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Social Anxiety

What Could Be Wrong with Me?

by Dr. Marie Hartwell-Walker May 25th, 2022
written by Dr. Marie Hartwell-Walker

From the U.S.: i think i need a mental evaluation because i have a lot of social issues. i often appear awkward or stupid to others because i don’t know how to respond to them on the spot. its almost like i think too slow or can’t completely pay attention to or understand what they are saying. i often zone out or daydream and i have a habit of saying “what?” every time someone asks or tells me something because it gives me an extra few seconds to get what they’re saying.

i also have really low self esteem and i just hate myself because i never seem to do or say the right things. i often have suicidal thoughts and do self destructive things like stealing/shoplifting, drugs/alcohol etc. i have dreams about doing bad things too. i often lie – sometimes to hide something, or when i don’t have anything else to say, or even for no reason at all most of the time. i get really depressed or anxious and i tend to talk even when people aren’t listening to me even when i know it.

i’m pretty introverted and observant and i only have a couple of friends because i just don’t know how to talk to people, not even my family. i’m afraid of the people i have in my life leaving me, and i try really hard to be a good friend because i don’t want to be any more alone. i always end up caring about people more than they care about me and i take more time to understand them, especially the people i like. i also have times where i feel like i’m not really there or empty, and i get really sentimental like i have all these flashbacks and memories of random things. i’m 15 so is this normal? because ive always felt different from everyone else, and ive been this way for as long as i can remember. what should i do?

A good deal of what you’re saying sounds like normal teen issues. You are struggling to find out who you are and how to relate to others. Sometimes memories and daydreams are happier than the present, so you go there in your mind. That’s normal, too. In addition, you are by nature introverted and kind of shy, so you are perhaps struggling more than some of your classmates who are more naturally social. The most positive thing you said is that you do have a couple of good friends and you do value their friendship. That means you do know how to connect with others. That’s something to build on.

I’m worried that you are measuring yourself against some ideal that is difficult, if not impossible, to reach. I assure you, many, many teens (and quite a few adults for that matter) have more trouble than you might imagine figuring out how to be social, how to say the “right” things and how to have the perfect retort. Although they probably serve as distractions, hurting yourself and doing destructive things is not going to make things better and will only further damage your self-esteem. Instead you need to be building on the friendships you have.

Often it is friends who help friends figure things out. If you and your friends have a trusting relationship, you may be able to talk together about how to be more at ease with other people. If your friends aren’t the type of people to do that, maybe seeing a therapist for a little while would be helpful. A therapist can help you put things in perspective, can teach you some new skills and can support you while you try out new ways to be with other people.

I wish you well.
Dr. Marie

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I Talk to Myself All the Time

by Dr. Marie Hartwell-Walker May 16th, 2022
written by Dr. Marie Hartwell-Walker

From Pakistan: I talk to myself all the time.i am doing this far as long as i can remember.what i do is that i create a lot of people in my mind and a story plot and then i start acting it out. i do it aloud and acted out the part of every person i created .i prolong single story for weeks at a time. it seems like my stories age with me. when i was a kid , stories were kid stories like a family of ants, talking animals, miniature people living in forest. but as i get older my stories became more of adult kind. now these are about couples, family issues or on friends.

in the start i used to do to this in bath room or closed room and the second i leave the room i am back in my present life. now i am more consumed by them , even if i am sitting with my family ,i would be in my head constantly talking to my characters as if an ongoing serial.
i tried writing my stories but as soon as i started writing my mind goes blank. what i do realize is if i am sad my stories get a happy turn, if i am angry stories became apologetic , if i am happy they turned to be sad.

The other problem i have is that i have no idea how to socialize. What normally happens is that i would be sitting with group but i wouldn’t take part in the conservation. It is like i am a spectator not part of the group. I am like this with every person i know, my parents, brothers, friends, cousins every one. But there are few days when i wont stop talking or laughing but this phase is becoming more and more small now. Now a days i am usually just want to be left alone in my room. I don’t want to be part of any conversation or any family gatherings. I would lay down on the bed and not move for hours at a time. would get furious over small things and start crying. sometimes i had quite a big fight but I’ll be emotionless afterwards.
Also i am losing interest in things i usually love to do before. I can’t concentrate on things now. my focus keeps on shifting. Its like one day i want to do something and next day i don’t want to do it. I would make plans and then keep postponing them. I am pushing my friends away.

I think the two problems are related. Since you have been unable to figure out how to be comfortable with other people, you started creating a different world in your head where you have more fun and more control. Apparently, this started when you were very young. It makes sense to me that the more uncomfortable you get socially, the more your alternative world takes over.

A problem like this cannot be solved with simple advice. I encourage you to find a therapist who can help you with this long standing problem. You need practical support and coaching to develop the skills you need to be comfortable with other people.

It would be sad if you give up your considerable story telling skills. A therapist can help you separate the useful part of your well-developed talent and skills as a writer from your social issues.

I’m glad you wrote to us. These are problems that can be solved if you get the proper help. I hope you will take the next step and work with a therapist.

I wish you well.
Dr. Marie

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Why Am I so Afraid?

by Dr. Marie Hartwell-Walker May 14th, 2022
written by Dr. Marie Hartwell-Walker

From a teen in India: I fear strangers. I fear to survive. I fear that someone will interfere in my life and change its course badly. I fear that someone will be an obstacle to my life’s progress. To some extent I fear of getting killed or robbed. I know that this is not rational. It is an irrational fear, kind of phobia. Because of this I afraid to meet new people.
(Mostly people who are close to my age group.)
I fear going out.
I enjoy solitude.
I desperately need this state of mind to change.
Please help me.
Thank You.

Although I can’t make a diagnosis on the basis of a letter, I do think you and a counselor should explore whether social anxiety is your problem. People with social anxiety have an extreme fear of being watched or judged by others. That fear can make it difficult to do school work or a job or be in social situations. Being around people one doesn’t know can be so difficult that it’s hard to even want to leave the house.

You are right to think you may have a phobia. Social Anxiety is also called Social Phobia for good reason. It can make people phobic about almost any social contact.

People with Social Anxiety get so uncomfortable being around new people or being in new social situations that they even have physical symptoms. Often their heart rate increases. They may feel dizzy, lightheaded, and perspire. Muscles may tense up. Some people develop stomach problems or diarrhea. Some find it difficult to breathe or hyperventilate.

