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Should I Be Concerned?

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I am under more stress lately than I have been at any other time in my life. This is largely due to some major life changes– marriage, job change, moving away from my hometown– all happening at once. I am very happy about all of these for the most part, however.

Meanwhile, I’ve been having what feel like unusual psychological symptoms for several months now. I wonder if these can all be put down as to reactions to stress or if there is some larger issue that needs addressing.

To summarize, I began having troubles with self injury and mild dissociation (sometimes referred to as depersonalization according to the reading I’ve done) several months ago, off and on. I believe I understand how and why cutting is unwise, but sometimes I would do it anyway as it was a very effective way of coping for me. However, I made a strong and mostly successful effort to quit. Around the time I quit, I started experiencing extremely frequent suicidal thoughts and images. This is especially perplexing to me because I really don’t want to die nor do I feel depressed. I’ve tried ignoring these thoughts, but it has been most difficult.

Then, yesterday, I felt like I was hearing voices. I did not experience them as coming from outside my head, nor was I deluded into thinking they were anything other than my mind playing tricks on me. But I did experience it as a voice speaking inside my head, and as an interruption to my conscious thought processes. It was questioning whether my life was worth living, and urging me to harm myself.

Sometimes I maintain inner dialogs with myself, which I assume is fairly normal and harmless. This was not the same thing.

I don’t know. Ignoring it was fairly easy, but I’m wondering what all these symptoms could be pointing to, if anything. I realize you cannot diagnose over email, but could you give me any ideas of possible causes for these things?

I have been maintaining my work and social life about as usual. I’m a little more tired than is typical for me, but otherwise have not had any difficulties functioning as usual and having a healthy and normal family life.

Since these problems are not affecting my day to day existence, I wonder if they are even worth addressing. Still, they seem so bizarre and I’m honestly rather concerned. Please point me in the right direction, if you can.

Should I Be Concerned?

Answered by on -


You are describing a most unusual situation. On one hand you describe a part of your life in which you are able to function well. You are able to maintain work and your social life as usual. You say that other than being tired you basically have a healthy and normal family life. On the other hand you report experiencing very serious psychological symptoms which include suicidal ideation, voices telling you to harm yourself and dissociation. You also have instances in which you are driven to purposely injure yourself as a way to cope (although you did not say what self injury specifically helps you cope with). What is unusual about your situation is that typically when an individual is experiencing the type of psychological disturbances you’ve described (i.e. self-injury, suicidal ideation, etc) these symptoms tend to permeate all aspects of their life, not just compartmentalized parts. You described being able to “fairly easily” ignore the symptoms and even wondered whether they are worth addressing. It’s almost as though you are experiencing two distinctly different realities.

If I were able to meet with you in person I’d have many questions about your experiences. I would be trying to ascertain the frequency and severity of your symptoms as well as explore more thoroughly the voices, self-injury and dissociation. Without having access to much more information about your situation it is difficult to know what exactly you are experiencing. The fact that you are able to ignore these symptoms indicates possibly one of several things: (1) the symptoms are infrequent and not severe; (2) you are not reacting appropriately to your symptoms and thus have misjudged the seriousness of your situation; or (3) you’re experiencing a high level of dissociation. Please know that this assessment is based on very little information and therefore may be incorrect. Also, there may be other possibilities to explain your symptoms that I have not mentioned here.

Generally speaking you should never disregard self-injurious behavior, suicidal ideation, voices or dissociation. It may be easy to ignore these symptoms but I would never advise anyone to do so. You should be evaluated by a mental health professional. An evaluation is necessary to determine what if any treatment you should receive. What is good about your situation is that even though you seem to be experiencing serious psychological symptoms they have not affected your work, social or family life. This is very encouraging. To ensure that these aspects of your life remain uninterrupted please consider being evaluated by a mental health professional. Thanks for writing.

Should I Be Concerned?

Kristina Randle, Ph.D., LCSW

Kristina Randle, Ph.D., LCSW is a licensed psychotherapist and Assistant Professor of Social Work and Forensics with extensive experience in the field of mental health. She works in private practice with adults, adolescents and families. Kristina has worked in a large array of settings including community mental health, college counseling and university research centers.

APA Reference
Randle, K. (2018). Should I Be Concerned?. Psych Central. Retrieved on May 25, 2019, from
Scientifically Reviewed
Last updated: 8 May 2018
Last reviewed: By a member of our scientific advisory board on 8 May 2018
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