Finding the Treatment that Helps

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Reader’s Question

I am 25 years old and ever since before I can remember I have been very angry. I suffered abuse as a child and in my teens I was in a violent relationship. I have seriously depressive days 98% of the time and feel hopeless quite a lot. Yet, at other times, I will be overly enthusiastic about stupid ideas and beliefs, and can get very frustrated and angry with myself when I realise how ridiculous the ideas really are. I’ve asked countless doctors for help to stop these feelings, as when I get angry I can get very violent and hit people I care about. The doctors just say I am depressed, anxious and suffer from post-traumatic stress disorder, then prescribe me medicine I can’t seem to remember to keep taking, or they send me to see someone who doesn’t do anything except ask me about things and take notes.

I feel I need serious help and that there is something else wrong with me. I mentioned bipolar disorder to one doctor and he said I do not suffer from it. However, the extremes I have when angry are in a way hyper, and I can be very childish and can’t control this when it happens. I snap at people without realising or being able to stop it until it is too late. I do not know what to do and this is affecting my job, as I have no energy when I am in this depressive state (which is most of the time).

What can I do? My doctors think I exaggerate things, and they will not listen to me.

Psychologist’s Reply

Although it may seem that it is important to have a definite diagnosis, often the much more important thing is to find a treatment that helps. Medications are frequently the starting point, especially when the issue is depression that is affecting your life to this degree. So, it seems like an important step in your own self-care is to give prescribed medications a thorough test. That means taking each one precisely as prescribed for a number of weeks before judging how much it helps.

Because there has been increased public awareness of bipolar disorder (formerly manic-depression), we sometimes equate moodiness or sudden mood swings with that disorder. However, the shift from depression to mania, or hyperactivity, in bipolar disorder typically takes weeks or months. Mood instability, irritability, and anger as you describe indeed can be aspects of depression or post-traumatic stress disorder. Another possibility is borderline personality disorder (BPD). Individuals with BPD frequently have had childhood experiences of trauma or abuse. Primary signs or symptoms of BPD include:

  • Unstable mood and identity — How the person feels is very much affected by how things are going in that person’s life at the moment, and mood changes accordingly (as does sense of self). The person has great difficulty regulating feelings or providing self-soothing when emotionally hurt. As a result, the person may be impulsive.
  • Black-and-white thinking — Events and people tend to be seen as either all good or all bad, and may go from good to bad quickly if they don’t live up to the person’s expectations and needs. Because the person often looks to others for a sense of worth, extra pressure is placed on loved ones to be always available and supportive.
  • Proneness to depression, self-harm behaviors (such as self-cutting), and suicidal feelings — Sometimes, when overwhelmed by feelings, the individual finds that the pain from self-harm behaviors provides a concrete experience to focus on, which is somewhat reassuring compared to the overwhelming emotions. Taken to the extreme, suicide may feel like the only option for escaping overwhelming feelings.

Of course I don’t know whether any of this applies to you, but it provides a possibility to explore. Regardless of whether it fits, I encourage you to dedicate yourself to treatment. For any of the possible disorders mentioned here, change won’t occur suddenly. Also, treatment providers may disappoint you in various ways, but it’s your responsibility to continue seeking out and evaluating treatment options (which typically requires trying the treatment for some time).

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