Do I Suffer from Depression or Dissociative Identity Disorder?

Am I suffering from depression or dissociative identity disorder?

Hello Dr.
Peng,
I am facing a complex issue that seems to have some underlying connections, yet also appears disjointed.
I would like your professional opinion on whether I should see a psychologist or if I can manage my mental health on my own.
Throughout my life, I have experienced very strict and punitive education; for instance, if I couldn't memorize my lessons, I would be made to kneel on an abacus, and if my grades were poor, I would be beaten with a belt until my skin was bruised and cracked.
I mention this because I am unsure if it relates to my current symptoms.
My symptoms include fragmented memories, extremely poor memory, hallucinations, depression, and possibly even dissociative identity disorder.
I have difficulty recalling events from my childhood, especially those recounted by other family members, which I feel never happened.
Sometimes, I remember things that they do not, or my memories differ from theirs.
My memory is so poor that I often forget something immediately after being told, and I can only confirm it by checking my notes.
Is there a gap in my memory? I don't know!
I was bullied as a child, which made me very insecure and withdrawn.
I remember a time when I held a knife to my wrist over a bundle of tape, and my father intervened just in time.
However, I was then punished severely and couldn't sit down for three days.
I have a tendency to self-harm, but I lack the courage to cut myself; instead, I slap my own face or bang my head against the wall.
Once, after arguing with my mother, I hit my head against the wall hard enough to feel dizzy.
I find that I cannot escape feelings of guilt unless I physically harm myself, often resulting in swollen cheeks.
After a fight with my younger sister, I used a hanger to hit my legs, which broke the hanger and left bruises on my thighs, but it seemed to relieve some of my emotional pain.
During my transition from middle school to high school, I experienced the presence of a man in my mind, and I still question whether he is still there.
He is cold, unfeeling, and speaks in a low voice, with simple black hair and large dark eyes.
We have never communicated, and I have no idea who he is or why he is in my mind.
One day, I noticed pencil markings on my wall that spelled "Yuxiang," which looked different from my handwriting, yet I vaguely remember writing those characters.
Sometimes, people around me suddenly discuss things I have never been told about (perhaps I forgot), or someone has replied to my blog using my account in a very indifferent tone, which they seem not to notice is unusual.
However, no one should know my password!
I once created a chat room to communicate with him but received no response.
Occasionally, I hear a low, slow, and cold voice in my head that speaks to me, but I cannot control it; I can only receive it.
It feels like a voice that emerges while I am thinking, and I cannot manage it.
After graduating high school and entering society, I forced myself to be more outgoing and to overcome my social anxiety (I am very afraid of strangers and have often been told I isolate myself).
I am trying to combat this fear, but I still feel terrified inside.
After this effort, Yuxiang seemed to disappear, and I have not heard his voice since, although I occasionally have thoughts reminiscent of him (for example, feeling indifferent about situations, even though I am usually very empathetic).
I still engage in self-harm and occasionally feel a presence similar to Yuxiang (though there is no response when I ask).
I researched Dissociative Identity Disorder (DID) and found much information, but it does not align with my situation, as those with DID have clearly defined alternate identities, while my experience feels more like a product of my imagination.
Whenever I mention this to my family, they tell me I am overthinking or suggest I exercise more, but I truly struggle with this!
I often find myself suddenly breaking down in tears for no apparent reason, even if I am just daydreaming, and once I cry it out, I feel fine again.
I am very worried that I may have a mental illness.
What should I do?
I apologize for the lengthy message; I am genuinely distressed, and I greatly appreciate you taking the time to read my inquiry.
Thank you for your hard work!

Su Su Liang, 30~39 year old female. Ask Date: 2020/05/13

Dr. Peng Liyun reply Psychiatry

Hello, from your letter, it is evident that you are experiencing discomfort and distress.
The diagnosis needs to be discussed with a physician, and a more in-depth evaluation of your personality may be necessary.
However, it is important to ask yourself if you have coping strategies for these situations.
If you cannot find suitable ways to manage, or if these issues are indeed affecting your life and interpersonal relationships, I recommend seeking further evaluation and follow-up care at a hospital.
Treatment options will vary based on the severity of the condition.
Our clinic has outpatient services available every Monday to Friday in the morning and afternoon, as well as on Saturday and public holidays (excluding Sundays) in the morning.
I suggest considering a visit for an evaluation to discuss the best treatment options together.

Reply Date: 2020/05/13

More Info

Based on your detailed description, it seems you are experiencing a range of complex psychological symptoms that may indicate underlying mental health issues. While I cannot provide a diagnosis, I can offer some insights into your situation and suggest steps you might consider taking.

Firstly, your experiences of fragmented memories, severe emotional distress, and self-harm are concerning. These symptoms can be indicative of several mental health conditions, including depression, anxiety disorders, and potentially dissociative disorders. The fact that you have a history of strict and abusive upbringing, along with experiences of bullying, may have contributed to the development of these symptoms. Childhood trauma can have long-lasting effects on mental health, leading to difficulties in emotional regulation, self-identity, and interpersonal relationships.

Your mention of feeling as though you are not a whole person and experiencing a presence or voice in your mind could suggest dissociative experiences. Dissociation is a common response to trauma, where individuals may feel disconnected from themselves or their surroundings. However, it is essential to differentiate between dissociative identity disorder (DID) and other forms of dissociation. DID typically involves the presence of distinct identities or personality states, which may not align with your description of a single, cold presence.

The emotional turmoil you describe, including sudden outbursts of crying and feelings of worthlessness, aligns with symptoms of depression. Depression can manifest in various ways, including cognitive difficulties (like memory problems), emotional instability, and self-destructive behaviors. Your self-harm, while a coping mechanism for emotional pain, is a significant red flag that indicates the need for professional help.

Given the complexity of your symptoms and their impact on your daily life, I strongly encourage you to seek professional help from a mental health provider. A psychologist or psychiatrist can conduct a thorough assessment to understand your symptoms better and provide an accurate diagnosis. They can also offer therapeutic interventions, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), which are effective for managing depression, anxiety, and self-harm behaviors.

It is also important to address the stigma surrounding mental health issues. Many people experience similar struggles, and seeking help is a sign of strength, not weakness. Mental health professionals are trained to provide a safe, confidential environment where you can express your feelings and experiences without judgment.

In the meantime, consider implementing some self-care strategies to help manage your emotional distress. These can include:
1. Journaling: Writing down your thoughts and feelings can help you process your emotions and gain clarity about your experiences.

2. Mindfulness and Meditation: Practicing mindfulness can help ground you in the present moment and reduce feelings of anxiety and overwhelm.

3. Physical Activity: Engaging in regular exercise can improve mood and reduce stress.

4. Support System: Reach out to trusted friends or family members who can provide emotional support. Sharing your feelings with someone who listens can be incredibly therapeutic.

5. Limit Stressors: Identify and minimize exposure to situations or individuals that exacerbate your anxiety or distress.

Lastly, remember that healing is a journey, and it is okay to seek help along the way. You deserve support and understanding as you navigate these challenges. Please consider reaching out to a mental health professional who can guide you through this process.

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