Leap Before you Look – Insufficient Self Control/Discipline

“The trouble with immediate gratification is that it’s not quick enough” ~Carrie Fisher
Let’s skip the pleasantries and jump right in, shall we?
Insufficient Self-Control/Self-Discipline
Patients who have this schema typically lack two qualities: (1) self-control – the ability to appropriately restrain one’s emotions and impulses;  and (2) self-discipline – the ability to tolerate boredom and frustration long enough o accomplish tasks. These people are unable to restrain their emotions and impulses appropriately . In both their personal and work lives, they display a pervasive difficult in delaying short-term gratification for the sake of meeting long-term goals. They seem not to learn sufficiently from experience – from the negative consequences of their behavior. They either cannot or will not exercise sufficient self-control or self-discipline.
            At the extreme end of the spectrum of this schema are people who seem like badly brought up young children. In milder forms of the schema patients display an exaggerated emphasis on avoiding discomfort. They prefer to avoid most pain, conflict, confrontation, responsibility, and overexertion – even at the cost of their personal fulfillment or integrity.
            Typical behaviors include impulsivity, distractibility, disorganization, unwillingness to persist at boring or routine tasks, intense expression of emotion, such as temper tantrums or hysteria, and habitual lateness or unreliability. All of these behaviors have in common the pursuit of short-term gratification at the expense of long-term goals.
            Every child is probably born with an impulsive mode. It’s a natural part of every human being. However the failure to bring impulsivity under sufficient control and learn self-discipline is what is maladaptive. Children are by nature, uncontrolled and undisciplined. Through experiences in our families and in society as a whole, we learn how to become more controlled and disciplined. We internalize a Healthy Adult mode that can restrain the Impulsive Child in order to meet long-term goals. Sometimes another problem, such as ADHD, makes it hard for the child to accomplish this (this is not a schema issue).
            Often, there are no specific beliefs and feelings that go along with this schema. It is rare for patients with this schema to say, “It’s right to express all my feelings” or “I should act impulsively.” Rather, people experience the schema as being outside of their control. The schema does not feel ego-syntonic in the way that other schemas do. In fact, most people with this schema WANT to be more self-controlled and self-disciplined: They keep trying, but cannot seem to sustain their efforts for very long.
            The impulsive mode is also the mode in which a person can be spontaneous and uninhibited. A person in this mode can play, be light, and have fun. There is a positive side to the mode, but when it is excessive – when it is not balanced by other sides of the self – the cost exceeds the benefit, and the mode becomes destructive to the person.
Goals of Treatment
            The basic goal is to help patients recognize the value of giving up short-term gratification for the sake of long-term goals. The benefits of venting one’s emotions or doing what is immediately pleasurable are not worth the costs in career advancement, achievement, getting along with other people, and low self-esteem.
Strategies Emphasized in Treatment
            The basic idea is: Between the impulse and the action, you must learn to insert thought. It is important to learn to think through the consequences of giving in to the impulse before acting it out.
            Occasionally the Insufficient Self-Control/Self Discipline schema is linked with another schema that may be more primary. For example, sometimes the schema erupts because patients have suppressed too much emotion for too long. This often happens with the Subjugation schema. Over long periods of time, people with the Subjugation schema do not express anger when they feel it. Gradually, their anger accumulates, then suddenly bursts forth in an out-of-control way. When patients display a pattern of swinging between prolonged passivity and sudden fits of aggression, they often have underlying Subjugation schemas. If a person can learn to express what they need and feel appropriately in the moment the anger will not build up in the background. The less people suppress their needs and feelings, the less likely they become to behave impulsively.
