drugs (unless she has a beer in your presence as you allow her to occasionally). If she does not refrain from these substances then there should be some type of consequence for this behavior. She needs to know that she cannot live in your home and engage in behavior that is unacceptable to you.

I would also advise you to check with the social worker or someone from the hospital to see what services are available to your family. I mentioned the service in which a nurse or a doctor could come to the home and give her an injection. There may be other services that can assist you and your sister to more effectively care for your mother.

The second option is the possibility of having to move your mother to a personal care home or a residential living facility. This, of course, would be extremely difficult for her and I’m sure for you and your sister. Nobody wants to place their family member in a personal care home or other care facility. But in some situations, such as when individuals cannot care for themselves or put themselves or others in danger, this difficult step may be necessary. Your mother is a danger to herself if she is not supervised.

I recognize that both of these options are difficult and challenging. You are dealing with a very complicated situation. I’ve worked with many families dealing with similar situations. They’re often faced with many of the same issues you’ve written about. Basically, the options with regard to dealing with these issues come down to the two I’ve presented to you.

With regard to Social Security Disability benefits, it is very common to be rejected the first time you apply. I would encourage you to hire an attorney to appeal the decision. In some states, it could take up to three years to receive a decision on an appeal. An attorney can expedite this process and increase the odds that the appeal will be granted. Generally, an attorney will not charge a fee if they don’t win the case. If your mother won the appeal the attorney would most likely only take a small portion of the Social Security Disability back benefits. I would strongly recommend you consider an attorney.

It’s clear you care about your mother and that you and your sister want do what is best for her. To the best of your ability you want to prevent this uncontrolled illness from majorly disrupting her life and yours. To accomplish this sometimes means you have to make difficult choices. It’s important to do what is best for your mother but also what is best for you and your sister. You can’t let this problem interrupt your life to the point where you can no longer hold a job or function normally because you’re constantly dealing with your mother’s problems. I am under no illusion that this is a difficult challenge but your quality of life has to matter and be a priority.

Your current living situation is unsustainable. Something needs to change. I understand the challenge of your situation and I hope that these suggestions will help you. If you have further questions please do not hesitate to contact me. I will be glad to help.

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Can Paternal Age & My Mental Illness Increase Schizophrenia Risk?

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

Hello. Due to obsessive compulsive disorder I have developed a new obsession that is causing me so much concern I am unable to think about anything else and in desperate need of some reassurance! Firstly I have suffered all my life with mental health problems. I was diagnosed with ADHD at the age of 7 then with OCD at the age of 13. The ocd symptoms were significantly reduced between the ages of 15 to 23 (last year) although in between this time I suffered significantly with depression, although extremely painful to me this was better than OCD. Unfortunately however the symptoms remerged late last year and have been chronic ever since. I am constantly looking for possible reasons for my problems and constantly undergoing countless amounts of treatments and therapy in the hope to finally put an end to all this. Unfortunately to no avail! My recent OCD obsession is a particularly scary one for me I’m seriously worried about developing serious mental illnesses in particular schizophrenia I have spent 2 days straight researching this when I came across the topic of age of the father and increased risk of mental illness. My dad was 44 when I was born and and according to recent studies and findings this doubles my changes of developing schizophrenia. To about 1 in 68 (I think) this worries me no end and I literally can not stop thinking about it. Especially as I am 24 and nearing the age where women tend to develop the illness. I’m basically just looking for some reassurance. Should I be overly concerned about this? I know I do not have the illness but I have convinced myself I will get it. I’m not sure if my mental problems I have experienced in my life so far are due to my fathers age at the time of my birth but if so my main question is if I am susceptible to mental illness does this therefore increase my risk even further when it comes to schizophrenia on top of the risk I already have due to my dad’s age?At the moment I am convinced that schizophrenia is going to affect me and I can honestly think of nothing worse. When I think about my fathers age and my history of mental illness i feel it is inevitable! Sorry this is so long winded I’m having trouble putting it into words but if you can offer any advise at all it will help me no end! Thank you so much.

There is a small but negligible increase in your likelihood of developing schizophrenia because of your fathers age at the time of your birth. There is no known cause of schizophrenia. There are many theories about what causes schizophrenia but not one of them has been identified as the true cause. Many people believe that schizophrenia is a brain disease. It is also believed that environment and exposure to stress play instrumental roles in the development of schizophrenia.

You have been diagnosed with obsessive-compulsive disorder (OCD). It is not uncommon for people with OCD to become fixated on, what many consider to be the most severe mental health disorder, schizophrenia.

The best way to eliminate fear is to focus on reality. Relative to other mental health conditions, schizophrenia is rare. It is diagnosed in approximately 1 to 2% of the population. Thus, it’s statistically unlikely that you will develop the disorder, especially if you have no symptoms.

If you’re not in treatment, you should be. OCD is highly treatable. Choose a therapist who specializes in anxiety disorders. You may also want to consider taking medication which can also help to control your symptoms. Once your OCD symptoms are under control, this fear will likely dissipate. Please take care.

