disorders on order

I feel like I’m being pulled in many different directions right now, like that Stretch Armstrong doll when I was a kid. I don’t have much time for myself, and I have to be “on” a lot. I’m often asked to solve the emergency of the day. I have to play different roles for different people, and it is really tiring right now. I need a break, but I don’t have time for a break. I have one vacation day remaining at work, and I need it for something fun in September.

I have so many unfinished tasks and projects, and it’s a trigger for anxiety. I can feel it closing in around the edges of my vision. I wish I had the motivation to finish a few things, or just to make progress, but I give up because I can’t break things down into manageable pieces. It’s all or nothing, and I know it is distorted thinking, but as a result I’m mentally paralyzed.

I have been officially diagnosed with social anxiety and general anxiety, and I’m certain I have ADD and some elements of OCD. I don’t know how likely it is that someone has all of these things going on, but here I am. My new therapist asked me to consider if I might be on the mild side of the autism spectrum. I’m skeptical, but I’m doing some research to see what I think. I don’t think I need another label at this time, so I will ask her to table that discussion and help me work on social anxiety (which currently seems to be my biggest problem).

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therapy 5.0

You might recall that I didn’t seem to connect very well with my previous therapist, who was intent on making me do mindfulness techniques despite my lack of enthusiasm. He then suddenly left the practice, and I declined his invitation to follow him to his new office. I thought I could work on my anxiety on my own. Yeah, right.

This week, I started seeing my fifth therapist, who works at my psychiatrist’s office. The first appointment is always difficult, especially for someone like me who feels awkward talking about myself, to a stranger, trying to summarize my dumpster-fire life in an hour. I started out very nervous, like it was a test I had not prepared for; she actually offered me some fidget toys if they would help. I passed on the toys, but I calmed down a little while we talked.

She seems like a good listener; even though she was typing notes as fast as I was talking, she asked the right questions when necessary. She appears to be quite young, but I don’t have any problem with that. Her personality would be good with children, but she didn’t treat me like a child. Overall I got a good feeling from the visit.

After the short life history (which I struggled to keep short), she asked what the most important things were to discuss. I told her that I have already written a “field guide” to my many mental health problems, but maybe we could start with my social anxiety and general anxiety. She was interested in reading my lists, so I will print that out for next time.

I’m guessing that starting with a new therapist is as difficult for everyone else as it is for me. I am forced to immediately allow her within my “trusted circle” rather than getting to know her slowly, which is quite unnerving. This is a place where only a few people are allowed, and yet here is a stranger I am telling things usually only reserved for my blog friends. At the same time, I have to remember she is a professional, paid to listen and help me solve problems, and we’re not going out for coffee afterward.

don’t wake the campers

We are on vacation this week at a campground about an hour from home, avoiding insects and raindrops, burning marshmallows, and trying to relax. Relaxation is not easy for three people with anxiety issues, but we’ll do our best.

This annual campout started out years ago as a fun thing to do with my wife’s daycare families. After she quit doing daycare, it became more of an extended friends and family event. More people have stopped coming, and this year even my wife’s parents stayed home. So it is just the three of us in a large, private group campsite, with lots of equipment, lots of food, and much less activity than in the past.

We may get a few visitors during the week, but it’s a lot less fun without more people. We could have expended much less effort by buying a fire ring and sitting at home to make smores, while getting to sleep in our own bed.

rear view

I was looking back at my posts from early 2021 that followed the arc of a long manic episode. The posts from that time aren’t scary like some of the deep depression posts from the old blog, but they are interesting to me.

My episode started with the side effects of starting on Latuda in November of 2020; I felt pretty good for a few weeks, but I started climbing the hill in December. By January 2021, I was frequently staying up in the middle of the night, my anxiety was climbing, and my OCD symptoms became overwhelming. I couldn’t concentrate at home or at work, I was having panic attacks, and I almost left my job out of frustration. After quitting Latuda and returning to Abilify, there was a long downslope where my symptoms were decreasing steadily, but were still there. I was afraid something had permanently changed in my brain. It wasn’t until May when a solo mini-vacation brought some relief from the storm.

Looking back from a year later, I am reminded how much I was struggling. This manic episode seems odd because on one level I knew what was happening and how dangerous it was, but at the same time I was very much caught in its uncontrollable grip. I didn’t think I could fly, but I believed that my life would be better if I tore everything down at work and at home. Had I followed through with my late-night schemes, it could have damaged my family relationships, cost me tens of thousands of dollars, and jeopardized the continued treatment for myself and for Nicole. I think I escaped the episode just in time, because I don’t know what I would have done if I had remained manic for a longer period.