Social Anxiety is more common than you may know. Research suggests that about 7 percent of Americans are affected.The good news is that it is treatable. The first step is to see your medical doctor to make sure your symptoms aren’t caused by a medical problem. If you are medically fine, then it’s time to see a mental health counselor to be evaluated. If you do have social phobia, the counselor will usually suggest a combination of medicine a talk therapy. The medicine will give you some immediate relief and may bring your anxiety down a notch so that you can get more benefit from the psychotherapy.

Cognitive Behavioral Therapy (CBT) has been found to be especially helpful for treating social anxiety disorder. CBT will teach you new ways to manage your anxiety and to cope with situations where you need to be around other people. Often it is helpful to participate in CBT in a group because you can then practice those new skills with the therapist there to coach you.

It’s not generally wise to depend on the medication alone. You don’t want to be dependent on medicine to get through life. Talk therapy will help you develop the skills you need to know so you can manage social situations for the rest of your life.

I wish you well,

Dr. Marie

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Extreme Anxiety

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

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

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

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

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

Thank you

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

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

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

I wish you well.
Dr. Marie

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Social Anxiety or Something More?

by Kristina Randle, Ph.D., LCSW May 9th, 2022
written by Kristina Randle, Ph.D., LCSW

For the past two years I’ve noticed my social abilities steadily declining, and I’m at a point where I don’t speak unless spoken to. My school life is being affected due to my fear and inability to ask for help on problems or such. I was diagnosed with social anxiety about four years ago, but this feeling is no longer the same. I’m constantly afraid in most all situations, and I shake like a small dog. I’m finding it hard to talk to some of my dearest friends due to my sentences being choppy, and they always have to ask me what I mean several times to the point where I just stop trying. I was also diagnosed with depression and ADHD four years ago. The depression has been awful for the past 2 years, a way that in never was before.. I started cutting myself when I was 10 years old. I hadn’t cut in 3 years last month, and the next thing I know, I’m hunched up in my bathroom holding a razor. When I went to use it, it was gone, and I was in the kitchen. I’m at submitting this right now because the other night, it wasn’t a frantic hallucination. I don’t remember a lot of it though, and I found pieces of paper on which I drew very disturbing images in my blood. I really don’t know what to think anymore. I avoid calling or talking to my friends, even when I’m aware that I like that person and would probably enjoy talking to them, I just stare at the phone while its ringing and wait for it to stop. There are also other, more minor, hallucinations that I’ve dealt with for some time. My vision is constantly obscured by a layer of static like..things, of which I was informed was incurable. At night I see horrible things in them. Lately, it doesn’t have to be night to see them. I just really want some idea of what’s happening to me- this is the only resource I have at the moment. Thank you in advance for your time.

You are very welcome. I’m not certain that I fully understand all of the symptoms you have described, especially the hallucinations. You stated that your vision is “constantly obscured by a layer of static like… things” which you described as being “incurable.” Are you saying that you were diagnosed with a vision problem? If so, it is possible that the experiences that you are referring to as hallucinations are associated with the vision problem.

You also described periods in which you lose consciousness. During those blackouts, you apparently engaged in disturbing behaviors of which you have no recollection.

There may be two potential issues. One is social anxiety that seems to be progressively becoming worse. The second may be a medical issue (i.e. problems with vision, blacking out, etc.).

The fact that you have been diagnosed with several mental health disorders means that you’ve been to see a mental health professional. Are you currently seeing a mental health professional? If not, it is important to be evaluated. If you are under the care of mental health professionals, inform them about the fact that your symptoms have become worse. An adjustment to your treatment plan may be necessary.

It is also important that you are evaluated by a physician, preferably an eye care professional if you have trouble with your vision. Problems with vision and losing consciousness might be signs of neurological problems. It may be best to consult your primary care physician, report all of your symptoms and ask for a referral to the appropriate medical specialist. Having a comprehensive medical evaluation is highly recommended at this time.

Please consider my advice. It is imperative that you receive the proper medical and psychological evaluations. In the meantime, if you feel as though you might harm yourself, tell your parents, go to the emergency room or call 911. Please take care.

Dr. Kristina Randle

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I Can’t Talk to People

by Dr. Marie Hartwell-Walker May 8th, 2022
written by Dr. Marie Hartwell-Walker

Hello! I know that there are a few questions in this topic, I browsed through them, but I didn’t seem to find one that applies well to me. I can’t talk to people properly except for a very few (my family and my best friend), I often fall silent and don’t speak for hours just sit and smile or communicate through facial expressions and touches and the likes.

I feel like my words have a personality, that they’re a community of little entities that would be hurt if I don’t use them correctly. I have a relationship with spoken words, however strange it seems even to me. It doesn’t apply to written word, I’ve been able to write, though in the past few weeks it seems to be harder than before. I’m quite scared that if I don’t do something I’ll stop talking altogether.

I’ve been trying to force myself in social situations and to force myself to talk, but I always end up just sitting in silence, either because I feel too dumb to say anything (and then I don’t use the words correctly, and they’d be hurt), or, in better cases, that I don’t have anything worthy to add, and I don’t want to use words just to fill the space. I feel like if I say something, it has to be important.

I don’t know what to do. I’ve had similar things happen to me all my life, I often have these episodes where something small becomes huge and I know it’s irrational, but this one is the worst of them all. I can’t talk to my friends at all, except for the one I live with. I’ve been called out on this in the last 5 months it’s been happening, and I feel guilty, too, because it hurts my friends, but I can’t tell them what’s going on. And I’m getting very worried that I won’t be able to shake it off.
Thank you for your help in advance!

Often, this kind of problem is actually the “solution” for another more hidden problem. If I were seeing you, I’d be looking for how losing your spoken voice helps you avoid or escape something that is painful to you. It might be helpful to trace when thinking your words were entities started. Something may have happened that makes it all make a kind of sense. We would then work on that.

I hope you will consider seeing a mental health counselor for some help with this. Your letter shows you to be a sensitive person who doesn’t want to hurt her friends and family. If you could have taken charge of the problem, you would have done so already. A few sessions with a skilled therapist may help you get to the root of the issue so you can have the kind of relationships you want and deserve.

