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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Girlnterrupted78 on May 27, 2009, at 1:24:20
I always call it depression, or anxiety, but I'm starting to wonder if maybe it's something else?
It's hard to describe, but it's like being perpetually upset. Like, right after you have a fight or a confrontation with someone important, you have all that adrenaline and you feel like you're going to pass out either out of humiliation or just feeling like absolute crap.. imagine feeling a less severe version of that, always, forever, and whenever you're around people.
At some point I thought it was social anxiety, but sometimes I realize I'm not anxious. Yet I feel emotional stiffness. I can't smile. I can't feel happy or enjoy a party. I have to force a smile. The hardest part is when people come excited and very cheery to tell me about something. I always have to force or feign excitement. It's like my emotional system is just incapable of ever feeling any sort of social enjoyment or pleasure.
I might feel ok when I'm home, but around people I'm always stiff. And as a result of that, I constantly worry that because I have no emotional energy, I'm giving the wrong impression--one of either disliking the person, being bored, or being fake.
So what is this? Could someone tell me if this has a diagnosis of some sort?
Thanks.
Posted by greywolf on May 27, 2009, at 3:01:29
In reply to Does this symptom fall into any category?, posted by Girlnterrupted78 on May 27, 2009, at 1:24:20
I'm not sure that we have enough information. Based on what you wrote, it sounds like depression with occasional bouts of anger. But you're suggesting something else. It could be an anxiety disorder or one of the many personality disorders.
Maybe you could take a look at some of these disorders and give more info to help define what you are experiencing.
Greywolf
Posted by Phillipa on May 27, 2009, at 10:56:29
In reply to Re: Does this symptom fall into any category?, posted by greywolf on May 27, 2009, at 3:01:29
Yes sounds like my anxiety disorder. I avoid intimate social situations prefer stores or just outside on the street then I can leave. Phillipa
Posted by Neal on May 27, 2009, at 21:52:40
In reply to Does this symptom fall into any category?, posted by Girlnterrupted78 on May 27, 2009, at 1:24:20
you might check-out what's called in the DSM Book a thing called asperger's syndrome.
Posted by garnet71 on May 27, 2009, at 22:03:08
In reply to Does this symptom fall into any category?, posted by Girlnterrupted78 on May 27, 2009, at 1:24:20
Looks like a variety of opinions here...
I don't understand the first part, but this sounds like a mix of social anxiety & dysthmia - or - it could even be side effects from a drug (some drugs give you emotional numbness/flatness):
"At some point I thought it was social anxiety, but sometimes I realize I'm not anxious. Yet I feel emotional stiffness. I can't smile. I can't feel happy or enjoy a party. I have to force a smile. The hardest part is when people come excited and very cheery to tell me about something. I always have to force or feign excitement. It's like my emotional system is just incapable of ever feeling any sort of social enjoyment or pleasure.
I might feel ok when I'm home, but around people I'm always stiff. And as a result of that, I constantly worry that because I have no emotional energy, I'm giving the wrong impression--one of either disliking the person, being bored, or being fake. "
Are you on meds?
Posted by raisinb on May 28, 2009, at 10:34:55
In reply to Does this symptom fall into any category?, posted by Girlnterrupted78 on May 27, 2009, at 1:24:20
I think you're describing a set of reactions and experiences that might not fall under a simple diagnosis. Sounds like the kind of complex issues that respond more to therapy. Medication, if you find one that helps you feel less stressed or "stiff," can help. But it will not on its own teach you to make real connections with others. My .02.
Posted by Girlnterrupted78 on May 28, 2009, at 15:13:52
In reply to Does this symptom fall into any category?, posted by Girlnterrupted78 on May 27, 2009, at 1:24:20
Thank you all for the feedback.
I think garnet got closer to what it might be. I almost totally fit the description for dysthymia and a little bit of social anxiety. The social anxiety seems to be a result of the dysthymia, since I always felt something was wrong with me because of my inability to feel as happy or socially comfortable as everyone else. That stiffness started to really mess up my self-esteem.
Definitely not aspergers. I'm very intuitive and very good at reading social cues and non-verbal communication. Asperger's doesn't appear to have a big depressive/distress component, which I have most of the time, hence, I doubt that is the problem.
