Autism/Nvld, Pdd-Nos, issues with anger and major depression
QUESTION: I spoke to you several years ago about how i should tackle my difficulties with major depression, and nvld, pdd-nos. i have had a few questions since that time about it. I will give you some background about me to refresh your memory. I am an adult that was diagnosed with NVLD, PDD-NOS and Major Depression 4 years ago at the age of 42. You at the time where confused about the diagnosis because you didn't understand why i was diagnosed with both pdd-nos and nvld and not just one. I went over the results of the testing and while and the man whom tested me was definitely sure i had nvld he wasn't sure about Asperger. He did seem some characteristics of Aspergers so he added the pdd-nos diagnosis to the mix in addition to major depression. Fast forward four years later and i still not sure how to approach these diagnosis. I have done lots on research online educating myself about my diagnosis i still don't know how to tackle them. I am going to see a neuropsychologist whom specializes in nvld, aspergers, pdd-nos etc next week for some family counseling since I happen to live with my mon and a psychiatrist for medication management. I also have problems with anger in addition to major depression. i think i am approaching this right way by seeing specialists but based upon past experiences with medications and psychotherapy i am not at all confident that either of these interventions will be helpful I didn't expect at age 46 i would be unemployed,not have a career, not have a girlfriend let alone be married, having a problemn being touched, live with my mother, be dependent on her for financial support because i blew all my inheritance because i had trouble managing my money wisely, gone to six different colleges and not graduating, be obsessed for the past 27 years with figuring out why dropped out my first college because in my mind i was happy and makes no sense to me then why i didn't want to go back, being depressed because i have trouble functioning with nvld and pdd-nos. and finally feeling horrible about myself because i believed i dropped of my first college when i want to. I understand what the psychiatrist is going to do. He is going to prescribe medication for my problems with anger and depression. What is the neuropsychologist going to do for my issues with anger, major depresion, nvld and pdd-nos?
ANSWER: Hello Peter,
Yes, I do remember you.
I've read over what you've written several times now. The first thing that comes to my mind is that you are not your diagnoses. A diagnosis or label may describe some of your characteristics or provide some explanation on your strengths and challenges, but does not define you. We are all complex individuals and even if you meet a dozen other people with your exact same diagnoses, they will not be just like you.
It's good to learn about these diagnoses - the common characteristics and more importantly, the sorts of strategies that work for other people. But just knowing about these diagnoses might not give you a prescription for how to tackle your own circumstances.
I wonder if a different approach might be more helpful. Rather than focusing on the diagnoses, what about focusing on what you want? Not the whole enchilada, of course, but pick something, one small goal you want to work towards. What is it that bothers you most? Is it not finishing college? If so, try to figure out just what about that plagues you. Is it that you started something and did not finish it? Is it that you feel you had the ability to to tackle college, but somehow didn't manage? Is it that you have a thirst for knowledge?
Perhaps the greatest concern has to do with your living situation. While you may not be able to move out of your mother's house at this moment, are there things you can do while residing there that will make you feel that you have more autonomy or are playing a functioning role in the household?
Yes, I agree with you that the psychiatrist will likely prescribe medications. The anger you mention is not uncommon with depression. Some meds might help with both things but you might need a combination of prescriptions to help. The obsessing you mention is also bundled in with depression (and with PDD-NOS and other mental health conditions). Again, meds can help. Since you're obviously an intelligent gentleman and have spent the past 27 years obsessing on why you dropped out of college originally, is there good reason to continue dwelling on this? You dropped out, yes. You may not understand the reasoning that went on in your young man's brain. It bothers you, is it worth spending decades pondering this? I know, I know. Saying "move on" does not make it happen, but medications might assist you, especially if you explain the length and depth of your the obsessing you've been doing.
The neuropsychologist does not prescribe meds, although he/she might work with a psychiatrist on this. Neuropsychs study how the brain works, especially in the areas of learning, memory, language, processing, etc. Many psychologists are trained in cognitive behavior therapy, an approach that is often helpful for people on the autism spectrum as well as for people with depression. CBT is helpful in reframing thinking, something you may find beneficial.
