Passive Origins, Aggressive Outcomes – Or is it the other way around?

When you have Borderline Personality Disorder and you’re displaying Passive-Aggressive tendencies there are a lot of issues that may affect you.
“Individuals with PAPD are vulnerable to anxiety, somatoform disorders, and depression. Major depressive episodes are not uncommon. In the PAPD depressive cycles, there is evidence of a tendency to blame others, a demanding and complaining attitude, and low self-confidence. These individuals are most likely to experience chronic dysthymia. Typically, individuals with PAPD display an agitated dysphoria, shifting between anxious futility and self-deprecation to demanding irritability and bitter discontent (Millon, 1996, pp. 198-199).”
This cycle describes me very well, though I don’t attribute it to a passive-aggressive disorder in me.  I think that having this cycle creates a sense of powerlessness in my moods that in turn, leads to passive-aggressive behavior. Not the other way around. So for someone with PAPD the PA trait would be the cause for this cycle, where in someone with BPD this cycle would be the cause for the PA actions. The results and ultimate actions may be the same though. It’s important to recognize these so that a  better way of dealing with these types of cycles and actions can be found.
Origin of PAPD behavior:
“Stone (1993, p. 361) suggests that the contrary, sulking, and verbal nitpicking behaviors of PAPD appear to have their origin in unending power struggles with parents. The comparative helplessness of youth made it impossible to win in these struggles so the face-saving technique of passive resistance was employed. Parental overcontrol, neglect, or favoring of a sibling can all contribute to the development of the silent protest and grudging obedience associated with PAPD (Stone, 1993, p. 361).”
For me growing up was a study in contradiction of independence. I was told over and over that independence was something to be valued, but at the same time I was no allowed to exert my independence without repercussion. Also, the very idea of being independent inspired an anxiety in me that I could not reconcile because while I knew I was supposed to value my independence, that meant I had to release my bond to my parents, which I both wanted, and did not. Having not felt particularly bonded to them in many ways, releasing what little hold I had on them was distressing. Having them tell me that I should be one way, and then be punished for exerting the nature they valued, made me feel like I had even less control over my life and its outcome. Especially since I had very little opportunity to exert my independence in the first place. I was one of those over achieving, over involved, super children. I played on a dozen different sports teams, various school clubs, piano, dance, etc. beginning when I was about 7 years old throughout high school and into college. My life was absolutely and utterly structured and scheduled beyond my ability to control, so yes, I acted out in ways that allowed me to exert some independence when I could. Unfortunately these ways were often very destructive for me. That I was told to be independent, but apparently only in a way that my parents found acceptable during a time frame they chose, seemed like a massive contradiction to me and I refused the contradiction.
For someone with Borderline Personality disorder the parent figure can be just about anyone that they feel has ‘authority’ over them. It’s been postulated that the emotional maturity of someone with BPD has not evolved past the age of 3-5 years old. This is often when the root contributors to the personality disorder has taken hold so emotionally speaking, most people that are in a close relationship with a Borderline person may act as a parental figure in some sense.

When someone with a Borderline Personality Disorder is actually a parent, they may struggle with the same issues they grew up with in their own childhood, but now from the flip side. Not having a stable sense of give and take, of communication and compromise, everything feels like rebellion or being told what to do. It feels like once again, their choices are being taken away. The control is in someone else’s hands and reduces that inner child to a place of past powerlessness.
I’m not an expert on this. I do not have my own children, but I know how it feels when people do things without including me in the process. I feel like my opinions are not enough, not good enough, and maybe even rejected. I want to be the sole decision maker because, to me, that shows how much I am needed in someone else’s life. If someone needs my opinions, and only my opinions than it means that I am a crucial aspect of their world and it is very unlikely that they will no longer need me. They won’t abandon me. I do recognize that this is not rational, but the fear that is inspired when people look to others for help, instead of me, is not rational. I don’t lash out, I internalize everything these days. My self-worth plummets, I feel hurt, bad, and unhappy; alone. I want the people that are close to me to revolve their activities around me. Well, maybe not around me entirely (I actually don’t like to be the center of attention), but I desperately want to be included in the process of things. Being included reinforces the idea that I have not been forgotten, that what I have to contribute is valuable, that I have value.
It’s incredibly disconcerting for me as I write this, because I realize just how dependent I can be on the need for strong relationships, for others to need me as much as I need them.  I am an incredibly independent person. The idea of being dependent/codependent makes me angry. The very thought makes me feel weak and not in control of my life. I need people, but I don’t want to need people, I want people to need me, but I don’t want them to need me too much. It’s a massive internal conflict.  Especially since, at the same time, I realize that the things I want so strongly, I also recognize are not necessarily obtainable from people. Other people have their own lives and can only do so much when they have other things to worry about. This knowledge does not ease my internal anxiety, but it does increase my awareness of those around me. It begins to lessen the resentment I feel just a little, which makes me less likely to shut down around others or shut others down.
“The classic passive-aggressive transference pattern is to comply (sort of) with the therapeutic recommendation, and then to declare triumphantly that it was a very poor suggestion and failed miserably. These individuals are programmed to ask for help and then both to defy it and to suffer from it. Clients with PAPD expect to be injured by a negligent and cruel caregiver.”
This is what’s considered Transference and/or Countertransference Issues. Getting help for passive-aggressive tendencies isn’t easy when you constantly fluxuate between wanting help and not believing you need it (effectively making you not want help). Tomorrow I’ll talk about ways to address and work through passive aggressive problems.  Or at least try to find some tricks and methods to work through it.
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Road to Recovery…

