Ask the Therapist Ask our resident Psych Central therapists. 2016-04-30T18:45:03Z Kristina Randle, Ph.D., LCSW <![CDATA[Friend Is Going ‘Crazy’]]> 2016-04-19T18:50:28Z 2016-04-30T18:45:03Z

I am really scared as my friend has started saying some really weird things like that I am going to hell and that someone close to me will turn on me which will cause me to go to hell and sometimes she goes into this trance and starts talking to someone like someone else is there when there is none she also says that she is part of another realm called the shadow realm and will just randomly be like we have to go its not safe here they are after us she also said that she is the daughter of the devil and when she was at my house she said that her dad was there and she started to talk to him as if he was there I am really worried and don’t know what to do. This has freaked me out so much that I don’t want to be her friend anymore.

A. You should immediately tell your parents and her parents about your concerns. Tell them everything you’ve written about in this letter and anything else you think would help. Her parents may not be aware of her problems. They need to know what is wrong so they can help.

You might worry that telling her parents will lead to her being upset with you. That is a possibility, but that should not stop you from telling her parents. The following cliché is true in this situation: it’s better to be safe than sorry. It’s best to be proactive and tell her parents what’s happening so that they can intervene before her symptoms worsen.

Her symptoms need to be reported no matter the consequences. Your friend needs help and she might not be able to ask for it herself. That’s the best way you can help your friend in this situation. Please take care.

Dr. Kristina Randle

Dr. Marie Hartwell-Walker <![CDATA[Do All the Different Medications Make It Worse?]]> 2016-04-19T18:52:52Z 2016-04-30T11:35:28Z

From Switzerland: My story began in 1999 at the age of 29, when I was diagnosed with depression and agoraphobia. In the years between now and then I struggled with various prescriptions. The „protagonist“ was always a SSRI. I tested around six of them. Then of course after the severe anxieties and panic attacks they gave me bezodiazepine Lorazepam (named Temesta), where soon I was addicted to and still am.

Now, after all these tests (been with several psychiatrists and therapies) and ups and downs, my lastest internist together with my latest psychiatrist prescribed the following:
1 SSRI (duloxetin: Cymbalta), 1 atypical antipsychotics (quetiapinum: Seroquel XR), 1 antiepileptics (pregabalinum: Lyrica) and of course Lorazepam (Temesta) on own need (ie. on reserve, presently up to 4mg/day).

When I now say, that I feel like “poisoned” (and that’s not just because of all the other medications I take because of the side effects), I am sure you understand what I mean.

Throughout the years I also had feelings to destroy myself (see pictures that I rip myself in pieces – there even was a summer, when I began in real burning myself, which I never did before – and there’s anger about myself), but was to afraid to do so. I have most of the nights surreal dreams, that left me confused. I sometimes hear knocks on the door or bell ringing. In the last months or so I cry a lot, feeling thin-skinned…

Although I went through several “medication tests”, none of them has lead to a striking improvement except for the benzodiazepine… and that’s what’s really depressing – it makes things worse, as I have an enormous fear being without them!

What would you suggest in this case? I mean, how can I run out of the “devil’s circle”?

A: I’m very sorry. None of the Ask the Therapist team is a psychiatrist (medical doctor) so we cannot advise you about medications. I can only urge you to work closely with your prescriber.

Take a few moments each evening to write down how you felt that day. Keep track of side effects, including those dreams, confusion and sensitivity. Also keep track of how many hours a night you are sleeping and a general indication of what you are eating and how much exercise you are getting. Do make sure you take the right dose of your medication at the right times each day. Record that as well. Bring that information to your next appointment.

You are the central member of your treatment team. Complete and detailed information can help your prescribing doctor more effectively monitor and adjust your medications.

Meanwhile, do continue see a talk therapist as well. Agoraphobia is often responsive to desensitization therapy. Depression often responds to increased attention to self-care. Your therapist can provide you with new skills and needed support. He or she can also help you address what you suggest is a psychological addiction to the benzos.

