Q. For the past two years I have been very depressed. I have had eating issues, cutting issues, and what I did not see as a problem but has gotten worse…skin and hair picking. I sought help of a psychiatrist after being confronted by a trusted adult about weight loss and sadness. This psychiatrist did not work out so I ended up going to a psychologist and then a separate psychiatrist for medication. The second psychiatrist diagnosed me with zoloft and risperdol (earlier this year) after speaking with me for 15 minutes..the risperdol did not work well with me at all, I was knocked out during classes at school and I constantly felt drunk..it depressed me even more than I had been and the stress from not being able to stay awake to finish any assignments or accomplish anything made me start to cut even deeper and more so than I had in the past. After being on this medication for just three days I started having serious suicidal thoughts to the point of actually having a plan. Granted I have and still do think about suicide..but it is just a passing thought and the fact that I had it planned out and was tempted to execute it made me break down at school with the same trusted adult who came to me two years back. From that break down I ended up for 5 nights in a psychiatric hospital. There I got my medication straightened out and changed my psychiatrist. After the hospital stay my mood was better than the low it had been on the risperdol..but the urge to cut was stronger than it had been in the past. I cut so deep that it would still be bleeding the next day and eventually the few who I cared about most and who cared about me found out and talked to me about this. I havent cut since the begining of May because the fear of having serious cuts on my arm throughout prom and graduation and my sisters wedding was enough to make me seriously focus on stopping and try to fight the urge and break the habit. For a while.. earlier this summer I was pretty good about not having the urge to cut and I was not skin picking or hair picking (something I continuously did through out the past two years but never thought it was serious..just annoying..and I only did it at school..though I am not sure why). Recently with the tension of going off to college..I have been making tons of lists…organizing everything (strange since I am the messiest person ever)..and my skin picking and hair pulling is at a place where I felt the need to ask about it. I get up at 3 in the morning sometimes when I can not sleep anymore (also strange seeing as I sleep for 14 hours + usually) to organize and make lists..and many times through out the day I see myself picking at my wrist..I pull out hair that is growing back on top of a scar I have had for a while. This picking at the hair..is basically picking through the skin til I bleed..until I find hair that is growing in and then pull that out before it even reaches the surface. Although this scar is the one thing I have been picking at for 2 years..the extent of how much and how badly I have been picking is getting worse and is making the scar worse. Within the past week and a half I have been pulling out hair from below my eyebrow and also cutting through the skin. Along with the eyebrow I found myself picking at my leg hair after I shave. This scared me because after getting out of the shower one morning I started picking at the hair that was deep under the skin picking away at the skin to pull out this deep rooted hair. Apparently this act of picking at my leg was an hour..I barely remember doing this and I deffinatly know it did not feel like an hour. I dont know necessarily what or why I am picking like this lately..or how I can stop it. I do see a therapist but I barely talk to her anymore about anything serious because everytime I would say something she would want to call in my parents…I learned that I could tell other adults if I needed to talk..although my problems would not really be worked through. I guess I lost the trust with my therapist and since I have not brought up anything serious in a while.. I feel extremely awkward bringing this up. I am also going to stop seeing her soon since I am moving away to Milwaukee for college. Im sorry this is long and scattered but if you could please help me with any part of this letter it would really be appreciated.

A. It sounds like you are suffering from a combination of depression, anxiety and OCD. What I would recommend for you is that once you start college later this month or early next month that you start over with a new therapist at the college counseling center in Milwaukee. I say this for several reasons. The first reason is because it does not seem as though you have developed a strong therapeutic relationship with current therapist. You’ll soon be leaving for college and probably ending your therapeutic relationship with her. The second reason I am recommending that you that start new counseling at the college counseling center is because beginning college, especially when you are moving into a new town, can be anxiety producing. You will likely be home sick and miss high school friends. It will be helpful to have support to help you through the initial move and transformation into being a collage student in a new town. The third reason for suggesting that you start over with a different therapist is that you can develop a new and hopefully more trusting relationship with him or her. Also, you may be more trusting of your new therapist since it is unlikely he or she will suggest bringing in your parents.

OCD behaviors are usually driven by unabated internal feelings that life is out of control. As a reaction, OCD suffers amend these feelings by performing rituals or giving in to obsessions that make them feel as though they have some level of control. These rituals and/or obsessions provide temporary feelings and assurance that they have control. When in reality, nothing healthy or meaningful has been accomplished.

The good news is that the behaviors (hair pulling, etc) you have described can be treated with good therapy. It is good to hear that you finally found a suitable medication combination. In sum, know that you can be helped and start by finding a new therapist in your new town. Good luck with college.