In terms of this schema, this is exactly where my problem lies. From the age of 8 years old I was raised in the martial arts. Control and Discipline are two words that are deeply ingrained into my mindset. If you lose control, people get hurt. Outwardly I always appear in control. However for me, this also means suppression of my emotional states. I was told not to express my feelings, not to let people see my next move. So I suppress, subjugate, what I’m actually feeling. This is coupled with the fact that, despite how much I know my father loved me, he was the parent that was primarily responsible for me growing up and he taught me to “suck it up” and not show when things were upsetting to me. I don’t ever recall a time when he tried to understand what was upsetting me. I only remember being told to stop expressing any negative emotion. To this day, any time I feel any kind of emotion that is not ‘positive’ or ‘strong’ I hide it from showing and refuse to express it. I put on a tough face and let people believe that I am unphased. This would result in the most magnificent explosions of anger and violence from me. By the time I turned 12 I began to lose my ability to control my temper. My frustration tolerance was non existent. One morning I was having trouble getting my hair perfect (I was borderline OCD was many things) and put my fist through the bathroom wall in a fit of rage. I would having screaming arguments with my parents almost every single day. I broke down doors, put my fists through windows and walls, my rage was absolutely uncontrollable. It wasn’t just anger that was impulsive though. Stealing, vandalism, sex…. I needed to feel better and I needed to feel better now.
            It’s often helpful to imagine past and current scenes in which insufficient self-control or self-discipline was displayed. From here the scene can be revisited but from the perspective of how a Healthy Adult would act in the situation and exert self-control. This is especially important for people with Borderline Personality Disorder. Because of their Subjugation schemas, people with BPD feel that they are not allowed to express their needs and feelings. Whenever they do, they feel they deserve to be punished by their internalized Punitive Parent. They repeatedly suppress their needs and feelings. As time passed, their needs and feelings build up, beyond their ability to contain them, and then the person flips into the Angry Child mode in order to express them. They suddenly become enraged and impulsive. When this happens, it’s important to vent the frustration fully, treat the situation with empathy, but also reality-check to measure the magnitude of the reaction in proportion to the actual event that triggered it.
I also completely relate to this aspect of Subjugation and needing to punish myself. I absolutely do not believe that I could express what I needed or felt. Hell, I still feel like this. I feel like I have no right to expect others to think about what I need. It’s my responsibility and my responsibility alone to think of myself (though I desperately wish someone would, at least every now and again)… usually after I’ve thought about everyone else first. Letting other people know that I need things is akin to admitting to weakness. Weakness means being vulnerable. Being vulnerable means someone has the chance to take advantage of you. That is not acceptable. So I hold it all in. Bottle it all up. And that works. Until I’m shaken by something. The internal pressure becomes too much. And then it all explodes.
            When the lack of parental involvement in childhood is the origin of this schema it’s important to establish limits and set boundaries.
Special Problems with This Schema
            Sometimes the schema appears to be biologically based and therefore very hard to change with therapy alone, for example, when the patient has a learning problem such as ADHD. If the schema is biologically based, then even when patients are highly motivated and expend tgreat effort, they may be unable to develop sufficient self-control and self-discipline. In practice, it is often unclear how much the schema is linked to temperament and how much it is related to insufficient limits in childhood. Medication should be considered for patients who have persistent difficulty fighting the schema despite an apparent commitment to therapy.
I wonder if this isn’t why so many kids are diagnosed ADHD these days. Instead of taking a good look at the parents and the home life, doctors just jump to the conclusion that it’s biologically determined. They don’t stop to consider that maybe kids aren’t being raised with any/enough discipline or boundaries. Doctors don’t want to make a judgment and blame the parents so they avoid the potential for uncomfortable truths and push for the prescriptions instead.
Advertisements

