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Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7662
Experience:  35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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I was recently diagnosed with dysthymia and have been seeing

Customer Question

I was recently diagnosed with dysthymia and have been seeing a therapist for a short time. I have never taken any antidepressants but have self medicated heavily with marijuana and at times alcohol. Accepting my "disorder" is very new and sometimes difficult for me. The problem is that couldn't get myself to leave my house this morning to go to school, despite waking up and getting myself ready. I did this a lot last year (I was a senior in high school) and barely graduated after over 100 absences. This is my first time missing a college class and I have given no signals to my teachers of my condition. I do not know how or if to deal with explaining to my teacher the reason for my absence and I would like help both with making approaches and with coping with my failure, especially because I have not had a chance to see my therapist due to a newly filled schedule.
Submitted: 10 months ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 10 months ago.

Elliott, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I believe that I can help with your situation.

Elliott, LPCC, NCC :

When you had trouble leaving this morning was is because you were feeling depressed or did you feel anxious about going outside?

Elliott, LPCC, NCC :

If you do not feel anxiety about going out, then this is all due to depression. I was hoping you would respond so that I can confirm this.

Elliott, LPCC, NCC :

I have taught at the college level for a number of years and I know that there is a policy at just about all schools to give special accommodations to students with any kind of disability, physical, mental, or emotional.

Elliott, LPCC, NCC :

With your diagnosis in hand, your professor would not only make accommodations for your absences (perhaps give you home assignments) but could not penalize you for missing classes.

Elliott, LPCC, NCC :

You would still have to make the grade, of course, but absence because of dysthymic disorder, would be excused.

Elliott, LPCC, NCC :

You would, in fact, report this to the dean or other responsible administrator, and it would be noted and you would be given a statement to give to your professor who would also be notified by administration.

Customer:

It is because of depression

Customer:

I do not like to be in public when I feel so emotional and prone to crying

Customer:

I want to talk to my teacher but I feel as though I am just making it more difficult for her to teach and it isn't fair to her or the other students

Elliott, LPCC, NCC :

Line your appointments up with your therapist and get the paperwork. These teachers are used to getting such requests and it is part of their responsibility to make accommodations for those students in need.

Elliott, LPCC, NCC :

She will not be annoyed.

Elliott, LPCC, NCC :

Are you taking any medications for your Dysthymia?

Customer:

no

Customer:

I do not want to set up a life style where I am dependent on drugs to feel "normal"

Customer:

but I am starting to think they might help

Elliott, LPCC, NCC :

There are medications, such as bupropion, which will help you, energize you, not cause weight gain (as other antidepressants do) and not cause sexual dysfunction, as others do.

Elliott, LPCC, NCC :

You now have a lifestyle that is dysfunctional and that will keep you held down.

Customer:

how will it affect my athletics?

Elliott, LPCC, NCC :

Often the best approach to any kind of depression is a combination of therapy and medication.

Elliott, LPCC, NCC :

It should not affect your athletics.

Customer:

okay

Elliott, LPCC, NCC :

In fact, engaging in athletics is one of the best things you can do to resist your depressive moods, as it creates hormones in your body that will resist the depression.

Customer:

I am also curious about how to deal with my "highs and lows"

Customer:

because I have been feeling good and productive lately (the past week or so)

Elliott, LPCC, NCC :

Get plenty of sunshine and fresh air, and supplements of Omega 3-6-9 and vitamin D3.

Customer:

but I will have triggers (last night I had a nightmare) that make it impossible for me to start my day

Elliott, LPCC, NCC :

Tell me about your highs.

Customer:

my highs are when I am busy

Customer:

like when I have water polo games

Customer:

and spend time with friends

Customer:

I used to experience them with my girlfriend but we aren't together anymore

Customer:

I feel like I know why I am alive, which I think is just to experience whatever it is I want at that moment

Customer:

because sometimes I feel like I won't feel right again, or that feeling good is a lie

Elliott, LPCC, NCC :

Have you ever suffered any trauma in the past?

Customer:

I was never sexually abused

Customer:

or beaten

Elliott, LPCC, NCC :

What about emotional abuse, neglect, or abandonment?

