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Lost and clueless

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

I have trouble focusing on anything I do. I’ve ALWAYS been like this. Ive also ALWAYS had social issues. I remember when I was very young and would see someone from school at the grocery store or whatever, they would say hello, and I would look at my feet and get embarassed. My mom would tell me I was rude, but I didnt know how to change. I HATE talking to people now. I have tried to learn body language, listening, and observational skills, with minimal success. I KNOW I am being misinterpreted. I KNOW that when I think people are talking about my social inadequacies, they ARE. The worst part about it is I KNOW that I am a social retard. I am completely aware of it, yet nothing seems to change. I have tried to find a root, as if there is some singular problem that can be fixed that will solve my social problems, but there isnt. I have tried to diagnose myself as having autism, asperger’s syndrome, depression, social anxiety, ADD, and others, but NONE of them really fit. Aspergers is the closest, but I have no OCD or anything similar.
I also have a speech problem. This, along with my social retardation, has encouraged people to think that I’m homosexual. I know that I’m not, but I still try to convince people that I’m not, even thought I know that this is probably affirming their convictions.

I know I shouldnt care what people think, but I dont understand how to be social if I dont at least consider it.

My girlfriend continues to ask me when we’re going to get married. I love her, but I dont know why. And I dont trust her. I cant prove that she cheats, but I know she does. I can see it in her eyes and hear it when she speaks. I also see it when we are in social situations. She will never admit it, and I cant talk about my feelings anymore or she will leave. Should I cheat too, and just be cool? I dont want to feel like this all the time AND be married. All I want out of life is to feel like a man, be a man, and have a woman that is as faithfull as I am. I dont have any of these. I dont even have anyone to talk to about anything, and I solve anything on my own.

These are just tips of icebergs, and may possibly be side effects of other problems that I am unaware of. Im not sure what kind of advice you can lend me, if at all, but Im pissed off that I have to deal with this stuff. At times, I would rather be oblivious to all of this, than be aware that Im retarded.

Thank you for writing. I have a guess that it wasn’t easy to lay out all of your troubles so starkly. It must be very, very painful to live with so many doubts about yourself and the woman you love. I don’t blame you for being angry and sad. I give you lots of credit for not getting married until you settle at least some of these issues. No, you shouldn’t cheat to keep things even. That would set a divorce in motion before you were even married. You should get some help that will get to the root of the problem.

You describe symptoms that are consistent with a number of different diagnoses. Without talking to you, I can’t narrow it down. What I can do is suggest to you that you make an appointment with a psychologist for a thorough evaluation. You’re a complicated guy. You want to find a psychologist who has the skills to do some psychological testing if she or he deems it necessary to go beyond the usual interview in order to understand you. Ask you doctor for a referral or contact your local community mental health center.

I think you will find that naming your problems will give you some relief. Once you know what you are dealing with, you and the therapist will be able to develop a plan of action that will help settle your anxiety and build your skills for dealing with the social world.

I wish you well.
Dr. Marie

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Anxiety and My Therapist

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

Three years ago I wanted to see a therapist because I was having trouble for anxiety. I was very nervous about talking to him so I emailed him first, telling him I was nervous in social situations and asking him if therapy was a good idea and if there was anything he could recommend. He recommended the Anxiety and Phobia workbook by Edmund Bourne. I felt panicked when I thought about talking to him over the phone and I worried that he would be disgusted with me unless I read through the entire book. So I got the book and it really struck a chord – I was never able to talk to anyone about my problems because I was too nervous about doing so, and for the first time in my life, I felt like I was genuinely understood by someone. I had not spoken to the therapist yet but felt profoundly comforted and touched by the compassionate nature of the book. I read through the entire thing and spent a month doing the exercises. It was such a relief to feel as though I was allowed to have compassion for myself and that I would get attention for my feelings, and finally, after a month, I worked up the courage to call the therapist. I booked an appointment with him, and when I came to see him I mentioned that I had read the book. The first think out of his mouth was, “okay, you don’t need that book.” He told me that I “seem to do okay” when I was talking to him. I felt devastated – I think he thought my problems were not serious enough to warrant that kind of help – and I also felt guilty and stupid for having used the book in the first place. I put it away and couldn’t look at it any more. I tried to tell him that I was experiencing really intense anxiety, hoping that he would suggest even a few exercises out of the book, but he only suggested that I do the things that frightened me, without any compassion for my anxiety. I told him I was nervous in sessions, but instead of suggesting something calming, he said “everyone feels nervous in sessions.” Now I still have problems with anxiety sometimes but I have become mostly numb; it hurts so much to think that I do not deserve compassion or attention for my feelings. I cut myself now when I am upset because it is the only thing that comforts me, and I am infuriated at the therapist for not responding to my problems and taking my money. I want someone to tell me that I was justified in using the book to help me, but I don’t know if that’s true or not. Am I justified in using the book to help me with anxiety? Is it ok to feel like I need breathing exercises to help calm me down, or someone there to hold my hand? It is killing me that I feel so upset and at the same time like I will not ever get any attention for it.

I get the impression that you are a highly sensitive individual. By this I mean that what other people say or think about you is important. Because of this trait, it is important to recognize that you may be overreacting. You don’t need the permission of a therapist or anyone else to validate what you should and should not do. If the anxiety workbook helped you then you should use it for as long as you feel necessary. You are a free individual. You are free to do anything you want, including using exercises from a book that has proven to be helpful to you. No permission is necessary.

