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Psychiatry & Psychology--General/Treatment and medication advice please.


(this question contains information about my childhood trauma..please be mindful this post may disturb some, but their is nothing offensive.)

Dear Dr Harrop,

Thank you in advance for your time.
I have trouble typing at the moment because one of my symptoms is muscle contractions and if I'm typing it locks my fingers up. Please excuse typos and grammar due to this. I am educated and have a degree from a San-Francisco University (Jesuit), hence my reason for reaching out to you particular.

I have a lot of questions and I realize you might need a little time to answer, so my review will consider that.

I have been running my entire life from the abuse I suffered as a child. I've had ongoing issues with hyper vigilance, irritability, mood swings, lack of emotional control, confused thinking, plans to hurt my self and others.
For example..I repeatedly think of perpetuating the same crimes that were committed to me to those that currently make me suffer in my life.
The intrusive thoughts and fantasies of inflicting pain on myself to punish myself for being so disgusting..because that is the sick blackness I feel inside me from the abuse.
The thoughts of hurting others is despicable and foreign to my normal thoughts..but I can't prevent them often despite utilizing techniques to bring me back to the present..I am undergoing group therapy for male survivors of child abuse. This is extremely helpful to realize a lot of these feeling are due to the crimes that happened to me and are not in themselves unique to me...however that cognitive realization is a comfort I desperately cling to as I try and push my thoughts from suicide and making it so my existence is annulled.
I don't want to die...but the flashbacks of the abuse literally drop me to the floor in their severity. Any stress I endure at all increases the likiness of these flashbacks.
Dr Harrop...when I have the flashbacks it is and can be at worst fully imercive to the point ath I can see and describe the materials in the rooma dn smells..when I remember that time I also remember the detachment adn the feeling of being like a limp piece of meat like a dead weight of latex rubber is how I feel because I have zero sensation..and experience the horros again of my childhood but as myself as that child.
In effect...stress..aneixtyies and such increase the triggers.

I have had random phantom sensations of them touching me and being inside me....this can be disturbing. The weight of food in my stomach increase the trigers as does eating inthe morning.

My sleep is usually alwasy distrubed.
I've woken up from dream in terror..grinding my teeth to the point of breaking one...driving a crown into my jaw bone...cracking another crown because of this night tension..I've woken up with my own teeth particles in my mouth throughout my life.
It is infrequent I remember dreams. The last week was very stressful due to disability payments are not enough income for me and I've faced eviction the last 2 mths. I literally have no money to the point of no food, no cat food ( I gave her less than half of her daily food this morning and don't know what I can do to give her GF is a PT worker and FT student and is also broke), no coming months rent, and the money I've saved has been spent on co-pays (psychiatrist is a $200 co-pay, but she saw me when I was in a crisis and took my appointment within three days of contacting her by my therapist..and I just want to be better so paid). This extra stress has increased the severity of all my symptons as I face the prospect of being homeless, out of work, out of treatment, of my meds and with no means of support..because I can't work at the moment.
I'm scared because I've eaten very little and have lost weight noticeably in the last week..on Thursday night. My dreams where the worst ever...I vomited in my sleep all over myself..but lack of food meant just bed was soaked through the foam memory top through to the mattress..vomiting didn't awake was when the fluid had become cold. This has happened once before to me. My gag reflex is highly sensitive in the mornings because of the dreams..I didn't eat the following day even though I am starving and don't like seeing my reflection because of how gaunt I'm looking. I couldn't eat the following day at all. I slept in the kitchen that night incase I vomited it would be on the floor...before going to sleep I hid and put away all knives, sharp object and things I might grab in my sleep. In the morning when I woke in a scared still motionless terror I soiled myself.I couldn't help it i couldn't move or do anything...I then stayed in the same rubber feeling position waiting till I cold move and clean myself.  

I've barley left my home in the last mth because of increased stress has meant I know I'm unafe to go into public.
I will challenge violently anyone who tries to exert power over me as happened as child...but this translates to people standing to close to me in the supermarket..or tailgating me...I will follow them home..try and force them off the road and have taken my seat belt off whilst been driven and opened the passenger door so I could hang out and scream death threats at the car tailgating..I don't know how I kept myself from leaping out of teh moving car towards the car behind me. that was on the way home from therapy which sometimes can leave me raw and overly sensitive)
My therapist has had extreme concerns about admitting me for an assessment.
Is their specific language I can use that will allow me to be open and honest but without fear of imprisonment?
I have always needed to sleep somewhere I could secure...otherwise I sleep on watch and will wake up and process any noises..changes in light etc (including dawn)...
The idea of being in an enclosed facility brings me to a point of terror that I have stated clearly to my therapist that I have the immediate means to barricade my home from intrusion within 10 mins. ( I have a hammer, nails, a large 2x4 by 7ft by 4ft rectangular frame close my the weakest point of entry to my home. I also have weapons distributed around my home in case I'm attacked and have to fall back or move to another room. This is all in relation to the fear of my bedroom door being opened as a boy and knowing what happens next...the unreality of the situation,no-one is coming to rape me..doesn't change that I have a lifetime of drills and practicing methods to harm someone if I wake up and they are stood over me)
I cannot be in an institution where I'm terrified I will be subjected to abuse...
When my therapist refereed me to a psychiatrist even though she is older and female I still had intrusive uncomfortable thoughts that she might take me and recognize that I can be abused.
This is one of my fears of being outside Dr that an evil person will look at me and just know....then they will abuse me.
Virtually all my relationships are marred by this.