Sexual Deviation: A Diagnostic Criteria in BPD

I’ve been reading again. This time I found two articles discussing sexual behavior in those with a Borderline Personality.
I couldn’t find good picture today

The first was Sexual Behavior in Borderline Personality: A Review by Randy A. Sansone, MD. And Lori A. Sansone, MD. According to the DSV-IV, various forms of impulsivity are associated with borderline personality disorder, including sexual impulsivity. The existing empirical literature indicates that patients with borderline personality disorder appear to differ from patients without this personality disorder in a number of relevant ways. Specifically, those with borderline personality disorder are more likely to exhibit greater sexual preoccupation, have earlier sexual exposure, engage in casual sexual relationships, report a greater number of different sexual partners as well as promiscuity, and engage in homosexual experiences. In addition, patients with borderline personality disorder appear to be characterized by a greater number of high-risk sexual behaviors; a higher likelihood of having been coerced to have sex, experiencing date rape, or being raped by a stranger. Overall, the psychological themes relating to sexual behavior in borderline personality disorder appear to be characterized by impulsivity and victimization.
Impulsivity is represented by: greater sexual preoccupation, earlier sexual exposure, more casual sexual relationships, a greater number of different sexual partners, promiscuity, and homosexual experiences.
Victimization is represented by: a greater number of high-risk sexual behaviors; a greater likelihood of being coerced to have sex, date rape, and/or rape by a stranger.
The authors created a compilation of 12 databases from both psychiatric and non-psychiatric sources and found that those with BPD reported approximately twice the number of different sexual partners. One clinician noted that more than 25% of his outpatients with BPD exhibited promiscuity which was decidedly uncommon from his non-BPD patients. In another empirical study it was shown that women with BPD showed evidence of greater sexual assertiveness, erotophilic attitudes, sexual esteem, sexual preoccupation, and sexual dissatisfaction. The article goes on to say that individuals with BPD reported earlier sexual experiences as well as a greater likelihood of date rape.  It also showed those with BPD as being significantly more likely to report having been raped by a stranger and having been coerced into having sex.
In reading this article I was amused that they described patients as “suffering” from promiscuity. Really? Because getting laid a lot really sucks. I was also fairly angry that it stated “patients with BPD exhibit heightened sexual impulsivity as well as a vulnerability to homosexual experiences”. Vulnerability to homosexual experience? As if it’s a bad thing? This article was written by a close minded bigot as far as I’m concerned. Clearly I’m not heterosexual. Frankly, I’m more vulnerable in heterosexual relationships than I am in homosexual ones. This makes me really furious that there would be such anti-homosexual sentiment in a recent medical publication. It’s 2011 for fraks sake! I think what they meant was ‘being more open to homosexual experiences’.
According to this article there are only 2 studies that seem to counter these trends. The only real conclusions that this article seems to draw are that people with BPD may have a higher risk for sexually transmitted disease. Well, sure, that follows, but it doesn’t get into any psychological reasoning for WHY this behavior seems so common.
In fact I think the last two sentences are the most relevant, “ In summary, the psychodynamic theme of impulsivity, as described in the DSM IV, appears to be a legitimate sub-criterion in many patients with BPD. What seems to be missing in the current descriptors is the undertones of victimization that also characterizes the sexual behavior of these patients.”
Basically it says that the criteria of impulsivity is a good indicator for BPD, especially in terms of sexual impulsivity, except it should also note that there is an increased risk of victimization and/or feelings of victimization. This at least I find useful.
I’m not going to lie. I think about sex a lot. And I do mean, A LOT. My sex drive is uncommonly high from my observations amongst my own friends and I often fantasize about seducing those around me. Not for any real attraction to them, often just out of curiosity to see if I could, though in my defense I very rarely act on this.
In another article by Sansone and Wiederman they assessed two types of sexual impulsivity 1) having sex with individuals whom respondents hardly knew (casual sexual relationships) and 2) promiscuity. Again, the goal seems to have been to determine if there was genuine empirical support for sexual impulsivity to be a diagnostic criterion. While many of the findings from the previous article supported this, findings from Dr. Zanarini found that 41% of  his BPD patients avoided sexual relationships entirely. So who do you believe? Well, that’s the point of this article.
The items for the current study relating to sexual impulsivity were as follows: 1) the Personality Disorder Questionnaires** item referring to casual sexual relationships: “I have done things on impulse that can get me into trouble…[such as] having sex [acts of a sexual nature] with people I hardly know”) and (2) Self Harm Inventory item 11: “Have you ever intentionally, or on purpose,…been promiscuous [i.e., had many sexual partners]?”.
Yes, and yes. Surprise. Now does having done these things mean you are one step closer to having a Borderline Personality Disorder? Not even close. Don’t forget you still need at least a couple more impulsive traits and 4 other DSM-IV diagnostic criteria. You may just enjoy sex.  Congrats. More power to you.
Promiscuous: I certainly am. I don’t seem to manage casual sexual relationships though. I’ve had many that I intended to be as such, but they always seem to progress and evolve into something long term so they’ve never ended up being truly casual. Even my promiscuity involves being in relationships of a significant duration. Sooo, what? I’m not as slutty as the stigma would have you believe.
Anyways, through all the technical jargon and statistics in these articles the general conclusion was this: The prevalence of these behaviors was approximately doubled among those with Borderline symptomology.  The data supports the concept that a substantial minority of patients with borderline personality disorder evidence casual sexual behavior as well as promiscuity and thereby supports the inclusion of this criterion in the assessment of Borderline Personality Disorder. 
These studies only compared those with Borderline impulsivity to those without a borderline diagnosis. I’d be curious to see how this compared to other personality disorders or personality types that were marked by impulsive behavior.
When I found these articles I was expecting something more along the lines of explaining and understanding why this phenomena is greater in those with BPD. Instead they were more a clinical study to justify the diagnostic criterion. So next I think I want to: Look at the study that provides counter evidence. Understand the ‘why’ behind this kind of behavior.
Going from my own personal experience I’m not going to argue their findings. I can’t. I have no reason to. The whole point of this blog is to be honest about my journey through this disorder after all and frankly, I’m not really ashamed of anything I’ve done in this arena. Have I had a lot of partners? Compared to some, sure. Am I impulsive and promiscuous? Well, yes. Am I preoccupied by thoughts of sex?  Definitely. Does that mean everyone with a Borderline Personality Disorder is? Not at all. However, now that we’ve determined that this is a valid diagnostic criteria, let’s look at why we crave this kind of attention. I know I have theories already.
My final question: How can two articles about BPD and sex be so bloody freaking boring. Yeesh.

** PDQ-R32 or PDQ- 48

Threat of Intimacy

Acting on Impulse. Reckless Sex. Being Promiscuous.

