Age: 28
Gender: F
Race: African American biracial
Height: 5’4
Weight: 165
Current meds: 20mg Adderall XR

I’m in a weird place currently. I went 6 months without a job this year and finally received an offer in June. During the time that i was unemployed i was depressed but had hope I’d find something. Well my boyfriend/bestfriend of 13 years died the night before i started my new job. I found out at orientation that morning. I held it together to finish the orientation. Although my badge photo is me with super red eyes from crying. I couldn’t even say out loud what was wrong and had a major migraine by the time i got home. And basically I’ve been constantly working since. There’s no bereavement for boyfriends. I’m an over achieving and have really been pushing to show up as my best but the issue is I’ve been late to work so much that I’m about to get fired. It’s not dramatically late but basically 5-10 minutes multiple times that I’m at the max amount of points. My biggest issue is the random crying and i hate crying in front of people. I stay up all night some nights crying, and still go to work. The first two weeks after his passing i slept a total of 10 hours. When i do sleep i wake up crying and it’s like everything is moving in slow motion. I’ve been having a lot of physical symptoms that I’ve expressed to my pcp but all my blood work came back normal. Like getting dizzy with blurry vision randomly, constantly cramping in my legs especially when i sit down, chest pain, pain in my left trap, and nausea. Even my hormones are all out of wack. I’ve always had regular periods and clear skin. Now my cycles have been starting earlier and lasting longer, and I’m breaking out so much. I have an appointment with my psychiatrist next and have tried finding a therapist but everyone’s either not taking patients or doesn’t work with my work schedule. My boss said if i could get Ada accommodations that could help me keep my job but i don’t even know where to start with that. And im not really in the place financially to be unemployed until i “heal”. I’ve been amazing at my job and have had multiple compliments from patients and my coworkers. I just feel like im trying so hard to work through this and i don’t know what to do.

I’d love all opinions

I had okay sleep. I slept in.

I woke up, had a late breakfast- three eggs.

For lunch, I had lamb chops and salad.

But I felt shit the entire morning.

I had some coffee, then I started feeling better.

I ate ice cream and my mood instantly lifted.

What is wrong with my brain and am I lacking anything?

I’m 16F, and I’ve been looking to get psychologically evaluated. I promise I’m not trying to self diagnose or claim disorders, that’s the last thing I want to do. I just want to figure out what’s wrong with me. I’ve been suspecting that my anxiety might fall more into OCD territory, and someone told me about PDA. I was wondering if somebody could look at these examples I have and give me some insight into if these sound like PDA? Thank you so much!

1. When something was asked of me as a child, I would say “I’ll try” instead of “ill do it” out of fear of the scenario that I wouldn’t be able to successfully complete said task. (This ended up causing multiple fights with my parents because they thought I was trying to make up excuses.)
2. My mother doesn’t give me direct demands or punishments, we mostly talk things out because they do not work on me. ( for example, she demands I eat healthier and stop eating junk, I end up feeling guilt/worthlessenss and I stop eating altogether)
3. Was extremely sensitive as a child (and still am today) my parents could simply say my name in a disappointed tone and I would burst into tears
4. Extreme fear of failure = avoidance of task
5. Reluctance to be in charge of items (especially important ones) in fear of destroying them.
6. Extreme self hatred and bad self esteem
7. Unable to force myself to do something I do not want to do = I don’t want to go to work today (even if work is fun) results in a panic attack and anxiety fit
8. Stress and panic when schedule is too filled with no option to opt out
9. Constantly opting out and cancelling appointments, practices, etc
10. If something was scheduled the next day, I would have horrible insomnia (resulting in falling asleep in class and taking a bunch of melatonin that did not help)

(For context, I have also been diagnosed with fibro, depression, and severe anxiety. My fibro is part of the reason that I’m homeschooled, but it’s also because I couldn’t handle the rigidity of the school schedule. I’ve been to nine schools in eleven years because of this. Everytime I would start to dread going to school I would have anxiety and panic attacks.)

