Inexplicable Emotions

Thanksgiving was bad, but not as bad as usual. I only started to throw up once and stopped myself. I picked at food steadily but didn’t over stuff and completely skipped dessert. Good job I suppose. I even only had 2 drinks <~~~~ Major shocker.

Friend texted me a lot. Last year his wife flipped the fuck out on him and me because Thanksgiving was “family time” and “no matter how close you are to Friend you are not family”, (though Friend constantly regards me as such) therefore none of his time should be spent speaking to me at all. Last year we sent a grand total of 8 texts to each other.  This year he spent the entire evening after dinner texting me practically until I fell asleep and not a word from the wife. He’s been texting me a lot since I left New York. A lot since I started seeing Tech Boy. I feel like there’s some holding back and underlying emotion that he’s not expressing. I’m not sure if I find this incredibly amusing or achingly sad.  I haven’t been as consistent or available with him as I used to be and I can tell he’s starting to miss me. I’m torn between wanting to be there for him, because without me he’s essentially left with only being very close to his horrid wife, and thinking that he made his decision so he’s going to have to live with it and deal with the fact that my life is going to move forward without him.  Or with him in a diminished place of importance. 

Tech Boy texted me a lot yesterday too. He spent most of the night with friends boozing it up. The thoughts running through my mind? “Drinking + house party = who’s the girl from back home that you’re going to end up in bed with?” What did I actually say? “Catching up with friends is great, have fun!”

Inside does not match the outside. Thoughts do not match the behavior.

I think this is one of the reasons Borderlines come across as so inexplicable at times. And why when we do blow up it appears to be ‘at random’ or ‘out of nowhere’.  I know what a person wants to hear, I know what to do that will make me look more attractive to someone; however these things are often in opposition to what I want, think and feel. We do what will win the approval of the other person, so as not to lose them and to draw them to us more, even though ultimately those things build up and drive us slowly crazy over time. We can hold this and everything will be fine, until it’s not. It’ll build and build and build, and usually that final thing that makes us snap is seemingly little, when the other person doesn’t realize just how much build up went into contributing to that explosion.

 Like right now I’m ready to explode all over the place.

Last night my cousin asked me when I was going back to New York because she wants a ride to Manhattan. She’s nice enough but I really don’t want to have to adjust my travel schedule, wait longer to get on the road, and then have to make inane small talk for 8 hours. Also, driving other people around makes me incredibly anxious. I’m not a chauffeur. But she’s family so I felt obligated to say ‘yes’ though I did leave myself an out and say that I may leave earlier than expected depending on when I can see my best friend…

Who is also Borderline, and prone to making excuses, and flaking out on plans. I love her to death, but the rest of my stay here is entirely dependent on her. If she cancels on me at the last minute I’m going to be furious. She took longer to text me back than usual and I could already feel the anxiety and irritation taking over.

Then I went shoe shopping with my mother who chats away incessantly trying too hard to relate to me. She’s curious and wants to understand my Borderline problems. But every time I start to explain various things she tries so hard to make it sounds like she’s been in my shoes. It’s infuriating and pisses me off. Every time I spend more than a few minutes alone with her my stomach starts to turn in knots and I get physically nauseous. I can feel my blood pressure rise and all I want is to stuff my new shoes that she’s trying to walk in straight down her throat to make her shut up.

But I keep my mouth closed.

Little thing after little thing, builds and builds, and I’m ready to flee this awful state.

Helpful Tools – Mood Tracker for Borderline Personality Disorder

I would say I hate Mondays, but I really have exactly the same feeling about Mondays as I do every other day I have to tear myself out of my big comfy bed and get to work by 730a. So I suppose I hate all work days. Except I don’t. Only that initial waking up, leaving my dreams behind, and throwing off the warmth of comforters I’m wrapped in. Once I’m moving I don’t really mind.

One of the first things I do once I’m up and at work is record my mood. Something I find very useful for Borderline Personality Disorder is my Mood Tracker (I use MedHelp.org). I’m not incredibly consistent with it. I only remember to log in to my account a few times a day, but I do remember to do it every day. I’m not able to catch every little mood swing, but I catch enough, and it really helps me see the trends and fluxuations I go through.   

