DSM-V: Somatic Symptom Disorder (Most of it anyways)

Somatic Symptom Disorder

Diagnostic Criteria(F45.1)
One or more somatic symptoms that are distressing or result in significant disruption of daily life.
~ Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
~ Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
~ Persistently high level of anxiety about health or symptoms.
~ Excessive time and energy devoted to these symptoms or health concerns.
~ Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Specify if:
With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.
Specify if:
Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
Specify current severity:
Mild: Only one of the symptoms specified in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

Diagnostic Features

Individuals with somatic symptom disorder typically have multiple, current, somatic symptoms that are distressing or result in significant disruption of daily life (Criterion A), although sometimes only one severe symptom, most commonly pain, is present. Symptoms may be specific (e.g., localized pain) or relatively nonspecific (e.g., fatigue). The symptoms sometimes represent normal bodily sensations or discomfort that does not generally signify serious disease. Somatic symptoms without an evident medical explanation are not sufficient to make this diagnosis. The individual’s suffering is authentic, whether or not it is medically explained.

The symptoms may or may not be associated with another medical condition. The diagnoses of somatic symptom disorder and a concurrent medical illness are not mutually exclusive, and these frequently occur together. For example, an individual may become seriously disabled by symptoms of somatic symptom disorder after an uncomplicated myocardial infarction even if the myocardial infarction itself did not result in any disability. If another medical condition or high risk for developing one is present (e.g., strong family history), the thoughts, feelings, and behaviors associated with this condition are excessive (Criterion B).

Individuals with somatic symptom disorder tend to have very high levels of worry about illness (Criterion B). They appraise their bodily symptoms as unduly threatening, harmful, or troublesome and often think the worst about their health. Even when there is evidence to the contrary, some individuals still fear the medical seriousness of their symptoms. In severe somatic symptom disorder, health concerns may assume a central role in the individual’s life, becoming a feature of his or her identity and dominating interpersonal relationships.

Individuals typically experience distress that is principally focused on somatic symptoms and their significance. When asked directly about their distress, some individuals describe it in relation to other aspects of their lives, while others deny any source of distress other than the somatic symptoms. Health-related quality of life is often impaired, both physically and mentally. The diagnosis can further be specified by stating whether complaints predominantly involve pain and/or if complaints are marked by a persistent course(Katz et al. 2015).

Additionally, severity of somatic symptom disorder can be specified by the number of fulfilled B criteria. Mild forms of somatic symptom disorder (one symptom as specified in Criterion B is fulfilled) are more prevalent(Rief and Martin 2014; Voigt et al. 2012), while moderate (two or more B criteria are present) and severe cases (two or more symptoms as specified in Criterion B are fulfilled in combination with multiple somatic complaints or one very severe somatic symptom) are marked by higher levels of impairment(Claassen-van Dessel et al. 2016; Hüsing et al. 2018; Limburg et al. 2016). In severe somatic symptom disorder, the impairment is marked, and when persistent, the disorder can lead to invalidism.

There is often a high level of medical care utilization, which rarely alleviates the individual’s concerns. Consequently, the individual may seek care from multiple doctors for the same symptoms. These individuals often seem unresponsive to medical interventions, and new interventions may only exacerbate the presenting symptoms. Some individuals with the disorder seem unusually sensitive to medication side effects. Some feel that their medical assessment and treatment have been inadequate.

Associated Features

Cognitive features include attention focused on somatic symptoms, attribution of normal bodily sensations to physical illness (possibly with catastrophic interpretations), worry about illness, a self-concept of bodily weakness, and intolerance of bodily complaints(Voigt et al. 2012; Voigt et al. 2013). Besides health anxiety, emotional features may include negative affectivity, desperation, and demoralization related to somatic symptoms(Rief and Martin 2014). The relevant associated behavioral features may include repeated bodily checking for abnormalities, repeated seeking of medical help and reassurance, and avoidance of physical activity(Voigt et al. 2010). These behavioral features are most pronounced in severe, persistent somatic symptom disorder. These features are usually associated with frequent requests for medical help for different somatic symptoms. This may lead to medical consultations in which individuals are so focused on their concerns about somatic symptom(s) that they cannot be redirected to other matters. Any reassurance by the doctor that the symptoms are not indicative of serious physical illness tends to be short-lived and/or is experienced by the individuals as the doctor not taking their symptoms with due seriousness. As the focus on somatic symptoms is a primary feature of the disorder, individuals with somatic symptom disorder typically present to general medical health services rather than mental health services. The suggestion of referral to a mental health specialist may be met with surprise or even frank refusal by individuals with somatic symptom disorder.