I wish you well,
Dr. Marie

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If Someone Talks or Asks Me Something, I Don’t Know What to Say So I Just Lie

by Kristina Randle, Ph.D., LCSW April 24th, 2022
written by Kristina Randle, Ph.D., LCSW

Im just 13 years old and i felt this since im a kid. I dont know but when i’m in my grade school i lied to my schoolmates that i have a blood illness even if i dont have but im wishing that i dont said that and when i turn grade7 from a different school far from my family but im staying in my aunt’s house. Im just a transferee in that school and no one knows me. Then something on me want to have reputation so i lied to all my classmates teachers to anyone in my school. I said that my family is rich (even if not) I always said to my friends that i felt like no ones loving me so i rebel in my past years (ofcourse that wasnt true again) my family loves me that’s the true. And ofcourse i dont want my auntie know about all what im doing so i always lie to her everyday ive seen her face and ofcourse i dont let her come to my school. I alwys lied to them but something on me felt some guilt when i remebered my family it feels that i want to shout the truth but everyt
ime i go to school another story i invented and im feeling that im more intelligent than ordinary.
And now i never think that my fearest day will come when everyone find out what’s the true. But it come and im so scared and another lie i invented just to shade my prev lie . I cry just to make them believe and even tried to kill myself coz im really ashame but i feel that i should’nt said that at all.

And now my family forgiven me but ofcourse not my aunt.
Now i turn grade 8 But i really didnt enrolled bcoz i dont have the report card on mine coz my previous school hold that one thats why i cant go to any school but again i lied to my parents i said that im enrolled and the school just take me some pre test (even if not) ANd until now im pretending that im going on school even if not.

Im just hoping that you can help me Cause im so guilt but i dont want to say the truth . It feels like i want some world different from mine.

Generally speaking, people who lie about themselves do so to appear more interesting or likable to other people. They want people to think highly of them. They may not be happy with themselves and feel like they need to embellish the truth so that people will like them. They tend to lack self-confidence and are insecure.

You also mentioned wanting to be in a different world than your own. That would suggest that you are unhappy, which might also be contributing to why you lie. If you were happy and contented with your life, lying in the manner that you have described might never have crossed your mind.

Thankfully, these are common problems that can be effectively addressed with counseling.

Ask your parents to assist you in finding a mental health professional in your community. Counseling will help you to determine why you feel compelled to lie but most importantly how to stop. It’s not enough to understand why you do it. Knowing why doesn’t prevent you from doing it. Counseling can teach you how to have more appropriate social interactions and relationships with people so that you don’t feel the need to resort to lying. Treatment might also help your family understand your behavior and how to better support you.

Be honest with your parents and tell them that you want help. You can even tell them that you wrote to us at Psych Central and that counseling was recommended. It is the ideal solution to this problem. It would help both you and your family.

Please also remember that lying is very common, much more common than the average person wants to admit. You are not the only person who lies. Many of the people, that you have lied to, also told lies to other people, on the very same day that you lied to them. It appears that you never told a lie to hurt someone. You lied to make yourself appear more interesting or to get sympathy or to appear more important, etc. From what you have written, it seems that you have never lied for malicious purposes. White lies are very common, very understandable and very forgivable. Good luck, my young friend.

Dr. Kristina Randlle

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I’m Constantly Thinking People Have a Negative View of Me and Can’t Stop Thinking about Past Mistakes

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP April 22nd, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

So, I’ll try to make this as quick and short to the point as possible. about a year and a bit ago something switched in me and I completely socially isolated myself from friends etc I stopped going to school and I basically work and avoid social situations as much as possible although I know I shouldn’t. I’m constantly thinking about situations and things that happened in the past from a week ago to 5 years ago and they could be the simplest things for example, I look at a co-worker then this part of my brain thinks “they think you’re weird they think you’re a freak” or for example I ask a question and again I start to think “they think you’re stupid you’re useless” and it’s like this on a constant basis. on top of that I’ll think about “cringe”; situations that happened years ago and still beat myself up about it. I’m constantly worried about how people look at me and view me even though I know it’s not a big deal but it’s like someone else is thinking for me and I have no control, I constantly have intrusive thoughts about anything and everything but I know I’ll never hurt myself or anything like that it just feels like I’m not in control of my brain. if someone could give me some insight or advice that would be great I have a lot more to say but I’m trying to keep this around 400 words since that’s the limit. thx (From the USA)

What you are struggling with is likely to be a type of thinking trap called ‘mind reading’. You think you know what others are thinking about you and respond accordingly. The issue is that thinking traps are making decisions with either too little or too much information. The way through them is to learn more about what thinking traps are, and then how to catch and challenge them.

Thinking traps are repetitive negative beliefs that influence your assessment of the future. Repeating negative beliefs will limit you. Noticing the pattern to your thought process is where the change begins. If you become aware that there’s a pattern, you’re more likely to be able to change it for the better. Here are some common thinking traps:

All-or-nothing thinking (or black-and-white thinking) happens when only extremely good or bad options seem possible. The idea of a “gray” or “beige” isn’t happening—nothing in-between is considered. Things are either good or bad, a success or a failure, right or wrong. For example, cheating once on your diet does not mean you have failed completely. You had a small setback, and all you need to do to correct it is get back on your diet tomorrow.

Jumping to conclusions is when you make an assumption without enough information. For example, Amy assumed being divorced would forever leave her single. These types of assumptions need to be challenged with facts, such as the fact that most people find love again after a divorce. Thinking traps are clever, and they pull in our behavior to support the illusion.

Mind-reading is when you believe you know what others are thinking or assume others know what you’re thinking. This is the one I think you are struggling with. Here are some examples of mind-reading: Nobody loves me. People think I’m stupid. She doesn’t like me. Nobody cares.

Overgeneralizing happens when we make sweeping judgments about ourselves (or others) based on minimal experience: Nobody cares. Nobody loves me. I’m a failure. I’ll never win. I’m a loser. I’m not smart enough. They take one bad experience and turn it into something that distorts our view. Words like “always” and “never” are often used in this type of trap: I’ll never be able to manage my anxiety. I always make mistakes. Mind-reading can get added on top of overgeneralizing—sometimes thinking traps work together to hold us back.

Negative brain-filtering is the ultimate form of pessimism. Everything is filtered through a negative lens. Only the negatives are noticed. You give a terrific presentation, then you notice one person out of the group looks bored and think everyone hated it. This is an ultimate form of pessimism, because no matter what happens that’s good, you’re going to focus on what went wrong, what wasn’t working, or what was a disappointment. It’s common for thinking traps to work together. You might filter the negative view of how people responded to your presentation, and then overgeneralize: I’m not good at public speaking.

Personalizing or externalizing occurs when everything is either your fault or someone else’s: By personalizing you are taking too much responsibility for the situation, and by externalizing you make everything someone else’s fault and not yours. No matter what I do things won’t change. What’s wrong with me? They never get it right.

Overestimating or catastrophizing exaggerates the likelihood something bad will happen. We imagine the worst and/or believe we won’t be able to cope with the outcome. The truth is that the worst very rarely happens and if it does we usually find a way to cope. Catastrophizing zaps us of our life force and energy: I’ll freak out. No one will help me if I screw up. I’ll make a fool of myself and will be too embarrassed. These are typical ways we convince ourselves of how bad things are going to be.