I started doing this about a year ago. This is when I was finally fed up enough to try something stronger to manage my moods. This is when I went back into therapy. This is when I found my first psychiatrist. This is when I really made the commitment to start changing my life. Oh don’t get me wrong. I’ve tried before. I’ve wanted things to change for years, done everything in my power to keep myself steady without anyone’s help. I’d sought help before, but still held back, didn’t allow it the time or honesty to benefit me. This was different. This is when I first accepted help. I’ve fought it at times. I’ve fallen back into bad habits plenty. But overall I’ve been taking more steps forward than I have backwards.

I was looking back on the entries I’d placed at this time last year and decided to compare it to today. It’s only been a  year but the difference is pretty drastic. Oddly I feel a little mixed. I feel like I’m missing a part of myself that made me feel gloriously, tortuously alive.  It’s strange to miss something so devastating. However, now, despite all the little things that I would normally obsess myself into oblivion over I am able to get out into the world, at least pretend to function like a normal person, and *gasp* actually enjoy a hell of a lot more things than I’ve been able to before. That last little bit makes it worth it.

So I thought it would be fun to share with you the transition I made. The way I scale things is slightly different. Along with Borderline, I’m also diagnose Major Depressive Disorder. My baseline is mildly depressed so in my tracking I adjust the scale to mean this:

Manic = Full blown mania (Never had this)

Excellent = Hypomanic

Good = Good

Okay = Okay

Bad = Mildly Depressed

Horrible = Moderately Depressed

Depressed = Severely Depressed

The trendline only gives you the average of the days moods. I can switch from hypomanic to severely depressed and the trendliine will average that to ‘Bad’ but you can see in the colors that I’ve been very up and very down. That’s why I included the color bars because those give you more of an idea of the individual shifts I am able to catch.

Year 2010:

Year 2011:

I noticed that sometime within the past couple months my Horrible shifted from an actual depressive state to feeling crappy but not depressed. This is mostly due to body image issues. Not depressed, but hating my body. This is also pretty weird for me. Normally I’d be full on depressed about this. Now I’m not happy, so I’m making changes, but I’m also not hidden away in full seclusion, I’m still getting out and trying to keep connected. I’ve been a little down lately, but overall you can see that I’ve been much steadier. I’m still fluxuating, but not as severely.

I don’t know about you, but to me this looks promising.

New day, new disorder: Emotional Deprivation Disorder

Fill her up!

I’ve discovered a new disorder! Is it just me or does everything have a disorder these days? Anyways, it’s called Emotional Deprivation Disorder.

Emotional Deprivation Disorder is a syndrome which results from a lack of authentic affirmation and emotional strengthening in one’s life. A person may have been criticized, ignored, neglected, abused, or emotionally rejected by primary caregivers early in life, resulting in that individual’s stunted emotional growth. ‘Unaffirmed’ persons are incapable of developing into emotionally mature adults until they receive authentic affirmation from another person. Maturity is reached when there is a harmonious relationship between a person’s body, mind, emotions and spiritual soul under the guidance of their reason and will.

—————————————————————————-

Some signs and symptoms include:

Insufficiently Developed Emotional Life

Abnormal Rapport
o Incapable of establishing normal, mature contact with others
o Feels lonely and uncomfortable in social settings
o Capable of a willed rapport but not an emotional investment in relationships

Egocentric
o Childhood level of emotional development
o Feels like a child or and infant and others must focus their attention on the individual just as an adult would focus on a young child.
o Incapable of emotional surrender to a spouse

Reactions Around Others
o May be fearful in nature or courageous and energetic
o More fearful people tend to become discouraged or depressed
o More courageous and energetic persons can become more aggressive

Uncertainty & Insecurity

Fear or anxiety
o Can be in the form of a generalized anxiety
o Fear of hurting someone else’s feelings
o Fear of hurting others or contaminating them (e.g. with germs or a cold)
o Need for frequent reassurance

Feels incapable of coping with life
o Worry that they’ll be put in a situation they can’t handle
o Can be easily discouraged or depressed
o May pretend to be in control in order to mask inner feelings and fearfulness

Hesitation and Indecisiveness
o Difficulty in making decisions
o Easily changes mind

Oversensitivity
o Overly sensitive to the judgments of others, criticism or slights
o Easily hurt or embarrassed