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Can’t Connect With Others

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

Within the last three years the following events occurred in my life in order: my mom became schizophrenic and got a divorce from my dad, I moved in with my ex boyfriend who immediately began to emotionally abuse me and physically abuse a cat which he took into our care (he was a childhood friend, we dated for five years and he was always very nonviolent so I never saw the abuse coming. I also stole the cat when I broke up with him. I treat her very well and love her a lot), my mom ran away from home after getting a diagnosis (of schizophrenia) from her psych and nobody knew where she was for two weeks (she also stopped seeing him after this), a boy stalked and blackmailed me (and would threaten to kill himself whenever I did not cooperate with him) and turned my entire class in college and even some of the professors against me… I did finish that program and I moved back home for a little while before moving back to where the college was in order to earn a postgraduate certificate. At this point I was severely depressed, socially anxious and would routinely stay up for days at a time. I also used to have extremely screwed up nightmares involving myself (often as a child) and my imaginary friend (which I made up as a child but still talk to every day. I know that he is not real), and my imaginary friend would talk to me (in my dreams while I was sleeping) about how my dad used to abuse my mom, but I didn’t really believe him at first… After awhile I asked around and found out that my dad used to cheat on my mom and emotionally abuse her constantly (especially during my early childhood), and that my mom had agoraphobia during this time. She was always depressed and is always telling extremely sad stories, and would frequently encouraged me to never marry or have children. I tried speaking to a psych at the school for awhile about how I was feeling about these events but she seemed to be kind of disgusted by me so after a couple of months I stopped going. As far as I know she never made a diagnosis besides like maybe depression. She would never talk about a possible diagnosis; perhaps she was not even in a position to do so? I don’t know.

I spent most of my free time that year locked away in my apartment alone drawing, reading and writing. In fact, it is all I do even now. Eventually (in an effort to become more social) I became involved in some humanitarian-type stuff, which turned both of the other girls in my program against me… I haven’t had any friends (that were not just hanging around because they wanted to have sex with me) since before I hit puberty, so I became even more depressed when they began to bully me. At the same time some of the professors were taking an interest in me but they frightened me very much (I have always had this thing about authority figures. I never trusted them even as a young child) so I would avoid them. One of them thought that I was interested in him sexually (when I was actually just afraid of him), and initially acted as if I was the one who wanted him (which is incorrect) but then started blowing things I did or said out of proportion and then started giving me advice which I would later discover (as I learned more about him) really would benefit him more than I. He eventually hacked into a password-protected, encrypted file that I kept on an external drive that I would routinely plug into one of the school’s workstations which contained my journal and tried to use the information within it to meet me in a place that he knew that I was going to be so that he could hook up with me (not only was he twice my age but also married with many children)… The worst part was that I nearly said yes… I was really confused and lonely, and I always got the feeling that he was as well… But in the end it just felt too horrible for me to say yes. I naively kept hoping that we could just be friends afterward (even though I have been in similar positions before and it always ended with me being alone) and became extremely upset when I realized that he would not allow it… I was angry that he could only be satisfied with the friendship when it was actually a potential relationship which he was completely in control of and felt angry that he could pretend to be so moral when he clearly was not. I did eventually try to approach him online about this but he ignored me. This was kind of the last straw for me when it came to dealing with other people. I have almost always been alone in the seven months since this occurred.

All of these events had a profound effect on me emotionally; having lost all faith in humanity, I immediately returned home after finishing school and I locked myself in my mother’s apartment for four months… I was too afraid to even go outside and thought about suicide constantly. Then my mom revealed to us that she was stealing everyone’s rent money but not using it to pay the rent. This was supposed to allow her to have an excuse to move in with her parents and distance herself from us (we were completely supporting her financially at that point but we are not as rich as they are). When she told me her plan she was absolutely giddy and told me that she did not care about what was going to happen to me. We eventually did sort it out (particularly after my grandparents told my mom that she could not stay with them and suggested that she stay in a women’s shelter), and we all still got to live together but it really messed with my head, especially since my siblings decided to get a place without me and said many bad things about me during this time. After this I told my older sister that I did not believe that I was well mentally… I asked her for help but she made fun of me and gave me the cold shoulder (and talked others into doing the same) for a couple of months. Then my older brother (who was a very dangerous and violent person for much of his life) was hit by a drunk driver and was in a coma for a month. Then my dad stole my bed while I was out one day and told me afterward that he was never going to talk to me again because his girlfriend asked him not to. I was actually starting to leave the apartment semi-frequently after the whole thing with my mom went down, mostly because the only person that I talk to regularly outside my family (who lives in another city) started inviting me over to his place occasionally, and doing that eventually got me used to everything enough to start going outside for other reasons without experiencing any fear. I go outside maybe 5/7 days of the week now and am okay with talking to clerks and salespeople, but I am still severely unconfident and anxious around people overall. When I am around new people that I think I may have to deal with regularly I become extremely emotionally strained and tense.

I have fantasies where I am a male, and I enjoy it way more than I probably should. I go back to my college days and become friends with everyone instead of being alienated by them (or alienating them) or stalked or hurt. I always blame myself when people do not want to be around me. Sometimes I actually feel angry at myself because I am female because it makes me feel like I am destined to only ever hurt other people and be hurt in return. I am an artist and when I draw pictures of myself it is always as a male. It is hard for me to draw my real self. In some ways I identify even more with this image that I have in my head than I do with my real self. I have this extremely deep fantasy world in my mind that I withdraw into when things get bad in the real world. I spend so much time daydreaming within that space that I worry that I will waste my entire life doing so.

When I am around people, especially new people, I feel as if I am entirely at their mercy, and that I have no real control over what they will do with me, and that nobody will like my real self… Sometimes I feel like no matter how much I object I will just be forced to play whatever role the people closest to me will want me to fill. I have a very good idea as to what I am like and what I stand for but I cannot shake the feeling that I can’t be that person and still have others around me. I can’t help but believe that if I am not useful then nobody will want anything to do with me, and because of that I respond to new people with great anger and fear without entirely desiring to.

