![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by g_g_g_unit on June 18, 2010, at 23:19:47
i've been having tremendous short-term/working memory difficulties, which i'd like to have assessed. i'd also like to settle the question of whether or not i might have co-morbid ADD.
the psychiatrist i'm seeing made me complete a short series of neurocognitive exercises which ran about 45 minutes in total, and which measured logic, executive functioning, etc. supposedly i was fine in all measures, but my scorecard is really failing to account for the phenomenological difficulties i'm facing.
comparatively, neuropsychological testing runs for 6 hours - but again, is this only going to be useful in instances of brain injury? how accurate is it in detecting ADD?
Posted by linkadge on June 19, 2010, at 6:42:23
In reply to anyone here had neuropsychological testing done?, posted by g_g_g_unit on June 18, 2010, at 23:19:47
What meds are/were you on? Some medications (esp 5-ht2 blockers) can impair short term memory.
AD/HD is generally executive prefrontal dysfunction. Short term memory problems can be due to many other factors. Not to rule anything out though.
Linkadge
Posted by g_g_g_unit on June 19, 2010, at 10:01:19
In reply to Re: anyone here had neuropsychological testing done?, posted by linkadge on June 19, 2010, at 6:42:23
> What meds are/were you on? Some medications (esp 5-ht2 blockers) can impair short term memory.
>
> AD/HD is generally executive prefrontal dysfunction. Short term memory problems can be due to many other factors. Not to rule anything out though.
>
> Linkadgethanks for your reply. maybe i mean working memory instead of short-term memory?
i am having difficulty thinking, reading (i literally have to drag my mind across the page, and retain very little when i do), basically doing anything that requires a mote of concentration ...i'm chronically depersonalized, and only really able to compulsively ruminate. i can't key into or engage with my environment. i periodically use nicotine lozenges to resolve these symptoms - the lozenges help me think and focus. the difference is night and day.
um ... i'm not on any medication; i've trialled various SSRI's and MAOI's, but have never found a drug i could tolerate.
i had difficulties concentrating as a kid - i was gifted but always liable to spacing out, unless i deliberately placed myself into anxiety-provoking situations. i've never been able to sit down and read for more than half an hour. i spent most of college doodling instead of taking notes. later, i developed full-blown OCD, and now suffer from depression.
can most of my problems be chalked up to depression? my psychiatrist said i am only moderately depressed and am underestimating my ability to function (which is rubbish).
i guess i figured it would be worth ruling out the ADD question at this point, because i thought it could be potentially exacerbating my problems.
Posted by linkadge on June 19, 2010, at 11:10:19
In reply to Re: anyone here had neuropsychological testing done? » linkadge, posted by g_g_g_unit on June 19, 2010, at 10:01:19
Well, whatever does it for you.
Linkadge
Posted by Phillipa on June 19, 2010, at 11:20:36
In reply to Re: anyone here had neuropsychological testing done?, posted by linkadge on June 19, 2010, at 11:10:19
Oh I had the testing done about five years ago. Is it the written kind with picture and scenarios, and even those rorshack sp? pics if so it took about that amount of time and was a waste. The results were seriously depressed and wasn't at the time. My neighbor is going to have it done next week. Not that she needs but her pdoc is frustrated as he can't give her a diagnosis calls her an enigma. But she's fine just gets anxious and takes xanax. My other pdoc never even read the results. Just treats me according to how I act and what I say. Phillipa
Posted by violette on June 19, 2010, at 18:49:07
In reply to anyone here had neuropsychological testing done?, posted by g_g_g_unit on June 18, 2010, at 23:19:47
Hi triple G!
If you have the resources, I'd recommend to defintely get the assessment..I had it done; my results were inconclusive, but I never completed all the neurological tests that were recommended. They did rule out depression as a cause of my memory problems and had some other conclusions that were helpful.
The tests quantify all different types of memory and brain functions. It's a good tool to rule things out, and the tests can determine if your cognitive issues are or may be related to ADD, epilepsy, brain injury or emotional issues (and other things). There are so many different types of epilepsy and some can cause cognitive and memory problems. If a conclusion isn't obvious, the test administrator can help make recommendations for follow up testing that a neurologist or psychiatrist should complete. I personally think more mental health patients should undergo this testing before taking psychiatric drugs if that is feasible.
Because my results were inconclusive, I decided to explore all the possibilities for my cognitive issues. If my doctors couldn't come up with a diagnosis--I thought, I may as well come to my own conclusions....and here's a list of articles that helped me do just that. I don't claim to be able to apply theories to myself, though, so my conclusions are just possibilities-perhaps only a guess...
Anway, I found that looking outside of the box-knowing I had ADD symptoms-but exploring all the other theories of the symptoms rather than the actual disorder of ADD helped me decide the best course of treatment to undergo.
I know you always write helpful comments in trying to help others and thought I'd dig deeper into this and see if it helps lead you to more understanding about your concerns. I won't be offended if you are not interested in these articles but am passing them along in hopes that they will be useful for you since they were helpful to me.
http://ajp.psychiatryonline.org/cgi/content/full/157/1/103
http://www.trauma-pages.com/a/fosha-03.php
http://www.myshrink.com/human-nervous-system.php
http://www.towson.edu/topddstudy/AssessmentDID2006Brandetal.pdf
http://www.acnp.org/g4/gn401000152/ch148.html
http://ajp.psychiatryonline.org/cgi/content/full/162/5/899
http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/32/3/489
http://www.addiction.umd.edu/Psyc434/Putnam%202005.pdf
http://www.toddlertime.com/dx/borderline/bpd-ekleberry.htm
http://www.tg.org.au/?sectionid=46
http://allpsych.com/psychology101/memory.html
http://www.behavioralandbrainfunctions.com/content/3/1/4
http://www.health.am/psy/histrionic-personality-disorder/
http://www.ataxia.org/pdf/Cognition,%20emotion,%20and%20the%20cerebellum.pdf
http://ccm.psych.uic.edu/PatientInfo/TBIInfo.aspx
Posted by violette on June 19, 2010, at 19:03:21
In reply to Re: anyone here had neuropsychological testing done? » linkadge, posted by g_g_g_unit on June 19, 2010, at 10:01:19
Sometimes when psychiatrists say moderately depressed, they mean dysthmia. And depression can be more of a side effect of ADD or anxiety or more permanent issues rather than primary. Maybe that's what he/she meant? People who don't respond to ADs sometimes have more permanent traits, as some research shows. On the other hand, my PDoc told me some people just don't respond to SSRIs, but will respond well to NA or dopamine targeting drugs...so maybe you are just have not yet found the appropriate cocktail?
