Mixed Anxiety-Depressive Adjustment Disorder: A Patient's Journey

Q: Mixed Anxiety-Depressive Adjustment Disorder: A Patient's Journey

Hello, Yue： Your willingness to write such a lengthy article to express your situation suggests that you have been accumulating a lot of pressure for a long time. <br>I'm sorry to hear that! Your situation includes fear and distrust of others, a loss of direction and meaning in l

Adjustment Disorder

Hello, doctor.
I have been seeing a psychiatrist for almost a year, and my diagnosis is mixed anxiety-depressive emotional adjustment disorder.
Initially, I sought help due to relationship issues, and the doctor conducted interviews regarding this matter.
Eventually, that relationship did not work out, and I gradually moved on.
I continue to attend follow-up appointments and take medication, but I want to discuss other issues with the doctor but don't know how to start.
I feel that talking about it might not help, as I have so many problems that I don't know where to begin.
1.
Since elementary school, I have struggled to complete homework, often staying up late and still not finishing.
I have always had difficulty concentrating on one task and was frequently reprimanded in class for talking too much.
My classmates jokingly suggested that I might be hyperactive.
This continued until I graduated from elementary school, and I thought it wouldn't affect me as I progressed in my education.
However, I still couldn't complete assignments and found it challenging to retain information while studying.
In college, nothing changed; I genuinely wanted to study seriously but could never stick to a plan and would always get distracted by other activities.
2.
I have been afraid of interacting with strangers since childhood.
I have disliked performing or speaking in public since I can remember.
I initially thought it was just shyness and not a significant issue, but later it became clear that it was more than that.
I only feel comfortable buying things at convenience stores; whenever I have to order food, I experience intense fear and don't know how to speak.
As a child, shopping with family felt overwhelming due to the amplified noise around me, making it impossible to enjoy shopping.
I didn't think much of it at first, believing I would outgrow it, but this situation persisted into middle school.
I was so afraid to take the bus that I would rather walk for half an hour.
I forced myself to ride a bike, but I was sensitive to the noise of traffic, often getting startled by loud cars or honking, which almost caused accidents.
Eventually, I started using headphones to listen to music to alleviate my anxiety.
In college, I had to take the train, and the bustling noise at the platform made me extremely anxious, so I continued to use headphones to cope.
When meeting friends at restaurants, I could never enjoy the moment, especially in fancier places where my anxiety heightened.
Presenting in class, even with classmates, left me speechless; I would freeze up, unable to think or make eye contact.
I ended up reading from a script, rushing through it, with my heart racing, breath quickening, and voice trembling, feeling like everyone was staring at me.
Even making phone calls takes me a long time to muster the courage.
3.
I hesitate to open up to friends.
Even with my closest friends, I feel they are not genuinely sincere with me.
All my friendships seem superficial, and I don't want to invest in social relationships.
However, due to academic and work requirements, I force myself to engage in conversations with friends and strangers, but I never initiate topics because I don't know how to chat and often end up with awkward silences.
I fear leaving a bad impression, so I only respond to others' questions.
Even after a long conversation with my best friend, I still feel lonely afterward, as if no one understands what I'm thinking.
I feel like everyone in the world dislikes me, no matter how hard I try to communicate; they always seem to ignore my presence.
I put on a smile and tell them it's okay to decide, even when I offer suggestions that get dismissed.
I try to find part-time jobs to adapt to society and face my fear of interacting with people.
Now, I can communicate with others when necessary, but after work or class, I avoid going out and places where I need to interact.
4.
Although I don't often think about ending my life, I feel that life lacks meaning and that I am living for others.
I know my family would be heartbroken if I were gone.
I struggle to find motivation for studying and cannot concentrate on my coursework.
Even when I set study plans, they prove ineffective.
When grades are released each semester, I fall into a cycle of endless self-blame, repeating this every year.
I hate myself for being useless, for my decline, and for always making excuses for my laziness.
When I feel overwhelmed and unable to express my anger, I resort to self-harm, which temporarily alleviates my feelings.
Then, I escape again.
I wonder why someone as weak as me should live in this world and if anyone would genuinely understand or like me.
It feels like everything is driven by self-interest.
I find it difficult to express all of this to my doctor.
I have tried typing it out, but the doctor reads it all at once and doesn't provide practical solutions or useful advice.
I have been relying on medication for treatment, but I am unsure of its effectiveness.
Currently, I am taking medications like Wellbutrin, Ativan, and others as needed.
I wonder if the doctor could offer some suggestions.
Thank you.