It’s all the same right? Not quite.
Impulsive behavior, or acting without thinking about the consequences of a behavior, is one of the symptoms of BPD listed in the DSM-IV. Impulsive behavior can include many different types of acts (Spending Sprees, Shoplifting, Drinking&Drugging, Dangerous Situations, Stripping, and  yes, Sex), but reckless sexual behavior seems to be a more common one among people with BPD (and Histrionic PD).
“People with BPD are most at risk of engaging in impulsive acts when they are experiencing intense emotional responses, or when they are disinhibited by alcohol or substances. Intense sadness, fear, jealousy, or positive emotions may lead to impulsive sexuality.
Why might people with BPD be more promiscuous? One possibility is that people with BPD use sex to combat feelings of emptiness that are associated with the disorder. When feeling empty, numb, lonely, or bored, sex may generate positive emotional responses.”
I’d like some intense emotional response on top of my intense emotional response please. With a cherry on top. What? No cherry? Yeah, that’s gone. It’s almost like a drug. When you’re already so emotionally driven, adding a situation that is even more intense can push me into an almost emotional high. If it’s someone I have a strong attachment to, the world slips away in a rush of touch, sweat and sensation. As someone that longs to escape the mundane and boredom that often suffuses my life and drives me to depression, sex, is the ultimate escapism.
“These patients struggle with feelings of depression, loneliness and isolation; they’re caught in a spiral of self-destructive behavior that eventually sabotages their lives. Lacking a stable sense of self, they attempt to compensate by seeking satisfaction in material possessions, superficial friendships and impersonal sexual encounters. They substitute empty lifestyles for real lives and shy away from channeling their energies into personal growth and fulfillment.”
I wouldn’t say I channel my energy away from personal growth and fulfillment. I wouldn’t say it, but that doesn’t mean it isn’t strictly true; at least in areas concerning healthy relationships. I have a lot of incredibly fulfilling hobbies and pursuits so I know this isn’t pervasive in my life but I can see the patterns of it in some aspects of me. The relationship aspects of me. Cognitively I know when I have a good thing going for me. Hell, cognitively I know when I have a bad thing going for me. But I get so swept up in not wanting to be alone, being bored, needing to fill the time, the space, the emptiness that I act without regard for the consequences that will inevitably follow. It’s not that my life is empty, it just feels so hollow some days and I’ll do anything to fill the void. Heh. I just don’t know what I want. Don’t know how to internalize what I should want. It’s easier to figure out what other people want.
I wonder if there’s an aspect of:  if I can give someone what they want, maybe I’ll have that feeling of satisfaction as well. I’ll understand what it means to have something I want, vicariously. I’m good at knowing what other people want. It’s very natural for me to quickly deduce what will make someone happy, make their life easier, turn them off or turn them on. It’s almost a game figuring out how to give that to them. It’s fun for me, for a while. Except it’s not really for me. I do things for other people, elsewhere, lock myself into some convoluted commitment and suddenly I’m trapped inside my own skin, clawing to get out of the situation I set myself up to fall from.  It’s like wearing a mask made from someone else’s desires. I forget what my own face looks like underneath.
A lot of people have occasional doubts about their identity and self-worth. There are times I’m not sure I even know what these things even are. Some days I am absolutely confident in my sense of worth. I do know I have value. Unfortunately it’s often after receiving validation from someone that I’ve done something for. Sex is the ultimate validation of desire isn’t it? It’s a very visceral display of approval for the things I can do. I wonder if I don’t seek this kind of attention to validate my own sense of worth. If I can get someone to want me enough to be with me, than I must be doing something worthy of their appreciation. Something, alright. In this manner it skews my tenuous sense of identity. I am who I am, and that’s whoever I need me to be. Or whomever I perceive that you want me to be. Ok, not to such an extreme. I’m not quite that kind of chameleon, but I can be. I just don’t want to be.
One psychologist postulates that adopting this sort of false Self is a way to cope.
“People dominated by false Self adopt an illusion of coping, which substitutes for genuine self-assertion. They depend on others to constantly provide them with a sense of internal security, a way of relieving feelings of worthlessness. The borderline personality is constantly on the defensive, guarding against intimacy out of a twin fear of being engulfed and abandoned. While it’s natural to feel anxious about a new relationship, most of us realize that we need love in our lives. The borderline, however, is incapable of handling closeness and substitutes inappropriate relationships with unavailable partners.
The threat of intimacy may lead a borderline patient to become promiscuous. Since her fears make her unable to make a lasting commitment to one person, she goes from one lover to another, acting out the fantasy of somebody taking care of her. Sex tends to be mechanical, in order to avoid the powerful drive to emotional intimacy that accompanies sex. What she seeks is not orgasm but being held, as if to compensate for her not having been held as a child.”
The threat of intimacy. This rings so true to me I can’t emphasize this point enough. I just like the phrase: the threat of intimacy.
“In addition to engaging in reckless or impulsive sex, there is evidence that people with BPD are more prone to being sexually promiscuous. This differs from impulsive sex in that promiscuity is the act of intentionally having multiple sexual partners (rather than having casual sex on a whim).”