Development and Course

The course of somatic symptom disorder is likely to be chronic and fluctuating and influenced by the number of symptoms, individual’s age, level of impairment, and any comorbidity(Creed and Barsky 2004; olde Hartman et al. 2009; van Geelen et al. 2015). The course is also influenced by personality traits, with less harm avoidance and greater cooperativeness associated with a shorter time to remission(Greeven et al. 2014).

In older individuals, pain localized in several body regions appears to be the most common symptom(Hiller et al. 2006). Somatic symptoms and concurrent medical illnesses are common as multimorbidity increases with age. Prevalence rates of somatic symptom disorder seem to be stable until age 65 years and might decrease thereafter(Hilderink et al. 2013). For making the diagnosis in older individuals, a focus on the requirement for excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns (Criterion B) is crucial. Somatic symptom disorder may be underdiagnosed in older adults either because certain somatic symptoms (e.g., pain, fatigue) are considered part of normal aging or because illness worry is considered “understandable” in older adults who have more general medical illnesses and medications than do younger people.

Risk and Prognostic Factors

Temperamental

The personality trait of negative affectivity (neuroticism) has been identified as an independent correlate/risk factor of a high number of somatic symptoms(Creed et al. 2012). Comorbid anxiety or depression is common and may exacerbate symptoms and impairment(Lee et al. 2015; Limburg et al. 2017).

Environmental

Somatic symptom disorder is more frequent in individuals with few years of education and low socioeconomic status, and in those who have recently experienced stressful or health-related life events(Creed and Barsky 2004; Creed et al. 2012; Deary et al. 2007; Reddy et al. 2019). Early lifetime adversity such as childhood sexual abuse is also likely a risk factor for somatic symptom disorder in adults(Eberhard-Gran et al. 2007; Rief and Martin 2014).

Course modifiers

Persistent somatic symptoms are associated with demographic features (women, older age, fewer years of education, lower socioeconomic status, unemployment), a reported history of sexual abuse or other childhood adversity, concurrent chronic physical illness or mental disorder (depression, anxiety, persistent depressive disorder, panic), social stress, and reinforcing social factors such as illness benefits(Deary et al. 2007). Total somatic symptom severity is probably associated with female gender, anxiety, depression and general medical illness(Tomenson et al. 2013). Cognitive factors that affect clinical course include sensitization to pain, heightened attention to bodily sensations, and attribution of bodily symptoms to a possible medical illness rather than recognizing them as a normal phenomenon or psychological stress(Deary et al. 2007; Rief and Broadbent 2007; Rief et al. 2004).

Culture-Related Diagnostic Issues

High numbers of somatic symptoms are found in population-based and primary care studies around the world, with a similar pattern of the most commonly reported somatic symptoms, impairment, and treatment seeking(Gierk et al. 2014; Lee et al. 2015; Rask et al. 2016). The relationship between number of somatic symptoms and illness worry is similar in different cultural contexts, and marked illness worry is associated with impairment and greater treatment seeking cross-culturally(Lee et al. 2011; Lee et al. 2015). In many cultural contexts, individuals with depression commonly present with somatic symptoms(Bagayogo et al. 2013; Dreher et al. 2017).

Despite these similarities, there are differences in somatic symptoms across cultural contexts and ethnoracial groups(Rohlof et al. 2014). Sociocultural factors, particularly stigma related to mental disorders, may explain differences in somatic symptom reporting across cultural contexts(Bagayogo et al. 2013; Löwe and Gerloff 2018; Wilkins et al. 2018). The description of somatic symptoms varies with linguistic and other local cultural factors.

