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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by girlnterrupted78 on April 1, 2007, at 1:54:15
I have several emotional symptoms, but I don't know what is the diagnosis for what I have.
The symptoms are the following:
1. Inability to smile.
I usually need to force a smile when meeting someone or when making conversation because it won't come naturally, and I can't even fake one well enough because it's a big strain to do so and it's probably noticeable.
2. Unable to enjoy myself at parties and social gatherings.
I'm not necessarily anxious, so I don't think it's social anxiety. I just don't feel able to engage in conversation because I know I will be uneasy and won't be able to smile or go on with the conversation. It's a mix of lack of inner interest and feeling emotionally disabled to do so successfully. I can start talking about work-related stuff, or make comments. But when it comes to start actually befriending people, I feel very uncomfortable and like not wanting to be there at all.
3. Self-conscious when talking to someone.
I feel uncomfortable when I have to talk to someone for a long period of time on a person to person basis. Like, having to talk to a therapist for an hour it's very hard. I know what to say and how to say it, it's not anxiety, but I have a reflex problem of feeling self-conscious about my facial expressions so I start to close my eyes too much and feel very uneasy. Its weird because some days, when I sleep well, I don't get those weird reflexes, but when I don't get much sleep it feels really bad and my eyes get very sensitive and I can't keep them open for long periods of time. It's especially bad when the other person doesn't make pauses and stares at me nonstop.
4. I get very easily nauseated.
I get car sick all the time, and sometimes even looking down and up right away will make me nauseous. I like to read when I take the subway, but that sometimes also makes me sick. I try to avoid it just in case, because if I happen to get nauseous, I know it will last for more than an hour, even after I'm no longer in the motion vehicle.
5. I am too sensitive to people's ways of dealing with me.
If people are slightly nasty, I find it hard not to get overly annoyed. I ruminate over it for a long time and sometimes I will simply get back at them right away to get it off my chest. I usually can't allow people to treat me wrong, and although I know I have to stand up for myself, I also notice other people dont take things that serioulsy and move on faster, so I think I might have a problem there. I can't tell when it's too much and when it's insignificant, and very often I end up in some sort of interpersonal problem because of it.
I have more symptoms, but these are the main ones and I don't know what kind of disorder this is. Could someone help me enlighten myself and figure out what my problem is and what solutions are available?
PS. By the way, these problems have seriously impaired my life. I haven't been in any relationships in my life because of the social problem (feeling emotionally disabled to talk or smile) and I feel left out, like if I had a real physical disability. I just don't know what to call this disability.
Thanx a lot.
Posted by bassman on April 1, 2007, at 11:15:53
In reply to What are these symptoms?, posted by girlnterrupted78 on April 1, 2007, at 1:54:15
O.K., I'll take the obvious diagnosis: depression with emotional sensitivity. Some of it sounds like one of the personality disorders, but since you seem to blame yourself and not constantly think it is the Nasty Old World Out to Get You, that seems unlikely to me. But I'll be bet you get some well-thought out and more educated answers.
I'll be interested in the sensitivity part myself-I have that and can't seem to shake it. I translate a lot of what people say as, "...and it's your fault!!!"
It will be interesting to see what other people come up with. I hope you feel better soon...
Posted by Honore on April 1, 2007, at 11:28:10
In reply to Re: What are these symptoms?, posted by bassman on April 1, 2007, at 11:15:53
I suppose if I had those experiences, I'd think I was pretty depressed.
Do you feel depressed?
Do you have energy? do you have mood shifts, so that sometimes you can be in a momentary good mood, despite a pervasive bad mood; or is your bad emotional state pretty constant?
do you notice patterns of energy or mood? better in the morning or evening? worse in the morning or evening?
You would need to talk to someone in person to get a more precise diagnosis, or even a suitable one-- but at the least, you sound depressed to me.
Sorry to hear that you're feeling that way. I do think consulting a pdoc would make sense.
