Completing Sentences

Here’s something I completely forgot to mention. After my last session Therapist had called and left me an additional homework assignment called Completing Sentences.  It’s exactly what it sounds to be. She starts a sentence, and I complete it. Over the course of her message she also said things like she was thinking about me, and worried about me. I had a really hard week and I’ve been upset but it’s all a part of the therapeutic process and I’m doing really well. My therapist is a very caring and nurturing woman. For as frustrating as I know I must be, she’s so very supportive and I am glad to have her as my therapist.
Assignment about my fears – Completing sentences:
No one
I’m afraid to
Will I ever
I want to
I feel most afraid when
One good thing about my fear is
Immediate impressions:
No one… will ever love me.
I’m afraid to… be myself.
Will I ever… be loved
I want to… be a whole person.
I feel most afraid when… I’m alone.
One good thing about my fear is… I am only myself.
Expanded and detailed:
No one… will ever love me. No one will stay with me.
I’m afraid to… be myself. People will see me for who I really am. See all my flaws, see that I’m not perfect, that I can’t be who they want me to be, and leave me or want me to leave. When they see this it will prove what I’ve always known, that I’m not good enough, I’ll never be good enough, nothing I do will ever be good enough.
Will I ever… be loved. For me. In a way that doesn’t end or leave. Will I have friends that love me and stay, will I find a partner that wants to spend their life with me. Will I ever be the kind of person that doesn’t need this kind of validation? The kind of person that can love herself and be safe in the knowledge that if I appreciate who I am, than that is all that truly matters?
I want to… be a whole person. I want to be in control of my life. I want to love myself and my body. I want to look in the mirror, recognize who I see, and appreciate who I see.
I feel most afraid when… I’m alone. No one will remember me. My attachment to them will dissolve. If I’m not around people they’ll forget me and I won’t be a part of their lives anymore.
One good thing about my fear is… I am only myself. I have no one to play to, pretend for. No one to influence who I should be. No one to tell me that I’m not good enough, not okay. What’s so weird for me is that in general I don’t care what anyone thinks of me. It’s only those very few people that are close to me that have this kind of influence and effect on me.
For this post I’m only doing my initial impressions. Thinking about it for a few minutes I can come up with probably dozens of things to expand on but that’ll just be overwhelming here. It’s a good exercise. Try it. I’d actually be really interested in seeing what you come up with so I invite you to e-mail me or leave it in the comments section if you feel like sharing.

ElectroShocking

Shocking news about Electroshock therapy. Then again, maybe it’s not so shocking afterall… Regardless, I’m rather fascinated so I thought I would share. Enjoy!

Hyperactive Nerve Cells May Contribute to Depression
Identification of cellular mechanism could lead to novel and effective treatments
Scientists at BNL, Cold Spring Harbor Laboratory, and the University of California, San Diego (USCD) School of Mediciine, have identified hyperactive cells in a tiny brain structure that may play an important role in depression. The study, conducted in rats and appearing in the February 24, 2011 issue of Nature, is helping to reveal a cellular mechanism for depressive disorders that could lead to new, effective treatments.
The research provides evidence that inhibition of this particular brain region – the lateral havenula – using implanted electrodes can reverse certain behaviors associated with depression, and also provides a mechanism to explain this effect. These findings lend support to the use of deep brain stimulation as a clinical treatment for people with long-standing, treatment-resistant depression.
This research was supported through Laboratory Directed Research and Development at BNL, and by the Simons Foundation, the Dana Foundation, the National Institute of Mental Health, and a Shiley-Marcos endowment at UCSD.
“This research identifies a new anatomical circuit in the brain that mediates depression, and shows how it interacts with the brain’s reward system to trigger a  constant disappointment signal – which certainly would be depressing,” said Fritz Henn, a neurobiologist and psychiatrist at BNL and Cold Spring Harbor laboratories and a co-investigator on the research. “But,” he added, “identifying this circuit and how it works may open new doors to reversing these effects.”
For example, said co-investigator Roberto Malinow, a professor of neurosciences at the USCD School of Medicine, “It’s possible that the genes specifically expressed in these neurons could be targeted genetically or pharmacologically in order to manipulate them and reduce depression.”
Scientists have known that cells in the lateral habenula are activated by negative or unpleasant events, including punishment and disappointment, such as when you don’t get an expected reward. It may seem intuitive that such negative stimuli can lead to depression, but not everyone who experiences disappointment collapses into a state of  helplessness. To explore this connection, the scientists took a closer look at the brain circuits.
Overall, the results showed that these lateral habenula nerve cells were hyperactive in the depressed animals but not in the control subjects. Furthermore, the degree of hyperactivity coincided with the degree of helplessness.
To explore whether electrical stimulation could potentially reverse this reward-dampening effect, the researchers placed a stimulating electrode in the lateral habenula and measured the effects on the brain cells leading to the reward center. They found that electrical stimulation of hyperactive habenula brain cells markedly decreased excitatory activity leading ot the reward center.
“The study provides a cellular mechanism that may explain the hyperactive of the lateral habenula nerve cells observed in depressed  humans and animal models of depression, as well as why ‘silenceing’ these circuits, whether surgically or pharmacologically, can reduce depression-like symptoms in animals,” Henn said.