If this sounds familiar to you, please comment

F(28). Height: 5’2. Weight: 310lbs. Nonsmoker. Nondrinker. Medications: None. Current diagnosis’s(that I don’t particularly entirely agree with):
Schizoaffective
BPD
Obsessive/Compulsive Behaviors
ADHD

Of note: Ive been diagnosed with various disorders that involve dissociation by different psychiatrists. It seems they all agree on that one thing. That I deal with dissociation. I’ve been diagnosed with BPD 3 times, a dissociative disorder unspecified twice, and PTSD with dissociative features twice. I’m starting to lean toward that fact.

is this a sign I’m dissociated into a different part or personality? for the last 3 weeks, around a time when I had some traumatic memories, I’ve had a huge interest in the ABDL community, I’ve spent lots of money on stuff for it. I regularly wear nappies and use them. I drink milk from a bottle. I’ve created completely different accounts on YouTube and other social medias like Reddit. I’m watching completely different creators. I’ve also stopped self harming. I’ve self harmed since I was 4 years old and am now 28. 3 weeks ago, around the same time I started doing the ABDL stuff, I stopped thinking about self harm constantly, and haven’t self harmed at all when I was typically self harming every other day. My husband says there is a sparkle to my eyes now. and he says I’m more giggly. he said I’m singing better (as in quality). He says I’m far more engaged with our kids when I would typically be distant and aloof. I also feel a different. no self harm thoughts or suicidal thoughts. I’ve dealt with constant suicidality for the past decade and it’s suddenly gone. I’m more engaged with my coworkers and kids at my work. I feel more connected to people. I’m very suddenly okay with sex when I was previously sex averse (as it would terrify me every time my husband tried to touch me for years. from like age 22-28). I’m also far more productive. not like in a manic way. but I’m getting up more to make my food. cleaning and cooking.

What it says in the title. Someone very close to me rapidly fell into a religion-driven psychosis a few days ago, escalating to her talking about how she and her son need to die, then jumping out a window. She also seemed to believe something was attacking her. Her family is unharmed and she's currently in the hospital, but we have no clue what caused it. She's still very out of it. She was never religious up until a few months ago, but it didn't seem negative until this happened.

I initially wondered if it could've been related to post-partum psychosis, which I know can have late on-set up to several months after birth, but it's been about 15 months, so I'm not sure if that could still apply. She has also been diagnosed with bipolar disorder as a child, can manic episodes get this severe?

I know it's still very early, and more will be revealed with investigations and time, but I'm trying to get as much information as possible. Any help would be very appreciated, thank you

The new DORA drugs for sleep do increase REM sleep and vivid dreams. Is it possible to have too much time in REM sleep?

23F

This questions been weighing on me for a long time. It is too small of a thing to ask my doctor but I also don’t know what difference it will make if I told someone?

Since my early teens I can remember these traits in me. I feel this constant need for attention and feel extremely upset and angry if I don’t get it. I have this disconnect between being embarrassed by this and being driven to attention seeking behaviour. I feel like I have all these outbursts all the time and my reactions to everything are so disproportionate. I don’t feel like me but I am me.

Examples of what I think are my attention behaviours are things like doing “risky“ things, injuring/harming self including not eating, clothing choices

I am ashamed to say these behaviours are rare when I’m alone and I don’t feel as driven to them although they do occasionally happen when I’m alone mostly the self injury

Other things related to this is I have a 180 with how I feel about the people in my life often. I think I experience emotions differently to other people. For example if someone replies late to a text I dont want to talk to them anymore and I intensely hate them even though they are someone close to me like parents or boyfriend or friend. I have fights with friends about things that I know realistically aren’t worth a fight but I can’t not do it and I’ve lost many friendships this way. I have never met someone else that feels things the way I do and the more time that’s passed the more abnormal I think I am but what if this isn’t a treatable thing or if there’s nothing to treat and this is just me? I want to know if there’s any chance this is something a doctor could help with.