I went on disability from work about 4 mths ago because these issues all intensified and made my job impossible because of thh social interactions and stresses involved.

It is extremely difficult for me to talk about these things and although my therapist is great is their a legal requirement for me to tell them the specifics of what, who, and where?
I'm only able to let out snippets of information out at a time because of this issue.
What pressure should I feel by my employer and the insurance company to get back to work?
and because of the troubles I have would an advocate be worthwhile?
What speed should I move through this recovery process with my therapist?
I want to get back to work ASAP, because that would mean I'm well again and I've a duty to my employer and much should that be weighed for me compared to the intensity of my therapies?
How hard should I push myself to get better?

If I tell my therapist of my plans to harm myself and others they become very alarmed because of the severity...and that makes me worry I will get institutionalized. How do I be open with my therapist Therapist in regards to this?

My meds are two kinds of Seroquel,one slow acting for sleep, one fast acting for as needed. I also have Zolaf and Trazdone for the anxiety.
Are their other medication you would recommend and do these seem suitable?
(Is there a drug that can help with this, because I can't imagine any drug would make a flashback be any less disturbing unless the drugs had totally numbed me emotionally and was sitting heavily in my system waiting for a trigger to occur so it could be effective, but then would make me a zombie)

Given the above information. I obviosly don't lead any degree of a normal life.
I do not "live".. If a neighbor might see me standing at my window looking outside, because I do this very often, I step back still feeling that sense of shame and knowing I'm a pale gaunt ghost like figure now.
...I Do Not socialize.
If my girlfriend has friends over, I will lock myself in another room and not come out. Of course I'm unable to do the higher order things like going in bars.

I have a very loving and incredibly supportive Girlfriend,who only on the advice of my therapist I haven't broken up with..because it is painful for another person to be close to me and see the damaged and broken thing I am. I understand this sense of deep loathing is common for survivors, but cognizance doesn't change it. On multiple occasions I've nearly struck her because she either woke me up at night, startled me etc...these all have made me cry because I do not want to hurt her. But, I can't control myself in sleep...(girlfriends in the past have been scared to sleep in my bed because of my thrashing and intense night sweats.)
What advice in the home can you give for emotional regulation?
(I do pray for help and ask God for help continually, although I haven't been able to attend Church for at least 6 mths..)
Is their another drug that can lighten me? Put me in an drug induced state of happyness or at least relaxed comfort. I have access to illegal drugs that haven't been proscribd to me...I've considered Percozet', but I want to function and have my life back not be doped up.

Would you recommend an advocate in dealing with insurance companies? I often feel a pressure to get back into work as quickly as possible due to the monthly .."submission of medical records/evidence for my claim"
I lack clarity in thought in virtually every situation that brings me into contact with other people, and I don't feel I really understand the whole process I'm involved in.

Again, thank you Dr Harrop for taking the time to read this all. It is hugely appreciated. In an effort to keep stable, my palms have poured with the sweat over the last 4 hrs it has taken to write this, I hope you understand proof-reading itself I'd rather avoid. Also, thank you for picking through where I'm not the clearest in my questions.

The biggest problem I see here is you no opening up about all your problems with your treating providers.  Yes, an advocate will help, and yes, there are several medication adjustment that might work, but really no medications will work until you are working in psychotherapy.

So my suggestion here is that you print out the question you sent me and hand it to your current therapist and psychiatrist for discussion at your next appointments.  

Psychiatry & Psychology--General

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Daniel S. Harrop, M.D.


Dr. Daniel S. Harrop received his B.A. and his M.D., both from Brown, and his M.B.A. from the Edinburgh Business School, Scotland. Board-certified in adult and geriatric psychiatry, he is a past president of the R.I. Psychiatric Society and a member of the Committee on Medical Quality of the American Psychiatric Association and the Committee on Continuing Medical Education of the R.I Medical Society. He serves as a consultant to four of the top five major medical management companies, including OptumHealth/United Healthcare, Magellan Behavioral Health Services, ValueOptions and APS Healthcare, and maintains a private practice in Providence, R.I. He also serves as chief psychiatric consultant on the Medical Advisory Board at the R.I. Workers Compensation Court. He was formerly on the faculty at the medical schools at both Brown University and Harvard University.

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