After the psychiatric assessment.

So as you probably already know, I had an appointment with the psychiatrist today to finally diagnose my dysthymia and talk about my possible AVPD. It all went much quicker than I would expect.

As I said yesterday, I was lucky, because I saw the same psychiatrist who saw me after I left the boarding school, who helped me to get individual learning for one year that I had until finishing the stage of education on which I was then, and who diagnosed me with reactive depression. She was very understanding for me and also for my Mum, and I got along with her so I was glad I could see her again as she already knew my story. It was my Mum’s idea to ask her whether she could assess me, because she was the one who first thought that I may have dysthymic disorder and because she already knew most basic things about me. I wouldn’t think she’d agree and have time for me, she works mostly with children, but she agreed.

Also my therapist Monika – the one with whom I have phone check-ins with – came for this appointment.

There was a lot discussed. She wanted to know how I’ve been doing during those four years since going out of the boarding school and then seeing her, so we brought up a lot of things and issues, but very basically I told her I’m of course much better now and less depressive, but I feel like I’m not really stable and struggling a lot with anxiety, plus my depression, althugh is definitely not as overwhelming as back then, is still soundly in place. The last time I saw her, I told her I think it’s my normal to be always more or less depressive, since I just was this way for as long as I could remember. She told me it’s certainly not the way I am, but how my surroundings and life circumstances have shaped me and that she thinks that when I’ll be in more friendly environment where I feel safe I will get better, however she read that I have hypothyroidism so she said I’d have to regulate it, because it’s commonly known that low thyroid hormones can make you depressive. And then she said that if depression will persist for abut four years, I probably would need to be treated for persistent depressive disorder. So I told her my thyroid hormones are pretty reasonable most of the time now, and I’m still low most of the time. I explained to her that it’s manageable and I can still enjoy things, but I often feel like everything is absolutely meaningless, am sad, hopeless, and frustrated with life and myself, I still have self harm urges, although not as often as in the past, and suicidal thoughts are still present somewhere in the background of my life, they’re never very strong, but they are there most of the time. I told her I can live normally most of the time but every few weeks have times when I feel so very flat and overwhelmed and it’s really hard to be normal then if even possible, not only because of my mood being so low and everything seeming overwhelming, but also of my energy being extremely low and that I get terribly exhausted very easily. And it always lasts for about a week. We talked about my mood in detail and how it is shifting and whether I’ve noticed any particular patterns in it. She also talked with my therapist who knows me for years and knows a lot about me and how I function. I also mentioned her about my self esteem being shitty and my feelings of inadequacy, and my therapist said an interesting and rather striking thing for me, that to be correct, we should actually say my self esteem is closer to non existent than low. I told them that actually that’s how it was before, but now I feel like it isn’t as very low as it was for example even two years ago. So we got deeper into it for quite a while. My Mum told the psychiatrist that she thinks that althugh I may seem gloomy, if she wouldn’t be my Mum, she would have a hard time believing I can have depression, because although it has improved slightly over the years and I am much better at talking/writing about feelings to people I feel safe with, I still stifle most of my emotions in interactions with other people. I told her I’m still scared of showing my feelings, and that actually now I’ve been bottling them up for so long that even if I want to express them, sometimes I just can’t and I’m very confused as for how to actually do it and that is frustrating and makes me feel even more inadequate ’cause I know very well what I feel but releasing it is another thing sometimes even putting it into words may take me quite a while. I mentioned to her how scary is for me processing some things from the past or even thinking about them, like about the roots of my anxieties, about which I don’t know much. I feel kinda conflicted because I want to get rid of it and know what it actually is and why, but I am afraid of uncovering it much much more.

And from that we moved on to those last events that led my Mum to the conclusion that I was actually emotionally abused for most of my childhood and how I find it still hard and uncomfortable to think about my past experiences as “traumatic”, because it sounds (in context of my experiences) kinda exaggerated to me. Other people can have traumatic experiences, but I hate thinking this way about my own, because… dunno, because it just makes me feel weak and like I shouldn’t be so traumatised by such things and should get over it long long ago.

Of course my Mum became very emotional and started to cry, I really feel for her that she cries in all kinds of moving situations in front of other people. We also talked a bit about all kinds of my relationships and how I’ve never had many of them, and even if so, very few of them were satisfying for me. I told her that socialising feels very exhausting for me, but although I generally don’t mind being alone, sometimes it feels a bit too lonely, but right now the only people with whom I’m in touch and happy of it are my family and some online friends. And we talked about my current situation in which I feel a bit like I’m stuck and don’t know what to do, I feel like there’s just a big black hole in front of it, or maybe I’m already inside of it, but it doesn’t feel so yet, because I’m still fueled by my achievements during the exams and that I’m finally free from school so maybe I’m just floating above this hole before I subside into it.