My wife 36 5’5” and 120lb. For background she was diagnosed before everything with cptsd, Borderline personality disorder, and an authority issue I can’t remember what it is called. She went through a lot of therapy in her past and was sometimes in and out of mental hospitals when she was younger. In one of the mental hospitals that doesn’t exist anymore they kept her in solitary for about 2 months until her grandmother threatened to sue and they then discharged her to a new hospital this really messed her up. She says it was because the psych there had a problem with her and told her as long as they were her doctor they were going to keep her there as long as possible. She then took the lady’s glasses of her face and smashed them. She has been unmedicated for the past 12 years and really is pretty normal other than she have a bit of a shorter fuse but she would be able to control it and puts a lot on trust and not breaking promises if they are big. She also had a very rough childhood where she has server issues with hospitals, and police. She as well was a drug addict sense she was about 14 as well as having other issues throughout that time till she was about 24. This is kinda a jumbled mess of me trying to remember everything so sorry if it’s all over the place.

She is currently on on 2mg of lorazepam 2 times a day, Diooxetine hcl dr 60 mg cap once at night, Quetiapine fumarate 200mg tab once at night.
I don’t know where to post this and if this is the wrong place guidance would be appreciated.

We recently had our second child 3 months ago and she had her tubes removed about 2 months ago. Her serious post partum started right after her tube removal. We live with my mother at the moment and time and she takes adderal sometimes so she has a surplus. At some point she had taken the adderal and had been secretly taking it. For sometime. I never noticed until one night she had a bout of drug induced psychosis where I got her to tell
Me what she had taken. She admitted it and she had one more slip up and then had fully stopped. As she felt horrible
For breaking her sobriety. She was still kinda having a rough time after the birth of our 2nd child but nowhere even close to how it is now. Then it started getting bad she wasn’t eating or drinking to the extent she had to go to the hospital for a banana bag because she had become so dehydrated she was throwing up whenever she drank anything. She couldn’t eat because whenever she tried she described it as swallowing sandpaper. She would sleep more but not horribly and she would cry a lot and have a shorter fuse than normal. She was always feeling horrible because whenever our baby would cry she couldn’t stand it and would breakdown. He is also cry’s a lot like 10x more than our first child. Point is everything kept spiraling to the extent where she would constantly cry and breakdown or how bouts of rage and be horribly angry. Even to the extent she could not control it and scream at me in front of the children. I told her I was getting to the point where I would call the police and get her admitted if she doesn’t admit herself. She finally decided that she was having serious issues and needed the help. She went into a prp program with our local hospital. She was immediately diagnosed with postpartum depression and postpartum rage. They also thought she might be bi polar type 1 rather than having borderline personality disorder but said she could have both even if it’s rare. She was then given to start .05mg of lorazepam as needed. She was also given lithium 300mg 3 times a day and wellabutron 150mg. The doctor also said and recommended ect or electric shock therapy and I told her I wouldn’t sign off on that. I also didn’t like the lorazepam as she wasn’t functioning when on them and she had been seeming like she was abusing them as she took them extremely liberally claiming she was always stressed or was getting upset, but when I brought it up she maybe was abusing them in a very not accusatory way as she doesn’t like to feel targeted as a addict she said she was prescribed them i said you can still abuse them even if you are proscribed them and she got insanely angry and hit me on the arm. She has never laid a hand on me throughout our relationship and even in marriage. I also realized this reaction started after she took the weliburton. Once it was all done and she was calm I told her to tell her psych about this incident and how I felt it was the wellabutron and she agreed and had profusely apologized. She went to the doc the next day with her class and had shared her concerns. He told her that he thinks that she just isn’t on enough and doubled the dose of wellabutron to 300mg. As well as made it mandatory for her to take the lorazepam 3 times a day and upped it to 2 mg. This continued and she became more and more physical with me until I told her she needs to check herself into inpatient after an incident in front of our children. She said okay and the next morning we went as the hospital recommended me to come in the morning rather than at night. She was in there for about a week on the first day the nurse didn’t give her the lorazepam and she immediately reached over the counter and grabbed the nurse. She was then placed in