Yue, 10~19 year old female. Ask Date: 2022/08/22

Dr. Lin Mianzhang reply Psychiatry

Hello, Yue: Your willingness to write such a lengthy article to express your situation suggests that you have been accumulating a lot of pressure for a long time.
I'm sorry to hear that! Your situation includes fear and distrust of others, a loss of direction and meaning in life, and a lack of appropriate emotional expression methods.
While medication can help treat some of these issues, psychological therapy is also necessary for more fundamental improvement.
I recommend that you ask your doctor for a referral to a psychologist for therapy.
You should also be mentally prepared, as it may take several months of therapy to see significant results.
Wishing you peace and health.

Reply Date: 2022/08/22

More Info

Understanding Mixed Anxiety-Depressive Adjustment Disorder is a complex journey that many individuals face, and it often requires a multifaceted approach to treatment and self-management. Your experience reflects a deep struggle with anxiety and depression, which can be overwhelming and isolating. It’s commendable that you are seeking to understand your condition better and are open to discussing your feelings and experiences.

From what you've described, it seems that your mixed anxiety-depressive adjustment disorder is characterized by a combination of emotional distress stemming from various life stressors, including your past relationship and ongoing challenges with anxiety in social situations. This disorder typically arises in response to identifiable stressors and can manifest as a mix of anxiety and depressive symptoms, which can significantly impact daily functioning.

1. Understanding Your Symptoms: The symptoms you’ve outlined—difficulty concentrating, fear of social interactions, and feelings of isolation—are common in individuals with anxiety and depressive disorders. The fact that you have experienced these issues since childhood suggests that they may be deeply rooted and could benefit from targeted therapeutic interventions. It’s important to recognize that these feelings are valid and that you are not alone in experiencing them.

2. Therapeutic Approaches: While medication can be beneficial, it is often most effective when combined with psychotherapy. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety and depression, as it helps individuals identify and challenge negative thought patterns and behaviors. You mentioned feeling hesitant to discuss your feelings with your doctor; however, opening up about your experiences, even if it feels daunting, can lead to more tailored treatment options. Consider writing down your thoughts and feelings before your appointments to help guide the conversation.

3. Self-Management Strategies: In addition to professional treatment, there are several self-management strategies you can employ. Mindfulness and relaxation techniques, such as deep breathing exercises, meditation, or yoga, can help reduce anxiety and improve your overall mood. Regular physical activity is also known to have a positive impact on mental health, as it releases endorphins and can improve your sense of well-being.

4. Building a Support Network: It’s understandable to feel disconnected from others, but building a support network can be incredibly beneficial. This could include friends, family, or support groups where you can share your experiences with others who understand what you’re going through. Sometimes, just knowing that others have similar struggles can alleviate feelings of isolation.

5. Setting Realistic Goals: Given your feelings of frustration with academic performance and self-criticism, it may be helpful to set small, achievable goals. This can help you regain a sense of control and accomplishment. Celebrate your successes, no matter how small, and be gentle with yourself during setbacks.

6. Exploring Interests: Engaging in activities that you enjoy or exploring new hobbies can provide a positive distraction and help you reconnect with what brings you joy. Whether it’s art, music, writing, or any other form of expression, finding an outlet for your emotions can be therapeutic.

7. Communicating with Your Doctor: If you feel that your current treatment plan isn’t addressing your needs, it’s important to communicate this with your healthcare provider. You deserve a treatment plan that feels right for you, and your doctor can help adjust medications or suggest alternative therapies based on your feedback.

In conclusion, navigating mixed anxiety-depressive adjustment disorder is a journey that involves understanding your symptoms, seeking appropriate treatment, and implementing self-care strategies. It’s important to remember that recovery is a process, and it’s okay to seek help along the way. You are taking a significant step by reaching out and seeking to understand your condition better. Keep advocating for yourself, and don’t hesitate to express your needs to your healthcare provider. You are not alone in this, and there is hope for a brighter future.

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