Association With Suicidal Thoughts or Behavior

Somatic symptom disorder is associated with suicidal thoughts(Wiborg et al. 2013a; Wiborg et al. 2013b) and suicide attempts(Asselmann et al. 2018). It is likely that suicidal thoughts and behaviors are partly explained by the diagnostic overlap and frequent comorbidity of somatic symptom disorder and depressive disorders(Wiborg et al. 2013a). In addition, dysfunctional illness perceptions and the severity of somatic symptoms appear to be independently associated with an increased risk of suicidal ideation(Jeong et al. 2014; Wiborg et al. 2013a; Wiborg et al. 2013b).

Functional Consequences of Somatic Symptom Disorder

The disorder is associated with marked impairment of health status and high psychological distress(Voigt et al. 2012). Many individuals with severe somatic symptom disorder are likely to have impaired health status scores more than 2 standard deviations below population norms(Lee et al. 2015; Tomenson et al. 2013). Health status is particularly impaired in the presence of multiple or severe symptoms(Creed et al. 2013).

Differential Diagnosis

If the somatic symptoms are consistent with another mental disorder (e.g., panic disorder), and the diagnostic criteria for that disorder are fulfilled, then that mental disorder should be considered as an alternative or additional diagnosis. If, as commonly occurs, the criteria for both somatic symptom disorder and another mental disorder diagnosis are fulfilled, then both should be diagnosed, as both may require treatment.

Other medical conditions

The presence of somatic symptoms of unclear etiology is not in itself sufficient to make the diagnosis of somatic symptom disorder. The symptoms of many individuals with disorders like irritable bowel syndrome or fibromyalgia would not satisfy the criterion necessary to diagnose somatic symptom disorder (Criterion B). Conversely, the presence of somatic symptoms of an established medical condition (e.g., diabetes or heart disease) does not exclude the diagnosis of somatic symptom disorder if the criteria are otherwise met. Factors that distinguish individuals with somatic symptom disorder from individuals with general medical conditions alone include the ineffectiveness of analgesics, a history of mental disorders, unclear provocative or palliative factors, persistence without cessation, and stress(Suzuki et al. 2017).

Psychological factors affecting other medical conditions

The diagnosis of somatic symptom disorder requires distressing or impairing somatic symptoms that may or may not be associated with another medical condition but must be accompanied by excessive or disproportionate thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns. In contrast, the diagnosis of psychological factors affecting other medical conditions requires the presence of a medical condition, as well as psychological factors that adversely affect its course or interfere with its treatment.

Panic disorder

In panic disorder, somatic symptoms and anxiety about health tend to occur in acute episodes, whereas in somatic symptom disorder, anxiety and somatic symptoms are more persistent.

Generalized anxiety disorder

Individuals with generalized anxiety disorder worry about multiple events, situations, or activities, only one of which may involve their health. The main focus is not usually somatic symptoms or fear of illness as it is in somatic symptom disorder.

Depressive disorders

Depressive disorders are commonly accompanied by somatic symptoms such as fatigue, headaches, or joint, abdominal, or other pains. However, depressive disorders are differentiated from somatic symptom disorder by the requirement of the presence of depressed mood or, in the case of major depressive disorder, either depressed mood or decreased interest or pleasure in activities. In some cultural contexts, these core symptoms of depression may be initially denied or deemphasized by individuals whose presentations would otherwise meet criteria for a depressive disorder(Lanzara et al. 2019; Ryder and Chentsova-Dutton 2012; Ryder et al. 2008). Such individuals might instead emphasize somatic symptoms that may be idiomatic (e.g., heavy heart) and unfamiliar to clinicians(Ahmad et al. 2018; Bragazzi et al. 2014; Haroz et al. 2017; Seifsafari et al. 2013).

Functional neurological symptom disorder (conversion disorder)

In functional neurological symptom disorder, the presenting symptom is loss of function (e.g., of a limb), whereas in somatic symptom disorder, the focus is on the distress that particular symptoms cause. The features listed under Criterion B of somatic symptom disorder may be helpful in differentiating the two disorders.

