[deliquesce]

saw austin-t on monday. been getting down, was talking about the experience of it all. at one point i mentioned a particular thought i tend to have about myself, and how as my depression gets worse how it progresses and becomes this all consuming thing which i live by. it's not something i typically believe -- if i'm not depressed the thought doesn't any reality to it.

austin-t kept starting to say that "people who have..." and then stopped himself, and started again saying instead that many people have those thoughts. but as we were talking he kept falling into the "people who have" territory and stopping himself short. i don't think the diagnosis is something he wanted me to hear.

he wants me to monitor this particular thought over the next week, so i can see how it changes. he also wants to know how i'm different when im not depressed -- why i see myself as two separate people. this is probably the firs time he's given me homework.

of course i got home and read up, and it looks like a feature of psychotic depression. i had assumed when we were talking that maybe he meant OCD, but it doesn't fit into the OCD spectrum . and yeah, yeah, yeah self diagnosis = bad, but i reserve my right to do so anyway! i preferred being melancholic. psychotic sounds so much worse.

[googley]

((((((((((Deli))))))))))

Take some deep breaths. It will be okay. Self-diagnosis is bad.

[jexa]

The worst thing about self-diagnosis is that it rarely helps you to know what you "have." The diagnostic categories are seriously flawed in that they categorize behavior by its form rather than its function. Competent PhD level psychologists may NEVER agree on a particular person's diagnosis, and then provide the exact same treatment to this person (say one therapist says someone has a specific phobia of illness, and the other says they have OCD. The treatment is the same -- exposure to germs). Some categories have been very useful (schizophrenia, bipolar), but mainly in prescribing medications. Diagnosis is sometimes, but rarely, useful in psychotherapy, especially when you are nitpicking at small details like how to categorize a certain thought process. I know you know this deli, but it's just a reminder.

Maybe austin-T stopped himself because he doesn't want to frame things in terms of a diagnosis? I know all of my T's have been hesitant to provide any kind of diagnosis to me..

[Dr.Muffin]

Originally Posted by deliquesce

saw austin-t on monday. been getting down, was talking about the experience of it all. at one point i mentioned a particular thought i tend to have about myself, and how as my depression gets worse how it progresses and becomes this all consuming thing which i live by. it's not something i typically believe -- if i'm not depressed the thought doesn't any reality to it.

austin-t kept starting to say that "people who have..." and then stopped himself, and started again saying instead that many people have those thoughts. but as we were talking he kept falling into the "people who have" territory and stopping himself short. i don't think the diagnosis is something he wanted me to hear.

he wants me to monitor this particular thought over the next week, so i can see how it changes. he also wants to know how i'm different when im not depressed -- why i see myself as two separate people. this is probably the firs time he's given me homework.

of course i got home and read up, and it looks like a feature of psychotic depression. i had assumed when we were talking that maybe he meant OCD, but it doesn't fit into the OCD spectrum . and yeah, yeah, yeah self diagnosis = bad, but i reserve my right to do so anyway! i preferred being melancholic. psychotic sounds so much worse.

i dont know that its necessarily psychotic. i mean, the cognitive triad of depression would probably help in magnifying negative thoughts about the self, even if they are much less believable when you arent so down....

[deliquesce]

haha, aww - thanks to all you pros for replying .

i'm trying to tell myself to just chill about it -- whatever "it" is happens to be something i've been dealing with for the past 5 years regardless of it having a name or not. i guess the problem is that i look at relapse/recovery rates, but i guess there isn't much difference between melancholic & psychotic depressive subtypes either.

austin-t believes really strongly that i need meds as part of my well being plan, which is maybe why he's a bit more into diagnosis than other therapists.

for reference, the particular thought = extreme guilt, a feeling of being a bad person. as i get more depressed it dictates how i behave more and more, to the point where e.g., i'm scared to go grocery shopping -- if i give the check out chick small change i'm worried i'm going to hurt her because she'll be touching the coins also. this is even if i'm super careful and don't make eye contact. then i worry that even standing on the same floor as her is going to hurt her, and then i worry about everyone else in the store. it gets bizarre, i guess, but it's only something i've really thought about now . at the time it does seem to make sense, just an automatic belief i dont even need to think through. it just is.

i also get auditory/visual hallucinations, but pdoc has always brushed them off as being part of a ptsd-phenomena. im kind of.... suspicious that he's always down played them, and now i'm (jumping ahead of myself) and starting to be sad that he hasn't been upfront with me about this previously.

[jexa]

Actually deli, in the clinic where I work -- an OCD clinic -- that could easily be categorized as OCD with aggressive obsessions / harm avoidance compulsions (but since it only occurs during a depressive episode, it might be an OC symptom of MDD, potentially -- BUT MDD can make OCD worse, so..). OCD, especially this type of OCD, is often wrapped up in feelings of guilt. I know that in the moment you see it as rational, but the fact that you now can recognize that it's absurd is all that's required for the "insight" criterion of the dx.

Not that I'm going back on what I said -- the most helpful thing is probably just to monitor the thought like austin-T said, without trying to categorize it. Still, you might be right. He might have been stopping himself from saying OCD.

[Dr.Muffin]

i think jexa has a point. OCD-based obsessions can focus on anything and the ones that focus on the self as a contamination to others/the world can be a bit frightening.

but it seems to me that you must be making progress in therapy because of your ability to monitor and challenge the thoughts. being able to step outside of whats going on in your head and evaluate it rationally is a great thing, deli!

if you boil it down to its simplest form, therapy's main goal is to teach people to monitor and modify their thoughts and behaviors. you are half way there.