Rules Regarding Spending and Gender: None

Oh it’s Friday. What should I talk about today? I absolutely cannot focus so I’m just going to start typing and we’ll see where I go with this.
         No meds induced rage yesterday. In fact I felt well rested and was very Okay all day.
         Went on date #3 with my new Lady Friend. For date #2 I took her on a picnic to a romantically secluded beach outcropping. We snuggled, had wine and watched the sunset. Note: I will be as romantic as you let me.  She’s writes me poetry.
         I made an amazing Turkish inspired 4 course meal last weekend: Almond Soup (Badem Çorbası), Potato Cigarette Borek (Patatesli Sigara Boregi), Turkish-Style Sirloin Steak in a Garlic-Fig Wine Reduction, and Honey and Nuts Snow White (Balli Cevizli Karbeyaz). Apparently I make an awe inspiring steak. This weekend I’m hoping to do Greek.
         I spend money unchecked….
Seriously. I don’t even realize I do this. I see something, and I get it. I don’t think it’s impulsive at the time. Half the time I believe it’s absolutely justified. Like I had a nervous breakdown on Monday for fear that I couldn’t do my job well enough so I looked up training courses and dropped $600 for advanced training. It’s an investment for my future with the lab, right? It took me all of 10 minutes to make this decision.
I’m tribalizing my Sith Costume b/c my character specializes in Sith alchemy and sorcery so I went to the craft store. Instead of picking out a few key pieces I just get everything I think will fit and could possibly need for my adornment construction. I go in with one or two things in mind, but I don’t stop there. And I don’t think twice about how much it will be.
Is this really a problem if I can actually afford it? I could survive on what I have in the bank, easily, for 6 months with no adjustment to my lifestyle. I have bills that are paid but otherwise no monetary obligations. I could save more I suppose. But for what? What’s the point of having money if not to spend it?
The weather is changing so I need new clothes for work. I want to fit in better at work too. I want to masculinize. I do not like the idea of appearing feminine at work. The women around my office wear skirts, and frilly office appropriate tops… I can’t fathom this. On some level I don’t respect it. I think if I were to do this I would not be taken seriously. As feminine as I get is to wear a sweater over dress slacks. I take my fashion cues from the men in my office. I want to blend in with them. Currently I dress too nice for my office, but this I also believe is acceptable. Dress slacks, button down shirts, nice sweaters. The men in my office typically wear jeans, polos, or even just plain t-shirts. With the changing weather I did just “invest” (read: drop a bunch of cash) in some new short sleeved polo shirts; black, white, and navy, which are more casual than the button down short sleeved shirts I own.


I want to purchase jeans. But not women’s jeans that tend to be form fitting. I’m going to buy men’s jeans. I don’t want to accentuate my sexual differences.
I do not want to convey a sexualized image at all. I want as androgynous as possible in my dress.
I don’t know if it’s a fear of not being taken seriously professionally.  I don’t think so because I have no qualms about pulling my hair back to display the 17 piercings (I do remove my lip ring) I have in my head. Or maybe I just appreciate the irony.
On many levels I resent being female. I resent that I have hips that curve so I can’t have a streamlined profile in my slacks. I resent that I am the minority in my field. I resent that my friendships and relationships are colored depending on the gender of the person opposing me. May it’s not being female that I resent. Maybe it’s gender in general. Or more specifically the cultural connotations that accompany gender.
How do you really know what gender you are? I’m not male. I don’t feel female. What does female feel like? It’s not something I can put on, take off, and try something else on for a comparison. Either this is it, or it’s not. There are some days I do feel very feminine and appreciate all aspects of what femininity I have. There are more days I feel very masculine. Gender and sexuality is not a categorical designation for me. It’s fluid. I identify gender neutral but really I’m gender fluid as I easily transition depending on my mood.
When I’m out with Lady Friend I’m happy to be a woman though I slip into the ‘masculine’ role. I hold doors, I pay for meals… I hate that this is considered masculine, especially considering most of the men I know =P. So fuck that. I’m reclaiming this as being the role of How I Display Appreciation For Your Company. Someone make that a better acronym or something. My brain is puffy today.
Accentuate the standards, diminish the differences. If I blend in with the dress code they won’t notice how truly different I am. I hate that I think this way. I’ve been judged, ridiculed, and debased for being who I am though. Outside in the real world I could give a fuck less what people think. Everyone can suck it up and deal. Professional environments require more finesse in order to accomplish tasks optimally. It requires playing a part in a bigger game. There’s really no point in making a fuss or standing out besides. Ultimately no one cares. What really matters is what gets done at the end of the day, not the type of pants I put on. I simply choose which face to put forward to best meet my goals for the moment. How much of any of it truly matters? Not much. Yet, we still continue to play the game.

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.