Comorbidity

Somatic symptom disorder is associated with high rates of comorbidity with other mental disorders as well as general medical conditions. The most relevant co-occurring mental disorders are anxiety and depressive disorders, each of which occurs in up to 50% of cases of somatic symptom disorders(Bailer et al. 2016; Newby et al. 2017) and significantly contributes to overall functional impairment and poorer quality of life(Liao et al. 2019; Löwe et al. 2008). Other mental disorders that have been found to co-occur with somatic symptom disorder are posttraumatic stress disorder and obsessive-compulsive disorder(Bailer et al. 2016; Liao et al. 2019). Other evidence indicates an association with sexual dysfunction in men(Fanni et al. 2016).

Elevated levels of the psychological features (Criterion B) of somatic symptom disorder have been found in several general medical conditions(Kop et al. 2019). When a concurrent general medical condition is present, the degree of impairment is more marked than would be expected from the physical illness alone. Moreover, somatization in medical illness has been shown to worsen disease and treatment outcomes, adherence, and quality of life and to increase health care utilization(Grassi et al. 2013).

Post-Session Reflection on Topics

Things discussed at todays session

- Being late
- Competency
- Emotional reaction, stress, frustrated, flustered
- Self-Doubt
- Army: Tex's section and being singled out. Ingroup and Outgroup.
- ID, Ego, SuperEgo in comparison to my idea of existential self and social self, and managing the two.

I was supposed to attend a DBT session at 3pm. However around 2pm the idea that it was 3:30pm not 3pm stuck in my mind, so I didn't plan to leave until around 3pm.
As it would happen, I looked at the time at 3pm and realised that this was the correct time to attend so I rushed to get ready and leave. I called and let them know I'd be late.
I began feeling self-conscious and frustrated with myself. I was thinking of walking in late and of everyone knowing that I was late, and of feeling incompetent because I managed to relax too much and didn't achieve a simple task. I felt somewhat flustered; I guess I was also frustrated that I was flustered, that this emotional reaction happened over something I didn't consider as something that 'should' set off those reactions.

I was still able to accept those emotions, the frustration, the fluster, the self-consciousness; I was still able to accept that I was late, that little could be done about it apart from remaining calm and focusing on arriving safely.
In reflection, I think another aspect may also be the shock of how quickly I switched from everything going well, emotionally steady (mood fluctuation included) for weeks without issues to being late, frazzled, uncomfortably self-conscious, and emotionally raw.
To be clearer, this wasn't a massive reaction to the situation in the sense of catastrophising or being overwhelmed by emotions but closer to the analogy of having stubbed your toe, it was sudden and it hurt but also it wasn't damaged or going to be painful for the whole day.

This bothered me through to the following day where I arrive to the wrong location, despite having known about the change for about a month in advance. I knew, I checked the night before, I jumped in the car and drove to the previous location out of habit. Just to top it off I arrived at the previous location just after 10am. 
Not only did I arrive slightly late but also to the wrong location.
I remember having a lack of urgency that morning .. until I was late. I do wonder if I'd relaxed too much and if that's the case, which I suspect it is, then I can take this all on board and fine tune things a bit so it's no longer the reason for my being late somewhere.
 
I spoke over the phone while driving, using headphones. It was just going over what I was experiencing and why those thoughts and feelings may be coming up. I was asked if I'd considered if other people made mistakes even when they're otherwise competent and I gotta admit it wasn't something that I had considered recently, or for a long while.