My bipolar experience has been mostly depression, with very brief manias or mixed episodes followed by a deep spiral. This episode was different in that it had a long buildup and a long letdown, and I didn’t crash in the same way I had in the past. Since that time I have had no mania and a few depressions, and not with the abruptness and intensity as in the past. I know mania will happen again in the future, but I think having been through this most recent episode makes me better equipped to deal with it.

dermatillomania

I have been picking at my fingers since I was a kid, but until recently I didn’t know there was an actual name for this. Dermatillomania is a real disorder in the DSM-5, and is diagnosed when someone causes repetitive injury to the skin through scratching, picking, or biting that results in an injury, with an inability to stop. It is related to OCD, but differs in that people with OCD perform compulsive actions to relieve anxious thoughts, but skin-picking is often more pleasure or sensory-based. [Link]

Picking at my fingers is something I feel the need to do despite the pain, blood, and embarrassment. I find visible or perceived imperfections and have the urge to pick the target area. I also look for fingers that seem “too perfect”. I pick at and mutilate my fingers and cuticles, usually with a fingernail, my teeth, or tools like tweezers or a push pin. There is never a time when my fingers don’t have some level of injury, and I have permanently damaged a couple of fingernails due to the repeated picking.

It’s an uncontrollable compulsion that is always present; in the moment I know what I am doing, and I know I should stop, but it feels good to remove that imperfect piece of skin. However I can’t always remove just the imperfection, and I make the problem worse. I know when it is going to hurt and bleed, but I follow through anyway. I do it even though I know my fingers will look horrible to anyone who notices. Sometimes it is bad enough that I have to use band-aids to stop the bleeding or to help heal the raw areas. When I take the band-aid off, the skin is moist and pliable, and sometimes I go right back to picking in that spot.

I think the urge to pick increases during stress or anxiety episodes, or during a hypo or mixed mood, but I pick when I am feeling well also. I keep score of how many fingers are bloody at a given moment, and it correlates directly to my anxiety level. Today my score is a 6, but tomorrow it could be 7 if there’s a nice juicy cuticle that needs picking. Sometimes I can temporarily will myself to stop picking, or put off the urge, but eventually I will do it anyway.

It’s not a harmless habit, but in the big picture it is a minor problem. In the moment I enjoy the picking, but later I regret doing it. Having people see my bloody and mutilated fingers is occasionally embarrassing, and covering multiple fingers with band-aids is noticeable, but I don’t seem to obsess on that thought.

I searched for ways to help stop this behavior; several resources focus on combinations of therapy (sometimes CBT) and stress reduction using mindfulness (oh fuck, not that again). The Cleveland Clinic even suggests substituting different behaviors such as going for a walk. One, I can pick my fingers while walking; and two, if I could substitute another less harmful behavior, I would already do it. I’ve thought about wearing a rubber band on my wrist and giving myself a good snap, but that would be less satisfying.

ending therapy

I received a letter from my therapist explaining that he is no longer practicing at my psychiatrist’s office, and my scheduled appointments are canceled. If I want to continue seeing him, I would need to visit him at his new location.

After some thought, I’ve decided I’m not going to continue therapy with him, or anyone else. I was thinking about ending our sessions anyway, as I wasn’t getting a lot of benefit out of them. His emphasis on mindfulness didn’t seem to work for me, and sometimes he appeared to not really have any alternatives. There were a couple uncomfortable moments where he would struggle to find something to talk about. He might be effective for someone else, but apparently not for me.

I’m not really emotionally affected by this. I know some people have a true connection to their therapist and see them as a lifeline to their continued mental health, but I never had that feeling. In the past I have had the idea that I “failed” therapy three different times. I don’t feel this was a failure for either me or the therapist, I think we just weren’t compatible or complimentary.

When I started seeing him, I wanted some techniques to work on the constantly increasing anxiety that I struggled with a year ago. I now think it was a physical effect of a long manic episode, because my anxiety slowly decreased when we got the medication right. I still have plenty of anxiety, but it has returned to a manageable level at this time. I don’t think I need individual assistance in dealing with my problems. I need strategies to work on my social anxiety, but I think I can do it on my own at this time.

mindfulness update: pop quiz

My next therapy appointment is looming, and I haven’t done my homework. He will ask me if I tried any mindfulness exercises, and I will:
a) lie;
b) tell him I think mindfulness is bunk; or
c) ask for a hall pass to the bathroom, then ditch the therapy session.