What you meant by depersonalization was not clear to me, but that's why I chose some of those articles I listed.
"i'm chronically depersonalized, and only really able to compulsively ruminate"
You mentioned SSRIs and MAOIs, but how did you respond to stimulants?
A patient doesn't have to have the official diagnosis of ADD to be prescribed stimulants as you probably already know. A think its reasonable to try them and the diagnosis isn't the most relevant thing here...Some psychiatrists will prescribe them 'off label' regardless of diagnosis. Maybe conservative PDocs do not do this, but I know several who use stimulants to augment for depression or dysthmia, especially if other things don't work.
I wonder why your PDoc is so hesitant to consider ADD?
Good luck!
Posted by g_g_g_unit on June 19, 2010, at 22:25:00
In reply to Re: anyone here had neuropsychological testing done?, posted by violette on June 19, 2010, at 18:49:07
hey violette,
thanks a lot for your reply. i'm a little worried neuropsych testing may just be an unnecessary extravagance, particularly when most of my symptoms could be attributed to depression/anxiety. but i dread the idea of another pointless AD trial ...
the cost is a little prohibitive - the woman i spoke to charges approx. $700US per assessment.
but it may be worth it - at least as a form of reassurance - given how chronic my symptoms have become.
i looked through the articles you posted. unfortunately, nothing in there seemed relevant, whereas i have experienced ADD-like symptoms since childhood ...
> Hi triple G!
>
> If you have the resources, I'd recommend to defintely get the assessment..I had it done; my results were inconclusive, but I never completed all the neurological tests that were recommended. They did rule out depression as a cause of my memory problems and had some other conclusions that were helpful.
>
> The tests quantify all different types of memory and brain functions. It's a good tool to rule things out, and the tests can determine if your cognitive issues are or may be related to ADD, epilepsy, brain injury or emotional issues (and other things). There are so many different types of epilepsy and some can cause cognitive and memory problems. If a conclusion isn't obvious, the test administrator can help make recommendations for follow up testing that a neurologist or psychiatrist should complete. I personally think more mental health patients should undergo this testing before taking psychiatric drugs if that is feasible.
>
> Because my results were inconclusive, I decided to explore all the possibilities for my cognitive issues. If my doctors couldn't come up with a diagnosis--I thought, I may as well come to my own conclusions....and here's a list of articles that helped me do just that. I don't claim to be able to apply theories to myself, though, so my conclusions are just possibilities-perhaps only a guess...
>
> Anway, I found that looking outside of the box-knowing I had ADD symptoms-but exploring all the other theories of the symptoms rather than the actual disorder of ADD helped me decide the best course of treatment to undergo.
>
> I know you always write helpful comments in trying to help others and thought I'd dig deeper into this and see if it helps lead you to more understanding about your concerns. I won't be offended if you are not interested in these articles but am passing them along in hopes that they will be useful for you since they were helpful to me.
>
> http://ajp.psychiatryonline.org/cgi/content/full/157/1/103
>
> http://www.trauma-pages.com/a/fosha-03.php
>
> http://www.myshrink.com/human-nervous-system.php
>
> http://www.towson.edu/topddstudy/AssessmentDID2006Brandetal.pdf
>
> http://www.acnp.org/g4/gn401000152/ch148.html
>
> http://ajp.psychiatryonline.org/cgi/content/full/162/5/899
>
> http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/32/3/489
>
> http://www.addiction.umd.edu/Psyc434/Putnam%202005.pdf
>
> http://www.toddlertime.com/dx/borderline/bpd-ekleberry.htm
>
> http://www.tg.org.au/?sectionid=46
>
> http://allpsych.com/psychology101/memory.html
>
> http://www.behavioralandbrainfunctions.com/content/3/1/4
>
> http://www.health.am/psy/histrionic-personality-disorder/
>
> http://www.ataxia.org/pdf/Cognition,%20emotion,%20and%20the%20cerebellum.pdf
>
> http://ccm.psych.uic.edu/PatientInfo/TBIInfo.aspx
>
>
>
Posted by g_g_g_unit on June 19, 2010, at 23:01:20
In reply to Re: anyone here had neuropsychological testing done? » g_g_g_unit, posted by violette on June 19, 2010, at 19:03:21
> Sometimes when psychiatrists say moderately depressed, they mean dysthmia. And depression can be more of a side effect of ADD or anxiety or more permanent issues rather than primary. Maybe that's what he/she meant?
no, he thinks atypical depression is my primary problem, and that most of my complaints are a confidence issue. so we've kind of reached a brick wall, because he's like "well what do you do with yourself all day" and i'm like - "well, not a whole lot, given that my identity was previously staked on my intellectual abilities, and now i can't really focus, concentrate, read" - and he's like "well, yes you can" and i'm like - i can't, etc. etc.
i was diagnosed with dysthymia a couple of years ago - i complained to a psych that i've never really been able to experience enjoyment in stuff since i was a kid - i'd get bored/frustrated with stuff really quickly, unless it was excessively challenging or stimulating, which seems more like an ADD trait to me
>People who don't respond to ADs sometimes have >more permanent traits, as some research shows. >On the other hand, my PDoc told me some people >just don't respond to SSRIs, but will respond >well to NA or dopamine targeting drugs...so >maybe you are just have not yet found the >appropriate cocktail?to be honest, i haven't really tried an AD since becoming seriously depressed. i was prescribed SSRI's for OCD initially, but could not tolerate them: they caused significant problems with focus, induced restless leg syndrome which was sometimes unbearable, worsened my social skills. maybe the doses were a little high, i donno.
i did try Nardil for 3 months, but couldn't sleep. i guess i should keep exploring though
>
> What you meant by depersonalization was not clear to me, but that's why I chose some of those articles I listed.