My fears have prevented me from really expressing myself, starting my career or making any new/positive connections with others. I work freelance over the Internet (and have never met any of my clients face-to-face before. They know very little about me but are happy with the work that I produce) and have attempted to take a part-time job in various occupations that I actually do not care about but would involve me talking to strangers regularly (so that I can become more comfortable being around new people) but I can’t even get past the first part of the interview process without screwing it up. I have avoided looking for non-freelance jobs in the field that I have my degree in because I know I would be even more afraid if I did and that I would not be selected. I had a job in sales before I went to college and I was one of the best salespeople they had at the time, but I just can’t do it anymore. They always see my hands shake or I start studdering like crazy and they cut the interview short and then never call back.

I don’t know what to do with myself or how to move past all of this, or what exactly I have wrong with me, and I cannot afford to talk to a psych in person, so I don’t know what to do. Please help me. I’m sorry for rambling on for so long.

Please do not be sorry for “rambling.” I appreciate that you’ve provided many details regarding your situation. The more information you provide the easier it is for me to help you. It seems that you’ve had multiple traumas and stressors occur throughout your life. I am sorry you are experiencing so much anguish and distress. It must not be easy to handle so much all at once.

You wrote about being secluded in your apartment. You are unable to leave your residence because you’re too afraid to go outside. You said you think about suicide constantly. You have imaginary friends that feed you information about your parents. You have an “extremely deep fantasy world” in which you visualize yourself as a male. Furthermore, this fantasy world is a place where you revert to when “bad things” happen. You also seem to be experiencing paranoia. You wrote that you are worried about other people around you. You feel that these people may be able to control you. You feel you are at their mercy. You fear that you will be forced into acting how they want you to act. You worry that you will lose your ability to be yourself. You not only fear this will happen but when it does it makes you angry.

You not only wrote about your current symptoms but you also offered some of your mental health history. Your mother has schizophrenia. You parents are divorced and your brother was severely injured by a drunk driver. You moved in with your ex-boyfriend and he abused you and your cat. These are all very difficult life circumstances. Any one of these situations might cause an individual to be traumatized, or at the very least stressed and upset.

In addition to your complicated family situation you may have a history of paranoia. You wrote about the boy who stalked and blackmailed you. Then there was the professor who thought you were sexually interested in him and then who you believe hacked into the external drive of your computer (for reasons that you did not specify). You said that on several occasions different groups of people turned against you, one occasion was your college classmates and the professor (as a result of the boy who stalked you) and the second was the girls associated with the humanitarian efforts you were involved in. I am not saying that these events or situations did not happen. Only you know if they did. They very well may have. What I am saying is that there does seem to be a pattern of paranoia currently and historically throughout your life. That conclusion seems reasonable and tenable.

It is difficult to know what you are experiencing. My two main concerns are that (1) you have a family history of mental illness and thus may be at a greater risk for developing a disorder yourself and; (2) you are currently not stable. At this point in time you are unable to interact with others, get a job or to move on with your life. As you have correctly noted, your fears have put your life on hold.

Are you sure that you are unable to see a mental health professional about these issues? There may be a community mental health center in your local area that might be able to provide counseling services to you for free or at a very low rate. There may programs that you are unaware of in your community. I’d encourage you to check your Yellow and White pages in the phone book and look up the words “counseling,” “Psychologist” or “social services.” Please look into this. You need help to deal with these problems with the help of a mental health professional or your life may continue to remain on hold.

I’d like to add this last thought. You have no reason to believe me or trust me. I am just words on the Internet but I’d like to tell you this. You can have a happy, productive life. Every problem that you have detailed in your letter can be solved and I have seen them solved over and over again. You think that your problems are overwhelming and you are held as an inescapable prisoner by them but this is simply not the truth. Your life seems frightening and you’ve contemplated suicide, not because you are weak but because you have tried all that you know and have had no success. Do not believe the illusion that all is lost. The truth is that you can be helped back to a perfectly happy successful life-in all ways. I have seen this and in your town or city there are many therapists who have accomplished this for their clients. If you want to believe the truth, believe this. Help is outside your door and all you have to do is believe it is there and then seek it out. I hate to see someone with so much sensitivity suffering when a cure and an end to that suffering is available. Good luck and please keep me posted on your progress.

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Am I Going Schizophrenic?

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

I had an anxiety attack and in the midst of it I thought I was losing control and was gonna have a heart attack. I thought I just needed to leave school for a minute and take a break. I told a parent about it and they told me that my stress was self inflicted and that I needed to fix my problems rather than run from them. They gave me a list of mental illnesses and reasons for why the illnesses may have happened. I read up on them and identified with them and saw that some people never heal from them and that petrified me into thinking it was no hope for me. That I would be that 1% I tried a self help program and it didn’t do much help because I was scared it was a scam because I couldn’t find any credible information about the program and because the guy who told me about it seems like a pathological liar. I was shook outta my mind realizing it didn’t work for me. A hospital psychiatrist and school therapist said I don’t have schizophrenia. I still have this fear even after hearing that. Ill explain the symptoms I recognize with: I went thru a phase where me and a friend were trying to unlock more than 10%of our brain and thought we could flow our energy in our body by thinking about it. After finding out what a delusion was I quickly realized I shouldn’t even keep trying this.I also believed in 1 too many conspiracy theories and thought that the gov. harmed people that were trying to do positive. I had a really positive idea that could help the world and fear they may come after me for working on it. I quickly dropped that idea too. Now when Im reading tweets I read them a little too quickly and my brain changes words around. This only happens with tweets and when Im stressing about going schizophrenic (almost 24/7now) Ive started having nightmares about my worst fears Anytime I get scared I think ima paranoid schizophrenic now. I’m always scared my thoughts will turn into delusions I fear any low noise that might mean Im hearing something None of this has gone on for more than 6months. Am I losing it? PS I smoked a lot of marijuana prior to the anxiety attack

The nature of anxiety is to excessively worry. Anecdotally it seems that many people with anxiety disorders worry about getting schizophrenia. In fact, it’s one of the most common questions that I receive.

