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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4297
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Hello Dr Z,My question is this, why is it OKMH1029217

Resolved Question:

Hello Dr Z, My question is this, why is it when I feel in control of my situational eviroment ( job, relationship or financial) I feel empowered and high self esteem. As opposed to losing these or not having these I dive into a seemingly regressive childlike state with extremely low self esteem. It is like there is no in between. Either feel on top of the world or completely under it. High self esteem extremely motivated and could move mountains or low self esteem depressed, anxious, low option or feel bad about myself guilt. I know my identity is dependant on external situations that provide security or structure or comfort zone. I grew up in childhood emotional abuse and neglect emotionally. Mother may have been bipolar and was depressed and anxious. Father was critical, unemotionally supportive, emotionally brutal rages and unforgiving. Pretty much on my own when a child. What the hell is going on here? :) Thank you, XXXXX XXXXX a male...lol

Submitted: 8 months ago.
Category: Mental Health
Expert:  Dr. Z replied 8 months ago.

Dr. Z :

Hello, thank you for requesting me

Dr. Z :

I am sorry that you are experiencing these issues, I can imagine how distressing it can be for you

Dr. Z :

Usually when someone is influenced by external stimuli in this way that you described it is typically caused by a low self-confidence, which is not an uncommon issue.

Customer:

Hello, thank you

Dr. Z :

While your mother may have had a Bipolar Disorder, I would not classify that for you based on these symptoms because Bipolar Disorder is typically not dependent on environmental stimuli

Dr. Z :

The childhood emotional abuse and neglect can cause low self-confidence where the external stimuli have a great influence on your emotions and self-esteem.

Customer:

I was diagnosised bp1. Experienced only one manic episode and was described by dr as grandiose. I was taking zoloft for about a year, then quit. Then started getting irritated and anxious and started my zoloft I had left over without dr being invovled and went throught the roof!

Dr. Z :

Well a sole use of an antidepressant should not be used for Bipolar Disorder as this can cause manic symptoms for some individuals. A mood stabilizer should be the predominant medication for the treatment of Bipolar Disorder

Customer:

Therapist stated before that I had signs of ptsd, depression, aniety. Was taking zoloft before bp1 daignosis

Dr. Z :

Okay that makes more sense. The PTSD is a usually a mix of depressive and anxiety symptoms and that can be caused by the emotional abuse and neglect you suffered as a child.

Customer:

I went for years off and on with never being seen as bp. Only the manic exposed the bp1. I believe the manic was AD induced or amplified by meds. Never had one or since. What I have read id that enviroment can be a cause for bp but not proven.

Customer:

I wonder about borderline also. Have hit myself before in anger but no cutting or anything else. Only hit myself when mad at myself or extreme anger at mistake, but rarely. Strange thing is everyone thinks I am normal, I don't discuss my problems to anybody. Never been abusive or out of control. Control my temper very well

Customer:

Something is going on here.

Dr. Z :

So while environmental stimuli can exacerbate symptoms of Bipolar Disorder, it does not influence them. For instance if you are in a Manic state and you lost your job or a relationship, you will still be in a Manic state, and not in a Depressive state. While depression, anxiety, and other disorders respond more acutely to those environmental stimuli, while Bipolar Disorder is caused by chemical imbalance in the brain

Dr. Z :

Now with BPD (Borderline Personality Disorder) that can be more influenced by environmental stimuli but you usually would not have any high moods and instead you would have more mood swings of negative emotions (e.g. Anxiety, Anger, and Depression).

Dr. Z :

By the way what did you mean by "AD induced?"

Customer:

I lost my marriage because of the manic, I was in my own world. I know AD, antidressants can switch on mania. I was taking zoloft. I had stopped the zoloft for several months. My parents became ill, wife and I having trouble. Started feeling anxious and irratated and started taking the zoloft that I had left over.

Dr. Z :

Instead of Zoloft, you should ask about a mood stabilizer like Lithium or Depakote that can help stabilize your moods and would be more effective for you and the Bipolar diagnosis.

Customer:

I believe bp was there all along and was having possible nature manic episode and the zoloft aggravated it. Never ever had anything like that before or since. The more time goes by I am almost certain that AD had something to do with this.

Dr. Z :

Most likely, the use of antidepressant for someone with a Bipolar Disorder can cause manic episodes, this is why I think going to a psychiatrist and being prescribed a mood stabilizer would be more effective for you

Customer:

I was on stabilizer for a time with selexa. Felt emotionally numb still depressed some.