Need to Please Others
o Pleases others in order to protect self from criticism or rejection and gain approval of others
o Easily taken advantage of or exploited
o Fear of asking for favors or services needed

Self-consciousness
o Worried about what other people think
o Self-doubt and need for reassurance

Helplessness
o Do not dare to say “no” for fear of rejection

Inferiority and Inadequacy

Feel Unloved
o Believe that no one could possibly love them
o Feel devoid of all feelings of love
o Believe they are incapable of loving others or God
o Suspicious of any token of affection – continually doubt sincerity of others

Physical Appearance
o May have feelings of inadequacy due to physical appearance

Feelings of Intellectual Incompetence
o May have difficult completing projects
o Repeated failure or fear of failure

Show Signs of Disintegration in New Circumstances
o Fear of new situations and challenges
o Difficulty coping with new job, landlord, moving, etc.

Sense Impairments
o Undeveloped or underdeveloped senses (touch, taste, sight, smell)
o Lack of order, disorganization
o Fatigue

Further symptoms found in some individuals with emotional deprivation disorder:

o Deep feelings of guilt
o Kleptomania
o Need to collect and hoard useless things
o Paranoid condition

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Essentially, it’s BPD Light without the wild mood swings, anger, impulsivity and penchant for self-harm and suicidal tendencies.

The cure? Simple! All you need is affirmation. Just find one person who can be your personal source of unconditional love and will provide all your emotional strengthening!

What?

I’m sure there’s more to it than that, like say, years of therapy. Affirmation Therapy in fact.

“Affirmation therapy involves the therapist’s affective, not effective, presence with a client—in other words, it is a way of “being” with a person as opposed to “doing” something for him or her. Affirmation therapy can be formally described as a way of being affectively present to another human person in a therapeutic relationship in which the therapist reveals to the client his or her intrinsic goodness and worth.”

Essentially the therapist will be your source of unconditional love in a therapeutic relationship.

I don’t know. My experience with people makes it very difficult to believe that there are people out there that can genuinely love you without really knowing you…. Especially when you’re paying them to love you. It’s like emotional prostitution. This has always been an issue of mine regarding therapy actually. The idea that a complete stranger can generally care about your issues and problems without having any emotional investment in you. You can pay someone to listen, but you can’t pay someone to care. Though to be true, it has been my experience that given time a therapist can and will develop a genuine investment in their patients. A genuine investment based on the very reason they went into the profession in the first place…. A desire to help people. I know my therapist cares about me. I know she thinks about me when I’m gone, though I can’t help but feel that her connection to me is stronger than my connection to her. This isn’t her fault though, it’s my own attachment issues at play. She hasn’t given up on me though and that is exactly the kind of support I need.

My question with this Affirmation Therapy is… How much emotional support can you really expect a therapist to give? To listen, to help you work through your issues, to guide and provide the tools you need in order to learn to deal with your own life… sure. But unconditional love? Maybe they’re like the Grand Master Zen Buddhists of the therapy world.

Personally I would have a really hard time accepting this as genuine. But to each their own I suppose. Hell, if you’re in a place where you can openly accept the unconditional love of a therapist you’re probably a leg up on my stubby little bipeds of emotional stuntedness.

Oxytocin and Borderline Personality Disorder

I saw this very recent article on the effects of Oxytocin and Borderline Personality Disorder and thought I would share. My immediate thought was, they are doing some wild things to study BPD, however this still means, they’re doing things to study BPD.

Posted by David Johnson on May 11, 2011 

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Often referred to as the “love drug” or “love hormone”, oxytocin has attracted increasing interest from researchers in recent years. It was originally shown to modulate aspects of social attachment and pair bonding in animals such as the female prairie vole, whose monogamous nature is dependent on oxytocin. Recent research in humans has shown that oxytocin increases trust behavior in economic exchanges and increases perception of trustworthiness in human faces, as well as promoting emotion recognition and altruism. This evidence inspired hopes among some, particularly in the mainstream media, that science might have found a possible pharmacological target for humans who show deficits in prosocial behavior.
But recent evidence has complicated the narrative a bit.

