Ask Dr Kim | Archived live chats

[Chris_B]

Good afternoon everyone, Dr Kim is here and we're ready to start.

Welcome Kim, our first question is below:

I am a 23 year old female with contamination-focused OCD. Do you have any advice about how I could deal with anxiety over my boyfriend's health? He is the only person I kiss and share drinks with, which means that if he does get sick, I will be likely to get infected. I really love and care about him, so the anxiety is not just about fear of contracting germs and illness, but also wanting him to be healthy and well.

[Chris_B]

Our next question is about depression scepticism:

do you believe that some people could take advantage of actually believing that they are depressed so they have got the attention they need or being psychosomatic and how can you recognise this

[Dr_Kim]

I think you may be referring to a psychological process called ‘secondary gain’, which is a real process, but one which we are hesitant to jump to as a first option to explain peoples behaviour.

Secondary gain is where somebody has a deep-seated and unconscious reason to behave in a certain way. An example might be that someone with an injury may subconsciously not get better as fast as they might, because they are on some level enjoying the attention and nurturing that they are receiving from people around them.

A lot of secondary gain is not conscious, but unconscious, just to be clear. Conscious secondary gain is called manipulation, and that is a completely different process, which might be what you’re referring to when you say ‘taking advantage of a situation’.

In my experience, most people with depression don’t have much to gain from being depressed. They are often losing work, education opportunities, losing friends, feeling the scorn of family, and losing the ability to participate in interesting and fun things in their lives.

If someone is behaving really poorly to get attention, my question would be, why have they had to resort to these behaviours in order to get attention from those around them.

[Chris_B]

Our next question is about suicidal thoughts:

What counts as a suicidal thought? I often think about dying and how easily/I have the means to do it but I know I would never do it the idea just pops up in my head which scares me a bit. Is this something to be overly concerned about? Thanks

[Dr_Kim]

A suicidal thought has to be taken in context. If the thought comes in the context of someone with a lot of depression, or a lot of trauma in their life, and if the thought is followed by planning or intent it’s a lot more serious than someone who is otherwise doing pretty well and has a random ‘pop-in’ thought.

When you say, “I often think about it”, I wonder how often that might be. I’ve had patients who have thought about it, but it’s not troubling to them and they just sometimes think about it like they would think about lots of other possibilities in their life.

For other people, these suicidal thoughts become very prominent and are there most of the time, very intense and extremely frightening. In this scenario, these thoughts are often understood as part of obsessive thinking syndrome where the flavour of the obsessional thinking has unfortunately settled on suicidal behaviours and thoughts. The treatment for that sort of obsessional thinking is the same as for other obsessional thoughts, but it doesn’t sound to me like this is what you are referring to.

In summary, the occasional suicidal thought or image without concurrent depression or trauma, and without it scaring you a lot, is something that I wouldn’t be overly concerned about. However, do seek help if they become more common, more intense or more scary.

[Chris_B]

Our next question is from someone having trouble with their breathing:

I feel like I often can't get enough air for hours at a time most days. It's not severe but I find myself breathing in again and again without exhaling so I can try to get enough - I am wondering if this could be connected to anxiety at all? Thank you!

[Dr_Kim]

I’m so glad that you posted this question, as I think this could definitely be associated with anxiety. Naturally, you should see your GP to ensure that you don’t have other medical conditions such as asthma that might be causing discomfort with your breathing.

However, if everything else checks out, that feeling of not getting enough breath is a very common symptom of anxiety. It may be explained by the sorts of hormones that are pumped out unbeknown to you when we are in a state of alert, that increase our breathing rate, as if we are in danger and running from a predator. So it’s a strange feeling of needing more air, like we are running, but we are sitting in a chair.

The treatments are based around giving your body the signals that you are not in danger by slowing your breathing down, through breathing exercises (breathing in to the count of 3, holding for 3, then out for 3), and progressive muscle relaxation exercises.

You may be able to teach yourself these techniques through mindfulness apps, or Youtube clips, if not I highly recommend getting involved in a yoga or mindfulness meditation class to learn slow breathing techniques.

[Chris_B]

Our next question is about anxiety related to eating:

Hello, I know this sounds a bit silly and I know it's irrational but I often am too scared to eat incase food will somehow make me sick or I'll have some random reaction to it or I have touched something bad and spread it to what I was going to eat. I know he likelihood is so low but I often freak about it. Is this from some form of anxiety disorder?

[Dr_Kim]

Hi, your hunch is correct! This is a form of anxiety disorder, and the key to diagnosis is that there is a battle going on between the healthy rational part of your brain, and the anxious irrational part of your brain about what you should do, think and react.

The rational part of your brain is saying, the food is fine, I’m going to be fine and there’s nothing to worry about. But the anxious part of your brain is saying all the bad things about the food and your possible reaction to it, which is producing a response in you.

This battle of healthy vs anxious brain is very common in our community, and is really annoying for people that have it, because a part of them knows that the thoughts coming from the anxious part of the brain are incorrect, “a bit silly” as you say, but they still can’t stop having them.

You might want to have a look at a book that explains this in easy language called “Change Your Thinking” by Sarah Edelman, which will give you some tips on how to start putting those silly but irrational thoughts in their place, and feel calmer.

[Chris_B]

Our next question is about uni stress:

Hi Dr Kim, I feel so shitty but I am scared to go to the doctors incase they won't take me seriously. At uni I do really well with quite high marks. I seem to be functioning fine but I always feel so awfully depressed and I have anxiety levels which seem to go through the roof all the time. How can I know if I'll be taken seriously if I try to get help if on the outside I seem like I'm functioning normally? Thanks so much

[Dr_Kim]

Most people working in mental health don’t need to see evidence of deterioration to take what’s happening inside your head seriously. I think it’s important that you seek help for your thoughts and feelings early, and don’t wait until things start to decline in your academic or social world.

It is important that you approach the right sort of people, who understand this. Seeing student health counsellors, or a Headspace counsellor might be a good start if you don’t trust that your GP would understand the difference between internal and external functioning.

I wonder if you’ve been able to broach this with friends or family, and if you’ve had any positive or negative responses from them to guide you in this. Do your friends and family see your depression and anxiety? Do they understand that, although you are doing amazingly well at keeping it together, you’re still not happy?

It might be worthwhile having a chat to someone and getting somebody who understands the situation to accompany you to the health professional so you have some support in explaining your circumstances.