I am 19 years old and I have had depression on and off for the last 9 years, since my grandfather died. Anxiety runs in my family and around the time I turned 18, I started feeling the symptoms of that as well. I constantly feel a need to hurt myself, whether through driving myself to despair, hurting myself physically through hitting/scratching (and one time, cutting), and drugs, alcohol & cigarettes. I have always had low self-esteem and feel like I don’t have a right to express myself or really be myself. I’m a perfectionist and have unrealistic expectations of people and myself, which of course, are never fulfilled, which always makes me intensely angry. I rarely or never express my anger though, instead always directing it inwards. I would always get in trouble for expressing my anger when I was little, so I figured it wasn’t worth it by the time I was 7. I can never trust people and always feel like they’re talking about me behind my back, plotting and are going to hurt me or leave me. I have been on prescription medication for anxiety, but it only works to an extent, I was wondering if there might be something more that you can see from my symptoms that neither my therapist nor I see.

A: Any thoughts that I would have about this are tentative guesses, at best. So please run any of these thoughts by your therapist and he or she will be able to offer you the best feedback on if these comments have any value for you.

The cutting, hitting, scratching, paranoia, lack of trust, drug and alcohol abuse, fear of abandonment, and driving yourself to despair can actually be part of a symptom cluster for something other than anxiety. My encouragement is to see a psychiatrist for a medical evaluation, and if your therapist is a psychiatrist you may want a second opinion as an evaluation to help in your therapy.

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