She was listening to both my Mum and me very carefully and was very understanding. Then she asked me quite straight-forward whether I feel like going on some medication, or like it’s manageable without and said that the decision whether she’d prescribe something for me like some SSRI today is up to me. That was a hard decision for me to make. But I decided I will stay without medication. I was coping unmedicated for my whole life. I’ve been through much, much, much worse depression in my life. These times when I feel most low are hard to go through, but I will try and I will go on meds if I’ll really really need to. I had an occasion to be prescribed SSRI before, when I was very concerned about my sleep paralysis and what it is, went to the neurologist and she said some people handle it with antidepresants because the mechanism that is responsible for sleep paralysis is somehow dependent on serotonin or something like this and she also asked me whether I want something for it. And I also decided to not take it and try to cope without. That stuff seems to have so many side effects that I would really need to think about it twice or even thrice to decide on taking it. I told her though that my GP has put me on anti-anxiety meds, because my anxiety was through the roof and I really needed them. She said it’s OK and that if I’ll feel like I need some medication I can schedule an appt with her. It was very nice of her that although she has so many children patients she is willing to carve out some time for me. She said though that I definitely need therapy and she wrote in my files that I have persistent depressive disorder and all the conclusions and wrote a referral for therapy for me.

Then my therapist told her that we’ve been talking a lot lately about this AVPD thing and I told her that whole story about how I found that Swedish girl with AVPD and how strongly her blog resonated with me and all she wrote about her condition and just how similar we seemed to be and then how I started to research it and it just shocked me how much like me it all was. Not everything to the same extend, but I can relate to all the criteria. I told her how I’ve actually never felt before like I react very strongly to other people’s critic and I didn’t feel like the fear of rejection and critic is what makes me avoid social interactions, but I didn’t know what else could it be, it was just always so that I was very anxious with other people and I never thought about the causes so when I thought more about it I realised that it may be the fear of rejection. After all I’ve been very often criticised and rejected by people for all my childhood and the whole situation that I have to be away from my family felt like rejection to me because well a 5-year-old won’t understand that “It’s better for you”. And my inner critic is constantly in action and she must hate me like shit I guess.

She read all the notes from that PD therapist whom I visited in March and seemed very involved. She asked me about my anxiety and how I see myself. She was also curious why I refer to my inner critic a bit like it was another person so I said I do it just for fun, I even call her Maggie. I often have, or maybe rather imagine having, stormy conversations with her in my brain and I imagine that she is a different person and the more stormy those discussions are, the more I feel like self-harming, Maggie is a very sarcastic and snarky part of me and almost always manages to make me feel terrible about myself. I feel like it all seems very complex and weird and I actually never talked with anyone in detail about it, my Mum just sat there very surprised, but they were very accepting and weren’t assuming at least not aloud that I’m freaky. 😀 So I also told them about other of my sort of imaginary friends, like that there is Bibiel, who always makes fun of everything and helps me create an impression, particularly around others,  that I am doing absolutely OK, if I need to seem OK, Bibiel is a little more social and very humourous me, slightly immature, likes to do strange things just for fun and has rather carefree, distant attitude to everything. And I imagine all of them as normal people, but who are parts of me and help me cope with some hard situations. She told me that creating imaginary friends is an often used coping mechanism for children, and if they still are with me, it looks as I still need them.

She also asked me some questions about all those my imaginary friends – Maggie, Bibiel and other weird individuals. I may do a separate post on them if you’d like to read it and if I’ll get some idea how to put it clearly and imaginably.

We talked about other stuff too, and then she filled some other papers, and actually it was all over. I got both of my diagnoses on paper, and referral to therapy. Somehow I thought it would take much longer to get the diagnosis, especially for AVPD, because it was something that came from me, not any specialist, and I wasn’t sure what they will do to confirm it fully.

I hope I’ll be able to start normal therapy soon. It’s a pity I’ll no longer be in touch with my therapist Monika, she was my therapist for so so long, and that she can’t fit me in, but I think that therapist with whom I met before who is working with personality disorders should be a good choice, or if not, I’ll be searching for something else, if not here in the area, then online, cuz there aren’t very many therapists here as far as I know.

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