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Frightening Thoughts - Fear Losing Control - Please Help!

Question:

hello, I’m a 23 year old male. For many years I have occasionally felt what i would describe as a "creepy dark cloud" over me. This feeling typically comes on only in the later evening hours before bed. I just don’t feel "right" at such times, although I am able to function normally, just as if i were simply in a ‘bad mood’. It is a very foreboding feeling. Back to normal when i wake up in the morning. A few months ago i had a bad day, and experienced some sort of an "attack" in which i felt like i was losing my sanity; slipping from my grip of reality briefly. I felt like i needed to speak with someone immediately – someone to ground me. I felt like i was losing control over myself. In recent months since then, I’ve begun to struggle with intrusive thoughts which often involve the worst things i can imagine. The idea will occur to me to kill someone I love, or a friend, or myself. I am *extremely* troubled by these dark thoughts and feelings. I feel so guilty, like a monster. I try to redirect myself, but sometimes that is of little comfort…These thoughts seem to be the product of my own mind – I’ve never had any auditory or visual hallucinations that I am aware of. No dreams of murderous acts or anything like that, either. i feel like whatever is wrong with me preys on my greatest fears. These thoughts represent the antithesis of what I *want to be*. I don’t think I am capable of ever hurting anyone, but I am very disturbed by these intrusive ideas. I hesitate to call them compulsions, but there is an element of that, I think. in recent weeks, i have improved a bit for no apparent reason. I’ve finally started to feel "normal" again on most days. Please, any thoughts or educated guesses you could offer would be really appreciated. I’m so scared that I’ve begun to slip into some psychotic zone here. What all might be wrong with me?

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Answer:

This could be a lot of things. If you want to know what it is definitively (more or less) then please make an appointment with a psychiatrist to talk about what is happening. all I can do is speculate, and that is not a substitute for the attention of a physician who is able to interview you and make a diagnosis.

You say that you’ve experienced a mood swing towards the depressive direction in the evenings for many years. You further suggest that you’ve had a temporary exacerbation of mood disturbance characterized by what I guess is experienced as anger and homicidal thoughts, though this is not typical for you to think this way. Importantly, these seem to be your own thoughts, and are not experienced as though someone else is talking to you. That suggests that this is not probably a full-on psychotic phenomenon. The whole thing is what is sometimes called "ego dystonic", meaning that you are thinking in a way that clashes with your normal self-concept and it feels deeply wrong.

These things could be pointing to your experiencing a relatively simple depressive episode, although only a doctor can rule out other important possibilities, including the more remote possibility of a neurological (brain) problem, or the beginning of something like a psychotic disorder (so go see a psychiatrist medical doctor, please). Depressive episodes can take on different forms, and though most are about feeling very sad and low energy, some are more about feeling irritable and quick to anger. Suicidal thinking is common in such episodes, but homicidal thinking can occur too. Depressed people can become psychotic in their own right, but you seem to be falling short of that, at least so far. My guess is that you have used the term psychotic because of the "Jekyll and Hyde" ego dystonic quality to your thought process while in the episode. But just because you feel like you are going psychotic, doesn’t mean you are psychotic. Psychotic is what happens when you can no longer distinguish your own thoughts from someone else’s thoughts.

Not that it is particularly normal to walk around wanting to kill people, but the thought does occur to a lot of people with some frequency. It’s not a weird thought, is what I’m saying. A weird thought is something like when people believe that the television is talking to them personally, giving them orders on how they personally are to behave (what is called a "delusion or idea of reference"). But people who aren’t comfortable with the more aggressive sides of their own nature can be frightened by such thoughts when they pop up. In a similar vein, many people will experience attractions to the same sex at some point in their lives, but just because this is experienced a couple times doesn’t mean that those people are homosexual in sexual orientation. Homosexuality is what is happening when someone is attracted in that manner consistently. Just keep in mind that just because you think of something that doesn’t mean that you have to act on it.

You use the word obsession in your letter, and that may be an issue for you. A true obsession is a thought that comes into your head that you can’t let go of. Sometimes such thoughts take on such force and repetition that people feel compelled to act them out, which then becomes a compulsion. You are maybe reporting an instance of obsessive thinking (in the Obsessive-Compulsive anxiety disorder sort of spectrum manner), but if that is so, it is occurring in the context of your mood episode and not as a normal part of your experience. Depression is often characterized by a somewhat obsessive thought process, what is often called rumination, so this isn’t such a shock either. the only non-standard part here is that normally, rumination in depression is about the failings of the self, rather than the desire to harm others.

I do think this is something you should get checked out, so once again I will suggest that you make an appointment with a psychiatrist for evaluation and possibly for treatment. but I also don’t think you need to panic, particularly in regard to the ego dystonic part of this story. You don’t have to act on such troubling thoughts; keep that in mind. And sometimes, people who do keep that in mind can find themselves moving from a position of fear and guilt, to a position of acceptance but not endorsement, which helps them to feel less panicked about the whole thing; half the battle right there.

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