Research has shown that oxytocin plays a role in increased emotional reactivity to both positive and negative social cues. For example, one study from 2009 (Shamay-Tsoory et al) had participants engage in a game of chance with another player (the actor). In one condition, the actor was made to win more than the participant, evoking feelings of envy in the participant. In another condition, the actor was made to lose more than the participant, evoking feelings of “schaudenfrude” or gloating. Participants who were administered oxytocin before playing showed increases in both envy and schaudenfrude (if oxytocin was involved only in enhancing prosocial behavior, we would expect to see the opposite result.) Other research has shown oxytocin increased approach behavior or affiliative drive rather than regulating positive or negative responding per se. And one recent study showed that oxycotin led humans to self-sacrifice for their own group while showing increased aggression toward out-group members. The gist of this set of findings is that oxytocin doesn’t seem to bias individuals toward the positive, but rather can magnify whatever “stimuli” happens to be in someone’s attentional spotlight, be it bad or good, thereby generating an increase in corresponding positive or negative emotional responses.

Jennifer Bartz and colleagues (2010) were curious to explore whether oxytocin could “correct” deficits in pro-social behavior in individuals with borderline personality disorder (BPD), a population famous for emotional instability, extreme impulsive behavior and identity confusion. People with BPD tend to be involved in intense, emotionally volatile relationships characterized by frequent arguing, repeated breakups and extreme aggression. This behavior often extends beyond their romantic relationships, as BPD individuals have also been shown to have difficulty cooperating with strangers. The existing body of research, Bartz et al suggested, offers up contrary predictions. On the one hand, oxytocin could be helpful in reducing the negative behaviors normally associated with BPD in favor of kinder, gentler behavior towards others. Alternatively, oxytocin might have increasingly negative effects for people with BPD, who are chronically concerned with (lack of) trust and abandonment and have difficulty cooperating with others. They’re essentially fixed in a constitutively negative state when it comes to social interactions and increased oxytocin could decrease prosocial behavior even further. Additionally (or alternatively), the oxytocin system might be dysregulated in BPD and could produce different responses (vs. control) to oxytocin as a result.

Bartz and company designed an experiment in which the participant was paired with a partner (in reality, a virtual “computer” partner) to engage in an economic game. In this game, the participant was to make one of two choices that involved financial rewards. The catch was that the amount of the reward was also dependent upon the choice that their “partner” made.

Both players clearly make the most money if they both choose strategy A. But because the player has to make the choice before the partner, the decision involves an element of trust (if your partner defects, you get nothing. If your partner trusts you and you defect, you get $4 and she gets nothing.)

So, what did they find?

Results showed the following:

1. BPD people trusted their partners in an economic game less after they received oxycotin than when they received a placebo.

2. Additionally, when asked if they would be more likely to make a hypothetical decision that would punish their partner, even when they knew their partner had extended trust toward them, they were more likely to punish after Oxytocin than placebo.

Administration of oxytocin to BPD individuals actually decreased pro-social behavior (and increased antisocial behavior). As the experimenters suggest, increasing the salience of a social cue that makes trust issues salient may have caused BPD participants to rely on their normal strategy for trust-dependent social interactions; that is, defect and punish the partner. Or it might have motivated approach/affiliative behaviors which triggered memory of past experiences gone awry and set off chronic and ever-present concerns about trust and rejection (e.g. “reject and punish them before they can do the same to me.”). Finally, the experimenters suggest the possibility that the oxytocin system itself may be dysregulated.

In short, the evidence doesn’t offer overwhelming support for the notion that exogenously-administered oxytocin will be a useful clinical treatment for people with pro-social deficits, such as those with BPD. Additionally, it’s difficult to imagine long-term benefits of oxytocin given that it’s half life when administered intranasally is only about three minutes. It’s been said that the most of the real action with regards to oxytocin is on the receptor end.

——————–

Something to think about for sure. Drugs have unpredictable side effects to begin with but couple this with the chemistry of someone that is already outside of normal reactivity? I’m almost surprised they thought this would help. It increases mood. People with BPD don’t have normal moods, by definition.

People with borderline aren’t only aggressive and disruptive. Our moods run the gamut of angry to ecstatic, albeit more rapidly and more intensely than normal. So by extension I would expect that not only would it heighten the good moods, but also the rest of our reactive moods.