Fortune-telling is the mantras of those who believe they can see the future and it isn’t bright: I’ll faint. I’ll go crazy. I’m not strong enough. I can’t win. I’ll never become what I want to be. I’m not strong enough. I can’t do it. The truth is, these thoughts do actually make success less possible, because they limit our effort and our belief in possibility.

“Should” statements. The famous psychologist Albert Elis called people who “should” on themselves “should-a-baters” and “must-er-baters.” Constantly telling yourself how you should or must behave is a surefire way to keep yourself feeling anxious, and disappointed in yourself and others. These are easy to identify because they have the terms right in them: I should never feel worried. I must control my feelings. I should never make mistakes.

There are many more of these. If you’d like to learn about fifteen of the most common ones check here.

Thinking traps can hijack out mind if left unchecked. It is beyond the scope of this blog to give you directions on how to do this, but one of the best self-help books I’ve read on the subject is called The Resilience Factor. It can help you learn how to challenge these thinking traps and not get so side-tracked by them.

Wishing you patience and peace,
Dr. Dan

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I Don’t Know How to Help My Brother

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

My brother’s always been a shy child, but he had a good relationship with family and friends. In his teenage years, he started to withdraw. I was the only one to whom he kept talking. He began to spend most of the day in his bedroom. He also began to use monosyllable words to reply to my parents, aunts, cousins… Never started a conversation unless you addressed him. Now, at 19 (almost 20), it has evolved to the point he doesn’t talk to anybody, not even to me, and not even with monosyllables. He doesn’t look anybody in the face either (he didn’t do that a few years ago). If I try to talk to him, he ignores me or makes a sound of annoyance and kicks me out of his bedroom. He is very childish too, in the sense that it is part of his routine to watch cartoons with his favorite stuffed toys (he refuses to throw toys away). He prefers their company to that of people. I don’t even know if he has friends. He certainly avoids his college peers. He has dinner alone and goes to sleep early (I bet it is only to avoid us too). He only goes out if he needs to get a book in the library or if he has to go to college. Otherwise, you’ll find him home.
Is he afraid to become an adult? Could that be the reason he behaves like a child despite being almost 20? Could he have social anxiety? Autism, even? Maybe Aspergers. Some symptoms coincide:
• Difficulty to socialize and make friends; isolation
• Rigid routines (he gets distressed if he can’t follow them)
• Fear of change (he doesn’t want to throw old/broken things away)
• Hygiene issues (he rarely showers and shaves and he never uses deodorant)
• Sensitivity to noises and light
• Repetitive motor mannerisms (which he didn’t have as a child)
If he had autism, though, he would have some speech difficulties, wouldn’t he? He actually uses sarcasm and understands it perfectly. Never shown any speech delay either. Besides, I think I read someone is born autistic, so he can’t become autistic at the age of 18. It’s been an evolution, that’s why I’m not sure what is going on. Is he just a very immature teenager or does he have a condition? (From Spain)

Your deep concern for your brother is admirable and your research about his condition is impressive. I can understand why you might think he has autism.

Since 2013 the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has classified Autistic disorder, Asperger’s, childhood disintegrative disorder, and Rett’s disorder all under the title of “autism spectrum disorder.” While it would not be possible to offer an official diagnosis, here is a brief online quiz that might help in identifying if your suspicions about your brother’s behavior are correct.

Typically, there are two major criteria in the classification of autism: Communication deficits and abnormal behaviors — so your concern is justified. His monosyllabic speech and repetitive mannerisms and lack of eye contact fit these categories. You can find greater details about autism diagnosis here. More information about Asperger’s is here, and Retts Syndrome here. There is also a wonderful memoir, Look Me In The Eye: My Life With Aspergers by John Elder Robison that is excellent.

But there may be a number of other possibilities causing his reaction and only qualified mental health or medical providers can make an accurate diagnosis. The fact that he is in college and cares about his grades is important. He may have all these reactions, but he must still be motivated academically. Having goals and needing to put the effort in toward them is always a powerful way to help someone — regardless of the diagnosis.

Also, the university will typically have a counseling center, which you could suggest for him to go to as a way of preparing for whatever will follow graduation.

If he is unwilling to go to the counseling center offer to go with him to get a physical check-up. A number of the other possibilities for his symptoms may be medical and a physician would be able to note this or make arrangements for follow-up evaluations.

I wish you well in looking for some solutions for your brother. He is lucky to have you as a sister.

Wishing you patience and peace,
Dr. Dan

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Family Thinks I Am Schizophrenic

by Kristina Randle, Ph.D., LCSW April 8th, 2022
written by Kristina Randle, Ph.D., LCSW

I have lived with depression/social anxiety and selective-mutism for the past 4-5 years. I recently had my sister express her concern for my mental health. She begged me to seek help.

I engage in cutting, overdosing, starvation. I have cut since the age of 14 and have never stopped, going so far as to cut my vein and be sent to hospital. I want death. In fact I dwell on suicidal thoughts 70% of the time and have tried many times to end my life.

I have people that I talk to, that only exist in my mind. To me they are very real. They are my friends. I have 6; Ana, Camilla, Everette, Dustin, Peachy and Court. Each emerged at times of great sadness, anger or happiness over a 5 year period. I can’t make them leave me alone. I don’t control them. They help me when I am sad. Camilla isn’t very nice though and would properly try to hurt me if I let her.

I miss parts of my day and never can remember what I did. I am forgetful and will forget a conversation minutes after having one.

I feel that I have another person with me. And that sometimes that person will take charge of my emotions. When this happens I am not myself. I feel trapped in a body that is not my own. I want to leave it, so I harm it. I take pictures of my wounds, and keep them for months after.

I am a recluse and rarely leave the house 1 day out of two months. I don’t have any desire to. I also live in my head all day. I don’t talk to my family. I imagine people around me and I talk to them in my head and work out my emotions that way.

My family is taking me to see the doctor Monday. I don’t feel I am sick, but I understand enough to know that they are scared, and I will do what it takes to make them feel happy. Please tell me if going to see professionals would be wise?

To answer your question directly: Yes, it would be wise to see a professional. You are experiencing serious symptoms and have been for many years. Professional help can assist you in decreasing your symptoms and improving your life.

Your family is worried that you have schizophrenia, but that may not be the case. Though I cannot provide a diagnosis over the Internet, your symptoms seem more characteristic of dissociative identity disorder (DID) than schizophrenia. The specific symptoms that I am referring to include: memory loss, your description of feeling trapped in a body that is foreign to you, your awareness of other personalities that are dissimilar to your own, and the fact that some of your behavior seems to be outside of your control.