>um, i feel like i'm stuck inside my head; at its worst, it's literally impossible to break out and focus on anything for very long. i also feel physically dead and basically 'non-present'.
depersonalization is (supposedly?)a distinct disorder that carries its own set of symptoms (including concentration difficulties), but i think it's more a symptom of anxiety and depression in my case
>
> You mentioned SSRIs and MAOIs, but how did you respond to stimulants?ritalin made my anxiety worse. dexamphetamine helped my anxiety, but i wasn't on it for very long ... a GP wrote the script and i wasn't comfortable taking it without a psychiatrist's supervision
>>
> I wonder why your PDoc is so hesitant to consider ADD?
>he said i couldn't have it based on my results from the brief neurocognitive assessment i did
Posted by violette on June 20, 2010, at 2:18:31
In reply to Re: anyone here had neuropsychological testing done? » violette, posted by g_g_g_unit on June 19, 2010, at 22:25:00
Most of those articles consider issues relevant to childhood...anyway, I'm sorry they were not helpful.
The first link there mentions the type of tests an neuropsych evaluation would include. You could get the names of the assessment tests from that (small) study and read more about them if you are still trying to decide on whether to get the test done or not. The one I took cost significantly more than $700.
Here's an example of one of the tests mentioned in that article - a Stroop test:
http://www.snre.umich.edu/eplab/demos/st0/stroopdesc.html
I didn't do the emotional version, but I scored really high on that particular test, which contributed to ruling out ADD for me. It was interesting to me that, even though that study was small, one of my worst scores was the block test, which mentioned as being the most highly correlated with depersonalization patients. I have problems with depth perception as well.
Actually, I've only had dp a few times during my lifetime..but have had dissociation. There's really a continuum so its difficult to tell sometimes which is which.
I suppose you have to outweigh the benefits and the risks of getting the test done, considering the possibility ADD will again be ruled out; but this time, with more evidence to support it.
Posted by violette on June 20, 2010, at 2:26:06
In reply to Re: anyone here had neuropsychological testing done? » violette, posted by g_g_g_unit on June 19, 2010, at 23:01:20
I don't see how helpful it is for a psychiatrist to say "yes you can do it" when you obviously are struggling so much. I also agree that depersonalization can result from anxiety. It can also be a schizoid trait (does anyone in your close family have schizophrenia?). Onset can be influenced in times of high stress.
Have you sought a second opinion with another doctor? You didn't say much about how you feel about your relationship with your PDoc; I sense a flattened effect in your writing in addition to your description of how life has been for you.
Did you try Effexor? That one can be difficult to get used to, and difficult to taper off, but that would be my initial suggestion.
You sound like a sweetie. I'm really sorry you're feeling so down. :(
Posted by g_g_g_unit on June 20, 2010, at 3:39:51
In reply to Re: anyone here had neuropsychological testing done? » g_g_g_unit, posted by violette on June 20, 2010, at 2:18:31
> Most of those articles consider issues relevant to childhood...anyway, I'm sorry they were not helpful.
oh no, please don't apologise! i don't really have the attention span to read through any of them in great detail, but the one on cognitive processes in depersonalization disorders is really interesting ...
i'm just confused about when depersonalization becomes a disorder in its own right, and when it's just a symptom. my psychologist dx'd me as suffering from DP (and said it often occurs in the presence of anhedonia, which is a persistent symptom of my depression) so i wonder if that could disturb the results of a neuropsych test. i have also read it's highly co-morbid with OCD.
i emailed the psychologist asking if things like depression could produce a false positive for ADD, but she said ADD generally has its own unique pattern, whereas depression manifests as a global deficit in functioning.
>
> The first link there mentions the type of tests an neuropsych evaluation would include. You could get the names of the assessment tests from that (small) study and read more about them if you are still trying to decide on whether to get the test done or not. The one I took cost significantly more than $700.
>
> Here's an example of one of the tests mentioned in that article - a Stroop test:
>
> http://www.snre.umich.edu/eplab/demos/st0/stroopdesc.html
>
> I didn't do the emotional version, but I scored really high on that particular test, which contributed to ruling out ADD for me. It was interesting to me that, even though that study was small, one of my worst scores was the block test, which mentioned as being the most highly correlated with depersonalization patients. I have problems with depth perception as well.i did that word-color test with my psychiatrist. the problem is (and i know that this is really stupid of me!) that i deliberately blurred my vision so i wouldn't be able to read the word, and thus could focus on the color, which might have resulted in my high score. at the time, i didn't realise i was completely sabotaging the test; i wasn't even really aware of what i was doing in a way ...
>
> Actually, I've only had dp a few times during my lifetime..but have had dissociation. There's really a continuum so its difficult to tell sometimes which is which.yeah, like i say, it seems DP more often occurs in the presence of other disorders, as opposed to being a primary problem ...
>
> I suppose you have to outweigh the benefits and the risks of getting the test done, considering the possibility ADD will again be ruled out; but this time, with more evidence to support it.
>oh, i don't mind it being ruled out. i would be more comfortable about returning to AD's if it was, since at least i'd know all my attentional problems are resulting from depression.
Posted by g_g_g_unit on June 20, 2010, at 3:47:10
In reply to Re: anyone here had neuropsychological testing done? » g_g_g_unit, posted by violette on June 20, 2010, at 2:26:06
> I don't see how helpful it is for a psychiatrist to say "yes you can do it" when you obviously are struggling so much.
well, his belief is that depression has messed with my confidence, so feels that it's necessary to 'bully' me a little
>I also agree that depersonalization can result >from anxiety. It can also be a schizoid trait >(does anyone in your close family have >schizophrenia?). Onset can be influenced in >times of high stress.
no schizophrenia that i know of. just various manifestations of jewish neuroses :)
interesting that my writing sounds flat; i used to work as a writer, in fact, and am hoping to return to the craft one day, so i hope it's not a permanent affliction.