Also, Celexa completely cured my dysthymic symptoms for an entire year, and therapy hasn't done much if anything. To me, it seems more of a chemical problem (maybe low serotonin, dopamine or norepinephrine?)
How could therapy alter serotonin and other neurotransmitters? Is that even possible? I mean, I went into full remission just through Celexa, without any mental changes. That says a lot (at least to me) about the nature of the problem.
Very sporadically, I feel some minor relief. For example, after months of not exercising, one day I exercised a lot and the next day I felt great. Unfortunately, it was only one day. I kept exercising and didn't continue to feel relief.
Thanks again for the info.
If anyone knows of any successful treatments for dysthymia, I'd appreciate any info you may have. I've tried most SSRI's, Nardil, Wellbutrin & Effexor without results (Except for Celexa, which pooped out after a year.)
Posted by bulldog2 on May 28, 2009, at 15:35:59
In reply to Does this symptom fall into any category?, posted by Girlnterrupted78 on May 27, 2009, at 1:24:20
> I always call it depression, or anxiety, but I'm starting to wonder if maybe it's something else?
>
> It's hard to describe, but it's like being perpetually upset. Like, right after you have a fight or a confrontation with someone important, you have all that adrenaline and you feel like you're going to pass out either out of humiliation or just feeling like absolute crap.. imagine feeling a less severe version of that, always, forever, and whenever you're around people.
>
> At some point I thought it was social anxiety, but sometimes I realize I'm not anxious. Yet I feel emotional stiffness. I can't smile. I can't feel happy or enjoy a party. I have to force a smile. The hardest part is when people come excited and very cheery to tell me about something. I always have to force or feign excitement. It's like my emotional system is just incapable of ever feeling any sort of social enjoyment or pleasure.
>
> I might feel ok when I'm home, but around people I'm always stiff. And as a result of that, I constantly worry that because I have no emotional energy, I'm giving the wrong impression--one of either disliking the person, being bored, or being fake.
>
> So what is this? Could someone tell me if this has a diagnosis of some sort?
>
> Thanks.sounds like social phobia/anxiety..There are some elements of depression you describe...are you happy in any situations...
Klonopin is good for social anxiety / phobia..nardil is recommended for social anxiety/phobia with depression..
Posted by garnet71 on May 28, 2009, at 18:27:36
In reply to Re: Does this symptom fall into any category?, posted by Girlnterrupted78 on May 28, 2009, at 15:13:52
Hey Girlinterrupted-I had that feeling for a while years ago...I used to attribute it to my meds. I had PTSD back then...I only read up on it recently though, and what you are experiencing seems to fall in line with PTSD or someone who is an abuse survivor; I can see a connection betwen feeling like that and hypervigilience, but not as extreme. If abuse/PTSD doesn't apply to you, you might want to try prozac anyway.
Prozac is supposed to work better for PTSD, so I would think someone with comparable symptoms too, I forget why but there is research on that.
I didn't take Prozac long enough to judge its efficacy, but my anxiety dissapeared by the 2nd day of my trial, and it was pretty severe at the time. It gave me weird neurological symptoms, though, not ones that effect the way you feel-but it sort of freaked me out and I couldn't continue it. I'm a pill phobic; anything that gives me strange symptoms scares me away. I think about going back to try it again, but haven't been able to get myself to.
Well the good news is that feeling can go away--I haven't felt that for a long time. I think it will for you too.
Posted by desolationrower on May 29, 2009, at 1:44:12
In reply to Re: Does this symptom fall into any category?, posted by Girlnterrupted78 on May 28, 2009, at 15:13:52
> Also, Celexa completely cured my dysthymic symptoms for an entire year, and therapy hasn't done much if anything. To me, it seems more of a chemical problem (maybe low serotonin, dopamine or norepinephrine?)
>
> How could therapy alter serotonin and other neurotransmitters? Is that even possible? I mean, I went into full remission just through Celexa, without any mental changes. That says a lot (at least to me) about the nature of the problem.