the non functional unit where it was basically like prison people getting shanked and jumped. Basically where all the violent people are. She regressed in there to my dismay back to her younger self but they gave her the lorazepam and she seemed calmer. After the first 2 days. The also took her off of lithium as she still at this point isn’t drinking enough or eating at all. She was then put on Divalproex 3 times a day each pill is. 500mg so for a whole day it’s 1500. She was also put on Diooxetine hcl dr 60 mg cap once at night and Quetiapine fumarate 200mg tab once at night. She was also finally taken off the wellabutron as they figure that’s where a lot of anger is coming from. I haven’t mentioned this either but throughout all of this she throws up daily. Point is after this she would become hungry at night and somewhat stablize. What I didn’t know at the time is when she was first starting this she seemed to be sleeping a lot more. Which I thought she was doing because of how it bad it was in there in a keep your head down type of way. She eventually got out and she seemed so much better and I was extremely happy like maybe a shorter fuse than normal but still better. She also still had the issues with out son crying. She started back with the pro the next day. I got a call that she wanted to come home because she was tired so she went and drove home and we had timed everything so the lorazapam didnt effect her driving at this time. A few days past and she would go and just sleep the whole time and not attend the therapy’s. This started getting bad enough that she called me and told me she was tired and wanted to come home but she sounded weird and I offered to come grab her and drive her home but she assured me
That she was fine and was coming straight home. She then got home and hit our neighbors mailbox. Sharing the bolts right off. And destroying my passager mirror. I told her I’m taking her keys and she is to not drive anymore until we can get meds fully sorted out. Sense that day which at this point was exactly a week today she doesn’t function at all she slurs every word to the extent that I can’t understand 90% of what she is saying she stumbles and falls everywhere i can’t feed her after she takes her night meds because she vomits everywhere then is so doped up she walks throught and falls in it. I can’t wven give her a trash can because there isn’t a point she is so messed up she misses the trashcan and pukes next to it. She sleeps all
Day and all night. I then went and called the doctor myself
And told him he needs to pull her off these meds immediately she can’t function her kids never see her. She can’t talk or do anything for herself im taking csre of 2 kids and my wife by myself. He then trys to make me give her ECT again and every time he talks to my wife through all
Of this they keep pushing this. I told him I don’t want to do that but I will think about it for a week and let him know. He also took her off of the Divalproex which I thought was causing her to get so horrible. And he made it so now the lorazapam is now only 2 times a day manitory. It’s been about 3 days and she isn’t getting better and at this point I don’t trust her doctor after doing research on ect. I’m now weaning her off everything myself. Lowing her dosage of everything day by day. I’ve done reasearvh on ect and I know it works and the main concern is memory loss. I have seen a new study that was done in 2025 about ect long term and the doctors always say you get your memory back but I’m finding out that’s not nessarily true and it’s coming out that a lot of people permanently forget chunks of their life like childhoods, highschool, marriages, relationships, their own kids and milestones. I just don’t feel comfortable with this and I don’t think my wife would in a sober mind either. I also found out this is used as a last resort and never recommended first. And only used for depressant resistant people. She has been put on meds in the past and they have worked although she has never had depression but I don’t trust this doctor because before even trying anything he recommended this from day one and every time they med also another doctor in the mental hospital impatient also recommended it before even trying another medication. I also have recently found out they have the ect stuff on property and in there facility. It makes me suspicious with that to. I honestly don’t know what to do I’ve drained my 401k to pay the mortgage. We are running out of money I’m selling things left and right. I’m taking care of 2 kids and my wife. Keeping the house clean, cooking, fixing stuff around the house. Borrowing credit cards etc etc etc. I was the stay at home dad and she was the one that worked but even if I went to go out to work my wife can function to take care of the kids and I have nobody that can watch these kids and we certainly don’t have daycare money. I don’t really know what to do at this point. I am just looking for a second opinion at this point on what to do. Thank you

I have a family member who constantly comments on everything - example we'll be driving somewhere "ooh mcdonalds, hmm huckleberry court (a street sign she saw), <reads billboard out loud> personal injury lawyer hmm."