Customer:

my ex-girlfriend and I were incredibly close and she cheated on me often before breaking up with me and then secretly hooking up with my 'bestfriend' and now she doesn't talk to me

Customer:

also I guess I have no real relationship with my father, but he tries in his own way

Customer:

I was bullied by my older brother in our youth, and possibly my dad to an extent, which contributes to my lack of self-worth

Customer:

early on I established a feeling to needing to fit in and feeling unwanted in social situations

Elliott, LPCC, NCC :

Were you late in developing socially?

Customer:

what do you mean late?

Customer:

like it took me a while to pick up on social cues?

Elliott, LPCC, NCC :

Yes exactly.

Customer:

Yes

Elliott, LPCC, NCC :

Do you also have trouble making eye contact?

Customer:

I guess I hadn't thought of that in a way aside from how I used to be weird

Customer:

and I taught myself how to fit in

Customer:

I do not think so

Elliott, LPCC, NCC :

You are adaptable and that is good.

Customer:

I feel as if I thrive in social situations now

Elliott, LPCC, NCC :

Do you engage in any repetitive motions such as rocking, or hand flapping?

Customer:

yes

Customer:

a lot

Elliott, LPCC, NCC :

Describe these events.

Customer:

I tap my leg

Customer:

and pick my finger nails

Customer:

or cross my arms

Customer:

if I can't pick anymore

Customer:

my public speaking teacher said my speech last class was good but that I tapped my foot

Customer:

in an awkward leaning way

Elliott, LPCC, NCC :

Are you fascinated with the details of an object?

Customer:

people

Customer:

and music

Customer:

especially

Customer:

I obsess over specific people and all of the little things that make them whole

Elliott, LPCC, NCC :

Do you focus on the parts of objects?

Customer:

I do not think so

Customer:

not in an abnormal way

Customer:

because everything else I said yes to was an instant correct for me

Elliott, LPCC, NCC :

What do you mean by that last statement, if you don't mind explaining?

Customer:

sorry

Customer:

i mean that the other yes or no questions you asked me were simple yes's

Customer:

like the social development

Customer:

even though I don't think about it too much

Customer:

your question immediately triggered memories and an answer

Customer:

and I do not consider myself unusually asphyxiated with objects other that people and sounds

Customer:

oops not asphyxiated

Elliott, LPCC, NCC :

Actually, asphyxiated is a good descriptive term.

Customer:

oh okay

Customer:

phew

Elliott, LPCC, NCC :

I have already asked this question but let me ask it again. Think carefully if you ever have trouble holding eye contact with others.

Elliott, LPCC, NCC :

lol on phew

Customer:

yes I do

Elliott, LPCC, NCC :

good sense of humor

Elliott, LPCC, NCC :

Can you expand that answer?

Customer:

I just thought about how sometimes in therapy when I feel overwhelmed I look at the ground

Customer:

overwhelmed or embarrassed by my emotions

Elliott, LPCC, NCC :

And in other situations?

Customer:

and I probably do it in other situations

Customer:

but I tend to feel comfortable when I am engaged with somebody

Customer:

it is when I am alone that I tend to trap myself

Elliott, LPCC, NCC :

Thank you so much for answering my questions. You have revealed a lot to me which I would like to share with you.

Customer:

I know that I always would look deeply into my ex-girlfriend's eyes often

Customer:

okay thank you very much

Customer:

and thank you for saying I have a good sense of humor, I will try to keep it up because it helps with a lot of things

Elliott, LPCC, NCC :

Yes, we must always try to keep our sunny side up.

Customer:

do you think that taking a medication such as bupropion might have a crippling effect if I stop taking it?

Elliott, LPCC, NCC :

You have very strong indications from several things you have said: the late social development, the bullying, the eye contact, and repetitive motions, and your dysthymia add up to something else, and that is a mild case of Apserger's Syndrome.

Elliott, LPCC, NCC :

I have worked with a number of children and adults with this hard to diagnose condition, and I believe that you may fit into this category.

Customer:

I am clumsy

Elliott, LPCC, NCC :

I can be too! :)

Elliott, LPCC, NCC :

It can also be an indicator.

Customer:

I feel as though conditions such as apserger's tend to accompany an inability to feel empathy

Customer:

which I know I sometimes feel too much

Elliott, LPCC, NCC :

Very often they do. You feel too much empathy?

Customer:

I am very apt at putting myself in other's shoes and feeling how they must feel

Customer:

I do not know if feeling too much empathy is possible but I try my very best to understand fully where somebody is coming from and to understand that I probably cannot relate to everything

Elliott, LPCC, NCC :

That is NOT characteristic of Asperger's, but you do have other symptoms.

