I might be suffering from Borderline Personality Disorder, but I don’t know. It might be Bipolar Disorder as well. I have a lot of mood swings, that can last a week at least, and sometimes a month. My moods varies between depression/anxiety with extreme suicidal thoughts and self-harm tendencies and “normal” episodes when I’m mildly happy and enthusiastic, but some other days I can be normal, not really depressed nor euphoric or something, but it generally doesn’t last much. The other day I may wake up depressed as well as enthusiastic and full of hope. It’s not stable at all.
You may say that I have the typical signs of a Bipolar Disorder, but my mood swings doesn’t last much you know, I mean today I’m happy the next day I’m sad and life goes on. My happy moments are usually alternated by sad moments when I feel like crap or when I’m extremely irritable and nervous. They say that Bipolar disorder usually works through episodes that last from 6 months to a year, literally, and that’s what makes me quite suspicious.

I looked through Wikipedia and social forums for Borderline personality disorder and it appears to be that I have many symptoms of the illness, including fear of abandonment, chronic feelings of emptiness, impulsivity, risky habits (alcohol, drugs, cigarettes, sex, wasting money) rage and anger.
I also have dissociative syndrome where I don’t know who I am anymore, I feel as if I’m getting out of my body, I sometimes feel very distant, too. Like a ghost. Like I’m not sure if I’m actually HERE or not, ALIVE or not. It’s really stressful. I also confuse my dreams with reality and have paranoid tendencies.

A: Of course it would not be possible to make an accurate diagnosis via an email query, but I am glad that you are taking the time to ask about your well-being. I can understand the concern and think getting a professional—a psychiatrist or psychologist –to help you sort through the symptoms would be a very good idea. The find help tab at the top can be of help in locating someone in your area.

But I would also want you to be aware of your strengths. You have listed the symptoms that trouble you and the possible diagnoses, but what are the strengths you have that have given you the resilience to cope and to seek answers to help you heal? While you are looking for a label for the condition I would also invite you to look at your strengths. Here is a link to the VIA character strengths survey which is free and can help you identify these features in your life.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

I see and hears things that none else can see, mainly demonic faces everywhere that looks like a zombie looking alien with huge goat looking horns, the other things i see could be black shadows that fly so quick past me or someone else with me that it looks like a black bird thats flew past, or even see things that im afraid of like when i seen millions of spiders all over the floor but was told nothing was there. i hear voices that tell me i should cut myself or try to kill myself and the voice sounds evil,not human, i sometimes also hear like as though the telly or radio is going off but nothings on at the time. there are times i end up having really high moods where i end up going out shopping spending £100s in a day on just stuff to use for all my ideas i have in my thoughts, when i think of lots of ideas i cant concentrate when others try talking to me, and i end up shouting at them aggressively just to be quiet while i think. according to my friends or family i dont make sense to them or think of too much and talk too fast for them to know exactly what ideas im talking about. I have told my doctor all of this and a counsellor but none of them seem to believe a word i say as though they just think im a freak or making the whole thing up, what should i do? as its getting worse every week.

A. Your symptoms are unusual. What you are seeing and hearing is distressing to you. Your symptoms seem indicative of an ongoing, untreated psychosis. You are also experiencing mood swings and having difficulty controlling your behavior. If you are currently in the midst of a psychotic episode, then it makes sense that you would have difficulty controlling your mood and behavior.

Psychotic episodes require immediate treatment. They typically do not get better on their own. Medication could significantly reduce or eliminate your symptoms.

I understand that you have told your doctor and counselor about the symptoms but it’s unclear why they have not taken action. If they continue to ignore your symptoms, then you must find a different set of mental health professionals who can help.

I am also concerned about the voices telling you to harm yourself. This is a common experience among people who hear voices. If you feel that you might harm yourself or someone else, then it’s imperative to go to an emergency room immediately. The hospital can protect you and ensure that you receive the proper treatment. They can also assist you in finding a treatment team who will take your concerns seriously. You must do what it takes to get the proper help. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

A 19 year old family member who was diagnosed with ADD as a teen and recently diagnosed as bipolar refuses to get professional help. He has had previous drug issues as well as law issues. no violence just dumb but it is straining our family, we never know what’s going to happen next. any suggestions?

A. This is a difficult problem. You cannot force people to do things they don’t want to do. You may be able to leverage him into treatment. By this I mean that your family bands together and informs him that he cannot live in your home if he’s unwilling to enter treatment. It may be the only way to convince him to participate in treatment.

Before getting to that point, there are other ideas to consider. Consult a family therapist. A family therapist can assist your family in determining the best way to intervene. Your family member may be willing to participate in treatment if other members of the family are also willing to participate in treatment.