Despite knowing that competent people make mistakes, I think that I'd been self-obsessed over my own errors and faults whilst simultaneously disregarding others errors as once off and not a reflection of their character or competence.
Having just reached the aforementioned conclusion it has just occurred to me as peculiar that I've been attributing certain groups/types of mistakes as proof my own incompetence. I can only think that this occurred directly as a result of being part of Tex's section on RCB 117. I don't recall having such an issue with confidence at 2coy 4pl, or IET's, or Basic, or ... heck, I don't think Asad bothered me as much as Tex. Yea, Asad dragged me down and made me question myself but I still left feeling intact.  
I still felt confident that I could do things. I nailed the cognitive tests, the physical, medical, psych, fucking everything. I didn't doubt or feel incompetent; I know at times I felt nervous, frustrated and sometimes confused but I don't recall doubting my capability to perform or letting mistakes bother me much. I just did it - I looked forward and did it. In a way it was one of the easiest things I've done. It was tough physically, emotionally/socially draining, and simultaneously both stimulating and brainless but it was just 'do this' and I'd do it and it would be done. Like following a path - just go forward.
I do miss that aspect of that time.
Was I a top soldier? Nope but I wasn't bad either. People liked me and wanted me to spend time with them. I know they tested me various times and they seemed happy with how I performed (or at least that's how I remember it), if I made mistakes they were willing to help me improve or if it wasn't a big issue then it may be remarked on then forgotten. I was part of the group. I never felt like my competence was doubted, actually I think almost the opposite where people saw potential with me. Even after I left a thermal sight in my pack for over a week and got ROP's, people didn't treat me as if there was something wrong with me. I think I was a bit frazzled by it, I think I was a bit frustrated that I'd made that mistake but I don't think it was overbearing. 