Last week a Reader asked:
Do you think you could share a little about how you decided to address the pain and try to recover? There is someone in our life who we WISH would seek treatment, and I’m wondering what might get her there. Thanks.
How I decided to address the pain and try to recover. I wish I could give a completely selfless answer and say that I saw how I was affecting the people around me, that I realized how hurtful I was. I wish I could say that I wanted to stop lashing out and devastating the world around me. Unfortunately when I was taking out my emotions on other people I mostly felt like it was everyone else that did not understand me and the only thing wrong with me was that I was misunderstood. I felt hopeless. No one and nothing could help me because no one understood and if no one understood how could anyone do anything at all. Eventually I began Acting Out less and turned inward. I took out the majority of my turbulence on myself, Acting In. This doesn’t mean that it doesn’t still affect the people around me. It does. I’m just not as actively aggressive towards other people. Anyone close to me is still caught in my wake, or at the very least, sees what I go through, realizes that I’m hurting, and wishes better for me. It came down to the fact that I wanted to stop feeling so turbulent. I wanted it for me. First and foremost I want to feel better. That doesn’t mean I don’t want to be a better friend and be better to everyone around me. I absolutely do, but this wasn’t my main driver though it is a product of what I’m working towards.   The people that I’m close to care about me and they truly want me to be happy.
I’ve been an emotional disaster, especially when it comes to relationships, for as long as I can remember. It’s depressing. It’s painful. How I take it out on myself is excruciating. How I take it out on others is worse. I finally came to the realization that there has to be something better than living in constant pain and depression.
Growing up I fought the idea of therapy and medication. When I moved to New York I was involved in a very abusive relationship.  I bottomed out.   Finally, I sought therapy as a last resort.
Unfortunately as is often the case, it takes hitting bottom to have the greatest motivation to dig ourselves out of the holes we’ve dug. I wish I could say that was the only time I’d hit bottom, but it happens a lot. However, it got me to open up to the idea of therapy. Having the help to work through is invaluable and I strongly encourage this.
I think the last big kick in the ass was what lead me to the Psych ER {Intro, Part 1, Part 2, Morals}. The relationship I had been in wasn’t good but it wasn’t bad. It was just boring. I had no reason or inclination to stay in it and yet, when it ended I Acted Out in a way that got the cops and an ambulance called on me. I scared the hell out of my friends, terrified my parents, could have lost us our new apartment, could potentially have lost future employment… the repercussions of my actions were just not acceptable.  Especially when there’s no rational reason for my reactions to have been as extreme as they were. I knew something was very wrong for most of my life, but this was the last straw. I determined to stay on an anti-depressant, which ultimately was not enough, but it was a start. All these things; the realization of just how bad my actions could affect me and everyone else, remembering that through previous therapy I had begun to see bright spots again. I could see glimpses of better ways of living. I wanted not just glimpses of a better way, but actually walking a better path completely. Constant depression is a vortex of joylessness. I wanted to escape the blackness. No. Not black. Everything was grey. Grey, dreary, dull, nothing being crisp or vibrant for long enough to glean any happiness from. It’s no way to live and it doesn’t have to be that way. Finally I began to want for myself what my friends and family have always wanted for me; the chance of happiness. It’s why I created this blog; to help me as I work towards this. It’s something I want for anyone fighting a Borderline Personality Disorder.
The turning point came for me when I realized I want to get better.  No one can understand me, if I don’t help people understand me. If I don’t reach out to allow myself to receive the help I need. This is also my responsibility. This is a big world. I’m only one person in this world. There are plenty of people that love and care about me, but they also have their own lives to deal with. Ultimately, I am responsible for my own happiness and healing. This sounds like a sagely bit of wisdom, but for someone with BPD who wants so much to be close to other people without actually knowing how in a  functional way, it’s anything but easy. But it is possible. And it gets easier the more we work to embrace this.
I don’t know. I’m so tired of being so self-consumingly lonely, so sad and depressed, so misunderstood… so afraid… of everything. Life does not have to be this way. I refuse to believe that this is simply my lot in life. There is only one thing that can determine my fate, and that’s me. If I choose to be a different way, I can take control of my world and make it something that is worthwhile.  
In order to do this, therapy has helped me immensely. Writing this blog has helped me more than I expected. Being able to reach out, connect with other people struggling with a Borderline Personality Disorder, knowing that I’m not alone, hearing from other people as they also fight, or as they seek advice, or simply leave a few words to let me know they’ve been by… knowing that I’m reaching out and connecting with others like me; helps. I’m also determined to stick to a medicinal regime as well. I’ve previously floundered with this a little, but I’m working with my Psychiatrist to find meds that will aid me. There is no medical cure for personality disorders, however there’s hope that meds can alleviate some of the symptoms like depression and anxiety.
Realizing just how much I could lose. The opportunities, the people I love , my friends,…  the disappointment… The thought of losing them or letting them down is my biggest motivation now. I have a lot of people that I love and care about, and I want to be able to be with them in a healthy way that won’t drive them away.
You need to understand that I’ve lived with this for well over half of my life. Almost two decades of feeling like things would never get better. It’s not something you can just turn to someone and say ‘cheer up, it’ll all work out’ when so far, for so long, it hasn’t. It’s hard to see a better way when you’ve never known a better way. It requires a leap of faith. A leap that is incredibly scary when so often things smash to bits on the rocks below. It’s looking for a safe way down to the ground when your path is lined with jagged rocks and chards of glass. Fortunately there’s never just one way around the obstacles set in front of you in life. It takes a shift of perspective, but that sense of being safe in your own Self, is absolutely attainable. At least, I believe it is.
I  hope that gives some insight into your question. Thank you for asking.

