Awaiting an appointment, wondering about possible diagnosis
Hi everyone,
Sorry that this is long.
I'm a 30 year old female in Ireland, awaiting a psychiatry appointment at the end of the month with the community adult mental health team. This was following an ED presentation for self harm requiring stitches. I wasn't trying to self harm that badly or kill myself, I didn't really feel anything when it happened but I don't really regret it and I can't say that self harm wouldn't happen again. I was assessed at the ED and the doctor mentioned dysthymia and possible neurodivergence, though I'm not sure if she was using dysthymia as more of a descriptive word. I told her that I had queried autism myself though I'm not sure if it fully fits and if it is the case, it doesn't fully explain my mood. I've been thinking about it more over the last few days and although I have some difficulty socialising and making friends and mask most of the time, I think it's related more to pretending that I'm okay because I don't want to be vulnerable and open up to others, and because I have low self worth and self confidence. I've always been an anxious, shy person and I think maybe feeling depressed meant I didn't develop very good social skills and I have a small support circle. I keep things to myself and I'm never really vulnerable about how I feel. I do have long term friendships, and I think I find socialising difficult mainly because I'm low and exhausted and don't have the energy to pretend I'm not. I also spoke to my mum about it and she said my development was totally normal (I have a brother too) and nothing was ever flagged by schools or healthcare professionals. I've been working alongside senior clinical psychologists and other members of MDTs for years including psychiatry, OT, nursing, SLT etc and no one has ever mentioned autism. I mentioned it once to my supervisor, a senior clinical psychologist, who knew me for three years and she said no straight away. I know that doesn't equal an assessment, but just for context.
I'm a second year trainee clinical psychologist myself and I've been studying and working in psychology roles for the last 11 years so I have some idea of what might be going on for me.
I think I might have persistent depressive disorder/dysthymia. I have been thinking about this for a few years already. I have experienced low mood/depression symptoms since age 14. I've been self harming since age 14 until now. Mostly I self harm to distract myself or to feel something different, like if I feel nothing or if I feel a difficult emotion I don't want to feel like self hatred, hopelessness or anger towards myself or others. I've had periods of suicidality that I haven't acted on. I think about it a couple of times a day but it's more like passive suicidality/TLNWL. I used to self harm multiple times a day at my worst and nowadays it's more like a couple of times a year. I feel this constant feeling that life is pointless and more difficult for me than it seems like for other people. I don't get reward out of life. I don't see a future for myself. Although there are things I'd like to achieve, like finishing the doctorate, I don't see it happening and I don't have any belief or confidence in myself although objectively, things with work are going well. I don't feel emotions very strongly; I feel quite numb and flat most of the time and I prefer being alone so I can just be low in peace. I do cry sometimes but mainly I feel quite detached. Even during better periods, I'm not happy and I don't feel emotions very strongly, like I don't get excited about things really anymore or enjoy things I thought I would, like concerts or holidays. I don't really do things that I enjoy, I just want to stay in bed all day if I'm not in work. I feel like time gets away from me and I'm wasting my days doing nothing but I don't want to do anything anyway and I can't concentrate. Sometimes in classes, I feel restless and suffocated in the room, and just can't bring myself to care about what's being talked about, or chat with other people or laugh at the lecturers jokes etc. I stopped running and going to the gym, I don't listen when I watch tv and it takes me months to finish a book these days. I find it hard to complete responsibilities like walking the dog and I mostly ask my boyfriend to do it, and I don't clean out my rabbits as often as I should. My self care is terrible and I always put work and assignments first as a distraction but I find it hard to get started. Lately I've found it harder to function, I've been sleeping in late, getting to college late, submitting assignments late which I've never done before. I've been late submitting paperwork like timesheets and performance review forms too but I just don't care. My time management is bad and I'm forgetful. I don't shower or get dressed if I'm not going out and I keep using dry shampoo instead of washing my hair. I haven't worn make up in weeks. I dread socialising and take ages to text people back, and have cancelled on people even though I want my friendships, I don't have the energy for it and I just feel crap. With sleep, my schedule is all over the place and sometimes I stay up late doing nothing and then because I have to get up earlier, I get barely any sleep. Sometimes I find it hard to get to sleep, sometimes I wake up during the night. I've been waking up earlier and not been able to get to sleep again on mornings that I don't have to get up like the weekends but I'll still stay in bed for most of the day. I'm tired all the time. My appetite is hard to describe because I've experienced disordered eating but it's reduced a bit recently and I've lost a small bit of weight.