Lucid Analysis: Trials in Therapy

 
Yesterday was stress beyond reason; read to quit my job, quit engineering, become a librarian, or a personal trainer, open a yoga studio, ANYTHING, that was not the pressure I have at work.  I looked into certification programs and e-mail department heads about enrollment. I couldn’t see the point of continuing on. Everything I’ve done until now, pointless, useless, futile. My LIFE is pointless. Not worth living or having if I can’t do this {one} thing right. I grabbed at options, ideas. Even as I did so I realized just how much is required to achieve those and I know just how I’ll be able to do it all but it all seems to big, too overwhelming. I see all the obstacles, I have no sense of time…I can see how long it will take, but the dread and anxiety of not having it achieved, the uncertainty, is paralyzing. I don’t have it done now so it feels futile. Like I’ll never get there before I even begin. Fortunately I’m not so out of control that I quit things on the spot.
I can’t say I’m not still thinking about finding a new profession, but I’m less stressed out today.
Let’s go back shall we. The focus of yesterday’s therapy session was my anxiety attacking about work. I am the newest engineer on my team. Everyone else has been here for years. I hired in a couple years after the project began. Everyone knows more about this project than I do. I feel incredibly behind in my knowledge. I’m afraid that I won’t measure up to the demands that are required of me because I don’t know everything already. I’m afraid this will reflect poorly on my ability and on my intelligence… because somehow I have not jacked in and assimilated all prior knowledge generated on this project. This fear paralyzes me. I can’t move forward. I’m mired down in the belief that I’ll never be good enough because everyone else will always know more, have accumulated more, knowledge. I don’t have the history of collection to be of a standard proficiency for what I perceive is my position.  
Once I’m stuck, I beat myself down harder into the muck. I’m afraid to even open drawings and my design programs for fear that I will look at it and have no idea what is required of me. Like suddenly everything will have changed and become completely foreign; every e-mail will be a judgment or termination.
I want to flee from the potential failure into something I won’t be so open to criticism with.
Therapist brought me around to things I might enjoy doing. Her immediate suggestion was to pursue costume design. Find a theater company and hire on to create costuming. I immediately slammed my foot down on this. I’m not a professional seamstress. I’ve never had schooling for fashion. I don’t want to move. I don’t want to live in the city.
Why didn’t I go to culinary school… b/c I’d have to do this, and it would make me hate that, and I wouldn’t have the freedom to do what I really love about cooking in the first place,…  
Stop.
I mire myself in all the details. Bombard myself with the ‘why nots’.  I see the end before anything has a chance to even begin. I psych myself out of ever beginning. If I don’t start, I can’t fail. Can’t let anyone down.
Therapist asks who I’m afraid I’ll let down if I don’t succeed? If I were to choose a different career?
Myself. My father. My friends.
Everyone jokes around about my genius; they introduce me to new people as Haven the rocket scientist, etc etc. I hate it. It just feels like more pressure to be something I don’t believe I’ve earned. Don’t believe I’ve earned <~~~ is a problem all of it’s own. I have multiple engineering degrees, was the sole female graduate in my Master’s program… and yet, I still don’t believe what I do is good enough. More specifically it’s my father. I’ve mentioned before how critical my father is, even though he was not actually discouraging. He never said anything like ‘you suck, you can’t do that, you’re not good enough”. It was always, everything I did could be better. Nothing was ever perfect, or just good on it’s own, or good enough. It was “that’s good, but here’s what you can do now, or should do next, or how it can be improved, how it can be better”… how you can be better. I don’t believe I’m good enough at anything. Everything about me is flawed. As a result everything I do is somehow deficient. I enter into everything believing that I won’t be able to do it good enough, that I won’t be good enough.
Trigger. Therapist made a point of recognizing that this is something that triggers me severely. Specifically my Unrelenting Standards schema.
Unrelenting Standards Schema: The underlying belief that one must strive to meet very high internalized standards of behavior and performance, usually to avoid criticism. Typically results in feelings of pressure or difficulty slowing down; and in hyper-criticalness toward oneself and others.  Must involve significant impairment in:  pleasure, relaxation, health, self-esteem, sense of accomplishment, or satisfying relationships.
Unrelenting standards typically present as:  (a) perfectionism, inordinate attention to detail, or an underestimate of how good one’s own performance is relative to the norm;  (b) rigid rules and “shoulds” in many areas of life, including unrealistically high moral, ethical, cultural, or religious precepts; or (c) preoccupation with time and efficiency, so that more can be accomplished.
When I’m met with any kind of criticism or something I perceive as criticism I freeze. I set my standards so high, put so much pressure on myself, that when anyone presents me with any though/critique/opinion in opposition or enhancement to what I’ve done, it feels like an attack on the rigid standard I’ve set for myself. I destroy myself, debase my accomplishments, and my immediate response is “I’ll never be good enough, I should quit now before everyone sees how incompetent I am.” When in reality this is not true. My Punitive Parent kicks in and I mentally and emotionally punish myself.
Punitive Parent – The Punitive Parent schema mode is identified by beliefs of a patient that they should be harshly punished perhaps due to feeling “defective”, or making a simple mistake. They may feel that they should be punished for even existing when “punitive parent” takes over the psyche. Sadness, anger, impatience, and judgmental natures come out in “punitive parent” and are directed to the patient and from the patient. Even a small and solvable issue or unrealistic perfectionist expectations and “black and white thinking” all bring forth the “punitive parent.” The “punitive parent” has great difficulty in forgiving oneself even under average circumstances in which anyone could fall short of their standards. The “Punitive Parent” does not wish to allow for human error or imperfection, thus punishment is what this mode seeks and what it desires.
Lesson: Recognize triggers!
I was ready to quit my job, sink to devastation about disappointing everyone in my life, lose hope and hold on my life completely. Recognizing the things that trigger me is so crucial in order to gain control of them. In recognizing them I can work to prevent their reoccurrence. Even when I can’t prevent them entirely I can work to form strategies for dealing with them. Therapist wants me to make sure I don’t let the Punitive Parent reign. I need to take a step back and remind myself of all the things I have accomplished, that I am good at, that I am skilled with. I’m the only one that sets my limits. In second guessing myself, berating myself… I, I, am the one that holds me back and keeps me down. No one else believes these things of me. Hell, most everyone else probably has a clearer picture and better appreciation of my skills than I do. They don’t limit me. They aren’t keeping me down. I am.
Homework: Work on silencing the inner punitive voice that constantly demeans me. Counter the self-doubts with positive affirmations. This! This, is not a quick process. This is in fact, one of the major overarching goals of therapy for BPD. It’s good to know your goals though =)

…but beautiful.



For the record. This morning I kicked myself in the ass. Opened up my software and had the first analysis model done within an hour. The second I will have completed by the end of the day. I have no one else to remind me that I’m competent. No, I don’t know everything. It is impossible for me to know everything. In fact, no one expects me to know everything. Not even everything about all the things I’m assisting in. I put this pressure on myself. Life is a learning process.
Note: Sleep on it. I was much more rational in the morning.
And as a more pleasant aside. Went on a date with my new Lady Friend last Saturday. She bought me a book – a mix of Sci-Fi, humor, and Eastern Wisdom. I’m seeing her again this weekend =) It was a really, really nice night. I was all butterflies and nervous. The hostess thought we were the most adorable things ever.
I’m seeing Psychiatrist next Tuesday =P