Oxytocin, like any drug, works differently for different people, and in the best of cases elevates a good mood. To me this makes me wonder if ideas of trust, paranoia are linked to the same emotional receptors. It seems that the study did indicate that moods were elevated but these other aspects were impacted differently than in a neuro-typical brain. Perhaps this points to a different area of the affected borderline brain to be taken into consideration for synapses connections.

Moral of the story: Drugs are bad kids…. And apparently don’t mix well with personality disorders.  

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Lows are low, Highs are high

My moods, have been in major fluxuation. I’ve noticed this pattern before. Often, actually. I’ll slowly slide down. Work myself up with anxiety, with actually sinks me further until one day I have a complete breakdown, massive anxiety attack, or temporary distortion of my reality. Bottom out. Utterly. Then the next day I’m up in a way that I haven’t felt like in ages. My mood is more optimistic, my energy is ramped up, the sun is brighter, the sky bluer… and I can ride this for a few days.

I was ready to give up my life and lifestyle, everything I’ve worked towards… two nights ago. Today I’m renewed. I’m tackling problems and projects one thing at a time. I have plans for what I can do to get the information I need. Plans to further my knowledge and increase my proficiency. I feel like I have the ability to get the work done that I need to do.  I might not know everything yet, but I have the capability to get it. And I will. It’ll just take some time. Time, time, who’s got the time? I need more of it, but not in a projected sense. More of it right on top of the time I already have now. Overlapping experience.  Time on top of time on top of I want to do so much more at once than one limited body is capable of.

With just the barest twinges of anxiety lurking around the edges of my consciousness.

Everything feels hyper focused too. The sun is brighter. Peoples voices are more focused. My thoughts are racing a little faster. It feels like information, ideas, to-dos, are bouncing off each other inside my mind vying for priority.

Everything is starting to feel a little rushed too. I have so much I want to do, that I have to spread it out over time in order to accomplish it… is an angle of anxiety. Like things can’t be collected fast enough. I can see exactly how all these things will fall together, I know what I need to do to get them, if only I could rush faster, push harder, I could have all of them already and then things would slip to place. That time seems so far away, like I can almost touch it with my fingertips but then I have to reach for something in a different direction. I just can’t get there fast enough because I know there are so many steps I have to take first and those first steps don’t flow fast enough.  Fast enough. I want things to move faster. Faster. That they don’t makes me anxious. But not debilitating anxious, motivating anxious.

I want another one of me. With a connected consciousness so that my other body and this body can both collect more information and coalesce the results inside one mind. That would be optimal. Much more efficient. Having only one body, being able to only do one thing at a time is frustrating. Frustrating. I want to be there already. Yesterday, actually.  

I feel slightly like I’m floating to project myself in so many directions.

But, upwards! Haha, and that’s better than downwards any day.

There’s just so much I want to do! I’m motivated and productive at work. Things that pull my attention away are actually disconcerting because there’s so much I want to accomplish and figure out. I want to be home; reading, writing, painting. Did I mention I started painting? I’ve never done it before in my life so last Friday I went to the craft store and bought a set of acrylics and brushes. It’s fun and freeing, playing with color and texture. There’s just so much to do at any given time. So much, so much.

It’s so lovely out as well.

This is actually something I worry about being on mood stabilizers. They stabilize from the bottom up so you don’t feel so depressed, but they also stability from the top down, dampening the good. I don’t have so much good that I want to squash that side of it. Especially since I’m starting to see someone new. I want to feel the highs that could come of it. Seem to be coming of it. I don’t want my moods to be mottled by medicine when I see an ok place.  I want to be receptive to all the good! I want to throw myself in and ride the wave of newness and excitement. I want, I want.

Lots to want. Lots to do. Lots to hope for.  

Bordering on Wakefulness

I have a terrible time sleeping. Not that this should surprise any of you dear readers, as it’s something I complain about a lot. I’ve had sleep problems, probably sleep disorders, since I was very young. Though I was never treated for it (until recently) I self-diagnosed my own insomnia. All through my teenage years, into college, and periodically still, I’ve had it. Sleeping maybe 1-3 hours a night for weeks on end, then finally crashing for 14-16 hours one day only to repeat the cycle over and over. I’ve been much better than this over the last few years, though certainly not great.