I understand that you were upset at your therapist. Your perception of the situation was that he was being insensitive to you and your needs. Perhaps that was the case but as I mentioned above, your reaction might have been inappropriate. Your therapist may have been attempting to make you feel better. He may have been trying to compliment you and to help you gain confidence when he said that you “seem to do okay.” He may also have been attempting to ease your nervousness and to normalize your feelings when he said that “everyone gets nervous in sessions.”

You were angry at your therapist because he told you to stop using the book but you did not inform him that it helped you. Had he known that it benefited you then he may have had a different opinion.

The truth is that his opinion of the book really should not matter. As I’ve indicated, if you like it then you should use it.

Each individual is unique. The most popular treatment for anxiety will not work for everyone. What’s most important about therapy is to find a treatment that works for the individual client.

I would suggest returning to treatment. Try not to be angry at your therapist and discuss with him your opinion of the book. It’s important that you be fully honest with him about how you’re feeling. Communication is very important during therapy. Perhaps once he knows how you feel then he could incorporate the book into your treatment. If he’s not willing to do this then you may want to consider another therapist.

The goal is to find a therapist who you feel comfortable with, who you like and who you feel respects you. If you choose to search for a new therapist it might be helpful if you mentioned the anxiety workbook to each therapist you contact and ask if he or she would be willing to include it as part of your treatment. I would advise against only using the workbook and forgoing therapy. I believe it is important that you continue therapy, primarily because of your cutting behavior.

In case you choose not to stay with your current therapist, here’s a link to Psychology Today. This service may help you locate a new therapist in your community. Thank you for your question.

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Do I Have Mental Illness Too?

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

I have a few family members with mental illnesses such as narcissistic personality disorder, bipolar, alcoholism, and arrested development and siblings with autism. I am not sure if I have a mental illness since I am only a teen and life is just starting out for me but I do have a lot of anxiety and I have been very depressed lately. I also have noticed that when I stopped seeing my school counselor on a weekly basis I started isolating myself from social situations and that’s when my anxiety and depression came along. It’s been 3 years since I talked with a counselor or a teacher and now when I am in need of talking with someone about my problems I find it very hard to do so without reading into their facial expressions and getting really nervous about what they think of me. When I use to stay home alone after school I use to get really paranoid and scared about every thing even when I tried to talk to myself telling myself everything’s alright. I couldn’t calm myself down and I would hide up in my room the whole time. When my mom would come home after work she would ask me why I didn’t clean or do anything productive in the time I was home. I would just tell her I was tired and I took a nap or I would tell her that I did do a few things but it was obvious that I was lying. I grew up with my parents thinking I was lazy and had no motivation of doing anything but that wasn’t the case they just didn’t know that I was just hiding the way I was feeling from them because I knew they wouldn’t understand. I have lost almost all of my friends because of my low self esteem since I am a bit on the heavy side and the constant weirdness that I have like not being able to trust people, not sure of other peoples intentions, anti social, low self esteem, a bit on the compulsive side, some OCD problems and more. I really want to be a psychologist because I like working with people and I do a lot of research on mental disorders but since now that I think I might have a problem myself I am not sure if I get diagnosed with a mental disorder they will let me go into that field. I believe I could really help people but than again if I have a mental issue how could I be a help to others. I think that if I go see a psychologist and I talk to someone about my problems then I will slowly be able to be myself again because I really feel like I am not myself and that I am trapped by what ever is going on with me. I am afraid to tell my parents about this and I feel like I have to wait to move out of my parents house before I can go get some help so I don’t have to drag them along with this. I hope you can tell me what’s going on with me and if it’s a good idea to wait to go get some help or if I should get help now. I also hope you can tell me whether or not something is wrong with me or not. Thank you for taking the time to read this.

Thank you for writing to us with your thoughts and concerns. The best therapists tend to be those who have had therapy for themselves and know what it is like to be on the receiving end of a therapeutic relationship. In everything your have said the tipping point for me was that things got worse for you when you stopped talking to your counselor. Since you are still in high school, go to your counselor and begin talking again. This will help to sort though your current concerns and begin the process of planning for your future. Take care of yourself now and this will serve you well in the future.

Wishing you patience and peace,
Dr. Dan

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Can’t Figure Out What’s Wrong with Me