I wish you well.
Dr. Marie

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[Why Do I Have Cravings to Poison My Body?]]> 2016-04-19T18:38:16Z 2016-04-29T18:45:28Z

From Sweden: So, I suffer from mild depression and severe social anxiety, and this past year I’ve been craving caffeine, cigarettes and alcohol even though I have never tried the two last ones and I always hated caffeine. I cut sugar from my diet almost entirely. I cannot stomach sugary things and instead I crave anything that’d somehow poison my body. The cravings are worse and worse and I told my therapist about this so I’ll be taking medication to stop the cravings, but I wonder why does this happen? It’s not like I’ve been drinking or smoking or even drinking that much coffee before so how come I can physically crave them? Does it have something to do with taking the psychological pain away? If yes then why am I able to crave it physically.

A: Thank you for reaching out with your question, but I do not think this is about you wanting to poison yourself. There are two things I would encourage you to get more information on. The first is about your depression. You live in a country where the incidence of seasonal affect disorder (SAD) is high because of the variations in sunlight. From research on other areas in the world also affect by this we know that less sunlight often results in vitamin D deficiency. Vitamin D (at least partially) comes from exposure to the sun, and lower levels of vitamin D are associated with depression. The use of caffeine, alcohol and nicotine are very common coping reactions for SAD and other forms of depression. I’d recommend being tested for vitamin D deficiency and SAD. If this is underneath your depression a vitamin D supplement or light therapy may be helpful. Here is an article I’ve written on this topic with more information.

Kristina Randle, Ph.D., LCSW <![CDATA[My Son Is Showing Strange Symptoms]]> 2016-04-19T18:47:50Z 2016-04-29T11:35:06Z

My 13 year old son has been before diagnosed with GAD, but recently he has been very depressed for most of the time, and only ever showing signs of happiness when he has food or toys. He spends most of his time alone, but his grades are fine. He never really wants to leave the house, and he never wants to socialize with his friends anymore. 2 years ago he switched to a private school for middle school, and we thought smaller classes would be better for him participating, but he is now detached from all his friends. Also, he gets very angry for no reason at me or my husband or people that have not directly done anything to harm him. He can get angry from the slightest thing. He seems to have trouble sleeping, and he says it is from thinking of something really said or worrying, and he cannot stop thinking about it. Girls do not hang out with him, but with many of the richer more popular boys, they like. He used to love doing a lot of things that he does not find enjoyment in anymore, and he doesn’t play sports. Many of the other kids make fun of him for being a nerd. He is mainly alone at school, and he stays away from the only people that he is friendly with because they can be fun when he is happy, but if he is sad, or angry, they drive him crazy. What can I do to help him?

A. Your son was diagnosed with generalized anxiety disorder and he might also have depression. Depression and anxiety commonly co-occur. He needs help.

The best way to help your son is to facilitate his consulting a mental health professional. It might be best to choose a professional who specializes in working with teens, preferably teenage boys. Counseling could help him understand what’s wrong and work through whatever is bothering him. Family therapy might also be helpful. Upon your initial consultation, you can discuss whether individual or family therapy (or both) would be the most appropriate treatment.

What you want to avoid, is minimizing his symptoms. Don’t regard them as a “phase.” Recognize that intervention is necessary and do whatever is needed to find him good help.

A recently published book underscores the importance of not minimizing the symptoms of mental illness among teen boys. Sue Klebold is the mother of Dylan Klebold, one of the Columbine High School shooters. In her book, A Mother’s Reckoning: Living in the Aftermath of Tragedy, she writes with sincere regret about how she overlooked and minimized the psychological problems of her son. Her son’s problems seemed so normal at the time but we now know that his problems were anything but normal. Dylan was profoundly suicidal and his mother had no idea just how much he was suffering. Most teenagers never act out violently or become school shooters but even so, there is great value in her book. It can help parents recognize teenage depression and its many forms before it’s too late. All proceeds from the book will be donated to mental health charities.

You will be doing your son a great service by facilitating his involvement with mental health professionals. It could mean the difference between him having lifelong psychological problems and his prospering in life. Study after study consistently shows that mental health concerns are as important as those of physical health. Please take care.

Dr. Kristina Randle

Dr. Marie Hartwell-Walker <![CDATA[Too Extreme and Frequent Mood Swings]]> 2016-04-19T18:22:54Z 2016-04-28T18:45:04Z

From India: Sometimes I feel so energetic, fresh, free and confident, I could say anything to anyone without hesitation. These are the times when I wonder why I ever get sad. But when I do get down, it’s intolerable, I feel desperate, restless, nauseated, I feel my stomach churning, a gut wrench, I cannot sleep, I keep turning, I get suicidal thoughts such that I often plan my suicide, I wish to cry and just keep sleeping. Right now, I’m feeling such a low, but a mere 3 hours ago, I was something else, I was dancing. I wouldn’t wish to self diagnose and I believe that Bipolar doesn’t have such quick and frequent swings.