Lucid Analysis: Trials in Therapy

I missed therapy last week because I was in Chicago. The brakes on my car went out so I missed therapy this Monday too, but my therapist was too concerned to let me go a whole other week and squeezed me in late last night.
I’ve been a serious mess. I missed my psychiatrist appointment some time ago b/c they didn’t call to remind me like they always do. I haven’t rescheduled. I don’t know if I want to go back. I decided I wasn’t going to take the Respirdal. Having not rescheduled my Pdoc appointment I’m almost out of my Lamictal, which I’m fine with. I’m weaning myself off. For the last few months I’ve been having really bad night sweats (gross, I know), and for the last two months I haven’t had my period (no, I’m not pregnant). I’ll go back eventually I’m sure.  The thought of going back is making me really anxious and I don’t want to. I have been massively depressed the last few days but idk if this is because I’m coming off my meds or because the last week or two is just catching up to me and I’ve been exhausted. Anyways.
One of the first things my therapist said to me when I sat down was, “Wow, have you lost weight? You look like you’ve lost a lot of weight”.  She didn’t really know me before I put on all the weight from the Symbyax so she doesn’t recognize this as being closer to my normal weight. However, my periodic bulimia has also become not so periodic. I’ve been binging, or just purging what I perceive as having eaten too much… almost every night for the last week. My weight loss has not actually been in any way dramatic in the last week though, so it’s probably a combination of that and my steady, healthier, weight loss.  Last night was the first night I was really able to monitor myself and I didn’t throw up.  She’s especially concerned because this is clearly an indicator of underlying emotional issues. I’ve been bored and lonely and I feel like I can’t fill up the time alone in my head. Food is there,  it’s something to do, it keeps me busy, it’s comforting and satisfying, it fills me up physically… until it isn’t, and I realize I’ve gone too far and I’ll be paying for it in the morning. Then there’s the release, and I feel calm, and more in control. Release. Calm. Control. This is not the right way to go about finding these things.
She thinks a lot of my underlying issues still revolve around Friend and how I’m trying to maintain one aspect of our relationship (our friendship) while repressing and shutting down the feelings that came with the physical/emotional aspect of it. She thinks this conflict is causing me a lot of distress. I think I’m sick of all of it. I’m lonely. I’m very, very lonely.  I need to accept the fact that Friend can not be the kind of friend I am used to and want to have. Accept this on all levels, not just the part where I obviously know this cognitively. I’m afraid to lose my friend, that I’ll lose one of the very few strong connections I have. A connection that I already feel is falling away from me. I can’t reconcile wanting to be friends with him and wanting to not be affected by him. I just want to enjoy the friendship and interests we have in common, but another part of my brain is yelling about how hurt it still is and won’t let me let go of it so I can just relax back into the comfortable space we used to share. It feels like a physical clashing inside my head. I’m lonely. I’m alone. I have no control over this feeling or this state.
From Myself towards Friend I want: To be free of the emotional baggage, have my friendship, and not feel used by everything that went on.
For Myself I want: Someone that I enjoy spending time with, that cares about me, and can be the kind of person that I need to have in my life.
Two separate things, of two separate sources.
Speaking of… I have a date Saturday =) I’m so out of the loop on this whole dating thing. I am really looking forward to it though. We seem to have a lot in common and she really does seem to be a warm, caring, positive person. One day at a time concerning her, but she’s someone to look forward to. If nothing else, a new friendship is healthy.
My therapist is hopeful. That I’m trying is even more important though. It’s so easy to stay locked in the same ruts and routines, regardless of how unhealthy they’ve become. It’s hard for me to pull myself away from something so familiar. I fall into those patterns because they’re predictable, they don’t change, I know what is coming next … even when it inevitably isn’t exactly what it was the time before. I have no way of predicting things I haven’t done before.
I don’t even know how to explain the anxiety that comes with the unexpected. What I’ve had before might not be good but it’s not surprising, there’s some line connecting the dots of the past, present, and future. I can’t predict everything, but I have some semblance of where my feet will fall. Pulling myself away from that familiarity… could lead down a path of wonderful adventures, but it’s all an unknown. What if it doesn’t work out and then I can’t find my way back? If I stop my patterns from before, I won’t be able to pick up where I left off. My connection will have slipped and I’ll be foreign there too.
What irritates me is I’m not a timid person. I’m not shy. I don’t let others lead me by the hand. I don’t balk at beginning new projects or endeavors… except when it comes to people. I’m still holding on to those last shredded threads of what had been this relationship. I don’t know how to let go and not lose all of it forever. I don’t know how to leave behind what something was and let it evolve into what it will be. It’s a leap of faith I need to take in myself.
All I can do is try.
           
She wanted to give me a journaling assignment and I could see her wanting to come up with something revolving around my bulimia but she decided against it. Instead:
Homework: Journal. Think about the therapeutic relationship I have with my therapist, whether I feel the space is safe, I feel she understands me, respects my boundaries, etc.
The things that immediately come to mind:
1.)    I still don’t feel a connection to my therapist. Clearly I know and recognize her, but I don’t have any real attachment to her. I doubt this is her fault.
2.) I don’t think she sees me for me at all. However, I also think this is because my view of myself is so distorted. I’m not sure I actually see me for me.  I’m a depressed, terrible, flawed person. I know all of my faults and imperfections. I see them all clearly. She tells me that I’m a role model for how well I treat those around me, for all that I’ve accomplished, that I’m capable of doing etc. What she sees in me, I don’t see in me. Is this her failing or mine? Probably mine.  She chooses to focus on the positive. I almost exclusively see the negative. I feel like she’s ignoring the negative because she wants to see the positive, but I’m beginning to wonder if she’s really just trying to get me to see myself in a more rounded way. She obviously works with me on the imperfect parts of my life. She’s not ignoring that. Maybe she just doesn’t have as hard a time remembering the other aspects of my life that I don’t seem to be able to hold onto.
3.) I’m not sure I have boundaries. If she doesn’t push my boundaries how am I going to uncover what I need to figure out about myself? If anyone should be able to pull me out of my comfort zone and confront the aspects of myself that I don’t want to face, it should be her. Right?
Those are my thoughts for today. I’m a little out of it. Distinctly depersonalizing more often, again.

Speaking of Changes: DSM-IV to DSM-V

What’s going to happen to Borderline Personality Disorder in the DSM-V? For that matter, what’s going to happen to any Personality Disorder in the DSM-V?
There is going to be a major reclassification of Personality Disorders in the DSM-V.  Apparently Axis-II disorders aren’t clear enough in terms of diagnosis in the DSM-IV so they need to be updated. Can’t completely disagree with their reasoning. The whole point of the DSMs are to accurately diagnosis disorders in order to aid the clinician and patient. Without proper classification and standardized diagnostic criteria it’s very difficult if not impossible to receive the most helpful treatment. If help is what you want that is. I’m sure we can all think of a few PD types that don’t need to change a thing 😉
The current DSM-IV:  Diagnosing disorders in the current edition of the DSM-IV involves two aspects.
First: Define what a personality disorder is. Currently, a Personality Disorder is defined as a pervasive pattern of “inner experience and behavior” that is deviant from a person’s cultural norms. These may be deviations in thoughts, emotionality, interpersonal relatedness, and impulse control. Deviations need to be pervasive, stable, present at least since adolescence, and not due to substances or another mental disorder. Importantly, these ways of thinking, feeling, or behaving need to be significantly distressful and problematic.
Deviant from cultural norms. This is inappropriate on so many levels. The most obvious being that since there are so many different cultures in the world what is considered a PD in one culture may be considered a different PD in another or more severely it may not be considered a PD at all.  Some cultures promote cannibalism. It’s a non-concern. I bet if I tried to apply that here and claim it was my standard proclivity to chow down on my neighbor I’d be tossed right into the ASPD category. People are food? Anti-social. Check.
Second: Define what type of personality disorder is present. DSM-IV currently lists ten Personality Disorders with a catch-all “not otherwise specified category”. Each personality disorder has a certain number of criteria, to which you must meet a cut-off. For example, To be Borderline you need to have five out of nine symptoms such as: self-harming, unstable relationships, fear of real/imagined abandonment, impulsivity, identity disturbance, etc.
There are a lot of problems with this system though.

First, the different personality types were poorly defined. They weren’t based on research-derived criteria, the individual symptoms were vague, and the idea of checking off abstract criteria such as “an exaggerated sense of self-importance” were difficult.