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

I’m 19, I don’t know what’s wrong with me. I almost always avoid social situations, or any situation where I feel like I won’t have a way to leave if I start feeling overwhelmed. I don’t feel comfortable being around more than one person at a time, whether it is close family or a friend since childhood. I have carried my backpack almost everywhere with me for about 6 months. I keep my laptop, chargers, random stuff that I wouldn’t want to lose. I have worn the same beanie since I was about 16. I can’t leave home without it on. It makes me feel more hidden from everyone. I can’t bring myself to see a psychiatrist.. I want to know what might be wrong with me. I have been searching what seems like forever for an answer, how to be myself again. I care about everyone a lot, I’m not able to show it/tell them though. I can’t talk to anyone about what’s troubling me. Last time I tried talking to a close friend, we were never as close again. I haven’t heard from her in months. Im constantly thinking about the past. After I hang out with a friend, I’m thinking of all the things I could have done wrong, or said that sounded odd. I hear voices of friends occasionally. Sometimes I think I hear them quoting everything I am doing in a sarcastic voice. I don’t talk to them. Most of the time I can tell if I am mistaking a sound for someone talking. No matter where I am, even in my own room, I feel like people are watching me or have set up a camera to record what I’m doing. I haven’t taken a picture of myself in years because I’m afraid that someone is getting copies of everything I do (pictures, internet browsing, text messages, etc). Usually when I go somewhere new, I look around for video cameras set up or people watching what I am doing. I am almost always listing off all of the possible negative things people could be thinking/saying about me. Whenever someone laughs, I automatically think that they are laughing at my awkward walk. I’m currently prescribed Amphetamine Salts (Adderall IR) 30mg 3x daily. I have been taking anywhere from 2-5 a day though. I can barely get out of bed in the morning until I take one. I think I am just putting everything into my head, and convincing myself that something is wrong with me. Even if I am, it is definitely taking it’s toll on my life. Im pretty sure, if anything, I have something similar to Social Anxiety.. I was abused from newborn, up until 16. Then my mom divorced my dad because he wouldn’t stop the mental/physical abuse. The fact that it was my fault has stuck with me to this day. I also went through one of the worst tornadoes in history May 22nd, 2011. Since then, I’ve lived in a FEMA trailer park. I’ve started smoking up to a pack a day. I’ve never done anything like this before, so I’m sorry if it was too long, too much personal information, or anything like that. It’s 4 in the morning, work in 5 hours. Any advice would help so much.

Without interviewing you in person, it is difficult to know precisely what may be wrong. There are two main possibilities. The first is that you have social anxiety. The second possibility is that you have schizotypal personality disorder. Individuals with schizotypal personality disorder characteristically have a great deal of social anxiety, tend to be loners, misinterpret situations, experience paranoia and have paranormal or peculiar beliefs.

A complicating factor in your situation is that you have been displaced from your home. Not being able to live in your home may be contributing to your anxiety problems.

You also mentioned that you have a history of abuse. That further complicates the situation and it may also be contributing to your current psychological symptoms. You blamed yourself but it is important to know that you are not to blame. The adults are to blame; you were an innocent victim.

In your letter, you stated that you have been prescribed medication. That means that you have likely been evaluated by either a mental health or medical professional. I would encourage you to speak to that person about the symptoms you have described in your letter.

The fact that you’re taking a medication that is not working is also important information that the prescribing physician needs to know. Ideally, you should be evaluated by a mental health professional and referred to a psychiatrist for psychiatric medication, if necessary. My main suggestion is that you need to contact the proper mental health professionals so they can properly assist you with your psychological problems. Please take care.

Dr. Kristina Randle

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Isolated, Low Self-esteem, And Want To Come Out To Family

by Julie Hanks, MSW, LCSW
written by Julie Hanks, MSW, LCSW

I’ve felt empty and isolated for a long time. I feel as though I haven’t been truly happy in many years and will be stuck this way forever. I haven’t enjoyed my teen years like I’m supposed to.

I’ll be starting college in two months, and would like to get back on track and start over in life, but it just seems impossible.

Each best friend I’ve had throughout my life has ended up moving away. This happened four times. My last and closest friend (who was like a brother to me) moved away shortly before high school started. I later found out that he had wanted to leave.

Well, after he moved away, I never really made true friends during my four years of high school.  I’m very shy in social situations which makes things more complicated. I didn’t feel like I had anyone to rely on but myself. I spent most of my time after school alone. Additionally, my parents had marital problems throughout high school and got divorced several days after my graduation.

I live in a rich, conservative, religious place and had to hide being gay during high school because of my low self-esteem and a lack of trusted friends. I worried that people would be disappointed/disgusted if i told them. I also had to abandon my religion which I once trusted. Worst of all, I had to create and act out a fake straight-person identity, and never developed a real identity for myself. I don’t even feel like myself most of the time. I’ve never been in a relationship whatsoever, which hurts my self-esteem further. Often, I feel sad/dead/empty on the inside, no matter how little it shows on the outside.

Additionally, for three months during my junior year, I would suddenly get dizzy/lightheaded, over-heated, shaky, and feel extremely nauseous about ten times a day. It lasted maybe 15 minutes each time. It seemed to be a mental thing because it only happened when I was in a non-relaxing setting. However, I was mostly able to ignore it, so I never saw a doctor or told anyone. Eventually it stopped happening, except on rare occasions.

The only thing I’ve managed to achieve in the last four years is good grades. I still haven’t told anyone I’m gay either. I want to tell my older brother and sister because I’m closer to them than anyone else. Hopefully it will happen before the semester starts.

For the future, what I want more than anything is to be a valued member of a group of friends rather than just an extra, disposable person. And I also hope to gain enough confidence to have a relationship and be open about myself, not hate myself, and feel normal again.

Could there be something wrong with me or my life that could be causing all of this? Also, how can I learn to forget the past and start new during college?

Thanks so much for writing in. How very painful to feel like you’ve never really been able to develop your sense of self, and openly explore and express who you are inside. Your parents’ marital instability and divorce likely didn’t help you to feel safe either. The dizziness and shakiness you described feeling during your junior year of high school sounds like anxiety, which is very understandable, given all of the stress and isolation you were holding inside.