While meds can alleviate some of the symptoms of depression and anger and obssessiveness, they will not make NVLD or PDD-NOS go away. If those are accurate diagnoses, they are part of you, part of how you see the world and how you respond to it. But neither of those diagnoses sentence you to a life of watching the world pass you by. The neuropsych may help you learn ways to capitalize on your strengths, using them to work around the areas that are more challenging for you. He may help you pick a goal, likely one small initial goal and make progress toward accomplishing that, then building on that success to move on to other areas that you want to improve.
Here are a couple books you might find helpful. They are written by adults with similar diagnoses to you:
Your Life is Not a Label by Jerry Newport (http://www.amazon.com/Your-Life-Label-Jerry-Newport/dp/1885477775
The Unwritten Rules of Social Relationships by Temple Grandin and Sean Barron (http://www.amazon.com/The-Unwritten-Rules-Social-Relationships/dp/193256506X
Somebody, Somewhere by Donna Williams (http://www.amazon.com/Somebody-Somewhere-Breaking-World-Autism/dp/0812925246
Pretending to Be Normal by Liane Holliday Willey (http://www.amazon.com/Pretending-Be-Normal-Aspergers-Syndrome/dp/1853027499
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QUESTION: I don't want to take up a lot of your time but i can specifically tell you what is bothering me. It is the fact that 27 years ago i was unable to go back to my original college due to high anxiety after completing my freshman year when i desperately wanted to but not just having this happen once, every time i had the opportunity to go back my original college after that. The result of which i would end up in other colleges and universities not because i wanted to be there but because due to high anxiety i wasn't able to go to my original college. I didn't stick around at any the other colleges and get my degree because it wasn't my original college and i was unable to go back to my original college when i wanted to because of high anxiety. A catch 22.
Have you ever heard the saying, "If you do what you've always done, you'll get what you've always got"? That's related to what I said yesterday about reframing your thinking through the help of the neuropsychologist and possibly CBT. For years, almost 3 decades now you have wanted to get your degree by replicating your initial college experience. Despite your efforts, it has not gotten you what you want.
The anxiety and obsessiveness could be decreased with the help of the right meds, but you would need to be patient. Each med might take two or three weeks to get into your system. Then, if you are not feeling the benefits you and your psychiatrist feel you should, the two of you may need to tinker with the dose or the time of day you take them, waiting several weeks to see if that helps. If not, you may need to switch to another medication, or a combo of meds. This takes time, lots of time and communication, but can be worth it.
Then, what do you want? If attaining a degree is the most important goal, why? It's not that I am anti-education, but why do you want that degree? Is it because you began but did not finish? Is a degree proof that you are smart? Is a degree a stepping stone toward a job you want?
Just because you had once said you wanted a degree and started down the path, must you continue? Perhaps it's okay to change your goal. With age, different things may become priorities. Maybe employment is more important now or some other ambition. Is there a chance that if you let the degree goal go, you could make progress in other areas? This would involve reframing your thinking, looking at things in a different way.
If you remain fixed of a degree, why must it be from that original college? Do you see that as the seat of failure and you must return to conquer that place? Again, is that logical? Is hanging on to that thought preventing you from making progress in other areas of your life? Reframing your thinking may help you look at alternatives. There are so many paths to get to where you would like to be and that place you'd like to be will alter over time. Proper meds can help reduce the obsessiveness that may keep you fixated on only one way.
There are many adults who manage satisfying lives without a degree. You seem frustrated by your living situation, which likely hinges on employment. What if you put aside the degree goal, at least for now? What if you made progress toward a job? What if you were able to earn enough money to live on your own? How would that make you feel? Might making progress in other areas help put the degree thoughts in perspective? Would it also give you confidence that might allow you to tackle even more challenges?
I think you are on the right track with your psychiatric and neuropsych appointments. Talk to them both about the anxiety and obsessing, what you want and what you have been doing for the last thirty years. Ask for help in forging a new path for yourself. It's alright to create a new dream for yourself, not necessarily the same one that your 20 year old self had in mind. Start with baby steps and bite off small chunks. You can get there but the route may look different. That's okay.