Don't Think I Can Bear feeling like this about myself any more

[tiredzombie]

I think this is probably more of a self-esteem issue than depression, but since there's no section for that, and it's making me feel pretty awful, I'll post here.

Basically, I don't think I can be around other people, or live in the 'real' world, without feeling awful about myself. I spend as much time as possible avoiding this, wrapped up in my own little universe, distracting myself from the feeling. But I can't go on like that much longer. Sooner or later I'm going to have to find a way to face reality full time, and I don't know how.

Whenever I have to interact with people (beyond my immediate family), I end up feeling bad about myself. It's like I'm constantly judging myself through other people's eyes, and looking for indications that I've done something wrong, for confirmation that they think as little of me as I do. The smallest mishap leaves me feeling miserable. I know it's ridiculous. But it's like I just lose all sense of perspective. Deep down I believe I'm pathetic, and it only takes a tiny thing to crack the confident facade I put up to protect myself, leaving me feeling awful.

I've felt bad about myself for most of my life, and it seems to just get worse and worse. I feel bad, so I avoid people, meaning I have no life, so I feel worse, and on and on it goes. But I don't know how to cope with facing the situation full-time, and breaking the cycle. The only way I got through it at school was the thought that it would all be different when I left. But it wasn't. Because the problem was with me, not the school. So I was miserable at uni, and dropped out.

I want to get 'help', but I'm scared that it will leave me feeling worse. I'm scared of feeling judged by counsellors/psychologists, and when I feel like that I find it almost impossible to be open or honest about how I feel, so I'm not sure how much help that would be anyway.

I also feel like I'd probably just end up doing CBT stuff again, and I don't really have much confidence in that. Maybe I just didn't practice it enough.

Anyway, apologies if this post was a bit garbled - I'm already starting to forget what the problem is and drift back into my alternate reality.

[BubbleBonce]

I want to get 'help', but I'm scared that it will leave me feeling worse. I'm scared of feeling judged by counsellors/psychologists, and when I feel like that I find it almost impossible to be open or honest about how I feel, so I'm not sure how much help that would be anyway.

OMG Tiredzombie thats just how I feel. I've been lurking around this board for ages and you and somneone else said it exactly.

I have been referred to the IAPT team for some kind of therapy - I'm not sure. I dare'nt even say what my problem is to my GP or family. My family just seem to make me feel worse, so my life is on hold until I feel beter about myself.

You know I don't even really kmow what my problem is, but you've almost put it in words as well as I could. Wow, do we really think we are so bad?
I'm sure this must be the nasty anxiety at work, but why?

Hugz

Bubble x

[daydreamer]

Zombie,

you've said yourself that you cant bear feeling like this anymore. I know your scared, believe me I know EXACTLY how you feel, it IS scary, I am scared, but whats the alternative, feel like this forever? Please consider some sort of therapy with a psychologist. Yes your going to feel worse at first because your doing something you dont really want to do, but Im sure it can help you. If it doesn't at least you can say you tried and you owe it to yourself to try......

[daydreamer]

Hi Zombie, how are you feeling? Hope you are feeling a bit better now

[tiredzombie]

Thanks for your replies, sorry it's taken me this long to come back. Like I said, I tend to go back into my little bubble as soon as I can, and forget all about the feeling for as long as possible. Since I started the thread it hasn't been as bad as it was, but it's still kind of there in the background. I just hate being around people, unless things are going really well, and it leaves me feeling bummed out on a regular basis.

I think part of what I'm scared of with counsellors/psychologists is that I'll end up feeling that it's my fault, and that I'm choosing to feel this way, or that I'm just making a big deal of something that effects everyone. That's kind of the feeling I got from one of my previous counsellors, and it was a real low point.

If my self-esteem was ok, then it wouldn't have been a problem. But as it was, I was kind of left with the feeling of 'what kind of crappy person must I be to choose to be like this.' Whenever something doesn't go well, it always feels like it's my fault. And I don't think I can take having that reinforced much more.

I really don't know if there's anything anybody else can do to help me. Maybe the only person that can help me is me. But I don't know how to feel differently about things, and about myself.

[daydreamer]

Hi Zombie,

Its probably always going to be there in the background untill you decide you can face it. You havent chosen to be like this but ultimately its you who can choose to do something about it, like getting some therapy. You just said you dont know how to feel differently about things and about yourself, these are the issues you need some help with.

I know that your past experiences have scarred you, I have been in the same boat myself. If you can afford it then a good idea would be to try and find a psychotherapist who deals specifically with things like self esteem issues. Dont be afraid to phone them and have a conversation with them over the phone at first, its usually a good indication of whether you'll feel comfortable with them. Im sure that if you do your research on therapists you'll find someone who you can work well with and wont judge you.