Contact your local chapter of National Alliance on Mental Illness (NAMI). NAMI is a nonprofit organization that provides mental health education, advocacy and support for both individuals who have a mental illness and those who have a family member with mental illness. Most communities offer free support groups for family members who are dealing with problems like you are facing.

It’s not unusual for individuals with a diagnosed mental illness to refuse to seek help. It may be that he doesn’t believe he’s mentally ill. It also could be that the stigma associated with having a mental illness is preventing him from seeking the proper help. In any event, it’s important that your family continues to encourage him to seek help. There is a limit as to what you can force him to do but you should try everything within your power to ensure that he receives treatment for his mental illness. I wish you the best of luck. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

I have thought maybe I would classify under ultradian/rapid cycle bipolar because my father, grandmother and great-grandfather suffered from bpd and my moods change over the course of hours to a couple of days at most. However I don’t really suffer through “manic” episodes, it changes between “depressed” and “normal”. My “depressed” moments go from being exhausted for no reason, just being.. “done”, being upset that my life will never be as happy as when I was younger, and thinking that the future is pointless because I’ll be in school for 5 years, work through my whole life, then die. But sometimes I seem to “get over” these phases for a couple of hours/days in which I consider my mood to be “normal” and then it repeats. I have not seriously considered suicide, but recently I don’t even want to risk putting myself in a tempting situation.. Would rapidly switching between “normal” and this kind of “depression” be a certain illness?

I am also slightly sceptical though because my mother has always been worried I will inherit the bpd gene so anytime when I was just sad as a younger teen she was worried that I was going through a depression phase. I am wondering if I’m just convincing myself that there’s something wrong with me, when there’s nothing (even though I would NEVER wish for myself or anyone else to experience mental illness)? I don’t know what to do because I feel like even if I go to the Dr, I can answer the questions the “right way” and it may not be accurate. For example, if I am convincing myself I have an illness I’ll answer the questions in a way that will “confirm” it, or if I’m convincing myself it’s all in my head I’ll answer the questions in a way that will “deny” any illness.. I’m confusing myself and I don’t know whether these thoughts would contribute to my “symptoms” or not….. I don’t really know what I’m doing or what I’m looking for from you guys…. I just don’t know.

I’m sorry for my weird thought process, if it doesn’t make sense to me I can’t assume it would make sense to you, but thank you for your time either way. All the best.

A: There is no need to apologize for yourself. You are asking very, very good questions.

First, there are two types of bipolar disorder. Cycling between depression and “normal” is Bipolar II. People who have also had at least one episode of mania are diagnosed with bipolar I. So, if you have bipolar at all, it’s likely that it’s bpII.

However, you ask another really good question: Is it at all likely that you have been made so hypersensitive to the possibility that you have bipolar that you are mistaking normal adolescent hormonal changes and emotional growth for a disorder? I can’t answer that question on the basis of a letter. What I can do is suggest that you make an appointment with a mental health professional and take your letter with you to the first session. Your letter describes the situation very well. Asking the counselor to read it first thing will help her understand your confusion. The counselor will then be able to ask you questions that will help determine what’s going on.

I do think that settling the question will be helpful to you. You don’t want to be constantly second-guessing yourself or worrying about yourself every time you have a sad feeling. On the other hand, if you do have bipolar II, you may want to consider some treatment so that you can manage it effectively. It doesn’t have to dominate your life.

I wish you well.
Dr. Marie

I hospitalized three times for attempted suicide. said bipolar 2 disorder, on meds for schizophrenia: I had what i term to be some sort of break down four years ago. I believed that the school system, my friends and family were trying to take my children from me. I would see random things like book titles that were laying around the house that led me to believe this to be true. I believed that songs that came on the radio were trying to warn me also. I quit showering, grooming and everything because I believed that there were video cameras that were placed throughout my house, in my car, and that i could be monitored throught the tv in my home or where ever i was by the police.Everytime i would see a police cruiser, i thought they were following me. I was seeing someone at the time,we were engaged to be married. I started believing my fiancee and my sister were secretly seeing each other and along with everyone I know and ever knew were trying to kill me by poisoning my food, drinks, or by doing/saying things to make me feel as is if I was loosing my mind. This lead me to barely eat anything for a period of three months. I tried talking to a few people as to what was going on, but only to have them think i was blowing it out of proportion, even my family doctor.I sat in my mothers living room at one time screaming and crying while home alone because i was surrounded by fire. I was convinced that my family was going to lock me in the basement and burn the house down to get my kids away from me. I would go outside and sit crouched facing the corner with a hood over my head just to smoke because i was so terrified. I tried to talk to my mom and aunt to tell them what was happening with me, to no avail. This lead me to try suicide on three seperate occassions within a year. I was hospitalzed on all three occassions being told i had bipolar 2 disorder. But one thing about that is, they had no clue of the things i was seeing/hearing. They never asked. Not one time. I have been placed on several different medications (9 at one time). we have tried depekote, and geodon but they just zombify me to the point where i can not function at all, just sleep. I fight insomnia but at the same time have days where i can not get to sleep. I have rapid thoughts that lead into anger and just break down and cry, even at work. My doctor has placed me on latuda to try and control the symptoms. But the research i have done says that this medication is for schizophrenia and is not approved for bipolar disorder. I dont really know much about schizophrenia and when i try to talk to my doctor about my diagnosis whether it be the bipolar or schizophrenia, he has just asked me why i would want to label myself. I don’t, i want to know more about the conditions so as to educate myself and how to control and recognize what the symptoms are to get a handle so i know what to do and how to recognize when im coming into a crisis situation, i do not have a support group, im on my own with this. My question is, does the bipolar 2 disorder have this sort of symptomology, or is this more leaning toward the paranoid schizophrenia? the Latuda does help control the delusional thinking to a point, but the paranoia is very hard to keep at bay. I just need a better understanding of what is going on with me. Thyroid has been ruled out, but the seratonin levels are all out of whack. Thank you ahead of time for your time and understanding.