When I don’t get enough sleep, I’m a mess. More of a mess than usual. General fatigue aside; I can feel my mind dragging itself down. My moods shifts, swings more than usual. Concentration is nearly impossible and I slip into daydreams trying to replace the night dreaming I don’t get enough of. My mood is very dependent on sleep. The longer the span of sleep deprivation I have the darker my moods and thoughts begin to get.

I can feel the pressure on the back of my eyes, trying to hold themselves open. My vision distorted by the fatigue I feel. Seeing things differently, especially myself, than I know appear in the real.

Time slips by slowly. The clock ticking endlessly as I wait to for my day to terminate.

My ability to distinguish between the rational and the irrational is obvious. At least it is to me. I can’t help it though. I can’t stop it. All I can do is hope that tonight I find some relief from the restlessness induced by the evening before.

My mind starts roaming and racing, creating scenarios and running away with me. Once my brain starts whirring, working itself up, it’s that much harder to ease myself in a calmer state conducive to restful sleep. I may be physically and mentally exhausted when I lay down, but as soon as I start thinking, my mental activity starts running a marathon and there is no slowing it down.

I love to dream. Dreaming is a wonderful escape for me. Wildly vivid, living a life filled with the fantastic. When I’m sleep deprived, the few hours I do manage to sleep, I seem to be more prone to nightmares. Even in these I’m fascinated by what my subconscious creates, but they only contribute to my fatigue. Causing me to waken frequently. Often in a cold sweat. Heart pounding. Which only makes it more difficult for me to fall back to slumber. Then when my alarm finally sounds I can barely pull myself out of bed. Slipping into deeper depression.

I’ve found very little research done on the correlation between sleep deprivation, insomnia and Borderline Personality Disorder. Most of what I’ve found is pretty typical of anyone that is sleep deprived. Regardless, as someone that doesn’t do it well, I can’t stress the importance of getting an adequate nights rest.

“Sleep disruptions can be a common occurrence for those with borderline personality disorder (BPD). It may be caused by everyday stress, medications, or even the hyper vigilance we’re so predispositioned to. Getting a good night sleep may be easier said than done, but recognizing a problem and discussing it with your treatment provider may help you get some needed relief.”

Since Borderline Personality Disorder is a highly affected mood disorder, anything that impacts emotional regulation is going to be a detriment to the moods in someone with BPD.  Sleep helps humans maintain optimal emotional and social functioning while we are awake by giving rest during sleep to the parts of the brain that control emotions and social interactions.The only small study I did find on BPD and sleep dep reported that “the risk of affective and impulsive personality disorder traits were exacerbated by lack of sleep”. I could have told you this with only myself as a test subject. Getting enough sleep is a serious factor with depression in general. Sleep deprivation is one cause of lower levels of serotonin in the brain. Serotonin as we all know, is the bodies natural way to encourage feelings of well being. Hence, having a deficit of sleep deprived seratonin production may contribute to greater levels of stress and depression. Sleep studies indicate that BPD is not {necessarily} related to depression but that serotonin studies do point to links with suicidal, aggressive and impulsive behaviors, stress and burnout.

“In tasks requiring judgment, increasingly risky behaviors emerge as the total sleep duration is limited to 5 hours per night. The high cost of an action is seemingly ignored as the sleep-deprived person focuses on limited benefits. These findings can be explained by the fact that metabolism in the prefrontal and parietal associational areas of the brain decrease in individuals deprived of sleep for 24 hours. These areas of the brain are important for judgment, impulse control, attention, and visual association.”

Only in the past few months (5-ish) was I finally able to get some treatment for my insomnia. This is actually one of the main things that brought me to finding my psychiatrist. I was having such a hard time sleeping. I knew how it affected me, so I went to see a regular doctor to see if he could prescribe me something for sleep. Turns out he couldn’t. That was something for a psychiatrist to do. That coupled with the fact that I was having very self-damaging thoughts he recommended I find a psychiatrist immediately (after he asked why I had come to see him instead of going straight to the psych ER).  As I’ve mentioned before, as a supplement to my current medication, I am also given Trazadone. Even this doesn’t always help. I can stay awake through it, continue to wake in the night, and feel completely exhausted when I need to get up. It does help sometimes though and something is certainly better than nothing. I have friends on Trazadone as well, and they seem to have much better results with it than I do, so I imagine I have other mitigating factors contributing to my sleep problems that most people simply don’t have.