I remember when we were packing our bags for RCB, I know my memory of the words used is a bit vague and I remember it as "Don't take your battalion PT shirts as you'll get given RCB PT shirts when you arrive. Those will be the PT shirts you wear when you do PT". 
I know that he said it several times. I know that the intended message was as previously mentioned even if I don't remember it 100%.
I remember when we got there, within the first couple hours of arriving on the base, Tex and section wanted to go to the gym. Oh who didn't bring a PT shirt? Must be the shit cunt.
What's this? Stafford didn't bring his gunner's rig? MJ has a spare? Hahaha we'll just forget this even happened because the person who didn't bring the PT shirts they were told not to bring is clearly the shit cunt.
It might not have been huge to start with but they also picked up on that I wasn't the fittest and strongest infanteer in the group. Like I wasn't unfit or slacking, just not the best at those weighted exercises. I wasn't trailing far behind everyone anyways. I could run and swim better than them but no lets just stick to doing Hundred 100's and similar exercises. I got looked down on for that.
When was the last time I've done volley ball? Once or twice 10+ years ago? Can't let MJ play cause he's bad.
What about the amount of times Tex shared orders when I left to go to the toilet? And then get berated for not being ready for that task. Holy fuck. The first time I put down to chance and them thinking someone else had filled me in. After the third time it was clear that it was deliberate so I began speaking to other sections and secco's to find out what was coming up. I remember when we were with the Malay Rangers I got grilled for hanging back at the mess to talk with other people. The reasoning was incase they received orders ... mother fuckers, call me, we've all got phones, and there's almost no place to go apart from maybe 3 spots. With that incident the icing on the cake was that they knew I stayed behind, they knew were I was. 
I'm pretty sure I ended up on armory piquet a few time times more than others.
I remember there was an incident, I can't place when it happened, where we patrolled into rows of these tall straight trees at night and we were supposed to sit down in rows. It's nearly pitch black under these tree's and Tex is obsessing over where I'm sitting. It was constant "Move forwards a bit. Move back a bit. Move back a bit more. Move forward a bit. Move back. Move forward." Like, holy fuck, I'm moving around in 10-20cm increments; he complains to sarge then drags me back like 20cm. It was bizarre and enraging - did it really matter that much for me to be in that exact fucking spot during an admin stop under near pitch black vision.
Imagine standing with your feet together and someone saying 'take a step back' so you do, 'take a step forward' so you take a smaller step forward, 'take a step back' so you take a smaller step back, and this process just continues. 
And the range. I'm on the mog pulling everyone's packs onboard. 'OK all the packs are on the mog, lets go', 'Oh wait guys I don't see my pack on the mog', 'Nope it's definitely on here, we put them all on, none left behind, stop worrying and overthinking shit -- WTF MJ why didn't you make sure your pack was on the mog? Gonna have to reprimand you for this'
I swear to fucking god, fucking ridiculous. 'trust us we definitely put your pack on the mog, woops it's not on the mog and it's all your fault'.
Then to add to that, during a pistol test, apparently I didn't look down the sight (didn't look down the sight correctly?) and I'm thinking 'uhm, yea I did' but can I say that to rank?? Can I prove I didn't??
Re-training!!
Just another thing to make me look and feel incompetent. Hey look, the shit cunt is so bad that he needs re-training on the pistol!
Cool. I've handled a pistol just long enough to get qualified. Did I do my drill wrong? I don't believe I did. Was I rigorously re-trained to the point I doubted myself? Yes.
The live fire shoot. 'Hey MJ, immediately after this shoot you're going out on piquet to replace so-and-so'.
'No problem lemme just oil the gun quickly before I jump on the vehicle'
'Nope, no time gotta go right now'
'Cheezy can you oil the gun please' 'MJ get on the vehicle now'
'Sure I'll make sure it gets oiled' 'MJ get on the fucking vehicle now!'
3 days later: 'MJ I just pulled out your gun and it was completely rusted, we spent half the afternoon cleaning it, I was so embarrassed'
No fucking shit, you made such an issue about me fucking getting on that fucking vehicle that I thought I was going to get a formal warning. You were so desperate to get me on that vehicle that you wouldn't let me oil the weapon and then you berate me for not oiling it.
The time we went to an island and they tried to get me to sleep with a trans lady. When I say 'tried' I mean it was closer to 'forcing'. I didn't want to, they didn't me but they tried to make it happen. I told that lady what was going on, they said they were happy for me to stay the night if needed, I didn't need to but I really appreciated it. I bullshitted out my arse to everyone about what happened.
There was a night were Rhode was making so many passive-aggressive remarks to me. I don't really know what or why, I vaguely remember him insinuating that they were trying to help me and I was being disrespectful. I remember everyone else was acting a quiet and cautious. So I had a punch on with Rhode. I end up on the ground and everyone decides it's over, and I'm confused - I'm fighting and I'm able to continue fighting and I want to keep fighting but they decided when it's over. It was stupid, it annoyed me. I got a lot of respect from Rhode after that. I still look back and don't understand why it happened nor why it was allowed to happen.
They left behind to piquet on Ex. Harangaroo. 
Ohh. That patrol where I get heat exhaustion, can barely stand and am about to pass out but first Tex has to grill me because the minimi stock pin has come out. I remember he ripped into me pretty hard but I was so fucked I don't remember much.
Later on only my weapon got the white glove inspection, every weapons inspection was white glove. Not literally as he didn't have any white gloves but if there a spec of carbon anywhere on the weapon I got a warning and went back to cleaning. Not for anyone else, just me. It got to the point where I wouldn't fire unless I couldn't get away with that and I'd clean the gun thoroughly every chance I got.
Also there was the bellend guy. Just a fucking random who's like "you look like a bellend, what would you do in this situation", fuck you champ.
What angers me about all these incidents is how Tex would act as if he's looking out for us and trying to be a good secco.
Don't forget Singapore! We wouldn't want to forget about all that bullshit. Oh yea, lets run MJ through urban drills and grill him for the minutest detail. Lets just fabricate some story about MJ pointing a rifle at someone elses head. At this point I know he has it out for me. I know. There was no way I was even close to pointing a rifle at someone's head, we were about a meter apart and I'm pointing 30cm above the second floor. Nobody steps in and points out that I wasn't. It was just me trying to convince Tex that I was didn't do the thing he fabricated, and he's like 'oh well from where I was standing it looked like you pointed it at his head'. Aha, is that right Tex? Are you really spending your time and energy to imagine faults with what I'm doing? Are you not able to disconcert angles or how how objects operate in 3D space? No? You're trying to find any and all fault with me. You'll imagine them if you have to. Nobody else has flaws in their urban clearance, nothing to improve on, only MJ.