Dr. Z :

Which mood stabilizer?

Customer:

Ok, I agree. Are the self esteem issues because of bipolar? To me they are more situational. If I had my family back I would be on cloud nine. I know my defense mechanisms have molded or adapapted around the bipolar symptoms.

Dr. Z :

Well the self-esteem issues are most likely a response to your childhood environment and could be a form of PTSD from that emotional abuse and neglect and that is why it is situational

Customer:

Lithium

Dr. Z :

Well you may want to try Depakote next as it is not as strong with the side effects of emotional numbing as the Lithium

Customer:

My parents were 2 extremes. Mother was weak but controlling. Father was either pleasant or explosive rage.

Customer:

Soft symptoms of bipolar until manic at age 48. Only depressive episodes. Maybe some hypomania, not sure. I think maybe c-ptsd instead of ptsd, not sure. Saw some pretty bad stuff between parents for years and years right in front of me.

Dr. Z :

Well a mood stabilizer can help with the Complex PTSD and also the Bipolar symptoms as well, this is why I recommend the Depakote.

Customer:

Mother tried to kill herself 2 or 3 times. Only saw one time with pills and vodka. I don't think she was serious but bad enough. Mainly very verbal, yelling, screaming, name calling. Thibgs I would never expose my children to!

Dr. Z :

I think some of your symptoms are situationally based as a form of complex PTSD and that is why therapy will help treat the PTSD and the medication will treat the Bipolar Disorder

Dr. Z :

The best therapy for the PTSD would be Cognitive Behavioral Therapy (CBT) as it is the most evidence based therapy modality to effectively treat symptoms of PTSD

Customer:

Ok, depakote. I have heard of it. So you think a lot of this is cptsd symptoms? As bp1 to, cormorbid perhaps?

Dr. Z :

Well I am not going to question the diagnosis of the Bipolar 1 since it was made by a professional in person, but I definitely see the PTSD symptoms and also some PTSD can trigger mania like symptoms based on your internal mental stress and environmental issues, so the mood stabilizer would be a safe option to treat both disorders medically and also the CBT would be a good therapy option for the PTSD.

Customer:

So possible no bpd here? Have a stellar reputation and not violent at all.

Dr. Z :

These are some good treatment books for PTSD if you would like

Dr. Z :

I do not see Borderline Personality Disorder, I see more PTSD from the symptoms.

Customer:

I know you need to go I am rambling. But it is possible the AD's might have triggered or amplified the mania?

Dr. Z :

Yes it is very possible that it amplified the Mania, but most likely did not cause it although for some people they can cause a mania-like reaction

Customer:

Thank you for the linksDr. Z! I have had therapy for years off and on, he never focused on ptsd, but mentioned it several times. But the more I read and know someone else with it I see it. When I think or see fighting like I saw, I have a physical reation to it. I think latest trauma puked it all out at once.

Dr. Z :

I am so sorry that you have experienced this and I think if you focus on the PTSD symptoms, this will help you a lot to recover and not be so influenced by the environmental stimuli

Customer:

I think bipolar was there all along but not serious yet. There were cycles but low amplitude

Customer:

Thank you very much Dr. Z!

Dr. Z :

Anytime, I am always happy to help. Is there anything else I can assist you with?

Dr. Z :

I agree by the way that the Bipolar Disorder was most likely there the whole time, but may have been influenced more by the PTSD and also by the use of antidepressants which could have made the manic symptoms worse for you

Customer:

Well if you have the time, sure.

Dr. Z :

Yes I still have time if you have other issues that you would like to discuss

Customer:

My father, not nurturing, critical, judgemental. Explosive rage. Always right. A PD issue here?

Dr. Z :

Well it could be a Narcissistic Personality Disorder (NPD) for your father. Here are a list of the symptoms if you want to see if they fit him.

Customer:

My mother was treated in the 60's with ElectroST, on a billion different drugs. Always depressed, a hoarder, probably OCD. I believe I have some OCD also but not a hoarder. I have ruminating thoughts and anxiety. She wanted a abortion I just fond out by my father. How would she have treated a infant with all this going on? I worry about some neurological damage with bonding? Lol... what a mess!

Customer:

Both parents are gone thank God! Sorry but not much fun to be with them. I was caring for them with the bp and divorce at the same time

Customer:

This is why I am nuts! :)

Customer:

Dad when mad would cut you like a knife with words. His face was pure rage, almost demonic!