Have you ever worked with a therapist? If not, I highly suggest it. “Forgetting the past” isn’t necessarily the goal of therapy. It is possible for you to process your experiences and make sense out of them in a way that allows you to move forward in your life. Your therapist can also help you develop healthy relationships and explore the best way to come out to your family. The great thing about becoming an independent adult is that you can define your life on your own terms, and seek out relationships that support who you are, and who you want to become. If you need help finding a therapist who specializes in working with GLTB issues click here.  Also, check with the student services department at your university for support groups for gay students to help you know that you’re not alone, and to help you find groups who are struggling with similar challenges.

Thanks again for your courage in writing in for help. Take good care of yourself!

Julie Hanks, LCSW

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Boyfriend May Be Schizophrenic

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

I recently found out that my boyfriend may have schizophrenia. I realize I am not a doctor, and he has never been diagnosed that I am aware of, but based on what he has told me and some research I have done that is what I believe his illness to be. At first I just thought he had trust issues because he was cheated on years ago by the mother of his son…I also thought he was just uncomfortable in social situations. Our relationship has been a little rocky because he sometimes gets withdrawn. It is also a bit hard to read him because we live in different states, so I thought distance was a problem as well. We were recently going through one of a few “break-ups”…he starts to think he can’t trust me and that he hears mens voices in my apartment when we are on the phone. He has never been angry or violent, just hurt and confused. I dismissed the men’s voices because I had a really bad cell phone that had a lot of interference on the line and would always drop calls…I thought it was just a bad connection. I have been nothing but faithful to him. During this time when he said he was thinking about ending our relationship again, I felt helpless…I thought that if he didn’t trust me at this point, he may never trust me. I have done nothing but reassure him. I thought maybe ending the relationship was our only choice instead of going through this cycle over and over again. I figured one of two things would happen:1) it wasn’t meant to be (which I don’t believe at all) and I could start healing or 2) me ending the relationship would make him realize that he didn’t want to be without me (as he has said countless times) and maybe he would start to trust me. When we were on the phone about to discuss the possible ending of our relationship he started to tell me about his ex cheating on him. I just listened…this was the first time he had opened up about it. As I was listening he started to tell me that that is why he had issues with trusting me. He believes that people can hear his thoughts. He believes that someone put a device in him that allows this and that he is certain that I have known about it all along and I may even be an undercover agent. He said he doesn’t understand how I could love him because I can hear his thoughts and sometimes he has terrible thoughts about me (pertaining to the cheating) His exact words were “I don’t think I am crazy, but if I am then I am really crazy…but I don’t feel crazy” I realize the word “crazy” is not an acceptable term…I am just quoting him. So I don’t know if he realizes he is ill or not. I think there is a window of hope there based on that statement. Maybe he will be open to treatment. This all came as a complete shock to me. I didn’t react very well…actually I didn’t really react at all. We still discussed our break up…I could not process anything really…and all I could say is that I love him. For the first time he didn’t say it back. I told him that hurt me, and he said what’s the point now, people who love each other don’t break up. I could tell he was very hurt. We haven’t had a whole lot of contact in the past few days. I don’t even know it he wants me in his life anymore. I sent him an email telling him I love him and I am here for him when he is ready to talk. He sent me back an email saying that he had gotten my email and we will sort this through in time. I am hopeful because he hasn’t shut me out completely. I love him very much and we have talked about spending our lives together…marriage…children…the whole deal. I don’t know what my next step should be…I do know that I love this man and I will not turn my back on him. I want to help him and be by his side 100%. I am worried he will not want to get help and I am not sure of how to approach it. He said this has been going on for many years…so he has managed to live with it for some time. He hasn’t worked in over a year, and he also has a son that lives with him. That is another reason I don’t believe he or anyone close to him really knows about his illness. I believe his son’s mother would not allow the son to live with him if she was aware. He did mention he told his mother…but I don’t know what came of that. If anyone has any support or suggestions for me, I would appreciate it. I have been trying to educate myself as much as possible. And any advice on how to talk to him about it would also help. I have a planned trip to see him next week…I still plan on going. I will only be there for two days, so time is an issue. Not that I have to figure everything out then…but I would like to make the most of the little time we have together. Thanks for reading!

The symptoms that you have described may be a sign of schizophrenia or a related psychotic disorder. His symptoms may also indicate illicit drug or alcohol use. A third possibility is that his symptoms are indicative of an untreated medical condition. All three possibilities need to be considered and explored.

You believe that he may be willing to go to treatment. That is very encouraging. Individuals who are willing to seek treatment have a more favorable prognosis than individuals who are unwilling to seek treatment.

On your next visit, encourage him to seek help. If possible, offer to attend some appointments with him. The idea is to make him aware of the fact that you’re willing to support him in any way that he needs. He is more likely to seek help if he feels that he has your support.

If he is resistant, remind him that he is loved. You and his son care and rely on him to be well. Inform him that ignoring the problem not only affects him but also you and his son. Reminding him that others rely and care about him may motivate him to receive treatment, even if he is reluctant to do so.

Generally speaking, be loving and supportive but also adamant about the need for help. In the case of psychosis, the importance of early treatment cannot be overstated. The “find help” tab, at the top of this page, can help you to locate a mental health professional in the community. If you have additional questions, please do not hesitate to write again. Take care.

