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Dr John B
Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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I seem to be more on edge these days and my dreams seem to be quite.. intense these days.

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I seem to be more on edge these days and my dreams seem to be quite.. intense these days. The problem is, even if I can't remember the details, I remember the sensation or the situation I was in and it's always stressful or distressful. I also wake up every 1-2 hours when I sleep at night and my fatigue just won't go away. Also, my friends say that my shoulders are stiff and I'm feeling discomfort because of stress. Can stress alone really do all that?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr John B replied 2 years ago.

Hi,

 

Sorry to hear of the situation. Stress (anxiety) certainly can lead to sleep disturbance and the subjective experience of more frequent or more intense dreams. Muscle tension (particularly in the shoulders) is a classic physiological symptom of elevated anxiety levels. Is there anything going on in your life at the moment that you would connect elevated anxiety to?

 

Disturbed sleep will quickly lead to fatigue during the day and if your are waking every 1-2 hours it would be understandable if you are feeling fatigued. Sleep disturbance and fatigue can also occur when a persons mood becomes low (mild depression).

 

How long have these symptoms been going on for?

Customer: replied 2 years ago.
Disturbed sleep has been going on for about a year or two so far.

I'm at a point in my life where I am already in my fifth year in college (super senior) and I'm having slight inferiority complexes to my friends who seem to be moving on with their lives. And I'm not doing so well in school despite the effort I'm putting in. I'm guessing I feel rushed? But that started around August, just before school started, so I'm not sure why I haven't been sleeping well before that.

But this whole stress thing has been going on for years. Probably since I was around 15 years old. The extent of the stress' effect has been different over the course of the years, and I've been on edge a lot, but I've never had THIS much physical pain nor have I had so much trouble sleeping to this extent.

Around three years ago, I was quite moody to a point that I've had... bad thoughts. That has gone away for the most part (I think) but I'm starting to feel really down again recently. I've never really talked to anyone about this nor have I gone for help because I never thought it was serious, but I now feel like I should seek help SOMEWHERE because I'm getting desperate. I feel like this is affecting my life greatly.
Expert:  Dr John B replied 2 years ago.

Ok, thanks for the extra information. It sounds like you are doing the right thing in beginning to seek help.

 

As you have mentioned the impact of anxiety can vary over time. Anxiety, depression and sleep disturbance can all go hand in hand, it might be useful at this point to try and get a sense of what is the underlying issue and what is secondary.

 

Let me ask a few more questions:

 

What kind of physical pain are you experiencing and do you think this effects your ability to sleep?

Do you have a history of trauma (assault, serious accident)?

Have you ever in you life experienced the urge to hurt yourself (cutting, bruising etc)?

How have your relationships been over the years (friendship and romantic)?

Was there any event when you were 15 that lead to the development of stress?

Are you a worrier?

Is there a family history of metal health problems?

Do you take any medications, recreational drugs or drink alcohol excessively?

 

It will help me greatly if you answer each question individually.

Customer: replied 2 years ago.

What kind of physical pain are you experiencing and do you think this effects your ability to sleep?

- I have stiff shoulders, quite bad actually, to a point that I feel the constant pressure. I also feel pressure I guess? On the back of my neck. I also seem to have some back pain, but I think that's due to my posture. Also, I feel like I'm always sick and I feel like I ache all over, like a cold.

 

Do you have a history of trauma (assault, serious accident)?

-When I was younger, my dad was not very good at keeping his temper down, and having had a fiery personality like him myself, he and I always clashed. Having grown up in a Korean household IN Korea when capital punishment at home was common, he used to let it out on me a lot of the times. At the time, I felt that it was getting close to physical abuse. He and I have changed and this has disappeared, but I have always had a fear of my father growing up. We both regret what happened back then -laughs-

Also, I almost drowned twice in the pool when I was younger and I've had stitches on my forehead and next to my eye because of a see-saw. A more recent one was in 2007 when a car crashed behind us and although it was not life threatening, we had to total our car and I've had back pain for months. I think that never really fully healed? For accidents, I think that's about it.

 

Have you ever in you life experienced the urge to hurt yourself (cutting, bruising etc)?

- I've had this a lot. It started in high school and continued until August of 2010. There were times when I actually attempted them and DID bring a blade to my wrist and tried to cut, but got too scared and only left a small scratch. I haven't had those recently but I do have thoughts like "man I wish I was dead" coming back. I sometimes have a habit of punching the wall when overly angry or the pillow.

 

How have your relationships been over the years (friendship and romantic)?

- I love to be around people but I get impatient with people easily these days.

Also, My romantic relationships were quite bad. One of my relationships caused me great distress because he tried to confine me to himself and would often threaten to kill my guy friends if I had contact with them, etc.. I haven't been in one in almost two years now.

 

Was there any event when you were 15 that lead to the development of stress?

- I was going through puberty and reached that rebellious age and that's when my dad and I clashed the most. I was also stressed because my grades dropped for the first time then. When my grades dropped, my parents always brought up how I wouldn't be able to go to a good college. College was always a topic for conversation with my parents. No matter what I talked about, it always led to college. If I wanted to hang out with friends, my parents would hint or just straight out say "when will you study?" or "where do you have time to study going out like that all the time" when in truth I went out maybe once a month. Right now, my parents call me and our conversations always end up being about how my brother causes sorrow to my mom, how we're tight on budget because we have two college students. I listen because I am the oldest daughter but honestly, listening to them adds to my acedemic stress. Also, they always talk about what I'm going to do with my life, and it's always about that. I don't want to be in denial but I don't want to talk about it everytime with my parents. I want to have a normal conversation about what I did or something funny that happened.

 

Are you a worrier?