I feel like I'm always low but I feel worse the last few weeks and I'm wondering if this is a depressive episode on top of PDD/dysthymia but I don't know. Because this has been going on for so long, I feel like this is just who I am now, like this is just my personality, and I find it difficult to remember feeling any other way. But I always compare things to when I was a teenager and it's never been that bad since so I don't know. I've been able to work and study while all of this has been going on but I think that's because I put a lot of pressure on myself and feel like I can't stop. But I have taken the next week as sick leave. I can function most of the time but I don't feel good. There's been a few things going on over the last few years like deaths in the family and leaving my job to start the doctorate, starting and ending placements, struggling with my relationship, but this feeling was present long before that and I would hate that it get dismissed as psychosocial stressors because I generally manage through these things and can still recognise good things that have happened like getting onto the doctorate, passing my driving test and getting my car and making new friends, but I still feel depressed. I do feel like things that are supposed to be really difficult, like losing both of my grandparents, I didn't feel a massive amount about, like I cried but I still went to work/met friends the same day both times etc and wasn't devastated, so I think I'm emotionally blunted.
I got help and attended services between 16-17 and was on 20mg Fluoxetine from 16 to almost 18. I found it extremely difficult to talk and open up and didn't share much but I recently found old letters in which the consultant psychiatrist I saw described a two year history of depression and features of clinical depression. There were things I never told them, like a history of disordered eating. This started at age 15 and included restricting/starving and purging and this went on for many years into my adulthood. I had a lot of food rules and fear foods etc. I'm not engaging in those behaviours anymore but I still do a lot of body checking and weight checking and am very aware of what I eat and am not happy with my weight and body at all and constantly want to try and lose weight, even though I'm objectively a normal weight. Fluoxetine worked for me at first but it started to lose effectiveness after a few months and I was still feeling depressed and self harming. My parents were concerned that seeking help at age 18 would go on my records and would affect college and jobs so I was discharged from services and the meds were discontinued even though I was still struggling a lot, but my parents didn't realise the extent of it.
I struggled a lot getting help again over the years due to a lot of barriers like anxiety, fear, shame and guilt, those old worries that I wouldn't be able to become a psychologist myself if I was struggling (now I know that's not true), and working in mental health services, I knew a lot of the psychiatrists and staff and worked in the main outpatient building in town myself so I felt like accessing help wasn't an option. I also just kept hoping things would get better.
In 2021, I tried to reach out to the GP for help but I was so anxious to call that I messaged them on Facebook and they didn't see it. It took me until 2023 to try again. I saw a GP who really didn't understand and said things like I was a beautiful girl and shouldn't feel this way and that I didn't have a sense of self. It really upset me and made me feel so misunderstood and invalidated. She prescribed Sertraline 50mg and I took it for six months but it didn't help at all and I stopped taking it. I went to six sessions of counselling over the summer as part of my doctorate and the clinical psychologist said I was very detached and trying to protect myself. I didn't feel safe with her and although I explained what happened when I was a teenager, she didn't ask if things were still bad and I didn't feel able to tell her or talk about it further, which is a shame because I really hoped I'd get something out of it, but I don't think it was a good fit. We have to get personal therapy each year so I'll try again this year and hopefully click with this person.
That brings us to now. I'd been considering going back to the GP and asking for a referral to adult mental health services before I ended up in the ED. Ideally, I'd like a proper assessment and to actually know what's going on and medication that I can take long term, because that's what I think I need because of how long this has been going on. I really don't want to be discharged back to the GP because this has been going on for so so long. I'm wondering if this sounds like PDD/dysthymia to you or something else, if medication sounds reasonable, and if so, what ones you might consider.
Thank you.
TLDR: I think I have PDD/dysthymia, and I'm wondering if that sounds right and what medication might a psychiatrist suggest if any.