It does seem that the number of criteria required is arbitrary. Why are 5 qualifications better than 4? 4 symptoms may be significantly severe. For that matter, who decides what is significantly severe? Why are 7 met criteria more accurate than 5 if many of the 7 criteria are relatively subdued. Who’s to judge? 4 = “normal”, 7 = “abnormal”.  Regardless. Oh, I’m sorry. You only have 4 majorly severe symptoms present? You’re fine, go about your day. Next!
Another problem is that the criteria overlapped heavily. A person meeting criteria for one personality disorder usually met criteria for 3 or 4 others, as well.
No disagreements here. I for one am sure I qualify for Histrionic PD in many ways. From a cultural stand point I cross over into Schizotypal (if not for my ‘spiritual’ beliefs alone), and so on. Hey! Check out the PD test, that’ll give an “accurate” crossover chart.

The proposed DSM-V:
The proposed revision for the DSM-V is relatively complicated and has 3 essential criteria for PDs.
(1)  A rating of mild impairment or greater on the Levels of Personality Functioning (criterion A),
(2)  A rating of 
        (a)  a “good match” or “very good match” to a Personality Disorder Type or
       (b)  “quite a bit” or “extremely” descriptive on one or more of six Personality Trait Domains (criterion B).
(3)  Diagnosis also requires relative stability of (1) and (2) across time and situations, and excludes culturally normative personality features and those due to the direct physiological effects of a substance or a general medical condition.
Quite complicated indeed. However when you think about it, it fits. Normal personalities are complicated. Personality Disorders are complicated to the order of {insert large magnitude}.
Let’s look at each of these 3 new criteria:
1.) First, the general definition of what a personality disorder is has changed. It will now suggest that instead of a pervasive pattern of thinking/emotionality/behaving, a personality disorder reflects “adaptive failure” involving: “Impaired sense of self-identity” or “Failure to develop effective interpersonal functioning”.
See, now I disagree that it should be defined as {solely} an “adaptive failure”. This implies that Personality Disorders are strictly a product of your developmental environment. I’ve done a lot of research into biogenetic temperament, pathology, differences in brain affectations/structuring (all of which I’ll be posting on eventually) and there is a biological aspect to personality disorders. This definition seems to ignore those factors completely. Maybe they’re just focusing on the manifestations though. They can always do brain scans later. I for one want my brain scan.
The breakdown of “impaired sense of self-identity” and “failure to develop effective interpersonal functioning” is good though. They even have a little severity scoring system. I like all these scoring levels actually. It’s like a game of personality disorders. Step right up folks. Place your bets, put your credibility on the line. Spin the wheel of characteristic crazy and I’ll guess your personal pathology. Takers? Loser are the norm. Winners get a shiny new Personality Type. Woot!

Five personality types
2.a.) DSM-V has simplified the system by cutting down Personality Disorders from10 to 5:
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder (ASPD)
Borderline Personality Disorder (BPD)
Histrionic Personality Disorder (HPD)
Narcissistic Personality Disorder (NPD)
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
They plan to collapse these 10 into the following 5 buckets:
Antisocial/Psychopathic Type
Avoidant Type
Obsessive-Compulsive Type
Schizotypal Type
Avoidant, O-C, and Schizotypal haven’t changed much. A/P Type and Borderline are apparently still pretty complex but hey! We made the cut! Take that Paranoid PD. Who’s watching you now? No one? Now you’ll never know. I’m actually not sure that this will make it easier to identify potential Personality Disorders. I don’t see why they couldn’t keep the established Personality Disorders and simply apply the new diagnostic techniques to them. This is supposed to be most helpful to clinicians who I suppose the DSM is specifically designed for, but it will make the information less accessible to the population at. Or, maybe the APA is trying to boost therapy sales by making it so confusing that patients need to seek professional help to figure out what’s wrong with them.
2.b.) Personality trait domains and facets
Finally there are a series of six personality “trait domains”. The six domains include: Negative Emotionality, Introversion, Antagonism, Disinhibition, Compulsivity and Schizotypy. Clinicians would be asked to rate each of the six domains on a 0-3 scale depending on how descriptive each is of the patient. The rating game continues.
Each of the six trait domains also comes with a subset of trait facets.  These are more descriptive indicators to help you decide which domains you fall under. I’m not sure these are enough. I fit all of these in some way, but then again, I have a Borderline Personality Disorder so Good Job! I think I just disproved my own concern. I guess when you pull the whole system together it will be able to distinguish maladaptive personalities versus, say, non-PD abuse victims, true A/P types versus your everyday douchebag.  Only time will tell I suppose.
3.)  And time is what it’s all about. One thing that has been kept from the DSM-IV is the fact that these characteristics need to be “stable”. I love that they use the term stable. Especially since the nature of half of these disorders is how generally unstable people with PDs can be. I know what they mean of course; these problems are persistent and unchanging over time and not situation dependent.
So there you have it. The new DSM-V.
I am curious as to where Narcissistic Personality Disorder will fall. Traditionally it’s a Cluster B group with BPD, Histrionic, and ASPD. My first inclination would be to say it will fall under the Borderline Type. BPD/HPD are highly reactive, often characterized by narc traits and there’s a more prevalent sense of needing people in some manner than is ASPD.  The inflated grandiosity and a pervasive pattern of taking advantage of other people suggests the A/P Type definition though(so obviously defined with narc traits). Maybe since narcissism is so pervasive in the PD spectrum the DSM believes it’s a symptom, a not a distinct problem. Sorry narcs, apparently you’re not important enough to have your own group anymore. Wow, that’s going to piss someone off; take that their egos! And for that matter, ASPD is also Cluster B and is even more commonly associated with BPD as a male/female flip side. It’s just so typical that the ASPDs would leave BPDs and take up with a more aggressive group. At least we still have the Histrionics. It’s gonna be a sexy fun time for the Borderline Types. Just sayin’.

Lucid Analysis: Trials in Therapy – 5

Therapy last night was an ordeal. I was exhausted and run down. I didn’t feel like talking. I honestly didn’t want to be there.