Customer:

seeing my girlfriend cut herself, sometimes thinking about it even after it has but many many months, I could feel pain

Customer:

so having apserger's doesn't remove the possibility of being empathetic?

Elliott, LPCC, NCC :

You may have have been slow to develop socially because you were not given enough attention and you may have been so put down as to suffer from very low self-esteem manifested as dysthymia.

Elliott, LPCC, NCC :

However, it is not a requirement for diagnosis if you feel empathy, so I would certainly urge you to have this checked out by a competent developmental psychologist.

Elliott, LPCC, NCC :

Lots of therapists miss this diagnosis. I seem to be able to diagnose accurately, but you cannot consider this a diagnosis on JustAnswer because it is officially not acceptable, even if I am correct.

Customer:

I will bring up your thoughts with my therapist

Customer:

because I have never considered this possibility myself and it is sort of eye opening

Elliott, LPCC, NCC :

That would be the wisest thing to do.

Elliott, LPCC, NCC :

Here are the "official" diagnostic criteria from the DSM-IV for Aspergers Disorder:



The following criterion are from the DSM-IV. Asperger's disorder is one of five specific "Pervasive Developmental Disorders" listed:


A. Qualitative impairment in social interaction, as manifested by at least two of the following:



  • marked impairment in the use of multiple nonverbal behaviors such as eye-to eye gaze, facial expression, body postures, and gestures to regulate social interaction

  • failure to develop peer relationships appropriate to developmental level

  • lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

  • lack of social or emotional reciprocity


B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:



  • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus

  • apparently inflexible adherence to specific, nonfunctional routines or rituals

  • stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

  • persistent preoccupation with parts of objects


C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.


D. There is no clinically significant general delay in language e.g., single words used by age two years, communicative phrases used by age three years).


E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.



F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.





So, if you have two criteria from part A, one from Part B, and if these factors cause significant impairment in your functioning, then you are diagnosable.as having this disorder.



Some clues are inability to maintain eye contact, inability to form strong emotional bonds, social phobia or anxiety, physical mannerisms or rituals. The guide above is your true indicator of whether or not you have this disorder.

Customer:

what about approaching my teachers? I feel as though I should try asap and I do not know the appropriate procedure

Elliott, LPCC, NCC :

Go to the school administration and they will facilitate the process. Bring in documentation from your therapist for which you will have to sign a release to him so that he does not run afoul of HIPAA privacy laws.

Customer:

the only thing is that I form overly strong emotional bonds with specific people

Customer:

and have extreme difficultly letting go

Elliott, LPCC, NCC :

Such as your girlfriend.

Customer:

yes

Customer:

or other girls in the past

Customer:

but mostly my girlfriend because she was the first to reciprocate

Customer:

ex-girlfriend

Elliott, LPCC, NCC :

Get rid of pictures, objects, mementos. Write her a letter saying that your are through with her forever and then just burn it.

Elliott, LPCC, NCC :

Don't forget the ex.

Customer:

I am not ready to let go

Customer:

especially because I have a very close relationship with her family

Customer:

and I do not want to lie to myself

Customer:

and I would take her back in a second

Elliott, LPCC, NCC :

Let her and her family go so that you can heal. You must work on it and not hang on to impossible dreams. THAT is lying to yourself.

Elliott, LPCC, NCC :

She is apparently done so you MUST move on with your life.

Elliott, LPCC, NCC :

Think about it.

Customer:

but she might come back

Elliott, LPCC, NCC :

There will be another.

Customer:

she broke up with me once and came back

Elliott, LPCC, NCC :

She has broken up with you twice. This is a pattern already.

Customer:

I am afraid that I will never find another person I can be that close to

Customer:

I do not relate well with many people

Customer:

and those that I do tend to be disinterested

Elliott, LPCC, NCC :

What is most important for you now is to get your school affairs in order. There will be no problem getting special accommodations and many schools have a special office of accommodations.

Customer:

and I cripple myself by not taking risks socially

Customer:

okay

Customer:

thank you

Elliott, LPCC, NCC :

As you progress in therapy you will learn to take more risks.

Elliott, LPCC, NCC :

You are very welcome.

Elliott, LPCC, NCC :

I shall keep you in my prayers.

