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Summary
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A young man describes evening mood changes and frightening intrusive thoughts about harming himself or others that conflict with his values. He fears psychosis and wants to understand what is happening.
The response stresses that an online explanation is speculative and recommends psychiatric assessment to consider mood, obsessive, and other possible causes.
It distinguishes distressing thoughts from an obligation to act on them and notes that feeling frightened by a thought does not by itself establish psychosis, while still taking the symptoms seriously.
Question
Reader · Identity withheldHi, I’m a 23-year-old male and for years I’ve felt what I can only describe as a “creepy dark cloud” hanging over me. This usually happens in the late evening before bed. During these times, I just don’t feel “right.” I can still function normally, almost like I’m just in a bad mood, but the feeling is heavy and foreboding. By morning it’s gone and I feel normal again.
\nA few months ago after a particularly rough day I experienced something more intense. It felt like I was briefly losing touch with reality, like I was slipping out of control. I had a strong urge to talk to someone right away, just to feel grounded again. That moment really scared me.
\nSince then I’ve been struggling with intrusive thoughts, really disturbing ones. Sometimes my mind flashes to horrific ideas like hurting someone I love, a friend, or even myself. These thoughts terrify me and make me feel deeply ashamed - like a monster. I try to push them away or redirect my attention but that doesn’t always work.
\nI’ve never heard voices or seen things that aren’t there and I haven’t had any violent dreams. These thoughts seem to come from within my own mind and they feel like the complete opposite of who I want to be. I don’t think I’m capable of actually hurting anyone but the fact that I even have these thoughts really disturbs me. I hesitate to call them compulsions but there might be a compulsive element to them.
\nLately I’ve started feeling more like myself again. For no clear reason, I’ve had more normal days and fewer of these dark thoughts but I’m still scared. I worry that I’m slipping into something like psychosis.
\nI would really appreciate any thoughts or educated guesses about what might be going on with me. I just want to understand what this is.
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Answer
Mark Vigil Dombeck, Ph.D.This could be a lot of things. If you want to know what it is definitively (more or less) then please make an appointment with a psychiatrist to talk about what is happening. All I can do is speculate, and that is not a substitute for the attention of a physician who is able to interview you and make a diagnosis.
\nYou say that you’ve experienced a mood swing towards the depressive direction in the evenings for many years. You further suggest that you’ve had a temporary exacerbation of mood disturbance characterized by what I guess is experienced as anger and homicidal thoughts, though this is not typical for you to think this way.
\nImportantly, these seem to be your own thoughts, and are not experienced as though someone else is talking to you. That suggests that this is not probably a full-on psychotic phenomenon. The whole thing is what is sometimes called \"ego dystonic\", meaning that you are thinking in a way that clashes with your normal self-concept and it feels deeply wrong.
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These things could be pointing to your experiencing a relatively simple depressive episode, although only a doctor can rule out other important possibilities, including the more remote possibility of a neurological (brain) problem, or the beginning of something like a psychotic disorder (so go see a psychiatrist medical doctor, please).
\nDepressive episodes can take on different forms, and though most are about feeling very sad and low energy, some are more about feeling irritable and quick to anger. Suicidal thinking is common in such episodes, but homicidal thinking can occur too. Depressed people can become psychotic in their own right, but you seem to be falling short of that, at least so far.
\nMy guess is that you have used the term psychotic because of the \"Jekyll and Hyde\" ego dystonic quality to your thought process while in the episode. But just because you feel like you are going psychotic, doesn’t mean you are psychotic. Psychotic is what happens when you can no longer distinguish your own thoughts from someone else’s thoughts.
\nNot that it is particularly normal to walk around wanting to kill people, but the thought does occur to a lot of people with some frequency. It’s not a weird thought, is what I’m saying. A weird thought is something like when people believe that the television is talking to them personally, giving them orders on how they personally are to behave (what is called a \"delusion or idea of reference\"). But people who aren’t comfortable with the more aggressive sides of their own nature can be frightened by such thoughts when they pop up.
\nIn a similar vein, many people will experience attractions to the same sex at some point in their lives, but just because this is experienced a couple times doesn’t mean that those people are homosexual in sexual orientation. Homosexuality is what is happening when someone is attracted in that manner consistently. Just keep in mind that just because you think of something that doesn’t mean that you have to act on it.
\nYou use the word obsession in your letter, and that may be an issue for you. A true obsession is a thought that comes into your head that you can’t let go of. Sometimes such thoughts take on such force and repetition that people feel compelled to act them out, which then becomes a compulsion. You are maybe reporting an instance of obsessive thinking (in the Obsessive-Compulsive anxiety disorder sort of spectrum manner), but if that is so, it is occurring in the context of your mood episode and not as a normal part of your experience.
\nDepression is often characterized by a somewhat obsessive thought process, what is often called rumination, so this isn’t such a shock either. the only non-standard part here is that normally, rumination in depression is about the failings of the self, rather than the desire to harm others.
\nI do think this is something you should get checked out, so once again I will suggest that you make an appointment with a psychiatrist for evaluation and possibly for treatment. but I also don’t think you need to panic, particularly in regard to the ego dystonic part of this story. You don’t have to act on such troubling thoughts; keep that in mind. And sometimes, people who do keep that in mind can find themselves moving from a position of fear and guilt, to a position of acceptance but not endorsement, which helps them to feel less panicked about the whole thing; half the battle right there.
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