Dr. Kristina Randle

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Could Genes Play A Part In Developing Schizophrenia?

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

Hello, My great Uncle suffers from schizophrenia, although I’m not sure what type (whether it’s paranoid, catatonic, etc.) It was brought to my attention that I [apparently] display some early symptoms of schizophrenia, though personally I believe it’s not so.

Some of these symptoms included anxiety, lack of motivation, social isolation, “stone faced” or expressionless, inability to differentiate dreams from reality (for things that happened up to 5 years ago), and so on.

Could they be right? Or is it nothing to worry about, just something that comes with age?

No one has determined conclusively that schizophrenia is genetic. There are still many theories about what causes schizophrenia but no one theory has been proven to be the cause. The prevailing theory is that schizophrenia is a brain disease. It is also believed, by many scientists and researchers, that stress and environment can play a major role in the development of schizophrenia.

Research shows that individuals who have relatives with schizophrenia are at an increased risk for developing the disorder. It is important to note that the increased risk is slight. Having a relative with the disease in no way guarantees that other family members will develop it. Again, the risk is slight and its development depends on many factors.

Some of the symptoms you have described are associated with both schizophrenia and schizotypal personality disorder. Anxiety is one such example as is social isolation. Lack of motivation, in the context of schizophrenia, would be considered a negative symptom of the disorder. Negative symptoms are characteristics of an individual’s behavior that should exist but do not.

Schizotypal personality disorder is characterized by a lack of social interaction and extreme anxiety in social situations. Individuals with this disorder tend to keep to themselves. They don’t have many or any close friends. They are very shy and have difficulty interacting with other people. They sometimes believe that they have special or magical powers.

Schizophrenia is similar to schizotypal personality disorder. In fact, it is most closely linked to schizophrenia, when compared to all the other personality disorders. The main difference between schizotypal and schizophrenia is that the individual with the personality disorder, for instance, may believe that other people are talking about them (ideas) versus the individual with schizophrenia who knows it’s true because they remember it happening (delusion).

The inability to express emotions, “stone faced or expressionless” might be considered a symptom called flat affect. Flat affect refers to an individual’s inability to show or to feel appropriate emotions.

You also mentioned having trouble with differentiating dreams from reality. You asked whether that is something that “comes with age?” I am not certain that I fully understand this question, however, it is abnormal to lack the ability to distinguish between dreams and reality. That symptom might be a reference to psychosis. Psychosis is a break with reality. Essentially, it is the belief in thoughts or ideas that are not real.

I cannot determine whether you have either disorder or any disorder. That determination would need to be made by a mental health professional who could evaluate you in person. I would highly recommend having a psychological evaluation. The “find help” tab could assist you in locating a mental health professional in your community. I wish you the best of luck.

Dr. Kristina Randle

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Depressed, Anxious, and Socially Awkward

by Julie Hanks, MSW, LCSW
written by Julie Hanks, MSW, LCSW

I don’t remember a time in my life where I’ve been totally happy but for the past approximately 2 years i have been extremely depressed as a result of my social anxiety and loneliness. I have always found social situations ‘awkward’, in fact the last time I remember frequently leaving my house for social reasons was when I was about 13. I then became more and more of a recluse from there on, i went out with my friends less and less outside of school, then upon leaving school i stopped doing things with my friends more and more until the point where i have not left my house for social reasons for about 2/3 years. I no longer have any friends and although my family is nice and supportive they cannot provide me with what I need. I have not spoken to anyone in person about my problems, I simply can’t. My parents will just tell me to go to a doctor. Doctors will just prescribe me with a drug that I don’t want. I don’t feel a psychiatrist can help me. I’ve become extremely lonely and depressed. My self esteem is extremely low and although I’m not a bad looking person I simply cannot accept my imperfections, no matter how hard I’ve tried. I feel I am in so deep that I cannot make a recovery. I cannot throw myself into social activities to make friends because of my social anxiety. I no longer find anything enjoyable and nothing at all interests me, this leaves me with the motivation to try nothing. I feel like I’m in a corner with no way out, every possible path I need to take to fix myself, I cant bring myself to walk down whether its my self esteem, depression or social anxiety stopping me. I hate it and I hate the person I am, I’m so sad it hurts. I feel so lost and lonely I cry randomly, its pathetic. There is no reason why I should feel like this, I’ve had a very normal life without any trauma, this only makes me feel guilty for the way I am. Guilt I don’t deserve to feel when there’s so many more out there in far worse situations.

I just want to live my life and be happy, but I truly believe I will never get there. Sometimes I feel like giving my life and donating what i have to give someone else a shot at life. Someone who can appreciate life.

I have read a lot of advice online about people in similar situations to myself but what are my options when the things I need to do to fix myself, I simply cannot bring myself to do?

Thanks so much for writing in and reaching out for help. I have seen many clients in my therapy office who express similar feelings of hopelessness, worthlessness, focus on their own imperfections, and have extreme guilt for feeling so sad and lonely because they’ve had a “pretty normal life.” It sounds to me like you are suffering from severe depression and anxiety that are keeping you in a downward spiral, unable to reach out for help. The good news is you have reached out on this forum, so I am very hopeful that you can reach out in other areas.