A: Thank you for writing. You’re correct. It’s not a good idea to diagnose yourself. And I can’t do it on the basis of a letter. Do see a mental health counselor for a thorough evaluation. You deserve to know what you are dealing with. Although Bipolar is a possibility, there may be medical or other psychological reasons for your feelings and behaviors.

Just for your information, though: Rapid Cycling Bipolar Disorder is a subcategory of Bipolar Disorder. Here’s a quote from the website of the Depression and Bipolar Support Alliance: “Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. With rapid cycling, mood swings can quickly go from low to high and back again, and occur over periods of a few days and sometimes even hours.”

If that does turn out to be the problem, there is treatment that can help. Do talk to the mental health counselor about your options.

I wish you well.
Dr. Marie

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[Supporting My Boyfriend’s Parents]]> 2016-04-19T18:20:41Z 2016-04-28T11:35:48Z

My boyfriend and I have been living together for almost a year. I know that he is the man that I am going to spend my life with and I have no doubts about that. We live in his home with his parents and because they are not working we completely support them and pay for everything. His mom has a multitude of health issues and is in her 50s she hasn’t worked in over 20 years. His dad is 46 and stopped working after hurting his knee at work when my boyfriend was 18. Since then my boyfriend has been supporting them completely. My boyfriend is a caring and loving man and his parents take advantage of him. They are not appreciative and always expect him to provide them with whatever they want—his dad in particular. At first when I moved in things were okay but recently it has been very hard. His parents both smoke in the house and no matter how many times we talk to them about it, it continues. They are constantly in our business and wanting us to run and get them things. Recently his dad came into a decent amount of money and with that money he was supposed to buy a vehicle, he did not. Instead his dad takes my car almost everyday and is gone until it’s time for me to go to work which just leaves me sitting at home. I want so badly to move out and have our own place just me and my boyfriend. But we cannot afford to pay for our own place and a place for his parents. My boyfriend is completely unwilling to wean his parents off of his support and I fear that we are going to be stuck living in the same home with them forever. We are only 25 and it feels like we are never going to have the chance to have our own family. I get so angry because his father is mostly just lazy and unwilling to work and would rather just have his son take care of him forever. He has the attitude of an unable elderly man when in actuality he is younger than my parents who both work. My dad had the same knee injury as him and got it fixed then went back to work. He didn’t forever stay “disabled” and expect me to take care of him. It’s beginning to feel impossible living with them and I am so depressed and discouraged. I sit in my room all day long and avoid his parents because I feel uncomfortable and when I hear them complaining it makes me angry. Am I crazy for thinking we deserve a life of our own? And am I selfish for thinking that if we just moved his parents would figure it out? They aren’t children, they’re adults and I’m getting really tired of caring for them like children and everyone I bring this up to my boyfriend he makes excuses for them and dismisses my feelings and just says he’s sorry but that’s just how it is. I can’t take it anymore. I need advice. Please. Thank you.

A: While the two of you making the effort to help his parents is admirable, it may be exactly the wrong thing to be doing. Helping his parents help themselves is a better way to approach this. The plan should be clear and with a distinct timeline that you are going to move out on a certain date and time — and that they will have to start looking into other sources of getting their needs met, such as social security disability, vocational rehabilitation, etc. If you allow yourselves to be an endless funding source with no plan of extracting yourself you may be enabling their lack of motivation to change. In other words, you might be the very thing that is keeping them stuck.

I would highly recommend a family or couples therapist to help you extract yourself from this situation. Supporting his parents at 25, with no plan to stop, will perpetuate the situation rather than resolve it. You can find a therapist near you by clicking the find help tab at the top of the page or you can look at people registered with this organization. I’d rather see you struggle with feeling a bit guilty for taking this path than feel resentful for the rest of your lives for not. The time for change is now.

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

Kristina Randle, Ph.D., LCSW <![CDATA[My Daughter Blames Me for Her Suicide in Her Farewell Letter. How Can I Survive?]]> 2016-04-19T18:00:34Z 2016-04-27T22:45:49Z

From Netherlands: Our beloved daughter committed suicide at age 20 on 9 September 2014. She was a brilliant student but had difficulties with her studies and holding friends. She was depressed and liked to be home with us her parents and sister. She was diagnosed with autism or schizoid. She decided not to be treated. She could never express her feelings, she said she could not feel. She took pills and left us on 9 September 2014.

