I have been working with a therapist and several psychiatrists, including inpatient, over the past year and a half to try to get to the bottom of my issues. It seems clear to all that I have a mood disorder somewhere on the bipolar spectrum, however there are other symptoms that seem to baffle everyone who has treated me. I often have vivid images of self harm, usually without any emotion or urgency attached to them. They are graphic and involve violent methods. At times, when I am under stress, these images become almost constant and attached to strong urges. I have gone as far as scratching my arm open with a fingernail, and holding a razor blade, ready to cut just to stop the images. I checked into the hospital after that incident.
Other symptoms include, paranoia that I will be attacked. If I see a person while I am out walking, I look at the person to assess if he or she is kind or not. If I feel the person is kind, then I feel safe. If I feel the person is not kind, I feel unsafe and worry that the person is going to decide to hurt me. I also worry that I will be accused of a crime I didn’t commit. If I am shopping I am afraid that the security camera is focused on me and that the security people will think that I am shoplifting, even though I am not. I think I have had a few visual and auditory hallucinations, but they don’t happen often and I might have been dreaming as they mostly happened while I was falling asleep at night.

I suffer from deep depressions and also have periods of time where I feel much better and am able to be productive.

Recently, I have noticed that it is difficult for me to do any small task and so my home goes uncleaned for long periods of time. I also have to force myself to showe once a week and I often wear the same dirty clothes over and over again because I just can’t make myself do the laundry.

I am a mom and it seems the only thing I can do is take care of my kids. It is like my instinct for being a mother seems to cut through all of this, but it is getting harder every day. I have spent the last two weeks trying to spend as much time in bed as possible so that these thoughts and feelings stop. It seems sleep is the only thing that helps right now.

The last time I was discharged from the hospital, the doctor told me that he isn’t sure what I really have and the doctor at the partial program I was released to questions if I might have ADHD, bipolar, paranoid schizophrenia, OCD or all of these, among other things.

I guess what I want to know is what is going on with me? What is it that I have and how can I get a handle on it before it takes me over completely?

A. It can be difficult to determine an exact diagnosis. Sometimes individuals exhibit symptoms associated with multiple diagnoses but they don’t technically match all of the criteria for any one particular condition. Based on the details of your letter, I would tend to agree with the other mental health professionals who believe that you may have a mood disorder, possibly bipolar disorder. You experience deep depressions and periods of productivity. Cycling between these extremes is an indicator of bipolar disorder.

OCD may also be a possibility. You worry about being accused of crime that you did not commit. Some individuals with OCD have similar fears. A common fear among some individuals with OCD is that they have accidentally hit someone with their car. For individuals with this particular obsession, they can become so afraid of accidentally harming another individual that they are frightened to drive their car or leave their home. The underlying fear associated with this particular obsession is losing control. Please keep in mind that having only one symptom of OCD does not mean that you have an OCD.

You also experience paranoia. To know if this is a symptom of any one particular disorder I would need to know many more details about the paranoia. If paranoia is an everyday part of your life, then it may be indicative of a psychotic disorder such as schizophrenia. If it only happens on infrequent occasions, then there may be another explanation.

The visual and auditory hallucinations that you mentioned may be associated with sleep deprivation and not necessarily a symptom of a psychotic disorder, such as schizophrenia. Having visual and auditory hallucinations on the verge of sleep is a relatively common phenomenon. I would suggest speaking to your psychiatrist about this symptom to determine if he or she believes these are actual hallucinations or part of a normal sleep pattern. If these auditory and visual hallucinations are disruptive, you may want to have a sleep study done to explore the possibility of a sleep disorder.

It is difficult to know your precise diagnosis but what is clear is that you are struggling. You need help. Even if you were given an exact diagnosis, it would not cure your problems; you would still need help. In my opinion, searching for a diagnosis is an inefficient use of your time and energy. A better use of your time and effort is finding a competent mental health professional who can help you deal with your problems. Look for a mental health professional who has a successful track record of helping people with similar problems. Medication may help to stabilize your mood. Counseling can help you to deal with your depression. Counseling can also help you with your possible OCD or fear of losing control. I hope you’re able to find the help that you need. I wish you the best of luck.

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Last reviewed: By John M. Grohol, Psy.D. on 2 Oct 2010

APA Reference
Randle, K. (2010). Bipolar, Schizophrenia, OCD, ADHD or All of The Above?. Psych Central. Retrieved on November 1, 2014, from http://psychcentral.com/ask-the-therapist/2010/10/02/bipolar-schizophrenia-ocd-adhd-or-all-of-the-above/

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