Honore
Posted by Phillipa on April 1, 2007, at 11:43:47
In reply to Re: What are these symptoms?, posted by Honore on April 1, 2007, at 11:28:10
I agree with Honore. Sorry I can't talk alot myself today. Love Phillipa
Posted by Quintal on April 1, 2007, at 12:08:40
In reply to What are these symptoms?, posted by girlnterrupted78 on April 1, 2007, at 1:54:15
Hmmm, well you just described pretty much all of my own problems in there. I don't know what it is, and I don't think any one category would explain everything satisfactorily. Social Anxiety Disorder with co-morbid depression is an obvious choice. Asperger's Syndrome could be another (though unlikely). Do you feel more at ease in social situations when your mood is good? Which medications have you tried and with what results?
Q
Posted by girlnterrupted78 on April 1, 2007, at 14:03:31
In reply to Re: What are these symptoms? » girlnterrupted78, posted by Quintal on April 1, 2007, at 12:08:40
My mood is never good. It's sort of a permanent, rooted problem that hasn't changed in the last 20 years (I'm 29 now.) I began feeling this way when I was around 3-4 years old. I don't remember my life at that point, but I know that my father was extremely abusive, he'd hit me and he'd insult me in horrible ways. I think he probably is to blame for this. I also didn't get along well with my stepmother and I remember feeling guilty all the time.
5 years ago I tried an antidepressant for the first time--Celexa. Strangely enough, it sort of "cured" those feelings of total unease and it made me want to meet people and I actually dated more guys during that 1 year period than I had in my whole life.
After a year of having zero depression while on Celexa, my doctor switched me to Lexapro, because it was supposedly a new, better version of Celexa. But once I started Lexapro, all my symptoms returned and I felt uneasy and annoyed all over again. I went back to Celexa but it never did the same thing and never worked again like the first time.
I tried a bunch of different meds after that, Effexor, Zoloft, Paxil, and nothing worked. I don't think my life is worth living with this problem. Nothing works anymore, and therapy is very hard because this problem began too early and has been with me for more than 25 years.
> Hmmm, well you just described pretty much all of my own problems in there. I don't know what it is, and I don't think any one category would explain everything satisfactorily. Social Anxiety Disorder with co-morbid depression is an obvious choice. Asperger's Syndrome could be another (though unlikely). Do you feel more at ease in social situations when your mood is good? Which medications have you tried and with what results?
>
> Q
Posted by bassman on April 1, 2007, at 14:44:31
In reply to Re: What are these symptoms?, posted by girlnterrupted78 on April 1, 2007, at 14:03:31
If the Celexa "worked"...despite the fact that other antidepressants have not worked for you yet, would suggest another AD to be The Path. It is not unusual to take many AD's before one works for you. At this point, I would suggest forgetting about thinking about what caused your condition-whether it was your father or your biochemistry (or whatever) matters less than trying to feel better about life. The fact that Celexa did help again suggest depression and finding a med might be easier for you right now than therapy. Your discomfort with therapy might preclude it being very helpful-but you know for a fact that an AD was helpful. It's like an Easter egg hunt trying to find a useful AD, but well worth the search if it improves your preception of the quality of your life-which seems pretty unpleasant at the moment.
Posted by capricorn on April 1, 2007, at 15:20:13
In reply to Re: What are these symptoms?, posted by bassman on April 1, 2007, at 11:15:53
> O.K., I'll take the obvious diagnosis: depression with emotional sensitivity. Some of it sounds like one of the personality disorders, but since you seem to blame yourself and not constantly think it is the Nasty Old World Out to Get You, that seems unlikely to me. But I'll be bet you get some well-thought out and more educated answers.
It depends of course whether you buy into the ntellectually simplistic 'blame yourself= depression don't blame yourself= PD' way of thinking.