So there’s the difference between just being sexually impulsive and being sexually promiscuous.

For example, as soon as Boring-Ex and I broke up, I was able to begin involvement with a girl I’d liked for years… and her girlfriend… and the misguided drama polygon with Friend… and my best female friend at the time. For the record, let me state that I operate in a group of people that view polyamory as almost the norm and no we’re not mormon. It’s not unusual for my friends to have open marriages and multiple partners so I don’t actually view this as being very deviant. My Therapist would disagree.  

I don’t mind being the secondary relationship of a poly couple. At least in the past I haven’t. It allows me to maintain my illusion of intimacy while not having the focus primarily upon me. When you’re involved in a polyamorous relationship and you’re not the primary significant other, there’s a safety from that threat of intimacy that arises. I was close, but not living with her. When I needed space it was fine because odds are her other girlfriend needed attention… and on it went. This works great, until it doesn’t, and I want more than I’m able to have. The question though: Do I want more because I really want more, or because I know I can’t have it? Hm.
I don’t necessarily want to have multiple partners. What I want is to be close, but not too close. I can’t figure out how to do this without pushing away and pulling closer. Allowing someone in, and then forcing them back out. I don’t set out to be promiscuous, I’m honestly not even sure it’s my fault. Or how it happens. I hermit away and I don’t have to worry about any of it. I’m secluded so I have no people to bother me. Really it’s as soon as I start putting myself out there that people begin to take an elevated interest in me. When I’m actively seeing someone though, it’s like a red cape is waved in front of the eyes of the bystanders that shouts at my potential unavailability and they begin to charge. My problem is, when faced with a fight or flight response, I tend to fight. I don’t run, I don’t stop, I don’t say no. I engage. With only vague thoughts that I could end up emotionally maimed, the act is practically impulsive. I don’t think about other people when they’re not in my immediate vicinity (people I’m not very attached to), because it’s like they’re no longer a part of my life. For as much as I hate to be alone, and want to have someone near, I do not attach easily. This is my problem with having a lack of object constancy. But when they are around…  Once I do finally attach my thoughts border on obsessive and I can’t extricate my mind. Once that happens there’s almost no thought or desire to allow anyone else near me and the problem of promiscuity disappears as quickly as it, came::grin:: What I’m getting at is, I don’t set out to be promiscuous, it just sort of falls in my lap. Or I fall into its lap. I don’t know. I blame the booze.
What I really want is to be close, and able to embrace that closeness without the terror of impending abandonment gripping my heart. That’s all I really want. My problem is I have no idea how to go about getting it. I’m trying. I’m actively focusing on things that are considered healthy in this new relationship with my Lady Friend. It’s so incredibly frustrating to know that what I’m doing, I have to do, because I’m simply incapable of being normal naturally. It shouldn’t be so hard to seek happiness. I know I really shouldn’t be seeking happiness in someone else. Everyone wants to be loved. It’s not really a matter of finding someone else to make me happy though, so much as finding someone that I can be happy with myself, with. If that makes any sense.

var _gaq = _gaq || []; _gaq.push([‘_setAccount’, ‘UA-21268009-4’]); _gaq.push([‘_trackPageview’]); (function() { var ga = document.createElement(‘script’); ga.type = ‘text/javascript’; ga.async = true; ga.src = (‘https:’ == document.location.protocol ? ‘https://ssl’ : ‘http://www’) + ‘.google-analytics.com/ga.js’; var s = document.getElementsByTagName(‘script’)[0]; s.parentNode.insertBefore(ga, s); })();

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.



::wink::



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::

Self destructive impulse

I just don’t know how to be alone some days. I know. Shut it. 
I’ve been kind of a hermit lately. Off the grid sort of anti-social. I’m always around people at work and my roommate is always here in the evening so it’s not like I’m really alone. Might not be talking or anything but I still feel her presence. 
My roommate is gone for the weekend. I hate being alone in the apartment for long periods of time.

I take for granted that she’s around so much. I take for granted the affect that having her here has on me.

I don’t always recognize how it affects me though. Or that it does in the first place. Like Thursday.

