How Would a Psychiatrist Diagnose This

Published: May 01, 2014
Dear TeenHealthFX,

I'm the functional cutter, back again. I don't cut on a daily basis, just whenever my depression gets really bad. I was diagnosed with clinical depression a few years ago and was on medication. I stopped taking the medication about a year and a half ago, however, because I didn't want to be dependent on something like that. My bouts come every two or three months and last anywhere from 2-4 weeks, depending on what is going on in my life at the time. I normally cut a couple of times during these bouts. I don't remember what it's like to be a normal teenager. I enjoy cutting and have taken up smoking, both in moderation. I log my bouts of depression in my period tracker app; I also log whenever I cut so that I don't allow it to consume my life. I still don't want help. I realize that I cannot be helped, although you'll probably disagree with me. I am curious, though, as to how a psychiatrist or a talk therapist would diagnose this.

Dear How Would a Psychiatrist Diagnose This,

It sounds like you borrowed a term that is often used to describe addictions. A “functional” alcoholic/addict is really someone who hasn’t hit bottom yet. It is based on the same mindset that you somehow you are in control of the behavior in question. It is interesting that you noted that you did not want to become dependent on medication but don’t recognize that cutting can become a compulsive ritual. Antidepressants are not addictive or alter a person’s state of mind. To reinforce this point, have you ever seen anyone selling Prozac at school? It is not mind altering nor does it produce euphoria, so there is no demand for it on the recreational drug market. 

Of course we are going to disagree that you cannot be helped. There seems to be a lot of pain in your situation but nowhere does it say hopeless. You are deceiving yourself about your cutting behavior. Look at your statement; “I also log whenever I cut so that I don't allow it to consume my life.” If a behavior is not problematic then you wouldn’t need to keep track of it. 

You already know from being in therapy what the diagnosis might be. Here is how they might describe you, “resistant to treatment.” Depression is a treatable condition but it can take time to find the right medication and build enough trust in therapy where you are willing to deal with the issues that make you feel vulnerable. You owe it to yourself to try.

Signed: TeenHealthFX