Troubled by Serious Conversations with Myself

Reader’s Question

I was diagnosed with depression and anxiety disorder at a very early age. I have seen several psychologists about these problems but there is one that always seems to be drowned out. Whenever I see a psychologist they always want to focus on my depression and why I’m depressed, my childhood and what not. But what I’m more concerned about is the fact that I have conversations with myself. I realize that this is normal for most people but I believe that the extent that this goes to is unhealthy. When I have these conversations, they aren’t with myself, they’re with other people. It could be anyone — someone I know or someone that I’ve “made up.”

My parents always said that I had an overactive imagination when I was a child, but I’m starting to wonder if it’s more than that. I physically react like I’m having a real conversation, making hand motions, smiling, laughing, even getting angry at things “they say.” I also find it almost impossible to stop myself from doing this. If I have just a second where I’m not focusing completely on something I start doing this. Do I need to take serious action, like check myself into an institution to be fully evaluated or does that fact that I realize I do this make it okay? I’m really worried.

Psychologist’s Reply

As you describe, there is a clinical range of “self-talk”. Your question prompts me to think about this clinical range of self-talk. As I think about it (a form of self-talk), I would suggest the following scale:

Below-Average Self-Talk (ST)

Individuals with limited imagination or those who seldom think before talking or reacting. They have little or no thinking-rehearsal for their actions.

Normal ST

This is a wide range of ST in which we might include self-soothing talk, thinking rehearsals as when planning what to say or how to respond in a conversation, imaginative conversation created out of boredom, fantasy ST such as rehearsing what you might say if you won the Academy Award, etc.

Emotional ST

This type of ST is more common in depression, anxiety, obsessive-compulsive disorder, etc. It’s self-talk that is emotionally upsetting such as “they hate you anyway”, “nobody likes me”, “I’d be better dead”, etc. When we remember that we feel what we think, “emotional self-talk” can be very distressing and dangerous to us and typically requires mental health consultation.

Intrusive and Overwhelming Self-Talk

Probably the most dangerous and most damaging type of self-talk, this includes self-talk that is overwhelming in productivity, frequency, and even volume. The self-talk seems to have a mind of its own as well as it’s own thoughts. This type of self-talk may seem external or outside the person, as though the thoughts were tormenting the individual. In a serious clinical situation, the self-talk seems projected outside the head/body of the individual, reaching the point of being considered auditory hallucinations or “voices”.

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As you have correctly determined, your self-talk is moving outside of the normal range into unhealthy “Emotional Self-Talk” if not “Intrusive Self-Talk”. As a healthy individual, we tend to use our self-talk to help us respond, react, and interact with the environment outside our personality. It’s unhealthy if we are spending a great deal of time reacting and interacting with our internal thoughts.

What can cause this? This may be related to Obsessive-Compulsive Disorder, which is often associated with depression. Both are linked to low levels of the neurotransmitter Serotonin and for that reason, occur together. This would be consistent with the tormenting theme.

At the same time, I’m concerned that you’re losing control of what “they say’ and reacting emotionally to their comments. If you’re also experiencing agitation, suspiciousness, paranoia, and increased thinking speed, you may be dealing with a more serious psychiatric issue that involves the neurotransmitter Dopamine. If this is true, you’ll gradually lose control of these voices — when they speak, what they talk about, their volume, their intrusiveness, and how many are present.

I would recommend a psychiatric consultation. A psychiatrist is best trained to identify not only the type of self-talk that might be involved, but whether such self-talk may by a symptom of a psychiatric concern. This is not likely to require hospitalization, but it does require the courage to see a psychiatrist and openly discuss the issue. In both cases involving a neurotransmitter, we have medications that are safe to use that will help you mange the intrusiveness of those internal conversations. This is very manageable from a mental health standpoint, so I’d make arrangements for a consultation as soon as possible.