>Well, this is sort of a theoretical argument, but how do you think the mind exists? As i see it, the mind is a emergent phenomenon that exists because of, and in turn changes the state of, the brain (including neurotransmitters, neural connections, blood flow, etc.). When we alter the brain, the psyche necessarily changes; when we change what we think, feel or know, the brain necessarily changes. there are brain imaging studies confirming this.
on a more helpful wavelength, have you tried a stimulant? or even just a TCA?
and on a personal note, you've described very exactly how i feel. I also have significant avoidance and trouble with attention and boredom. I found sri drugs to worsen things. parnate has fixed all the depression i started to experience, but less helpful for the other aspects.
-d/r
Posted by Girlnterrupted78 on May 29, 2009, at 14:15:08
In reply to Re: Does this symptom fall into any category?, posted by garnet71 on May 28, 2009, at 18:27:36
Thank you for the info, garnet.
I had some abuse from my stepmother and father. But how severe does it have to be to create PTSD? I recall I used to cry almost every night because of some kind of bad event with my parents, and my relationship with my stepmother was always pretty dysfunctional and she treated me like I was an adult since I was 4-years-old. She'd stoop to my level and fight with me, and of course, she'd always win. Could that be the reason?
I haven't tried Prozac. I might give it a try, but in the meantime I'm going to give a try to a research program at Columbia Psychiatric Institute. I'm going next week and will see what they tell me.
Just a question: You said you "had" PTSD? You mean you got cured, or how can you not have it anymore? Since you didn't give Prozac enough time, did you try something else that worked?
I've felt this way for my entire life, about 30 years, and it doesn't seem like it's going to change after all this time. It impairs me socially, at work, in relationships, pretty much everywhere. It's like hell on earth. It's not worth living with a chronic problem like this.
Thanks again.
Posted by garnet71 on May 29, 2009, at 20:12:53
In reply to Re: Does this symptom fall into any category? » garnet71, posted by Girlnterrupted78 on May 29, 2009, at 14:15:08
It's pretty easy to not feel comfortable around others when you grew up with dysfunction at the level you described. I used to have moderate social anxiety until I was about 20. Felt disconnected from people-mainly strangers/acquaintences/coworkers, and even friends, as a result of growing up with abuse and dysfunction, very similar to what you described but to a lesser degree. I moved out away my parents when I was 16, and got better on my own, it progressed from there until I had no psychological issues for a few years and became very confident, outgoing, poised; felt "normal" and comfortable around people. I had never talked to a therapist or been to a PDoc until I was 29.
I had a situation when I was about 29, PTSD was a result. I became a basket case, and it also triggered childhood trauma I never dealt with emotionally, though I spent plenty of effort dealing with it intellectually and rationally throughout my childhood and teen years. It was at this time I felt much like you described.
PTSD can be protracted, building up slowly, though it might be only a theory, not sure. If you think of it on a scale from mild to extreme, it makes sense to think you don't have to be a victim of war or extreme violence to have the symtpoms. Also, people can present symtpoms more intense than others, that's pretty obvious. People's experiences can be more or less traumatic than others; or people can be more traumatized than others in response to the same thing.
I'll leave this link for you, a conversation with another member here regarding PTSD.
http://www.dr-bob.org/babble/psycho/20090421/msgs/894593.html
symptoms of PTSD can go away. I was never treated appropriately for it because my therapist, the one who easily recognized the symptoms, passed away. He was an angel, truly a compassionate human being who dedicated his life to his profession. He was also the first one to explain why I felt the way you described. I remember the visuals during that conversation like it was yesterday--no one had ever recognized or explained that to me. It was a relief that someone understood exactly how I felt-well, enough to explain it to me articulately.
I wish I had known then that treatment should be different for PTSD than depression/anxiety. I think I would have healed sooner. I'm much, much better now, and the feeling you described hasn't appeared in a few years now, though I do get relapses of social anxiety once in a blue moon.
Yes, you can present PTSD symptoms from neglect and abuse. I remember crying many nights too. Being in that environment for many years can really harm your mental health. If I were you, I wouldn't minimize that abuse, even though you didn't provide details, it sounds like you had a pretty traumatic childhood. You don't have to have physical abuse to be traumatized; i've found emotional abuse and other abuse to be much worse than physical abuse. I suppose everyone's different though.
Regarding your med quesiton, Effexor with Wellbutrin worked for me when I was at my worst. I don't have depression symptoms anymore, but have had chronic anxiety for a number of years. Still trying to find an appropriate remedy now that I know there are other things out there for anxiety besides xxRIs.