The Blame Game

Everything feels like a provocation. Something always creates a reaction. Or does it?  I recently talked about Blaming, but I want to get further into it with some other stuff I’ve found that I think provides a deeper understanding of where blame comes from for someone with Borderline Personality Disorder.
The Blame Game
Dr. A.J. Mahari says that those with Borderline Personality Disorder tend to blame others for their problems and how they feel. Borderlines as a means of protecting themselves from the unrecognized and/or unconscious pain of the core wound of abandonment project their thoughts and feelings onto others. This makes everything seem to the borderline as if what is coming from or being done by him or her is actually coming from or being said or done by the loved one – the non-borderline. It can be confusing for those with BPD and crazy-making for loved ones of those with BPD. It leads to a relational dynamic that I refer to as the blame game – a game that nobody actually has a chance of winning. A game that hurts all involved in the dynamic of borderline relating that manifests in this borderline blame.
It is very typical for someone with BPD to honestly believe, while in the throes of a cognitively distorted thought process that everything they feel is someone else’s fault. So often, a person with BPD will take out their confusion and pain on those who try to care for them; on those who try to get close and try to stay close to them. What happens when someone tries to care or to be close for many with BPD is that once a certain line is crossed in closeness or familiarity the other person ceases to be who they are in the reality of the world of the borderline.

Borderline narcissism takes over. What is then experienced from the inside (usually unbeknownst to the borderline) is a very deep and intense transference. What the borderline feels deep inside (often this is a very large amount of pain) is projected out on to the close person (or caring person) who often then becomes a “parent figure” as a transference takes place – the closest loved one.