I urge you to talk to your parents and ask them for help. You said you haven’t talked to your parents because they will tell you to go to a doctor. If they love and care about you they will tell you to go to a doctor or a therapist because that’s the right thing to do when a family member is ill. I suggest that you keep an open mind about medication. While it doesn’t need to be the first course of treatment, it can definitely be a helpful tool in treatment. Ask your doctor for a psychotherapist referral as individual psychotherapy can be very effective. Often, a combination of medication and psychotherapy can be effective in treating depression and anxiety.

In order to experience some change in your life and find happiness you will need to take some action, even if you don’t want to, and even if it’s a small one – like talking to your parents about how hopeless you feel. You can do it. It sounds to me like what you’re experiencing isn’t really “you” but is mental illness clouding your thoughts and feelings. You can have more satisfaction and joy in living than what you’re experiencing.

Take good care of yourself!

Julie Hanks, LCSW

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Concerned with Telling a Doctor

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

I’ve been having problems for a while. I am highly disorganized, I have a fear of social situations but have a strong desire for them at the same time if that makes sense. I’ve tried being in talk therapy for those issues, not that much has come of it, however I’ve always been too scared to tell my therapist about other issues. I sometimes see images in the corner of my eye, a face in a window and then its gone, or a person standing on the side of an empty road and when I look in the mirror, nothing. I’m not sure if I’m seeing things or just thinking I see things, I’m concerned with being diagnosed with schizophrenia or something like that. I’m high functioning, about a 3.2gpa in college and I keep burying the issue in fear that treatment might intrude in my school life.
I also hear music sometimes and have taken to writing it down as compositions, would this be a hallucination as well? I don’t compose the music, I literally hear it as if it were being played in the same room as me, would this be a symptom of something?

My last symptom I’ve never told any therapists is the fact I usually hide away, closed doors, closed blinds, avoid going out quite a bit. My mood will fluctuate to being very happy like this, to longing for social contact but too fearful to even leave my own room and I don’t even know why. I just don’t know what’s going on and fear that if I tell a doctor they’ll put me on some treatment that will interfere with what little is going right in my life or send me to a hospital. I don’t expect a diagnosis really, I just want to know what are the chances of being sent away or some other life intrusive treatment?

I understand your fears but you can’t continue to ignore your symptoms. Even though you seem to be experiencing delusions and hallucinations, they are not characteristic of schizophrenia. They may be more indicative of a possible neurological problem. The only way to know for certain is to be evaluated either by a psychiatrist or neurologist, or both.

Compounding the problem is your withholding very important information from your therapist. He or she cannot effectively help you if you don’t disclose your symptoms. Part of the reason therapy has been ineffective for you may have been your lack of honesty. Only you have the power to change this aspect of your treatment.

In addition, there is little to no chance that you will be “sent away” to a hospital. You do not meet the criteria for psychiatric hospitalization which in most states is very strict and requires that someone be a danger to themselves or to others. Often individuals who desperately need or want to be hospitalized have difficulty being admitted. Once admitted, many individuals are released within a few days. The latest data from the National Hospital Discharge Survey by the Centers for Disease Control and Prevention (CDC) shows that the average psychiatric hospital stay is only 7.1 days.

I’m not certain what you consider to be “life intrusive treatment.” Individuals should work with their treatment providers to decrease the intrusiveness of treatments in their life. It is important that you convey this desire and fear to your therapist.

Fear is holding you back from getting the help that you need. Fear can be crippling but only if you allow it to be. Don’t let fear hold you back. Report your symptoms to your therapist. Be honest. Ask him or her for a referral to a neurologist or a psychiatrist for an evaluation. It is the most effective and efficient way to handle this situation.

I wish you well. Please take care. Please consider writing back to let me know how you’re doing.

Dr. Kristina Randle

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Lacking Emotions in Social Situations

by Julie Hanks, MSW, LCSW
written by Julie Hanks, MSW, LCSW

I am a 17 year old High School student and I have felt this conflict my entire life, but only now can I ignore it no longer. I am a 17-year-old female high school student, and amidst all of the discussion about college and ‘finding the right fit,’ I have realized that the major internal problem I have is that I lack an identity, lack interests, lack emotions, and therefore have trouble with social interaction. I am hopelessly apathetic at heart, and I don’t know how to reconcile the true ‘me’ with the image others expect–that of a ‘normal’ person who has passions and desires. I care about nothing–not politics or current events, not my friends or family or other people, not sports or music or art. Outwardly, I am a high-achieving, well-rounded student. I do well in every subject and participate in a variety of extracurricular activities, some of which I hold leadership positions in. However, none of them truly interests me, and I only continue them to get into college. Nothing ‘outside’ school much concerns me either. The various problems of society don’t matter to me, even when I’m affected. Occasionally a particularly poignant tragedy or example will make feel like helping out, but on the whole, I am completely apathetic. The same goes for the social aspects of my life. My childhood, family, and friendships were and are normal, but I do not have emotional connections to anyone; if somebody ‘close’ to me died, I would only be concerned with how it would affect my own convenience. I don’t have any academic, athletic, or arts-related interests either, and I do not believe the problem is lack of exposure. The only things I like to do are things that make me forget my existence and consciousness–playing games or reading a book or watching television, but the appreciation I have for those things is completely aesthetic and surface-level.

