Saturday, September 26, 2015

Life with an anxiety disorder - Part IX: Anxiety and depression

You know, I may have dropped a hint here and there, but I never really talked about depression past anything but a hint in this blog. Yet, while I don't know the statistics, from my personal observations I have been under the impression that everyone who is diagnosed with an anxiety also seems to be diagnosed with depression, and vice versa. So in a series about life with an anxiety disorder it is a subject that seems unavoidable.

Depression, of course, is the most diagnosed mental disorder on the planet, and I reckon everyone who reads this either has this diagnosis him- or herself or knows someone who does. Probably more than one someone. And what do you know? It's been on my list of diagnoses for a long time, as well. My latest one is "recurrent depressive disorder, current episode moderate", from when I was in therapy a few months ago. So apparently that means I have ups and downs in life. Everyone kind of does, but I have it on paper. And could get antidepressants for it if I was interested in those.

Personally of course I have never really seen myself as a person who suffers from depression per se. For me, the symptoms that lead to the diagnosis are all directly related to my anxiety disorder, specifically the social anxiety and the agoraphobia with panic disorder things, because if you don't leave the house and don't talk to people, life does get kind of bleak. And on the other hand, the more time I spend outside and among people, the less I feel any sorts of symptoms that could indicated a depressive disorder. So it really is more of a side-effect that any sort of illness I have. People who actually do suffer from depression do so no matter how much time they spend outside the house or with other people. They're just depressed. The bleak mood I get when I spend too much time alone in my four walls is not something I would classify as such.

I've met a lot of people who just seem to be miserable no matter what they do, and don't find any enjoyment in anything. I do not really know what causes this, and from what I've learned doctors really are clueless, too. For those people, from the other side of the spectrum, it seems that anxiety always comes as a side-effect. As they grow more and more detached from life, they become more and more scared by even the smallest things. Like I wouldn't consider myself as someone suffering from a depressive disorder, I wouldn't consider these people as suffering from an anxiety disorder, for them, the anxiety symptoms are a side-effect of their depression as the depressive symptoms are a side-effect of my anxiety. But through these side-effects, these two issues always seem to be linked. The ethics of doctors turning the side-effects into a full-on separate diagnosis of course are questionable, but generally symptoms seem to be related.

What I do know about treatment is that anxiety is always the best starting point because it is very straight-forward to treat. Face your fears and learn to live with them. That of course is ideal for me as someone with mainly anxiety issues who only gets depressive symptoms on the side, but I think it is also a good starting point for those who mainly suffer from a depressive disorder and only get the anxiety symptoms on the side. Get rid of the latter, even if your depression might be unaffected. There's actually a good chance that it will be affected. Positively. Anyone with anything in the anxiety spectrum, whether it be the main thing or a side-effect of something other, should always work on that first, because it's the most effectively treated when backed up with the will to do so. Lesson one: Learn to not be scared. Everything else you can deal with afterwards, and will be a lot easier to deal with at that point.

Monday, September 14, 2015

She has a great personality - Part II: Avoidant personality disorder

Avoidant personality disorder, also called anxious personality disorder, and referred to as something like "self-insecure" personality disorder in German, is that second partial diagnosis I got in therapy. I was never quite sure if I recognised myself in it very much, a lot of it is just completely unlike me. The thing is that it has a lot of overlap with social anxiety disorder, to the point that some scientists debate they are really two different names for the same thing. Which is probably the thought behind the diagnosis.

Basically, what we have here is "social anxiety plus", with all the symptoms of social anxiety but going a step further. The core idea behind avoidant personality disorder is that the afflicted always needs his or her "safe place" and feels anxious outside of it. For most people that would be their own four walls, and as soon as they're out of them, it becomes impossible for them to deal with all the new situations outside life presents and they display all the symptoms of social anxiety disorder. Inside their home or other safe place they are fine, happy, sociable people, but outside their zone of comfort they get in a terrible state of mind and all their social skills are gone. This is the first part where I really don't see myself in, because I am not dependent on my home, and my personality - or how I display it - in any place I am. So already at the core issue I begin to doubt my diagnosis.

From what I've learned, their are two ways the issues with social skills are displayed when those who suffer from avoidant personality disorder leave their safe place. One of them is a cold and distant personality that does not really participate in social interaction, appears to ignore people and minds his or her business exclusively. Guess that applies to me in some way, but that is also a common social anxiety thing. The other one is something I was majorly offended by the therapist even suggesting it, a type of personality that agrees to everything somebody says and never speaks up for him- or herself in fear of negative consequences. You know, "do you want to go for a coffee?", and you don't want to at all, but you say "yes" because you are scared of the person asking being mad at you. That really isn't me at all. I mean, yes, I have agreed to doing things I didn't feel like to be nice, but everyone has. Never to the degree of a "disorder", or any sort of personality that would do this regularly and forego being independent and standing up for him- or herself.

Another core issue is of course what it says in the name, the tendency, or compulsion, to avoid. Any situation that may cause discomfort must be avoided in this disorder. This goes hand in hand with the safe place thing, of course, where leaving said place is avoided entirely. And there seem to be many stories out there of people who do just that. Situations in which fear might arise are avoided to such an extent and safe havens clung to with such obsession that normal life becomes impossible. It's also where the overlaps with social anxiety come in, in that being situations which are being avoided entirely. It's what Germans call "self-insecure" (I just don't know how to translate "selbstunsicher", it's such an odd word), such a strong barrier of self-doubt that avoiding situations which could go wrong socially becomes a must. Again, this is something that goes too far to properly describe me, so I continue to have serious doubts about the diagnosis, even if it is only a partial one.

The things I did recognise myself in were indeed the overlaps with social anxiety disorder, of course, such as fear of being judged or rejected. But since nothing of the other symptoms applies it seems to make more sense to simply leave social anxiety disorder as a diagnosis and not make up anything else.

There are of course people out there who are aptly described by the outlines of this disorder, and I don't envy them. Luckily, there is treatment, and it's actually fairly simple, as it's the same as for social anxiety disorder: Get out, go out, meet people, interact. Takes a load of practice, but it works. And reaffirm your self-esteem, because you might not think so, but you're actually pretty cool. At least I am, hey, I'm the middle of treatment (self-treatment at the moment, no therapist), starting to think I really am pretty cool. And anyone can. And I'm having fun meeting people. And anyone can do that, too. So if you're reading this, and you're diagnosed with avoidant personality disorder, and it actually describes you well, be sure to have some fun and feel good about yourself, even if it is actually no fun at all at first, and you actually feel crappy about yourself at first. If I can do it, anyone cool enough to read my blog can do it, too.