So what does all that have to do with me today, with the over-reactions and hyper-vigilance reactions of me post army? 
Well I think that I'd internalised some of this somehow.
I think I grew into a person who didn't like interpersonal conflicts, as in, I greatly valued getting along with others and fitting in with the group to the point that I would devalue myself to conform to the groups values. I think that moving around as much as I did also had a side effect of not understanding how to fit into close groups appropriately. I think that statement is lacking, it's not quite correct, moving around a lot is part of it but ...
I think by wanting to be part of the group, being ostracized by the group, unable to leave the group, being lead into situations by the group where I'd be in the wrong or make a mistake then having those mistakes tallied against me as proof of my incompetence as a person has lead to me having the issues that I have now. Having strong emotional reactions over simple or perceived mistakes, lacking confidence in myself, feeling inadequate and incompetent as a human after making any mistake, becoming hyper-vigilant and self-conscious when doing tasks where I could perceive the people around me as judging my competence doing the task.

Where do I go from here?
(what does the literature say?)

During the session I'd tried to explain the things I can't disprove, that I'm consciously aware of phenomena and its consistent change, and I'm consciously aware of the use of language to explain what's happening. They asked if I was aware that I was describing Freud's ID and Ego, I wasn't and I thought that was interesting but also how was this related to proving and disproving reality and truths.
Anyways.

A Different Perspective On My Life: It Can Be Broken Down To Three Stages

About 30 minutes ago I was driving home from the gym and I was thinking about how I was basically trying to re-structure my life, more specifically how I was re-structuring my life after discharging. This lead me to think about the reason for trying to re-structure my life. I'm re-structing my life because everything before now was not working or working poorly. Interestingly this wasn't the only this has happened to me. I went through a massive change in perception and belief when I stopped believing in Christianity.

It's a little difficult to contrast this new way of thinking with the old, though I suppose I was thinking of the current moment as building upon the previous such that my motivation for going to uni and studying was still part of the previous way of living. 

To explain in a more linear fashion would be to point out what lead to the dissolution of my belief in Christianity. While there are many factors involved I think it ultimately came down to:
    My belief in Christianity was not working and many more things could be explained through the absence of a God, and through science and technology. It's possible to argue about tests of faith and temptation, about how I was tempted off the path of Christ through the temptation of Satan and how I needed to continue my faith in God or the Holy Trinity. In response I find myself drawn to the Parable of the Lost Sheep (Luke 15:1-7) where Jesus talks about the shepherd who goes out to find a lost sheep whereupon finding it the shepherd celebrates. Were I to be the lost sheep and Jesus as the Shepherd then I ask/ed "How difficult is it to bring me home? I'm looking for truth, for what's there, and what's real. Where are you if you are The Way, The Truth, and The Light that you proclaim to be?"

I've had no response to that for the last 11 years. 

I now see this as a transition stage. At this point onwards I'm re-structuring my life.

It lead me to try seek out what's "really out there" and "what's really going on?". Those questions, that line of thinking, and where I was emotionally and situationally lead me to move to Townsville. I think I was driven by two, maybe three, aspects here: "What drives me as a person?" and "What is this existence and my beliefs about it?". 

Tarot, spiritualism, drugs, introspection, psychology, metaphysics, sensory experiences, philosophy, Buddhism/Taoism, history, anthropology, dreams and trances, serial killers, sonder and solipsism, ect.

I found my desire to win at League of Legends rather intoxicating. It was a goal I'd set and parameters to determine how well I was moving towards that goal. It was a huge contrast to the difficult and confusing attempt at understanding everything in existence, one that was feeling overwhelming and pointless. I wish I did well at LoL but I can't say I was that good and living circumstances didn't help. Ironically I performed best when my father cut me out of the internet and I was going to an internet café to play. 

Perhaps the next question would be "why uni?"

I know I didn't have anything else going for me at the time. I'd just quit the door-to-door sales job, and my mother suggested I take a look. There was a few things that interested me so I did the Bach. Health Science to cover them all. Really titillating. To start with. I remember being frustrated because it was just pre-job training and I was feeling unfulfilled. I think unfulfilled in the sense that I didn't know who I was or how I saw the world, how I operated within it or with other people. What was my purpose? My life had no meaning.

I had an argument with my father that lead to me staying with Nick, his partner and his mother. Later I moved to stay with Andrew and met Trish. Trish introduced me to muntrie picking at the neighbours which turned to grape picking with a local Italian family. I enjoyed doing something, having my mind free to process things, and the outdoors. I decided to do some orange picking for a living up in Waikerie at a backpackers hostel. That lead to the work on the vineyard, Asad and the Army.