A. It is difficult to know precisely which disorder you may have. It’s possible that you have schizophrenia but another possibility is schizoaffective disorder. Schizoaffective disorder is loosely a combination of bipolar disorder and schizophrenia. In many cases, finding the right treatment is more important than pinning down a diagnosis.

What may be happening in your case is that you withheld information from your prescribing doctor, and were given an ineffective medication. To the best of your ability, it’s important to report all of your symptoms so that you can receive the most appropriate treatment. My advice is to contact the prescribing physician, report every symptom and be as honest as possible. Given new information, your doctor may prescribe a different medication which could significantly reduce your symptoms. Having the right medication could be the difference between having controlled and uncontrolled symptoms.

You also stated that you have no support. Is there a support group in your local community? Are friends and family willing to assist you? At this point in time, you need as much support as possible.

You’ve been through a lot. You have been battling significant mental health symptoms for at least four years and you refuse to give up the fight. I admire your determination and persistence. Having the proper medication could greatly assist you in reducing or potentially eliminating your symptoms. Talk to your doctor and hopefully, a change can be made immediately that would bring you relief. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice

I served in the military for 7 years with two deployments to Afghanistan and two deployments to Egypt. When my first deployment ended 2008 (13 month tour), my best friend committed suicide and it hit me for a few months. After those few months I was then sent off to Egypt for two years. Upon arrival back to America from Jan 2011 – July 2011, I noticed I started drinking heavily but never caused any problems. In October of 2011 – October 2012, I did one last tour in Afghanistan. Since I have moved back home, for the first time in 7 years, I noticed I have been literally uncontrollable at times. I already received a Drunk in Public (which was dismissed) and just received a DUI. I feel like Ive been careless, depressed, crazy mood swings and all of the above. I don’t know why I feel this way and it is driving me crazy. I have lost contact with my best friends and even my father the past few months because I feel like I can’t trust anyone. How can I stop this over thinking? I feel like life overseas was so much easier and I was happy. Back home It is so stressful and I don’t know what to do anymore. Thank you for reading.

A. I had the good fortune to meet a high-ranking lieutenant colonel, who had served many tours in the Middle East. He explained that many soldiers found it stressful to be home. That may seem counterintuitive. One would imagine that it would be easier for soldiers to be home, to be in the presence of their friends and family, but that’s not necessarily the case. The lieutenant explained that when soldiers were stationed with the military, they had a definitive job. Virtually every moment of their day was structured. After returning home, that structure was gone. There was no longer a definitive role for them. For many soldiers, they were much happier when their day was structured and they had a definitive role to fulfill.

Perhaps part of your struggle may be lack of structure. The lieutenant also explained how difficult it was to interact with others in the way that he had prior to his being deployed. He was no longer sure how to behave.

Many soldiers, he also explained, never felt more alive than when they were fighting in war. That feeling was difficult to match or recapture upon their return.

You feel out of control and your behavior has led to trouble with the law. I’m not certain what disorder you may have. I would recommend being evaluated by a mental health professional. Many soldiers are struggling with similar issues and have been helped by mental health professionals. Check with your local veterans hospital, your insurance company or local community mental health center about what services are available to you. The lieutenant I spoke about above was a social worker and was in the process of setting up a private practice to focus his work on individuals struggling with the same problems you have described. Consider working with a therapist who specializes in the problems of working with soldiers returning from war.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

Hi! I get mood swings that can last from an hour to a day where I can be depressed or really angry and I just I cant control myself sometimes but I cant concentrate very well and sometimes I just cant sit still. I was just wondering could that be just normal teenage behavior or bipolar or ADHD? And I have ADHD and OCD in my family. Thanks

A: Thank you for asking this question. It must be difficult for you to have these mood swings and concerns and still try to manage. But there is too little information from what you’ve told me to know if there is a diagnosis. But what I can say is that what you have described sounds well within the range of symptoms that go along with being a teenager.

