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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5109
Experience:  Dr. Mark is a PhD in psychology in private practice
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Hi, Im a 23 year old female and for many years now Ive wondered

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Hi, I'm a 23 year old female and for many years now I've wondered if I have some kind of personality disorder. I'll go through short bouts of feeling like I'm going insane every month or so. Usually, this 'insanity' causes me to have a sense of foreboding, complete terror, depression, and anger and frustration when all I want to do is scream and break things. Quite often I'll also feel completely dissociated from my surroundings and almost like I'm walking around in a dream. Large crowds and lots of people will induce panic and stress in me, and sometimes when I'm walking around all I'll want to do is stop still or sit down on the ground. I'll also have urges to throw myself in front of traffic, and I have awful self-destructive thoughts in my head that I can't stop (for example of cutting my limbs off or stabbing myself etc). I dislike myself entirely in my looks and as a person and just want to hurt myself when I think of things I've done around people, even if these are completely normal things like talking to someone about their favourite films.

I'm OK in my life right now - I have a good education, good job, good family relations and a good boyfriend. I recently found out that my boyfriend was a bit of a 'womaniser' before he met me which I think has caused the latest bout of what I have described above. I'm terrified he's going to leave me to sleep around again even though he's promised he won't and deep down I know that's true. I usually end up taking these things out on him by getting really paranoid and questioning him about ridiculous things and getting upset over very little. This has pushed him away a lot in the past and I'm worried one day it'll push him away for good. I also feel completely inadequate around him as I've only had half the number of sexual partners than him, which again causes me to push him away and hate myself.

I was bullied quite badly (psychologically - there was hardly anything physical) between the ages of 11 and 18. I spent the whole time wondering why these things were happening to me as I wasn't a bad person and hadn't done anything to them. I was very depressed and used to fantasise about killing myself during this time. I was hoping that when I moved away from those people these feelings would stop, but if anything they've just increased in intensity and new feelings have been added.

Please help me by letting me know what might be wrong with me and what I can do to stop this. I don't want to go to a doctor or for counselling as I don't think I could talk about this to anyone face-to-face. I know so many other people have been through so much worse and I feel like a very weak pathetic person for being like this.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! I believe I can be of help with this issue.


First let me say that I can imagine how difficult and frustrating this situation must be for you. On one hand you have such extreme symptoms and emotions but on the other hand you feel shame at your symptoms and don't want to have to face professionals and tell them what's going on with you.

And this is actually the key to my answer to you that you need to think about and consider and act on. That you are still hopeful and seeking help is a very good thing. My answer is going to focus therefore on three things: first, on HOPE itself, second on your shame, and third on the the type of psychotherapy I recommend for you. I will also at the end of the posting give you a technique you can use on your own as well for when you are in the throes of depression, anxiety, or hopelessness, or panic. Because whatever the diagnosis will finally be, whether a personality disorder, a traumatic disorder, or a mood disorder, what you are dealing with is at times a depressed state and other times a state of anxiety. Like wanting to sit down in public seems to be an anxiety induced panic reaction.

First, though, hope:

To bring you a measure of HOPE and some confidence, I'm going to take a moment to have you bookmark two videos that will give you just a moment's break from your own difficulties and will be inspiring. It's not to be curative; it's to give you a sense that we all live in the same world and we all have such different challenges and tests and we all have the ability to come to a good place in life:

Here's one about a young man who has a hard road in life but also had a dream:

http://vodpod.com/watch/1165857-walk-on-espn-video

The next is about a severely autistic girl. Let's see if she can help us here just a bit in the hope department:

http://www.youtube.com/watch?v=a1uPf5O-on0

Now on to the second point and something that is so important for you. Your shame and feelings of unworthiness are very important features of who you see yourself to be. Shame is so important that you are willing to endanger your relationship with someone you love and on in this state of misery rather than face having to tell a psychologist and a psychiatrist of what is going on with you. I am very hopeful that the discussion on hope and my placing your shame in such sharp relief in front of you will make you see how this is part of the disorder, not a feature of who you ARE. Shame is a reaction. You do not need to act from it. So, I want you to accept that shame is one of the things you will need to work on in therapy but that you will commit to not letting it STOP you from therapy! Use the technique at the end to propel you to call the psychologist and psychiatrist and get the help you need.

Okay, on to the third part about psychotherapy. You need to find a psychologist to help you with the underlying CAUSES of these symptoms, who can help you also get to a psychiatrist for a full evaluation and to see if there are medications that can help in your treatment. You need to feel comfortable with the psychologist and I don't want you to accept just any psychologist. You have the right to interview them until you find one who you feel comfortable with and that you feel will understand your experience!

I have found that with your situation you will do better with a more introspective, humanistic approach in therapy. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades.

I would like you to interview psychologists who have a more humanistic focus. For example, one therapy that might be very useful to you:

The therapy is called Focusing. It was founded by a great psychologist named Eugene Gendlin. I use these techniques in my practice often. Here is the link to the Focusing Institute:

http://www.focusing.org/

They have a list of certified therapists and you may find one in your area in the UK.

Here is the web address for the UK association of humanistic psychotherapists. I want you to be very careful to make sure you get a psychologist because your symptoms have been and continue to be very severe. I want you to ask the psychologist if he/she is experienced in trauma work and personality disorders. This is important. Also, it is important that he/she not be against medications and have psychiatrists to refer you to. Here's the web site; they have a search for therapists there.

http://www.ahpp.org/

The idea here isn't that these types of therapy are magic. It's that I want you to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions and panic reactions. You need to explore this if therapy will be ultimately worthwhile. Okay. So, hope and dealing with your shame. Those are the first orders of business! Then getting the help you need. I wish you the very best!

Now, I want to give you a tool to use for when the depression is overwhelming or there is anxiety panic. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks and for feeling as though you are in a dark hole of depression as well.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in a panic attack is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class for seniors and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

 

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5109
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
Relist: Answer quality.
Expert:  Dr. Mark replied 3 years ago.
Hi, I'm sorry I was off the mark with my answer. I'll be glad to try again if you tell me what I missed as I tried to be as thorough and comprehensive as I could be.

If you feel you received some benefit from my answer, pressing the accept button will be appreciated. If you feel you want to try again with someone else, the easiest way is to just abandon this question and re-ask your question again. You can then re-use your deposit in the other question.

Dr. Mark

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