I think the orange picking was a bit of a confidence booster. Thoughts come and go but oranges get picked, processed, packaged and consumed. Similar with the vineyard work. I noticed that I could work fairly hard for most of the day, I liked being outside and moving, I liked being part of a process that benefited people. I also began to notice that I really needed to think deeply about things as I'd frequently find a quiet spot and just process things. I remember this girl saying "Because I know who I am" and it really struck me hard because of the conviction in which she said it, it made me question myself. I still don't think I can say the same thing with the same conviction she had.

Kristina occurred around here, and the pain of no longer being a part of her life or how it ended.

Asad and his lies. Promised to build up my confidence. Teach me Krav. 

So all these experiences, all this stuff is my reality, my beliefs, perceptions and motivations drives my decision into the army.

This idea of being physical, being outdoors, a not-for-profit organisation, being able to fight and kill, of being the shield in front of others, of being useful and having purpose.

Well army didn't work out that well for me.

I guess I did learn that I don't want to be that physically fit all the time, that I'm a lot more gentle than I thought, I'm definitely quite introverted, that I'm more prone to conceptual thought and that I want something along the lines of helping people.

Physical injury and adjustment disorder diagnosis.

So a lot of stuff had occurred up to that point and I go to study psychology, which is kind of a big change from before. I begin trying to change my whole world, to develop a new and hopefully better reality, and to put that into practice; trying to process all these experiences into something useful and understandable, using what I learnt about myself and changing. I've developed habits and thoughts that aren't helpful, I'm having disproportionate emotional responses, I'm feeling insecure and all over the place, my view of the world is complicated and my sense of self is obscure.

This leads back to the thoughts I was having during the car drive home. I'm re-structuring my life.

What I was doing before was not working well and helped create the problems I'm struggling with, which is why I'm working on changing and rebuilding myself and my worldview. 
This process is the change before the next stage in my life.

The first stage was as a Christian up to 18yo, the next was what lead to the army, and the current stage is now.

At the very least this is a different perspective for me.

Recent thoughts and feelings

In the passing month I've found myself feeling rather lonely and empty. Dissatisfied. Hopeless. Unmotivated.

Ironically there are moments where I'm hopeful, grateful, looking to the future and content with myself and situation despite not having what I would like. 

One thing I've found is that I've been yearning for a partner and a handful of good friends. Kids even.

    In that regard its been hard to stay positive.

    Often I feel like I missed the whole dating memo, though with all the moving I did that's probably not        entirely inaccurate. I feel like when everyone else was making relationships, learning how to date, have     families and a professional role within society ... I was still trying to form an understanding of the world     that made sense and a sense of identity. I felt behind everyone else and partially like an alien. 

How do I even make friendships or find relatable things when it's difficult to find relateable topics or             discussion; even people who travelled a lot don't quite understand. OK it's not quite 'that' bad but how         do you relate to someone who grew up in one place compared to someone who'd already lived in 3             countries, 8 homes and attended 8 schools by the time they were 14.

Without going into all the different ideologies and attitudes I phased through, after a while it became clear     to me that I thought and perceived things differently. Perhaps not drastically different but noticeably so     and not in an easily explainable way, so I wouldn't talk much about it anymore.

I kept moving. I joined the military. I'm attending university.

Whilst I feel more at ease in the university setting, most students are much younger than me and the ones     closer to my age tend to be those in teaching positions.

So, coming back to dating.

It seems that nobody seems interested. If they are, I feel like I'm struggling to maintain an interest or             worse I feel like I'm not seen as relationship material. Similar situation for both dating apps and                 meeting people in person. The trend seems to be: They're in a relationship, they're much younger than         me, they're married, they're the same age but looking for something else, or they're not interested. 

I'm finding it difficult to believe that anyone will be interested in me. Who was the last person interested        in me, and how long ago?

Like what do I have to offer?
I think that touches on the main issues I feel.

10th Feb 2022