chipperdear, that's a complex situation, and you described it so well. Sounds like several things going on. I think working on these things with a therapist would indeed be really helpful--they could help you tease out the different strands and make things clearer. I agree it seems like there is more than social anxiety going on. You really are very articulate and seem very motivated to work on your life--I bet you would make really swift progress with a therapist.

One theme I noticed was your reactivity--you get lonely or depressed when people are not around you. You get irritable and angry when the cousins are around. Not being able to discuss a problem with your boyfriend "makes" you depressed/anxious. You react to what is around you instead of being you, not matter the circumstance. I'm not sure I described that well. It seems like several times you regretted being left alone because it was the weekend or for some other reason, and this got you down. Why? Why do you feel unhappy when not surrounded by people? Why do you need other people there in order to find a way to occupy yourself? Yet you also withdraw from people too, so cause some of your isolation yourself. You don't want to be alone, yet you do. Push-pull. That sounds really hard! I'm a natural introvert so I need time to recharge all by myself. I know the cousin situation would make me really irritable too. Can you get your own family (is it your parents you live with in summer?) to help you set boundaries for the cousins' visits? If your parents knew how upset the constant presence of the cousins made you, would they try to help? Perhaps limit their visits to certain times? Or make them call first? Or support your efforts to get them to leave when they have overstayed their welcome?

I do agree with you that some of these issues may be things you can work on without medication. Some of them seem like relationship and communication issues.

Regarding your boyfriend's libido comment, I had a kind of similar thing happen with a past boyfriend. I did not take birth control pills because they made me extremely moody (depressed and manic both--yuck) and also took away my libido. I just felt no real sex drive if I took those hormones. Yet my BF was pissed off about this because he wanted to have easy sex without having to pause a few minutes to use a less convenient form of birth control. He would have preferred that I was depressed and manic and had no sex drive just so he could have more convenient sex. Sheeesh! I remember he said, "all my other girlfriends took the pill, why can't you?" LOL, fun times back then. Hopefully your BF understands now that it's not like you want to have decreased libido.

MDs tend to approach problems from a medical viewpoint so your doc may recommend meds even if there are other options that could help. But I like how you said you want to fix things instead of covering up. Hopefully, your doc can give you some options and perhaps some names of good therapists, if you decide to go that route.

Best of luck!