Tag:

Trigger

Paranoid Partner

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP September 7th, 2021

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

Hi, I have been knowing my SO for a year now, I like to believe that we have a great connection. He has told me in the beginning that he has trust issues and have a hard time letting people into his life. He doesn’t have many friends and he prefers to be home on his own which at first I had no problem with because I am a homebody myself. However, after a while, I noticed he had intimacy issues which then rose quite a few problems within our relationship. He distances himself quite often, becomes very cold. He also shared with me that he was sexually abused when he was young but he didn’t go into detail and I did not ask questions because I felt like he didn’t want to talk about it so I comforted him and we have not spoken about it since. I also know he did not come from a good background. He has also gone through my phone and found some messages from social media. The trust was fully broken then but after a couple months of separation, we decided to work out the relationship. A couple of days ago, he became very distant and I began to worry what was on his mind. He finally opened up and told me he suspects his roommates are plotting to get him. I reassured him that that was all in his head and to stay positive. He also bought a knife for protection which I didn’t think much of. However last night, he smoked a little bit of marijuana (he has before and has never acted weird) and after an hour, he began to shake uncontrollably. I had asked him what was going on but he told me he was just cold and told me to go to bed. As I am laying next to him, I couldn’t help but notice his behavior. He was still shaking, his heart was pounding and he was looking straight at the door and noticed he was holding a knife in his hand as he looked like he was prepared for whatever was going to happen. I began to worry even more and he suggested we leave his place.. it was 2am. While we were in the car, he began to suspect I was hiding something from him. He kept saying “What’s going on” and began interrogating me and went through my phone again believing I was out to set him up. I was afraid for my safety and I told him to get out of my car, he got a lyft and just left. I have not heard from him since and I am still worried about his mental state. What should I do? I deeply care for him but he doesn’t trust me and believes I am out to get him. I believe he has paranoia disorder but he doesn’t have medical insurance and I am afraid it is going to get worse. I don’t want him to hurt himself and I want to help but I don’t know if he wants help from me.

It is very difficult when the people we love and want a relationship decompensate, and I admire your tenderness and compassion. However, a paranoid delusion is nothing to try and deal with on your own. There is potential for him to hurt you, someone else, or himself during these states and justify it with these irrational thoughts. This is a situation that requires professional assistance with an evaluation from a psychiatrist or psychiatric nurse practitioner.

Set a clear boundary with the primary goal of protecting yourself physically and emotionally. This is not an opportunity for you to reason with or convince him. This is a situation you must view as a self-care priority with your well-being coming first and foremost. Individuals can recover from these episodes, but it will require professional guidance and (most likely) medication. An evaluation for him is imperative.

It is not uncommon for intimacy to be the trigger for such episodes and you may not be able to offer more than your compassion from a distance. If he is sleeping with a knife he intends to use it if he feels it is necessary—and that necessity may be determined by a delusion. Worse—the use of drugs may exacerbate his anxiety and disordered thoughts.

Set clear boundaries for yourself. Explain that his actions and behavior are such that you are concerned and cannot be with him until he finds some help. I know this seems difficult, but your well-intentioned acts can easily be misinterpreted and used to justify his paranoia. Don’t put yourself in harms way.

Wishing you patience and peace,
Dr. Dan

September 7, 2021 0 comment

Anxiety & Inability to Commit in Work, School, Relationships

by Kristina Randle, Ph.D., LCSW July 2nd, 2021

written by Kristina Randle, Ph.D., LCSW

I’m 23 and up until about 4 years ago, I was outgoing, had a big social circle, and a part time job I had maintained for a couple years. Since then, I’ve somehow become very depressed, self-hating, antisocial and have terrible anxiety whenever I’m obligated to a work or social situation, sometimes even when it’s just a family get together. It gets so bad that I’ve quit about 8 jobs in the past 4 years. It’s very hard to explain it in writing, but it feels uncontrolable when I start to feel the anxiety and apprehension. It’s embarassing and I feel like a child having a temper tantrum but I can’t stop it. I’ve gone as far as hysterically crying until my boyfriend told me I didn’t have to go into work, I’ve pretended to go but actually went somewhere else to kill time, or I’ve just stopped showing up to work all together and never called. It sounds so irresponsible, spoiled, and childish which is why it’s so hard for me to talk about because I can’t convey the way it feels to me inside. I prefer to spend my time alone in my apartment or with my boyfriend only and I don’t understand why it’s so hard for me to be around other people. My family growing up was very dysfunctional and my parents were verbally and sometimes physically abusive toward one another my entire childhood. I can still to this day vivdly remember some of their fights and the things I’ve heard them say and seen them do. As I’ve gotten older, I get preoccupied thinking back to those times and it bothers me more now that I can reflect back on it as an adult. I’m very hypervigilant and I’d say I’m in a state of fear or anticipating something bad about 75% of the time for no valid reason. I’ve been that way my entire life though, not just recently. I slept with my parents until I was 11 and I still have night terrors to this day, usually about myself being killed by a man. I just don’t understand how I was so fuctional as a teenager, but now as an adult I’m falling apart emotionally. I hate the way I am, it’s shameful and embarassing and the more I feel shameful, the harder it is for me to snap out of it.