We found an extensive farewell letter in English called ‘Lost cause’ of 16 pages. She describes the trauma coming early but not saying what is was. She said love was supposed to be something special. She was always feeling guilty about her parents potentially breaking up and not understanding why others did not see it her way. She called herself empty and got directions about feelings from her ‘inside thing’ taking over since age 5. She left us also a copy of an article about priming trying to make clear why she was so upset about breaking love and used priming to make a link to her past at age 5 when I had an affair and left home for 2 months and my wife cried a lot. My daughter states in her letter: don’t leave, we can work it out, we don’t need money.

Ever since finding the farewell note O blame myself that she had relationship trauma and became schizoid of this. I am seeing a therapist but I blame myself and cannot find a way to prove that a break up of 2 months could not have caused her death. A copy of her farewell letter can be forwarded.

A. Mental illness can be difficult to treat. In your letter you said that she chose not to take treatment. Without treatment, there is very little chance of improvement. With the course that she chose her suicide is not to be unexpected.

Her suicide is a result of her mental illness and that is clear. What you are questioning is the cause of her mental illness. With schizophrenia and autism there is no evidence to suggest that the actions or inactions of a parent can cause these disorders. This research is objective and if there was a possible link to the actions of a parent as the cause or a potential cause of these disorders, it would have been reported in the literature.

Unfortunately, it is very difficult and in many cases impossible to force someone into therapy or to take medication. There are many family members, who have loved their daughter, brother, mother, sister, father, etc., as much as it is possible to love and still they were unable to get their very loved family member, to accept treatment.

It is safe to say, that leaving your wife and child for two months did not cause your daughter’s schizophrenia or autism. Leaving for two years would not have caused your daughter’s mental illness. Divorcing your wife and never again contacting her or your daughter, would not have caused your daughter’s schizophrenia or autism. It is obvious from your letter that you love your daughter very much. It is also safe to say that from what I’ve read, at least in my opinion, you would have very gladly given up your life for your daughter, and if it would bring her back you probably still would. However, even sacrificing your life for your daughter would have neither prevented or cured her schizophrenia or autism.

If you had never known that you had a daughter, if you had never known that you had impregnated her mother and thus never even known of the existence of your daughter, her schizophrenia or autism would still have occurred. Her death was a result of her mental illness, just as surely as a death caused by cancer.

Use the love that you have for your daughter, take that love and spread it in the world by doing good for others. Honor your daughter by helping others. Spreading flowers on her grave will not help your grief. Spreading love in this world will.

Good luck my friend.

Dr. Kristina Randle

Dr. Marie Hartwell-Walker <![CDATA[Terrible Fear that I Am Going to Kill Myself or Someone Else]]> 2016-04-19T17:55:18Z 2016-04-27T16:35:38Z

From a teen in the U.S.: For months, I have been having thoughts that I am going to kill myself or my family. I am afraid that I am a killer and not a good person, and this has made me want to kill myself to avoid hurting someone else. I have been diagnosed with OCD, specifically harm OCD, but I’m just having trouble believing that I’m not just an awful person. I never actually want to hurt anyone, but there are times when I feel like I have to, like my brain is telling me that it has to and is going to happen. I feel out of control.

I’ve also been having some issues with suicidal thoughts. Most of the time, it’s not that I hate life, it’s just that something inside me is telling me that I should kill myself. It’s not like a voice that I hear or anything; I don’t think I’m schizophrenic.

Do I really have OCD, or are my thoughts indicators that I have some sort of murderous or psychopathic personality? And how should I deal with these suicidal impulses?

A: The first thing to do is to see a therapist. You said you’ve been diagnosed, but you didn’t indicate what you did with that diagnosis. I hope you are seeing a therapist regularly. The therapist can monitor and perhaps refine the diagnosis, can reassure you and can teach you new ways to manage your anxiety and the obsessions.

I doubt you are a bad person. I do think you are suffering and you deserve help. OCD is particularly responsive to a combination of some medication with talk therapy. Most people need the combination — at least to start. If you haven’t started therapy, please ask your doctor to refer you to a clinician who specializes in OCD. If you are in therapy, I hope you sharing your thoughts and concerns honestly and completely. Your therapist only knows what you choose to share. Although your thoughts may be frightening for you to talk about, you owe it to yourself to bring them up in session so they can be dealt with.

