I’m Isolated and Depressed — Where Did It All Start?

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Reader’s Question

I was wondering if being an only child raised in a single-parent household could increase the likelihood of developing avoidant personality disorder.

My father died just before I was two, and my mom never remarried. She wasn’t abusive in any way intentionally, but she wasn’t able to be around for me very much either. I had no cousins until I was 15, and though I have three aunts and one uncle, I don’t see them much more than on Christmas (if that anymore). My maternal grandmother and I weren’t very close, but I was close to my maternal grandfather, who unfortunately died when I was 13. I wasn’t close to my paternal grandmother either, and never even knew my paternal grandfather. I spent a great deal of time alone as a kid, and now, at 30 years of age, I feel like I spend more time alone than ever. I am often depressed; have been a self-injurer on and off for over a decade; had substance abuse issues; was raped by, married to and divorced from an abuser…there’s more, but the list is pretty long. At any rate, I’ve struggled with low self-esteem and relational issues for years, and I’m trying to determine where it all started. Any information/advice/resources you may be able to give me is greatly appreciated.

Psychologist’s Reply

Something is going on for you, but I’m not sure it is avoidant personality disorder. That diagnosis suggests that there is a global anxiety about approaching relationships with others to the point of withdrawing and isolating yourself from relationships. That definitely results in depression, but anxiety remains the overriding mood. In your description, I don’t hear that the anxiety within relationships is the predominant mood you’re experiencing.

While it is important to have a diagnosis to formulate a treatment plan (something that a skilled therapist can develop with you), understanding yourself might best come from another formulation. That is,

  1. what is the main affect or emotion you experience,
  2. what psychological defenses do you mount to help you cope with that emotion, and
  3. what are the so-called ‘object relations’ underlying the emotion?

That is, emotions represent communication to another person or ‘object’. Emotion is our primary language, known to us at birth and developed before spoken language is even possible for us physiologically. You might ask yourself what your emotional state says about your relationships; whether you respond to others as if the other were your mother/father or grandfather.

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Understanding yourself, with the help of your therapist, can help you gain insight into your relationships and your mood. It can interrupt the automatic responses you have to others that contribute to your current condition.

It is never easy or straightforward to answer these questions. Further, the answers to the questions change with each changing relationship and situation. Having an ongoing relationship with a therapist, preferably one with a psychodynamic background, can help you trace these dynamics to their source and understand what alternatives you have in relating to others and yourself. This process takes time, but can lead to a change in your global perspective.

If you wish to find a therapist who can work with you psychodynamically and at an affordable rate, ask your local psychoanalytic training institute for a referral. Often, one can receive excellent, inexpensive treatment from an analyst in training who is being supervised by a highly experienced trainer. For example, here in Los Angeles we have several institutes that have low-cost clinics that provide this service (e.g., LAISPS, The New Institute, the California Graduate Institute, and others). Even if you are not near a major metropolitan area, these institutes may have associates near you. The US state licensing board for psychologists can also be very helpful in offering referrals.

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