Having a good therapist makes a lot of difference. What type of research study are you thinking of participating in?
Posted by garnet71 on May 31, 2009, at 15:10:52
In reply to Re: Does this symptom fall into any category? » garnet71, posted by Girlnterrupted78 on May 29, 2009, at 14:15:08
Hi GI. I thought I'd post this if you were still around. In reexamining my own source of anxiety last night, I came across this article and I thought it might help you figure things out. I think it makes a difference in your treatment to know whether or not your symptoms present mostly as PTSD or another form of anxiety.
Note that with PTSD it is common to present Avoidance symptoms, which are symptoms I inferred from your post, and are related to the feeling of "dysthmia". Avoidance is very complicated and can be one of the most devastating feelings--a persistant feeling of exteme discontent that is worse than the normal dread of anxiety attacks and maybe even the hoplessness of depression for some people, depending upon the degree of avoidance; of course one would have to experience both to make that sort of comparison. Relativity sometimes can emphasize a point of discussion. You may want to read more about Avoidance.
PTSD doesn't necessarily mean you have to focus on one single event, such as one abuse situation. It can manifest from a protracted abuse situation. Maybe this is common sense, but I thought I'd point it out because stereotypes of PTSD are sometimes misleading.
"There are different types of anxiety disorder depending on their causes or triggers."
Thus, it may be beneficial for you to identify your specific anxiety type to develop a more appropriate course of therapy. Identifying causes and triggers, of course, is always helpful.
I thought this article was a good summary of the main types of anxiety disorders: PTSD; Generalized Anxiety Disorder; Specific Phobia; Panic Disorder; Social Phobia.
Of course, your symtpoms may be a blend of all of them, but I do think it's helpful to know the specific category they tend to fall into. I have come across some research that concludes treatment for PTSD anxiety should be differentiated from other types; however, I can't think of any concrete examples and only remember that concept in the abstract. I do think it would be helpful for therapy; in my case, I wished I had made this distinction years go.
I hope this information could be helpful for you. Take care.
Different Types of Anxiety Disorders
Anxiety is a common occurrence when a person faces potentially problematic or dangerous situations. It is also felt when a person perceives an external threat. However, chronic and irrational anxiety can lead to a form of anxiety disorder. There are different types of anxiety disorder depending on their causes or triggers.
PTSD Post-traumatic stress disorder - may occur after a person experienced a severely traumatic event. He or she may relive the experience in his or her mind which causes stress and anxiety. If a person with PTSD comes into contact with stimuli (any object, person, or situation) that he or she associates with the traumatic event, he or she may literally re-experience the event by crying uncontrollably, panicking, or losing control. Subtler symptoms include insomnia and avoidant behavior. PTSD may manifest itself immediately after the traumatic event or even years after. Determining the type of anxiety disorder a person has is crucial to seeking treatment and recovery. Techniques and methods that are used to help a person cope with a certain anxiety usually target not only the management of symptoms but coping mechanisms when exposed to triggers. Only after thorough diagnosis can treatment and recovery for anxiety disorders really commence.
Generalized anxiety disorder - A person who has this type of anxiety disorder usually experience prolonged anxiety that is often without basis. More accurately, people with generalized anxiety disorders cannot articulate the reason behind their anxiety. This type of anxiety usually last for six months and often affect women. Due to the persistence of the anxiety, people affected with generalized anxiety disorder constantly fret and worry. This results to heart palpitations, insomnia, headaches, and dizzy spells.
Specific phobia - Unlike someone with generalized anxiety disorder, a person who has a specific phobia experiences extreme and often irrational fear of a certain situation or object. When exposed to the object or situation they fear, people with specific phobias exhibit signs of intense fear like shaking, shortness of breath, heart palpitations, and nausea. Common specific phobias include fear of heights, enclosed spaces, blood, and animals. The fear a person with phobia feels can be so extreme that he or she may disregard safety just to escape the situation.
Panic disorder - Also known as Agoraphobia, panic disorders are characterized by recurring panic attacks which are often unexpected. Symptoms are usually shaking, chest pains, dizziness, fear of losing control, and reluctance of being alone. People with panic disorder are aware that their panic is usually unfounded and illogical. This is why they avoid public situations and being alone. A panic attack can be so severe that people may lose control and hurt themselves.