What this means is that instead of being in the here and now with someone who is trying to care about you and know you, if you have BPD, you somewhat dissociate from the here and now and re-play out an old relationship causing you to lose sight of both who the “other” is and who “you” are. This happens because many with BPD cannot meet their own needs and tend to look for others to do this for them. Needs and wants are often confused and left up to others. Borderlines are easily triggered when needs or wants aren’t met by people in their lives that have come to represent “object other”.
The borderline demands from the “object other”, who is being experienced as someone from their past. This other person, not knowing what is unfolding has no chance to be able to find the right response, or enough of any response that will please the borderline for long. The person with BPD then does the push-pull, in an effort to gain or maintain control. They feel out of control because they are re-experiencing painful feelings from their pasts. So unmet needs continue to escalate and the borderline gets angry – often to the point of rage, whether that rage is acted in or acted out – and demands more from the other person.
The other person, no doubt is confused, feeling attacked and like they can’t do anything “right” enough begins to pull away, in one form or another. This is the classic repeat of the borderline nightmare of abandonment.
But if you have BPD, and you haven’t worked through this you may not realize that you, yourself are causing your own re-abandonment. The abandonment is perceived abandonment. In reality they are not abandoning you they are taking care of themselves, which every human being has both the right and responsibility to do. 
The Blame Game: Person A feels blamed by the borderline. The borderline feels blamed and shamed and let down and abandoned by person A. Person A then feels attacked by the borderline. Person A may attack back. The borderline then feels like a helpless victim which will then precipitate either their further acting out or acting in. Acting out often means rage, punishment, and verbal abuse aimed at the loved one. Acting in by the person with BPD often means an inner-rage often not consciously connected to and punishing the loved one in the form of the silent treatment.
Person A then feels like they’re in a no-win situation. The borderline keeps upping the ante, demanding what he/she needs and wants in often less than direct and highly manipulative ways. At this point the borderline has regressed to a child-like state wherein, for them, they are the center of the universe (this is where the BPD narcissism comes in). This is their reality. The other person, person A, has no idea now what is going on. Loved ones need to learn how break free from what keeps them from living with healthier boundaries and find their own healing and recovery.
The blame game begins right here. The borderline blames the person A for (essentially whatever those close in childhood did to him/her) everything. Usually the borderline cannot see their role in this. (Not until a certain amount of healing has taken place.) Person A blames the borderline. Then both blame the borderline’s past. Others in their lives, jobs, therapists….etc may also be blamed. No one knows how to take responsibility here and usually at this point enmeshment is deep and intense. When any two people get enmeshed everything can seem foggy and unclear. From this clouded haze each party, like a blind bird flying in the wind seeks control in an effort to protect themselves and to try to regain some balance.
For person A in this scenario you cannot “win”. You are going to be blamed because often the borderline has lost total sight of you. (Or will for periods of time) You have become someone from their past that they could not trust.
The key to understanding what becomes the “blame game” is for the person with BPD to want to get better. To want to get better means be ready to face the pain. It is only when you face the pain that you will begin to gain a healthy perspective from which you can then think in less frequently-distorted ways to the point where you will be able to recognize when you are so triggered as to blur your past with someone in your present. The process of recovery from BPD requires that each person with BPD find ways to gain more awareness of what must be learned and accepted in order to take personal responsibility for in his or her life and for the regulation of his or her own triggered dysregulated emotions.
Personal responsibility is key here as well. You must take responsibility for your needs, your wants, your pain, your actions and you must learn that there is no excuse for abuse. Blaming anyone else, even someone who abused or hurt you in childhood is not going to help you heal now. It will not help you meet your needs. It will not help you learn how to maintain relationships. It will not help you to find yourself. It will only continue to support your staying stuck in borderline suffering due to what amounts to continuing to choose to abandon your pain.
Blame is a defense mechanism. The pain is real. The pain feels immediate. It can also feel very overwhelming. If you have BPD and you do not learn to catch the triggers and see the patterns and take responsibility you will continue to drive people who care about you away and do great emotional damage to yourself and to others in the process. Blaming others will only keep you stuck in the active throes of BPD and the suffering that means in your life.
Taking responsibility for yourself and your emotions now is the only way to end the blame game and get on and stay on the road to recovery. To unwind the clues that are no doubt there in your thinking before you get into this pattern over and over again it is important to discuss with your therapist what you feel and think just before you have “blow-ups” with others, or just before you lose your temper, or just before you begin to push and pull or manipulate, control or get physically intimidating and or abusive.
What happened in your past needs to be unwound today. Blaming anyone for the choices that you’ve made as to how to cope with your past up until now is not a healthy choice. It is often a very lonely and isolating choice to make.
It is important to stop blaming anyone or anything else. Look to yourself. The way you relate to others and the ways that you experience others are generated from your own past patterns of relational experience. Experience that for those with BPD included shame of abandonment. When you open up to understanding these patterns and the ways and reasons they trigger so much emotion that is difficult to regulate or cope with you will actively be engaging the process of recovery. When you can understand the blame game you will no longer have to go there. The result will be happier and healthier patterns of relating.
These are things I think are SO important. Personal Responsibility. Take responsibility for your own actions. Stop blaming other people. I know it’s hard. I know it hurts. But what is done is done. All there is now, is to move forward. Look to solutions. The past cannot be changed, so blaming the past only furthers to keep us stuck in a black hole of hurt and hindered healing. We do have a choice in how we choose to walk into our future.

Get over it ~and~ Push Away-Pull Back: Controversy in Borderline Personality Disorder – Part 6