The more important thing is that they bother you. I would talk to your school guidance counselor or your parents and go to your general practitioner to get a checkup. He or she will know if these things are outside of the norm.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

When I was 21 years old I started having visions and hearing things that others did not. I thought and still do think, I am special because of it. However, I started to feel like I did not want to be special any more. I went to the doctor and was treated for depression…

I am now 35 years old. I am college educated, I had a great career…children and now everything is falling apart. I used to be able to drown out the voices when they became overwhelming. I am having trouble dealing with it. They call me names and scream at me. They used to be friendly and even helpful. I am also extremely worried that someone will hurt me and my children.

I started seeing a therapist in October but I could not tell him everything. I did not really trust him. I felt by the way he was speaking to me that he was trying to judge me. I was also very afraid that he would have me arrested and take away my children. I was taking medication, but the voices told me that if I continued to take them I would die…I thought it would be in my best interest to listen….

I have an appointment with a new doctor next month…what should I do? Should I tell the doctor everything? Is this normal? Am I suffering from a depression?

A. Yes, you should tell your doctor about the symptoms that you are having. Withholding information from your doctor makes it difficult for him or her to properly treat your problem. The fact the you withheld this information from previous mental health professionals means that they may have misdiagnosed you with depression. Nothing in your letter suggests that you have depression. Your primary symptoms seem to be delusions and hallucinations, neither of which are symptoms of depression. They are in fact symptoms of a possible psychotic disorder such as bipolar disorder or schizophrenia. I cannot say with certainty whether or not you have a psychotic disorder but it is a possibility. That is why it is imperative that you report all symptoms to your doctor so that he or she can treat your symptoms accordingly.

There’s no reason to believe that you will be arrested or that your children will be taken away from you. Your children are not in danger. The authorities only remove children from their parents in cases of imminent danger. You’ve done nothing to suggest that you might harm your children. Simply having symptoms of a mental health disorder does not make you a danger to your children.

I would encourage you to read the New York Times article by Elyn Saks entitled “Successful and Schizophrenic.” Elyn Saks is a university professor, a successful researcher and the recipient of the MacArthur Foundation genius grant. She has schizophrenia and has been wildly successful in her life. In the article, she describes some of the ways in which highly successful individuals with schizophrenia manage their delusions and hallucinations. Some utilize cognitive techniques. In one instance, one particular individual would ask the following questions of himself when he began to experience hallucinations: “what’s the evidence for that? Or is it just a perception problem?”

She describes another individual who would simply “blow off” their derogatory voices. Another individual identified their triggers for the purpose of preventing a “full blown experience of symptoms.” Others used techniques such as minimizing sensory outputs, exercising, focusing on work, getting proper sleep, healthy diet, avoiding alcohol, and prayer.

There are very effective treatments and strategies that you can employ to significantly decrease or eliminate your symptoms. The sooner that you report these symptoms to your doctor, the sooner your symptoms can be properly dealt with. Please take care.

Dr. Kristina Randle

My father is narcissistic and borderline. We have seen signs that he may also be histrionic and antisocial as well. He used to be a pastor, but when he left the ministry, there was no one feeding his narcissism any longer and he started looking elsewhere for the attention he craved…bars, strip clubs,dating websites, etc. He basically threw his family away for strangers who would laugh at his jokes and make him feel attractive. We tried everything to try to get through to him before we realized and were told that there were severe personality disorders at work here. He refuses to accept there is anything wrong. “We twist the truth” and “it’s our fault” because we “don’t love him anymore”. He believes his own lies. He tried marriage counseling, but he would have the therapists believing he was a victim until the rest of the family met with the therapist and set them straight on his lies. I had (what i thought) a wonderful childhood. I was a daddy’s girl. I just adored the ground my father walked on. Now I wonder if I helped feed the disorders.