>
> Have you sought a second opinion with another doctor? You didn't say much about how you feel about your relationship with your PDoc; I sense a flattened effect in your writing in addition to your description of how life has been for you.i used to 'doctor shop' in my last country (my family has just immigrated), so am trying to be more patient; but the truth is, i am really intimidated by my pdoc and find it hard to share anything with him. he's highly qualified, and would be useful in a crisis i imagine, but he has a certain 'bite' which i find off-putting.
my GP, however, is a saint, and said he would be happy to refer me to someone else if i continued to struggle. the neuropsychologist said she could also refer me to someone based on the results of my report. i just wish i was financially independent, because i hate relying on my parents.
>
> Did you try Effexor? That one can be difficult to get used to, and difficult to taper off, but that would be my initial suggestion.i haven't yet, no
>
> You sound like a sweetie. I'm really sorry you're feeling so down. :(thanks :)
Posted by violette on June 20, 2010, at 5:35:29
In reply to Re: anyone here had neuropsychological testing done? » violette, posted by g_g_g_unit on June 20, 2010, at 3:47:10
oh no - please don't take that a criticism of your writing-I didn't see anything wrong with how you expressed yourself-it wasn't that...though there are depressive undertones, understandingly..
It was your relationship with your PDoc-you kept writing about your experience, but you didn't mention how you felt about him-like there was some kind of emotional disconnect. That was very notable to me...but in your last posts you mentioned quite a few feelings...and now that you expressed how you felt in the relationship wtih your doctor, the intimidation, and feeling like his pushing you...It seems almost as if he is intrusive to you-crossing your boundaries so to speak; it appears to make you very uncomfortable. Does ot resonate to you that these feelings might be related to his being intrusive to you (mentally)? Sort of like a mental attack? I have felt that way around my mother, though I am unsure of how to explain it right now - I get feelings of 'emotional attack' when she talks to me.
Yes I've also noticed DP is usually a trait that goes with other things. Psychiatrists sometimes use diagnoses that don't make sense to us, but often have reasoning unrelated to 'best fit'-such ss billing, government reporting, or frequency of visits..or newer patients whose diagnoses are not yet conclusive.. Just a thougt, I don't know-a guess.
Stimulants can make depersonalization and related conditions worse, that could be a possible reason ofr his reluctance to try ADD meds. Based on only a short narrative you wrote, you might consider taking up your GP on that referral. It seems with your symptoms, you really need someone who understands your internal boundaries possibly being 'penetrated'. I'm sorry if this doesn't realte to you; these are just my thoughts in trying to help you look into the big picture.
Blurring the words on that test could be a creative adapting to focusing-I don't see it as a sabatage unless you did that on purpose (but from what you said-you didn't realize you were doing that until after?). I had found ways to adapt to some cognitive problems like you. When I took that test, I didn't read the words-like for school, I had developed using patterns to take exams when i had troulbe concentrating and reading. It worked great sometimes-I could remember the patterns of sentences, remembering the picture of how phrased looked rather than even reading the content. It's adaptation-I think that is one of your strenghts.
If you get the neuro-psych tests done, what do you have to lose? It could lead you closer to a solution to your issues. You sound sad; relying on parents can be discouraging, in addition to everything else going on in your life right now, but in relying on them now, it must just be an investment or sacrifice that will benefit you in the long run.
Best,
Violette
Posted by g_g_g_unit on June 20, 2010, at 6:07:35
In reply to Re: anyone here had neuropsychological testing done? » g_g_g_unit, posted by violette on June 20, 2010, at 5:35:29
> oh no - please don't take that a criticism of your writing-I didn't see anything wrong with how you expressed yourself-it wasn't that...though there are depressive undertones, understandingly..
sure, of course, i didn't take it as a criticism. but in interactions with mental health professionals, for example, i'm often described as having a 'flat' affect, etc. - even when i feel i'm projecting emotion - so it's curious to see how it does come out, even when i do my best to hide it.
>
> It was your relationship with your PDoc-you kept writing about your experience, but you didn't mention how you felt about him-like there was some kind of emotional disconnect. That was very notable to me...but in your last posts you mentioned quite a few feelings...and now that you expressed how you felt in the relationship wtih your doctor, the intimidation, and feeling like his pushing you...It seems almost as if he is intrusive to you-crossing your boundaries so to speak; it appears to make you very uncomfortable. Does ot resonate to you that these feelings might be related to his being intrusive to you (mentally)? Sort of like a mental attack? I have felt that way around my mother, though I am unsure of how to explain it right now - I get feelings of 'emotional attack' when she talks to me.definitely. as soon as i am uncomfortable around someone, i just shut down. i don't mean to make him sound like a tyrant; he's very nice, in his own way, but tough ...
my mom said that it might be good to have someone who pushes me, because otherwise they'll just spend their time reassuring me.
> Yes I've also noticed DP is usually a trait that goes with other things. Psychiatrists sometimes use diagnoses that don't make sense to us, but often have reasoning unrelated to 'best fit'-such ss billing, government reporting, or frequency of visits..or newer patients whose diagnoses are not yet conclusive.. Just a thougt, I don't know-a guess.
>
> Stimulants can make depersonalization and related conditions worse, that could be a possible reason ofr his reluctance to try ADD meds.my psych doesn't know about my DP symptoms. i haven't felt able to confide in him.
> Based on only a short narrative you wrote, you >might consider taking up your GP on that referral. >It seems with your symptoms, you really need >someone who understands your internal boundaries >possibly being 'penetrated'. I'm sorry if this >doesn't realte to you; these are just my thoughts >in trying to help you look into the big picture.
that's what i'd like, but i'm not sure how to leave this pdoc, in the instance that i did go ahead and see someone else. i usually just don't go back to them, but i don't think that's very respectful.
>
> Blurring the words on that test could be a creative adapting to focusing-I don't see it as a sabatage unless you did that on purpose (but from what you said-you didn't realize you were doing that until after?). I had found ways to adapt to some cognitive problems like you. When I took that test, I didn't read the words-like for school, I had developed using patterns to take exams when i had troulbe concentrating and reading. It worked great sometimes-I could remember the patterns of sentences, remembering the picture of how phrased looked rather than even reading the content. It's adaptation-I think that is one of your strenghts.do you have ADD? yeah i wasn't trying to sabotage the results; it definitely was an adaptation technique. my life is riddled with those ... during high school and college, i had difficulty studying and really grasping material (especially in subjects i hated), so i'd just resort to basically memorizing the textbook (i used to have a great memory...). as college progressed though, things got more out of hand, which is when the OCD started to develop; it gave me something i had to try and control.