Psychological problems are no more shameful and embarrassing than developing the flu or a toothache. You are not purposely causing your symptoms. You are doing your best to deal with your symptoms but you’re not a trained professional. Most people are not and thus can’t treat themselves.

You were doing great until about four years ago. Try to think back about what may have happened to trigger these problems. If you think about it, there’s probably something that caused a change. Identifying the trigger might provide important insight about what might be wrong.

As you already may recognize, untreated anxiety tends to become worse over time. That’s because people with anxiety disorders tend to inadvertently reinforce their anxiety. It’s called negative reinforcement. In your case, each time you avoid something because of your anxiety, you are inadvertently reinforcing your anxiety. This will cause the anxiety to increase in the future. Avoidance only makes the problem worse.

Highly effective treatments exist for the problems with which you are suffering. You should not hesitate to seek help. Mental health professionals are specifically trained to deal with anxiety and depression. Counseling and medication have both been shown to improve the symptoms of anxiety and depression.

Finally, do your best to refrain from self-criticism. I highly doubt that if you had the flu or a toothache you would refer to yourself as yourself “irresponsible, spoiled or childish.” Mental health problems affect many people, including smart and successful people. Your continued self-criticism might make the process of seeking help more difficult for you. I hope that you make the wise decision to seek help because it is the correct way to deal with this problem. Please take care.

Dr. Kristina Randle

July 2, 2021 0 comment

Engrained Symptoms Being Triggered Involuntarily

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP January 28th, 2021

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

From Canada: First, I’ve always had a ton of stress, depression, and anxiety from being raised by dysfunctional parents (which persists), along with other things. However, newer issues have really started taking there toll on me when I suffered an injury to my neck.

This neck injury (atlas and upper neck instability) actually caused overwhelming symptoms by basically constantly overactivating my sympathetic nervous system, and also impeding blood flow to my brain. These symptoms were things such as dizziness, disorientation, brain fog, cognitive decline, short term memory loss, anxiety, bone aches, forgetting word meanings, and many less common and much weirder ones.

At the time I was working hard at a fairly intellectually demanding job. Of course, when you have to use your brain and you can’t think properly, you start to become stressed and anxious even more.

Eventually, with time, the physical problems with my neck started to improve, and I noticed that the symptoms described above started to come and go (they were 24/7 constant before). I started to notice that these symptoms would reduce if I just watched tv or didn’t really use my brain at all. However, the second I started working again and/or using my brain all of the symptoms described above (anxiety, cognitive decline, brain fog, memory issues, bone aches, etc) returned.

My logic is that all of these symptoms have become ingrained at this point and my body can’t really completely let go of them (despite the physical problem to my neck, in many scenarios, not being the direct cause anymore).

In the past I had attached so much stress to working (because I couldn’t do it properly) that it now acts as a stress “trigger” that activates all of these symptoms again.

I’ve tested this over and over again. And without fail, the second I start working I get symptoms, and the second I stop working, stop thinking, and watch tv, everything (eventually) returns to normal.

I have a huge project that I need to work on. And it’s what I was primarily working and stressing on when my neck was bad and the symptoms were constant. I seem to have particularly attached so much stress to this specific project in the past that it literally induces all of these symptoms in just minutes of beginning to work on it. So much so that I can’t even construct a single proper sentence. Though, again, it goes away when I do something else that doesn’t require much thinking.

The problem is I have a finite amount of time to complete this project and can’t wait for my body to naturally let go of it as being a trigger.

I’ve tried meditation, a month break from all work, I eat healthy, etc, but it hasn’t helped. When I go back to the work/project (work from home, no environmental difference) the symptoms come back…

My local family doctor is not very helpful and will not listen to all of this. Instead will just try to put me on whatever general anti-anxiety/depressant is currently trending.

What I am wondering is, if you can inform me of a way to get rid of this problem (whether that be a specific therapy, pharmaceutical, supplement, etc), to “break” the stress trigger/engrained issue here so I can stop getting these symptoms from my project that I desperately need to work on?

I am immediately struck by two things: First the chronicity of the situation and your ability to cope with physical and emotional pain. I admire your grit in managing the struggle and seeking a solution. Secondly, I can’t help but noticing the clarity and complexity of articulation in your email. If this is the kind of quality you can produce when you are not up to par, then your coping strategies may be working better than you think.

I have two suggestions. The first is a very specific type of meditation known as Tonglen. It is designed to help you manage the stress directly. My guess is the meditation you were doing was more generalized — which is always a good strategy — but you may find this one a bit more targeted.

Secondly I would seek out a therapist trained in Cognitive-Behavioral Therapy (CBT). This form of therapy is typically very effective when there is a specific activator, such as your thinking or working, which can be targeted more precisely.

Write us back and let us know how it goes.

Wishing you patience and peace,
Dr. Dan

January 28, 2021 0 comment