I am the oldest daughter of three. I am 27, my sisters are 21 and 17. My father is too wrapped up in his new friends (one of which is a woman a year younger than me with 5 children) and finding attention that he has actually said he doesn’t want to “parent” anymore. My mother thinks my sisters have been through enough, so she refuses to come down on them the way she needs to, and even when she tries, she no longer has a second parent in the household to back her up. The 17 year old has friends over at the house at all hours of the night, which prompted the neighbors to call the police, thinking there were drugs being dealt out of the house. They ended up finding enough evidence in the garbage to get a search warrant because the 21 year old occasionally smokes marijuana. They found alcohol in 17′s room and charged her with a minor in possession and a joint in the 21′s room and charged her with possession. Neither of my parents did a thing about it. The 17 has also become a cyber-bully,posting on facebook that people at her school have std’s, etc. Both of my sisters are severely self-centered. I am starting to wonder if they haven’t inherited some of the personality disorders. As for my mother, I feel so bad for her, because not only is she having to file for divorce after 30 years of marriage, but both of her children are out of control and she can’t seem to do anything about it. I shouldn’t have to tell her how to be a parent, but it seems like she has forgotten how. She lets both of my sisters walk all over her.

My husband and I were living in the house for about a year and a half when all of this started. It was incredibly draining emotionally. We moved across the country for work, and I struggle with just moving on and leaving them all to their own demise. I can’t keep pouring my heart out, giving advise, trying to help them see what’s broken, when they just pretend to listen and change nothing. I just don’t know how to cope. I love them all, but it hurts so much to watch my family implode. I just want to walk away, check back in in 5 years or so. My husband and I are very close to having children, and I don’t want them to be a part of this circus.

A: You didn’t ask a question so I’m not sure what you hoped would come of your letter. I can only make some general comments.

I think you are probably right that your father has a significant mental health issue. What you describe is consistent with a personality disorder. However, it is also possible that there is an undiagnosed bi-polar disorder. I trust that when you talked to mental health providers, they’ve considered that. Whatever the label, the impact of his behavior on his family is tragic — both for him and for everyone else. He doesn’t seem to understand what he has thrown away. It feels terrible to everyone that they have all been rejected.

It may be that your sisters’ behavior is at least partly rooted in the fact that their father doesn’t love them enough to be a father and their mother can’t pull herself together enough to parent them either. When kids don’t feel valued by their parents, self-esteem suffers. They often then push the limits to see if someone cares enough about them to tell them to stop — and means it. So far, both parents are failing them in that respect.

As for your mom: She sounds totally overwhelmed! My hope for her is that she will get herself into some therapy. She needs and deserves the support. She could also use some practical advice about how to get back in charge as the parent of the household. You can’t be the family therapist and shouldn’t try. You will only frustrate yourself and alienate your sisters. What you can do is love them all and encourage your mom to get into treatment.

You could also research when and where support groups for single parents meet in your home city and pass the information on to your mother. I did a quick search of the web and found two that might be helpful to your mom. It’s often helpful for people who are dealing with challenging problems to feel less alone and to get support and advice from others who are going through the same thing.

You may also be concerned about whether a personality disorder is hereditary. As far as I know, it is uncertain how much is inherited and how much is learned. My guess is that you have strong motivation and support for not repeating your father’s self-centered behavior. In some strange way, a negative role model such as he is can be as powerful as a positive role model. You may well have sworn to yourself that you will never, ever treat people who love you as he has. That’s a powerful incentive to keep your own life balanced.

I hope this was helpful. I wish you well.
Dr. Marie

My doctor wants me in hospital. I am middle aged and morbidly obese. I am also bi polar and have been medicated for the last 11 years. Before medication I was thin and healthy. I was a bit crazy and reckless and sometimes got into trouble. After I was medicated I gained 150 pounds and now have a number of health issues. I was scheduled for weight loss surgery and met with the surgeon 2 days before the surgery. He canceled the surgery because I was too unhealthy and it would be too risky.

I feel like I’m going to die soon and I need to do something drastic. I’ve decided to stop taking all my medication and do what I have to do to restore some of my health. I canceled my appointment with my pdoc and did not reschedule. He called me and said I should not go off my meds and I should go straight to the hospital. Of course I refused because there was no need to go. He has forced me to go to the hospital twice before, against my will. Can he force me to go now because I’m not taking my meds?

A. I do not have enough details about your situation to provide you with a definitive answer about forced hospitalization. Generally speaking, an individual cannot be forcibly hospitalized unless there is strong evidence that they are intending to deliberately end their life or harm others. Individuals typically are hospitalized against their will when it is believed that they are a danger to themselves or to others.

It was a mistake to abruptly stop taking your medication. Your doctor may have suggested going to the hospital because he was concerned about the possible side effects associated with stopping your medicine. Your doctor is correct to be concerned. If you intended to stop taking your medicine, then you should have done so with the assistance of your doctor. Sometimes, abruptly discontinuing medication can lead to illness relapse, among other problems. By not following the advice of your doctor, you are putting yourself at risk for dangerous health consequences.

