[20F] Experiencing severe emotional distress and anxiety

Patient Description

A 20-year-old female reports experiencing significant emotional distress for many years, including feeling overwhelmed, shutting down, and dissociating. She often feels stressed, lacks a sense of purpose, and has no drive or energy. When someone says something slightly hurtful, she becomes reactive, feeling intense anger and worthlessness, which sometimes leads to panic attacks, hyperventilation, screaming, sobbing, and vomiting. She has a loss of appetite, often not eating for days during episodes of emotional distress, and this has been happening since she was 15. Anxiety exacerbates her inability to keep food down, and she has noticed changes in her weight because of this. Additionally, she experiences constant anxiety, isolation, reactive behavior, and suicidal thoughts. Her episodes of emotional distress have been occurring more frequently lately, almost daily, but typically happen at least once every week to two weeks. Triggers include the death of her mom and brothers, thinking about her mom leaving when she was 5, yelling and screaming, and feeling that someone is trying to hurt her mentally or physically. She also reports changes in sleep patterns, such as difficulty falling asleep, staying asleep, or sleeping too much, and changes in energy levels, feeling unusually tired or fatigued. In the past, she has used substances like alcohol, marijuana, MDMA, and cocaine to cope with her emotions and stress, but she no longer does so. She has a family history of depression and anxiety but has not been diagnosed with any mental health conditions herself and is not currently taking any medications.

Arora's Assessment

What might be happening

Based on the symptoms and history you've shared, it seems like you might be dealing with several interconnected issues. Here are some possible explanations:

1. Post-Traumatic Stress Disorder (PTSD)

Given your history of trauma, including the loss of family members, abuse, and sexual assault, PTSD is a strong possibility. PTSD can cause severe anxiety, emotional distress, and reactive behavior. Symptoms often include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the traumatic events.

2. Major Depressive Disorder (MDD)

Your feelings of worthlessness, lack of energy, loss of appetite, and suicidal thoughts are indicative of major depression. Depression can also cause changes in sleep patterns and energy levels, as well as physical symptoms like nausea.

3. Generalized Anxiety Disorder (GAD)

Constant anxiety, panic attacks, and hyperventilation suggest that you might be experiencing generalized anxiety disorder. GAD can cause persistent and excessive worry about various aspects of life, leading to physical symptoms like nausea and difficulty sleeping.

4. Complex Trauma

Given the multiple traumatic events you've experienced, complex trauma could be a unifying diagnosis. This condition involves prolonged or repeated trauma and can lead to severe emotional and psychological distress.

Typical Treatments and Testing

Psychotherapy: Cognitive-behavioral therapy (CBT), trauma-focused therapy, and other forms of counseling can be very effective.
Medications: Antidepressants, anti-anxiety medications, and other psychiatric medications may be prescribed.
Support Groups: Connecting with others who have experienced similar traumas can provide emotional support.
Lifestyle Changes: Regular exercise, a healthy diet, and mindfulness practices can help manage symptoms.

What you can do

Seek Professional Help

Therapist or Counselor: A mental health professional can help you navigate your emotions and develop coping strategies.
Psychiatrist: A psychiatrist can evaluate whether medications might be helpful for you.

Immediate Steps for Emotional Distress

Grounding Techniques: Practice grounding techniques like deep breathing, focusing on your surroundings, or holding a comforting object.
Safe Space: Create a safe space where you can retreat when feeling overwhelmed.
Journaling: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider.

Managing Anxiety and Panic Attacks

Breathing Exercises: Practice deep breathing exercises to help calm your mind and body.
Distraction Techniques: Engage in activities that distract you from your anxiety, such as listening to music or engaging in a hobby.

Improving Sleep and Appetite

Sleep Hygiene: Establish a regular sleep routine, avoid screens before bed, and create a calming bedtime environment.
Small, Frequent Meals: Eat small, frequent meals to help manage nausea and maintain your energy levels.

Lifestyle Changes

Exercise: Regular physical activity can help reduce anxiety and improve mood.
Healthy Diet: Eat a balanced diet rich in fruits, vegetables, and whole grains.
Avoid Substances: Try to reduce or eliminate nicotine use, as it can contribute to anxiety and other health issues.

What you should look out for

Given the severity of your symptoms and the potential for life-threatening conditions, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:

Suicidal Thoughts: If you have thoughts of harming yourself, seek immediate help from a healthcare provider or call a crisis hotline.
Severe Panic Attacks: If you experience severe panic attacks that you cannot manage on your own, seek medical attention.
Physical Symptoms: If you experience significant weight loss, persistent nausea, or other concerning physical symptoms, consult a healthcare provider.

Remember, while I can provide information and suggestions, it's crucial to seek care from real health professionals to receive a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.