When I was searching for a copy of the book on Amazon, the first promoted suggestion was a book about crystal therapy for anxiety. I have approximately the same attitude toward crystal therapy as I do mindfulness, right wing ideology, and the Los Angeles Dodgers. My wife said it would be funny if I went into the session and placed crystals in a pattern around me on the floor before beginning.

I contacted the therapist because my anxiety was off the charts and I needed coping mechanisms in a hurry. I didn’t really get what I wanted, although it was helpful to talk through a few things. Now my anxiety is down to my normal background level – it is there, but it doesn’t scare me. I survived bipolar and anxiety without therapy since 2007, so maybe I don’t need it now.

Then again, I shouldn’t break up with him just yet. If I get this new job, my anxiety will increase, but I haven’t heard back from HR yet. My anxiety will definitely increase in my current job, because we continue to get more work without adding people to spread the new work around.

mindfulness update: opening the book

I finally read the introduction and first two chapters of the book, but I have not actually done any exercises yet. My library wants the book back, so I might buy a used copy of the book. Surely some relaxed, anxiety-free person on Ebay or Bookfinder has an old dog-eared copy they would let go for a few bucks.

Here are a few disjointed thoughts:

Quote from the introduction:
… [there are] three common patterns of responding to anxiety … reacting to the painful emotions of anxiety with … self-criticism and judgement; then trying to escape the anxiety mentally; and finally, when that doesn’t ease the discomfort, trying to avoid whatever triggers the anxiety.

That sounds like my behavior in stressful situations. I have learned how to avoid many things that cause me stress, however I also miss out on things that might be beneficial, such as opportunities for professional advancement or just for fun.

The authors claim that mindfulness is a method of dealing with anxiety that will help me overcome fears and will provide me with a sense of fulfillment.

It turns out there are audio exercises to go along with the text in the book (well of course there are), but the link led to a defunct website. After some googling, I found the exercises at the publisher’s website. There are some short exercises, then there are longer ones lasting up to 37 minutes. I cut my mother off at 30 minutes on a good day, so there’s no way I’m listening to someone drone on about relaxing my muscles for that long.

Another interesting quote: “… we might recommend particular coping strategies that seem counterintuitive or that don’t immediately strike you as likely to be effective for you. We know from our own experience that sometimes all of us prematurely judge and dismiss information that doesn’t fit with how we typically view ourselves and the world.” This describes exactly what I am thinking about mindfulness right now.

mindfulness update: the book

As I told you in a previous post, my therapist recommended a book about mindfulness. I picked up the book from the library, and it has sat on my table for over a week now, unopened. I had a therapy appointment scheduled for today, which I knew wasn’t going to go well, so last week I moved that appointment to sometime in August. Just in case I go to that one, I made a second appointment for September.

In the meantime, the book on mindfulness still sits on my table, mocking me and my overactive brain. I picked it up once or twice in the past week, looked at the cover, thought “I’m feeling too anxious to concentrate right now,” then put it back down. I’ll probably renew the book so I have longer to worry about how futile it would be to try mindfulness.

mind over ice cream

I don’t know if I am on the same page as my therapist. Yesterday was an awkward appointment. I had very little to say and didn’t want to be there, and he seemed like he was stumped, trying to find something to talk about. Neither one of us seemed prepared. Granted, I’m the one asking for help, so I guess I should be the one with questions. I would have been fine if he had let me go home early.

After flailing for a few minutes, he started talking about mindfulness as a tool for reducing anxiety. He described what mindfulness is, and I was having trouble concentrating … as he’s telling me how to concentrate on acknowledging distractions then coming back to the moment. My brain was tired but bouncing all day yesterday, so it was a particularly poor time to have to listen to someone talk.

I have to admit I don’t get the mindfulness thing. I thought it was more about doing something to distract you from everything in your brain, allowing you to have a little reset. I know how to be totally present in the moment, like while listening to my favorite music for the 100th time, or when being by myself in the woods, or reclining with a purring cat. But either I get distracted by something or someone, the moment is gone, and I start thinking about all the things I took a break from.