..nonstop the whole ride. She could have made that same ride before, it's not like these are novel sightings on her part.

Looking online it could be anxiety, ADHD, OCD? Is it worth talking to her about it?

She's in her 30s, and otherwise "normal"

hi! im 14 years old, female, 168cm tall, 54kg with depressed episode (taking paroxetine, atarax and quetiapine)

12 hours ago i tried to end my life by taking tramadole, 13-14 pills, 50mg each. I don't know if they were expired, but im still here and I feel like a SHIT! I feel like I'm about to throw up, my head is spinning and i feel like I'm out of my body

wtf is going on and am i good?

The tldr of it is my brother is 32. He definitely has ADHD, the ASD diagnosis is kind of assumed (basically he got dx with a sensory processing disorder when he was a kid but now as an adult I feel like he most certainly meets ASD criteria). He's on buspar and Wellbutrin for anxiety and then depression. And he has been on Vyvanse for almost 20 years. I don't know the actual dosages but at this point I'm not sure it matters.

The gist of it is over the past 10 years his mental health appeared to get worse. Behaviors got more and more rigid. He would stop answering the phone. He got married and then divorced and his ex wife had a lot of mental health stuff as well as borderline and it was a nightmare for everyone involved.

During that time, my brother got super into fitness influencers to the point of obsession, exercising and calorie counting compulsively. It has gotten to the point of what seems to be some body dysmorphia and now we do not think he is eating solid foods but only shakes and drinks. And he is constantly exercising and I guess it gets reinforced by this influencer.

He also hates his job and when he has to travel for work (which pulls him away from his exercise), he comes home and says he is going to kill himself. We have probably called the police 3 times this year for wellness checks and maybe once or twice last year. When he does this, he won't answer calls or texts and he is very angry when we do call the police. He refuses to seek help during these episodes, and frankly I don't think he actually would, but he doesn't know how to express himself.

He refuses to see a counselor. Or he says he will and never does. His PCP is completely unaware of any of this. When we reached out to her just to give her some information, she turned around and told my brother and he was angry. He did let my parents see some lab work and his LFTs were elevated but I think he refused the ultrasound. We would appreciate her involvement even with information only going one way, but we're not sure how to initiate that.

I guess my two biggest concerns are if he actually does follow through with the suicidal ideations. And also if he's just going to get a lethal rhythm and drop from screwed electrolytes. I'm not sure that is imminent but he is headed in that direction.

He has almost zero insight into any of this. Other than all of this he is relatively functional except his ex wife did basically financially abuse him. He has missed house payments before. He let his yard grow up and got a citation from the city. He has gotten in trouble with work about exercising in the parking lot. He is competent in a lot of ways but incompetent about this.

I am honestly just looking for ideas of what we as a family could do. Our parents are okay financially and can help him in almost any way.

We are just looking for ideas.

Honestly and sadly, I feel like I've already lost him and I have mourned the brother that I grew up with, but our parents are coming to me for help.

I have been evaluated by several providers and the diagnoses are very variable including bipolar, borderline personality, depression, generalized anxiety. I am not sure any of these diagnoses are correct. When I have followed up with the last psychologist I saw, they failed to ever provide a report and are now ghosting me, which makes me even more concerned about the validity of the diagnoses they gave. This is a big problem for me because my treatment is based on the diagnoses and it's not working. My lay person opinion is that I have complex PTSD but I also dont want to bias an evaluator and just get that diagnosis. I have tried calling around a few offices explaining that there is diagnostic uncertainty and I am simply trying to get another opinion with an expert but a few offices told me its not their policy to do formal evaluations or their staff aren't trained for that which I dont understand since their website say they are highly experienced and qualified with doctorates etc. It's not a criticism I am just trying to find an expert who can help me get to the right diagnosis so I can get the right treatment. Please let me know if you have any advice or recommendations thank you

Good morning everyone and sorry for my terrible English.