>
> If you get the neuro-psych tests done, what do you have to lose? It could lead you closer to a solution to your issues. You sound sad; relying on parents can be discouraging, in addition to everything else going on in your life right now, but in relying on them now, it must just be an investment or sacrifice that will benefit you in the long run.
>
> Best,
> Violetteum, my only hesitancy is that since i'm a hypochondriac, having neuropsych testing done was a form of reassurance.
my parents are well-meaning, but don't have the first clue when it comes to psychological issues. their attitude is basically, "why aren't you fixed yet?"
anyway, i really appreciate the thoughtfulness of your posts! thank you so much for caring!
Posted by violette on June 21, 2010, at 2:41:37
In reply to Re: anyone here had neuropsychological testing done? » violette, posted by g_g_g_unit on June 20, 2010, at 6:07:35
Hi Triple G,
Being a 'hyperchondriac' is just a manifestation of anxiety. I get that too sometimes. Try not to be hard on yourself about it. It's good to get a pseudo medical education anyway. Also, if you have kids someday, it'll pay off.
Well the flat effect is difficult to pick up online, but there are some glimpses. Does your PDoc do therapy, and how long have you been seeing him? Or do you just talk to him for a half our or so once a month? For someone with your traits, that pushing behavior is really contradictory. From what I can tell from what you said, you do sound like you have some avoidant or schitzoid traits. Most of us with dissocation/depersonalization issues have some form of emotional dysregulation and cogntive problems that respond best to psychotherapy.
"my mom said that it might be good to have someone who pushes me, because otherwise they'll just spend their time reassuring me."
Even though your Mom has good intentions, that is an AWFUL approach for someone with your particular psychologic construct. And not being able to tell your doctor about the depersonalization? That is a major sign that you do NOT feel safe with him-but I can surely understand why it would be difficult to tell him-his approach does not fit you. When my T/PDoc 'pushes me', it is so subtle I don't even realize it. It's funny we just talked about this last week-he said he's been (gently) pushing me to talk about more, and I was suprised because I realized I had not even been aware of it. We laugh alot and talk about non-therapy stuff too. he's very friendly and open, and gives lots of reassurance-which helps me feel safe.
Can I call your Mom and tell her you need reassurance? (Are you still in college?) I will say: "Mrs. Unit, this is Doctor Violette from Ivy Root University. I am Triple G's academic advisor. The reason for my call is to inform you that GGG REQUIRES REASSURANCE instead of PUSHING from Mr. Nice-PDoc-But-Wrong-Approach!".
An appropriate attachment-based therapist would give you reassurance until you are able to open up and talk about stuff. The 'need' for reassurance slowly dissolves...But there is need to worry about 'wanting it'. That is perfectly fine to want reassurance. With the right type of therapy, your pattern of 'shutting down' will occur less and less. It does take time though.
There are Ts who are so gentle and welcoming and accepting that they will just wait and wait until you are ready to talk. Would a T or PDoc who talked about her/himself a lot during sessions at first, or even for a few months, help you deal? Or maybe a female would work better? Does your GP who can help you find someone know of your depersonalization issues?
It's not disrespectful to not go back to therapists, but it feels that way doesn't it? Try not to worry about upsetting a Ts feelings (easier said than done). Ts are used to this and GGG needs to get well-not the therapist! The therapist is just fine and realize patients are shopping around.
If your pdoc is not doing therapy, you can stay with him for meds and go with a psychologist/LCSW or other PDoc who does therapy. Or-you could find a new PDoc who does both therapy and meds. Either way, someone psychodynamic and attachment oriented, who is more understanding of your fear and difficulties would be most able to help you. My T is so patient-he gives me as much reassurance as I need and is so understanding and accepting. During the first couple of months when I began seeing him, I could actually feel this bubble of safety forming around the perimeter of his office. That sounds strange, but I do feel and sort of 'see' emotions sometimes. (My sensory system is overactive.) And I sensed the safety-almost as much as I'd notice a thick fog around us.
Yes, my memory is shot now too. Similar to you, I could memorize a textbook a decade ago. I think that depersonalization, dissociation, and or anxiety can mess your brain up after a while. It takes a lot of energy to use those psychological defenses. When stress levels are higher-it gets worse, like when you started having more problems with college and your anxiety increased.
The good thing is that better cognitive functioning can come back with the appropriate treatment. But you need cared for and nurtured by someone who understands how you relate to them.
I'm sorry it is so hard for you to talk to them. You are such a sweetie, yeah I know I already said that...it's just sad to see you suffer.
Well I hope I'm not being too pushy here myself...feel free to let me know if I am. :)
Posted by violette on June 21, 2010, at 3:03:10
In reply to Re: anyone here had neuropsychological testing done? » violette, posted by g_g_g_unit on June 20, 2010, at 3:47:10
"well, his belief is that depression has messed with my confidence, so feels that it's necessary to 'bully' me a little "
"i am really intimidated by my pdoc and find it hard to share anything with him. he's highly qualified, and would be useful in a crisis i imagine, but he has a certain 'bite' which i find off-putting."
I agree with your PDoc that depression ruins confidence. I guess the main point is - a therapist really has to work on establishing safety and trust first for people who have difficulties sharing. That can take a year sometimes less sometimes longer. It seems a bit agressive/too soon. If you are unable to talk to him about DP symptoms, I'd be you'd be unable to tell him he's going to fast.
Considering you can talk more openly with your GP, asking for a referral for a specific type of therapist who is more attachment-oriented and understanding of your particular issues might be your best move right now. Maybe consider a female this time?
I really hope you figure everything out...sounds like your parents are trying to make decisions for you, but you would be best off making them yourself.