Dont deny yourself help because you think you arent worth it, because you are!

[BubbleBonce]

Hi Zombie,

I saw this link posted somewhere else and had a little looky myself. It looks like it might help the likes of you and me and it doesn't cost anything and no person at the other end to make you feel bad. At least it might give you an idea of what might help. I'll be doing it myself too over the next few weeks.
I think both you and me need to stop being so hard on ourselves - and that's not to say that it's our fault!

Bubble

http://www.cci.health.wa.gov.au/reso...cfm?Info_ID=47

[Workplace Doctors]

Resource Text for Depression


Depression is not a new condition related to 'modern living'. It has been written about in many ancient texts. However, it is only since the end of the 19th century that depression has been categorised separately from other forms of mental illness. With the end of the second world war, the advent of more sophisticated forms of treatment made the management of depression more worthwhile in the early stages before it becomes chronic.
It can be difficult to describe depression, but generally it is thought to be characterised by a pathologically ‘low mood’. As with all diseases, there is a spectrum of conditions within depression from mild at one end to severe forms at the other.
Genetic factors
From a genetic perspective, it is thought that inheritance plays a strong role in depression susceptibility. Studies have looked at identical twins, separated at birth and have shown a high concordance rate of about 70% for depression. If one parent is affected then the risk is 10%, and if two parents are affected the risk us thought to be about 20%. If there is no family history then the risk is thought to be 1-2%.
Interestingly there is a subgroup of depressed women who lost their mothers when they were entering puberty aged 10-15. Therefore, this is now a well recognised crucial age for young girls.
Biological causes
It is thought that there is a deficiency of one or more of the amine neurotransmitter communication systems involved in depression. The monoamine hypothesis is the oldest theory, based on the belief that depression is caused by a lack of either serotonin or noradrenaline at the post-synaptic receptors, so reducing the passage of nerve impulses.
The chemicals involved are:
5-hydroxytryptamine (5HT)
dopamine
noradrenaline.
However, this is not thought to be the whole story, as the amine theory does not explain why antidepressants can take some weeks to establish their therapeutic effect. Other transmitters such as acetylcholine, substance P and pregabalin are being looked at in closer detail and may hold more clues to the jigsaw puzzle that is the biochemistry of depression.
The 'over-sensitive' receptor hypothesis relates to the known fact that that low levels of neurotransmitters can lead to alterations in the receptors themselves. The understimulated receptors become more sensitive or increase in numbers on the cell membrane. This may be associated with the start of depression.
The permissive hypothesis theory stresses the interaction between serotonin and noradrenalin in regulating mood. If serotonin levels are too low, its control of the noradrenalin system is lost. If the noradrenalin level also falls, the person becomes depressed, but if they become abnormally high, then mania may result - as seen in bipolar affective disorder (BAD).
The hormonal hypothesis is based on the observation that changes in the hypothalamo-pituitary-adrenocortical axis can influence neurotransmitter levels and function. This may push the individual over the edge into depression, or may contribute the component of anxiety that so often accompanies depressive illnesses of all kinds.
Physical symptoms
Physical symptoms are prominent in patients suffering from depression. It can be useful to think of depression as a possible diagnosis if the patient makes you feel miserable during the consultation.
You should consider the following in any patient who you suspect of having depression.
Sleep disturbances: patients who are depressed may experience frequent waking episodes during the night and may wake early in the morning. Depressed patients will often tell the doctor that they don’t feel refreshed after sleep.
Appetite: loss of appetite is a common symptom that patients who are depressed encounter. You should ask them directly how much weight they have lost (over 5% can be indicative of severe depression). However, some depressed patients may put on weight, so be alert to this as well.
Bowel changes: patients who are depressed can experience constipation.
Energy levels: patients may present with tiredness, lethargy and general psychomotor retardation (in severe cases).
Concentration: patients may lose their ability to concentrate at work or at home. They also show poor motivation and an inability to make decisions.
Loss of libido: patients who are depressed may lose their interest in sex.
Non-specific aches: depressed patients may present with generalised aches and pains and can often give a long list of minor ailments. It is important to recognise these as symptoms of depression.
Anxiety is mentioned in International Classification of Diseases (ICD) 10, but not DSM 4 (diagnostic criteria) although it recognises ‘agitated’ depression”. In general practice about 70% of the patients we see with depression have an associated anxiety state. However, psychiatrists like to keep the classifications clear, either depression or anxiety even though mixed anxiety and depression is an every day condition seen in general practice.