Bottled



Sometimes I wonder if my therapist understands me at all. She keeps going on about Friend. I’ve been more down than usual, she thinks in part because it is their 10th year anniversary and it keeps coming up. I mentioned previously that I have no intention of attending their gathering.  Did I mention that Friend asked me to babysit so they could go out to dinner one night? Seriously? As soon as he asked me I wanted to punch him in the face and scream at him. My self-control is better than that now and what I ended up saying was ‘no, babysitting really isn’t my thing’. Which he knows so it was a plausible excuse. Yet he still asked me (Asshat).  I instantly feel guilty for not doing it, but I’d hate myself and trigger myself into doing something stupid if I did. I want nothing to do with this event. I say good for me. Yesterday the wife IMd me to help her find an anniversary present for him. WTF?!? Either I’m really that good at hiding my hatred of this whole thing, they’re utterly oblivious to my residual feelings (Friend) or intentionally poking at me because wife is a huge bitch (Yes). Therapist thinks their insensitivity is causing me to spiral down. If Friend was really caring he would know that this bothers me and not put me in a position to make me uncomfortable. Dick. I just kept saying, ‘it’s whatever, he’s a guy, what am I supposed to do about, he’s just a guy’.  Considering how close we were, and how much I cared about him, maybe even loved him, that I’m Splitting him into the all bad category in my life is my inner Angry Child acting out.
I thought this session was a complete waste until about 5 minutes before it was supposed to end. Then she started to upset me. Whatever she was saying made me face how I was really feeling. I had to confront the fact that I was feeling jealous, hurt, because such an intense part of our connection changed and was basically abandoned. She said I need to pay attention to those feelings of hurt and jealousy. Don’t dismiss them. That I am feeling these emotions means that I am lacking something in my life. I’m missing those things that would counter those emotions. I need to find something healthy to fill that void.
Note: Pay attention to my feelings. Negative emotions indicate a lack of something I need.
Therapist again, brought up the idea that maybe this relationship is no longer a healing relationship for me. That continuing to spend so much time with him, talking to him may be triggering my depression. What I had to make clear to her was I’m always depressed. I’ve been depressed since I was 12, this isn’t new. I did finally have to admit that he was contributing to it though.
Homework: Get out. Begin to form new relationships outside of him and the people connected to him.
I honestly have not felt ready for this, but after this session I think I should. I’ve been casually chatting with a woman I met on-line (don’t judge). Last time we communicated she gave me her phone number. I’m going to text her at lunch and see if she responds. I brought my phone charger to work so I couldn’t sabotage this plan and use my phone dying as an excuse to not do this (I need a new battery). That I’ve been so hesitant about this has meant to me that I’m not ready to be involved. Last night I came to a place that I think I can at least reach out, is a step in a healthier direction. I’m going to try. Maybe nothing will come of it, but at least I’m making an effort. I even have little thoughts and visions of double dating with Roommate or some other friends that live out by her. That’s good right? A little vindictive part of me hopes this makes Friend jealous, but it’s just a little voice in the back of my mind.  
Also, Sunday I did hang out with another guy I’ve known for ages. When I finally got home I was starving b/c I hadn’t eaten since my run. Poured myself a glass of wine and had dinner, then a snack, then more food until I binged out completely. Purge. Your last thought before going to bed should not be “this is how bulimia is supposed to work”::headdesk:: Therapist was obviously concerned about this. That my bulimia is coming back regularly is an indicator of my depression and my feeling out of control. This is most likely the result of my emotions revolving around Friend. Going out makes me worry I’m abandoning something and that’s scary for me, because my going out, will make him jealous, angry and push me out. She hopes he’ll tell me that I am important to him and that he will not discard our friendship because I am making new ones. I need to get past this.
I had no intention of really talking much this session. I don’t feel all that connected to Therapist and I didn’t want to say anything. For the beginning of it I was aloof, detached, I couldn’t focus on what she was saying, and honestly I did not care. I know it showed. She mentioned I seemed disgusted. Around mid-session I was starting to get angry, very angry, but still detached from my deeper emotions. I was lashing out about the wife and even swearing. I KNOW Therapist was trying to push me past this. She was actually trying to upset me, but in a direction away from anger. By 5 minutes to the end she did it. I shifted again and she actually made me start to cry. I hate this. HATE this. I hate myself for not being able to control this. I do have to admit that these were feelings I needed to face and work through. She ended up keeping me in session for a half hour after our time was up because she wanted to continue helping me work through this. I was ready to run out the door by this point and I practically did. I felt more connected to her at the end.
On a different note, when I told her about my tattoo consultation she was a little worried that I was going hypomanic because my excitement and up mood was so unusual for me and disproportionate to what that should have inspired. She’s not worried that it’s an impulsive decision. She is a little worried that I’m completely unconcerned with how much pain it’s going to cause. I have very little fat on my ribs and the majority of this piece is going to be right there, which is a notoriously painful location for tats. My other tattoos didn’t really hurt at all. Pain is normal for tattoos though. It’s really just something you have to accept if you’re going to have them done.  Maybe I’m rationalizing, but it is the reality of the thing.
She also told me to come in Thursday if I felt I needed it. I doubt I will but that she’s suggesting two sessions a week again is disconcerting. Sigh.