Other concerns about your situation include your tendency to be isolative, your history of suicide attempts and the fact that you spend 70 percent of your time contemplating suicide. All the aforementioned concerns significantly increase your risk for suicide. Under no circumstances is suicide the correct choice. In addition your family, who obviously loves and cares about you, would be devastated if something were to happen to you. For those reasons, it is imperative that you do what your family is suggesting and meet a mental health professional.

For many people, the thought of getting help is frightening. That comes from not knowing what to expect. Fear is understandable; however, please know that you have nothing to be frightened of. Mental health professionals are trained to assist their clients in solving their problems. They sincerely want to help you. Their ultimate goal is to improve the quality of your life.

Listen to your family. They are doing the right thing. You are blessed to have such a caring and loving family. I hope that you will attend the appointment and get the help that you deserve. I wish you well. Please take care.

Dr. Kristina Randle

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My Psychologist and Psychiatrist Disagree

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

From the U.S.: Ok, I will so my best to make my situation clear. I have battled with panic disorder (with agoraphobia), and severe generalized anxiety disorder since I was 7 years old (I’m 19). I’ve had two severe major depressive episodes, one of which I am going through right now. I’ve tried a variety of treatments, and am currently NOT on any medication.

I have had some new symptoms lately. I have terrible thoughts of harming my loved ones (specifically my boyfriend and my mother). These thoughts are really vivid, and they are nearly constant. When I have them I fear that I am losing control or that I’m going to go crazy. These thoughts are completely opposite of who I am we a person; I can’t even harm a bug! I have no history of violent behavior. But sometimes I have “urges” to act on these thoughts which makes me panic even more. I don’t know if these are real urges (I don’t want to act on them!) or just adrenaline from my anxiety.

I also recently developed a fear of developing psychosis or schizophrenia. I started obsessing over the possibility of having psychotic symptoms, and spend a lot of my time researching these disorders on the internet. Since I have started doing this, I’ve begun to “hear” voices IN MY HEAD (not external). These “voices” (which aren’t in my own voice BUT I recognize them as my own thoughts) can be commanding, or can be just scary things like laughter. I’ve also started to “have delusions” (which I don think are true delusions because when I have them I panic and think, “why am I thinking like that”). I’ve also started “imagining” that I am seeing things, although I don’t think that I am truly hallucinating. Almost every “symptom” that I am experiencing is something that I’ve read online. I also suffer from racing thoughts, and my mind is NEVER quiet. I constantly have music running through my head as well. Could this be from stress and anxiety?

After discussing my new symptoms with both my psychologist and my psychiatrist, I got two different opinions. My psychologist believes that all of this falls on my anxiety, and might be a form of OCD. My psychiatrist (who I just met for the first time; as I was considering trying medications again), however, diagnosed me with major depressive disorder-severe, recurrent, with psychotic features. The fact that he diagnosed me with a form of psychosis makes me panic even more. Again, my therapist of four years is reluctant to label me “psychotic” as I have full insight to what I am experiencing. She thinks I am obsessing over the potential of losing control and harming others, and obsessing over developing psychosis or schizophrenia.

What is happening to me? Do you think I am psychotic or do you think that this is likely a result of my long-standing, unsuccessfully treated anxiety?

I’m so sorry you are suffering so much. I admire you for being so help-seeking. But in this case, by writing here you are asking the wrong psychologist. You have a therapist who has known you for four years. Please bring your concerns to her and sort them out together. It may be that the psychiatrist saw something she didn’t. Or it may be that there was something about the way you presented yourself in your first time encounter that led to a faulty conclusion. Please stop reading online. It’s only making you more anxious. Trust the therapist you already trust and take it from there.

I wish you well.
Dr. Marie

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I Can’t Figure Out What’s Wrong with Me

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP March 28th, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I honestly don’t know what my problem is. Some days I wake up and instantly hate everything and everyone around me. I go out of my way to block very solution people present me to whatever problem I focus on, and any form of happiness or consolation downright enrages me. If I see someone who is happy, I’ll want to make them unhappy. If I sense any positivity, I want to turn it into negativity. I seldom act on these feelings of anger, I just let them sit until eventually they go away. Though it should be noted that every now and again I lash out at my loved ones in the form of intense arguments and verbal fights.

I have struggled with social anxiety and depression since I was 13, and am now 21. My anxiety has improved somewhat, but not to the point that I would like. I still have incredible difficulties in many social situations, and thinking about those difficulties just makes me angrier. I’ll begin to feel like my friends are just pretending to like me, that my successes in life must be meaningless because someone like ME did it, and that things will stay this way forever, and that’s where the depression comes in.

I’ve been in and out of therapy for as long as I can remember. I have tried just about every antidepressant in the book, (SSRI’s, Buspar, some Beta-Blockers, and benzo’s for my anxiety), and none have given me the kind of results I seek or read that others have had, so I assume my problems aren’t biochemical.

I understand I just need to find the right therapist, and have been looking, but I cannot for the life of me get a read on what it is I’m dealing with here, and to me that is a necessary first step. Outside of my occasional outbursts I have a very close relationship with my family, and no trauma as a child. I just want to understand where these feelings are coming from so I can address them. I want to feel like a human being, not like I’m just some machine that runs the same pre-programmed routine day by day until the batteries die.

Thanks for writing in. I’d highly recommend group therapy. The difficulties you are experiencing need to managed in real time — as they are happening. When you go into a group all of these symptoms will happen in the group. This will give you a direct chance to deal with them. The find help tab at the top of the page will help you find someone in your area. You can also use this locator service to find qualified group therapists.

Group therapy brings all of the features of the symptoms into play — and then give the facilitator a chance to help ameliorate them through interaction with other members.

Wishing you patience and peace,
Dr. Dan

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What Do I Do about Social Anxiety?

by Dr. Marie Hartwell-Walker March 17th, 2022
written by Dr. Marie Hartwell-Walker

From a young man in Pakistan: I have so much social anxiety, I can’t speak in-front of anyone not even family members. Whenever I try to speak nothing comes in to  my mind, my mind just gets blank and I don’t know what to speak.Secondly I just overthink everything, every little thing. So much negative thoughts comes into my mind and I can’t deal with it. I imagine fake scenarios and cry over them. I don’t know what to do about this

It’s okay to need help for this. Having social anxiety is not something to be ashamed of. You didn’t ask for this burden. Chances are you are a particularly sensitive person who embarrasses easily. Over time, your sensitivity to others’ judgment grew to where it is now.