A related common question that I receive involves using marijuana and subsequently developing psychiatric symptoms. Some studies suggest that smoking marijuana increases the risk for psychosis and for that reason it’s a dangerous drug to use.

Psychosis involves a break with reality. People with schizophrenia have psychotic episodes but not everyone who experiences psychosis has schizophrenia. Some people have one psychotic episode and never have another. Usually those cases involve drug abuse or a physical condition.

The bottom line is this: people who use drugs, including marijuana, have an increased risk of psychosis when compared to people who do not use drugs. It is best to avoid drugs if you want to preserve your mental health.

You stated that a hospital psychiatrist and a school therapist said that you don’t have schizophrenia. That should give you some peace of mind. If the experts don’t believe you have it (the people who are trained to know), then you should believe the experts. If you continue to worry, you might try seeking a second or a third opinion.

Finally, if you have an anxiety disorder, you should seek treatment. Once your anxiety is under control, these fears might dissipate. Please take care.

Dr. Kristina Randle

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Concerned About Friend/Ex With Schizophrenia

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

When I’d just turned 15 I started being friends with this boy (hes 1 year 4 months younger then me, so he was 13 about to turn 14 at the time). We were friends for a while and became very comfortable around each other very quickly. After about 6 months we became each others closest friend. I knew at this point that he sometimes got very angry. He said little things could set him off or often there would be no reason. But it wasn’t that bad at the time. I knew he had ADHD and was taking Ritalin.

After we’d been friends almost a year (when I turned 16, in February) he started going out with a girl in his year. This didn’t impact our relationship at all, and things were normal and fine. He said he loved her, but that if she asked him not to see me he would pick me over her, because I was a better friend to him. Our friendship meant a lot to both of us.

After he had been with her for 7 months I think (in September) I was over at his house and we kissed. We both decided not to go there again but did anyway. After a couple of weeks he left his girlfriend, saying that he could never feel about her the way he felt about me. Pretty soon after that he told me he loved me. We started seeing each other, but never made it ‘official’ and kept it a secret. This was partly because I was in the year above him at school/college and we thought people would find it weird, partly because for so long people had been saying that they thought we had a ‘thing’ or something, so to come out and say we were together seemed unappealing. And… well I think we just felt comfortable keeping it private. I’ve never had an official boyfriend, and he has dated other people, so when I asked (later in the relationship) why he personally wanted to keep it a secret when he’d been openly together with other girls, he said because it does something to change you, and that if we are openly together people will comment and expect things, and it makes us more prone to mistakes, and also that he didn’t see me like he saw the other girls, he saw me as a “life-long partner” type thing… even though we new the chances of a teenage relationship being successful long term were slim, we both had intentions of being together, and we always assumed that we would, at least, always be friends.

But then his anger started getting worse, he started feeling pressured from all angles of his life. He was confused about what he felt and thought, and in the end “I don’t know” was his answer to everything. He said he felt unable to make decisions.

This really upset me when his feelings for me started becoming part of what he was confused about, I was unfair to him I think. But at the time I didn’t know he had a problem. We’d argue a lot, and he later told me that he felt all my problems were being put on him, as well as all his problems, and he just couldn’t handle it.
We went up and down in the last 3 months (overall we were together for a year). He said he didn’t love me any more, he went through periods of wanting to end it and then not being sure. Things were bad before he went away for the whole of August, but then the day he left he was texting me, messaging me at least once a day, and telling me that he did miss me, more then he expected to. But then that stopped with no warning and he said he was just “indifferent” and he was sorry. But then the day he got back we spoke and he wanted to see me and I went over to his house and it was all great. And a few days after that he had to go to hospital, hes scared of needles and called me when he had a cannula in his arm. He asked me to come see him and I did, the whole time he was hugging me and keeping me close to him. Afterwards he told me he thought of me to get him through every injection.

By this point though his anger was really bad. He’d started biting himself (his arm, really badly, leaving welds that lasted for days and made him bleed) to let his anger out. Shortly after he was out of hospital we argued over something and he ‘snapped’, he got uncontrollably angry and took his anger out on himself and everything around him. After that he said something inside him had snapped and he just didn’t feel anything for me any more. I was devastated, as I still loved him. He was still angry with me and would hardly talk to me, although after a week or so he started sitting next to me on the bus every day again.

But then, in late September he started seeing someone else. She was new at our College and he wasn’t even speaking to her really when we broke up, so I know he didn’t leave me for her. But still, I’ve never felt more hurt, and seeing them together every day killed me.

For the first 3 months he still really wanted to be friends with me. He’d sit with me and talk every day. He called me up 2 or 3 times, to play me some music on the piano, or just chat. We’d sometimes text, although I initiated a lot of it. I know I did a lot of damage purely from a ‘getting your ex back’ perspective by being desperate and needy and still telling him I loved him. Our relationship after we split was just as up and down. We’d talk all the time but still ague, because he’d think I was ‘getting better’ and wanted to be just friends, and I’d want more and when that surfaced things got ugly. But there were times when we’d talk and get along well and he’d even be a bit flirty without seeming to notice, though when he did he would pull himself back.

By this point his anger had gotten even worse. He said he was angry all the time. He had also started Dissociating, where he wouldn’t care for or about anyone or anything. He wouldn’t feel anything for anyone. This would pass but it still unsettled him.

Then in late December we argued and he ‘snapped’ again. After that he was just angry with me. I didn’t know what to do, but I knew he wanted to be just friends, and I’d been thinking before about telling him that I wanted that too; by this point I could see the pressure he was under and was starting to worry. I thought that at least telling him I only wanted to be friends would be best for us both.