- I am one of the biggest worry-wart I know. I can't take the first step because I always worry.

 

Is there a family history of metal health problems?

- I am not really sure about this because my parents never received mental health checkups. And because most of my relatives are in Korea and the few that are in the states are far away, my parents are the only reference I can get. My brother was diagnosed with depression recently though.

 

Do you take any medications, recreational drugs or drink alcohol excessively?

-I do not take medications nor do I drink excessively. I'll have light drinks at most once every week or two.

 

 

Expert:  Dr John B replied 2 years ago.

Ok, thanks for the extra information.

 

Two things stand out to me from your description so far as being potential underlying problems. Keep in mind that it is impossible to diagnose someone via JustAnswer so my suggestions here should be taken as potential areas for consideration.

 

1) Borderline Personality Disorder (BPD). Self harming is a hallmark of BPD and it also often involves chronic problems with depression and anxiety. BPD often develops in people have a traumatic childhood (particularly physical violence). People with BPD often seek treatment for anxiety or Depression and generally find the typical treatments for these problem areas of minimal efficacy.

 

2) Generalized Anxiety Disorder (GAD). The key feature of GAD is pathological worrying.Worrying about everything nearly all and nearly of the time. People with GAD often describe physical pain due to stress related tension in th muscles and they often develop problems with Depression. Self harming is not typical of GAD.

 

There is no golden rule that says that it must be one of these (it may be both) and there is also no golden rule that says you must have the complete sympXXXXX XXXXXst of any disorder (you can have sub clinical or mild versions).

 

What to make of all of this? Based on your description so far these would be the two areas I would begin to investigate further as the difficulties you describe could be accounted for by these problem areas. I would be happy to discuss either of these areas further but will wait for you response before proceeding.

Customer: replied 2 years ago.
I think I understand what GAD is but I'm having trouble quite understanding what BPD might be. Could you maybe explain what this disorder is in more detail?
Expert:  Dr John B replied 2 years ago.

Absolutely.

 

Take a look at a description I'll post below. Try to keep in mind that you need not meet all of the symptoms for it to be relevant.Take a look through it all and let me know which bits (if any) seem relevant to your situation and which don't.

 

BPD

 

The main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive. This disorder occurs in most by early adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the person's self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person's emotions and feelings. Relationships and the person's emotion may often be characterized as being shallow.

 

A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:

 

● Frantic efforts to avoid real or imagined abandonment

● A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

● Identity disturbance, such as a significant and persistent unstable self-image or sense of self

● Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

● Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

● Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

● Chronic feelings of emptiness

● Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

● Transient, stress-related paranoid thoughts or severe dissociative symptoms

 

Key Features in Detail

Frantic efforts to avoid real or imagined abandonment

 

The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.

 

Unstable and intense relationships

 

People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.

 

Identity disturbance

 

There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.

Customer: replied 2 years ago.

There seems to be some symptoms that are very relavent or partially relavent.

● Frantic efforts to avoid real or imagined abandonment

- when a friend says he/she can't come out for lunch, it's not always but I do get upset at times and feel like I'm not worth their time. Especially if this is repeated by the same person. I get especially upset when a plan was made and is broken off by the other party. But again, this is only sometimes.

● A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

- I don't know if I can really relate with this for friends, but it did happen with a boyfriend. It was my first relationship and I didn't really know what to do. I just wanted him to always pay attention to me.

● Identity disturbance, such as a significant and persistent unstable self-image or sense of self

- I'm not so sure where I stand with this. My values and goals don't change dramatically, but it is true that I have a negative self-image. I see myself as someone incapable and as someone who always lags behind. And I feel everyone's better than me, be it looks or personality.

● Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

- Recently, I haven't physically HURT myself or tried that, but I think I binge eat. I eat even though I'm not hungry and it'll be large portions at a time.

● Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

- I had recurrent suicidal behaviors in the past, but I haven't had any in the past year. I think that's about it.

● Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

- I am very easily affected by my mood. I think this relates to me greatly.

● Chronic feelings of emptiness

- This also applies greatly to me.

● Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

- This has started to surface once again. I can't seem to control anger and I feel angry for no apparent reason.

● Transient, stress-related paranoid thoughts or severe dissociative symptoms

- I'm not so sure about this one.

 

I can see a lot of them relate to me in some way, and some more than others. But does that mean I DO have BPD? Where can I go to get a more clear diagnosis? I've never thought of the possiblity that I might have a psychological disorder so I'm not really sure where to start.

Expert:  Dr John B replied 2 years ago.

Ok, well based on your description and comments so far I think it would be worthwhile that you get an assessment for BPD. Again, it may come up negative but I think there are enough similarities in your description to get an assessment and at least rule it out.

 

BPD is actually rather common, especially mild/sub clinical conditions where people have trouble with specific aspects of the diagnosis. You can get an assessment done by either a Clinical Psychologist or a Psychiatrist and given that the main treatment for BPD is non-pharmacological consulting with a Clinical Psychologist is probably the best option. You contact the American Psychology Association for assistance with finding a Psychologist near you. Take a look at the American Psychology Association's locator service - here . You can use this to find Psychologists in your area and there is a phone number you can contact if you want a referral arranged for you.

 

If it does turn out that the difficulty you are experiencing is BPD related then you should be aware that the treatment generally regarded as the best approach to BPD is Dialectical Behavior Therapy (DBT). DBT is a system of therapy developed specifically to treat persons with borderline personality disorder. DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD. DBT is usually offered by Clinical Psychologists (although not exclusively) and again you can contact the American Psychology Association for assistance with finding a DBT trained Psychologist near you.

 

I hope this has been of some help. Please let me know if you have further questions or would like me to clarify any part of my answer.

Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
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