As part of their medical training, physicians intensely study the body and how medicine affects the body. Consider them experts on the subject. As patients, it is important to work in collaboration with our doctors but they are the experts.

You should take the advice of your doctor and go to the hospital if he deems it to be the most appropriate intervention at this time. At the very least, return to his local office so that he may evaluate your status and monitor your progress. That is especially important because you have a diagnosed serious mental illness. The concern is that the illness symptoms will return and you may require his expertise in knowing how to handle this outcome. Please take care.

Dr. Kristina Randle

I have been treated for depression for almost a year now. I am on medication for clinical depression. I’ve switched to a new school this year, which was my choice to do. This year, I have been doing really well in the new school. I have friends. I have no reason right now to be upset, but I feel really lonely and depressed all of the time. I’m not having any troubles at school or in my life at the present time. What is going on with me? My friend thinks I’m bipolar. Is this a possibility since I have no reason to be upset but I still am?

A: I’m not sure about the bipolar, I don’t know what your friends are seeing and they may see some things that I’m not seeing. What you’ve described doesn’t suggest bipolar but what it might suggest is that your medication might not be working. Watch the video to hear the rest of the answer.

Take good care of yourself,

Julie Hanks, LCSW

I graduated from college last year but I moved to a new country and haven’t got a job yet. Hence I spend most of my time at home alone. I have bipolar 2 disorder diagnosed 2 years ago. I am on daily medication(Valproate 750 mg). My illness is well controlled on the whole. I haven’t had hypomanic episodes after i started medication. However, I have been feeling low and don’t feel like doing anything for the last few months. I have been taking a language course for the last 1 month so that was keeping me busy in the mornings. I feel normal when I’m out around classmates or with my husband. However once I’m back home and alone, I feel depressed and lonely. I don’t have real friends here. Just a handful of people I hang out with once a week or once in 2 weeks.

Now that my course is over, I just feel depressed all day. Don’t feel like studying, doing house chores…nothing. I just eat(I also want to binge) and watch TV all day. I feel like im sabotaging and self-destructing myself but can’t help it. I feel safe and comfortable just lying on the sofa all day. The only time of the day I feel better is when my husband is back from work and I have him around.
This feels so much like the depressive periods I used to have years ago before I got diagnosed. However, it isn’t as serious as before. I don’t know how to get out of this vicious cycle.
I also haven’t visited a psychiatrist here and it’s going to be complicated since I’m in a new place.

Do you think it’s my Bipolar or the loneliness or stress of moving/not having a job?
What can I do to help myself?
Thanks

A: Thank you for writing. You have made many changes in the last year that are causing you stress. Please don’t scold yourself for it. Many people would find your situation challenging. That being said, it’s time you took better care of yourself. You are taking serious medication without any support of monitoring from a psychiatrist. It may be that you need a change in dose or a change in medication. Please identify a psychiatrist today and make an appointment.

And, yes, you may be quite lonely and at loose ends. As difficult as it may be to think about, you need to do more to connect with people and make some new friends. A job will help. So will finding an activity or club (book club? art lessons? political work?) that puts you in contact with people who share some of your interests. It’s a time of winter sports in your part of the world. If you don’t know how to ski or skate, think about taking some group lessons. You will get out of the house and you will meet some people. As you know, some strangers are just friends you haven’t met yet. Gather up your courage and get out there. With more to do and more people to do it with, you will soon feel more comfortable in your adopted home.

I wish you well.
Dr. Marie

I’ve suffered from depression from a very young age–pill overdose at 14 and mh hospitalization at 21. All of my “relationships” until now have been of a sexual nature and I have been very promiscuous since losing my virginity at 23. I’ve had about 20 partners, most of them as a result of prostituting myself–at 26 and at 30 years of age. I’ve felt like I’ve lived a double life for so long. Despite it all, I’ve managed to get myself in graduate school this year; ironically, I’m going for my MSW. I have been living with my current–and the only person I consider a “legitimate”—boyfriend for a year but dating for two. I question the authenticity or the healthiness of my relationship with my partner because he was initially my “john.” Needless-to-say, I have a lot of insecurities around his faithfulness. We have a lot of problems because I feel he’s not affectionate enough towards me and I’m always seeking validation. I love his family and he loves mine but I don’t know if he’s the one. I think he’s a great guy but I also think he’s as good as I’ll be able to do because no one else would accept me with my past. He’s a typical guy in every sense of the word and gets easily frustrated when we talk about “feelings and emotions.” He thinks our relationship is fine–and for the most part it is–and says I just can’t help but self-sabotage. He’s perhaps the only person that knows EVERYTHING about me–I told him about my depression, he obviously knows about the prostitution–but he uses it against me when we have arguments. I want to make this relationship work but I don’t know if it’s because the only one I’ve ever really had or because I think I’m in love. My PCP, who knows my mh history seeing since I was a teenager, suspects I have Cyclothymia and encouraged me to get professional help. Needless-to-say, I’ve been lackadaisical about it. Sometimes I feel like I want to run away from everything because no one will ever understand me but I also feel like I want to try to get better. I’m confused about my relationship and I wonder how much my mh instability is affecting my expectations? Or am I really asking for too much?