I gotta take a break from the computer since I spent too much time here lately, but I'll check in to see what happens and how you are doing so please keep us updated. :)
Posted by g_g_g_unit on June 21, 2010, at 4:09:39
In reply to Re: anyone here had neuropsychological testing done? » g_g_g_unit, posted by violette on June 21, 2010, at 2:41:37
> Well the flat effect is difficult to pick up online, but there are some glimpses. Does your PDoc do therapy, and how long have you been seeing him? Or do you just talk to him for a half our or so once a month? For someone with your traits, that pushing behavior is really contradictory. From what I can tell from what you said, you do sound like you have some avoidant or schitzoid traits. Most of us with dissocation/depersonalization issues have some form of emotional dysregulation and cogntive problems that respond best to psychotherapy.um, i've only been seeing them a couple of months as i recently moved towns. i see him once every two weeks just to talk about how i'm doing; he hasn't prescribed any meds yet. prior to that, i was seeing a cognitive behavioural therapist for about a year to help treat OCD.
i definitely have avoidance issues, which crippled me throughout college; i was too shy to approach people. but after that, i fell in amongst a really nice group of friends and came into my own. i have always craved the company of others. if anything, i fall on the more narcissistic side of the spectrum: i was sharp-witted and intelligent and enjoyed the challenge of making others laugh to stoke my ego, at the expense of forming deep connections. i saw people as opportunities, which sounds pretty horrible i guess. i was, however, never without at least one very close friend.
then, after a few years of accumulated stress, depression and OCD, i just woke up one day feeling really different. i lost my affect. i went on a date with a girl i'd just met and it was a nightmare: i could barely communicate with her. my mind felt empty. it was so disturbing. i'm not sure if that was just the beginning of severe depression or something else, but that's when the cognitive problems, depersonalization etc. began (a year and a half ago). that's also when i began *seriously* avoiding people because it was too humiliating to deal with them; they basically just thought i was 'slow' or 'weird'. so it's hard to say, but my impression is that the depression is causing the social alienation rather than visa versa.
i try not to read up on schizo stuff because it just scares me. i mean if i dig deep enough, i have schizo traits, borderline personality traits, histrionic personality traits, narcissistic personality traits. i really hope that this is just the result of severe depression, as i do see my functionality and emotions rising and falling over time.
>
> "my mom said that it might be good to have someone who pushes me, because otherwise they'll just spend their time reassuring me."
>
> Even though your Mom has good intentions, that is an AWFUL approach for someone with your particular psychologic construct. And not being able to tell your doctor about the depersonalization? That is a major sign that you do NOT feel safe with him-but I can surely understand why it would be difficult to tell him-his approach does not fit you. When my T/PDoc 'pushes me', it is so subtle I don't even realize it. It's funny we just talked about this last week-he said he's been (gently) pushing me to talk about more, and I was suprised because I realized I had not even been aware of it. We laugh alot and talk about non-therapy stuff too. he's very friendly and open, and gives lots of reassurance-which helps me feel safe.maybe you're right. i'm beating myself up inside saying that i need to be bullied by a pdoc, that my pdoc is highly regarded and really prestigious and it's my fault for not complying with them. but maybe it's as simple as the fact that we just don't match and i need someone with a softer approach.
>
> Can I call your Mom and tell her you need reassurance? (Are you still in college?) I will say: "Mrs. Unit, this is Doctor Violette from Ivy Root University. I am Triple G's academic advisor. The reason for my call is to inform you that GGG REQUIRES REASSURANCE instead of PUSHING from Mr. Nice-PDoc-But-Wrong-Approach!".heh, are you kidding? no i finished college a couple of years ago. i sincerely appreciate the offer, but don't think my mom would be so down with it
>
> An appropriate attachment-based therapist would give you reassurance until you are able to open up and talk about stuff. The 'need' for reassurance slowly dissolves...But there is need to worry about 'wanting it'. That is perfectly fine to want reassurance. With the right type of therapy, your pattern of 'shutting down' will occur less and less. It does take time though.
>
> There are Ts who are so gentle and welcoming and accepting that they will just wait and wait until you are ready to talk. Would a T or PDoc who talked about her/himself a lot during sessions at first, or even for a few months, help you deal? Or maybe a female would work better? Does your GP who can help you find someone know of your depersonalization issues?
the problem is that because i suffer from OCD, reassurance can be deadly. ideally i could sit talking to a therapist for hours about everything that's happening to me, but that can also function as an avoidance tactic to not have to deal with the OCD. so i would need to find someone well versed in OCD and psychotherapy i guess. my last therapist dealt with OCD primarily, but did shift things towards psychotherapy a lot (even though it wasn't really his area of specialty).>
> It's not disrespectful to not go back to therapists, but it feels that way doesn't it? Try not to worry about upsetting a Ts feelings (easier said than done). Ts are used to this and GGG needs to get well-not the therapist! The therapist is just fine and realize patients are shopping around.
>
> If your pdoc is not doing therapy, you can stay with him for meds and go with a psychologist/LCSW or other PDoc who does therapy. Or-you could find a new PDoc who does both therapy and meds. Either way, someone psychodynamic and attachment oriented, who is more understanding of your fear and difficulties would be most able to help you. My T is so patient-he gives me as much reassurance as I need and is so understanding and accepting. During the first couple of months when I began seeing him, I could actually feel this bubble of safety forming around the perimeter of his office. That sounds strange, but I do feel and sort of 'see' emotions sometimes. (My sensory system is overactive.) And I sensed the safety-almost as much as I'd notice a thick fog around us.i think i'd prefer a separate therapist, as i do need someone to deal with the OCD. and i probably should find a pdoc i trust, though that's hard, because i think that opening up to them will result in me just ending up heavily medicated.
>
> Yes, my memory is shot now too. Similar to you, I could memorize a textbook a decade ago. I think that depersonalization, dissociation, and or anxiety can mess your brain up after a while. It takes a lot of energy to use those psychological defenses. When stress levels are higher-it gets worse, like when you started having more problems with college and your anxiety increased.
>
> The good thing is that better cognitive functioning can come back with the appropriate treatment. But you need cared for and nurtured by someone who understands how you relate to them.
>
> I'm sorry it is so hard for you to talk to them. You are such a sweetie, yeah I know I already said that...it's just sad to see you suffer.