She was gone Thursday. I got home from therapy, was alternately very frustrated b/c of my therapist and increasingly hypomanic. Left alone to my own devices I make mildly irresponsible (destructive) decisions. I’ve been trying to drink less, but I mixed myself a drink and a half.  This lead to me just being more hyper and prolific. Also hungrier. I’ve been very, very good about watching what I eat, but I completely binged. Being bulimic you can imagine what followed that. I haven’t done that in many months. Everything goes so fast. From start to finish not a second to stop and think.  Roommate came home eventually and I basically hid myself away after that, didn’t say anything, but she was home and I just felt better. 
Last night Roommate said she’d see me in a couple days, headed out and I went about my evening.  I went to Friends, which was only mildly uncomfortable for me. He had sort of a non-stop  need to fill the silence chatter going on which is unusual. I was mostly sleepy. I didn’t really have any great need to stay but I didn’t want to come home. I hate coming back to an empty apartment. Meh. It’s too quiet. Too empty. My room is too isolated. I can’t hear if anyone gets in our not. I pull my comforter out into the living room and crash on the couch. Ever since I was little, in high school, through college, if my brother or sister were gone for the night/weekend I always sleep in the living room where I can hear better if someone tries to get in. It’s more open and lived in. Meh. IDK. It just feels safer. 
Woke up this morning. Really hard to even pull myself to a sitting position. I just wanted to stay curled up.  I went to the gym. Came back. Empty apartment. I just feel, hollow. I know I could call people and make plans, but I’m already turning inward. Day already feels too long. There’s too much time to fill and I have no thoughts for how to fill it. I just want this low level anxiety to calm down. My psychiatrist doesn’t prescribe anti-anxietals and I need a new PCP so I’m out of Xanax. Pour myself a drink instead. 
I even told Friend that I didn’t think that I quit the drinking thing. I could see my fingers moving just for a reaction, any reaction, attention, but then I just got annoyed upon getting a response. Not about what the response was, just that he texted me back. I was more annoyed at myself for bothering to text him.  
One drink turns into half a bottle of wine. Turns into eating to soak up the alcohol, turns into freaking out about how many calories I’ve consumed, but I’ve already fucked up this much and it’s actually easier to get rid of everything if I’m filled to capacity so I make myself everything else I want. My wine is awful (that’s what I get for listening to the lady at the liquor store), switch to Jameson while I cook so the alcohol absorbs into my bloodstream while my stomach is still relatively empty. Vodka, wine, whiskey…. Bingeing on everything I have in the apartment (which admittedly isn’t all that much), finally so full that it’s easy to get rid of everything. Release. Release  from the anxiety, my thoughts,  my loneliness, from an endless few hours of uncertainty, trying to figure out how to just get through them. The span of 3 hours from start to finish. Then sleep. 
My favorite part being the residual alcohol in my blood just makes me sleepy enough to pass out at 5pm for a  2 hour nap. Sleeping is the best thing for me. Unconscious time machine. Time passing faster when my eyes are closed. Can’t be lonely when you’re not conscious.
I am not very social lately. With the exception of the first year or two when I moved to NY, I’ve never been very social, but less so than usual lately. But I haven’t really been alone, alone, too often.  This sucks so much.

Being alone is intolerable, but I don’t want to leave, don’t want to go out either. It’s just as intolerable but in a different way.  Ugh. I went to Friends last night, which was fine as far as that went. I was surrounded by a bunch of engaging people. I just don’t know. I wasn’t alone, but I didn’t feel /with/ anyone either. I always feel separate. It’s better than actually being separate though. There’s just no winning. Alone. Not alone. Still alone. 
 I eat. I drink. To keep myself busy.  I know before I start this shit that it’s not healthy for me, but I can’t stop myself. I just keep going, feeling more and more guilty the further in I get.  I’m sure my therapist would say this is poor impulse control. I’ve been doing this too long. I know this is bad, but it doesn’t feel bad. It feels normal, just another Saturday afternoon. That, is a problem.

I’m not even sure I can call it a relapse. Well the bulimic tendency, yes, but everything else? This is exactly what I’m working to stop, but it just seems like no matter how much work I do I still slip. I keep falling back into bad habits and screwing up. No one is perfect. I get that. I know there’s a certain amount of relapsing in the recovery process but I can’t help feeling like I’m not making any progress. Maybe I expect too much of myself. I’ve been dealing with this shit for so long, I just want it to be done. I want to feel better. At least, not crazy. I know I have to keep trying, keep working. Just because I have a couple bad days doesn’t mean everything is a wash. ::sigh:: Tomorrow is a new day. A new chance. I’ll just have to try to be better come morning.  