Left alone, I would be fine with this situation and content with engaging myself in passive activities for the rest of my life. However, society demands interaction. I sometimes have difficulty projecting the ‘right’ appearance in conversations and social interactions because I never feel anything (happiness at a friend’s success, sadness at someone’s death, gladness when someone praises me). Most days I do not have trouble interacting with people, but the times when I ‘mess up’ cause me great consternation because I am somewhat of a perfectionist and do not want people to think of me badly. I do not believe I have a social disorder because I understand what people mean and what kind of reaction to give–I just cannot act out that reaction because I do not truly feel it and I do not have enough acting prowess to express that emotion believably. People occasionally comment that my expression is too serious (that’s my default expression–blankness that is misinterpreted as seriousness, sadness, etc.), that I do not smile–in fact, I barely move, because I have trouble acting out body language as well even though I know what the proper response is. The emotions I do feel in social interactions are solely derived from self-consciousness–did I smile enough just then? Do I look relaxed? Most of all, do I look NORMAL? This kind of nervousness impedes my acting and therefore my daily interactions. Because I want to look what ‘normal’ is in any situation, I project different personalities to different people, causing conflicts when I deal with them together. I cannot just ‘let things go’ and be who I am–silent, still–in public; I want to look normal, but I can’t seem to force my body to comply.

What should I do? I want to make my social interactions normal so that I can live more conveniently–‘conveniently’ in this case means in a state where my physical needs are attended to and I am left alone and not thought about much by others, where I fit in, so that when alone I can drown myself in fiction and escapist activities. If I have a disorder or psychological problem with this lack of emotions–perhaps a refusal to recognize them?–I want to be able to deal with it. However, I don’t think I could deal with speaking to a counselor in real life because my guard would always be up, always trying to act and never expressing what I truly mean. I won’t be trite and say that I am spiraling down into darkness, but this problem truly does bother me.

It sounds extremely exhausting to be constantly on guard worrying about the appropriateness of your social interactions, especially when your internal state doesn’t match your behavior. I’m so glad that you are reaching out for help to find your way through this confusing situation.  Yes, it does sound like there is a problem going on, either psychologically or medically. I recommend that you seek help from a counselor to get an evaluation, and to get a thorough physical exam from a physician. There are many medical and mental illnesses that can cause the blank feelings that you’re describing and the feeling of disconnection and despair. While I can’t diagnose you based on an email, the emptiness that you are describing sounds like severe depression. To learn more about the symptoms and treatment for different types of depression click here.

You mentioned that you’re not sure you can put your guard down with a counselor, but keep in mine that psychotherapists are trained to help you lower your guard over time, to help you get to the root of the problem, and to help you develop skills to live a more fulfilling life.  Additionally, a therapist can help you resolve any life events or relationship problems that may have contributed to shutting down your emotions and help you to reconnect with who you are, how you feel, and what you want.

I have seen many clients in my clinical practice develop the disconnection that you are describing after experiencing trauma or loss as a way of protecting themselves against further pain. If you need help finding a good therapist in your area click the Find Help link at the top of this page. Don’t wait. Life and relationships can be much more rewarding than what you are currently experiencing and there are many, many resources available to help you. Please let your parent, guardian, or school counselor know that you need help so they can support you and help you.

I urge you to get professional help so you can reconnect to your emotions and find joy and fulfillment in your life.

Take good care of yourself!

Julie Hanks, LCSW

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I’m a Wallflower

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

The problem in a nutshell is that I have no close friends and when I’m single (which is the case right now) I’m completely lonely and more depressed than ever. In social situations where I don’t know anybody I fit the definition of a wallflower to a T. I’ve been so desperate to make friends that I’ve pushed myself to go to parties or events but when I get there I’m so awkward and introverted that I’m nearly brought to tears and usually leave early. Once I even traveled 40 minutes to a social event I found online just to see all the people there and turn around without even going inside.

I think I’m a great guy with a lot to give and would make a great friend but the truth is that I don’t have any.

In terms of dating the girlfriends I do get I find on online dating sites and even that is sparse. For every 50 girls I find online that I think we could really connect I’ll get 1 or 2 responses. I’ve tried everything from long, serious thought-out emails to short and relatively funny emails and still I get very little responses. I don’t think I’m that ugly, but I’m no Brad Pitt either. If I was to rate my looks I’d say I’m a solid 7. When the conversation with anyone I go on a date with turns to “my friends” and I have a real hard time lying or sidestepping the truth and usually say that I don’t have any. The girl almost always says “I bet that’s not true, I’m sure you have friends” and this always hurts more than you could know that one could just assume a decent guy in their mid-20s would obviously have a small group of friends.

I had two best friends in my life. One for 2 years when I was in kindergarten and first grade until he moved away and a second for a year in high school until he got caught up with a different crowd and left me behind so to speak. Those two exceptions aside I’ve had nothing but acquaintances my entire life. Acquaintances that I’ve attempted to be closer with but they’ve always kept me at a distance while they kept their own circle of friends close.

My lack of friends and social skills is quite baffling if you look at my parents. My parents are still together, love each other, and did everything they could to give me the best upbringing. My mom is always the life of any party and my dad is the jokester at his work and everyone seems to like him.