>
> Well I hope I'm not being too pushy here myself...feel free to let me know if I am. :)no you're not being pushy at all. i really really appreciate all your advice. it's comforting to just have someone listen and interact with one's difficulties i guess. thank you so much; im jealous of whoever has you as a mom
Posted by g_g_g_unit on June 21, 2010, at 4:12:21
In reply to Re: anyone here had neuropsychological testing done? » g_g_g_unit, posted by violette on June 21, 2010, at 3:03:10
> It seems a bit agressive/too soon. If you are unable to talk to him about DP symptoms, I'd be you'd be unable to tell him he's going to fast.yeah, i really can't speak up for myself around him. he seems kinda put out by complaints sometimes (maybe just the impression i get).
>
> Considering you can talk more openly with your GP, asking for a referral for a specific type of therapist who is more attachment-oriented and understanding of your particular issues might be your best move right now. Maybe consider a female this time?yeah i think i will go talk to them this week
>
> I really hope you figure everything out...sounds like your parents are trying to make decisions for you, but you would be best off making them yourself.
>
> I gotta take a break from the computer since I spent too much time here lately, but I'll check in to see what happens and how you are doing so please keep us updated. :)yeah totally, you have been more than helpful! thanks again
Posted by violette on June 22, 2010, at 19:38:52
In reply to Re: anyone here had neuropsychological testing done? » violette, posted by g_g_g_unit on June 21, 2010, at 4:09:39
Yeah I was just kidding about calling your Mom. :)
Reading about the descriptions of PDs is like reading astrology-Pisces, Aquarius, Taurus, or Scorpio. Hardly anyone fits into one category, but most people can find one or some traits in all of them that they can relate with. It's not very useful imo...
Whether you are a 'hyperchondriac' sometimes to relieve anxiety or to try to get dependency needs met--you totally seem cluster C to me! Basically, I think these traits are dynamic, but representing aspects of self and defense mechanisms, rather than 'seprate disorders': avoidant, OCD, anxiety, dependency, schizoid, social anxiety, schizotypal, dissociation, depersonalization = ways to deal with fear resulting from attachment issues.
If you were mostly narcissistic, you probably wouldn't have said about 10 things I'd read in your posts - such as being disrespectful to a therapist-worried about their feelings, or thinking your Mom and PDoc have good intentions for you, seeing shortcomings in yourself...Wanting others to like you and developing friendships to get your needs met is just wanting to be connected to people; not necessarily a narcissistic defense.
"the problem is that because i suffer from OCD, reassurance can be deadly. ideally i could sit talking to a therapist for hours about everything that's happening to me, but that can also function as an avoidance tactic to not have to deal with the OCD...."
Regardless if you have dependency, OCD issues, or other symptoms, my experience with CBT practitioners is that talking about it like you just described is an avoidance tactic against feeling emotions. Intellectualiztion=talking is a defense just like OCD. Did CBT help you after a year? Supposedly CBT is best for anxiety/OCD. Well maybe it is for some, but it made me worse. The difference is thinking vs. feeling. Talking about psychological aspects of yourself and life is totally different than experiencing feelings. You have to feel safe and develop a relationship with a T before you can share those inner feelings. Your self, your inner core state, is what needs healed so that you no longer have to use defenses to avoid feelings. CBT reinforces blocking emotions-blocking out your inner state. The problem is, anxiety/OCD also is a way to block emotions.
I keep thinking you have an attachment issue like most who get new symptoms upon starting or ending a relationship with a person. This stuff usually comes out when you get older and is hard to pinpoint until then; now that you are older, it might become more clear. What you described when going on that date sounds like terror. She activated your attachment system, which is why you 'lost your affect'. it was terrifying to think of getting close to someone. Holding on to your intellect kept your defenses in tact until then. That's not necessarily narcissistic-but a sign of not being allowed to be your true self as a child. The intellect helped you contian your self; relate to the world; then dissolved/fragmented upon feeling an awarenss of your inner child state. I know you don't like to read about schizoid, but if you scroll down to the part in this article about psychotherapy, it describes how/why developing trust first in therapy is so important.
http://www.psychologytribe.com/schizoid.pdf
Schizoid is sometimes viewed as a childhood development state-much like narcissism, where all children experience being 'narcissistic". I think a lot of people having underlying schizoid fears (and after reading this article, I think I'm a bit more schizoid than I had previously thought-projecting my fears on my T-always telling my T I feel like I'm going to overwhelm him with my feelings.)
Schizoid is basically a fear of being too close and a fear of being alone at the same time. It's not a 'personality type' like you read in that DSM. You can get more schizoid tendencies if your mother, for example, was someone always watching eery move you make-intrusive, not letting you explore on your own, not letting you 'be yourself', make decisions, looking through your stuff all the time/searching your room, not giving you freedom/respecting your boundaries...etc. (If your Mom is like that-don't get a female T!). Basically being overprotective so strongly does not fulfill developmental needs or leave room for emotional growth-it reinforces a pattern of not developing a strong self (you are not allowed to be yourself and it is bad to be yourself)-being comfortable with yourself and how you relate to others. Smothering you. So later in life, it's scary to reveal your feelings and be yurself since you developed a lifetime habit of repressing yourself since a parent never let you be autonomous.
But it is important for someone to understand aspects of your inner core state before you can open up. The fact that you could not tell your PDoc you have DP is major...A psychodynamic therapist, one who understands attachment issues and trained with childhood development, could do just that. If you end up with a therapist trying to 'change you', it reinforces feelings of low self worth (the confidence you describe); being defective; not being accepted as you are....you are defective so you must change. When a T understands and accepts your inner state and fears, it truly does create real and lasting change from within. No one forces it on you, no one tells you to change; the feelings emerge, are accepted, processed, and understood, leading to more insights and finally integration of the self.
In fact, I was getting angry at your Mom and PDoc when I was reading that article--as if you were unable to get angry at them, so I felt it for you. I realize you can't tell your PDoc what's going on...and maybe you present yourself totally differently in person, or maybe I'm not seeing the big picture here, but it upsets me that your PDoc does not know what is going on inside of you.
Posted by CaffeinePoet on June 25, 2010, at 9:29:09
In reply to anyone here had neuropsychological testing done?, posted by g_g_g_unit on June 18, 2010, at 23:19:47
I hope you do get some done! Even if you have to wait 6 months, it could answer a lot of questions for you.
