Question:
Hi Dr. Dombeck. I recently realized that I have some of the symptoms of schizoid personality disorder. However, while I was investigating this and other disorders online, I remembered about a problem I used to have often as a child and that reoccurs even now, although quite rarely. What used to happen is basically this. All of a sudden I would begin to feel differently, as if there was someone else present either “in me” or “around me”, but who I always knew was not actually there. This presence felt very “oppressive” and I felt as though there was a voice talking. For some reason, when I was a child, this voice reminded me of my mother’s voice. I didn’t so much hear it speaking, as I “felt” it speaking. I cannot even quote what it said, but my reaction to it was like a reaction to someone “issuing commands” or “instigating” me, the kind of reaction one would feel to someone yelling “Come on!! Well??!! Do it!! Come on!!”. The strangest thing about it was the feeling I had during these episodes, almost as if a part of my mind was racing a million miles a minute. In other words, I consciously could think just as clearly, calmly, and rationally as before, but there was also like another presence, or “another me” thinking and reacting very quickly to the voice issuing commands, almost like a “panicked babble.” I haven’t had this kind of episode for months, so I cannot quite recall the exact relationship between my racing mind and the voice issuing commands. You have to forgive me, but I find it all very hard to explain. I’m pretty sure it used to happen often to me as a child, and I clearly remember associating my mother’s voice with the voice that I “felt” was talking to me. I am 22 years old now and have a great relationship with both my mother and father. My parents weren’t really abusive to me when I was a child, except for the occasional yell or slap or what not. I don’t harbor any ill feelings towards my parents today. I would say that these episodes started becoming rarer (maybe once every few months) when I reached the age of 10 or 11, but in all honesty, I cannot be 100% sure on how often they occurred before that since my memory is vague now. For all I know they never occurred more often than every few months even when I was little, but for some reason I feel that they did indeed occur more often. It’s important to note that these episodes never lasted for more than a minute or so, at least those that I can remember, so I never really made much of them. But now remembering about them, I just want to be sure that they are not a prelude to something more intensely delusional. Are these symptoms familiar to you? Do you feel that maybe they can indeed be evidential of a problem that may develop later? For all I know most people may have these kinds of experiences every now and then, so I want to be sure. In case you are wondering, I don’t see any connection at all between these episodes and my schizoid personality, for these rare attacks were never the reason for my preferred withdrawal from society. Plus, my preference to being alone does not interfere with my necessary social interaction, as I attend college, I’m a good student, and I interact normally with my friends at school. I just prefer to be alone and not place myself into social situations. I’m just informing you of these factors in case they are relevant to my delusional episodes, which is what I really need advice on. Thank you very much.
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Answer:
A couple thoughts on your letter:
I have no real idea what your experience is all about or what it means. Only a Psychiatrist or Psychologist, or possibly even a Neurologist whom you see as a patient is going to have a chance at figuring out what this experience of yours really is, and what it means for your health. Your symptoms may mean something, and they may mean nothing much at all. There are people in the world who have experiences like you are describing and nothing much more happens to them. Also, there are people who go on to get more serious disorders. Me personally, I would want to know what might be going down and would want to get myself diagnosed by a Psychiatrist.
The experience you describe is relatively uncommon and not one that most people experience.
My first statement about your probably needing to see a doctor to get answers notwithstanding, your experience is probably not a delusion, as it doesn’t (by your description) seem to involve your unquestioning acceptance of a false belief. There are a number of possibilities which might, either singly or in combination, explain your experience, among them dissociation, anxiety, some sort of neurological activity (a seizure problem?) or a transient ‘psychotic’ process. I’m assuming that you are clean and sober and that this experience is not related to drug or alcohol use.
Your experience does seem similar to the way that persons with schizophrenia and related psychotic disorders describe their auditory hallucinations. Often, they hear one or more voices who either command them to do things, or provide a running commentary about their behaviors. Where a person with voices differs from what you are describing is that they lose the ability to discriminate that the voices are coming from themselves (are a part of their own thought process) and not coming from somewhere external to the person.
Schizophrenia and related disorders are thought to occur in a spectrum with more extensive and disabling forms and milder forms. Schizoid and Schizotypal personality disorders are considered part of the mild spectrum of schizophreniform disorders. There are suggestions in the literature that persons with Schizoid and Schizophreniform disorders are more vulnerable to crossing over to full blown schizophrenia than the average person on the street. The onset of Schizophrenia usually occurs in early adulthood, but can occur at most any point in the lifespan really. For these reasons, it may be a good idea to see a psychiatrist for a diagnosis. I believe that some psychiatrists under some scenarios offer prophylactic (preventative) anti-psychotic medication to persons they believe are at risk for crossing into full blown psychosis. If a psychiatrist determines that you may be at a higher risk, you might ask about this sort of preventative medication.
As I pointed about above, there are a number of things that could cause a person to hear ‘almost voices’ in his or her head, Schizophreniform Diagnoses being only one. You’ll just have to see a doctor for better information. I hope that this information is helpful to you.