A: First I want you to know how much I admire your courage for pulling yourself together and making it into graduate school. MSW programs are not easy to get into and the fact that you want to use your evolution to help others is to be celebrated. People who have recovered from life’s hurts almost always make good therapists.

Let’s not, as the ’60s slang phrase goes, push the river. So far you have been systematically evolving and resilient in making changes in your life. You are having more of what you want and less of what you don’t want. This means your life is moving in the right direction. Someone who self-sabotages is typically ambivalent about their circumstance – so if this is your concern, keep talking about what you want and don’t want in a relationship. Clarity is the antidote for staying in an ambivalent situation. If you keep moving toward clarity the risk of sabotage goes down.

I am assuming you are already in therapy, but if not I would encourage you to use the services at the graduate school you are attending. This will help with the process of clarifying.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Thank you. A month ago (or so) Dr. Kristina Randle helped me answering my question. (Misperceiving reality without medication). After reading the answer I decided to contact my former psychiatrist (the one I used to trust) and started a treatment with her.

I was feeling so much better and wanted to write just to say thank you, was not fine yet, but better, lot better. So thanks :D really.

I understand you answered my question, and don’t want to continue bothering you, but I’m in a little despair. My delusions diminished a lot, I think my official diagnosis is Bipolar Disorder with Psychotic features (or something like that), my mood was fluctuating, but was ok.

The thing is that 3 days ago I started to think of myself dead, uh… not sure how to say it. Like I see me killing myself in my mind (hope makes sense), was not feeling depressed or sad, actually I was fine, just this idea, and it started to invade my thoughts and now I just think in it. I don’t want to really kill myself, despite everything, I love my life, my plans. It has been hard to achieve certain stability, and I like being functional, but there’s this image that don’t leave me alone.

Then I started to listen other people’s thoughts (again), but I usually heard the thoughts of one person at a time, and now are a lot of thoughts of lot of people, so I can’t distinguish everything and my head is aching all the time because of the constant noise.

I wrote to my doctor explaining, I try not to call unless is a real emergency I don’t like when I am demanding, anyway I wrote to her, and she told me I have to give time to the med to kick in.

I know I have to be patient, but I can’t concentrate, or work, and I have datelines, and now I am starting to feel desperation, and don’t know how to deal with this until the med works fine, what if the meds don’t work? What if I’m not fine again?

And I ask myself if I really can’t control this or why am I doing it? Why a person would be like imagining things? Listening or seeing things that really are not there or happening? Am I just a freak? Should people be afraid of me? Should I stay away from people, to avoid hurting them?

And I feel so guilty and afraid for thinking of “me killing myself,” I know I like my life now (generally speaking), and was hard to get to this point. And people say that if you say it is just because you want attention, that people who wants to do it just do it. I don’t want to do anything like that, and also don’t want to have this images in my head, but don’t want to like to “call for attention.” How do I know if I have to say it to someone or not? How do I know if is real, and I should be worried or not? I used to want to die, I even try once and barely survived, and I am grateful I did, ’cause some years after my life improved and I liked it, but I feel ashamed as well (of feeling, saying and trying to kill myself and be alive) because it makes me feel like it was fake, that I was fake. Does that make sense? Should I ask for help or just wait until the meds work?

I’m sorry, I wanted to be just a thank you note, and I understand there are other people, and you have answered a question of mine before, so it’s OK if u don’t answer this time.

Thanks a lot for your time and previous advice.

A. I’m so glad to hear that you contacted your psychiatrist and have begun treatment again. I very much appreciate you writing back and letting me know how you’re doing. Thank you.

Please never feel that you are bothering me. I am glad to help you.

Your symptoms are obviously distressing but they are not your fault. No one would willingly choose to experience what you are experiencing. Those thoughts and images are essentially your brain playing tricks on you. It’s unfair, unpleasant, and frightening, and I’m sorry that this is happening to you. It will stop. It does take time. Be patient but also carefully monitor the suicidal thoughts that are occurring. If you feel that you might attempt suicide, you should call 911 or go to the emergency room. Keep your doctor informed about every change in your thinking.