More sex… Criteria 4/ Impulsive Behavior Part 9b

Sex. Attraction. I don’t really have a type of person that I’m drawn to, but I do tend to like more assertive people. More aggressive. I like men that can take charge and challenge my dominance or strong women with soft well trimmed features that give me a run for my money. That softness, femininity coupled with an inner strength appeals incredibly. There’s something in being with a woman that I don’t get with guys. A connection. I don’t believe that sex should be meaningful, but there should be some kind of connection, even if it’s just for a night or two. Some spark of excitement. Heat. Intensity. Some thing that attracts. Without that kind of attraction sex becomes pretty pointless for me. I could do more for myself without exerting so much effort. This is probably why I don’t just jump into bed with anyone to feel something. Most people don’t have substance enough to hold my attention, connection.

I love being maimed during sex. Tooth and nail, biting, scratching… marked. The best sex is rough. The best foreplay is fighting. I had a friend that I used to spar with (I never actually screwed him). We would beat the shit out of each other but the sexual tension was palpable. I’d wake up covered head to toe in deep bruises and feel like I just had a night of the greatest sex. Of course, everyone else was horrified at my bruises but I loved them. Marks of an evening well spent.

Oh that’s not to say that sex can’t be good if it’s not rough, it definitely can be, but that’s what really gets my blood flowing. Sometimes literally.

I don’t really understand why I like things that hurt me. When I can throw all of my repressed emotional turbulence into the heat of a moment I feel free. It’s fun, exhilarating, almost intoxicating. I like dangerous things and the adrenaline rush. I guess that’s something I should work through with my therapist. Maybe I’m really just an adrenaline junkie. Does it really matter what society thinks at all? Sometimes it makes me sick, why does it mean there’s anything wrong with me? Maybe I’m just more in tune with myself, less repressed than the rest of society. It’s them that are all stuck and jammed down, I’m more free. Who the hell knows….

Sex… Yes, Please. – Criteria 4 / Impulsive Behavior Part 9

Sex. Being promiscuous.
This is one of the trademark Borderline attributes. There’s no point denying that this is one of my ‘issues’. So I won’t. I love sex. I am a very sexual, sensual creature. I love the flirting, the game of it all. Seeing what get’s people going and what each button does. It doesn’t take a whole lot to get me to bed… if you’re a woman. I have a lot of issues with men. It takes me a very long time to warm up to a man, if I do at all. And I never sleep with more than one guy at a time, if I choose to sleep with men at all. Now, women on the other hand.
Women.
I love the feel of women. The soft curves, the delicate scent. They way their body hugs my own, how our curves fit together. I can see an attractive woman and just KNOW that I want her. This doesn’t happen with guys, I never just see a guy and think he’s good looking enough to jump in bed with. Sex with men is invasive, a violation. It takes a long time for me to get past the point where the idea of having sex with a guy no longer feels intrusive. Even then, I believe men just want to use me for sex. Some part of me always resents men afterwards. With very rare exception, I will never be convinced that men don’t have ulterior motives when befriending me. I’m always suspicious. Oddly it doesn’t bother me when women do this though. Maybe because there’s always been more there, something deeper. I’ve had no truly traumatic experiences with women.
I have with men. Consequently, sex with men has all the appeal of getting stabbed in the vag with a blunt object. Or maybe the men I’ve managed to fall into bed with are just boring. Oh, not always. There have been a few to get past my walls, and curl my toes, but most don’t have the patience for this and that’s just fine by me. With women there’s an equality I don’t generally feel with men. A natural ease and flow.
But, sex, I do so love sex. It’s one of the few times it’s absolutely appropriate for me to lose any hold of my rational mind. Sex is heat, passion, intense. I FEEL, and only feel. Sex turns off my brain and just lets my body go.
One of my greatest weaknesses is simple human contact. Just touching me makes me feel more connected, less dissociated. With my dissociative disorder I process emotion from a different place. As mentioned before I can either Think about my emotions, rationally but detached from actually feeling them, or Feel my emotions but lose hold on the rational mindset that tempers them. If it’s someone I’m close to, intimate with, physical contact is like a life line tethering me to reality. Sex amplifies this; times a thousand. Fully physical, and fully connected. It’s a heady experience to say the least.

It’s no small wonder I want to reach for this feeling. If I’m attracted to a woman I won’t think twice before wanting to sleep with her. There will be no doubts. With men there are always doubts and suspicions at first. This doesn’t mean I always jump in bed with women though. Attraction to me is not just physical appearance. It’s attitude, demeanor, intelligence, personality. You can be the prettiest person on the planet but if your attitude sucks I’ll have zero attraction and want nothing to do with you. But if a person is able to stimulate my mind, my intellect, as well as my sex drive, the melding is intense. Pulling all aspects of me together. It’s about as close to spiritual experience as I get.

Generally the more interested I am in a person, if I want to cultivate a relationship or there are other circumstances I will take things slower. I know what it is to be used, and I don’t want to leave anyone that I could care about with this feeling. That doesn’t mean it’s not on my mind though.