I wish you well.
Dr. Marie

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[Confusion about ADHD Medication]]> 2016-04-19T17:55:06Z 2016-04-27T11:35:40Z

From Denmark: Hi, I am living in Denmark, I found your website, very interesting about ADHD and, I have a question about medication, which I would to have some advice about. And sorry if my message is a bit long.

I am a 35 male, diagnosed with ADHD, for 4 months ago. I do work as a doctor, taking my residency in orthopedic surgery. Due to the stress at work, my symptoms were aggravating, and I was at the point of loosing my residency. That’s why I sought help, at a psychologist and a psychiatrist, who diagnosed me with ADHD.

1) I started with 5 mg Ritalin, increasing to 20 mg x 1, which was the optimal dose. Then I started to take it 3 times a day. It was very good. But I was interested in taking a drug that lasts a long time so I do not need to take it many times.

2) My psychiatrist, changed me to Concerta 18 mg x 2, and then increased 36 mg x 2. But I could feel nothing at all. I felt kind of depressed.

3) My psychiatrist changed me back to Ritalin long long lasting, this time, 50 mg x 3 a dag. I had no sideffects, and it was working I got more productive, and the inner and outer restless disappeared, so I could sit and study quietly and focused. The problem is that I have to take it every 3,5 hours, which is not optimal at work, and after 3-4 weeks I starts to get ticks in my eyes and tachycardia.

4) Lately my psychiatrist changed med to Vyvanse 50 mg x 1 and Ritalin 10 mg as a supplement as needed. The problem is I cannot feel any changes with Vyvanse, other than no appetite, I feel a lot of inner and outer restless, I cannot sit and study, I start procrastinate. But as soon as I take 20 mg Ritalin. After like 25-30 min. my body quiets, no restless legs, no inner anxiety.

My questions are:
– should I increase Vyvanse to 70 mg ?
– Is it better to go back long lasting Ritalin ?
– I have night shifts sometimes ( 15:30 – 09:00) … who should I take medication there ?

Sorry for the long mail, but I hope you can give med some advice.
Thank you

A: As I am not a physician I cannot give medical advice, but I can point you in the direction of some comprehensive information about effective medicines and concomitant treatments. This article will give you some excellent information on the medicines — but perhaps more importantly — information about concomitant treatment with psychotherapy. The combination of medicine with therapy tends to be most effective. As your email only focused on the medical aspects, I thought sharing some of what we know about other effective treatments would be helpful.

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

Kristina Randle, Ph.D., LCSW <![CDATA[Hunger to Kill]]> 2016-04-19T17:54:55Z 2016-04-26T22:45:43Z

I get a hungry feeling when I think of murder. The blood, the meat, it fascinates me. I’m always thinking of the kill. I’ve never done it though. But I’ve done horrible things that are illegal, cheated on tests, lied and had sex with other women while having a girlfriend, etc. I know I’m insane, nothing will change the psychopathy in my deranged soul. But I’d like to know why I want to shoot people, even children. I was bullied a lot in school though. Maybe that’s it?

A. People who have been bullied or abused often feel weak and powerless. Their fantasies might involve situations where they stop being victims and become the victimizer, having all the power and control. Fantasies about harming people can give someone the feeling of ultimate power and control, even if only temporarily. No one likes to feel weak and powerless.

Sometimes, it isn’t clear why people think the way they do. In many cases, it doesn’t necessarily matter why. What matters most is preventing violent behavior. This is especially true for people who struggle with self-control and impulsivity. When those issues arise, it is clear that professional help is needed.

You mentioned that you were “insane” and that nothing will change the “psychopathy.” There is an important distinction between insanity and psychopathy. Insane is a legal term, not a medical term. It essentially means that someone has trouble distinguishing reality from non-reality (psychosis).

Psychopathy is a term used to describe a set of personality characteristics in which a person engages in illegal and immoral behavior, is fully aware of what he or she is doing and simply doesn’t care. Generally, people are not both psychotic and psychopathic (but it can and does happen).