Curling up in my big comfy bed, buried under blankets, surrounded by soft pillows, lying there waiting for unconsciousness to take me. I always look forward to trying.

“The best thing about dreams is that fleeting moment, when you are between asleep and awake, when you don’t know the difference between reality and fantasy, when for just that one moment you feel with your entire soul that the dream is reality, and it really happened.”

~Random Quote

Axis I vs. Axis II: Controversy in BPD- Part 4

Where does Borderline Personality Disorder belong?

I’m referring to the DSM criteria for Axis I and Axis II designation. Let’s start off with, what’s the difference between Axis I and Axis II.

* Axis I: major mental disorders, developmental disorders and learning disabilities. Axis I disorders are predominantly mood disorders.
 * Axis II: underlying pervasive or personality conditions, as well as mental retardation. Axis II disorders are personality disorders.

For or Against?

[For Axis 2] Personality disorders are classified as Axis II disorders.

Personality disorders in general have their own list of general criteria that must be satisfied. They’re a class of personality types and behaviors that the American Psychiatric Association (APA) defines as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it”.

“These behavioral patterns in personality disorders are typically associated with severe disturbances in the behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in the client adopting maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress and depression in clients.”

The behaviors cause serious interpersonal and social difficulties as well as general functional impairment. I don’t think anyone can argue that BPD fits this criteria, which is a large part of why it is considered Axis II. It also has a sub-designation as Axis II, Cluster B which is characterized by dramatic, emotional or erratic behavior. No argument there either.

Debate:

[For Axis 1] Both Axis I and Axis II are psychiatric disorders. Only personality disorders and mental retardation are segregated onto Axis II. All other psychiatric disorders are Axis I. Does it really make sense to segregate these if they are essentially the same type of thing?

[For Axis 2] However Axis I disorders are generally treatable with medication. While some presenting symptoms of Axis II disorders may be treatable with medication, it’s not shown that medication can ‘cure’ a personality disorder and correct all presenting symptoms.

 [For Axis 1] Moving BPD to Axis I would have economic benefits. Many insurance companies don’t recognize BPD as a treatable condition and use it as an excuse to withhold payments. I know for a fact that my therapist classifies me as Major Depressive when billing my insurance company. I am pretty certain my psychiatrist does as well. This is certainly true, but not completely accurate.  I’m not going to complain though.

I think the major debate lies here:

[For Axis 2] Axis II BPD is pervasive to a person identity, characterlogical in nature.

[For Axis 1]: But…There’s some debate about whether BPD should be considered a ‘personality disorder’ at all because it has such a high rate of co-morbid symptoms that fall into the Axis I designation.

Axis I disorders are primarily for mood disorders that are reactions to atypical situations which are not part of a person’s character. “Mood disorder is the term designating a group of diagnoses in the DSM IV TR classification system where a disturbance in the person’s mood {not their character} is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in ICD 10.”

[For Axis 1] There are many disorders that are just as pervasive as BPD such as bipolar, anxiety, and depression that are not caused by atypical situations, and are classified as Axis I disorders.

“Two groups of mood disorders are broadly recognized (though not limited to these two); the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder (MDD) commonly called clinical depression or major depression, and bipolar disorder (BD), formerly known as manic depression and characterized by intermittent episodes of mania or hypomania, usually interlaced with depressive episodes.”

People with Borderline Personality Disorder almost always have a history of long term, pervasive depression.  I’ve never heard of anyone that didn’t, but I’m not a clinician. Hypomania is not always present. If you have manic phases though, that is the definition of Bipolar and while you can have bipolar disorder and BPD, I think you would then have both Axis I and Axis II designations, not just one or the other. From here it could be argued that the mood regulation disorders are the underlying cause for all the other disorder manifestations.

[For Axis 1] There’s also the stigma that a personality disorder just means that a person has a flawed personality that can’t be changed.  Except there has been plenty of research to support the idea that this is an emotional regulation disorder.  Which means it would technically be a mood disorder and qualify it for Axis I.

