Hi! I am a junior in a BSN program. Nursing school is obviously a lot of hard work. I love my major, but I have such bad “anxiety” lately. I make very strict to-do lists every day, I am incredibly organized, and can time manage very well.  However, it never feels like I do enough. I study every day. All of my time goes towards school work and studying for my exams. I read the same paragraphs over and over again because I am certain that I must have missed something and if I don’t read it two more times I will fail my exam. It’s almost a waste of time when I think about it, but I still “have” to do it or I just get this feeling I’m going to fail that I can’t argue with. I make school my first priority every day. I am not sure what else I can do. I don’t allow myself to go to bed at night until I have completed my list completely so I often get 2 hours of sleep a night which is crazy when I have clinical the next day. I run off adrenaline & Adderall incredibly well though.  I got a 90% on my first exam this semester and felt disappointed in myself (and I know I shouldn’t be). Then I scored two Bs on my next two exams and was disgusted in myself. I know I should feel more accepting of those grades but I keep telling myself I can do better. I have to do better. At night I struggle to fall asleep. I will go to bed at 10pm sometimes if I get my list done and will be so excited for a normal nights rest and yet I still lie there until 4am thinking about my to-do lists and how much I need to do or what I need to study. I will just keep making lists over and over in my head. I’m always making lists! Whenever I try to “have fun” I feel so guilty as though I should be studying. I am just constantly afraid of failing and just never feel like I am good enough. My friends always compliment how organized I am or make jokes about me being “a perfectionist” and that they wish they had my dedication, but I wish I could be more relaxed like them and still score high on exams! The only way I can actually “relax” when I hang out with them is to drink so that I forget about school. It’s wrong and I know that. I always feel ashamed the next day.  My leg is always shaking and friends point it out all the time but unless I consciously think about not doing it then my leg shakes while sitting in class or even lying in bed at night. It’s embarrassing at times to have to keep explaining you are fine and say it’s just a bad habit. I have been considering consulting my PCP to ask for some anxiety medications on a PRN basis.  I am nervous though because I know that medications like Xanax have a lot of addiction risks and I don’t want to fall into that kind of issue. Maybe just so I can sleep at night without stressing or feeling guilty. I think maybe also for before exams because I do the same thing where I have to read things multiple times even if I know I read it right the first time because I am convinced I misread it and will fail if I don’t read it again. I constantly second guess myself. I feel like I take twice as long to do things as other people just to get it done to my standard because I am a perfectionist, but how much more could I be getting done if maybe I just lowered my standards a bit? Maybe I don’t need to always color organize my notes. But to me, if I don’t = I will fail. It literally gives me tachycardia when I don’t do an assignment to my standards even if it is “good enough” to pass. I’ve literally rewritten notes just because my handwriting isn’t neat enough. I have this same problem with odd numbers where things always have to be in evens or something bad will happen (example: the car radio has to be on an even number or I will get in an accident and kill some innocent kid). I’ve had this number issue my whole life, my mom has always laughed about it. It’s basically a family joke because I never explain my rationale for needing to eat two of something or change the volume, but to me it’s real and stressful and ever since this semester has started it’s gotten more anxiety provoking because the consequences are always failure centered. I just am tired of feeling so on edge all the time. I am tired of feeling like a failure and so out of control of everything in my life.

I guess my question is do you think anxiety medication is a good idea? And if so, how do I go about explaining myself to my mom who is very against anxiety medication. I brought it up to her while in high school because I used to cut myself and she was very clear in her disapproval and so I’ve never felt comfortable considering it again. We have a system where we just ignore problems and pretend like they don’t exist, but I can’t pretend like I’m not overwhelmed right now and  really don’t want to go back to cutting myself to feel better but it’s scary to think how easy it is to fall right back into that position. I can obviously go to the doctor and get a prescription on my own but seeing as I am on her insurance still she will find out and then I’ll need to defend myself. It almost seems better to just not get medication yet she calls me and always complains about how irritable I am towards her and doesn’t understand my stress from school. She just expects me to be calm and happy and perfect 24/7 despite running off 2 hours of sleep, studying for 3 exams in 2 weeks and fitting in other assignments (and let’s just forget about even having time to eat regularly!). I know this might all sound so crazy, but I just want to make it clear that school is not the problem because I LOVE School, I just don’t love the way I need to do everything so perfectly and how it causes me such anxiety. Please advise.

P.S. I saw my school psychologist as I am sure that would be a suggestion you give. He told me to exercise and give myself a break from studying. Not really all that helpful!

A: There’s a lot going on for you, and I can tell that the stress is really getting to you. It sounds like you are a really good student and work hard at everything you do. But the perfectionism and anxiety are starting to take a toll. Perfectionism can be a tricky thing to deal with because many times it reinforces itself. For example, you over-study for an exam and get a good grade so the message you send yourself is that you need to do that every time. However, this pattern will ultimately lead to exhaustion and burnout. 

Furthermore, you are not just describing perfectionism, you also include many descriptions of anxiety and obsessive rituals. I have found that these things tend to go hand in hand. Throw in a good dose of feeling “not good enough” and you have a pressure cooker situation. I’m sure you have studied the statistical principle of the bell shaped curve in college. As anxiety increases, performance increases, but then if it continues, performance begins to decline.

Your main question seems to be about whether or not you should speak to your doctor about adding another medication to address the anxiety (you already mentioned Adderall). By all means, I suggest you speak with your doctor, but you may get to a point that it might be better to speak to a psychiatrist because they specialize in these areas.

You mentioned that you spoke to the school psychologist but didn’t find it helpful. I highly recommend that you try again. You might not have had enough sessions to make a difference or you might not have found the right therapist for you. Remember, medications only address symptoms. The underlying problems will not go away unless you also address the thinking patterns and behaviors that create the symptoms. This is where therapy is most helpful. 

There’s a lot you can do on your own too, such as learning to relax and meditate, take some “fun” classes, and read some self-help books, such as Brené Brown’s work. I would also suggest that you look into the concept of Adrenal Fatigue to more fully understand the long term effects of running on “adrenalin,” not to mention that it may be helpful knowledge for your future patients. 

Finally, you are concerned that your mom won’t be supportive of medication or counseling. Typically, if you receive services through your school’s counseling center, she wouldn’t have to know. But, yes, she may find out if you use your health insurance benefits. This will be good practice as an adult college student. You need to do what is right for you, not what you think others want for you. You can be the one to break the family patterns and learn to prioritize psychological health, rather than continuing to “pretend” the problems don’t exist.

All the best,

Dr. Holly Counts

 

 

Last reviewed: By John M. Grohol, Psy.D. on 2 Apr 2014

APA Reference
Counts, H. (2014). Perfectionist Qualities Causing Me School Related Anxiety. Psych Central. Retrieved on August 29, 2014, from http://psychcentral.com/ask-the-therapist/2014/04/02/perfectionist-qualities-causing-me-school-related-anxiety-2/