Apologies to people who have answered this question before, but I found the answers insufficient. Giving the consequences of playing out the urge does not make the feeling disappear. I am seeking an explanation or, hopefully, a solution.

I am extremely neurotic. I do express empathy and I immensely seek acceptance from others.

The urge to kill is such an overwhelming and powerful emotion that someone who has experienced it cannot go without lingering on it. I have experienced this feeling since I was 10; I’ve always drawn morbid images and enjoyed the soft, pleasant, sickly throb in my stomach that often accompanies the feeling. I am now 17 and am beginning to find it an issue. I am extremely scared of myself – not because I don’t understand it, but because of regret. I know I would regret hurting someone I know after being withdrawn from this state of mind. I am usually able to appease (or provoke) the urge through drawing or viewing morbid images, such as gore, or playing through fantasies in my head (I believe I have a very vivid imagination). I often provoke the feeling when I’m feeling depressed or anxious, as it completely overrides it. I have a bad relationship with my parents and would like to avoid talking to them about it. Three of my good friends are aware.

Background: I have been feeling much more depressed and anxious as of lately. I dropped out of my high school last year to continue the work at home, as I was constantly self-conscious about myself in general and I couldn’t take the anxiety that came with that. While I was in school, my grades fell fast due to this anxiety; dropping from the top 5 best grades in the year (first in chemistry, English, Chinese and biology) to some of the lowest by Year 10. My confidence disappeared. I already had a low self-worth and self-esteem, now accompanied by a very low motivation in work and life. My anxiety has almost disappeared and depression has settled in a lot more now that I do work at home, but I believe I can manage it well enough. Thank you.

A. I don’t think it’s a coincidence that your urge to kill co-occurs with depression and anxiety. It could be the reason why the urge exists. Eliminate your mental health symptoms and your urges may also be eliminated.

You could also be using it to suppress the unpleasant feelings that accompany depression and anxiety. You “often provoke the feeling… when depressed or anxious, as it completely overrides it.” The urge might serve as a psychological Band-Aid in the same way that some people use cutting to feel something other than intense, unpleasant emotions. People who engage in cutting will often say that it offsets or redirects their psychological stress. It is not an advisable or effective coping mechanism because it side-steps the underlying problem but people use it nonetheless.

Think about why people use drugs and alcohol. It suppressed unpleasant emotions. It is a form of avoidance. It is temporary and ineffective because once the high wears off, the emotions and problems of life return. Still, people use it. Perhaps your urges serve a similar function.

Dropping out of school, to study at home, may have been a mistake. You did it to avoid triggering your psychological issues but avoidance is not a cure. School provides the opportunity and the necessity for social interaction. Social interaction is necessary as long as there are other people living on this planet. Social interaction should not trigger unpleasant feelings of any kind, certainly not anxiety or depression.

When mental health problems arise, it is not the norm for people to seek professional help. There are many reasons why and many books have been written on the subject but it essentially boils down to people not wanting ask for help because it makes them feel week. Self-reliance and rugged independence are seen as virtues. People do not like to feel weak and thus many will not seek help. Unfortunately, that results in their suffering with curable problems.

My recommendation is to seek counseling. Once you begin treatment, you will see the world differently. You will realize that depression and anxiety don’t have to rule your life. Don’t just manage your symptoms, eliminate them. With counseling you will learn to effectively handle problems and stressful times without defaulting to avoidance as a coping mechanism. Avoidance doesn’t improve mental health. It only acts to strengthen psychological problems.

I hope you will consider my advice. Ask your parents to assist you in finding a local therapist. Choose a therapist who specializes in depression and anxiety and with whom you feel comfortable. Working with someone you like increases the likelihood of a positive outcome. Good luck and please take care.

Dr. Kristina Randle