Previously I’ve talked about Controversy in Borderline Personality Disorder (starting here). I also said that I’d continue to update them as I stumbled upon more. Well, unsurprisingly I have found more so I’ll be adding to my previous blog series today. So, here are a couple more Controversies and Misconceptions about BPD:
Misconception: You can bring about recovery in a person with a Borderline Personality Disorder through your own actions.
Fact: Personality Disorders are Real Mental Illnesses – and they don’t depend on what anyone else does, or doesn’t do, said, or didn’t say. You can’t cure a personality disorder with love, anger, submission or ultimatums. That’s like trying to hit a puppy by throwing a live bee at it (points if you know where that line is from).
Man, if only this were true. Let a friend or loved one know you have a mental issue, let them wave their hand around your head and Poof! no more personality disorder.
I can’t tell you how many times I’ve had friends and family sit down with me, give me advice or tell me to just get over it. Growing up my dad did the latter very often. He invalidated my feels, told me suck it up and get over it. I don’t think he was intentionally trying to be mean, but he clearly wasn’t helping me develop a healthy emotional state. Granted, if I wasn’t predisposed to having such emotionally charged response to things I may not have elicited these response from him so often. They did make me afraid to show my emotions though. Like when my grandmother died, instead of allowing myself to grieve naturally I locked myself away in my closet to cry instead of voicing my hurt. I needed to suck it up and be strong for my brother and sister. Instead of processing my emotions in a situation that actually was very appropriate to be upset, I repressed how I felt because I believed that showing these feelings was bad and wrong.
My parents love me. They love me a lot. Even today my mom continues to send me holistic articles on releasing negative emotions and gaining a calmer state of mind, as if reading an article will help cure me. I know her intentions are good and she just wants me to get better. It’s her way of showing she cares, but it’s almost completely useless and makes me feel guilty for not being able to be better for them.
The point is, no matter how much you care, how guilty you feel, how much you talk about and give advice to someone with a Borderline Personality Disorder, you can’t magically make it go away. That’s not to say that you shouldn’t be there when they need you (please don’t abandon us), give your love and support, just understand that it’s not your fault if it isn’t cured.
Controversy: People with BPD can get better if they just try harder.
Fact: Although management of symptoms is possible through a combination of medications, therapy and personal work, they can’t make the disorder disappear altogether. Personality disorders are mental illnesses based on neurological differences for which there is no known cure.
This goes right along with the previously mentioned myth. Sometimes I have doubts, sometimes I’m afraid to give up the familiar feelings, sometimes I fall to hopelessness, but I don’t think anyone really wants to deal with this. If we could get better by willing ourselves into a more normal state, of course we’d do it. Personality disorders are deeply ingrained disorders built up over a lifetime, biological dispositions, and/or a combination of both. They’re characterological, not a choice. They chose us, we didn’t choose them, and we can’t tell them to take a hike whenever we want. Hell, a huge, huge number of those with Borderline Personality Disorder are not diagnosed, will never be diagnosed, and have no idea what they are going through even has a name because they don’t have the help and support they need. How do you fix something that is so much a part of you when you don’t even know there is something to work on. Even when you do, it may take years of therapy and medicinal help and encouragement to learn better coping mechanisms to deal and heal wit BPD. It is not easy to change a lifetime of living in turmoil. I’m trying. I’m trying really damn hard. I think I’m seeing progress, but I have a long ways to go.
Controversy: People with BPD are basically just selfish.
Fact: Personality Disorders have been shown in some studies to be rooted in neurological differences in the way different regions of the brain communicate with each other. This isn’t suggesting that people with PDs shouldn’t be held accountable for their own behaviors – they absolutely should. But it would also be a mistake to regard people who suffer from PDs simply as mentally healthy people who are being selfish.
This one is tricky. Everyone is selfish. Everyone. Even those people that are seemingly altruistic derive a sense of well being from helping others that brings about a feeling that they are doing good. That feeling is for that person. People don’t generally do things that make them feel bad just because someone else needs something. That said, it’s not bad to be selfish, it’s just a byproduct of being human. So yes, someone with BPD can be selfish, but this isn’t our basic nature.
Someone with BPD though, can be very needy. Extremely needy. We often need validation that are feelings are real, that someone loves us, won’t leave us and therefore a lot of attention to ‘prove’ this. We covet this and don’t want to lose it. This isn’t something we set out to do though. We don’t wake up in the morning and say, “Gee, I think I want to monopolize someone else’s mental state, attention, and resources. Selfish powers activate!” Maybe some do, but there are plenty of ‘normal’ people that do this (maybe not the ‘selfish powers activate’ part). It’s not just a product of Borderline Personality Disorder. For the most part I think it’s a fear response. Fear that we will be left, that we aren’t worthy of being loved, that people are lying and trying to use us… an endless list of other things. We need reassurance and it takes a lot of energy to show us that. Unfortunately it’s a part of our nature to need this, feel smothered by it, push it away, fear the loss of it, frantically try to retrieve it, and repeat the cycle endlessly, for as long as someone will let us. So it does appear that we are acting mostly on our own behalf. This doesn’t negate the fact that we do care about the people in our lives, this doesn’t change the fact that we love the people in our lives and want to take care of those around us. That we do have so much to give. We just need to be shown this in return to a degree that many don’t require.

I do want to stress accountability. We are responsible for our own actions. Just because we feel incredibly out of control does not mean it’s ok to Act Out. I know it’s very, very difficult to reign this in sometimes, but we do need to try. Otherwise it just ends up hurting the people around us and acts to push them away.  

Morals of the Psych ER Saga

I was actually very reluctant to post this experience.
So why am I telling you this? Because this is the ugly side of having a Borderline Personality Disorder. It’s not just the therapy and the research or relatively harmless. It’s explosive and uncontrollable. It’s frantic impulse, threats, self-harm, and actual suicide for some. In that moment I felt crazy. I was in tears, feeling hollow and abandoned, worthless. With nothing to hold onto. My mind screaming, thoughts rattling around until I couldn’t tell the difference between reason and reality. When you can’t see the next minute because your entire world is dissolving in the one you’re in; there is no next minute. Just the one you’re living in.
It is meant to scare you. It is meant to make you think. To help you understand how extreme the emotions can be, and the things they can make us do. How difficult it is to control and not get swept away in the maelstrom that is the borderline mind. This is my reality.
I really didn’t belong there. It’s certainly not something that I’m proud of. I absolutely made a very bad choice. The reason I was there was a death threat even though there was absolutely no way I would have ever done it. I do not believe in suicide as an answer. As long as you’re alive, there’s a chance. A chance that things can change. Change is a powerful thing. As long as there’s change there’s hope for something better. This is my belief.
A belief that my ex knew very well that I held. I later found out that he’d been in my position for this kind of situation too. He made a dumb impulsive decision that he had no intention of acting out and had to take the consequences. There was a little vindictiveness in his refusal to listen. That’s what I get I suppose.
I wanted attention. I certainly got it from this. Not in the way I wanted though. These things never really turn out how you want them to. Everything about it is unhealthy. This type of behavior is part of why Borderline has such a stigma for manipulation. I’ll talk more about this some other day, because I’m really just now beginning to understand what this means in terms of BPD.
I wasn’t afraid of anything that happened to me in there, though maybe I should have been. This was a very dangerous situation to be in. There is no predicting who you will be kept with. No predicting how monitored you will be. No predicting what could happen to you. Most people would not have been so calm in the face of a huge guy about to rampage. Mostly I was annoyed and inconvenienced by the whole thing.