Social phobia - Alternatively called social anxiety, a person with social phobia may exhibit similar symptoms like those of panic disorder especially in social situations. Shaking, dizziness, shortness of breath, and heart palpitations may ensue when a person with social phobia finds his or herself at the center of attention or in the company of many people, regardless whether they are strangers or not. Obsessive-compulsive disorder People with obsessive-compulsive disorder experience anxiety caused by a persistent obsession or idea. They tend to avoid experiencing anxiety by resorting to repetitive actions or behaviors that prevent anxiety. For example, a person who is obsessed about cleanliness may experience anxiety at the mere sight of a vase placed slightly off-center. To prevent anxiety, he or she will clean and organize everything compulsively or without reason.
Posted by desolationrower on June 1, 2009, at 3:12:27
In reply to Re: Does this symptom fall into any category? » Girlnterrupted78, posted by garnet71 on May 31, 2009, at 15:10:52
hm....i wonder what the nexus is between internalizing symptoms, atypical depression, PTSD, avoidance, social isolation, and the observation that what we do to ourselves hurts the worst (can't reconstruct enough of that quote to find it on google)
probably also cortisol
-d/r
Posted by garnet71 on June 1, 2009, at 13:57:00
In reply to Re: Does this symptom fall into any category?, posted by desolationrower on June 1, 2009, at 3:12:27
Cortisol! Yeah, I wish I had known about cortisol years ago...
"hm....i wonder what the nexus is between internalizing symptoms, atypical depression, PTSD, avoidance, social isolation, and the observation that what we do to ourselves hurts the worst"
What do you mean, exactly, about the observation of "what we do to ourselves"?
Posted by Girlnterrupted78 on June 2, 2009, at 23:47:50
In reply to Re: Does this symptom fall into any category? » Girlnterrupted78, posted by garnet71 on May 31, 2009, at 15:10:52
Thanks for the info. I've been familiar with these descriptions for several years now. My only new discovery is that of C-PTSD.
Anyway, the study I might participate in is for the trial of a new medication for treatment-resistant depression. I went to the first interview and they require still some more info to know if I'm eligible.
Thanks again.
Posted by desolationrower on June 8, 2009, at 3:32:13
In reply to Re: Does this symptom fall into any category? » desolationrower, posted by garnet71 on June 1, 2009, at 13:57:00
> Cortisol! Yeah, I wish I had known about cortisol years ago...
>
> "hm....i wonder what the nexus is between internalizing symptoms, atypical depression, PTSD, avoidance, social isolation, and the observation that what we do to ourselves hurts the worst"
>
> What do you mean, exactly, about the observation of "what we do to ourselves"?wish i could find what i was reading on this, but basically that its harder to move past things if we feel complicit or the blame for them
-d/r
Posted by garnet71 on June 8, 2009, at 13:48:45
In reply to Re: Does this symptom fall into any category?, posted by desolationrower on June 8, 2009, at 3:32:13
Kind of like anger directed inward turns to depression? I spent some time being angry at myself, blaming myself for abuse subjected upon me by another in that I was angry at myself for somehow "letting" it happen. It was very unhealthy and I didn't realize it at the time. Later I realized it had little to do with me, personally. I've been so much better off since I finally woke up from that. Still, that was years ago, but the feeling still does emerge, though briefly, from time to time.
I'd be interested in what you read, if you come to think about it again sometime.
Posted by desolationrower on June 10, 2009, at 19:49:24
In reply to Re: Does this symptom fall into any category? » desolationrower, posted by garnet71 on June 8, 2009, at 13:48:45
> Kind of like anger directed inward turns to depression? I spent some time being angry at myself, blaming myself for abuse subjected upon me by another in that I was angry at myself for somehow "letting" it happen. It was very unhealthy and I didn't realize it at the time. Later I realized it had little to do with me, personally. I've been so much better off since I finally woke up from that. Still, that was years ago, but the feeling still does emerge, though briefly, from time to time.
>
> I'd be interested in what you read, if you come to think about it again sometime.i think you've got as good of an idea of what i was trying to say as i do :)
-d/r
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