So I told him, but he said he didn’t want to talk to me. That he needed a complete break from me. That he was angry with me and now associated me with his anger.
Sometimes during the last 3 months we have spoken. I’ve almost always initiated it, and he seems fine, until the end when he gets angry and says to leave him alone, that things aren’t fine and that he was only acting polite so we wouldn’t argue.

There has been a couple of times when he messaged me saying he needed someone who understands to talk to. He says I’m the only one who understands him. That he can’t and doesn’t talk to anyone about anything. He says he has to ‘act’ all the time (with everyone, he is still with that girl but she’s included in the ‘everyone’) because hes always either angry or just withdrawn and not feeling anything. He has to act interested, and not just flat and emotionless.

Hes been diagnosed with more things now; first it was Dissociation Disorder and Paranoia (He gets paranoid that someone will kidnap and torture him, like in the Hostel and Saw films. He first mentioned this to me last April, but it didn’t seem serious then. Now he sleeps with a jujitsu weapon in his bed and wont close his eyes in the shower or put his head under the water in the bath, but he says he can usually overcome the fears by thinking logically), as well as Autism. He stopped biting himself to release his anger and started cutting. He cut himself 50 times up his arm when he ‘snapped’ (this time for no reason, but the worst so far). He says he can’t release his anger any more without cutting.

He started talking to me on MSN saying he needed someone who understood, but then he went offline. The next day I spoke to him and he said he had been diagnosed with Schizophrenia (not the type with hearing voices and delusions). Then I started asking him (which I think was a mistake) if he missed me, if he wanted to talk to me, etc…. he said he didn’t know to everything… I asked if he cared and he said he didn’t think so. He said that he would probably start talking to me now, and when I asked why he said because he had started so he may as well continue. I don’t know if he was just saying this as his way of making sense of things, but at the time I didn’t think it was good enough. I asked him not to just use me and he started getting a bit angry and that was the end of our conversation.

After that I decided to try and be friends with him, and to not bring up my feelings or concerns, because I thought he needed someone. I was nice to him when I saw him, and we chatted a few times, he leant me a book and gave me a stress ball he’d been given by a university stall, but I still felt like I was making all the effort. I said this to him and he started getting angry and told me not to. He said he didn’t want to talk to me, that he had nothing to say to me, and that he didn’t want to be friends. He told me that he didn’t even like me any more and that he hadn’t since December. He said that yes, I was the only one who understood him, and that he HATES that because he doesn’t like me and doesn’t want to talk to me. He said that I was always putting all my problems on him and that we always argue. He was getting really angry and said that he hadn’t been able to release his anger in months because his parents have hidden every sharp object (his parents know all about this and have him in psychotherapy). He said that all the bad feeling towards me was magnified because he couldn’t take his anger out on anyone else. He told me that he ‘knew’ I didn’t want to be just friends because of the way I looked at him when he was with her (which yeah I am very guilty of) and that he didn’t like me because I was so persistent and wouldn’t let go. He said that there was nothing between us at all and nothing to salvage.

He was being really cruel and harsh and at the time this devastated me. I took everything he said to heart and when I got home I fell to pieces, and it took me a day to recover from it. But now I don’t know how much of that he meant. I don’t know what effect Schizophrenia is having on him. And I don’t know if he only said those things out of anger and didn’t mean them, or if I just wish that were the case.

At the end of that conversation with him I think I managed to convince him that I only want to be friends (which is partly true, I still love him but I don’t really like him right now, because of how hes acting and how hes treated me. I don’t know if I’m ‘in love’ with him right now, but I do love him. I do want to get on the path to rebuilding our relationship, but right now the most I could handle would be friendship) and he said he’d think about it over the 2 and 1/2 week break we have from college and get back to me.

What should I do about all this? And what’s going on with him? Does he mean what he says or even know what he feels?

Your friend is not well. He is not stable and needs help. He may be unable to engage in a healthy relationship at this time because of his problems. My biggest concern is your friend’s uncontrolled anger. He has been engaged in self-harm until recently, when his weapons of self-destruction were removed by his parents. This has intensified and redirected his anger towards you. He has become so angry at times that he has “snapped” and taken out his anger on “everything and everyone around him.” Other concerning aspects of this situation include paranoia, to the point where he sleeps with a weapon under his pillow. His symptoms are not well controlled. Your safety may be at stake.

He has been diagnosed with several psychiatric conditions, the latest one being schizophrenia. Having schizophrenia does not mean that an individual is dangerous. In fact, research shows that individuals with schizophrenia are more likely to be victims rather than perpetrators of violence but under certain circumstances, the risk for violence increases. When? Risk factors of violence include:

  • Active and uncontrolled psychotic symptoms (i.e. paranoia, delusions, etc)
  • Not taking medication or not taking it consistently or as prescribed
  • Under the influence of drugs and alcohol
  • Uncontrolled anger outbursts
  • Has a history of violence

Past violence is the best predictor of future violence. Your friend has a history of violence toward himself and not others but as I pointed out, you may have become a convenient target of his anger. His mood is unstable and when he becomes upset, his behavior is unpredictable. This puts you at risk.

You should encourage your friend to remain in treatment. Do his parents know how angry he can become? If not, you should inform them. He may require more intensive treatment than he is currently receiving. His symptoms do not seem well controlled. He needs time to stabilize his mood and symptoms before you should pursue a relationship with him.

To answer your specific question, it may be difficult for him to know how he feels. That might remain the case until he is stabilized.

I also believe that you should consider therapy. A therapist could advise you about how to handle this situation. You could benefit from guidance with regard to this relationship. It is difficult and challenging.

I hope this answers your question. If you have any followup questions, please do not hesitate to write.