Lucid Analysis: Trials in Therapy – 4

Monday was a good therapy session. Again, not one I got incredibly worked up over but productive none the less.
We talked about how my recent trip home to see my family affected me, how it triggered me.
My mom especially. My dad doesn’t seem to have an incredible interest in what’s going on with me. He really doesn’t engage me or start conversations with me unless I start talking first. I wonder if this is because my issues make him uncomfortable. Hm, I’m actually just realizing this as I type. My mom however starts talking to me the second I’m within sight and does not shut up. She automatically inspires the most irrational anger in me. I know this is a byproduct of my growing up and probably because she was so ‘interested’ in my life. Instead of talking to me, she’d search for my journals and read them.  I don’t trust her at all. She’d then talk to me about it, tell me of her disapproval (to be fair a lot of that disapproval was justified) and sometimes ground me for things that I did, instead of talking to me and helping me go about things in a better way. Act more appropriately. It cultivated my mistrust of her. That she takes such an interest in my life now still makes me very angry, because it feels intrusive to me even though I know she just cares. Trigger.
I was very closed off to them, to everyone. I refused to talk about my feelings, I refused to ask for help, I refused to get help. Since I was 12-ish for sure. Even before this though I was afraid that asking for help would mean I wasn’t good enough, would be a sign of weakness in my abilities. This is a direct result of how critical my father was. Anytime I did any kind of art he would ‘critique’ it. Not in a mean way. It was always directed as a means to help me ‘improve’, but I get overly happy when he does praise me and I need to keep inspiring this so I push myself harder.
This translates into how I am now. How I need to do things for other people that make them happy, that they’ll praise me for. It’s why, despite the fact that I can be mad at Friend, and really don’t like wife, I continue to cook for them because I know it’s something I’m good at and they’ll show their appreciation for it. This is especially necessary for me because my father was such a picky eater. He only likes a few select foods so when I would make new things that I liked and the rest of my family enjoyed he would either not try it or only try a little bit and let me know that he didn’t like it. I’ve always told myself this was simply because he didn’t like a variety of things, which he doesn’t, but he has never been encouraging. Even when I make new things when I visit he always comments on how ‘it stinks up the kitchen’. Those few times though, those few rare amazing times when he has liked what I made were my proudest moments. Since he was so critical, he never just placated me, I absolutely believed the compliments he would give.  Especially when I cook, when Friend or my other friends tell me they really enjoy what I make I am filled with an extraordinary sense of happiness that I am appreciated, while at the same time I don’t necessarily believe them. Amusingly the only one I really believe is Friends wife. I ask for criticism or how I can improve on some things (I cook meat dishes for people even though I’m strict vegetarian and have no idea what meat tastes like). She’s the only one that critiques me, though she is also very impressed with my abilities and has enjoyed everything I make for them, but she’s also one of the only people I believe. (She often tells people that ‘Haven makes vegetables taste like food’ or ‘Make whatever you want it’s going to be good.) Heh, but that I seek criticism and that’s the only thing I truly believe is obviously a direct result of how my father raised me. Trigger.
We didn’t talk about my brother. That my sister is the only one in this world that I truly connect to makes her my strongest base. I was horrible to her. I took out a lot of my anger on her and she was afraid of me. Until one night I came home and saw that she had been cutting as a direct result of the pressure she felt from our father. My entire relationship with her changed that night. She was afraid to talk to them about how she felt. She was always the angel, I was the devil. As a result she felt overly pressured, incapable of doing things that would possibly make them mad. I fought with them constantly and ‘didn’t need their approval’. Clearly I rebelled against them, but they’d never abandoned me for all my horrible behavior so I was able to convince her to at least sit down and talk with them so they could understand that she needed something different. Which she was able to do. We bonded over  something so ingrained in us, understood each other on a different level than we had before and realized that we could lean on each other when we needed help. She’s my best friend in the world and I would do anything for her. I love her with everything I have. I mistrust my parents, even now.
I get incredibly anxious when my sister is late getting home. I need her to be there to feel grounded. Safe. To the extent that I don’t want to go back, be there at all, if she’s not there.
Therapist doesn’t seem to be worried about the fact that I needed to have a couple drinks to deal with the barrage of questions and interest in my life that the rest of my family inspires (holiday gathering at my relatives – all of my relatives, both sides of my family). I see my family so rarely that when I do it’s practically nonstop questions and explanations. Fortunately ( I think?) my mom’s side of the family isn’t very interested in me. I was always so rebellious, so different, that they never took an interest in me. I don’t think I talked to them at all except for my aunt telling me I looked really good and lost a lot of weight (she hasn’t seen me since I was on the Symbyax that made me gain weight).  That was nice. The rest of my family though is very interested in my new job and my mental state. I can only deal with so much. So much attention is overwhelming. So I have a couple drinks to calm down. I knew before I went over that I’d be drinking though. Therapist is much more worried about my bulimia. I’m usually very good at keeping this under control. Until the holiday gatherings start. I’ve never had trust issues with my dad’s side of the family. I actually think I connect to them better than my parents. I’m  really not sure what the exact trigger here is. My parents? My mom’s side of the family? The questions? My bulimia has always been a form of control for me, so I know it has to have something to do with feeling out of control. Why the rest of my family would make me feel so out of control is still a mystery to me currently.
Note:  Identifying those issues that trigger me is the first step in figuring out how to avoid them and control them in the future.
Emo moment
Then we talked about my Abandonment issues and why Friend going out made me so ‘unhappy’  (read: hurt, anxious, depressed, jealous, left out, unnecessary, afraid). The real problem here is that I do feel like if he has more people around he won’t need me as a friend anymore. That I won’t be so important to him. That he’ll reject and abandon our friendship. Therapist is beginning to worry that our friendship is holding me back. That he triggers my abandonment issues is not healthy. I cling to our friendship too strongly. I do forsake going out on my own to meet new people because if I do I won’t be able to spend more time with him. If I go out more our friendship won’t be as strong. He will find other people. I’ll be replaced. She wants him to tell me that he doesn’t want our friendship to end, that he won’t leave me, but he should encourage me to form new, healthy relationships outside of our friendship.  That {six} years down the line we’ll still be friends. I have no way of believing this though, because I’ve never had close proximity friendships that have lasted this long in (though I have had friendship that lasted much longer than this).  I don’t know. I don’t know if I’m ready to open myself up to anyone new yet. I’m tired of being hurt. I don’t think I can do that again right now. Therapist thinks I should though.
Homework: Stop being a hermit. Get out more, outside of going to Friends’. Cultivate new relationships.
Therapist also breached the topic of wanting family, what I thought motherly qualities should be. Not that I want to have kids, but what qualities do I believe a mother should have, and how would I display these. If, if, I were to have kids, how would I demonstrate these qualities, blah blah blah.
Point:  It’s a helpful exercise to understand where I think my family failed. How I wish they had done things differently with me. 
Finally she asked about what I’d been drawing lately. Mostly I’ve been drawing my next tattoo. She was a little concerned about this because it’s so large (will hit me under my breast, down my entire right side, and over my hip). She asked me if we needed to talk about it in further sessions. I told her ‘no’ I would get it regardless. She laughed at my ‘rebelliousness’.
Update on this Friend Abandonment issue; when I was over Monday out of nowhere he did say that I should pick up the activity and join them in the future. This made me too happy and my mood improved for the rest of the night. Then my paranoia kicked in that he’s reading my blog which would make me incredibly unhappy and probably (probably? Geezus) pissed off. Bleh. I want him to include me because he enjoys my company, not because he feels obligated to me. Then I remembered that he made this offer before I’d posted about it, so my paranoia is completely crazy and entirely composed in my own mind, but that still didn’t stop me from having a small anxiety attack.
So yeah, productive day in therapy. Long, long post. Again, sorry about the day switching for this.