Not to mention I lost an entire evenings worth of sleep. I ended up being awake for almost 40 hours because I couldn’t rest once I got home. No sleep is never good for me. This usually deteriorates my mental state even more. 

I was afraid that this would come back to bite me in the ass though. That it could potentially leak out, and bar me from future employment, make it impossible to get a job. This was my biggest fear.

That and the fact that my landlords were not pleased. I could have lost my apartment, which I had just moved into.
It doesn’t just affect me/you either.  I felt like utter shit once I thought to consider the other people in my life. The people that care about me. I scared my roommate. I terrified my family. I had no right to put them through that. I never stopped to consider that this could affect them too. It’s something I won’t forget again.
The consequences of things like this hit you from all sides.
Like the bill. The whole experience, most of which was just sitting around, cost $2000. No extra zero there. Two thousand dollars. The nurses that have to watch you, the psych that has to be on call, the blood work they had to do, all of it is very, very expensive. This gave me something of a heart attack. Fortunately, I was on unemployment at the time so I could get this waved, but still. Very, very expensive. In money, time, and sanity.
Always, there are consequences to my actions. I reiterate. Actions that I will never indulge again. Mistakes that I have learned from. Having been through it once, believe me, once is enough. I am not altogether unhappy that I had this experience. It has made me consider the impulsive decisions that I am prone to, want to make, and rein them in. I take full responsibility for the mistakes I’ve made, but sometimes you need a swift kick in the ass to make you remember that, had I not been so impulsive in the first place, the whole thing could have been prevented. Prevention is something I work very hard on. It has helped me control my impulses. It has helped me consider my actions. It doesn’t necessarily stop the thoughts, but it has made me work harder to control them, get help for them. I don’t want to be controlled by these kinds of thoughts and behaviors. I’ve never wanted this, but now I have a little more motivation to really work to overcome them. It’s the nature of having a Borderline Personality Disorder to act this way, but we still have a choice in the matter, and the ability to change.
All these things are what I hope people see and understand. If this experience can help someone not make these kinds of poor choices than it was worth putting this story out there. I hope it helps someone. It sure opened my eyes. 

Where are all the men?: Controversy in BPD – Part 6

Discrepancy in Gender Diagnosis
Why does it seem that men have such a low frequency of Borderline Personality Disorder?  There seems to be two main reasons.
1.)    Men are diagnosed with something else.
2.)    Men are more likely to be treated only for their major presenting symptoms.
Some studies have reported that men are more likely to be diagnosed as paranoid, passive-aggressive, narcissistic, sadistic, or with anti-social personality disorder. I’ve done a lot of research into BPD (clearly) and I’ve often come across articles that focus on BPD with ASPD. Primarily the subject study group for BPD is women, and the study group for ASPD is men. This is not necessarily an accurate distinction though.
Men and women do often present with different symptoms when you break it down to Axis I and Axis II comorbid criteria. However these symptoms are still all encompassed in the range of BPD diagnostic criteria.
Axis I co-morbid disorders:
Men with BPD tend to have higher rates of substance use disorders, while women have higher rates of PTSD and eating disorders.
There isn’t a significant difference in frequency though. These things are pretty much expected with you take into account general psychopathology/temperamental differences in gender. In things like major depressive disorder, anxiety disorders, or mood disorders there was not found to be any significant difference in BPD diagnosed gender representation.
Axis II co-morbid disorders:
There is significant difference in how men and women present in Axis II disorders which are the presentation of other personality disorder traits. Men are found to have higher rates of antisocial, narcissistic, and schizotypal personality disorders.
When you take a look at the diagnostic criteria for BPD the only real significant difference is women tend to have greater frequency of identity disturbance. Men do present slightly higher in Intense Anger and Impulsivity criteria while women tended to be a little higher in Affective instability and Avoiding abandonment.
When it comes to diagnosis between genders in BPD it was found that the function of impulsivity, how men and women tend to differ in the specific type of impulsive behavior displayed, were often different, even though the frequency was negligible. That is, Acting In or Acting Out. While women might tend towards food (internalizing behavior) men might turn towards drugs or alcohol (externalizing behavior) for self-destructive behavior. But because men tend towards externalizing it is easier to overlook the other more passive/internalized symptoms.
More aggressive acting out is likely to overshadow other symptoms that are also present. So men will be referred to anger management or therapy will focus on that particular displaying symptom, what brings it out, how to react appropriately. Or try to. I don’t know how well this works if you’re only treating one symptom and not the entire problem. Or take something like alcohol/substance abuse for example. If a woman walks into therapy and says she has a drinking problem the therapist is likely to delve into the more emotional reasons for drinking. Social stigmas for men tend to focus on the physical problem, focus on rehab and detox. They might ask what events make them want to drink and suggest how to cope with these, but not as likely to look into why they are more prone to having these reactions that cause them to imbibe in the first place.  
Additionally, finding men to have higher co-occurrences of Personality Disorders is consistent with basic differences in how men and women relate to others socially. Women are socialized to be more interpersonally connected then men. A higher percentage of men with BPD also having antisocial, narcissistic, and schizotypal PDs shows increased difficulty in relatedness to others, a typical gender difference in the more pathological forms of these PDs. For example, in a sample comprised of inpatients and outpatients, men scored significantly higher on mistrust, manipulativeness, aggression, entitlement, detachment, and disinhibition, while women scored significantly higher on negative temperament, dependency, and propriety. Because the presentation of these symptoms is different, and there is a stigma towards the more passive symptom presentations, it is easier to overlook BPD as a diagnosis in favor of a more aggressive diagnosis, like ASPD for men.
All of this muddies the ability to make distinct diagnosis in men, because there may not be a distinct diagnosis for some men or they’re not being treated for their whole problem.
Maybe men should just seek psychiatric treatment more often so clinicians can get a better idea of how their PDed brains work and take some of the stigma off of us. Come on guys, help us out here. Just kidding.  Sort of. ::smiles::