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OCD, Current Obsession Psychosis/Schizophrenia

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

For as long as I remember I’ve dealt with ocd. When I was younger and used to walk to school, I would set a number for crossing the street, and if I didn’t make it to the other side – let’s say by 10 seconds, then I would “go to hell” and “not make it to heaven”. When I was 14 I had my first panic attack and it was extremely scary. I entered a extreme dissociative state and that’s where everything spiraled. I’ve been dealing with chronic depersonalization/derealization. My anxiety mostly manifested into hypochondria. In typical anxiety disorder fashion, I convinced myself I had every disease and disorder under the sun. One time I was right, and actually had bacterial meningitis which was a life or death situation that permanently scarred me with “what if I’m right again” questions about some other disease or illness. After an evaluation they came to a conclusion of pure ocd. I have those sleep hallucinations, I’ve actually had them for as long as I remember, but of course when looking up what they’re actually called, I see that they’re a symptom of schizophrenia. That’s when I went into a schizophrenia deep search and convinced myself that I was in my prodrome and I have been for years. My mind began playing tricks on me these past couple of days, shadows in the corner of my eyes, the white noises like my bird chirping, TVs, and fan noises became auditory hallucinations, everything has became too loud and too bright, my depersonalization turned into a “Alice and wonderland” affect and my ocd itself even became a schizophrenia symptom. I did used to be peer pressured by my ex best friend to smoke marijuana which was not good for me at all, and it scares myself because I feel like I put myself at risk. White cars became intrusive thoughts that “what if I’m being followed “ even thought I’m able to disregard that as ridiculous – I can’t help but think what if I’m developing some form of psychosis. Is it possible for ocd to play tricks on people like this? Because the good old internet keeps telling me no- saying that I am indeed in a prodrome.

I understand your desire to learn more about what you think might be wrong but it’s causing major distress in your life. That is one reason why people should avoid attempting to diagnose themselves via the internet. It’s a bad idea. This is especially true for people prone to anxiety. The nature of anxiety is to worry, often about things that are unlikely to be true.

It is worth mentioning again, as I have in prior responses to similar questions, that this is one of the most common questions that I receive here at Psych Central. Most commonly, these questions seem to come from either worried teenagers or people with anxiety disorders who fear that their symptoms are indicative of schizophrenia.

Obviously, it would be impossible for me to know whether or not your symptoms are indicative of any particular mental disorder without having interviewed you professionally. However, it’s important to note that anecdotally, it does seem common that people with anxiety worry about developing schizophrenia.

There may be an explanation for it. In the minds of many people, a diagnosis of schizophrenia is a psychological disaster. It’s considered the “worst of the worst” disorder. It may even be the most stigmatized mental health disorder around the world. People with anxiety often focus on worst-case scenarios. It makes sense that people with anxiety disorders, who are often focused on worst-case scenarios, would worry about developing schizophrenia.

Regarding use of marijuana, it has been linked to an increased likelihood of psychosis. While that may be true, it does not mean that you will develop schizophrenia. It should be something you avoid in the future so as to protect yourself from any possible negative outcomes associated with drug use. What may be happening is that your untreated OCD is worsening and causing you to feel more out of control.

Why have you been dealing with OCD “for as long as you can remember”? This would suggest that you have not been in treatment. If you’re not in treatment, you should be. The sooner, the better. Anxiety disorders are highly responsive to treatment. There’s no reason to continue to experience symptoms when both psychotherapy and medications can successfully treat your condition.

I would highly recommend contacting a mental health professional as soon as possible. Left unabated, your symptoms may be worsening. Couple that with your actively searching the Internet for more information about schizophrenia. You may be feeding your fears. A change is needed. It takes years of specialized training and advanced degrees to diagnose. The solution is consulting a mental health professional.

In the meantime, avoid self-diagnosis. Consult a professional who would be in the best position to advise you about a potential diagnosis. I hope that you will strongly consider mental health treatment. Once you begin treatment your symptoms should decrease and you will likely feel better. Good luck and please take care.

Dr. Kristina Randle

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Worried About Schizophrenia/Schizoaffective disorder

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

I’m sorry if this sounds repetitive of past posts but I’ve been looking everywhere to ask/talk about this. I’m also sorry if this is too long, I’m going to try to keep it as short as possible, yet informative.

I can’t even tell you how long this has been going on because I only realized last year that a lot of things aren’t normal. For the past year I have had hallucinations (vision and auditory). They used to happen once a month, to once a week, to now everyday. They aren’t always clear, most of the time it’s a shadowy looking thing, like a silhouette. I’ve had auditory hallucinations for a while and I didn’t realize that the voice controlling me wasn’t normal till recently.

I used to be happy, smiling almost all the time. I would be terribly upset if I wasn’t able to go out with my friends, or they weren’t able to. I used to laugh over nothing with friends and we always had fun. I just graduated from high school, and I haven’t seen or spoken to anyone except family and people at work. I hate being with people, and feel nervous around them. I remember since about 3 years or so ago, I developed this weird thing, that I would turn bright red in the face and tremble if anyone spoke to me or even looked at me. I wouldn’t be embarrassed or anything, just really uncomfortable. Even around family. Whenever I would encounter any social situation I would do anything to avoid it. I made excuses not to hang out with friends. I spend most of my time locked in my room now.

Throughout high school, the number of friends or even people I’d talk to decreased each year. Senior year I only spoke, and barely, to my two best friends, who I haven’t spoken to since graduation.
I have weird feelings that time stands still, but just for me. Everyone’s time is normal, but I’m in slow motion or something. I also feel like my thoughts and body and not connected. I feel unreal and empty. I keep a rubber band on my wrist and stretch it so it hits me to reassure that I am human and real. Also, I often stare straight ahead of me, as if in a day dream. I don’t move, don’t think, just stare. I feel like I leave my body or something, then it kind of clicks. I feel like I’m just sitting within my empty body looking through my eyes. I blink my eyes, and I’m back.