I love to talk about sex, wrap myself in the idea and play of it all. In sex I’m free to feel. There’s no disconnect because I’m feeling when I SHOULD be feeling. I don’t feel myself two feet to the left of the situation because it’s appropriate for me to let loose. When I can throw logic to the wind and let my blood pump, my body connect, my inhibitions are lowered in the flood gate and finally I can just feel. Everything

Stripping – Criteria 4 / Impulsive Behavior Part 8

One of the most dangerous situations I put myself in nightly was when I started stripping. I was unemployed so a couple of friends convinced me to do it. Now, I’m small and athletic so I have a good body, but I also have a very high sense of self worth, a poor sense of body image and a major problem with men touching me. I wasn’t sure I’d be able to be objectified, oggled,and groped, with my body so exposed . I thought I’d be self-concious and degraded.
Quite the opposite happened in fact.
My self-esteem elevated and I learned that I may not be what is attractive to some, but everyone has different tastes and 95% of the time I was made to feel like a goddess. A goddess seducing men out of their money, but still. It was all a role play for me. I partitioned my personality, placed my core in a sacred space to be protected, created a stage name and a faux ‘real’ persona and let my character take over. She was a seductress. A nerdy gothic seductress. My niche was killer when I was on stage, dancing, disrobing. Hot, heavy, metal music, grinding to the rhythm of my hips swinging around the pole, I was free. No thoughts of self consciousness, just me and the music. There was no end to my potential for clients. This seems like a good thing, until it’s not. I put a lot of faith in the bouncers. One night I was doing a private room dance and the guy tried pinning my wrists to get me to kiss him. I wouldn’t. The bouncers had to intervene three times before throwing him bodily from the club. Other nights I’d have men wait for me, follow me to my car, ask me for rides until the bouncers moved them away from my car. Every night men gave me their numbers, promised me money, clothes, flash and adventure if I’d come home to them after my shift. I never did, but I could have. I learned to use my body as my primary means of communication. Dealing with clients was the greater of my trouble but they always fell for my seductive lies leaving my garters filled from emptying their pockets. And they tried to push every inch of advantage they could get away with.

The money coupled with the post feminist feeling of self confidence and liberation, feeling comfortable and beautiful in my own skin was the greatest thing I took from this experience. Never in my life would I have ever considered stripping because my body image was so bad, despite everyone’s protests. When I made the decision I just did it. And didn’t look back. This is why I always try things, jump right in, because worrying about things is always worse than the actual doing of things.

Dangerous Situations – Criteria 4 / Impulsive Behavior Part 7

I find what suits me by jumping in, feet first. If there is a walk of life I don’t understand, an experience I haven’t tried, I just do it. Somewhere along the way I consider the consequences but I don’t feel I’m fully justified in making an assessment of something until I’ve tried it on. The one exception to this is I’ve never done drugs, I’ve been tempted but I value my brain too much. My body though, well, my body is tough, it can take the wear and tear.
When I was younger and thought I wasn’t into guys, I didn’t sit and ponder it, I just started dating girls. I met women on-line and never though twice about meeting them in person. Dating women isn’t exactly dangerous (except occasionally to my sanity), more so the meeting people on line, in real life, by myself. This is one of the best things I ever did though. Gradually I realized, not that I was a lesbian, but that guys weren’t my primary attraction, not my preference. I figured it out by doing, not just thinking.
When I found out a boyfriend of mine was a skinhead, I researched where his beliefs came from and submerged myself in the subculture. I would travel out of state, alone, being a small, white, unimposing female, travelling to huge rallies of skinheads and klan just to understand the mentality of this group that was so foreign to me. In general they were poorly educated racist fucks, but they were also very inclusive and ready to accept me with open arms. Once I put myself in that place, I could make my own judgements and not feel like a hypocrite saying it wasn’t right, because I’d tried it. I was lucky I wasn’t raped and molested considering I am pretty much the embodiment of everything they stand against (of course I didn’t let this be known).
When I’m out with friends, especially dancing, lining up the shots of alcohol and downing them fast enough for the music to drown out the racing thoughts in my mind, one after another letting the world spin into a comfortable blur. Everything seems softer.  Don’t think, just drink, again and again.
Even, driving. Hell, I’m a New Yorker, you have to be aggressive on the road or you won’t get anywhere. And you won’t get anywhere fast. I’m less careful about drinking and driving than I should be considering I was arrested for a DUI last summer (charges got dropped). I love to drive, it’s freeing and my mind can roam out on the open road. I drive stick and I have control of my car. Control my car, control my life. It’s the same things really…..
My brain just doesn’t want to say Stop.