Posted by g_g_g_unit on June 28, 2010, at 1:17:36
In reply to Re: anyone here had neuropsychological testing done? » g_g_g_unit, posted by violette on June 22, 2010, at 19:38:52
sorry for taking so long to get back to you - i've been trying to intermittently stay away from pbabble
> Yeah I was just kidding about calling your Mom. :)
>
> Reading about the descriptions of PDs is like reading astrology-Pisces, Aquarius, Taurus, or Scorpio. Hardly anyone fits into one category, but most people can find one or some traits in all of them that they can relate with. It's not very useful imo...
>
> Whether you are a 'hyperchondriac' sometimes to relieve anxiety or to try to get dependency needs met--you totally seem cluster C to me! Basically, I think these traits are dynamic, but representing aspects of self and defense mechanisms, rather than 'seprate disorders': avoidant, OCD, anxiety, dependency, schizoid, social anxiety, schizotypal, dissociation, depersonalization = ways to deal with fear resulting from attachment issues.
>
> If you were mostly narcissistic, you probably wouldn't have said about 10 things I'd read in your posts - such as being disrespectful to a therapist-worried about their feelings, or thinking your Mom and PDoc have good intentions for you, seeing shortcomings in yourself...Wanting others to like you and developing friendships to get your needs met is just wanting to be connected to people; not necessarily a narcissistic defense.thanks .. yeah, me and my therapist basically agreed that any narcissism on my part is really just a compensatory mechanism
>
> "the problem is that because i suffer from OCD, reassurance can be deadly. ideally i could sit talking to a therapist for hours about everything that's happening to me, but that can also function as an avoidance tactic to not have to deal with the OCD...."
>
> Regardless if you have dependency, OCD issues, or other symptoms, my experience with CBT practitioners is that talking about it like you just described is an avoidance tactic against feeling emotions. Intellectualiztion=talking is a defense just like OCD. Did CBT help you after a year? Supposedly CBT is best for anxiety/OCD. Well maybe it is for some, but it made me worse.i did exposure response prevention therapy, which did actually help my OCD. i just wasn't always committed enough to stick to it, but when i did, i saw improvements. i think it's necessary to exam issues surrounding OCD through psychotherapy, but trying to directly treat OCD with psychotherapy is a huge mistake and will just exacerbate it.
The difference is thinking vs. feeling. Talking about psychological aspects of yourself and life is totally different than experiencing feelings. You have to feel safe and develop a relationship with a T before you can share those inner feelings. Your self, your inner core state, is what needs healed so that you no longer have to use defenses to avoid feelings. CBT reinforces blocking emotions-blocking out your inner state. The problem is, anxiety/OCD also is a way to block emotions.
>
> I keep thinking you have an attachment issue like most who get new symptoms upon starting or ending a relationship with a person. This stuff usually comes out when you get older and is hard to pinpoint until then; now that you are older, it might become more clear. What you described when going on that date sounds like terror. She activated your attachment system, which is why you 'lost your affect'. it was terrifying to think of getting close to someone.i appreciate you doing your best to work with limited information - i realise it's hard when you dont have someone's life history on hand - but that isn't right. the 'loss of affect' came after years of accumulated stress, and for me was the first clear sign that my depression had become major/severe. going on a date didn't trigger it. i was like that around my best friend as well. and while i definitely have issues getting close to people, i had successfully been in relationships prior to that.
Holding on to your intellect kept your defenses in tact until then. That's not necessarily narcissistic-but a sign of not being allowed to be your true self as a child. The intellect helped you contian your self; relate to the world; then dissolved/fragmented upon feeling an awarenss of your inner child state. I know you don't like to read about schizoid, but if you scroll down to the part in this article about psychotherapy, it describes how/why developing trust first in therapy is so important.
>
> http://www.psychologytribe.com/schizoid.pdf
>
> Schizoid is sometimes viewed as a childhood development state-much like narcissism, where all children experience being 'narcissistic". I think a lot of people having underlying schizoid fears (and after reading this article, I think I'm a bit more schizoid than I had previously thought-projecting my fears on my T-always telling my T I feel like I'm going to overwhelm him with my feelings.)
>
> Schizoid is basically a fear of being too close and a fear of being alone at the same time. It's not a 'personality type' like you read in that DSM. You can get more schizoid tendencies if your mother, for example, was someone always watching eery move you make-intrusive, not letting you explore on your own, not letting you 'be yourself', make decisions, looking through your stuff all the time/searching your room, not giving you freedom/respecting your boundaries...etc. (If your Mom is like that-don't get a female T!). Basically being overprotective so strongly does not fulfill developmental needs or leave room for emotional growth-it reinforces a pattern of not developing a strong self (you are not allowed to be yourself and it is bad to be yourself)-being comfortable with yourself and how you relate to others. Smothering you. So later in life, it's scary to reveal your feelings and be yurself since you developed a lifetime habit of repressing yourself since a parent never let you be autonomous.it's interesting what you say about my mom (which is also exactly right). maybe things would have been worse if i'd let her continue like that, but at about 17 i made a definitive break from her and stopped really including her in my life. our relationship isn't nearly as close these days, but im not so psychologically dependent on her. and thanks - i'd been wondering if a female tharpist might be a bad idea in that light. all of my therapists have been female up to this point, but i just myself just reliving those feelings of reassurance i get from my mom.
>
> But it is important for someone to understand aspects of your inner core state before you can open up. The fact that you could not tell your PDoc you have DP is major...A psychodynamic therapist, one who understands attachment issues and trained with childhood development, could do just that. If you end up with a therapist trying to 'change you', it reinforces feelings of low self worth (the confidence you describe); being defective; not being accepted as you are....you are defective so you must change. When a T understands and accepts your inner state and fears, it truly does create real and lasting change from within. No one forces it on you, no one tells you to change; the feelings emerge, are accepted, processed, and understood, leading to more insights and finally integration of the self.
>
> In fact, I was getting angry at your Mom and PDoc when I was reading that article--as if you were unable to get angry at them, so I felt it for you. I realize you can't tell your PDoc what's going on...and maybe you present yourself totally differently in person, or maybe I'm not seeing the big picture here, but it upsets me that your PDoc does not know what is going on inside of you.
This is the end of the thread.
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