I feel empty and apathetic. The only things I feel are unbearable anxiety, frustration, hostility and fear/paranoia.

I lack empathy. I cannot connect with people, I don’t feel their pain, nor do I care. My sister has a disorder and needs a attention/help at school, and I don’t care. Don’t get me wrong, I’m not a horrible person, I try to feel sympathy and concern for people, but I need to force it out of me, and it’s fake.
For the last few months I’ve had a night here and there that I couldn’t fall asleep, or stay asleep. But, for the past month, that’s gotten worse. I sleep 3 hours some nights, or I wake up every hour. I wake up some nights and think I hear people breaking into my house or walking up and down the stairs, but everyone is asleep. I’ve also heard that voice in my head scream just to get me scared/angry. The nights that I do sleep, I have nightmares or really strange dreams.

I attended an art high school, and will be an art student in college this fall, but all my motivation has vanished. I don’t want to draw or paint or photograph anything, but last year you weren’t able to stop or control me. It’s not just that, I don’t want to get out of bed some days. I go days without showering, or even brushing my hair. I go out in pajamas. I spend my days in front of the tv, not really watching just staring at it. My mom thinks I’m lazy, but I just don’t have the will to do anything. (and it’s not like how depressed people don’t want to do things or get out of bed, i can’t really explain it. )

My thoughts always go astray and are jumbled up. My speech has been weird lately too. I mix up my words. (Ex: I up mix my words) or I speak really fast. But that’s when I talk.

I make up scenarios in my mind that as of recently, I can’t tell which are my thoughts and which are real. I’ll have a conversation in my mind with someone and than continue it in person.
When I leave the house I feel like everyone is watching me.

I used to believe I was psychic because my dreams would come true, and I could feel the presence of people. I also used to think that there are cameras built in my house and someone is always watching, which I still think, but kind of doubt. But I do feel like someone is watching me.

I go from months of not wanting to speak, or even look at people. Then I feel hyper and invincible. Then I feel normal. Most of the year consists of being unusually antisocial, unreal and apathetic.
My problem is that I want help, but I don’t want to get help. I want answers without talking to someone about it. It doesn’t make any sense. I don’t know. I have trouble putting my thoughts and feelings into words. I have for a while now, and I feel that a doctor may misunderstand me. and put me in a hospital. I also don’t want to be in a room alone with a stranger for an hour talking about myself and what’s wrong. I’ve never told anyone, and I don’t know where or how to start. I want to get help before all this gets worse and consumes me leading me to believe that I am fine and don’t need help. There are some days that I think to myself “why am I worried? I’m fine, there’s nothing wrong at all”. The thing is that I don’t have the courage, nor the motivation, to get up, look for a psychologist, make an appointment and go. I always told myself “When I get a car, when I get a license I will take myself to one”. Well, I have both the car and license now, but there’s still something pulling me back.

I don’t know what to do. I need advice. I tried telling my mom. I mentioned that I don’t really laugh anymore or feel anything and that I want to see a psychologist, for a few days she was sympathetic but got over it.

What can I do? I’m 18, but I’m still under my parent’s insurance.

I know you don’t have the energy or the motivation to see a mental health professional but you should try. Part of your concern is having difficulty communicating your thoughts and feelings in words. That’s understandable. Could you use the letter you wrote as a blueprint for what to say when you meet with a therapist? The letter is very descriptive and clear. You outline all the areas in which you are having difficulty. If you gave this letter to a mental health professional it would provide valuable details and insight about your symptoms.

The symptoms you’ve described are concerning but if you are willing to seek treatment they can be corrected. They are treatable. Some may be treated with medication. Talk therapy may also prove to be helpful. Don’t ignore this problem. You want to be proactive with treatment. Treat the symptoms now before they become worse and interrupt the next phase of your life, which is to attend college.

When you spoke to your mother you didn’t give her the full story. There’s a major discrepancy between what you told her and your actual experiences. She doesn’t know the extent of your symptoms. If she did then she may be much more willing to help you access treatment.
What should you do? The next step is to either be more descriptive with your mother about your symptoms or bring her this letter. Tell her the truth. Don’t keep it a secret any longer. You are legitimately suffering and you need help. Tell her you’re frightened to seek help and that you need her support and assistance. If you could count on her support then you might feel more comfortable about seeing a mental health professional.

Lastly, getting help is nothing to be frightened of. Like you, many people are fearful about the prospect of seeing a mental health professional, for many of the same reasons you’ve cited. Unfortunately many people needlessly suffer and choose not to access help because of their fears associated with therapy. Those fears are understandable but in most cases they’re not based on reality. Those who have moved beyond their fears are often grateful for having sought help. For many it has saved their lives.

I hope you can move beyond your fear, receive support from your mother and find the help that you deserve. Please take care.

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Psychosis and Schizophrenia

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

Hello. I am concerned lately as to the state of my mind in relation to psychosis. I have been diagnosed with Borderline Personality Disorder, however the symptoms I am experiencing fall out of the regular signs associated with this personality disorder.

Now, I was told in the past, that I was at high risk for developing schizophrenia. I have been having some persistent symptoms that have me worried that I may very well be heading in the direction of this diagnosis. I am not a professional and have no clue what is going on in my mind. I would just like some guidance and ideas as to what might be going on.

For starters, I have been experiencing some persistent confusion. I have difficulty ‘keeping up’ with my racing thoughts and logic. My mind seems to be taking me to places that I had no intention of going, and faster then I could possibly grasp. This leads me to feeling extremely confused and disoriented.