Customer:

I hate being something people have to make accommodations for. I want to help society not take away from it and the kind people who want to help but shouldn't be burdened by me. I wish I could inform my teachers of the reasons for my disappearances without forcing them to take special notice of me in a negative way

Customer:

I am not used to initiating my professional relationships with "hi, I am emotionally damaged and I will make your job more difficult."

Elliott, LPCC, NCC :

Nobody has asked you to do that and you are creating a totally false situation.

Elliott, LPCC, NCC :

This is a bureaucratic matter, You go to the office, where they are REQUIRED BY LAW to make accommodations and do so quite willingly. This is a normal procedure. You do not discuss this with your teachers and they do not make value judgments on you.

Elliott, LPCC, NCC :

It you had impaired hearing, instead, you would be accommodated.

Elliott, LPCC, NCC :

This has become a core American value so you should not try to make it something other than it is.

Elliott, LPCC, NCC :

You have gone silent.

Customer:

sorry i am just thinking

Customer:

but you are right

Elliott, LPCC, NCC :

OK :)

Customer:

my therapist is teaching me to analyze my thoughts and to see when I am lying to myself so that I can see what is really true

Customer:

but sometimes I feel like my initial thoughts are there for a reason and that it is lying to run away from how my brain wants to react

Elliott, LPCC, NCC :

It is named after a river in Egypt: Denial

Customer:

the thing that really gets me is how sometimes I feel good enough to make good choices for myself and be manageable, and at these times I do not search out help because I think I do not need it

Customer:

and when I feel as if I need help, I do not have the energy, drive, and value to search it out

Customer:

and that is a good one

Customer:

i will use the river joke later and pretend I came up with it

Elliott, LPCC, NCC :

Make the help available and benefit from it when you can. YOU must force yourself to act.

Elliott, LPCC, NCC :

Discuss this with your therapist who is hopefully well-versed in understand the complexities of Asperger's, and see what he says about that, and about the antidepressant bupropion.

Customer:

Okay, that sounds like a great idea

Customer:

I hope I can manage myself before then

Customer:

but I feel as if I can

Elliott, LPCC, NCC :

Great. I wish you great success and self-motivation.

Customer:

I have something to say about my attachment to my exgirlfriend

Elliott, LPCC, NCC :

OK

Customer:

she was raped about 3-4 years ago and during the course of our love I saw a great deal of pain and learn a great deal of what it takes to be a woman and how much anxiety comes with the unique struggles a person in her situation and with her level of genius can experience

Customer:

I made many promises to her and never leaving her and never abandoning her, the kinds of promises she made back but has been unable to hold (which I understandP)

Customer:

I want to let go of her but I do not want to break the things I said and I do not want to abandon a person I consider worth a lifetime of waiting but I know that I need to do something to help myself

Elliott, LPCC, NCC :

That surely has affected and hurt her. Broken promises end the ties that bind.

Elliott, LPCC, NCC :

It is your choice to hang on, but it is dysfunctional to your life.

Customer:

especially because on a selfish level, she makes me feel more right in the world than anything ever came close to

Customer:

but even before her i felt dysfunctional emotionally

Customer:

it is just that now is has an affect on my life professionally as well

Elliott, LPCC, NCC :

She is not the only one who can do this, and you are the one that makes the choices for yourself. You don't have to rationalize this to anyojne.

Customer:

is emotional instability typical of apserger's?

Customer:

in the way that i feel extreme happiness sometimes, which competes with incredible sadness

Elliott, LPCC, NCC :

Asperger people have difficulty processing emotion and may therefore display abnormal emotional reactions to various stimuli.

Customer:

Alright

Elliott, LPCC, NCC :

We have been chatting for nearly an hour and a half. Is there any other way that I can help you? I cannot solve all of your problems here and now but I hope that I have given you good guidance and comfort.

Customer:

Sorry about that

Customer:

and yes you have

Elliott, LPCC, NCC :

My pleasure to help you.

Customer:

you have given my another perspective in addition to a helpful way for me to release the angst I've been feeling this morning

Elliott, LPCC, NCC :

Wonderful. I shall continue to keep you in my prayers.

Customer:

I tend to close myself off from people in a self defeating way because conversation always helps me to feel better. Have a great day/life

Customer:

whoever your significant other is must be very lucky

Elliott, LPCC, NCC :

You too. I am here if you need me in future.

Elliott, LPCC, NCC :

If I had one she would be, alas. LOL.

Customer:

I hope I can help people one day.

Thank you :)

Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7662
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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