I asked him if mindfulness was blocking everything out and just clearing your mind for a few minutes, and apparently that was incorrect, because he was trying to convince me that something like eating ice cream or the act of standing up can be the object of a mindfulness exercise. (Really? Does pooping count?) I asked him what did that solve, and I never really got an answer. He said he wrote a dissertation about the subject, so I decided not to tell him I didn’t get the point.

Then he started talking about Buddhists and India, and honestly he lost me at that point. Nothing against Buddhism, but I just need something I can understand. However he did refer me to a book on mindfulness for anxiety, so I’ll get that from the library and see what I think. He also told me about some guy’s videos, but I told him I can barely sit through an episode of a TV show on Netflix. My brain moves way too fast to listen to some dude drone on for an hour about how to enjoy ice cream.

I don’t know if mindfulness exercises are going to work for me, but I guess I will give it a good faith effort to see if I can get something useful out of this. If anyone has any tips or references for helping me understand this, I’m willing to listen. Comment or email me if you have something that might help.

news of the world

A quick update post, then I’ll write something more substantial later.

My anxiety has had a few moderate spikes, but overall has been decreasing slowly since I discontinued the Wellbutrin and resumed taking Abilify. The twitchiness comes and goes with the anxiety, but the OCD ritualistic behaviors remain.

My therapist has talked about using CBT for my OCD. To prepare for that, he asked me to observe and document the behaviors I’m doing (no problem) without being judgmental (very difficult). I am also supposed to learn a little about specific CBT techniques for OCD. I see him again tomorrow.

At work, every time I complete a project, I get two new ones, adding to my anxiety. I actually let fly a bitchy rant during a video staff meeting this week. The department manager was on the call, and I was inspired. This is very uncharacteristic of me, and I guess a few people were surprised. I’m so bad at speaking to others though, so I just read parts of a bitchy email I had written a few weeks ago. Point was made, however.

I’m taking Friday off and spending this weekend hiking and communing with nature at Black Moshannon in Pennsylvania. I was supposed to do this when my anxiety was higher, but that was when my daughter was in the hospital. I still want to do this for myself, though. Weather is iffy but not too cold, so I’m going for it. I’ll post a few pics.

We’re waiting for my son to get his 2nd vaccine shot, then we will have a family barbecue somewhere. It’s been a long time. We have made the effort to keep my in-laws from getting too lonely, but it’s been difficult for them.

Finally, Genesis will be at the Q in Cleveland on November 30th, and we’ll be there. Phil can’t play drums and can just barely walk, and in fact he will be sitting for much of the show, but I couldn’t resist the opportunity to see them one last time. I know they’ll play mostly the pop-rock songs rather than the old prog-rock stuff, but I’m okay with that, as long as they don’t play Whodunnit. Having said that, I wish I had seen them in 2007 instead.

I guess this wasn’t so quick after all.

behind

I’m playing catch-up this week. I’m way behind on work projects, on reading blogs, on writing, on projects at home, on planning for the future, blah blah blah, yada yada. I made some progress on work stuff this week, so I feel a little better about that.

I also got my second vaccine shot, so I am fully juiced and ready to go. I’m ready to lick door handles and have someone cough on my airline food as I travel to a crowded city. Okay, maybe not, but I do feel more at ease knowing I have a little protection. I can see the possibility of everyone requiring a booster sometime in the next 12 months (I guess Pfizer has already indicated this). I was sore at the injection site until yesterday, and I was tired and achy for about 48 hours after the shot, which was about what I expected. Nothing serious, and I didn’t miss work.

I also saw my psychiatrist this week. I printed out part of this post and let him read it, and he said it was textbook OCD. (I also told him his “How are you doing” forms are crooked on the paper, and it mildly bothers me.) He said we can work on the anxiety first, and then see if the OCD symptoms need more attention. I agree with that, since the OCD gets worse with higher anxiety. In addition, he said I was much more stable when I was taking Abilify, so maybe we should go back to that. I had the same thought previously, so I told him that was fine. I’ll just have to eat better and get more exercise somehow. I’m also going to quit the Wellbutrin, since it can cause instability and maybe anxiety.