I can see how the mood disorder aspects can affect a lot of the behaviors and symptoms of BPD. I’m not sure it can explain all of them though. Things like a tendency towards impulsive behavior, identity disturbance, fear of abandonment, etc… these are not necessarily dependent on mood alone.

I certainly don’t believe that a personality disorder just means you have a flawed personality. Calling it a flaw implies that it’s a minor issue, easily corrected. BPD is not minor, nor is it easily treatable. You might not be able to change everything about who you are (or want to), but if there is an aspect of your life that you do not value; if you are willing to put in the effort; if you have hope of living a better life or just a life different from what you currently experience– it is absolutely possible to make changes in yourself. Without hope for change there can only be resignation to the inevitable. But people do have control over their lives, what choices they make, how they want to live. It may not be easy, maybe everything can’t be ‘fixed’, but it is possible to heal from those things that we are willing to work to change.

Mood Swings – Criteria 6 / Instability of mood

Criteria 6: affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

Duh. That’s really all I want to say to this one but that wouldn’t be very informative now would it. The important thing here is to understand WHY the moods of a borderline are so unstable. The problem is, it’s going to be different for everyone so I’ll just have to stick with why they’re so difficult for me.

I’m major depressive so my base set mood is mildly depressed. The best I can hope for on an average day is to just feel nothing; not happy, not sad, just a sort of blankness that doesn’t swing me in either direction. Of course it’s wonderful to feel happy. Merely talking to a friend, connecting with a loved one, will do this. This feeling rarely stays though because eventually people have to have their own lives or return to work. Resume normal everyday behavior. But to me it’s like I lose my hold, my connection to them. Having been happy while talking to them, now I slip from being happy to being left with only the thoughts in my own head and not knowing when I’ll be able to have that connection again; alone. I slip from happy, to alone, empty, spiraling down. In the space that was filled with that connection to a loved one, I’m now left with a hollow void where they’re gone and my thoughts can race and ruminate. This bleeds back to being alone, abandoned. It’s not rational, but it feels like something that was there is now gone. Being a thinking creature I can’t know for sure when it will be back. That uncertainty is maddening.

Anxiety is a big one. The smallest things seem to set me off, spike my anxiety and it feels like my world will crash in on itself. Especially if it’s something I’ve planned just so. I try to arrange things to bring about the most comfortable, stable environment for me. Calm. To feel secure in my surroundings I plan every detail to create the perfect scenerio. That house of comfort is built on a foundation of cards that even the smallest suggestion of change adds a weight, a pressure to, that can send it toppling to the ground. I have an incredibly difficult time getting through the fact that any change will not rock my foundation and will not wreak havoc on my plans because it feels like it does.

Lack of control of my environment means a lack of control of myself, my life. If I can’t even control my own life than what control can I possibly have in an ever changing world.

When a change attacks my plans it’s like an attack on my character. My plans weren’t good enough, that they had to be changed, an attack on me, my judgement when someone suggests I do something differently. They don’t want to accept my idea and therefore don’t accept me by extension. Of course this is not true, but that’s how it feels. Understanding how to make the emotional connection to the logical occurrence of this being not true is what’s difficult. For me there is a complete disconnect between what I logically know to be true and what I feel, if I feel at all.

Disappointment. I read disappointment into your reaction/suggestion because you wanted more than I thought to provide which translates to disappointment in myself because I couldn’t guess what it was that you would have wanted best. Or worse, that you don’t want what I want and I begin to fear that this one instance extends into the entire friendship, relationship, etc. What I’ve done isn’t good enough, I wasn’t good enough, it’s only a matter of time before you realize I’ll never be perfect and you’ll seek company elsewhere. Leave…  

On the other hand, if things go well, if I can do something that makes someone happy this also validates who I am. That I am someone good and worthy of being loved or cared for. If I can do something to show I care, and it’s appreciated, I can physically represent that I am an important aspect of someone’s life. Knowing this, in the moment, it’s euphoric. My simply being there isn’t enough, I must be able to SHOW it. If I can’t show it, how could they SEE it. I have a very difficult time believing that if I’m not immediately in someone’s presence that they can remember the care I hold for them (more on this later). Contrariwise, if it’s something I do isn’t appreciated I’m left with