I can blame myself for sometimes/often not handling things as well as i should whilst being
all too aware of the negative experiences that impacted on my mental health and ability to function.Unfortunately psychiatrists and therapists often fail to see the difference between invalidating/trivialising the very real and negative experiences of their clients/service users and acknowledging that whilst X happened one may need help with the reaction to the reality that is X.
Posted by Joe Bloe on April 1, 2007, at 16:05:02
In reply to Re: What are these symptoms?, posted by capricorn on April 1, 2007, at 15:20:13
I would like to suggest that the ruminating thoughts, over-analysis of mundane social interaction even hours later, and general hypersensitivity could be indicative of comorbid depression and an anxiety/obsessive disorder.
Have you tried Prozac? Even at 20 mgs, I found it very very helpful for the ruminating thoughts that you describe.
I experienced No.s 1 and 2 as a side-effect of SSRIs. Now that I'm off, I am extremely social. No. 4 could possibly be related to an anxiety and obsessive thinking about car sickness, or it could be an endemic motion sickness condition (which maybe could also be attributed to SSRIs? People have complained here before about movement and SSRIs, I think). No.s 3 and 5 sound like obsessive thoughts which might come from an anxiety disorder.
By the way, do you have any compulsive OCD-type behavior?
Posted by Quintal on April 1, 2007, at 16:29:15
In reply to Re: What are these symptoms?, posted by girlnterrupted78 on April 1, 2007, at 14:03:31
I can relate to the thing about the abusive father. Although he didn't hit me, he was (and still is) verbally abusive and insulting. It's almost as if I've conditioned myself to be avoid feeling good because he would always find a way of destroying the first sign of happiness or self-confidence.
Your positive response to Celexa is a good sign that you can be helped by antidepressants. Inability to regain effectiveness after switching to another med is an all too common story here. I think SSRIs are probably out in your case, but there's plenty of hope for MAOIs - particularly Nardil, and Lyrica, which is good for both anxiety and depression without some of the drawbacks of benzos. Then there are combos such as Lyrica and Wellbutrin, a sort of upper/downer cocktail that I'd like to try myself, and many other options. There's plenty of hope left in the medicine chest and you might make enough progress in therapy with the help of the right med to be independent again after a while.
Q
Posted by Phillipa on April 1, 2007, at 18:31:06
In reply to Re: What are these symptoms? » girlnterrupted78, posted by Quintal on April 1, 2007, at 16:29:15
Quintal would lyrica help me? Love Phillipa
Posted by Quintal on April 1, 2007, at 18:48:56
In reply to Re: What are these symptoms? » Quintal, posted by Phillipa on April 1, 2007, at 18:31:06
Yes Phillipa, I think it's the med most likely to help both your anxiety and depression bar Nardil that you'd be able to tolerate. I think it's possible that you've reached the end of the line with benzos - there's a point you reach after many years of using direct agonists where an increase in dose just doesn't regain the original effect, you just get more side effects, and I think that might be what's happened to you. Lyrica could work well because it increases GABA but doesn't act directly at the benzodiazepine receptor. Given that you seem to respond well to GABAergic 'downers' and that Lyrica is good for depression, it seems the most logical choice in your case.
Q
Posted by DStupid on April 1, 2007, at 20:46:35
In reply to What are these symptoms?, posted by girlnterrupted78 on April 1, 2007, at 1:54:15
Actually, I have a lot of symptoms you've described, and I have extensively researched them.
Applying the U.S. psychiatric categories, you (and I) have:
Axis I: Dysthymia, Early Onset.
You've been depressed and experienced only limited interest and enjoyment ever since you were a child. You haven't described a sleep or appetite disturbance and that's why a Major Depressive Disorder doesn't appear to be applicable. (I have both of the latter and have qualified for an MDD.)
Axis I: Social Phobia, Generalized Type.
You have lifelong social anxiety that makes it difficult for you to maintain even the most minimal social contact (if that's the case). You may be fearing that you have nothing to say and that you will be thought of as dumb. It appears to apply to all of your social situations and that's why it's of the generalized type.