Female Problems: Controversy in BPD – Part 5

Myth: Only women have BPD, it’s female disorder. 
That’s not to say that BPD isn’t diagnosed more often in women. It certainly is with a 3:1 ration or approximately 75% of people diagnosed with BPD are women. But men have it too. There are a lot of theories about why women are diagnosed with BPD more often:
          Sexual abuse, which is common in histories of BPD patients happens more often to women than men.
This in itself is debatable. Women tend to report these things more often, but does that mean men don’t have a similar frequency?
          Women experience more inconsistent and invalidating messages in this society.
Fortunately I think this is beginning to change, but there’s still a ways to go. And it doesn’t make up for the fact that women have been treated differently than men for most of documentable history. Especially in recent decades of greater communication women have had strong messages of how we’re supposed to act, behave, look, dress, take care of others, etc. imposed upon us… and any deviation from these cultural norms has not been met with open acceptance.  We’re often told it is acceptable to be one way, but when we are it is met with negativity and sentiments of being difficult and different.
          Women are more vulnerable to BPD because they are socialized to be more dependent on others and more sensitive to rejection.
This goes along with the cultural norms imposed upon women. Personally I was taught independence to a fault, and railed against the conflicting messages of the control my parents tried to assert.  I hate the idea of being dependent on anyone. Functionally, in terms of my job, my finances, the day to day aspects of my life this holds true and anyone that questions my ability to do these things is met with a rather volatile response. I hate the idea of emotionally dependent as well. I hate it. I hate it more that this is something that I can’t control when it comes to the people I get close to and involved with. The magnitude of emotional attachment that comes with BPD is part of what makes it a disorder in the first place. Becoming dependent on someone for emotional validation does make the idea of rejection so scary. Especially when there is a tendency for black and white thinking, splitting. If you do one thing wrong, you’ll lose the love and caring of that person. If they reject one thing, they’ll reject all things, and all that will be left is loneliness and abandonment. It’s not rational, but what about this disorder really is? It’s what it feels like that makes it so devastating.
          Clinicians are biased. There have been studies that show professionals tend to diagnose BPD more often in women than men, even when patient profiles are the same.
It’s not that men aren’t diagnosed with anything, their diagnosis is just different. Men tend to display symptoms differently and meet some criteria for paranoid, passive-aggressive, narcissistic, sadistic,
and antisocial personality disorders, which leads to a diagnosis of these even when BPD is a more accurate diagnosis. Since BPD has a feminine association, it’s ruled out for men almost automatically.
          Men seek psychiatric help less often.
It’s hard to diagnose someone with something when they don’t seek help for a problem. I can’t tell you how many guys I know that refuse to even go to the regular doctor when they’re ill, let alone seek therapy. I think it has to do with a culturally cultivated concept of the male ego and how men are supposed to behave. But I could be wrong.
          Men are more likely to be treated only for their major physical presenting symptoms, not necessarily the emotional associations that correspond to them. Their BPD symptoms go unnoticed because it’s assumed to be a woman’s disorder.
          Female borderlines are in the mental health system; male borderlines are in jail.
While Acting In and Acting Out are major issues for anyone with BPD, women acting out still tends to be directed towards themselves or of a magnitude that is not so outwardly destructive. Men tend towards aggression and act out towards other people leading to different consequences.
* I was incredibly destructive and explosive. I absolutely took out my problems on myself. However I constantly picked fights with my family, explosive screaming arguments, I broke down doors, put my fist through windows and walls…though these things weren’t the kind of thing that could get me thrown in jail. However, the vandalizing, drinking, shop lifting all could have.
          There has simply been very little research specifically investigating the occurrence of BPD in men.
This couples with men seeking psychiatric help less often. It’s very difficult to form a study when you don’t have a target group to focus on. It also couples with the fact that men are diagnosed and treated with potential inaccuracy so those men where BPD does present are overlooked.
So, it’s not that Borderline Personality Disorder is only a women’s disorder it’s, again, given a biased perspective. It make me sad really, that there are so many misconceptions and biases in the mental health field. It’s getting better. In the past it was taboo, not something to ever be talked about or admitted. Today it’s pretty common to seek therapy, for men and women. There’s still a ways to go though. Part of my goals for doing this blog are to increase awareness and education for Borderline Personality Disorder. I’m in no way a clinician, but I know how I’m affected, how some people in my life are affected, and I am happy to do A LOT of research to futher my own process of change. Knowing what I’m/we’re up against, options, information, treatments… simply that we’re not alone in this struggle, is encouraging. Hopefully, and it seems to be so, others find this useful as well.
Tomorrow I’ll talk more about the difference in presentation of BPD symptoms in men vs. women.