Dr. Z :

Well it is hard to tell if anything neurological occurred with your bonding, but I definitely feel their emotional abuse/neglect may have caused a PTSD reaction currently, which is common with this level of abuse.

Dr. Z :

The reactions that your father had could be a result of the NPD an also could be a result of a co-morbid personality disorder called Antisocial Personality Disorder (APD) where the person reacts with anger to these situations. NPD and APD are co-morbid very often

Customer:

Possible mother had bipolar I believe. She was on lithium. Her father was abusive and alcoholic.

Dr. Z :

It is possible, but right now you cannot focus on your parents so much as that was in the past and instead focus on what you can control which is yourself in the present

Customer:

I know, ocd here! I analyze this looking for answers. I read constantly on internet about all this and don't believe everything either.

Dr. Z :

I understand, but with CBT you are not focused on the past because that is an area that happened and cannot be controlled. CBT will help you focus on the here and now

Customer:

Just looking for answers. You have done well! Thank you for your time Dr. Z, I appreciate it very much. Could talk all day! But you have others to help.

Dr. Z :

Anytime, I am happy that I was able to help you. I wish you all the best with your treatment and I understand that you are looking for answers, but instead focus on getting better that will help you a lot with these symptoms. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime


Dr. Z :

Before you sign off though, I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

Customer:

Ok. Thank you Dr.Z! You have been insightful and much help! Have good day and be blessed!!!

Dr. Z :

Thank you for the compliment and you are most welcome :)

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4297
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and other Mental Health Specialists are ready to help you
Customer: replied 8 months ago.

Hi dr z, yes you were a big help! Unless I messed up I left you a excellent rating! :)

Expert:  Dr. Z replied 8 months ago.
Thank you, XXXXX XXXXX glad that I was a big help to you and yes you did leave me with an excellent rating and I truly appreciate it. I wish you all the best :)
Customer: replied 8 months ago.

If you have a little time there are couple more questions.

Expert:  Dr. Z replied 8 months ago.
Sure no problem, what are your questions?
Customer: replied 8 months ago.

Not sure if you remember me, sorry I was so redundant with my questions. Ok I think I have symptoms of bpd. Online test have indicated this, maybe they are a joke, idk:) but have hit myself in the past but not often, shift from high low esteem, fear of abandonment, failed relationships, NO suidcide attempts. 4-5 out of 9 traits. Also have 90 percent of ACOA of dysfunctional family traits from my past. Never violent or abusive:) your thoughts? Mother was mentally ill.

Expert:  Dr. Z replied 8 months ago.
Yes I do remember you actually, and its okay about being redundant you just want to make sure. First off those online tests are a joke and should never be taken seriously ever. Anyone who ever tells you that the online tests are a good diagnostic tool for personality or intelligence do not know what they are talking about. The best personality tests that can help determine, along with clinical judgment, if you have BPD are the Personality Assessment Inventory (PAI) and the Minnesota Multiphasic Personality Inventory Second Edition (MMPI-2), which should only be done by a trained psychologists with experience in assessments. With BPD actually your mood swings would not be from high to low, the mood swings are typically of negative emotions between anger, anxiety, depression, etc…Now I remember discussing your case and I felt that you fit more the category of Complex PTSD given your childhood history and I still feel that is a better fit diagnosis then BPD at this time. The hitting yourself in the past was infrequent, and could be a result from stress, and with no suicide attempts leads me away from the BPD diagnosis as this is a predominant feature of BPD. The fear of abandonment and failed relationships can also be accounted by the childhood abuse and neglect, as these are common features in Complex PTSD from this type of childhood trauma. So I still believe that the Complex PTSD is a better fit, but if puts your mind at ease the treatment for Complex PTSD and BPD are very similar with similar medications (often mood stabilizers) and similar therapies (CBT (Cognitive Behavioral Therapy) and DBT (Dialectical Behavioral Therapy)). So if you go into treatment for this, you should see a lessening of your symptoms. I hope this helps to answer your questions, if you need anything else please feel free to contact me again at anytime. Also here are a couple good self-help websites on CBT and DBT as well for you to look at.

https://moodgym.anu.edu.au/welcome

http://www.dbtselfhelp.com/
Customer: replied 8 months ago.

Ok, that clears that up:) thank you! :)

Expert:  Dr. Z replied 8 months ago.
You are most welcome :) Let me know if you need anything else at all, I am happy to help.
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4297
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and other Mental Health Specialists are ready to help you

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