Axis II: Avoidant Personality Disorder.
The symptoms for Dysthymia and Social Phobia overlap somewhat with those of Avoidant Personality Disorder. You may have displayed a pervasive pattern of social discomfort, fear of negative evaluation, and timidity throughout your life. It doesn't appear that you have close friends, you avoid activities that involve significant interpersonal contact, and you're reticent in social situations. It's also likely that are easily hurt by disapproval and are unwilling to become involved with people unless you're certain of being liked.
That's my take on your case.
Posted by Honore on April 1, 2007, at 20:53:13
In reply to Re: What are these symptoms? » Phillipa, posted by Quintal on April 1, 2007, at 18:48:56
Why is Nardil precluded for Phillipa?
Honore
Posted by Quintal on April 1, 2007, at 20:55:47
In reply to Re: What are these symptoms? » Quintal, posted by Honore on April 1, 2007, at 20:53:13
Phillipa has said in the past the she refuses to take MAOIs because she's afraid of them.
Q
Posted by Phillipa on April 1, 2007, at 21:14:24
In reply to Re: What are these symptoms? » Quintal, posted by Honore on April 1, 2007, at 20:53:13
Honore yes Quintal speaks the truth. Plan is no luvox tonight just took 5mg more of valium as it's obvious from Q that I am in benzo withdrawal and I don't need a seizure. I will try and add 20mg at bedtime no xanax and then l0mg later when I wake up. And call the new pdoc in am and husband will talk to him as he wants answers too and I'm too out of it for it to stick and find out if he will prescribe lyrica. Love Phillipa stupid Phillipa
Posted by Honore on April 1, 2007, at 22:26:13
In reply to Re: What are these symptoms? » Honore, posted by Phillipa on April 1, 2007, at 21:14:24
Thanks, Quintal.
I'm glad you took the valium at Quintal's suggestion, Phillipa. I hope it helped,and that taking some tomorrow also will help you regain some measure of greater calm. Sleep well.
Honore
Posted by DanielJ on April 2, 2007, at 7:44:21
In reply to Re: What are these symptoms? » girlnterrupted78, posted by Quintal on April 1, 2007, at 16:29:15
Anti- social personality disorder? I hate to say that I heard this description on the "Sopranos" when Psychiatrist Elaine Bracco read it from her reference book. Also a little paranoia.
I am 67 yrs old and originally came on this forum because my son has schizophrenia. I think I have the same thing as you do. The way I cope with it is trying to keep a very positive attitude about life. It isn't easy though and you just have to keep working on it.
Never smiling can be a "flat affect" thing. My son has been taking Zoloft for three years. He was taking a good anti psychotic medication but still wasn't smiling or laughing until he started Zoloft.
I think a good positive therapist and the right AD will work for you. Keep trying until you find the right combination. If your therapist brings you down, dump him/her. Having the habit of not smiling or always frowning is a hard one to break but first you need to have internal reasons to smile. Cheers!
Posted by bassman on April 2, 2007, at 8:00:37
In reply to Re: What are these symptoms?, posted by DanielJ on April 2, 2007, at 7:44:21
What great advice! The problem is simple: there are very few good therapists and only a few meds that will help you. The search to find both requires trial-and-error at a time when you aren't in the mood for frustration and emotionally-tiring stuff. And worse yet, it is no doubt hard for you to believe right now that even if you go on that search that you'll end up feeling better. Think of it as a hobby. :>}
Posted by Viking on April 5, 2007, at 8:52:10
In reply to Re: What are these symptoms?, posted by girlnterrupted78 on April 1, 2007, at 14:03:31
I can relate to almost anything you wrote ( apart from carsickness which may be a seperate issue). Do you think this applies to you ?http://www.workpsychcorp.com/newsweek2.tpl
Treatment options:
http://www.mcmanweb.com/article-200.htm
I can elaborate further but wont do it if this does not apply to you at all.
brgds Viking
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