Acting In, Acting Out with a Borderline Personality

“Most borderline behavior is about one thing: trying to cope with internal anguish. BP’s commonly manage their intense pain in two ways: they either act “in” or act “out”. Some BP’s will mainly act “in”. Some will mainly act “out”. And some will act both in andout.
Acting “out” behaviors are attempts to alleviate pain by dumping it onto someone else – for example, by raging, blaming, criticizing, making accusations, and abusing others either verbally, emotionally or physically. They blame loved ones for all their problems, put others in no-win situations, and use emotional blackmail to get the love they need. Acting-out behaviors cause direct anguish for friends, family members, and partners.
BP’s who act “in” may mutilate themselves, make suicide attempts, express self-hate, and engage in selfdestructive behavior. They may try to hold in their anger, and blame themselves for problems that are not their fault. Acting-in behaviors mostly hurt the BP themselves, although, those who love and care for them are affected.”
To pull on a BDSM term, I’m a switch. I like to think I’ve grown out of the more violent ‘acting out’ of my youth, but really I’ve just changed to almost solely internalizing and that’s not necessarily any healthier. It’s probably better for those around me, because I no longer take out my anger and frustration so overtly on those around me. However, all that anger and frustration is almost exclusively aimed at myself now. Though there are those certain occasions when something triggers me otherwise.
When I was younger (pre-diagnosis) I would rage at how little anyone seemed to understand me. Of course I also did my damnedest to keep people out of my life and my turmoil. Rarely did a day pass that I didn’t get into a screaming fight with my family. I would get in physical fights with my siblings. I would put my fists through windows, walls, kick down doors. I was wrath personified. I blamed all my problems on all things external. It was people not ‘getting’ me, people not taking the time to talk to me, people not being smart enough to understand, people not caring enough to understand, pushing my buttons to agitate me, make me uncomfortable to control me. All I saw were the things that set me off outside of me.  I didn’t understand what was going on inside me.
Through out this time however, I ‘acted in’ as well. I was suicidal. I kept what I was really feeling locked inside, not knowing how to deal with it, I’d take out my inner pain on my own flesh. I hated my life, the constant turmoil that my life was in, the pervasive feelings of hopelessness that this was all there was for me. Nothing else to look forward to. I hid these things. To me, the feelings of perpetual sadness, loneliness, these were ‘weaker’ feelings and I didn’t want anyone to know I had weak moments. The rage I felt, at least was strong.
Now, externally I’m calmer. I have developed a lot of self control over the outward manifestation of my emotions. I can still have a very sharp tongue and I do tend to criticize but I also try to temper this. Frankly I also justify my criticisms with the fact that I am incredibly intelligent and also generally honest to a fault, so when someone has an opinion or an idea that I know isn’t plausible I don’t stay quiet. I do try not to be mean, but I don’t let people run with silly ideas. Maybe I should just stay quiet and people will like me better, but that wouldn’t be me. I’d rather be disliked for who I am, than liked for who I am not. 
My self destructive behaviors have lessened significantly but they do still crop up. I’m working to end my expessions of self harm, though the thoughts can still be nagging. I have no idea how to stop these thoughts. I try to temper my drinking which can occasionally get out of control. I still have a lot of self-loathing, resentment for how my brain works and that I can’t lead a healthier life. I still struggle with hating my body image which I am also taking steps to work on. I am also prone to making impulsive decisions and letting myself get swept up in moments that would probably be better observed from the sidelines, but a girl’s got to live a little, right?
Maybe it’s maturity, or maybe it’s just being so sick and tired of living in so much turbulence. I don’t believe I can live this way any longer. The path I’ve tread most of my life will end quickly if I let myself go to the darkness. I can’t do this anymore. I want to live a happy, healthy life. One that is not wracked with such emotional upheaval. I’ve chosen to become a stronger version of myself and I’ve been doing everything in my power to not give up the only chance I have at this life.

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