You should tell your therapist about your strong urges. Your therapist needs to know about everything that’s going on, especially this particular symptom. It’s a symptom that is not necessarily consistent with depression, anxiety or self-harm. The more information they know about what may be wrong, the easier it will be to ensure that you are receiving the right treatment.
You also mentioned the possibility of hearing a voice that is not yours. Hearing voices is associated with psychotic disorders such as schizophrenia. The key to knowing if you are hearing voices or if it is your conscious mind (i.e. your inner voice) typically is if the voice sounds like it’s coming from outside of you. It would be an external voice, a voice that you do not recognize. In your situation, you recognize it is as partly your voice, in combination with your mothers’ and aunts’ voices. Those voices would be recognizable to you so it’s difficult to know if you are hearing voices in the clinical sense or if you are hearing the voice of your conscious mind. That is something that should be explored in therapy. This is yet another reason why it’s important for you to report all of your symptoms.
Relatedly, you also mentioned self-harm. People who engage in self-harm often have a very critical inner voice. Negative and critical internal dialogues are also among people with depression. Possibly, the voice you hear is a critical inner voice as opposed to an external voice. Again, this is something that should be explored in therapy.
You are now beginning to question whether or not you have schizophrenia. There is a family connection. Research indicates that having family members with the disorder increases the possibility of other family members getting it too. It is hereditary, at least in part. However, environmental factors are thought to be contributors as well.
Environmental factors often include abuse and drug use, among others. A thorough mental health evaluation could help to determine if schizophrenia is present.
Regarding your family doctor, she obviously wasn’t familiar with the research about self-harm. You mentioned having engaged in self-harm to punish yourself. That is common reason why some people engage in self-harm. Unfortunately, your doctor seemed ill-informed about the reasons why some people engage in self-harm. Not all doctors would react in the way that she did. In fact, most would never have responded in the manner that she did. They would have been more supportive, open-minded and likely more knowledgeable about self-harm. Perhaps you need a different family doctor.
I understand your fear about being ridiculed, especially after the incident with your family doctor. However, I doubt you would have that same experience with a therapist. Therapists are knowledgeable about these kinds of issues and will not judge. Consider therapy a no judgment zone. If on the off chance your therapist did have an inappropriate reaction, then you can always find a new therapist. Not all therapists are the same. Some are better than others. It’s always best to find one you like and who makes you feel a little bit better after every session. Good luck with your efforts. Please take care.
Dr. Kristina Randle