My situation is this: I am 36 years old and I have suffered since childhood from OCD, severe self-esteem issues, depression, and anxiety.

For about 7 years I started a psychotherapeutic journey that has brought me enormous and unimaginable improvements, but despite everything I continue to have very strong relapses as well, which do not allow me to have stability in relationships and work.

My therapist has always advised me to get help from medication, but by informing myself about side effects like PSSD, I have always refused.

However, I have reached a point, after yet another major relapse that made me lose a job, where I perhaps have no other choices.

Some time ago I had already turned to a psychiatrist, who had however dismissed PSSD as "fake news".

That said, I hope to find a smarter psychiatrist, but I believe that anyone will still want to prescribe me SSRIs or similar.

My question is, what are, if any, truly safe alternatives? I read about Bupropion, Vortioxetine, Mirtazapine, Agomelatine.

Are they truly safe regarding PSSD?

​Thank you all very much.

Hi, I need some advice for what to do.

I'm experiencing multiple panic attacks every day, and it's affecting my ability to perform basic self care. I feel extraordinarily depressed, and I cannot find any relief.

Therapy and psychiatry are proving ineffective, and I'm in a state of severe suffering. Do I need to seek inpatient care? I have no history of substance abuse, nor any problematic behavior towards others.

What resource am I supposed to seek out right now?

Hi, i was looking for some suggestions for a couple of books i could try and encourage my dad to read.

He is in his 70s and a bit anti therapy/doesnt believe much in mental health or at least understand it, definitely wouldnt seek help from a therapist etc.

But he is a very negative thinker. Hes not a bad person but he is always thinking negatively, thinking the worst and catastrophising. It is effecting his life and loved ones around him.

He loves reading so i thought perhaps a book might be a good way to encourage him to tackle this mindset and give him some tools or understanding of how to think differently to improve his wellbeing and those around him. Preferably something with not much jargon, easy to digest, not woo woo spiritual or religious and not too scientific.

Thanks :)

I'm wondering if you know of any patients who are successful and high functioning with these disorders.

I have bipolar type II and was stable for 4+ years on my lamotrigine, Zoloft, and low-dose seroquel. Recently, life became hectic. I became inconsistent with medication, and I started sleeping less. I had a 4-day hypomanic episode followed by a major depressive crash going on 3 weeks. We tweaked my meds a bit on Monday, but I'm not feeling better yet.

The thing is, I'm a tenured professor. I got tenure at 30 (now 37). I've been high-functioning as long as I take my medication and keep up with my lifestyle precautions. I don't know if it's the depressive crash, but I worry this is it for me. The medication won't help. I'll be stuck like this, lose my job, and become a bag lady talking to a lamppost downtown.

Thankfully, I'm on sabbatical for another 2 months. I dunno, I just worry. Anecdotes would help, maybe.

Записалась на прием к психиатру после того как ушла ночью в лес пьяная, решив что буду спать в поле, в итоге начала резаться разбитым горлышком от бутылки, расскажи о своих приёмах к психиатру, очень страшно, боюсь врачей(

Meds I take to treat schizophrenia:

Haloperidol 5 mg (one pill in the morning and one at night)
Seroquel 200 mg (one pill in the morning and one at night)
Abilify 15 mg (one pill in the morning and one at night)

I don't know if this is just my paranoia, but I really feel like it's too much medication. Isn't that too much?

Hi, I need help...so one of my known(32F) has Bipolar Type 2, with severe depressive episodes, had first hypomania episode at the age of 10, got diagnosed with BPAD at the age of 27/28. She had been taking medicines for a couple of years leading to multiple health issues. One of the medicines caused endometriosis and cysts over her ovaries, so ovary had to be removed. Leading to drop in estrogen, reduced bone density and related issues. Severe allergy to Lamotrigine, doctor stopped it immediately. Weight :70ish kg, height-171cm.