Resource Text for Depression


Useful questions to ask patients who are at risk of depression
This list is not exhaustive and you may not ask all the questions. It is merely a basis to form an opinion as to the severity of depression.
1. Do you have generalised aches and pains most of the time?
2. Are you tired most of the time? Do you suffer from insomnia?
3. Have you noticed that you find it hard to concentrate?
4. Do you enjoy doing anything in particular?
5. Do you feel that your mood is low most of the time?
6. Do you find that you start crying for no reason sometimes?
7. Do you feel the weight of the world on your shoulders and an inability to cope?
8. Do you ever feel that you need to escape?
9. Have you ever thought you would harm yourself or end it all?
NICE advice
The recent National Institute for Clinical Excellence (NICE) guidelines for management of depression in adults from December 2004 (see later section) suggest that there are two particularly useful screening questions.
1. “During the last month, have you often been bothered by feeling down, depressed or hopeless?”
and
2. “During the last month, have you often been bothered by having little interest or pleasure in doing things?”
Social factors
Always ask about social factors that could play a part in a patient’s depression. Consider the patient’s living conditions, family support or any adverse social elements that could impact on the patient’s illness (e.g. abusive relationship, divorce etc).
Red flag signs
Is the patient a substantial suicide risk? If so, then he/she may need to be admitted urgently to hospital under the psychiatric services.
Does the patient exhibit any signs of pressured speech or does he/she have a history of mania?
Is the patient consuming large amounts of alcohol or other drugs?
Core symptoms
The following are considered the key symptoms of depression. Usually several are present, but not necessarily all.
Unhappiness
Loss of concentration
Poor appetite
Insomnia/early morning waking
Loss of energy
Feelings of guilt and self worth
Feelings of suicide
The Hamilton Depression Rating Scale
The Hamilton scale is a depression rating scale that was devised by Max Hamilton in the 1950s. The Hamilton Depression Rating Scale is the most widely used in the world and has been a standard assessment criterion in many clinical trials. Some have argued that there are better scales, but it has stood the test of time and is simple to use. From the overall score it can give an indication of the severity of depression (see below). However, it is thought to be more useful in the assessment of change in patients’ depressive state. In contrast to many other scales, it is completed by the clinician.
The Hamilton is used to rate the severity of depression in those already diagnosed as depressed. It is administered by a health worker. Each question is individually scored – for example suicide:
no thoughts of suicide rates 0
“my life is not worth living” rates 1
“I wish I was dead” rates 2
suicidal ideas or gestures rates 3
attempts at suicide rate 4.
Somatic symptoms, such as aches & pains, sexual dysfunction, gut problems are scored 0,1 or 2. For example,
no loss of appetite = 0
loss of appetite but food intake normal = 1
marked reduction in appetite and food intake = 2.
There are 21 questions, some with a maximum score of 2, most with a max score of 4. The most you can score is 64. A score of 8 or less means no longer depressed (in remission), a score of 30 means severe depression, with gradations.
Total Score
Levels of Depression*
1-10
These ups and downs are considered normal.
11-16
Mild mood disturbance.
17-20
Borderline clinical depression.
21-30
Moderate depression.
31-40
Severe depression
over 40
Extreme depression.

* A persistent score of 17 or above indicates treatment is required.
The Hamilton scoring tool may be useful to use as a tool for assessing progress after starting antidepressant medication. Patients improve so slowly that they often don’t realise how far they have come. Showing them how their scores have improved over the past few months is an effective technique to keep them taking the pills for the full six months (or longer for recurrent episodes, elderly or severe depression).

Having worked within occupational health for a number of years I personally have come across individulas that are indeed to hard on themselves as they see that they are different from other, in my opinion they look to much into situations and depress themselves over minor issues at work, however some of these issues are major so the above essay which I hope has not offened anyone, gives you an insight into the other side of the table of what a medically trained individual will look for within an individual who is suffering from depression.

All the best, chin up and apologies before hand if the above is of no use to you or alternatively has sent you to sleep on your keyboard.

www.workplacedoctors.co.uk

[tiredzombie]

Thanks again for your replies. I might give that stuff a try next time I'm feeling really bad about myself and want to try and change things.

[Typer]

Hi tiredzombie.

It is a strange feeling to not feel good enough when in the company of others. Is it that you feel lesser a person than those you are with?

Therapy may really help you understand the root of this feeling and perhaps help you to describe the feeling in more words. Sometimes if we explore the feeling, both in a thinking way, and in our bodily sensations (e.g. start to slump, or maybe feel ugly, ect). Perhaps being with a "good and understanding" therapist will allow you to have a safe relationship in which you can explore and bounce these feelings off of someone else. For example if you feel "bad" with your therapist, it could be a safe place to talk about it while its actually happening.

Anyway, I am sending you a big hug and well wishes