You are not alone in your feelings. Anxiety disorders are the most common mental health orders. Social Anxiety (also called social phobia) is the term that is used for when a person gets extremely nervous whenever they are with other people. It comes from a fear that others will judge what they do and say.

According to the World Health Organization, one in 13 people globally have Social Anxiety. It is currently the third largest mental health problem in the world.

Everyone experiences some social anxiety every now and then. It is normal to be nervous when asked to do a presentation in a class or at work. It is usual to be anxious if you have to interact with someone in authority. It is normal to be upset when you feel unfairly judged by someone else. But these normal instances pass fairly quickly and don’t generally limit a person’t life.

Social Anxiety, however, is limiting. It often causes a person to continually narrow their lives so they don’t have to interact with other people. Although people with Social Anxiety certainly want to have friends and to participate in activities with others, their fear of judgment gets in the way. As it progresses, the person gets nervous about being nervous, which makes the feelings even worse. People with severe Social Anxiety often don’t want to even venture out of their own house or will do so only when accompanied by someone they know and trust.

The good news is that Social Anxiety is treatable. According to the Social Anxiety Association, “Appropriate active, structured, cognitive-behavioral therapy (CBT) is the only solution to this problem”. Although anti-anxiety medication can provide some relief, it does not provide long-term results unless it is combined with CBT  Studies supported by the U.S. National Institutes of Mental Health show that a combination of individual CBT therapy and a  behavioral therapy group is highly successful.

Therefore, the best way for you to recover from your Social Anxiety is to take advantage of what studies show is most helpful.  Find a CBT therapist who specializes in anxiety disorders.

The paradox for some people is that the thought of seeing a therapist is so anxiety provoking that they avoid it — even though they know it is the best way to solve their problem. Some anti-anxiety medication from your doctor might help you get over that obstacle. Also, consider taking a trusted person with you to a few therapy sessions until you are comfortable with the therapist.

If there are no CBT therapists in your area, start your journey to better mental health by working through a workbook on Social Anxiety. There are several good workbooks available from online booksellers. When you are feeling ready, do consider using an online therapist who is trained in CBT.

You made a first step toward health by writing to us here at LifeHelper. Please take care of yourself by making the next step. Begin the work you need to do to be comfortable with family and friends and to have the social life you deserve to have.

I wish you well.
Dr. Marie

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I Can’t Trust My Therapist Enough or Be Willing to Share Thoughts with Him

by Kristina Randle, Ph.D., LCSW March 5th, 2022
written by Kristina Randle, Ph.D., LCSW

I’m a freshman in high school, just starting therapy bc of social anxiety and mild depression. We’ve had 3 sessions so far. My therapist is a man and I’m a girl, and having anxiety doesn’t make it great when talking with the opposite gender. Ive also avoided telling my therapist about things or lied about it bc I feel uncomfortable sharing my thoughts with someone else. The first time, I admitted about having suicidal thoughts to my therapist, which I’ve never told anyone else before, and I cried a lot afterwards.
Having social anxiety makes me genuinely afraid of sharing things with someone else, even though my therapist has told me that he won’t judge me or tell anyone else about it. I’m very used to having thoughts all to myself. My therapist is a very good man, he can talk to me easily even though we’re far from the same age group and encourages me on my hobbies. But sometimes I would pop up thoughts like, “he’s just doing this to be nice,” “it’s just part of his job,” etc. I don’t know why these thoughts come up and they bother me a lot. I’m very scared of someone not caring enough about me.
I just really don’t like sharing my thoughts with someone else, to me it’s very difficult to form it into words and actually tell someone else or write it down.
Do I address this with my therapist? If I do, I don’t know how should I start it. I’m still uncomfortable around my therapist since we’ve only just started.

I think that you identified the main problem when you wrote the following: “I’m still uncomfortable around my therapist since we’ve only just started.” That makes perfect sense. You don’t know him very well yet. It is uncomfortable to discuss your most intimate thoughts with a relative stranger. Relationships, therapeutic relationships included, take time to build. The more you and he work together, the more you will learn trust him and his advice.

In addition to having only just met him, three sessions ago, you have social anxiety. The nature of social anxiety is being uncomfortable around other people, especially people who you don’t know very well. The social anxiety might make therapy more difficult for you, compared to someone without the added social anxiety.

You may not see it this way but the fact that you have shared your suicidal thoughts with him is major progress. That had to be difficult for you but you did it. That’s a step in the right direction.

Yes, you should address this problem with your therapist. Your feelings are perfectly natural and he’ll know how to help. One key to success in therapy, is honesty. Being honest will make it easier for him to understand what’s wrong and advise you accordingly.

The next time you have a therapy session, simply say you have something you would like to discuss and proceed to tell him what you wrote in this letter. You might even show him the letter you wrote to us. It articulately and succinctly outlines your concerns and it would give him a deeper understanding about what you are thinking. You are off to great start. Keep up the good work. Please take care.

Dr. Kristina Randle

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Social Anxiety Disorder?

by Kristina Randle, Ph.D., LCSW February 24th, 2022
written by Kristina Randle, Ph.D., LCSW

I show a lot of signs of different disorders, but I’m not sure if I actually have one or which one or ones I do have. Within the past few months, I’ve gradually found it much harder to leave my house. It is affecting me to the point where I have to take days off of school because I get physically ill (nauseous) from being around so many people for such a long time. I tend to stay in my room more than anywhere else. I am extremely cautious about talking to other people and it is a very hard thing for me to do. I don’t pick up the telephone no matter what, and I will not call people either. I don’t keep many close friends, and the ones I do have I only see at school or talk to online. I’m terribly afraid of public speaking, working in groups, or being around people in general, and a lot of that is because I’m afraid of what they will think of me. I get very anxious about doing things like going to school, and I have suffered a few minor panic attacks from that. I have extremely low self esteem, maybe even close to self-loathing, and this also prevents me from talking to people I believe. My moods also change very quickly, and are pretty extreme as well.

It is always difficult to offer a reliable diagnosis over the Internet. Please keep this in mind. Based on the information you have provided you may have agoraphobia or social phobia. Both are anxiety disorders. Agoraphobia is a fear of being in places where you may not be able to escape. It usually involves a fear of crowds or being with other people in general. Some individuals with severe agoraphobia can no longer leave their homes due to extreme fear. The fear can be crippling. They essentially become prisoners in their own home. You can read more about the characteristics of agoraphobia here.