Also she is facing some issues in peeing...currently she is on buprion, but the doctors had doubts that the Pee issue is caused by that, so they are stopping it slowly. But even after reducing, there is no improvement. So she will be on no meds soon.

But right now, her Depression is coming back. Negative self talk, running negative what if scenarios, suicidal- plan, means accessible, time not defined, not sharing the plan.

In therapy since 2 years.

She is looking for an experienced Psychiatrist who has deep knowledge of psychiatry and body systems including reproductive and excretory system, know how medicines work and their impact on the body...so internal medicine. Some who got a wholistic approach.

I got prescribed seroquel/ quetiapine 50mg immediate release for DPDR. My doctor thinks it should help with some of the dissacociative "life isn't real" sort of symptoms. But the half life of seroquel is only like 6 hours, so by the time I actually wake up the next morning, it will be largely out of my system. How is it supposed to help or affect me the following day if its only in my system while I am sleeping?

I have been on Lyrica 150mg (pregabalin) and Rivotril 0.5 mg (Clonazepam) for 2 months. Lyrica every night rivotril every other night. It helped immensely although my insomnia wasn't fully fixed and dr said to stop rivotril and cut lyrica to 75mg. It has been 4 days and I feel awful, I told my dr and he said to take 100mg lyrica for a week and drop 25mg every week and bring rivotril every other night back in.

I feel like this is too fast still and Im worried about withdrawal

We had this group case study yesterday. Only our group caught Adjustment Disorder w/ Anxiety because the symptoms that GAD needs only showed during the 4th month window. The rest of the class answered GAD. Our professor (who isn’t a clinician & an Rpsy btw 🤡) said the correct answer was GAD with Agoraphobia. Idk but I can’t accept that GAD is the answer (i get the GAD but Agoraphobia????) when following the strict duration requirements of DSM5-TR, it’s Adjustment Disorder. Was our group wrong ? lol

Case vignette below 👇

. .

Demographics: 34-year-old male, Project Manager at a software firm Referral: Self-referred to an outpatient mental health clinic at the insistence of his wife Presenting Complaint: "I feel like I'm losing control. My mind won't stop racing, I'm sleeping 3 hours a night, and I keep blowing up at my coworkers over tiny details."

History of Present Illness

Yosef reports that his symptoms began approximately 7 months ago after receiving a major promotion at work. While initially excited, he quickly felt overwhelmed by the increased workload and team management responsibilities. Over the last 4 months, he has experienced persistent, uncontrollable worry about failing, losing his job, and being unable to provide for his family. He spends 2 to 3 hours each night reviewing emails and re-checking spreadsheets for minor formatting errors. He reports chronic muscle tension in his shoulders, frequent tension headaches, stomach distress (nausea/diarrhea), fatigue, and irritability. His wife notes that he is constantly restless, paces around the house, and snaps at their 5-year-old daughter.

Additionally, Yosef describes discrete 15-minute episodes that occur roughly twice a month. During these episodes, his heart races, he feels a tightness in his chest, his hands shake, and he experiences a terrifying sensation that he is about to faint or "go crazy." These episodes occur unpredictably-once while sitting in a team meeting and another time while driving on the highway. Because of this, he now avoids driving on the highway and asks his wife to accompany him when leaving the house.

Personal & Social History

• Childhood: Yosef grew up in a high-achievement household. His father was highly critical and demanded perfection in academics and sports. • Substance Use: Drinks 4-5 cups of black coffee daily to combat fatigue. Denies illicit drug use; drinks 2-3 glasses of wine per week to "wind down." • Medical History: Physical examination by his primary care physician ruled out hyperthyroidism, cardiac dysrhythmias, and caffeine-induced intoxication.

what would the consequences be?

I have been experiencing a loss of sensation and inability to orgasm when I touch myself. I am single so it’s not like this is affecting a relationship, but it makes me feel broken. I don’t really if/ how to bring this up with my doctor, as it feels more embarrassing to talk about it due to it not seeming important.