Thought Control is Mind Control

I found an article written by Dr. Amen who’s a psychiatrist, neuroscientist and brain-imaging specialist. It’s about how to conquer negativity and encourage positive thoughts. It’s not about Borderline Personality Disorder per say. It’s aimed at people that do have negative thoughts but are basically ‘normal’ (meaning: don’t have a personality disorder). However I found what he had to say runs parallel to BPD.
The article is about negative thinking, what he calls ANTs = Automatic Negative Thinking. These are thoughts that automatically pop into your head, but don’t necessarily have any rational hold. Or if they do, they run away with you instead of allowing for the ability to come up with solutions instead of dwelling on them. The thoughts that jump into your head automatically after something triggers them and refuse to go away. For me these thoughts run rampant and spin me down into a dark hole that I can’t climb out of.
He goes on to say that powerful thoughts can lead to physical reactions. Negative thoughts actually release chemicals in your brain that do make you feel bad. The opposite is true too, the happy, the positive can lead to chemical release that makes you feel good.
Therapists have identified 10 ‘species’ of the automatic negative thoughts. (I think the term ANTs just sounds ridiculous. I can’t take it seriously.)
1.)  All or nothing (thinking in black and white).  This is what Splitting is.
2.) Always thinking (overgeneralizing). Well, yeah.
3.)  Focusing on the negative (ignoring the positive). When things are always bad, when nothing turns out how you need it to, when every little thing shakes your foundation, it’s hard to think about the positive. On the other hand, if you swing {hyper}manic, it’s the opposite, everything can be positive, everything is superhuman, everything is achievable. I think the mood swings of someone with BPD can be a little too changeable for this, but generally speaking I think the principle here is true.
4.) Think with your feelings (believeing negative feelings without evidence). Obviously. BPD is all about emotional dysregulation. Emotions that take control, cloud your judgment, and make you act in ways that most people wouldn’t.
5.)  Guilt beating (thinking in words like “should”, “must”, “ought to). I do this a lot. Believe I should be other than I am, should have done something better, was not good enough at something else, failed myself in some way… I tell myself that I’m not good enough if I can’t be perfect.
6.)  Labeling (attaching negative labels to yourself and others). For someone with BPD I think this is an extension of Splitting. I label someone as all good (ex. Roommate). I label someone as all bad (Friends wife). It may be both all good, or all bad for the same person at different times, depending on the last interaction (ex. Friend or myself).
7.)  Fortune Telling (predicting the future in a negative way). Hopelessness, abandonment, believing that eventually everyone will leave, things will always turn out devastatingly wrong. Just walking into a situation and knowing it’s going to turn out bad for you. I find this usually happens worse when it’s something I really want.
8.)  Mind Reading (believing you know what someone else is thinking). This goes hand in hand with hypersensitivity. When you’re so attuned to what someone does, if there’s any variation, anything to shake that tenuous stability, there’s no helping the wild thoughts that run away to figure out why someone has changed in some way. Even if that change is miniscule.
9.)  Blame (Blaming others for you problems). If he just did this, if she felt this way, if I wasn’t so misunderstood… these tend to be the kinds of thoughts I have to give ‘reasons’ for my negative feelings. 
10.)               Denial (refusing to admit you have a problem). Heh, I don’t think this is really my issue, or anyone’s issue that has BPD and is seeking help or treatment. Well, maybe. Identifying ALL the areas that need helping I can see where there can be denial.
The first step is to realize these things are a problem. Keeping in mind that these thoughts happen may help figure out how to change them.
Everybody lies
To combat these he makes a good point: Thoughts can lie; they lie a lot. However you don’t have to believe every thought that pops into your head. But how do you determine which thoughts you can believe? All things in life aren’t positive, some things are negative. Just because you’re paranoid doesn’t mean you’re wrong, sort of thing. The problem is they feel like the truth. These are what automatically popped into my head, and it’s pretty obvious to me that they’re self-defeating in term of incorporating a helpful idea. I often fight against things that are good for me, and I don’t know why.
In order to get ahold of these thoughts and recognize which ones are not rational he makes a suggestion. Write them down. “The simple act of writing down your thoughts helps get them out of your head and begins to diffuse any negative feelings so you start to feel better”.  This is something I do almost daily. I’ve kept journals since I was 12/13 years old. For me it only tends to be a temporary fix. It doesn’t help the irrational thoughts from coming back in the future, or even the next day, but it does help me get ahold of them and allow me to work through them at the time. I can’t always write as soon as I have ridiculous thoughts, so often they  stay with me for days, weeks. When I do have time to write I do feel calmer. I’m able to look at the problem and try to sort things out. If nothing else, it reminds me of the things I need to talk about in therapy. My therapist encourages me to write every day. If I’m comfortable I read what I’ve written in session so that we can work on these things.    I try to write everyday but sometimes I’m just too busy or I don’t want to… and sometimes I want to dwell on my problem. I want to hold things to me, believe that these things are true, not my fault, feel misunderstood so I can believe these kinds of thoughts are justified. I know this isn’t rational but sometimes I hold things to me and don’t want to let them go.  I know this is something I need to work on. I can generally get my thoughts down on paper, and it does help me put things into perspective for a while.

Continue with: write down the ‘negative’ situation that brought about the negative thoughts and feelings, identify the moods felt during the situation, write down the automatic thoughts that were experienced when that certain mood was felt, identify the evidence that supports these thoughts, identify the evidence that does not support these thoughts, next identify the fair and balanced thoughts about the situation, and finally observe the new mood and think about what to do.

The problem with this article, for me, is that when you have a personality disorder you can’t just think your way out of the barrage of overblown thoughts that accost you . Beat you into submission mastered by your emotions.  You feel them whether you want to or not and no amount of telling yourself otherwise alleviates them. If it was as simple as remembering a few principles**, PDs wouldn’t be a problem for anyone that wants to change.  I can’t internalize a lot of these, and unless I read them every single day, my neurotic thoughts will crowd out the helpful ones. Maybe other people can remember them and use these techniques to keep some calm. Find a little relief. A way of infusing some rational explanation into the irrational behavior.  
** This is the point of therapy. However therapy realizes that it takes time, practice, and work to change these behaviors. It’s not as simple as reading an article.

Lucid Analysis: Trials in Therapy 3

This was a mellow week in therapy. I was hyper yesterday so my mood was up for a change.  My therapist didn’t want to talk about things that would upset me because she wanted to encourage my better mood. I told her about the Sci-Fi Convention. First, about running into my exes. She was glad I was able to control my impulses around Boring-ex especially since I wanted to strangle him. She also thinks that my dream about screaming at him was my subconscious channeling my rage into a healthier outlet.
I was concerned that I feel better in a persona that wasn’t me. She disagrees that it wasn’t me. She was less concerned that the persona I identify with is basically an evil creature and supportive of the fact that I was doing something positive for myself. Since I put so much of myself into the character the energy I put into it IS me. Had I not invested so much of myself, my time, my creativity into the project, had just worn a costume I bought or had made for me, I wouldn’t have had the same kind of experience. It’s not so much about the character I chose as it is that the idea was mine and I made the character mine. Even that I did choose such a volatile character it was a way to express my more destructive tendencies in a non-destructive way. To personify them and release the emotions I struggle with.
That in this character I was able to remain attached to my conscious and overcome my dysmorphia, even for a day was an insight. That I invested so much of myself into this character, it was really me allowing myself to remain connected to the world, and not just the pretending I was someone else so I could slip into a different mindset and lose who I am. Which is what I thought. I still kind of think this has something to do with it. Then again, I’ve always felt more like myself, whoever that is, when I’m in character. In character I can act how I want, be who I want, without repercussion… because it’s the character I’m choosing to be. Her interpretation is: It’s a manifestation of who I want to be, by extension allowing myself to come through without fear that I’ll be judged poorly.
 This point is probably more important than I gave it credit for. Finding things, hobbies, distractions that are a healthy means to channel my energy are very helpful for me.
I actually don’t remember how this came up: I have also been able to say on two occasions that I can’t deal with other peoples shit right now, I have my own to deal with, was a big step. I spend so much of my time worrying about other people. Helping, taking care of, doing things for other people. Basically putting other people before myself. That I have said that my needs are important also is a healthy step in taking care of myself that I don’t usually put to the fore. I need to take a break from making other people happy and focus on making me happy. I put the needs of other people ahead of my own for fear that they will leave if I don’t do everything I can to help them through whatever they’re going through. I’m always afraid that they’ll abandon me if I can’t meet and take care of those needs. That I have said twice that my needs are important without be afraid that they’d leave me is progress.
Previous Homework: Fortunately she didn’t ask me about the homework she’d set for me last week. It really did/does make me angry.  I didn’t bring it up, though I probably should have. Maybe it’s not fortunate because it would have given her more insight into my thought process. Idk. She recognized and reiterated that finding healthy, creative outlets are good for me and thinks I should look into finding more events to throw myself into. This isn’t really anything I haven’t been doing for years though. Unfortunately as soon as they’re done I just revert back to my usual state of mind. At least I have previously. We’ll see.
So maybe being upset from therapy isn’t necessarily the mark of a good session.

