u/4ChawanniGhodePe

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My sister (25F) has been going through severe mental health issues for some time now, and our family is trying to understand what may be happening psychologically. We have already consulted a qualified psychiatrist and started medications + counseling, but I wanted additional perspectives from people experienced in psychiatry/psychology.

I’ll try to summarize everything clearly.

Symptoms / behaviors:

• She has urges to hurt herself, and after self-harming she reportedly feels relief/calm.
• She says when stress builds up inside her, she sometimes makes aggressive “animal-like” angry expressions/faces and feels better afterward, almost like tension is being physically released.
• She has intrusive thoughts about harming people she loves (including my 1-year-old nephew), but these thoughts scare her and make her feel guilty. She has never harmed him and actively resists the thoughts.
• She once told me that whenever she sees blood (for example if someone gets injured), she gets an urge/thought about licking the blood. Again, she feels ashamed/disturbed by these thoughts.
• More recently, she said she sometimes hears a “middle-aged man’s voice” in her head telling her to cut herself because “it will feel good.” She says these voices come in episodes — either continuously for some time, or not at all for long periods.
• She is actively fighting/resisting the voice and does not want to obey it.
• She sounds scared and ashamed of these thoughts/voices, not pleased by them.

Important psychological background:
Over the last few days she opened up about a lot of deep insecurity and trauma-related experiences:

1. She is a graphic designer and has very low self-worth. During job discussions, even if someone offers her ~15k INR salary, her thought process becomes “Am I even worth that much?”
2. She has struggled academically and says whenever she sits to study, she feels: “Whatever I do is never enough. I will fail anyway.”
3. She remembers childhood incidents where our father told her that if she failed exams he would ask her to leave the house. She still remembers this strongly and associates studying with fear/failure.
4. In previous workplaces, she experienced office politics, bullying, humiliation, and people mocking her graphic design skills. Now whenever she works on design-related tasks, those memories return strongly.

My own interpretation (not a diagnosis):
It feels like years of shame, fear, low self-worth, bullying, emotional invalidation, and trauma may now be expressing themselves as:

• self-harm,
• violent intrusive thoughts,
• emotional overload,
• and possibly dissociation/voices.

At the same time, I understand the “voice telling her to cut herself” is serious and may go beyond simple trauma/anxiety.

Current situation:

• We consulted a psychiatrist (MBBS + DNB Psychiatry).
• He said this is treatable with medication and counseling.
• She has started medicines.
• Medicines are making her low-energy/lazy/sedated, but she is finally sleeping properly.

My questions:

1. Does this sound more like trauma-related emotional dysregulation / dissociation, OCD-spectrum intrusive thoughts, psychosis-spectrum symptoms, or some combination?
2. How concerning are the “voice” symptoms in someone who still has insight and resists them?
3. Is the guilt/shame around the violent thoughts considered a good prognostic sign?
4. What can family members practically do to support recovery?
5. Are there specific therapy modalities that are especially useful for this type of presentation (DBT, trauma therapy, ERP, etc.)?
6. Any advice about handling the medication side effects early on?

I know Reddit cannot diagnose her. I’m mainly trying to understand the situation better and learn how we as family can support her appropriately without either dismissing or catastrophizing her symptoms.

Thank you.