Secondly, I am having difficulty distinguishing my dreams from reality. Often times I will dream of simple, everyday activities, and upon mentioning, or asking if these events occurred, I will be told that nothing of that sort happened. I constantly experience hypnagogic and hypnopompic hallucinations, with and without sleep paralysis. I also have what I like to call ‘para-hypnagogic/hypnopompic hallucinations’. I use this to refer to times when I am not quite as far into the sleep cycle in which these hallucinations usually occur. More often then not, I am quite awake.

Thirdly, I am extremely paranoid! This is to the point that when i am having a paranoid episode I began acting out impulsively. A few examples include: jumping off a bus when I felt a paranoid panic that something horrible would happen. Hiding in bushes and behind cars when I felt that someone was following me, or watching me, and locking all my doors and windows upon being convinced that someone had followed me home with bad intentions.

At some points, I have actually hallucinated both auditory and visually someone watching me, or following me. I would not have known that these things were not real, had some friends and family not called me out on them.

I also experience intense depersonalization. I might feel I am in a dream, or that I am watching myself. I experience intense bouts of de ja vu and strange, indescribable feelings.

I have intense mood changes (yes, this has to do with BPD, mentioning for the sake of it). These vary in intense anger, to intense happiness. I am also extremely sensitive and the smallest degree of insult will leave me in tears for days.

I am often told that I jabber on about nothing and that my stories or conversations make no sense. This might be just a poor memory, but one can never be sure. I also have some thought disorder including trailing, and sudden stops in conversation. This is because I get distracted or totally forget what i am saying. This is another symptom that I was not aware of until It was pointed out.

I have experienced other auditory hallucinations on and off. Usually short comments or my name being whispered. Other times i hear footsteps. All of these symptoms wane and wax and have been occurring for a little over a year. They have been most prominent over the last 6 months.

Help! Is this a sign of schizophrenia? Or is the psychosis surfacing from something else?

Thank you!

Research shows that individuals with borderline personality disorder (BPD) can experience brief states of depersonalization, hallucinations, paranoia and suspicion. They can also experience psychosis-like symptoms such as feeling as though they are losing their grip on reality. The symptoms you described may be part of BPD. I cannot say for certain whether your symptoms are associated with BPD or if they are a sign of another disorder such as schizophrenia but generally speaking, your symptoms are fairly consistent with BPD.

I would recommend having a psychiatric evaluation. An evaluation would be helpful in determining whether your symptoms constitute the development of schizophrenia. As I remarked above, your symptoms seem consistent with BPD but it is important to rule out a possible developing psychosis or schizophrenia diagnosis.

You did not mention whether you are in treatment. If not, you should be. It would be difficult to experience the many frightening symptoms you have described. I get the impression that you may feel like you are living in a fog, not sure of what is real and what is not. This is not a healthy way to live.

Psychotherapy may help to address symptoms such as mood instability, racing thoughts, confusion and memory loss. Medications might be helpful as well. Medicine may be particularly helpful for hallucinations and paranoia. Some physicians prescribe a low-dose antipsychotic to treat hallucinations and paranoia in individuals with BPD. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have been found to be helpful for mood instability. These are all treatments you could explore with a therapist and a physician, preferably a psychiatrist because of their additional training in mental health.

Here’s a link to Psychology Today where you can search for a therapist in your community. Many individuals with BPD prefer to consult a therapist who is specially trained to work with this population. If possible, I would recommend you do the same. Thank you for your question.

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Unreal Memories, Unreal People, Voices, Trouble Talking?

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

I’ve been having trouble for the past 3 years with various things like hearing strange voices tell me to do things and once in awhile seeing strange things that no one else can see. For a while I thought they were messengers sent to me and I was terrified of them but couldn’t get away. Now I’m doing a bit better. I think this is some type of psychosis? But what is even more confusing to me are these clear memories I have of events that never happened. In these memories I am a different person entirely, but they feel so real. I don’t know what’s going on, and it’s kind of freaky.

Another thing which I can’t account for is that sometimes I feel certain person, let’s say “Bill,” is angry with me. I’m really distraught for a while just to realize later that I don’t even know the “Bill” I was thinking of. It seems I make people up to be mad at me or otherwise have things against me. All these things put together make me wonder if I don’t have Schizophrenia. I’m horrible at expressing myself and often say things that my friends tell me don’t make sense at all, or, if I’m really nervous, just a sentence put together with random words. I don’t realize I’m doing it at the time though. I also struggle with sudden thoughts of seriously harming myself. I’m able to control them, and my family is helping me through a lot. I am depressed a lot, and I think maybe I struggle with anxiety…is that all this is, or do you think I may be struggling with something more? Is this something medication may help? I don’t want to seek help if all they can do is diagnose me and then leave me. I hate talking to people as it is, so if all they can do is talk to me I’d rather not get help. The only reason I think schizophrenia is because my friend thought I had it. Do you think she’s right?

 

 Your symptoms are unusual and could indicate psychosis but I do not have enough information to provide a diagnosis. It is possible that you have schizophrenia or another mental illness, but you would need to have an in-person evaluation with a mental health professional to determine what may be wrong.

The idea that you would be diagnosed and then forgotten is more fear than reality. That is not how mental health treatment works. Mental health professionals don’t diagnose and then discharge their clients. They first conduct an assessment to identify the problem. Then they develop a comprehensive treatment plan to correct the identified problem. True professionals work with you, to get better, for however long it takes.

Mental health problems are treatable but not if you avoid seeking help. It would be a mistake not to seek help. It could make your symptoms worse. Please consider consulting a mental health professional. It will be worth your time and effort. Both medication and therapy could help you tremendously. Please take care.

Dr. Kristina Randle

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