Last week I met with the therapist for the first time (same office as my p-doc). We got to know each other a little, and he was interested by some of my problems (social anxiety, lack of self-esteem, avoidant tendencies, inability to deal with stress, etc.) He said something that bothered me though: when I was explaining about being overwhelmed at work, he didn’t seem to accept the reality that I absolutely cannot take a week or more off work for my mental health right now – maybe an occasional day or two, but not an extended period. I also don’t feel like I can ask to have some work shifted to other people, because everyone I work with is swamped and unhappy and drowning in projects. The day after he suggested I ask for less work, I received two more projects. Yay. We’ll see what he has to say on Monday.

The weather is cool but nice, so I am going outside to enjoy some nature and not think about life for a while. But first, I need Second Breakfast (the best meal of the day).

a busy week ahead

I have felt a little better this week. I am not as anxious during the weekend because I can stop thinking about work. I still have issues at home I am not dealing with very well, and I’m not getting any help to solve the problems.

I’m glad to have a short week. Next week will be short also, as I am taking a vacation day to make a 3-day weekend. I’m going to the highlands of central Pennsylvania to do some longer day hikes. I’m hoping there will be only a few people there so I can feel like I have the forest to myself. I’ll post a few photos if they turn out well.

I’m going alone, although I wish my wife could go too, but she’s working hard as usual. She only gets one week of vacation this year, and we’ve already scheduled a camping trip in August. However, we couldn’t leave our daughter alone for an entire long weekend, and she wouldn’t want to go with us as she hates traveling.

In other news, I have my first appointment with a therapist Monday. I’m going to see if he can give me some better coping tools for stress and anxiety and feeling overwhelmed by everything. What I’m doing now isn’t working very well. I’ve been in therapy in the past, and it wasn’t really successful, but I’m willing to try again. I know one appointment won’t solve everything, but I’m hoping to gain something from talking things out and getting feedback from someone more knowledgeable than me.

running to stand still

Up. Down. Sideways.

Hopelessness. Defiance. Acceptance.

Spinning wheels, hit the brakes, stuck in first gear.

Restlessness. Depression. Mania. Fear. Anxiety. Psych meds with a whiskey chaser.

I don’t have a center right now. I can’t find balance. My brain is all over the place.

My doctor called me back tonight, and he is going to try a couple of things. My faith is wearing thin.

Work piling up, waiting for me to stop feeling overwhelmed and make my brain work properly. The forecast doesn’t look good for that at the moment.

I’m also calling a therapist tomorrow. Without help, I’m a train wreck waiting to happen, and I can’t crash right now. Actually I can’t ever, but that’s another discussion for later.

panic! at the home office

So Friday afternoon I may have had a little panic attack. Apparently I posted something here and then trashed it immediately. Then I started drinking.

I was trying to email a request form to someone for a project, but I didn’t know just what to say. But I got stuck thinking about it, and it never got sent. Then the 10 am department meeting happened, and the department manager started demanding more output than we have been producing lately. Just what I needed to hear. After the meeting, I froze up again.

I took a long lunch, thinking I would take a break and calm down, then get back to work. The getting back to work never happened, and instead of producing more, suddenly I’m producing less. Thinking about this made me start freaking out, and I gave up around 2 pm. I literally got into bed and covered up hoping I could calm down, but it just got worse. I briefly thought about calling my psychiatrist, but I don’t think I could have made it through the phone call, and I didn’t want to get sent to the hospital involuntarily.

So when my shift ended at 3:30, I poured a glass full of scotch whiskey and started drinking with the intent of knocking myself out as quickly as possible. After an hour I was successful, and I slept until about 8 pm.


I fear the manic episode from January has permanently damaged something in my already defective brain. I can’t organize tasks, I can’t follow through, I can’t regulate my mood, I can’t control the anxiety. I can’t stop thinking that I will no longer be able to do my job, and that I will have to find something less stressful for much less pay and worse benefits.

Before the manic episode I was relatively unhappy at work but I was able to cope with the stress and managed to produce work in a timely manner. Now I am completely unable to deal with my mental state. I have no coping skills; I have nothing in the toolbox that I can use to improve my situation. My fight-or-flight instinct has been engaged, but I have nothing to fight with. The urge to flee is overwhelming.

The only thing that helps me relax is when I am doing something new, like yesterday when I drove new roads for a few hours and walked at a park for over an hour. But there are only so many roads within a reasonable distance, and I can’t do that every day. Eventually I have to come back home to my life, and start thinking about everything again.

I will call my doctor on Monday when I am relatively calm and explain the situation, and see if he can recommend something.