You were wise to inform your doctor about your ongoing symptoms. Don’t feel like you’re a bother to your doctor. You are not. If you are a bother to your doctor, then she should find a new occupation. No good therapist would ever be upset with your providing the very information that they need to do their very best work. She needs you to keep her informed or she simply cannot do her job. What I am trying to say is you are being a responsible client. Without your self-reporting, she would not know how you are doing. As she noted, it may take time for the medication to “kick in.” Alternatively, your ongoing symptoms may be a sign that a dosage adjustment is needed. It’s important that you continue to inform her about your symptoms. It helps her to know whether your medication needs adjustment.

You may also want to consider the addition of psychotherapy. A therapist could help you to stay grounded in reality. For instance, he or she could help you to distinguish between what is real and what is not, teach you strategies for dealing with distressing hallucinations, voices, paranoia, and suicidal thoughts. During any distressing time, it’s important to surround yourself with a great deal of support. The more support you have, the better you will feel.

Thanks again for writing to let me know how you’re doing. Please consider writing back to keep me posted on your progress. I wish you continued success. Please take care.

Dr. Kristina Randle

Hello, I am inquiring about the plausible causes of some symptoms that I have experienced. Sometime during my prepubescent years, I believe to have had mild auditory hallucinations. Beginning shortly after laying my head down on a pillow at night, it often sounded like two people were conversing in the distance. It was never coherent, and when I would pick my head up to try and listen, it would abruptly stop. This was a common occurrence for a couple of years, but is rare to happen now. However, I still do experience mild auditory hallucinations from time to time. It seems as if I perceive them as an outside stimulus, rather than hearing it “in my head”. Occasionally I will hear someone calling my name (when no one actually is), doors being opened or closed (even if there is no one else in the house), or the distinct sound of this really noisy fan that has not been in use for quite some time now.

Within the past four months, I have had two instances of very brief visual hallucinations. They were both extremely vivid, and they both disappeared in the blink of an eye. The first was of an elderly man, whom I did not recognize. I looked across the room to see him standing near the corner, and as I blinked, he vanished. In that split second of seeing him, I understood that he could not be real; yet his existence seemed just as palpable as my friend’s, who was sitting beside me. I can recall his exact outfit, hair color, and approximate age and height. Shocked, I told my friend about what I just saw. His response was, “Huh, that’s weird”. I don’t think he believed me, but I know what I saw. The second instance was of my cat, as I entered my house. Upon being let through the front door by my cousin, I noticed one of our cats walking around a rocking chair. I looked up to say something to my cousin, and as I redirected my focus back to the cat, he was gone. I asked my cousin where the cat ran off to, and she said that he was never down there to begin with. This troubled me much more than seeing the man, because I truly believed that the cat was there.

My question is this, what could be causing these hallucinations? I have read through the DSM IV about psychotic disorders, and cannot find diagnostic criteria that matches my experiences.

I have also speculated on the idea of having bipolar disorder, as my father has been diagnosed with bipolar I, with his most recent depressive episode being severe with psychotic features. I have noticed mood and energy abnormalities within myself over the past seven months or so, but I am not sure if it has been prominent enough for diagnosis. I think I experienced a depressive episode for about five months, but I am still debating on whether or not it was actually depression caused by chemical imbalances, or if I was just extremely sad due to the loss of a relationship with a once close friend. I know that I have never had an episode of mania, but I seem to have exhibited hypomanic symptoms, following the end of that depressive state. I woke up one day full of energy, optimism and ambition. It lasted for about a week and a half to two, then I returned to a more normal medium. Since then, I have not experienced any lasting mood differences; but there are many days where irritability or sadness will strike me. What is your take on this?

I do wish to consult a psychiatrist, but at the time, this is not possible for me. I would greatly appreciate a reply, as I am very curious for an assessment. Thank you for your time.

A. With the facts that you have provided, it is difficult to determine what might be wrong. Your experiences and symptoms are noteworthy but may not necessarily be indicative of a psychotic disorder. As you said in the latter half of your letter, you recently experienced a distinct period of depression after ending a relationship with a close friend. It is normal to grieve the loss of a friendship.

You mentioned that your father has bipolar disorder and has experienced psychosis. People who have family members with a mental illness are often concerned that they might also develop a mental illness.

Having said that, I believe that you should be evaluated by a medical professional. It is always prudent to undergo a medical evaluation if psychosis is a possibility. Such an evaluation generally involves ruling out neurological problems.

Having a mental health evaluation is also advised. Even if no definitive mental illness is present, you would likely benefit from psychotherapy to assist with the stress associated with having a mentally ill parent and in managing your emotions. Also consider contacting the National Alliance on Mental Illness (NAMI), an advocacy group that provides free psychosocial support to family members who have a loved one with a mental illness. I think you would greatly benefit from a NAMI support group. Please take care.

Dr. Kristina Randle