Ask a doctor on the topic of Neurology

Physical or psychological discomfort?

April 10, 2012 | 25,00 EUR | answered by Dr. med. Ralf Berg

Symptoms of the body:
My entire skin burns, especially the muscle attachments (arms, legs) hurt more intermittently.
I quickly get muscle soreness after exertion, which also lasts longer.
I feel weak (very tired in the evening), but this varies in intensity (better with Ritalin).
It temporarily improves with adrenaline release (high stress at work).
I have a hand tremor (like my father), which temporarily improves with alcohol.
Fructose intolerance was diagnosed positively through a breath test, gastroscopy and intestinal examination were inconclusive (no Candida or other issues).
I always have a white/yellowish thick sticky coating on my tongue, which increases quickly with sugary foods (floury taste, scrapable with a tongue scraper).

Symptoms of the mind:
I had a very controlling mother (I was the emotional contact person as my father was more focused on work than home). (I am currently in psychological treatment). I have been treated for depression several times: SSRIs showed little effect, it improved with Bupropion, and best (symptom-free) with Ritalin. I was prescribed Ritalin due to an ADHD diagnosis, but the treatment was discontinued by the doctor (without explanation). A subsequent diagnostic psychologist could not confirm ADHD through d2 and performance tests. I still have difficulties with concentration (word omissions/letter omissions, missing parts of sentences (since school)). The psychologist also noted that I tend to self-pity.
Sometimes I feel like I can't trust myself, as desires I had one day can turn into strong aversions the next. Or small things (e.g. cold floor) that were already known to me, which bothered me but I accepted, inflate into elephants of consciousness and then my thoughts begin to circle very strongly around the problem.
I can get very angry, sometimes feeling like anger is suffocating me.
Often I have uncertain feelings (emotional fog, struggling to articulate my desires or assert myself) (improves with alcohol or Ritalin).
There is often a deep-seated hatred within me that manifests through impatience and overreactions. Often I can only control my frustration through alcohol.

I am especially frustrated with myself, as I feel like I hit my limits very quickly. I have to ask myself too often why things are not working again.
I ask for help! I believe that a physical ailment is exacerbating or triggering a psychological one.
I ask for advice on which direction to continue searching. I am tired of fighting with myself.
In addition, there are family problems with my partner.

Dr. med. Ralf Berg

Dear Inquirer,

you are in significant difficulties that cannot be solved with online counseling, as you are well aware. Nevertheless, you deserve help and I am happy to offer advice for you.

1. Advice: If you haven't already, involve your partner, despite the current problems, whenever possible. You need someone you can confide in and talk to outside of counseling hours.
2. Before you do this, make it clear to yourself that you do not have to "fight" against your partner, no matter how individual conversations with her go. Try to keep your emotions in check, especially: do not be aggressive towards yourself.
3. Even though this advice is tough: the direction you need to look in is yourself. Your dissatisfaction, overwhelm, frustration are, in my opinion, the key to your accompanying somatic symptoms. The opposite is also true: mental ailments amplify physical symptoms. Even if you are tired of battling with yourself: who else should deal with your emotions? Please articulate this to your psychologist. I hope he can support you in this.
4. I can hardly make a suggestion for psychiatric medication from here, especially since you have already tried some things. But I would advise you to definitely seek treatment from a psychiatrist, who can also treat you with psychotropic drugs, in addition to your psychologist. As you have noticed, there are situations where you cannot fight against your negative feelings with willpower or concentration alone.
5. If you have the opportunity to take a break or at least get 2-3 weeks off, please consider admitting yourself to a psychosomatic clinic for inpatient treatment during this time.

I believe you are aware that with alcohol and Ritalin, your symptoms can only be temporarily improved, and your underlying problems: emotional instability, lack of concentration, racing thoughts, etc. cannot be permanently resolved.

I sense that you need allies who can fight alongside you now. Whether this is within the family, in your circle of friends, or in a specialized clinic, you should find out for yourself. I am sure that once you make a start, your physical problems will also improve.

I hope that my thoughts and advice have been helpful to you, and can assist you in deciding how to proceed from here.

With best wishes and many greetings,
Dr. R. C. Berg