You admitted to doing what you described as “horrible things.” That would suggest you might have harmed people or animals and you should do everything in your power to prevent this from happening again. When you harm others, you are actually harming yourself. If you engaged in the fantasies that you described, your life as you know it would end. You could easily find yourself in prison for the rest of your life, deprived of your freedom and living in a cage. Life in prison is more torturous than you could ever imagine. It would be in your best interest to seek help as soon as possible. Please take care.

Dr. Kristina Randle

Dr. Marie Hartwell-Walker <![CDATA[If He Recovers from Depression, Will We?]]> 2016-04-19T17:54:42Z 2016-04-26T16:35:38Z

From the U.S.: A little over a month ago, my boyfriend decided he was no longer happy with me and broke off our four year relationship. He thought I didn’t trust him. He thought I wanted to keep him isolated.

Lately, he parties more, eats less, doesn’t want to be around his friends or his family, has difficulty sleeping, and seems generally sad and/or angry.

In the last week, I’ve tried letting him know that I will always be there for him. I wrote him a note that let him know how much he meant to me, and how I am happier having him in my life.

He keeps saying he doesn’t to hurt me. He keeps apologizing for letting me down and hurting me, no matter how often I let him know that he isn’t doing anything wrong. I try to bring him out with me and invite him to spend time with our mutual friends. He tells me he would rather stay in, but then it seems he does not come home. I eventually moved out of the house we rented together. I’ve suggested having him see a therapist about possible depression, but he is adamant that this is not an issue for him.

I don’t know if the breakup was caused by depression (he lost a family member back in September and has been undergoing a lot of stress since then). And I wanted to know if it’s possible that the breakup was caused by that depression. Do people who end their relationships because of depression end up back with their spouses? How do I help him recover from the depression if he does not believe he’s dealing with it?

A: I’m sorry this is so difficult for you. It was wise of you to leave the house. Sharing space while the two of you sort this out would be painful.

I’m not convinced from what you wrote that your boyfriend is depressed. It’s possible, of course. But it’s also possible that he is trying out what it means to be on his own and is partying with the idea that he is reclaiming being single. He may be trying to meet new people rather than hang out with people who know you both and who have opinions about who he is and what he should do.

If he is depressed, there is nothing you can do to encourage him to get help that you haven’t already done. But if he is truly wanting to take a break from the relationship, the best thing you can do is take some distance for yourself.

What you didn’t mention in your letter is how you are doing. I imagine that the possibility of really losing him after 4 years is very difficult. I hope you are taking care of yourself and thinking about how to move forward if he decides it is truly over between you. Do reach out to friends and do whatever you need to do to grieve, to learn from the experience and to heal.

I wish you well
Dr. Marie

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[Terrified of My Father, Nightmares that He Will Kill Me]]> 2016-04-19T17:54:34Z 2016-04-26T11:25:57Z

My father has always had issues with drugs, drinking, and anger issues. All three together are just toxic. He is fine, fine, fine – for weeks/months – then will decide he doesn’t need his meds (for his anger problems) and go off them. Within a day, he is a raging lunatic. Screaming, yelling, hitting my mother, breaking doors, snapping his cell phone in half, kicking the dogs. Recently he started cheating on my mother as well, he keeps denying it even though he has been caught. He is driving while extremely drunk, ignoring all calls, and coming home from work 5-6 hours late.

I am trying to continue living at home until I finish college, so I can save and have money for a house when I graduate, instead of moving out and paying rent. If I moved out, I’d likely need to quit school to work two jobs to support myself. I really want to just finish school and get on with my life, have a good life – but living in this house is starting to effect my mental health. I have dreams about my father killing me and my family, several times a week. I have to tip toe around him – sometimes, even just making eye contact will set him off. I’m extremely stresses and worried in my own house. I’m scared to leave my mother and sister and dogs alone with him. Often, when I get home from school at night, I brace myself to walk in and find that he had killed them.
I really just don’t know what to do. I’ve struggled with depression and anxiety since my early teens but I’ve learned to cope fairly well – but in such a toxic environment I find it hard to stay in a good mental place.
I’m faced with choosing between living in constant fear and worry, or finishing school to have the life I always wanted. Help, please?

A: Your mental health is more important than anything. Living in that kind of chaos and fear won’t serve you well. Don’t defer your moving out. Start the process of looking for solutions rather than tolerating the abuse. I recommend talking to financial aid at your university — asking about housing (both on and off campus) — and speaking to the counseling center (and the women’s center in your county.) There may be resources to help you with finances, living arrangements and therapy as you transition out of your house — and into your independence.