Characteristics of social phobia include having an irrational fear of interacting with people. It also involves a fear of putting yourself in situations which may involve scrutiny or judgments by others. Individuals with social phobia tend to avoid social events because of their intense fear of being judged. You can read more about social phobia by clicking here.

Your situation is very concerning. Your anxiety is preventing you from attending school. If you cannot attend school then you risk failing. Social anxiety disorders tend to become progressively worse over time. It is important that you seek help for this issue. Anxiety disorders are very treatable. Many individuals with anxiety disorders are able to overcome them.

According to HelpGuide’s website, “When it comes to treating anxiety disorders, research shows that therapy is usually the most effective option. That’s because anxiety therapy—unlike anxiety medication—treats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them.”

The first step in getting help for social anxiety disorders is often the most difficult because it usually requires physically leaving your home to attend psychotherapy appointments. The prospect of that may be very frightening but it is a necessary step to cure this problem.

My advice is this: speak to your parents. Inform them that you possibly have an anxiety disorder. Tell them that you need help and you need it now. As indicated above, anxiety disorders are very treatable but it requires you asking for help. I hope that you are able to get the help you need. Please consider writing back to let me know how you’re doing. I wish you well.

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I Don’t Like People and Want to Be Left Completely Alone

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP February 17th, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I want to be alone. Talking to even one person leaves me emotionally drained and I feel like I need to go to bed. Social interactions like visiting someone’s house or going out with a family member feel pointless. I don’t need to talk to people, nor do I have anything to talk about. So why bother in the first place? Sometimes I’ll ask myself: “Would I be happy if everyone in the world disappeared?”, and lately the answer has been “Yes”.

I’ve never been crazy about being around people for as long as I can remember because growing up, people always fucked me over. Be it others my own age or adults, including my parents who would hide in their room all day smoking pot. I hated it when my grandmother dragged me to some kind of family event and I’d end up sitting by myself because no one else my age was there.

These days no one in my family even wants me to talk anymore. No matter what I say, I’m wrong. I can’t express any of my feelings because I’m labeled as a drama queen for even bringing anything up or I’m told I’m wrong just for feeling a certain way about something. (Example: I hate my aunt because she kicked my cat against the wall and killed it about 3 years ago when she visited. I’m told I’m “wrong for hating her”. I don’t get a reason as to why I’m wrong, I just am)

If anyone even talks to me, they’re talking DOWN to me like I’m an idiot or something. Yet for some reason they wonder why I don’t talk to them anymore.

It’s much more comfortable to be alone in my room, because other people annoy me too much. I don’t like people, and it seems like they don’t like me.  (From the USA)

 What strikes me most about your email is that there is no question, concern, or desire to change. You are simply stating that you do not like want need or care about social contact or connection. So why write the letter?  Why reach out and declare you need to stay isolated?  What were you hoping for? What would have been a good response?

I ask these questions because you wrote the email for a reason. Finding out what your purpose was in writing it might be a good place to begin. Remaining isolated is a choice and a freedom you have as an individual. If you don’t want to connect there is no law that says you should. But just because it is a right doesn’t make it physically or emotionally healthy. It is clear there are many people you don’t like and don’t want to be with. But if the real question in the email is if there is something you can do about it — the answer is yes. But if I am wrong and you just want us to know that you don’t like people and want to be left completely alone, then your intent has been fulfilled.

If you do want to change let us know and use the same PC username. Let us know what you want and one of us will write back with some ideas to consider.

Wishing you patience and peace,
Dr. Dan

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How Do I Cope with Bullying?

by Dr. Marie Hartwell-Walker February 13th, 2022
written by Dr. Marie Hartwell-Walker

From the U.S.: I’m a sophomore in high school, and I feel low on confidence. Mainly because in my odd day 4th period class there is always this kid who makes fun of me, and he always tries to point out my flaws. I tried saying something to the teacher, because he was talking to me about it but he just made the situation even worse. It’s hard ignoring him when he is saying you look like a man,you have a huge forehead, you’re ugly,etc. The thing is nobody else I’ve met point any of that out.

I went to the principle and he said something to him, but he is still doing the same thing. It’s worse that I have to sit next to him since we have assigned seats in class. He always gets in trouble, suspended, always being rude to everyone else, but yet everyone else in the class just laughs at him despite them also having the same thoughts about this boy in class.

I’ve had a history of getting bullied, and I also had some disappointing friendships. I’m a painfully shy girl, and I find it hard opening up to people because I am afraid of being judge,they’re staring at my flaws that I have, or I have nothing interesting to say.

My family have yet to know anything about this.I mostly have a bad habit on staying on the internet most of the time because I feel like it’s my only escape. Tired of being this quiet girl that everyone knows of that speaks so quietly, it’s starting to grow into anger because I never say anything I just cast it aside and try to ignore it. Tired of bottling things up, and I don’t want to end things in violence, I know I don’t have the right to put my hands on him. Sometimes I feel like I am too nice to people when they don’t need my respect. It’s so hard because I am tired of being silent, and people saying whatever to me. I don’t know what I should do at this point…

I’m so, so sorry that you are having to deal with this on a daily basis. You should absolutely not have to sit next to this guy and put up with his comments. No one, no matter how shy, should be subjected to such constant abuse.

I’m glad you tried to reach out to the teacher and principal. I’m astounded that they didn’t change your class or at least your seat. I’m even more astounded that this kid is allowed to continue making life hard for others.

What you do now is get off the Internet and talk to your parents. Withdrawing into the “net” isn’t going to stop the bullying. Withdrawing from other people by staying in your room isn’t going to help you get over being shy. Tell your parents what you’ve told me and ask them to intervene. You’ve done all that can be expected of a teen. Now it’s their turn to do what parents are supposed to do — protect you. They can insist that something be done.

If shyness continues to be an issue, please consider getting some counseling to help you learn new skills for expressing yourself and being more social. If you could do it on your own, you would have done it already. There is no shame in getting some help when you are in emotional pain.

I wish you well.
Dr. Marie

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Mother Daughter Relationship

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP January 9th, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Growing up, I lived a quite sheltered life because I wasn’t allowed to go out and have friends. This has really affected me even later in life as I have always felt a bit behind socially. I’m naturally shy and a bit of a loner. I don’t make friends easily even though I would like to.
My relationship with my mother is very difficult as she was very controlling and manipulative. When I was young, I wasn’t very rebellious and I stayed home most of the time even though I was dying to go out. My mother knew this, which was easier for her to control me. She told everyone that I prefer staying home and I’m not so much and outdoorsy type. She didn’t have many friends herself back then and was focused mainly on my older sisters and some family members.