Judging Me: Stigma of Borderline Personality Disorder

 Please, don’t judge me before you know me.
I’ve mentioned this in various posts but I wanted to pull it all together. I’m talking about the stigma that accompanies Borderline Personality Disorder.
What is a stigma: a mark of disgrace or infamy; a stain or reproach, as on one’s reputation; a distinguishing mark of social disgrace; any sign of a mental deficiency or emotional upset.
Stigmas are a negative judgment based on a personal trait.
What is a stigma: a mark of disgrace or infamy; a stain or reproach, as on one’s reputation; a distinguishing mark of social disgrace; any sign of a mental deficiency or emotional upset.
Stigmas are a negative judgment based on a personal trait.
These are a very real problem for anyone with a mental illness/difference/disorder Personality disorders especially and notably for someone with a Borderline Personality Disorder. Compared to many other disorders it seems to have a surplus of stigma.
1) theories on the development of the disorder, with a suspect position placed on parents;
2) frequent refusal by mental health professionals to treat BPD patients;
3) negative and sometimes pejorative web site information that projects hopelessness;
4) clinical controversies as to whether the diagnosis is a legitimate one, a controversy that leads to the refusal of some insurance companies to accept BPD treatment for reimbursement consideration.
Many clinicians and people believe that Borderline Personality Disorder is not a characterological problem and merely a learned response to environmental factors. This thought process leads to an inability to treat patients properly. To believe that someone with BPD is just acting our or trying to get attention. Tragically it is often believed that these environmental factors are the parents fault (though in many cases this may absolutely be a contributing factor: Nature vs. Nurture). What’s truly horrible about this is that parents may be afraid to get their children help or may alienate their children once diagnosed for fear of being judged themselves.
All Borderlines are ‘angry, violent, and explosive’, in other words, very hard to cope with. All of us. Instead of getting to know a patient individually we are judged on the behavior of a few. Clinicians will discriminate against someone with BPD because of what others have said, not what they have experienced. Yes, the moods of someone with BPD can be all of these things. Hell, my behavior can be all of these things at time, but I’ve never brought it to therapy. However this is not the most predominant mood. These occurrences are much more rare (if they occur at all) compared to the day to day operating mode of someone with BPD.
“People take a couple of bad examples then deems everyone else with the same disorder through one very narrow perspective and then tells all of their friends of this belief who continue to pass it along but it seems like no one stops this communication to actually take the time to understand the disorder so all of this false information is allowed to saturate through society until everyone takes it as common knowledge and then uses it to judge others”
Extension to above: Borderline Personality Disorder IS characterized by mood swings between anger, anxiety, depression, and temperamental sensitivity to emotional stimulus. We can be destructive and prone to self-destructive behavior. Because of this, it is one of four related pathologies classified as Cluster B (“dramatic-erratic”) in the DSM IV. This is hallmarked by disturbances in impulse control and emotional dysregulation. Someone with BPD is often very sensitive and reacts strongly. They may have love/hate relationships with everyone and themselves, substance abuse, and impulsive behavior, or a multitude of other problems. Because of these potential qualities many professionals will not treat someone with BPD as they may not be comfortable doing so, and this is their prerogative. So while it is not as severe a stigma as the last one, it is still a problem. It does not make them bad doctors or therapists, it just makes them not right for the person suffering with a personality disorder. I can understand this. We do have a lot of things to deal with and some people simply are not equipped to handle as much as we tend to bring with us.Extension to above: Borderline Personality Disorder IS characterized by fluctuations between anger, anxiety, depression, and temperamental sensitivity to emotional stimulus. We can be destructive and prone to self-destructive behavior. Because of this, it is one of four related pathologies classified as Cluster B (“dramatic-erratic”) in the DSM IV. This is hallmarked by disturbances in impulse control and emotional dysregulation. Someone with BPD is often very sensitive and reacts strongly. They may have love/hate relationships with everyone and themselves, substance abuse, and impulsive behavior, or a multitude of other problems. Because of these potential qualities many professionals will not treat someone with BPD as they may not be comfortable doing so, and this is their prerogative. So while it is not as severe a stigma as the last one, it is still a problem. It does not make them bad doctors or therapists, it just makes them not right for the person suffering with a personality disorder. I can understand this. We do have a lot of things to deal with and some people simply are not equipped to handle as much as we tend to bring with us.
Since there is no medical treatment professionals think there is no hope. I hate this. I think it’s a lazy attitude because especially with recent development in therapy it has been clearly shown that there IS hope. Medication may not work to cure all of our problems, but that does not mean we can’t learn to cope and recover from our problems. We just need a different approach than throwing drugs at it.
Those with BPD are treatment resistant. This is often a problem in the therapeutic technique, not that someone with BPD is resistant. Some styles of therapy are not conducive to treating Borderline Personality Disorder or one technique is simply not enough. It’s often difficult for us to internalize some concepts because the nature of BPD is so transient. What may work for someone without BPD probably won’t work the same for us. Or what does work for us one minute, may not work for us in another because our moods shift so rapidly. All this means though, is that we need to focus on changing our overall mentality, not just on techniques to get us through a situational development (though these can be helpful!). We can’t just record, talk through, and repeat new behaviors and expect them to work right away because these are things that are ingrained in our character, not a learned behavior that we’re just trying to reverse. It might take a variety of integrated techniques, not just one, but treatment is absolutely possible!
Someone with BPD will never get better. With this attitude many clinicians adopt an attitude of hopelessness for someone with a Borderline Personality Disorder. They won’t even bother to treat someone with BPD because they don’t have the knowledge of current treatments and options for the patient. Because it requires more effort to change characterological problems many won’t read updated information and therfore remain stuck in outdated modes of thinking.
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Someone with a Borderline Personality Disorder is intentionally manipulative. This is one of the worse stigmas in my opinion. Borderlines are just manipulative, “bad” and hurt other people on purpose. The truth is we don’t always know that we do these things. We don’t know what the behavior itself is that comes to this conclusion, let alone know how to change these behaviors (more on this in a separate post).
Everyone with BPD is a self-injurer.
1.) All people with Borderline Personality disorders engage in self-harm practices, and
2.) That it is merely a cry for attention so it should be ignored and the person will stop doing it.
First, I know of quite a few people with BPD that do not cut, burn, bang, or engage in these kind of tendencies. BPD presents in a huge variety of ways and this is only one potential aspect. Second, many of us that do have these self-harm/cutting tendencies do not tell people about it at all. It is a way to take control of our lives, emotions, stress, or a dozen other things. Yes, some people may do it for attention, but ignoring it is never a good answer because this is harmful and in some cases could lead to death.
Because of all of these things someone with BPD may not even consider finding treatment. If they’re pre-judged by the mental health industry, if their attitudes are already set, what hope is there of getting effective help? It’s a defeatist attitude that bleeds into the thoughts of the patients themselves. If the psychiatrist, the psychologist, the therapist have no hope, what hope can we have for ourselves? I was aware of most of these stigmas when I was diagnosed. I was already seeing my therapist when my psychiatrist diagnosed me with BPD. I was actually very reluctant to tell my therapist about the diagnosis because I was afraid she’d drop me as a patient. This fear is not okay. Especially for someone that is so afraid of rejection! Without the ability to be open and honest with the person that is trying to help you it makes it almost impossible, at least very difficult, to get effective treatment. This is a very sad thing to me. Hopefully with understanding and new therapeutic developments this mentality will begin to change. Pulling these things together and taking a good look at them will be beneficial. That’s the goal at least.