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

Kristina Randle, Ph.D., LCSW <![CDATA[I Feel Embarrassed to Go Out and Meet New Friends]]> 2016-04-19T17:54:23Z 2016-04-25T22:45:18Z

I’m taking Renax 0.5 Alprazolam medicine and Risperdal Consta Risperdal injection. Doctor prescribed Renax 0.5 half pill when needed for anxiety. But haven’t told him about having the phobia and panic attacks. The appointment is in one month from now. Is this Renax drug suitable also for phobias, social phobias and panic attack also? How much maximum pills i can take per day? Now i’m taking half pill of a whole pill that is 0.5mg per pill. Also in how much hours i can take another one? I want to take more per day
as alprazolam have immediate action.

A. These questions would be best answered by your prescribing physician. Each person’s situation is different and the answers to your questions will be specific to you.

You mentioned feeling embarrassed about the prospect of meeting new friends. As you noted, this may be due to your untreated social phobia and panic attacks. Be certain to report your these symptoms to your doctor. He can’t treat symptoms that he doesn’t know you have. Once your symptoms are more under control the prospect of meeting new people should no longer frighten you.

If these issues continue to be a problem, then consider counseling. Medication helps to reduce or eliminate anxiety and counseling can teach you the skills necessary for social interaction. One without the other is often not enough. I would highly recommend it. Please take care.

Dr. Kristina Randle

Dr. Marie Hartwell-Walker <![CDATA[Unhealthy Obsession with a Celebrity]]> 2016-04-19T17:54:16Z 2016-04-25T16:35:36Z

I’m 18 and am deeply obsessed with a celebrity who’s 15 years older than me. I’m unable to concentrate on my studies and everything. He’s a singer and the thought of his voice makes me love him all the more. I’ve been wasting all my time searching about him watching all his interviews, performances, etc. I think I have an intense-personal level of obsession. I can’t stop myself from imagining myself with him..HELP!

A: The most important thing you said is “help.” You know that you are out of control. That’s the first step toward getting back in charge of your life.

Often, when someone like yourself is obsessed like this, it is in the service of avoiding something that is troubling or frightening. At 18, you are at a time of life when there are many important decisions to be made. Will you go out to work or will you go on to more school? Whether work or school, what is your life/career direction? Will you leave home or will you continue to live with your parents? Are you interested in getting involved with someone? You are certainly not alone if questions like these make you anxious.

The fantasy keeps you occupied and prevents you from experiencing romantic rejection. But it isn’t helping you get on with life. By asking for help, you’ve admitted to yourself that you can’t get out of the spin on your own. I hope you will listen to your wise self and get the help you need. A therapist can help you put your attention back to where it belongs.

I wish you well
Dr. Marie

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[Self-Harm]]> 2016-04-19T17:54:00Z 2016-04-25T11:25:33Z

From Ireland: Sometimes I don’t know how I’m feeling and cut myself. Whenever I cut I don’t go deep at all. I barely cut the surface and I doesn’t even really leave any scars… lately I’ve been punching my arms and leaving these bruises. I’m close with my mum but no I don’t want to tell her. I don’t even know what I’m thinking or what’s wrong so what’s the point, I don’t want to cause any trouble and don’t want anyone to know. My parents can get quite strict and I don’t want to tell any of my friends because they would tell a teacher or my parents and that’s just not what I want. I get in such bad moods and get quite tired and just want it to stop and I think that could be one of the reasons I self harm. I also find my past relationship with my dad and brothers to upset me even thought we get along well now, id say we are quite a vocal and physical family went things get heated sometimes I just feel trapped. Wow I don’t think I’ve ever even looked for advice before so I guess this is a start.

A: A very good start — and I think the right place to begin. You are showing a tremendous amount of courage by explaining yourself here. You also show good insight by linking your bad moods and tiredness to the self-harm. Sometimes, when there is a lot of pain inside, the self-harm moves it to the outside so it can be seen.

I can understand you may not want to tell your friends or a teacher or your parents. But telling a physician would be the next step after writing us here. First of all, the physician can check out the cuts and bruises to make sure they are healing properly. This is when you can talk to him or her and ask what the next thing to do is. Telling a medical professional who has had training in how to help is the best thing you can do for yourself right now. It is time to be brave and continue what you’ve started here.

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