I moved out after high school and went abroad and tried to move on from all of this and build a new life for myself. This worked for a while until some circumstances happened that forced me to move back to my hometown and live with my parents.

My mother has changed her life a bit since. She now has a lot of friends with whom she hangs out with almost every day. In my hometown I don’t have any friends at all and the reason for this is that I wasn’t allowed to make any while in high school. I sit at home and I’m very lonely and it hurts that I’m reminded by my past almost every day.

What hurts even more, is that my mother has a busy social life now, which she deprived me from when I was growing up. I should be happy for her but I’m mostly sad because I don’t feel this is fair.

She doesn’t care about the fact that I’ve moved back and she’s out most of the time. I understand that I’ve grown up but it hurts to see that she has improved her life while she ruined mine. She is obviously much stronger mentally and she often tells me that I shouldn’t mind her business. This is just too hurtful for me. I’m constantly reminded by the things that happened to me in my teens and tend to link everything to it. How can I move on from this? (From the UK)

Thanks for writing to us. You need an escape plan. You state your age as 26, so it is time to formulate a plan to develop away from the shadows of your mother. You need a life of your own outside of your mother’s influence. When you moved abroad it worked for awhile — so the next move needs to be planned with an emphasis on what pulled you back. To have this next move be successful I recommend some individual therapy to figure out how to make a move toward your independence, emotionally and socially.

Wishing you patience and peace,
Dr. Dan

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I Can’t Talk to Therapists about My Sex Life

by Dr. Marie Hartwell-Walker December 24th, 2021
written by Dr. Marie Hartwell-Walker

From a teen in Romania: By the time they are 18, most people have already had their first kiss and quite a lot of them have already had sex. I haven’t even come close to kissing anybody and I am terribly embarrassed by that. I can talk about it with really close friends probably because they also have a lot of different problems at this age and I feel like I am equal to them in a way because of that, even though their problems are different from mine.

When it come to talking about that to a therapist, I just feel that they will judge me, maybe pity me. I feel inferior and that shame that I already feel regarding this intensifies. I’m almost sure that I will cry if i ever confess this to a therapist and that I hate as well. I dislike how much my lack of experience in this domain bothers me but I can’t stop the way I feel, not when I know my situation is simply abnormal and when I know how much I really do want to be in a relationship but can’t. I don’t mind talking about sex in general. In fact, I like it. Teenagers who have had sex tell me that I know more about it than they do, which shocks me.

My friends can never help me with this. I don’t find their advice helpful and in the end, even if they are supportive, after having talked to them, I think I’m even more right to believe I might just die a virgin. I’m introverted, I hate parties, dancing, I find flirting ridiculous and I never initiate a conversation with a stranger, whether I’m attracted to him or not (I don’t have the arrogance to assume they’d like me since that doesn’t happen much). I also rarely like anyone myself. I’ve only really wanted to be with maybe three people in my life, if not two and the feeling was never mutual.

I do believe therapy may be my only chance but it is so incredibly hard to talk about this. Even the thought of it makes me uncomfortable. I don’t know how to make it easier for me. I don’t think I can see a therapist as an actual friend, especially because of the age difference. What should I do?

I don’t know where you get the idea that most people your age have had sex. A recent study of Romanian teens showed that only about 20% have had their first experience with sex before age 20. Teens aren’t always honest about their own experience. They often want to seem more experienced, more sophisticated and more knowledgeable than they are in order to “fit in.” Wouldn’t it be ironic if all the people you know are just trying to impress each other and none have actually done any of the things they talk about to fit in with other people who were also telling tales?

Of more concern to me than your sexual inexperience is your discomfort around other people. With a therapist’s guidance and support, you can learn the social skills you need and to feel more confident socially.

As for your worries about therapists: Therapists aren’t interested in judging. They are interested in helping. I doubt very much that a therapist will make you feel ashamed. (If one does, leave immediately and find someone else.)

As for a way to start: Just bring your letter and this response with you and ask the therapist to read it as a way to start your first session.

I wish you well.
Dr. Marie

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I Have Visions & Daydreams of Killing People

by Kristina Randle, Ph.D., LCSW December 12th, 2021
written by Kristina Randle, Ph.D., LCSW

I have no idea if this is normal or not, but I didn’t want to talk to anyone about it in real life if it wasn’t normal, because then they’d probably just think that I was crazy or something (maybe I am, I don’t know). I have a tendency to want to kill people and I feel addicted to the sight of blood. I get these visions where I cut peoples throats, rip their heads off, strangle them, etc. and if I feel like I’m losing control I often have to find a spot as soon as possible where I can be alone and then I’ll watch people die on the internet and I always go for the most brutal torture blood red ones I can find, but I’m running out of good videos to be honest.

Back to the visions: I get them whenever I’m annoyed at someone or if I get anxious (note: I have always hated people and I never saw at them as other than “useless things”). The person I get most annoyed/angry at is my mom and first of all, I don’t feel any sympathy or empathy towards anyone, second is that I get these visions and third is that lately I don’t feel like I have any control at all of my movements so there’s something in me that knows that I might one day actually kill her. It’s not because I don’t want to because the desire is very strong and I think the only thing stopping me is the thought of going to jail or a mental hospital.

I’m getting tested for Social Anxiety Disorder and Attention Deficit Disorder this year and I see myself as a masochist and a sadist, if that helps.

Other than that I would really like a response to this and if there’s any mental disorder that fits then I would really like to hear about it. I really feel like I need some sort of diagnosis and explanation for all of this because I’m kinda falling into pieces here.

It’s encouraging that you’re seeking help. Your awareness and openness to treatment significantly increases the likelihood of a positive outcome. You are doing the right thing by choosing treatment.

Your concerns are warranted. It’s worrisome that you feel out of control. Murder fantasies might function as mental preparation for future behavior. In other words, they might be a form of premeditation. They need to be addressed and extinguished. These issues can be effectively addressed in counseling.

You mentioned not wanting to reveal your fantasies because of your fear of judgment. Counselors will not judge you. They understand this type of thinking. They will gather information about the problem, determine a diagnosis, if one is appropriate, and design a treatment plan. They want to help you.

I have read the biographies of many people who have committed murder. It is common for them to have fantasies of murder, to view violent media and to feel out of control. It is my sincere belief that had they sought mental health treatment many of them would have never killed. With treatment you can gain control of your behavior. Without treatment, you might act on your fantasies. If so, you would likely be sent to prison for life or executed for your crimes. If you want to avoid those outcomes, then you must seek help as soon as possible. Treatment could save your life. Please take care.

Dr. Kristina Randle

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