I used to cry that I didn’t have any friends in elementary school and my mom would console me and tell me that it would be better in middle school. In middle school she would tell me that high school would be much better as everyone would be more mature and I’d meet lots of friends. When high school came and I would voice my sadness over not having friends she told me that college would be the best years of my life. Well college came and went and sure I had girlfriends from time to time and a number of acquaintances but I never had any close friends, no one who would call on me to hang out or help me out with their problems.

Having this lack of companionship and friendship in my life had made me more and more depressed over the years until finally midway through college I couldn’t take the depression anymore and I saw someone who prescribed me anti-depressants. It wasn’t until my dosage was at 150mg a day of Zoloft that it seemed to make any difference. 6 years later I’m still on Zoloft which definitely takes the edge off, the severe depression is downgraded and the suicidal wishes go away but I’m no less lonely, I’m no more outgoing, and still I’m surrounded by people who have their BFFs while I’m sitting in my apartment typing my life story here online.

I’m now 26 years old, I live in New York City and I just want to be like the rest of the people I’ve seen my entire life. I want a handful of close friends and a best friend or two. Not that television and movies is a good sense of reality but I want to be like Ted Mosby in How I Met Your Mother and not like Paul Rudd’s character in I Love You Man.

I’m so sorry that you’ve had this longstanding problem and haven’t found the help you need. Zoloft may help take the edge off but it isn’t going to help you find the friends you long for. At this point, you may be feeling so defeated in this area of life that you radiate pessimism even when you do approach people.

I strongly suggest you get involved in some group therapy. In group, you will get feedback about what you do and don’t do that gets in your way. You will have the opportunity to interact with people in a safe place where everyone is working on their issues. With the guidance of the therapist, you will not only learn some new skills, but you will have the opportunity to rehearse them with group members before you take them out into the world. This will give you some new and much-needed self-confidence.

Google search either “social therapy, NYC” or “Group therapy, NYC” and you will find quite a long list of resources.

You made an important first step in writing. I hope you will take the next step and get some practical and emotional help. It’s completely understandable that you are discouraged. But you are only in your 20s. If you take care of this issue now, you will have many, many years of having more of what you want in life.

I wish you well.
Dr. Marie

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Schizotypal Friend?

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

The other day, there was a girl on the bus talking about her friend, who is in my class. Apparently, she’s acting weird and she imagines she has magical powers. She tries to throw spells on people (she takes herself very seriously), says she can hear people’s thoughts and other stuff like that. She also thinks there’s four witches that’re going to save the world, or something strange like that, and she thinks she’s two of them, since her body is also inhabited by some girl, named Laura, who died a while ago (Laura doesn’t exist by the way). I believe the reason she’s like that is that her parents are never at home and she does all the work there (cooking most of the time, dishes, cleaning, etc.). Her situation is made worse by her other friend, who entirely believes her. He even decided to change school to find the four witches, because God told him to (what I don’t get is that he believes that he’s one of them, that the girl is two of them and that the girl’s friend is one. That makes it four, no?).

I made a bit of research on Internet, and I’m fairly sure she’s schizotypal (though I’m not sure about him, but he’s leaving school so I can’t really help him). Me and another girl, we’d like to help our friend, but I don’t know how we can do that. I’d like to know if there’s a way I can help a schizotypal girl. I would go ask the school’s counsellor, but my friend already went to see her and she’s mad at her because she told her she’d help my friend get rid of her “powers”. Also, I went to see on Internet about how to deal with schizotypal people, but I found no information. Could someone possibly help me?

You believe that your friend is schizotypal but I think you may have meant schizophrenic. Schizotypal personality disorder is characterized by a lack of social interaction and extreme anxiety in social situations. Individuals with this disorder tend to keep to themselves. They don’t have many or any close friends. They are very shy and have difficulty interacting with other people. They do sometimes believe that they have special or magical powers, much like your friend does.

Schizophrenia is similar to schizotypal personality disorder. In fact, it is most closely linked to schizophrenia, when compared to all of the other personality disorders. The main difference between schizotypal and schizophrenia is that the individual with the personality disorder for instance may believe that other people are talking about them (ideas) versus the individual with schizophrenia who knows it’s true because they remember it happening (delusion).

On one hand, it is possible that your friend has schizotypal personality disorder, schizophrenia or another psychotic disorder. On the other hand, it is equally possible that she has none of these disorders. Sometimes people experience problems that do not meet the definition of any mental health disorder. Problems can be fleeting and temporary.

It is very difficult to know exactly what is happening with your friend but she does seem to be experiencing troublesome symptoms. You recognize this and I believe you are correct to be concerned.

Your question is: what can you do to help your friend? Your options are limited but there are several things you can do. You should support and encourage her to seek help. You can suggest this to her but it would be best if adults handled the situation. You mentioned that one of your friends has already attempted to speak to the school guidance counselor and it did not go well. I’m not sure that I understand why she had that result. I would encourage you to also speak to the guidance counselor about this problem. You may have a different result than your friend. If you are unable to receive help from the guidance counselor then you should speak to a trusted teacher, the school nurse or the principal. Another option is to speak to your parents about this issue and ask for their guidance. They may be able to speak to the guidance counselor or other school officials on your behalf.

Your friend is very fortunate that you care about her well-being. You not only noticed a potential problem, you also took the time to research it and are now in the process of trying to find her help. You have gone out of your way to be of assistance to her. You should be commended for your care and concern.

I hope your friend is able to receive the proper help. Thanks for your question. Please take care.

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